Integrated primary health care services in two protracted refugee camp settings at the Thai-Myanmar border 2000-2018: trends on mortality and incidence of infectious diseases

Abstract

Aim: This study aimed to assess the health outcome of four epidemic-prone infectious diseases, in the context of a Primary Health Care project implemented in a protracted refugee setting along the Thai-Myanmar border.

Background: Refugees settled at the Thai-Myanmar border are fully dependent on support for health services, shelter, food, education, water, and sanitation. The Non-Governmental Organization Malteser International developed an integrated Primary Health Care program in close cooperation with trained camp residents over 25 years in the two settlements under its supervision. The project has been funded by the European Commission Civil Protection and Humanitarian Aid Operations (DG ECHO).

Methods: This was a retrospective primary health care project evaluation. All-cause mortality; morbidity trends in malaria, lower respiratory tract infections (LRTIs), watery diarrhea, and dysentery; and health service utilization covering a time span of 18 years were assessed. Programmatic changes in the Primary Health Care (PHC) project and events with a potential effect on health of the target population were examined.

Findings: Despite the continuous drain of trained health care workers, the volatile influx of refugees, and the isolated location of the two camps, the initial basic curative health care developed into an integrated and comprehensive PHC project including a SPHERE-compliant water, sanitation, and hygiene program. Malaria, LRTIs, watery diarrhea, and dysentery morbidity dropped twelve, three, two, and fivefold, respectively, over the 18-year period evaluated while the health services utilization dropped from 7.1 to 2.9 consultations per refugee/year. The international community may face situations where integration of refugees into the health services of the host country is not possible. In such a context, integrated and evidence-based PHC adequately funded and implemented by one health agency is an effective and relevant approach to reduce the infectious diseases burden under the constraints of semipermanent living conditions.

Keywords: Thai-Myanmar border; infectious diseases; mortality; primary health care; refugees; south east Asia.

Figure 1.

Map Thai–Myanmar border. Source: Shoklo Malaria Research Unit, Mae Sot, Thailand

Figure 2.

Annual mean population variations and utilization of health services in Mae La Oon and Mae Ra Ma Luang camps combined, 2000–2018.

Figure 3.

Trends in all-cause mortality rate (with 95% CI) for the all population (CMR) in Mae La Oon and Mae Ra Ma Luang camps combined, compared to that in Thailand, 2000–2018.

Figure 4.

Trends (with 95% CI) in watery diarrhea and dysentery in Mae La Oon and Mae Ra Ma Luang camps combined, 2000–2018.

Figure 5.

Trends (with 95% CI) in lower respiratory tract infections in Mae La Oon and Mae Ra Ma Luang camps combined, 2000–2018.

Figure 6.

Trends (with 95% CI) in all-causes malaria in Mae La Oon and Mae Ra Ma Luang camps combined, 2000–2018.