Migrant tuberculosis patient needs and health system response along the Thailand-Myanmar border.

Naomi Tschirhart,Angel M Foster,Francois Nosten

doi:10.1093/heapol/czx074

Abstract

This article aims to identify how the health system in Tak province, Thailand has responded to migrants’ barriers to tuberculosis (TB) treatment. Our qualitatively driven multi-methods project utilized focus group discussions, key informant interviews, and a survey of community health volunteers to collect data in 2014 from multiple perspectives. Migrants identified legal status and transportation difficulties as the primary barriers to seeking TB treatment. Lack of financial resources and difficulties locating appropriate and affordable health services in other Thai provinces or across the border in Myanmar further contributed to migrants’ challenges. TB care providers responded to barriers to treatment by bringing care out into the community, enhancing patient mobility, providing supportive services, and reaching out to potential patients. Interventions to improve migrant access and adherence to TB treatment necessarily extend outside of the health system and require significant resources to expand equitable access to treatment. Although this research is specific to the Thailand–Myanmar border, we anticipate that the findings will contribute to broader conversations around the inputs that are necessary to address disparities and inequities. Our study suggests that migrants need to be provided with resources that help stabilize their financial situation and overcome difficulties associated with their legal status in order to access and continue TB treatment.

Highlights

IntroductionSocioeconomic status influences adherence to TB treatment, as therapy is lengthy and patients may experience a reduction in income (Mauch et al 2013; Naidoo et al 2013; Paz-Soldan et al 2013; Richter et al 2014)
In this article we address the research question: how have community and non-governmental healthcare providers responded to treatment barriers? Drawing from focus group discussions (FGDs), key informant (KI) interviews and a Community health volunteers (CHVs) survey, we identify how the health system, inclusive of CHVs, medics, doctors, and programme administrators, has responded to barriers to TB treatment experienced by migrants in Tak province, Thailand
Migrants identified legal status and transportation difficulties associated with not having the appropriate documentation as the primary barriers to seeking TB treatment (Tschirhart et al 2016a)

Summary

Introduction

Socioeconomic status influences adherence to TB treatment, as therapy is lengthy and patients may experience a reduction in income (Mauch et al 2013; Naidoo et al 2013; Paz-Soldan et al 2013; Richter et al 2014). Migrant populations experience this tension between their financial obligations and a need to continue TB treatment as well as additional difficulties related to legal and registration status (Xu et al 2009; Bele et al 2014; Shringarpure et al 2016). Literature on how providers respond to TB patients’ non-medical needs remains limited and little is known about how health systems respond to migrants’ needs, in particular(Noyes and Popay 2007; Richter et al 2014)

Objectives

Methods

Results

Conclusion