Health care access and challenges: a case study of women migrant labourers in Newcastle, KwaZulu-Natal=Ukufinyelela kwezempilo nezinselelo: ucwaningonto ngabesifazane bokufika abasebenza eMadadeni, KwaZulu-Natali.

Abstract

Extreme economic disparity, both within and between nations, as well as unequal national political settings, characterize Southern Africa. “In 2019, 272 million people worldwide were international migrants” (Jinnah, 2020). Different types of cross-border mobility take a pivotal role in the livelihoods of both individuals and households in these circumstances. Historically, formal male migrant labour had dominated intra-regional labour mobility, particularly in the mining industry in South Africa (SA). Even now, the major destination is still South Africa, but over the past 20 to 25 years, political and economic shifts have led to a greater diversity of intra-regional migrant flows by location, temporality, and demography, including gender. Additionally, migrants' jobs and means of support now cover a diverse range of formalities, industries, and security. Female migrants often work in feminized labour, such as domestic and care work, but they also engage in a variety of service sector jobs and informal cross-border trading. Their presence in the labour market puts them in confusing and contentious relationships with South African citizens, who also deal with high unemployment and insecure employment rates. As a result, immigrants face xenophobia, gender and employment vulnerability and are accused of "taking jobs" from South African citizens. There is a great heterogeneity and history to migration in Southern African Development Community (SADC), including but not limited to, forced migrants fleeing conflict; individuals moving in search of improved livelihood opportunities; asylum seekers and refugees; traders and seasonal workers displaced within their own countries or moving cross-border - some have legal documents while others are without (Crush et al., 2005). In cases of labour migrants each situation may create and respond to its own set of health concerns, dependent on part upon where migrants work and live, the duration and conditions of their stay, and whether and when they return home (Preston-Whyte, 2006:33). Various interrelated factors account for migrant health, including behaviour, health-seeking behaviour and care-seeking decisions. Some behaviours are born of vulnerability, such as risky sex to procure food security, and some vulnerabilities are born of discrimination. Furthermore, health is not solely a physical condition that should be attained or maintained, but one that also incorporates mental health, which can be damaged through trauma, torture or depression, and ultimately causes much detriment to the well-being and the ability to adapt to a new environment (IOM, 2013; UNAIDS, 2014). The behaviour of health professionals has similarly ix | P a g e been indicated as one of the two factors that most determine the use or non-use of health services by immigrant communities. Studies suggest that these professionals frequently present a limited knowledge of legislation and/or its applicability and act in accordance with social stereotypes (Wolffers & Fernandez, 2003 and Dias et al., 2010), not responding to the effective needs of the users. In addition, they tend to have no cultural competencies necessary to relate with users from other nationalities, and do not know their specific characteristics (Pusseti et al., 2009). The South African legislative framework advocates for the universal acquiring of health services and the basic determinants of health. The National department of health has committed to providing efficient, equitable and accessible health services to all people residing within the country regardless of their identity status. Inaccessibility of healthcare service not only violate women migrants’ rights, but also may results in increasing the prevalence rate of Human Immunodeficiency Virus (HIV); Sexually-transmitted Infections; Prevention of Mother-toChild Transmission (PMTCT); Non-communicable diseases and Child mortality rate. This may also threaten the women labour migrants’ lives if they had not taken necessary precautions. Women labour migrants from Southern Africa, working in the Newcastle Municipality textile industry, are also not immune to the challenges of healthcare accessibility. This study examines the experience of women migrants labourers from Southern Africa to determine their accessibility to healthcare services given their working conditions, culture shock, language barrier and their socio-economic conditions. This is an empirical qualitative study that adopted in-depth interviews for the data collection of women labour migrants’ views and experiences regarding access to healthcare services within Newcastle Municipality in KwaZulu-Natal Province. The in-depth interviews were purposively conducted with 35 participants from Newcastle textile firms, and these comprised 7 key informants. The sample was only limited to women labour migrants from Southern Africa working in the textile industries within Newcastle Municipality. The analysis of the datum, which was intended to give meaning to the conundrum of women labour migrants’ access to healthcare services, adopted a thematic analysis that capitalized on structured themes throughout the analysis process. The study employed the theories of intersectionality feminism, the health capability approach thus including capabilities of gender inequality, access to health care, and the social exclusion theory. This study found out that within the transnational space, women experienced overt and x | P a g e covert issues regarding access to health-care services on transition and during their stay whilst working in the textile industry. However, there were some factors that influence their utilisation of healthcare facilities within the Newcastle Municipality area, these include culture, degree on basic education, the number of years stayed in the area and spoken language.

IQOQA Umehluko omkhulu womnotho, ngaphakathi naphakathi kwezizwe, kanjalo ukungalingani kwezimo zombusazwe kuzwelonke, kuhlonza iNingizimu Afrika. “Ngowezi-2019, izigidi zabantu ezingama-272 emhlabeni wonke bayizihambi zamazwe ngamazwe” (Jinnah, 2020. Izindlela ezahlukene zokuwela umngcele zibambe elikhulu iqhaza empilweni yokubili kumuntu ngamunye nasemindenini kulezi zimo. Ngokomlando, ukuhamba kowesilisa okusemthethweni ngokomsebenzi bekudlangile nokuhamba ngomsebenzi kwangaphakathi, ikakhulu embonini yezimayini eNingizimu Afrika (SA). Ngisho namanje, ufuduko lusalokhu lubheke eNingizimu Afrika, kodwa eminyakeni eyedlule engaphezu kwama-20 kuya kwengama-25, izinguquko kwezombusazwe nakwezomnotho ziholele kokukhulu ukwehlukana ngokutheleka kwezihambi ngaphakathi kwesifunda ngokokuhlala, ukugoba amadlangala nezibalo zabantu, kubandakanya ubulili. Ukwengeza, imisebenzi yezihambi nezindlela zokwesekela manje zifaka izinhlobonhlobo zemigomo, izimboni nezokuphepha. Izihambi zesifazane zivame ukwenza imisebenzi yabesifazane, njengokuthi nje imisebenzi yasekhaya neyokunakekela, kodwa futhi bayazibandakanya emikhakheni yezinsiza yemisebenzi eyahlukahlukene nasekuhwebeni okungagunyaziwe emingceleni. Ubukhona babo emisebenzini yokuhweba kubabeka ebudlelwaneni obudidayo nobunezinxushunxushu nezakhamuzi zaseNingizimu Afrika, nazo ezibhekene nezinga eliphezulu lokungaqashwa namazinga aphakeme okungavikeleki kokuqashwa. Ngenxa yalokho, izihambi zibhekana nokucwaswa ngokobuzwe, ngokobulili nokuba sengozini ngokuqashwa kanye nokugxekwa “ngokuthatha imisebenzi” kwizakhamuzi zaseNingizimu Afrika. Kukhona okukhulu ukwehlukaniswa kanye nomlando wokufuduka komphakathi osathuthuka eNingizimu Afrika (SADC), kuhlanganisa kodwa okungenamkhawulo kukho, okuphoqa izihambi ukubalekela izinxushunxushu; ukuhamba kwabantu ngabanye ngabanye ukuyofuna amathuba angcono okuzithuthukisa empilweni; abafuna ukukhoseliswa nababaleki; abahwebi nabasebenza ngenkathi ethile abadingisiwe emazweni akubo noma behamba beqa umngcele – abanye banezimvume ezisemthethweni lapho abanye bengenazo (Crush nabanye, 2005). Ezindabeni zokusebenza kwezihambi isimo ngasinye singase sidale futhi siphendule esimeni saso sokukhathazeka ngempilo, kuncike engxenyeni yokuthi izihambi zisebenza futhi zihlala kuphi, ubude besikhathi nezimo zokuhlala kwazo, nesimo sezulu nokuthi zibuyela nini ekhaya ((Preston-Whyte, 2006:33). Izimo ezahlukahlukene ezihlobene ziyimbangela yempilo yezihambi, kubandakanya ukuziphatha, impilo yokufuna ukuziphatha nezinqumo zokufuna ukunakekelwa. Okunye ukuziphatha kubangelwa ukungavikeleki, njengokuba socansini olubucayi ukuba kutholakale ukuvikeleka kokudla, nezinye izingozi ezidalwa wukucwaswa. Ngaphezu kwalokhu, impilo akuyona kuphela eyesimo somzimba okufanele itholakale noma inakekelwe, kodwa enye futhi ifaka impilo ngokomqondo, engalimazeka ngokuhlukumezeka, ukuhlushwa noma ngengcindezi, bese umphumela udale omkhulu umonakalo kwinhlalakahle nangokukwazi ukwamukela indawo entsha (IOM, 1013; UNAIDS, 2014). Ukuziphatha kongoti bezempilo kuvezwe ngokufanayo njengezinto ezimbili ezinquma ukusetshenziswa noma ukungasetshenziswa kwezinsiza zezempilo wumphakathi wezihambi. Ucwaningo luphakamisa ukuthi labo ngoti bavamile ukwethula ulwazi olungenele lwesishayamthetho nokuthi noma ukusetshenziswa kwalo nokwenza ngokuhambisana nemibono yenhlalo (Wolffers & Fernandez, 2003 no-Dias nabanye, 2010), hhayi ukubhekana nezidingo ezisebenzayo zabazisebenzisayo. Okunye, babonakala bengenalwazi ngokwesiko oludingakalayo ukuhlobana nabasebenzisi abavela kwezinye izizwe, futhi abazazi izimpawu zabo ezikhethekile (Pusseti nabanye, 2009). Uhlakakusebenza lomthetho waseNingizimu Afrika luqhakambisa ukutholakala kwezinsiza zempilo emhlabeni nezinqumo eziyisisekelo sezempilo. UMnyango kazwelonke wezempilo uzibophezele ekuhlinzekeni ngempumelelo, izinsiza zezempilo ezingakhethi nezitholakalayo kubo bonke abantu abahlala ezweni ngaphandle kwesimo sokuhlonzwa kwabo. Ukungafinyeleli osizweni lwezempilo akuphuli nje kuphela amalungelo abesifazane abayizihambi, kodwa futhi kungase kuholele ekwandiseni izinga lokudlanga kwegciwane lesandulela ngculazi/Human Immunodeficiency Virus (HIV); ukuthelelana ngezifo zocansi ezithathelwanayo; ukuvikelwa kokudlulisela kukamama enganeni ukuthathelwana (PMTCT); izifo ezingathathelwani kanye nezinga lokufa kwezingane. Lokhu kungase futhi kubeke engcupheni impilo yabesifazane abayizihambi abangabasebenzi uma bengathathi izinyathelo ezidingekayo. Abesifazane abangabasenzi abayizihambi bevela eNingizimu Afrika, abasebenza kuMasipala eMadadeni embonini yendwangu, nabo futhi abagonyelwanga izinselelo zokufinyelela kwezempilo. Lolu cwaningo luhlola ulwazi lwabesifazane abayizihambi besebenza eNingizimu Afrika ukunquma ngokufinyelela ezinsizeni zezempilo abazithola ezimeni zabo zokusebenza, ukungajwayeli isikompilo, umgomo wolimi nezimo zomnotho womphakathi. Lokhu wucwaningo olwenziwe lwekhwalithethivu oluthathe inhlwayalwazi ejulile ukuqoqa imininingo yenhlolombono yabesifazane abangabasebenzi nolwazi lwabo mayelana nokufinyelela ezinsizeni zezempilo kuMasipala waseMadadeni esifundeni iKwaZulu-Natal. Inhlolovo ejulile yenziwe ngehloso kwabangama-35 ababambe iqhaza baseMadadeni ezimbonini zendwangu, futhi labo babandakanya abanolwazi abayisikhombisa abaqavile. Ilinge belinomkhawulo ophelela kuphela kwabesifazane bokufika babasebenzi bevela eNingizimu Afrika besebenza ezimbonini zendwangu kuMasipala eMadadeni. Uhlaziyo lomniningo, obeluhlose ukuveza incazelo ngenselelo yabesifazane abayizihambi ngokufinyelela ezinsizeni zezempilo, ukwamukela ukuhlaziywa kwendikimba okusebenzise izindikimba ezihleliwe kuyo yonke inqubo yokuhlaziya. Ucwaningo lusebenzise izinjulalwazi ezixubile ezaziwa ngabesifazane, indlela yekhono lezempilo ngakho kuhlanganisa ukukwazi ngokungalingani kobulili, ukufinyelela ekunakekelweni kwempilo, nenjulalwazi yokungabandakanywa emphakathini. Lolu cwaningo luthole ukuthi phakathi endaweni yamazwe ngamazwe, abesifazane babhekana nezindaba ezisobala nezifihlakele maqondana nokufinyelela ezinsizeni zokunakekelwa kwezempilo ekuguqukeni nangesikhathi sokuhlala kwabo lapho besebenza embonini yendwangu. Kodwa zikhona ezinye izinto ezinomthelela ekusebenziseni kwabo izikhungo zempilo kuMasipala wasendaweni yaseMadadeni, lezi zihlanganisa isikompilo, izinga lesisekelo semfundo, iminyaka esihlalwe endaweni nolimi olukhulunywayo.