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PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the

. PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION. MIGRATION AND HEALTH AT THE BORDERS Dra. Hilda Leal de Molina. The Health of Migrant Populations in Border Territories.

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PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the

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  1. . • PAN AMERICAN HEALTH ORGANIZATION • Pan American Sanitary Bureau, Regional Office of the • WORLD HEALTH ORGANIZATION MIGRATION AND HEALTH AT THE BORDERS Dra. Hilda Leal de Molina

  2. 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 poor • Little access to sanitary infrastructure • Difficulty 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

  3. CHARACTERISTICS OF MIGRANT POPULATIONS AT THE BORDERS • An opportunity to: • Create health spaces • Design and implementation of binational or trinational plans and programs. • Borders – Third Space. • Their own identity, ethnic, cultural and language differences that are independent from national levels. The flows of population, goods and services are not unilateral. • Borders become blurred • Developing solidarity • Sharing of resources • Family ties Sovereignty criteria are special. Respect of Human Rights

  4. IDENTIFICATION OF PUBLIC HEALTH ISSUES OF COMMON INTEREST * • 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. *Modified criteria of Dr. Vicente Palerm

  5. 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. Plan Andino de Salud de las Fronteras PASAFRO Sept 10-11 2004

  6. What is the scope of the problem? (Incidence, prevalence, mortality, main causes of death, trends, disability) GENERAL CRITERIA TO ADDRESS HEALTH PROBLEMS WITH A BILATERAL APPROACH YES Is the scope of the problem the same on the other side of the border? NO NO Is the problem affecting the relationship between countries/states/cities (general public, media, politicians)? Does the problem have to be addressed bilaterally in order to solve it? YES NO YES YES NO Is the problem of interest to researchers/ academics? Bilateral approach Bilateral approach SI Adress as a domestic problem NO Bilateral approach Based on Vicente Palerm’s (UCMEXUS) criteria for binational approach of academic issues. PAHO EPFO 1999

  7. 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

  8. 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.

  9. TYPES OF COOPERATION • Humanitarian Assistance • Collaboration • Cooperation for development

  10. BASIC ELEMENTS OF COLLABORATION • Interest in a common matter or shared problem • Respect, trust, and consensus • Joint use of resources • Equitable distribution of results

  11. 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

  12. Two countries, one island: “Hispaniola” Located in the Caribbean

  13. DEVELOPMENT OF HEALTH COOPERATIONHAITI – DOMINICAN REPUBLIC BILATERAL AGREEMENTS • Areas of Cooperation 2002/2004: • Access to Maternal and Child Health Care • HIV/AIDS • PAI • Tuberculosis • Rabies • Filariasis • Malaria • Epidemiological Surveillance • Catastrophes

  14. Migrant 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.

  15. RELEVANT SANITARY ASPECTS AT THE BORDER Substance abuse in the border communities at the Mexico- USA border requires consensuated bilateral interventions.

  16. 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

  17. ESTABLISHING 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.

  18. SAFE 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

  19. SAFE AND HEALTHY SISTER CITIES • 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

  20. “COMUNIDAD ANDINA” AND “MERCOSUR” Ven/Col Community-based epidemiological surveillance Ecu/Per Protección Ambiental Bra/South Protection of the Environment Per/Chi Healthy Spaces Arg/Bra/Par Health Service Network Triple Border Arg/Bol/Par Indigenous population in the South American Chaco PAHO EXPERIENCES …

  21. INTEGRATED HEALTH SYSTEM OF THE “MERCOSUR” IN THE POLITICAL AGENDA • STRENGTHENING THE INTEGRATION PROCESS • FOCUS ON LOCAL DEVELOPMENT • SOCIAL INCLUSION PAHO EXPERIENCES …

  22. 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. PAHO EXPERIENCES …

  23. 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. PAHO EXPERIENCES …

  24. CENTRAL AMERICA Meeting of the Health Sectors of Central America and the Dominican Republic (XVIII RESSCAD) Study: Flacso and WHO/PAHO – Feb. 2004 Migrant and mobile populations and their health impact in Central America and the Dominican Republic Services: Limited capacity for response Inexistent Social Protection System Lack of knowledge about the problem Women: Domestic service Sex workers Agricultural work Indigenous population, women, girls, and boys are most affected. Girls and boys: Agricultural work Domestic service Sex trade Indigenous Population: Agricultural work En domestic service

  25. MIGRATION PHENOMENON 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.

  26.                    • 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.

  27. 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. PAHO EXPERIENCES …

  28. 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) DIMENSIONS: DIMENSIONS OF CROSSBORDER WORK. CRISTINA VON GLASCOE. COLEF

  29. 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

  30. 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.

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