Assessing healthcare status and challenges in border regions: insights from Tak and Mae Hong Son provinces, Thailand - a mixed-method approach

Abstract

Background: Thailand's Tak and Mae Hong Son (MHS) provinces, bordering Myanmar, are critical entry points for individuals seeking employment or healthcare. The COVID-19 pandemic and Myanmar's political instability have significantly impacted the health and performance of border-area health systems. This analysis examines the current state of the health sector, border health challenges resulting from cross-border movement, and identifies key gaps through data from health organizations and interviews in Tak and MHS provinces.

Methods: A mixed-method situational analysis was conducted, incorporating documentary analysis (quantitative health facility data, national reports, and online survey data) and key informant interviews in five districts: Umpang, Mae Ramat, and Tha Song Yang (TSY) in Tak province, and Mueang and Pang Mapha in MHS province. A purposive sample of 42 participants, including community health workers and service providers, was interviewed on-site. Thematic analysis was used to interpret patterns within the interview data.

Results: The non-Thai population makes up 20-30% of Tak and MHS provinces, with varying compositions across districts. Umpang has a high number of hill tribe ethnic minorities, TSY sees many cross-border patients, Mae Ramat has a large migrant worker population, and Mueang and Pang Mapha host people displaced by conflict. Between 2020 and 2023, malaria cases surged in Umpang and TSY, while TB incidence spiked in TSY, with non-Thais being 2-3 times more affected than Thais. This puts significant financial pressure on local health systems, as many non-Thais, including cross-border Myanmar nationals, lack health insurance, limiting access to subsidized healthcare. Additionally, resource shortages and insufficient healthcare staff further strain border health management. To bridge these gaps, many non-governmental organizations actively work to support healthcare services in Tak province. Addressing these challenges requires coordinated efforts to ensure equitable healthcare access and sustainable resource allocation in border regions.

Conclusion: The study highlights significant health challenges in Tak and MHS provinces, particularly in districts with high non-Thai populations. Diseases like malaria and TB are more prevalent in these areas, straining local health systems. Financial and staffing challenges underscore the need for proactive government support and cross-sector collaboration to improve health equity in these culturally diverse border communities.

Keywords: Border health; Health facilities; Health service; Population movement.