PAN AMERICAN HEALTH ORGANIZATION

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MIGRATION AND HEALTH AT THE BORDERS Dra. Hilda
Leal de Molina

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

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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

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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
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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
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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
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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)
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/ academ
ics?
Bilateral approach
Bilateral approach
SI
Adress as a domestic problem
NO
Bilateral approach
Based on Vicente Palerms (UCMEXUS) criteria for
binational approach of academic issues.
PAHO EPFO 1999
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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

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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.

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TYPES OF COOPERATION

• Humanitarian Assistance
• Collaboration
• Cooperation for development

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BASIC ELEMENTS OF COLLABORATION

• Interest in a common matter or shared problem
• Respect, trust, and consensus
• Joint use of resources
• Equitable distribution of results

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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

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Two countries, one island Hispaniola
Located in the Caribbean
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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

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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.

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

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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.
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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

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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

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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
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INTEGRATED HEALTH SYSTEM OF THE MERCOSUR IN THE
POLITICAL AGENDA

• STRENGTHENING THE INTEGRATION PROCESS
• FOCUS ON LOCAL DEVELOPMENT
• SOCIAL INCLUSION

PAHO EXPERIENCES
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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
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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
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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
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• 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.

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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
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CONSIDERATIONS FOR AN EFFECTIVE COOPERATION FOR
HEALTH OF MIGRANTS
DIMENSIONS

• CENTRAL (Federal) PERIPHERIC (Regional/Local)
• GOVERNMENTAL (different levels) CIVIL SOCIETY
  (NGOs, Associations, Service Networks, Private
  Sector)
• SECTORIAL (Health) MULTI-SECTORIAL (Foreigh
  Affairs)
• INSTITUTIONAL VOLUNTEERS
• NATIONAL - INTERNATIONAL (External Cooperation)

DIMENSIONS OF CROSSBORDER WORK. CRISTINA VON
GLASCOE. COLEF
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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

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CONCLUSIONS

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