Background Malaysia is widely credited to have achieved universal health coverage for citizens. However, the accessibility of healthcare services to migrant workers is questionable. Recently, medical fees for foreigners at public facilities were substantially increased. Mandatory health insurance only covers public hospital admissions and excludes undocumented migrants. This study explores barriers to healthcare access faced by documented and undocumented migrant workers in Malaysia. Methods We use qualitative data from 17 in-depth interviews conducted with key informants from civil society organisations, trade unions, academia, medical professionals, as well as migrant workers and their representatives. We interviewed doctors working in public hospitals and private clinics frequented by migrants. Data were analysed using thematic analysis. Results We found that healthcare services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector. Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers. Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities. Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent. Conclusions We propose instituting migrant-friendly health services at public facilities. We also suggest implementing a comprehensive health insurance to enable healthcare access and financial risk protection for all migrant workers. Non-health sector solutions include the formation of a multi-stakeholder migration management body towards a comprehensive national policy on labour migration which includes health.

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Objective Yunnan Province, located in southwest China, is one of the poorest province in China. The maternal mortality ratio (MMR) is about twice the national average (56.2/100 000 live births), and in remote mountainous regions, the rate is five times higher. This study aimed to examine the progress in reduction of maternal mortality in the 1990s and early 2000s and the factors associated with this reduction in Yunnan.Design A population-based, longitudinal, ecological correlation study.Setting A remote province of China with a proportionately large indigenous population.Population Populations at county, prefecture and provincial level.Methods Using maternal mortality data collected at the province, prefecture/region and county levels, trend and time series analyses and multivariate linear regression analyses were performed using SPSS (Version 13).Main outcome measure MMR and its change over time.

In this paper, the CFD-DEM coupling numerical method was applied to study the ship resistance of a certain type of ice-strengthened Panama bulk carrier in the brash ice channel. The ship-water interaction is established under Euler framework, and the ship-ice interaction is realized by means of the DEM method under Lagrange framework. The DEM ice particles modelling and the establishment of numerical brash ice channel were firstly carried out with reference to the HSVA ice tank test image and test parameters. Next, the influence of DEM ice particle shape on contact force and ship-ice interaction was studied. After that, the influence of the one-way coupling and two-way coupling computational scheme between fluid and particles on the calculation accuracy and the interaction phenomenon was studied and analyzed. Finally, the ship-ice interaction process and mechanical behavior of ship and particle interaction in the brash ice channel was simulated, and the numerical results were compared with the experiment of HSVA ice tank. The results show that the CFD-DEM coupling numerical method which takes full account of the effect of ship-water and the interaction between fluid and particles, can well simulate the phenomenon and process of ship-ice interaction, and compared with the experimental results, the average error of the numerical prediction is about 5.03~5.23% for ICE-1 case with one-way and two-way coupling.The CFD-DEM coupling numerical method includes water resistance, which improves the prediction accuracy of the alone DEM calculation method. The research work in this paper can provide a reference for the numerical prediction of navigation process of ships in the brash ice channel.