Every year, around this week each May, thousands of country delegates and health experts convene at the World Health Organisation’s (WHO) World Health Assembly in Geneva.
Among these global health experts, Thailand holds special status. Though not a large country, nor a particularly wealthy country, when it comes to providing care for its citizens Thailand is both global leader and role model for neighbouring Asean countries attempting to expand universal health coverage (UHC). Looking back at Thailand’s health reform history, a set of key lessons can be drawn.
Four decades ago, Thailand chose to invest wisely in health when it was still a low income country. It prioritised developing human resources such as medical doctors and particularly, nurses and community health workers. In the 1980s, it bucked a global trend to build new, shiny hospitals, focusing instead on increasing the number of rural primary facilities. Successful priority setting in health is an invaluable lesson that other countries are now learning.
In addition to wise investments, Thailand’s success is also a result of staying true to its vision, and fastidiously pursuing its goals despite prevailing trends, such as the free-market liberalism of the 1980s that espoused the adoption of user fees for health care. Many countries that have adopted such a practice suffered setbacks to health outcomes.
Indeed in 2001, when Thailand was recovering from the 1997 Asian financial crisis, it embarked on the journey towards UHC by setting up the “30-baht scheme” — now the universal coverage scheme (UCS). Again, contrary to cautionary advice from foreign experts, Thailand plowed ahead to establish one of the greatest safety net programmes that would cover 75% of its population.
Because of Thailand’s resolve, it achieved a goal much lauded by the global health community — the attainment of UHC to ensure all people can obtain health services they need without suffering financial hardship when paying for them.
The UHC implies not only financial protection from catastrophic and impoverishing healthcare expenditures, but also access to quality healthcare services when needed. Most importantly, it led to equity in health, as the rich-poor gap in out-of-pocket expenditure was largely reduced.
Another important lesson is that the collaboration of a myriad of stakeholders proved necessary to Thailand’s success. Over the decades, a range of institutional actors have emerged from investments in human resource development. For example, the Public Health Ministry’s International Health Policy Programme aims to improve the national health system by generating knowledge and evidence, and the Health Intervention and Technology Assessment Programme provides economic evaluations to guide decisions on pharmaceutical reimbursements under the UCS.
In addition, national universities and researchers form another critical group bolstering the health system. The set of health-related institutions working together is a unique attribute that has enabled Thailand to maintain a resilient public health system.
The involvement of non-traditional health actors is also a positive balancing factor for a more inclusive health system. This is possible through a rather unique mechanism — the National Health Assembly, which allows patients and consumer groups, and local NGOs, a venue to exercise agency and a voice to shape national health priorities.
Having achieved so much through home-grown solutions spanning four decades is an accomplishment in itself, but knowing how to leverage its achievements to positively influence the global agenda makes Thailand even more unique. This week, at the World Health Assembly, we will see debate around assessing health technologies for the universal coverage scheme, and Thailand will testify about its experience before the global community.
Recognising that globalisation affects health, Thai health leaders are working with their counterparts from the Ministry of Foreign Affairs to influence and shape the global post-2015 development agendas through the UN General Assembly sessions, notably by placing UHC as a priority.
In most developing countries, direct collaboration between health and foreign affairs ministries is an exception, and Thailand is once again an outlier in global health diplomacy.
Achieving good health outcomes requires a responsive health system that recognises changing contexts, emergent trends and new drivers.
Challenges that Thailand faces are real and serious such as rapidly increasing total health expenditure, demands for improved quality services, effectively engaging with the private sector, managing chronic disease prevention and treatment, an ageing society, as well as intensifying population and trade flows resulting from the Asean Economic Community.
These will no doubt require creative solutions, and adaptive processes requiring cross-sectoral collaboration. If past performance can predict that of the future, Thailand’s accomplishments should provide it with a solid foundation to tackle these challenges — and show the rest of the world how to do the same.
Natalie Phaholyothin is the Associate Director of the Rockefeller Foundation, Asia.