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

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Pan american health organization pan american sanitary bureau regional office of the

.

  • PAN AMERICAN HEALTH ORGANIZATION

  • Pan American Sanitary Bureau, Regional Office of the

  • WORLD HEALTH ORGANIZATION

MIGRATION AND HEALTH AT THE BORDERS

Dra. Hilda Leal de Molina


The health of migrant populations in border territories

The Health of Migrant Populations in Border Territories

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

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

    • Very poor

    • Little access to sanitary infrastructure

    • Difficulty accessing services (economic, language, geographical)

    • Higher incidence of diseases ( mainly transmissible diseases) than the general population.

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

      Dra. Mirta Roses

      Sept.2003


Characteristics of migrant populations at the borders

CHARACTERISTICS OF MIGRANT POPULATIONS AT THE BORDERS

  • An opportunity to:

  • Create health spaces

  • Design and implementation of binational or trinational plans and programs.

  • Borders – Third Space.

    • Their own identity, ethnic, cultural and language differences that are independent from national levels.

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

  • Borders become blurred

  • Developing solidarity

  • Sharing of resources

  • Family ties

Sovereignty criteria are special.

Respect of Human Rights


Pan american health organization pan american sanitary bureau regional office of the

IDENTIFICATION OF PUBLIC HEALTH ISSUES OF COMMON INTEREST *

  • Limited respect for Human Rights of migrants

  • Lack of Social Protection Systems

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

  • Public health issues that affect the relationship between countries.

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

*Modified criteria of Dr. Vicente Palerm


Considerations for assessing the health situation at the borders

CONSIDERATIONS FOR ASSESSING THE HEALTH SITUATION AT THE BORDERS

  • Identifying inequities

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

  • Facilitating community and civil society participation throughout the process.

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

  • Facilitating the multi-sectorial approach

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

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

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

Plan Andino de Salud de las Fronteras

PASAFRO Sept 10-11 2004


General criteria to address health problems with a bilateral approach

What is the scope of the problem?

(Incidence, prevalence,

mortality, main causes of death, trends, disability)

GENERAL CRITERIA TO ADDRESS HEALTH PROBLEMS WITH A BILATERAL APPROACH

YES

Is the scope of the problem

the same on the other side of

the border?

NO

NO

Is the problem affecting

the relationship between

countries/states/cities

(general public, media,

politicians)?

Does the problem have

to be addressed

bilaterally in order

to solve it?

YES

NO

YES

YES

NO

Is the problem

of interest to

researchers/

academics?

Bilateral

approach

Bilateral

approach

SI

Adress

as a domestic

problem

NO

Bilateral approach

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

PAHO EPFO 1999


Objectives of health programs for migrant populations and populations of border regions

OBJECTIVES OF HEALTH PROGRAMS FOR MIGRANT POPULATIONS AND POPULATIONS OF BORDER REGIONS

  • Promoting respect for Human Rights

  • Promoting equity

  • Creating healthy spaces

  • Developing solidarity

  • Promoting cooperation

  • Contributing to peace and governance


Who paho priorities for improving the health of migrant populations

WHO/PAHO PRIORITIES FOR IMPROVING THE HEALTH OF MIGRANT POPULATIONS

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

  • Developing information exchange networks and systems for health development.

  • Promoting the development of health service networks to ensure access.

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

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

  • Articulating health promotion programs.

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


Pan american health organization pan american sanitary bureau regional office of the

TYPES OF COOPERATION

  • Humanitarian Assistance

  • Collaboration

  • Cooperation for development


Pan american health organization pan american sanitary bureau regional office of the

BASIC ELEMENTS OF COLLABORATION

  • Interest in a common matter or shared problem

  • Respect, trust, and consensus

  • Joint use of resources

  • Equitable distribution of results


Who paho experience in health cooperation in the border regions

WHO/PAHO EXPERIENCE IN HEALTH COOPERATION IN THE BORDER REGIONS

  • Healthy Cities:

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

    • Canal Zarumillas, Peru - Ecuador : Environmental Protection

  • Immunization

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

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

  • “Trifinio”, Guatemala, Honduras and El Salvador.

  • Borders between: Guatemala, Belize, and Mexico

  • Border cities in: Argentina, Brazil, and Paraguay,

  • Border regions between:

    • Brazil, Colombia, and Peru

    • Haiti and the Dominican Republic

    • Nicaragua and Costa Rica

  • In different border regions in the Americas


  • Pan american health organization pan american sanitary bureau regional office of the

    Two countries, one island:

    “Hispaniola”

    Located in the Caribbean


    Development of health cooperation haiti dominican republic

    DEVELOPMENT OF HEALTH COOPERATIONHAITI – DOMINICAN REPUBLIC

    BILATERAL AGREEMENTS

    • Areas of Cooperation 2002/2004:

      • Access to Maternal and Child Health Care

      • HIV/AIDS

      • PAI

      • Tuberculosis

      • Rabies

      • Filariasis

      • Malaria

      • Epidemiological Surveillance

      • Catastrophes


    Migrant population at the mexico usa border

    Migrant Population at the Mexico – USA Border

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

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


    Relevant sanitary aspects at the border

    RELEVANT SANITARY ASPECTS AT THE BORDER

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


    Structures and mechanisms for health collaboration across borders

    STRUCTURES AND MECHANISMS FOR HEALTH COLLABORATION ACROSS BORDERS

    • BINATIONAL COMMISSION MEXICO - USA

    • BORDER HEALTH COMMISSION MEXICO-USA

    • CONFERENCE OF GOVERNORS OF THE BORDER REGION

    • CONFERENCE OF LEGISLATORS OF THE BORDER REGION

    • BORDER LINKAGE MECHANISM


    Establishing the field office

    ESTABLISHING THE FIELD OFFICE

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

    The first Manager was Dr. Joseph S. Spoto.


    Safe and healthy sister cities

    SAFE AND HEALTHY SISTER CITIES

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

    • Adapts principles of the “healthy municipalities” movement

    • Develops methods and instrumentos for a binational context


    Pan american health organization pan american sanitary bureau regional office of the

    SAFE AND HEALTHY SISTER CITIES

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

    • Binationality criteria

    • Binational balance

    • Press coverage (press conferences and bulletins).

    • Developing a script for protocols


    Pan american health organization pan american sanitary bureau regional office of the

    “COMUNIDAD ANDINA” AND “MERCOSUR”

    Ven/Col

    Community-based epidemiological surveillance

    Ecu/Per

    Protección Ambiental

    Bra/South

    Protection of the Environment

    Per/Chi

    Healthy Spaces

    Arg/Bra/Par

    Health Service

    Network

    Triple Border

    Arg/Bol/Par

    Indigenous population in the South American Chaco

    PAHO EXPERIENCES …


    Integrated health system of the mercosur in the political agenda

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

    • STRENGTHENING THE INTEGRATION PROCESS

    • FOCUS ON LOCAL DEVELOPMENT

    • SOCIAL INCLUSION

    PAHO EXPERIENCES …


    Integrated health system sis mercosur

    INTEGRATED HEALTH SYSTEM -SIS-MERCOSUR

    • “ACROSS BORDERS” AND HARMONIZATION

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

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

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

    PAHO EXPERIENCES …


    Pan american health organization pan american sanitary bureau regional office of the

    TRIPLE BORDER = ARGENTINA, BRAZIL, AND PARAGUAY

    • Triple border is a highly urbanized area.

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

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

    PAHO EXPERIENCES …


    Central america

    CENTRAL AMERICA

    Meeting of the Health Sectors of Central America and

    the Dominican Republic (XVIII RESSCAD)

    Study: Flacso and WHO/PAHO – Feb. 2004

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

    Services:

    Limited capacity for response

    Inexistent Social Protection System

    Lack of knowledge about the problem

    Women:

    Domestic service

    Sex workers

    Agricultural work

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

    Girls and boys: Agricultural work

    Domestic service

    Sex trade

    Indigenous Population:

    Agricultural work

    En domestic service


    Pan american health organization pan american sanitary bureau regional office of the

    MIGRATION PHENOMENON

    INTERNAL:Inter-departaments

    Inter-municipal

    EXTERNAL:

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

    Men and women to the US.

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

    Transit: Mainly Hondurans, Nicaraguans, Salvadorians

    Deported: Asian, Hindus, South Americans, Central Americans

    Guatemala is a country with internal and external migration.


    Pan american health organization pan american sanitary bureau regional office of the

    • Integrated health care model in Escuintla: MSPAS-IGSS.

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

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

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

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

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


    Challenges for health care for migrants

    CHALLENGES FOR HEALTH CARE FOR MIGRANTS

    • Equity and solidarity in health care services, on both sides of the borders and in the countries.

    • Reducing differences.

    • Taking advantage of competencies and capacities of health care services at each side of the border, creating real service networks.

    • Establishing timely and reliable information and health surveillance systems.

    PAHO EXPERIENCES …


    Considerations for an effective cooperation for health of migrants

    CONSIDERATIONS FOR AN EFFECTIVE COOPERATION FOR HEALTH OF MIGRANTS

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

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

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

    • INSTITUTIONAL – VOLUNTEERS

    • NATIONAL - INTERNATIONAL (External Cooperation)

    DIMENSIONS:

    DIMENSIONS OF CROSSBORDER WORK. CRISTINA VON GLASCOE. COLEF


    Conditions for moving forward in health of migrant populations at the borders

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

    • Identifying the common problems

    • Recognizing the sovereignty of each country

    • Trust and mutual respect

    • “Good neighbor” principle

    • Consensus in decision-making

    • Equitative distribution of resources and acknowledgements

    • Comprehensive approach to address problems

    • Cooperation, Non-Imposition

    • Shared surveillance and information system


    Conclusions

    CONCLUSIONS

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

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

    • The process itself is as important as the results.

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

    • The results should be recognized and communicated.

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


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