Migrant workers: The human right to access health care

This is according to Mpilo Nkomo, officer in charge at the International Organization for Migration's (IOM) office in Musina.

In 2006, the South African and Zimbabwean governments began a joint border project to ensure improved access for migrants to health care. That and other efforts to shift attitudes have paid off, says Nkomo. "We had a lot of issues on attitude. You would find that, at the time … that for one to access health services within the institutions here, service providers would demand foreigners to be in possession of a [South African] green bar-coded ID. And by so doing, that was actually discriminating, and yet access to health has nothing to do with whether you are documented or not.

"So having recognised that, then IOM started engaging both governments on issues of human rights …  [They] were workshopped on the rights of migrants … to allow migrants access to health services, bearing in mind that denying a migrant access to health may have repercussions in the sense that some communicable diseases if not treated timely may actually affect the community," he says. "Diarrhoea, cholera, these are some of the diseases, which would actually negatively impact the community."

Nkomo adds: "We can safely say there has been a total shift in attitude. Then, when someone would be demanded an ID, that is now a thing of the past. People can now safely access the hospital and clinic facilities without being asked for the green bar-coded ID."

After a cholera outbreak in 2008, government departments and inter-governmental organisations such as IOM further stepped up collaboration efforts, he says.

"So I would say, currently there has been a scaled-up access of health services for migrants … and within that's also when IOM came in, and after discovering that were gaps on the farms … This is how IOM then deliberately engaged the services of the implementing partner, Centre for Positive Care [CPC], to actually work with the communities on the ground, migrant communities and the locals on the ground, to address the challenges that they are faced with."

Many problems
CPC is IOM's implementing partner for Ripfumelo, a programme providing access to HIV and Aids, and TB prevention, testing and care services to migrant farmworkers and the communities they interact with.

A 2010 study commissioned by IOM found a high HIV infection rate among farmworkers in Limpopo and Mpumalanga. Conducted on 23 commercial farms in the Malelane, Musina and Tzaneen areas, the survey involved 2810 farmworkers and found that 39.5% of farmworkers were HIV positive as opposed to the national prevalence rate in South Africa of 18.1%, at the time.

Beatrice Ncube, the Maroi farm worker, is one of CPC's volunteer "Change Agents" within the programme. She says that the conditions faced by women when she first arrived here in 2008 were very difficult.

"Many of them, they come here. They were having sex for food, sex for job. The supervisors were not treating them very well. They were promising that 'if we're getting love, I'm going to employ you'. And some men were taking women to be their wives so that they can help them with food.

"So I saw many problems, that's why I volunteer to be a change agent. So that I can also help other people on how they can have proper life when they get here at the farms," she adds.

Ncube says that living conditions for women have improved greatly since she started working as a change agent in 2010. "We educate the supervisors and the community to work together properly without oppressing each other. Now the supervisors have more information so they are also helping us when we are educating people. "And they are also helping us [to teach] that people must not discriminate [against] those who are living with HIV and Aids. People are now open to tell their status to each other. So people are coming in larger numbers now to test," she adds.

Commuting across the river
It's difficult to know exactly how many Zimbabweans make up the fluid migrant workforce in this border-region farming community, but it could be tens of thousands of workers. CPC serves eight farms located in the area near the Zimbabwe border, including the Maroi farm. The estimated number of farmworkers on the eight farms is 1500 during off-peak season and 4 500 during peak season, according to Norman Sebe, a CPC project manager. CPC estimates that 90% of the farmworkers at these eight farms are Zimbabwean nationals, and 10% South African nationals.

The border-region workforce also includes Zimbabweans who cross the border to go to work in South Africa each day. Some of them might be legally authorised to work here, but still cross the river because it's quicker and cheaper.

"Some people who stay along the border don't bother themselves to go and apply for a passport," says IOM's Nkomo.  "They come across and just do some business, and go back, or come to work this side, but when they are living on the other side of the border. So you will find that they are so used to that, and nothing is happening to them, and they just come and work on a daily basis, and go back home in the evening, come back again, and go back in the evening," he says.

Jo Rispoli, IOM regional specialist on labour migration and migration and development for East and Southern Africa, says low-skilled migrant workers coming to South Africa sometimes end up using the "no-go zone" – the illegal border crossing– because it's difficult to obtain the required documentation to enter South Africa purely as an economic migrant worker.

No job security
Some South African farmers who have employed migrant workers from Zimbabwe for seasonal work on a repeated basis for decades are having trouble getting their required documentation renewed in a timely fashion for sufficient lengths of time, as compared with earlier years, explains Rispoli.

So although a farmer might have been employing a Zimbabwean worker continually for seasonal work over a number of years, the farmer might only manage to get a permit for individual workers for months at a time.

"Some overstay because they are given visas of a limited duration," he adds. This translates to little or no job security. And workers often end up risking getting robbed of what they have earned by opting for the same "no-go zone," crossing the border without appropriate documentation when returning to Zimbabwe, or sending cash back to relatives. "They are not able to open bank accounts with their Zimbabwe IDs only," explains Rispoli, without also having other valid documents pertaining to their work and stay here, which means they can't use bank channels to send their money.

Simpewe Zaducha (43), another woman employed at Maroi farm, who joined her husband here in 2005, says that after regularly sending money back to Zimbabwe to care for her two children, there is no money left to save for retirement.

"Me and my husband, the plan is, if we are finished with what we are doing then we go back to Zimbabwe. I think we go back and stay with our children. That is our plan," she says. "I don't have any money for savings or insurance, but I'm trying to make some other things which will help us when we go back there," she says. "I buy two machines, a sewing machine, and another cooking machine for potatoes [for making chips], that are those things I'm thinking can help me if I go back to Zimbabwe."

This feature was produced in partnership with the Southern Africa Trust

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