Immigrants’ and refugees’ unmet reproductive health demands in Botswana: Perceptions of public healthcare providers

Background: The healthcare of Batswana (citizens of Botswana) as indicated in the country’s Vision 2016 is one of the top priorities of the government of Botswana, yet Botswana’s National Health Policy, the Immigration Policy and the National Sexual and Reproductive Health Programme Framework all are silent on the obligations of the government to provide health services to the immigrant and refugee population. In view of the high prevalence of HIV/AIDS in Botswana, South Africa and other sub-Saharan countries, it is critical that reproductive health services be as affordable and accessible for the immigrants and refugees as they are for other residents in Botswana.This study measured the views of the primary healthcare providers in Botswana on the perceived reproductive health needs of immigrants andrefugees and the availability and accessibility of reproductive healthcare services to the immigrant and refugee populations in the country. Thisinformation will be important for policy makers, the government of Botswana and the private sector to shape intervention measures to assistimmigrants and refugees in seeking and accessing the desired reproductive health services.Methods: The study targeted all 4 667 medical doctors and nurses who were serving in various hospitals and clinics in 23 health districts ofBotswana as at June 2005 when this study was conducted. Using NCS Pearson statistical software, the sample size for the study was determined to be 851. This estimated sample size was allocated to the 23 health districts (strata) using probability proportional to size (PPS). Having obtained the sample size for each district, the healthcare providers to be interviewed from each health district were selected randomly and in proportion to the number of doctors and nurses in each district.Questionnaires were administered to these healthcare providers by research assistants, who explained the purpose of the study and obtainedinformed consent. The questionnaires were coded to ensure the anonymity of the respondents. It contained questions about the healthcare providers’demographic characteristics, their opinions on the reproductive health needs of immigrants and refugees, and their views on factors that influence the accessibility of these services to immigrants and refugees. Data were collected from 678 doctors and nurses (about 80% of the targeted sample).Results: The majority of the healthcare providers indicated that the most important reproductive health needs of the immigrants and refugees, namely pregnancy-related services (prenatal, obstetrics, postnatal conditions), treatment for sexually transmitted infections (STIs), HIV/AIDS treatment and counselling and family planning were not different from those of the locals. However, some major differences noted between the local population and the foreigners were (i) that antiretroviral (ARV) treatment and prevention of mother-to-child-transmission (PMTCT) programmes were never accessible to the non-citizens; and (ii) that while treatments and other health services were free to Batswana, a fee was charged to non-citizens.Although 86% of the 21 studied reproductive health services were available in the healthcare system more than 50% of the time, only 62% of themwere accessible to the immigrants and refugees 50% of the time. The major reasons for inability to access these services were: (i) The immigrants and refugees have to pay higher fees to access the reproductive health services; (ii) Once an immigrant or refugee is identified as HIV positive, there are no further follow-ups on the patient such as detecting the immune status using a CD4 count or testing the viral load; (iii) The immigrants and refugees do not have referral rights to referral clinics/hospitals for follow-ups in case of certain health conditions; and (iv) The immigrants and refugees are required to join a medical aid scheme to help offset part of the costs for the desired services.Conclusions: The study recommended that the government of Botswana should improve the availability of reproductive health services to immigrants and refugees, and expunge those laws and practices that make it difficult for immigrants and refugees to access the available reproductive health services

The Transit Phase of Migration: Circulation of Malaria and Its Multidrug-Resistant Forms in Africa

In the third article in a six-part <I>PLoS Medicine</I> series on Migration & Health, Cally Roper and Caroline Lynch use a case study of migration and anti-malarial drug resistance in Uganda to discuss the specific health risks and policy needs associated with the transit phase of migration

Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence from the Nairobi Urban Health and Demographic Surveillance System

The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor

“Two Steps Forward, One Step Back”: Zimbabwean Migration and South Africa’s Regularising Programme (the ZDP)

South Africa’s announcement and implementation of a legalising amnesty under the Zimbabwe Documentation Project (ZDP) in 2010 was lauded as a step away from the laissez-faire approach to Zimbabwean immigration. The amnesty, granting migrants stay, work, study and business operation rights in the country on 4-year permits, was clouded by uncertainties and exclusions and implementation hassles. This article explores this legalising amnesty in relation to trends in Zimbabwean immigration over the years, noting in particular the complexity and fluidity in migration patterns. The article highlights these complexities and how they expose the limitations of any ad hoc and short-term approach to managing complex immigration flows. It argues that such an approach fails to recognise differences in migration trends over time and space, sources of migration and migrant’s strategies, and, more importantly, that these factors result in different migrants with differing needs. As way of conclusion, the article suggests that any progressive immigration strategy on Zimbabwean immigration should not only build on the BTemporary Immigration Exemption Status for Zimbabweans^ of 2009 and embrace ideals of diversity, inclusivity and openness but also draw upon existing efforts at regional cooperation and integration.http://link.springer.com/journal/121342018-05-30hb2016Anthropology and Archaeolog