The Academy for African Migration Research (AAMR): supporting the development of the next generation of African migration scholars
Lead Research Organisation:
University of the Witwatersrand
Department Name: Research Office
Abstract
Over a three year period, the Academy for African Migration Research will undertake two key activities:
(1) Four 'institutes' to provide capacity building for doctoral students and early-career researchers who are a maximum of 3-years post-PhD, to refine their research focus and promote professional development and scholarly contributions.
(2) A series of research visits/exchanges for established academics and postdoctoral fellows to support building research capacity and strengthening the intellectual project for migration research in Africa.
The Academy currently includes seven institutions in 5 countries [TBC]. Applications for the institutes will be accepted from doctoral students and early-career researchers from any African institute.
1. University of Addis Ababa and/or OSSREA, Ethiopia
2. University of Ghana, Legon, Accra, Ghana
3. Makerere University, Kampala, Uganda
4. Eduardo Mondlane University, Maputo, Mozambique
5. University of the Western Cape, Cape Town, South Africa
6. University of Cape Town, South Africa
7. University of the Witwatersrand, Johannesburg, South Africa
Institutes: A series of four 'institutes' will be held at different locations across the ARUA network, each focusing on a different thematic area: migration and urbanization; migration, health and wellbeing; belonging, difference and diaspora; and, the knowledge politics of migration research in Africa. These institutes will also incorporate professional development training, including the development of peer-support and mentorship mechanisms. A final event will be held in the final/third year. This will take the form of a conference for early career researchers and postgraduate students - including those who have participated in the institutes - working on migration and mobility in Africa.
The institutes will be designed to:
- Support African migration scholars to embrace theory building, engagement with migration/social theory, and the knowledge politics associated with migration research in Africa. Participants will benefit from rigorous theoretical and methodological foundations in inter-disciplinary migration studies in addition to disciplinary perspectives from resource persons.
- Offer practical professional advice/professional development including: academic publishing; project management; organising and managing data; consulting colleagues and others in the field; and the risks and benefits of interdisciplinary work in an academic universe still largely organised in disciplinary formations.
- Provide mentorship and peer support by facilitating engagements between doctoral students, early career researchers and established academics both virtually and in-person. These structures will provide support for the required outputs associated with the institutes, including written work; presentation skills; and the development of professional CVs and online profiles.
Research visits/exchanges: The Academy will fund various activities for established and early career researchers. Funds will be awarded on a competitive basis, and will be assessed by a review panel made up on their planned activities and outputs. Preference will be given to proposals aiming to support research capacity building and strengthening of the intellectual project for migration research in Africa. All proposals will need to demonstrate collaboration/partnership building as a central activity.
- one-week visits for established researchers to travel to another institution to undertake teaching/supervision/research exchanges;
- one-month visiting postdoctoral fellowships; and
- symposiums and/or proposal development workshops to support the establishment of new research partnerships.
(1) Four 'institutes' to provide capacity building for doctoral students and early-career researchers who are a maximum of 3-years post-PhD, to refine their research focus and promote professional development and scholarly contributions.
(2) A series of research visits/exchanges for established academics and postdoctoral fellows to support building research capacity and strengthening the intellectual project for migration research in Africa.
The Academy currently includes seven institutions in 5 countries [TBC]. Applications for the institutes will be accepted from doctoral students and early-career researchers from any African institute.
1. University of Addis Ababa and/or OSSREA, Ethiopia
2. University of Ghana, Legon, Accra, Ghana
3. Makerere University, Kampala, Uganda
4. Eduardo Mondlane University, Maputo, Mozambique
5. University of the Western Cape, Cape Town, South Africa
6. University of Cape Town, South Africa
7. University of the Witwatersrand, Johannesburg, South Africa
Institutes: A series of four 'institutes' will be held at different locations across the ARUA network, each focusing on a different thematic area: migration and urbanization; migration, health and wellbeing; belonging, difference and diaspora; and, the knowledge politics of migration research in Africa. These institutes will also incorporate professional development training, including the development of peer-support and mentorship mechanisms. A final event will be held in the final/third year. This will take the form of a conference for early career researchers and postgraduate students - including those who have participated in the institutes - working on migration and mobility in Africa.
The institutes will be designed to:
- Support African migration scholars to embrace theory building, engagement with migration/social theory, and the knowledge politics associated with migration research in Africa. Participants will benefit from rigorous theoretical and methodological foundations in inter-disciplinary migration studies in addition to disciplinary perspectives from resource persons.
- Offer practical professional advice/professional development including: academic publishing; project management; organising and managing data; consulting colleagues and others in the field; and the risks and benefits of interdisciplinary work in an academic universe still largely organised in disciplinary formations.
- Provide mentorship and peer support by facilitating engagements between doctoral students, early career researchers and established academics both virtually and in-person. These structures will provide support for the required outputs associated with the institutes, including written work; presentation skills; and the development of professional CVs and online profiles.
Research visits/exchanges: The Academy will fund various activities for established and early career researchers. Funds will be awarded on a competitive basis, and will be assessed by a review panel made up on their planned activities and outputs. Preference will be given to proposals aiming to support research capacity building and strengthening of the intellectual project for migration research in Africa. All proposals will need to demonstrate collaboration/partnership building as a central activity.
- one-week visits for established researchers to travel to another institution to undertake teaching/supervision/research exchanges;
- one-month visiting postdoctoral fellowships; and
- symposiums and/or proposal development workshops to support the establishment of new research partnerships.
Planned Impact
This proposal is designed to support the goal of the African Research Universities Alliance (ARUA) to enhance research and graduate training in member universities through a number of channels, including through Centres of Excellence (CoEs). The CoE on Migration and Mobility is a focal point for providing opportunities for graduate students from the region to build their research and professional development skills, and to support the development of collaborative research between institutions on the continent. Key impacts relate to building research capacity and professional development amongst the next generation of African migration scholars. These impacts will be achieved through a set of objectives, outlined below:
Building research capacity of the next generation of African migration scholars
- Foster more theoretically informed work on migration and mobility in Africa
- Incubate a network of emerging African scholars deeply connected to peers and colleagues across the continent, and with other global contexts
- Increase the visibility of African scholars in the scholarly/theoretically informed literature on migration in Africa
Supporting professional development of the next generation of African migration scholars
- Build professional development skills, including in teaching, supervision, writing research proposals, project management, peer reviewing, building professional CVs and online profiles
- Creating peer support and mentorship opportunities, including the pairing of doctoral students with ECRs and established academics
- Develop online resources and a networking platform
The proposed activities will enhance the impact of the project and deliver benefit directly to participating researchers and to the involved institutions. The needs of partner institutions will be reflected in the finalisation of the project workplan and in the development of the content of each Institute. The project will have a long-lasting and transformative impact by supporting the professional development and research capacity of the next generation of African migration scholars. These scholars will benefit from improved skills training and networking with other institutions across the continent. This will, as a result, support the development of research partnerships, including in the joint writing of collaborative research proposals that will be submitted for funding to relevant authorities.
Building research capacity of the next generation of African migration scholars
- Foster more theoretically informed work on migration and mobility in Africa
- Incubate a network of emerging African scholars deeply connected to peers and colleagues across the continent, and with other global contexts
- Increase the visibility of African scholars in the scholarly/theoretically informed literature on migration in Africa
Supporting professional development of the next generation of African migration scholars
- Build professional development skills, including in teaching, supervision, writing research proposals, project management, peer reviewing, building professional CVs and online profiles
- Creating peer support and mentorship opportunities, including the pairing of doctoral students with ECRs and established academics
- Develop online resources and a networking platform
The proposed activities will enhance the impact of the project and deliver benefit directly to participating researchers and to the involved institutions. The needs of partner institutions will be reflected in the finalisation of the project workplan and in the development of the content of each Institute. The project will have a long-lasting and transformative impact by supporting the professional development and research capacity of the next generation of African migration scholars. These scholars will benefit from improved skills training and networking with other institutions across the continent. This will, as a result, support the development of research partnerships, including in the joint writing of collaborative research proposals that will be submitted for funding to relevant authorities.
Organisations
- University of the Witwatersrand (Lead Research Organisation)
- Makerere University (Collaboration)
- QUEEN MARGARET UNIVERSITY (Collaboration)
- International Organization for Migration (Collaboration)
- UNIVERSITY OF THE WESTERN CAPE (Collaboration)
- Addis Ababa University (Collaboration)
- Amref Health Africa (Collaboration)
- Evangelical University in Africa (Collaboration)
- UNIVERSITY OF JOHANNESBURG (Collaboration)
- UNIVERSITY OF EXETER (Collaboration)
- UNIVERSITY OF OXFORD (Collaboration)
- UNIVERSITY OF EDINBURGH (Collaboration)
- Tata Institute of Social Sciences (Collaboration)
- University of Kinshasa (Collaboration)
- Africa University (Collaboration)
- UNIVERSITY OF GHANA (Collaboration)
- London School of Hygiene and Tropical Medicine (LSHTM) (Collaboration)
- Somali Institute for Development Research and Analysis (Collaboration)
- Kenya Medical Research Institute (Collaboration)
- UNIVERSITY OF ESSEX (Collaboration)
- University of Cape Town (Collaboration)
People |
ORCID iD |
| Joanna Vearey (Principal Investigator) |
Publications
Bisnauth MA
(2022)
Providing HIV Prevention of Mother to Child Transmission (PMTCT) Services to Migrants During the COVID-19 Pandemic in South Africa: Insights of Healthcare Providers.
in Health services insights
De Gruchy T
(2021)
Research on the move: exploring WhatsApp as a tool for understanding the intersections between migration, mobility, health and gender in South Africa.
in Globalization and health
De Gruchy T
(2019)
After the handover: Exploring MSF's role in the provision of health care to migrant farm workers in Musina, South Africa.
in Global public health
De Gruchy T
(2020)
Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community-based responses.
in Health & social care in the community
De Gruchy T
(2022)
Framing Migration During the Covid-19 Pandemic in South Africa: A 12-Month Media Monitoring Project
in Media and Communication
De Gruchy T
(2022)
Left behind: why South Africa must develop migration-aware responses to COVID-19 and future pandemics
in South African Health Review
Gruchy T
(2020)
"Left behind": why implementing migration-aware responses to HIV for migrant farm workers is a priority for South Africa.
in African journal of AIDS research : AJAR
Khalid A
(2023)
Turning up the heat: A conceptual model for understanding the migration and health in the context of global climate change.
in Journal of migration and health
| Description | To date, the AAMR has successfully undertaken various capacity building activities for the next generation of African migration scholars. This has included: - provision of completion grants to doctoral and postdoctoral students who, via a competitive process, became fellows of the AAMR - professional development training provided to AAMR fellows - development, piloting and successful implementation of three open access online modules - partnering to deliver a month-long summer school. The Refocus: An Online Summer Forced Migration in Africa Workshop Series facilitates developing knowledge and critical thinking on forced migration and protection issues in Africa; and facilitates the training of early career and emerging scholars. It is being run and hosted by the Refugee Law Initiative, University of London, the Centre for Migration Studies, University of Ghana; the African Centre for Migration & Society, University of the Witwatersrand; and the African Academy of Migration Research (AAMR). |
| Exploitation Route | The AAMR has developed a model for an online modality of shared, collaborative and open-access training. Critically, the AAMR has shown that a very cost-efficient and sustainable platform - Learndash - can be used to build modules. These self-directed learning modules allow participants to register for courses. Upon successful completion, they are awarded a certificate of completion. We are in the process of building new modules and creating further open-access teaching resources in the field of migration. |
| Sectors | Education Other |
| URL | http://www.acms-aamr.org |
| Description | (un)Healthy movement in southern Africa: towards improved responses to communicable diseases. |
| Amount | £692,642 (GBP) |
| Funding ID | 104868 |
| Organisation | Wellcome Trust |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 02/2016 |
| End | 02/2020 |
| Description | GEMMS: Global Health Research Group on Disrupting the cycle of gendered violence & poor mental health among migrants in precarious situations |
| Organisation | Africa University |
| Country | Zimbabwe |
| Sector | Academic/University |
| PI Contribution | As a co-directed and collaborative international programme, we have an open approach to developing the groups outputs. For publications we follow our authorship guidelines. Our next outputs will include working papers of the literature reviews and policy reviews, which will be developed for publications. GEMMS workstream activities have generally progressed well, with work in WS1 and formative work for WS2 significantly advanced in the past six months. Some highlights to date: • 4 PhD scholarships awarded (3 male; 1 female; 2 with disabilities; all international, from Zimbabwe, Nepal, India and South Africa) • A joint PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS) • Distress protocol • Situational analysis for countries (working documents) • Scoping and systematic reviews underway/nearly finalised (this included developing training materials for researchers) • International Advisory Board established comprising a group of influential experts across UN system, academia and independent experts • GEMMS Handbook for the project team; Communications Strategy; IP Policy; Data Management Strategy (draft); Preventing Harm in Research (draft); Authorship Guidelines; Training strategy and plan (draft) • Presentations at the NIHR Training Forum • Website, X (twitter), LinkedIn accounts https://gemms-research.org/ | https://twitter.com/GEMMS_research | https://www.linkedin.com/company/gemms-research/mycompany/ • Four blogs published on the GEMMS website https://gemms-research.org/blog/ • Contributions to the publication, Migration in South Asia [https://link.springer.com/book/10.1007/978-3-031-34194-6]; edited by a member of the IAG. • Report from the workshop and stakeholder meetings held in Musina that resulted in the development of the South Africa Local Advisory Group and an associated Local Advisory Network Inclusion & Community Engagement: meetings have taken place in India, Zimbabwe and South Africa. India: 25 leaders from informal settlements at the research site in India were brought together. The aim was to understand migration patterns and precarities associated with the site. This was important for identifying these patterns, who the community gatekeepers are, and labels used for migrants as well as their overall living situation. The meeting has initiated a process to identify the most vulnerable groups among migrants and to start the process for community engagement. Zimbabwe: two local advisory networks and groups have been established in Manicaland Province, one in Mutare and one in Chipinge. These LAGs have met and advised the team about where to undertake research and supported access to the Tongongara Refugee Camp in Chipinge where the research is now focusing. This includes direct engagement with the Camp Manager who is guiding the process for obtaining formal approvals. Once the AU research team is in place, they will take over this process. South Africa: At our research site in Musina, we have constituted the Musina Local Advisory Group and a Musina Local Advisory Network. The Network has met once (May 2023) and comprises 30 individuals from various organisations and migrant groups. The LAN will meet again in June 2024. The Local Advisory Group - a group of five members of the Network - will work with us on the research methods to assess their feasibility and appropriateness in Musina and a visit to Musina in November 2023 provided opportunities to update LAG members on progress and receive feedback/updates on the current context. In Musina, the Local Advisory Network has improved our understanding of the practicalities of the project in the local context. Issues that we need to be aware of and respond to include, language barriers and the isolation of some migrant communities. Myanmar: We are at the stage of planning key informant interviews and to identify those who can lead the research in the selected areas. The situation in Myanmar means our research must be extremely sensitive to the constantly changing conditions. Health Poverty Action our lead partner for Community, Engagement and Inclusion, has an established reputation in the region and field offices along the border region between Myanmar and China. Their staff are embedded within the communities they support and will lead the research work for GEMMS in Myanmar. Three staff from Myanmar have been identified to join our NIHR training event in Mumbai. Addition of a new research site: Myanmar and especially Kachin state (the focus of GEMMS research activities) continues to be a challenging and politically fraught geography to proceed with the research as intended and has become inaccessible in light of the recent political developments. In view of this we submitted a CtP request - now approved - that involves: • Terminating all research activities in Myanmar. Maintain Myanmar as a site for piloting interventions if access becomes possible in the final year. • Initiate a new research site in Cambodia, a context characterized by high internal migration as well as out migration (regular and irregular) and return migration, and where our partner Health Poverty Action has a strong base (with an office and where the staff from Myanmar are currently located). Managing Risk: added in a risk on data management and security: Revised the risk on staff turn-over including (1) implications for the project depending on when staff changes take place (e.g. during initial phases vs during fieldwork vs during analysis and dissemination stage) and (2) the need to review procedures and lessons learnt from the departure of the Wits project coordinator following resignation from Wits. This includes understanding the implications/risk associated with team members who are on precarious academic positions; their need for career/professional development; and the associated need for increased security in academic positions (i.e. lack of opportunities for permanent positions and reliance on fully grant-funded fixed-term contracts that align with initial project end dates) Safeguarding: All GEMMS staff (other than those at HPA who undergo very comprehensive safeguard training) are required to complete the on-line Safeguarding Hub introduction to safeguarding course. To date 14 of 26 staff have completed the training; and we anticipate all staff would have completed the training by March 2024. Staff are required to read and sign our GEMMS code of conduct which acknowledges acceptance of our preventing harm in research strategy. This code of conduct is being finalised and will be ready for signing by all staff in Feb 2024. There are no reported safeguarding incidents to date. Data Management: one staff attended the University West of England data management training. We are using this as the basis of our plan and developing this using https://dmponline.dcc.ac.uk As University of Essex is the data manager, we have in place a Data Protection Impact Assessment (led by the University of Essex Data Protection Officer). We are currently developing Information Sharing agreements as all the partners are Data Controllers. Monitoring and Evaluation: Theory of change reviewed during all team on-line workshop (December 2023); being developed into a revised conceptual and logical framework for further development of outcome / impact indicators. Monitoring data is being collected in relation to training and other outputs (such as attendance at workshops; invites to conferences, etc). Governance and Policy Analysis: We have substantially developed the focus on reviewing and analysing policies on integration of migrants' health in health policies, an area that was rather limited in the original proposal. This drew on tools and analysis frameworks in networks led by members of the GEMMS group. We anticipate in the coming year we will use the tools to undertake more in-depth analysis of existing policy landscape in migration health for the four countries, as well as the regions. In the coming year, drawing on the tools developed, a review of the global governance architecture of migration and health will be undertaken. CADA Training: In addition, drawing on a successful CADA grant awarded to TISS and led by GEMMS training lead, we will be conducting a cross-country research academy in September - December for ECRs in GEMMS and its partner institutions. We will offer the virtual sessions to other members of the NIHR academy. GEMMS early career researcher network: The development of a GEMMS early career researcher network is underway. This involves linking WITS Migration & Displacement MA and PhD students working on migration and health with the GEMMS PhD and postdoctoral fellows. Finest achievements of GEMMS to date Prioritising the process (or the means) and not the outputs (or the end) alone have underpinned the key achievements of the GEMMS research group. This involved paying due attention to establishing arrangements that were new to all partner institutions, and shared understandings of the collaborative model of working. While on occasions this has been difficult to achieve (because of institutional demands on staff in partner institutions, staff sickness and absences), members of GEMMS team have stepped in to support other members on these leadership roles. Given the focus on process, and for a programme in its first year of establishment/ implementation, we have laid the foundations of achieving more sustained impact in the countries in focus. This is achieved through: • Established International Advisory Group with diverse sectoral and country membership; including WHO, IOM, Statistics South Africa and International Institute for Migration and Development (India). All IAG members are influential in their fields and bring to GEMMS a wealth of international policy expertise in migration and health. • Creation of Regional Advisory Groups. The Southern Africa Advisory Group held its first meeting in May 2023 with a second in-person meeting planned for October 2023. The Asian Advisory Group membership has been finalised and a first meeting is planned for October 2023. • Mobilising key experts and policy actors via high-impact plenary held in inception phase. The launch event brought together international development partners with academics and international agencies - all expressing a need for the types of intervention delivered by GEMMS. The event created a shared understanding among both developmental and academic partners of the links between the developmental and research objectives of GEMMS. • Launch event featuring David Miliband, President, and CEO of International Rescue Committee (IRC). In his speech (delivered via video), he emphasised that "IRC does seek to be a supporter and partner of your work but we're also looking forward to being a consumer of the work that you launch today I hope that we can partner in research but also in delivery and in advocacy because we can't afford the programmes that we develop to be boutique programmes they need to be scaled programmes and we talk about impact and scale as being at the heart of our strategy". • Development of regionally-sensitive tools for policy appraisals that are now being implemented to analyse and index policies in the countries. • Engagement in global platforms. This includes: • the 3rd Global consultation on the health of refugees and migrants coordinated by WHO, IOM and UNHCR. GEMMS (Vearey) and IAG members (Severoni, Wickramage, Iturralde) participated and led expert panels. The consultation led to the ground-breaking political declaration, the Rabat Declaration, to strengthen the global commitment to improve the health of refugees and migrants, and was signed by the governments of at least two of the four countries (India, South Africa). Vearey is a co-writer of the meeting report. • Technical Advisory Group member (Vearey) for the consultation process of the WHO training course on building the capacity of health care workers providing care to refugees and migrants (2024 onwards) • Project Advisory Group Member (Vearey): Developing Strategies to coordinate HEalth care provision between The GAmbia and Senegal (SHEGAS) (2023 onwards) • Advisory Board Member (Vearey) Academy in Exile (2023 onwards) • Technical Working Group Member: World Health Organization (WHO) Migration and Health Programme (MH) - development of a Global Migration and Health Research Agenda (Vearey, 2022 onwards); Chair for global consultations held in the MH programme (Kapilashrami). • International Advisory Board Member: Boston University Center on Forced Displacement (Vearey, 2023 onwards) • International Advisory Board Member and trustee (Vearey, Kapilashrami) for the Global Society on Migration, Ethnicity and Race (GSMERH) • Establishment of an African Research Universities Alliance (ARUA) and The Guild Universities Network 'Cluster of Excellence' in Migration and Health (CEMH) (co-led by Vearey), involving WHO regional offices in Europe, the Eastern Mediterranean and Africa. Membership includes IAG member (Wickramage) and Southern Africa Advisory Group member (Leung) • Shared PhD programme and training strategy, which includes post-docs and researchers in all partner institutions (Zimbabwe - AU; TISS - India, Wits • Implementing both a dual PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS). • Supporting the development of a GEMMS early career researcher network, including through establishment of a monthly hybrid migration and health journal club bringing together GEMMS PhD and Postdoctoral fellows with WITS Migration & Displacement MA and PhD students • Research Officer (UoE) receiving a global talent visa sponsored by UKRI • WITS GEMMS team joined the Statistics South Africa Migration and Urbanisation Forum coordinated by IAG member (Iturralde). Technical Advisor (Vearey) to the development of a National Migration Profile coordinated by IAG member (Iturralde) |
| Collaborator Contribution | Working with diverse migrant groups in precarious situations in India, Myanmar, South Africa, and Zimbabwe, we aim to create conceptual and methodological tools and actions to disrupt the damaging cycle of gendered violence and poor mental health for migrant and mobile populations. The link between gendered violence and poor mental and psychosocial health is widely acknowledged, yet poorly understood. Interventions that address these global health challenges generally focus on either gendered violence or mental health and ignore the damaging cycle of gendered violence reinforcing poor mental health and vice versa. In addition, these interventions are limited in their reach as they often address the needs of sedentary populations, ignoring the needs and realities of migrant and mobile groups including people displaced due to conflict and disaster and the rural poor moving in search of better livelihood opportunities. These situations are associated with chronic precarity in work and living conditions, barriers to healthcare access, and an increased exposure to violence and burden of ill-health. Such precarity creates different risks, responses, and resilience to gendered violence and poor mental health. Appropriate and effective interventions require better understanding of the intersecting risks of gendered violence and poor mental health, factors determining these risks, and how they change over time and place. The GEMMS research group brings together academics and practitioners with relevant expertise and experience in six institutions across four countries. We will develop an evidence-informed intervention to provide on-going support to migrants in precarious situations in SA and India, and border spaces in Myanmar and Zimbabwe. The research group will establish a programme of work to generate new knowledge, improved understandings, and co-designed training and public health solutions. We will apply theoretical and empirical insights to support efforts to improve the lived realities of migrants in precarious situations through participation of affected populations in research. Ultimately, our vision is to create the necessary tools, actions, and an intervention pathway to disrupt the damaging cycle of gendered violence and poor mental health in order to improve the wellbeing of migrants in precarious situations, including responsive interventions that can address migrants' changing needs over time and in different contexts. |
| Impact | Outputs are currently being produced. |
| Start Year | 2022 |
| Description | GEMMS: Global Health Research Group on Disrupting the cycle of gendered violence & poor mental health among migrants in precarious situations |
| Organisation | International Organization for Migration |
| Country | Switzerland |
| Sector | Charity/Non Profit |
| PI Contribution | As a co-directed and collaborative international programme, we have an open approach to developing the groups outputs. For publications we follow our authorship guidelines. Our next outputs will include working papers of the literature reviews and policy reviews, which will be developed for publications. GEMMS workstream activities have generally progressed well, with work in WS1 and formative work for WS2 significantly advanced in the past six months. Some highlights to date: • 4 PhD scholarships awarded (3 male; 1 female; 2 with disabilities; all international, from Zimbabwe, Nepal, India and South Africa) • A joint PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS) • Distress protocol • Situational analysis for countries (working documents) • Scoping and systematic reviews underway/nearly finalised (this included developing training materials for researchers) • International Advisory Board established comprising a group of influential experts across UN system, academia and independent experts • GEMMS Handbook for the project team; Communications Strategy; IP Policy; Data Management Strategy (draft); Preventing Harm in Research (draft); Authorship Guidelines; Training strategy and plan (draft) • Presentations at the NIHR Training Forum • Website, X (twitter), LinkedIn accounts https://gemms-research.org/ | https://twitter.com/GEMMS_research | https://www.linkedin.com/company/gemms-research/mycompany/ • Four blogs published on the GEMMS website https://gemms-research.org/blog/ • Contributions to the publication, Migration in South Asia [https://link.springer.com/book/10.1007/978-3-031-34194-6]; edited by a member of the IAG. • Report from the workshop and stakeholder meetings held in Musina that resulted in the development of the South Africa Local Advisory Group and an associated Local Advisory Network Inclusion & Community Engagement: meetings have taken place in India, Zimbabwe and South Africa. India: 25 leaders from informal settlements at the research site in India were brought together. The aim was to understand migration patterns and precarities associated with the site. This was important for identifying these patterns, who the community gatekeepers are, and labels used for migrants as well as their overall living situation. The meeting has initiated a process to identify the most vulnerable groups among migrants and to start the process for community engagement. Zimbabwe: two local advisory networks and groups have been established in Manicaland Province, one in Mutare and one in Chipinge. These LAGs have met and advised the team about where to undertake research and supported access to the Tongongara Refugee Camp in Chipinge where the research is now focusing. This includes direct engagement with the Camp Manager who is guiding the process for obtaining formal approvals. Once the AU research team is in place, they will take over this process. South Africa: At our research site in Musina, we have constituted the Musina Local Advisory Group and a Musina Local Advisory Network. The Network has met once (May 2023) and comprises 30 individuals from various organisations and migrant groups. The LAN will meet again in June 2024. The Local Advisory Group - a group of five members of the Network - will work with us on the research methods to assess their feasibility and appropriateness in Musina and a visit to Musina in November 2023 provided opportunities to update LAG members on progress and receive feedback/updates on the current context. In Musina, the Local Advisory Network has improved our understanding of the practicalities of the project in the local context. Issues that we need to be aware of and respond to include, language barriers and the isolation of some migrant communities. Myanmar: We are at the stage of planning key informant interviews and to identify those who can lead the research in the selected areas. The situation in Myanmar means our research must be extremely sensitive to the constantly changing conditions. Health Poverty Action our lead partner for Community, Engagement and Inclusion, has an established reputation in the region and field offices along the border region between Myanmar and China. Their staff are embedded within the communities they support and will lead the research work for GEMMS in Myanmar. Three staff from Myanmar have been identified to join our NIHR training event in Mumbai. Addition of a new research site: Myanmar and especially Kachin state (the focus of GEMMS research activities) continues to be a challenging and politically fraught geography to proceed with the research as intended and has become inaccessible in light of the recent political developments. In view of this we submitted a CtP request - now approved - that involves: • Terminating all research activities in Myanmar. Maintain Myanmar as a site for piloting interventions if access becomes possible in the final year. • Initiate a new research site in Cambodia, a context characterized by high internal migration as well as out migration (regular and irregular) and return migration, and where our partner Health Poverty Action has a strong base (with an office and where the staff from Myanmar are currently located). Managing Risk: added in a risk on data management and security: Revised the risk on staff turn-over including (1) implications for the project depending on when staff changes take place (e.g. during initial phases vs during fieldwork vs during analysis and dissemination stage) and (2) the need to review procedures and lessons learnt from the departure of the Wits project coordinator following resignation from Wits. This includes understanding the implications/risk associated with team members who are on precarious academic positions; their need for career/professional development; and the associated need for increased security in academic positions (i.e. lack of opportunities for permanent positions and reliance on fully grant-funded fixed-term contracts that align with initial project end dates) Safeguarding: All GEMMS staff (other than those at HPA who undergo very comprehensive safeguard training) are required to complete the on-line Safeguarding Hub introduction to safeguarding course. To date 14 of 26 staff have completed the training; and we anticipate all staff would have completed the training by March 2024. Staff are required to read and sign our GEMMS code of conduct which acknowledges acceptance of our preventing harm in research strategy. This code of conduct is being finalised and will be ready for signing by all staff in Feb 2024. There are no reported safeguarding incidents to date. Data Management: one staff attended the University West of England data management training. We are using this as the basis of our plan and developing this using https://dmponline.dcc.ac.uk As University of Essex is the data manager, we have in place a Data Protection Impact Assessment (led by the University of Essex Data Protection Officer). We are currently developing Information Sharing agreements as all the partners are Data Controllers. Monitoring and Evaluation: Theory of change reviewed during all team on-line workshop (December 2023); being developed into a revised conceptual and logical framework for further development of outcome / impact indicators. Monitoring data is being collected in relation to training and other outputs (such as attendance at workshops; invites to conferences, etc). Governance and Policy Analysis: We have substantially developed the focus on reviewing and analysing policies on integration of migrants' health in health policies, an area that was rather limited in the original proposal. This drew on tools and analysis frameworks in networks led by members of the GEMMS group. We anticipate in the coming year we will use the tools to undertake more in-depth analysis of existing policy landscape in migration health for the four countries, as well as the regions. In the coming year, drawing on the tools developed, a review of the global governance architecture of migration and health will be undertaken. CADA Training: In addition, drawing on a successful CADA grant awarded to TISS and led by GEMMS training lead, we will be conducting a cross-country research academy in September - December for ECRs in GEMMS and its partner institutions. We will offer the virtual sessions to other members of the NIHR academy. GEMMS early career researcher network: The development of a GEMMS early career researcher network is underway. This involves linking WITS Migration & Displacement MA and PhD students working on migration and health with the GEMMS PhD and postdoctoral fellows. Finest achievements of GEMMS to date Prioritising the process (or the means) and not the outputs (or the end) alone have underpinned the key achievements of the GEMMS research group. This involved paying due attention to establishing arrangements that were new to all partner institutions, and shared understandings of the collaborative model of working. While on occasions this has been difficult to achieve (because of institutional demands on staff in partner institutions, staff sickness and absences), members of GEMMS team have stepped in to support other members on these leadership roles. Given the focus on process, and for a programme in its first year of establishment/ implementation, we have laid the foundations of achieving more sustained impact in the countries in focus. This is achieved through: • Established International Advisory Group with diverse sectoral and country membership; including WHO, IOM, Statistics South Africa and International Institute for Migration and Development (India). All IAG members are influential in their fields and bring to GEMMS a wealth of international policy expertise in migration and health. • Creation of Regional Advisory Groups. The Southern Africa Advisory Group held its first meeting in May 2023 with a second in-person meeting planned for October 2023. The Asian Advisory Group membership has been finalised and a first meeting is planned for October 2023. • Mobilising key experts and policy actors via high-impact plenary held in inception phase. The launch event brought together international development partners with academics and international agencies - all expressing a need for the types of intervention delivered by GEMMS. The event created a shared understanding among both developmental and academic partners of the links between the developmental and research objectives of GEMMS. • Launch event featuring David Miliband, President, and CEO of International Rescue Committee (IRC). In his speech (delivered via video), he emphasised that "IRC does seek to be a supporter and partner of your work but we're also looking forward to being a consumer of the work that you launch today I hope that we can partner in research but also in delivery and in advocacy because we can't afford the programmes that we develop to be boutique programmes they need to be scaled programmes and we talk about impact and scale as being at the heart of our strategy". • Development of regionally-sensitive tools for policy appraisals that are now being implemented to analyse and index policies in the countries. • Engagement in global platforms. This includes: • the 3rd Global consultation on the health of refugees and migrants coordinated by WHO, IOM and UNHCR. GEMMS (Vearey) and IAG members (Severoni, Wickramage, Iturralde) participated and led expert panels. The consultation led to the ground-breaking political declaration, the Rabat Declaration, to strengthen the global commitment to improve the health of refugees and migrants, and was signed by the governments of at least two of the four countries (India, South Africa). Vearey is a co-writer of the meeting report. • Technical Advisory Group member (Vearey) for the consultation process of the WHO training course on building the capacity of health care workers providing care to refugees and migrants (2024 onwards) • Project Advisory Group Member (Vearey): Developing Strategies to coordinate HEalth care provision between The GAmbia and Senegal (SHEGAS) (2023 onwards) • Advisory Board Member (Vearey) Academy in Exile (2023 onwards) • Technical Working Group Member: World Health Organization (WHO) Migration and Health Programme (MH) - development of a Global Migration and Health Research Agenda (Vearey, 2022 onwards); Chair for global consultations held in the MH programme (Kapilashrami). • International Advisory Board Member: Boston University Center on Forced Displacement (Vearey, 2023 onwards) • International Advisory Board Member and trustee (Vearey, Kapilashrami) for the Global Society on Migration, Ethnicity and Race (GSMERH) • Establishment of an African Research Universities Alliance (ARUA) and The Guild Universities Network 'Cluster of Excellence' in Migration and Health (CEMH) (co-led by Vearey), involving WHO regional offices in Europe, the Eastern Mediterranean and Africa. Membership includes IAG member (Wickramage) and Southern Africa Advisory Group member (Leung) • Shared PhD programme and training strategy, which includes post-docs and researchers in all partner institutions (Zimbabwe - AU; TISS - India, Wits • Implementing both a dual PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS). • Supporting the development of a GEMMS early career researcher network, including through establishment of a monthly hybrid migration and health journal club bringing together GEMMS PhD and Postdoctoral fellows with WITS Migration & Displacement MA and PhD students • Research Officer (UoE) receiving a global talent visa sponsored by UKRI • WITS GEMMS team joined the Statistics South Africa Migration and Urbanisation Forum coordinated by IAG member (Iturralde). Technical Advisor (Vearey) to the development of a National Migration Profile coordinated by IAG member (Iturralde) |
| Collaborator Contribution | Working with diverse migrant groups in precarious situations in India, Myanmar, South Africa, and Zimbabwe, we aim to create conceptual and methodological tools and actions to disrupt the damaging cycle of gendered violence and poor mental health for migrant and mobile populations. The link between gendered violence and poor mental and psychosocial health is widely acknowledged, yet poorly understood. Interventions that address these global health challenges generally focus on either gendered violence or mental health and ignore the damaging cycle of gendered violence reinforcing poor mental health and vice versa. In addition, these interventions are limited in their reach as they often address the needs of sedentary populations, ignoring the needs and realities of migrant and mobile groups including people displaced due to conflict and disaster and the rural poor moving in search of better livelihood opportunities. These situations are associated with chronic precarity in work and living conditions, barriers to healthcare access, and an increased exposure to violence and burden of ill-health. Such precarity creates different risks, responses, and resilience to gendered violence and poor mental health. Appropriate and effective interventions require better understanding of the intersecting risks of gendered violence and poor mental health, factors determining these risks, and how they change over time and place. The GEMMS research group brings together academics and practitioners with relevant expertise and experience in six institutions across four countries. We will develop an evidence-informed intervention to provide on-going support to migrants in precarious situations in SA and India, and border spaces in Myanmar and Zimbabwe. The research group will establish a programme of work to generate new knowledge, improved understandings, and co-designed training and public health solutions. We will apply theoretical and empirical insights to support efforts to improve the lived realities of migrants in precarious situations through participation of affected populations in research. Ultimately, our vision is to create the necessary tools, actions, and an intervention pathway to disrupt the damaging cycle of gendered violence and poor mental health in order to improve the wellbeing of migrants in precarious situations, including responsive interventions that can address migrants' changing needs over time and in different contexts. |
| Impact | Outputs are currently being produced. |
| Start Year | 2022 |
| Description | GEMMS: Global Health Research Group on Disrupting the cycle of gendered violence & poor mental health among migrants in precarious situations |
| Organisation | Tata Institute of Social Sciences |
| Country | India |
| Sector | Academic/University |
| PI Contribution | As a co-directed and collaborative international programme, we have an open approach to developing the groups outputs. For publications we follow our authorship guidelines. Our next outputs will include working papers of the literature reviews and policy reviews, which will be developed for publications. GEMMS workstream activities have generally progressed well, with work in WS1 and formative work for WS2 significantly advanced in the past six months. Some highlights to date: • 4 PhD scholarships awarded (3 male; 1 female; 2 with disabilities; all international, from Zimbabwe, Nepal, India and South Africa) • A joint PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS) • Distress protocol • Situational analysis for countries (working documents) • Scoping and systematic reviews underway/nearly finalised (this included developing training materials for researchers) • International Advisory Board established comprising a group of influential experts across UN system, academia and independent experts • GEMMS Handbook for the project team; Communications Strategy; IP Policy; Data Management Strategy (draft); Preventing Harm in Research (draft); Authorship Guidelines; Training strategy and plan (draft) • Presentations at the NIHR Training Forum • Website, X (twitter), LinkedIn accounts https://gemms-research.org/ | https://twitter.com/GEMMS_research | https://www.linkedin.com/company/gemms-research/mycompany/ • Four blogs published on the GEMMS website https://gemms-research.org/blog/ • Contributions to the publication, Migration in South Asia [https://link.springer.com/book/10.1007/978-3-031-34194-6]; edited by a member of the IAG. • Report from the workshop and stakeholder meetings held in Musina that resulted in the development of the South Africa Local Advisory Group and an associated Local Advisory Network Inclusion & Community Engagement: meetings have taken place in India, Zimbabwe and South Africa. India: 25 leaders from informal settlements at the research site in India were brought together. The aim was to understand migration patterns and precarities associated with the site. This was important for identifying these patterns, who the community gatekeepers are, and labels used for migrants as well as their overall living situation. The meeting has initiated a process to identify the most vulnerable groups among migrants and to start the process for community engagement. Zimbabwe: two local advisory networks and groups have been established in Manicaland Province, one in Mutare and one in Chipinge. These LAGs have met and advised the team about where to undertake research and supported access to the Tongongara Refugee Camp in Chipinge where the research is now focusing. This includes direct engagement with the Camp Manager who is guiding the process for obtaining formal approvals. Once the AU research team is in place, they will take over this process. South Africa: At our research site in Musina, we have constituted the Musina Local Advisory Group and a Musina Local Advisory Network. The Network has met once (May 2023) and comprises 30 individuals from various organisations and migrant groups. The LAN will meet again in June 2024. The Local Advisory Group - a group of five members of the Network - will work with us on the research methods to assess their feasibility and appropriateness in Musina and a visit to Musina in November 2023 provided opportunities to update LAG members on progress and receive feedback/updates on the current context. In Musina, the Local Advisory Network has improved our understanding of the practicalities of the project in the local context. Issues that we need to be aware of and respond to include, language barriers and the isolation of some migrant communities. Myanmar: We are at the stage of planning key informant interviews and to identify those who can lead the research in the selected areas. The situation in Myanmar means our research must be extremely sensitive to the constantly changing conditions. Health Poverty Action our lead partner for Community, Engagement and Inclusion, has an established reputation in the region and field offices along the border region between Myanmar and China. Their staff are embedded within the communities they support and will lead the research work for GEMMS in Myanmar. Three staff from Myanmar have been identified to join our NIHR training event in Mumbai. Addition of a new research site: Myanmar and especially Kachin state (the focus of GEMMS research activities) continues to be a challenging and politically fraught geography to proceed with the research as intended and has become inaccessible in light of the recent political developments. In view of this we submitted a CtP request - now approved - that involves: • Terminating all research activities in Myanmar. Maintain Myanmar as a site for piloting interventions if access becomes possible in the final year. • Initiate a new research site in Cambodia, a context characterized by high internal migration as well as out migration (regular and irregular) and return migration, and where our partner Health Poverty Action has a strong base (with an office and where the staff from Myanmar are currently located). Managing Risk: added in a risk on data management and security: Revised the risk on staff turn-over including (1) implications for the project depending on when staff changes take place (e.g. during initial phases vs during fieldwork vs during analysis and dissemination stage) and (2) the need to review procedures and lessons learnt from the departure of the Wits project coordinator following resignation from Wits. This includes understanding the implications/risk associated with team members who are on precarious academic positions; their need for career/professional development; and the associated need for increased security in academic positions (i.e. lack of opportunities for permanent positions and reliance on fully grant-funded fixed-term contracts that align with initial project end dates) Safeguarding: All GEMMS staff (other than those at HPA who undergo very comprehensive safeguard training) are required to complete the on-line Safeguarding Hub introduction to safeguarding course. To date 14 of 26 staff have completed the training; and we anticipate all staff would have completed the training by March 2024. Staff are required to read and sign our GEMMS code of conduct which acknowledges acceptance of our preventing harm in research strategy. This code of conduct is being finalised and will be ready for signing by all staff in Feb 2024. There are no reported safeguarding incidents to date. Data Management: one staff attended the University West of England data management training. We are using this as the basis of our plan and developing this using https://dmponline.dcc.ac.uk As University of Essex is the data manager, we have in place a Data Protection Impact Assessment (led by the University of Essex Data Protection Officer). We are currently developing Information Sharing agreements as all the partners are Data Controllers. Monitoring and Evaluation: Theory of change reviewed during all team on-line workshop (December 2023); being developed into a revised conceptual and logical framework for further development of outcome / impact indicators. Monitoring data is being collected in relation to training and other outputs (such as attendance at workshops; invites to conferences, etc). Governance and Policy Analysis: We have substantially developed the focus on reviewing and analysing policies on integration of migrants' health in health policies, an area that was rather limited in the original proposal. This drew on tools and analysis frameworks in networks led by members of the GEMMS group. We anticipate in the coming year we will use the tools to undertake more in-depth analysis of existing policy landscape in migration health for the four countries, as well as the regions. In the coming year, drawing on the tools developed, a review of the global governance architecture of migration and health will be undertaken. CADA Training: In addition, drawing on a successful CADA grant awarded to TISS and led by GEMMS training lead, we will be conducting a cross-country research academy in September - December for ECRs in GEMMS and its partner institutions. We will offer the virtual sessions to other members of the NIHR academy. GEMMS early career researcher network: The development of a GEMMS early career researcher network is underway. This involves linking WITS Migration & Displacement MA and PhD students working on migration and health with the GEMMS PhD and postdoctoral fellows. Finest achievements of GEMMS to date Prioritising the process (or the means) and not the outputs (or the end) alone have underpinned the key achievements of the GEMMS research group. This involved paying due attention to establishing arrangements that were new to all partner institutions, and shared understandings of the collaborative model of working. While on occasions this has been difficult to achieve (because of institutional demands on staff in partner institutions, staff sickness and absences), members of GEMMS team have stepped in to support other members on these leadership roles. Given the focus on process, and for a programme in its first year of establishment/ implementation, we have laid the foundations of achieving more sustained impact in the countries in focus. This is achieved through: • Established International Advisory Group with diverse sectoral and country membership; including WHO, IOM, Statistics South Africa and International Institute for Migration and Development (India). All IAG members are influential in their fields and bring to GEMMS a wealth of international policy expertise in migration and health. • Creation of Regional Advisory Groups. The Southern Africa Advisory Group held its first meeting in May 2023 with a second in-person meeting planned for October 2023. The Asian Advisory Group membership has been finalised and a first meeting is planned for October 2023. • Mobilising key experts and policy actors via high-impact plenary held in inception phase. The launch event brought together international development partners with academics and international agencies - all expressing a need for the types of intervention delivered by GEMMS. The event created a shared understanding among both developmental and academic partners of the links between the developmental and research objectives of GEMMS. • Launch event featuring David Miliband, President, and CEO of International Rescue Committee (IRC). In his speech (delivered via video), he emphasised that "IRC does seek to be a supporter and partner of your work but we're also looking forward to being a consumer of the work that you launch today I hope that we can partner in research but also in delivery and in advocacy because we can't afford the programmes that we develop to be boutique programmes they need to be scaled programmes and we talk about impact and scale as being at the heart of our strategy". • Development of regionally-sensitive tools for policy appraisals that are now being implemented to analyse and index policies in the countries. • Engagement in global platforms. This includes: • the 3rd Global consultation on the health of refugees and migrants coordinated by WHO, IOM and UNHCR. GEMMS (Vearey) and IAG members (Severoni, Wickramage, Iturralde) participated and led expert panels. The consultation led to the ground-breaking political declaration, the Rabat Declaration, to strengthen the global commitment to improve the health of refugees and migrants, and was signed by the governments of at least two of the four countries (India, South Africa). Vearey is a co-writer of the meeting report. • Technical Advisory Group member (Vearey) for the consultation process of the WHO training course on building the capacity of health care workers providing care to refugees and migrants (2024 onwards) • Project Advisory Group Member (Vearey): Developing Strategies to coordinate HEalth care provision between The GAmbia and Senegal (SHEGAS) (2023 onwards) • Advisory Board Member (Vearey) Academy in Exile (2023 onwards) • Technical Working Group Member: World Health Organization (WHO) Migration and Health Programme (MH) - development of a Global Migration and Health Research Agenda (Vearey, 2022 onwards); Chair for global consultations held in the MH programme (Kapilashrami). • International Advisory Board Member: Boston University Center on Forced Displacement (Vearey, 2023 onwards) • International Advisory Board Member and trustee (Vearey, Kapilashrami) for the Global Society on Migration, Ethnicity and Race (GSMERH) • Establishment of an African Research Universities Alliance (ARUA) and The Guild Universities Network 'Cluster of Excellence' in Migration and Health (CEMH) (co-led by Vearey), involving WHO regional offices in Europe, the Eastern Mediterranean and Africa. Membership includes IAG member (Wickramage) and Southern Africa Advisory Group member (Leung) • Shared PhD programme and training strategy, which includes post-docs and researchers in all partner institutions (Zimbabwe - AU; TISS - India, Wits • Implementing both a dual PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS). • Supporting the development of a GEMMS early career researcher network, including through establishment of a monthly hybrid migration and health journal club bringing together GEMMS PhD and Postdoctoral fellows with WITS Migration & Displacement MA and PhD students • Research Officer (UoE) receiving a global talent visa sponsored by UKRI • WITS GEMMS team joined the Statistics South Africa Migration and Urbanisation Forum coordinated by IAG member (Iturralde). Technical Advisor (Vearey) to the development of a National Migration Profile coordinated by IAG member (Iturralde) |
| Collaborator Contribution | Working with diverse migrant groups in precarious situations in India, Myanmar, South Africa, and Zimbabwe, we aim to create conceptual and methodological tools and actions to disrupt the damaging cycle of gendered violence and poor mental health for migrant and mobile populations. The link between gendered violence and poor mental and psychosocial health is widely acknowledged, yet poorly understood. Interventions that address these global health challenges generally focus on either gendered violence or mental health and ignore the damaging cycle of gendered violence reinforcing poor mental health and vice versa. In addition, these interventions are limited in their reach as they often address the needs of sedentary populations, ignoring the needs and realities of migrant and mobile groups including people displaced due to conflict and disaster and the rural poor moving in search of better livelihood opportunities. These situations are associated with chronic precarity in work and living conditions, barriers to healthcare access, and an increased exposure to violence and burden of ill-health. Such precarity creates different risks, responses, and resilience to gendered violence and poor mental health. Appropriate and effective interventions require better understanding of the intersecting risks of gendered violence and poor mental health, factors determining these risks, and how they change over time and place. The GEMMS research group brings together academics and practitioners with relevant expertise and experience in six institutions across four countries. We will develop an evidence-informed intervention to provide on-going support to migrants in precarious situations in SA and India, and border spaces in Myanmar and Zimbabwe. The research group will establish a programme of work to generate new knowledge, improved understandings, and co-designed training and public health solutions. We will apply theoretical and empirical insights to support efforts to improve the lived realities of migrants in precarious situations through participation of affected populations in research. Ultimately, our vision is to create the necessary tools, actions, and an intervention pathway to disrupt the damaging cycle of gendered violence and poor mental health in order to improve the wellbeing of migrants in precarious situations, including responsive interventions that can address migrants' changing needs over time and in different contexts. |
| Impact | Outputs are currently being produced. |
| Start Year | 2022 |
| Description | GEMMS: Global Health Research Group on Disrupting the cycle of gendered violence & poor mental health among migrants in precarious situations |
| Organisation | University of Essex |
| Department | University of Essex EssexLab |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | As a co-directed and collaborative international programme, we have an open approach to developing the groups outputs. For publications we follow our authorship guidelines. Our next outputs will include working papers of the literature reviews and policy reviews, which will be developed for publications. GEMMS workstream activities have generally progressed well, with work in WS1 and formative work for WS2 significantly advanced in the past six months. Some highlights to date: • 4 PhD scholarships awarded (3 male; 1 female; 2 with disabilities; all international, from Zimbabwe, Nepal, India and South Africa) • A joint PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS) • Distress protocol • Situational analysis for countries (working documents) • Scoping and systematic reviews underway/nearly finalised (this included developing training materials for researchers) • International Advisory Board established comprising a group of influential experts across UN system, academia and independent experts • GEMMS Handbook for the project team; Communications Strategy; IP Policy; Data Management Strategy (draft); Preventing Harm in Research (draft); Authorship Guidelines; Training strategy and plan (draft) • Presentations at the NIHR Training Forum • Website, X (twitter), LinkedIn accounts https://gemms-research.org/ | https://twitter.com/GEMMS_research | https://www.linkedin.com/company/gemms-research/mycompany/ • Four blogs published on the GEMMS website https://gemms-research.org/blog/ • Contributions to the publication, Migration in South Asia [https://link.springer.com/book/10.1007/978-3-031-34194-6]; edited by a member of the IAG. • Report from the workshop and stakeholder meetings held in Musina that resulted in the development of the South Africa Local Advisory Group and an associated Local Advisory Network Inclusion & Community Engagement: meetings have taken place in India, Zimbabwe and South Africa. India: 25 leaders from informal settlements at the research site in India were brought together. The aim was to understand migration patterns and precarities associated with the site. This was important for identifying these patterns, who the community gatekeepers are, and labels used for migrants as well as their overall living situation. The meeting has initiated a process to identify the most vulnerable groups among migrants and to start the process for community engagement. Zimbabwe: two local advisory networks and groups have been established in Manicaland Province, one in Mutare and one in Chipinge. These LAGs have met and advised the team about where to undertake research and supported access to the Tongongara Refugee Camp in Chipinge where the research is now focusing. This includes direct engagement with the Camp Manager who is guiding the process for obtaining formal approvals. Once the AU research team is in place, they will take over this process. South Africa: At our research site in Musina, we have constituted the Musina Local Advisory Group and a Musina Local Advisory Network. The Network has met once (May 2023) and comprises 30 individuals from various organisations and migrant groups. The LAN will meet again in June 2024. The Local Advisory Group - a group of five members of the Network - will work with us on the research methods to assess their feasibility and appropriateness in Musina and a visit to Musina in November 2023 provided opportunities to update LAG members on progress and receive feedback/updates on the current context. In Musina, the Local Advisory Network has improved our understanding of the practicalities of the project in the local context. Issues that we need to be aware of and respond to include, language barriers and the isolation of some migrant communities. Myanmar: We are at the stage of planning key informant interviews and to identify those who can lead the research in the selected areas. The situation in Myanmar means our research must be extremely sensitive to the constantly changing conditions. Health Poverty Action our lead partner for Community, Engagement and Inclusion, has an established reputation in the region and field offices along the border region between Myanmar and China. Their staff are embedded within the communities they support and will lead the research work for GEMMS in Myanmar. Three staff from Myanmar have been identified to join our NIHR training event in Mumbai. Addition of a new research site: Myanmar and especially Kachin state (the focus of GEMMS research activities) continues to be a challenging and politically fraught geography to proceed with the research as intended and has become inaccessible in light of the recent political developments. In view of this we submitted a CtP request - now approved - that involves: • Terminating all research activities in Myanmar. Maintain Myanmar as a site for piloting interventions if access becomes possible in the final year. • Initiate a new research site in Cambodia, a context characterized by high internal migration as well as out migration (regular and irregular) and return migration, and where our partner Health Poverty Action has a strong base (with an office and where the staff from Myanmar are currently located). Managing Risk: added in a risk on data management and security: Revised the risk on staff turn-over including (1) implications for the project depending on when staff changes take place (e.g. during initial phases vs during fieldwork vs during analysis and dissemination stage) and (2) the need to review procedures and lessons learnt from the departure of the Wits project coordinator following resignation from Wits. This includes understanding the implications/risk associated with team members who are on precarious academic positions; their need for career/professional development; and the associated need for increased security in academic positions (i.e. lack of opportunities for permanent positions and reliance on fully grant-funded fixed-term contracts that align with initial project end dates) Safeguarding: All GEMMS staff (other than those at HPA who undergo very comprehensive safeguard training) are required to complete the on-line Safeguarding Hub introduction to safeguarding course. To date 14 of 26 staff have completed the training; and we anticipate all staff would have completed the training by March 2024. Staff are required to read and sign our GEMMS code of conduct which acknowledges acceptance of our preventing harm in research strategy. This code of conduct is being finalised and will be ready for signing by all staff in Feb 2024. There are no reported safeguarding incidents to date. Data Management: one staff attended the University West of England data management training. We are using this as the basis of our plan and developing this using https://dmponline.dcc.ac.uk As University of Essex is the data manager, we have in place a Data Protection Impact Assessment (led by the University of Essex Data Protection Officer). We are currently developing Information Sharing agreements as all the partners are Data Controllers. Monitoring and Evaluation: Theory of change reviewed during all team on-line workshop (December 2023); being developed into a revised conceptual and logical framework for further development of outcome / impact indicators. Monitoring data is being collected in relation to training and other outputs (such as attendance at workshops; invites to conferences, etc). Governance and Policy Analysis: We have substantially developed the focus on reviewing and analysing policies on integration of migrants' health in health policies, an area that was rather limited in the original proposal. This drew on tools and analysis frameworks in networks led by members of the GEMMS group. We anticipate in the coming year we will use the tools to undertake more in-depth analysis of existing policy landscape in migration health for the four countries, as well as the regions. In the coming year, drawing on the tools developed, a review of the global governance architecture of migration and health will be undertaken. CADA Training: In addition, drawing on a successful CADA grant awarded to TISS and led by GEMMS training lead, we will be conducting a cross-country research academy in September - December for ECRs in GEMMS and its partner institutions. We will offer the virtual sessions to other members of the NIHR academy. GEMMS early career researcher network: The development of a GEMMS early career researcher network is underway. This involves linking WITS Migration & Displacement MA and PhD students working on migration and health with the GEMMS PhD and postdoctoral fellows. Finest achievements of GEMMS to date Prioritising the process (or the means) and not the outputs (or the end) alone have underpinned the key achievements of the GEMMS research group. This involved paying due attention to establishing arrangements that were new to all partner institutions, and shared understandings of the collaborative model of working. While on occasions this has been difficult to achieve (because of institutional demands on staff in partner institutions, staff sickness and absences), members of GEMMS team have stepped in to support other members on these leadership roles. Given the focus on process, and for a programme in its first year of establishment/ implementation, we have laid the foundations of achieving more sustained impact in the countries in focus. This is achieved through: • Established International Advisory Group with diverse sectoral and country membership; including WHO, IOM, Statistics South Africa and International Institute for Migration and Development (India). All IAG members are influential in their fields and bring to GEMMS a wealth of international policy expertise in migration and health. • Creation of Regional Advisory Groups. The Southern Africa Advisory Group held its first meeting in May 2023 with a second in-person meeting planned for October 2023. The Asian Advisory Group membership has been finalised and a first meeting is planned for October 2023. • Mobilising key experts and policy actors via high-impact plenary held in inception phase. The launch event brought together international development partners with academics and international agencies - all expressing a need for the types of intervention delivered by GEMMS. The event created a shared understanding among both developmental and academic partners of the links between the developmental and research objectives of GEMMS. • Launch event featuring David Miliband, President, and CEO of International Rescue Committee (IRC). In his speech (delivered via video), he emphasised that "IRC does seek to be a supporter and partner of your work but we're also looking forward to being a consumer of the work that you launch today I hope that we can partner in research but also in delivery and in advocacy because we can't afford the programmes that we develop to be boutique programmes they need to be scaled programmes and we talk about impact and scale as being at the heart of our strategy". • Development of regionally-sensitive tools for policy appraisals that are now being implemented to analyse and index policies in the countries. • Engagement in global platforms. This includes: • the 3rd Global consultation on the health of refugees and migrants coordinated by WHO, IOM and UNHCR. GEMMS (Vearey) and IAG members (Severoni, Wickramage, Iturralde) participated and led expert panels. The consultation led to the ground-breaking political declaration, the Rabat Declaration, to strengthen the global commitment to improve the health of refugees and migrants, and was signed by the governments of at least two of the four countries (India, South Africa). Vearey is a co-writer of the meeting report. • Technical Advisory Group member (Vearey) for the consultation process of the WHO training course on building the capacity of health care workers providing care to refugees and migrants (2024 onwards) • Project Advisory Group Member (Vearey): Developing Strategies to coordinate HEalth care provision between The GAmbia and Senegal (SHEGAS) (2023 onwards) • Advisory Board Member (Vearey) Academy in Exile (2023 onwards) • Technical Working Group Member: World Health Organization (WHO) Migration and Health Programme (MH) - development of a Global Migration and Health Research Agenda (Vearey, 2022 onwards); Chair for global consultations held in the MH programme (Kapilashrami). • International Advisory Board Member: Boston University Center on Forced Displacement (Vearey, 2023 onwards) • International Advisory Board Member and trustee (Vearey, Kapilashrami) for the Global Society on Migration, Ethnicity and Race (GSMERH) • Establishment of an African Research Universities Alliance (ARUA) and The Guild Universities Network 'Cluster of Excellence' in Migration and Health (CEMH) (co-led by Vearey), involving WHO regional offices in Europe, the Eastern Mediterranean and Africa. Membership includes IAG member (Wickramage) and Southern Africa Advisory Group member (Leung) • Shared PhD programme and training strategy, which includes post-docs and researchers in all partner institutions (Zimbabwe - AU; TISS - India, Wits • Implementing both a dual PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS). • Supporting the development of a GEMMS early career researcher network, including through establishment of a monthly hybrid migration and health journal club bringing together GEMMS PhD and Postdoctoral fellows with WITS Migration & Displacement MA and PhD students • Research Officer (UoE) receiving a global talent visa sponsored by UKRI • WITS GEMMS team joined the Statistics South Africa Migration and Urbanisation Forum coordinated by IAG member (Iturralde). Technical Advisor (Vearey) to the development of a National Migration Profile coordinated by IAG member (Iturralde) |
| Collaborator Contribution | Working with diverse migrant groups in precarious situations in India, Myanmar, South Africa, and Zimbabwe, we aim to create conceptual and methodological tools and actions to disrupt the damaging cycle of gendered violence and poor mental health for migrant and mobile populations. The link between gendered violence and poor mental and psychosocial health is widely acknowledged, yet poorly understood. Interventions that address these global health challenges generally focus on either gendered violence or mental health and ignore the damaging cycle of gendered violence reinforcing poor mental health and vice versa. In addition, these interventions are limited in their reach as they often address the needs of sedentary populations, ignoring the needs and realities of migrant and mobile groups including people displaced due to conflict and disaster and the rural poor moving in search of better livelihood opportunities. These situations are associated with chronic precarity in work and living conditions, barriers to healthcare access, and an increased exposure to violence and burden of ill-health. Such precarity creates different risks, responses, and resilience to gendered violence and poor mental health. Appropriate and effective interventions require better understanding of the intersecting risks of gendered violence and poor mental health, factors determining these risks, and how they change over time and place. The GEMMS research group brings together academics and practitioners with relevant expertise and experience in six institutions across four countries. We will develop an evidence-informed intervention to provide on-going support to migrants in precarious situations in SA and India, and border spaces in Myanmar and Zimbabwe. The research group will establish a programme of work to generate new knowledge, improved understandings, and co-designed training and public health solutions. We will apply theoretical and empirical insights to support efforts to improve the lived realities of migrants in precarious situations through participation of affected populations in research. Ultimately, our vision is to create the necessary tools, actions, and an intervention pathway to disrupt the damaging cycle of gendered violence and poor mental health in order to improve the wellbeing of migrants in precarious situations, including responsive interventions that can address migrants' changing needs over time and in different contexts. |
| Impact | Outputs are currently being produced. |
| Start Year | 2022 |
| Description | GEMMS: Global Health Research Group on Disrupting the cycle of gendered violence & poor mental health among migrants in precarious situations |
| Organisation | University of Johannesburg |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | As a co-directed and collaborative international programme, we have an open approach to developing the groups outputs. For publications we follow our authorship guidelines. Our next outputs will include working papers of the literature reviews and policy reviews, which will be developed for publications. GEMMS workstream activities have generally progressed well, with work in WS1 and formative work for WS2 significantly advanced in the past six months. Some highlights to date: • 4 PhD scholarships awarded (3 male; 1 female; 2 with disabilities; all international, from Zimbabwe, Nepal, India and South Africa) • A joint PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS) • Distress protocol • Situational analysis for countries (working documents) • Scoping and systematic reviews underway/nearly finalised (this included developing training materials for researchers) • International Advisory Board established comprising a group of influential experts across UN system, academia and independent experts • GEMMS Handbook for the project team; Communications Strategy; IP Policy; Data Management Strategy (draft); Preventing Harm in Research (draft); Authorship Guidelines; Training strategy and plan (draft) • Presentations at the NIHR Training Forum • Website, X (twitter), LinkedIn accounts https://gemms-research.org/ | https://twitter.com/GEMMS_research | https://www.linkedin.com/company/gemms-research/mycompany/ • Four blogs published on the GEMMS website https://gemms-research.org/blog/ • Contributions to the publication, Migration in South Asia [https://link.springer.com/book/10.1007/978-3-031-34194-6]; edited by a member of the IAG. • Report from the workshop and stakeholder meetings held in Musina that resulted in the development of the South Africa Local Advisory Group and an associated Local Advisory Network Inclusion & Community Engagement: meetings have taken place in India, Zimbabwe and South Africa. India: 25 leaders from informal settlements at the research site in India were brought together. The aim was to understand migration patterns and precarities associated with the site. This was important for identifying these patterns, who the community gatekeepers are, and labels used for migrants as well as their overall living situation. The meeting has initiated a process to identify the most vulnerable groups among migrants and to start the process for community engagement. Zimbabwe: two local advisory networks and groups have been established in Manicaland Province, one in Mutare and one in Chipinge. These LAGs have met and advised the team about where to undertake research and supported access to the Tongongara Refugee Camp in Chipinge where the research is now focusing. This includes direct engagement with the Camp Manager who is guiding the process for obtaining formal approvals. Once the AU research team is in place, they will take over this process. South Africa: At our research site in Musina, we have constituted the Musina Local Advisory Group and a Musina Local Advisory Network. The Network has met once (May 2023) and comprises 30 individuals from various organisations and migrant groups. The LAN will meet again in June 2024. The Local Advisory Group - a group of five members of the Network - will work with us on the research methods to assess their feasibility and appropriateness in Musina and a visit to Musina in November 2023 provided opportunities to update LAG members on progress and receive feedback/updates on the current context. In Musina, the Local Advisory Network has improved our understanding of the practicalities of the project in the local context. Issues that we need to be aware of and respond to include, language barriers and the isolation of some migrant communities. Myanmar: We are at the stage of planning key informant interviews and to identify those who can lead the research in the selected areas. The situation in Myanmar means our research must be extremely sensitive to the constantly changing conditions. Health Poverty Action our lead partner for Community, Engagement and Inclusion, has an established reputation in the region and field offices along the border region between Myanmar and China. Their staff are embedded within the communities they support and will lead the research work for GEMMS in Myanmar. Three staff from Myanmar have been identified to join our NIHR training event in Mumbai. Addition of a new research site: Myanmar and especially Kachin state (the focus of GEMMS research activities) continues to be a challenging and politically fraught geography to proceed with the research as intended and has become inaccessible in light of the recent political developments. In view of this we submitted a CtP request - now approved - that involves: • Terminating all research activities in Myanmar. Maintain Myanmar as a site for piloting interventions if access becomes possible in the final year. • Initiate a new research site in Cambodia, a context characterized by high internal migration as well as out migration (regular and irregular) and return migration, and where our partner Health Poverty Action has a strong base (with an office and where the staff from Myanmar are currently located). Managing Risk: added in a risk on data management and security: Revised the risk on staff turn-over including (1) implications for the project depending on when staff changes take place (e.g. during initial phases vs during fieldwork vs during analysis and dissemination stage) and (2) the need to review procedures and lessons learnt from the departure of the Wits project coordinator following resignation from Wits. This includes understanding the implications/risk associated with team members who are on precarious academic positions; their need for career/professional development; and the associated need for increased security in academic positions (i.e. lack of opportunities for permanent positions and reliance on fully grant-funded fixed-term contracts that align with initial project end dates) Safeguarding: All GEMMS staff (other than those at HPA who undergo very comprehensive safeguard training) are required to complete the on-line Safeguarding Hub introduction to safeguarding course. To date 14 of 26 staff have completed the training; and we anticipate all staff would have completed the training by March 2024. Staff are required to read and sign our GEMMS code of conduct which acknowledges acceptance of our preventing harm in research strategy. This code of conduct is being finalised and will be ready for signing by all staff in Feb 2024. There are no reported safeguarding incidents to date. Data Management: one staff attended the University West of England data management training. We are using this as the basis of our plan and developing this using https://dmponline.dcc.ac.uk As University of Essex is the data manager, we have in place a Data Protection Impact Assessment (led by the University of Essex Data Protection Officer). We are currently developing Information Sharing agreements as all the partners are Data Controllers. Monitoring and Evaluation: Theory of change reviewed during all team on-line workshop (December 2023); being developed into a revised conceptual and logical framework for further development of outcome / impact indicators. Monitoring data is being collected in relation to training and other outputs (such as attendance at workshops; invites to conferences, etc). Governance and Policy Analysis: We have substantially developed the focus on reviewing and analysing policies on integration of migrants' health in health policies, an area that was rather limited in the original proposal. This drew on tools and analysis frameworks in networks led by members of the GEMMS group. We anticipate in the coming year we will use the tools to undertake more in-depth analysis of existing policy landscape in migration health for the four countries, as well as the regions. In the coming year, drawing on the tools developed, a review of the global governance architecture of migration and health will be undertaken. CADA Training: In addition, drawing on a successful CADA grant awarded to TISS and led by GEMMS training lead, we will be conducting a cross-country research academy in September - December for ECRs in GEMMS and its partner institutions. We will offer the virtual sessions to other members of the NIHR academy. GEMMS early career researcher network: The development of a GEMMS early career researcher network is underway. This involves linking WITS Migration & Displacement MA and PhD students working on migration and health with the GEMMS PhD and postdoctoral fellows. Finest achievements of GEMMS to date Prioritising the process (or the means) and not the outputs (or the end) alone have underpinned the key achievements of the GEMMS research group. This involved paying due attention to establishing arrangements that were new to all partner institutions, and shared understandings of the collaborative model of working. While on occasions this has been difficult to achieve (because of institutional demands on staff in partner institutions, staff sickness and absences), members of GEMMS team have stepped in to support other members on these leadership roles. Given the focus on process, and for a programme in its first year of establishment/ implementation, we have laid the foundations of achieving more sustained impact in the countries in focus. This is achieved through: • Established International Advisory Group with diverse sectoral and country membership; including WHO, IOM, Statistics South Africa and International Institute for Migration and Development (India). All IAG members are influential in their fields and bring to GEMMS a wealth of international policy expertise in migration and health. • Creation of Regional Advisory Groups. The Southern Africa Advisory Group held its first meeting in May 2023 with a second in-person meeting planned for October 2023. The Asian Advisory Group membership has been finalised and a first meeting is planned for October 2023. • Mobilising key experts and policy actors via high-impact plenary held in inception phase. The launch event brought together international development partners with academics and international agencies - all expressing a need for the types of intervention delivered by GEMMS. The event created a shared understanding among both developmental and academic partners of the links between the developmental and research objectives of GEMMS. • Launch event featuring David Miliband, President, and CEO of International Rescue Committee (IRC). In his speech (delivered via video), he emphasised that "IRC does seek to be a supporter and partner of your work but we're also looking forward to being a consumer of the work that you launch today I hope that we can partner in research but also in delivery and in advocacy because we can't afford the programmes that we develop to be boutique programmes they need to be scaled programmes and we talk about impact and scale as being at the heart of our strategy". • Development of regionally-sensitive tools for policy appraisals that are now being implemented to analyse and index policies in the countries. • Engagement in global platforms. This includes: • the 3rd Global consultation on the health of refugees and migrants coordinated by WHO, IOM and UNHCR. GEMMS (Vearey) and IAG members (Severoni, Wickramage, Iturralde) participated and led expert panels. The consultation led to the ground-breaking political declaration, the Rabat Declaration, to strengthen the global commitment to improve the health of refugees and migrants, and was signed by the governments of at least two of the four countries (India, South Africa). Vearey is a co-writer of the meeting report. • Technical Advisory Group member (Vearey) for the consultation process of the WHO training course on building the capacity of health care workers providing care to refugees and migrants (2024 onwards) • Project Advisory Group Member (Vearey): Developing Strategies to coordinate HEalth care provision between The GAmbia and Senegal (SHEGAS) (2023 onwards) • Advisory Board Member (Vearey) Academy in Exile (2023 onwards) • Technical Working Group Member: World Health Organization (WHO) Migration and Health Programme (MH) - development of a Global Migration and Health Research Agenda (Vearey, 2022 onwards); Chair for global consultations held in the MH programme (Kapilashrami). • International Advisory Board Member: Boston University Center on Forced Displacement (Vearey, 2023 onwards) • International Advisory Board Member and trustee (Vearey, Kapilashrami) for the Global Society on Migration, Ethnicity and Race (GSMERH) • Establishment of an African Research Universities Alliance (ARUA) and The Guild Universities Network 'Cluster of Excellence' in Migration and Health (CEMH) (co-led by Vearey), involving WHO regional offices in Europe, the Eastern Mediterranean and Africa. Membership includes IAG member (Wickramage) and Southern Africa Advisory Group member (Leung) • Shared PhD programme and training strategy, which includes post-docs and researchers in all partner institutions (Zimbabwe - AU; TISS - India, Wits • Implementing both a dual PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS). • Supporting the development of a GEMMS early career researcher network, including through establishment of a monthly hybrid migration and health journal club bringing together GEMMS PhD and Postdoctoral fellows with WITS Migration & Displacement MA and PhD students • Research Officer (UoE) receiving a global talent visa sponsored by UKRI • WITS GEMMS team joined the Statistics South Africa Migration and Urbanisation Forum coordinated by IAG member (Iturralde). Technical Advisor (Vearey) to the development of a National Migration Profile coordinated by IAG member (Iturralde) |
| Collaborator Contribution | Working with diverse migrant groups in precarious situations in India, Myanmar, South Africa, and Zimbabwe, we aim to create conceptual and methodological tools and actions to disrupt the damaging cycle of gendered violence and poor mental health for migrant and mobile populations. The link between gendered violence and poor mental and psychosocial health is widely acknowledged, yet poorly understood. Interventions that address these global health challenges generally focus on either gendered violence or mental health and ignore the damaging cycle of gendered violence reinforcing poor mental health and vice versa. In addition, these interventions are limited in their reach as they often address the needs of sedentary populations, ignoring the needs and realities of migrant and mobile groups including people displaced due to conflict and disaster and the rural poor moving in search of better livelihood opportunities. These situations are associated with chronic precarity in work and living conditions, barriers to healthcare access, and an increased exposure to violence and burden of ill-health. Such precarity creates different risks, responses, and resilience to gendered violence and poor mental health. Appropriate and effective interventions require better understanding of the intersecting risks of gendered violence and poor mental health, factors determining these risks, and how they change over time and place. The GEMMS research group brings together academics and practitioners with relevant expertise and experience in six institutions across four countries. We will develop an evidence-informed intervention to provide on-going support to migrants in precarious situations in SA and India, and border spaces in Myanmar and Zimbabwe. The research group will establish a programme of work to generate new knowledge, improved understandings, and co-designed training and public health solutions. We will apply theoretical and empirical insights to support efforts to improve the lived realities of migrants in precarious situations through participation of affected populations in research. Ultimately, our vision is to create the necessary tools, actions, and an intervention pathway to disrupt the damaging cycle of gendered violence and poor mental health in order to improve the wellbeing of migrants in precarious situations, including responsive interventions that can address migrants' changing needs over time and in different contexts. |
| Impact | Outputs are currently being produced. |
| Start Year | 2022 |
| Description | GEMMS: Global Health Research Group on Disrupting the cycle of gendered violence & poor mental health among migrants in precarious situations |
| Organisation | University of Oxford |
| Department | Oxford Hub |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | As a co-directed and collaborative international programme, we have an open approach to developing the groups outputs. For publications we follow our authorship guidelines. Our next outputs will include working papers of the literature reviews and policy reviews, which will be developed for publications. GEMMS workstream activities have generally progressed well, with work in WS1 and formative work for WS2 significantly advanced in the past six months. Some highlights to date: • 4 PhD scholarships awarded (3 male; 1 female; 2 with disabilities; all international, from Zimbabwe, Nepal, India and South Africa) • A joint PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS) • Distress protocol • Situational analysis for countries (working documents) • Scoping and systematic reviews underway/nearly finalised (this included developing training materials for researchers) • International Advisory Board established comprising a group of influential experts across UN system, academia and independent experts • GEMMS Handbook for the project team; Communications Strategy; IP Policy; Data Management Strategy (draft); Preventing Harm in Research (draft); Authorship Guidelines; Training strategy and plan (draft) • Presentations at the NIHR Training Forum • Website, X (twitter), LinkedIn accounts https://gemms-research.org/ | https://twitter.com/GEMMS_research | https://www.linkedin.com/company/gemms-research/mycompany/ • Four blogs published on the GEMMS website https://gemms-research.org/blog/ • Contributions to the publication, Migration in South Asia [https://link.springer.com/book/10.1007/978-3-031-34194-6]; edited by a member of the IAG. • Report from the workshop and stakeholder meetings held in Musina that resulted in the development of the South Africa Local Advisory Group and an associated Local Advisory Network Inclusion & Community Engagement: meetings have taken place in India, Zimbabwe and South Africa. India: 25 leaders from informal settlements at the research site in India were brought together. The aim was to understand migration patterns and precarities associated with the site. This was important for identifying these patterns, who the community gatekeepers are, and labels used for migrants as well as their overall living situation. The meeting has initiated a process to identify the most vulnerable groups among migrants and to start the process for community engagement. Zimbabwe: two local advisory networks and groups have been established in Manicaland Province, one in Mutare and one in Chipinge. These LAGs have met and advised the team about where to undertake research and supported access to the Tongongara Refugee Camp in Chipinge where the research is now focusing. This includes direct engagement with the Camp Manager who is guiding the process for obtaining formal approvals. Once the AU research team is in place, they will take over this process. South Africa: At our research site in Musina, we have constituted the Musina Local Advisory Group and a Musina Local Advisory Network. The Network has met once (May 2023) and comprises 30 individuals from various organisations and migrant groups. The LAN will meet again in June 2024. The Local Advisory Group - a group of five members of the Network - will work with us on the research methods to assess their feasibility and appropriateness in Musina and a visit to Musina in November 2023 provided opportunities to update LAG members on progress and receive feedback/updates on the current context. In Musina, the Local Advisory Network has improved our understanding of the practicalities of the project in the local context. Issues that we need to be aware of and respond to include, language barriers and the isolation of some migrant communities. Myanmar: We are at the stage of planning key informant interviews and to identify those who can lead the research in the selected areas. The situation in Myanmar means our research must be extremely sensitive to the constantly changing conditions. Health Poverty Action our lead partner for Community, Engagement and Inclusion, has an established reputation in the region and field offices along the border region between Myanmar and China. Their staff are embedded within the communities they support and will lead the research work for GEMMS in Myanmar. Three staff from Myanmar have been identified to join our NIHR training event in Mumbai. Addition of a new research site: Myanmar and especially Kachin state (the focus of GEMMS research activities) continues to be a challenging and politically fraught geography to proceed with the research as intended and has become inaccessible in light of the recent political developments. In view of this we submitted a CtP request - now approved - that involves: • Terminating all research activities in Myanmar. Maintain Myanmar as a site for piloting interventions if access becomes possible in the final year. • Initiate a new research site in Cambodia, a context characterized by high internal migration as well as out migration (regular and irregular) and return migration, and where our partner Health Poverty Action has a strong base (with an office and where the staff from Myanmar are currently located). Managing Risk: added in a risk on data management and security: Revised the risk on staff turn-over including (1) implications for the project depending on when staff changes take place (e.g. during initial phases vs during fieldwork vs during analysis and dissemination stage) and (2) the need to review procedures and lessons learnt from the departure of the Wits project coordinator following resignation from Wits. This includes understanding the implications/risk associated with team members who are on precarious academic positions; their need for career/professional development; and the associated need for increased security in academic positions (i.e. lack of opportunities for permanent positions and reliance on fully grant-funded fixed-term contracts that align with initial project end dates) Safeguarding: All GEMMS staff (other than those at HPA who undergo very comprehensive safeguard training) are required to complete the on-line Safeguarding Hub introduction to safeguarding course. To date 14 of 26 staff have completed the training; and we anticipate all staff would have completed the training by March 2024. Staff are required to read and sign our GEMMS code of conduct which acknowledges acceptance of our preventing harm in research strategy. This code of conduct is being finalised and will be ready for signing by all staff in Feb 2024. There are no reported safeguarding incidents to date. Data Management: one staff attended the University West of England data management training. We are using this as the basis of our plan and developing this using https://dmponline.dcc.ac.uk As University of Essex is the data manager, we have in place a Data Protection Impact Assessment (led by the University of Essex Data Protection Officer). We are currently developing Information Sharing agreements as all the partners are Data Controllers. Monitoring and Evaluation: Theory of change reviewed during all team on-line workshop (December 2023); being developed into a revised conceptual and logical framework for further development of outcome / impact indicators. Monitoring data is being collected in relation to training and other outputs (such as attendance at workshops; invites to conferences, etc). Governance and Policy Analysis: We have substantially developed the focus on reviewing and analysing policies on integration of migrants' health in health policies, an area that was rather limited in the original proposal. This drew on tools and analysis frameworks in networks led by members of the GEMMS group. We anticipate in the coming year we will use the tools to undertake more in-depth analysis of existing policy landscape in migration health for the four countries, as well as the regions. In the coming year, drawing on the tools developed, a review of the global governance architecture of migration and health will be undertaken. CADA Training: In addition, drawing on a successful CADA grant awarded to TISS and led by GEMMS training lead, we will be conducting a cross-country research academy in September - December for ECRs in GEMMS and its partner institutions. We will offer the virtual sessions to other members of the NIHR academy. GEMMS early career researcher network: The development of a GEMMS early career researcher network is underway. This involves linking WITS Migration & Displacement MA and PhD students working on migration and health with the GEMMS PhD and postdoctoral fellows. Finest achievements of GEMMS to date Prioritising the process (or the means) and not the outputs (or the end) alone have underpinned the key achievements of the GEMMS research group. This involved paying due attention to establishing arrangements that were new to all partner institutions, and shared understandings of the collaborative model of working. While on occasions this has been difficult to achieve (because of institutional demands on staff in partner institutions, staff sickness and absences), members of GEMMS team have stepped in to support other members on these leadership roles. Given the focus on process, and for a programme in its first year of establishment/ implementation, we have laid the foundations of achieving more sustained impact in the countries in focus. This is achieved through: • Established International Advisory Group with diverse sectoral and country membership; including WHO, IOM, Statistics South Africa and International Institute for Migration and Development (India). All IAG members are influential in their fields and bring to GEMMS a wealth of international policy expertise in migration and health. • Creation of Regional Advisory Groups. The Southern Africa Advisory Group held its first meeting in May 2023 with a second in-person meeting planned for October 2023. The Asian Advisory Group membership has been finalised and a first meeting is planned for October 2023. • Mobilising key experts and policy actors via high-impact plenary held in inception phase. The launch event brought together international development partners with academics and international agencies - all expressing a need for the types of intervention delivered by GEMMS. The event created a shared understanding among both developmental and academic partners of the links between the developmental and research objectives of GEMMS. • Launch event featuring David Miliband, President, and CEO of International Rescue Committee (IRC). In his speech (delivered via video), he emphasised that "IRC does seek to be a supporter and partner of your work but we're also looking forward to being a consumer of the work that you launch today I hope that we can partner in research but also in delivery and in advocacy because we can't afford the programmes that we develop to be boutique programmes they need to be scaled programmes and we talk about impact and scale as being at the heart of our strategy". • Development of regionally-sensitive tools for policy appraisals that are now being implemented to analyse and index policies in the countries. • Engagement in global platforms. This includes: • the 3rd Global consultation on the health of refugees and migrants coordinated by WHO, IOM and UNHCR. GEMMS (Vearey) and IAG members (Severoni, Wickramage, Iturralde) participated and led expert panels. The consultation led to the ground-breaking political declaration, the Rabat Declaration, to strengthen the global commitment to improve the health of refugees and migrants, and was signed by the governments of at least two of the four countries (India, South Africa). Vearey is a co-writer of the meeting report. • Technical Advisory Group member (Vearey) for the consultation process of the WHO training course on building the capacity of health care workers providing care to refugees and migrants (2024 onwards) • Project Advisory Group Member (Vearey): Developing Strategies to coordinate HEalth care provision between The GAmbia and Senegal (SHEGAS) (2023 onwards) • Advisory Board Member (Vearey) Academy in Exile (2023 onwards) • Technical Working Group Member: World Health Organization (WHO) Migration and Health Programme (MH) - development of a Global Migration and Health Research Agenda (Vearey, 2022 onwards); Chair for global consultations held in the MH programme (Kapilashrami). • International Advisory Board Member: Boston University Center on Forced Displacement (Vearey, 2023 onwards) • International Advisory Board Member and trustee (Vearey, Kapilashrami) for the Global Society on Migration, Ethnicity and Race (GSMERH) • Establishment of an African Research Universities Alliance (ARUA) and The Guild Universities Network 'Cluster of Excellence' in Migration and Health (CEMH) (co-led by Vearey), involving WHO regional offices in Europe, the Eastern Mediterranean and Africa. Membership includes IAG member (Wickramage) and Southern Africa Advisory Group member (Leung) • Shared PhD programme and training strategy, which includes post-docs and researchers in all partner institutions (Zimbabwe - AU; TISS - India, Wits • Implementing both a dual PhD agreement (a first for University of Essex) with Wits University (PhD awarded jointly by both institutions) and a cotutelle agreement (PhD awarded by UoE but joint supervision between UoE and TISS). • Supporting the development of a GEMMS early career researcher network, including through establishment of a monthly hybrid migration and health journal club bringing together GEMMS PhD and Postdoctoral fellows with WITS Migration & Displacement MA and PhD students • Research Officer (UoE) receiving a global talent visa sponsored by UKRI • WITS GEMMS team joined the Statistics South Africa Migration and Urbanisation Forum coordinated by IAG member (Iturralde). Technical Advisor (Vearey) to the development of a National Migration Profile coordinated by IAG member (Iturralde) |
| Collaborator Contribution | Working with diverse migrant groups in precarious situations in India, Myanmar, South Africa, and Zimbabwe, we aim to create conceptual and methodological tools and actions to disrupt the damaging cycle of gendered violence and poor mental health for migrant and mobile populations. The link between gendered violence and poor mental and psychosocial health is widely acknowledged, yet poorly understood. Interventions that address these global health challenges generally focus on either gendered violence or mental health and ignore the damaging cycle of gendered violence reinforcing poor mental health and vice versa. In addition, these interventions are limited in their reach as they often address the needs of sedentary populations, ignoring the needs and realities of migrant and mobile groups including people displaced due to conflict and disaster and the rural poor moving in search of better livelihood opportunities. These situations are associated with chronic precarity in work and living conditions, barriers to healthcare access, and an increased exposure to violence and burden of ill-health. Such precarity creates different risks, responses, and resilience to gendered violence and poor mental health. Appropriate and effective interventions require better understanding of the intersecting risks of gendered violence and poor mental health, factors determining these risks, and how they change over time and place. The GEMMS research group brings together academics and practitioners with relevant expertise and experience in six institutions across four countries. We will develop an evidence-informed intervention to provide on-going support to migrants in precarious situations in SA and India, and border spaces in Myanmar and Zimbabwe. The research group will establish a programme of work to generate new knowledge, improved understandings, and co-designed training and public health solutions. We will apply theoretical and empirical insights to support efforts to improve the lived realities of migrants in precarious situations through participation of affected populations in research. Ultimately, our vision is to create the necessary tools, actions, and an intervention pathway to disrupt the damaging cycle of gendered violence and poor mental health in order to improve the wellbeing of migrants in precarious situations, including responsive interventions that can address migrants' changing needs over time and in different contexts. |
| Impact | Outputs are currently being produced. |
| Start Year | 2022 |
| Description | Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs: DiSoCo |
| Organisation | Amref Health Africa |
| Country | Kenya |
| Sector | Charity/Non Profit |
| PI Contribution | We developed an extensive policy review and analysis project. The review included two key approaches: a systematic policy review per country (South Africa, Somalia, Kenya and the DRC) and a set of semi-structured key informant interviews with policy makers and those shaping and implementing policy. The policy review used an assessment framework developed from previous policy reviews on migration and health to assess the extent to which laws and policies engaged with migration, health, mental health and gender - for each of the four countries. The assessment was based on 4 key questions which considered how the policies engage with a migrant's rights to health, with migration within healthcare planning, with mental health in health systems planning and with gender in terms of migration and health. Country reviews outline the status ratings given to each country on the 4 key questions. This allows to see the progress and the challenges that each country faces as well as to compare each country in terms of their legislative approaches to migration, gender and health. This allowed for comparisons within and across countries. The interviews targeted individuals working in a migration and/or health context and sought to better understand the links between policy and practice, changes in policy and challenges faced on the ground.A total of 70 interviews were conducted: 25 in South Africa (nationally and locally); 12 in Somalia (at a federal and state level); 32 in the DRC (at national level and in four provinces of the DRC (Kasai Central, Tanganyika, South Kivu and Ituri) and in 25 in Kenya. Between policy commitments and healthcare realities: From the reviews it is clear to see that the specific contexts and priorities of each country lead to significant differences in how they manage migration flows and uphold migrant rights, including in access to healthcare. Across all four countries although there is signs of progress no one country has has sufficiently incorporated and implemented migration, health and gender concerns within their legislative frameworks. Migrants rights to health: Constitutionally, Kenya, Somalia, the DRC and South Africa all provide for the right to health for all, although limitations are posed by either a lack of explicit inclusion of non-citizens and migrants or associated laws and policies which do not affirm Constitutional rights. While South Africa and Kenya both support health as a basic human right with rights-based legislative frameworks gaps in implementation and for South Africa a proposed National Health Insurance, restrict and undermine these rights. In Somalia the right to health for all is guaranteed by the Provisional Federal Constitution however, the Health Sector Strategic Plan (HSSP) and Essential Packages of Health Services (EPHS) do not explicitly include refugees and migrants. The DRC's 'Law on the Status of Refugees' stipulates administrative restrictions which may apply to foreigners. Migration-aware health systems planning: All four countries have made some progress in migration-aware health systems planning. Neither the DRC or Somalia have a comprehensive legal framework specifically governing migration and refugee rights, relying on fragmented legislation and policies. This impacts on the extent to which health systems are migration aware and can ensure the right to health for all. While the DRC's National Health Policy acknowledges the needs of IDPs and refugees and aims to integrate them into the national health system, Somalia's federal Government struggles with limited control over its territory and resources, hindering effective migration governance and health systems-planning. South Africa and Kenya, both have more comprehensive frameworks through which the challenges and needs of migrants are addressed. For South Africa the National Health Act is supported by the progressive National Integrated Sexual and Reproductive Health and Rights Policy (2019), which specifically includes gender-sensitive, and migrant-friendly reproductive health services within its broader framework. Meanwhile, the Kenya Health Policy 2014-2030, and the Universal Health Coverage Policy 2020-2030 align with the goals of UHC to offer quality health services generally and for refugees, specifically. Yet, both country's also face significant gaps in implementation and, have developed frameworks for National Health Insurance which are more exclusionary than assuring healthcare for all. Mental Health Aware health systems planning: The integration of mental health services and planning into broader health systems is neglected by Kenya, Somalia and South Africa - with the DRC alone comprehensively engaging with mental health care for migrants and refugees at a primary healthcare level. Both the DRC and `Somalia face increased challenges in addressing mental health needs among migrants and citizens exacerbated by the protracted political instability and conflict. The DRC has initiated efforts such as community-based programmes yet their reach and sustainability remain limited. Somalia outlines some rights and obligations for mental healthcare service provision however, this is not guaranteed in the Constitution nor recognised as a priority in the National Roadmap to Universal Healthcare. In Kenya, despite the right to access mental health services for all refugees and asylum seekers are often excluded from accessing care and/or face significant barriers. Kenya's Refugee Policy Framework also fails to include specific guidelines in access to psychosocial support for refuges. In South Africa, migrant populations have been mostly ignored in mental health policies and frameworks. Gender-aware health systems planning: South Africa has ensured that gender is integrated into health systems planning. However, there is a clear gap between policy and practice and a failure to engage with the intersection of migration and gender in terms of specific health needs. The DRC's National Migration Policy (2012) and the National Health Development Plan (2016) emphasise the need for gender-sensitive approaches however, limited resources, capacity and coordination present implementation obstacles. Similarly, for Kenya a set of gender-sensitive policies such as the National Policy for Prevention and Response to gender-based violence (2014) are restricted in impact due to a lack of coordination and collaboration while the heightened needs of refugee and asylum seeker women and girls are largely ignored. In Somalia efforts towards gender inclusion are reflected in The National Development Plan (2019-2023), which recognizes the need for gender-sensitive approaches in migration and health. While sexual offence legislation also exist the health and mental health legislation to not sufficiently engage with gender issues. Key findings: 1. All 4 countries have made progress in migration-aware health system planning although this remains limited. 2. Policies have been driven by siloed approaches to migration and health despite the significant intersections 3. South Africa has the most comprehensive legislation in terms of the right to health for all. Somalia and Kenya have some legislation which provides for the right to health but this remains limited. The DRC does not ensure the right to health for all 4. Kenya and Somalia have yet to develop gender-aware health systems while the DRC is making progress and South Africa has strong legislation in this regard. 5. The DRC is the only country with mental-health aware systems planning while South Africa, Kenya and Somalia still fall short on this. 6. Policies have been shaped by increasingly securitised approaches to borders impacting access to health services and increasing health and mental health challenges amongst some of the most marginalised in all four contexts. 7. Perceptions of mental health and of gendered norms impact on accessing support through health systems While committed to achieving UHC the DRC, Kenya, Somalia and South Africa face challenges posed by ongoing political tensions and conflict, weak health systems, as well as a lack of laws and policies that directly address the health needs of displaced populations. Considered through a policy lens these four countries provide an important picture of what happens in the gap between policy commitments and implementation and, the opportunities in addressing the challenges facing displaced populations by ensuring access to healthcare including mental health services as crucial their well-being. The Sustainable Development Goals (SDGs) - which aim to 'leave no-one behind' and promote broad human rights-based approaches to development - recognise the importance of addressing the right to access healthcare services for all. Goal 3 of the SDGs aims to "ensure healthy lives and promote well-being for all at all ages" and, through Goal 3.8, calls on states to "Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all." The need to address vulnerabilities and needs particular to migrants have been further articulated in the subsequent Political Declaration of the High-Level Meeting on Universal Health Coverage, which emphasises the need to progressively include migrants in advances towards achieving UHC. Increasing recognition of the need to improve responses to migration and health - including ensuring access to healthcare services - is evidenced through a growing global governance movement which is linked to three intersecting agendas: 1. Migration Governance - notably the Global Compacts on (1) Safe Orderly and Regular Migration and Refugees - which outline the importance of addressing the health needs of all migrants. 2. Development - Sustainable Development Goals (SDGs)43 and the target of achieving Universal Health Coverage. 3. Global Health - including ensuring the right to health for all migrants is articulated in two World Health Assembly (WHA) Resolutions and the resultant 2019 Global Action Plan (GAP) for the Health of Refugees and Migrants that encompasses six objectives that aim to address the health of refugees and migrants. As part of this work, we hosted and facilitated the DiSoCo Policy Analysis Workshop in September 2023.The workshop took place in Johannesburg, South Africa, from 11-15 September 2023, at the African Centre for Migration and Society (ACMS) at the University of Witwatersrand and brought together a group of researchers from the DiSoCo multi-sited country teams from South Africa, Somalia, Democratic Republic of Congo (DRC), Kenya, the Netherlands, and the UK. The focus of the workshop was to better understand and further explore the relationship of violence, protracted displacement, gender and mental health through a policy lens across the countries and regions included in the DiSoCo project. The DiSoCo project aims to assist displaced people including refugees, asylum seekers, Internal Displaced Persons (IDPs) and returnees in Somalia, Kenya, DRC and South Africa to access appropriate healthcare amidst protracted displacement, conflict and gendered violence. The first research question of this project - focuses on identifying and analyzing current policy processes that respond to the health needs of displaced people and thereby identifying existing models for integrating those populations into health systems that could be made applicable to our various protracted displacement contexts. The countries of interest in this research project experience significant levels of both inward and outward migration. This can be attributed to the presence of political and military instability and economic challenges within these nations. For example, both Somalia and DRC have endured several years of protracted conflicts and displacement, with their citizens exposed to several human rights violations including sexual abuse, torture and movement of people both within their borders and to global destinations including neighboring countries like Kenya and as far as South Africa. These two destination countries, situated in East Africa (Kenya) and the Southern African Development Community (SADC) region (South Africa), boast vibrant economies and rich cultural diversity, making them attractive to immigrants from around the world. However, despite their frequent experience with migration, the majority of their policies have lacked explicit provisions addressing migration-related issues. Policies in countries like the DRC, Somalia, and Kenya have not clearly outlined their implementation strategies for addressing migration challenges, especially concerning the protection of the rights of internally displaced persons (IDPs), asylum seekers, and refugees, who constitute a significant and often overlooked population in these nations. In the Somalia policy context for instance, the multiple levels of governance and political dynamics from the federal level, as well as the state levels within their decentralized federal system, creates tensions and implementation difficulties as many policies remain contested and in draft form. On the other hand, in South Africa, although the constitution and various policies have provided substantial and progressive provisions for refugees and asylum seekers, policy implementation is met with resistance and the country has recently introduced policy amendments that appear to restrict immigrants' access to basic services such as healthcare, employment, and psychosocial support for mental health challenges. In the Kenyan context, the current policies and frameworks designed to attain national health objectives and universal health coverage (UHC) lack a comprehensive guide or roadmap for displaced individuals, notably refugees and asylum seekers. Despite the presence of established programs and services, deficiencies in documentation hinder refugees from accessing the same services available to Kenyan nationals. This underscores the need to focus on the health and wellbeing of refugees, asylum seekers, internally displaced persons (IDPs), and returnees, with particular attention to the provision and accessibility of mental healthcare services. We believe that access to healthcare is a fundamental right for these vulnerable populations, one that should be guaranteed and protected by policy and legislation in both their hom e countries and host nations. Therefore, a comprehensive understanding of healthcare policies in the DiSoCo field contexts-Somalia, DRC, Kenya, and South Africa-is essential for promoting universal healthcare and fostering a migrant-aware and inclusive society.Inclusiveness is anchored in policies and legislation that consider migration, displacement, gender, health, and mental health. Among the critical focal points in policy analysis, various questions arise, such as: How comparable are policies regarding internally displaced persons (IDPs) and refugees, especially in terms of migration and health? How can we bridge the gap between policies as stated on paper and their actual implementation in practice? How do we ensure accountability? These critical inquiries position migration as a potential catalyst for inclusive, gender-sensitive, and mental health-focused policy discussions. Furthermore, the contextual factors in the field highlight how diversity and various dynamics propel the need for more specific approaches when addressing migration and mental health. While these questions do not have straightforward answers, this workshop offered an important step in thinking through these policy issues and how to make actionable recommendations to various policy stakeholders. ------ We led Work Package 1 which identifies which elements of existing models for integrating displaced people into healthcare systems were applied in our protracted displacement contexts. This was done through systematic reviews of the literature on: (a) healthcare systems that seek to integrate displaced people and (b) the evolution of legal and regulatory frameworks for IDPs (in Eastern DRC and Somalia) and refugees (in Kenya and South Africa) so as to understand why they have hitherto been organised differently. We evaluated the implications of recent international commitments such as Kenya's implementation of a Comprehensive Response Framework, the Kampala Convention for IDPs in Africa, and other binding and non-binding agreements and guidelines brokered by regional bodies (African Union, WHO Afro) and sub- regional bodies (East African Community, SADC). Semi-structured interviews were undertaken with key informants including policymakers identified via our network of partners - especially the Migration Health and Development Research Initiative and the Panzi Foundation and Mukwege Chairs networks associated with Nobel Peace prize winner Dr Dennis Mukwege. Key findings: Mental health in relation to refugees and migrants in South Africa is understood primarily as trauma and sexual violence. This means that mental health that is layered (i.e., trauma experienced at all stages of migration); complex and, shaped by specific socio-cultural experiences is ignored. Mental health challenges are determined by structural violence: Lack of documents, exclusion, poverty, poor access to housing, employment and support systems; discrimination, stigma and xenophobia; Violence within healthcare. Mental health challenges for refugees and migrants are felt through the body: "The body knows the score": Can be due to a lack or inability of language to express pain; Link between body and mind and somatic experiences; Visible/invisible pain. Health care workers do not understand the needs of refugees and migrants: the system is over-whelmed and refugees and migrants with some of greatest mental health challenges are seen as a threat and burden to the system while also misunderstood. This is compounded by: A shortage of psychiatrists and psychologists and community-responses; Lack of understanding and compassion; Poor mental health literacy; HCW themselves struggling with mental health. Services work but there is limited to no access to mental health care for refugees and migrants in South Africa: The mental healthcare system in South Africa is under-resourced, over-burdened and unable to respond to the needs of all and especially migrants. Responses: "Plugging the gaps" and responding to immediate needs to reduce mental stress: In recognition of specific needs and challenges faced by refugees and migrants' civil society create "parallel systems" to by-pass state services and reduce risks of stigma and discrimination; Recognition that responding to immediate needs ie no food, no rent money, access to schools etc. is the central response needed to reduce stress created by structural violence - this is the starting point. |
| Collaborator Contribution | DiSoCo is a GCRF Protracted Displacement project that aims to help Somali and Congolese displaced people to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence. DiSoCo is a multi-sited project focusing on Somali and Congolese Internally Displaced People (IDPs) in Somalia and Eastern DRC respectively, and Somali and Congolese refugees and asylum seekers in Kenya and South Africa. The DiSoCo team brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Specialists at Panzi Foundation (DRC), ARQ International (Netherlands), and Queen Margaret University (UK) support teams of researchers based at: Kinshasa School of Public Health (DRC) Université Evangélique en Afrique (DRC) Somali Institute for Development and Research (Somalia) Amref International University (Kenya) University of the Witwatersrand (South Africa) The University of Edinburgh (UK) Field Sites The DiSoCo project has eight field sites in Eastern DRC, Somalia, Kenya, and South Africa. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. Project Aims DiSoCo aims to help Somali and Congolese displaced people in Somalia, Eastern DRC, Kenya, and South Africa to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence by: Improving diagnosis, provision, and accessibility of healthcare for neglected chronic physical and mental ill-health conditions amongst displaced populations. Helping develop resilient, responsive, inclusive health systems which ultimately contribute to strong and welcoming societies. Supporting the development of mechanisms and organisations that empower displaced communities when they seek healthcare. |
| Impact | https://doi.org/10.1108/IJMHSC-11-2021-0103 https://thepolyphony.org/2021/09/21/behind-the-masks-mental-health-and-marginalisation-covid-19/ https://www.dailymaverick.co.za/article/2021-01-08-drones-dinghies-and-an-army-helicopter-why-the-states-new-toys-wont-help-south-africas-response-to-covid-19/ https://displacement.sps.ed.ac.uk/2021/04/05/your-home-is-the-place-you-cant-return-to-and-the-place-where-you-are-doesnt-appear-to-want-you/ https://www.emerald.com/insight/content/doi/10.1108/IJMHSC-11-2021-0103/full/html |
| Start Year | 2019 |
| Description | Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs: DiSoCo |
| Organisation | Evangelical University in Africa |
| Country | Congo, the Democratic Republic of the |
| Sector | Academic/University |
| PI Contribution | We developed an extensive policy review and analysis project. The review included two key approaches: a systematic policy review per country (South Africa, Somalia, Kenya and the DRC) and a set of semi-structured key informant interviews with policy makers and those shaping and implementing policy. The policy review used an assessment framework developed from previous policy reviews on migration and health to assess the extent to which laws and policies engaged with migration, health, mental health and gender - for each of the four countries. The assessment was based on 4 key questions which considered how the policies engage with a migrant's rights to health, with migration within healthcare planning, with mental health in health systems planning and with gender in terms of migration and health. Country reviews outline the status ratings given to each country on the 4 key questions. This allows to see the progress and the challenges that each country faces as well as to compare each country in terms of their legislative approaches to migration, gender and health. This allowed for comparisons within and across countries. The interviews targeted individuals working in a migration and/or health context and sought to better understand the links between policy and practice, changes in policy and challenges faced on the ground.A total of 70 interviews were conducted: 25 in South Africa (nationally and locally); 12 in Somalia (at a federal and state level); 32 in the DRC (at national level and in four provinces of the DRC (Kasai Central, Tanganyika, South Kivu and Ituri) and in 25 in Kenya. Between policy commitments and healthcare realities: From the reviews it is clear to see that the specific contexts and priorities of each country lead to significant differences in how they manage migration flows and uphold migrant rights, including in access to healthcare. Across all four countries although there is signs of progress no one country has has sufficiently incorporated and implemented migration, health and gender concerns within their legislative frameworks. Migrants rights to health: Constitutionally, Kenya, Somalia, the DRC and South Africa all provide for the right to health for all, although limitations are posed by either a lack of explicit inclusion of non-citizens and migrants or associated laws and policies which do not affirm Constitutional rights. While South Africa and Kenya both support health as a basic human right with rights-based legislative frameworks gaps in implementation and for South Africa a proposed National Health Insurance, restrict and undermine these rights. In Somalia the right to health for all is guaranteed by the Provisional Federal Constitution however, the Health Sector Strategic Plan (HSSP) and Essential Packages of Health Services (EPHS) do not explicitly include refugees and migrants. The DRC's 'Law on the Status of Refugees' stipulates administrative restrictions which may apply to foreigners. Migration-aware health systems planning: All four countries have made some progress in migration-aware health systems planning. Neither the DRC or Somalia have a comprehensive legal framework specifically governing migration and refugee rights, relying on fragmented legislation and policies. This impacts on the extent to which health systems are migration aware and can ensure the right to health for all. While the DRC's National Health Policy acknowledges the needs of IDPs and refugees and aims to integrate them into the national health system, Somalia's federal Government struggles with limited control over its territory and resources, hindering effective migration governance and health systems-planning. South Africa and Kenya, both have more comprehensive frameworks through which the challenges and needs of migrants are addressed. For South Africa the National Health Act is supported by the progressive National Integrated Sexual and Reproductive Health and Rights Policy (2019), which specifically includes gender-sensitive, and migrant-friendly reproductive health services within its broader framework. Meanwhile, the Kenya Health Policy 2014-2030, and the Universal Health Coverage Policy 2020-2030 align with the goals of UHC to offer quality health services generally and for refugees, specifically. Yet, both country's also face significant gaps in implementation and, have developed frameworks for National Health Insurance which are more exclusionary than assuring healthcare for all. Mental Health Aware health systems planning: The integration of mental health services and planning into broader health systems is neglected by Kenya, Somalia and South Africa - with the DRC alone comprehensively engaging with mental health care for migrants and refugees at a primary healthcare level. Both the DRC and `Somalia face increased challenges in addressing mental health needs among migrants and citizens exacerbated by the protracted political instability and conflict. The DRC has initiated efforts such as community-based programmes yet their reach and sustainability remain limited. Somalia outlines some rights and obligations for mental healthcare service provision however, this is not guaranteed in the Constitution nor recognised as a priority in the National Roadmap to Universal Healthcare. In Kenya, despite the right to access mental health services for all refugees and asylum seekers are often excluded from accessing care and/or face significant barriers. Kenya's Refugee Policy Framework also fails to include specific guidelines in access to psychosocial support for refuges. In South Africa, migrant populations have been mostly ignored in mental health policies and frameworks. Gender-aware health systems planning: South Africa has ensured that gender is integrated into health systems planning. However, there is a clear gap between policy and practice and a failure to engage with the intersection of migration and gender in terms of specific health needs. The DRC's National Migration Policy (2012) and the National Health Development Plan (2016) emphasise the need for gender-sensitive approaches however, limited resources, capacity and coordination present implementation obstacles. Similarly, for Kenya a set of gender-sensitive policies such as the National Policy for Prevention and Response to gender-based violence (2014) are restricted in impact due to a lack of coordination and collaboration while the heightened needs of refugee and asylum seeker women and girls are largely ignored. In Somalia efforts towards gender inclusion are reflected in The National Development Plan (2019-2023), which recognizes the need for gender-sensitive approaches in migration and health. While sexual offence legislation also exist the health and mental health legislation to not sufficiently engage with gender issues. Key findings: 1. All 4 countries have made progress in migration-aware health system planning although this remains limited. 2. Policies have been driven by siloed approaches to migration and health despite the significant intersections 3. South Africa has the most comprehensive legislation in terms of the right to health for all. Somalia and Kenya have some legislation which provides for the right to health but this remains limited. The DRC does not ensure the right to health for all 4. Kenya and Somalia have yet to develop gender-aware health systems while the DRC is making progress and South Africa has strong legislation in this regard. 5. The DRC is the only country with mental-health aware systems planning while South Africa, Kenya and Somalia still fall short on this. 6. Policies have been shaped by increasingly securitised approaches to borders impacting access to health services and increasing health and mental health challenges amongst some of the most marginalised in all four contexts. 7. Perceptions of mental health and of gendered norms impact on accessing support through health systems While committed to achieving UHC the DRC, Kenya, Somalia and South Africa face challenges posed by ongoing political tensions and conflict, weak health systems, as well as a lack of laws and policies that directly address the health needs of displaced populations. Considered through a policy lens these four countries provide an important picture of what happens in the gap between policy commitments and implementation and, the opportunities in addressing the challenges facing displaced populations by ensuring access to healthcare including mental health services as crucial their well-being. The Sustainable Development Goals (SDGs) - which aim to 'leave no-one behind' and promote broad human rights-based approaches to development - recognise the importance of addressing the right to access healthcare services for all. Goal 3 of the SDGs aims to "ensure healthy lives and promote well-being for all at all ages" and, through Goal 3.8, calls on states to "Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all." The need to address vulnerabilities and needs particular to migrants have been further articulated in the subsequent Political Declaration of the High-Level Meeting on Universal Health Coverage, which emphasises the need to progressively include migrants in advances towards achieving UHC. Increasing recognition of the need to improve responses to migration and health - including ensuring access to healthcare services - is evidenced through a growing global governance movement which is linked to three intersecting agendas: 1. Migration Governance - notably the Global Compacts on (1) Safe Orderly and Regular Migration and Refugees - which outline the importance of addressing the health needs of all migrants. 2. Development - Sustainable Development Goals (SDGs)43 and the target of achieving Universal Health Coverage. 3. Global Health - including ensuring the right to health for all migrants is articulated in two World Health Assembly (WHA) Resolutions and the resultant 2019 Global Action Plan (GAP) for the Health of Refugees and Migrants that encompasses six objectives that aim to address the health of refugees and migrants. As part of this work, we hosted and facilitated the DiSoCo Policy Analysis Workshop in September 2023.The workshop took place in Johannesburg, South Africa, from 11-15 September 2023, at the African Centre for Migration and Society (ACMS) at the University of Witwatersrand and brought together a group of researchers from the DiSoCo multi-sited country teams from South Africa, Somalia, Democratic Republic of Congo (DRC), Kenya, the Netherlands, and the UK. The focus of the workshop was to better understand and further explore the relationship of violence, protracted displacement, gender and mental health through a policy lens across the countries and regions included in the DiSoCo project. The DiSoCo project aims to assist displaced people including refugees, asylum seekers, Internal Displaced Persons (IDPs) and returnees in Somalia, Kenya, DRC and South Africa to access appropriate healthcare amidst protracted displacement, conflict and gendered violence. The first research question of this project - focuses on identifying and analyzing current policy processes that respond to the health needs of displaced people and thereby identifying existing models for integrating those populations into health systems that could be made applicable to our various protracted displacement contexts. The countries of interest in this research project experience significant levels of both inward and outward migration. This can be attributed to the presence of political and military instability and economic challenges within these nations. For example, both Somalia and DRC have endured several years of protracted conflicts and displacement, with their citizens exposed to several human rights violations including sexual abuse, torture and movement of people both within their borders and to global destinations including neighboring countries like Kenya and as far as South Africa. These two destination countries, situated in East Africa (Kenya) and the Southern African Development Community (SADC) region (South Africa), boast vibrant economies and rich cultural diversity, making them attractive to immigrants from around the world. However, despite their frequent experience with migration, the majority of their policies have lacked explicit provisions addressing migration-related issues. Policies in countries like the DRC, Somalia, and Kenya have not clearly outlined their implementation strategies for addressing migration challenges, especially concerning the protection of the rights of internally displaced persons (IDPs), asylum seekers, and refugees, who constitute a significant and often overlooked population in these nations. In the Somalia policy context for instance, the multiple levels of governance and political dynamics from the federal level, as well as the state levels within their decentralized federal system, creates tensions and implementation difficulties as many policies remain contested and in draft form. On the other hand, in South Africa, although the constitution and various policies have provided substantial and progressive provisions for refugees and asylum seekers, policy implementation is met with resistance and the country has recently introduced policy amendments that appear to restrict immigrants' access to basic services such as healthcare, employment, and psychosocial support for mental health challenges. In the Kenyan context, the current policies and frameworks designed to attain national health objectives and universal health coverage (UHC) lack a comprehensive guide or roadmap for displaced individuals, notably refugees and asylum seekers. Despite the presence of established programs and services, deficiencies in documentation hinder refugees from accessing the same services available to Kenyan nationals. This underscores the need to focus on the health and wellbeing of refugees, asylum seekers, internally displaced persons (IDPs), and returnees, with particular attention to the provision and accessibility of mental healthcare services. We believe that access to healthcare is a fundamental right for these vulnerable populations, one that should be guaranteed and protected by policy and legislation in both their hom e countries and host nations. Therefore, a comprehensive understanding of healthcare policies in the DiSoCo field contexts-Somalia, DRC, Kenya, and South Africa-is essential for promoting universal healthcare and fostering a migrant-aware and inclusive society.Inclusiveness is anchored in policies and legislation that consider migration, displacement, gender, health, and mental health. Among the critical focal points in policy analysis, various questions arise, such as: How comparable are policies regarding internally displaced persons (IDPs) and refugees, especially in terms of migration and health? How can we bridge the gap between policies as stated on paper and their actual implementation in practice? How do we ensure accountability? These critical inquiries position migration as a potential catalyst for inclusive, gender-sensitive, and mental health-focused policy discussions. Furthermore, the contextual factors in the field highlight how diversity and various dynamics propel the need for more specific approaches when addressing migration and mental health. While these questions do not have straightforward answers, this workshop offered an important step in thinking through these policy issues and how to make actionable recommendations to various policy stakeholders. ------ We led Work Package 1 which identifies which elements of existing models for integrating displaced people into healthcare systems were applied in our protracted displacement contexts. This was done through systematic reviews of the literature on: (a) healthcare systems that seek to integrate displaced people and (b) the evolution of legal and regulatory frameworks for IDPs (in Eastern DRC and Somalia) and refugees (in Kenya and South Africa) so as to understand why they have hitherto been organised differently. We evaluated the implications of recent international commitments such as Kenya's implementation of a Comprehensive Response Framework, the Kampala Convention for IDPs in Africa, and other binding and non-binding agreements and guidelines brokered by regional bodies (African Union, WHO Afro) and sub- regional bodies (East African Community, SADC). Semi-structured interviews were undertaken with key informants including policymakers identified via our network of partners - especially the Migration Health and Development Research Initiative and the Panzi Foundation and Mukwege Chairs networks associated with Nobel Peace prize winner Dr Dennis Mukwege. Key findings: Mental health in relation to refugees and migrants in South Africa is understood primarily as trauma and sexual violence. This means that mental health that is layered (i.e., trauma experienced at all stages of migration); complex and, shaped by specific socio-cultural experiences is ignored. Mental health challenges are determined by structural violence: Lack of documents, exclusion, poverty, poor access to housing, employment and support systems; discrimination, stigma and xenophobia; Violence within healthcare. Mental health challenges for refugees and migrants are felt through the body: "The body knows the score": Can be due to a lack or inability of language to express pain; Link between body and mind and somatic experiences; Visible/invisible pain. Health care workers do not understand the needs of refugees and migrants: the system is over-whelmed and refugees and migrants with some of greatest mental health challenges are seen as a threat and burden to the system while also misunderstood. This is compounded by: A shortage of psychiatrists and psychologists and community-responses; Lack of understanding and compassion; Poor mental health literacy; HCW themselves struggling with mental health. Services work but there is limited to no access to mental health care for refugees and migrants in South Africa: The mental healthcare system in South Africa is under-resourced, over-burdened and unable to respond to the needs of all and especially migrants. Responses: "Plugging the gaps" and responding to immediate needs to reduce mental stress: In recognition of specific needs and challenges faced by refugees and migrants' civil society create "parallel systems" to by-pass state services and reduce risks of stigma and discrimination; Recognition that responding to immediate needs ie no food, no rent money, access to schools etc. is the central response needed to reduce stress created by structural violence - this is the starting point. |
| Collaborator Contribution | DiSoCo is a GCRF Protracted Displacement project that aims to help Somali and Congolese displaced people to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence. DiSoCo is a multi-sited project focusing on Somali and Congolese Internally Displaced People (IDPs) in Somalia and Eastern DRC respectively, and Somali and Congolese refugees and asylum seekers in Kenya and South Africa. The DiSoCo team brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Specialists at Panzi Foundation (DRC), ARQ International (Netherlands), and Queen Margaret University (UK) support teams of researchers based at: Kinshasa School of Public Health (DRC) Université Evangélique en Afrique (DRC) Somali Institute for Development and Research (Somalia) Amref International University (Kenya) University of the Witwatersrand (South Africa) The University of Edinburgh (UK) Field Sites The DiSoCo project has eight field sites in Eastern DRC, Somalia, Kenya, and South Africa. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. Project Aims DiSoCo aims to help Somali and Congolese displaced people in Somalia, Eastern DRC, Kenya, and South Africa to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence by: Improving diagnosis, provision, and accessibility of healthcare for neglected chronic physical and mental ill-health conditions amongst displaced populations. Helping develop resilient, responsive, inclusive health systems which ultimately contribute to strong and welcoming societies. Supporting the development of mechanisms and organisations that empower displaced communities when they seek healthcare. |
| Impact | https://doi.org/10.1108/IJMHSC-11-2021-0103 https://thepolyphony.org/2021/09/21/behind-the-masks-mental-health-and-marginalisation-covid-19/ https://www.dailymaverick.co.za/article/2021-01-08-drones-dinghies-and-an-army-helicopter-why-the-states-new-toys-wont-help-south-africas-response-to-covid-19/ https://displacement.sps.ed.ac.uk/2021/04/05/your-home-is-the-place-you-cant-return-to-and-the-place-where-you-are-doesnt-appear-to-want-you/ https://www.emerald.com/insight/content/doi/10.1108/IJMHSC-11-2021-0103/full/html |
| Start Year | 2019 |
| Description | Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs: DiSoCo |
| Organisation | Queen Margaret University |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We developed an extensive policy review and analysis project. The review included two key approaches: a systematic policy review per country (South Africa, Somalia, Kenya and the DRC) and a set of semi-structured key informant interviews with policy makers and those shaping and implementing policy. The policy review used an assessment framework developed from previous policy reviews on migration and health to assess the extent to which laws and policies engaged with migration, health, mental health and gender - for each of the four countries. The assessment was based on 4 key questions which considered how the policies engage with a migrant's rights to health, with migration within healthcare planning, with mental health in health systems planning and with gender in terms of migration and health. Country reviews outline the status ratings given to each country on the 4 key questions. This allows to see the progress and the challenges that each country faces as well as to compare each country in terms of their legislative approaches to migration, gender and health. This allowed for comparisons within and across countries. The interviews targeted individuals working in a migration and/or health context and sought to better understand the links between policy and practice, changes in policy and challenges faced on the ground.A total of 70 interviews were conducted: 25 in South Africa (nationally and locally); 12 in Somalia (at a federal and state level); 32 in the DRC (at national level and in four provinces of the DRC (Kasai Central, Tanganyika, South Kivu and Ituri) and in 25 in Kenya. Between policy commitments and healthcare realities: From the reviews it is clear to see that the specific contexts and priorities of each country lead to significant differences in how they manage migration flows and uphold migrant rights, including in access to healthcare. Across all four countries although there is signs of progress no one country has has sufficiently incorporated and implemented migration, health and gender concerns within their legislative frameworks. Migrants rights to health: Constitutionally, Kenya, Somalia, the DRC and South Africa all provide for the right to health for all, although limitations are posed by either a lack of explicit inclusion of non-citizens and migrants or associated laws and policies which do not affirm Constitutional rights. While South Africa and Kenya both support health as a basic human right with rights-based legislative frameworks gaps in implementation and for South Africa a proposed National Health Insurance, restrict and undermine these rights. In Somalia the right to health for all is guaranteed by the Provisional Federal Constitution however, the Health Sector Strategic Plan (HSSP) and Essential Packages of Health Services (EPHS) do not explicitly include refugees and migrants. The DRC's 'Law on the Status of Refugees' stipulates administrative restrictions which may apply to foreigners. Migration-aware health systems planning: All four countries have made some progress in migration-aware health systems planning. Neither the DRC or Somalia have a comprehensive legal framework specifically governing migration and refugee rights, relying on fragmented legislation and policies. This impacts on the extent to which health systems are migration aware and can ensure the right to health for all. While the DRC's National Health Policy acknowledges the needs of IDPs and refugees and aims to integrate them into the national health system, Somalia's federal Government struggles with limited control over its territory and resources, hindering effective migration governance and health systems-planning. South Africa and Kenya, both have more comprehensive frameworks through which the challenges and needs of migrants are addressed. For South Africa the National Health Act is supported by the progressive National Integrated Sexual and Reproductive Health and Rights Policy (2019), which specifically includes gender-sensitive, and migrant-friendly reproductive health services within its broader framework. Meanwhile, the Kenya Health Policy 2014-2030, and the Universal Health Coverage Policy 2020-2030 align with the goals of UHC to offer quality health services generally and for refugees, specifically. Yet, both country's also face significant gaps in implementation and, have developed frameworks for National Health Insurance which are more exclusionary than assuring healthcare for all. Mental Health Aware health systems planning: The integration of mental health services and planning into broader health systems is neglected by Kenya, Somalia and South Africa - with the DRC alone comprehensively engaging with mental health care for migrants and refugees at a primary healthcare level. Both the DRC and `Somalia face increased challenges in addressing mental health needs among migrants and citizens exacerbated by the protracted political instability and conflict. The DRC has initiated efforts such as community-based programmes yet their reach and sustainability remain limited. Somalia outlines some rights and obligations for mental healthcare service provision however, this is not guaranteed in the Constitution nor recognised as a priority in the National Roadmap to Universal Healthcare. In Kenya, despite the right to access mental health services for all refugees and asylum seekers are often excluded from accessing care and/or face significant barriers. Kenya's Refugee Policy Framework also fails to include specific guidelines in access to psychosocial support for refuges. In South Africa, migrant populations have been mostly ignored in mental health policies and frameworks. Gender-aware health systems planning: South Africa has ensured that gender is integrated into health systems planning. However, there is a clear gap between policy and practice and a failure to engage with the intersection of migration and gender in terms of specific health needs. The DRC's National Migration Policy (2012) and the National Health Development Plan (2016) emphasise the need for gender-sensitive approaches however, limited resources, capacity and coordination present implementation obstacles. Similarly, for Kenya a set of gender-sensitive policies such as the National Policy for Prevention and Response to gender-based violence (2014) are restricted in impact due to a lack of coordination and collaboration while the heightened needs of refugee and asylum seeker women and girls are largely ignored. In Somalia efforts towards gender inclusion are reflected in The National Development Plan (2019-2023), which recognizes the need for gender-sensitive approaches in migration and health. While sexual offence legislation also exist the health and mental health legislation to not sufficiently engage with gender issues. Key findings: 1. All 4 countries have made progress in migration-aware health system planning although this remains limited. 2. Policies have been driven by siloed approaches to migration and health despite the significant intersections 3. South Africa has the most comprehensive legislation in terms of the right to health for all. Somalia and Kenya have some legislation which provides for the right to health but this remains limited. The DRC does not ensure the right to health for all 4. Kenya and Somalia have yet to develop gender-aware health systems while the DRC is making progress and South Africa has strong legislation in this regard. 5. The DRC is the only country with mental-health aware systems planning while South Africa, Kenya and Somalia still fall short on this. 6. Policies have been shaped by increasingly securitised approaches to borders impacting access to health services and increasing health and mental health challenges amongst some of the most marginalised in all four contexts. 7. Perceptions of mental health and of gendered norms impact on accessing support through health systems While committed to achieving UHC the DRC, Kenya, Somalia and South Africa face challenges posed by ongoing political tensions and conflict, weak health systems, as well as a lack of laws and policies that directly address the health needs of displaced populations. Considered through a policy lens these four countries provide an important picture of what happens in the gap between policy commitments and implementation and, the opportunities in addressing the challenges facing displaced populations by ensuring access to healthcare including mental health services as crucial their well-being. The Sustainable Development Goals (SDGs) - which aim to 'leave no-one behind' and promote broad human rights-based approaches to development - recognise the importance of addressing the right to access healthcare services for all. Goal 3 of the SDGs aims to "ensure healthy lives and promote well-being for all at all ages" and, through Goal 3.8, calls on states to "Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all." The need to address vulnerabilities and needs particular to migrants have been further articulated in the subsequent Political Declaration of the High-Level Meeting on Universal Health Coverage, which emphasises the need to progressively include migrants in advances towards achieving UHC. Increasing recognition of the need to improve responses to migration and health - including ensuring access to healthcare services - is evidenced through a growing global governance movement which is linked to three intersecting agendas: 1. Migration Governance - notably the Global Compacts on (1) Safe Orderly and Regular Migration and Refugees - which outline the importance of addressing the health needs of all migrants. 2. Development - Sustainable Development Goals (SDGs)43 and the target of achieving Universal Health Coverage. 3. Global Health - including ensuring the right to health for all migrants is articulated in two World Health Assembly (WHA) Resolutions and the resultant 2019 Global Action Plan (GAP) for the Health of Refugees and Migrants that encompasses six objectives that aim to address the health of refugees and migrants. As part of this work, we hosted and facilitated the DiSoCo Policy Analysis Workshop in September 2023.The workshop took place in Johannesburg, South Africa, from 11-15 September 2023, at the African Centre for Migration and Society (ACMS) at the University of Witwatersrand and brought together a group of researchers from the DiSoCo multi-sited country teams from South Africa, Somalia, Democratic Republic of Congo (DRC), Kenya, the Netherlands, and the UK. The focus of the workshop was to better understand and further explore the relationship of violence, protracted displacement, gender and mental health through a policy lens across the countries and regions included in the DiSoCo project. The DiSoCo project aims to assist displaced people including refugees, asylum seekers, Internal Displaced Persons (IDPs) and returnees in Somalia, Kenya, DRC and South Africa to access appropriate healthcare amidst protracted displacement, conflict and gendered violence. The first research question of this project - focuses on identifying and analyzing current policy processes that respond to the health needs of displaced people and thereby identifying existing models for integrating those populations into health systems that could be made applicable to our various protracted displacement contexts. The countries of interest in this research project experience significant levels of both inward and outward migration. This can be attributed to the presence of political and military instability and economic challenges within these nations. For example, both Somalia and DRC have endured several years of protracted conflicts and displacement, with their citizens exposed to several human rights violations including sexual abuse, torture and movement of people both within their borders and to global destinations including neighboring countries like Kenya and as far as South Africa. These two destination countries, situated in East Africa (Kenya) and the Southern African Development Community (SADC) region (South Africa), boast vibrant economies and rich cultural diversity, making them attractive to immigrants from around the world. However, despite their frequent experience with migration, the majority of their policies have lacked explicit provisions addressing migration-related issues. Policies in countries like the DRC, Somalia, and Kenya have not clearly outlined their implementation strategies for addressing migration challenges, especially concerning the protection of the rights of internally displaced persons (IDPs), asylum seekers, and refugees, who constitute a significant and often overlooked population in these nations. In the Somalia policy context for instance, the multiple levels of governance and political dynamics from the federal level, as well as the state levels within their decentralized federal system, creates tensions and implementation difficulties as many policies remain contested and in draft form. On the other hand, in South Africa, although the constitution and various policies have provided substantial and progressive provisions for refugees and asylum seekers, policy implementation is met with resistance and the country has recently introduced policy amendments that appear to restrict immigrants' access to basic services such as healthcare, employment, and psychosocial support for mental health challenges. In the Kenyan context, the current policies and frameworks designed to attain national health objectives and universal health coverage (UHC) lack a comprehensive guide or roadmap for displaced individuals, notably refugees and asylum seekers. Despite the presence of established programs and services, deficiencies in documentation hinder refugees from accessing the same services available to Kenyan nationals. This underscores the need to focus on the health and wellbeing of refugees, asylum seekers, internally displaced persons (IDPs), and returnees, with particular attention to the provision and accessibility of mental healthcare services. We believe that access to healthcare is a fundamental right for these vulnerable populations, one that should be guaranteed and protected by policy and legislation in both their hom e countries and host nations. Therefore, a comprehensive understanding of healthcare policies in the DiSoCo field contexts-Somalia, DRC, Kenya, and South Africa-is essential for promoting universal healthcare and fostering a migrant-aware and inclusive society.Inclusiveness is anchored in policies and legislation that consider migration, displacement, gender, health, and mental health. Among the critical focal points in policy analysis, various questions arise, such as: How comparable are policies regarding internally displaced persons (IDPs) and refugees, especially in terms of migration and health? How can we bridge the gap between policies as stated on paper and their actual implementation in practice? How do we ensure accountability? These critical inquiries position migration as a potential catalyst for inclusive, gender-sensitive, and mental health-focused policy discussions. Furthermore, the contextual factors in the field highlight how diversity and various dynamics propel the need for more specific approaches when addressing migration and mental health. While these questions do not have straightforward answers, this workshop offered an important step in thinking through these policy issues and how to make actionable recommendations to various policy stakeholders. ------ We led Work Package 1 which identifies which elements of existing models for integrating displaced people into healthcare systems were applied in our protracted displacement contexts. This was done through systematic reviews of the literature on: (a) healthcare systems that seek to integrate displaced people and (b) the evolution of legal and regulatory frameworks for IDPs (in Eastern DRC and Somalia) and refugees (in Kenya and South Africa) so as to understand why they have hitherto been organised differently. We evaluated the implications of recent international commitments such as Kenya's implementation of a Comprehensive Response Framework, the Kampala Convention for IDPs in Africa, and other binding and non-binding agreements and guidelines brokered by regional bodies (African Union, WHO Afro) and sub- regional bodies (East African Community, SADC). Semi-structured interviews were undertaken with key informants including policymakers identified via our network of partners - especially the Migration Health and Development Research Initiative and the Panzi Foundation and Mukwege Chairs networks associated with Nobel Peace prize winner Dr Dennis Mukwege. Key findings: Mental health in relation to refugees and migrants in South Africa is understood primarily as trauma and sexual violence. This means that mental health that is layered (i.e., trauma experienced at all stages of migration); complex and, shaped by specific socio-cultural experiences is ignored. Mental health challenges are determined by structural violence: Lack of documents, exclusion, poverty, poor access to housing, employment and support systems; discrimination, stigma and xenophobia; Violence within healthcare. Mental health challenges for refugees and migrants are felt through the body: "The body knows the score": Can be due to a lack or inability of language to express pain; Link between body and mind and somatic experiences; Visible/invisible pain. Health care workers do not understand the needs of refugees and migrants: the system is over-whelmed and refugees and migrants with some of greatest mental health challenges are seen as a threat and burden to the system while also misunderstood. This is compounded by: A shortage of psychiatrists and psychologists and community-responses; Lack of understanding and compassion; Poor mental health literacy; HCW themselves struggling with mental health. Services work but there is limited to no access to mental health care for refugees and migrants in South Africa: The mental healthcare system in South Africa is under-resourced, over-burdened and unable to respond to the needs of all and especially migrants. Responses: "Plugging the gaps" and responding to immediate needs to reduce mental stress: In recognition of specific needs and challenges faced by refugees and migrants' civil society create "parallel systems" to by-pass state services and reduce risks of stigma and discrimination; Recognition that responding to immediate needs ie no food, no rent money, access to schools etc. is the central response needed to reduce stress created by structural violence - this is the starting point. |
| Collaborator Contribution | DiSoCo is a GCRF Protracted Displacement project that aims to help Somali and Congolese displaced people to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence. DiSoCo is a multi-sited project focusing on Somali and Congolese Internally Displaced People (IDPs) in Somalia and Eastern DRC respectively, and Somali and Congolese refugees and asylum seekers in Kenya and South Africa. The DiSoCo team brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Specialists at Panzi Foundation (DRC), ARQ International (Netherlands), and Queen Margaret University (UK) support teams of researchers based at: Kinshasa School of Public Health (DRC) Université Evangélique en Afrique (DRC) Somali Institute for Development and Research (Somalia) Amref International University (Kenya) University of the Witwatersrand (South Africa) The University of Edinburgh (UK) Field Sites The DiSoCo project has eight field sites in Eastern DRC, Somalia, Kenya, and South Africa. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. Project Aims DiSoCo aims to help Somali and Congolese displaced people in Somalia, Eastern DRC, Kenya, and South Africa to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence by: Improving diagnosis, provision, and accessibility of healthcare for neglected chronic physical and mental ill-health conditions amongst displaced populations. Helping develop resilient, responsive, inclusive health systems which ultimately contribute to strong and welcoming societies. Supporting the development of mechanisms and organisations that empower displaced communities when they seek healthcare. |
| Impact | https://doi.org/10.1108/IJMHSC-11-2021-0103 https://thepolyphony.org/2021/09/21/behind-the-masks-mental-health-and-marginalisation-covid-19/ https://www.dailymaverick.co.za/article/2021-01-08-drones-dinghies-and-an-army-helicopter-why-the-states-new-toys-wont-help-south-africas-response-to-covid-19/ https://displacement.sps.ed.ac.uk/2021/04/05/your-home-is-the-place-you-cant-return-to-and-the-place-where-you-are-doesnt-appear-to-want-you/ https://www.emerald.com/insight/content/doi/10.1108/IJMHSC-11-2021-0103/full/html |
| Start Year | 2019 |
| Description | Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs: DiSoCo |
| Organisation | Somali Institute for Development Research and Analysis |
| Country | Somalia |
| Sector | Charity/Non Profit |
| PI Contribution | We developed an extensive policy review and analysis project. The review included two key approaches: a systematic policy review per country (South Africa, Somalia, Kenya and the DRC) and a set of semi-structured key informant interviews with policy makers and those shaping and implementing policy. The policy review used an assessment framework developed from previous policy reviews on migration and health to assess the extent to which laws and policies engaged with migration, health, mental health and gender - for each of the four countries. The assessment was based on 4 key questions which considered how the policies engage with a migrant's rights to health, with migration within healthcare planning, with mental health in health systems planning and with gender in terms of migration and health. Country reviews outline the status ratings given to each country on the 4 key questions. This allows to see the progress and the challenges that each country faces as well as to compare each country in terms of their legislative approaches to migration, gender and health. This allowed for comparisons within and across countries. The interviews targeted individuals working in a migration and/or health context and sought to better understand the links between policy and practice, changes in policy and challenges faced on the ground.A total of 70 interviews were conducted: 25 in South Africa (nationally and locally); 12 in Somalia (at a federal and state level); 32 in the DRC (at national level and in four provinces of the DRC (Kasai Central, Tanganyika, South Kivu and Ituri) and in 25 in Kenya. Between policy commitments and healthcare realities: From the reviews it is clear to see that the specific contexts and priorities of each country lead to significant differences in how they manage migration flows and uphold migrant rights, including in access to healthcare. Across all four countries although there is signs of progress no one country has has sufficiently incorporated and implemented migration, health and gender concerns within their legislative frameworks. Migrants rights to health: Constitutionally, Kenya, Somalia, the DRC and South Africa all provide for the right to health for all, although limitations are posed by either a lack of explicit inclusion of non-citizens and migrants or associated laws and policies which do not affirm Constitutional rights. While South Africa and Kenya both support health as a basic human right with rights-based legislative frameworks gaps in implementation and for South Africa a proposed National Health Insurance, restrict and undermine these rights. In Somalia the right to health for all is guaranteed by the Provisional Federal Constitution however, the Health Sector Strategic Plan (HSSP) and Essential Packages of Health Services (EPHS) do not explicitly include refugees and migrants. The DRC's 'Law on the Status of Refugees' stipulates administrative restrictions which may apply to foreigners. Migration-aware health systems planning: All four countries have made some progress in migration-aware health systems planning. Neither the DRC or Somalia have a comprehensive legal framework specifically governing migration and refugee rights, relying on fragmented legislation and policies. This impacts on the extent to which health systems are migration aware and can ensure the right to health for all. While the DRC's National Health Policy acknowledges the needs of IDPs and refugees and aims to integrate them into the national health system, Somalia's federal Government struggles with limited control over its territory and resources, hindering effective migration governance and health systems-planning. South Africa and Kenya, both have more comprehensive frameworks through which the challenges and needs of migrants are addressed. For South Africa the National Health Act is supported by the progressive National Integrated Sexual and Reproductive Health and Rights Policy (2019), which specifically includes gender-sensitive, and migrant-friendly reproductive health services within its broader framework. Meanwhile, the Kenya Health Policy 2014-2030, and the Universal Health Coverage Policy 2020-2030 align with the goals of UHC to offer quality health services generally and for refugees, specifically. Yet, both country's also face significant gaps in implementation and, have developed frameworks for National Health Insurance which are more exclusionary than assuring healthcare for all. Mental Health Aware health systems planning: The integration of mental health services and planning into broader health systems is neglected by Kenya, Somalia and South Africa - with the DRC alone comprehensively engaging with mental health care for migrants and refugees at a primary healthcare level. Both the DRC and `Somalia face increased challenges in addressing mental health needs among migrants and citizens exacerbated by the protracted political instability and conflict. The DRC has initiated efforts such as community-based programmes yet their reach and sustainability remain limited. Somalia outlines some rights and obligations for mental healthcare service provision however, this is not guaranteed in the Constitution nor recognised as a priority in the National Roadmap to Universal Healthcare. In Kenya, despite the right to access mental health services for all refugees and asylum seekers are often excluded from accessing care and/or face significant barriers. Kenya's Refugee Policy Framework also fails to include specific guidelines in access to psychosocial support for refuges. In South Africa, migrant populations have been mostly ignored in mental health policies and frameworks. Gender-aware health systems planning: South Africa has ensured that gender is integrated into health systems planning. However, there is a clear gap between policy and practice and a failure to engage with the intersection of migration and gender in terms of specific health needs. The DRC's National Migration Policy (2012) and the National Health Development Plan (2016) emphasise the need for gender-sensitive approaches however, limited resources, capacity and coordination present implementation obstacles. Similarly, for Kenya a set of gender-sensitive policies such as the National Policy for Prevention and Response to gender-based violence (2014) are restricted in impact due to a lack of coordination and collaboration while the heightened needs of refugee and asylum seeker women and girls are largely ignored. In Somalia efforts towards gender inclusion are reflected in The National Development Plan (2019-2023), which recognizes the need for gender-sensitive approaches in migration and health. While sexual offence legislation also exist the health and mental health legislation to not sufficiently engage with gender issues. Key findings: 1. All 4 countries have made progress in migration-aware health system planning although this remains limited. 2. Policies have been driven by siloed approaches to migration and health despite the significant intersections 3. South Africa has the most comprehensive legislation in terms of the right to health for all. Somalia and Kenya have some legislation which provides for the right to health but this remains limited. The DRC does not ensure the right to health for all 4. Kenya and Somalia have yet to develop gender-aware health systems while the DRC is making progress and South Africa has strong legislation in this regard. 5. The DRC is the only country with mental-health aware systems planning while South Africa, Kenya and Somalia still fall short on this. 6. Policies have been shaped by increasingly securitised approaches to borders impacting access to health services and increasing health and mental health challenges amongst some of the most marginalised in all four contexts. 7. Perceptions of mental health and of gendered norms impact on accessing support through health systems While committed to achieving UHC the DRC, Kenya, Somalia and South Africa face challenges posed by ongoing political tensions and conflict, weak health systems, as well as a lack of laws and policies that directly address the health needs of displaced populations. Considered through a policy lens these four countries provide an important picture of what happens in the gap between policy commitments and implementation and, the opportunities in addressing the challenges facing displaced populations by ensuring access to healthcare including mental health services as crucial their well-being. The Sustainable Development Goals (SDGs) - which aim to 'leave no-one behind' and promote broad human rights-based approaches to development - recognise the importance of addressing the right to access healthcare services for all. Goal 3 of the SDGs aims to "ensure healthy lives and promote well-being for all at all ages" and, through Goal 3.8, calls on states to "Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all." The need to address vulnerabilities and needs particular to migrants have been further articulated in the subsequent Political Declaration of the High-Level Meeting on Universal Health Coverage, which emphasises the need to progressively include migrants in advances towards achieving UHC. Increasing recognition of the need to improve responses to migration and health - including ensuring access to healthcare services - is evidenced through a growing global governance movement which is linked to three intersecting agendas: 1. Migration Governance - notably the Global Compacts on (1) Safe Orderly and Regular Migration and Refugees - which outline the importance of addressing the health needs of all migrants. 2. Development - Sustainable Development Goals (SDGs)43 and the target of achieving Universal Health Coverage. 3. Global Health - including ensuring the right to health for all migrants is articulated in two World Health Assembly (WHA) Resolutions and the resultant 2019 Global Action Plan (GAP) for the Health of Refugees and Migrants that encompasses six objectives that aim to address the health of refugees and migrants. As part of this work, we hosted and facilitated the DiSoCo Policy Analysis Workshop in September 2023.The workshop took place in Johannesburg, South Africa, from 11-15 September 2023, at the African Centre for Migration and Society (ACMS) at the University of Witwatersrand and brought together a group of researchers from the DiSoCo multi-sited country teams from South Africa, Somalia, Democratic Republic of Congo (DRC), Kenya, the Netherlands, and the UK. The focus of the workshop was to better understand and further explore the relationship of violence, protracted displacement, gender and mental health through a policy lens across the countries and regions included in the DiSoCo project. The DiSoCo project aims to assist displaced people including refugees, asylum seekers, Internal Displaced Persons (IDPs) and returnees in Somalia, Kenya, DRC and South Africa to access appropriate healthcare amidst protracted displacement, conflict and gendered violence. The first research question of this project - focuses on identifying and analyzing current policy processes that respond to the health needs of displaced people and thereby identifying existing models for integrating those populations into health systems that could be made applicable to our various protracted displacement contexts. The countries of interest in this research project experience significant levels of both inward and outward migration. This can be attributed to the presence of political and military instability and economic challenges within these nations. For example, both Somalia and DRC have endured several years of protracted conflicts and displacement, with their citizens exposed to several human rights violations including sexual abuse, torture and movement of people both within their borders and to global destinations including neighboring countries like Kenya and as far as South Africa. These two destination countries, situated in East Africa (Kenya) and the Southern African Development Community (SADC) region (South Africa), boast vibrant economies and rich cultural diversity, making them attractive to immigrants from around the world. However, despite their frequent experience with migration, the majority of their policies have lacked explicit provisions addressing migration-related issues. Policies in countries like the DRC, Somalia, and Kenya have not clearly outlined their implementation strategies for addressing migration challenges, especially concerning the protection of the rights of internally displaced persons (IDPs), asylum seekers, and refugees, who constitute a significant and often overlooked population in these nations. In the Somalia policy context for instance, the multiple levels of governance and political dynamics from the federal level, as well as the state levels within their decentralized federal system, creates tensions and implementation difficulties as many policies remain contested and in draft form. On the other hand, in South Africa, although the constitution and various policies have provided substantial and progressive provisions for refugees and asylum seekers, policy implementation is met with resistance and the country has recently introduced policy amendments that appear to restrict immigrants' access to basic services such as healthcare, employment, and psychosocial support for mental health challenges. In the Kenyan context, the current policies and frameworks designed to attain national health objectives and universal health coverage (UHC) lack a comprehensive guide or roadmap for displaced individuals, notably refugees and asylum seekers. Despite the presence of established programs and services, deficiencies in documentation hinder refugees from accessing the same services available to Kenyan nationals. This underscores the need to focus on the health and wellbeing of refugees, asylum seekers, internally displaced persons (IDPs), and returnees, with particular attention to the provision and accessibility of mental healthcare services. We believe that access to healthcare is a fundamental right for these vulnerable populations, one that should be guaranteed and protected by policy and legislation in both their hom e countries and host nations. Therefore, a comprehensive understanding of healthcare policies in the DiSoCo field contexts-Somalia, DRC, Kenya, and South Africa-is essential for promoting universal healthcare and fostering a migrant-aware and inclusive society.Inclusiveness is anchored in policies and legislation that consider migration, displacement, gender, health, and mental health. Among the critical focal points in policy analysis, various questions arise, such as: How comparable are policies regarding internally displaced persons (IDPs) and refugees, especially in terms of migration and health? How can we bridge the gap between policies as stated on paper and their actual implementation in practice? How do we ensure accountability? These critical inquiries position migration as a potential catalyst for inclusive, gender-sensitive, and mental health-focused policy discussions. Furthermore, the contextual factors in the field highlight how diversity and various dynamics propel the need for more specific approaches when addressing migration and mental health. While these questions do not have straightforward answers, this workshop offered an important step in thinking through these policy issues and how to make actionable recommendations to various policy stakeholders. ------ We led Work Package 1 which identifies which elements of existing models for integrating displaced people into healthcare systems were applied in our protracted displacement contexts. This was done through systematic reviews of the literature on: (a) healthcare systems that seek to integrate displaced people and (b) the evolution of legal and regulatory frameworks for IDPs (in Eastern DRC and Somalia) and refugees (in Kenya and South Africa) so as to understand why they have hitherto been organised differently. We evaluated the implications of recent international commitments such as Kenya's implementation of a Comprehensive Response Framework, the Kampala Convention for IDPs in Africa, and other binding and non-binding agreements and guidelines brokered by regional bodies (African Union, WHO Afro) and sub- regional bodies (East African Community, SADC). Semi-structured interviews were undertaken with key informants including policymakers identified via our network of partners - especially the Migration Health and Development Research Initiative and the Panzi Foundation and Mukwege Chairs networks associated with Nobel Peace prize winner Dr Dennis Mukwege. Key findings: Mental health in relation to refugees and migrants in South Africa is understood primarily as trauma and sexual violence. This means that mental health that is layered (i.e., trauma experienced at all stages of migration); complex and, shaped by specific socio-cultural experiences is ignored. Mental health challenges are determined by structural violence: Lack of documents, exclusion, poverty, poor access to housing, employment and support systems; discrimination, stigma and xenophobia; Violence within healthcare. Mental health challenges for refugees and migrants are felt through the body: "The body knows the score": Can be due to a lack or inability of language to express pain; Link between body and mind and somatic experiences; Visible/invisible pain. Health care workers do not understand the needs of refugees and migrants: the system is over-whelmed and refugees and migrants with some of greatest mental health challenges are seen as a threat and burden to the system while also misunderstood. This is compounded by: A shortage of psychiatrists and psychologists and community-responses; Lack of understanding and compassion; Poor mental health literacy; HCW themselves struggling with mental health. Services work but there is limited to no access to mental health care for refugees and migrants in South Africa: The mental healthcare system in South Africa is under-resourced, over-burdened and unable to respond to the needs of all and especially migrants. Responses: "Plugging the gaps" and responding to immediate needs to reduce mental stress: In recognition of specific needs and challenges faced by refugees and migrants' civil society create "parallel systems" to by-pass state services and reduce risks of stigma and discrimination; Recognition that responding to immediate needs ie no food, no rent money, access to schools etc. is the central response needed to reduce stress created by structural violence - this is the starting point. |
| Collaborator Contribution | DiSoCo is a GCRF Protracted Displacement project that aims to help Somali and Congolese displaced people to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence. DiSoCo is a multi-sited project focusing on Somali and Congolese Internally Displaced People (IDPs) in Somalia and Eastern DRC respectively, and Somali and Congolese refugees and asylum seekers in Kenya and South Africa. The DiSoCo team brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Specialists at Panzi Foundation (DRC), ARQ International (Netherlands), and Queen Margaret University (UK) support teams of researchers based at: Kinshasa School of Public Health (DRC) Université Evangélique en Afrique (DRC) Somali Institute for Development and Research (Somalia) Amref International University (Kenya) University of the Witwatersrand (South Africa) The University of Edinburgh (UK) Field Sites The DiSoCo project has eight field sites in Eastern DRC, Somalia, Kenya, and South Africa. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. Project Aims DiSoCo aims to help Somali and Congolese displaced people in Somalia, Eastern DRC, Kenya, and South Africa to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence by: Improving diagnosis, provision, and accessibility of healthcare for neglected chronic physical and mental ill-health conditions amongst displaced populations. Helping develop resilient, responsive, inclusive health systems which ultimately contribute to strong and welcoming societies. Supporting the development of mechanisms and organisations that empower displaced communities when they seek healthcare. |
| Impact | https://doi.org/10.1108/IJMHSC-11-2021-0103 https://thepolyphony.org/2021/09/21/behind-the-masks-mental-health-and-marginalisation-covid-19/ https://www.dailymaverick.co.za/article/2021-01-08-drones-dinghies-and-an-army-helicopter-why-the-states-new-toys-wont-help-south-africas-response-to-covid-19/ https://displacement.sps.ed.ac.uk/2021/04/05/your-home-is-the-place-you-cant-return-to-and-the-place-where-you-are-doesnt-appear-to-want-you/ https://www.emerald.com/insight/content/doi/10.1108/IJMHSC-11-2021-0103/full/html |
| Start Year | 2019 |
| Description | Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs: DiSoCo |
| Organisation | University of Edinburgh |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We developed an extensive policy review and analysis project. The review included two key approaches: a systematic policy review per country (South Africa, Somalia, Kenya and the DRC) and a set of semi-structured key informant interviews with policy makers and those shaping and implementing policy. The policy review used an assessment framework developed from previous policy reviews on migration and health to assess the extent to which laws and policies engaged with migration, health, mental health and gender - for each of the four countries. The assessment was based on 4 key questions which considered how the policies engage with a migrant's rights to health, with migration within healthcare planning, with mental health in health systems planning and with gender in terms of migration and health. Country reviews outline the status ratings given to each country on the 4 key questions. This allows to see the progress and the challenges that each country faces as well as to compare each country in terms of their legislative approaches to migration, gender and health. This allowed for comparisons within and across countries. The interviews targeted individuals working in a migration and/or health context and sought to better understand the links between policy and practice, changes in policy and challenges faced on the ground.A total of 70 interviews were conducted: 25 in South Africa (nationally and locally); 12 in Somalia (at a federal and state level); 32 in the DRC (at national level and in four provinces of the DRC (Kasai Central, Tanganyika, South Kivu and Ituri) and in 25 in Kenya. Between policy commitments and healthcare realities: From the reviews it is clear to see that the specific contexts and priorities of each country lead to significant differences in how they manage migration flows and uphold migrant rights, including in access to healthcare. Across all four countries although there is signs of progress no one country has has sufficiently incorporated and implemented migration, health and gender concerns within their legislative frameworks. Migrants rights to health: Constitutionally, Kenya, Somalia, the DRC and South Africa all provide for the right to health for all, although limitations are posed by either a lack of explicit inclusion of non-citizens and migrants or associated laws and policies which do not affirm Constitutional rights. While South Africa and Kenya both support health as a basic human right with rights-based legislative frameworks gaps in implementation and for South Africa a proposed National Health Insurance, restrict and undermine these rights. In Somalia the right to health for all is guaranteed by the Provisional Federal Constitution however, the Health Sector Strategic Plan (HSSP) and Essential Packages of Health Services (EPHS) do not explicitly include refugees and migrants. The DRC's 'Law on the Status of Refugees' stipulates administrative restrictions which may apply to foreigners. Migration-aware health systems planning: All four countries have made some progress in migration-aware health systems planning. Neither the DRC or Somalia have a comprehensive legal framework specifically governing migration and refugee rights, relying on fragmented legislation and policies. This impacts on the extent to which health systems are migration aware and can ensure the right to health for all. While the DRC's National Health Policy acknowledges the needs of IDPs and refugees and aims to integrate them into the national health system, Somalia's federal Government struggles with limited control over its territory and resources, hindering effective migration governance and health systems-planning. South Africa and Kenya, both have more comprehensive frameworks through which the challenges and needs of migrants are addressed. For South Africa the National Health Act is supported by the progressive National Integrated Sexual and Reproductive Health and Rights Policy (2019), which specifically includes gender-sensitive, and migrant-friendly reproductive health services within its broader framework. Meanwhile, the Kenya Health Policy 2014-2030, and the Universal Health Coverage Policy 2020-2030 align with the goals of UHC to offer quality health services generally and for refugees, specifically. Yet, both country's also face significant gaps in implementation and, have developed frameworks for National Health Insurance which are more exclusionary than assuring healthcare for all. Mental Health Aware health systems planning: The integration of mental health services and planning into broader health systems is neglected by Kenya, Somalia and South Africa - with the DRC alone comprehensively engaging with mental health care for migrants and refugees at a primary healthcare level. Both the DRC and `Somalia face increased challenges in addressing mental health needs among migrants and citizens exacerbated by the protracted political instability and conflict. The DRC has initiated efforts such as community-based programmes yet their reach and sustainability remain limited. Somalia outlines some rights and obligations for mental healthcare service provision however, this is not guaranteed in the Constitution nor recognised as a priority in the National Roadmap to Universal Healthcare. In Kenya, despite the right to access mental health services for all refugees and asylum seekers are often excluded from accessing care and/or face significant barriers. Kenya's Refugee Policy Framework also fails to include specific guidelines in access to psychosocial support for refuges. In South Africa, migrant populations have been mostly ignored in mental health policies and frameworks. Gender-aware health systems planning: South Africa has ensured that gender is integrated into health systems planning. However, there is a clear gap between policy and practice and a failure to engage with the intersection of migration and gender in terms of specific health needs. The DRC's National Migration Policy (2012) and the National Health Development Plan (2016) emphasise the need for gender-sensitive approaches however, limited resources, capacity and coordination present implementation obstacles. Similarly, for Kenya a set of gender-sensitive policies such as the National Policy for Prevention and Response to gender-based violence (2014) are restricted in impact due to a lack of coordination and collaboration while the heightened needs of refugee and asylum seeker women and girls are largely ignored. In Somalia efforts towards gender inclusion are reflected in The National Development Plan (2019-2023), which recognizes the need for gender-sensitive approaches in migration and health. While sexual offence legislation also exist the health and mental health legislation to not sufficiently engage with gender issues. Key findings: 1. All 4 countries have made progress in migration-aware health system planning although this remains limited. 2. Policies have been driven by siloed approaches to migration and health despite the significant intersections 3. South Africa has the most comprehensive legislation in terms of the right to health for all. Somalia and Kenya have some legislation which provides for the right to health but this remains limited. The DRC does not ensure the right to health for all 4. Kenya and Somalia have yet to develop gender-aware health systems while the DRC is making progress and South Africa has strong legislation in this regard. 5. The DRC is the only country with mental-health aware systems planning while South Africa, Kenya and Somalia still fall short on this. 6. Policies have been shaped by increasingly securitised approaches to borders impacting access to health services and increasing health and mental health challenges amongst some of the most marginalised in all four contexts. 7. Perceptions of mental health and of gendered norms impact on accessing support through health systems While committed to achieving UHC the DRC, Kenya, Somalia and South Africa face challenges posed by ongoing political tensions and conflict, weak health systems, as well as a lack of laws and policies that directly address the health needs of displaced populations. Considered through a policy lens these four countries provide an important picture of what happens in the gap between policy commitments and implementation and, the opportunities in addressing the challenges facing displaced populations by ensuring access to healthcare including mental health services as crucial their well-being. The Sustainable Development Goals (SDGs) - which aim to 'leave no-one behind' and promote broad human rights-based approaches to development - recognise the importance of addressing the right to access healthcare services for all. Goal 3 of the SDGs aims to "ensure healthy lives and promote well-being for all at all ages" and, through Goal 3.8, calls on states to "Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all." The need to address vulnerabilities and needs particular to migrants have been further articulated in the subsequent Political Declaration of the High-Level Meeting on Universal Health Coverage, which emphasises the need to progressively include migrants in advances towards achieving UHC. Increasing recognition of the need to improve responses to migration and health - including ensuring access to healthcare services - is evidenced through a growing global governance movement which is linked to three intersecting agendas: 1. Migration Governance - notably the Global Compacts on (1) Safe Orderly and Regular Migration and Refugees - which outline the importance of addressing the health needs of all migrants. 2. Development - Sustainable Development Goals (SDGs)43 and the target of achieving Universal Health Coverage. 3. Global Health - including ensuring the right to health for all migrants is articulated in two World Health Assembly (WHA) Resolutions and the resultant 2019 Global Action Plan (GAP) for the Health of Refugees and Migrants that encompasses six objectives that aim to address the health of refugees and migrants. As part of this work, we hosted and facilitated the DiSoCo Policy Analysis Workshop in September 2023.The workshop took place in Johannesburg, South Africa, from 11-15 September 2023, at the African Centre for Migration and Society (ACMS) at the University of Witwatersrand and brought together a group of researchers from the DiSoCo multi-sited country teams from South Africa, Somalia, Democratic Republic of Congo (DRC), Kenya, the Netherlands, and the UK. The focus of the workshop was to better understand and further explore the relationship of violence, protracted displacement, gender and mental health through a policy lens across the countries and regions included in the DiSoCo project. The DiSoCo project aims to assist displaced people including refugees, asylum seekers, Internal Displaced Persons (IDPs) and returnees in Somalia, Kenya, DRC and South Africa to access appropriate healthcare amidst protracted displacement, conflict and gendered violence. The first research question of this project - focuses on identifying and analyzing current policy processes that respond to the health needs of displaced people and thereby identifying existing models for integrating those populations into health systems that could be made applicable to our various protracted displacement contexts. The countries of interest in this research project experience significant levels of both inward and outward migration. This can be attributed to the presence of political and military instability and economic challenges within these nations. For example, both Somalia and DRC have endured several years of protracted conflicts and displacement, with their citizens exposed to several human rights violations including sexual abuse, torture and movement of people both within their borders and to global destinations including neighboring countries like Kenya and as far as South Africa. These two destination countries, situated in East Africa (Kenya) and the Southern African Development Community (SADC) region (South Africa), boast vibrant economies and rich cultural diversity, making them attractive to immigrants from around the world. However, despite their frequent experience with migration, the majority of their policies have lacked explicit provisions addressing migration-related issues. Policies in countries like the DRC, Somalia, and Kenya have not clearly outlined their implementation strategies for addressing migration challenges, especially concerning the protection of the rights of internally displaced persons (IDPs), asylum seekers, and refugees, who constitute a significant and often overlooked population in these nations. In the Somalia policy context for instance, the multiple levels of governance and political dynamics from the federal level, as well as the state levels within their decentralized federal system, creates tensions and implementation difficulties as many policies remain contested and in draft form. On the other hand, in South Africa, although the constitution and various policies have provided substantial and progressive provisions for refugees and asylum seekers, policy implementation is met with resistance and the country has recently introduced policy amendments that appear to restrict immigrants' access to basic services such as healthcare, employment, and psychosocial support for mental health challenges. In the Kenyan context, the current policies and frameworks designed to attain national health objectives and universal health coverage (UHC) lack a comprehensive guide or roadmap for displaced individuals, notably refugees and asylum seekers. Despite the presence of established programs and services, deficiencies in documentation hinder refugees from accessing the same services available to Kenyan nationals. This underscores the need to focus on the health and wellbeing of refugees, asylum seekers, internally displaced persons (IDPs), and returnees, with particular attention to the provision and accessibility of mental healthcare services. We believe that access to healthcare is a fundamental right for these vulnerable populations, one that should be guaranteed and protected by policy and legislation in both their hom e countries and host nations. Therefore, a comprehensive understanding of healthcare policies in the DiSoCo field contexts-Somalia, DRC, Kenya, and South Africa-is essential for promoting universal healthcare and fostering a migrant-aware and inclusive society.Inclusiveness is anchored in policies and legislation that consider migration, displacement, gender, health, and mental health. Among the critical focal points in policy analysis, various questions arise, such as: How comparable are policies regarding internally displaced persons (IDPs) and refugees, especially in terms of migration and health? How can we bridge the gap between policies as stated on paper and their actual implementation in practice? How do we ensure accountability? These critical inquiries position migration as a potential catalyst for inclusive, gender-sensitive, and mental health-focused policy discussions. Furthermore, the contextual factors in the field highlight how diversity and various dynamics propel the need for more specific approaches when addressing migration and mental health. While these questions do not have straightforward answers, this workshop offered an important step in thinking through these policy issues and how to make actionable recommendations to various policy stakeholders. ------ We led Work Package 1 which identifies which elements of existing models for integrating displaced people into healthcare systems were applied in our protracted displacement contexts. This was done through systematic reviews of the literature on: (a) healthcare systems that seek to integrate displaced people and (b) the evolution of legal and regulatory frameworks for IDPs (in Eastern DRC and Somalia) and refugees (in Kenya and South Africa) so as to understand why they have hitherto been organised differently. We evaluated the implications of recent international commitments such as Kenya's implementation of a Comprehensive Response Framework, the Kampala Convention for IDPs in Africa, and other binding and non-binding agreements and guidelines brokered by regional bodies (African Union, WHO Afro) and sub- regional bodies (East African Community, SADC). Semi-structured interviews were undertaken with key informants including policymakers identified via our network of partners - especially the Migration Health and Development Research Initiative and the Panzi Foundation and Mukwege Chairs networks associated with Nobel Peace prize winner Dr Dennis Mukwege. Key findings: Mental health in relation to refugees and migrants in South Africa is understood primarily as trauma and sexual violence. This means that mental health that is layered (i.e., trauma experienced at all stages of migration); complex and, shaped by specific socio-cultural experiences is ignored. Mental health challenges are determined by structural violence: Lack of documents, exclusion, poverty, poor access to housing, employment and support systems; discrimination, stigma and xenophobia; Violence within healthcare. Mental health challenges for refugees and migrants are felt through the body: "The body knows the score": Can be due to a lack or inability of language to express pain; Link between body and mind and somatic experiences; Visible/invisible pain. Health care workers do not understand the needs of refugees and migrants: the system is over-whelmed and refugees and migrants with some of greatest mental health challenges are seen as a threat and burden to the system while also misunderstood. This is compounded by: A shortage of psychiatrists and psychologists and community-responses; Lack of understanding and compassion; Poor mental health literacy; HCW themselves struggling with mental health. Services work but there is limited to no access to mental health care for refugees and migrants in South Africa: The mental healthcare system in South Africa is under-resourced, over-burdened and unable to respond to the needs of all and especially migrants. Responses: "Plugging the gaps" and responding to immediate needs to reduce mental stress: In recognition of specific needs and challenges faced by refugees and migrants' civil society create "parallel systems" to by-pass state services and reduce risks of stigma and discrimination; Recognition that responding to immediate needs ie no food, no rent money, access to schools etc. is the central response needed to reduce stress created by structural violence - this is the starting point. |
| Collaborator Contribution | DiSoCo is a GCRF Protracted Displacement project that aims to help Somali and Congolese displaced people to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence. DiSoCo is a multi-sited project focusing on Somali and Congolese Internally Displaced People (IDPs) in Somalia and Eastern DRC respectively, and Somali and Congolese refugees and asylum seekers in Kenya and South Africa. The DiSoCo team brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Specialists at Panzi Foundation (DRC), ARQ International (Netherlands), and Queen Margaret University (UK) support teams of researchers based at: Kinshasa School of Public Health (DRC) Université Evangélique en Afrique (DRC) Somali Institute for Development and Research (Somalia) Amref International University (Kenya) University of the Witwatersrand (South Africa) The University of Edinburgh (UK) Field Sites The DiSoCo project has eight field sites in Eastern DRC, Somalia, Kenya, and South Africa. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. Project Aims DiSoCo aims to help Somali and Congolese displaced people in Somalia, Eastern DRC, Kenya, and South Africa to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence by: Improving diagnosis, provision, and accessibility of healthcare for neglected chronic physical and mental ill-health conditions amongst displaced populations. Helping develop resilient, responsive, inclusive health systems which ultimately contribute to strong and welcoming societies. Supporting the development of mechanisms and organisations that empower displaced communities when they seek healthcare. |
| Impact | https://doi.org/10.1108/IJMHSC-11-2021-0103 https://thepolyphony.org/2021/09/21/behind-the-masks-mental-health-and-marginalisation-covid-19/ https://www.dailymaverick.co.za/article/2021-01-08-drones-dinghies-and-an-army-helicopter-why-the-states-new-toys-wont-help-south-africas-response-to-covid-19/ https://displacement.sps.ed.ac.uk/2021/04/05/your-home-is-the-place-you-cant-return-to-and-the-place-where-you-are-doesnt-appear-to-want-you/ https://www.emerald.com/insight/content/doi/10.1108/IJMHSC-11-2021-0103/full/html |
| Start Year | 2019 |
| Description | Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs: DiSoCo |
| Organisation | University of Kinshasa |
| Country | Congo, the Democratic Republic of the |
| Sector | Academic/University |
| PI Contribution | We developed an extensive policy review and analysis project. The review included two key approaches: a systematic policy review per country (South Africa, Somalia, Kenya and the DRC) and a set of semi-structured key informant interviews with policy makers and those shaping and implementing policy. The policy review used an assessment framework developed from previous policy reviews on migration and health to assess the extent to which laws and policies engaged with migration, health, mental health and gender - for each of the four countries. The assessment was based on 4 key questions which considered how the policies engage with a migrant's rights to health, with migration within healthcare planning, with mental health in health systems planning and with gender in terms of migration and health. Country reviews outline the status ratings given to each country on the 4 key questions. This allows to see the progress and the challenges that each country faces as well as to compare each country in terms of their legislative approaches to migration, gender and health. This allowed for comparisons within and across countries. The interviews targeted individuals working in a migration and/or health context and sought to better understand the links between policy and practice, changes in policy and challenges faced on the ground.A total of 70 interviews were conducted: 25 in South Africa (nationally and locally); 12 in Somalia (at a federal and state level); 32 in the DRC (at national level and in four provinces of the DRC (Kasai Central, Tanganyika, South Kivu and Ituri) and in 25 in Kenya. Between policy commitments and healthcare realities: From the reviews it is clear to see that the specific contexts and priorities of each country lead to significant differences in how they manage migration flows and uphold migrant rights, including in access to healthcare. Across all four countries although there is signs of progress no one country has has sufficiently incorporated and implemented migration, health and gender concerns within their legislative frameworks. Migrants rights to health: Constitutionally, Kenya, Somalia, the DRC and South Africa all provide for the right to health for all, although limitations are posed by either a lack of explicit inclusion of non-citizens and migrants or associated laws and policies which do not affirm Constitutional rights. While South Africa and Kenya both support health as a basic human right with rights-based legislative frameworks gaps in implementation and for South Africa a proposed National Health Insurance, restrict and undermine these rights. In Somalia the right to health for all is guaranteed by the Provisional Federal Constitution however, the Health Sector Strategic Plan (HSSP) and Essential Packages of Health Services (EPHS) do not explicitly include refugees and migrants. The DRC's 'Law on the Status of Refugees' stipulates administrative restrictions which may apply to foreigners. Migration-aware health systems planning: All four countries have made some progress in migration-aware health systems planning. Neither the DRC or Somalia have a comprehensive legal framework specifically governing migration and refugee rights, relying on fragmented legislation and policies. This impacts on the extent to which health systems are migration aware and can ensure the right to health for all. While the DRC's National Health Policy acknowledges the needs of IDPs and refugees and aims to integrate them into the national health system, Somalia's federal Government struggles with limited control over its territory and resources, hindering effective migration governance and health systems-planning. South Africa and Kenya, both have more comprehensive frameworks through which the challenges and needs of migrants are addressed. For South Africa the National Health Act is supported by the progressive National Integrated Sexual and Reproductive Health and Rights Policy (2019), which specifically includes gender-sensitive, and migrant-friendly reproductive health services within its broader framework. Meanwhile, the Kenya Health Policy 2014-2030, and the Universal Health Coverage Policy 2020-2030 align with the goals of UHC to offer quality health services generally and for refugees, specifically. Yet, both country's also face significant gaps in implementation and, have developed frameworks for National Health Insurance which are more exclusionary than assuring healthcare for all. Mental Health Aware health systems planning: The integration of mental health services and planning into broader health systems is neglected by Kenya, Somalia and South Africa - with the DRC alone comprehensively engaging with mental health care for migrants and refugees at a primary healthcare level. Both the DRC and `Somalia face increased challenges in addressing mental health needs among migrants and citizens exacerbated by the protracted political instability and conflict. The DRC has initiated efforts such as community-based programmes yet their reach and sustainability remain limited. Somalia outlines some rights and obligations for mental healthcare service provision however, this is not guaranteed in the Constitution nor recognised as a priority in the National Roadmap to Universal Healthcare. In Kenya, despite the right to access mental health services for all refugees and asylum seekers are often excluded from accessing care and/or face significant barriers. Kenya's Refugee Policy Framework also fails to include specific guidelines in access to psychosocial support for refuges. In South Africa, migrant populations have been mostly ignored in mental health policies and frameworks. Gender-aware health systems planning: South Africa has ensured that gender is integrated into health systems planning. However, there is a clear gap between policy and practice and a failure to engage with the intersection of migration and gender in terms of specific health needs. The DRC's National Migration Policy (2012) and the National Health Development Plan (2016) emphasise the need for gender-sensitive approaches however, limited resources, capacity and coordination present implementation obstacles. Similarly, for Kenya a set of gender-sensitive policies such as the National Policy for Prevention and Response to gender-based violence (2014) are restricted in impact due to a lack of coordination and collaboration while the heightened needs of refugee and asylum seeker women and girls are largely ignored. In Somalia efforts towards gender inclusion are reflected in The National Development Plan (2019-2023), which recognizes the need for gender-sensitive approaches in migration and health. While sexual offence legislation also exist the health and mental health legislation to not sufficiently engage with gender issues. Key findings: 1. All 4 countries have made progress in migration-aware health system planning although this remains limited. 2. Policies have been driven by siloed approaches to migration and health despite the significant intersections 3. South Africa has the most comprehensive legislation in terms of the right to health for all. Somalia and Kenya have some legislation which provides for the right to health but this remains limited. The DRC does not ensure the right to health for all 4. Kenya and Somalia have yet to develop gender-aware health systems while the DRC is making progress and South Africa has strong legislation in this regard. 5. The DRC is the only country with mental-health aware systems planning while South Africa, Kenya and Somalia still fall short on this. 6. Policies have been shaped by increasingly securitised approaches to borders impacting access to health services and increasing health and mental health challenges amongst some of the most marginalised in all four contexts. 7. Perceptions of mental health and of gendered norms impact on accessing support through health systems While committed to achieving UHC the DRC, Kenya, Somalia and South Africa face challenges posed by ongoing political tensions and conflict, weak health systems, as well as a lack of laws and policies that directly address the health needs of displaced populations. Considered through a policy lens these four countries provide an important picture of what happens in the gap between policy commitments and implementation and, the opportunities in addressing the challenges facing displaced populations by ensuring access to healthcare including mental health services as crucial their well-being. The Sustainable Development Goals (SDGs) - which aim to 'leave no-one behind' and promote broad human rights-based approaches to development - recognise the importance of addressing the right to access healthcare services for all. Goal 3 of the SDGs aims to "ensure healthy lives and promote well-being for all at all ages" and, through Goal 3.8, calls on states to "Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all." The need to address vulnerabilities and needs particular to migrants have been further articulated in the subsequent Political Declaration of the High-Level Meeting on Universal Health Coverage, which emphasises the need to progressively include migrants in advances towards achieving UHC. Increasing recognition of the need to improve responses to migration and health - including ensuring access to healthcare services - is evidenced through a growing global governance movement which is linked to three intersecting agendas: 1. Migration Governance - notably the Global Compacts on (1) Safe Orderly and Regular Migration and Refugees - which outline the importance of addressing the health needs of all migrants. 2. Development - Sustainable Development Goals (SDGs)43 and the target of achieving Universal Health Coverage. 3. Global Health - including ensuring the right to health for all migrants is articulated in two World Health Assembly (WHA) Resolutions and the resultant 2019 Global Action Plan (GAP) for the Health of Refugees and Migrants that encompasses six objectives that aim to address the health of refugees and migrants. As part of this work, we hosted and facilitated the DiSoCo Policy Analysis Workshop in September 2023.The workshop took place in Johannesburg, South Africa, from 11-15 September 2023, at the African Centre for Migration and Society (ACMS) at the University of Witwatersrand and brought together a group of researchers from the DiSoCo multi-sited country teams from South Africa, Somalia, Democratic Republic of Congo (DRC), Kenya, the Netherlands, and the UK. The focus of the workshop was to better understand and further explore the relationship of violence, protracted displacement, gender and mental health through a policy lens across the countries and regions included in the DiSoCo project. The DiSoCo project aims to assist displaced people including refugees, asylum seekers, Internal Displaced Persons (IDPs) and returnees in Somalia, Kenya, DRC and South Africa to access appropriate healthcare amidst protracted displacement, conflict and gendered violence. The first research question of this project - focuses on identifying and analyzing current policy processes that respond to the health needs of displaced people and thereby identifying existing models for integrating those populations into health systems that could be made applicable to our various protracted displacement contexts. The countries of interest in this research project experience significant levels of both inward and outward migration. This can be attributed to the presence of political and military instability and economic challenges within these nations. For example, both Somalia and DRC have endured several years of protracted conflicts and displacement, with their citizens exposed to several human rights violations including sexual abuse, torture and movement of people both within their borders and to global destinations including neighboring countries like Kenya and as far as South Africa. These two destination countries, situated in East Africa (Kenya) and the Southern African Development Community (SADC) region (South Africa), boast vibrant economies and rich cultural diversity, making them attractive to immigrants from around the world. However, despite their frequent experience with migration, the majority of their policies have lacked explicit provisions addressing migration-related issues. Policies in countries like the DRC, Somalia, and Kenya have not clearly outlined their implementation strategies for addressing migration challenges, especially concerning the protection of the rights of internally displaced persons (IDPs), asylum seekers, and refugees, who constitute a significant and often overlooked population in these nations. In the Somalia policy context for instance, the multiple levels of governance and political dynamics from the federal level, as well as the state levels within their decentralized federal system, creates tensions and implementation difficulties as many policies remain contested and in draft form. On the other hand, in South Africa, although the constitution and various policies have provided substantial and progressive provisions for refugees and asylum seekers, policy implementation is met with resistance and the country has recently introduced policy amendments that appear to restrict immigrants' access to basic services such as healthcare, employment, and psychosocial support for mental health challenges. In the Kenyan context, the current policies and frameworks designed to attain national health objectives and universal health coverage (UHC) lack a comprehensive guide or roadmap for displaced individuals, notably refugees and asylum seekers. Despite the presence of established programs and services, deficiencies in documentation hinder refugees from accessing the same services available to Kenyan nationals. This underscores the need to focus on the health and wellbeing of refugees, asylum seekers, internally displaced persons (IDPs), and returnees, with particular attention to the provision and accessibility of mental healthcare services. We believe that access to healthcare is a fundamental right for these vulnerable populations, one that should be guaranteed and protected by policy and legislation in both their hom e countries and host nations. Therefore, a comprehensive understanding of healthcare policies in the DiSoCo field contexts-Somalia, DRC, Kenya, and South Africa-is essential for promoting universal healthcare and fostering a migrant-aware and inclusive society.Inclusiveness is anchored in policies and legislation that consider migration, displacement, gender, health, and mental health. Among the critical focal points in policy analysis, various questions arise, such as: How comparable are policies regarding internally displaced persons (IDPs) and refugees, especially in terms of migration and health? How can we bridge the gap between policies as stated on paper and their actual implementation in practice? How do we ensure accountability? These critical inquiries position migration as a potential catalyst for inclusive, gender-sensitive, and mental health-focused policy discussions. Furthermore, the contextual factors in the field highlight how diversity and various dynamics propel the need for more specific approaches when addressing migration and mental health. While these questions do not have straightforward answers, this workshop offered an important step in thinking through these policy issues and how to make actionable recommendations to various policy stakeholders. ------ We led Work Package 1 which identifies which elements of existing models for integrating displaced people into healthcare systems were applied in our protracted displacement contexts. This was done through systematic reviews of the literature on: (a) healthcare systems that seek to integrate displaced people and (b) the evolution of legal and regulatory frameworks for IDPs (in Eastern DRC and Somalia) and refugees (in Kenya and South Africa) so as to understand why they have hitherto been organised differently. We evaluated the implications of recent international commitments such as Kenya's implementation of a Comprehensive Response Framework, the Kampala Convention for IDPs in Africa, and other binding and non-binding agreements and guidelines brokered by regional bodies (African Union, WHO Afro) and sub- regional bodies (East African Community, SADC). Semi-structured interviews were undertaken with key informants including policymakers identified via our network of partners - especially the Migration Health and Development Research Initiative and the Panzi Foundation and Mukwege Chairs networks associated with Nobel Peace prize winner Dr Dennis Mukwege. Key findings: Mental health in relation to refugees and migrants in South Africa is understood primarily as trauma and sexual violence. This means that mental health that is layered (i.e., trauma experienced at all stages of migration); complex and, shaped by specific socio-cultural experiences is ignored. Mental health challenges are determined by structural violence: Lack of documents, exclusion, poverty, poor access to housing, employment and support systems; discrimination, stigma and xenophobia; Violence within healthcare. Mental health challenges for refugees and migrants are felt through the body: "The body knows the score": Can be due to a lack or inability of language to express pain; Link between body and mind and somatic experiences; Visible/invisible pain. Health care workers do not understand the needs of refugees and migrants: the system is over-whelmed and refugees and migrants with some of greatest mental health challenges are seen as a threat and burden to the system while also misunderstood. This is compounded by: A shortage of psychiatrists and psychologists and community-responses; Lack of understanding and compassion; Poor mental health literacy; HCW themselves struggling with mental health. Services work but there is limited to no access to mental health care for refugees and migrants in South Africa: The mental healthcare system in South Africa is under-resourced, over-burdened and unable to respond to the needs of all and especially migrants. Responses: "Plugging the gaps" and responding to immediate needs to reduce mental stress: In recognition of specific needs and challenges faced by refugees and migrants' civil society create "parallel systems" to by-pass state services and reduce risks of stigma and discrimination; Recognition that responding to immediate needs ie no food, no rent money, access to schools etc. is the central response needed to reduce stress created by structural violence - this is the starting point. |
| Collaborator Contribution | DiSoCo is a GCRF Protracted Displacement project that aims to help Somali and Congolese displaced people to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence. DiSoCo is a multi-sited project focusing on Somali and Congolese Internally Displaced People (IDPs) in Somalia and Eastern DRC respectively, and Somali and Congolese refugees and asylum seekers in Kenya and South Africa. The DiSoCo team brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Specialists at Panzi Foundation (DRC), ARQ International (Netherlands), and Queen Margaret University (UK) support teams of researchers based at: Kinshasa School of Public Health (DRC) Université Evangélique en Afrique (DRC) Somali Institute for Development and Research (Somalia) Amref International University (Kenya) University of the Witwatersrand (South Africa) The University of Edinburgh (UK) Field Sites The DiSoCo project has eight field sites in Eastern DRC, Somalia, Kenya, and South Africa. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. Project Aims DiSoCo aims to help Somali and Congolese displaced people in Somalia, Eastern DRC, Kenya, and South Africa to access appropriate healthcare for chronic mental health conditions associated with protracted displacement, conflict, and sexual and gender-based violence by: Improving diagnosis, provision, and accessibility of healthcare for neglected chronic physical and mental ill-health conditions amongst displaced populations. Helping develop resilient, responsive, inclusive health systems which ultimately contribute to strong and welcoming societies. Supporting the development of mechanisms and organisations that empower displaced communities when they seek healthcare. |
| Impact | https://doi.org/10.1108/IJMHSC-11-2021-0103 https://thepolyphony.org/2021/09/21/behind-the-masks-mental-health-and-marginalisation-covid-19/ https://www.dailymaverick.co.za/article/2021-01-08-drones-dinghies-and-an-army-helicopter-why-the-states-new-toys-wont-help-south-africas-response-to-covid-19/ https://displacement.sps.ed.ac.uk/2021/04/05/your-home-is-the-place-you-cant-return-to-and-the-place-where-you-are-doesnt-appear-to-want-you/ https://www.emerald.com/insight/content/doi/10.1108/IJMHSC-11-2021-0103/full/html |
| Start Year | 2019 |
| Description | MiGHS: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers |
| Organisation | Kenya Medical Research Institute |
| Country | Kenya |
| Sector | Public |
| PI Contribution | This research is funded through the Health Systems Research Initiative (HSRI) in the UK, a collaboration of UK MRC, ERSC, DFID, and the Wellcome Trust. Grant number: MR/S013601/1. Grant title: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers Grant duration: January 2019 - January 2022 (36 months) MiGHS is a research collaboration between researchers at the London School of Hygiene and Tropical Medicine (LSHTM), the African Centre for Migration & Society (ACMS) at the University of the Witwatersrand (Wits), the University of Cape Town (UCT) and the South African Department of Health (DoH). It has been developed to address one of the most pressing issues facing health systems globally and at a national level in South Africa - the impacts of and response to migration and its intersection with gender. MiGHS responds specifically to needs identified through exploratory research undertaken by the investigators in South Africa. The project has been designed to directly inform policies and build capacity amongst researchers, policymakers and implementers, to make health systems more responsive to the intersection between gender and migration in South Africa and globally. It will do so by generating new knowledge and a series of innovative impact activities. This project will examine how migration and population mobility affect the South African health system, and how the health system responds and adapts as a result of migration and population mobility. The research explicitly explores gender and the role of gender in shaping the above interactions. It uses an intersectionality lens to understand the complex interaction between migration, gender and health systems. The project addresses key gaps in evidence and knowledge on patient migration and mobility and their impacts on health systems globally and in South Africa. Each of the following research objectives addresses an important gap in the evidence to address the research aim: To assess levels of migration by patients and health workers within, into and out of South Africa; To examine the health care experiences of both migrant and non-migrant patients and health workers; To analyse how the South African system adapts and responds in light of the population movement identified in Objective 1; To examine how the experience and responses garnered from Objectives 1-2 are shaped by gender. |
| Collaborator Contribution | At the beginning of March 2020, investigators and study staff decided not to proceed with the planned enrolment into the WhatsApp Study, which forms a core part of field work and data collection for the grant, as COVID19 led to an unprecedented global lockdown. In light of the need to halt the primary data collection, investigators and study staff discussed how to continue work in a meaningful way. Here, two areas of immediate work emerged as feasible and important to ensure continuation of work. The work set out here below is envisaged for a six month period from April - October 2020: Framing analysis of policy documents at the global, regional and national levels, and sub-national level in South Africa, to inform the policy analysis as part of Objective 2 and 3 of the MiGHs grant, and result in an independent analysis of how migration and mobility is perceived as an issue in these primary documents. For example, whether it is seen as a problem or an opportunity, whether there is focus on health workers or patients, whether migration is seen in relation to urbanisation or employment. Framing analysis of media coverage of COVID19 in Southern Africa and the way in which migration is viewed within this, and how it develops over time. To ensure coherence across these two activities, the following objectives are intended to cover both sets of activities. They intend to: Understand the ways in which mobility and migration are framed in primary policy documents relating to health and migration at global, regional, national and sub-national levels. To understand: a) to what extent this is phrased as a challenge or an opportunity b) how rising levels of mobility are conceptualised within policy and to finally understand c) how this might inform specific approaches or the preference of certain policy options over others. Such analysis will enable the ascertainment of both coherence and incoherence across different levels of policymaking within global health and at national and sub-national levels in South Africa. It also aides the analysis and understanding of how the issue is viewed, how its perception changes over time and the political economy underlying it. Similar focus on analysis of how migration and mobility is represented in media coverage of COVID19 in the Southern African media will equally help understand how migration and mobility are perceived as part of the current outbreak of COVID19. Such analysis is of great importance as migration and mobility have been closely linked to the spread of the disease, while at the same time, mobile populations and migrants are amongst the groups facing great challenges as a result of both the disease and the measures taken to address it. |
| Impact | https://doi.org/10.1186/s12939-023-01862-1 https://doi.org/10.17645/mac.v10i2.4990 https://doi.org/10.1186/s12992-021-00727-y https://doi.org/10.1093/heapol/czab024 https://doi.org/10.1177/1468018120922228 |
| Start Year | 2019 |
| Description | MiGHS: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | This research is funded through the Health Systems Research Initiative (HSRI) in the UK, a collaboration of UK MRC, ERSC, DFID, and the Wellcome Trust. Grant number: MR/S013601/1. Grant title: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers Grant duration: January 2019 - January 2022 (36 months) MiGHS is a research collaboration between researchers at the London School of Hygiene and Tropical Medicine (LSHTM), the African Centre for Migration & Society (ACMS) at the University of the Witwatersrand (Wits), the University of Cape Town (UCT) and the South African Department of Health (DoH). It has been developed to address one of the most pressing issues facing health systems globally and at a national level in South Africa - the impacts of and response to migration and its intersection with gender. MiGHS responds specifically to needs identified through exploratory research undertaken by the investigators in South Africa. The project has been designed to directly inform policies and build capacity amongst researchers, policymakers and implementers, to make health systems more responsive to the intersection between gender and migration in South Africa and globally. It will do so by generating new knowledge and a series of innovative impact activities. This project will examine how migration and population mobility affect the South African health system, and how the health system responds and adapts as a result of migration and population mobility. The research explicitly explores gender and the role of gender in shaping the above interactions. It uses an intersectionality lens to understand the complex interaction between migration, gender and health systems. The project addresses key gaps in evidence and knowledge on patient migration and mobility and their impacts on health systems globally and in South Africa. Each of the following research objectives addresses an important gap in the evidence to address the research aim: To assess levels of migration by patients and health workers within, into and out of South Africa; To examine the health care experiences of both migrant and non-migrant patients and health workers; To analyse how the South African system adapts and responds in light of the population movement identified in Objective 1; To examine how the experience and responses garnered from Objectives 1-2 are shaped by gender. |
| Collaborator Contribution | At the beginning of March 2020, investigators and study staff decided not to proceed with the planned enrolment into the WhatsApp Study, which forms a core part of field work and data collection for the grant, as COVID19 led to an unprecedented global lockdown. In light of the need to halt the primary data collection, investigators and study staff discussed how to continue work in a meaningful way. Here, two areas of immediate work emerged as feasible and important to ensure continuation of work. The work set out here below is envisaged for a six month period from April - October 2020: Framing analysis of policy documents at the global, regional and national levels, and sub-national level in South Africa, to inform the policy analysis as part of Objective 2 and 3 of the MiGHs grant, and result in an independent analysis of how migration and mobility is perceived as an issue in these primary documents. For example, whether it is seen as a problem or an opportunity, whether there is focus on health workers or patients, whether migration is seen in relation to urbanisation or employment. Framing analysis of media coverage of COVID19 in Southern Africa and the way in which migration is viewed within this, and how it develops over time. To ensure coherence across these two activities, the following objectives are intended to cover both sets of activities. They intend to: Understand the ways in which mobility and migration are framed in primary policy documents relating to health and migration at global, regional, national and sub-national levels. To understand: a) to what extent this is phrased as a challenge or an opportunity b) how rising levels of mobility are conceptualised within policy and to finally understand c) how this might inform specific approaches or the preference of certain policy options over others. Such analysis will enable the ascertainment of both coherence and incoherence across different levels of policymaking within global health and at national and sub-national levels in South Africa. It also aides the analysis and understanding of how the issue is viewed, how its perception changes over time and the political economy underlying it. Similar focus on analysis of how migration and mobility is represented in media coverage of COVID19 in the Southern African media will equally help understand how migration and mobility are perceived as part of the current outbreak of COVID19. Such analysis is of great importance as migration and mobility have been closely linked to the spread of the disease, while at the same time, mobile populations and migrants are amongst the groups facing great challenges as a result of both the disease and the measures taken to address it. |
| Impact | https://doi.org/10.1186/s12939-023-01862-1 https://doi.org/10.17645/mac.v10i2.4990 https://doi.org/10.1186/s12992-021-00727-y https://doi.org/10.1093/heapol/czab024 https://doi.org/10.1177/1468018120922228 |
| Start Year | 2019 |
| Description | MiGHS: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers |
| Organisation | University of Cape Town |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | This research is funded through the Health Systems Research Initiative (HSRI) in the UK, a collaboration of UK MRC, ERSC, DFID, and the Wellcome Trust. Grant number: MR/S013601/1. Grant title: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers Grant duration: January 2019 - January 2022 (36 months) MiGHS is a research collaboration between researchers at the London School of Hygiene and Tropical Medicine (LSHTM), the African Centre for Migration & Society (ACMS) at the University of the Witwatersrand (Wits), the University of Cape Town (UCT) and the South African Department of Health (DoH). It has been developed to address one of the most pressing issues facing health systems globally and at a national level in South Africa - the impacts of and response to migration and its intersection with gender. MiGHS responds specifically to needs identified through exploratory research undertaken by the investigators in South Africa. The project has been designed to directly inform policies and build capacity amongst researchers, policymakers and implementers, to make health systems more responsive to the intersection between gender and migration in South Africa and globally. It will do so by generating new knowledge and a series of innovative impact activities. This project will examine how migration and population mobility affect the South African health system, and how the health system responds and adapts as a result of migration and population mobility. The research explicitly explores gender and the role of gender in shaping the above interactions. It uses an intersectionality lens to understand the complex interaction between migration, gender and health systems. The project addresses key gaps in evidence and knowledge on patient migration and mobility and their impacts on health systems globally and in South Africa. Each of the following research objectives addresses an important gap in the evidence to address the research aim: To assess levels of migration by patients and health workers within, into and out of South Africa; To examine the health care experiences of both migrant and non-migrant patients and health workers; To analyse how the South African system adapts and responds in light of the population movement identified in Objective 1; To examine how the experience and responses garnered from Objectives 1-2 are shaped by gender. |
| Collaborator Contribution | At the beginning of March 2020, investigators and study staff decided not to proceed with the planned enrolment into the WhatsApp Study, which forms a core part of field work and data collection for the grant, as COVID19 led to an unprecedented global lockdown. In light of the need to halt the primary data collection, investigators and study staff discussed how to continue work in a meaningful way. Here, two areas of immediate work emerged as feasible and important to ensure continuation of work. The work set out here below is envisaged for a six month period from April - October 2020: Framing analysis of policy documents at the global, regional and national levels, and sub-national level in South Africa, to inform the policy analysis as part of Objective 2 and 3 of the MiGHs grant, and result in an independent analysis of how migration and mobility is perceived as an issue in these primary documents. For example, whether it is seen as a problem or an opportunity, whether there is focus on health workers or patients, whether migration is seen in relation to urbanisation or employment. Framing analysis of media coverage of COVID19 in Southern Africa and the way in which migration is viewed within this, and how it develops over time. To ensure coherence across these two activities, the following objectives are intended to cover both sets of activities. They intend to: Understand the ways in which mobility and migration are framed in primary policy documents relating to health and migration at global, regional, national and sub-national levels. To understand: a) to what extent this is phrased as a challenge or an opportunity b) how rising levels of mobility are conceptualised within policy and to finally understand c) how this might inform specific approaches or the preference of certain policy options over others. Such analysis will enable the ascertainment of both coherence and incoherence across different levels of policymaking within global health and at national and sub-national levels in South Africa. It also aides the analysis and understanding of how the issue is viewed, how its perception changes over time and the political economy underlying it. Similar focus on analysis of how migration and mobility is represented in media coverage of COVID19 in the Southern African media will equally help understand how migration and mobility are perceived as part of the current outbreak of COVID19. Such analysis is of great importance as migration and mobility have been closely linked to the spread of the disease, while at the same time, mobile populations and migrants are amongst the groups facing great challenges as a result of both the disease and the measures taken to address it. |
| Impact | https://doi.org/10.1186/s12939-023-01862-1 https://doi.org/10.17645/mac.v10i2.4990 https://doi.org/10.1186/s12992-021-00727-y https://doi.org/10.1093/heapol/czab024 https://doi.org/10.1177/1468018120922228 |
| Start Year | 2019 |
| Description | MiGHS: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers |
| Organisation | University of Exeter |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | This research is funded through the Health Systems Research Initiative (HSRI) in the UK, a collaboration of UK MRC, ERSC, DFID, and the Wellcome Trust. Grant number: MR/S013601/1. Grant title: Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers Grant duration: January 2019 - January 2022 (36 months) MiGHS is a research collaboration between researchers at the London School of Hygiene and Tropical Medicine (LSHTM), the African Centre for Migration & Society (ACMS) at the University of the Witwatersrand (Wits), the University of Cape Town (UCT) and the South African Department of Health (DoH). It has been developed to address one of the most pressing issues facing health systems globally and at a national level in South Africa - the impacts of and response to migration and its intersection with gender. MiGHS responds specifically to needs identified through exploratory research undertaken by the investigators in South Africa. The project has been designed to directly inform policies and build capacity amongst researchers, policymakers and implementers, to make health systems more responsive to the intersection between gender and migration in South Africa and globally. It will do so by generating new knowledge and a series of innovative impact activities. This project will examine how migration and population mobility affect the South African health system, and how the health system responds and adapts as a result of migration and population mobility. The research explicitly explores gender and the role of gender in shaping the above interactions. It uses an intersectionality lens to understand the complex interaction between migration, gender and health systems. The project addresses key gaps in evidence and knowledge on patient migration and mobility and their impacts on health systems globally and in South Africa. Each of the following research objectives addresses an important gap in the evidence to address the research aim: To assess levels of migration by patients and health workers within, into and out of South Africa; To examine the health care experiences of both migrant and non-migrant patients and health workers; To analyse how the South African system adapts and responds in light of the population movement identified in Objective 1; To examine how the experience and responses garnered from Objectives 1-2 are shaped by gender. |
| Collaborator Contribution | At the beginning of March 2020, investigators and study staff decided not to proceed with the planned enrolment into the WhatsApp Study, which forms a core part of field work and data collection for the grant, as COVID19 led to an unprecedented global lockdown. In light of the need to halt the primary data collection, investigators and study staff discussed how to continue work in a meaningful way. Here, two areas of immediate work emerged as feasible and important to ensure continuation of work. The work set out here below is envisaged for a six month period from April - October 2020: Framing analysis of policy documents at the global, regional and national levels, and sub-national level in South Africa, to inform the policy analysis as part of Objective 2 and 3 of the MiGHs grant, and result in an independent analysis of how migration and mobility is perceived as an issue in these primary documents. For example, whether it is seen as a problem or an opportunity, whether there is focus on health workers or patients, whether migration is seen in relation to urbanisation or employment. Framing analysis of media coverage of COVID19 in Southern Africa and the way in which migration is viewed within this, and how it develops over time. To ensure coherence across these two activities, the following objectives are intended to cover both sets of activities. They intend to: Understand the ways in which mobility and migration are framed in primary policy documents relating to health and migration at global, regional, national and sub-national levels. To understand: a) to what extent this is phrased as a challenge or an opportunity b) how rising levels of mobility are conceptualised within policy and to finally understand c) how this might inform specific approaches or the preference of certain policy options over others. Such analysis will enable the ascertainment of both coherence and incoherence across different levels of policymaking within global health and at national and sub-national levels in South Africa. It also aides the analysis and understanding of how the issue is viewed, how its perception changes over time and the political economy underlying it. Similar focus on analysis of how migration and mobility is represented in media coverage of COVID19 in the Southern African media will equally help understand how migration and mobility are perceived as part of the current outbreak of COVID19. Such analysis is of great importance as migration and mobility have been closely linked to the spread of the disease, while at the same time, mobile populations and migrants are amongst the groups facing great challenges as a result of both the disease and the measures taken to address it. |
| Impact | https://doi.org/10.1186/s12939-023-01862-1 https://doi.org/10.17645/mac.v10i2.4990 https://doi.org/10.1186/s12992-021-00727-y https://doi.org/10.1093/heapol/czab024 https://doi.org/10.1177/1468018120922228 |
| Start Year | 2019 |
| Description | Partnership with African Universities |
| Organisation | Addis Ababa University |
| Country | Ethiopia |
| Sector | Academic/University |
| PI Contribution | Addis Ababa University is a partner in this project. |
| Collaborator Contribution | Addis Ababa University is a partner in this project and has been involved in the development of the proposal and the project, including both thematic and administrative input. |
| Impact | The AAMR. |
| Start Year | 2018 |
| Description | Partnership with African Universities |
| Organisation | Makerere University |
| Country | Uganda |
| Sector | Academic/University |
| PI Contribution | Makerere is a partner in the project. |
| Collaborator Contribution | Makerere is a partner in the project. Individuals provide thematic and advisory inputs and have been involved in the development of the project and its implementation. |
| Impact | Development of AAMR. |
| Start Year | 2018 |
| Description | Partnership with African Universities |
| Organisation | University of Cape Town |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | The University of Cape Town is a partner in the project. |
| Collaborator Contribution | The University of Cape Town is a partner in the project and has been involved in the development of the proposal and the project implementation, including in both thematic and administrative areas. |
| Impact | The AAMR. |
| Start Year | 2018 |
| Description | Partnership with African Universities |
| Organisation | University of Ghana |
| Country | Ghana |
| Sector | Academic/University |
| PI Contribution | The University of Ghana is a partner in this grant. |
| Collaborator Contribution | Members of the University of Ghana's Centre for Migration Studies are partners in the grant. Individuals provide thematic and advisory inputs and have been involved in the development of the project and its implementation. |
| Impact | Development of the AAMR |
| Start Year | 2018 |
| Description | Partnership with African Universities |
| Organisation | University of the Western Cape |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | The University of the Western Cape is a partner in this project. |
| Collaborator Contribution | The University of the Western Cape provides thematic and advisory inputs and has been involved in the development of the project and its implementation. |
| Impact | The AAMR. |
| Start Year | 2018 |