Inception meeting: Migration, gender and health system responses in South Africa – A focus on the movement of healthcare users and workers
As taught Masters students, it is rare to be in the same room as a team of researchers working on honing an international grant-funded project. Let alone a room full of collaborators from the University of the Witwatersrand, University of Cape Town, the London School of Hygiene and Tropical Medicine, the South African Department of Health, the International Organization for Migration, and other stakeholders. Yet this was exactly what we were able to do on May 10, as we sat in on a research project inception meeting. The “Migration, gender and health system responses in South Africa: A focus on the movement of healthcare users and workers” is a three-year project (Grant MR/S013601/1), funded by the Health Systems Research Initiative of DFID/ESRC/MRC and the Wellcome Trust, will examine how mobile users and health workers interact with the health system in South Africa, focusing in particular on the role of gender in this interaction.
The objectives are as follows:
1. To assess levels of migration by patients and health workers within, into, and out of SA;
2. To examine healthcare experiences of both migrant and non-migrant patients and health workers;
3. To analyse how the SA health system adapts and responds in light of population movements (and health needs) identified in Objective 1; and
4. To understand how the experiences of migrants and health workers, and responses of health systems are shaped by gender.
The meeting that we observed was to delve into the details of the project and to allow multiple additional stakeholders to add input. From the morning meeting to the more specific afternoon planning session, everyone involved was invested and committed to figuring out how the project would work. Several of the members who had laptops open were researching sources and software tools as they were mentioned in the meeting. It was an absolute pleasure to sit in and learn more about the project and how research methodologies are discussed and adjusted.
Since the start of the development of the grant, there have been many findings showing there is a lot of migration in the South African Development Community (SADC), as well as many variations in terms of patterns. These patterns affect both the way people use and access health systems, and how health systems respond, but there is a need to investigate more about this process. Starting by acknowledging there are a complex variety of migrant identities, it is essential to understand how these different identities impact the way migrants use healthcare. Specifically, there is a gap in evidence regarding intersectionality; how gender identity, cultural identity, and legal status may combine to create challenges for accessing healthcare. This project aims at exploring this nexus.
This research covers three dimensions; migration, health, and gender. The plan for the next three years is to build on a foundational project of 2015 that did an overall scoping exercise on different medical facilities and how they work to support migrants with health needs in South Africa. The next stage will build on the research and lessons of the previous one, and utilise existing networks to recruit participants.
This project is ambitious: it has the objective of further investigating the complex reality of migration and health system responses, but also wants to determine and suggest practical recommendations to policymakers and South African health system professionals. Furthermore, the project also wants to contribute new methods for investigation in the area of migration and health.
The investigators will utilise WhatsApp and other technological devices to communicate with different migrant sub-types about their experiences with healthcare systems in South Africa. The idea of using mobile phone technology was to adapt to the fact that migrants and mobile people move often and a device that utilises Wi-Fi/data is a good way to ensure the ability to follow-up. The researchers are especially interested in the comparison between non-migrants and migrants in different geographical areas as well, which makes the idea of an app-based process even more appealing.
The methods will start with an analysis of existing data and literature, especially the research from the foundational project. During the primary research process, several hundred mobile patients will be enrolled into the program. They will have an extended period of follow-up via WhatsApp or other programs, being asked simple questions about their experience with healthcare. A smaller proportion of these patients will have in-depth interviews in person at two points during the research. The researchers will also interview healthcare workers and policymakers at different levels of government to get the health system point of view.
A particularly enjoyable piece of the discussion was when Dr Johanna Hanefeld, the facilitator of the inception meeting, accepted questions from the group toward her and her fellow investigators. Each scholar built off of each other in asking methodological and conceptual questions about the project. They interrogated terminology and pushed further ideas that needed more thought. It felt like a research methods course in which we presented a proposal and our classmates asked questions, except in this room there was a lot more experience and insight behind the questions!
Some of them covered topics like the following:
Gender & Migration
What is it about gender that interests you? How will you incorporate patients with differing gender identities? What does gender imply exactly? What nuances in gendered experiences are you hoping to find in this research?
What would the recruitment process look like? If you access people who are already active in health facilities will it exclude those who are not as involved as others? How will you contact frontline providers? To what extent is the health system already aware, adaptive and responding to the challenges? Will you be looking at the implementation of the middle layer of health systems?
Mobile Phone Use
How does age play into the use of WhatsApp? Will you exclude the older generation who may not use the app? WhatsApp is very suitable for cross-border migrants, but have you considered using other methods for other types of migrants (i.e. internal migrants from one province to another one)? Can WhatsApp be used but not relied on too heavily? What would be the Plan B if WhatsApp doesn’t work?
These questions were taken in stride, and the entire group worked to find answers that would fit with the objectives of the research, take into account the intersectionality of the project, and support the patients as they accessed care.
This initiative is a great example of an effort to use previous evidence on the different types of migrants and migration patterns to follow-up on how these patterns shape the use of healthcare. It is emblematic of the institutions’ efforts to bring together international experts in health, migration, and health systems to exchange experience and skills towards a common objective – the health of migrants.
Johanna Hanefeld (Principal Investigator); Helen Walls (Co-Investigator); Richard Smith (Co-investigator); Jo Vearey (Co-investigator); Lucy Gilson (Co-investigator); Catherine Molyneux (Co-investigator)
[The text is directly from notes taken by the authors at the conference. The featured photo of this blogpost has been taken by Lucy Gilson and accessed via Twitter]
Elizabeth Hampson: MSc Comparative Public Policy student from the University of Edinburgh. She is writing her dissertation during placement at the ACMS. She wants to support refugees and those who are forcibly displaced and has studied public policy, immigration, anthropology, performing arts, and visual arts to create an interdisciplinary mindset and approach. Her undergraduate thesis focused on refugee artists and their agentive placemaking through creating art.
Sarah Talon Sampieri: MSc Global Health Policy student from the University of Edinburgh. She is writing her dissertation during a placement at the ACMS. Her background is in interdisciplinary life sciences and her areas of interest include global health, social policy, medical anthropology and communication.
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