Health Care Access Challenges for Undocumented persons in Thailand

Background: Thailand is one of the countries that host many people with citizenship status or called undocumented persons, for example, irregular migrants, refugees in temporary shelters, urban refugees, and ethnic minorities with stateless status. Each group has unique social determinants of health, health needs, and barriers toward healthcare services. In the past ten years, a few studies have used systematic review methods to conclude health-related aspects of these undocumented populations. This thesis summarized all health-related aspects of undocumented populations in the past ten years. In addition, to suggest policies and humanitarian practices recommendation to improve their health. Methods: Systematic review by following the PRISMA guidelines and analyzed using thematic synthesis. PubMed, Medline, CINHAHL, and PsycINFO were searched from January 2010 to December 2020. The thematic synthesis involved a three-step inductive process in understanding health situations better and suggesting policy and humanitarian practices for each population. Results: One hundred and ninety-one articles were identified. The health of undocumented persons was drawn from the data covering six board areas: epidemiology; health perceptions and behaviors; healthcare accessibilities and facilities; health interventions and assessment tools; national health policy; and research and education. Health problems and challenges related to irregular migrants were malaria, tuberculosis, sexually transmitted diseases, undernutrition, geographic and transportation costs to healthcare facilities, authoritarian practice and policy, the duration of the National Verification process, and the clear-cut practical MHIS policy for healthcare providers. While for ethnic minorities with stateless status, problems were methamphetamine addiction, unsafe sexual practices, geographic and transportation to healthcare facilities, caregiver or companion support during visits, cultural sensitivity, and literacy. For refugees in shelters along the border were pneumonia in infants, perinatal depression, mood disorder, unplanned teenage pregnancy, and alcohol dependence. Urban refugees were the group that required immediate attention since no agency was mainly designed for healthcare and no insurance scheme for them. Conclusions: Undocumented persons in Thailand are an inhomogeneous group with different demographic, epidemiologic, and health risks. To understand and resolve the problems, one must consider the customer, provider, and system levels from internal and external causes. Policies and practices should be tailor-made for each type with particular attention to the legal barrier, especially the legal status, one of the most crucial barriers for undocumented persons to enjoy the right to health.