The Greater Mekong Subregion

These countries make up a developmental area referred to as the Greater Mekong Subregion(GMS). The subregion is vast, diverse and dynamic, covering 2.5 million square kilometres and home to more than 300 million people with a myriad of ethnicities and cultures.

By 2012, all GMS countries are expected to be connected to each other, by a series of all-weather roads or "corridors." Together with improvements in power and telecommunications, these roads will play a key role in promoting closer economic cooperation.

However, enhanced subregional integration, also poses corresponding challenges to existing lifestyles and cultures, and serious health and environmental threats. The market-oriented vision for economic development of the GMS has not always been balanced by social and human development.

As a general trend, development in the subregion is creating an unprecedented flow of people, capital and goods across borders, including illicit trafficking in labour, prostitution, arms, drugs and other contraband.

Transport Workers

Truck drivers travelling across borders in the GMS are a good example of a population that will face a negative health impact unless measures are taken to look beyond the economic benefits of South-East Asia’s developing highways to consider the health challenges as well.

One of the results of expanding economic ties and trade collaboration is the rapid increase in cross-border land transport in the GMS and the consequent rise in health risks for people involved in this economic sector.

• Is based on incomplete & outdated evidence-base, leading to many misconceptions;
• Is limited in scope focusing largely on solutions centred around HIV/AIDS such as condom promotion, peer-counselling & health promotion through IEC material;
• Does not address underlying working conditions & occupational health & safety issues as determinants of vulnerability;
• Is short-term in outlook and fragmented in its analysis of the situation;
• Focuses mainly on country-level, not on cross-border dynamic;
• Fails to involve transport sector stakeholders in a meaningful way.
  

UNESCAP's Health and Development Section embarked on the Health Without Borders project at the beginning of 2005. The aim of the project, undertaken in collaboration with the Transport Facilitation Section of the Transport and Tourism Division, was to find sustainable policy solutions to improve the health of truck drivers in the GMS.

The inter-divisional collaboration was meant to address the health and transport dimensions of the problem equally.

A key activity of the project was undertaking a situational analysis of working conditions and health behaviour along selected transport corridor(s) in Thailand, Lao PDR and Viet Nam as a basis for planning better interventions.

Based on the analysis, one health stop was piloted in Thailand in partnership with existing health facilities for transport workers. The research findings, the lessons learned from the pilot interventions and policy recommendations to address the underlying concerns of this target group were discussed at the Regional Project Workshop held from 26-27 October 2006, in Bangkok..

The project also mobilized various stakeholders, including the transport workers themselves, transport enterprises, relevant ministries and government agencies, as well as local and international NGOs to work more closely together to address the health concerns of long-distance road transport workers.

Phase I

Phase I of the project was designed with the following activities/outputs:

Building of partnerships. In all participating countries partnerships were forged with key players who would either be in a position to address the issues identified or to lobby those who can.

Situational Analyses were conducted in Lao PDR, Thailand and Viet Nam to understand the underlying causes of ill health and risk behaviour as well as the key health issues and their magnitude. These issues vary from country to country and would consequently require different interventions.

A pilot intervention is underway at the border between Lao PDR andThailand (Friendship Bridge, Nong Khai – Vientiane). The pilot intervention involves, inter alia, setting up of a health stop (referral clinic), outreach work and peer education, a behaviour change communication strategy, working with the respective ministries and employers to highlight the issues at stake.

A final regional workshop was held from 25-27 October 2006 bringing together all project stakeholders to discuss the project outcomes, the policy implications/recommendations and to fine tune activities for a second project phase.

A policy advocacy document and a comprehensive project report is also available online.

UNESCAP’s Role

In the context of the wider UN reforms, UNESCAP has been evaluating its work and is in the process of re-focusing its activities. The ‘Health Without Borders’ project fits well into this approach:

• It is multisectoral in nature and relies on a partnership between two UNESCAP Divisions;
• It looks at mainstreaming of social development in a predominantly economic sector, namely transport;
• It focuses on research as well as policy recommendations.

Outcome

The project hopes to provide policy directions to address the cross-border health dynamics in the transport sector by informing stakeholders with up-to-date research.