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 Malaysia’s TB control efforts.