Abstract for: Exploring the dynamics of maternal, newborn and child health services for undocumented immigrants in Thailand along the Thai-Myanmar border

Access to healthcare by undocumented immigrations along the Thai-Myanmar border are challenged by the lack of legal status, limited financial capacity, and cross border dynamics. Health facilities also face significant financial and resource constraints in delivering care. We applied systems thinking to reveal the deep structural patterns that drive persistent challenges in maternal newborn and child health (MNCH) services for undocumented immigrants along the Thai-Myanmar in Thailand. We developed causal loop diagrams (CLDs) for MNCH services in Kanchanaburi, a province with the highest unpaid expenses among foreign patients. A total of 30 undocumented immigrants and 21 providers and 2 policy makers were interviewed. To compare dynamics across provinces, CLDs will be developed for Tak, a province with more established immigrant health programs in Thailand. System archetypes were identified and validated through a stakeholder consultation. Service delivery capacities gaps are addressed by increasing workload which leads to turnover of hospital staff or volunteers. Allowance of partial payment by immigrants supports facility financial deficits but detracts from efforts to improve insurance enrollment. Infectious disease control programs improve health status of immigrants, but its effectiveness may be undermined by immigrants’ delayed health seeking behavior. Findings from Tak will be synthesized subsequently for comparison with Kanchanaburi. Potential solutions rely on having more healthcare staff or volunteers to execute (provide education, conduct outreach and triage, promotion of insurance) which further places pressure on the health system if underlying dynamics of staff and volunteers are not addressed. Monetary and non-monetary incentives can serve to support turnover rates, along with mobilization and recognition of frontline Myanmar nationals in Thailand to support with service delivery.