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Health Seeking Behaviors and Access to Health Services

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Health Seeking Behaviors and Access to Health Services HEALTH SEEKING BEHAVIORS AND ACCESS TO HEALTH SERVICES OF SHAN MIGRANT WORKERS IN HANG DONG DISTRICT, CHIANG MAI PROVINCE พฤติกรรมการแสวงหาและการเข้าถึงการบริการด้านสุขภาพ ของแรงงานไทยใหญ่ ในต�าบลสันผักหวาน อ�าเภอหางดง จังหวัดเชียงใหม่ 1 2 3 Sai Han Nwi , Chitima Katonyoo and Narong Na Chiangmai ชาย หาญ หนุ่ม1, จิติมา กตัญญู2 และ ณรงค์ ณ เชียงใหม่3 Chiang Mai Rajabhat University, 202 Chang Puak Road, Chang Puak Sub-district, Mueang District, Chiang Mai Province, 503001,2,3 มหาวิทยาลัยราชภัฏเชียงใหม่ 202 ถ.ช้างเ ผือก ต.ช้างเผือก อ.เมือง จ.เชียงใหม่ 503001,2,3 ABSTRACT The objectives of this descriptive study were to describe the health seeking behaviours and access to health services of Shan immigrant workers in sub–district of San Phak Wan, Hang Dong District, Chiang Mai Province. Data was collected by a questionnaire in March, 2017. Percentage, mean and Chi-square were used to determine the association between personal characteristics and barriers to health service access. The results found that the majority of the sample were male 61.9 % and aged between 30-39 years 38.1%. Most of them came from various cities in Shan state with unspecified origins of birth. Buddhism 44.8% denominated as their religion, and 89.5% did not attend formal schooling. 65.7% were married and had a household member of 3-4 persons. 43.1% had been working in Thailand for 3-4 years at the time of data collection. 49.7% held a working visa. 84.4% were registered with the labour department. 84.4% worked as construction workers. 60.8% regularly bought medicines from local pharmacists. The more reported barrier to health service access was long waiting queue. While personal factor had no relationship to access to health services. KEYWORDS: Health Seeking Behavior, Health Services Accessibility, Shan Migrant Workers 1 นักศึกษาหลักสูตรสาธารณสุขศาสตรมหาบัณฑิต สาขาวิชาสาธารณสุขศาสตร์ 2 อาจารย์ ดร. สาขาวิชาสาธารณสุขศาสตร์ 3 รองศาสตราจารย์ สาขาวิชาสาธารณสุขศาสตร์ 34 พิฆเนศวร์สาร ปีที่ 14 ฉบับที่ 1 เดือนมกราคม - มิถุนายน 2561 บทคัดย่อ การศึกษาพฤติกรรมการแสวงหาและการเข้าถึงการบริการด้านสุขภาพของแรงงานไทย ใหญ่ในต�าบลสันผักหวาน อ�าเภอหางดง จังหวัดเชียงใหม่เป็นการศึกษาเชิงพรรณนา มีวัตถุประสงค์ เพื่อศึกษาพฤติกรรมการแสวงหาและการเข้าถึงบริการด้านสุขภาพของแรงงานไทใหญ่ ในต�าบลสัน ผักหวาน อ�าเภอหางดง จังหวัดเชียงใหม่ เก็บข้อมูลจากกลุ่มตัวอย่าง จ�านวน 181 คน ระหว่างเดือน มีนาคม พ.ศ. 2560 โดยใช้แบบสอบถาม วิเคราะห์ข้อมูลโดยใช้ค่าร้อยละ ค่าเฉลี่ย และทดสอบ ความสัมพันธ์ระหว่างปัจจัยส่วนบุคคลกับอุปสรรคในการแสวงหาและการเข้าถึงการบริการ ด้านสุขภาพโดยใช้การทดสอบไคสแควร์ ผลการวิจัยพบว่า กลุ่มตัวอย่างส่วนใหญ่เป็นเพศชาย ร้อยละ 61.9 มีอายุระหว่าง 30-39 ปี ร้อยละ 38.1 ส่วนใหญ่มาจากเมืองต่าง ๆ ของรัฐฉาน แต่ไม่ได้ระบุภูมิล�าเนาเดิม ร้อยละ 44.8 นับถือศาสนาพุทธ ร้อยละ 89.5 ไม่ได้เรียนหนังสือ ร้อยละ 42.0 กลุ่มตัวอย่างส่วนใหญ่แต่งงานแล้ว ร้อยละ 65.7 จ�านวนสมาชิกในครอบครัว 3-4 คน ร้อยละ 43.1 กลุ่มตัวอย่างเข้ามาท�างานใน ประเทศไทย 3-4 ปี ร้อยละ 43.1 โดยมีหนังสือเดินทางข้ามประเทศ ร้อยละ 49.7 และจดทะเบียน แรงงานอย่างถูกต้องตามกฎหมาย ร้อยละ 84.4 ส่วนใหญ่ท�าอาชีพก่อสร้าง ร้อยละ 60.8 กลุ่ม ตัวอย่างเลือกใช้บริการร้านขายยาในพื้นที่เป็นประจ�า ส่วนใหญ่อุปสรรคของการเข้าถึงบริการ ด้านสุขภาพ คือ ระยะเวลาของการรอที่ยาวนาน ขณะที่ปัจจัยส่วนบุคคลไม่มีความสัมพันธ์กับการ เข้าถึงบริการด้านสุขภาพ ค�าส�าคัญ: พฤติกรรมการแสวงหาบริการด้านสุขภาพ, การเข้าถึงบริการสุขภาพ, คนงานไทใหญ่ Introduction from 222 million in 2010 and 173 million in The United Nations (UN) defines 2000 and nearly two thirds of all international an international migrant as anyone who migrants live in Europe 76 million or Asia changes his/her country of usual residence 75 million. A dramatic number of migrant and the most socially significant migrations workers simultaneously increases the social can be found within or between developing and health related issues globally (United countries in Asia and Africa. In the International Nations, Department of Economic and Social Migration Report 2015, it mentioned that the Affairs, 2016; International Migration Report, number of international migrants worldwide 2015). has continued to grow rapidly over the past According to the study of the fifteen years reaching 244 million in 2015, up International Labor Organization (2015), พิฆเนศวร์สาร ปีที่ 14 ฉบับที่ 1 เดือนมกราคม - มิถุนายน 2561 35 migrant workers account for 150.3 million spreading Buddhism or Christianity, trading, of the world’s approximately 232 million merchandising, education, etc. Due to the international migrants. Globalization, economic development of Thailand, foreign demographic shifts, conflicts, income laborers are in demand for the abandoned or inequalities and climate change will encourage low skilled jobs by the local people, such as ever more workers and their families to cross fishing, factories, construction, domestic work, borders in search of employment and security. entertainment, agriculture, etc. Migrant workers contribute to growth and development in their countries of destination, Migration in Chiang Mai while countries of origin greatly benefit from Chiang Mai, the second largest their remittances and the skills acquired during province of Thailand has 1.6 million their migration experience. Yet, the migration (1,678,284) population and holds 200,000 process implies complex challenges in terms migrant workers from Myanmar. Myanmar is of governance, migrant workers’ protection, a neighboring country to Thailand and Chiang migration and development linkages, and Mai is bordered by Shan State of Myanmar international cooperation. The International in the North East. Shan ethnic groups from Labor Organization (ILO) works to forge Myanmar migrant to Chiang Mai because policies to maximize the benefits of labor of its economic, geological location, culture, migration for all those involved. language and dialect similarity between Thai and Shan language, the main reasons Migration in Thailand for the flow of emigration from Myanmar Transnational migration and into Thailand, and their intent is to reside or trans-border migration are well-known settle as permanent residents/citizens or take phenomenon in Thailand. Chinese traders up an employment for a better life and job and laborers are said to be the early and opportunity in Thailand. largest immigrant groups who arrived A number of restrictions and Thailand in the 18th and 19th centuries. From complications causes misunderstanding, the Bangkok Census in 1909, it was reported language barriers, discrimination, registration that 162,505 Chinese migrants settled in the costs, legal documentation, and other capital other nationalities from neighboring expenses are the most significant problems countries or Western countries came and of the migrants from Myanmar, particularly settled in Thailand for various reasons such as Shans (Suwanvanichkij, 2008). Registered 36 พิฆเนศวร์สาร ปีที่ 14 ฉบับที่ 1 เดือนมกราคม - มิถุนายน 2561 migrants are covered by the Compulsory working conditions with high occupational Migrant Health Insurance Scheme. However, health risks, poor living conditions with a significant proportion of registered and crowded housing, and limited access to clean unregistered migrants deny their rights to water and sanitation (Hu, Cook, & Salazar, access the Thai health system. In 2004, 2005 2008 ; Li et al, 2009) and 2006, more than half of the registered According to Choy (2011), migrant migrants did not collect their health cards, workers in Singapore were commonly exposed even though the card was entitled for them to several occupational related diseases such to access the Thai health system (Pearson as occupational skin diseases, occupational et al., 2006 ; Archavanitkul et al., 2007) lung diseases, toxin exposure, noise induced because employers and migrants did not hearing loss, and work related musculoskeletal understand the system (Pearson et al., 2006). disorders amongst others. Migrants, largely The outpatient utilization rate for registered from South Saharan Africa (SSA), represented was lower than the rate for Thais. It seemed, a considerable proportion of AIDS and most migrants would only seek health care HIV reports in European Union, especially from hospitals when they were seriously among heterosexual and mother-to-child ill (Srithamrongsawat, Wisessang, and transmission (MTCT) infections (Del Amo et.al, Ratjaroenkhajorn, 2009). 2011). In Chiang Mai, AIDS was found Literature Review to be the most common disease in Shan Migrant Workers Health Issues migrants reported to Thai health authorities Growing international migration (WHO Thailand, 2005), and Tuberculosis was also thought to be the greatest factor was identified in the nation-wide health contributing to the rise in the cases and examination of migrants, conducted in 2014 by changes observed in the epidemiology of TB in the Thai Ministry of Public Health, as the most the developed world (WHO, 2001). In China, common disease of concern among migrants. migrants had made a major contribution to Since, migrant workers’ health issues were China’s industrial development and economic being raised up around the world and the growth, but they faced a variety of public well-being of Shan migrant workers in San health and social problems (Song, 2006). Phak Wan sub district, Hang Dong district in Concerns for migrants’ health had been Chiang Mai, was equally important as other centered on the consequences of dangerous foreign migrant workers. Chiang Mai had not พิฆเนศวร์สาร ปีที่ 14 ฉบับที่ 1 เดือนมกราคม - มิถุนายน 2561 37 only provided a wider variety of opportunity, that prevent them from accessing
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