Hong Seo Ah, Tipayamongkholgul Mathuros, Tinn Chit Su, Thepthien Bang-On
Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
ASEAN Institute for Health Development, Mahidol University, 25/25 Phutthamonthon 4 Rd, Phutthamonthon, Nakhon Pathom, Thailand.
BMC Health Serv Res. 2025 Jul 5;25(1):934. doi: 10.1186/s12913-025-13082-0.
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.
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.
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.
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.
泰国的来兴府和夜丰颂府与缅甸接壤，是寻求就业或医疗服务的人员的重要入境点。新冠疫情和缅甸的政治动荡对边境地区卫生系统的健康状况和运行产生了重大影响。本分析通过来自卫生组织的数据以及对来兴府和夜丰颂府的访谈，审视了卫生部门的现状、跨境流动带来的边境卫生挑战，并确定了关键差距。
进行了一项混合方法的情况分析，纳入了文献分析（定量卫生设施数据、国家报告和在线调查数据）以及对五个地区的关键信息提供者访谈：来兴府的乌邦、湄拉玛和达宋央，以及夜丰颂府的湄昂和邦玛法。对包括社区卫生工作者和服务提供者在内的42名参与者进行了目的抽样现场访谈。采用主题分析来解读访谈数据中的模式。
非泰籍人口占来兴府和夜丰颂府人口的20%-30%，各地区构成不同。乌邦有大量山地部落少数民族，达宋央有许多跨境患者，湄拉玛有大量外来务工人员，湄昂和邦玛法收容了因冲突而流离失所的人群。2020年至2023年期间，乌邦和达宋央的疟疾病例激增，而达宋央的结核病发病率飙升，非泰籍人口受影响的程度是泰籍人口的2至3倍。这给当地卫生系统带来了巨大的财政压力，因为许多非泰籍人士，包括跨境的缅甸国民，缺乏医疗保险，限制了他们获得补贴医疗服务的机会。此外，资源短缺和医护人员不足进一步加剧了边境卫生管理的压力。为了弥补这些差距，许多非政府组织积极努力支持来兴府的医疗服务。应对这些挑战需要共同努力，以确保边境地区公平获得医疗服务并实现可持续的资源分配。
该研究凸显了来兴府和夜丰颂府面临的重大卫生挑战，特别是在非泰籍人口众多的地区。疟疾和结核病等疾病在这些地区更为普遍，给当地卫生系统带来压力。财政和人员配置方面的挑战凸显了政府积极支持和跨部门合作的必要性，以改善这些文化多元的边境社区的卫生公平性。
