Strengthening Health Security in Thailand by Improving Health Statuses of Myanmar Refugees and Displaced Persons in Tha

1. Monitoring Migrants’ Health Strengthening Health Security in Thailand by Improving Health Statuses of Myanmar Refugees and Displaced Persons in Thailand High Level Multi-stakeholder Dialogue on Migrant Workers’ Health and Access to HIV services in the ASEAN Region Bangkok, Thailand / 29November 2011

2. Objectives • Provide brief overview on the status of refugees (“displaced persons”) and migrants in Thailand • Describe current health surveillance and provision of health services for this population • Describe WHO-MoPH project to strengthen health security (focus on health surveillance) • Objectives • Key components • Status of implementation • Challenges and lessons learned

3. Myanmar refugee camps (‘temporary shelters’) in Thailand Population in 9 camps* Registered: 95,330 Unregistered: 45,746 Estimated total: 141,076 *Source: Thailand Migration Report 2011

4. Health care services for refugees -NGOs provide basic primary care, wat/san, and prevention services -Tertiary care provided by local District/provincial hospitals Camp commander COEER

5. Migrants in Thailand *87% Myanmar 6% Lao 6% Cambodian Source: Thailand Migration Report 2011

6. Disease Surveillance Systems—refugees and migrants Special Programs^ Refugees MoPH routine UNHCR- CCSDPT* -NGOs report to CCSDPT and BoE e.g. HIV -migrants, seafarers thru annual sero surveys -pregnant women thru ANC Bureau of Epidemiology (506 system) BoE PHO DHO *Committee for Coordination of Services to Displaced Persons in Thailand ^HIV, TB, Malaria

7. Key Challenges • Thailand is not a signatory of the UN Convention on Refugees • Uneven policies regarding migrants results in uneven access to health services and limited coverage of health insurance for non-Thai populations. • Gaps in health services for migrants/refugees: inaccessibility, language barriers, etc. • Sustainability of funding to NGOs and unfunded services covered by districts/provinces for those unable to pay • Lack of timely, accurate demographic and health data on migrant populations • Improve surveillance and disease control coordination among all key actors (GOs, IGOs, NGOs, local administration office, communities) Given links betw Thai and non-Thai populations, recognize need for broad health system strengthening to achieve equitable, sustained improvement

8. Strengthening health security in Thailand by improving health statuses of Myanmar refugees and displaced persons (“AUP Project”) • EU funded under “Aid to Uprooted People Program” for 2011-14 • Objectives: • To develop appropriate long term policiesand mechanisms to ensure equitable access to government mainstream health services for refugee and MDPs living in camps and surrounding areas. • To ensure public health security of society by strengthening disease surveillance and outbreak response and outbreak prone disease preparedness in refugee camps and surrounding areas. • To ensure that public health gaps of the target populations are well defined and addressed.

9. AUP Project • Key partners: WHO and Bureau of Policy and Strategy (MoPH) • Other key collaborators: Bureau of Epidemiology, Provincial/district health offices, Mae Sot Hosptial, NGOs, Inst for Population & Social Research-Mahidol University • Target • Refugees (140,000) and displaced persons-migrants (+/- 300,000) in 4 provinces (Mae Hong Son, Tak, Ratchaburi and Kanchanaburi) • ~150 medical staffs from 5 medical agencies (AMI, ARC, IRC, MI and SMRU) in refugee camps • Ultimately, wider Thai and migrant populations

10. Objective 1: Develop long term policies and mechanisms • Ultimately involves ‘migrant regularization policy’ • Recognition that health of migrants is an important issue from perspective of human rights, public health, and economics • 3 major health policy issues: • How to pay for the system • How to ensure that migrants can access the health system • How to improve the quality of services migrants receive • Key strategies: • Support development of revised Border Health Master Plan for MoPH • Provide evidence base to formulate coherent policy across sectors to promote the right to health of refugee/non-Thai displaced persons

11. Objective 2: Strengthen health information system and outbreak response • Key strategic activities—pragmatic and immediate steps • Establish “border health units” within BPS and at provincial/district levels to compile and update all relevant health information of refugees/migrants; coordinate with other NGOs and other relevant collaborators • Provide revised surveillance guidelines, including standardized reporting formats and feedback mechanisms • Develop SOPs for outbreak response and preparedness in refugee camps • Establish rapid response teams with links betw NGOs and MoPH

12. Key components of refugee health information system Disease surveillance Health services Population -immediate notification for 8 diseases* -weekly reporting on others -demographic data updated annually -q3 mo reporting on MCH and reproductive services *Avian influenza, influenza A, cholera, measles, AFP, meningitis/encephalitis, dengue, anddeath of unknown etiology

14. Status of implementation • Border Health Units established in BPS and all provinces/districts • Expanded migrant data • Standardized forms No. of cases of diarrhea in migrants staying in Mae Sot District in 2011, by month Source: Mae Sot Hospital

15. Challenges/Lessons Learned • Need to engage all relevant parties in the process • Acknowledge differing agendas and allow for flexibility as long as key objectives are met • Need for dedicated staff • Emphasize importance and utility of using data for decision making and public health planning • Importance of addressing sustainability early in the process

16. AUP Project Team • Bureau of Policy and Strategy • Dr Supakit Sirilak • Mr Krisnan Lasnub • Ms Suparaporn Thammachart • Ms Wannee Kunchornratana • WHO/Thailand • Dr Brent Burkholder • Ms Aree Moungsooklareoun • Ms Sushera Bunluesin THANK YOU