How unpopular policies are made: Lessons from Bangladesh, Singapore, & S.A.

In December, in a post titled #Decrim: A call for evidence-based policymaking, I referred to work which I had done with Ingrid Palmary investigating the making of South Africa’s 2013 Trafficking in Persons Act. This project formed part of a larger project, funded by the Migrating out of Poverty Research Consortium (MOOP), which included three case studies. The first being our one on the processes and decision making which led to the creation, passing, and implementation of the TIP Act. The second case study was conducted by The Refugee and Migratory Movements Research Unit (RMMRU) at the University of Dhaka in Bangladesh, and is an analysis of the Domestic Workers Protection and Welfare Policy (DWPDP), which was approved by the Bangladeshi government in 2015. And the third was undertaken by the Asia Research Institute (ARI) at the National University of Singapore and investigated the mandatory weekly day off policy for migrant domestic workers (MDWs) introduced by Singapore’s Ministry of Manpower (MOM) in 2012.

The three case studies are obviously all quite different. They explore different contexts; different kinds of policy; and different political structures. However, what Ingrid and I were able to do in this working paper*, which has just been published, is explore the similarities and differences that could go some way in helping us to better understand policy making in post-colonial settings.

To be clear, a lot has been written about policymaking and policy processes. However, most of this has centred on understanding policy making in European and North American contexts – for example 84 % of studies using the Advocacy Coalition Framework to analyse policy making between 1987 and 2013 were conducted in Europe and North America.

But aside from trying to address this gap in the literature, the work highlighted three important things to bear in mind when trying to advocate for policy change in these contexts.

The first is that when trying to make interventions in the policy making process, being able to either harness or successfully address ideas and panics about morality, and women, is powerful. For example, the anti-trafficking movement in South Africa was helped enormously by its ability to use pre-existing normative ideas, which many South Africans have, about sex work and the inability of women, particularly poor women of colour, to make decisions about their own lives and, particularly, sex lives. Whilst I certainly don’t agree with these ideas or this tactic, it is important to acknowledge that this is a reason that many, what I would call, socially conservative causes are able to gain traction.

Secondly, building coalitions and relationships with those involved in policy making is important. Social and political capital go a long way when trying to convince policy makers of your cause. Policy makers often have their own personal agendas – this was clear in both the case studies focused on domestic work. Policy makers where, by-and-large, also employers of domestic workers and, therefore, more sympathetic to maintaining the status quo than incurring additional personal cost through implementing policy which gave more rights to domestic workers. Building coalitions and relationships with other organisations and individuals, both locally and internationally, who agreed and sympathised with the efforts of civil society in Singapore and Bangladesh was incredibly important in the fight for the two policies.

And finally, more work needs to be done to build the trust of policy makers and the public in research, whilst insuring that they maintain a critical perspective and understanding of the limitations of the research with which they are presented. In other words, we need to improve research literacy so that people are better equipped to figure out whether the evidence and (alternative) facts with which they’ve been presented are sound (this is obviously something which many people are advocating for in the age of Trump). And, so that people, who aren’t familiar with how research and universities work, are better placed to understand what peer reviewed research is able to bring to the policy making table.

*A working paper is quite different from a journal article: 1. They’re not peer reviewed; and 2. They generally report on an entire project, whereas a journal article would advance a particular argument drawing on some aspects of the project and possibly other work that the author(s) has done.

#Decrim: A call for evidence-based policy making

One of the biggest reasons that has been given by the South African state for the continued criminalization of sex work has been that decriminalizing sex work would fuel the trafficking industry in the country. The problem with this reasoning is that it relies on assumptions about trafficking for the purposes of sexual exploitation that we have very little evidence to support. And, what’s particularly concerning is that these assumptions have effected the making of anti-trafficking policy in South Africa.

Let’s be very clear, the trafficking (recruitment, transport, and coercion) of anyone, regardless of purpose, is completely apprehensible and should be criminalized. BUT, it should also not be confused with sex work. Sex work is actively chosen by people as a livelihood, whether it be for economic reasons or simply because they enjoy the work.

Through research that Ingrid Palmary and I have done over the last two years, as part of the Migrating out of Poverty Research Consortium – tracing the development of the Trafficking in Persons Act of 2013 – it has become apparent that myths and misconceptions about trafficking and sex work drove both the emergence of an anti-trafficking movement in South Africa and the development of the Act.

A good example of one of these myths was the panic that emerged just prior to the 2010 FIFA World Cup in South Africa about the fact that thousands of women and children would be trafficked in to South Africa for the purposes of sexual exploitation at the hands of soccer-loving tourists. This, thankfully, did not happen. But what’s concerning is that this panic was simply another panic in a long list that emerge prior to major sporting events and which never come to fruition.

Unfortunately, most of what we ‘know’ about trafficking is not evidence-based. But what’s concerning about our findings, is that these myths were and are accepted at face value by policy makers. It’s one thing that ordinary people are unable to effectively interrogate what they read, a global phenomenon. But it’s another thing entirely when our policy makers embrace the post-truth/ post-factual world and fail to sufficiently interrogate the information with which they are presented and upon which they make policy.

As it currently stands, the fight for the decriminalization of sex work and against trafficking in South Africa, and globally, seems to be one in which we won’t see the triumph of evidence-based policy making. Rather the triumph of conservative ideas, which advocate for the continued policing of women and men and their decisions in respect to their sexuality.

If we are serious about human rights, specifically the rights of people in deciding what to do with their bodies and not be exploited or trafficked, policy makers need to do a better job of taking into account the evidence-based case for #Decrim.

**

This blog is part of a really great blog carnival initiative by Change: Centre for Health and Gender Equity. See here for other great blogs on the importance of #Decrim!

If you’d like to know more about the importance of and case for decriminalizing sex work, specifically in relation to the fight against trafficking, the New York Anti-Trafficking Network have produced a great video on the topic. Bhekisisa have also produced a great video on the importance of decrim in the fight against HIV/AIDS.

 

 

NHI: Understanding the implications of excluding immigrants from health care provision

If you don’t know this by now, I’m not quite sure what rock you’ve been living under, but South Africa is moving towards national health insurance. Whilst in theory I think a lot of us like the idea of cutting out medical aids (yes, please!) there remain a few practicalities that need to be ironed out.

But first, it’s important to note why universal health insurance could be a fantastic move for RSA. At the moment, less than 20% of the population are on medical aid, but 80% of all healthcare specialists work within the private healthcare sector. Post-apartheid, healthcare provision and access in RSA has not become more equitable, and, in theory at least, the NHI could finally address this.

At the end of last year, the National Health Insurance (NHI) White Paper was released. A White Paper is essentially the second step in the process of making an Act. The first is the production of a Green Paper. Comments that are made on the Green Paper are then taken into consideration in the writing of the White Paper which lays out what government is intending to do with the Act. Submissions on the White Paper are then invited (these were to be made by 31 May – the JHB Migrant Health Forum, of which ACMS is a part, made a submission) before a Bill is drafted.

The White Paper says a lot of things that can’t all be discussed in a blog post, and obviously what I’m most interested in is what it says about health care access for migrants (by migrants I’m referring exclusively to non-national, cross-border migrants in this piece).

Currently – according to legislation – everyone physically in South Africa is entitled to free primary health care. This includes the 3.5% of the population that are non-nationals, although there is some leeway for the Minister to exclude specific groups. All health care should be free for pregnant and lactating women and children under 6 in SA. And refugees, asylum seekers, and undocumented migrants from SADC should be means tested the same as South Africans when accessing hospitals (this is in accordance with the Uniform Patient Fee Schedule against which anyone accessing public health care is assessed).

Of course, we all know that this is not the reality – migrants are often denied health care. But that’s for another blog post.

The NHI would, as currently constructed, make the following four changes:

  1. Refugees* would be entitled to “basic health care services” funded through a special contingency fund that will be set up (s121). It’s worth noting that no definition has ever been provided for what “basic health care services” are;
  2. Asylum seekers* would only be entitled to emergency medical care and treatment for notifiable conditions (i.e. seriously contagious diseases like Ebola or the Zika virus) (s122);
  3. Any other migrant* would have to pay in full for any health care accessed, even at a primary level (s123); and
  4. Lastly, there is no mention of coverage for pregnant or lactating women or children.

Whilst a lot can be said about the constitutionality of these changes, I’ll leave that to a lawyer and focus on the practical implications.

Excellent research that has been done on migrants who access health care in RSA and it basically says three things:

  1. In order to migrate you have to be relatively healthy, so when migrants arrive in RSA they’re usually a good deal healthier than the local population. Migrants then assimilate into the local population and become less healthy – this is when they start to seek health care in RSA. Finally, when migrants get quite sick, they tend to return home. Migration is an economic strategy – if you can’t make money, you’re not going to stay in a place which is highly xenophobic and unwelcoming;
  2. Migrants do not overcrowd our health care facilities – they use them as would be expected by any population group. In fact, the discrimination that migrants face often means that they don’t seek health care when they should and thus become even less healthy. We should be encouraging migrants to use our health care facilities and remain healthy as this is beneficial to our whole population especially given the HIV and TB epidemics in RSA; and
  3. Migrants contribute an enormous amount to the RSA economy. The idea that RSA is losing money through providing health care to migrants is simply not true – the presence of migrants in RSA brings in more money than we could possibly spend on their health care.

The changes proposed by the NHI would simply lead to a less healthy migrant population, and therefore general population, and decreasing efficacy in public health initiatives around HIV, TB, and any new nasty contagious diseases that occur. The fact that we might save a little through denying vaccinations to non-national children is inconsequential when you think about how much a measles outbreak would cost.

 

Some of the submissions on the White Paper can be accessed here.

*Whilst legal permanent residents and documented refugees are provided for, these two categories of migrants really make up a small number of the overall migrant population in RSA mainly because DHA hate granting refugee status or legalising the stay of migrants.