Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals

Abstract

BackgroundMyanmar and Thailand belong to the top 22 high burden countries for tuberculosis (TB). Health care organizations play an essential role in addressing TB control in the two bridging border jurisdictions, Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. However, health professionals face difficulties in TB control effort due to the nature of fluid population movements, resource constraints and ambiguous mechanisms to implement collaboration along the border. The purpose of this study is to identify the challenges to TB control among Myanmar migrants faced by stakeholders, focusing on the area of collaboration and interaction along the border.MethodThe study conducted in-depth interviews with health policy makers and health care providers responsible for developing and implementing policies and TB programs in Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. The participants included members of government organizations, United Nations agencies, community based organizations, and international NGO. One or two key stakeholders from each organization were approached to participate in the study. We gathered baseline information to identify TB policies and programs available on websites, brochures, and publications. Observations including field notes were made on site. The data transcriptions were coded for qualitative data analysis. Coding also developed categories that led to key themes.ResultsA total of 31 respondents (18 in Thailand and 13 in Myanmar) participated in the study. The main theme reported by participants was challenges in limited corroboration and coordination among stakeholders. Unstructured information sharing and lack of communication hindered the stakeholders from engaging in TB control. The respondents stressed that referral mechanisms across the border need to be strengthened. Other challenges were associated with increasing loss to follow up and subsequent MDR cases, constraints of service delivery, shortage of human resources, limited staff capacities within organizations and poor socioeconomic status of patients.ConclusionsHealth professionals face many challenges in effectively addressing TB control. Addressing the insufficient coordination and collaboration by strengthening bi-national collaborative mechanisms among health care organizations is an essential step in reducing the burden of disease. Additional support and resources from governmental and non-governmental agencies will be required to address the challenges.

Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border

“…Enumerating the burden of TB in migrant populations will make it easier to plan further interventions to address it. Our findings support the suggestion made by previous research that public health officials from Thailand and Myanmar continue to work together to strengthen data sharing on TB cases between the two countries [11]. …”

“…Another possibility is for Myanmar to help fund migrants’ TB treatment in Thailand through a direct fund transfer to treatment providers or through the development of a health insurance scheme for Myanmar citizens working abroad which is similar to what has been established in the Philippines [21]. Our findings support the suggestion that bi-national referral mechanisms be further developed, to allow patients to transfer between the two countries while reducing the likelihood that they will be lost to follow up [11]. This cross-border referral mechanism in addition to proper counseling may reduce concerns about drug resistance among treatment providers.…”

“…A 2007 demonstration project collected TB data from all government and non-government care providers in Tak province including non-Thai patient data, however the authors indicated that data are not uniformly reported to the National TB Programme [10]. Along the Thailand-Myanmar border limited coordination among stakeholders, unstructured information sharing, loss to follow-up, and limited resources have been identified as challenges to cross-border TB control as well as for control within the respective Thailand and Myanmar border regions [11]. …”

“…Beyond the TTBI there is additional evidence of cross-border collaboration as official transfer forms have been developed for cross border referral. While key informants in a 2014 study indicated that the border referral system needs further improvements to be of practical use, the study documents that preliminary border referral discussions have begun [11]. …”

Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

“…Studies (11)(12) show that the quantitative deficiency of professionals and the turnover of professionals within the services may generate work overload and care fragmentation to TB patients, thus affecting the problem-solving capacity of the services, the process of interaction with patients, and commitment and adherence to the treatment.…”