As a region that is rapidly developing economically, ASEAN is attractive to migrant workers – both internationally and intra-regionally. World Bank figures show that in 2013, there is an estimated 10.2 million international migrants residing in ASEAN countries, of which 6.8 million are intra-regional migrants (i.e. from ASEAN). Amongst the ASEAN Member States (AMS), the asymmetry of economic opportunities pushes people from less developed economies such as to seek employment in more developed economies, mostly as transient labour migrants. 70 per cent of the total emigrant stock from ASEAN come from Indonesia, Vietnam and the Philippines, while Singapore, Malaysia and Thailand account for 80 per cent of the immigrant stock in ASEAN.
Migration flows as disease transmission pathways?
Such large flows of migration present a potential health security risk to the ASEAN nations. In all stages of the migration cycle – i.e. from country of origin, transit, destination and return – migrant workers are exposed to various health risks. As migrants travel between nations, they take with them their health profiles, disease prevalence, and cultural values and beliefs that reflect their country of origin. These health profiles, values and beliefs may be different with those of their host countries, and may have potential impacts on the host communities such as the introduction of communicable diseases. Further compounding the problem are undocumented migrants who – due to the fear of deportation – do not seek medical help when they are sick. The reverse is also true as migrants may carry a disease that they picked up in their host countries back home. Studies by scholars and reports from the Thailand Health Ministry have shown that a persistent problem that facing Thailand is the prevalence of contagious diseases such Tuberculosis, syphilis, leprosy, and elephantiasis brought in by migrant workers from neighbouring countries. There is also the fear of the importation of drugresistant Malaria in the Greater Mekong Subregion (GMS) that is associated with movement of migrant workers. With the launch of the ASEAN Economic Community (AEC) in 2015, these fears are exacerbated as greater intra-regional labour mobility is anticipated. Current attempts to provide health protection Given these risks, there is a greater need to enhance the healthcare support of migrant workers in the ASEAN region. Currently, universal health coverage (UHC) schemes exists in both sending and receiving countries in ASEAN. For receiving countries such as Singapore and Malaysia, legislation exists that provides guarantee for employer assistance in the case of disability and death for the migrant workers, and enrolment in private medical insurance schemes are mandatory. In Thailand, a UHC scheme provides access to a comprehensive range of medical services, which also allows undocumented migrants to opt in. For sending countries such as the Philippines and Indonesia, healthcare coverage is financed by social health insurance schemes. The implementation of the Philippines’ UHC system for overseas workers is currently more robust than Indonesia’s given theirs as the latter’s implementation of UHC is more recent (rolled out in 2014).
Challenges to Universal Health Care
These healthcare coverage schemes are available, they face challenges such as constraints in the implementation process and incomplete coverage. In the case of Singapore, private insurance coverage is insufficient and in Malaysia, migrants are charged higher co-payments compared to locals. In Thailand, annual premiums need to be paid by migrant workers themselves and the benefits are less comprehensive compared to Thai citizens. All schemes – with the exception of Thailand – face the problem of covering undocumented migrants.
Suggestions for ASEAN
Currently, the ASEAN Committee on Migrant Workers (ACMW) is still drafting the ASEAN framework Instrument of the Protection and Promotion of the Rights of Migrant Workers since the Declaration in 2007. This is an opportune time to re-examine the issue of healthcare protection and how the future convention will cover it. With the Philippines assuming the Chair of ASEAN in 2017, President Duterte could leverage on his country’s experience in providing healthcare insurance for his country’s overseas workers to inform the development of a framework for migrant healthcare protection.