Migrant Workers in Thailand: Voiceless group left out of public health safeguard policy

Unlike Thai nationals, migrant workers in Thailand cannot enjoy healthcare benefits and are left out from access to lifesaving medicines, particularly ARVs, even though a public health safeguard policy has been brought into practice to reduce prices of essential drugs and to enable the government to provide those medicines to its citizens at no cost through existing health insurance systems.

The Thai law allows the migrant workers from Laos PDR, Cambodia, and Myanmar to work in the country. It is mandatory for these migrant workers to register and pay an annual fee of 1,300 baht for health insurance, which is known as the Compulsory Migrant Health Insurance Scheme, an extra health insurance separated from the other national health insurance schemes. They are also required to pay extra 30 baht per visit when they come to the hospital for medical services. However, healthcare services they received under the scheme are limited and they have to pay out of their own pocket for benefits not covered by the system. Health services related to HIV & AIDS are not covered by the scheme; no free ARVs are available for these migrant workers.

Currently 1.3 million migrant workers from Laos PDR, Cambodia, and Myanmar have been registered and working in Thailand. However, it’s estimated that the number of undocumented migrant workers in Thailand is much higher, at least 2 or 3 times. 

Type of Health Insurance Scheme

Coverage

Financing

Universal Coverage Scheme (UCS)

47 million (Thais not covered by the other schemes)

Government

Social Security Scheme (SSS)

9 million (private employees)

Contribution from employee, employer, and government

Civil Servant Medical Benefit Scheme (CSMBS)

5 million (government employees and dependents)

Government

Compulsory Migrant Health Insurance Scheme

1.3 million (registered migrant workers from Laos PDR, Cambodia, and Myanmar

Employee

Health Insurance Scheme for Ethnic Minority waiting for the nationality verification

450,000

Government





Compulsory Licensing

In late 2006 to early 2007, the Thai government made an unprecedented decision to implement a public health safeguard policy to address lack of affordable lifesaving medicines in the country, which is known as compulsory licensing. As a result, Thailand has imported generic versions of antiretroviral medicines (efavirenz and lopinavir/ritonavir) and drugs required for other chronic diseases’ treatment like cardiovascular diseases and cancers from India. The costs of the medicines supplied by Indian generic manufacturers are much lower than the original versions, at least 50%, that it allows the Thai government to improve and scale up its healthcare services to those who need it and the medicines have been provided for free to people entitled to the health benefits under the three main health insurance systems, covering over 90% of the total population. Up to now, there are more than 180,000 Thais living with HIV receiving free ARVs from the systems.

In June – Aug 2010, the Thai civil society groups working on HIV & AIDS and access to medicines ran a movement requesting the government to extend their compulsory licensing policy on lopinavir/ritonavir, as the policy would reach its end before the patent term of Kaletra (the brandname of the original lopinavir/ritonavir), while the need for the medicines would continue increasing. With constant pressure by the civil society, the  Ministry of Public Health, agreed to extend the CL policy in the following ways: extending the policy term until the patent of Kaletra would be over and covering all forms and derivatives, and extending the coverage to the people not entitled to the three health insurance programs. However, it doesn’t include migrant workers due to their non-Thai nationality.

The civil society groups had a follow-up meeting with policy makers for clarification. The Ministry of Public Health’s concern was that it would be against the TRIPS Agreement and their interpretation of the non-commercial government use provision, which is the rationale the Thai government used to issue compulsory licensing to extend the license to non-Thai nationals. The groups have consulted IP legal experts in Thailand and in the United States and it was confirmed that it is not against the TRIPS Agreement and not limited to certain groups of people. This information will be used to move forward in further negotiations with the government.

Quotes:

Ms Supatra Nacapew, Director of Foundation for AIDS Rights and Chairperson of the Thai NGO Coalition on AIDS:

“To improve healthcare services for migrant workers, at least for registered migrant workers, CL is an opportunity to start from. CL policy should not be restricted to a particular group of people. Registered migrant workers have to co-pay, by the law, for their health benefits to the government and they should access healthcare services and ARV treatment according to the national treatment guideline by accessing free ARVs under the CL policy.”

“Thailand gave their commitment to the global community in fighting against HIV & AIDS and committed itself to the UNAIDS 2011-2015 Strategy: Getting to Zero. It’s impossible if we leave migrant workers in Thailand out from access to treatment, which is a core pillar of the UNAIDS’s 3 Zero goal in the next five years.”

“It’s a vague argument that migrant workers are not eligible to have benefits from low-cost generic drugs by the TRIPS-flexibility CL policy. None of any clause in the TRIPS Agreement restricts the use of TRIPS flexibility measures not be applied for a particular group of populations. The Ministry of Public Health should review their decision and extend the benefit of the migrant workers.”

“We’d like to join force with networks of non-Thai people and PLHIV to voice out our demand to public health policy makers to re-consider their decision that excludes documented migrant workers from the benefits of the CL policy on lopinavir/ritonavir. That’s the starting point and then it should expand to other health benefits and undocumented migrant workers.”

Mr. Apiwat Kwangkaew, Chairperson of the Thai Network of People Living with HIV/AIDS (TNP+)

“ARVs under the CL policy should be used for everyone in an equal manner. In Thailand, migrant workers and other non-Thai people can access to original ARVs only via the treatment program supported by the Global Fund, which are expensive and accessible by a very limited group of people, approximately 1000 people.”

“Recently Thailand announced at the UN High Level Meeting in New York City that the nation had its national AIDS plan and a mission was to promote “access for all”. Every person in Thailand has to access to ARV treatment regardless whoever they are Thais or migrant workers. CL on lopinavir/ritonavir should not be limited to Thai citizens only.”

Mr. Nimit Tienudom, Director of AIDS Access Foundation

“Basically it’s all about rights, rights of patients to access to standard medical cares. Any legal measures should not be a barrier preventing patients from health services. Restriction of the CL policy would not have been applied to vulnerable groups like migrant workers. We need to break through the kind of legal restriction.”

“We [ASEAN countries] are moving to the ASEAN Community in the next few years.  Governments should have a talk on health issues as well, not only focusing on economy ad trade. Labour migration across countries in the region will happen regarding the ASEAN Community policy. So, what will happen to the life quality of migrant workers in the region? Governments should have a measure to ensure that migrant workers can access to quality and affordable medicines without discrimination in the same way as it’s happening to migrant workers in Thailand now.”

 

 

 

 




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