Thai_Health_2017

9 Universal Health Coverage The chances of going bankrupt and falling into poverty of Thais from health care expenditure have continually reduced. However, Tthe sustainability of national health security system remains a challenge. hat all Thais are protected from the high health care costs, able to access quality basic health services that are safe and efficient including essential medicines and vaccines is the basis of achieving universal health coverage in Thailand. Thailand began its universal health coverage policy in 2001-2002. Currently, this basic right of accessing universal health care covers all people through three health care schemes. These are the Universal Health Coverage Scheme or the Gold Card Scheme (73.7 percent), the Social Percent of households that fall into poverty and go bankrupt Security Scheme (17.2 percent) and the from the health care expenditure (1988-2013) Civil Servant Medical Benefit Scheme (7.4 7.9 wheTCnhoevtihmeyerepaaUgleernm2iPv0eoe0nlr1istc-aey2ld0wH0ae2sa, lth percent). For the past 15 years, Thai people 6.8 have been better protected from the risk of high health care cost reflected by 6.0 5.7 reduced percent of households that have gone bankrupt and fell into poverty as 4.1 % caused by the burden of health care costs of from 5.7 percent and 2.0 percent in the 2.4 2.3 2.2 2.0 3.1 year 2000 down to 2.3 percent and 0.5 2.6 2.3 percent, respectively, in the year 2013. Several studies report that access to basic 1.1 0.8 0.5 0.5 health care has seen an improvement, 1988 1992 1996 2000 2004 2008 2012 2013 Year especially in groups that are vulnerable and Bankrupt from health care expenditure Into poverty from health care expenditure living close to the poverty level such as labor in the informal sector, the elderly and Source: Analysis results in the Health Financing Recommendations for Sustainability of the National Health Security System (goals, indicators and targets) people with disabilities. Nevertheless, the use of these rights Per capita health care expenditure (age-adjusted) by the people and the costs that are of the 3 main health schemes (2015) incurred have increased continuously (in one sense is seen as good that people have Social SScehceumritey 3,145 improved access to services and, partly, may be due to illness from non-communi- BenCeifivtilSMSceehrdevimacnaetl 12,000 cable diseases that have increased including the aging of the population of the country CoUvneivraegrseaSl cHheeamlthe 2,895 where the number of the elderly have increased along with a high rate of illness). Baht Thus, the sustainability of the universal Source: Policy Brief: Health Systems in Transition. The Public Health System of Thailand Success and Challenges, International Health Policy Program (IHPP). 98 Thai Health 2017

health coverage system with the question of Rate of utilization for out-patient 55.7 whether there is a sufficient health financing and in-patient care have become a large challenge. The same can be said in harmonizing the inequities of the % of Population 29.5 3 health schemes in both the area of co- payment and the coverage of benefit package 18.1 11.5 14.8 16.9 17.5 that are still unequal in many aspects. 14.3 3.1 3.5 7.0 4.7 The Health Financing Recommendations 0-14 Years 4.1 5.6 4.2 for Sustainability of the National Health Security System have stipulated the identification of 15-24 Years 25-59 Years 60 Years up Total 4 clear objectives of SAFE or S-sustainability, A-Adequacy, F-fairness and E-efficiency, Outpatient (Ill/felt not well, did not admit to the hospital in the last 1 month) including the 11 indicators as a monitoring Outpatient (Chronic illness, did not admit to the hospital in the last 1 month) framework in the health financing management Inpatient (Admitted to the hospital in the last 12 months) that will enhance sustainability of the health security system for Thai people in the long run. Source: National Statistical Office 11 Indicators and Goals of the Recommendation on Financing for Sustainability (Sustainability, Adequacy, Fairness, Efficiency: SAFE) Goal 1 21.. GGTooetnvaeelrrnHalmeGaelontvhteEErnxxppmeeennnddtiittHuuerreeal((tGThHGEEEx))pnenodt imtuorere(GthGaHnE)5n%otofmtohreeGtDhaPn 20% of General Sustainability 3. Total Health Expenditure (THE) not less than current level (4.6 percent of GDP, ipGPnreeiv2rnca0eet1rena3tl)HoGefoaGvlteehrnnEemxrpaelenGntdoHivteeuarrnletmh(PeErnixHptEeE)nxnpdoeittnumdreitou(rGereGtH(hGEaG)nEn2)o,0ti%nle2os0sf1tT3hH)aEn, Goal 2 4. current level (17 Situation as of year 2013 Adequacy 5. where house- - THE at 4.6% of GDP hold health expenditure not more than current level (11.3 percent of THE, in - GGHE at 17% of GGE 2013) - PriHE at 11.3% of THE 6. ntIInnhoccatiinddmeecnnouccrrereeetnoohtffahhlneoovcuueusslreer(hhe0oon.4tll7ddl%ssevibnoealfnp(ako2lrv.lu3ehprpottyeufrrsfocreeomhnmotcldaohtsfea,aasillnttlrho2hp0och1auir3sce)ehheeoxapldletshn,dicniatur2er0e1en3x)poet nmdoitruere - Icbcenaaqactrnuieadkaserelturnxtopocpptee2hfnor.i3codf%mihthueorauelstehholds 7. - Icitnnoacrp0iedo.4eev7nxe%cprteeynofdrfoithmuoruehseeeaqhluothaldl s Goal 3 8. itInmiocpnrerotaovsien7gftaicmireneilesinssogfiontfhcmeonomtnrintibhimulytuiopmnaywsmyasegtneetmcaolfcuthlaetiSooncioafl tSheecubreitnyeSficchiaermiese’ (cSoSnSt),ribbuy- Fairness 9. Achieve fairness in pre-payment and co-payment system 9.1 Consider 2 options for pre-payment: Everyone must pay or no one must pay 19100.2..t1hAReAacihgaseieve-evamredaojgufraeseitrenfudenspsdesinrfrccoaampreitcapore-opxvpaidyemenrdeipntuatyraemtoepfnoatinlsltypsoutfebsmleicrvsicche.emes are +/- 10% of 10.2 Standard rate of payment for all public schemes Goal 4 11.ecoIfnfilcclerieecnatitsveereepimfufirbcciuehrnascseiymng–epnuotsiwannegdrcalponrsidceedap-mepnordonpibtrouiarditneggegtaonsvydesrtcneommnetrfnootlrliiannltglepsrvyuesbtnelticmios,ncushseinmges, Efficiency Source: Summarized from Health Financing Recommendations for Sustainability of the National Health Security System (goals, indicators and targets) 11 Indicators on Thai Health and the Sustainable Development Goals 99

10 Health Workforce The distribution of health personnel in Thailand show an improving trend. The differences in the proportion of doctors per population between Bangkok and the Northeast have reduced from approximately T8 times in 2004 down to approximately 4 times in 2015. he current production of health personnel show that Thailand should have adequate doctors for its future needs. However, there is still need for better distribution of doctors for a more equitable access to services for all Thai people. Health personnel are the heart of any health system as they are the key in providing health services, such as diagnosis, treatment, consultation and advice. Thus, the goal of good health cannot be achieved if there is no development in both the quantity and quality of health personnel. Efforts must be made to ensure the adequacy, dispersion and coverage such that all people have Proportion of health personnel in public and private sectors equal access and receive a good standard % of total health personal 100 93.6 85.8 88.1 of service. 90 14.2 11.9 80 80.7 23.2 11.2 4.7 The distribution of health personnel in 70 6.4 Thailand has improved. Data on the numbers 60 53.9 of health personnel at various levels of 50 service outlets show that community 40 hospitals have more health personnel than 30 provincial hospitals and regional hospitals. 20 19.3 This shows that Thailand has distributed its 10 health workforce to all regions, and places 0 Dentists Pharmacists Professional nurses importance more at the community level. doctors Nevertheless, the number of doctors Public sector Private sector (full time) Privatesector(parttime) per population is only one aspect that SNoouterc:eNa:nuRdmepPbroeorrfteoosfnsdiooPnucatblolrnicsuH=rsee3as1lt,=9h51R94e,9sD,o1eu8nr3tciset,sBu=re6a,9u5o3f, PPhoalircmieascaisntds =St1ra2t,e2g3y1. reflects equity in the access to medical services. Though Bangkok has the highest proportion of doctors per population, more Number of health personnel at various facilities than half are in the private sector full time under the Ministry of Public Health which limits access for some group of the Doctors Regional General Community District Health population. The need for health personnel Dentists Hospital Hospital Hospital Promotion in Thailand in the future is a challenging Pharmacists hospitals task particularly when Thailand enters into Professional nurses 4,543 3,915 7,539 an aging society and non-communicable Technical nurses 525 939 3,109 10,114 diseases become more common. The 3,778 production of personnel must change and 1,272 1,788 37,342 adapt to suit the changing needs of the Total 19,856 24,300 419 645 737 26,841 31,679 52,187 10,114 future. The sub-committee on planning for Source: Report on Public Health Resource,Bureau of Policies and Strategy. 100 Thai Health 2017

10 Provinces with the best Proportion of population per 1 doctor proportion of medical doctors per population 2015 (number Ch2ia,4n7g7Rai of population per one doctor) 2004 2015Ch6ia,1n0g4Rai Mae 5H,P6oh0n3Ra4gC,4na9Ph,Sn1g93hio2n,8oa5u7,ngKnnL730kSaaag7g9Ke0u4C5mn,2trTr2M,,hac94a8a58pUbKhu2a,t95Tk,456Rht1aii5am7,rT,K6hLaSP2uP59mnaS5ah1hut9a1epr32n7nua3,cma5pia,i54pth,6484rbg,kh8cc,5n9T5hihS1,o75,hpuah9h37,2i5hKTaaCa183,noNab3rN8au441ethahn75ihPnt5b8uau73aaPnn7ah2aa6h,gk2rpkunB50hPUnigmP2aii,hah,5ru74Pha,hi61tN64ti3o87o6Sm9rthytr,51i,,ai4,an6toa2nh346a8i9501satc29r8e,n4ao02a82a,SrLhSC674l5g4P6and7iouaN51ih3k3,4Stht14u1iwpnahot8a4Ce,20lN18gnalnro9Nh,tB6a1aa54nc1bk8aau,bk83h21u1581762349cyrRh3u58ai3h7or3PaoC...0......r7,3ib,L,ok2iya3n0h,ue.92ePSSNPABSANot47Raina1406nrnC94aBiaaaSaaany0n,3yNaoggh6tuc,ia5smmmictnau8W8Nakhgrnnap,Lhk2hi471noi1ohagKhthna,68tgt7uuu0nhmTuhStsuohk2Nho1,Ugiaoh8m7nmattt3po8hmooB3d1a,nTbnB86K2hna,a1olrBPkSSu5ouu,968abugKa8en1uya7r,1eao8d6rPa2nSriTK6ruo,a8ea4Taii5khnaKgMh9n6rhRr0kaah,taiag4ia9ikaanhmnh9ohkKn1in7aagoh1an10NRmS1iSl0d0,omaau2r0a,,k21si3ra,okpP9iih12E9nno6mY3otm6ren7aonS8rs136433i,op22SM1t3,,,,,P9N,aoh8910021uh0,ao810K61131d3kraRk,n0,dte1na7Ch501010oiAt9at8ohoo2332242449Uc7---h15m2mca,nh36o4o,0b,,,,,,,,,na0rt8251186736na0ono,,,2rrota1892en41974062914hotnlmr531a4995544712efn409siopsroe(pth(utMehlaaeebt3Hieow,P2ohs7nn3oRat8gC,2na7)Prh,Sn1g27hsio1n,4oa4u2t,ngKnnL630)kSaaag3g9Ke5u2C2mn,8rtTr3M,,ahc72a7a30pUbKhu5,at52Tk,201Rht1aii4am5,rT,K5hLaSP9uP15mnaS3ah2hut4a6epr352nnua1,cma2pai,i73pth7,343rbg,kh1cc,2n9T3hihS8,o43,hpuah0h06,6i6hKTaaCa877,noNab1rN8au727ethahn36ihPnt3b2uau35aaPnn7ha4aa3h,gk9rpkunB35UhnigmPaiPi,ha2h3,ru64Pahi30tNh26ti,2o2o2Sm8rt8hyt,31i,r,aia,n3to4nh1443a7ai9501satcr22,n8a94o6ea8a4,SrLhSC456l25gP0and0iouaN15ih20k3,Stht16ui7wpnah,to3aCe6,4l3N1gnalnro4Nh6,tB1aa34nac,bk80aua5bk59hRu19746318512cyr8h7uP2aia3h34or27Coa....0.....r,iby,,L,ok4i804tnhoue.1ePaNBSAPNSAS310Ranin21nnr0C714aBiaaaSaaagyn,yNaoigh4,tucง4a2smmmcitnau0NakhgrnWna2p,Lhk1hi28noio5hagKhthna,41tgt6uuunmTuhsStuo,hhk4Nho59Ugiaohm1nm1atttp59hmooB2od,anTb,Bn3K38h2na,aorBuSkSP6ouu,32alb6ugKa1n1uyar,e3e53aod6rPa0nriSTK0ruo,a8ea6Tiia7khnaghn1M3KrhRr5kaah,taiag63aiakiamhnnh0ohkKnin7aa4ohagnNR34mS,BiSl24doma,ua,rua714,k5sir5akn835oiih,E4nno95g9mYot3n0maKnS46sai,o55MnSt,P025aNhu1h753oa,kKRa6,,0knd14enaCh36aAt3toho42321112123Uch32mma,5nh,a7b,,,,,,,,,9rn2076635447an5oo6ta3en00112375532htna5563108817ni Bangkok 716 Nakhon Nayok 813 Chonburi 1,135 Phuket 1,205 Khon Kaen 1,265 Samut Sakhon 1,350 Chiangmai 1,398 Phitsanulok 1,406 Pathum thani 1,438 Songklha 1,503 10 provinces with the worst proportion of medical doctors per population (number of population per one doctor) Bungkan 5,906 Sri Sakate 5,576 Nakhon Panom 5,133 Nongbualumpoo 4,993 Amnart Charoen 4,753 Petchabun 4,587 Sakhon Nakhon 4,543 Yasothorn 4,501 3Y,4al7a9 Nar8a,2th4i7wat 2Y,7al5a1 Nar4a,0th1i2wat Sa Kaew 4,497 Source: Report on Public Health Resource,Bureau of Policies and Strategy, Ministry of Public Health 2004 and 2015. Kamphanphet 4,447 Source: Report on Public Health Resource, Estimation on the demand and Supply of human resources Bureau of Policies and Strategy, for health in the year 2026 manpower in health in the next Estimated demand in 2026 Estimated supply decade, under the national in 2026 committee for manpower in health Method 1 Method 2 Method 3 have estimated the demand for 62,779 health personnel in the year 2026. 1. Doctors 30,610-37,620 34,913-41,437 180,9921-193,0482 According to the estimates, it is 2. Nurses 194,205-237,870 215,565 recommended to maintain the 3. Dentists 16,457-20,546 17,415 (18,675) rate of doctor and dentist produc- 4. Pharmacists 14,020-17,135 19,677- 20,955 16,557 39,9133 tion but increase the number of 47,786-64,700 - professional nurses and pharma- cists. In addition, an increased Source: sub-committee on manpower planning on health in the next decade under the National Committee on enrollment of students from rural yMeaanrspo(2w0e1r7o-2n02H6e)a. lth, 2016. Policy recommendation on planning for manpower in health in the next ten areas is suggested so that they NMDooecttetho:ords return to their place of origin after Method 1 HapCteolutaphsluttehelarpdtrtieiohmmnaatatrwhnyadactsabirsdyeeaulsgesiegvinneagaldtSujeuesdsrintvwegicdhet.ehUreetninliuzumamtbiboeenrr aoonffdddoeocsctttoiomrrssaotaifot n6th,5ine0t0porpitmheerasrofyuntlseuavreecclboiysrdeuiqnsiugnagtlotthtoeh1ec:h1P0ari,nm0g0ae0ryinCare graduation. In this way the rural 2 population will have an adequate number of personnel for their MNMueerttshheoosdd 12 HU21..esiUUanlssgtiihnnhggedattehhlmteehassndccdeeemnnaaarrniioodttahhnaadtt nnseuurrrvsseeicssehhtaaavvrgeeeaatnnfoaarvveeelrrdaaeggeerlywwpooarrkktiiiennnggtyyseebaaerrdooffrid22d52eyyneeaaarrtsshome and community DMMeeentthhtioostdds 12 UMpsoixinpegudlhametiaeoltnthhoraddteiumsianngdhealth demand with determining a service target Method 3 Using the modified needs. This will create more equity in the access to quality health and medical services in the coming future. 11 Indicators on Thai Health and the Sustainable Development Goals 101

11 Overall Health-related SDG Thailand still follows behind other countries in achieving the overall health-related SDGs, where its ranking is 112 from a total of 188 Icountries. n addition to the indicators on sustain- Scores and Ranking of Health-related SDG Index of countries ability under the SDG: Goal 3 that relate in ASEAN (of the total 188 countries around the world). to health there are also many other targets where Thailand is in a situation of unpre- 100 Singapore Br(2u1n)ei paredness and cannot yet achieve its goals (2) such as the impact and loss due to natural Laos disasters, sanitation and water resource (136) 80 85 consumption safety and personal violence. 78 The Global Burden of Disease (GBD) My(1a3n5m) ar 60 69 Ma(l4a6y)sia Collaborators have developed a Health- 45 related SGD Index to measure the status and progress of the 188 countries related to 40 health in various aspects of 33 indicators. Most of these are under SDG3 and others 46 20 are in other SDG goals. The results show that Thailand’s index was at 56 points (from 0 a total of 100) ranked 112 - according to the highest down to the lowest - which is in the Cam(13b0o)dia 47 60 latter half of the world ranking behind other 50 countries in ASEAN such as Singapore, Brunei, Ind(o9n1e) sia Malaysia, Indonesia and Vietnam. 59 56 Phi(l1ip2p7i)nes Th(1ai1la2n) d Vie(9tn4a) m Source: GSGBtouDadl2sy0i2n1051185S8D. LGcaoCnuconeltltarib2e0so:1raa6t;obprasus.beMlliinseheaesadunrioanlngylsitnihseefrShoeempatltt2hh1e-.rethhltaettpeG:d/l/odSbuxa.s-ltaBiunradbelne DofevDeisleoapsmeent doi.org/10.1016/S0140-6736(16)31467-2 Percent of source of drinking water in Thai households, 2014 9.4 8.4 Percent of drinking water 97.1 14.7 30.8 source that did not pass acceptable standard 2559 15.9 20.8 72.8 Bottled water Piped water 58.0 59.4 Rain water 49.2 Coin operated machine 39.7 Shallow well Artesian well Bottled water Piped water Rain waCteorin opmearactheinde Shallow well Artesian well Source: Situation Report on Quality of Water for Consumption in Thailand Year 2008-2016, Bureau of Food and Water Sanitation, Department of Health 102 Thai Health 2017

Number of domestic violence, year 2010-2016 Accumulated number of deaths and affected 1,200 1,075 from disasters in ASEAN countries from 2006-2015 1,000 949 901 881 Cambodia Accduemauthlasted Acacuffmecutleadted Indonesia 947 3,977,465 800 711 Lao PDR 14,826 10,587,329 600 730 817 689 707 543 Malaysia 1,423,020 533 Myanmar 179 2,856,160 Philippines 600 12,335,552 400 547 Thailand 139,608 107,230,842 429 428 Vietnam 20,078 62,800,658* 2,235 18,708,726 200 258 2,825 2011 219 212 174 114 164 105 ป Note: D(siusacshtearsuenadrtehrqtuhaiskedse,fivnoitlicoanniccoenrsuispttsioonf,tdwrooucgahtet gaonrdiehs.eNaat twuaravled, iflsaosotdeirnsg, 0 2010 2012 2013 2014 2015 2016 storms, snow storms ) and technological disasters (such as chemical The affected in the predicament where they could officially report incident Sourced:isWtaoosmtrelodrsrrDofriwsoamsteinrsduRsetpryor(tle2a0k1in6gR, eesxiplileondcien:g)S,atvrainngspliovertsatnoddacyo,minmveusntiincagtfioonr ). The affected in the predicament where they could not officially report incident Total number of incidents Source: DDaotma ecsotlicleVctioeldenfrcoem, MthineisOtrpyeorfatSioonciaCleDnetevrelfoopr mPreenvtenantiodnHoufman Security Number of women and children exposed to violence The indicators outside from the data of the One-Stop Crisis Service (OSCC) of SDG3, where Thailand has Dctauhtmoraitnteaghltatonhduremevcyiboeeeliaevrrnesots2fae0wcr0vto4simc-2aeeg0ona1fi5na,2snt0tdh6te,hc2rhe4emi4lwdcertaehrsenaetas Most recently in 2016 a low figure, is in the issue of oorr 63T23h2ce,ac8as5teso0estscapalpeswererahss,doauyr “disaster”. Referring to the World Disaster Report 2016, even though the accumulated deaths of Thais from disasters tCh(hemilftodaosmrtselieylnyxf,uroolaafmlc1mk0nooe8lfge,cl9seat3carett3iowlecnitaa)hdsiniensg is not dangerously high when compared to other countries but the number of affected in the past 10 years, is as high as 62.8 million persons, some of qWuaorrreme(lmlaientoingostnaolsynfhdf9irpop7smh,,2yjesf9aaicl1moaluiclasyaybs,uesse) this due to the numbers of Source: https://www.hfocus.org/content/2016/11/13049 people affected by flooding during the 2011. Next issue is “source of water”, especially for consumption purposes which found that Thai household’s consume a large amount of bottled water ranked 1 followed by piped water, rain water and water from coin operated dispensers. According to the nationwide survey by the Department of Health, the results show that many of sources of water in the country have a quality that do not pass standards; for example, bottled water and piped water where almost 60 percent did not pass the drinking water standards. Another health-related indicator that is a major challenging task is “interpersonal violence”. In 2016, there were 533 cases of domestic violence in the country. Data from the One-Stop Crisis Center (OSCC) report that every hour there are three children and women that have acts of violence done against them. These numbers are worrying because they may not include many other incidents of violence and those affected that are not reported. 11 Indicators on Thai Health and the Sustainable Development Goals 103

Citation: Thai Health Project.2017. Title of article. In Thai Health 2017. (page number). Nakorn Pathom: Institute for Population and Social Research, Mahidol University. Example: Thai Health Project.2017. Thai Referendum Approves the New Constitution, Paving the Way for the General Election. In Thai Health 2017. (page 106-109). Nakorn Pathom: Institute for Population and Social Research, Mahidol University.

10 Outstanding Situations

1 Thai Referendum Approves the New Constitution, Paving the Way for the General Election What has to be documented as an historical event for Thailand is the national referendum on the draft constitution on 7 August 2016. In this event, the people voted in support of the draft constitution, the highest law of the land. They also voted in favor of the supplementary question that enables the senate to vote along with members of parliament, the choosing of the Prime Minister during the first five years after the constitution comes into use. Following the referendum, the government will move forward by enacting various laws related to the general election. It is estimated that the next general election will be held in late 2018 after King Bhumibhol’s royal funeral. cfoornPsetiAatuscetaioamnndautOntedrrdeeorrft(hfNaeCctPd,Oitrh)eehcatNidoandtirooanfftaePldrCoiotfesusfnisrcositrl pwCeharassiordonesfstidghneisasiCtgeondmataminsgit6tMeeme.eoTcnhhteahidsRrfaurfocthimnugpNtuiomnveeafmsratbmheeer CB20oo1wm5ombrnuittstuethkee.UNTwahatiisnoonfia,rlsatRsedtfhoraermftCChwoaaiusrnoccfioltmdhideplnDeotreat fdptainisngs t2aaiton0r1wnet5ofhielutleronetcnKAhedipendurngimla2bfs.o0eFtr1hr6poeh.rmiAeshfsitgtreehohnreeytcnaseotldtmlhsaietpwgolndeoatrtaitfhoufetntrhewoepfiealctlonohbpdueelnedttshrreayfenof.nttr, tdhraisf,tilnegadpirnogcetoss.anTohteheNrCrPoOuntdheonf acpopnositnittuetdiona new Constitutional Drafting Committee of 21 106 Thai Health 2017

This Meechai draft constitution consists of awmlhsuoestraebneianhdedtlhidteiofsoneraslcesactsitpeiousnlasatiinonntahtfieoorgneaannl earremafleecrnaedtnemdgouernmyt, 2ttrh7ae9nspistuieobcnlitaciolinnpcsroluvadinseido“nt1sh.6eIssccuahetoesogsooifnrgiimeospfoitnrhtcealnuPcdreimintoeg toohnfeitnhndeaetmpioeonnnadalercrnhetyfeo, arregnandndoiuznamttihooennps.o7SwuAecurhgautnhsdatato,ubfthe2of0or1irt5ey bsoMoofefimncPtiohasemtreeloiaerfN”mPwCtrehPhimnaOottme(oaMMpnaPierdne)n.issasTtenehtlhoreeetorchertweewwradhyilfbolrfoyobimsrethna2enot5htco0eaouisrmMtesnoimedafmefititocrbteirteasoerl, timhepraectwiaf sthae mdraajoftr cdoenbstaitteutioonn tdhide npootsspibalses fMpooirnsciitseitosryn, soAsfrumIcnhytearCisoorpm, ecmromamanmndeaennrtdsienercorCefhtaiaerlylf,aoNrfmatehvdey ctchooennscnteaitrtuinoteinodanl trmhefaaeytreatnhfdfeeucmtfa. tiMlhuearnelyegtpoiteimoppaalcesyswatenhrdee CTChoheimerfemawannidldl eCbroeimnamCtohatineadfl,enAruirimnFboCerhcriee5f0C0oofmMtmehmeanbPdeoerlsircoeinf. spgtroaopbuuiplliastyr mdoisafcyothnteatekneNtCtaPhgOaisi,nosatnptdphoevratguorinoveiutrysnmptooenlirtta.icisael ooPafnreMliaePmlseecptneiotrn(eMblePaclstl)oiotcnhaondsdisetcnraiclbtcyufolaprtritonhpgeothrnteuiomnnubmuesrbinoegrf Public health rights of the people iMnPtesrienstthteopathrtey lpisut.bAlincotishetrhiempmoertcahnatnisissmue toof under the Meechai constitution ptdorreabfvteecncoot nmcsoetrirtuuapntitoiMonn,Pp,beyserpsnooanltitsoicrwiaoinlrlsn.mIoninttibhstieserMalielfoetwchheeadyi oconnrsitgiIhtsustsutieoasnnrdeolfiant2de0ed1pt5eonapdrueebnflcoiceuhnoedfatlithnheicnpaettehogepoldreyraof3tf ahacnatvdioendbseidsehunorinsnegenestlteeync,ctieoodnr sb.cyIontmhademdciiottitouinnrt,gfitodrisicssohtirporuunpleattsioetdny tToharileacSneedicvtseieocnptiuo4bn7l:i4c7“-Ihn4e8da.ivltidhuaselsrvhicaevse ftrhoemritghhet tinnhaat7itotnmhaealjanofarfatiaiorrsnebaalysrteohffeo: rgpmoovlseithriconsmu,ldemnbat,enjauugsnetdimceeer,tnlaatkweosnf, gatItnhhondeevdievgrporiidgnrvhuometatreenltsnocmtthi.reoaeInnnvctdeewfiirvvtoiihtedhmeuoparuduilgtsabhcnwltoigchstetoohraoeraceuarceclsotehircnidvosipenmeogrpmvvtroieecurevtnthesyiecnhfartlaobaiovwmlnee. atteoonddausmectahcNettenieioopdvnner.,oTr2ttvhhh5iese3eilopeeonrscofsso,ctwtehnhisiotissshmoidMnyfreaiataefmtmnc,hdeasantkoiidepdtmuhritaleefamrtntsceot.,osraentcshdctiaoitfutfridcttiiuohnlnegt dbiesfeoarseSeeascnbtdioynatfh4tee8r:s“btaTirthtehewirsiigtphhrtoosutoetfccttohesedt.m”anodthseurpbpootrht asaumnpdepnuodnrmtdfeeronr mttrheenqouciloreenssdsaittmihoananjot1rhi0taytpfretohrmceerneptamrolifaumestveebnrtey, oainsvceotrhme6e0latowyemasrtasipinuatlnaaidtnesdt.hoeIninrdoilvitvidehusaaavlsnedwaiintshduifvafinidcuiaeagnlest pTcoohnliistsitciitasul tpdioaifnrfteytrhaeanntdto1nfrilnoy m3reaqptuhpireroevd1a9al 9fmr7oamajonsreditnya2vt0oo0rtse7. rtwehhceeoliavawereasptlippivruoinlpagrtieaisnt.e”paossvisetratnycheafrvoemththeersitgahtte taos wcfrooinnmsstsituthupetpioponart,rlafiranommamepneotn.wdTemhrufeusnl itgnriostuhppiosssMisniebpeleacrholiaanimlyderiafnftitt. ctt5hoa5attrethegiascoItneer“iyfvtfaieh5cdeietduhsnnittataiinottaetntnehmdretrouuhdpsautttshetimgyidsop,ooplfidetutmbhcisoeleicvnasettlhrafsaoeotgeraetlwith,nhperiSrtspoteeeemcronvtopiioctlinneee pBuotwiefr,athgreoruepwoilrl bgreounposchhaavnecelitwtlheatbsaoregvaeinrinogf saounnpdtphdoeertvhetelhoaeplthdpeeaovnepdlloepprtemoveehnnattvieoonfbaoksnficodwkisnleeoadwsgeleeadongdne an amendment. Even more than that, there is traditional Thai medicine for the highest benefit.” 10 Outstanding Situations 107

ftataCvncfaihtStaifbscrtStuartftpstcnmreooehhuhhhhhohceoooinnseocoosehoretlhreheraeeearreekmmcnnddeccpeltsommwavttttoarenstpaicsrapRhovkhiealoocipibacpcsmwtuopoteteisleuuelveehttptimAOhlobaehirwudstrwnrahrolhwrbeeearSpnunesleinoeoanonlpot1eefieserlrntlei,tmtoaltvtiiimwio4ene9ddebcctrginictsidgcitsoDesnGShetan7hd9,dthrhooeyeieauhihrtoosonotnouehttoo7eagtotaerntmshnoreeeahDntisany,carsehefilirendtnstiiass;ndtesmptltra.lsgoabeebmdyvtl.o,latbtisinaokasolcyttnseaneuTdoptdrCnaSntrehhssetOdehdioptsrtihhrfrgruliuireaetuindnnaelnmdamiainehfshoeasGbrspi4cteslfeio2cnfefevdnpsindtaweotbofolrtapSctcfr0tsrifnnigopirgbiegahecvimntnieochteeorocto0trhso2ceurhwlolsicaetiosgur,aafHccm7o.htrameoehwivbepetosvkhttsutetssltaotveideNmerteeatiaipeeumoohtcspoioasliiuadft,grwsannrleadsecaclwouethnnmnstneltthdretNtticeglovasstoyerinaoahwdmehdahsosthnwttiseeuniao,giltfssonr,o,ttdsr4seebnaftt,Drihtbteesatasfusagts-tnseiwioettetethanyhcitndta2woehshrptnN.vrihonfsuererhtoterendhoa,tnuerNntegofhHeuvsaaetotsaoncnviefaeclaotiisiniothhctpmkhSameottmcceereesreoatefiuolpooiceoOidiuacshettenjqpnepsttsru,incvllitsrnamstnoH.bsehttducedueomhm,sihlauocabeoTtbirlnieeetcdtoaysvrhiceeeDtnfhcbiwce“leaueoatqaleiipitctdanpodlortdnprrucccmihhslamnueeishwlt.otb.tgghsutenktoaetesteleeaudpah1eoshblrwVepeuievlo-tc,Tctr.yrlmqdeetddpchtaeeiinialasoJoapuaahgttcasonufTaaiaoaetetrllryhebeiaavvhrrlhnunotebnlhdehmiinyiedestotofrreeatatlhtasiiddpoddedieeeeeee”yayy.sssstttrrrrf,,,i mmtotdhrdsatiSwsabtftss“trtstesabvnoeehhhhhhhhttcypeabncctqetoeeeeaarfhahehsieaeaeaherhrecdoonsauocnaittltqnvtttaoceee,foeecetterrearcleapbpiuyhhttdomupirtmiidtrmcwlmfosthrashfWeiiaiedat.serheteittecltnlehpoehietlohisynioeraIistSoFiotishstssnwst,aaefahaeptispuemtkyGntpctestaintegstoeitrotiilonlc,soonmfttsloorti3esldecfeporuihcseteditdwynmffsopl0ubaouiamieciolntaodtbsocwteawugwralihrrmubanhutse,orBnilihecmavrhsenlhi,eaCltevienslilangaanotnialsignlP2gcnaaete-aloucoeganthotnraelihse5tantdeinreeoirdmdnsnbruttsdigsrtfdet8ntsdadirlinesmmsrdteegneetttcySa—c3qptucinbhascepmrcteenttdoi.fc(edio,eaphudcerertnhat5rsdoc,hievaieoaitilhnnesWteuivtoa)endemhvrierhelurtnvnecpeepllttgiiehKemhaarsntsdaiparpoeebtuunatortrsheuuestc,naakprrrlrsyesodes(freebaaatanotoim4scegudottgeum,tncthvhdfttecnatt)emmolhcf—tbaaaeemipelhitpnMthocdtttpdsioyeatidiltasifqhhimointeirnonareiiortezptdmatecialotjcuaeoiatoviutaaehgnnnasrpipncciscotakStiveoscobnbdshletveepochtrueawelncleoetotefnreooelieeercehtndaailrgayecs.dcgvshraeiycuauosanponetei(trut,.rfiesi.etmic)eoslaitraimsatordvpitmreotiI.rReshhrinIerttunneclthmiarrtleestenoyleuifneieaNdtsaemaggrbamcaasnbidtcsadsoscesotohrsn5doherfsycvepeacehri4eeeeif”embnttro5ftyddaavaic.hstrrrstaurrtcemiovrevtriushmvehoomtceeapittattaraiuivorintatrchhhhmceannouiinnnunehheicvniuenoteoortaaaaanllsddddddnhoeeeee3yyygssstttttttffl, Direction of reform in Thai Public The draft constitution passes the Health referendum easily at 61:39 sprtqpCeucrouuethcabniesoelsleiiinmitcvtnMyueethhteaaieaotmeniasinnocdloatnihnhirlteaeoc”sDfilnfruaicbacRd“nofeiteutedninhnndcteesgcehtfytanciCuht,ottospeewnmudssahuontmnteinthdrtiuitav(ehttmeteiaaorttetseshnhs)ameetuglaharnbdephevdrereeeaeraotrfaehtlptwofaschlopeftiolrelmncttwcashhbitriiailneeeis-ll ouA3tvtfttrhhrho8nruoaeae.tignm6nnteuss5otstuciseh%ttTttpoihoreohrpfmeru2rnoerel0peea6rdb1snjtlm1aetieh6nap.hyc3edotreet5inwoouioadn%tvflgnicagdtiotc,shalmhivobliqwoteerete.unrdhhreoeeWnaieetfnpsthiercnhtigeenraialgoieaantltpgeonnusioipnnsdootf1rtgehuohtn0ftheomiveh:,n5epfa“en9ltrdtaeawhe8hcrotnoef,aleio0eosifysauc3urpnoe1mon7ihaaunn6ntelregrv,dlsa8lsyinotdau5pt2irttmtmpt0ayueoor,tesetw4oneianoob0vgoirltnn2ee7ysrl, 108 Thai Health 2017

if5lrN2wh1N2Rvdodcnoaro0795oaifrraaoegtwaan1.,,n2rktehm9176fafe6heos0tce6143ttoir0onodh.s%20ctA8fto7ntcghme,,isoosw560.4.onoernvwt%57pf1SaurnOaoosa07ea.hrttttls9rtfinrhihteoetpt3wevgh5deiuetrife%oets0ehaelrotutnrtainm,isirghso0festtqleeeooi,hlii7snbmsproalurnemea1tvlprnoe1hiaselwr,coon5pleor.s0retyvctia8rtrt,pet5iaoT9wetiht9nhvNos8,esh2vhceeotpe.norea6tP0weersthletrl,ehy7esoi6thegepoweh%uidp4niern2orpbaeeka8risir5c,mfrllreonaeseel.avc9vtsuooYfv2e,enootovwaadi0tfmnrdrtoSltp0emeahreate4cute7dinpono,sltese5irc,lh.dndr.airPstoCovaiseiAutlnmas,ocynthtvtmwthhc5rhteuettieledpaeaeh9iirmdltgj”ndnoepi.oeehoh4.itrpintfc%tnwhsyrtoeTaahotttraeiinn.ohrhhheantootanddnnheeeeeeIsrrrf, omfgssKdcAltct2mtrbfobaMtbiauerhhaooeho0lirerffdleanwivkneyeasaem1nnrynnutegaeirt.ftese7dssaehistos6l,esmealsTe,,trilytor.iiemtntwalialnstPiaNhdaanetohAtieneicggslrlodhudoeerga.wefictsneedmtetcnftisevsuertrroetdoDeirPoel,iaeoeihOjeeaoetornnpdirrrmganaorwnpgfseitcn.ffMteitmnfhgcofthadttamtwfitrWtschdiiitcthaoshvoenruehrueotohadeoesnimaeleiihnetebsvcseneecscMtuttareacee3e,edcmssoopTesnhcllenisnttodggederlnnfhloamidmh,aoosauiottrPcndiadubusesrwdstntwnvtrtooaeiuhoothraetaiinKatteagseonf.inccneoryaohgopktrereoryrntcgPutacutntenoenedvhbucsotRshnoaamirttaohersotaetrrholoyipnsnrnanrRow,repifnepCeeteyngtlatweati-lt1aelosih2enoactaadmmoerahanghtc3ora0ralndrtl.itfeekdmieateetenl1uttfetnOuSinhichthKitnnn-7lpdrcoaNt,hoehtttadaceiemgthd.auiianuccaaavtotfDttOpaleronttohgcrnttiootnenttcehetedircnonoabiioceedtaeeprottttaBtnhteenwaiwhasu1hhssshnmurhsemne,taruari0eseeteottthywunnftlehp2dpyoiryfupehtJememKotAndei0pauaraalslenerogiulsacP1dtitootenniodgatrgwsefibnttd6rtoonrucgnnerniihtctwnhot.ttmreeentyai7fimhahahheaevzAooonars.raiarfdllneeeeeeeeaystttt-r--lllll The general election is scheduled Conclusion after the royal funeral hasTtaatthrcavcTuhhheooapnnheehnaeerrnfnpaaadavitainollisesrrgiilttmcowtiltuaoqhhnciaoAievtntsivaguiulnpsufeclcdlerbtaytaedtdaefte.lrieiloorehrnro,reaCendbranemtnataeidyooottvisnonefhhcseirchittldntnoodeerohttgasvstsomchoesbfiootitdbcrelaahfeehdcnnoeierlinesnisreaasregdpcdyseftgatiamwueeetiinsfyesoncriqbtcmtttndianaclesoaugdulletaniormownrceirorbotlinaunatcddaifheulyfrselsrblateaewpeateirtprlhnfliaa,.sethdleltiraglneliuorartipcWlvezecdeshsttveexetaulinbhioiasopcdrotttpdteeyvthanihpeeonoepuisnreeccldednomtessateh,etre.ntuwurataatmhoetddiinnhsnnnigleafeiieal.dgruvvmbl2etnbteeiplnTv0ttheaclerrtuheie1hssiewehnerairaia6wiinnnneeyssstrll, cramacsfercmlslcclwtdwCHoaaoeoietoooolsnlmaoiiiewteesfnairyltlnnnndyneeulltpapcapgesMsscssidrortrrnrtletltecttthoeieiitlauaaitsiioogTArpaeeotnttelfnurnfjnuuuaohnrpettaeftdwnutsgnhoettctttioearspsrioupaeiiidaoeefeaireotsooftroinnmpdyrendnhfopdrnronnd.di2rePraaz5evrt,MTetfsat0i.ohlleronatwwtmthhseittiff1tPhzhhenmldieiAhoerhviiopne7tesellaeneaefrahlleK,nteaC.ottewntthtneeilmt.ocbletenenTidihettihzpreMmotnnellImghahigtiaeelivlnmscaatdsteiieaostftcsnpesiahiinbosiioursswnstntmeoliraopetsetuEnirsepneyontonsefperitrllteohtapttraneoetenirraxhoahhrnbultsorecccrcegprhlneyt.asicecnetrofttneopeteatveieiioPelfccearoonisgellcooevroromelaststnsnneDteacnerehfy.mncteibeantyrcmosiadsTeeaolsitdtCeutdoaehlupttifhdifiooemtliowtunshnCtoattreiathnnhssnmeiunmhtpouseotboheigaasstoeapnlnofmsyCavnieu,ltwdCiorntusrn,fsinanhbaoontnit,iacttatttttthibtsasatmhhvgahtthfhohhlisoaetneeuneiataneeeeirzeemkfqanie-tgcalsndemoreo.is2,duorlonnnidioTtoc1n0twrttetttmbnteee.nahhhhhhha5ne1tnaailwwwfdoloeeeeeeee0a4ygttlll 10 Outstanding Situations 109

2 The 20-Year National Strategic Plan In the era of the National Council for Peace and Order (NCPO), some observers have mentioned the term national strategy numerous times. Many are curious as to what this national strategy, that has been stated on numerous occasions, mean and how has this national strategy been determined. When the public have come to learn that the country is developing a 20-year national strategy on development many have questioned whether this determination to have a strategy so far into the future is appropriate or not. Will the next government that comes to power have enough independence to govern and determine its own policies? In addition, what will be the role of the national economic and social de- velopment plan that already has a 5-year plan and what relationship will it have with the 20-year strategic plan. This chapter will discuss the 20-year national strategic plan and the impact on future health mechanisms of the people. The national strategic plan is a The draft constitution of Thailand has national development goal highlighted the national strategy in numerous sections such as in Section 65: The state must The draft constitution that passed the develop a national strategy as a goal for sustain- national referendum on 7 August 2016 designated able national development according to good that there will be a national strategic plan to governance principles. This can then be used as lay the long term goals and process in the a framework for various plans that are to be development of the country for the next 20 coordinated and integrated and act as a power- years. This began in earnest on 30 June 2015 ful force towards the ultimate goal. This will with a cabinet resolution approving the recom- involve setting goals and a timeframe to achieve mendation of its Secretariat to develop a 20 year the goals to be implemented under procedures national strategic plan for 2017-2036. Approval that will be set by laws. was given for the establishment of a committee to develop this national plan with the Secretariat Section 142: In the presentation of the as the Chair to move the country towards a draft Act on the annual budget it should state Secure, Prosperous and Sustainable future1. the amount of the budget as well as the expected income, estimated results or benefits from the 110 Thai Health 2017

expense and its interrelationship with the Why must there be a National national strategy and various development Strategy? plans using legal guidelines and financial discipline. In the past, the country has set a goal and strategy for development under the National Section 162: The Cabinet that comes into Economic and Social Development Board power must announce its policy to parliament (NESDB). Each plan covers only 5 years but in and this policy must be related to its duty as practice each government that comes into the government, the policy direction of the power places higher importance on its party’s government and its overall strategy… policies and campaign promises. When there is a change in government, there often is a change As detailed above, after the new constitution in many economic and social policies, resulting comes into use, the national strategy will come in a break in the continuity of work. Thus, in into effect as a framework for the management order to reform national development strategy, and planning of the government and its various and to ensure that all governments that come departments including budget planning. Such into power are committed to the larger goal that that, the contents and issues that will be have already been set, the country should have contained in the national strategic plan must be a long term national goal or National Strategy. under the laws that govern it. Diagram 1: The Vision of the 20-year National Strategy “Security, Prosperity, Sustainability” in accordance with the principles of Sufficiency-Economy Philosophy. Security Prosperity Sustainability ••••• smmStbcgePaNmNesiaciSctnnnoheieohebneorneyaoaadeeuaecnarcdlcvatcotthndieiinnutinvntuiuuiglioparho,ileecttiringnottrrtrdvoneelnortaeodaymeetgnoeeuyayiuslithnmftmtpauaaao,lhnsoofwat,nrtnlenntrnteaooeteeovohodotdorbidstlacnntnehsymeeopeuerrhoethshifevcSkslacslaria’caueaaaeseohiwaalpmistovtdevanavr.lynyffariaceeeuclletedediisnAaaniln,heiutfnptysnnledyfacdisoahsrrlctnerpidte.edrotfpafoirnnyopolnoatTcsieetmlebimnhadteleononoovnwoivooteetcisccldndesigmneiiinothidoucottot,ltccbhlasieonahahrscnsumoifetetleult’vpaieahetuignunnrsatpeiilelnmooscsennrnried.tltaolteaiooinicutrniaeyrnfoelfnncragueendlgeos,pyanundyuspd.cnotutegptadiaifraatlietsmav.oeTasonanauaninunannqiomvcdnndrrrdidtsdmacedgeoeeuiaedton,inoerhtnallanawnantatr,dyscruastmuouhtnstoatc,ysaetvsnaansosescarateeltttoteagiiaeciitmnnhedhtvantefslvceryidddoeeeeelia..st-----.,, • gairwFTciprcodcfctwplTernmoeeeerlaranicrrohefhiiivonevlsrdoatttpedopapveeoehhieabtalupoditanehoutstuiilanaiconnenaeeomttleolrbcrlemcotlrac,itcnvl,motoltoafaiaaytopeeietashueoiunukncnnroshnmiletlanatnncnhadntuoniooaenptorseicerrtnhpainmc.sereaecwsqoorntaoepiodnminyxrggouumnytnlterolnhipdehdatyoegtdaerotsicdphraal,ntstbheinimot,dgneentflicsaudcmrnreteiniecspooasintoieseect,niotdriocmoiieavnnntioctvinmfbniaennhrenhinvaeoedtnecnoleielueseimwiriuoalmdmtntsoaucteshncsap.iheccnrntosudpotssncTemhooeidmcoemefaoiorodgaeuruotsecceonrotilebpnnonrtohmio,nit,manaahnoettheaannetliinrarmtutnsn.vhbetnyyor.qttbbemidaee.r.uatalTumuloasdiiufinrvhnvnTTaa.oinistaaettsioodenneheeigckssf--ll, • repMcPtttPfepgfbsgicpntDnoeoohhrtroronneriarroeiaeclerooeseaeonimrvvovbotoattotatsgvndiyidthpieptrrmlenrutmcideooeedeneeueltohlrieroopeovrnnevsulucricavylseraeaptmmebaenotnteieboatltnsahnmitesisogidioeetnreotoonweoonnuypolanndnenndansypteolatmeltthanun.eolhfhi.trdonqnitesadtfadeftsFeyciefoivtcuo.rnentnoarsivttvrtaoerntdceaethdihhreotenhlfnstnhaiesaepalnirteoepnosvusdauyttaecmdpureriptesacsroosoaife,selomoebmctpmfpelmnhooiafwlnenuclpialeosptpfaaieptoinfmhlsdennuow,acnrlisttdfieonthtscenmaecloeeneoalcevaohssdabfecnuntyrapveetothfirooiitsecutcemi.nbmltftasemieirathriveyvotcicpaoyptnefdeiyeqhioorlnoronacdntuoauoeemnhrerlfrtdenefleatcigoesttopahspmnsolsrfomohtlooneeplaeraewnyoifeanusrccsortyooosenusetttitkr.tnttnpmiochrhthorehhstllaaeiiriddonnneeeeeeiyass-ll, • • • • • 10 Outstanding Situations 111

Diagram 2: Goal: So that Thailand can raise its level 20-year National Strategic Framework of development from a middle income country to a high income country by the year 2036. Prosper Vision: For Thailand to be prosperous, 2. secure and sustained. A country that is developed according to the philosophy of sufficiency economy Creating that has been expanded in its meaning to competitiveness include secure, prosperous and sustained as shown in Diagram 1. 1. 3. 4. It can be seen that the national strategy Security Development Creating has set the goal, vision and path for the and creating opportunity, development that each successive government should give importance to. Successive capacity equality governments can then set their policies in a and equity coordinated manner and in the same direction in society in order to set the budget in an efficient and integrated manner. However, the incoming Secure 6. 5. Sustain governments will be able to determine its policies, plans and projects suitable to the Maintaining balance Creating growth situation in the future. and development on the basis of The National Strategy and Thai of processes in quality of life Health Systems the management that is friendly to of government the environment The 20-year national strategy has some affairs clauses related to the health system in two strategies. The first strategy is on development This view has been well supported by numerous and supporting capacity of people—the creation groups such as the National Reform Council and of improved capacity for people to have good academics. A government that comes into power health. The second strategy is on the creation will then determine policies leading to the major of equality and equity in society. It will focus on goal and can then set a framework for determining developing mechanisms for service provision its policies along the longer term direction and the management of health. with greater integrity. This will lead to the effective allocation of resources and result in a more Due to the nature of the 20-year strategic coordinated move towards the shared goal. plan that has a long term goal, it is necessary to set various time periods for implementation. The Thai National Strategy Currently there is the use of the National The government of General Prayuth Chan- Economic and Social Development Board (NESDB) as the mechanism to move the national o-cha established a National Strategic Committee strategy into short and medium term goals for with General Wilas Arunsri, Secretariat of the five years3. The 20-year national strategy (2017- Prime Minister, as Chair2 on 30 June to draft the 2036) will then be carried out by the 5-year 20-year national strategy 2015 as a first draft NESDB in its 12th to 15th publications. according to the Constitution. Up till the begin- ning of 2017, the National Strategy Committee developed the draft 20-year national strategy by articulating feedback and recommendations from its members that came from various areas including government officials, the private sector, politicians and academics, the National Reform Council, and civil society. The 20 year Strategic Plan consists of: 112 Thai Health 2017

For the 12th NESDB (2017-2022), the first the environment and development of service NESDB that will come under the 20-year national centers. strategic plan, its goal aims to promote good health for Thai people by setting various 2. Service Excellence Strategies include 4 indicators such as: population aged 15-79 years plans. 2.1 Development of Royal wishes. 2.2 that are overweight must be reduced; deaths Development of primary medicine. 2.3 from road accidents are below 18 persons per Development of public health systems and 100,000 population, total health expenditure to 2.4. Thailand 4.0 in the area of public health, be not more than 5% of the national GDP; and medical health and technology, legal aspects of the elderly living at home with an appropriate health in special economic zones and access to environment to increase to 20%. services in the southern border areas. Moreover, the strategy in the first 5 years 3. People Excellence strategy includes 4 emphasizes behavior change in health and plans: 3.1 Planning for manpower in health. 3.2 reduction of risk factors that may affect health. Developing and producing manpower. 3.3 It includes improving health knowledge on good Development of management mechanisms in health, promoting health fitness appropriate manpower and 3.4 Manpower in health and for each age, using legal action and taxes in network partners. controlling consumption that is negative to health, the creation of an environment that is 4. Governance Excellence Strategy supportive to good health, and overcoming include 4 plans: 4.1 Data management systems/ problems of deaths from road accidents. This health laws. 4.2 Universal health care scheme. 12th 5 year plan also places importance in the 4.3 Security in pharmaceuticals and drugs and promotion of a culture of safety through mass consumer protection and 4.4 Good governance media to change behavior and reduce accidents, principles in research. and the setting up of mechanisms to manage Summary risk from road accidents. 20-Year National Strategy of the Thailand, in the era of the National Council Ministry of Public Health for Peace and Order (NCPO), has launched the 20-year National Strategic Plan that has set the The Ministry of Public Health has developed long-term strategy for national development. the 20-year national strategy by determining 3 The Ministry of Public Health has used this goals for good health of the population: The national strategy to determine its own 20-year people are in good health, officials are content strategy that consists of excellence in health and the health structure is sustained4. The promotion and prevention of disease, service goal has a Strategy of Excellence in 4 areas excellence, excellence in personnel and excel- with 16 plans and 8 projects that include: lence in management with good governance. From this, the 12th NESDB will be the first plan 1. Promotion and Prevention of health that will implement this overall national strategy and disease (PP Excellence Strategies) that by setting targets to promote good health for include 4 plans of: 1.1 Development of the Thai people. From the present to the next 20 quality of life of Thai people in all age groups. years, it is expected Thailand will develop with 1.2 Prevention and control of disease and health the goal of good health with sustainable public dangers. 1.3 Food safety. 1.4 management of health systems. 10 Outstanding Situations 113

3 A Decade of the National Health Act: Laws for the Health of Thais In 2016, Thailand launched the second charter on national health systems as the framework that determines the direction of the health system of the nation. The aim is for the people to be in good health following the use of the first Health Act of 2007. The 1st Health Act of 2007 led to the creation of many laws including1 the health impact assessment, the law on the prevention and control of adolescent births of 2016, the draft law on protection of people from the impact of public health services, and the draft law on the control of marketing of food products for children. The National Health Act of 2007 the people to participate in the government’s and the Charter on National policy and management of the health system Health Systems as a healthy society “is not the responsibility of any particular person but is the responsibility of The National Health Act of 2007 is a kind everyone in society that must be created of “social engineer” that has designed the ideal together”3. By using ‘health’ as a goal a society public health system of Thailand. This law must strive towards it together and creatively demonstrates the health concepts of 4 develop policies on public policy with dimensions that include the wellbeing of one’s participation and shared knowledge. health, mind, knowledge and society that are all linked2 to achieve real results and change in The tools in the creative development of the society. This is considered an innovation of public policy with participation according to the society because this law is a change in the Public Health Act 2007 consists of 4 major paths thinking on public health from the previous of the rights and responsibility in the areas of thinking, where it has been the responsibility of health, the charter on health systems, health the government. This law opened an arena for assembly and the participatory health impact assessment as follows: 114 Thai Health 2017

1. The rights and responsibilities in With the ministry regulation according to section 12, paragraph 2, there arose a new idea health for the development of various laws and policies of the state to promote and support a good The National Health law 2007 stipulated death, such as amending the law of illegal drug the rights and responsibility in section 5-12 use that allows easier access to the use of whereby rights on health is divided into 7 areas morphine in the care of patients at home. Efforts of: Section 5 paragraph 1: The right to maintaining are also made to develop and improve care one’s life under an environment that is of benefit regulations on finance of health to support care to one’s health. Section 6: The right to health of at home, to develop standards of health and women and children, the disabled, the elderly, medical personnel, and assistance in the the disadvantaged in society and various groups provision of care. that are in need of protection that is appropriate and related. Section 7: The right to information 2. The Charter on health systems on health of the individual. Section 88: The right to information when receiving public health The charter on the national health system service. Section 9: The right to have information is a framework and pathway to determine when participating in a research program. policy, strategy and implementation of health Section 10-11: The right in the request for an in the country so that people are in good health. evaluation and participation in the process of Though the charter on health systems is not the impact on health from a public policy. compulsory by law, the national health law of Section 12: The right to express in writing the 2007 had already laid the mechanisms that bind decision not to receive public health service in government agencies to implement the Charter. the last stage of one’s life and another role on health is Section 5, paragraph 2, the role together The first Charter on national health system with the state in working towards an environ- 2009 led to the use of Thai traditional medicine ment and social environment that promotes in the hospital for primary care, and initiatives good health, whereby the various rights and for the family doctor. Since the first charter on responsibilities are to be developed into specific national health systems came into use, it has laws and related laws as well as improving created the extension of the charter into the existing laws. community level. Communities began to set up local health systems in accordance with the For example, Section 5 and 6 are used as national Charter. To date, 100 local charter sites the foundation in the development of the law are operating in conjunction with strategic on prevention and overcoming the problem of partners such as the Office of the Universal Care pregnancy among adolescents. In 2016 the draft scheme regional offices and Office of primary law on occupational disease and environment education regional zones. and the draft law controlling the promotion of infant and child food industry have been Later, the Cabinet approved the second developed. Currently the latter draft law is in charter on national health systems on 9 August the stages of tremendous debate between 2016. This second charter has been approved supporters of the mother and the infant food by the Review Committee of the 2007 National industry. In addition, there is the development Health System, and passed the public referendum of the draft law to protect individual information in all regions with a total participation of 1,115 according to section 7, and the draft law on persons from around the country, including the research on human subjects in section 9. public referendum of the national health refer- 10 Outstanding Situations 115

endum on 8 May 2015, and with feedback from From the year 2008 to the present, there almost 100 agencies. The charter will be reviewed have been 9 Assemblies on Health with a total every 5 years after its implementation. of 77 resolutions presented to the National Health Committee. The resolutions from the The second charter reflects a picture of national health assembly, the National Office of the future national health system in the next 10 the Committee on Health and various partner years, and designates challenges on health risks networks have resulted in numerous concrete such as emerging diseases, communicable actions. The Health Minister is tasked to take diseases, non-communicable diseases, the action on the resolutions by the Health Assembly ageing population and the impact of the urban and to monitor the progress of these actions. environment. The second charter is an integral Such actions include the push for the law on part of the draft 20-year national strategy of preventing and overcoming the challenge of 2017-2036 by the government, where the health adolescent pregnancies 20155 and development system is one part that will ensure the security in of the draft law on protecting people affected life and support human development, knowledge by public health services6, the draft law investment, natural resource investment and controlling the market promotion of food industry the environment that creates prosperity, and for children7, the draft law on occupational the development in all facets with equality, diseases and the environment8, the draft law equity and sustainability, in accordance with the on the prohibition of sale of alcohol in industrial philosophy of sufficiency economy. At the same areas9, the improvement of the law on psycho- time, it is also in line with the 12th NESDB, not only logical health (2009)10 and the improvement of just in health, but also the health dimensions the draft law on non-communicable diseases of the self, the wisdom and the society4. (2015)11. 3. Health Assembly In addition to the development of various laws, there is also the use of the national health The Health Assembly is the process where assembly resolutions to develop government the people and government agencies concerned policies that have an impact on society such as come together to exchange ideas and learn the resolution of 1.2 on access to medicine for together through a consensus building process all Thais, Resolution 1.4 Participation of the that lead to recommendations on public health people in determining the free trade negotiation. policy through a participatory manner. There are Resolution 1.11 Structure and mechanism on the 3 types of health assembly of assembly in impact on health in Thai society. Resolution 2.88, specific areas, health assembly on specific issues Managing overweight and obesity. Resolution and the national health assembly. 3.1 Measures for Thailand to be free of asbestos. Resolution 3.6 Measure to control risk factors to Organizing the assembly as explained tobacco. Resolution 3.88 on overcoming the above is a social innovation that creates learning challenge of adolescent unwanted pregnancies. together through consensus building based on Resolution 4.1 on food safety in the management knowledge data. The assembly is not an of use of old cooking oil. Resolution 5.1 on academic meeting or a seminar but is a process managing the infrastructure to promote walking that is creative and attempts to have learning and use of bicycles in daily life. Resolution 5.4 together on economics and social issues, and on managing excessive smoke and Resolution from various disciplines, leading to the conclusion 7.4 on managing improper steroid use. for all sides. 116 Thai Health 2017

4. Health Impact Assessment 1. The law on the protection and overcoming problems of adolescent Health Impact Assessment (HIA) is a pregnancies 2016 process that was developed as one tool for health policy development. It looks at the Currently, Thailand has experienced a impact of the activities of projects, plans and large number of unwanted pregnancies, and various policies on the health of the population. ranked as one of the highest rate of unwanted The decision making process will consider pregnancies in the world. Partner networks and factors that impact on health of the people. The academics have used the national health data acquired from this assessment is beneficial assembly as one avenue in the push for this for policy makers at all levels to take decisions issue to become a national agenda, and on policy that are most beneficial to the people. proposed for a new law on this issue. This led to the drafting of a law on preventing and The HIA has been used in many large overcoming the problem of unwanted adolescent projects such as the building of bio-electricity pregnancies of 2016. This law designates the plants, waste disposal sites, and licensing of gold role of the education system, workplaces, care mines. As a result, the Central Administrative centers and local administrative organizations Court has ordered a temporary restraint to 76 to have the key role in the support and promotion, projects with a value of 400,000,000 million baht prevention and overcoming the problem of in Map Ta Phut Industrial Estate, Rayong adolescent pregnancies. province in 2009. This was done to protect the community and the environment of the area. 2. The draft law on protecting people Since then, the HIA has been used in many affected from public health services … other areas around the country. Conflicts between those who receive Recently, the 2016 constitution of services and those who provide services is one Thailand12 requires the HIA in projects which important problem in the service provision of may have an impact on natural resources, the environment, health and sanitation, and the quality of life of the people13. It requires compulsory measures from agencies involved, or else responsible officials will be relieved from their positions14. New Laws and the National Health Service The partnership networks of the govern- ment, private sector and civil society have used the national health assembly process, initiated by the national health law 2007, to develop various laws that help to improve the Thai health service system such as: 10 Outstanding Situations 117

health in Thailand. In the past, there had been 4. The draft law on occupational health several charges made against public health diseases and safety... services and hospitals. These conflicts have increased over the years as seen in the media. Overcoming health challenges of These conflicts reduce the spirit of service occupational health and safety originally was providers in their duty, and create negative the responsibility of the Ministry of Labor and feelings for the general public. Therefore, related agencies. Local health agencies have a recommendation has been made for a draft very little input on the issue despite the fact law that would protect those affected from that occupational health and safety is very public health services. The National Assembly complicated. This draft law would empower the is still working on this project. Department of Disease Control and health personnel in the provinces in the promotion, 3. Draft law to control the promotion prevention, treatment and rehabilitation of of marketing of food products for children those affected from occupation illness. It also places high importance on the environmental The industry on supplementary food and problem and health and safety issues. Presently, milk powder for children and infants in Thailand this draft law is under review by the Royal is valued at around twenty thousand million Decree Committee. baht15. Milk product companies and supplementary food companies have marketed their products The Next Steps inappropriately such as paying service providers The National Health Act of 2007 is a law to advertise their milk products, and providing free lunches and gifts to health personnel to that arose from the joint effort of Thai society promote their products, etc. These actions are to push for the development of a law that against ethics of the occupation as it promotes would improve Thailand’s health system. This powder milk products for young children and led to the announcement of the first and infants to replace the mother’s milk, resulting second charters on the national health system. in negative effects to infants in the long run. In addition, the network partners of the Such consumption also incur more unnecessary government, civil society and academics have expenses to the mother and her family. Civil used the national health assembly as a platform society, academics and government agencies to present views and work together on various thus have used the national health assembly health issues to develop public health policies to discuss this issue, and propose for a law to and laws. Whether the efforts will become control the marketing of milk powder and successful depends on the support from various supplementary health products by private networks, and joint efforts to pushing forward companies, and the sale of these products by their goal, guided by the principle that “good health personnel and hospitals. health is not for sale, but one has to do it for oneself.” 118 Thai Health 2017

4 The 2nd Charter on National Health System: Towards the Future Development of Thai Health Services Thailand’s new charter on the national health system was passed by the cabinet and the National Legislative Assembly, and was announced in the government gazette on 7 December 2016. This charter will be used as a blueprint for health strategy and policy development in the next 10 years. It emphasizes the concept of health as a basic human right where all national policies must take into account this principle. The charter was carried out by public participation in the drafting process and public referendum in all 4 regions of the country, before being submitted for hearing at the national health assembly on 8 May 2015. This article will summarize the main contents of the charter and its future health impacts. Background of the 2nd Charter on tgaSooypsvpitemreromnpvmla.elemAnocetcfnoattgrhdetenihncegcieaCtsbohainansredettec,orttiiohtonenirs4Nrei6naltacpituoeamnrdaabgal ergHaenpenthacflieto4hsr, National Health System tyShyeesatreCsm.haTrchtaeemr fewirislintl tbCoehuarseretveierownoen2d NDaaettclieoemansabtleerHve2e0ary0lt9h5. tCTohooemkremfpoitlrtaeec,eethoeinnrNe2va0ite1iow4npawlrohHceeenaslstthohfeStyhosetfeffiimcrsetsCeothfautrptheear The National Health Act 2007 section 251 aonndNsaeticotnioaln H4e6alethsttaoblbiseheredspthoensiCbolemfmoritttheee Sdyesvteelmop. Tmheisncthoafrttheer wCihllabrteerusoendNaastiaofnraaml Heewaoltrhk for health strategy and policy development of the country. Section 48 states that after the 10 Outstanding Situations 119

Diagram 1 Process of Review of the 1st Charter on National Health System Power of wisdom “The triangular strategy for moving paPrrtiincoicPpfiorpaciwtnlrieeoncnaieptrPlisnearhcgiwniorpeacfraipetlnineegwosoosPsaenffrymoo“copitenhuesaoetnsPrf”rcojuictriezysesnalPicsrvatoeidtoecnoewfeimnssasgnicHtdhoeCcfeanoorrlom1metNmhTsvtmamhiceStteiihiwyhtottatsenseetraeetedelmrratofhtfetpoamongwedoteuhprcnoreorDhoetnerwavafrcfaieitrnsooethfroe”rtwmecorclimfeihnttaekhynns,ecgadnpotsephshaamoytTeptetosawoimiahrtoortneoteleeninhtftrvmhto.arta”eoerollefepwwopoilosirTcdkwAhLyCaoEseeepasnmgrmebpTsdNismirehoanloanetrbevtsitoltiaevy’nl-se’.asl lPdisrfiatoentcandeiifnsnrsgogsmotof relgPisirotoencnaeilnsvsgieotwof s Thaeshseneaamlttibholnyal ainnnGothauTeznhecReetotmeyeanlt Power of Power of society the state breyviDerw. NcaormonmgisttuekeAonngk2h8aNsouvwepmlab1e.rT2h0e14e,shtaebaldisehd- StwvphiooeoeupwrktushelblaodyatneinotrdshnlyyesBitnca(ejonumtmgrhoksmeorfskoiNtrtwooecfereatrr1heoe2,nisNnpaaoecmtrhratspedholeenelmoasdsnitceg,farrtoCceehmesrme)natatrrfhnacohdler, ment of this committee was announced in the taTonhdestaoucpdaiydneiaomnndisccfcrooommmpmviliaetrtiedoeautasalssfotraorkemechevoiavlerdidoeurfses.eisdsbuaecsk. government gazette on 7 December 2016. charte2Tr.h. ePsroeccreestsarwiaht ialenddaecvaedleompiincsg the draft basedTohne raecvaideewmpircofcinedssinogfstahnedcohmeamlthittdeeatwa.aIst presented gaanvdethimepfeoertdabnaccek tforomthealpl asertcictoiprastaiocncoprdroincgestso, upthsreeesidretndhtaeetaddatthotaetiirhnpetrhoCegordmersamsftioitntnegeroe.fgTuthhlaeerCCinhotaemrrtvmeariltast.nede tlehaerntinriganbgyutlhaer ssotcraietteyg,yp—ubtlhicepaawrtiacripeanteiosns, aanndd draft c3h. aPrtreorc:eTshseapftreorcetshsecoconmsisptsleotifo(n1) oPfubthliec creating ownership. The review process can be Hinea4rinreggoiofntshewditrhaf1t ,C1h15artpearratitcihpeaanrtins.g Hveeanruinegs summarized as follows: semin1a.r wThaes phreolcdesins b5evfoerneutehsetdora‘fstecehkaartewr:aAy out’ in order to listen to views of the public (organized in 4 regions and 1 central gathering with a total number of 500 participants). A meeting of public jurors of one event in order to hear 120 Thai Health 2017

venues 2a0t 1th5e(483th0napteiorsnoanl shepaalrtthicaipssaetmedb)lyanodn dkicsnheoarfiarwntteehlerdedrhgbabeysroataanhdddedaesnndoadctsiiaoeclncotaavisloepnrhsesecbatosolnt.thhTphAslueycscgt,aholot,hflome2gi0i2nc0nda7dl, 8 May hreesaplothnsaibnidlithieesa, lstho othfatthethme isnodc,ieatnydcraignhtbseattnedr heexpareinrtgsbaynwdritgtoenvemrnemanesn(t99agwernittceiensr,eapcliaeds efrmomic uronldeesrsshtaonudldwbhea.tIttshienitrernigthiststhaaret aalnldsewcthoartstthaekeir isnescttitourt)ioannsd, oc(2c)upeadtiitoinngaltghroeudpsra, fatndchthareteprrivaantde this path of “Health in all Policies” by creating pHreeaslethntSinygsteitmt,oththeeCCaboimnemt itatnede tohne NNaattiioonnaall policies that are in support of good health, Legislative Assembly before announcing it in the whereby the state and all sectors must work as Royal Gazette. partners in networks and support participation othfeairllmPsreiencsdtesonrttshlyea,tsgoaolcvliaellernvdmeeltese.nrmtThainegayennmtcsiueossft hshueacavhlethai2ns. Comparing the 1st and 2nd National Ethceonooffmiceic oafntdheSCoocimalmDitteeveelfoopr mtheentNaBtiooanradl Health System Charters im(DmNeeEpvnSoeDtlrotBoap)fnmatchneeednin1tth2PuetlshaiMnNngian(NttiihsoEtiSsrnyDaCloBhEf)acdPrtouuenbrrionliinmcg t2Hich0ee1aan7dlt-deh2v0Spe2oll2aco.cipaIet-l Dweilvlesleorpvme eanst Satrbaatesigsyf(o2r01t7h-e202306-)yweaitrhNthaetiogonaall 1. The 2nd Charter on National Health mofeancth. iIenvaindgdtithioenc,otuhnetBryo’asrsduostfaIninvaebsltemdeenvte(lBoOpI-) System 2016 added information on health has begun using the Charter to set HIA standards trends that may have an impact on health in for investment promotion in private hospitals. the next 10 years. Past Achievements of the 1st Charter definit2i.o nIms ipnrothveem2nednCtshaarntder.additions on new on National Health System 2009 3. Five additional contents that include: The first Charter on National Health System a section on rights and responsibilities in health, hinasmleadnytowthaeysdaesvefloolplomwesn3t. of Thai health systems section on psychological health, mental health, specialized health areas and a section on local 1) Its use as a reference in the development charters. The process of review found that these Dofevtheel-o npamTtiheoennta1l1PtslhtarNnaate(t1igo1icnthaplNlEaEcnSo:DnBo)maincdantdheSo1c2iathl issues are related to the changing dynamics of plan for health development has placed tishseuecsoufonrtrTyh, aainhdeaarlethesxypsetecmtesditnotbhee ifmutpuorert.ant importance in the promotion of health, reduced of eac4h. seRcetoiorgnatnoizheadvethaessetcrtuioctnuoren o“fimcopnotretanntst risk factors to health, promoted greater mpreinnctiaptlieosn”wanasdn“odtesspireecdifoieudtcboemcaeu”s.eTohef vimaripolues- participation in the development of public possible ways that could be used and adapted health policies, developed health service to implement the Charter. ddeelviveelorypseydstpeumb,ldicevheelaolpthedpdearstoanbnaesel, oanndheuaslethd, explan5a. tiAodndinedeacthhesecitniotennotf tohfe cuhsaert,era, nbdy tboulbleetttpeorinutndineorsrtdaenrdfoitrsthmeeraenaidnge.r and the user The 2nd Charter on National Health System and its impacts The 2nd Charter specifies that health is a basic right of people at levels of individual, family, community and society. The word “health” 10 Outstanding Situations 121

financial measures for health efficiency and oreflahtieo-a nlsthPhiaprptme1ars1no:angCenrmeelae.tniRotenbceaotnwmdemedneendvdoeaclottoipormsnaeonndnt usunsivtaeir-ns aablSilhtitreyaa.tlethgycaoren sythsteemde(2v0e1l2o-p20m1e6)ntwiothf cst3hoaaerilenv”dtio,-s tiwohrehneScictoCerhfahiv“tiaeseertagvpeciecrrcroyoptpraepdlrcaetatnrni3soco,nfe6noowrathnnittadhhute1nCre2ihvIs.aneidrsrtesteaistrluoshteneecTatihflootanhri ppoaptiueln-a ttsio.PnaI.nrtcr1e2a:sFiningandcoectfoorrs to serve rural health services. Tdehveeleopstmaebnlitsohfmfineanntcioalfmtehcehacnoismmms oitnteheealftohr. rheefaelrteh3n)ccheTahrtteoeorusl,slieneaotdhfinetghdteoevm2e0olo0rep7mtCheahnnatr4to0ef0r llaoosccaaall tHohneaa“tlKtishnjouSwsytslaetendmdgessumRsetaasnienaageredcm”h.eITnnhstitstitouuwsteeasr(dt2hs0ea11Cs-yh2sa0tre1tme6r) health charters around the country. dpearvte1l2op)pomEixneatnm7t.palnedosfecctoionncr9etaes the basis for its pimaprtlse-min celPnuatdaretti:o3n: references and The 2nd Charter and Health Impact related to the charter in various Assessment To insure and protect health. OThffeiceCa(bNinHeStOa)nsdupthpeorNtsathioenaallthHeinasltuhraSnecceurfiotyr Health impact assessment is the process sintfaotreml-ePasalsrwt po5er:koePprrsle.ev,enmtiiogrnanotf populations and of learning together by the society so that the diseases and the people, the community, government agencies, aocosfsneetsrlsoimgl ioebnfilthiteoyafltgthhueirdisiekmsli.pn(ae1c)stToahnnedhaenmanloethutnh(coHedIAms)e(on2tf) the private sector, and academics to analyze wnSuohpticphporrdotomfonoroteHt IfAionlvilnoewstthmteheecnotCmhinmartupenrrii.vtya.te(3)hoBOspIitwaillsl and forecast the impacts on health that might mhTNheaekaadhilitoct-hir nnaedcpPaiartaorniroevtdnin7tsarcc:laehdWm.eiti(mies2odd)neoiacP.mlirno(d.3emo)(c1hotD)otoeeSrssvpuTeipinthlapoatlohipreittnrnuatdSnahaiitevtikioeohfrnniosraaasntlll occur from certain policies and projects. This is swtirsadtoe-mg icaPnpadlrattnra8df:oitrCiootnhnaesluTdmheaevierhleopaprlomthtee(n2c0tti1oo2nf-2. l0oT1ch6ae)l. done by applying various tools through a process eterdsatudacebaltiasioghrnmeeeamnndtenomtfsotnwhiethoiccrihonmgmmtihgiehttteneaefgfteooctitasutpipoupnboliirnct of appropriate participation in order to come up hgoevaeltrhn- ,manePdnarttt.o1p0r:eDseisnstermecinoamtimonenodfaitniofonrsmtoattiohne with decisions suitable for the health of people oconmhemailtttheteh.rough the national health information in the short and long term. policieHsIA, pcloannssi,stpsroojfec6tsstoerpsacotfiv: i(t1ie)sFbiltyerpinugbloicf msceretheondinsg.of(2a)sDseestsemrmenintinogf shteuadltyh ziomnpeasctanbdy hPueablltich. S(4c)oRpeinvgie. w(3o) fArsespeosrstms eonntaonfd iamnpalaycstisoonf impact on health or public review. (5) The push into the process of decision making or influencing. (6) PuSbelicctimonon2i5to(r5in)goafntdheevNaaltuioantiaolnH. ealth Act 2se0t0t7hdeegsuigidnealtineedstahnadt tphreocCeodmurmesittfoeremononHiteoarlinthg hiatnes daimltehpvpaacolutliacotineinshginetahitlesth1nstathtreiaoptnomarlta.hyBeuaatrlidstheuefsrytoosmtepmopluicabienlisdc, projects and development activities that have changed rapidly, the National Committee on Hreevaieltwh haandd tihmeprreosvoeluittsioncriotenria19aMndaym2e5t5h9odtos 122 Thai Health 2017

http://www.thaihealth.or.th/data/content/2014/12/26892/cms/e_cilmnpquxz16.jpg aonf dfolhloewal-tuhpimreplaatcetds,totonabteionmaol rheeaulpthtsoysdteatmes4., Towards Sustainable Health The task was completed on 2 May 2016, and The Charter on the National Health System announced in the Royal Gazette on 6 September 2016. is a framework and pathway to determine policy, in theT2hned Cohbajertcetirv5eisonfotdeovnelylotpoincgretahtee ccrrititeerriaia, strategy and implementation for the country’s the implementation procedure, and strict health system that would helps all sectors to regulations, but also the intention to promote better understand health from a broad perspec- public participation in the process, according to tive. It is health lens that incorporate the rights the intent of the Act on National Health Act and roles in health as well as an awareness that 2in00m7o. rTehespseeccifriictepriuarpcaonsebsedaedpaepntdeindgaonnd luosceadl all policies should take into account health issues and contexts. However, this must be done pasoplieccytsm. IatksitnagtessothtahtatHIgAoboed uhseeadltahs caotuolodl fboer according to the 4 steps of (1) Proactive HIA. wtshhuehesaitclat2hhinnhdesyadCssthbebaymerteTeonhrfamoTi hnusacoiNhlcaainepttdiroyan.sishaeInolduHtlbhdeyeablittefushbtiunSarcsyeelsu,tdestiomhvnee, R(s2pe)esocOilfnuIinetgsiooacdinnldegaiatniHrodlyInA(4t.th)o(aS3ttu)htsihCstaeocinnraiaftslebsicerlietsas,HamtnhIAede.nt2CnoodnmChphealaartlintehtr and participatory process. should proceed according to democratic principles, just and fairness, an appropriate use of evidence, an appropriateness of practice, the principle of participation, the principle of health inclusion and the principle of sustainability. 10 Outstanding Situations 123

5 The Draft Act on Patient Protection from Public Health Services Public health services are about the quality of life. It is one of the four requisites of clothing, food, housing and medicine that humans cannot live without. When health and medical care alleviates or cures an illness, it creates wellbeing for the patient and his/her family. On some occasions, however, there are incidents when medical treatment causes injury and death, creating great financial loss for the cost of care and the legal expense involving court cases. http://www.thairath.co.th/media/NjpUs24nCQKx5e1DGjstPIMsgn7TxCzBNQ1auQwO4Zs.jpg PdaistcielonIsnturtfehoerofyPeianatfiroe2nrm0t 0aS2tai,ofWentHyoO1n had a program on TMEN and the Medical Council2 tmoisetankceosumraagedethbey MI1en.d giTceahnleeCrdaoelu,lnTibMceilrEaaNtsiopfnorelosloefwnptsee:tdititohnesirmcaasdees to physicians in order to develop mechanisms to the by prevent damage and to save patients’ lives. In Tishwaielaankd. ,Ptahteiesnytssteamndthtahtepirrerevleantitvsessucthhudsajmoiangtelys ltlineohjanaudtgrients2digtm.a tptoeeManst(oifoerstonhtcmtaosdtmea3tlpnhitbedoeentrs1“haa0ctetiaioiyorsennerasefrolhsahr)ata.asivvffeenesocattneaedkvoeipdusaetatcnieovcnmeetr”sey., 2se0t0u2ptothdeemThaanidMfeodrijcuasltiEcrerofor rNaeftfwecotrekd(TpMatEieNn)tisn, and to push for a mechanism to compensate them, in an effort to reduce legal cases. This led mbeatttteer3rs.k ntHhoeawanllethpdagpteieeanrsntosdnaagnlo,doadrsesldauetpifvpeeonsrdtweorhsno, hlfeiaggvhaetl to the drafting of an Act to protect those who have been injured by public health services to reduce court cases between doctors and patients. btheefoirrce4a. tseeWsstiittfnoyeindsgseemisnaatrnhedeoffcotoernujurttrs,atwiincehederbeyasphpyastiiceianntss aknnodwlreedlgaetiovnesmehdaivceal aleffassirsitnofofigrhmtathtieoirncaasnesd. 124 Thai Health 2017

5. The medical networks usually seek • Medical records are the only evidence csSuoucochhpaepsrratahtcieotinncaeatnicodonuaallsdpsiosinltiacflneucdeeunrfcirneogmtthhesetadinteveleiabsgteiegranattciioioenns. hgriniesektaasnltthybh•ee infiinancFcgifdioiglteihratmnytmit.na,pgTtbiehoturheneterdtenhcfewoaeesyriteedha,ecrdtbeah,nyienobtrhptehteahvetedeiehreniyanftenefondxmrdpsmaeeoyranf.tsntiiohvoneet of the cases in favour of the defender. bfoertwpae•t eiennWtthsheeannddtohcreetolcaratsaivenediss.tpaakteiennttoicnocurerta,sceosnaflnicdt The problem of arbitration the relationship between the two is harmed. in petIintioandidnigtioton ttohethmeefadilicuarel ctoouanchciile,vveicstuimccseossf amarsbepidtericac•• atiailolITnfmbhtuahiessdetgafacoekgotleelmosonwnpcayeslc:nsoaosmtatfpoiaoercniengiissnaoitnbdioesovnteaitscalbenlseo,tipnhuabthvlieec Lessons learnt from a case study hhoeaspltiht•a al goTefhneocriceigesiniluinsguaolflycosmhifptetnhseatbiounrdisennottohtihghe providInecrisdeonf tsmoefdciocnalfliscet rbveictewseehnavreeceinivcerersaasnedd aernboiturga•h tiotPnoauatilseluenavtlislaytaelneddaadmsreatlogaettisvheiensstthfaeeteullsotnqhguaotteartmnhde. otwSropeamemsrkaeautnniaodnnoauKpasaptleyew.RnAokdoncinpxlagibsjousupnicl3eehrrxaoeatscmipeoiipntvaeleldinionaf2nsN0uaa0cpk2hhp. oecMannsdreSsixs.i sutauskupeapllnl•iyeo sdaTtocohetiesaosnnsho.iosttsppdrioistvaailbdleiendmtpehadeticieaanrlbtesiqttruoaitpreemdceoncvatesore.r wThhaemnmthaeradtopcrtoovrignacvee. aBustpiannalecrorordr itnojeocktipolnactoe The problem of suing Mrs. Somkuan, resulting in a complication that and taking the case to court caused the life of Mrs. Somkuan. The children case isWthaekennatrobictroautirot,nthdeoaefsfencotetdwpoarktieanntds atnhde of Mrs. Somkuan took the case to court as a lbrboeaeslttaetwtleitev•h eeaennsiPrdahccstoaaiuemvsfneefmetssrtoibnoanegnccdavaosiulrnletsafhelrgaeoetintirfvosteislslapoanrwwnodiillnuolagnnmsegl:aoversedgtnelliefkaigegnhaldytl criminal case. The court of Thungsong province twimelel-fo•u fn1dD0ee-d1li2bmeyereadatiricnsa.gl ntheetwcoarskes.can take a long gave a verdict of imprisoning the doctor for 3 friensdtsa•o mneTtdhhieecaaplfafwetiictetnneetdsssp.oaArtsireetnhltaestifvbineudsr,ditefigdnhifotfiifncugplrttohtooef years without suspension of the sentence. case is an uphill battle. This case created huge conflicts between the medical network and the people’s network, leading to the closing of operating rooms in all community hospitals around the country as a protest. also inInvoadlvdeitdioan tcoivtilhecocurirmt icnaaslecaasse,ththeecinhcilidderennt of Mrs. Somkuan asked for compensation from the Office of the Permanent Secretary of the fMoirnimstraynoyf Pyuebalrisc Huenatillth1.1ThMisacyas2e0h1a6d wprhoelonngthede oSuf pPruebmliecCHoeuarltthgavceomthpeevnesradtiect1t.h2atmthilleioMninbisathryt wSoitmhkaunanin’tsefraemstiloyf(i7n.5thpiserccaesnet, tpheer cyoeuarrttoofMfirrsst. instance agpapveealaresvimerilsaerdvtehredivcet,rdbicutt)4.later the court of 10 Outstanding Situations 125

The problem of receiving initial The intent of the draft law was to protect compensation according to Section ctpfTuoohenmerrdseompdwneuaisntcinhesaafpatfthreisioenctantcnenipuddtlhmienfarbgwtoecmairossomthefoemfpfahiaicltatttiiveheeenenstatetshracvsaonuitcmdiednpsegjueldiinsbnotes.coartartToditohreesnesr. 41 of the National Health Commission rrpeeradocuchecesdsethcweisoinouunldm. Tbthaeekreaodfnvcoaansmteasogegreowintahgsattnohac1toiutyrewta.orTuhtldoe 2002 Epvroetnectthsotuhgeh htehaeltNhasteiorvniacleHreecaeltivheAr cfrtoomf bptimraitneieg,nbmtasocknanegdyooardneldraetililvaletwisoilnwls. hoImiuplpsdobrnetaotwnttewlyea,nsittdewocothtuoelrdisr tifnihnepanramcciateilcdaeisctsahisletarmenicasetrea, akscetcilolbrpydrionpbgrloteovmidSseinicngtiroeanqnu4e1in,sitbtiinuagtl atshenecduuprintayitvieesnrcsthase.lmMheeo,anletthhyewcacarisveitloosfeb2rev0aa0nc8tq, uftuihrneedds,ofraconimadl pfoartitehne•t sinuTinthidaisel rafitsnhsaiesntGaconialcdleacaasssrdifsotaalnlnodcwedso:ceosvneortscoonvelyr private hospitals. mpaotireen•t thsaiTnnho4e0th0cee,0ri0lsi0ncghbeafmohrte,stah.nedansostistaallnccaeseiss wnoiltl abrelelaecavhila••ot thneigsTTthhthceeeeerimlisiinnntisagitto.iniaaldlulatpifroirdnonsab.nloecfmiatlhoeanslscyio,stmaannmdcietctaeinsentoiont Disagreements between doctors setaacnhda•p rrdosIvn. inccaesdeisffewr,hreerseultainssgisintannocenaistionnoatl and the TMEN atahnpeparpionpvteeenadltotoorfdtShoeeecsatidnomontin4r1iesattrchahtaitvtheheacsoceuthirltie.nTgoh,btishjeiescrtneivoiest protecAttiotnheofetnhdosoef a2f0fe1c0t,etdhferodmrapftuAbclitc ohneatlhthe to assist patients without proving right or wrong. sothefreSvticaaegtesenpadaftsaesretd1o1dbmeeliobdneitrshacstu,iosansnesddfrwoinmasptinhacerlliuCadmoeuednncitnil. tTHteoolhoeemwwmyeaeekvtanheertursc,bsoplinanirncitvctrkihaibtteteueodtmihopdoenroedstpcsiocstitaoutalhrrlsesecoatctourhoognemuecntpgilhdoeedvnrtiesdhawrentniimtoochnotemunfwuntaantntndroyyt. Draft Act on protection of persons affected from public health services: A new path to reduce conflicts dsueslpibeeTnrhadteitohnneesdtowrfaofttrhkiAscoltaf,wrae.fsfuelcttinegd in the delay of During the years 2002-2006, there was persons later a crisis in the relationship binejtuwreedenpamtieednitcsa5l. cPthariemmlpeaawiMgtnioneidgstoefoarrhatenhaeddp.HuWobhuliescentotShpseeenagkodevlreerttntoemrsseutnpotptdohirdet personnel and relatives of As there was an increase in the number of court cases, two patients were shot and killed and asnupopptprotoavrketedfrtoahnmeydtarhacefttiomAncet,d, tbiahu.etFtnihneeatlmwlyeo, drtkihceaglacctaohbueinrneceditl two doctors were imprisoned. Many relatives of injured patients were also jailed for stealing medical records from the hospital. At the end tsfruehtiqraltltuhoiterhberejeimnicnstotieterideaaldictco.ooTnfmhtprepiabesmusntiensioadgntiacioafnnrloecfmwuonulvdanawcbriioleturheesaxqttpuewaenrostdtuieeelsddd. of 2006, the Minister of Public Health at the time, Dr. Monkol Na Songklha gave the order to draft a law to protect those affected from pseucbtloicrshceaamlthe steorgveictehse.rRteoprdersaefnt ttahtiisvelsawfr,omusianlgl the Swedish law as a model. 126 Thai Health 2017

The NCPO gave the green light to The Draft Act on Protection of the New Law Those Affected from Public Health Services During the era of the NCPO under Prime establTishhemmenatinofpcooinmt poefntshateiodnrafuftndAcftorisboththe Minister Prayuth Chan-o-cha, there were attempts pinroovriddeerrstoanrdedreucceeivtehres onfupmubbelirc ohfeaclothurstecrvaisceess. to solve the issue of people affected from General Chusak Sunthiworawuth stated that this medical services again. The Committee on Legal Act has the mediation process that is just and Reform began a new draft law to cover only hdaestearmcoinmepwernosnagtidooninfugsn.dEwveitnhothuot uthghe ntheeerde tios Cpaatrdie,ntthseinSotchiael tSherceuerithyeaanltdhCfiuvnildsse—rvtahnet fGuonldd. aabmleedtoiatitoankeprtohceeisrs,cathseesatffoecttheed cpoarutriet.s Tsthilel sdoPToirhfrrgiagnvCe6faaotTttnteuAMosrchueEtuomsN7trshge.poeLrrinsotaacuottlehesgfrehtcahtoghaeNaueCiClcndCPoooOcujlolmaneimnctcmoitlpoiiofsnaposnigiuraonNosnvehfaodftl2oifuoo2vrnnirPatwtarahloCaroRytrheuedbacsfnoatatigsrnohmiesdne.. compensation fund consists of 1% from the drafted a new law called “Draft Act to Protect three health funds, according to section 41 of Those Affected from Public Health Services”. the universal health care of Thailand. The Council for National Reform later passed the draft Act with a vote of 148 to 13, no vote Not all members of the National Reform of 18, and presented this draft Act to the cabinet Council supports the draft Act. Assoc. Prof. Kitti on 29 July 2015 for consideration. Later, the Pitaknitinun is of the opinion that the rights to Ministry of Public Health worked on the draft this protection should cover all persons, and all Act that covers only the three funds. Professor service organizations, in both government and Dr. Piyasakol Sakonsatayatorn, the Minister of the private sector. It should provide details Public Health presented this draft to the Cabinet of exemptions that are not covered in the in June 2016, but the cabinet sent it back for compensation. Kasit Bhirom wanted more the revision. specifics from the Commission on whether this law actually gives benefits to those that actually Later, General Chusak Santiworawuth, masakpehamrmistaackieess, inanbdotphusthheeshtohsepitbaul radsenweollf CPrhoateirctoiofn,tChoemsmuibss-icoonmonmNitatteioenaol nSocCiaolnRseufomrmer, roefstphoencsiobmiliptyentosattaioxnpfauynedr9s. in the establishing cthaeseCtooutnhceilEoxntraNoartdioinnaaryl RCeofmormmitptereesaenndtefdinathlley Transitioning into the future preacreliiavmedenatppdreolivbaelrtaotiionncsluodne1t6hisJadnruafatryAc2t0i1n6t.hIne this session, among 151 persons in attendance, The Draft Act to Protect Those Affected 48 persons voted yes for the draft Act, 26 persons fbpreuotmbwliecPeunhbetlihaceltHhneeastlewtrhovriSkceeorsvf ipcaeensrdsoistnhsaealfonfenecgttwestdorurfkrgogomlef vthoetesdunpop,oarntedrs77ofabthsteaidnreadftfrAocmt wtheerevoletes.sStihnacne ipogmtoantevtoidteeohirnckenatamblgtraseooecntukratvpslbi.scouFetfrorn1ope5tmrhory,evetuihdadnerretsairlfffsitoirtsltrahtbtwahcet,eacalalslanmstsrdtufeeotgdhragelljeiufvnosetrtpoiacmlahgecaaaebnvindeyy, mlaabteseetratciinnogen8ds.idveortaetiros,n tohfethme ederatifntgAcrteiqnutehsetefudtuforer twRheoifsuorllmdawshoaionsnrpeml-aigcanetiet.erTdiahlniezeewC, ohaunonpdceilsthotahntatcNotahnteifolilncaatwsl sbeertvwiceeesnctohueldprboevidreesroslavnedd.receivers of medical 10 Outstanding Situations 127

6 Registration of Low-Income Persons: Reducing Inequality and Improving the Quality of Life Back in June 2016, the Thai government initiated a policy to compile the list of low-income earners, those whose income are not more than 100,000 baht per year, in order to plan for welfare benefits suitable for them. The Finance Ministry was in charge of implementation of the project called “Registration for State Welfare”. Qualified persons were asked to register at 3 Thai banks and wait for the proof of their validity by government agencies. At first, it was not yet clear as to what benefits they would receive. However, the policy was aimed at improving the quality of life of low-income earners, and reducing social and economic inequality in Thailand1. 128 Thai Health 2017

Challenges of the poor in Thailand Registration of low-income persons “Poverty” is one problem that has arisen In order to solve the problem of income in Thai society for some time, causing health distribution in Thai society, the government of deterioration and affecting the daily life of many General Prayuth Chan-O-cha has initiated a people. The poverty in Thailand has increased policy to register low-income people between over the years and undermined national 15 July-15 August of 2016 to update the development and the quality of life of millions government’s data base of the level of poverty of people. The root causes of poverty in in Thailand, and to develop state welfares for Thailand include: them. On 22 November 2016, the Cabinet approved the policy initiative. The “low-income 1. Internal factors. Lack of opportunities person” according to the criteria set by the and limited capacities to earn incomes such as government is a person that is of Thai nationality, poor infrastructure, lack of negotiation power, aged over 18 years on 15 August 2016 (or born little knowledge, etc. before 16 August 1998) and is not employed, or those whose income are not more than 100,000 2. External factors. The economic system baht in the year 20152. which is a mixed economic system between capitalism and socialism. But in practice, Those who wish to register must provide capitalism in Thailand led to the exploitation of information on the status of their assets. The natural resources at the expense of the local assets that have to be declared are: community. As income distribution deteriorates, poverty has increased. • Income proof, which includes monthly income, savings in the bank, bond holdings, etc. The main causes of death among Thai population are cancer and heart disease, which • Assets such as land, buildings, vehicles affect more low-income people than other such as car and motorcycle. groups. Therefore, the reduction of poverty will not only solve the economic problem, but it • Debts that include loans from banks, will also lessen the health problem as well. It informal loans, credit card debts, agricultural will certainly boost the quality of life of the debts, business debts, education debt, majority of people in the country. consumption debt, land purchase debt. etc. State welfare is separated into two categories: cash assistance of 3,000 baht for persons with an income of not more than 30,000 baht per year; and cash assistance of 1,500 baht In 2016, it was found that there were 5.4 million3 applicants who were not farmers. Among them, 3.1 million applicants earned not more than 30,000 baht per annum, and 2.3 million others earned 300,001-100,000 baht per annum. The total welfare subsidy amounted to 12,750 million baht. 10 Outstanding Situations 129

for persons with an income between 30,001- register. The steps of registration can be done 100,000 baht per year. Financial payment will in two ways: be done by bank transfer through the Bank for Agricultural Cooperative or the Government 1. Filling in the form at the bank under Savings Bank. the project. After the first stage of the registration, the 2. Download the form from the website government had decided to extend the program of the Ministry of Finance or banks under the by opening another round of registration in April project, fill out the form, and take it to the bank 20164 to allow those who missed the first round under the project. of registration to join the program. Details of the Past programs and Comments benefits include the followings: As a matter of fact, the project is nothing • An identity card for low income persons new in Thailand as previous governments also to receive benefits from the government in the introduced similar policies. For example, the future such as reduction in water and electricity Thaksin government launched the program of costs, free ride for public buses and trains. “registration of poor people” where 7 million people registered. During the Abhisit government, • Life insurance for low income persons there was a measure called “checks to help the with a premium of 99 baht per year that covers nation” where checks of 2,000 baht were given 50-60 thousand baht insurance for accidents and to low-income people in 3 groups of5: illness. 1. People who contribute to the social • Subsistence allowance for the elderly security fund with an income of less than 15,000 with low income. In the case of elderly with a baht, and those who have been laid off, or higher income, they can also use this benefit to resigned from work and are waiting their replace their elderly allowance. unemployment compensation. There were 8.1 million persons. Those who desire to register can go the website of the Revenue Department and 130 Thai Health 2017

2. Pensioners of 2.3 hundred thousand. Agency that the assistance would boost the 3. Government personnel of 1.4 million economy as it was the distribution of money persons to the populations who would use it for Later, the Yingluck government adopted consumption purposes. But when asked if this two policies to help low income persons6: was a good policy or not, he was quoted as 1. The policy on increasing the minimum saying: “as an academic it is very worrying wage to 300 baht per day. because policies such as this are not farsighted 2. The policy on the minimum salary of while Thailand has a far more important whose who obtain a bachelor degree of 15,000 problem of indebtedness. That is, the people baht a month. are still not able to manage their own debt. If Though each government had good we give out money and do this without trying intentions in raising the quality of life of people, to change the behavior of the people, the however, there are different views among social situation will not change. The burden of debt critiques on these programs. Major debates on will never change like water draining out of a the policy of the current government are as sandy pitch. Thus, whatever policy that comes follows: out, it must be very careful because we are General Sunsern Kaewkumnerd, the using tax payer’s money”. Dr. Nonrit stated that spokesperson attached to the Prime Minister’s we must first solve the problem of household Office, viewed that the government policy debt, though not easy and may take some time, would boost consumption in the country, it was essential that we change the spending increase income distribution, and reduce debts behavior of the Thai people7. of the poor. In addition, the registration of low Conclusion income persons would help improve the database that will be useful for targeted measures. The program on the registration of low- However, the persons who received the benefits income people to receive government welfare must also make efforts to help themselves. is one program that has the objective of raising Krisdika Jeenawijarn Director of the Fiscal the quality of life of the Thai people. In the first Policy Office stated that the registration policy stage of the program, some people were not would support economic growth as it would able to access the program, and the registration increase internal dynamism. The asistance of figure was lower than was first estimated. This “disadvantage groups” was necessary for the resulted in the expansion of the program as well country. as the benefits designed for them. Although But Pichai Naripthappun, former Minister the government has a policy to assist as many of Energy under the Yingluck government had a people as possible, the people themselves different opinion. He stated that the policy should rely on themselves and develop their would not create any benefit in boosting the own capacity, work hard, have financial economy because in reality the entire economy discipline, and increase their savings in order to dis not depend on the financial hand-out to one raise their quality of life in the long run. group only. Dr. Nonrit Bisalbutra, an academic attached to Thailand Development Research Institute (TDRI), gave an interview to the Isara News 10 Outstanding Situations 131

7 Measures to Assist the Elderly in Ageing Society It is auspicious that the cabinet approved measures to help the elderly as presented by the Ministry of Finance in November 2016 to prepare Thailand for an ageing society. The measures consist of promoting employment for the elderly, building residences for the elderly, reversed mortgages for the elderly, and the integration of pension schemes. These measures will help to strengthen the security of the elderly by increasing their income generation, savings and home ownership. Thailand and the elderly aged society when the proportion of population Thailand passed the threshold of an ageing aged 60 and above reaches 20 percent in 2021. In 2031, Thailand will become a super-aged society in 2005 (the aging society takes pace society when the population aged 60 and above when the population aged 60 and above are reaches 28 percent of the total population. more than 10 percent of the total population). From that point on, the proportion of the aged This occurrence is likely to affect the population increased to 10.8 percent or 17% of development of the economy and society at the total population, according to the National the individual level, family level, community Economic and Social Development Board level and the national level, and dramatically (NESDB, 2013)1. Thailand will become a fully- change the picture of Thai society. The Thai 132 Thai Health 2017

population will age at a very fast rate as the baht per month). The employer can use this workforce will have a lower proportion. As the right up to 10% of total employed workers. The household size reduces, the way elderly live will employee, however, cannot hold any shares in also change. The government must therefore the organization, and is not a board director or come up with policies and measures to prepare senior manager of the organization2. for an ageing society. This measure can be considered as a form Measures to help the elderly of income security for the elderly so that they Measures to help the elderly in the past can take care of themselves in the long run3. It is a change from the previous view of the emphasized the security of income by paying elderly “as a burden” to “a value” in the society. out subsistence allowance for the elderly. But Although income from children is still dominant, it is still not sufficient to maintain a high quality there is a tendency that this traditional income of life for the elderly. The government also source will decline in the future as Thai people promotes good health through the dissemination have fewer children4. Promoting longer working of health knowledge so that the elderly can life and active ageing for the elderly is an maintain good health both physically and important issue not only for income generation, mentally when they get old. but also for mental and social health reasons. Currently, the issue of employment of the 2. Measures to build residences for the elderly has gained strong interests in Thailand. elderly Research studies and seminars have promoted longer work life for the elderly in order that they This measure promotes the building of maintain the quality of living with similar standards homes designed for the elderly in order to to what they have before retirement. Active improve their quality of life and to secure home ageing would also promote psychological and ownership. Chonburi, Nakhonnayok, Chiangrai social health of the elderly. This thinking is a and Chiangmai provinces are chosen as sites for positive sign that the Thai society is aware of the new elderly residences to be built by the the ageing society and make efforts to support National Housing Authority and the Institute for the elderly. The new government measures are Community Development5. This measure will as follows: also give the first right to children who are care providers for parents. It reflects the culture of 1. Measures to employ the elderly Thai society that children are expected to look after their parents. For those elderly residing in For any organization that employs a person their original homes, they will not require a new aged 60 years and above, the salary paid to the place of residence. But there is a tendency that elderly can be tax-deducted at a high rate (when they will be living alone or will be living with a salary of the elderly is not more than 15,000 10 Outstanding Situations 133

their spouse in the future. This measure will thus 4. Integration of the pension systems include the improvement of original homes of the elderly to suit them, rather than moving This measure supports compulsory savings them to the elderly residence complex. in order to create income security when one gets old. A survey of the savings of the elderly10 3. Reversed Mortgage for the elderly found that the Thai elderly have a very low level of savings; 65 percent of persons aged 60 Home mortgage means a long term loan years and above do not have any savings at all. from a financial institution or bank to purchase It means that Thai elderly do not have any or build a residence, whereby that residence is income security after their retirement, especially used as a collateral for mortgage to the bank or those in the informal labor sector, or those who the financial institution6. This particular measure, do not belong to any provident fund. however, is to provide a loan to the elderly aged 60 years and above who already have a residence This measure requires the set-up of a that is free from any debt, so that the elderly national committee on the provident fund can use this residence to generate an allowance, under the chairmanship of the Prime Minister. It where the amount of the loan will depend upon is tasked to set a policy and direction to develop the age of the person, the value of the house the national provident fund that is to be and the interest rates. The elderly can choose to “compulsory provident fund” that covers receive payment as a lump sum or in installments private sector employees, temporary employees until their death or until the end of the loan of the government, government staff and state contract. On their death, their residences will enterprise employees aged 15-60 years, who are be owned by the bank7. The person taking out not members of any previous provident fund. the reverse mortgage does not have to prove The money to support this will come from two their income, nor do they have to undergo a sources: the employees and the employers. The health check-up. Only the house and land that employee will receive a pension in a lump sum is free from debt is sufficient for the scheme. or monthly basis when they reach 60 years of This measure is already in use in the United age, so that they will have a sufficient income States and South Korea8. In Thailand, some after retirement. It requires that the fund be banks have agreed to join the government open for membership in the year 2018 onwards. scheme such as the Government Savings Bank9. Employees and employers will each contribute This measure aims to help the elderly who are to the fund at 3% percent of the salary, but not not civil servant pensioners, and those who do more than 1,800 baht a month, and gradually not have sufficient savings, or children to care the rate will increase to 10% in the tenth year. for them. The number of elderly in this group But employees with a salary of less than 10,000 shows a tendency to increase every year. baht do not have to contribute to the fund, whereas the employer will have to make contribution still11. 134 Thai Health 2017

The survey on the informal labor sector of The step forward the National Statistical Office 201512 found that The acknowledgement of the rapid there were 38.3 million persons employed in Thailand, of which 16.9 million were in the increase of older persons by the government formal sector (41.1%), and 21.4 million (55.9%) and various stakeholders has led to the were in the informal sector. Of the 16.9 million implementation of four measures to help the persons in the formal sector, a high proportion elderly. These measures will help the elderly was not members of any provident fund. They to have more security in their income and include employees in the private sector, to secure income savings for their retirement. temporary employees in the government sector, Moreover, it will also reduce the burden of care government and state enterprise staff. This of the elderly by the government and society measure will help to increase savings of informal as they will be able to take care of themselves labour after retirement by up to 50% from the better. Importantly, the elderly should be current number of 19%. It will also urge labor viewed as an active agent in society, and that in the formal sector to save more for their they should have a good quality of life in their retirement. It is estimated that this measure will later lives, both physically and mentally. increase the level of savings of the country by 68,000 million baht13. 10 Outstanding Situations 135

8 Thai Migration Policies: Preference for Labour Import via the MoU Channel On 23 February 2016, the Thai Cabinet approved the resolution to regulations for two major groups of foreign labor that hold the alien card (pink card), and those that hold the ID card from their country of origin, to stay and work in Thailand for two more years ending on 31 March 2018. Foreign labor in both groups must report and register with the Thai authorities, and request permission to work and obtain a foreign identity card (pink card) during 1 April- 29 July 2016. This resolution was expected to reduce irregular migrant workers in a more organized manner. This move also signaled the policy preference of direct labour imports from the country of origin via the MoU channel. Whether this policy to solve irregular labour migration will be successful or not remains to be seen. In 2016, the number of foreign labor registered totaled 1,178,678 persons, whereas it was estimated that there were more than 4 million migrant workers in the country1. The management of foreign labor focused on modifying immigration and from the past to the present employment regulations to allow foreign labor to reside and work temporarily in the country. Thai immigration policy concerning foreign From 2005 onwards, the Thai policy of foreign labor was to reduce the problem of irregular labor management has been more institution- migrant workers. Its policy in the past 20 years alized, and Thailand has collaborated with its neighboring countries by signing Memorandum 136 Thai Health 2017

of Understandings (MoUs) on legal employment accounted for 279,311 persons a steady increase of foreign labor in two aspects: from 9,877 persons in 2006, 100,000 in 2013, and over 200,000 in 2014. Nevertheless foreign One: Allowing foreign labor to reside and labor who went through the MoU process still work in the country while waiting for the proof constitutes a much smaller proportion compared of their identity with the country of origin. This with irregular labor (see Table 1). led to the issuance of temporary passports or official substitute papers for migrant workers in In addition, Thailand has allowed cross- Thailand. border employment as seen in Section 15 of the Foreign Employment Act of 2008. Two: Direct labor imports through Thai Migration Policy on foreign legal employment agencies according to labor in 2016: Great confusion in the Memorandum of Understanding on the the registration process Employment of Workers between Thailand and neighboring countries including Cambodia, The Thai Cabinet agreed to the registration Myanmar, Laos and later Vietnam. of two foreign labor groups, those with the foreign permit (pink card), and those with the In the year 2015, the number of foreign identity card provided by their country of origin, labor allowed to live and work in Thailand while from 1 April -29 July 2016. The employment waiting for identity check was approximately 1 permission will end on 31 March 2018. million persons, and those with proven identity Afterwards, these two groups must undergo numbered 989,374 persons. Meanwhile, foreign another registration and request for a new work labor who came through the MoU system permit. This policy led to the registration of 1,178,678 foreign migrant workers, despite the Table 1 Number of foreign labor of three fact that close to 3 million migrant workers were nationalities (Myanmar, Lao and Cambodia) estimated to live in Thailand2. from 2005-2015) The network on foreign labor stated that Year Proven identity MoU Channel although this policy was intended to relax employment regulations for foreign labour, but 2005 1,681 0 it might cause negative consequences for those with proven identity, because it would turn 2006 49,214 9,877 them into irregular migrant workers who needed to register and wait for another identity check. 2007 72,096 14,150 As a result, the policy will lead to a vicious cycle of irregular migration again3. 2008 71,017 17,059 Long-term policy emphasis on the MoU Channel 2009 77,914 27,447 Aung San Suu Kyi Chi, in her capacity as 2010 228,411 43,032 adviser to the President of Myanmar and Foreign Minister, made an official visit to Thailand on 2011 505,238 72,356 23-25 June 2016. During her visit, a signing 2012 733,603 93,265 2013 847,130 174,042 2014 971,461 206,168 2015 989,374 279,311 Source: Data from the Office of Foreign Labor Management: http://www.doe. go.th/alien 10 Outstanding Situations 137

ceremony on three new MoUs between changed to “ when work is 4 years completed Thailand and Myanmar took place. The MoUs foreign labor must return back to the country which emphasized the care and protection of origin for 30 days and then return back of foreign labor was seen as a positive to work” (after the completion of both MoUs development of Thailand’s policy on foreign with Myanmar Thailand developed a similar labour management. agreement with Vietnam on 23 July 2015 and with Kamphuchea on 19 December 2015 and 1. The first MoU was on cooperation i with Lao on 7 July 2016.) n foreign labor that specified the development of relationship and support in both countries 3. MoU on Border crossing between 2 that will be the basis of foreign labor skill countries. In this agreement, there is a section development, protection of foreign labor and on cross-border migration to support the special social insurance. border economic zones in Thailand. 2. The second MoU is on employment of In addition, the cabinet resolution on labor that determines a process of training for 25 October 2016 approvve the Strategy on preparation of foreign labor before they travel Management of Foreign Labor 2560-2564 that to outside by the country of origin. The country consists of a 5 areas as follows: of origin is to develop a clear employment contract, determine the role and responsibility Strategy 1- Mechanism to reduce of the private employment agency and change dependency of foreign labor the conditions of work from originally that set “foreign labor able to work in the country of Strategy 2- Control, direct and care of destination of no more than 2 years per time foreign labor for two inclusive time periods (or a total of not more than 4 years) and then to return back Strategy 3- Determining standards of before to the country of origin for 3 years before employment of foreign labor according to they can then return back to work again” international practices Strategy 4- Efficient management of foreign labor Strategy 5- Monitoring and evaluation Table 2. Foreign labor statistics, November 2016 Type/nationality Myanmar Cambodia Laos Total Nationality verified 754,037 99,030 63,025 916,09 149,485 43,502 381,966 MoU 188,979 385,829 69,489 1,178,678 21,730 1,038 49,992 Extended permit 723,360 35,632 4,408 140,550 Fishermen 27,224 6,436 - 7,032 698,142 181,102 2,674,310 Seafood Processing 100,870 Border employment 596 Total 1,795,066 Source: Foreign Workers Administration Office: November 2016 138 Thai Health 2017

Strengthening management of Obstacles in bringing in foreign foreign labour labor via the MoU Channel In addition to the MoUs, the Ministry of Though the Thai government and the Labor suggested that there should be a new Ministry of Labor have plans to increase the royal decree to regulate the employment of import of foreign labor through the MoU channel, foreign labor in 2016 to reduce irregular migrant there are still concerns to the success of this workers. This decree passed on 16 August 2016 policy. Looking at the statistics, the number has the objective of controlling the recruitment of labour import from the three neighboring and employment of foreign labor and preventing countries of Cambodia, Laos and Myanmar the illegal migration of foreign labor. This decree through the MoU channel was around 200,000 sets two major conditions for the recruitment persons, compared to the total number of of foreign labour: foreign workers at 4 million plus (see Table 1). 1. The employer who brings in foreign The main obstacles to bring in foreign labor by themselves must place insurance labor through the MoU process are the money to the authorities. complicated procedures involved, high expenses, and the long waiting period. On this issue, Dr. 2. The employment agency that has a Nuttanan Vijitaksorn, researcher attached to license must place insurance money not less Thailand Development Research Institute, than 5 million baht. commented that “the tendency for the number of foreign labor (via the MoU channel) to increase This decree made it clear that employment or decrease depends on the active implemen- expense must be paid by employers, not tation of this law. One problem is the long employees. Also, if an employment agency procedure for the national verification of violates the agreement, the insurance money prospective migrant workers. I would recommend they placed with the Department of Employment the government to develop new regulations will be given to employers. Moreover, it requires and amend certain parts of the MoU to be less that the recruitment agency and the employer complicated, to reduce expenses to be suit the be responsible for foreign labor that they bring income of the labor, to expand or set the time in to the country. These measures will protect period for the registration to be more appropriate foreign workers and employers as well as to with the types of work, and to allow workers to improve the control of employment agencies change employers”6. in Thailand4. Concerning the MoU with Vietnam, it was Also, the cabinet resolution on 26 July found that from 23 July 2015 until 31 December 2016 established 3 service centers for foreign 2015 there had been no import of foreign labor labor in Tak, Sakaew and Nongkhai provinces from Vietnam. One reason was that Thailand set to provide advice on labor laws, and the conditions that Vietnam labour can only work coordination with employers after the in two occupations of fishing and construction completion of employment contract5. This industries, whereas the demand for Vietnamese arrangement will assist foreign labor who come labour was in other occupations such as retailed in through the MoU process. sales and restaurant services. 10 Outstanding Situations 139

Another challenge to manage foreign labor Future Steps is the cross-border migration of labor in the The recent management of foreign labor special economic zones along the Thai borders. Because, illegal travel across borders can be in Thailand was not much different from the done easily, the possibility of solving illegal past as it emphasized the regularization of employment is difficult. foreign labour in the country to reduce the number of irregular migrants, coupled with the As the population structure of Thailand is encouragement of foreign labour imports becoming an aging society, the need for foreign through the MoU channel. However, the new labor is likely to increase in the long-run because royal decree which aims to better regulate of the declining Thai workforce. Dr. Thanapong labour imports and employment conditions for Podhipud’s research on “The need for foreign migrant workers should be able to improve labor in an aging society” projected that at least labour management in Thailand. However, 6.4 million foreign workers will be required in the inefficient MoU process requires the Thai 2030. But if Thailand wants to maintain stable government to negotiate with the origin GDP growth, it will need a total amount of 9.14 countries to speed up the process and reduce million foreign workers7. If the government its related expense. Thailand should try to wants to control labour import by focusing on reduce obstacles in the MoU channel in order the MนU channel only, there would be a great to increase regular migration and reduce the bottleneck in labour imports. number of irregular migrants in the future. 140 Thai Health 2017

9 Special Economic Zones: Precaution Is Better Than Cure In early November 2016, the Love Maesot Locality Network and 60 local representatives of the North filed a lawsuit with the Administrative Court in Phitsanulok province to oppose the Treasury Department’s plan to turn its land into special economic zone areas. These areas are in Maesot District of Tak province. Representatives of the local areas affected stated that they did not object to the development policy, but they demanded justice as villagers who lived in the areas should be protected, and they should be given an alternative to make a living. Sumitchai Hathasaarn, lawyer from the Before this incident, there were also Center to Protect and Revive Localities, stated moves to request the government to review its that this lawsuit arose from the announcement policy on the special economic zones in many of the head of the NCPO of 17/2015 that led to provinces. On 16 August 2016, civil society the Treasury Department’s land reclamation of groups in 13 districts of Narathiwat province met 2,183 rai to set up the special economic zone the Deputy Governor of the province and in that area. Villagers filed the lawsuit to the representatives of the southern border province Land Office, leading to the Land Office’s order administrative center region 4 in order to present to investigate property ownership of villagers. their view, to be forwarded to the Prime Later the Land Office specified that the Treasury Minister. Villagers were concerned that their Department had the rights to own the land. culture, the way of life, and identity would be However, the law allows villagers to send harmed as a result of this development. They this matter to the Administrative Court for also want to participate in the mechanism to consideration. This case is still pending the establish the special economic zone in the area. court’s decision1. This result in the declaration of 18 points to be 10 Outstanding Situations 141

submitted to the government to take into zones, resulting in the change of land use. This account the way of life of the people, natural policy was opposed by local people in many resources and the environment2. border areas as people’s participation in the decision making was non-existent. Locals The events above reflect the viewpoint of wanted the government to uphold sustainable the community in border areas towards the development by protecting fertile areas, natural policy on special economic zones. This chapter resources, and coastal areas to secure will discuss the background of the policy, their sustainable life of the people. impact, and local movements of the civil society The view of the government on the policy. Thailand’s policy on special The concept of special economic zones has economic zones the main objective of spreading development to various areas so that the prosperity will not The government under the NCPO has be concentrated only in large cities. In addition introduced a policy to set up special economic to the development of specific areas such as zones along border areas in many provinces. special economic zones, it hopes to raise the Its objective is to raise the level of economic standard of living of local people in the development, trade and investment by “linking surrounding area as well4. The policy committee economies in the ASEAN region and expand on the special economic zones has a strategy cooperation in the Greater Mekong Sub-region to: 1) develop new special economic sites in which is part of the agreement in cooperation border areas to increase benefits from the link between the Ayeyawady- Chao Phraya - Mekong with neighboring countries; 2) to support Thai Economic Cooperation Strategy (ACMECS)”3. SMEs to invest continually in the neighboring countries; 3) to manage the border area The government focuses on the properly, to solve the issue of irregular migrants development of trade and investment zones and smuggling of agricultural products from the gates to support regional linkages that will neighboring countries. arise through the special economic zones. These zones have been established by special laws In each zone, there will be different that promote, support and provide special activities depending on the potential of the area conveniences and privileges to of businesses and local need. Activities are grouped into 13 that will be of benefit to the economy. industrial categories and 62 activities such as industrial ceramic production, precious stones From 2014 onwards the government set and jewelry, and tourism industry (see Table 1). the policy to develop special economic zones Later, the government added 10 other target in many areas. The implementation of the first activities, according to the announcement of the phase began in 2015 in border areas which Policy Committee on investment 12-16/2015 on showed high potential including Tak, Srakaew, 10 January 2016 (see Table 2)5. The special Songkhla, Mukdahan and Trat provinces. The economic zone is seen as a strategy to improve second stage began in 2016 in Nongkhai, comparative advantages of the Thai economy. Narathiwat, Chiangrai, Nakhon Phanom and Kanchanaburi provinces. Section 44 of the Though the government has clearly temporary Constitution of 2014, which gave announced the plan to establish special special power to the Prime Minister, was used economic zones in 10 border provinces, but the to demarcate the area for special economic 142 Thai Health 2017

progress has been slow6. Investment is below studied both the physical and financial aspects expectation as investors are not yet fully of the projects such as architectural, engineering, confident in the project. They are concerned investment, cost-benefit issues. Management about future Thai politics after the next election. and marketing issues are also covered. In 2016, Moreover, special economic zones in many the committee began a study on the areas are troubled by protests and the land use environmental impact assessment (EIA) and issue7. carried out public forum for stakeholders and Impacts on the local community the local community. In 2015, the policy committee on the The civil society has both positive and development of special economic zones began negative views on the establishment of special a feasibility study in the first 5 zones (Tak, economic zones. Positive impacts are that Songkhla, Mukdahan, Trat and Sakaew). It people will live better lives, their children will find it easier to find jobs near homes, new Table 1: Target industries in the areas 13 Industries Tak Nara-thiwat (62 types of business) Sakaew Trat Mukdahan Songkhla Chiangrai Nongkhai Nakon Phanom Kanchanaburi 1. rAeglraicteudltuarcet,ivfiitsiheisng and ü ü ü ü ü ü ü ü ü The Board of Investment issues 2. Ceramics ü ü ü BOI Announcement No. 4/2557 and the 3. Weaving, clothing and leather ü ü ü ü ü ü ü list of targeted ü ü ü ü industries being 4. Household products üü 5. Precious stones and jewelry ü ü ü ü ü promoted in the Special Economic 6. Medical equipment üü ü ü ü Development Zones, 7. Automotive, machinery üü ü ü in accordance with and parts the Announcements üü ü ü ü of the Board of 8. Electrical and electronics üü Investment Nos. 9. Plastics üü ü ü ü 1/2558, 2/2558, 10. Pharmaceuticals ü ü ü 3/2558, 4/2558, 11. Logistics ü ü ü ü ü ü ü ü ü 5/2558. 12. Industrial parks üüüüüüüüü 13. Tourism üüüüüüüüü 10 Outstanding Situations 143

Table 2: Types of business Business Tak Sakaew Trat Mukdahan Songkhla Chiangrai Nongkhai Nakon Phanom Kanchanaburi 1. Grains and silos üüüüüüüüü 2. Ceramics 3. Weaving, clothing and leather üüüüüüüüü 4. Household equipment 5. Precious stones and jewelry üü üüüüüü 6. Medical equipment 7. Automotive, machinery and parts üüüüüüüüü 8. Electrical and electronics 9. Plastics üüüüüüüüü 10. Pharmaceuticals üüüüüüüüü üüüüüüüüü üüüüüüüüü üü üüüüüü üüüüüüüüü businesses will emerge, and skill development employ foreign labor at lower costs. 4) Migrant will improve. Moreover, business opportunities workers may replace local people due to their will increase in the areas of trade, homestays, lower labor costs, resulting in unemployment accommodation, petrol stations and infrastructure and the lack of access to resources in the local development8. area9. The movement of civil society On the other hand, negative impacts include: 1) The power and rights of local people Because the community has faced to management natural resources and the uncertainties and possible negative impacts environment will be affected, whether it is the from the special economic zones, the stakeholders ownership of land, water resource management, of both the private sector and civil society held management of forests, for example. 2) The public forum in many provinces to gather structure of the community, economy, the way opinions on the establishment of the special of life of local people, and original communities economic zones. The results from the various may be affected. 3) Economic inequalities may stages can be summarized as follows: increase as a few groups of people who owners the resources may benefit whereas local people may be just wage earners Employers may also 144 Thai Health 2017

1) Tak: There may be economic environment, logistics and public health services. inequalities in the area and between the areas In the meeting of the 8th National Health Assembly of Maesot in Thailand and Myawaddy in titled “Creating a Healthy Society in the Special Myanmar, leading to unequal in development. Economic Zone” on 22 July 2015, these issues There will be differences in laws and regulations were discussed. There are also concerns on the between the two countries, causing difficulties safety of local people from the increasing traffic, for investors and traders. As most of the western the way of life of the community, water resource part of the province is protected national forest, management,, waste accumulation, and the it is difficult to develop basic infrastructure for delivery of public health services. economic development. Conclusion 2) Sakaew: Impacts will be felt due to The policy to set up special economic differences in economic development between zones was intended to opening new economic the two areas of each country, including laws areas to connect with Thailand’s neighboring and regulations. Political uncertainties may result countries. As the ASEAN Community has in a lack of confidence for investors. Business emerged, there are opportunities to spread activities and transport that arise without efficient development to many local regions to reduce planning will complicate cross-border problems inequalities and improve the quality of life of such as illicit drugs, criminal activities, human the people. But the success of the program has trafficking, and log poaching. yet to be seen as investors still adopt the wait- and-see attitude towards the program. Local 3) Songkhla: Violence in Sadao district communities, meanwhile, are concerned on the may impact trade, investment and tourism. management of natural resources, economic inequalities, income distribution, and problems 4) Mukdahan: Industries may cause air and of crimes, drugs, traffic, and pollution. The future water pollution and affect agricultural areas and success of special economic zones is still a long the community’s food chain. Existing problems way as many issues have yet to be resolved. like drug, illegal immigration in border areas, animal poaching and human trafficking could get worse from the increasing cross-border flows10. In addition, the special economic zones have created a lot of concern at health assembly networks in many border provinces. They are concerned about issues of cross-border migration, communicable diseases, water management, 10 Outstanding Situations 145

10 AFaClhl orofnRiiccPerPorbicleems: for Thailand http://nizeetrading.com/ In 2016, the fall of rice price topped the headline news for weeks as the price of Thai rice fell to its lowest in the last few years. A major reason for this was the global market price reduction due to the oversupply of rice as many rice-growing countries increased their production to a very high level1. This was a nightmare for the Thai government as it had a direct severe impact on Thai farmers, a major population of the country. The government, the private sector and Thai society had worked together to find measures to relieve the hardship of Thai farmers, while at the same time more and more farmers adjusted themselves by selling their rice directly to consumers without passing through the middlemen to gain a higher price margin. Introduction of the world”. During 2008-2009, a global food “Rice” is one important global agricultural crisis caused the price of unhusked rice to rise. Thai farmers saw this as an opportunity to product which is consumed by most people in increase their income and began to grow more Asia. Rice is also the main food traded in Asia. rice and the rice stock grew to 19 million tons. Thailand is a major producer and exporter of When the price of rice began to fall, Thailand rice so much so that it is known as “the kitchen faced with a problem and could not export 146 Thai Health 2017

much of their rice anymore due to the global 1) In 2015 and early 2016, the country was surplus. However, the country was lucky again in affected by El Nino which caused long drought 2010-2011 when major rice exporting countries and the reduction in agricultural output. Many had a severe drought and rice production businessmen expected that the rice price would dropped. As a result, Thailand was able to export rise and began stockpiling rice. But in mid-2016, a large amount of rice and reduce its stockpile2. the El Nino effect reduced and rain began to fall Later, when rice prices became very volatile and in most of the rice-growing regions. Businessmen then came down again, Thailand introduced the thus had the accumulated stock of unhusked rice subsidy scheme, causing the stockpile of rice that was likely to increase as the new rice rice to rise to millions of tons once again. In 2014, crop was ready to be harvested. With the large Thailand was in yet caught in another price war stockpile of rice waiting to be sold, millers and of the global rice trade. Nibhon Wongthrngan, traders had the liquidity problem and could not former Chair of the Rice Millers Association of purchase the new crop. Rice prices then began Thailand, stated that Thai rice prices had been to plummet when the new harvest came out. lower than in 2013 due to the mistakes in the rice subsidy scheme, the high production cost, 2) Thailand lacks a system to forecast rice and the large production of substitute food supply based on the real data of national rice staple such as wheat and corn3. stocks of both the government and the private A Record low price in 2016 sector. The lack of accurate data led to the mistake in calculating the demand and supply Although the problem of low rice prices of rice in the country. When the exact amount has been a frequent crisis for Thailand, in 2016 is not known, some businessmen would do their Thai farmers had to experience their largest own surveys by collecting data from rice mills challenge for many years when the price of and traders. This leads to the calculation of unhusked Hom Mali rice dropped sharply from purchasing price that could be distorted from 12,090 baht per ton in September 2016 to only the real market. 10,500 baht per ton in late October. To understand Another problem—the tarnished the reasons of the price drop, one must first image of Thai rice realize that the current rice price is calculated based on the forecast of demand of consumers In addition to the low prices, the Thai rice and future supply in the coming season. Such image was also tarnished in 2016, causing its projection will form a basis of purchasing price popularity to decline in the global market. An during the harvest season4. But due to the American woman took Thai Hom Mali rice and volatility in supply and demand in 2016, there stir fried it and it caught fire and turned black. was a mistake in the calculation of rice prices She then posted this on the internet and stated during the harvest season in 2016, resulting in that there was plastic mixed with the rice, this the sharp drop in purchasing price, when the news had gone viral5, and shook the consumers’ global rice trade remained stable. The speculation confidence of Thai rice. The real facts came out of supply and demand that was so volatile can later that Hom Mali rice from Thailand was pure be explained as follows: and not contaminated. However, Thai rice had lost its credibility, and importers began imposing additional measures to check the quality of Thai rice, adding to the higher cost of Thai rice exports. 10 Outstanding Situations 147