Tuberculosis awareness and access to treatment among Uzbek labor migrants in Kazakhstan

Kazakhstan has become an important destination for labor migration from neighboring Central Asian republics. Many of these migrants come from Uzbekistan and most are undocumented seasonal workers. Kazakhstan has a high incidence of tuberculosis (TB) and migration poses a risk both for increased transmission and treatment default. Residents of Kazakhstan are entitled to free TB treatment; however, anecdotal evidence suggests that migrants are reluctant to seek care. This study was conducted in Kazakhstan and Uzbekistan in summer 2008 to understand Uzbek migrants' barriers in accessing health care in Kazakhstan. Qualitative methods were used and consisted of 12 focus group discussions with Uzbek labor migrants, 10 in-depth interviews with migrants who were on treatment for TB, and 18 in-depth interviews with health providers in Kazakhstan. Textual data was analyzed using a Grounded Theory approach and entered into MAXQDA 2007 software. Results show that migrants experience multiple levels of barriers in their access to health care in Kazakhstan. Migrants' lack of legal status makes them vulnerable to exploitative work conditions and their lack of registration impedes their access to primary health care services. Migrants also cannot afford the fees, both formal and informal, charged for health services. A lack of awareness of the symptoms of TB, and especially of the availability of TB treatment, makes migrants less likely to seek care for TB. Health system barriers include perceived negative attitudes of health providers towards migrants and administrative problems that arise from treating unregistered patients. Barriers to access at the primary health care level impede migrants' access to TB treatment at the TB dispensary level. The results of the study will contribute to the development of information campaigns to raise awareness of TB among migrants and provide empirical evidence for policy to improve migrants' access to health services in Kazakhstan.