Stressors Specific to Refugees, Asylum Seekers and Displaced Persons That Can Inform the TBHLM at UNGA78: Lessons from Kenya 2018-2023

All health is Public Health. Healthy meetings such as the seventy-eighth session to be held from Tuesday, 19 September to Saturday, 23 September, and on Tuesday, 26 September 2023; as well as UN?High-level Political Forum on Sustainable Development?(HLPF), also known as the SDG Summit, to be held on?Monday, 18 September and Tuesday, 19 September 2023 are opportunities to center issues on an agenda that will inform policy, programming and planning. The B HLM is one of the issues to be debated, analyzed, highlighted and on which resolutions will be reached. Global deliberations are cues that create the contexts which in turn influence behaviour in all people including refugees, asylum-seekers and displaced persons.

Re-imagining TB Prevention and Elimination that serves all population groups is one of the solution products that will propel us through and to the end TB by 2030 goal. Kenya has set up Public Health-mediated models that provide for inclusion of refugees, asylum-seekers and displaced persons to access healthcare services other countries hosting refugees can use as benchmarks. Health-promoting daily activities from the perspective of refugees, asylum-seekers and displaced persons range from enjoying basic fulfillments which include protection against eviction from houses, access to food, access to health-services, engagement in productive work, ability to sustain agency and proper documentation.

Cultural competency principles as applied to refugees, asylum-seekers and displaced persons reveal considerations such as establishment of inclusive spaces; a culture where mindfulness is paramount; a partnership approach in which refugees, asylum seekers and displaced persons’ led Organizations are allowed to work with indigenous entities such as the Stop TB Partnership-Kenya, UNHCR-Kenya, Amnesty International, HIAS, CSOs, FBOs and the Government of Kenya (GoK);? the Support Organizations synthesize the needs expressed by refugees, asylum-seekers and displaced persons and present them in an actionable manner; the networking catalyzes contexts where trust is built, individualization, recognition, empathy, planning, support, referrals and follow-up are possible.

In this culturally-mediated context one notes that the GoK recognizes the diversity in the communities that make up Kenya and ?has that embedded in one of the most progressive Constitutions in Africa; recognizes the individuals within those communities; set up mechanisms where refugees, asylum-seekers and displaced persons trust and respect the processes; and the existence of systems, services and community partnerships crystallizing a near one-stop service point known as Huduma.

From a Public Health-mediated point of view, the systems and structures serving Kenyans are robust and accessible to refugees, asylum-seekers and displaced persons too. This cultural competency drives effective consumer engagement and in in turn serves all population groups including the minority groups.

We drew heavily from studies analyzing the link interpersonal behaviour has with social networks, social support and using social cognitive theories to develop Anti-TB interventions. We generated a character of experiences shared freely by 637 refugees, asylum seekers and displaced persons whom we have worked with since 2018. We aimed at understanding the deeper norms that influence behaviour and how these affect health outcomes. We considered four (4) thematic phenomenology: physiological needs; documentation status; arrival in Kenya status; and displacement or dispersal reasons. Seventeen dimensions defining the life of refugees, asylum seekers and displaced persons were elicited in the following areas: housing, food, medical care, TB care, psychosocial support, livelihood, HIV care, Delaying or using Substance, Delaying or using Alcohol, being documented, undocumented, having expired documentation, arrival before 2009, arrival after 2009, climate related causes for displacement, political-crises’ related reason for displacement and cultural-social identity related cause for displacement.

We administered a Key Informant Questionnaire with 17 questions to elicit responses. Later, we used an In-Depth Interview Guide during Focus Group Discussions (FGDs) to elicit further responses.

·????? Physiological Needs: Housing, Food, Medical care, TB care, Psychosocial support, engage in livelihood activities, HIV care, Delaying or using Substance and Delaying or using Alcohol.

·????? Documentation Status: Documented; Undocumented; and Expired Documents.

·????? Arrival Status: Arrived before 2009; and those who arrived after 2009.

·????? Displacement and Dispersion causes: Climate, Political, Cultural-Social Identity Issues.

Out of the 637, those who self-reported having lived in a stable house since 2018 were (242); had at least one meal everyday since 2018 (274); needed medical care due to illnesses including chronic illnesses and trauma (149); needed TB care services (87) ((DS-TB (77), (MDR-TB (04), XDR-TB (06)); attended psychosocial support sessions to address trauma (250); have a livelihood? activity through which they earn income (120); need HIV care (94); have not used substances (172); have not used alcohol (257); documented (210); undocumented (200); have expired documents (227); arrived before 2009; arrived after 2009; those forced to flee due to climate-change (03); those forced to flee due to political reasons (340); and those forced to flee due to cultural-social-identity reasons (294).

Not everyone will be in New York to talk, debate, discuss, make submissions and advocate on behalf of their constituencies. Through this paper references on issues around TB Prevention among refugees, asylum seekers and displaced persons have been produced to be amplified in many fora. If we are to end TB let us learn from a country that allows contexts that recognize persons in all their forms. It is the first step in finding people who will be eligible for TB diagnosis, screening, testing, treatment and follow-up. ?It should also be noted that UNGA 78 in New York has come at a time when another august body, the U.S. Congress is deliberating on a number of issues some of which will influence Public Health anywhere in the world. Threats of shutdown and the need to reauthorize PEPFAR are heard in Washington. This is globally connected world and we hope that eventually local issues happening both in New York and Washington will end up boosting aspirations for quality global health outcomes for all.