Thailand - Stop TB Partnership

TB Cluster, expansion of this system would improve the efficiency and accuracy of reports,
reduce reporting delays, and facilitate reporting from the private sector as well. Though
manuals and workbooks are reportedly ready for distribution to clinical staff at all levels, 94
the expansion of the system itself was not assured as of December 2005.
Targeting vulnerable populations
Though the NTP has developed some targeted programming for vulnerable groups, including
migrants, prison populations, the urban poor, ethnic minorities, and mobile workers, TB
experts and NGO workers alike express serious concern about the resurgence of TB among
these groups, the lack of official data and information about what many experts consider
to be subepidemics, 95 and the significant barriers such groups face in accessing diagnostic
and treatment services. 96
Migrants
There are strong indications that TB is a serious issue among migrant populations from
neighboring Burma, Laos, and Cambodia. Mandatory health testing among migrants
detected 1,766 active TB cases in 2003, and a single clinic in the Mae Sot district detected
700 new cases in 2004, 250 of which needed immediate treatment. 97 As the total number
of migrants is unknown, it is difficult to estimate the total TB burden among the migrant
population.
Most recent migrants, particularly those from Burma, seek temporary employment
opportunities in Thailand, often as undocumented workers. 98 Thus, even if they are
diagnosed with TB, many do not complete treatment, and health workers find it difficult to
ensure proper follow-up. 99 In fact, in one analysis, the cure rate for migrants from Burma
is only about 25.8 percent. 100 In the same analysis, the authors note that the DOTS coverage
rate for migrants from Burma was only 22.9 percent, and Burmese migrants had a 66.5
percent default rate. 101 The level of treatment interruption suggested by these figures has
raised growing concern about the rise in primary drug resistance. 102
Many migrants lack official documentation, such as residence and work permits,
and fear deportation if they come into contact with public authorities. Many cannot read
or speak Thai, hampering outreach activities by health workers. Most are poor and lack the
resources to seek out health care. 103 Ethnic minority groups from within Thailand face similar
linguistic and financial barriers. To effectively reach these communities, the NTP must
partner closely with community-based organizations and researchers who have the contacts
and linguistic skills to overcome these barriers.
PUBLIC HEALTH WATCH MONITORING REPORTS 53