Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand

Pocock, Nicola S.; Chan, Zhie X; Loganathan, Tharani; Suphanchaimat, Rapeepong; Kosiyaporn, Hathairat; Allotey, Pascale; Chan, Wei-Kay; Tan, David T.

doi:10.1371/journal.pone.0231154

Cited by 46 publications

(43 citation statements)

References 34 publications

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“…Migrant workers face complex barriers in accessing healthcare in Malaysia, including financial constraints, the need to present legal documents like passports and work permits at public facilities, language barriers, discrimination, and physical inaccessibility [23,54]. Immigration policies in Malaysia essentially deny maternal and child health services for migrant workers at public facilities.…”

Section: Discussionmentioning

confidence: 99%

Migrant Women’s Access to Sexual and Reproductive Health Services in Malaysia: A Qualitative Study

Loganathan

Chan

Smalen

et al. 2020

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Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants’ views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.

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Section: Discussionmentioning

confidence: 99%

Migrant Women’s Access to Sexual and Reproductive Health Services in Malaysia: A Qualitative Study

Loganathan

Chan

Smalen

et al. 2020

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“…To assess economic impact, a dynamic simulation model was used to estimate the migration flows and labour markets between countries for economic systems development [ 14 ]. In the context of Southeast Asian countries, systems thinking was employed in a qualitative study to explore stakeholder perceptions towards challenges in migrants’ and health workers’ language and cultural competency in Thailand and Malaysia [ 15 ]. To unpack these challenges, a thorough understanding of all migrant health policies (including the NV process, the issuance of work permits and insurance measures) and how these policies interact with each other is necessary.…”

Section: Introductionmentioning

confidence: 99%

Understanding the Problem of Access to Public Health Insurance Schemes among Cross-Border Migrants in Thailand through Systems Thinking

Kunpeuk

Teekasap

Kosiyaporn

et al. 2020

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Thailand has become a popular destination for international migrant workers, particularly from Cambodia, Lao PDR, and Myanmar. However, only a fraction of these migrant workers were insured by public health insurance. The objective of this study was to apply systems thinking to explore contextual factors affecting access to public health insurance among cross-border migrants in Thailand. A group model building approach was applied. Participants (n = 20) were encouraged to share ideas about underlying drivers and barriers of migrants’ access to health insurance. The causal loop diagram and stock and flow diagram were synthesised to identify the dynamics of access to migrant health insurance. Results showed that nationality verification is an important mechanism to deal with the precarious citizenship status of undocumented migrants. However, some migrants are still left uninsured. The likely explanations are the semi-voluntary nature of the Health Insurance Card Scheme, administrative delay of the enrollment process, and resistance of some employers to hiring migrants. As a result, findings suggest that effective communication is required to raise acceptance towards insurance among migrants and their employers. A participatory public policy process is needed to create a good balance of migrant policies among diverse authorities.

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“…Such diverse backgrounds pose a challenge to health systems in coping with distinctive languages and cultures. 29 Not surprisingly, the implicit expectation of destination country health systems, seen here with examples from Malaysia and China, is for non-citizens to develop local language proficiency. We suggest that destination countries actively invest in developing migrantsensitive health systems, engaging migrant communities as patient navigators and intercultural mediators, hiring professional interpreters and training culturally competent health professionals.…”

Section: Discussionmentioning

confidence: 89%

“…27 28 Patient and public involvement The topic guides for Malaysia and China were informed by review of literature and cross-country meetings to discuss research priorities. In Malaysia, purposive sampling of participants from a previous migration health workshop in November 2017 29 was conducted, with further snowball sampling until no new participants were identified. In China, purposive sampling was also used to select key informants in two study sites.…”

Section: Definition Of Termsmentioning

confidence: 99%

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Healthcare for migrant workers in destination countries: a comparative qualitative study of China and Malaysia

2020

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ObjectivesThis paper explores policies addressing migrant worker’s health and barriers to healthcare access in two middle-income, destination countries in Asia with cross-border migration to Yunnan province, China and international migration to Malaysia.DesignQualitative interviews were conducted in Rui Li City and Tenchong County in Yunnan Province, China (n=23) and Kuala Lumpur, Malaysia (n=44), along with review of policy documents. Data were thematically analysed.ParticipantsParticipants were migrant workers and key stakeholders with expertise in migrant issues including representatives from international organisations, local civil society organisations, government agencies, medical professionals, academia and trade unions.ResultsMigrant health policies at destination countries were predominantly protectionist, concerned with preventing transmission of communicable disease and the excessive burden on health systems. In China, foreign wives were entitled to state-provided maternal health services while female migrant workers had to pay out-of-pocket and often returned to Myanmar for deliveries. In Malaysia, immigration policies prohibit migrant workers from pregnancy, however, women do deliver at healthcare facilities. Mandatory HIV testing was imposed on migrants in both countries, where it was unclear whether and how informed consent was obtained from migrants. Migrants who did not pass mandatory health screenings in Malaysia would runaway rather than be deported and become undocumented in the process. Excessive attention on migrant workers with communicable disease control campaigns in China resulted in inadvertent stigmatisation. Language and financial barriers frustrated access to care in both countries. Reported conditions of overcrowding and inadequate healthcare access at immigration detention centres raise public health concern.ConclusionsThis study’s findings inform suggestions to mainstream the protection of migrant workers’ health within national health policies in two middle-income destination countries, to ensure that health systems are responsive to migrants’ needs as well as to strengthen bilateral and regional cooperation towards ensuring better migration management.

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Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand

Cited by 46 publications

References 34 publications

Migrant Women’s Access to Sexual and Reproductive Health Services in Malaysia: A Qualitative Study

Migrant Women’s Access to Sexual and Reproductive Health Services in Malaysia: A Qualitative Study

Understanding the Problem of Access to Public Health Insurance Schemes among Cross-Border Migrants in Thailand through Systems Thinking

Healthcare for migrant workers in destination countries: a comparative qualitative study of China and Malaysia

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