Policy Change in Support of Increased Access to Quality Health Care Burmese Migrants in Thailand

1. Policy Change in Support of Increased Access to Quality Health CareBurmese Migrants in Thailand 33rd Global Conference of ICSW Presented by Dr. Nyunt Naing Thein SHIELD Migrant Health Project – Thailand

2. Burma (Myanmar) Location: Southeastern Asia, Area total:678,500 sq km total:France Area Total 643,427 sq km; 547,030 sq km (metropolitan France) Land boundaries: 5876 Km Border countries:Bangladesh 193 km,India 1,463 km,China 2,185 km,Laos 235 km,Thailand 1,800 km Population 47,758,181 ( July 2008 est) Source: https://www.cia.gov/library/publications/the-world-factbook/geos/bm.html

3. Push Factors for migration Oppressive Military Government • 1962 until now • < 3% annual expenditures on health systems vs. 40% on military • Brutally suppress own citizens • Crack down on September 07 uprising led by Buddhist monks • Refuse international aid response to Cyclone Nargis

4. Singapore Straits Time News Paper

5. Push Factors for migration (con) • Increasing number of Internally Displaced People • More than 50 years of Civil wars • Military-favoured economic development (gas pipeline, timber trade, Dam development) • Livelihood vulnerability • Low foreign investment and international pressure on foreign investment • Population below poverty line:32.7% (2007, est) • Labor force - by occupation: agriculture: 70% industry: 7%services: 23% (2001) Source: https://www.cia.gov/library/publications/the-world-factbook/geos/bm.html

6. Pull factors for migration to Thailand • Long Thai-Burma border • Easy to cross the border • Similar physical appearance • Economic Growth of Thailand • Thailand needs blue collar labourers • Thai people do not want to do the 3 D jobs Source: IOM

7. Burmese Migrants in Thailand • Over one million Burmese migrant labourers • Vast majority is taking up un-skilled labour jobs, the more difficult, dangerous and dirty (‘3 Ds’) work • Minimum wages for Burmese migrants are much lower than for Thais (3 to 5 Euro/ day) • Migrant need to pay 3,800 Baht (76 Euros) annual fee for temporary work permit with employer’s recommendation (1,900 B for registration, 1,900 B for health insurance) • Very limited health care and social service supports available for registered migrants.

8. Burmese migrant workers in fishery industry (1 of 3 Ds) Photo Source: 1st National Migrant Health Conference Paper. Thailand

9. SHIELD Project Support to Health, Institution building, Education and Leadership in policy Dialogue • The SHIELD Project assists Burmese migrants and refugees in Thailand to meet essential needs by improving access to primary healthcare, educational opportunities and justice. • SHIELD collaborates with community groups, international organizations and the Royal Thai Government to find local solutions to migrant and refugee concerns and priorities.

10. Barriers to access health care • Legal status • Financial problems • Language barriers • Transportation • Lack of knowledge on health and health system in Thailand • Restrictions by employers • Cultural appropriateness, prejudice • Human resource shortages in Thai MoPH

11. SHIELD Project’s Objectives • Increased knowledge about health and improved health behaviors in migrants. • Increased access to sustainable quality preventive and curative health care services for migrants.

12. SHIELD Health Strategies

13. Advocacy Process‘improving access to primary healthcare’ • MHWlegal in the Thai Health System • Employ MHW through SHIELD project • Document MHW contributions to Thai Health system and Thai economic • Support MoPH to advocate with MoL, MoI, and National Security Council • Create opportunities to discuss and debate to employ MHW (e.g. - 1st National Migrant Health Conference in 2006 Theme “Healthy Migrant Healthy Thailand”)

14. Advocacy Process Local and central level advocacy activities • What we want to see • What we have to say Photo Source: 1st National Migrant Health Conference Paper. Thailand

15. What we want to see • MHW legally working in the Thai health system • Migrants receiving health promotion and prevention knowledge with their own language • Migrants understanding their health problems and treatment process when they go to get health services • Isolated migrant community getting services from Health post and mobile clinic • More migrants accessing health insurance card and able to access Govt health services

16. What we have to say • Mosquitoes and flies do not need visa to come Thailand • If there is a communicable disease outbreak in a migrant community (e.g. AI), it could spread to Thai populations - MHW can carry out active surveillance to prevent • MHW help interpretation between doctor and migrant patient – reduce time for consultation, more time for Thai patients, no need to do expensive diagnosis test – save medical insurance $ • MHW can promote health insurance card to buy by migrants

17. Achievements up to date • Central Budget Bureau allow to spend migrant health insurance fee for MHW salary • Migrant child will get Birth Certificate if born in Thailand (The law will be effective from 1st Aug 08) • The SHIELD project and other NGOs help to develop advocacy paper for MoPH to submit to MoL to add MHW as one occupation in migrant worker registration • Hospitals in SHIELD project started employing MHW • 2nd National Migrant Health Conference on 8–10 Jul 08 in Bangkok

18. Merci beaucoup Dr. Nyunt Naing Thein l Health Coordinator International Rescue Committee nyuntnaing.thein@thailand.theIRC.org 66 55 537 178-9 Mobile.66 89 814 460