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Using technology to break delivery challenges when administrating health aid meant for refugees in South Africa.

Solutions to barriers to transportation, logistical challenges, poor human resources, and a lack of transparency.

Photo of Joseph Asiiwa
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What specific problem(s) are you trying to address?

The innovation am trying to develop will answer the following challenges, that the donor community has faced when administering aid in Africa, The challenges have been barriers to transportation, logistical challenges, poor human resources, and a lack of transparency in the supply chain, as well described by Human Rights watch," December 7, 2009 No Healing Here Violence, Discrimination and Barriers to Health for Migrants in South Africa'' .The DOH has a complicated system of user fees in the public health system, which vary from 20 to 100 percent of the total cost of health care depending on the type of care and the income level of the patient. Documented and undocumented asylum seekers, refugees,have to seek services through other means.

What are some of your unanswered questions about the problem(s) you are working to address?

From the top, refugees/migrant persons should have access to Health care free of charge, because of their level of incomes as most are living on hand to mouth, but at the bottom ( health facilities) the situation is different, a refugee has to bribe security guards, nurses to seek health facilities on top of being insulted by health front line workers. So its at this stage that my innovation will address those barriers and come up with a better way of accessing health aid .

Explain Your Idea

My innovation involves updating the list of foreign doctors from African countries working in the country and their specialties, to link them to refugees or migrant workers from their country of origin. Most of these doctors have private practices where they meet their private patients, its at these premises where we they can treat their own and then they are refereed to the Government Hospital to collect drugs. These doctors have an experience of diseases faced by refugees as the burden of disease associated with refugees in host countries, has been met with the doctors prior to coming in the host country. The system will reflect immediately and will be interlinked with the system used in the hospitals. In cases of severe illness, still the software will indicate the days when the major treatment or surgery will be conducted by the Doctors on duty. What the government pays for patients will still be paid to the doctors through their salaries, the same way private ambulances operate. We can also add a small fee for the doctor, something like 2 Us dollars for administration which is affordable by refugees and asylum seekers.

Name the three most important ways that your idea will address your identified problem(s).

1) It will address the racist, xenophobic utterances experienced in hospital where refugees access Health services. 2) It will overcome communication gaps experienced by Front line health workers as some refugees come from Francophone, Arabic countries and can not communicate matters of reproductive health easily in English.

How is your idea unique?

My idea is unique in the sense that , the innovation can provide more potential that provides more options. This can be elaborated further that even if the original idea fails, the capabilities and insights generated could lead to many other opportunities . For example with the funds available , we can invest in broader capabilities like healthcare information administration, delivery and administration of aid in conflict areas. This idea is not the fist of its kind, but lack of data in Africa has proved to be a challenge, but it has been used in China and Bangladesh. The other problem related to data is there is no successful country in Africa with so many indigenous tribes that has a successful health system. Developed countries are united with a common language spoken by all people unlike in Africa.

What are some outstanding concerns or questions that you have regarding your idea?

My innovation is anticipating how the local communities will react when refugees and asylum seekers are seeking health services from their own folks in country full of xenophobic sentiments. The other concern is the department of health (DOH) and other stakeholders weather they will support the initiative throughout the whole cycle.

Who are your end users?

My end users will be women and girls from the refugee /asylum seekers section in the country.It is the women and girls who suffer the brunt of endless racism and xenophobic utterances as they seek health services in public health centers. The innovation will craete the following benefits: a) provide refugees with a platform on which they can share there ideas. b) increase community engagement of refugees and adolescent women/girls. c)provide an accessible platform for refugees to be producers of information not consumers. This project will target refugees / asylum seekers in the provinces of Northwest and Limpopo aged between 14- 49. The project will look at 4000 refugees for the whole year.

Where will your idea be implemented?

  • South Africa

What is the primary type of emergency setting where your innovation would operate?

  • Armed conflict
  • Prolonged displacement
  • Community at risk of disaster

Tell us more about the emergency setting that you intend to implement in

The south African department of health has affirmed the rights of asylum seekers and migrants to seek health care, but health care workers repeatedly violated that provision and discriminated patients on the basis of their nationality or lack of proper documents. The delayed or denied treatment of migrant health threatens to further strain the country's already stretched system. We need also to remind our selves about the coming elections wheaten the incoming local governments will support us.

What is your organization's name?

Allied Migrant Forum sa

Tell us more about you.

We are an organisation and we have a team ready to roll out this challenge. Our past work include, we negotiated with local groups within the province under the supervision of Department of Public Health in the province to put an end to the xenophobic attacks that engulfed the country in 2016-17.

Organizational Characteristics

  • Women-led organization
  • Displaced person / refugee-led organization
  • Locally/community-led organization

What is the current scale of your proposed innovation?

  • Still in planning phase and does not exist yet

Experience in Implementation Country(ies)

  • Yes, for less than one year.

Expertise in Sector

  • Yes, for more than a year.

Organization Location

Northwest province - South Africa

What is your organizational status?

  • Registered non-profit, charity, NGO, or community-based organization.

What is the maturity of your innovation?

  • Existing Prototype or Pilot: Tested a part of my solution with users and am iterating.


Join the conversation:

Photo of Eunice Kajala

Have you considered the possibilities that your innovation can be allowed by the Health Professions Council of South Africa? Is there anyway you can help them through a low cost insurance/ medical aid at low cost. You may develop an application that can allow refugees to access health services(from foreign and local doctors) linked to the low cost health insurance/medical aid.Whatever you do, in your innovation, it is wise to include both locals and foreign doctors.

Photo of Joseph Asiiwa

At this stage, we need to have a lot of data as much as possible, because you can not present the innovation bluntly without much data to the Health Professional Council of South Africa. The innovation if granted funding, will involve Health MEC's (Members of the Executive Committee) in the provinces of Northwest and Limpopo to support the innovation. When much data and its impact has been felt, that is when we shall seek the input of the Health Professional council for roll out to the whole country.
Eunice, the issue of low cost insurance or medical aid to bear fruit in the modern South Africa, we need to advocate for fair rules and regulations in other sectors of the economy which are not health related. For example the banking sector need to enable refugees and asylum seekers open up accounts with easy, understand that refugees and asylum seekers mostly work in the informal sector mostly, on a few occasions, banks which opened up accounts for asylum seekers closed their accounts without notice because the money on accounts was questioned, it was either too much, he was depositing and withdrawing cash not showing the sources of income to the Bank. When an asylum seeker looses money like that, its hard to develop trust with such banks again.
Another area that the banks need to improve is, they have a wrong perception about refugees/ asylum seekers, just like other people in society they think every one in that category has to dirt, begging, and impoverished. So many asylum seekers have entrepreneurial skills that they apply within the country and make a descent life out of their misery. So if institutions like banks can improve on the issues i have explained above, the idea of devolving a low cost insurance or medical aid can start to attract investors for the innovation.
Another perception that need to change is that the financial and insurance institutions look at refugees/asylum seekers as a 'risk' population, they have a high burden of disease, always on the move- moving from one area to another looking for 'greener pastures' which makes them prune to accidents. Lack of proper family structures for refugees/asylum seekers persons with proper documents also hinder investors to fund innovations addressing such populations. Its about engaging the institutions listed above, that the way to develop an application for asylum seekers/refugees can start to attract people or organisations with funds .
In the event, the innovation goes through, the idea of involving local doctors presents another scenario of need for interpreters. This innovation is about how the marginalize people in community can access reproductive health services, definitions for marginalized people communities is that, '' people who suffer from discrimination and marginalization also have higher mental, emotional and health problems, as well. That also then have a particular impact on development and the costs of a lack of development''. Pat Morris, Bureau of Democracy, Human Rights, and Labor
October 14, 2014.This innovation will give them a voice but my worry is are local doctors willing to go the extra mile to offer a service free of charge during the testing period or accept to have a translator. But after examining the available data from the testing phase, we shall see how the innovation can involve both Local and foreign doctors.

Photo of Eunice Kajala

Hi Joseph, South Africa is governed by laws, and once an issue involves doctors and patients, regardless of the circumstances, the Health Professions Council of South Africa must be involved.Xenophobia is all over the world, the only, difference, may be the South Africans don't hide it.Which part of the Northwest are you working, that area is cool, patients are being attended regardless of their nationality.

Photo of Joseph Asiiwa

Eunice, You should pay me a visit, at molopo shopping complex, station road, Mafikeng. I agree with you, but the professional council of Doctors is still governed by the respective health departments of each province. To explain this further, look at how doctors are paid and enrolled. They are paid and enrolled by the Department of Health of a particular province . This means the Health Department has more authority than the Health Professional Council.
Secondly, we are not underestimating the value of the council, but we are intending to try out this innovation in one particular area or two (provinces) before rolling it out to other parts of the country, by the time we roll out, we should have got enough data for all stakeholders to see the results including the Health professional council.
You say xenophobia is all over the world, so should we just close our eyes and let minority groups be bullied and yet there are clear national and international laws that can protect them, why should we embrace a certain evil in society yet we cam eliminate it. If we do no act now, who will.
Eunice, you seem to be informed wrongly at what is happening on the ground, i told you of refugee and asylum seekers in Limpompo, you said they do not exist with clear statistics from the last census. Now you are telling me , its cool people are being treated regardless of their Nationality, so just answer for me these questions
a) How many clinics are fully operational within Ngaka modiri Molema district? And those not operating, for how long have they been closed?
b)The last report on the Health of Refugees and asylum seekers in South Africa compiled by Human Rights watch, what were there recommendations.
c) check this archive of this newspaper:Mail & Guardian June 23 to 29 2017, PG 26. There is an interesting article that summarizes my discussion, it was written by Bongani Mojala - Chairperson of the South African Human rights council.

Photo of Eunice Kajala

Hi Joseph, I didn't say that, the asylum seekers are not present in Limpopo.But what I was saying, is that foreigners (including the asylum seekers) are still being attended in Limpopo Province. I'm not sure of the Mafikeng side, I have worked at Mecklenburg Hospital near Dilokong Hospital, 30 minutes ride from Burgersfort, almost five years ago. I have never seen any of my colleagues denying the asylum seekers of the medical services, provided that they had paid for the services.I was under the Northwest Health Department, but I still had to be registered with the Health Profession Council of South Africa. I am not sure of what is going on within Ngaka Modiri Molema district, it might be other factors that have led to closure of those clinics, one of them, could be shortage of staff.I don't have the actual figures of the asylum seekers in Limpopo.

Photo of Eunice Kajala

Where exactly are the asylum seekers in Limpopo Province? I have been to Limpopo almost five years ago. I have been to Moroke area, Sekhukhune district where Mecklenburg Hospital is located.In those areas individuals(foreigners) can access health services, the main problem is the lack of medical insurance.

Photo of Joseph Asiiwa

This project is about reaching the people whom the normal system does not cater for, undocumented migrants or asylum seekers do not go to hospital because of the xenophobic sentiments uttered to them and fear of being arrested.These asylum seekers carry a burden of disease from their neighboring countries to South Africa, so my intervention is how to bring them on board. there is a lot of available data for this problem