Migrant health: call for inclusion « Healthy migrants, healthy Thailand: Improving health condition of migrants in priority provinces of Thailand » ECOSOC.

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