Displaying all 13 publications

Abstract:
Sort:
  1. Pocock NS, Phua KH
    Global Health, 2011;7:12.
    PMID: 21539751 DOI: 10.1186/1744-8603-7-12
    Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.
  2. Loganathan T, Chan ZX, Pocock NS
    PLoS One, 2020;15(12):e0243629.
    PMID: 33296436 DOI: 10.1371/journal.pone.0243629
    BACKGROUND: For Malaysia, a nation highly dependent on migrant labour, the large non-citizen workforce presents a unique health system challenge. Although documented migrant workers are covered by mandatory healthcare insurance (SPIKPA), financial constraints remain a major barrier for non-citizen healthcare access. Malaysia recently extended protection for migrant workers under the national social security scheme (SOCSO), previously exclusive to citizens. This study aims to evaluate healthcare financing and social security policies for migrant workers to identify policy gaps and opportunities for intervention.

    METHODS: A total of 37 in-depth interviews were conducted of 44 stakeholders from July 2018 to July 2019. A mixed-methods analysis combining major themes from qualitative interviews with policy document reviews was conducted. Descriptive analysis of publicly available secondary data, namely revenues collected at government healthcare facilities, was conducted to contextualise the policy review and qualitative findings.

    RESULTS: We found that migrant workers and employers were unaware of SPIKPA enrolment and entitlements. Higher fees for non-citizens result in delayed care-seeking. While the Malaysian government nearly doubled non-citizen healthcare fees revenues from RM 104 to 182 million (USD 26 to 45 million) between 2014 to 2018, outstanding revenues tripled from RM 16 to 50 million (USD 4 to 12 million) in the same period. SPIKPA coverage is likely inadequate in providing financial risk protection to migrant workers, especially with increased non-citizens fees at public hospitals. Undocumented workers and other migrant populations excluded from SPIKPA contribution to unpaid fees revenues are unknown. Problems described with the previous Foreign Workers Compensation Scheme (FWCS), could be partially addressed by SOCSO, in theory. Nevertheless, questions remain on the feasibility of implementing elements of SOCSO, such as recurring payments to workers and next-of-kin overseas.

    CONCLUSION: Malaysia is moving towards migrant inclusion with the provision of SOCSO for documented migrant workers, but more needs to be done. Here we suggest the expansion of the SPIKPA insurance scheme to include all migrant populations, while broadening its scope towards more comprehensive coverage, including essential primary care.

  3. Loganathan T, Rui D, Pocock NS
    BMJ Open, 2020 Dec 02;10(12):e039800.
    PMID: 33268413 DOI: 10.1136/bmjopen-2020-039800
    OBJECTIVES: This 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.

    DESIGN: Qualitative 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.

    PARTICIPANTS: Participants 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.

    RESULTS: Migrant 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.

    CONCLUSIONS: This 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.

  4. Guinto RL, Curran UZ, Suphanchaimat R, Pocock NS
    Glob Health Action, 2015 Jan;8(1):25749.
    PMID: 28156768 DOI: 10.3402/gha.v8.25749
    Background As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of citizenship and reimagine UHC systems that transcend national borders. Conclusions By enhancing migrant coverage, ASEAN countries can make UHC systems truly 'universal'. Migrant inclusion in UHC is a human rights imperative, and it is in ASEAN's best interest to protect the health of migrants as it pursues the path toward collective social progress and regional economic prosperity.
  5. Loganathan T, Chan ZX, de Smalen AW, Pocock NS
    PMID: 32722563 DOI: 10.3390/ijerph17155376
    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.
  6. Pocock NS, Mahmood SS, Zimmerman C, Orcutt M
    BMJ, 2017 11 15;359:j5210.
    PMID: 29141900 DOI: 10.1136/bmj.j5210
  7. Loganathan T, Rui D, Ng CW, Pocock NS
    PLoS One, 2019;14(7):e0218669.
    PMID: 31269052 DOI: 10.1371/journal.pone.0218669
    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.

  8. de Smalen AW, Chan ZX, Abreu Lopes C, Vanore M, Loganathan T, Pocock NS
    BMJ Open, 2021 01 18;11(1):e041379.
    PMID: 33462099 DOI: 10.1136/bmjopen-2020-041379
    BACKGROUND: A large number of international migrants in Malaysia face challenges in obtaining good health, the extent of which is still relatively unknown. This study aims to map the existing academic literature on migrant health in Malaysia and to provide an overview of the topical coverage, quality and level of evidence of these scientific studies.

    METHODS: A scoping review was conducted using six databases, including Econlit, Embase, Global Health, Medline, PsycINFO and Social Policy and Practice. Studies were eligible for inclusion if they were conducted in Malaysia, peer-reviewed, focused on a health dimension according to the Bay Area Regional Health Inequities Initiative (BARHII) framework, and targeted the vulnerable international migrant population. Data were extracted by using the BARHII framework and a newly developed decision tree to identify the type of study design and corresponding level of evidence. Modified Joanna Briggs Institute checklists were used to assess study quality, and a multiple-correspondence analysis (MCA) was conducted to identify associations between different variables.

    RESULTS: 67 publications met the selection criteria and were included in the study. The majority (n=41) of studies included foreign workers. Over two-thirds (n=46) focused on disease and injury, and a similar number (n=46) had descriptive designs. The average quality of the papers was low, yet quality differed significantly among them. The MCA showed that high-quality studies were mostly qualitative designs that included refugees and focused on living conditions, while prevalence and analytical cross-sectional studies were mostly of low quality.

    CONCLUSION: This study provides an overview of the scientific literature on migrant health in Malaysia published between 1965 and 2019. In general, the quality of these studies is low, and various health dimensions have not been thoroughly researched. Therefore, researchers should address these issues to improve the evidence base to support policy-makers with high-quality evidence for decision-making.

  9. Pocock NS, Tadee R, Tharawan K, Rongrongmuang W, Dickson B, Suos S, et al.
    Global Health, 2018 05 09;14(1):45.
    PMID: 29739433 DOI: 10.1186/s12992-018-0361-x
    BACKGROUND: Human trafficking in the fishing industry or "sea slavery" in the Greater Mekong Subregion is reported to involve some of the most extreme forms of exploitation and abuse. A largely unregulated sector, commercial fishing boats operate in international waters far from shore and outside of national jurisdiction, where workers are commonly subjected to life-threatening risks. Yet, research on the health needs of trafficked fishermen is sparse. This paper describes abuses, occupational hazards, physical and mental health and post-trafficking well-being among a systematic consecutive sample of 275 trafficked fishermen using post-trafficking services in Thailand and Cambodia. These findings are complemented by qualitative interview data collected with 20 key informants working with fishermen or on issues related to their welfare in Thailand.

    RESULTS: Men and boys trafficked for fishing (aged 12-55) were mainly from Cambodia (n = 217) and Myanmar (n = 55). Common physical health problems included dizzy spells (30.2%), exhaustion (29.5%), headaches (28.4%) and memory problems (24.0%). Nearly one-third (29.1%) reported pain in three or more areas of their body and one-quarter (26.9%) reported being in "poor" health. Physical health symptoms were strongly associated with: severe violence; injuries; engagement in long-haul fishing; immigration detention or symptoms of mental health disorders. Survivors were exposed to multiple work hazards and were perceived as disposable when disabled by illness or injuries. Employers struggled to apply internationally recommended Personal Protective Equipment (PPE) practices in Thailand. Non-governmental organizations (NGOs) encountered challenges when trying to obtain healthcare for uninsured fishermen. Challenges included fee payment, service provision in native languages and officials siding with employers in disputes over treatment costs and accident compensation. Survivors' post-trafficking concerns included: money problems (75.9%); guilt and shame (33.5%); physical health (33.5%) and mental health (15.3%).

    CONCLUSION: Fishermen in this region are exposed to very serious risks to their health and safety, and their illnesses and injuries often go untreated. Men who enter the fishing industry in Thailand, especially migrant workers, require safe working conditions and targeted protections from human trafficking. Survivors of the crime of sea slavery must be provided with the compensation they deserve and the care they need, especially psychological support.

  10. Pocock NS, Suphanchaimat R, Chan CK, Faller EM, Harrigan N, Pillai V, et al.
    BMC Proc, 2018;12(Suppl 4):4.
    PMID: 30044886 DOI: 10.1186/s12919-018-0100-6
    Migrants and refugees face challenges accessing both healthcare and good social determinants of health in Malaysia. Participants at the "Migrant and Refugee Health in Malaysia workshop, Kuala Lumpur, 9-10 November 2017" scoped these challenges within the regional ASEAN context, identifying gaps in knowledge and practical steps forward to improve the evidence base in the Malaysia.
  11. Pocock NS, Nguyen LH, Lucero-Prisno Iii DE, Zimmerman C, Oram S
    PMID: 30288452 DOI: 10.1186/s41256-018-0083-x
    Background: Little is known about the health of GMS commercial fishers and seafarers, many of whom are migrants and some trafficked. This systematic review summarizes evidence on occupational, physical, sexual and mental health and violence among GMS commercial fishers/seafarers.

    Methods: We searched 5 electronic databases and purposively searched grey literature. Quantitative or qualitative studies reporting prevalence or risk of relevant outcomes were included. Two reviewers independently screened articles. Data were extracted on nationality and long/short-haul fishing where available.

    Results: We identified 33 eligible papers from 27 studies. Trafficked fishers/seafarers were included in n=12/13 grey literature and n=1/20 peer-reviewed papers. Among peer-reviewed papers: 11 focused on HIV/AIDS/sexual health; nine on occupational/physical health; one study included mental health of trafficked fishers. Violence was quantitatively measured in eight papers with prevalence of: 11-26% in port convenience samples; 68-100% in post-trafficking service samples. Commercial fishers/seafarers whether trafficked or not worked extremely long hours; trafficked long-haul fishers had very limited access to care following injuries or illness. Lesser-known risks reported among fishers included penile oil injections and beriberi. We found just one work safety intervention study and inconclusive evidence for differences in the outcomes by nationality. Findings are limited by methodological weaknesses of primary studies.

    Conclusion: Results show an absence of high-quality epidemiological studies beyond sexual health. Formative and pilot intervention research on occupational, physical and mental health among GMS commercial fishers and seafarers is needed. Future studies should include questions about violence and exploitation. Ethical and reporting standards of grey literature should be improved.

    Trial Registration: Review registration number: PROSPERO 2014: CRD42014009656.
  12. Pocock NS, Chan Z, Loganathan T, Suphanchaimat R, Kosiyaporn H, Allotey P, et al.
    PLoS One, 2020;15(4):e0231154.
    PMID: 32251431 DOI: 10.1371/journal.pone.0231154
    BACKGROUND: Cultural competency describes interventions that aim to improve accessibility and effectiveness of health services for people from ethnic minority backgrounds. Interventions include interpreter services, migrant peer educators and health worker training to provide culturally competent care. Very few studies have focussed on cultural competency for migrant service use in Low- and Middle-Income Countries (LMIC). Migrants and refugees in Thailand and Malaysia report difficulties in accessing health systems and discrimination by service providers. In this paper we describe stakeholder perceptions of migrants' and health workers' language and cultural competency, and how this affects migrant workers' health, especially in Malaysia where an interpreter system has not yet been formalised.

    METHOD: We conducted in-depth interviews with stakeholders in Malaysia (N = 44) and Thailand (N = 50), alongside policy document review in both countries. Data were analysed thematically. Results informed development of Systems Thinking diagrams hypothesizing potential intervention points to improve cultural competency, namely via addressing language barriers.

    RESULTS: Language ability was a core tenet of cultural competency as described by participants in both countries. Malay was perceived to be an easy language that migrants could learn quickly, with perceived proficiency differing by source country and length of stay in Malaysia. Language barriers were a source of frustration for both migrants and health workers, which compounded communication of complex conditions including mental health as well as obtaining informed consent from migrant patients. Health workers in Malaysia used strategies including google translate and hand gestures to communicate, while migrant patients were encouraged to bring friends to act as informal interpreters during consultations. Current health services are not migrant friendly, which deters use. Concerns around overuse of services by non-citizens among the domestic population may partly explain the lack of policy support for cultural competency in Malaysia. Service provision for migrants in Thailand was more culturally sensitive as formal interpreters, known as Migrant Health Workers (MHW), could be hired in public facilities, as well as Migrant Health Volunteers (MHV) who provide basic health education in communities.

    CONCLUSION: Perceptions of overuse by migrants in a health system acts as a barrier against system or institutional level improvements for cultural competency, in an already stretched health system. At the micro-level, language interventions with migrant workers appear to be the most feasible leverage point but raises the question of who should bear responsibility for cost and provision-employers, the government, or migrants themselves.

  13. Van Minh H, Pocock NS, Chaiyakunapruk N, Chhorvann C, Duc HA, Hanvoravongchai P, et al.
    Glob Health Action, 2014 Dec;7(1):25856.
    PMID: 28672540 DOI: 10.3402/gha.v7.25856
    Background The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC. Design Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and 'snowball' further data. Results We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency. Conclusions We believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations.
Related Terms
Filters
Contact Us

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links