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The bilateral agreements signed between South Africa and countries in Southern and Eastern Africa are a rare example of efforts to regulate health-related issues in a world region. As far as we know, there are no comparable bilateral health governance mechanisms in regions elsewhere. Furthermore, the rapidly growing literature on global health governance and governance for global health has to date not addressed the issue of patient mobility and how to govern it. In this study, we examine the issues included in these agreements, highlight key issues that they address, identify areas of omission and provide recommendations for improvement. This analysis should inform the development of such governance agreements both in Southern Africa and in regions elsewhere. We obtained 13 bilateral health agreements between South Africa and 11 neighbouring African countries as part of a broader research project examining the impact on health systems of patient mobility in South Africa, and thematically analysed their content and the governance mechanisms described. The agreements appear to be solidarity mechanisms between neighbouring countries. They contain considerable content on health diplomacy, with little on health governance, management and delivery. Nonetheless, given what they do and do not address, and how, they provide a rare insight into mechanisms of global health diplomacy and attempts to address patient mobility and other health-related issues in practice. The agreements appear to be global health diplomacy mechanisms expressing solidarity, emerging from a post-apartheid period, but with little detail of issues covered, and a range of important issues not addressed. Further empirical work is required to understand what these documents mean, particularly in the Covid-19 context, and to understand challenges with their implementation. The documents also raise the need for particular study of bilateral flows and experience of patients and health workers, and how this relates to health system strengthening. [ABSTRACT FROM AUTHOR]

Introduction: Global migration policy discussions are increasingly driven by moral panics--public anxiety about issues thought to threaten the moral standards of society. This includes the development of two Global Compacts--agreed principles to guide an international response--for (1) 'Refugees' and (2) 'Safe, Regular and Orderly Migration.' While the need to address migration and health is increasingly recognized at the global level, concerns are raised about if this will be reflected in the final Compacts. The Compacts focus on securitization, an approach that aims to restrict the movement of people, presenting potentially negative health consequences for people who move. Globally, concern is raised that migration-aware public health programming initiatives could be co-opted through a global health security agenda to further restrict movement across borders. This is particularly worrying in the Southern African Development Community (SADC)--a regional economic community associated with high levels of migration and the largest population of people living with HIV globally; this case is used to explore concerns about the health implications of the Global Compacts. Discussion: Current HIV responses in SADC do not adequately engage with the movement of healthcare users within and between countries. This negatively affects existing HIV interventions and has implications for the development of universal HIV testing and treatment (UTT) programmes. Drawing on literature and policy review, and ongoing participant observation in policy processes, I outline how Global Compact processes may undermine HIV prevention efforts in SADC. Conclusions: The global health imperative of developing migration-aware and mobility-competent health responses must not be undermined by moral panics; the resultant international policy processes run the risk of jeopardizing effective action at the local level. Globally, migration is increasingly recognized as a central public health concern, providing strategic opportunities to strengthen public health responses for all. Without mainstreaming migration, however, health responses will struggle. This is particularly concerning in SADC where HIV programmes--including UTT initiatives--will struggle, and key health targets will not be met. Globally, contextually appropriate migration-aware responses to health are needed, including and a specific focus on HIV programming in SADC. Keywords: migration; mobility; HIV; southern Africa; Global Compact; SADC, 1 | INTRODUCTION While health has long been considered an essential component of human and economic development, the health of migrants has remained in the shadows of key global health, [...]

We are honoured to present this special issue of the I Refugee Survey Quarterly i on the contemporary role of the global refugee regime in Africa. THE GLOBAL REFUGEE REGIME IN AFRICA TODAY The global refugee regime remains difficult to define, with no legal or even agreed definition.[2] As a result, it is frequently left undefined in policy discussions and academic articles. Indeed, the papers show how different forms of State marginalisation instrumentalise refugee regime norms, categories and laws to realise broader political goals of African governments. The third theme that arises through the five papers is I resisting the refugee regime. i Supporting previous research on this topic, Hetaba et al. highlight how many forced migrants in Egypt prefer to settle informally due to the perceived barriers in obtaining refugee status through UNHCR and the host State. [Extracted from the article]

Background: In March 2020, COVID-19 entered South Africa, resulting in 2.9 million cases, the country took preventative and precautionary measures to control the spread of COVID-19 infection. These measures limited population mobility especially for migrant women living with HIV (WLWH) and the provision of PMTCT services. The purpose of this research was to explore the challenges of the COVID-19 pandemic on PMTCT provision by healthcare providers and understand what strategies could be implemented with lifelong antiretroviral therapy (ART) for migrants to better manage the program. Methods: Twelve in-depth interviews were conducted with healthcare providers across city and provincial levels on how the changes to the healthcare system with COVID-19 affected highly mobile patients' adherence and utilization of PMTCT services. A thematic content analysis was used for emerging themes and guided by The Utilization of PMTCT Services conceptual framework. Results: Five main themes emerged: (1) Facilitators and barriers to adherence, which included the need for multi-month dispensing for the long term supply of antiretrovirals (ARVs) and the fear of contracting COVID-19 at the hospital that disrupted patients' continuum of care; (2) Healthcare providers work environment, where participants felt overwhelmed with the high patient demand and the lack of infrastructural resources to follow social distancing protocols; (3) Financial challenges and opportunity costs, PMTCT proved difficult for migrants due to border closures and documentation required to receive care, this resulted in treatment interruption and left many unable to receive support at the facility due to capacity restrictions; (4) Interpersonal interactions, mistreatment, and xenophobic attitudes existed toward the migrant HIV population; and (5) "Program sustainability" revealed three key areas for strengthening: longer duration of time allocated with counseling for same-day initiation, the increased use of technology, and translation services for migrants. Conclusions: It is important to take what was learned during the pandemic and integrate it into routine service delivery, which includes long-term medication supply to reduce risk with multiple visits to collect medication, and the use of technology to alleviate the high-burden of patient demand. Healthcare policies that work toward inclusion and sustainability for migrants are needed to improve the integration of safer and practical methods of PMTCT provision into health systems. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has interrupted the prevention of mother-to-child transmission of HIV (PMTCT) programming in South Africa. In 2020, it was estimated that there were 4 million cross-border migrants in South Africa, some of whom are women living with HIV (WLWH), who are highly mobile and located within peripheral and urban areas of Johannesburg. Little is known about the mobility typologies of these women associated with different movement patterns, the impact of the COVID-19 pandemic on mobility typologies of women utilising PMTCT services and on how changes to services might have affected adherence. To qualitatively explore experiences of different mobility typologies of migrant women utilising PMTCT services in a high mobility context of Johannesburg and how belonging to a specific typology might have affected the health care received and their overall experiences during the COVID-19 pandemic. Qualitative semi-structured interviews with 40 pregnant migrant WLWH were conducted from June 2020-June 2021. Participants were recruited through purposive sampling at a public hospital in Johannesburg. A thematic approach was used to analyse interviews. Forty interviews were conducted with 22 cross-border and 18 internal migrants. Women in cross-border migration patterns compared to interprovincial and intraregional mobility experienced barriers of documentation, language availability, mistreatment, education and counselling. Due to border closures, they were unable to receive ART interrupting adherence and relied on SMS reminders to adhere to ART during the pandemic. All 40 women struggled to understand the importance of adherence because of the lack of infrastructure to support social distancing protocols and to provide PMTCT education. COVID-19 amplified existing challenges for cross-border migrant women to utilise PMTCT services. Future pandemic preparedness should be addressed with differentiated service delivery including multi-month dispensing of ARVs, virtual educational care, and language-sensitive information, responsive to the needs of mobile women to alleviate the burden on the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Reflecting global norms, South Africa is associated with high levels of cross-border and internal population mobility, yet migration-aware health system responses are lacking. Existing literature highlights three methodological challenges limiting the development of evidence-informed responses to migration and health: (1) lack of engagement with the process of migration; (2) exclusion of internal migrants; and (3) lack of methodologies that are able to capture 'real-time' data about health needs and healthcare seeking experiences over both time and place. In this paper, we reflect on a four-month pilot project which explored the use of WhatsApp Messenger - a popular mobile phone application used widely in sub-Saharan Africa - and assessed its feasibility as a research tool with migrant and mobile populations in order to inform a larger study that would address these challenges.Method: A four-month pilot was undertaken with eleven participants between October 2019 and January 2020. Using Survey Node, an online platform that allows for the automatic administration of surveys through WhatsApp, monthly surveys were administered. The GPS coordinates of participants were also obtained. Recruited through civil society partners in Gauteng, participants were over the age of 18, comfortable engaging in English, and owned WhatsApp compatible cell phones. Enrolment involved an administered survey and training participants in the study protocol. Participants received reimbursement for their travel costs and monthly cell phone data.Results: Out of a possible eighty eight survey and location responses, sixty one were received. In general, participants responded consistently to the monthly surveys and shared their location when prompted. Survey Node proved an efficient and effective way to administer surveys through WhatsApp. Location sharing via WhatsApp proved cumbersome and led to the development of a secure platform through which participants could share their location. Ethical concerns about data sharing over WhatsApp were addressed.Conclusions: The success of the pilot indicates that WhatsApp can be used as a tool for data collection with migrant and mobile populations, and has informed the finalisation of the main study. Key lessons learnt included the importance of research design and processes for participant enrolment, and ensuring that the ethical concerns associated with WhatsApp are addressed. [ABSTRACT FROM AUTHOR]

Globally, the use of mobile phones for improving access to healthcare and conducting health research has gained traction in recent years as rates of ownership increase, particularly in low- and middle-income countries (LMICs). Mobile instant messaging applications, including WhatsApp Messenger, provide new and affordable opportunities for health research across time and place, potentially addressing the challenges of maintaining contact and participation involved in research with migrant and mobile populations, for example. However, little is known about the opportunities and challenges associated with the use of WhatsApp as a tool for health research. To inform our study, we conducted a scoping review of published health research that uses WhatsApp as a data collection tool. A key reason for focusing on WhatsApp is the ability to retain contact with participants when they cross international borders. Five key public health databases were searched for articles containing the words ‘WhatsApp’ and ‘health research’ in their titles and abstracts. We identified 69 articles, 16 of which met our inclusion criteria for review. We extracted data pertaining to the characteristics of the research. Across the 16 studies—11 of which were based in LMICs—WhatsApp was primarily used in one of two ways. In the eight quantitative studies identified, seven used WhatsApp to send hyperlinks to online surveys. With one exception, the eight studies that employed a qualitative (n = 6) or mixed-method (n = 2) design analysed the WhatsApp content generated through a WhatsApp-based programmatic intervention. We found a lack of attention paid to research ethics across the studies, which is concerning given the controversies WhatsApp has faced with regard to data protection in relation to end-to-end encryption. We provide recommendations to address these issues for researchers considering using WhatsApp as a data collection tool over time and place. [ABSTRACT FROM AUTHOR]

Like many other countries, South Africa (SA) has committed to the Sustainable Development Goals that aim to "leave no-one behind", in efforts towards universal health coverage, and meeting the UNAIDS 90–90–90 targets through the implementation of universal test and treat (UTT) interventions. SA is associated with high levels of international and internal migration that, in certain contexts, are known to (1) increase the risk of acquiring HIV and (2) present challenges to HIV treatment access and continuity. Despite this, migration and mobility are not adequately considered in responses to HIV. As SA rolls out UTT programmes and antiretroviral treatment as prevention (TasP) interventions, including pre-exposure prophylaxis (PreP), there is an urgent need to ensure that these are migration-aware and mobility-competent. In SA, a key population that experiences a disproportionate HIV burden is international migrant farm workers living and working on commercial farms along the border with Zimbabwe. In this article, a social determinants of health approach is applied to explore the context within which this population struggles to access positive determinants of health, including the public health care system, and the implications of this for HIV programming. It is argued that, unless policies and programming become migration-aware and mobility-competent, UTT and TasP interventions will struggle to address the high burden of HIV among this population and, as a result, progress towards global health targets will be limited. [ABSTRACT FROM AUTHOR]

Background: While multisectoral action (MSA) is advocated as one of the strategies to address complex health and development challenges, there is limited clarity about the process of multisector collaboration in practice. Objectives: Informed by the findings of the research on implementation of the multisectoral response to HIV in South Africa, and drawing from the existing literature; we propose a framework for multisector and multilevel collaboration. The framework describes key components of the process of multisector collaboration, and aims to inform policy and practice. Methods: An integrative review and synthesis of existing frameworks, models and approaches on multisectoral action in public health, governance and health, and in public administration was conducted to inform the development of the proposed framework. Results: There are seven key components that are critical in the process of multisector collaboration namely: preconditions; key drivers; structure; mechanisms; administration; execution and evaluation. Multisector collaboration is presented as an iterative process that allow for improvement and learning. The framework is presented through a visual representation which shows how the seven elements are connected, and how learning happens through-out the multisector collaboration process. Structure and mechanisms are the two central and interrelated elements of the proposed framework. Conclusion: The framework does not suggest that multisector collaboration is a panacea, but that MSA remains critical to address complex health and development issues. Focus should be on finding innovative ways to inform and strengthen its implementation in practice. The framework can be used by practitioners and policy makers to inform design, implementation, and evaluation of multisector collaborations. It reflects on complexities of MSA, and brings to the fore critical information to assess readiness and to inform the decision whether to engage in MSA or not. [ABSTRACT FROM AUTHOR]

Whilst progress has been made, evidence of effective approaches to improve action on addressing the social and structural drivers of the HIV epidemic remains a priority, to meet the 2030 sustainable development agenda, and to achieve key HIV targets, including the 90-90-90 target and the Treatment as Prevention (TasP) intervention. With a focus on the public sector in South Africa, we critically reflect on the HIV mainstreaming approach, assessing its ability to augment multisectoral action on the response to HIV. We reflect on progress made in mainstreaming HIV in non-health sector departments, exploring factors that have enabled and hindered the process. We also highlight limitations in the adopted approach to mainstreaming HIV in non-health sector departments in South Africa; which currently promotes working in silos and does not encourage collaboration and partnerships. We propose a three-step approach to effective mainstreaming of HIV that will augment multisectoral action. The approach also contributes towards realising the sustainable development agenda of "leaving no one behind" and achieving the national and global targets on HIV that are embedded in collaborative efforts. [ABSTRACT FROM AUTHOR]

South Africa's public healthcare system responses seldom engage with migration. Our exploratory study investigates migration profiles and experiences of primary healthcare (PHC) users. A cross-sectional survey involving non-probability sampling was conducted with 229 PHC users at six purposively selected PHC clinics in three districts of SA. The survey captured socio-demographic information, migration histories, and PHC experiences. Chi square and Fischer's exact tests were used to compare categorical variables, whilst Mann-Whitney U tests compared continuous variables between groups. Most PHC users were migrants (22% internal South African; 45% cross-border) who generally move for reasons other than healthcare seeking. Length of time accessing services at a specific clinic was shown to be key in describing experiences of PHC use. Understanding population movement is central to PHC strengthening in SA and requires improved understanding of mobility dynamics in regard to not just nationality, but also internal mobility and length of stay. [ABSTRACT FROM AUTHOR]

Background: Unmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas. This article describes and reflects on the authors' experiences in designing and implementing an HIV intervention originally intended for migrant men living in single-sex hostels of inner-city Johannesburg. It shows how formative research findings were incorporated into project design, substantially shifting the scope of the original project.Methods: Formative research activities were undertaken to better understand the demand- and supply-side barriers to delivering HIV prevention activities within this community. These included community mapping, a baseline survey (n = 1458) and client-simulation exercise in local public sector clinics. The intervention was designed and implemented in the study setting over a period of 18 months. Implementation was assessed by way of a process evaluation of selected project components.Results: The project scope expanded to include women living in adjacent informal settlements. Concurrent sexual partnerships between these women and male hostel residents were common, and HIV prevalence was higher among women (56%) than men (24%). Overwhelmingly, hostel residents were internal migrants from another province, and most felt 'alienated' from the rest of the city. While men prioritised the need for jobs, women were more concerned about water, sanitation, housing and poverty alleviation. Most women (70%) regarded their community as unsafe (cf. 47% of men). In the final intervention, project objectives were modified and HIV prevention activities were embedded within a broader health and development focus. 'Community health clubs' were established to build residents' capacity to promote health and longer term well-being, and to initiate and sustain change within their communities.Conclusions: To improve efforts to address HIV in urban informal settings, intervention designers must acknowledge and engage with the priorities set by the marginalised communities that live here, which may well encompass more pressing issues associated with daily survival. [ABSTRACT FROM AUTHOR]

This article explores the intersecting vulnerabilities of non-national migrant mothers who sell sex in Johannesburg, South Africa – one of the most unequal cities in the world. Migrants who struggle to access the benefits of the city live and work in precarious peripheral spaces where they experience intersecting vulnerabilities associated with gender norms, race, and nationality. These vulnerabilities manifest as abuse, discrimination, criminalisation, and multiple levels of structural and direct violence. Migrant women who sell sex also face stigma and moralising associated with the illegal sale of sex, being foreign, and being a single parent. Drawing on ethnographic work with non-national migrant mothers who sell sex in Johannesburg, and from ongoing work exploring research, policy and programmatic responses to migration, sex work and health, we use an analytical lens of intersectionality to explore the daily challenges associated with encountering and negotiating intersecting vulnerabilities. We consider how these vulnerabilities formentanglements(drawing on Munoz, 2016) and are (re)produced and embodied in everyday practice in the city. We explore how they shift in significance and impact depending on context and social location, and argue for a nuanced approach to understanding migration and the sale of sex that recognises these intersecting vulnerabilities – and entanglements. [ABSTRACT FROM PUBLISHER]

Transactional sex has been associated with a high risk of HIV acquisition and unintended pregnancy among young women in urban slums in sub-Saharan Africa. However, few studies have explored the structural drivers of transactional sex from the perspective of both genders in these settings. This paper explores how young men and women understand the factors that lead to transactional sex among their peers, and how deprivation of material resources (housing, food and health care access) and consumerism (a desire for fashionable goods) may instigate transactional sex in the urban slums of Blantyre, Malawi. Data from 5 focus group discussions and 12 in-depth interviews undertaken with a total of 60 young men and women aged 18–23 years old, conducted between December 2012 and May 2013, were analysed using anticipated and grounded codes. Housing and food deprivation influenced decisions to engage in transactional sex for both young men and women. Poor health care access and a desire for fashionable goods (such as the latest hair or clothing styles and cellular phones) influenced the decisions of young women that led to transactional sex. Interventions that engage with deprivations and consumerism are essential to reducing sexual and reproductive health risks in urban slums. [ABSTRACT FROM PUBLISHER]

South Africa’s Constitution, Bill of Rights, and Freedom Charter are globally ground-breaking for providing provisions of non-discrimination, and, of particular note, on the basis of sexual orientation. Since the introduction of these protective frameworks, lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) communities, allies, and advocates in the country have won major legal battles on these issues; however, in spite of these successes, LGBTIQ communities continue to face hostility and violence. As a result, South African LGBTIQ individuals often travel to urban centres, such as Johannesburg, in the hope that these spaces will be more tolerant of their sexual orientation and gender identity; the reality, however, suggests otherwise. Moreover, despite South Africa’s designation as a safe haven for LGBTIQ communities, migrants from other African countries — where same-sex relationships are criminalised — are overwhelmingly met with xenophobic verbal, emotional, physical, and political violence. This article describes the authors’ engagement with nine lesbian, gay and bisexual (LGB) migrants and asylum seekers from Zimbabwe, Malawi, and elsewhere in South Africa during a weeklong poetry workshop exploring their lived experiences in Johannesburg. This workshop followed a body mapping and narrative writing workshop held previously with the same participants. This article investigates the themes identified from the body mapping process that guided the poems produced: migration, violence, citizenship, and freedom. The poetry created during the workshop illuminates how lesbian, gay, and bisexual migrants in Johannesburg work on a daily basis to build social trust as they demand to be seen and recognised, to enact their rights, to make and remake homes, to show up in public as Black people, as LGB individuals, and as human beings. We explore these strategies of citizen-making as informed by the LGB poets with whom we had the opportunity to work. [ABSTRACT FROM PUBLISHER]

Background: This paper considers the question of dietary diversity as a proxy for nutrition insecurity in communities living in the inner city and the urban informal periphery in Johannesburg. It argues that the issue of nutrition insecurity demands urgent and immediate attention by policy makers. Methods: A cross-sectional survey was undertaken for households from urban informal (n = 195) and urban formal (n = 292) areas in Johannesburg, South Africa. Foods consumed by the respondents the previous day were used to calculate a Dietary Diversity Score; a score < 4 was considered low. Results: Statistical comparisons of means between groups revealed that respondents from informal settlements consumed mostly cereals and meat/poultry/fish, while respondents in formal settlements consumed a more varied diet. Significantly more respondents living in informal settlements consumed a diet of low diversity (68.1%) versus those in formal settlements (15.4%). When grouped in quintiles, two-thirds of respondents from informal settlements fell in the lowest two, versus 15.4% living in formal settlements. Households who experienced periods of food shortages during the previous 12 months had a lower mean DDS than those from food secure households (4.00 ± 1.6 versus 4.36 ± 1.7; p = 0.026). Conclusions: Respondents in the informal settlements were more nutritionally vulnerable. Achieving nutrition security requires policies, strategies and plans to include specific nutrition considerations. [ABSTRACT FROM AUTHOR]

As with many issues associated with the movement of people, linkages between mobility, HIV, conflict and post-conflict settings have often been based on conjecture rather than fact. Conflict was assumed to increase transmission of HIV, and displaced populations, refugees and armed forces were presumed to have higher HIV prevalence than host communities. However, recent evidence challenges these assumptions. This article explores the complex relationship between HIV and post-conflict settings, and considers if and how migrants and mobile populations – including returning refugees – are at increased risk of HIV acquisition in post-conflict settings. [ABSTRACT FROM PUBLISHER]

South Africa has the largest population of people living with HIV globally and is associated with high population mobility. The majority of migrants move in search of improved livelihood opportunities, and many who migrate (both internally and across borders) move into urban areas, often through peripheral informal settlements where HIV prevalence is shown to be double that of urban formal areas. While the relationship between migration and the spread of HIV is acknowledged as complex, the context of migration may place individuals at increased risk for acquiring HIV. Studies have demonstrated the long-wave impact of HIV and AIDS on livelihood activities and, more recently, on patterns of migration. Many migrants engage in livelihood strategies situated within the urban 'informal economy'; these informal workplaces are often overlooked in global and national legislation governing workplace responses to health and HIV and AIDS. This study draws on existing research and limited primary data to explore the implications of HIV/AIDS programming for diverse migrant groups labouring in informal workplaces in Johannesburg, South Africa. We describe three case studies: waste-pickers at a dumpsite in a peripheral urban informal settlement; barmen and cleaners working in inner-city hotels where sex is also sold; and, migrants engaged in informal livelihood activities who are also members of burial societies. Given the importance of varied informal livelihood activities for diverse migrant groups, particularly in urban areas of South Africa, we propose that the national HIV/AIDS response can and should engage with internal and cross-border migrants in informal workplaces — which is in line with the principle of universal access and will strengthen the national response. Especially, we point out the potential for burial societies to provide an entry point for HIV/AIDS programming that targets migrant groups involved in the informal economy of South African cities. [ABSTRACT FROM PUBLISHER]

Drawing on a 2008 household study conducted with internal and cross-border migrant households in Johannesburg, South Africa, this article explores the impact of HIV-related sickness and the gendered provision of care on migration patterns. Findings show that the provision of care helps to sustain links between the livelihood systems of urban and rural households. In times of sickness, many migrants choose to return to their household of origin, to seek care. Female migrants play a pivotal role in the provision of care, potentially disrupting their productive livelihood roles within the city in order to return home to provide care. [ABSTRACT FROM AUTHOR]

Around 3% of the world’s population (n = 214 million people) has crossed international borders for various reasons. Since March 2011, Syria has been going through state of political crisis and instability resulting in an exodus of Syrians to neighbouring countries. More than 1 million Syrian refugees are residents of Lebanon, Jordan, Turkey, Egypt and North Africa. The international community must step up efforts to support Syrian refugees and their host governments.

The article offers information on interactions between migration, mobility and health and discusses need to improve health-system. Topics discussed include impacts of population movement on patterns of disease transmission; effects of mobility on health-service access and health-related behavior; and need of Demographic and Health Surveys to understand mobility and migration as well as insufficient robust data.

Johannesburg is home to a diverse migrant population and a range of urban health challenges. Locally informed and implemented responses to migration and health that are sensitive to the particular needs of diverse migrant groups are urgently required. In the absence of a coordinated response to migration and health in the city, the Johannesburg Migrant Health Forum (MHF) - an unfunded informal working group of civil society actors - was established in 2008. We assess the impact, contributions and challenges of the MHF on the development of local-level responses to migration and urban health in Johannesburg to date. In this Commentary, we draw on data from participant observation in MHF meetings and activities, a review of core MHF documents, and semi-structured interviews conducted with 15 MHF members.The MHF is contributing to the development of local-level migration and health responses in Johannesburg in three key ways: (1) tracking poor quality or denial of public services to migrants; (2) diverse organisational membership linking the policy process with community experiences; and (3) improving service delivery to migrant clients through participation of diverse service providers and civil society organisations in the Forum. Our findings indicate that the MHF has a vital role to play in supporting the development of appropriate local responses to migration and health in a context of continued - and increasing - migration, and against the backdrop of rising anti-immigrant sentiments. [ABSTRACT FROM AUTHOR]

Background: A multi-sectoral response is advocated by international organisations as a good strategy to address the multiple drivers and impact of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and was historically mandated as a condition of funding. In March 2017, the South African National AIDS Council (SANAC) launched the latest 5 year National Strategic Plan (NSP) to address HIV, sexually transmitted infections and tuberculosis. As with previous iterations, the NSP calls for multi-sectoral action (MSA) and mandates AIDS councils (ACs) at different levels to coordinate its implementation. Efforts have been made to advocate for the adoption of MSA in South Africa, yet evaluation of these efforts is currently limited. Objective: This paper assesses the implementation of a multi-sectoral response to HIV in South Africa, through a case study of the Mpumalanga Province. Methods: We identified and reviewed key policy documents, conducted 12 interviews and held six focus group discussions. We also drew on our involvement, through participant observation, in the development of NSPs and in AC meetings. Results: SANAC is struggling to provide much-needed support to provincial, district and local ACs. Therefore, most ACs are generally weak and failing to implement MSA. Membership is voluntary, there is a lack of sustained commitment and they do not include representatives from all sectors. There is little capacity to undertake the activities necessary for coordinating the implementation of MSA, and unclear roles and responsibilities within ACs result in divisions and tension between sectors. There is inadequate senior political leadership and funding to facilitate effective implementation of MSA. Conclusion: We identified three interventions that we argue are required to support the effective implementation of MSA: strengthening and stabilising the SANAC structure; building capacity of ACs; and creating an enabling environment for effective implementation of MSA through political leadership, support and resourcing of the HIV response. [ABSTRACT FROM PUBLISHER]

Competing Interests: Contributors and sources: JV established the Migration and Health Project Southern Africa (maHp) and is vice-chair of the global Migration Health and Development Research Initiative (MHADRI) and director of the African Research Universities Alliance (ARUA) Centre of Excellence on Migration and Mobility hosted at the ACMS, Wits University. MO coordinates the UCL-Lancet Commission on Migration and Health and previously worked for Médecins sans Frontières and the World Health Organization. LG directs the World Health Organization Collaborating Center on Global Health Law, where he has worked closely with WHO on global health. CAB is a doctoral student who has spent several years studying and researching the health needs of migrants, and has a broad interest in access to healthcare for marginalised groups across Africa and Europe. PD has been working in migration health for over 12 years in multiple settings across Asia as well as the Americas, with a particular interest in public health response to large scale population displacement. JV conceptualised the paper and wrote the first draft. JV, MO, LG, PD, and CAB reviewed and contributed to the article. JV revised the manuscript based on helpful comments from three reviewers. All authors approved the final manuscript. Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.