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Pan AmericanHealthOrganization

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PAN AMERICAN HEALTH ORGANIZATIONPan American Sanitary Bureau, Regional Office of the

WORLD HEALTH ORGANIZATION

PAN AMERICAN HEALTH ORGANIZATIONPan American Sanitary Bureau, Regional Office of the

WORLD HEALTH ORGANIZATION

MIGRATION AND HEALTH AT MIGRATION AND HEALTH AT THE BORDERSTHE BORDERS

Dra. Hilda Leal de MolinaDra. Hilda Leal de Molina


The Health of Migrant Populations in Border Territories

The Health of Migrant Populations in Border Territories

" POPULATIONS THAT LIVE NEAR THE BORDERS HAVE BEEN THE MOST NEGLECTED HISTORICALLY”

While the borders are identified as development corridors; given that their population is comprised by a high number of migrant and irregular population, these areas are still neglected:

Very poorLittle access to sanitary infrastructureDifficulty accessing services (economic, language, geographical)Higher incidence of diseases ( mainly transmissible diseases) than the

general population.

In the past the border was stigmatized as the entrance of migrant populations; it was the entrance for diseases, the only vulnerable point to transmit a sanitary risk. We know today that virus enter through the airports.

Dra. Mirta Roses

Sept.2003

" POPULATIONS THAT LIVE NEAR THE BORDERS HAVE BEEN THE MOST NEGLECTED HISTORICALLY”

While the borders are identified as development corridors; given that their population is comprised by a high number of migrant and irregular population, these areas are still neglected:

Very poorLittle access to sanitary infrastructureDifficulty accessing services (economic, language, geographical)Higher incidence of diseases ( mainly transmissible diseases) than the

general population.

In the past the border was stigmatized as the entrance of migrant populations; it was the entrance for diseases, the only vulnerable point to transmit a sanitary risk. We know today that virus enter through the airports.

Dra. Mirta Roses

Sept.2003


CHARACTERISTICS OF MIGRANT POPULATIONS AT THE BORDERSCHARACTERISTICS OF MIGRANT POPULATIONS AT THE BORDERS

Borders – Third Space. Their own identity, ethnic, cultural and language differences that are independent from national levels.

An opportunity to:• Create health spaces• Design and

implementation of binational or trinational plans and programs.

The flows of population, goods and services are not unilateral.

Sovereignty criteria are special.

• Borders become blurred • Developing solidarity • Sharing of resources• Family ties


Limited respect for Human Rights of migrants

Lack of Social Protection Systems

Public health issues that affect large segments of population in both countries.

Public health issues that affect the relationship between countries.

Public health issues that are not included above but that are of interest to academics and researchers in both countries.

Limited respect for Human Rights of migrants

Lack of Social Protection Systems

Public health issues that affect large segments of population in both countries.

Public health issues that affect the relationship between countries.

Public health issues that are not included above but that are of interest to academics and researchers in both countries.

IDENTIFICATION OF PUBLIC HEALTH ISSUES OF COMMON INTEREST *

*Modified criteria of Dr. Vicente Palerm


CONSIDERATIONS FOR ASSESSING THE HEALTH SITUATION AT THE BORDERS

CONSIDERATIONS FOR ASSESSING THE HEALTH SITUATION AT THE BORDERS

• Identifying inequities

• Adapting methods and instruments for analysis of the actual situation at the borders

• Facilitating community and civil society participation throughout the process.

• Including and considering the factor of multi-ethnic and multi-cultural characteristics of the migrant population

• Facilitating the multi-sectorial approach

• Involving and strengthening the actors’ technical capacity in the border regions.

• Including the geographical perspective through strategic development areas established by the countries.

• Helping to develop information systems in the health service network in the border regions.

• Identifying inequities

• Adapting methods and instruments for analysis of the actual situation at the borders

• Facilitating community and civil society participation throughout the process.

• Including and considering the factor of multi-ethnic and multi-cultural characteristics of the migrant population

• Facilitating the multi-sectorial approach

• Involving and strengthening the actors’ technical capacity in the border regions.

• Including the geographical perspective through strategic development areas established by the countries.

• Helping to develop information systems in the health service network in the border regions.

Plan Andino de Salud de las Fronteras

PASAFRO Sept 10-11 2004


GENERAL CRITERIA TO ADDRESS HEALTH PROBLEMS WITH A BILATERAL APPROACH

GENERAL CRITERIA TO ADDRESS HEALTH PROBLEMS WITH A BILATERAL APPROACH

What is the scope of the problem?

(Incidence, prevalence, mortality, main causes of death, trends, disability)

Is the scope of the problem the same on the other side of

the border?

Does the problem have to be addressed

bilaterally in order to solve it?

Bilateralapproach

Is the problem affecting the relationship between

countries/states/cities (general public, media,

politicians)?

Is the problemof interest to researchers/academics?

Bilateralapproach

Adressas a domestic

problem

Bilateral approach

YESYES

YES

YES

NO

SINO

NO

NO

Based on Vicente Palerm’s (UCMEXUS) criteria for binational approach of academic issues.PAHO EPFO 1999

NO


OBJECTIVES OF HEALTH PROGRAMS FOR MIGRANT POPULATIONS AND

POPULATIONS OF BORDER REGIONS

OBJECTIVES OF HEALTH PROGRAMS FOR MIGRANT POPULATIONS AND

POPULATIONS OF BORDER REGIONS

Promoting respect for Human Rights

Promoting equity

Creating healthy spaces

Developing solidarity

Promoting cooperation

Contributing to peace and governance

Promoting respect for Human Rights

Promoting equity

Creating healthy spaces

Developing solidarity

Promoting cooperation

Contributing to peace and governance


WHO/PAHO PRIORITIES FOR IMPROVING THE HEALTH OF MIGRANT POPULATIONS

WHO/PAHO PRIORITIES FOR IMPROVING THE HEALTH OF MIGRANT POPULATIONS

To be able to help reducing health inequities and advocate comprehensive and coordinate action the following is required:

Developing information exchange networks and systems for health development.

Promoting the development of health service networks to ensure access.

Being able to unify epidemiological surveillance and continued treatment of transmissible diseases like tuberculosis or AIDS in sister cities.

Harmonizing Sanitary Codes, medical treatment and sharing networks of specialized medical services.

Articulating health promotion programs.

Promoting the development of shared sanitary objectives de objetivos sanitarios and their inclusion in the political agenda.

To be able to help reducing health inequities and advocate comprehensive and coordinate action the following is required:

Developing information exchange networks and systems for health development.

Promoting the development of health service networks to ensure access.

Being able to unify epidemiological surveillance and continued treatment of transmissible diseases like tuberculosis or AIDS in sister cities.

Harmonizing Sanitary Codes, medical treatment and sharing networks of specialized medical services.

Articulating health promotion programs.

Promoting the development of shared sanitary objectives de objetivos sanitarios and their inclusion in the political agenda.


Humanitarian Assistance

Collaboration

Cooperation for development

Humanitarian Assistance

Collaboration

Cooperation for development

TYPES OF COOPERATIONTYPES OF COOPERATION


Interest in a common matter or shared problem

Respect, trust, and consensus

Joint use of resources

Equitable distribution of results

Interest in a common matter or shared problem

Respect, trust, and consensus

Joint use of resources

Equitable distribution of results

BASIC ELEMENTS OF COLLABORATIONBASIC ELEMENTS OF COLLABORATION


WHO/PAHO EXPERIENCE IN HEALTH COOPERATION IN THE BORDER REGIONS

WHO/PAHO EXPERIENCE IN HEALTH COOPERATION IN THE BORDER REGIONS

• Healthy Cities:

• Mexico-USA Border: Security and Health in Sister Cities

•Canal Zarumillas, Peru - Ecuador : Environmental Protection

• Immunization

• First Vaccination Week in the Americas. 10 border crossings. 20 cities.

• Alliances between public and private sector for developing capacities and promoting healthy spaces.

• “Trifinio”, Guatemala, Honduras and El Salvador. • Borders between: Guatemala, Belize, and Mexico • Border cities in: Argentina, Brazil, and Paraguay, • Border regions between:

•Brazil, Colombia, and Peru •Haiti and the Dominican Republic•Nicaragua and Costa Rica

In different border regions in the Americas


Two countries, one island: “Hispaniola”

Two countries, one island: “Hispaniola”

Located in the Caribbean

Characteristic HAITI DOMINICAN

REPUBLIC

LANGUAGE FRENCH/CREOLE SPANISH

GDP 4.1LIFE EXPECTANCY

50.0 66.6

LITERACY 52.8 84.7

INFANT MORTALITY

80.3 31.0


BILATERAL AGREEMENTSAreas of Cooperation 2002/2004:

•Access to Maternal and Child Health Care•HIV/AIDS•PAI•Tuberculosis•Rabies•Filariasis•Malaria•Epidemiological Surveillance•Catastrophes

DEVELOPMENT OF HEALTH COOPERATIONHAITI – DOMINICAN REPUBLIC

DEVELOPMENT OF HEALTH COOPERATIONHAITI – DOMINICAN REPUBLIC


Migrant Population at the Mexico – USA BorderMigrant Population at the Mexico – USA Border

Implementation of the Free Trade Agreement has generated economic and demographic growth.

Approx. 400 million legal border crossings (south to north) each year.

Implementation of the Free Trade Agreement has generated economic and demographic growth.

Approx. 400 million legal border crossings (south to north) each year.


RELEVANT SANITARY ASPECTS AT THE BORDERRELEVANT SANITARY ASPECTS AT THE BORDER

Substance abuse in the border communities at the Mexico- USA border requires consensuated bilateral interventions.


STRUCTURES AND MECHANISMS FOR HEALTH COLLABORATION ACROSS BORDERS

STRUCTURES AND MECHANISMS FOR HEALTH COLLABORATION ACROSS BORDERS

• BINATIONAL COMMISSION MEXICO - USA

• BORDER HEALTH COMMISSION MEXICO-USA

• CONFERENCE OF GOVERNORS OF THE BORDER REGION

• CONFERENCE OF LEGISLATORS OF THE BORDER REGION

• BORDER LINKAGE MECHANISM

• BINATIONAL COMMISSION MEXICO - USA

• BORDER HEALTH COMMISSION MEXICO-USA

• CONFERENCE OF GOVERNORS OF THE BORDER REGION

• CONFERENCE OF LEGISLATORS OF THE BORDER REGION

• BORDER LINKAGE MECHANISM


ESTABLISHING THE FIELD OFFICEESTABLISHING THE FIELD OFFICE

The WHO/PAHO Office at the Mexico – USA border was established at the beginning of 1942 by request of the Federal Government of Mexico and the US for technical cooperation with local and state health authorities at the border to address emerging health demands.

The first Manager was Dr. Joseph S. Spoto.


SAFE AND HEALTHY SISTER CITIESSAFE AND HEALTHY SISTER CITIES

Applies lessons learned from the strategy of healthy municiipalities and safe communities within the binational context

Adapts principles of the “healthy municipalities” movement

Develops methods and instrumentos for a binational context

Applies lessons learned from the strategy of healthy municiipalities and safe communities within the binational context

Adapts principles of the “healthy municipalities” movement

Develops methods and instrumentos for a binational context


• Focus on available information (“Mortality Profiles” and “Community Health Status”).

•Binationality criteria

•Binational balance

•Press coverage (press conferences and bulletins).

•Developing a script for protocols

• Focus on available information (“Mortality Profiles” and “Community Health Status”).

•Binationality criteria

•Binational balance

•Press coverage (press conferences and bulletins).

•Developing a script for protocols

SAFE AND HEALTHY SISTER CITIESSAFE AND HEALTHY SISTER CITIES


Arg/Bra/Par

Ven/Col

Per/Chi

Arg/Bol/Par

Ecu/Per

“COMUNIDAD ANDINA” AND “MERCOSUR”

PAHO EXPERIENCES …

Community-based epidemiological surveillance

Bra/SouthProtection of the

Environment

Health Service Network

Triple Border

Healthy Spaces

Protecci

ón Ambient

al

Indigenous population in the South American Chaco


INTEGRATED HEALTH SYSTEM OF THE “MERCOSUR” IN THE POLITICAL AGENDA

INTEGRATED HEALTH SYSTEM OF THE “MERCOSUR” IN THE POLITICAL AGENDA

STRENGTHENING THE INTEGRATION PROCESS

FOCUS ON LOCAL DEVELOPMENT

SOCIAL INCLUSION

STRENGTHENING THE INTEGRATION PROCESS

FOCUS ON LOCAL DEVELOPMENT

SOCIAL INCLUSION



INTEGRATED HEALTH SYSTEM -SIS-MERCOSUR

INTEGRATED HEALTH SYSTEM -SIS-MERCOSUR

• “ACROSS BORDERS” AND HARMONIZATION

• Health Care organization in border regions as a paralell process that provides structure and fosters integration.

• CONCEPT OF “HEALTHY BORDER” AND RESPONSIBILITY FOR THE HEALTH OF MIGRANT POPULATIONS

• Identifying and strengthening the role and capacities of municipalities within the complexity of developing health care systems and border service networks that ensure access and protection of migrant populations.

• “ACROSS BORDERS” AND HARMONIZATION

• Health Care organization in border regions as a paralell process that provides structure and fosters integration.

• CONCEPT OF “HEALTHY BORDER” AND RESPONSIBILITY FOR THE HEALTH OF MIGRANT POPULATIONS

• Identifying and strengthening the role and capacities of municipalities within the complexity of developing health care systems and border service networks that ensure access and protection of migrant populations.



TRIPLE BORDER = ARGENTINA, BRAZIL, AND PARAGUAY

•Triple border is a highly urbanized area.

•Commitment to improving access to health services based on findings from a study that has been conducted with cooperation of WHO/PAHO.

•Analysis of the public and private network and demand and supply; determining gaps; alternative solutions and development proposals.



CENTRAL AMERICACENTRAL AMERICA

Study: Flacso and WHO/PAHO – Feb. 2004

Migrant and mobile populations and their health impact in Central America and the Dominican Republic

Meeting of the Health Sectors of Central America and the Dominican Republic (XVIII RESSCAD)

Indigenous population, women, girls, and boys are most affected.

Women:Domestic serviceSex workersAgricultural work

Indigenous Population:Agricultural workEn domestic service

Girls and boys: Agricultural work

Domestic service

Sex trade

Services:Limited capacity for responseInexistent Social Protection SystemLack of knowledge about the problem


INTERNAL: Inter-departaments

Inter-municipal

EXTERNAL:

Going: Temporary agricultural workers (men, women, and children) to México

Men and women to the US.

Coming: Temporary agricultural workers, mainly from El Salvador, Nicaragua, and Honduras.

Transit: Mainly Hondurans, Nicaraguans, Salvadorians

Deported: Asian, Hindus, South Americans, Central Americans

Guatemala is a country with internal and external migration.

MIGRATION PHENOMENONMIGRATION PHENOMENON


Integrated health care model in Escuintla: MSPAS-IGSS.

Tables for national migrants and migrants from the departments: civil society organizations, MSPAS,IGSS, Ministry of Labor, Catholic Church, Migration, NGOs, CRS, WHO/PAHO, Médicos sin Fronteras. Projected table in San Marcos.

Establishing an epidemiological surveillance network between health areas in countries of origin and destination.

Developing local operational plans in countries of origin and destination. Health kiosks are planned.

Improving sanitation conditions in a coordinated manner together with the sugar industry. Proposals from the agro-industrial sector for health care for migrants.

Afiliación al IGSS, de 50,000 trabajadores agrícolas migrantes.


CHALLENGES FOR HEALTH CARE FOR MIGRANTS

CHALLENGES FOR HEALTH CARE FOR MIGRANTS

• Equity and solidarity in health care services, on both

sides of the borders and in the countries.

• Reducing differences.

• Taking advantage of competencies and capacities of

health care services at each side of the border, creating

real service networks.

• Establishing timely and reliable information and health

surveillance systems.

• Equity and solidarity in health care services, on both

sides of the borders and in the countries.

• Reducing differences.

• Taking advantage of competencies and capacities of

health care services at each side of the border, creating

real service networks.

• Establishing timely and reliable information and health

surveillance systems.



CONSIDERATIONS FOR AN EFFECTIVE COOPERATION FOR HEALTH OF MIGRANTS

CONSIDERATIONS FOR AN EFFECTIVE COOPERATION FOR HEALTH OF MIGRANTS

• CENTRAL (Federal) – PERIPHERIC (Regional/Local)

• GOVERNMENTAL (different levels) – CIVIL SOCIETY (NGOs, Associations, Service Networks, Private Sector)

• SECTORIAL (Health) – MULTI-SECTORIAL – (Foreigh Affairs)

• INSTITUTIONAL – VOLUNTEERS

• NATIONAL - INTERNATIONAL (External Cooperation)

• CENTRAL (Federal) – PERIPHERIC (Regional/Local)

• GOVERNMENTAL (different levels) – CIVIL SOCIETY (NGOs, Associations, Service Networks, Private Sector)

• SECTORIAL (Health) – MULTI-SECTORIAL – (Foreigh Affairs)

• INSTITUTIONAL – VOLUNTEERS

• NATIONAL - INTERNATIONAL (External Cooperation)

DIMENSIONS OF CROSSBORDER WORK. CRISTINA VON GLASCOE. COLEF

DIMENSIONS:


CONDITIONS FOR MOVING FORWARD IN HEALTH OF MIGRANT POPULATIONS AT THE BORDERS

CONDITIONS FOR MOVING FORWARD IN HEALTH OF MIGRANT POPULATIONS AT THE BORDERS

• Identifying the common problems• Recognizing the sovereignty of each country• Trust and mutual respect • “Good neighbor” principle• Consensus in decision-making • Equitative distribution of resources and

acknowledgements• Comprehensive approach to address problems • Cooperation, Non-Imposition• Shared surveillance and information system

• Identifying the common problems• Recognizing the sovereignty of each country• Trust and mutual respect • “Good neighbor” principle• Consensus in decision-making • Equitative distribution of resources and

acknowledgements• Comprehensive approach to address problems • Cooperation, Non-Imposition• Shared surveillance and information system


CONCLUSIONS CONCLUSIONS

• Cooperation on migration and health at the borders has to be perceived as a permanent and dynamic process.

• WHO/PAHO’s role is to accompany and facilitate the technical aspects of this process.

• The process itself is as important as the results.

• Working in migration and health at the borders becomes a bridge for understanding and solidarity.

• The results should be recognized and communicated.

• The lessions learned from these experiences need to be applied in other settings.

• Cooperation on migration and health at the borders has to be perceived as a permanent and dynamic process.

• WHO/PAHO’s role is to accompany and facilitate the technical aspects of this process.

• The process itself is as important as the results.

• Working in migration and health at the borders becomes a bridge for understanding and solidarity.

• The results should be recognized and communicated.

• The lessions learned from these experiences need to be applied in other settings.

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