สำนักงานหลักประกันสุขภาพแห่งชาติ (สปสช.)
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News And Events

Strong social movements in Thai health.

BANGKOK, 31 Jan 2019 — Social movements have a long history of shaping up a strong health system and driving the successful establishment of Universal Healthcare Coverage (UHC) in Thailand. But in recent years, health activists and civil society groups have been facing an encumbrance from the political uncertainty that undermines their power and access to ‘health for all.’

“Social movements have been challenged by political uncertainty in the past few years. [Military-led] government looks at civil society groups as an opposition party,” said Apiwat Kwangkaew, president of Thai Network of People Living with HIV/AIDS.

“Some political players blame patients, many of whom join the social movements to call for health equity, for being the cause of their own illness. This attitude makes the state feels reluctant to fund the UHC. It pushes the whole health system into vulnerability.”

His comment came during a Wednesday panel Health Initiative on Prevention and Promotion by Patient Network and Local Government at the sideline of Prince Mahidol Award Conference 2019.

He referred to the uncertain circumstance of the tax-fund UHC in the post-2014 coup, which Prime Minister Gen Prayuth Chan-o-cha slashed the scheme for causing a financial burden to the nation. His government proposed the idea to force copayment on the scheme’s beneficiaries.

The UHC, launched in 2002, has covered medical fees for over 48 million Thais disregarding of their financial status. The scheme has reduced health catastrophic expenditures by 60% in the past decade. The success of the UHC is mainly driven by social movements that can be traced back to the 1973 popular uprising.

Dr Vichai Chokevivat, a chairman of Heart to Heart Foundation also a prominent former leader of many health movements, said that the rural doctor movement emerged during the uprising that ended the long-standing military dictatorship Thanom Kittikachorn. They became core leaders in public health development.

Civil society groups including Thai Volunteer Service Foundation and Aid Access Foundation were formed up after the restoration of democracy in the 1980s. They were part of the movements calling for UHC establishment in the late 1990s.

In 2002, the National Health Security Act became ineffective, supported by over 60,000 citizen signatures collected by health activists and civil society groups. The law recognizes health access as basic human rights. It legalizes the National Health Security Office, of which board members engage civil society and patient representatives in the UHC's operation.

The UHC’s Lover Group was formed up by the scheme beneficiaries in the 2000s. They act as a watchdog group, investigating the government for protecting the UHC from excessive political power.

“The UHC will survive only when people take actions,” said Boonyuen Siritham, a core leader of the UHC’s Lover Group.

“We don't just demand the government to sustain the UHC. We also try to improve the health conditions of people in our networks so they'll be healthy and reduce the burden for the government.”

Engaging social movements in the health system is not unique to Thailand. Across the world, social movements have sustained health access for the population.

In Vietnam, a non-profit organization Global Focus on Cancer has trained local patients to adopt peer-to-peer support model. In Japan, a mother Kyoko Ama leads a citizen group to promote patient participation in healthcare consultation.

Göran Tomson, a senior professor at the International Health Systems Research and a senior advisor to the Health Systems and Policy research group, said that UHC was a forerunner of the United Nations’ Sustainable Development Goals to be achieved by 2030.

“To achieve the UHC, it needs to strengthen health system,” he said.

An open society and public participation are the keys to achievement, he said, along with transparency and health information access.

................... 31 January 2019