Abstract:Background: Multiple factors affect access maternal, newborn and children health services (MNCHS) among Myanmar migrants who cross the Thailand-Myanmar border. Systems thinking offers a comprehensive approach to understand interdependencies of these factors to guide effective policymaking. Objectives: To apply systems thinking to understand the dynamics of access challenges for MNCH among migrants from Myanmar along the Thailand-Myanmar border. Materials & Methods: A causal loop diagram was constructed using findings from a systematic literature review of PubMed, Embase and Scopus. Two independent reviewers searched the databases and included studies that involved 1) migrants from Myanmar at the Thailand-Myanmar borders, and 2) reported on health outcomes, service delivery, or health financing for participants aged less than 18 years old and those who are pregnant. Published studies as of 17 February 2025 were included without language restrictions. Results: A total of 101 studies, published 1989 to 2025, were included from 1451 records. Four dynamic interactions influencing service delivery for and access to MNCH in Thailand were identified. First, health financing involved a health insurance, out-of pocket-payment by patients, and by donations where sustainability concerns persist. Second, the pathways for national verification for undocumented or irregular status people are often complicated and costly. Third, limitations in healthcare manpower and capacity exist, and co-dependence of NGO and public sector providers facilitates service delivery. Lastly, demand for health services in Thailand were influenced by health seeking behaviours and livelihood of migrants. Conclusion: Systems thinking and causal loop diagrams are valuable tools to understand the context, and interrelated access barriers and facilitators for MNCH services among Myanmar nationals along the Thailand-Myanmar border. Complemented with multi-sectoral stakeholder engagements, this serves to guide the development of policy interventions.
Keywords: Migration and Health, Myanmar, migrants, maternal and child health, service delivery, systems thinking
