Making “Migrant Friendly” Health Services a Reality in Thailand

Brahm PressRaks Thai Foundation PHAMIT Program

Overview of presentation

• Situation of Migrant Workers and HIV in Thailand

• PHAMIT Project• Accomplishments / Gaps• “Migrant Friendly Health Services”?

Reasons migrants come to Thailand

• Economic prosperity: GDP per capita(USD) 2007: Camb 440; Lao 485; Myn 220; Thai 2,750

• Long, porous borders• Chain migration• Thais reject unskilled low-

paying jobs, or go abroad

Current Situation of Migrant Workers in Thailand

Currently, 1.45 million documented migrant workers from three countries as of Feb. 2013:

MyanmarCambodiaLao PDR

•Myanmar: 1,086,734•Cambodia: 263,706•Lao PDR: 99,567

Estimated twice as many undocumented = over 3 million migrants in total

Documented by sex:Men 57% Women 43%

Migrants’ Vulnerability to HIVMigration is not a risk factor for HIV, but does increase conditions that contribute to vulnerability:

• Limited rights due to legal status as non-citizen (related to being low-skilled labor)

• Removed from traditional social controls and in prime reproductive years

• Limited access to information and services due to language barriers and restrictions on mobility

• Inaccurate knowledge and sub-culture norms contribute to engaging in behaviors that increase their risk of HIV, STIs and unplanned pregnancy

HIV Prevalence among Migrant Workers and Fishermen in Thailand (1997-2007)

2540 2541 2542 2543 2544 2545 2546 2547 2548 2549 25500.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

18.00

fishermen

migrant workers

HIV Prevalence 2010: Migrant workers (6 provinces)

Male Female Total

Age 15-24 1.0% 1.4% 1.1%

All ages 1.7% 2.1% 1.9%

IBBS, Bureau of Epidemiology 2010, MOPH, Thailand (Unofficial)

HIV prevalence among migrants all ages by nationality in 6 provinces

IBBS, Bureau of Epidemiology 2010, MOPH, Thailand (Unofficial)

HIV prevalence among migrants all ages by occupation (6 provinces)

IBBS, Bureau of Epidemiology 2010, MOPH, Thailand (Unofficial)

PHAMIT ProjectPrevention of HIV and AIDS among Migrant Workers in Thailand

• 2003 extended to 2014 – supported by

• Raks Thai Foundation and DDC are PR w/ 7 partner NGOs and local health office

• Have reached over 800,000 migrants with direct interventions

• Covering 36 Provinces (almost half the country)

Goal - Scale up comprehensive HIV prevention for migrants

• Objective 1: To strengthen and scale up delivery of comprehensive HIV prevention services

• Objective 2: To build a strong enabling environment

• Objective 3: To strengthen strategic information systems for program and policy improvement

HIV prevention interventions– Outreach at workplaces and communities• Development of Migrant Field Officers and

Migrant Health Workers linked to networks of migrant volunteers• Provide small group outreach activities• Language appropriate communication

materials (diverse media)• Condom distribution (direct, volunteers, boxes)• Drop-in centers (activities, referral)

– Referral for VCCT and STI

Condom Use Last Time Had Sex by Partner Type - Average of All Sites, 2004-2008 (Phase 1)

Sex worker Non-regular partner Regular Partner0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%91%

43%49%

97%

90%

56%2004

2008

Institute for Population and Social Research, Mahidol University, 2009

Condom use last sex episode by type of sex partner past 12 months – 2010 Baseline Phase 2

Institute for Population and Social Research, Mahidol University, 2011

Referral to VCCT• Agreements made with local hospitals to receive

migrants for HIV testing and STI diagnosis and treatment

• Referral made through MHW, FO / FOM or volunteers

• Pre-pre and post-post test counseling provided at drop-in centers by FOM / MHW

• HIV counseling and testing provided at hospital with translation by MHW

• Approx 8,000 migrants have tested for HIV and know their results over the past 4 years…

Migrants in need of ART• Quota of ART for 2,000 migrants supported by GF

under NAPHA-Ex Program by Thai Govt is filled • PMTCT for all (if enter ANC on timely basis), but no

guarantee of treatment for mother after birth• Estimated that at least another 3,000 migrants are

currently in need of ART (could be much higher)• Pay out of pocket 2,000 THB / month for first line

(almost 1/2 month salary)• Migrants wait until health fails to test or buy

treatment

Cross-Border ART?

• Return home, start treatment but then return to work in Thailand…

• Arrangements w/ Cambodia to receive ART at the border

• Some purchase large quantities in Myanmar to take with them

• Lao come to Thai side to initiate treatment• But, currently no cross-border referral system

“Migrant Friendly” Health Needs

“Migrant Friendly” Policies

Policy Goal: Migrant Health Workers (MHW)

Achieved:• Occupation to register migrants doing social work• Verbal agreement with Ministry of Labour to allow hospitals

to use MHW• Around 10 hospitals utilize MHW for counseling (ANC, VCCT)

and other services – some paid by hospital others by NGOMissing:• Lack of formal National-level policy leaves hospitals

reluctant to hire MHW, hinders expansion• Changes in health insurance policies have reduced migrant

health “prevention” budgets

Policy Goal: ART for MigrantsAchieved• ARV for around 2,000 migrants (both doc and undoc) –

around half referred through PHAMIT• Covered by Social Security (w/passport) receive ARTMissing• Questions of sustainability and coverage of ARV

currently supported by GF• Changes are being made to compulsory insurance

scheme to include ART – price needs to remain low enough to encourage subscription

• Transferable or portable ART service package intra- and inter-national

Migrant Participation

Access to services and treatment

through supportive policies

Earlier HIV

testing

Improved health

outcomes

Access to services and treatment

through supportive policies

Thank Youwww.phamit.org