Thailand was hit by the second wave of Coronavirus Disease 2019 (COVID-19) in a densely migrant-populated province (Samut Sakhon). COVID-19 vaccines were known to be effective; however, the supply was limited. Therefore, this study aimed to predict the effectiveness of Thailand’s COVID-19 vaccination strategy. We obtained most of the data from the Ministry of Public Health. Deterministic system dynamics and compartmental models were utilized. The reproduction number (R) between Thais and migrants was estimated at 1.25 and 2.5, respectively. Vaccine effectiveness (VE) to prevent infection was assumed at 50%. In Samut Sakhon, there were 500,000 resident Thais and 360,000 resident migrants. The contribution of migrants to the province’s gross domestic product was estimated at 20%. Different policy scenarios were analyzed. The migrant-centric vaccination policy scenario received the lowest incremental cost per one case or one death averted compared with the other scenarios. The Thai-centric policy scenario yielded an incremental cost of 27,191 Baht per one life saved, while the migrant-centric policy scenario produced a comparable incremental cost of 3782 Baht. Sensitivity analysis also demonstrated that the migrant-centric scenario presented the most cost-effective outcome even when VE diminished to 20%. A migrant-centric policy yielded the smallest volume of cumulative infections and deaths and was the most cost-effective scenario, independent of R and VE values. Further studies should address political feasibility and social acceptability of migrant vaccine prioritization.

Thailand has become a popular destination for international migrant workers, particularly from Cambodia, Lao PDR, and Myanmar. However, only a fraction of these migrant workers were insured by public health insurance. The objective of this study was to apply systems thinking to explore contextual factors affecting access to public health insurance among cross-border migrants in Thailand. A group model building approach was applied. Participants (n = 20) were encouraged to share ideas about underlying drivers and barriers of migrants’ access to health insurance. The causal loop diagram and stock and flow diagram were synthesised to identify the dynamics of access to migrant health insurance. Results showed that nationality verification is an important mechanism to deal with the precarious citizenship status of undocumented migrants. However, some migrants are still left uninsured. The likely explanations are the semi-voluntary nature of the Health Insurance Card Scheme, administrative delay of the enrollment process, and resistance of some employers to hiring migrants. As a result, findings suggest that effective communication is required to raise acceptance towards insurance among migrants and their employers. A participatory public policy process is needed to create a good balance of migrant policies among diverse authorities.

In mid-2021, Thailand faced a fourth wave of Coronavirus Disease 2019 (COVID-19) predominantly fueled by the Delta and Alpha variants. The number of cases and deaths rose exponentially, alongside a sharp increase in hospitalizations and intubated patients. The Thai Government then implemented a lockdown to mitigate the outbreak magnitude and prevent cases from overwhelming the healthcare system. This study aimed to model the severity of the outbreak over the following months by different levels of lockdown effectiveness. Secondary analysis was performed on data primarily obtained from the Ministry of Health; the data were analyzed using both the deterministic compartmental model and the system dynamics model. The model was calibrated against the number of daily cases in Greater Bangkok during June–July 2021. We then assessed the outcomes (daily cases, daily deaths, and intubated patients) according to hypothetical lockdowns of varying effectiveness and duration. The findings revealed that lockdown measures could reduce and delay the peak of COVID-19 cases and deaths. A two-month lockdown with 60% effectiveness in the reduction in reproduction number caused the lowest number of cases, deaths, and intubated patients, with a peak about one-fifth of the size of a no-lockdown peak. The two-month lockdown policy also delayed the peak until after December, while in the context of a one-month lockdown, cases peaked during the end of September to early December (depending on the varying degrees of lockdown effectiveness in the reduction in reproduction number). In other words, the implementation of a lockdown policy did not mean the end of the outbreak, but it helped delay the peak. In this sense, implementing a lockdown helped to buy time for the healthcare system to recover and better prepare for any future outbreaks. We recommend further studies that explore the impact of lockdown measures at a sub-provincial level, and examine the impact of lockdowns on parameters not directly related to the spread of disease, such as quality of life and economic implications for individuals and society.

Thailand is a popular host nation for international migrant workers, particularly those from Cambodia, Lao PDR, and Myanmar. Thailand has introduced approaches to protect their rights for health and social welfare, using various mechanisms over many years. However, the implementation of these policies is dynamic and has been influenced by national security, economic necessity, and public health concerns. The aim of this study was to explore how Thailand designs and implements health and social welfare policies for migrants in Thailand, both before and during COVID-19. A qualitative analysis was used alongside interviews with 18 key informants in various sectors in this field. Thematic coding was applied. Results show that there were seven key themes emerging from the analysis, including: (i) sustainability of the HICS; (ii) people dropping out from the Social Security Scheme (SSS); (iii) quality of health screening in the Memorandum of Understanding (MOU) migrants; (iv) health screening problems and state quarantine management in response to COVID-19; (v) managing the migration quota and dependency on migrant workers; (vi) influx of migrants in the backdrop of COVID-19; and (vii) poor living conditions of migrants and the impact of COVID-19. The majority of interviewees agreed that undocumented migrants is a critical concern that impedes access to migrants’ health and social welfare. This situation was especially pronounced during the second wave of COVID-19 in Thailand, which took hold in migrant communities. In the short term, the poor living conditions of migrants urgently need to be addressed in order to contain and mitigate this crisis. In the long term, there needs to be an improved health system design that includes migrants, regardless of their immigration status. This requires intersectoral policy coherence, including the hastening of nationality verification to sustainably mitigate undocumented migrants.

Although physicians in Thailand can carry out abortions legally, unsafe abortion rates remain high and have serious consequences for women’s health. Training programs for healthcare providers on the ‘Care of unplanned and adolescent pregnancies for the prevention of unsafe abortions’ have been implemented in Thailand with the aim of providing information and challenging negative attitudes about abortions. This study investigated the participants of the training courses in order to: (i) evaluate their knowledge and attitudes towards safe abortions; and (ii) investigate the factors that determine their knowledge and attitudes. A pre-post study design was applied. Descriptive statistics were calculated to provide an overview of the data. Bivariate analysis, a Wilcoxon signed rank test and a multivariable analysis using multiple linear regression were applied to determine the changes in attitudes and assess the likelihood of behaviour change towards adolescents and women experiencing unplanned pregnancy and abortions, according to demographic and professional characteristics. Having had the training, healthcare providers’ change in attitudes towards adolescents and women experiencing unplanned pregnancies and abortions were found to be 0.67 points for the nine responses of attitudes and 0.79 points for the 14 responses on various abortion scenarios. Changes in attitude were significantly different among the varying health professional types, with non-doctors increasing by 0.53 points, non-obstetricians and non-gynaecologists increasing by 0.46 points and obstetricians and gynaecologists (OBGYN) increasing by 0.32 points. Positive attitudes towards unplanned pregnancies and unsafe abortions and attitudes towards abortion scenarios significantly increased. The career type of the health professional was a significant factor in improving attitudes. The training program was more effective among non-doctor healthcare providers. Therefore, non-doctors could be the target population for training in the future.

IntroductionAlthough Thailand achieved Universal Health Coverage since 2002, there remained gaps in the insurance coverage as undocumented migrants were ineligible to be enrolled in the national public insurance. In 2004 the Thai Ministry of Public Health implemented the Health Insurance Card Scheme (HICS) to cover undocumented migrants. The objective of this study was to investigate the effect of the HICS on out-of-pocket payments (OOP) made by migrant patients at point of care.MethodsThe study applied quantitative methods, using individual patient records from one provincial hospital, one district hospital and two health centers between 2011 and 2015. Ranong province was chosen as a study site as it had the largest proportion of migrants to Thai residents compared with other provinces. Descriptive and inferential statistics were employed. In descriptive statistics, mean and median were used. In inferential statistics, the two-part model (TPM) was applied to examine the relationship between the HICS and OOP for both outpatient (OP) and inpatient (IP) care.ResultsThe HICS reduced IP and OP OOP expenditures by 2471 Baht (US$ 75) and 293 Baht (US$ 9) respectively. The attributes contributed to the reduction of IP and OP OOP included insurance status, residential address close to the facilities, and a history of visiting health facilities after 2013 (the year that the HICS expanded its benefit package). In contrast, severe illness, and advanced age were expected to increase IP and OP OOP.ConclusionThe HICS appeared to reduce the financial burden from accessing care among its beneficiaries. Future studies to explore supply-side financing and equity aspects of the impact of HICS on OOP are recommended.

Migrant health workers (MHWs) and migrant health volunteers (MHVs) are key health workforce actors who play a substantial role in improving the health of migrants in Thailand. The objective of this study was to explore the factors associated with health literacy in MHWs and MHVs in Thailand. A self-administered questionnaire was conducted from December 2018 to April 2019 in two migrant-populated provinces. A total of 40 MHWs, 78 MHVs, and 116 general migrants were included in the survey. Results showed that a higher education level was associated with a greater health literacy score. MHWs were more likely to have a higher health literacy score (5.59 points difference) than general migrants. The province per se and type of affiliations did not significantly contribute to the difference in the health literacy score of each individual. Most MHWs received health information from health professionals, health staff, and the internet, while MHVs and general migrants received information from health professionals, MHWs/MHVs, family/friends, and posters/leaflets. This study suggests that a higher education level should be used as a criterion for recruitment of MHWs and MHVs. Access to interactive health information like health professionals should be promoted as the main source of information to ensure better health literacy among MHWs and MHVs.

Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease, and risk communication is one of several public health emergency responses. During the pandemic, many migrant workers in Thailand experienced barriers that hamper access to health information. This study aims to explore factors related to the outcomes of health risk communication, including awareness of public health measures and preventive practices. We conducted a cross-sectional survey on migrants between January and April 2021 using cluster sampling in Phuket, Ranong, and Samut Sakhon. In the descriptive analysis, we presented the median, proportion, and ratio, while in the inferential analysis, we employed a logistic regression with robust standard errors. Although a total of 303 participants were initially included in this study, the final number was narrowed down to 288 samples due to insufficient information required for the analysis. Frequent reception of health information and primary school education showed a statistically significant association with preventive practices. Middle-aged migrant workers demonstrated a significantly lower level of preventive practices than younger migrant workers. A longer stay in Thailand was significantly related to a lower degree of awareness toward public health measures. Thus, it is necessary to promote the accessibility of health information among migrant workers in Thailand, especially those who have lived in Thailand for more than eight years, are older, and have no formal education.