Cross-Border Health Challenges

Migration is part of human nature and people keep moving to find shelters, food, peace and better life. However, one of the major challenges for health services globally is to deal with the mobile population and migrants, to provide equitable health care and to monitor the movement of people living with chronic or infectious diseases.

We might be overwhelmed by the acute crises caused by wars, but we must not ignore the major silent migrations that constantly challenge health service capacity and organization in Africa. One of these floods of people on move is the economical migration in Southern Africa region where South Africa is the major hosting country and absorbing millions of migrants across the continent, from Horn of Africa to West Africa. Challenges to all countries in Africa, despite sending or receiving countries, nobody knows how many people who are migrating annually, but it might be more than millions.

The political and economic aspects of this migration have been addressed by International Organization of Migrants, SADC and other international agencies for several years. The medical aspects came into focus as a result of the re-emergence of tuberculosis and the emergence of HIV from the mid-1980s. For both these problems we are now fortunate to have standardized, effective and affordable means of treatment, that seems to achieve full acceptance among people and halt the spread at national level.However, patients on treatment mostly have to interrupt their treatment when they are forced to migrate to other countries to find jobs, attending schools or conducting business. This will consequently cause relapse with new spread and development of drug resistance to both diseases.

Through four international conferences (three in the region and one in Oslo) since 2009, LIN has gathered policymakers and “do’ers” to discuss this challenge. Through these conferences it has become clear that relevant governments are aware of the dangers, realize that it is a win-win-situation if solutions could be found, and they are ready to act. What remains is to fill the knowledge gap and bring in ad-hoc available technology solutions, so they can know what to do.

In the conference in Oslo, October 2014, we agreed on a strategy: To build a network of knowledge gathering centers based on local universities engagements. On site universities join hands with local health services to mold practical challenges into researchable questions and thereby create a knowledgebase for action. The “model” is adapted from Sudan (EpiLab) and has proven to be an efficient and non-expensive way to move from “academic evidence” to practical implementation. The key is that all research is run and owned by local institutions. The difference from “action research” is that research is done in small steps following strict scientific methodology, and universities stay fully independent, but not detached, from policymakers and health services.

Three professional domains were named; political (legal aspects, numbers, economy, privacy protection, etc.), medical (harmonization of regimens, care if patients who are unable to work, etc.) and technical (compatibility and communication between health information systems, appropriate soft- and hard-ware, etc.). All three are highly interlinked.

University of Oslo, and any other resource institution that wants to join in, play the role only as advisors and facilitators. Institute for Informatics, UiO, has pioneered the development of DHIS2, software for health systems informatics and management, which is in use in most of the nations in the Southern Africa region. They have on-going research and competence building with professionals from these countries. Institute for Health and Society has been heavily involved in development of the EpiLab model and is training MPhil and PhD students in public health projects based on this model.

LIN is a small Norwegian NGO with a vision “to restore human’s health and dignity”. It’s profile is to identify gaps between various public and NGO activities and “glue” stakeholders together by filling in the gaps. The main activities have so far taken place in Malawi, Northern Zone, and have been focused on implementation of health informatics in the national health services at health facility level. But it includes various development projects for vulnerable groups. The strategy is to bring people from charity to self-sustainability. In the last couple of years LIN has established a branch in South Africa to support the country’s efforts in solving the challenge of securing cross-border patients continuous treatment.

LIN has historical roots in Taiwan, in Pingtung Christian Hospital, once established by Norwegian missionaries, now contributing funds for development work in Africa. There is a strong environment for technological innovation with basis in this institution and they serve LIN activities in Malawi and South Africa.