broadening uhc beyond national boundaries · broadening uhc beyond national boundaries: a...
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Broadening UHC beyond national boundaries: a prerequisite to addressing the challenge of Tuberculosis and Migration
Background• Ending the TB epidemic is a part of
SDGs that requires UHC to ensure access and adherence.
• Human migration challenges the success of TB care and control at global and national levels.
• Thailand is still in WHO’s list of TB HBCs after two decades of UHC.
• In Thailand, most of the 4.65 million migrants (including 0.15 million refugees) were from Myanmar,1 one of the other 14 top TB HBCs.
Objectives • To understand UHC—TB control
relationship in a borderland• To find ways to design a health care
system to ensure all people’s securityMethodology• Fourteen-month ethnographic study
in Umphang district, Tak province, Thailand (Aug. 2016-Oct. 2017)
Wirun Limsawart, MD, PhD Society and Health Institute, Ministry of Public Health, Thailand
Major Findings • As UHC is designed to focus mainly on
citizens, non-citizens, including migrants, lack access to TB care.
• “Non-Thai” TB patients had a high rate of LTF (figure 2) with low returning (table 1) thus complicated the MDR-TB epidemic.
• Closed observation of the biology and social context of the ”non-Thai” population helps to understand their unique illness stories and needs.
Contact InformationWirun Limsawart MD, PhD.E-mail: [email protected]
Mobile phone: +66 92 336 1212
References1. Department of Disease Control. National Strategic Plan on Tuberculosis B.E.2560–2564 (2017–2021), in Thai. Bangkok: Department of Disease Control, Ministry of Public Health; 2017.2. Yongyuth M, Somsri K, Suporn K, Kittipat I, Wittaya S.Situation of Thai Journal of Tuberculosis Chest Diseases and Critical Care. 2014;35(1):8–17.3. http://tbcmthailand.ddc.moph.go.th4. Chuengsatiansup K, Limsawart W. Tuberculosis in the borderlands: migrants, microbes and more-than-human borders. Palgrave Communications. 2019;5(1).
AcknowledgementThe research is funded by the Health System Research Institute, Thailand (grant # HSRI
60-052). The preliminary phase of the study is supported by Harvard University Asia Center, Society and Health Institute, and Umphang Hospital Foundation, Thailand.
Conclusion/recommendations • Borderland has historical and sociocultural
context that complicates the flow of humans and microbes, and the migrants’ access and adherence to TB care.4
• The scope of UHC needs to be broadened beyond “national boundaries” to ensure “universal health security” for all people.
Enabling care beyond the nation’s boundaries begins with closed observation, biologically and socially.
(Umphang, Thailand, Jan. 2017)
Figure 1. Map of Tak province and Umphang district on the Thai-Myanmar border
Table 1. Types of MDR-TB patients in Tak Province, FY 2011-April 2014.2
Acronym: UHC: Universal Health Coverage; TB: Tuberculosis; HBC: High Burden Countries; MDR-TB: Multi-Drug Resistant TB; LTF: Loss To Follow Up; FY: Fiscal Year
Type Total (%) Thai (%) Non-Thai (%)
New case 10 (29.4) 3 (37.5) 7 (26.9)
Previous Failure 17 (50.0) 2 (25.0) 15 (57.7)
Previous LTF 1 (2.9) 1 (12.5) 0
Relapse 4 (11.8) 2 (25.0) 2 (7.7)
Other 2 (5.9) 0 2 (7.7)
Total 34 (100.0) 8 (100.0) 26 (100.0)
Figure 2. Thailand TB treatment outcome, FY 2014-2018.3
75.0080.0085.0090.00
2014 2015 2016 2017 2018
total success rate (%)
0.00
10.00
20.00
2014 2015 2016 2017 2018
LTF rate (% of each group)
Thai NonThai