Migrant tuberculosis patient needs and health system response along the Thailand–Myanmar border

Abstract

This article aims to identify how the health system in Tak province, Thailand has responded to migrants’ barriers to tuberculosis (TB) treatment. Our qualitatively driven multi-methods project utilized focus group discussions, key informant interviews, and a survey of community health volunteers to collect data in 2014 from multiple perspectives. Migrants identified legal status and transportation difficulties as the primary barriers to seeking TB treatment. Lack of financial resources and difficulties locating appropriate and affordable health services in other Thai provinces or across the border in Myanmar further contributed to migrants’ challenges. TB care providers responded to barriers to treatment by bringing care out into the community, enhancing patient mobility, providing supportive services, and reaching out to potential patients. Interventions to improve migrant access and adherence to TB treatment necessarily extend outside of the health system and require significant resources to expand equitable access to treatment. Although this research is specific to the Thailand–Myanmar border, we anticipate that the findings will contribute to broader conversations around the inputs that are necessary to address disparities and inequities. Our study suggests that migrants need to be provided with resources that help stabilize their financial situation and overcome difficulties associated with their legal status in order to access and continue TB treatment.

Understanding the Problem of Access to Public Health Insurance Schemes among Cross-Border Migrants in Thailand through Systems Thinking

“…Furthermore, the linkage between HICS and public health security could be observed as an accelerator to the likelihood of the HICS selling. The concern over spreading certain infectious diseases from migrants to the wider Thai public (such as tuberculosis, HIV, syphilis and malaria) was a major factor which encouraged providers to sell the HICS [ 35 , 36 , 37 , 38 , 39 , 40 ]. As a result, the relationship in access to the HICS and public health security was positive as shown in R2 in the CLD.…”

Understanding the problem of access to public health insurance schemes among cross-border migrants in Thailand through systems thinking

“…Furthermore, the linkage between HICS and public health security can be observed as an accelerator to the likelihood of the HICS selling. The concern over spreading certain infectious diseases from migrants to the wider Thai public (such as tuberculosis, HIV, syphilis and malaria) that could cause public health threats is a major factor which encourages providers to sell the HICS [30][31][32][33][34][35]. As a result, the relationship in access to the HICS and public health security is positive as shown in R2 in the CLD.…”

Pulmonary tuberculosis screening and quality of life among migrant workers, Northern Thailand

“…This is supported by the study of Tchirhart, et al [36] which reported that insurance, and access to free or low-cost services were major factors affecting access to health care system among migrant TB patients. Moreover, migrant TB patients are in serious need of health system response along the Thailand-Myanmar border [37]. Therefore, migrant workers particularly those who are living in Thailand illegally are insecure regarding access to health care system.…”