Among the estimated 1 million migrants living in Thailand along the remote Thai-Burmese border, threats to health abound.
Infectious diseases such as malaria, HIV/AIDS, hepatitis, tuberculosis, diarrheal conditions and dengue fever run rampant. Migrants often suffer serious injuries in accidents while working on construction sites, factories and farms. Also common are pregnancy and childbirth complications, cardiovascular and respiratory diseases such as high blood pressure and asthma, metabolic diseases such as diabetes, and digestive diseases such as gastritis and ulcers.
Compounding the problem is the fact that most migrants in the impoverished area are shut out of health insurance – and, as a result, essential health care.
“They’re largely a forgotten and marginalized population when it comes to health care,” says Nicolas Durier, MD, MPH.
To bring better health—and dignity—to a transient group trapped in the gaps between 2 health care systems along a porous border, the French-born, Thai-based physician has founded a nonprofit that aims to build health care access by providing low-cost insurance. Called Dreamlopments—a name that merges “dream” and “developments”—the Bangkok-based group will offer much-needed preventive screening and other services in partnership with a network of public and private health care providers on both sides of the border.
The border migrants, most of whom come from Burma (also known as Myanmar), are among more than 3 million across Thailand (2 million of them in the country illegally, the rest in the country legally, with work permits). They make an average of only about $5 a day, change jobs frequently and are often paid day-by-day. Under these circumstances, migrants can’t afford the estimated $105 the Thai government requires them to shell out upfront for 2 years’ insurance. Those who can pay for government insurance are limited to treatment at one designated hospital – an impractical arrangement for people who move often and want free healthcare in both Thailand and Burma.
These barriers explain why a Dreamlopments survey found more than 90% of the migrants surveyed in Tak province along the Thai-Burmese border (home to 200,000 migrants), where the organization is operating a pilot program, had no health insurance at all.
Dreamlopments will remedy that, with coverage costing just $3 a month. Durier says the idea took hold after he worked with MSF in 2004 and 2005 as medical coordinator for programs in Thailand. There, the organization provided health care in 3 refugee camps along the Thai-Burmese border and ran a treatment program for migrants with tuberculosis.
Now Durier has raised about $80,000 of the $100,000 his fledgling nonprofit needs this year to conduct a feasibility study and design the program. He estimates operating the program will cost $2 million during the first 3 years, until reaching self-sufficiency. With support from crowdfunding, grants, corporations, and individuals who want to buy shares in the nonprofit, Durier believes Dreamlopments can be financially self-sufficient by 2020.
Durier’s team has visited 7 hospitals as well as health clinics and NGOs along the border to discuss possible partnerships for the migrant insurance project, and has met with regulatory agencies, research institutes and academic experts. The nonprofit is also striving to foster partnerships with and garner support from governments, insurance companies, a mobile phone operator and international organizations like UNICEF, the International Organization for Migration and the International Labor Organization.
Nipit Piravej, MD, the CEO of Bangkok Healthcare, a health care consultancy and health services provider, underscores the need for a new approach to giving migrants better, more affordable access to healthcare.
“I am personally hopeful for any innovative model because the mainstream systems have failed,” he says.
They’ve failed for migrants not just in Thailand, but throughout Asia. For that reason, Durier eventually wants to expand to other areas along the border and around Bangkok and perhaps well beyond. Such growth, he says, would allow his organization to serve and put into a common health-insurance pool disparate groups of migrant workers: Burmese in Thailand; Indonesians in Malaysia; Cambodians and Laotians in Thailand and Vietnam; Burmese and Africans in China; and Filipinos in Singapore and Hong Kong.
The approach would indeed be novel. Though shared-cost “microinsurance” plans cover low-income families in India, Pakistan, Africa and elsewhere, Durier knows of no other private, nonprofit health insurance program in the world exclusively serving migrants, especially undocumented ones.
“The health situation and lack of access to health care of migrants in Thailand and along the border has been pretty much the same for at least the past 10 to 15 years,” Durier says. “So it’s urgent to develop a solid health protection-insurance scheme for this population to fulfill this very real need.”
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