Special settings: health system impact and requirements Facilitator(s): Rapporteur(s): Organizations represented: *session 1, **session 2, ***sessions 1 and 2 (separate signup sheet will be provided and this information can be added later) Monitoring Migrant Health (surveillance systems, data availability, analysis, program monitoring) Rapporteur: Please collect any available data on incidence/prevalence, including MDR-TB for later compilation. General question To what extent does the health information we collect, routinely and through surveys, help us plan and measure progress for TB control among migrants? *+ The current system is hardly functioning at all ++ There are some very limited systems in place +++ There is an adequate system in place, but it is not sustainable ++++ There is a very useful and sustainable system in place Overall rating* ++ In addition to the epidemiologic and descriptive information you collect for all Thai TB patients, what specific data do you collect on migrant TB patients? For example: -country of origin -length of time in Thailand -documentation status -family members -etc. As examples. Country of origin Length of stay Information of family Not good for new arrivals and casual visits. Highly mobile. 1
What information is shared with the Electronically National TB program? Monthly Quarterly basis How frequently? How do you report this data (electronically, hard copy, fax)? Do you use the 506 system or others? What data analysis on migrant TB patients do you conduct? Do you receive any regular feedback on the information you provide to the national program? Do you collect or have access to general information (e.g. demographics, movements) about migrant communities in your area? Do you receive any data or information about the status of TB or health systems across the border? How do you monitor your TB control efforts among migrants? What, if any, specific program indicators (e.g. from Global Fund) are tracked regularly? Not directly to National TB program (via Provincial/District Health Offices) Some camps used to provide 506 system, but no longer do. Number of cases, cured rate, default rates. No Yes to some extent. Number of screened cases, cured rate, default rates, TB-HIV. No feedback from National TB program of what the big pictures are after all reports have been sent. Small number of cases (low sample size). Each NGO conduct own analysis. No feedback from National TB program of what the big pictures are after all reports have been sent. Highly mobile. (During UNHCR-repatriation activity- flexible for movement.) National TB program share info/ feedback. Meeting between PHO and NGO in the next 3 weeks to discuss about reporting format for TB. National TB program share info/ feedback. 2
Migrant Sensitive Health System (service delivery, human resources, drugs) General questions Overall rating To what extent are there good quality services being delivered and taken up by the people who need them? +++(+) To what extent are there the right levels of staff, with the right levels of training and support, in posts where they are +++ needed? Diagnostic method for all case To what degree do we have the right medicines distributed where and when they are needed? *+ The current system is hardly functioning at all ++ There are some very limited systems in place +++ There is an adequate system in place, but it is not sustainable ++++ There is a very useful and sustainable system in place Not sustainable (staff high turnover rate) resettlement What case detection activities are in place to identify migrant TB patients? What is done to promote passive screening? Outreach screening activities? IRC- Recent community surveillance survey by CHW. Education about signs/symptoms. PU-AMI- Contact case investigation (HW). TB health worker (raise awareness) by ex-tb cases. Home visit and refer to clinic. MI Community surveillance by CHW. Suggest 3 sputum samples with Chest X-ray for all suspected cases to promote passive screening. 3
What diagnostic tests are available at your facility for diagnosing migrant patients? Xpert MTB/RIF? Culture? Resettlement candidates/others Only AFB smear. What % of migrants diagnosed with TB is also tested for HIV in your facility? What is the referral mechanism for HIV+ patients? How do you deliver TB meds? DOTS? Home/community based care model? Do you have Thai staff who focus on migrant populations? Do they speak the migrants language? Do you have any migrant health workers (MHWs) or migrant health volunteers (MHV) who work on TB? If yes, - Do you have any training materials, manuals or other TB control materials targeting MHW and MHV? -How are the MHV and MHV trained and supervised? How do you obtain first line TB drugs for migrants? Are supplies sufficient? How do you obtain second line TB drugs for migrants? Are supplies sufficient? Almost 100%. (TB Number is low). Resettlement candidates- IOM Others. Community based/health center. Yes in some camps. Yes. In-house training with support from others (like SMRU). Refer to Thai hospital. Refer to Thai hospital. Language barrier. (Burmese, Karen, Karenni) High turn-over rate (resettlement, find better job) Thai hospital provides instruction in Thai language (barrier). Thai hospital provides instruction in Thai language (barrier). Harmonize/streamline existing multiple systems (based on MOPH s guidelines) ie. Screening diagnosis method. 4
What is your referral systems for Camps to district/provincial Road access difficulty. migrant TB patients? hospitals 5
Policy and Legal Frameworks (financing, legal access to care, links to non-health sectors) General Questions Overall rating* Is there enough money available for your efforts to control TB among migrants, given the burden of disease and the need +++ For NGOs to ensure adequate access? Is the current Compulsory Migrant Health Insurance Scheme functional in terms of controlling TB among migrants + *+ The current system is hardly functioning at all ++ There are some very limited systems in place +++ There is an adequate system in place, but it is not sustainable ++++ There is a very useful and sustainable system in place Specific Questions Status Gaps/Challenges Recommendations What is the source of funding for providing TB services to migrant patients? Is funding sufficient? What is the source of funding for providing first and second line TB drugs to migrant patients? Is funding sufficient? What links does your health program have with other relevant government sectors (e.g. MoI, MoL, etc) at your level in dealing with migrant TB issues? Are you aware of any efforts by MoL to engage employers in TB control among migrants? New national minimum wage draw attention from refugees to find job outside camps. Link IDP, refugee, migrants registration. 6
Partnerships, Networks, Multi-country frameworks (stakeholders, leadership, cross-border collaboration, community involvement) General Question To what extent is the necessary leadership, policy, planning and organizational support in place to adequately address TB control among migrants? *+ The current system is hardly functioning at all ++ There are some very limited systems in place +++ There is an adequate system in place, but it is not sustainable ++++ There is a very useful and sustainable system in place Overall rating* Specific Questions Status Gaps/Challenges Recommendations What organizations in your district/area are involved with District Health Office Provincial Health Office Language barrier (NGO-Thai authorities) controlling TB among migrants? MOPH (BOE, BTB) Others (Academics SMRU,.) Is there any coordination or links Yes. among these organizations? Is there any coordination or links specifically to private practitioners or private employers of migrants? To what extent does your organization communicate or link with national level counterparts in the BTB? To what extent do you have communication with TB control counterparts across the border in Myanmar, Cambodia, or Lao PDR? Are any local migrant community organizations involved with TB control among migrants? (Yes for vector-borne diseases) 7
In the last 5 years, have you had any opportunity to exchange experiences in controlling TB among migrants with other key stakeholders? In the last 5 years, have you had direct contact with WHO, STOP TB, or other international organizations involved with migrant TB issues? What do you think should be the role of these organizations? SMRU annual meeting (Malaria and TB) 8