HEALTH SYSTEMS STRENGTHENING FOR MARGINALIZED AND UNDOCUMENTED MIGRANTS IN TAK PROVINCE, THAILAND: A FOCUS ON SEXUAL AND REPRODUCTIVE HEALTH NEEDS”
Expertise France and L'Initiative are proud to start a new partnership with the Shoklo Malaria Research Unit (SMRU) of Mahidol Oxford University Research Unit (Thailand) to strengthen health systems for marginalized and undocumented migrants on the Thai-Myanmar border.
As of 2019, the total number of registered migrants in Thailand was estimated at over 3.0 million, hailing from Myanmar, Cambodia, and Laos. The estimated percentage of registered migrants in Thailand that are women hovers around 40-45%. According to International Office for Migration (IOM) in Thailand, the number of registered Myanmar migrant workers in Thailand is estimated to be at least 2.3 million, with an additional 800,000 undocumented migrants.
These undocumented migrants are not covered by public health insurance schemes, are confronted with formidable barriers in accessing quality care, exacerbated by poor health literacy and limited disease knowledge. On the Thai side, marginalization and lack of documentation for Myanmar migrants precludes them from accessing services provided by the Thai government. On the Myanmar side, the lack of infrastructure, poorly qualified human resources and limited health facilities prevents migrants from accessing quality services for health, including MCH, TB/HIV, and malaria.
Myanmar today remains one of the poorest countries in the world. Women, particularly pregnant women, are severely affected by the lack of access to essential services, especially in Karen State. The maternal mortality ratio is 282 deaths per 100,000 live births. This is one of the highest ratios in Southeast Asia. Nearly 87% of maternal deaths occur in rural areas, where infrastructure is poor and access to reproductive health services is limited or non-existent. These data reflect structural determinants that impede health access for migrants in Myanmar: costly and difficult transportation over rugged terrain, lack of community and/or health infrastructure, deprived and marginalized socioeconomic status of migrants, and poor health literacy and awareness of reproductive health needs in the communities at-large.
The demographics of labor migrants in Thailand (predominantly individuals in their late teens to late 30’s) coincides with the most active and vulnerable time in the sexual and reproductive health (SRH). Reproductive age women and adolescents bear the brunt of SRH problems. Even when migrant men are able to register and receive health insurance, they are frequently accompanied by their wife and children who are often left uncovered in such schemes. Access to health, education, and social welfare services are therefore sorely limited for migrants in general, but the brunt of this is borne by migrant women and children.
To provide access to health care for these women in Myanmar, consultations are provided by private clinics, such as the Wang Pha Clinic, which is run by the SMRU on the Thai border. These women must illegally cross the Moei River that separates the two neighbouring countries on a daily basis to give birth and receive first aid before leaving.
This project aims to answer the complex health access needs of migrant women from Myanmar, living in Thailand. This aligns with the goal 3 of the sustainable development goals to ensure healthy lives and promote well-being for all at all ages. Its ambition is to:
- Support networking and coordination of sexual and reproductive health stakeholders in Phop Phra and Mae Ra Mat, Tak Province;
- Strengthen capacity of rural community health workers and scale up outreach in sexual and reproductive health activities;
- Establish a surveillance systems for sexual and reproductive health activity including emergencies and gender-based violence cases.
The project is being implemented by SMRU for three years in Tak Province includes Mae Sot, Mae Ramat and Phop Phra districts—known to be the largest and busiest crossing points for people from Myanmar to Thailand. These locations concentrate a high proportion of mobile populations, including women and pregnant women, seeking care in primary health centers of the Thai health system or in private facilities.
The SMRU propose a proactive approach to allow better cross-cutting integration of health services and to develop a community-based approach to facilitate the integration of marginalized populations currently outside the health care network. A first phase of assessment and quantification will bring stakeholders together to quantify and qualify the breadth, reach, spoken languages and types of sexual and reproductive health services provided to migrants on the Thailand side of the Thai-Myanmar border. Forums and workshops will be organized to build the capacity of community health workers and the outreach team. Mobile outreach sexual and reproductive health screening, counselling and referral will be delivered on identified sites by community outreach teams. Ultimately, a shared adolescent-friendly and gender-sensitive sexual and reproductive health curriculum will be developed. It will enable health workers to provide preventive SRH care, screening (pregnancy testing, nutrition, rapid tests for malaria and HIV) and sensitization workshops on managing signs of tuberculosis and danger signs during pregnancy.
This project will be implemented by SMRU in partnership with the Tak Provincial Public Health Office (TPHO) and the Borderland Health Foundation (BHF).
In addition to these operational partnerships, the SMRU will benefit from the support of the M-FUND, funded by the Global Fund and Expertise France, and UNICEF, which is implementing a new model of non-profit, low-cost health insurance for Myanmar migrants living in Thailand. The SMRU will build on its collaboration with the M-Fund to extend insurance coverage to migrants.