Thailand Shares Successful Experiences on Universal Health Coverage

Dr. Viroj Tangcharoensathien, the Director of International Health Policy Program, MOPH Thailand and the winner of Edwin Chardwick Medal Award, shared the successful experiences of Thailand over 27 years to achieve full Universal Health Coverage at the First Global Symposium on Health Systems Research (HSR), 16 – 19 November 2010, Montreux, Switzerland. Read more.

“By 2002 Thailand achieved full population coverage, which helps people to be able to access health services without pushing them to poverty because Thai government subsidized payments. Today all 650 districts were covered by a district hospital.” Dr.Viroj announced.

The key factors which helped Thailand to contribute to universal coverage includes political decision making and leadership, extensive trust base networks, policy networks, research networks and linkages among them.

Government effectiveness in its capacity to translate policy intention into actual implementation also contributed to success. In addition, Civil society involvement which included agenda setting on various policies: ART, renal replacement therapy for example. Health Service platform is vital otherwise Universal Coverage is a ‘citizen right in paper’ and Knowledge management: application of tacit knowledge, Health Systems Research also contribute to the achievement of universal coverage.

Thailand initially offered a favorable health package to low income group of 30 THB (US$ 0.7) and later on patients were not asked to pay anything. The Thai government contracted service providers and paid a certain amount to cover a certain number of people per year, instead of free choice fee for services reimbursement model.

Thailand still faces some serious challenges and these include:

1. How to sustain efficiency, equity and quality achievement while strengthen capacity to address new challenges through evidence.
2. And the demand for research outpaces the capacity in generating evidence.
3. Also demographic and epidemiological transition for example Chronic long term care versus hospital acute care, effective coverage of interventions and primary prevention of risk factors.
4. Non-health sector actions against determinants of ill-health such as Tobacco, alcohol, transfat, obesity, physical inactivity, safe environment and injury prevention.
5. Institutional capacity to generate evidence on ICER, fiscal impact, equity and ethical considerations of new medicines, interventions.

“We have to maintain a sustainable model and continue to develop our research,” Said Dr.Viroj.

“We have to prepare the longer term care and ensure that our aging people are healthy and it would be better to encourage them to stay at home with family instead of in the health care centre and links between home care and the health sectors need to be established,” he said.

“Due to the increasing of cost related to health issues we should formulate policy which is related to long term care. On the benefit package we need to improve and strengthen of new intervention and new medicine.” he added.

Jittima Jantanamalaka - CNS
(The author is the Managing Director of Jay Inspire Co. Ltd (JICL), produces radio programmes in northern Thailand and writes for Citizen News Service (CNS). She is also the Director of CNS Diabetes Media Initiative (CNS-DMI) in Thailand. Website: www.jay-inspire.com, Email: jittima@citizen-news.org) 


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World News, Montreux, Switzerland                                                             

The Dreams Of The World In The Palm Of Your Hand

“Every year almost 9 million children and infants die from preventable causes.”

“1 in 5 children are now over weight. Childhood obesity is 10 times higher than it was in 1970.”

“Poverty and disease in any one country has an impact on every other country because we are all living in an age where national borders should matter less and humanity matters more.”

These are some of the hard hitting quotes that Judith Rodin, the president of Rockefeller Foundation stated over the opening session of The First Global Symposium on Health Systems Research (HSR) which was held in Montreux, Switzerland, from 16 to 19 November 2010. The event was hosted by the World Health Organization (WHO) and its partners in order to scale up better health systems research. Read more

Rodin pointed out that the challenges of polio and yellow fever, which were faced in the last century have now been replaced by bigger challenges of HIV/AIDS, TB, Malaria, Diabetes and other devastating diseases.

Apart from this, many communities in developing countries are plagued by weak health systems which are insufficient to deliver life saving interventions to the poor and the ailing.

There is an urgent need to increase public awareness, to put more pressure on their own governments to spend for their social safety and health protection, said Rodin.
In addition, citizens need to be empowered in order to demand simple access to appropriate health care services for all at an affordable cost.

As we are moving into the final stretch of Millennium Development Goals the Rockefeller Foundation aims to make 'transformation of health systems' as its revolutionary goal. This would require sharing of experiences between partnerships of countries, finding sustainable solutions, improving human resources, and scaling up specific health services, alongside supporting the governments with technological training and tools, to become better stewards for improving the financing and quality and finances of their services.

“Universal Health Coverage would mean better health outcomes, greater equity and lower poverty, and we can make this happen. Achieving universal health coverage is not so much about mobilizing more capital (although it is necessary ), but it is more about reorganizing health financing at country level. The key is shifting 50 to 80 percent of the total health spending to appropriate public and private risks pools, so that the resources can have a better impact on health interventions for the most vulnerable populations,” said Rodin.

As an example, Ghana spent approximately 150 million dollars in institutional reforms over the last 6 years. By a paradigm shift from the out of pocket model to the risk pools model, it has been able increase the population coverage from 5% of the population covered to approximately 75% coverage.

In India, in the state of Uttar Pradesh, they have invested more than 60 million dollars in 3 years on infrastructure and thus were able to scale up population coverage from 10% to 85% , including hospitalization and surgery.

“We believe that these successes will lead to other successes, only if international communities would learn from these achievements and replicate this model in the other parts of the world,” she added.

Broadly speaking, it has to be a three pronged action plan:-
Firstly we need more negotiations, more dependable data to guide theefforts of the countries. They need more research on mechanism that links universal health coverage with poverty and deprivation, with improved health outcomes. There is also need for more collaboration between researchers and policy makers so that proven solutions are put to work right away

Secondly we need to provide national governments with the technical and financial support that they need to transform their health systems.

Thirdly we need to make the case that health sector reforms for universal health coverage are sound financial investments and should be a priority for all national governments.

According to Rodin, the Rockefeller Foundation, has been proud to support the great idea behind this conference in Montreux, the magnificent steps where the ideas, discussions, and relationships will be shared and will become the foundation for a movement to bring health care broadly, towards the common goal of universal health coverage.

They have also adopted several strategies for acting on this imperative; such as dedicated resources to support research on universal health coverage and establishing new centres for research and training on universal health coverage in Bangladesh and Vietnam and others.

The Rockefeller foundation has also supports nations to bring up national health reforms by convening cross border partnerships, by holding workshops for health, encouraging new developing countries to share the lessons that they have learnt in managing universal health coverage and set up a task force in universal health coverage, whose secretariat is based in Washington D.C. and Bangladesh.

At the end of the speech, Rodin mentioned the song of Freddie Mercury, the lead singer of Queen, that he wrote in Montreux.

"It is about the place that is most quiet and magnificent -- a place filled with great possibilities. In his words, it's a kind of magic in the air, with the dreams of the world in the palm of your hand. During your work in this conference, remember that you hold the world's dreams in the palm of your hand. We know where to start, we know how to start. So let's begin here."

And now let me pass these dreams of the world into the palm of your hand.

Jittima Jantanamalaka - CNS
(The author is the Managing Director of Jay Inspire Co. Ltd (JICL), produces radio programmes in northern Thailand and writes for Citizen News Service (CNS). She is also the Director of CNS Diabetes Media Initiative (CNS-DMI) in Thailand. Website: www.jay-inspire.com, Email: jittima@citizen-news.org)


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