The advent of ASEAN Economic Community has increased cross-border mobility between different countries in the Greater Mekong Sub-region (GMS), which poses serious threats to malaria elimination in the region. Thailand is one of the most viable destinations for labour migrants from the neighboring countries. It is estimated that Thailand hosts nearly four million migrants from Myanmar, Laos and Cambodia, with around 80% of them coming from Myanmar. Financial hardships and search for better job employment opportunities is a key driver of migration in the GMS.
In Thailand, most of the mobility with malaria risk is happening along the border with its neighboring countries. Myanmar, Cambodia and Laos have a large number of internal seasonal migrants in addition to cross-border migration. Seasonal mobility for the forest and farm work has put people to the high risk of Malaria along and across the border. large number of an ethnic community in Myanmar and Vietnam are still living in malaria risk area with limited service access. In general, most of the mobile and migrant workers in the GMS work in the farm, forest, mining, construction and plantation and they are highly at risk of Malaria.
Malaria is a disease, which not only has the pathological causes; it bears the cultural, social, economic, and geographical significance too. The underestimation of malaria might lead to re-emergence of malaria in the eliminated areas. Hence, human mobility is the important factor for elimination agenda. GMS has the target of malaria elimination within 2030 collectively, with the strategy of reducing malaria in all high transmission areas and prevent the reintroduction of malaria in areas where it has been interrupted. Moreover, it works to eliminate malaria in areas with multidrug resistance, including ACT resistance.
Challenges
Mobile populations pose additional challenges to countries that are often already struggling to cope with day-to-day demands on their health-care systems. Mobile and Migrants also encounter obstacles to accessing basic health care services, as the provision of health services is contingent on their legal and administrative status. Eligibility and capacity to purchase migrant health insurance is a big issue for the migrants working without a legal document, with very low wages and living with families.
There is great variability in the capacity of health-care systems in the region to address migrant health. Thailand has demonstrated good capacity in this regard and has signed a MoU with Cambodia, Myanmar and Lao People’s Democratic Republic, providing support for health service access to migrants. However, discrimination, fear of arrest, and language is being biggest challenges to migrant population in accessing services in the region. Currently the Global fund is supporting with free malaria service in high risk areas, sustainability of this investment is an issues as Malaria is getting down.