FIGHTING BARRIERS LIMITING ACCESS TO COVID-19 HEALTHCARE FOR UNDOCUMENTED MIGRANT WORKERS IN THAILAND
FIGHTING BARRIERS LIMITING ACCESS TO COVID-19 HEALTHCARE FOR UNDOCUMENTED MIGRANT WORKERS IN THAILAND
Author: Ms. Su Yadanar Myint
Advisor: Asst. Prof. Warathida Chaiyapa, PhD
Co-advisor: Ajaree Rayanakorn, PhD
Key messages
- Undocumented migrant workers are not well informed about Covid-19 healthcare because of the language barriers and security concerns. To overcome those barriers, public information campaigns with multilingual approaches should be organized as the communication strategy of the Thai government regarding migrant health.
- The untraceability of undocumented migrant workers’ data is one of the migrant challenges for the Thai government in providing healthcare plans. So the help of CSOs, CBOs, volunteering groups, and labor organizations are crucial in connecting with undocumented migrant workers.
- Migrant labor plays a crucial role in Thailand’s economic development contributing between 4.3 and 6.6 percent of Thailand’s GDP. Therefore economic interest approach would be a powerful narrative strategy for the Thai policymakers to give attention to the undocumented migrants’ health and convince the public, raising their awareness of that issue.
Introduction
Information matters in public policy formulation and its success. The availability of credible information, which explains the nature of Covid-19 healthcare provisions and procedures for accessing these services given to undocumented migrant workers in Thailand, is one of the critical challenges for the Thai government’s attempt to control the spread of the pandemic in migrant worker communities. Thus far, the preliminary observations suggest that security concerns, language barriers, transportation, and other factors have prevented a considerable number of undocumented migrant workers’ access to available Covid-19 healthcare services. No effective communication strategy is being employed to address these concerns of undocumented migrant workers. As a result, these vulnerable communities are not well informed. A better information ecology, which incentivizes and makes the procedures more accessible for undocumented workers to access Covid-19 health services, is a critical link in this public health policy formulation and eventual success. In short, this policy brief submits that easy access to information is a key to the success of Covid-19 public healthcare services in communities of undocumented migrant workers in Thailand.
Thailand is the migrant hub among the regional countries. According to the Thailand migration report (2019)[1] published by the UN, the number of non-Thai residents inside the country has increased from 3.7 million in 2014 to 4.9 million in 2018, including an estimated 3.9 million migrant workers from its neighboring countries such as Lao’s People Democratic Republic, Cambodia, Vietnam, and Myanmar[2]. Many studies say that Migrant labor plays a crucial role in Thailand’s development and economic performance[3]. Migrant workers are filling the needs of working hazardous and grueling jobs that are not found attractive to the local workers. Moreover, they are working in low-skilled jobs, including fishing, agriculture, construction, manufacturing domestic works, and so on. Migrant labor contributes 4.3 and 6.6 percent of Thailand’s Gross Domestic Product (GDP)[4]. As Thailand has had Universal Health Coverage with comprehensive benefit packages since 2002, the government decided to deliver the fully-funded comprehensive package for Covid-19, which includes laboratory tests, contact tracing, active case findings, 14-day quarantine measures (including tests, food, and lodging), field hospitals, ambulance services for referral, clinical services both at hospitals and in-home and community isolation, vaccines and vaccination cost, all without copayment by users[5]. The benefits package is for Thai citizens and migrant workers. Thailand Ministry of Public Health has implemented the migrant health insurance scheme for all registered and undocumented migrant workers for two decades, and the scheme expanded to include the migrants’ dependents in 2005. This insurance scheme is voluntary, and migrant workers need to pay yearly. Thus, language barriers, fear of getting arrested, lack of legal documents, and other factors could be the barriers for undocumented migrant workers in accessing Covid-19 healthcare.
Undocumented migrant workers in Thailand
According to the International Labor Organization, undocumented migrant workers mean migrant workers who are in an irregular situation and illegally employed[6]. In Thailand, most migrant workers are from Cambodia, Lao, and Myanmar, so-called CLM migrants. Many CLM migrant workers are undocumented since they entered Thailand without legitimate travel documents, and their dependents were born in Thailand without registering for a birth certificate[7]. A significant amount of migrant workers, from 1–2.5 million of the estimated 4–5 million in Thailand, are undocumented[8]. The statistics of the illegal migrant workers are untraceable, and it is one of the migration challenges for the Thai government.
When the pandemic hit, the migrant workers
In 2019, the unforeseen arrival of the Covid-19 pandemic hit the migrant workers in Thailand. They panicked, and some decided to return home because the Thai government announced the closure of the borders, and no one knew how long the borders would remain close. Nevertheless, some migrant workers decided to stay in Thailand. However, Myanmar migrant workers could not return home due to the expensive cost to return and the political instabilities[9]. Therefore, it became the responsibility of the Thai government to provide pandemic responses for migrant workers who remain inside the country and are still working. The Thai government initiated responses to assist the migrant workers, such as automatic visa extensions, suspending the 90-day reporting requirements, temporary financial assistance of THB 5000 per month, and migrant workers in formal sectors are even entitled to the Social Security Scheme. However, it can be challenging for undocumented migrant workers to access the healthcare services such as vaccination easily and unconcernedly. According to the studies, labor trafficking and the unregistered migrant workers’ fear of arrest is one of the social origins of the Covid-19 pandemic outbreak in Thailand. In the second wave, a large number of undocumented migrant workers spread the virus in their workplace and a large wholesales seafood market in Samut Sakhon Province because the undocumented migrant workers were not captured the border quarantine system, and they were afraid to report the authorities[10]
Thai government’s healthcare plans
There are different healthcare insurance coverage types for migrant workers in Thailand. Migrant workers in the professional or highly skilled groups can enroll in private insurance or social security. According to Tuangratananon et al.(2020)[11], low-skilled migrant workers in the formal sector can also enroll in social security, while the Health Insurance Card Scheme covers those in the informal sector for migrants, managed by Thailand’s Ministry of Public Health. Health Insurance Card Scheme (HICS) was initiated as public-oriented health insurance for undocumented migrant workers. Undocumented migrant workers must undergo nationality verification to obtain a work permit to be insured by the scheme. Successful applicants receive a temporary passport and visa, ratifying their legitimate stay in Thailand. Therefore, regular migrant workers whose employers have not enrolled them in the social security scheme and undocumented migrant workers are excluded from the right of access to healthcare and social security.
Barriers limiting access to Covid-19 Healthcare for the undocumented migrant workers
During the Covid-19 pandemic, although the Thai government set policies to ensure non-Thais nationals’ access to medical services, including Covid-19 vaccines. Nevertheless, there is no comprehensive Covid-19 healthcare package for the undocumented migrants because the government cannot trace them, and they also face barriers to accessing care. Therefore, civil society organizations, volunteer groups, and the Thai Red Cross stepped in and worked closely with local health officials to allocate vaccines for undocumented migrants and their adherents. This helped close the loophole of unclear government policies toward undocumented migrants[12]. Nevertheless, undocumented migrant workers are still untraceable, and the authorities cannot follow up on their vaccine plans and other health conditions. Migrants face particular health challenges as a socially excluded group, including difficulties in accessing healthcare where they experience legal, financial, language, cultural, and informational barriers[13]. In this situation, the challenges are worse for undocumented migrant workers because of the security concerns, language barriers, transportation, and other factors that have prevented them from accessing healthcare.
The Motivations for Thai policymakers
There are three rationales for the government’s intervention in public problems; political, moral, or ethical, and economic and market failures[14]. Thai policymakers have three motivations for setting comprehensive policy actions to solve the problem of limiting access to Covid-19 healthcare for undocumented migrant workers in Thailand. The first one is social justice. All the people living inside the country should access the pandemic healthcare without concern about their security because it is a pandemic, and everyone can be contagious. So all people should be covered under health justice during the Covid-19 pandemic. The second one is a political motivation. A government that treats all those living in the country, including undocumented workers equally at least their access to health care in a live or death pandemic will be able to reap an excellent political image and reputation for its policy decision. The third motivation is the economic interest, which is the most significant and crucial motivation for Thai policymakers. As migrant labor is a huge contribution to the Thai economic performance, if they don’t have access to vaccines and proper healthcare, the transmission of the virus will continue, it will affect Thailand’s tourism sector, foreign investments will be affected, schools will remain closed, and it will have socio-economic impacts. These consequences threaten Thailand’s economy as a broadly conceived national security interests term will be a powerful narrative element to convince the Thai public, raising their awareness of the issue.
Conclusion and Policy Recommendations
Among the international policy dialogues, health justice and migrant health became popular and got attention recently. As not only the policy community but also the general public can have different values and beliefs, policymakers try to shape the opinions and create the story of why the proposed policies should be adopted and why the general public should support that policy. Policy disputes can be more easily resolved, and essential information is more effectively dispersed by understanding the root of narratives shaping specific individuals or coalitions[15]. As one of the policy narrative strategies to ensure the undocumented migrant workers are well-informed for accessing Covid-19 healthcare, the government should organize creative, widespread, and language-sensitive public information campaigns and create mediators to inform the workers, such as civil society organizations and volunteer groups. The following policy recommendations aim to eliminate the barriers to accessing Covid-19 Healthcare for undocumented migrant workers in Thailand.
- State – Business Engagement
The role of the employers for undocumented migrant workers is vital because they have accepted and hired the undocumented ones. Therefore they have a responsibility for the workers’ access to Covid-19 healthcare. As one of the policy actions for migrant health, Thai regional governments of the regions with large numbers of migrant workers should engage with employers to ensure there is no labor exploitation and let the workers get the Covid-19 vaccines as soon as possible.
- Organizing campaigns for the undocumented workers
As the undocumented migrant workers are not well informed to access Covid-19 healthcare, including vaccination, organizing campaigns focused on awareness and procedural knowledge for those populations could be one of the practical policy actions. Through the campaign activities, the undocumented migrant workers would be aware of how they get the vaccines without concerning their security. Campaigns need to convince the workers to get the vaccines without concern about their status and security and explain step-by-step procedural guidelines for accessing Covid-19 healthcare when they get an infection. Eliminating language barriers should be considered for public information campaigns, and the multimedia approaches such as broadcasting, publications, and social media should be used.
- Setting up a mechanism for future pandemic crises
Thailand has attracted a million migrant workers from its neighboring countries, and illegal migration cannot be stopped because of deep-rooted problems such as human trafficking and smuggling. As future global pandemics are inevitable, Thailand need to prepare for future migration health crises by setting up the systems and institutionalizing the standard operating procedures through the lesson learned.
References
[1] UN. (2019). Thailand Migration Report. https://thailand.un.org/sites/default/files/2020-06/Thailand-Migration-Report-2019.pdf
[2] UN. (2019). Thailand Migration Report. https://thailand.un.org/sites/default/files/2020-06/Thailand-Migration-Report-2019.pdf
[3] OECD/ILO. (2017). How Immigrants Contribute to Thailand’s Economy.
[4] UN. (2019). Thailand Migration Report. https://thailand.un.org/sites/default/files/2020-06/Thailand-Migration-Report-2019.pdf
[5] Tangcharoensathien V, Sachdev S, Viriyathorn S, et alUniversal access to comprehensive COVID-19 services for everyone in ThailandBMJ Global Health 2022;7:e009281.
[6] ILC Report (1999) https://www.ilo.org/public/english/standards/relm/ilc/ilc87/r3-1b4.htm
[7] http://www.ihppthaigov.net/DB/publication/attachinter/383/Full-text.pdf
[8] Tangcharoensathien V, Sachdev S, Viriyathorn S, et alUniversal access to comprehensive COVID-19 services for everyone in ThailandBMJ Global Health 2022;7:e009281.
[9] Stockholm Environment Institute. (2021, December 14). Migrant workers in times of Covid-19: An empathetic disaster response for Myanmar workers in Thailand. SEI. Retrieved April 6, 2022, from https://www.sei.org/perspectives/migrant-workers-covid-disaster-response/
[10] Migrant Working Group. (2021, November). Situation on Migrant Workers and Border Crossing During the Covid-19 Pandemic. Sirada Khemanitthathai. https://mwgthailand.org/sites/default/files/2022-02/Situation%20on%20Migrant%20Workers%20and%20border%20crossing%20During%20the%20covid19%20pandemic.pdf
[11] Tuangratananon, T. R. S. (2020, September 16). In Thailand, Noncitizen Health Matters | Think Global Health. Council on Foreign Relations. Retrieved April 6, 2022, from https://www.thinkglobalhealth.org/article/thailand-noncitizen-health-matters
[12] Migrant Working Group. (2021, November). Situation on Migrant Workers and Border Crossing During the Covid-19 Pandemic. Sirada Khemanitthathai. https://mwgthailand.org/sites/default/files/2022-02/Situation%20on%20Migrant%20Workers%20and%20border%20crossing%20During%20the%20covid19%20pandemic.pdf
[13] World Health Organization. Promoting the health of refugees and migrants. Geneva: Draft global action plan, 2019–2023 [Internet]; 2019. Available from: http://www.unhcr.org/uk/figures-at-a-glance.html,%0A; http://www.who.int/migrants/news-events/A70_24-en.pdf?ua=1
[14] Kraft, M. E., & Furlong, S. R. (2019). Public policy: Politics, analysis, and alternatives. Cq Press.
[15] Wabash CarbonSAFE. (2020, September). Application of Policy Frameworks for Improved Carbon Capture and Storage Social Site Characterization & Stakeholder Engagement. Amelia Brumbaugh and John A. Rupp. https://www.osti.gov/servlets/purl/1664756
Download full paper >>> Click