migrant health: call for inclusion « healthy migrants, healthy thailand: improving health condition...
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Migrant health: call for inclusion
« Healthy migrants, healthy Thailand:
Improving health condition of migrants in priority provinces of Thailand »
ECOSOC Innovation Fair 2009
Jacqueline Weekers
Snr Migration Health Policy Advisor, Migration Health Department, IOM
IOM is…….
• Intergovernmental body• 125 Member States • >400 offices globally• Committed to the principle
that humane and orderly migration benefits migrants and societies
• MHD: promote migrants’ health & advise States and partners
Objectives
• Health as a component to a positive migration outcome
• Key determinants to migrant health
• Effective practices towards inclusiveness: Thailand Migrant Health Pogramme
Migration today
Reality of inequalities begs for inclusive approach
Well-managed migrant health benefits all
Facilitates integration: healthymigrants are productive
members of society
Stabilizes societies
Inclusion
Does migration affect health?
• Migration is in and of itself is not a risk-factor to health
• The circumstances surrounding the migration process can pose risks to health
• Diversity in types of migrating persons: labour migrants, IDPs, irregular migrants, returnees, refugees, immigrants,…
• The most vulnerable: those with irregular status those forced to move, those who suffer discrimination and exploitation
Identify the vulnerable
Health determinants
transit
origin
return
destination
No access to
health but many risk
factors
Migrant Health Programme, Thailand 2003- ongoingAssists the government to improve health and well-being of migrants & host communities in Thailand through the provision of comprehensive, participatory, sustainable and cost-effective health services.
Partners: health authorities at national, provincial and community level; immigration bureau, detention centres, NGOs, UN, international donors and private sector.
“Healthy Migrants, Healthy Thailand”
Chiang Rai
Tak
Samutsakorn
Bangkok
Ranong
Pang Nga
Barriers to health services
• Financial burden (e.g. out of pocket; costs of migrant health insurance)
• Fear of deportation
• Language and cultural
• Lack info about services
• Hard to reach, no transport
• Negative attitudes
• Mobility
Inferior health status
• Only 50% seek care compared to 78% among Thai• 77% incomplete immunization;• 50% measles coverage• 12% malaria compared to 1.5% among Thai• Migrant sex workers HIV rate 21.3%• Abortion rate is 2.4 times higher than among Thai• 16% access to clean water; <50% sanitation, waste
disposal• MDR TB linked to mobility• Leading cases reported: Malaria, diarrhea, fever,
Pneumonia. (sources: Provincial health offices; WHO; MoPH; IOM; UNDP)
Strategies: capacity building
Capacity building of all counterparts:
health care providersauthoritiesmigrants
84 MCHW; >1000 MCHV; MOPH officers
Strategies: Migrant friendly services
Migrant friendly services:
Community Health Workers& Voluteers;Accessible: mobile/outreachLinguist. & cult. Appropriate
10 community health posts, 56 health corners; (e.g. >55.000reached for health education;>16.000 Rx; > contraceptive use; >antenatal cases threefold; > immunization coverage)
Strategies: multi sectoral network
Coordination amongsectors and partners
Provincial Migrant HealthCommitteeCoordination Centre forMigrant HealthMigrant Working GroupBi annual migrant healthconference
Health sector
Employers
Academia
UN partners, IOs
Migrants
Government
MHP
Strategies: positive policies
Advocate for positive migrant health policies and support their implementation
Border health strategyMigrant health strateyMigrant health financing
What worked?
Country ownership
PHC pillars& HSS
Connect countries
Rightsbased
Involve community
Inclusive: access to
all
Across sectors
Some challenges
• Crisis leading to tougher rules for registration and increased threat for deportation of the undocumented
• Health insurance not available to all• Need for mix of external and
government financial support• Hard to research migrant health• Hard to provide cross border services
due to political situation
Publications
• 2007: Assessment of Mobility and HIV Vulnerability among Myanmar Migrant Sex Workers and Factory Workers in Mae Sot District, Tak Province, Thailand
• 2008: Migration and HIV/AIDS in Thailand: A desk review of migrant labour sectors
• 2009: Avian and Human Influenza Pandemic Preparedness Plan in 4 Piloted Districts of Chaing Rai Province, ThailandSoon coming out:
• 2009: Financing health care for Migrants: A case study from Thailand
• 2009: Migration and HIV/AIDS in Thailand: Comprehensive data analysis in 10 provinces of Thailand
• 2009: Environmental Health Assessment in Selected Migrant Communities in Thailand
• 2009: IOM-MOPH Migrant Health Program Model: A summary of good practices, achievements and lessons learned
Please come and visit us
Integrated migrant health services