IN KENYA AN ANALYSIS OF MIGRATION HEALTH

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© 2011 International Organization for Migration

Regional Mission for East & Central AfricaChurch Road – off Rhapta Road, WestlandsPO Box 55040 – 00200, Nairobi, Kenya

Tel: +254 20 444 4174 Email: migrationhealthnairobi@iom.int

www.nairobi.iom.int

The opinions expressed in the report are those of the author and do not necessarily reflect the views of the International Organization for Migration.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form, or by any means including, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

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HEALTHY MIGRANTS IN HEALTHY COMMUNITIES

COVER: A Kenyan woman weaves in and around trucks hustling for business in Busia, a border town sandwiched between Kenya and Uganda © IOM 2011 (Photo: C Hibbert)

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CONTENTS

04 BACKGROUND

05 OVERVIEW

07 MIGRATIONASASOCIALDETERMINANTOFHEALTH

09 MIGRATIONHEALTHCONCERNSINKENYA

14 POLICYANALYSIS

15 THEWAYFORWARD

16 RECOMMENDATIONS

18 REFERENCES

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BACKGROUNDObjective

AnAnalysis of Migration Health in KenyawascommissionedbytheMinistryofPublicHealthandSanitation (MoPHS)and the InternationalOrganizationforMigration(IOM)toprovideanoverviewoftheissueofmigrationhealthin Kenya. Informationwas derived from an extensive literature review andinterviews with key informants, including the Government, United Nationsagenciesandnon-governmentalorganizations.

The twin goals of Kenya’s SecondNationalHealth Sector Strategic Plan areto reduce inequalities in health care and reverse the downward trend inhealth related impact and outcome indicators (Republic of Kenya, 2005a).By providing an analysis of migration health in Kenya, this report aims tostimulatediscussionwhichwillleadtodecisiveactionfromtheGovernmentandpartners toensuremigrantsmaybegin toenjoymoreequitableaccesstohealthservices.Asmigrantsdonot live in isolation,butrather indiversecommunities,theirhealthstatushasanimpactonthecommunityat-large.Itisthereforetheresponsibilityof–andinthebestinterestof–Kenyatocaterfortheirbasichealthneeds.

BACKGROUND

Migrationcanbedefinedas“aprocessofmoving,eitheracrossaninternationalborder,orwithinaState.Itisapopulationmovement,encompassinganykindofmovementofpeople,whateveritslength,compositionandcauses;itincludesthemigrationofrefugees,displacedpersons,uprootedpeopleandeconomicmigrants”(IOM,2004).

GovernmentchildgrowthmonitoringandimmunizationcampaignattheEastleighCommunityWellnessCentreinNairobi©2011(Photo:A.Corio)

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OVERVIEW

Migration Health in Kenya

Migration is now a global phenomenon, with 3 per cent of the world’spopulationlivingtemporarilyorpermanentlyoutsidetheircountryoforigin(WorldBank,2009).Climatechange,urbanization,andexpandedtradearelikewisedrivingincreasedpopulationmobilitywithinandbetweencountries.

Likemostcountries,Kenyaishosttodiversetypologiesofmigrants.WithinKenya,povertyispushingpeopletomoveinsearchofwork.Ethnicconflictandviolentcattleraidshaveforcedwholecommunitiesintodisplacementcamps.Climatechangeisslowlytighteningitsgriponarableland,pressuringfamiliestofindlivelihoodselsewhere.Agooddegreeofrural–ruralmigrationtakesplacetosugar,flower,andteaplantations.Kenyaalsoabsorbsavarietyofmigrantsandrefugeesfromitsneighbours,namelySudan,Somalia,Ethiopia,Tanzania,andUganda.Mobilepopulationsincludesexworkers,pastoralists,fishingcommunities,transportworkers,andcivilservants.

Aspopulationmobilityisoneofthedefiningcomponentsofthe21stCentury,migrationmustalsoberecognizedasasocialdeterminantofhealth;mobilitynotonly impactsuponan individual’s vulnerability and socialwelfare,butalsotheirmentalandphysicalwell-being.

However, not all migrants and mobile populations are equally at risk toadversehealth.Itisnotpeoplemoving,perse,thataggravatespoorhealth,but theway inwhich theymoveand thecontextwithinwhichmovementtakesplace.Forexample,incomedisparities,separationfromfamily,alcoholuse,andalackofeffectivepreventionprogrammingaredrivingriskysexualbehaviour, and thusHIV transmission, along transport corridors. Crampedurbansettlementsarepronetotuberculosistransmission,andhighly-mobilepastoralistsneedtobereachedwithservicesatthoselocationswheretheysettleatparticulartimesofyear.

Anumberofsocialfactors,suchasimmigrationstatus,stigma,andlanguagebarriers are preventing migrants from accessing quality health care. Inreducinghealth inequity inKenya,aconcertedeffort isrequiredinmakinghealth systems more “migrant friendly”. As some health issues relatedto trans-border mobility cannot be solved by Kenya alone, internationalcollaborationisrequired.

Typologies of migrants

Ofteninappropriatelyclumpedtogetherundertheterm“refugee”,migrantsandmobilepopulationshavelargelybeenoverlookedwithinKenya’shealthcare system, including policies and strategies, financing, research andsurveillance,humanresources,healthpromotion,andservicedelivery.

BACKGROUND OVERVIEW

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Types of migrants in Kenya commonly include irregular migrants, asylumseekers, labour migrants, economic migrants, trafficked persons, urbanmigrants,commercialfarmworkers,internallydisplacedpersonsandrefugees.Migrants also includemobile populations such as sexworkers, pastoralists,fishingcommunities,transporters,civilservants,anduniformedpersonnel.

Irregularmigrantsarethosewhohaveenteredahostcountrywithout legalauthorizationand/orwhohaveoverstayedtheirauthorizedentry,andassuch,faceuniquevulnerabilities,notablythoserelatedtohealth.Oftendesperatetoavoidaccessingpublicservicesduetodistrustorforfearofbeingdeportedordiscriminatedagainst,irregularmigrantsoftenonlyseekmedicalassistancewhenthere isnootheralternatecourseandtendtomissouton importantpromotivehealthmeasuressuchasimmunizations,pregnancycare,andsafechildbirth(IOM,2009).Non-migrantfriendlyservicesalsodiscouragepatientsbynotcateringfortheirculturalandlanguageneeds.

Push and pull factors: determinants and consequences of migration

Theclassictheorytoexplainwhypeoplemigratefromonecountrytoanotheristhe“pushandpull”factor: peoplemigrateinresponsetopushfactorsintheircountryoforiginand/orpull factors inthecountryofdestination.Thepushfactorsaregenerallynegative,whilstthepullfactorsarelargelypositive(Potocky-Tripodi,2002).

Fromtheliteraturereviewanddiscussionswithkeyinformants,thefollowingpushandpullfactorswereuncovered:

Economic:

• Wideningfinancialdisparityandthegrowingneedforyoungand relativelycheaplabourdrivespeopleawayinsearchofemployment;• Inequitabledistributionofresourcesencouragespeopletosearch forequalityandwealthelsewhere;• Workrequirementsoftennecessitatetravelformilitaryofficials, tradesmen,andtransportworkers;• Kenyaisatransitcountryforgoodsflowingtoitslandlocked neighbours,thuslargenumbersofmobilepopulationssaturateits roadandwatertransportcorridors.

Socio-cultural:

• Poorschooling,socialservices,healthcare,familyreunification andprotectionpushespeopletomoveinsearchofnewlocales withimprovedfacilities;• Insufficientfamilysupportstructuresencourageindividuals tomigrate.

OVERVIEW

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OVERVIEW OVERVIEW

Natural, environmental and seasonality:

• Climatepushespastoralistsandcattlerustlerstomoveseasonally;• Ruraltourbanmigrationcan,inpart,beattributedtothescarcity; ofnaturalresources;collapsingandcontractingindustriesforce peopletomoveinsearchofanewtrade;• Naturaldisasterspushthoseunabletocopeorsurviveintosafer localesordisplacementcamps;• Outbreaksofdiseasecompelpeopletomoveinto non-susceptibleregions.

Socio-political environment:

• OngoingconflictinSomaliaandSudanandeconomicdisparityin EthiopiahasresultedinalargenumberofmigrantscrossingKenya’s porousborders.

MIGRATION AS A SOCIAL DETERMINANT OF HEALTH

The definition of health

The1946constitutionof theWorldHealthOrganizationdefineshealthasa“stateofcompletephysical,mentalandsocialwell-beingandnotmerelytheabsenceofdiseaseor infirmity.”“Migrationhealth” refers to thewell-beingofmigrants,mobilepopulations,theirfamilies,andcommunitiesaffectedbymigration.Migration as a social determinant of health

Althoughmobilityisnotofitselfdetrimentaltohealth,itisasocialdeterminantof health. The circumstance in which migration takes place, together withindividualfactorssuchasgender, language, immigrationstatus,andculture,have a significant impact on health-related vulnerabilities and access toservices(IOM,2010a).ThechallengefortheKenyanGovernmentandpartnersistounderstandthesesocialdeterminantsinordertoimprovethewelfareofmigrantsandcommunitiesasawhole.

A multitude of sources indicate that a major challenge facing the healthof migrants is access to appropriate services. Geographical accessibility,availability, affordability, and acceptability are the fourmajor challenges toaccess,allofwhichmustbeaddressedwhenreassessingKenyanhealthpolicy.

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So,whyisitimperativethatmigrantsgainaccesstohealthservicesinKenya?Addressingthehealthneedsofmigrantsnotonlyimprovestheirwell-being,but it also safeguards the health of Kenyan host communities. In additionacceptance and integration of migrants contributes towards social andeconomic development. Furthermore, well-being is a fundamental humanrightwhichisrecognizedinthenewConstitution.

With data captured from the literature review and interviews with keyinformants,thefollowingwerecitedasmajorhealth-relatedvulnerabilitiesformigrants:

MIGRATION AS A SOCIAL DETERMINANT OF HEALTH MIGRATION HEALTH CONCERNS IN KENYA

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MIGRATION HEALTH CONCERNS IN KENYA

Tuberculosis and migration in Kenya

Kenya is among theworld’s top22high tuberculosis (TB) burden countries(WHO,2010).AmajorreasonforincreasedTBinKenyainthepastdecadeistheconcurrentHIVepidemic,with44percentco-infectionin2009.

The national TB strategy specifically highlights the need for strengtheningprogramming to reach migrants in crowded urban centres, nomadiccommunities, migrant workers, and transport workers. These populationsoftenfacebarrierstoaccessinginformationandservices,includingappropriatediagnosis.Treatmentiscomplicatedbytheneedtoadheretotheregimeforsixmonths,andtrans-bordercollaborationisthereforenecessary.Surveillanceneedstobestrengthenedinborderareas(RepublicofKenya,2010c).

IN FOCUS: Tuberculosis among urban migrants

Eastleigh,alargetradingdistrictinNairobi,ishometothousandsofmigrantslargely fleeing prolonged poverty and conflict in Ethiopia and Somalia.Eastleighisalsoamajortransitpointbetweenrefugeecamps,Somalia,andthirdcountriestowhichmigrantstravelthroughlegalandirregularchannels.

A largeproportionof thepopulation lives inovercrowded,dark,andpoorlyventilatedapartmentblocks,whichareconducivetothespreadoftuberculosis(TB).

ThevastmajorityofmigrantsresidinginEastleighareresidingwithirregularimmigration status, andarehencedeprivedofbasichealth servicesdue tofearordistrustoftheauthorities.Stigma,languagebarriers,andlackofhealthliteracyaresomeofthesocialfactorswhichdiscouragemigrantsfromseekingappropriate diagnosis and treatment. For these reasons, private healthfacilitiesarepreferred,andmanyarenotlicensedbytheGovernment.

Due to their mobile nature, many migrants who start on TB treatment inEastleigh do not complete their course of medication and often leave thedistrictwithoutadequatefollow-up.ThisleadstofurtherTBtransmissionandcanresultindrugresistancewhichcarrieshighermortalityratesandburdentothehealthsystem.

A key issue in addressing this issue is to understand thatmigrants are notspreading TB, but rather, that they are unable to access the appropriateservicesfordiagnosisandtreatment.

MIGRATION AS A SOCIAL DETERMINANT OF HEALTH MIGRATION HEALTH CONCERNS IN KENYA

“Inmyhouse,therearemany,manypeople.The

houserentsareveryhigh.Thesearehardships

thatcausethespreadofvariousdiseases.Wealsodonothavemoneytoaccessqualitymedical

healthcare.”

AnurbanmigrantresidinginEastleigh,IOM2011a

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MIGRATION HEALTH CONCERNS IN KENYA

HIV and mobility in Kenya

ThenationalHIVprevalenceinKenyawasestimatedat7.4percentin2007(RepublicofKenya,2008)and6.3percent in2009 (KNBSand ICFMacro,2010).Mobility has often been falsely highlighted as a risk factor forHIVinfectionandithasoccasionallybeenmisconstruedthatmobilepopulationscarryHIVfromhighertolowerprevalencecountries.Therealityis,inordertospreadthevirus,anindividualmustfirstbeinfectedwithdetectablelevelsofthevirus,andthenengageinriskbehaviour,suchasunprotectedsexordruginjection.Aswithotherhealthissues,itisthecontextofmigrationandhowoneismobilethatdifferentiallyimpactsvulnerability.

Others have assumed that “vulnerable” populations must also havehigherHIVprevalence.Asynthesisofsevensub-SaharanAfricancountriesfound refugees in all but one camp setting to have a prevalence whichwas comparativelymuch lower than in surrounding host communities. Agradual rise in prevalence in camps was attributed to refugees engaginginriskbehaviourwithmembersofhostcommunities(Spiegeletal,2007).IOMhas likewisefoundthatHIVprevalenceamongrefugeesandmigrantsundergoingmigrationhealthassessmentsinNairobiisjustasmallfractionoftheprevalenceofNairobi,andmoreorlessonparwiththeprevalenceincountriesoforigin.Thepost-conflictsetting,however,mayseeaprecipitousriseinHIVprevalenceasmaybethecaseinnorthernUganda,Somaliland,andpartsofsouthernSudan.

WhiledataisnotsufficienttoidentifyalinkbetweenpopulationdisplacementintheemergencycontextandincreasedHIVtransmission,Kenyaexperiencedmajor breakdowns in the provision of HIV-related services in the 2008election aftermath. Guidelines and capacities are required at all levels topreventsimilarsystemicbreakdownsinfutureemergencies.

IN FOCUS: Risky sexual behaviour along transport corridors in East Africa

Most-at-risk populations, such as female sex workers and their clients,account for an estimated 14 per cent of all new infections. This is asubstantialdecreasefromtheearlyyearsoftheepidemicwhenfemalesexworker and truck drivers were seen as core population groups; however,vulnerablegroupsalongtransportcorridorsremainsubstantialcontributorsofnew infectionsand remainamong themost importantpopulationsnotadequatelycoveredbythepreventionefforts(NACC,2009a).A2005studyestimated that along theMombasa-Kampalahighway3,200 to4,148newHIVinfectionsoccureveryyear(Morris&Ferguson,2006).

Inports,cities,bordercrossings,andtruckstops,incomedisparitiesbetween“mobilemenwithmoney” andwomen of lower economic status fuels amarketforsex(IOM&UAC,2008).Asmanyoftheserelationshipsevolveinto

“SometimesyoufindthatthosewhoarenotHIVpositivearegivensupportandyouwhoispositivedonotbenefit.ThisiswhyifherhusbandtriestoseducemeIwillnotrefusebecausetheybenefitfromthesupportwhichIamsupposedtoget,andIwillsay‘tohellletthemdiewithme.’”HIVpositivefemalesexworker,Salgaa(IOM&NACC,2010)

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MIGRATION HEALTH CONCERNS IN KENYA MIGRATION HEALTH CONCERNS IN KENYA

long-termpartnerships,condomuseremainslow.Manymenandwomenintheselocationshaveseveraldifferentsexualpartners,thereishighpotentialofspreadingthevirus,especiallyamongthosewhoarenewlyinfectedandthushavemuchhigher levelsofvirus in theirbodies (Halperin&Epstein,2007).

TheepidemiologyofHIValongtransportcorridorsisnotrestrictedtotruckdriversandsexworkers.AshighlightedinFigureOne,afemalesexworkerengageswithadiverseclientele,ofwhichonlyabout30percentaretruckerdrivers(RepublicofKenya,2005b).Asimilar2008IOMstudyontheKampala-Jubacorridorshowedsimilarfindings.

FigureOne:ClienteleoffemalesexworkersalongtheMombasa–Kampalacorridor,datagatheredusing28-dayFSWdiaries(RepublicofKenya,2005b)

ThelackofeffectiveHIVpreventioninterventionsinspacesofvulnerabilityalong Kenya’s major transport corridors is cause for alarm. A 2010response analysis of fivemajor sites along the corridor fromMombasato Busia witnessed no instance of behavioural interventions thoughnearly30agenciesclaimedtorunsuchprogrammes.Over60percentof600 truckers and female sexworkers interviewed reportedhavingneverreceived informationonHIV/AIDS. Inspiteofworking incloseproximity,noinstanceofcollaborationbetweenagencieswasreported(IOM&NACC,2010).Clinicalservices,includingHIVCounsellingandTesting(HCT),arenotsufficientlyaccessible.

Thescenario isakintothatofatug-of-warwitheachagencypullingtheropeinadifferentdirectionandtheresponsemovingnowhere.Anationalstrategy has yet to be developed to guide implementing partners on acommonapproachthatcanbebroughttoscale.

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MIGRATION HEALTH CONCERNS IN KENYA

Reproductive health and migration in Kenya

The reproductive health needs of refugees living in camp settlements arewell documented; however, significant gaps remain in understanding thereproductive health needs of other mobile populations, whether irregularmigrants, pastoralists, or others (Hynes, Sheik, Wilson, & Spiegel, 2002).Irregularmigrants and female sexworkers are often overlooked in regardstohealthpromotionactivities, includingaccesstofamilyplanning,prenatal,delivery,andearlychildhoodhealthcare.Thisleadstosuchissuesasmaternalmortalityandchronicmeaslesoutbreaksinurbanslumsduetolackofcoveragebyvaccinationcampaigns.

A pilot study found substantial differences in access tomaternal and childhealth services betweenmigrant and Kenyanwomen in the community ofEastleigh.Most notablewere the differences in antenatal care, labour anddelivery,contraceptionandbreastfeeding.Followinguponthefindingsusinginformal discussions, itwas found that despite a general consensus on theimportance of accessing maternal-child health care, migrant women citednumerousbarriers,includingcost,languagebarriersandreligiousbeliefs,anda lackof trust inavailable servicesdue tohealthcareworkerattitudesandqualityofserviceswithinthefacilities(IOM&McGill,2011).

Additionally,appropriateservicedelivery isvital,especiallywiththecurrentpush among the Government and donor community on utilizing maternalchildhealthservicesasaconduittoaccessfemalesexworkersandvulnerablewomen with HIV prevention programming, which is an approach that theInternationalOrganizationforMigrationhaslongadvocatedfor.

IN FOCUS: reproductive health among pastoralists in Northern Kenya

NorthernKenyahasoneofthehighestmaternalmortalityratesinthecountry,estimatedat1,000–1,300deathsper100,000livebirths,comparedto530per100,000livebirthsnationally.Asoneofthepoorest,remotestregionsinKenya,malnutritionisrampantandaccesstosafedrinkingwaterandimprovedtoilet facilities is non-existent for the majority of pastoralists (Republic ofKenya,2008;IOM/IGAD,2009).

The2009droughtpushedmalnutrition levels to 12per cent in theGarissadistrict, and15per cent in theBaringodistrict.WithdroughthittingKenyahardin2011,foodinstability,childundernutritionandmaternalmortality iscurrently a looming national disaster. Remote pastoralist communities willinvariably be affected; maternal health facilities are severely lacking andpastoralistsregularlyhavetotravellongdistancestoreachthenearesthealthfacility.

Moreover,thereisareluctancetoseekservicesinhealthfacilities.PastoralistsinKenyatendtoprefertraditionalhealthcareprovidersovermodernmedical

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MIGRATION HEALTH CONCERNS IN KENYA MIGRATION HEALTH CONCERNS IN KENYA

“Therewasnomeanstotakehertoahealth

centreandshehadbeeninlabourforfourdays.Thebleedingdidnot

stopafterdeliveringsowejustwatchedasshe

continuouslybledtodeath.”

Pastoralistmother,Turkana,IOM2011a

practices(IOM/IGAD,2009),ashealthfacilitiesareperceivedaslesssufficientbecausetheyaretoofaraway,lackthenecessaryservicesandequipmentandservicesofferedarenotadaptedtoamobilelifestyle.Anunfavourableattitudeadoptedbyhealthworkersandnomoneytopayfortreatmentwerealsocitedasreasonstoshunexistinghealthservices(IOM/IGAD,2009).

Improved access for pastoralist communities must be scaled-up throughoutreachprogrammesthatareavailabletoremotepopulationsinawaythatistailoredtoseasonalmobilitypatterns.

Additional health concerns facing migrants in Kenya

MalariaistheleadingcauseofmorbidityandmortalityinKenya(RepublicofKenya,2008).Migrantsandmobilepopulationsareparticularlyvulnerableastreatedmosquitonetsremainelusiveandhealthservicesarelacking.AreportbyMosca,Wagacha,Aketch,StuckeyandGushulak(2000)indicatesthatabulkofmigrantswhoresettletothirdcountriesoriginatefromruralrefugeecampswheremalariatransmissionmaybehyper-endemic.Severalstudieshavealsohighlightedthatmalariaisthetophealthconcernofmobilepopulationssuchastruckers,whosleepinorundertheirvehicleswithoutaccesstomosquitonets(IOM&GLIA,2006).

Theinformalprivatesectorhasproliferatedsinceitsliberalizationduringthelate1980s.MuchlikethemajorityofKenyans,irregularmigrantsrelyontheprivatesectoranditcanbeassumedthattheymightnotreceiveappropriatediagnosisortreatmentastheyself-medicatewithshop-boughtanti-pyreticsand anti-malarials that may not meet national standards for quality andeffectiveness(RepublicofKenya,2001).

Measles and other vaccine-preventable infections: Kenya hasexperiencedmultipleoutbreaksofmeaslesoverthelastdecadedespitetheexistence of an effective and affordable vaccine. In 2005, 2007 and 2009outbreaks began with unvaccinated migrants, many of whom come fromnationswithhistoricallylowimmunizationcoverageandminimalhealthcaredeliveryinfrastructure.Migrantsfrequentlydistrustandhavemisconceptionssurroundingvaccinations;theseneedtobebetterunderstoodandmessagingdevelopedtobetterpromote immunizationuptake inmigrantcommunities.Thepotentialre-emergenceofpolioisanotherparticularconcerninmigrantcommunities.

Occupational health: Long hours, loneliness and harsh, dirty livingand working environments often expose labour migrants to risks suchas occupational injury, gastrointestinal issues, tuberculosis, and HIV risk-behaviour.

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MIGRATION HEALTH CONCERNS IN KENYA

Psychosocial health:Thosewhomigrateclandestinely,orfallintothehandsof traffickers and end up in exploitative situations, are disproportionatelyaffectedbypsychosocialhealth.Conflictanddisplacementalsoinciteahugeemotionalburdenforthoseaffected.

POLICY ANALYSIS TheBillofRightswhich isanchored in thenew2010ConstitutionofKenyarecognizes that it is a fundamental duty of the State to observe, respect,protect,promote,andfulfiltherightsandfundamentalfreedomsofallpeopleinKenya.ItalsoassertsthateverypersoninKenyahastherighttothehighestattainablestandardofhealth.

However, Kenya still has a longway to go before this is realized. Logisticalchallenges to reach migrants and mobile populations, top-down healthsystems that fail to contextualize services forvulnerablepopulationsareallchallengesthatcan,andmust,beaddressed.

Interviews with key informants highlight a growing concern that theKenyanGovernment’smandate for securing a healthy population does notcommensurate with its lack of initiative in reducing health disparities incommunitiesaffectedbymigrationandpopulationmobility.TheprioritizationofmigranthealthshouldbeembeddedwithinallKenyanMinistries.InKenya,assistanceprovided to internalmigrants is implementedby theMinistry ofState for Special Programmes, which in most cases responds to disasters,withminimal preventive or health promotion programmes in place. Theseprogrammesprotectingmigrantscannotbesidelined,andinsteadshouldbeingrainedwithinnationalactionplansandstrategies.

How can we prioritize migrants with a stretched health care system thatevenKenyansarenotaccessing?Thisisacommonquestionarguedinmanypolicyforums;however,communicablediseasesdonotrespectbordersandmigrants live in communities with Kenyans. It is only through partnership,ledbytheGovernmentofKenya,thatwecanprovidehealthcareforallwhoresidewithinitsborders.

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MIGRATION HEALTH CONCERNS IN KENYA POLICY ANALYSIS

THE WAY FORWARD As Kenya progresses towards Vision 2030, it will continue to be a primedestination for its East African neighbours as a regional economic hub.MigrantswillcontinuetocometoKenyathroughoutthisforthcomingeconomicexpansion,andasaresultofincreasedmovementoftradegoodsandpeoplewithinspacesofvulnerability,therewillinevitablybeanimpactonthehealthofcommunitiesthroughoutKenya.

Migrant andmobile populations access to essential health informationandservices is often problematic.With the potential for increased numbers ofmigrants, it is essential thatpolicymakers andprogrammemanagers gain abetterunderstandingofthevarioustypologiesofmigrantsandtheirunderlyinghealth drivers, so that the national health package can be tailored to theirspecificneeds.

Achieving the healthMillennium Development Goals, the challenges facedby theGovernmentofKenyaand itspartners is toensureequitableaccessto health and social serviceswithin the context of increasing diversity anddisparities. At the same time, long-standing programming gaps related tomigrants and mobile populations have yet to be adequately addressed.In order to meet these demands, strengthened partnerships are requiredamongstakeholderswithinKenya,withthedonorcommunity,aswellaswithneighbouringcountries.

NationalpolicyinregardstomigranthealthmustbeasboldastheConstitutionandBillofRights,wheretherightsofmigrantsareprotected.UtilizingsuchalensitiseasilyunderstoodthatKenyacanadoptanapproachwherehealthymigrantsliveinhealthycommunities.Toachievesuchagoal,itisimperativethatwecometoacommonconsensusontheinclusionofmigrationhealthingeneralhealthpromotionandverticalhealthstrategiesinKenya.Specificallythis could include the formation of a National Forum forMigration Healthchaired by the Government of Kenya, to strengthen coordination amongstakeholdersandtodrawaCommonActionPlan(CAP)formigrationhealth.

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THE WAY FORWARD

RECOMMENDATIONS TheGovernment,withsupportfrompartners,shouldtakeleadershipon:

1. Establishinganinstitutionalreferencepointforhealthissues relatingtomigrantsandmobilepopulations,forexample, adedicatedunitwithintheMinistryofHealth;

2. Reviewingnationalstrategiesandguidelinesandensuringthat mechanismsareinplacetoreducehealthdisparitiesfaced bymigrantsandmobilepopulations;

3. Facilitating,providing,andpromotingequitableaccessto comprehensiveavailable,affordableandnon-discriminatoryhealth services.Thisshouldincludehealthpromotion,diseaseprevention, andcareformigrants;

4. Offeringhealthservicesintargetareaswheremigrantsarepresent andwheretheycanbeaccessed,forexample,cross-border communities,hotspotsalongtransportcorridors,fishingvillages, plantations,andurbansettlements;

5. Providingbasichealthservicestomigrants,regardlessof immigrationstatus,asapublichealthpriority;

6. Makingservicesmoremigrant-friendlythroughsuchmeansas engagingmigrantcommunityleadersandemployingstaffwho speakmigrantlanguages;

7. Developingnationalstrategiestoaddressspecificissues,for instance,onscaling-uponenationalframeworkonpreventingHIV alongtransportcorridors;

8. Sensitizingandbuildingcapacityofpolice,healthcareproviders, andgatekeepers(includingsecurityguardsatclinics)tothe importanceofensuring“healthforall”andformeetingthespecific needsofmigrants;

9. Strengthenthedocumentationofhealthissuesfacingmigrants andmobilepopulations,includingqualitativeresearchonaccess andacceptability,disaggregatingsurveillancedatatoidentify migration-relateddata,andincludingmigration-relatedindicators inDemographicandHealthSurveysandrelatedactivities;

10. Expandingfundingandresearchcapacityforthoseinvestigatingtopics withinthefieldofmigrationhealth;

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THE WAY FORWARD RECOMMENDATIONS

11. Addressingtheenvironmentalandstructuralfactorsimpactingthe healthofmigrants,inadditiontoindividualriskfactors;

12. Strengtheningthecoordinationofhealthissuesthatfacemigrants amongstakeholderswithincommunities,countries,andbetween countries;

13. Asfeasible,strengtheningcollaborationonhealthprogramming betweenplacesoforigin,transit,anddestination;

14. Harmonizingtreatmentprotocolsbetweencountriesandestablish trans-borderreferralmechanismsforissuesincludingtuberculosis, HIV/AIDS,andmaternal-childhealth;

15. DevelopaRegionalDisasterManagementPlantodealwithpandemics, breakdowninHIV/AIDSprogramming,andotherdisastersthataffect migrantsanddisplacedpopulations.

Whole families can live in just one room in Eastleigh © 2011 Silverscreen Pictures

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RECOMMENDATIONS

REFERENCES Halperin, D. and H. Epstein 2007 WhyisHIVPrevalencesoSevereinSouthernAfrica?Therole ofmultipleconcurrentpartnershipsandlackofmalecircumcision: ImplicationsforAIDSprevention.TheSouthernAfricanJournal ofHIVMedicine,March2007,pages19-25.

Hynes, M. et al 2002 Reproductivehealthindicatorsandoutcomesamongrefugee andinternallydisplacedpersonsinpostemergencyphase camps.JournaloftheAmericanMedicalAssociation, 2002Aug7;288(5):595-603.2002 Reproductivehealthindicatorsandoutcomesamongrefugee andinternallydisplacedpersonsinpostemergencyphase camps.JournaloftheAmericanMedicalAssociation.

Intergovernmental Authority on Development (IGAD), National AIDS Control Council (NACC), and International Organization for Migration (IOM)2009 PastoralismandHIV/AIDSinIGADCountries:Programme mapping,datasynthesis,andrecommendationsforpolicyand furtherresearch–KENYAREPORT,IOM,Nairobi.

Intergovernmental Panel on Climate Change (IPCC)2007 WorkingGroupIIContributiontotheIntergovernmentalPanel onClimateChangeFourthAssessmentReportClimateChange 2007:ClimateChangeImpacts,AdaptationandVulnerability, April2007.

International Maritime Organization (IMO) and Ports Management Authority of East & Southern Africa (PMAESA)2008 ImpactAssessmentStudyofHIV/AIDSinPMAESAPortof Mombasa,Kenya,IMO,Nairobi.

International Organization for Migration (IOM)2011a TheSocialDeterminantsofHealthinMigrant PopulationsinKenya.2010a BackgroundPaperfor2010WorldMigrationReport:Future CapacityNeedsinManagingtheHealthAspectsof MigrationIOMGeneva.2010b MigrationandHealthinSouthAfrica:Areviewofthecurrent situationandrecommendationsforachievingtheWorldHealth AssemblyResolutiononthehealthofMigrants,IOM,Pretoria.2010c NationalConsultationMigration&HIVinTanzania:Uniformed Personnel,MobilePopulations,andBorderCommunities,1-2 June2010,DarEsSalaam,Tanzania.IOM,DaresSalaam.

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RECOMMENDATIONS REFERENCES

2009 SessionSummaryReport:Sub-plenary5–HealthPromotion:An ApproachtoImprovingtheHealthofMigrants,IOM,Nairobi.2004 InternationalMigrationLawNo.10,GlossaryonMigration, IOM,Geneva.2000 Malariareductioninmobilepopulations:TheIOMSupplementary MedicalProgrammeforSub-SaharanAfrica,IOM.

International Organization for Migration and McGill University2011 AccesstoMaternal&EarlyChildhoodHealthCareforUrban MigrantsinEastleigh,Nairobi,Kenya.IOM,Nairobi.

International Organization for Migration and National AIDS Control Council (NACC)2010 ResponseAnalysisofCombinationPreventionalongthe NorthernTransportCorridorinKenya(inpress).

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