Thailand’s success story paving the way for UHC across South and Southeast Asia - Hindustan Times
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Thailand’s success story paving the way for UHC across South and Southeast Asia

ByHindustan Times
Feb 22, 2024 08:04 AM IST

Authored by - Professor Yongyuth Yuthavong, senior advisor to the president, National Science and Technology Development Agency, Thailand.

For low-income citizens of many South and Southeast Asian countries, the prospect of an unexpected illness for themselves or a loved one can spell disaster.

Thailand (Unsplash)
Thailand (Unsplash)

The medical bills, lost wages, travel and accommodation expenses to the big city where the specialist hospital is located and the constant mental stress of asking friends, relatives and even strangers for help adds up to a vicious circle. It is a downward spiral that pushes many families over the edge and into poverty. The World Health Organization (WHO) has estimated that out-of-pocket health spending dragged 344 million people into extreme poverty in 2019, a number that has surely increased since the pandemic.

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The WHO constitution declares that health is a “fundamental right of every human being” while also defining it as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The United Nations places good health and well-being as one of the 17 Sustainable Development Goals (SDGs) goals, but it can be argued that the attainment and maintenance of good health in the global populace is key to achieving all 17 goals.

It is in this context that Thailand’s Universal Health Coverage (UHC) model, instituted in 2002 as “30 baht cures all diseases”, is such a significant step and provides for an important case study, not only in South and Southeast Asia, but the entire world. Another major achievement was the passage of the law establishing the National Health Assembly in 2007, which gave people a chance to participate in health policy formation and action.

The Thai UHC model was born out of the consolidation of various existing health coverage schemes into a unified effort. It makes comprehensive healthcare accessible to all, for little cost at the point of delivery. This covers in-patient and out-patient care, primary and secondary, and even includes high-cost specialised treatments like cancer therapy and areas that are frequently underfunded such as rehabilitation and palliative care. The model also owes its success to a good system of village health volunteers and the establishment of health centres in remote areas.

Over the past few months, I have been working with a group of other experts on a new report from the Observer Research Foundation, Health Equity and Inclusion in Action. The report looks at six countries in Africa and Asia (which didn’t include Thailand) to see how they have used technology and innovative approaches to boost health equity and inclusion, and I was part of the launch of the report at the Raisina Dialogue this Wednesday.

As I worked on the report, I thought there were some universal lessons about how Thailand has successfully implemented UHC for its people. I think these lessons would help any country planning to expand health coverage. They fall into five areas:

  • Stable financial framework: Many health system developments in high and lower-income countries are undermined by politicians switching funds into their preferred areas, or by a focus on hospitals rather than preventive care. Thailand has mostly avoided this by having a consistent funding model that does not vary despite many changes of government. The health budget has grown each year, in line with the growing health needs of an ageing population and rising costs of health service provision. This consistent and steady financing has ensured its sustainability over the years.
  • Primary healthcare focus: Thailand's UHC model places a strong emphasis on primary health care services, aiming to prevent diseases and address health issues at the community level. This proactive approach has not only improved health outcomes but has also reduced the burden on hospitals. The establishment of a robust network of community health centres and village health volunteers has played a pivotal role in reaching remote areas and marginalised populations.
  • Innovative healthcare delivery models: Thailand has embraced innovative health care delivery models to enhance efficiency and accessibility, with the help of digital and other technologies. These initiatives have not only improved patient care, but have also supported efficient management of healthcare resources.
  • Decentralisation and local empowerment: Thailand's UHC success is also attributed to its decentralised approach to healthcare management. The government has empowered local authorities and communities to make decisions that best suit their specific needs. This has led to a more responsive and adaptable healthcare system, capable of addressing regional variations in health challenges. Well-coordinated district health systems enable individuals to seek care or referral at health units close to home, avoiding the burden of having to travel to the big city for specialist treatment.
  • Strong political will and governance: Perhaps the most critical factor in Thailand's UHC success has been the unwavering political will and commitment to healthcare reforms. The government has consistently prioritised healthcare as a fundamental right, transcending political ideologies.

Thailand’s UHC has thus continued beyond the lifecycle of parties and elections, and has flourished through many different ministers and governments. This unfaltering political commitment has been complemented by strong public and civil society support.

The numbers tell a story of resounding success. A study published in the International Journal for Equity in Health has estimated that since implementing UHC, Thai citizens have seen their catastrophic expenditure drop by almost half and poverty incidence decrease six-fold.

The Thai experience is important not just regionally, but globally. Several Indian states are working in many of these areas already, and the strides India has already made through the implementation of the seminal Ayushman Bharat Digital Mission shows that the use of technology and innovation to bolster health equity and inclusion is driving the development of its health system. With Thailand as an inspiration, the world's most populous and complex nation needs to continue developing its health system and become another leader in promoting UHC across the Global South. The lives of millions depend on it.

This article is authored by Professor Yongyuth Yuthavong, senior advisor to the president, National Science and Technology Development Agency, Thailand and member, WHO Science Council.

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