Abstract
In 2019, approximately more than 3 million migrants were working in Thailand. Major labor source countries (2,816,241 migrants) were the neighbouring countries including Myanmar, Cambodia and Laos. Occupational health (OH) problems among migrants were often found as a result of language and cultural barriers to health care access, and documentation status. This study was conducted to develop the occupational health services model (OHS) for migrant employees. This action research consisted of three stages including the situation analysis, formation and institutionalization. In the first stage, existing OHS situations were explored among participated agencies using both quantitative and qualitative methods. Data were collected from safety officers or human resources personal among 48 factories in Samut Prakan and Samut Sakhon using the structured questionnaire. Among them, 52 migrant employees were selected to participate. Then, qualitative data were collected from stakeholders using in-depth interviews and focus groups methods. In the second stage, Delphi technique was used to develop a friendly-migrant OHS model following the data from 21 experts who worked in occupational health field. In the institutionalization stage, some OHS activities of such model were chosen to launch in 4 pilot factories. Quantitative data were analyzed using frequency, percentage, Chi-square test and Fisher Exact test. In addition, qualitative data were analyzed using Thematic analysis. Results showed that among participated factories, most of them were food, beverages and drinking water factories (37.5%) which had 100 – 499 employees (37.5%). Only the large factories (employees >1,000) which had the number of migrants higher than Thais. Most of factories (97.9%) had safety officers (professional level). The interpreters were employed in 32 (66.7%) factories. Only 10 (20.8%) factories had migrant health volunteers who were interpreters as well. Occupational injuries and occupational diseases (OD) were found in 35 (72.9%) and 3 (6.2%) factories, respectively. The study found the association between number of migrant employees and accident statistics (P<0.001). The size of factories also associated with interpreter employment (P=0.017) and existing OH volunteers (P=0.040). Of 52 migrant employees, they were female (57.7%) aged 20-29 years old (53.8%). Myanmar was the most proportion (92.3%) who had worked for 1-5 years (53.8%). Most of such employees (70%) were trained on the topic influencing safety at work. Few of them had been trained to prevent OD, communicable diseases or family planning. Animated media which could access through internet were most preferred among participated employees. For the government side, related agencies which are under Ministry of Labor provided the services for employers and employees following the own legislations. In Samut Sakhon province, the provincial hospital could provide both passive and pro-active OHS to migrant employees. To be the effective services, hospital had a specific migrant clinic where had the interpreters whom employed to facilitate during services provision. In the same time, the provincial hospital in Samut Prakan provided services mostly for communicable diseases and health examination indicated for health insurance. Interpreters were available in Tuberculosis clinic offered by nongovernmental organization. According to the gap found from information in the first phase, OHS model was established to address on activities related to OH risk communication, coverage of some OHS services to migrant workers such as OD diagnosis and record, return to work management and health database development. Based on time constraint, this study selected some activities to perform addressed on the OH risk communication. OH migrant volunteer curriculum and training, 3 languages OH media, and self-health evaluation corner were launched in 4 factories. The core content of such curriculum was the OD and injuries protection. Immediately after the training, more than 60% of participants were very satisfied. However, after 3 months follow up, only trainees in 2 factories could partly organize OH and safety activities with related staff. The limitations of this study revealed as follow; 1) the generalization of the results was limited because of qualitative oriented data collection 2) the OHS model was developed based on the context of only formal migrant workers and 3) the curriculum was developed to train the migrant employees to be the OH volunteers but only few employees could perform the activities following their roles. This study recommended that the Ministry of Public Health should bring the OHS model to implement especially in the abundant migrants provinces. Additionally, the developed curriculum should be integrated with the existing one and details of OD protection should be addressed. The Ministry of labor should consider the quality of employed migrants and more enforce the factories to comply related conventions for improvement the occupational health and safety among such employees. The OHS model in the present study were addressed on formal migrant workers. Therefore, OHS for informal sector should be considered in further study.
