Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community‐based responses

Thea de Gruchy (2019), ‘Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community‐based responses‘, Health and Social Care, 00: 1– 9, DOI: [OPEN ACCESS].

Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub‐district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration‐aware community‐based programmes that included the training of community‐based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi‐structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non‐state interventions and the fragmented state approach to community‐based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community‐based interventions that do not recognise community‐based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls.

About Thea de Gruchy

Thea de Gruchy is a postdoctoral researcher at the ACMS working on migration and health. Since the outbreak of the Covid19 pandemic in South Africa, much of Thea's work has pivoted to exploring the effect of the pandemic and implications of the South African state's response to the pandemic for migrant and mobile populations. As part of this work, Thea helps to coordinate the Migration and Coronavirus in Southern African group (MiCoSA).

Her PhD research, which was supervised by Jo Vearey, funded by the Wellcome Trust and part of the Migration and Health Project (maHp) at ACMS, centred on questions of policy process and asked how policy is made and influenced in South Africa. In 2015 and the beginning of 2016, Thea worked with Ingrid Palmary to answer some of these questions and inform a conceptual framework on how policy is made in South Africa using the Trafficking in Persons Act of 2013 as a case study. Her doctoral work uses a case study of health and occupational safety policy in the South African agricultural sector to elaborate on and develop this framework.

Thea’s MA, which was funded by the National Research Foundation (NRF), focused on the immigration industry and the relationship between the state, immigration intermediaries, and migrants. Part of this research explored the increasing precarity experienced by immigrants in South Africa as a result of changing and increasingly stringent immigration policy and regulations. Having received a Faculty of Humanities Ad Hoc Grant from the University of the Witwatersrand for 2016 to follow on with some of this research and as part of the Security at the Margins (SeaM) project – a collaborative project between ACMS and the Centre for African Studies at the University of Edinburgh – she continues to be interested in the relationship between policy, specifically policy framed in terms of security, and the precarity of marginalised and vulnerable groups.

Thea currently co-ordinates the PhD Work in Progress seminars at the ACMS.