Community Health Navigator

Background

Health and Share Foundation (HSF) is an organization working on health and society in border area of Thai-Lao Khemmarat district, Ubon Ratchathani where Mae Khong River is 40 kilometer border line between Thailand and Lao PDR.  Some Lao migrants cross their country to live in the site, Khemmarat district, both daily and regularly. Based on Khemmarat Registration database (2016), the number of non-registered migrants is 520: 334 females and 186 males.  Most of the migrants are in Na Wang sub-district, Khemmarat, Ubon Ratchathani province.  The foundation, associated with the Center of Excellence in Research on Gender, Sexuality and Health (GSH), Mahidol University and the Provincial Public Health Office, Ubon Ratchathani, conducts a project Developing Strategic Mechanism at District Level in Providing Lao Migrant Female Sexuality and Reproductive Health (SRH) care and services in the border of Thai-Lao, Ubonratchathani province, Thailand during January 2017-March 2018”.  “Lao Migrant Female” is pushed to be “the minority group” in Thai society.  Living in a long distance limits the migrant to approach to basic health care and services; they cannot approach to health information, rights, and have less opportunity to improve quality of life than others. Lao Migrant Females were encounter difficulties for living. In 2017, a survey of 100 Lao Migrant Female in 3 sub-districts (Khemmarat, Na Wang, and Hua Na) revealed that most of the Lao migrant females were 31-40 years old, living in Thailand for a lone time.  They worked in farms and as employees.  The Lao migrant females were worried about health services in terms of expense, waiting list, wasting time, transportation, lack of human right information, incomprehension of hospital health service processes.  They did not realize that sexual reproductive health e.g. leucorrhea, hypogastrium pain, and dysuria indicated infection in reproductive system. Some of the labors experienced oppression from husbands, others, family members; this decreased their self-esteem, negotiation power, and self-control. In particular, the labors were willing to have health services from family members, health volunteers, and staff in the health promotion hospital.

Objectives and method:  The project aims to build up machinery to work in district level for advocating policy and implementation on sexual reproductive health and sexual wellbeing of Lao Migrant Female, with collaborations of organizations through field workers like ‘Community Health Navigator or Health Buddy’, peers who take care of health and sexual reproductive health.  Community health navigator originally started when Thai and Lao health volunteers attended empowering and driving community activities with coaching system.  The coaches are sub-district health promotion hospital staff, municipal, and civil society.  The community health navigator are key workers driving in the community e.g. survey information about Lao female labors, home visit, conducting meeting for case solutions, organizing group health activities, building up information center in community, and encouraging Lao female labors to check up for cervical cancer at the sub-district health promotion hospital.      

Results: The project establish network implementation in community level consisting of staff from public health, administration, community organizations, and civil society.  The Community health navigator interrelate Lao Migrant Female and health services; also, they are important people approaching the target due to their contextual, cultural, and ethical understanding with great complicated working skills to deal with sexual wellbeing among Lao female labors.  They are working as the insider; they are reliable for the targets considering the Community health navigator as friends and counselors.  In addition, they could suggest the targets to access hospital health services, to accommodate e.g. taking care of documentation, taking patients/cases to health service processes, decreasing gap between government officers and the labors since the migrant labors feel uncomfortable to deal with the officers.  These make multi-dimension of work: sexual reproductive health, violence agent women, and labor rights. They were building power of negotiation among the labors to take care and protect themselves.  Moreover, the Community health navigators are able to give health information and knowledge through activities to the Lao Migrant Females so that they can take care of their health wellbeing and sustainability.

Conclusion: Although the “Community Health Navigators” are able to relate issues of migrant labors in the project site and the implementation is clear at community, sub-district, and district levels with machinery and system built up together. However, some Lao Migrant Females are illegal migrants. The illegal migrants feel worried about expense, transportation to Thailand, accessibility to government health services; this makes them unable to access health services. Previously, the project could support only some cases; therefore, policy support at sub-district, district, provincial, national, and international levels should be advocated so that the health volunteers and staffs will be able to ethically and equally serve, coordinate, refer the migrant labors in the area both legal and illegal migrants.   

Key world: Community Health Navigator, Community networking, Machinery, Integrated, Lao Migrant Female, Sexual and Reproductive Health, Thai-Lao border