Thailand's health ambitions pay off.

Abstract

Q: Thailand has a long tradition of investing in health, why? A: Over the last decades, we have built and maintained leadership among health professionals with a strong sense of commitment. At medical and health schools in our country, we learn the teachings of Prince Mahidol. His Royal Highness, the father of our King, is considered the father of modern medicine and health in He taught us to interests first and self-interest second. He said: don't want you to be only a doctor, I also want you to be a man. Health professionals learn his teachings by heart. Every seven years we have a national medical education conference and in 1982 it adopted a resolution that medical gradates should be four things: skilled clinicians so that they can more or less alone in rural hospitals; good teachers as they must train community health workers and volunteers; good managers as they must manage district hospitals; and good supporters of primary health care. Q: Thailand is one of the first developing countries to make major progress towards universal health coverage. Why did it pursue this goal in the midst of economic crises? A: The drive towards universal health coverage came hand-in-hand with democracy. After the student revolt against the military government in 1973 and our first democratic elections in 1975, the new government made health services available free of charge to the poor. We then started to improve health insurance coverage for people with low-incomes, the formally employed, children and the elderly. It took us from 1975 to the year 2000, to move from zero to 71% of the population covered by health insurance. Then, in the 2000 election, one of the parties promised to move from 71% to 100%--full coverage--if elected. Within a year of their victory, we closed the 29% gap and on 1 January 2002 the whole population was covered. This was largely thanks to the late Dr Sanguan Nitayaramphong, the first secretary-general of Thailand's National Health Security Office, who worked tirelessly to persuade politicians and the to embrace universal health coverage. He is considered the Father of universal health coverage in Thailand. Q: How did Thailand achieve 71 % coverage in spite of the financial crises of the 1980s and 1990s? A: When the government started to provide free health care to the poor in 1975, we soon found that service access was poor because there weren't enough rural health facilities. In the spirit of the times--of primary health care and health for all--our government started to construct more district hospitals in rural areas. In 1981, annual GDP was about US$ 390 per capita, we were a low-income country facing economic downturn. We had to negotiate an International Monetary Fund loan and had a zero growth budget for five years. Despite this, our government took the courageous decision to continue expanding the rural health infrastructure. Q: How? A: The government froze all new capital investment in urban hospitals from 1982 to 1986 and invested these funds in building rural district hospitals and health centres as well as mass training and employment of doctors and community health workers. Before this, the health ministry budget for these districts was lower than in urban provinces. After 1982, it was higher, and this trend continues today. We established a compulsory public work placement of three years for medical graduates and four years for nursing graduates. We strengthened primary health care by recruiting and training volunteers in villages across the country. Today, we have about one million volunteers. So our government put us on the path to universal health coverage by investing in the rural health infrastructure. Q: Why was health policy a vote winner in the 2000 general election? A: People wanted to have access to essential health services of good quality without facing financial ruin. …