UHC in support by Hi AP Thailands Experience

UHC in support by Hi. AP Thailand’s Experience Ms. Nanoot Mathurapote Head of Global Collaboration Unit National Health Commission Office, Thailand nanoot@nationalhealth. or. th 1

Presentation Points 1. Overview of UHC in Thailand 2. Health in All Policies implemented through National Health Assembly 3. Lessons learnt 2

Overview of UHC in Thailand: 3 Health Insurance Schemes Low Income Scheme – social welfare First for low income group then extended to elderly, children and disable groups CBHI – voluntary based CSMBS SHI Civil servant and their dependants Population coverage 29% 1975 42% 1980 1983 Employees in Private sector 53% 1990 71% UCS Those not covered by CSMBS and SHI 100% 2002 CSMBS = Civil Servant Medical Benefit Scheme SHI = Social Health Insurance UCS = Universal Coverage Scheme 3

Solid platform for UHC: health delivery, health workforce, medical products, health info 1942 1968 1975 1978 1980 1990 s Primary Health Care policy Scaling up District Health System Mandatory rural services 2000 s • Full coverage of health service providers (infrastructure, health professions, equipments, medicines) at district level • Gain trust from patients (MD, dentist, pharmacist, nurse) Establishment of Ministry of Public Health • Increase utilization rate District Health care facilities District Hospital 30 -120 beds cover 30 -80, 000 population Health center 3 -6 health personnel cover 2, 000 -5, 000 population 4

If you achieve UHC, Will population HEALTH be BETTER? 5

How can Hi. AP support UHC? ILLNESS Hi. AP Beyond HEALTH Promotion Prevention Root Causes of Teenage Pregnancy - Education - Teenager’s Understanding of Sex - Teenager's families - Use of drugs and alcohol - Gender inequality - Environment, society and culture Curative Rehabilitation HEALTH Focus Root Causes of Stroke - Stress - Financial and social status - Work-Life Imbalance 6

CHALLENGE OF HIAP How to make non-health policies concern health Systematically? 7

Hi. AP Practice in Thailand Vertical Structure Horizontal Structure Gov Academia National Health Commission Mechanism Law, Framework Health Charter Platform, Process Health Assembly Tool, Process Health Impact Assessment 8

National Health Assembly : Public Participation in the Policy Process Cabinet Technocrats Implementation National Health Commission Community Various channels of Implementation CSO Others National Health Assembly People as beneficiaries of public services People as policy drivers 9 Business Sector SOFT POWER HARD POWER Politicians

National Health Assembly (NHA): A year-long process Call for agenda Agenda selection by NHAOC Circulate for constituency consultation Revise document Stakeholder / constituency consultation National Health Assembly resolutions Submitted to Cabinet by Implementation National Health Commission Drafting technical background and resolution Adjusted from PPT of Dr. Churnrurtai Karnchanachitra President of 3 rd and 4 th National Health Assembly Organizing Committee 10

National Health Commission: a multi-sectoral governance mechanism • Give advices to the Cabinet on Policies and Strategies on Health • Facilitate the process of developing healthy public policy with a participatory manner Government sector Mo. PH, Mo. SD, Mo. NRE, Mo. A, Mo. Ind, Representative of Local government (4 ppl) NHC Academic/ Professional Sector Chaired by the PM Comprised 3 sectors equally Civil society elected from 13 zones ie. Medical Council, Dental Council, Nursing and Midwifery Council, Pharmacy Council, Physical Therapy Council, Medical Technology Council, Thai Traditional Medicine Council and Academic from Non-Health sector: public policy, economy, business, media, specific pop group, social development 11

National Health Commission NHA Organizing Committee NHA Resolution Follow-up and Drive Committee Subcommittee on technical matter Subcommittee on convening the meeting Subcommittee on grouping and capacity building Subcommittee on evaluation Subcommittee on Medical and Public Health (35 Resolutions ) 12 Subcommittee on Social Determinants of Health (38 Resolutions)

Example of NHA Resolutions which strengthen UHC Medical, Public Health Issues • Res 1. 2 on access to medicine • Res 1. 8 on equal access to basic health services • Res 2. 1 on long term care for dependent elderly people • Res 3. 2, 5. 10 on equal access to health services by the people living with difficulties SDH Issues • Res 1. 9 on impact of media to children and family • Res 2. 1 on hazardous waste management • Res 3. 9 on Impact from Free Trade Agreement • Res 5. 2 on impact from biomass power plant • Res 6. 2 on targets of preventing and controlling NCD • Res 5. 5 on food safety: agriculture chemicals • Res 7. 2 on development of health technology assessment and its decision making • Res 6. 4 on illegal advertisements of drugs, food and health products 1313

Provincial Health Assembly: PHA Functions: 1. 2. 3. Collectively find solutions and solve problems Organize public consultation for NHA Implement NHA resolutions that fit to the provincial setting Working Steps Step 1: PHA Organizing Committee is set up and a provincial database system on network and health situation is in place. Step 2: PHA organized Type of Secretariat of PHA Organizing Committee Government agency Research or Educational Institute Civil Society Organizaiton 14

NHA solve CHALLENG of HIAP because ü It opens a neutral platform for all sectors to participate the policy process. ü The participatory process builds understanding and trust among stakeholders. ü It motivates new champions to work for health. 15

Factors of making Hi. AP possible in Thailand ü Broaden Definition of Health Thailand redefines “health” as “wellbeing” covering physical, mental, spiritual and social aspects ü Legitimacy National Health Act in 2007 is a law specifying an multi-sectoral mechanism and tools such as NHA that builds Hi. AP. ü Responsible organization National Health Commission Office under the Office of Prime Minister plays as a policy facilitator. ü Participation Thailand calls “Triangle that moves the mountain”: government, academia and civil society 16

CONCLUSOIN Hi. AP is complementary to UHC If you want to achieve UHC, please take attention to Hi. AP. 17

NHA 10 : December 2017 Draft Programme • • Keynote speech Consultation on resolutions Progress report Side Meetings Exhibitions Cultural activities Special programme for int’l guests Participants • Constituencies (280) - MA: 77 provinces’ rep - MP: Government agencies, political parties - MK: Academia /Professions - MS: Civil Society, Community, Private Sector • Resource Persons incl. international guests • Media • People as observer 18

Thank you Please click on to www. nationalhealth. or. th for more info 19