Opinion: Addressing tuberculosis screening challenges for migrant workers

March 21, 2025

Healthcaretoday, Tuberculosis, TB, FOMEMA, Migrant workers, Malaysia's Foreign Workers, World Tuberculosis (TB) Day,

The annual health screening process for migrant workers suspected with latent TB infection (LTBI) are deemed unfit with no opportunity for treatment and continuation of work in the country. Their work permits are denied with no exceptions.

By Dr Jo Ann Andoy Galvan, Senior Lecturer
School of Medicine, Faculty of Health and Medical Sciences,
Taylor’s University.

World Tuberculosis (TB) Day, observed annually on March 24, serves as a global reminder of the urgent need to eliminate TB. According to the Ministry of Health Malaysia’s 2023 annual report, 26,781 TB cases were recorded in that year, marking a 5.47% increase from 25,391 cases in 2022.

Despite medical advancements, Malaysia continues to grapple with TB, particularly among vulnerable populations like migrant workers. Systemic gaps in policy and healthcare access allow cases to go undiagnosed and untreated, fueling further transmission.

Challenges in TB prevention among migrant workers
Migrant workers, both documented and undocumented, face significant barriers to healthcare access, which increases their risk of TB transmission. Many live and work in high-traffic environments such as restaurants, construction sites, and factories — crowded settings where TB can spread easily.

The Ministry of Health provides free TB treatment for all, including foreign workers. Through decentralisation, treatment facilities have expanded into underserved semi-urban and rural areas, reducing barriers to healthcare. This initiative, eliminating costs for everyone, marks a significant step toward eradicating TB in Malaysia.

However, the fear of deportation discourages undocumented workers from seeking medical care, often leading to delayed diagnosis and treatment. Meanwhile, documented workers who test positive for TB during mandatory screenings often face refusal to renew their work permit by relevant authorities. During the annual health screening process for migrant workers suspected with latent TB infection (LTBI) — a non-contagious, treatable condition that has not progressed to active disease, are deemed unfit with no opportunity for treatment and continuation of work in the country. Their work permits are denied with no exceptions.

One of the key challenges in TB prevention is the lack of differentiation between:
●Active TB Disease: Symptomatic, contagious, and requiring immediate treatment.
●Latent TB Infection: Asymptomatic and non-contagious, but with the potential to become active.

Currently, the Immigration Department of Malaysia refuses to renew work permit of workers who test positive for TB through the QuantiFERON-TB Gold (QFT-G) test, without distinguishing between active and latent infection. As a result, individuals with LTBI lose their legal work status, risking overstaying, illegal employment, and ultimately becoming undocumented migrants.

This outcome forces many to choose between health and survival. Driven by the need to support families back home, some sacrifice their health and avoid seeking treatment — a decision that increases the risk of TB transmission within the community.

Instead of refusal of work permit renewal, migrant workers diagnosed with LTBI should be encouraged to seek treatment at Klinik Kesihatan under Directly Observed Therapy (DOT) or regular follow up for those able to comply. This approach would not only prevent the progression to active TB but also reduce the risk of possible transmission rates and strengthening TB control efforts.

A call for accelerated action
Malaysia’s National Strategic Plan to End TB (2021-2030) aligns with the World Health Organization’s End TB Strategy, yet gaps remain in addressing Active TB and LTBI among migrant workers. A multidisciplinary, evidence-based approach is essential to improve TB prevention and treatment.

Key actions for a more effective TB response:

Interagency collaboration: The Immigration Department of Malaysia, Department of Occupational Safety & Health Malaysia (DOSH), Malaysia’s Foreign Workers Medical Examination Monitoring Agency (FOMEMA), and employment agencies must coordinate data-sharing and policy integration.
Legal protection for LTBI cases: Legal migrant workers with LTBI should receive treatment and support without the risk of work permit renewal refusal.
Refined screening protocols: Positive QFT-G results should prompt secondary testing (e.g. chest X-ray, sputum test) to confirm active disease before initiating treatment or making public health decisions.
Comprehensive patient follow-up and adherence monitoring: Robust tracking systems should be implemented to monitor patient adherence through digital tools (SMS reminders, mobile apps), home visits, or direct healthcare provider engagement. A patient-centered approach should also be adopted when screening close contacts to ensure early detection and timely intervention.
Health education initiatives: Medical professionals should educate migrant workers on early detection, adherence to treatment, and prevention of TB transmission among vulnerable populations.

World TB Day is not just a day of reflection, it is a call to action. Malaysia has the expertise and infrastructure to eliminate TB. However, systemic gaps in TB management, particularly concerning migrant workers, continue to hinder progress. By closing policy loopholes, strengthening interagency collaboration, and implementing targeted LTBI treatment strategies, Malaysia can accelerate its fight against TB.

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