Taikichiro Mori Memorial Research Grants Report

Project Name

Health Insecurity of Myanmar Registered Migrants workers in Rural Border Areas of Thailand-Myanmar

Researcher

MINN HTUN OO

Affiliation

Department of Human Security and Communication

Graduate School of Media and Governance

Keio University

1. Background

There are estimated 3 million migrant workers from Myanmar, Cambodia and Laos in Thailand. Among them nearly 2 million migrant workers is Myanmar national. Myanmar and Thailand are close neighbours sharing not only a long border of over 1300 miles, but more importantly, they share the same religious faith, and cultures making it easier for migrants. Thailand is an attractive destination due to rapid economic growth, employment opportunities and higher wages. For instance, Myanmar migrants can make two or three times as much in daily wages in Thailand as they can in Myanmar.

Estimated 1.2 million Myanmar migrant have been living in border area and the vast majority are economic migrants those who enter seeking a better life, or sojourners hoping to send remittance home. Myanmar migrants are employed in fishery, agricultural, manufacturing, construction and domestic service sectors in Thailand. Migrant workers contribute an estimated 5-6% of Thailand’s GDP per year and mainly from Myanmar migrants. Despite the enormous contributions made by migrants, Myanmar migrants still faced significant hardship and physical danger, poor wage, less health and safety systems especially in rural border areas of Thailand. With increasing numbers of people on the move, migrant health has become a key public-health issue in Thailand. Migrants face limited or inadequate access to basic public health services is the crucial role to play in Thailand’s health Policy.

Thailand has a relatively well established public health system featuring the launch of universal health care coverage in 2001. The development of the public health system and healthcare financing has contributed significantly to an equitable service provision and financial contribution of the health care system.

2. Problems

(1) Due to the high costs of registration for work permit and Health Insurance Scheme, Myanmar migrant workers tend to be unregistered illegal migrants. According to Thai government policy, registration for work permit and health insurance fees should be paid for by private employers. However, employers are either reluctant to pay or expect the next employer to pay for them, so the fees are transferred to the workers and deducted from wages.

Myanmar migrant workers who eligible to access health care also faced limited health care in Kanchanburi and Chiang Mai provinces due to the recently more migration from Myanmar causes inadequate of Thailand health capacity.

3. Research Objectives

(1) To differential perception of among registered legal Myanmar migrant workers on Thailand’s Health Insurance policy and health care access.

(2) To evaluate existing Thailand’ health insurance policy, and seek to address the issues/problems from migrants side and as well as health service provider side.

(3) To provide the key information of Myanmar migrants’ health problems to respective governments in order to improve health care objectives.

4. Expected Results

Recent migration has increased the burden on Thailand’s Health services and manpower, and added challenges to the disease surveillance and outbreak control system. Through the fieldwork, various factors that negative perception of Myanmar migrants on Thailand health care coverage policy, not seeking health care access, might have an impact on the Thai people. But positive perception also causes inadequate medical facilities and limited services for Thailand health service provider side. For doing this fieldwork and understanding the situation of migrant workers in Thailand would be vitally important in the use for the process of analyzing as well as my final thesis in the area of local development for migrant workers. I am sure that also receiving of precise data and acknowledge would be utilize for not only my master’s thesis also in human security aspect.

5. Fieldwork Activity Plan

Time : 23August to 21 September 2010 (30 days)

(I) Interview and Discussion with Project Coordinator – Global Fund Project,

World vision in Bangkok, Thailand

World Vision Foundation of Thailand has been operational in Thailand for more than 30 years, and working on migrant issues for more than 15. It currently runs mobile and stationary health clinics in a number of border locations. 

(II) Interviewed with Director of Social Service from Fang Hospital, Chaing Mai, Thailand

Fang Hospital of Thailand, located near Thailand-Myanmar border area, has experienced of facing difficulties to handle crowded migrants due to lack of capacity.

(III) Interviewed with Assistant Director of Immigration Ministry, Yangon, Myanmar

During my fieldwork, I had a chance to meet an Immigration officer who is dealing with migrants’ current problems.

(IV) Interviewed with Director from Ministry of Foreign Affairs, Nay Pyi Taw, Myanmar

Ministry of Foreign Affairs from Myanmar has been handling migrants’ issues and also counterpart of Thailand Labour Ministry.

(V)The number of migrants who participated in focus group discussion sessions in each site:

Characteristic of respondents	Number of migrants	Place
Age group : 24-30 Marital status: 2 married, 3 single Occupation : Farm workers	5 Sex : Male	Suphan Buri, Thailand
Age group : 30-45 Marital status: 8 married, 7 single Occupation : sugarcane plantation workers	15 Sex : 8(M), 7(F)	Kachanaburi, Thailand
Age group : 18-35 Marital status: 9 married, 6 single Occupation : Factory workers	15 Sex : 6(M), 9(F)	Lashio(1), Taungyi(14), Shan State, Myanmar
Total – 19 male, 16 female 20 married, 15 single	35

6. Fieldwork Findings

(I) Reason of migrated from Myanmar to Thailand (total - 35 respondents)

(II)Myanmar Migrants’ obstacles to access Thailand Health Insurance

(total - 35 respondents)

(III) Non-standard wages

Most migrant workers’ personal histories revealed that formal education in their own countries was not an option for them. As a result, most are unskilled in jobs other than manual work. The lack of formal job skills limited the types of jobs that were open to them; thus, they often have to accept any offer of paid employment and consider themselves fortunate to find paid employment in Thailand. High cost of health insurance is one of the barriers to obtain health insurance scheme due to receiving of less than Thailand’s basic wages. Based on my fieldwork data, case sample show as follow:

- Basic wage in Kachanaburi – 169 baht

- Migrants from Sugar cane – 130 baht

plantation( monthly income - 3,900 baht)

- Migrants from other sectors - between 80–100 baht

- (monthly income between 2400 – 3000 baht)

- 3,800 Baht for work permit and Health Insurance Scheme

(IV)Different attitude on health care access in the same group

Another significant is contradicted attitude of Myanmar migrants within same group on Thailand’s health Insurance policy. Migrants who are working in the same workforce, same employer, same legal status, and same length of stay in Thailand. There has two attitudes of Myanmar migrants view on Thailand’ health Insurance policy such as negative attitude and positive attitude. Some returnee migrants when I interviewed in Myanmar, they also expressed their perception that they would return to Thailand if they have a chance and tend to bring their family along with them due to insecurity health situation in Myanmar. On the other word, to seek medical health care in Thailand is one of the pull factor of cross border migration to Thailand.

(V)Migrants’ responded on questions about health related issues

Knowledge of Health Security		Positive view on Thailand’ public health system in border area			Negative view on Thailand’ public health system in border area
Before migrate	After migrate	Low Cost	Good treatment	Consider as migrant hospital	Ignorance	Inadequate Facilities	Language barrier
5 yes 26 no	28 yes 2 no	30 yes 1 no	31 yes	16 yes 15 no	27 yes 5 no	21 yes 10 no	22 yes 9 no

7. Conclusion

This fieldwork obtained the importance of notion of Myanmar migrants’ health Security in the context of an increasingly cross border migration to Thailand is a fact of life. Based on fieldwork results described health disparities that impact Migrants society as a whole. The issue of despite provide registered migrants with access to health services is not main concern; it is clearly in everybody’s best interest to ensure that registered migrants have equitable access to affordable and meaningful health services. The key issue then is how to strengthen health systems within and between countries so as to promote the health of migrants and, furthermore, what capacity will be required in order for governments to effectively address migration‐related health challenges in the future. Minimum standards in accessing health should be elaborated for all migrants, weighing the rights and dignity of migrants in light of the best interest of the host society, and the costs and benefits of inclusive approaches.

A key challenge facing countries is that of tackling the transborder dimension of health. Increased human capacity is required within developing countries to carry forward the international health agenda, including the harnessing of donor and national resources towards transborder health programming. Bilateral and regional initiatives will need to be evidence‐informed, prioritized and of manageable scope, while complementing gaps in national responses. Highly complex, but possibly key to the development of effective and sustainable responses to the growing challenges of migrant health, is the review and harmonization of national policies related to immigration, labour, security, economic development and social welfare. Well managed migration will set a more stable framework within which to couch the health sector response. Multisectoral partnership and a global alliance of stakeholders are required in order to advance advocacy, inform debate, and address multiple platforms of migration dialogues in the quest for policy coherence in migration and health.

Migrant workers are subjected to difficult conditions that impact their well-being. There are no easy answers to the problems that have been identified; however, taking no action violates our humanity. Laws that control basic wages are in place and should be enforced. In the Thai context, healthcare providers need to urgently develop systems to support migrant workers’ quality of life.

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