ccs_tha_en

Thailand

WHO Country Cooperation Strategy2008-2011

, July

WHO Country Cooperation Strategy 2008-2011ii

© World Health Organization 2007

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The designations employed and the presentation of material in this publication do notimply the expression of any opinion whatsoever on the part of the Secretariat of theWorld Health Organization concerning the legal status of any country, territory, city orarea or of its authorities, or concerning the delimitation of its frontiers or boundaries.

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Contents

Preface .............................................................................................................. v

Foreword ........................................................................................................ vii

Executive Summary .......................................................................................... ix

1. Introduction ............................................................................................... 1

2. Country health and development challenges in Thailand ............................ 3

1. Economic and social development ................................................................. 3

2. Health policies ............................................................................................... 4

3. Burden of disease and the health development situation ................................ 5

3. Development assistance and partnerships:Aid flow, instruments and coordination ..................................................... 17

1. Partnership with UN and other international development agencies ............. 17

2. Partnership with developing countries .......................................................... 19

3. Technical cooperation with other countries .................................................. 19

4. WHO Collaborating Network ....................................................................... 20

4. Current WHO cooperation ....................................................................... 21

1. Work of the WHO Country Office encompasses .......................................... 21

2. Focus of WHO’s collaboration with Thailand ............................................... 21

3. Funding of WHO collaborative programmes. ............................................... 22

4. Fellowships .................................................................................................. 22

5. Regional Sub-units ....................................................................................... 23

6. Staffing ........................................................................................................ 23

7. Office premises ............................................................................................ 24

8. Information and communication technology ................................................ 24

9. Use of CCS .................................................................................................. 24

WHO Country Cooperation Strategy 2008-2011iv

5. WHO policy framework – Global and regional directions ......................... 25

1. Global challenges in health .......................................................................... 25

2. Global health agenda ................................................................................... 26

3. Regional policy framework ........................................................................... 27

6. Strategic agenda: Priorities jointly agreed for WHO cooperationin and with countries ................................................................................ 28

1. Principles ..................................................................................................... 28

2. Strategic agenda .......................................................................................... 28

3. Modalities of implementation: ..................................................................... 32

7. Implementing the strategic agenda: Implication forWHO Secretariat, follow-up and next step at each level ........................... 34

1. Introduction................................................................................................. 34

2. Staffing: Current and future .......................................................................... 34

3. Financial allocation ...................................................................................... 35

4. Information and communication support ..................................................... 35

5. Implementation of the strategic agenda ........................................................ 35

Annexes

1. National health development data ............................................................... 37

2. Strategic objectives and their scope under MTSP 2008-2013 ....................... 38

3. MoPH budget in present value and real terms .............................................. 43

4. Health budget allocation for major types of programmes duringthe first half of the Ninth National Health Development Plan ....................... 44

5. Thailand’s scorecard on MDG Targets (Goal 1-7) .......................................... 45

6. Organogram – Ministry of Public Health ....................................................... 46

7. Morbidity rates of hospitalized cases (per 100 000 population)due to selected NCDs, injuries and mental illness Thailand(excluding Bangkok), 2001–2004 ................................................................. 47

8. Organogram WHO Country Office Thailand ................................................ 48

9. References ................................................................................................... 49

Thailand v

Collaborative activities of the World Health Organization (WHO) in the South-EastAsia (SEA) Region are geared to improve the health status of the population of MemberStates. Although WHO has been contributing as a key catalyst to Thailand’s healthpolicies and programmes, there is a need to thoroughly analyze and discuss how theOrganization can further improve its contribution to the development of health inThailand.

The South-East Asia Region was the first among WHO’s Regions to promote theCountry Cooperation Strategy (CCS) as a process to identify how the Organization canbest support health development in our Member States. All 11 Member States of theRegion have prepared their CCSs over the past six years. In the case of Thailand, twoCCSs have already been prepared and have been used continuously as guidelines forthe WHO Country Office (WCO) to plan and coordinate work effectively with theirnational as well as international counterparts for health development in the country.

Analyses of the current health situation and the likely scenario over the next fouryears have together formed the basis of the priorities outlined in this CCS. The inputsand suggestions from the Ministry of Public Health, whose officials have been themajor collaborators in developing this document, are appreciated. In addition, theadvice and recommendations of the health development partners in Thailand and theUnited Nations Partnership Framework (UNPAF) 2007-2011, of which the WHOCountry Office is also a signatory, were invaluable in guiding the development of thisCCS. The consultative process here will help ensure that WHO inputs provide themaximum support to health development efforts in the country.

To help achieve the objectives of this CCS and to promote technical assistancefrom Thailand to other Member countries, we recognize the importance of a strongWHO Country Office working closely with key counterparts, keeping in mind localconditions. Nonetheless, the entire organization is committed to the work of the CCS.The staff of the WHO Regional Office will use this CCS to determine regional prioritiesand support collaborative activities in Thailand. Furthermore, we will also seek assistance,as necessary, from WHO Headquarters towards bolstering these efforts.

I would like to thank the Ministry of Public Health and Faculty of Tropical Medicine,Mahidol University, Bangkok for providing office space for the regional-level units,Communicable Disease Surveillance and Response Sub-unit and the Malaria MekongSub-unit.

Preface

WHO Country Cooperation Strategy 2008-2011vi

I would like also to specially thank all those who have contributed to developmentof this Country Cooperation Strategy, which has the full commitment of the RegionalOffice. We will provide our maximum support towards achieving its objectives overthe next four years. Our joint efforts, I am confident, will help in achieving the maximumhealth benefits for the people of Thailand.

Samlee Plianbangchang, M.D., Dr.P.H.Regional Director

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Thailand is one of the countries in the South-East Asia Region that have an advancedhealth infrastructure, a robust surveillance system and public health professionals witha high degree of expertise. The country has demonstrated excellence and expertise inmany areas of public health, medical specialities and nursing. Thailand has also achievedmany of the Millennium Development Goals (MDGs).

The WHO Country Office (WCO) is in a unique position to have national expertsin both long-term and short-term positions who can contribute to the work of theOrganization in Thailand. The Country Office also facilitates training programmes forFellows from neighbouring countries and other Member countries of the Region, forcapacity building.

Even with such remarkable progress, communicable diseases such as HIV/AIDS,tuberculosis (TB) and avian influenza (AI) continue to have a negative impact on thecountry, with certain situations exacerbated by the prevalent circumstances alongThailand’s borders. Health promotion efforts and control measures for NCDs are welladvanced in terms of both legislation and intervention. The WCO provides the necessarysupport to enhance these efforts.

The purpose of this Country Cooperation Strategy (CCS) is to reflect the medium-term vision of WHO for its cooperation with Thailand and to elucidate the strategicframework for such cooperation. The CCS represents a balance between evidence-based country priorities and organization-wide strategic priorities in order to contributeoptimally to national health development.

It is very timely for WCO Thailand to prepare the new CCS covering the period2008-2011, since the current Strategy will end in 2007. The WHO Medium-TermStrategic Plan (MTSP) 2008-2013 is being prepared and a new planning approach hasbeen introduced. The priorities and strategic framework are based on: (1) Nationaland international partners’ recommendations; (2) The national health developmentsituation, and (3) Strategic objectives of WHO and the Regional Office for South-EastAsia under the MTSP. Overall, the priorities and strategic framework presented in thisCCS are consistent with WHO’s strategic objectives in meeting Thailand’s needs.

We hope that this CCS shall be disseminated and used by national and internationalpartners in health for better cooperation and collaboration in planning and implementingrelevant activities to enhance the health and well-being of the people of Thailand.

P.T. Jayawickramarajah, M.D., M.Ed., Ph.DWHO Representative to Thailand

Foreword

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Thailand ix

Executive Summary

Since the current Country Cooperation Strategy (CCS) will end in 2007, the preparationof a new CCS is timely to cover the period of 2008-2011. In the context of a new CCS,it is relevant to list the following important related documents that are being or havebeen prepared for the corresponding period: (a) The 10th National Health DevelopmentPlan, 2007-2011; (b) The WHO six-year Medium Term Strategic Plan (MTSP), 2008-2013, which serves as an outline of WHO’s strategic objectives and (c) The UnitedNations Partnership Framework, Thailand (UNPAF 2007-2011), of which the WHOCountry Office is also a signatory.

Thailand is a developing country that has registered impressive successes in botheconomic and social development, though all regions of the country have not registeredthe same degree of advancement. The country also has a long and successful history ofhealth development. The Ninth Five-Year National Health Development Plan, 2001-2006, has just been completed, and the Tenth Plan is in the final stages of completion.The basic principles of these plans are based on a people-centered approach andphilosophy of “sufficiency economy.” The Thailand Human Development Index hasimproved, inexorably aided by major contributions from the robust health indicators.Almost all MDGs relating to maternal and child mortality have been achieved.

Although considerable progress and achievement has been registered, Thailandstill faces several challenges with the health situation and health development. Someof the major challenges to advancement of health development are as follows:

(1) Important communicable diseases remain key public health concerns inThailand. These include malaria, dengue haemorrhagic fever, HIV/AIDS, TBand emerging diseases, particularly avian influenza. The coordination of thedisease surveillance and epidemic response, and the efficiency of DOTS atthe peripheral level still leave room for improvement.

(2) Morbidity and mortality of major non-communicable diseases such as injuriesand mental illnesses show a rising trend. The country requires clear andwell-defined national multi-sectoral coordination policies and strategies forthe effective prevention and control of these diseases.

(3) Environmental pollution and contamination of food by hazardous substancesare still important public health issues. Occupational safety standards andthe permissible levels of hazardous substances are yet to be enumerated.

(4) Thailand has increasingly become prone to natural disasters. Although thegovernment is relatively self-reliant in disaster relief, WHO and the UN DisasterManagement Team have important roles to play to support the country in

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assessing the health situation and needs as well as coordinating joint actionfor health.

(5) Cross-border health risks have become important health and political issuesover the past few years. These risks include the spread of communicablediseases and drug-resistant pathogens, and also national security. There aremany players involved in the improvement of the living conditions and healthof migrants and refugees along the border of Thailand. Better coordinationamong all involved is needed.

(6) Thailand has accorded high priority to health promotion, as is clearly reflectedin the Ninth and Tenth National Health Development Plans. The Ministry ofPublic Health (MoPH) has initiated many programme and project approaches.The Thailand Health Promotion Foundation plays an important role infinancing and advocating health promotion. However, the country’s mainchallenge lies in establishing firm levels of collaboration with sectors outsideof the Ministry of Public Health.

(7) The most recent phase of health systems reform began in 2000. Several officesand institutes were established to strengthen health systems developmentand enable the reform process. For example, the National Health SystemsResearch Institute (HSRI) established the Health Systems Reform Office tofunction as the secretariat for the National Health Systems Reform Committeeto guide health systems development. The International Health PolicyProgramme (IHPP) was established to develop and strengthen nationalcapacity in health policy research and international health. The NationalHealth Security Office (NHSO) was established in 2003 to expand coverageof health insurance/security for those citizens who have not as yet beencovered by any government insurance scheme.

The national health budget has gradually increased from 5.8% of the totalgovernment outlay in 1993 to 7.6% in 2004. About 60% of all health expenditurecomes from government sources compared with 40% from private sources. In 2001the government introduced the Universal Health Care (UC) policy (the “30-Bahtscheme”). In April the next year, the government announced universal health carecoverage and in 2007 universal coverage without pay was introduced. In 2004, theUC scheme represented 75.2% of the total health insurance schemes that covered apopulation of about 47 million. There are still issues concerning the quality of services,sustainability of the schemes, and the resignation of physicians from public service thatneed to be addressed.

Thailand is gradually becoming a development partner, like other middle-incomecountries, by assisting other developing countries. Therefore, in terms of developmentalassistance, Thailand has received mostly technical support, but only limited financialsupport, from donor agencies and countries. In relation to partnerships with developing

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countries, Thailand is active in a number of regional and sub-regional cooperativeinitiatives in many sectors including health.

The work of WHO with Thailand is based on the WHO-Country CollaborativeProgramme, which is developed on a biennial basis. The WCO focuses overall onsupporting policy development, advocacy, technical advice, and the development ofnorms, standards and guidelines. In addition to the WCO, there are two WHO sub-regional units in Thailand: a) Mekong Malaria Control Project (MMP) that was establishedfor coordinating malaria control activities in the countries of the Mekong Basin thatinvolves two WHO Regions and for coordinating border health activities, and b)Communicable Disease Surveillance and Response (CSR) regional sub-unit that wasestablished to support countries to strengthen capacities in areas of epidemiology,disease surveillance and epidemic response. The WCO has National ProfessionalOfficers (NPO) who work in programme planning, monitoring and evaluation, HIV/AIDS-Tuberculosis, communicable disease control and tobacco control. All otherinternational technical staff are assigned to work for the above two sub-units.

WHO has established a clear Global and Regional Framework, under the TenthGeneral Programme of Work (GPW) and the Medium Term Strategic Plan (MTSP), andall the offices will work to perform six core functions of WHO.

Based on the above situation analysis and extensive consultations, the followingseven strategic agendas have been identified as priorities for the next four years:

(1) To enhance primary prevention, surveillance and control of communicablediseases and epidemics;

(2) To integrate measures to reduce the risks of non-communicable diseases(NCDs), injuries and mental illnesses;

(3) To build capacity and partnerships for health promotion and healthy publicpolicy;

(4) To strengthen capacity for monitoring and evaluating health systemsdevelopment;

(5) To initiate a multi-sectoral approach to address health services for the poorand at-risk population, including those in border and conflict areas;

(6) To promote environmental health and surveillance of environmental hazards;

(7) To strengthen the development of human resources for health through existingnetworks within and outside the country.

WHO Country Cooperation Strategy 2008-2011viii

Thailand 1

Thailand is one of the countries that has already formulated two Country CooperationStrategy (CCS)* reports. The first covered the period of 2002–2005, and it was laterupdated in 2004 for 2004–2007. As one of the fundamental principles of the CCS, thestrategic agendas identified in these documents have been used as a basis for theWHO country collaborative programmes and for the Organization’s operations in thecountry.

The CCSs were developed in close consultation with the national authorities fromwithin and outside the Ministry of Public Health (MoPH). Consultations were heldwith most UN Agencies and other partners who are active in the health sector. As thecurrent CCS will end in 2007, it is timely to formulate a new CCS for the followingreasons:

(1) The Royal Thai Government (RTG) has drafted its Tenth National HealthDevelopment Plan (2007–2011) which outlines its strategies and prioritiesbased on the vision of “sufficiency economy”. This will allow WHO to alignits medium-term strategies, including the planning cycle, with the strategiesand priorities of the RTG.

(2) The six-year WHO Medium-Term Strategic Plan (MTSP) based on WHO’sEleventh General Programme of Work (GPW) 2006–2015 outlines theOrganization’s global strategies covering the period 2008–2013. This exercisecan take into account the latest WHO long- and medium-term strategiesand priorities while identifying the Organization’s strategic agenda for itstechnical cooperation with the RTG for the period 2008–2011. This will alsohelp RTG respond, in a flexible and dynamic manner, to a changinginternational health environment.

(3) The United Nations Development Assistance Framework (UNDAF), which isreferred to in Thailand as the United Nations Partnership Framework (UNPAF),covering the period 2007–2011, has just been developed and fully aligned

Introduction

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*The CCS reflects a medium-term vision of WHO for its work with a given country and defines a strategic agendafor working with that country. The timeframe is four to six years but may be less for countries in crisis. The CCSis the WHO instrument used to aligning with the national agenda while harmonizing with the functions of otherorganizations in the UN system and other agencies in the country.

WHO Country Cooperation Strategy 2008-20112

with the national priorities. WHO, as agreed in the Paris Declaration, followsthe principles for alignment and harmonization of its strategies andprogrammes with that of the United Nations system and other developmentpartners working in the area of health. Although the WHO Country Office,Thailand did not have a distinctive role to play in the poverty reductionstrategy of UNDAF, the strategy was considered a core value and anoverlapping element that has to be integrated into WHO’s strategic objectives.

Taking advantage of the opportunities stated above and in accordance with theagreements with the national authorities, it was decided to formulate the CCS in Thailandfor WHO’s cooperation with RTG over the period of 2008-2011.

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1. Economic and social developmentIn terms of social and economic development, Thailand has achieved outstandingprogress over the last few decades to emerge a middle-income country. Per capitaincome in terms of Purchasing Power Parity (PPP) in 2005 was (Intl. $) 8440. Thailandhas a Human Development Index (HDI) of 0.784, which increased from 0.615 in1975. The number of people living below the poverty line was reduced by almost two-thirds between 1990 and 2002. The reach of education has also increased, with almostall children attending primary school and enrolment in secondary schools rising everyyear. Aided by high levels of attendance in schools, the literary rate is currently 92.6%1.

Despite this impressive progress, the fruits of development have not reached allregions of the country in equal measure. While the Bangkok Metropolitan Area in2002 had less than 2% of its population living in poverty, the incidence of poverty wasas high as 16% in the north, 17% in the north-east, and 8% in the south of the country.Poverty rates in Narathiwat and Pattani, two of the southern-most provinces, were18% and 23%, respectively2. Furthermore, drawn by Thailand’s economic wealth andstability in comparison with some of its neighbours, many migrants arrived in search ofemployment and a living. These migrants do not always have full access to socialservices such as health care and those not registered are often vulnerable to exploitation.

The Tenth National Health Development Plan, currently in draft form, coveringthe period 2007–2011 will follow the vision and philosophy of the Ninth Plan. Thisnew plan focuses on three areas for strengthening and developing the national capitalformation: (a) economic capital, (b) social capital, and (c) natural resources and theenvironment. Health falls under social capital, and the health sector is considered tobe a new wave in Thailand’s competitive surge in the context of global tradeliberalization. While the Ninth Plan has emphasized a life-cycle health approach,promoting healthy lifestyles, improving the quality of health care, disease preventionand control, and preparing for the need of an ageing population, the Tenth Planemphasizes public and national self-reliance in health.

In the past, government administration and services had been largely centralized.However, decentralization is now an accepted political objective and is gradually beingimplemented. Efforts are already on to decentralize public services, including health,to the 76 provinces and 876 districts, including Bangkok. This will require substantialefforts to build capacity at the local level.

Country health and developmentchallenges

2


2. Health policiesThailand has had a long history of health development going back to the 13th Century.More recently, the First (five-year) National Health Development Plan was initiated in1961, and subsequent plans continued through the Ninth Plan, which covered theperiod 2001–2006. There has been continuous change in and evolution of healthpolicies in response to the country’s social and health problems and in line withinternational developments in health. At the end of the Seventh Plan and throughoutthe Eighth Plan, WHO introduced a Health Future Studies approach to the Ministry ofPublic Health. Consequently, since 1999 public sector reform, including health, hasbeen part of the government’s agenda.

The Ninth Plan provided a clear vision of a people-centered approach and thephilosophy of a “sufficiency economy”. Its objectives were to: (a) promote health andprevent and control diseases; (b) establish health security; (c) build capacity in healthpromotion and health system management; and (d) establish measures in generatingknowledge through research. In 2003 “Healthy Thailand” was adopted as a nationalagenda to be used as guidance to reducing behavioural risks and to solve major healthproblems in pursuing the target Millennium Development Goals (MDGs) by 2015.

While continuing with the philosophy of “sufficiency economy,” the Tenth NationalHealth Development Plan places more emphasis on national self-reliance, quality ofservices, people’s values and dignity. Its objectives are as follows:

• Develop uniformity and good governance in the management of healthsystems.

• Accelerate the pro-active health promotion approach to develop basicelements for good health.

• Develop a health culture and ways of life with sufficiency and happiness.

• Develop community health systems and a strong primary care service network.

• Develop a health service system that will lead to both health care receivers’and health care providers’ satisfaction.

• Develop health security systems with equitability, good quality, and betterdistribution.

• Develop individuals’ immune systems and readiness to minimize the impactfrom diseases and risks to health.

• Develop several alternative healthcare services, integrating the respectivestrengths of Thai and international approaches.

• Develop a foundation of health knowledge through knowledge management.

• Develop societies that do not neglect sufferers and that care for the poor anddisadvantaged people with due respect for their values and human dignity.

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In September 2006, political developments led to the establishment of an interimgovernment in Thailand. The health minister subsequently announced health policiesthat are in line with the Tenth National Health Development Plan. On account of theproblems that were encountered in implementing the 30-Baht health-care scheme,universal coverage without fees was initiated. In general, health systems reform andhealth security, especially social health insurance, will continue to be an importantpart of the health development agenda in Thailand for the next four to five years.

3. Burden of disease and the health development situationAlong with Thailand’s impressive economic development, the government hasdeveloped an effective public health system to improve the health of its population.Since 1989, Thailand’s Infant Mortality Ratio (IMR) has improved from 38 per 1000live births in 1990 to 19.8 in 20053. According to the Millennium Development GoalsReport 2004, the maternal mortality rate, a good indicator of the effectiveness of apublic health system, has decreased from 36.2 per 100,000 live births in 1990 to 14 in2002, with about 98% of births having been attended by skilled health personnel.Thailand’s progress with the MDGs (Annex 5) has been so impressive that the countryhas adopted targets beyond those in the MDGs, which are known as the MDG-Plustargets. However, despite the progress made with the MDGs, challenges still remain inthose regions with a high number living in poverty and among migrant populations,particularly in the border areas.

Thailand is witnessing a series of both demographic and epidemiologic transitions.The total fertility rate (TFR) has dropped from 2.41 in 1990 to 1.6 in 2006 with anaverage population growth rate of 0.7% in 2004-152. With the reduction incommunicable diseases, improved nutritional status, and the provision for skilled birthcare, the pattern of morbidity and mortality has gradually veered towards non-communicable Diseases (NCDs), injuries and mental illness.

3.1 Communicable diseases

While progress has been made in the reduction of communicable diseases, somesignificant problems remain. These will be the focus of efforts during the next fouryears, as enumerated below:

(a) HIV/AIDS: In 1991, the number of new HIV infections reached 143,000,indicating that Thailand was on the brink of a major health crisis. TheGovernment, working with NGOs, mobilized effective interventions toincrease general awareness on HIV and thereby reduced the transmission ofHIV appreciably. With the number of new infections at 19,000 per annumin 2004, Thailand is one of the few countries to make substantial progress infighting AIDS. Currently, of the estimated 500,000 people who are livingwith AIDS, anti-retroviral drugs (ARVs) are being provided to about 100,000of them who urgently need such treatment. With the government committalsince October 2003 to the policy of universal access to anti-retroviral drugs


for AIDS patients. But with the possibility of limited funds for the same, theauthorities, in March 2007 applied compulsory licensing measures to producetwo low-price, generic HIV/AIDS drugs. Over the past three years there hasbeen growing concern regarding the increasing incidence of HIV/AIDS amongadolescents, almost consistent with an increasing incidence of sexuallytransmitted infections (STIs).

(b) Tuberculosis: Thailand ranks 17th of the 22 global high-burden countries fortuberculosis4. The DOTS (Directly Observed Treatment, Strategy) still requiresstrengthening to ensure higher case detection and treatment success rates.

In 2004, the country achieved the 70% case detection target. However, thetreatment success rate achieved was 74% which is significantly lower thanthe target of 85%. There is a need to strengthen TB programme managementand capacity to guide and oversee the implementation of TB services underthe decentralized health system. The lack of coordination between variousstakeholders including provincial administrations poses constraints to theprogramme. Inadequate treatment supervision and sub-optimal drugprocurement and supply management need to be addressed. The emergenceof multi-drug resistance and a high HIV prevalence among TB patients, the issue ofTB among migrants both internal and in the border areas, are other major concerns.

The WHO estimates for tuberculosis incidence and mortality rates in Thailandin 2005 were 142 and 19 per 100,000 population4 respectively. These ratesare about three and 80-fold higher respectively than those reported underthe routine surveillance system, Bureau of Epidemiology5. However, thesurveillance report has been used for monitoring the disease trends ratherthan the actual disease burden (Figure 1).

Figure 1: Morbidity and mortality of pulmonary turberculosis, Thailand, 1996-2005

Source: Bureau of Epidemiology (Surveillance Data)

Thailand 7

(c) Vector-borne diseases: The countrywide incidence of malaria has beendecreasing but problems remain in border areas, both in terms of number ofcases and drug resistance. To ensure that the disease will be controlledcompletely, malaria is likely to remain a vertical programme before fullintegration into the routine health services. While the country has beensuccessful in case management of dengue haemorrhagic fever (DHF) and inreducing its case fatality rate to less than 1%, disease morbidity is still highwith an increasing incidence among adults. The main strategies of diseasecontrol have been focused on eliminating vector breeding places byschoolchildren and on improving the environment using a “healthy setting”approach. Long-term results are yet to happen. It should be noted that malaria,DHF and outbreaks of some other communicable diseases often increaseafter natural disasters.

(d) Epidemic preparedness and response: In 2003 there were nine reported casesof Severe Acute Respiratory Syndrome (SARS) and two deaths due to it inThailand. Following reports of human avian influenza (AI) in China andVietnam in 2003, Thailand reported confirmed AI outbreaks and deaths inpoultry in July 2004. The first confirmed human case of AI in Thailand occurredin August 2004 and by the end of November 2006 25 AI cases and 17deaths in humans were reported. In response to this, the Governmentestablished a multi-sectoral National Committee for Avian Influenza Control,comprising representatives from the ministries of Public Health, Agriculture,Natural Resources and Environment, the Institute of Animal Health, theBangkok Metropolitan Administration and WHO. However, it is still achallenge to extend this coordination to the sub-national level because thereis no standard policy and decentralization is still in a transitional phase.

(e) Surveillance: Outbreaks of communicable diseases can be prevented if casesare detected early as well as the related risk factors and effective actionimmediately taken. The performance and quality of disease surveillance inthe provincial health offices and public health laboratory services in provincialhospitals are not adequate yet. This may adversely affect the timeliness andeffectiveness of responses to epidemics. Health personnel also have to betrained in risk communication so that families and communities will knowhow to avoid high-risk behaviour related to the outbreaks or epidemics.Efforts to strengthen surveillance systems are also needed to support theimplementation of the new and revised International Health Regulations (IHR)2005 being implemented since June 2007. The disease surveillance systemand capacity building for epidemiology are the responsibility of the Bureauof Epidemiology, which has since long been recognized globally as one of afew successful centres for FETP (Field Epidemiology Training Programme).The short-course FETP may be considered in tandem with the existing two-year course to address the increased requirements.


3.2 Maternal, child and adolescent health

While Thailand has already achieved MDG targets for child and maternal mortality onU5MR and MMR (Annex 5), Maternal and Child Health (MCH) and reproductivehealth services still need strengthening for poor households and in underserved regions.Micronutrient deficiencies, especially of iron and iodine, remain and are often associatedwith increased morbidity and retarded mental growth. Special attention is required foradolescent health since this group is susceptible to sexually transmitted diseases suchas HIV. There are separate programmes for MCH, reproductive health and adolescenthealth, while target populations are the same or overlap. School health programmesalso need strengthening to support better health practices and health services need tobe adjusted to provide effective services to adolescents.

3.3 Noncommunicable diseases, injuries, and mental health

The burden of disease in Thailand is gradually shifting to noncommunicable diseases,injuries and mental health. The greatest public health benefits are gained throughprevention of NCD (cardiovascular diseases, cancers and diabetes mellitus in particular),injuries and mental health disorders. This can be achieved if the risk factors are identifiedand appropriate interventions implemented to reduce or avoid these risk factors. Inaddition, if NCDs and mental illnesses are detected at an early stage and appropriatecontrols initiated, the severity of these can be reduced. It should be noted here thatthe burden of noncommunicable diseases usually falls disproportionately on the poorwho often have excess exposure to risk factors and limited access to health services.Diseases such as diabetes, cancers and of the heart are often not detected till at anadvanced level.

Aware of the increasing trends of NCDs and injuries, the RTG has placed highpriority on prevention and control initiatives. The Bureau of Noncommunicable Diseasesis responsible for NCDs, injury prevention, and tobacco and alcohol controlprogrammes. The Bureau has made appreciable progress in monitoring the burden ofNCDs and injuries and identifying major behavioural risk factors classified by theirprovinces. The Bureau also plans to improve the collection and analysis of NCD andinjury mortality and morbidity data in order to monitor trends and evaluate the successof interventions for risk factors. Due to the unreliability of incidence data for selectedNCDs, injuries and mental illnesses among the population, cases of hospitalizationwith more accurate diagnosis are presented to ascertain the trends in the burden ofdisease depicted in Figure 2 and in Annex 7.

Since the NCD and injury prevention and control programmes emphasize thepublic health and primary care approaches (rather than secondary and tertiarytreatment), effective multi-sectoral collaboration is required. Clearly, traffic injuryprevention and tobacco and alcohol control programmes cannot be implemented bythe health sector alone. The RTG has demonstrated a strong commitment to the control

Thailand 9

of tobacco use and alcohol consumption by drafting legislations, particularly in thearea of advertisement. However, the major challenge ahead remains how to effectivelyreduce risk behaviour (smoking and alcohol consumption) and increase regular exerciseand healthy diet.

The Department of Mental Health, Ministry of Public Health (MoPH), is in theprocess of developing National Strategies on Mental Health, based on the Tenth NationalHealth Development Plan. To ensure the success of implementation, advocacy andmulti-sectoral collaboration are required to address the root of social problems thatare considered to be the major causes of mental illness.

3.4 Environmental health and food safety

After several reorganizations in the government, the main responsibilities for watersupply and sanitation and pollution control services have been transferred from theMinistry of Public Health to the Ministry of Natural Resources and Environment. TheBureau of Environmental Health limits its responsibilities to providing technical supportand capacity building, especially to local organizations. The healthy settings approachis used to promote healthy cities with clean public toilets and healthy markets, schoolsand hospitals. The Bureau is currently developing a National Environmental HealthAction Plan (NEHAP). The Health Impact Assessment (HIA) is an important tool tominimize the adverse environmental influences on health. More support is needed toimprove national capacity for conducting HIAs. Future environmental challenges includeclimate change, increasing urbanization, and the danger posed by hazardous waste

Figure 2: Morbidity rates of selected diseases/conditions in Thailand(excluding Bangkok) 2001-2004

Source: Bureau of Policy and Strategy


and chemicals, including exposure to heavy metals in the environment. Thesecontaminants, from industrial or natural sources, include asbestos, cadmium, arsenicand lead. Standards have yet to be set for permissible levels of hazardous chemicals infood, water and the environment, and surveillance of violations should be strictlyenforced.

Although occupational health has been a prime concern for Thailand for morethan 30 years, accidents and diseases caused by the workplace environment are onthe rise. Besides accidents, the most common reports of occupational health incidentsare pesticide poisoning, skin disease due to exposure to chemicals, back pain, leadpoisoning and silicosis. The government response to these problems is rather passive,and largely confined to providing medical care or financial compensation to the victims.Effective prevention of occupational hazards is still limited. Systems to report alloccupational health events need to be established and strengthened. Occupationalsafety standards should be established and inspections undertaken to ensure compliance.

The promotion of food safety is one of the government’s priorities under theHealthy Thailand campaign. Food should be safe for domestic consumption as well asfor export. The government currently assigns responsibility to several agencies. In theMinistry of Public Health these include the Food and Drug Agency, the Bureau ofHealth Promotion, and the Bureau of Environmental Health. In the Ministry ofAgriculture, the agencies concerned are the National Bureau of Agriculture Commoditiesand Food Standards, the Department of Livestock Development, and the Departmentof Fisheries. Good coordination and collaboration among these concerned agenciesneeds to be strengthened.

3.5 Emergencies

Thailand is prone to natural disasters, a fact demonstrated most tragically by the devastatingtsunami in December 2004 that struck the southern provinces of the country. The countrywas affected again by heavy floods during August and September 2006, which hit 47central and southern provinces and forest fire in the Northern Region in 2007. The RoyalGovernment of Thailand is self-reliant in disaster relief operations. WHO and the UNDisaster Management Team have however, supported the country in assessing the healthsituation and needs as well as in coordinating joint action for health.

3.6 Cross-border health risks

Thailand shares borders with the Union of Myanmar, the Lao People’s DemocraticRepublic, the Kingdom of Cambodia and Malaysia. However, border health concernsare mainly located along the Thailand-Myanmar border and within the Mekong Basinwhich spans the frontiers with Lao PDR and Cambodia. In the ten provinces of Thailandthat border Myanmar there are 401 000 registered migrants, about 117,000 registered

Thailand 11

in the camps, and an estimated 300 000 to 500 000 people who are not registeredcitizens. Malaria is a particular concern in the provinces bordering Myanmar becausethey account for nearly 70% of the disease burden in Thailand. On account of thefrequent and unregulated movement of migrants and their varying access to healthservices, drug resistance to malaria and tuberculosis are a major concern. This is moreso since these migrants can potentially spread resistant strains to people in other partsof the country.

Apart from six UN agencies, including WHO, about 25 international NGOs areworking along the Thailand-Myanmar border. Department for InternationalDevelopment had provided funds to WHO Thailand for its Border Health Programmeduring 2001–2005. While substantial progress had been made, the same cannot besustained without inter-agency collaboration and intersectoral support from theMinistries of Public Health, Foreign Affairs, Interior and Labour.

3.7 Health promotion

Under the umbrella of “Healthy Thailand,” the Ministry of Public Health initiated nineprogramme/project approaches. These are: Child Development, School Children inHealth Promoting Schools, Healthy Families for a Healthy Thailand, Healthy Cities,Physical Activity and Diet for Health, Reproductive Health, Food Safety, Healthy PublicToilet and Healthy elderly. Several health promotion programmes, campaigns andinitiatives have been launched in different parts of the country with either targetedmessages or target groups.

While there is adequate infrastructure within the MoPH to implement healthpromotion practices and policies through 12 Regional Health Promotion Centres and75 Provincial Health Offices, the biggest challenge is to establish effective collaborationand partnerships with other sectors outside the MoPH. These include the Ministries ofEducation, Interior, Social Development and Security, and Agriculture and Cooperation,and NGOs and civil society.

Although the MoPH has a limited budget for developing health promotion, substantialsupport is being provided by the Thailand Health Promotion Foundation, established bythe 2001 Health Promotion Foundation Act. Two per cent of the excise taxes on tobaccoand alcohol, or about US$ 55 million annually, has been allocated as revenue for theFoundation, which serves as a catalyst for health promotion activities. The Foundation issupervised by a governing board chaired by the Deputy Prime Minister.

In August 2005, the Sixth Global Conference on Health Promotion which yieldedthe Bangkok Charter for Health Promotion was organized in Bangkok, Thailand.Thailand is in the process of implementing the Bangkok Charter actions andcommitments with WHO support.


3.8 Health systems

Health systems development and stewardship

Thailand has a developed health infrastructure, and good financial and health resources.Access to basic health care has steadily increased over the past 30 years. The governmenthas accorded high priority to social health security to meet the goal of universalhealthcare coverage. However, efforts are needed to improve the quality of servicesand to ensure the sustainability of the health system.

There is also the issue of inequitable access to quality health care in different partsof the country. There are large gaps, for example, between Bangkok and the northeasternregion in the magnitude of health resource distribution. The Bangkok MetropolitanArea has about one-fourth and one-tenth of the population per bed and per physicianrespectively as compared to the corresponding figures for the Northeastern Region(Table 1). While private hospital beds account for about 25% of the total, these mostlyserve a limited number of patients who can afford them.

The most recent Health Systems Reform began in 2000. The National HealthSystems Research Institute (HSRI) established the Health Systems Reform Office (HSRO)to serve as the secretariat to the National Health Systems Reform Committee (NHSRC),which plays a guiding role. With the involvement of society and communityorganizations, the Committee drafted the National Health Bill policies to address thehealth needs of the people, and to propose an essential health infrastructure that wouldsustain the new health systems. After seven years of concerted efforts, the Bill wasfinally approved by the Cabinet in March 2007.

The International Health Policy Programme (IHPP), a semi-autonomousorganization, was established in 2001, with joint collaboration by the Ministry of PublicHealth and the HSRI. It aims to develop and strengthen national capacity in healthsystems, policy research and international health. In 2003, the National Health SecurityOffice (NHSO) was established with the main responsibility of expanding the coverageof health insurance or security to the people who have not been covered by any othergovernment health insurance scheme. It is also responsible for developing standardized

Table 1: Distribution of health resources classfied by region, 2004

Source: Report of Health Resources, Bureau of Policy and Strategy, MoPH6.

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benefit packages and financing and ensuring health security rights to target populationgroups.

Considerable progress in health systems development – particularly in expandinghealth services – notwithstanding, many national challenges remain. These includeimprovement in the equity and efficiency of services among the poor and disadvantagedgroups of the population. At the same time, capacity building in the areas of financialmanagement, health policy development, healthcare system research, medicalanthropology, and health-related public laws is being enhanced.

With these initiatives Thailand has demonstrated its commitment to health systemsdevelopment. The National Health Act should generate healthy public policy that wouldthen be implemented by all sectors concerned. The National Health Act blends andbalances the philosophy of “sufficiency economy” and the principles of the TenthNational Development Plan. Having learned from the experience of the World HealthAssembly, the National Assembly will aim to function effectively, in response to localand national health needs. In conclusion, the health system in Thailand is geeredtowards raising the level of happiness of the people and the quality of their life asopposed to merely confining itself to the prevention and control of disease.

Health financing

(a) Health expenditure

The national health budget has increased from 5.8% of the total government expenditurein 1993 to 7.6% in 2004 (Annex 3). As depicted in Table 2, about 60% of total healthexpenditure comes from government sources, against 40% from private sources (out-of-pocket and private prepaid plans). External aid in health is as low as 0.1%–0.3% ofannual government health expenditure.

Table 2: Sources of health expenditure (%)

Sources: World Health Report,20067.


(b) Health insurance schemes

During 2002–2004 the budget allocation of the Ministry of Public Health for healthsecurity accounted for 77.8% of total health budget (Annex 4). These funds supportedcapitation for nationwide health services under the scheme for universal health carecoverage (UC), at that time called the ‘30-baht Scheme’, including a special fund forpreventive and promotive health services. In 2004, the UC Scheme was estimated toaccount for 75.2% of the total health insurance schemes in Thailand, and it covered apopulation of about 47 million. Although the study showed the appropriate capitationrate for the UC is Baht 1,510, the actual per capita payment in 2004 was Baht 1,309(Table 3).

The UC scheme combined and amalgamated many healthcare coverage schemesand only three public health insurance schemes remained. These were the Social SecurityScheme (SSS), Civil Servants’ Medical Benefit Scheme (CSMBS) and the UC Scheme (UCS).

Other important achievements of UC include the continuously increasing utilizationrates of health care at district hospitals (from 14% to 22%) and at primary healthcarefacilities (from 22% to 26%) in 2001 and 2003 respectively, while utilization rates atprovincial hospitals were reduced by 50%9. Moreover, the catastrophic healthexpenditure, among the group of 10-25% of non-food expenditure on health, wasreduced from 11.9% in 1996 to 7.6 in 2002, and, among > 50% non-food expendituregroup, from 1.4% to 0.5% during the same period10.

Table 3: Coverage of health insurance schemes in Thailand in 2004

*Due to overlap in coverage the totals may not add up.Sources: Jongudomsuk, NHSO Report 20048.

Thailand 15

Health systems and infrastructure

Health care in Thailand is organized and provided by both the private and publicsectors. The Ministry of Public Health (MoPH) is the principal agency responsible forpromoting, supporting, controlling and coordinating all health services for the people.In addition, there are several agencies playing significant roles in providing healthservices as well as health development. These include the Ministries of Defence, Interior,and Education, the Bangkok Metropolitan Administration, state enterprises, and theprivate sector. There are also a number of non-profit agencies that provide healthservices to the people. The main sources of their funding are from the MoPH subsidizedbudget or from international donors.

Health services in Thailand are generally classified into five categories accordingto the level of care:

• Self-care level (in the household).

• Primary healthcare Level (village level: midwifery centre).

• Primary care level (Tambon level: health centre).

• Secondary care level (District level: community hospital).

• Tertiary care (provincial level: provincial/regional hospital).

According to the Decentralization Act 1999, decision-making and managementauthority has been decentralized to the community in response to a demand for localgovernment accountability and a role in national development. Hence, at the primaryhealth care and primary care levels, the Tambon Administrative Organizations (TAOs)are the responsible units for disease prevention and provision of basic health services.

During the past 10 years, the number of private clinics and hospitals in Bangkokand other provincial cities has rapidly increased. The total number of beds in thesehealth facilities accounts for about 20% of the total hospital beds. The proportion ofhealth service utilization by private and public services is 24% and 76% respectively6.

3.9 Human resource for health

In 2006 there were 25,932 physicians in Thailand, which is about 12,000 less than theoptimal requirement stipulated by WHO. The inequitable distribution of physiciansand other health personnel between urban and rural, and central and other regions–particularly the north-eastern region is taken into account. According to a Ministry ofPublic Health report in 2005, about 76% of the people utilize the services at primaryhealthcare facilities and district hospitals, which have no specialists. However, currentlyabout 77.7% of available physicians are specialists, in either area, who provide servicesmostly in major hospitals.


The problem of an acute shortage of physicians was exacerbated by a considerablenumber of physicians and nurses having resigned from the public health system. Manyof them shifted to private hospitals. There was a net loss of physicians, between 194(22.0%) to 756 (74.6%), during 2001–200311. The principal reasons for their resignationwere improved educational opportunities, unsatisfactory hospital management ofgovernment, higher pays, and better work conditions12. The biggest exodus was seenin the three southernmost provinces, due to continous unrest situation in the areas. Ifall requests for transfer from these provinces were granted, government hospitals andclinics would lose 70% of their staff strength13.

Thailand, however, has the advantage of two important international HRHnetworks, namely, the South-East Asia Public Health Institution Network (SEAPHEIN),the Asia-Pacific Action Alliance on Human Resources for Health (AAAH) and South-East Asian Regional Association for Medical Education (SEARME) being located in thecountry, whose expertise it can be fully utilized.

Thailand 17

1. Partnership with UN and other internationaldevelopment agencies

Partnership in health is a key component in the strategy for the progress of healthdevelopment in Thailand. The country has established viable mechanisms foreffective coordination and collaboration on two fronts:

• Thailand receives support from development partners in terms of technicaland financial resources to strengthen national capacity in specific areas inthe health sector.

• Thailand is also gradually becoming a development partner, like other middleincome countries such as People’s Republic of China, Republic of Korea,and others, by assisting developing countries, both within and outside theregion, through its foreign policy of “forward engagement”. It has establishedthe Thai International Technical Cooperation Agency (TICA) for technicalcooperation with other countries.

With regard to the first issue above, key partners of Thailand in health include UNagencies (ILO, IOM, UNAIDS, UNDP, UNESCO, UNFPA, UNICEF and WHO),development banks (The World Bank and Asian Development Bank), bilateral donors(DFID, USAID, EU, etc.) and a few international NGOs. The Ministry of Public Healthhas also established the Thailand MoPH–US CDC Collaboration Center (TUC) tostrengthen national capacity in the prevention and control of epidemics and emergingcommunicable diseases.

Thailand has ratified a range of UN conventions and treaties, those on humanrights, child rights (CRC), discrimination against women (CEDAW), labour, environmentand tobacco being among them. In addition to UN country offices, the country hostsa number of UN regional offices (23 UN agencies and two development banks) whichare based in Bangkok and provide services to neighbouring countries.

The United Nations Development Assistance Framework (UNDAF), referred to asthe United Nations Partnership Framework (2007–2011) in Thailand, has beendeveloped jointly with the Royal Thai Government (RTG). In keeping with the UN’sreform, alignment and harmonization agenda, it provides a framework to jointly planand support, in a complementary and coordinated manner, the national plans and

Development assistance and partnerships:Aid flow, instruments and coordination

3


strategies in areas where the UN has mandated expertise and comparative advantage.As a specialized agency, WHO is one of the signatories to this framework, which outlinesthe following five areas of cooperation:

(a) Access to quality social services and protection;

(b) Decentralization and provincial/local governance;

(c) Access to comprehensive HIV prevention, treatment, care and support;

(d) Environmental and natural resources management, and

(e) Global partnership for development – Thailand’s contribution.

With regard to the second item above, with large-scale financial contributionsfrom other development partners being reduced, these do not have permanentprogrammes in Thailand any more. Assistance is provided to the country throughtargeted areas of action and cooperation. Health-related areas that received financialand technical cooperation from the development partners in 2004–2005 includingsupport for women and gender issues; HIV/AIDS treatment, prevention, and advocacy;and support for improvement of land and water resources to reduce vulnerability tonatural disasters and enhance productivity.

The UNDAF 2002–2006 for Thailand was developed with the overarching goalof promoting the reduction of disparity and ensuring sustainable humandevelopment. An indicative programme resource framework, according to individualagency mandates, was also made14. This is indicated in Table 4 below.

Table 4: UNDA Indicative Programme Resources Framework, 2002–2004

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2. Partnership with developing countriesThailand has been active in a number of regional and sub-regional cooperation initiativeswith developing countries in many areas, including health. These initiatives have beencarried out through agencies, mechanism and other initiatives such as the Associationof South-East Asian Nations (ASEAN), Asia-Pacific Economic Cooperation (APEC),Greater Mekong Sub-region (GMS), Mekong-Ganga Cooperation (MGC), Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy (ACMECS) and the Bay of BengalInitiative for Multi-Sectoral Technical and Economic Cooperation (BIMST-EC).

The Greater Mekong Sub-region, which comprises six countries along the Mekongbasin (Cambodia, PR China, Lao PDR, Myanmar, Thailand and Viet Nam), builds strongpartnerships in social and economic cooperation. In the area of health, programmessuch as the Mekong Basin Disease Surveillance (MBDS), Mekong Malaria Programmeand Human Resource Development Projects are included. The Asia-Pacific ActionAlliance on Human Resources for Health (AAAH), its main office being located inThailand, is a response to the international recognition of the need for global andregional action to strengthen country planning for HRH.

Thailand is the only non-member of the Organization for Economic Co-operationand Development (OECD) that produced a report on Millennium Development Goals(MDG) -8: The Global Partnership for Development. This goal sets targets for increasedOfficial Development Assistance (ODA), ensuring access for developing countries totechnology and essential drugs.

By engaging in the South-South development cooperation and taking a leadingrole in regional and sub-regional cooperation initiatives, Thailand is actively sharingwith other countries its own knowledge of what it takes to reduce poverty rapidly,improve health and education, and confront the challenges of environmentallysustainable development. This cooperation policy has also led to an engagement inprogramme development assistance to African countries, notably in the field of HIV/AIDS prevention, in collaboration with UNDP.

3. Technical cooperation with other countriesDuring 2004–2006, a total of 602 Fellows from all Member countries of the South-EastAsia, Western Pacific and Eastern Mediterranean Regions visited Thailand to gainexperience in different medical and health fields. Their fields of study were healthsystems, primary health care, health promotion, nursing care, laboratory investigationand epidemiology. During 2005–2006 about 50 Thai experts were recruited asconsultants by WHO and other international health-related agencies to work withinand outside the Region. They contributed in varied sectors including health insurance,quality assurance of laboratory services, disaster preparedness and response, registrationof medicines, HIV/STD, dengue prevention and control, and epidemiology training.


4. WHO collaborating networkCurrently Thailand has 33 designated and functioning WHO Collaborating Centresand 35 Centres of Expertise. These centres provided training to national and internationalfellows, conducted studies in areas identified or stipulated by WHO, and offeredreference laboratory services. A “Network for WHO Collaborating Centres and Centresof Expertise in Thailand” (NEW-CCET) was established to share experiences andstrengthen institutional capacity. The “National and Regional Experts System for South-East Asia Region (NRES)” was developed under the NEW-CCET. This system includesThai experts and institutional databases. This is a good initiative, but to be fully functional,it requires improvement and sustainable funding. The role of the NEW-CCET is beingreviewed.

Thailand 21

1. Work of the WHO Country Office encompasses:

• Advocacy, technical advice, and technical services/support to the government,UN agencies and other development partners on health and health-relatedmatters;

• Partnerships and coordination with other stakeholders for effective response,especially in tackling health issues;

• Identifying Thai technical expertise and facilitating the sharing of that expertisewith neighbouring countries, other Regions, and also globally;

• Providing administrative support to the Regional Office, HQ and otherCountry Offices in arranging fellowships, consultations, conferences andtechnical meetings and facilitating laboratory services to Bhutan, Myanmarand Nepal under the polio eradication programme;

• Disseminating WHO’s policies and positions through the media and othercommunication channels, and

• Providing administrative support and common services to WHO sub-regionalhealth units that are based in Bangkok.

2. Focus of WHO’s collaboration with ThailandWHO’s collaboration with Thailand is based on the WHO Country CollaborativeProgramme which is developed on a biennial basis. The current CCS 2004–2007 wasused as a framework and guideline for the development of the biennial programmebudget and workplans in the 2004-2005 and 2006-2007 bienniums. The CountryOffice focused on supporting policy development, providing technical advice, anddeveloping norms and guidelines. In accordance with the CCS 2004-2007 and incontinuation of some priorities from the 2004-2005 biennium, the WHO CountryOffice has in the current biennium focused on the following areas of work:

• Communicable disease prevention and control, including epidemic alert andresponse;

• Prevention and management of chronic and non-communicable diseases,and health promotion;

Current WHO cooperation

4


• Health research, evidence, and health systems development;

• Emergency preparedness and cross-border health;

• Immunization and vaccine development;

• Technical cooperation among countries, and

• Health and environment.

Previous CCSs have helped to focus WHO collaboration with the RTG on a fewpriority areas where the Organization has an advantage and for which it receives requestsfrom the government. Nevertheless, additional efforts are required to streamline thenumber of activities carried out within the ambit of these broad priority programmes.The WHO Country Office still issues a large number of contracts to implement theseactivities. The administration of these contracts require considerable time and efforton the part of the Country Office staff.

In order to ensure that the research and studies undertaken with WHO supportare applied to developing and monitoring health programmes, principal investigatorswere requested, at the end of 2006, to present their work at the WHO Country Office.Many of these were found to be valuable, and feasible to implement. Some have beenreplicated within the MoPH and other related institutions. However, it will be useful toreview the studies undertaken and models developed to ensure that there is noduplication, and that they are practical and feasible.

3. Funding of WHO collaborative programmes.Budgetary support to carry out these programmes comes from WHO’s assessed andvoluntary contributions, and from other international agencies outside WHO. The assessedcontribution for the WHO Country Programme in 2004–2005 was US$ 5.18 million. Inaddition, about US$ 1.69 million in voluntary contribution was mobilized for Thailandfrom across WHO, including US$ 281,000 for the tsunami relief operation. There hasbeen an increase by 11% in assessed contributions for 2006–2007 to US$ 5.78 million,following the decision of the 2005 World Health Assembly to increase the assessedcontributions by Member States. In addition to this assessed contribution, the CountryOffice has till date received about US$ 2–3 million through voluntary contributions.

4. FellowshipsFrom the 1998–1999 bienniums till the current biennium, the WHO Country Officehas provided 36 long-term fellowships to staff of the Ministry of Public Health anduniversity. Fellows have completed courses leading to five certificates, 17 Masters degreesand 14 PhDs in the field of public health, HRH, health economics, health servicesmanagement, international health, health policy, health planning and financing,epidemiology, policy analysis, health promotion, medical anthropology, health serviceresearch, public health nutrition and Genetic Epidemiology.

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5. Regional Sub-unitsIn addition to the Country Office, WHO has two Regional Sub-units in Thailand:

• Mekong Malaria Programme: This is a bi-regional project based in Thailandto coordinate WHO activities in countries of Mekong Basin.

• WHO Regional Sub-unit for Communicable Disease Control (CSR Sub-unit): The Regional Director decided in 2005 that a CSR Regional Sub-unitwas to be established in Bangkok. The rationale behind this unit being locatedoutside the Regional Office was its locational advantage, its infrastructure interms of transport and communications, and the technical expertise thatThailand possessed. The decision to establish a sub-unit was in keeping withthe decentralization policy initiated by the Regional Office and the felt needto establish a regional presence in Bangkok to better interact with agenciesin that part of the Region.

The Sub-unit will operate within the broader context of supportingcountries to develop the required core capacities for: a) implementing theInternational Health Regulations (IHR); b) strengthening the FieldEpidemiological Training Programme (FETP); c) the Asia-Pacific Strategy forEmerging Diseases (APSED); d) developing early warning systems and riskassessment of potential public health emergencies of international concern(PHEICs) and response, and e) promoting research, particularly evaluativeresearch.

At the same time, Thailand will desire maximum benefit of technicalsupport from the CSR, and the Sub-unit will engage with the MoPH to supportother Member States as well. Although this sub-unit is established under theRegional Office’s technical and administration settings, its operations maygo beyond the Region to assist countries in the Greater Mekong Sub-region,whenever there is a cross-border outbreak of an important disease.

6. StaffingThailand has a relatively small office in terms of number of technical staff. Moreover, itis able to provide and share technical expertise, particularly with its neighbouringcountries. WHO has played an important role in identifying and facilitating this sharing.

Currently there are only two international professional staff (WR and theAdministrative Officer), six national professional officers and 13 national support staffin the Thailand Country Office. Additionally, the Regional Sub-units have threeinternational Professional staff and one General Service staff. The support for the Sub-unit is covered by funds from outside the country budget. The organogram is providedin Annex 8.


7. Office premisesThe Ministry of Public Health has provided office space gratis for the WHO CountryOffice as well as for the CSR Regional Sub-unit. The Mekong Regional Sub-unit islocated in the Faculty of Tropical Medicine, Mahidol University, Bangkok.

8. Information and communication technologyAlthough Thailand has very good communication facilities, the Country Office as wellas the CSR Sub-unit have been connected with the Global Private Network (GPN)enabling faster connections with the Regional Office and Headquarters. It is equippedwith tele and video conference facilities. In view of Thailand’s strength in IT expertise,the Regional Office may consider decentralizing the maintenance and updating of theITC system to the Country Office for reasons of expediency.

9. Use of CCSOverall, the current CCS has been well utilized by the WHO Country Office to developworkplans that align with the National Health Plan and other national health anddevelopment frameworks. Whether the priorities identified in the previous CCSs haveinformed the regional or global strategies and priorities still remains an issue.

The extent to which the priorities identified in the CCS were implemented in linewith the six core functions of WHO is presented in Table 5. The relative weight assigned,in terms of the number of pluses (+) in the table, is based on the scope of workundertaken in the biennium 2004–05 and calendar 2006.

Table 5: Performance in priority areas, in relation toWHO core functions (2004–2007)

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1. Global challenges in healthThe General Programme of Work (GPW) is the highest-level policy document of WHO.The Eleventh GPW (2006-2015) sets out the direction for international public healthfor the period of 2006 through 2015. The document notes that though there havebeen substantial improvements in health over the last 50 years, significant challengesremain, as elucidated in the following four gaps:

(a) Gaps in social justice: Clearly, poverty is a key factor that impedes access toquality health services. In some countries, life expectancy of the poor is 20years lower than other, more privileged members of society. Poor health andpoverty form a vicious cycle. Other factors that reduce access to services arediscrimination by ethnicity or gender and women’s health, which are oftennot adequately addressed.

(b) Gaps in responsibility: Health problems are no longer merely theresponsibility of those working in health, but also require positive action bythose outside the health sector. International conflicts and national crisesoften lead to the disruption of social services, including healthcare.Globalization and decisions on international trade have a direct impact onhealth, especially in pharmaceuticals and the movement of healthprofessionals. In many countries, ministries of health often do not have thecapacity to influence adequately important causes of ill health that are outsidethe purview of the health sector.

(c) Gaps in implementation: Very often the technology to implement cost-effective interventions to improve health may be available, but is notimplemented because of paucity of funds and human resources, or theabsence of an effective health system. Available resources may often beallocated to high-cost curative services that tend to favour urban areas, leavinginexpensive and effective interventions in rural and remote areas neglected.

(d) Gaps in knowledge: Global advances in science and technology haveimproved the effectiveness and efficiency of medical services and theprevention and treatment of diseases. However, information about theseadvances is often not available in many countries. In addition, the lack ofinformation about health conditions and existing rigidities in many countries

WHO policy framework – Globaland regional directions

5


have in turn made it difficult to formulate and manage effective health policiesand interventions. Even operational research for those most in need of healthservices is generally not conducted, thereby reducing the efficiency of keyprogrammes.

2. Global health agendaIn order to reduce these gaps over the coming ten years, the Eleventh GPW outlines aglobal health agenda consisting of seven priority areas:

• Investing in health to reduce poverty;

• Building individual and global health security;

• Promoting universal coverage, gender equality, and health-related humanrights;

• Tackling the determinants of health;

• Strengthening health systems and equitable access;

• Harnessing knowledge, science, and technology, and

• Strengthening governance, leadership, and accountability.

The global health agenda is intended for everyone engaged in the field of healthdevelopment. WHO will contribute to this agenda by concentrating on its core functions,which have been built on the comparative advantages of the Organization. Inaccordance with the global health agenda and WHO’s core functions, the Organizationhas set the following priorities:

(1) Providing support to countries in moving to universal coverage with effectivepublic health interventions;

(2) Strengthening global health security;

(3) Generating and sustaining action across sectors to modify the behavioural,social, economic, and environmental determinants of health;

(4) Increasing institutional capacities to deliver core public health functions underthe strengthened governance of the ministries of health, and

(5) Strengthening WHO’s leadership at global and regional levels and supportingthe work of governments at the country level.

WHO will pursue these priorities through its Medium Term Strategic Plan (MTSP)(2008-2013) and the biennium budget of the Organization. The Director-General hasclearly placed emphasis on the work of the Organization at the country level. TheRegional Offices and Headquarters have been directed to emphasize support for countrywork and implement these priorities in Member States, especially where the healthneeds are greatest.

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3. Regional policy frameworkThe South-East Asia (SEA) Region has the second highest population among the sixWHO Regions and has the greatest burden of disease. While there has been considerableeconomic development in this Region in recent years, poverty and poor health remainsignificant issues of concern. Many Member countries have faced health emergenciesof varied magnitude in the past decade and the threat of disease outbreaks alwaysexists. Noncommunicable diseases have also become an increasingly important causeof morbidity and mortality in the SEA Region. Therefore, the global policy frameworkof WHO is appropriate for countries of the Region with special attention towardsstrengthening the capacity of Member States to support cost-effective public healthinterventions.

The Regional Office has always placed strong emphasis on its work in MemberStates. Of the total budget provided to the Region, 75% is allocated for countrieswhich is the highest ratio among the six Regions. The Regional Director for South-EastAsia has recently enhanced the delegation of authority to country offices to enablethem to plan and implement programmes with a higher degree of independence andto be more accountable for their work. At the same time, he has emphasized that theRegional Office staff should give the highest priority to support the work in thesecountries.

WHO’s core functions

• Providing leadership on matters critical to health and engaging inpartnerships where joint action is needed;

• Shaping the research agenda and stimulating the generation, translation,and dissemination of valuable knowledge;

• Setting norms and standards, and promoting and monitoring theirimplementation;

• Articulating ethical and evidence-based policy options;

• Providing technical support, catalyzing change, and building sustainableinstitutional capacity;

• Monitoring the health situation and assessing health trends.


1. PrinciplesThe key principles for the WHO Strategic Agenda are to:

• Enhance advocacy in supporting government matters critical to health, basedon WHO mandates and governing body resolutions;

• Be more selective and focused in determining which health sectorprogrammes are to be supported;

• Maintain flexibility to respond to requests as they arrive, while defining theboundaries within which WHO will respond and focus on what theorganization can do best;

• Emphasize the role of WHO as a policy adviser and broker, and differentiateWHO’s work and performance from that of the government, while continuingto work as government’s key partner in health, and

• Seek out opportunities to enhance and strengthen partnerships with UNagencies and actors, and explicitly take into account the harmonization ofprogrammes among development partners.

This approach will increase the effectiveness of WHO country programmes. Well-defined priorities will help to ensure a better match between the needs of the countryand the globally agreed strategic objectives, in which WHO has a clear advantagecompared to other partners.

2. Strategic agendaBased on the health issues and challenges identified in the situation analysis, WHO’sGPW and Medium Term Strategic Plan, and recognizing WHO’s comparative advantageidentified through the consultations with national and international partners, sevencomponents of the strategic agenda have been jointly agreed for WHO’s cooperationwith the Government of Thailand.

Strategic Agenda 1: Enhancing primary prevention, surveillance andcontrol of communicable diseases and epidemics

Important communicable diseases that are still major public health concerns in Thailandinclude malaria and dengue haemorrhagic fever, HIV/AIDS, STI, TB and emerging

Strategic agenda: Priorities jointly agreed for WHOcooperation in and with countries

6

Thailand 29

diseases, avian influenza in particular. In addition to disease prevention and controlinterventions by the government and stakeholders, it is very important to empowerpeople to know how to avoid risks of contracting diseases. For national self-reliance,the government has also announced an ambitious plan to strengthen its capacity invaccine production. Important strategies include:

• Strengthen risk communication skills for health personnel.

• Improve managerial skills and coordination in epidemic surveillance andresponse, particularly at the peripheral level.

• Facilitate quality assurance of laboratory investigations.

• Support for monitoring directly observed treatment, short-course (DOTS),antiretroviral therapy (ART) and malaria treatment at all levels.

• Support for timely implementation of IHR.

• Support for vaccine production.

Strategic Agenda 2: Integrating measures to reduce risks of non-communicable diseases (NCDs), injuries and mental illness

NCDs are groups of chronic diseases that have common risk factors. Prevention andcontrol require multi-sectoral collaboration to address them collectively. The sameprinciples can be applied for injury prevention. National personnel require managerialskills, especially in collaboration with multi-stakeholders and for effectiveimplementation of the programme. Prevention of mental illness will focus on communitymental health by promoting mental health through young children and adolescents.Important strategies include:

• Develop a policy of integrated control measures for non-communicablediseases, injuries and mental health.

• Strengthen capacity on programme management at the central and regionallevels.

• Support scaling up of primary prevention and care for NCDs, injuries andmental illness.

• Standardize and systematize NCD risk factor surveillance, as well as morbidityand mortality surveillance.

• Strengthen implementation and monitoring of Global Strategy on Diet, PhysicalActivity and Health and Framework Convention for Tobacco Control (FCTC).

• Enhance advocacy in implementing the National Mental Health Policy.

Strategic Agenda 3: Building capacity and partnerships for healthpromotion and healthy public policy

Thailand has accorded very high priority to health promotion as a most important approachfor public health implementation, as reflected in the Tenth National Health Development


Plans and the National Health Act. The Ministry of Public Health is one among many keyplayers, and it is important that health promotion be sold to the non-health sector toensure the success of public health interventions. Attracting investment to health promotionrequires strong evidence of health promotion effectiveness, in terms of raising peoples’health status as well as economical gain. Important strategies include:

• Advocate for healthy public policy in different sectors.

• Strengthen the National Health Commission and facilitate the roadmap forthe Public Health Initiative under the National Health Act.

• Strengthen implementation, evaluation and dissemination of outcomes ofHealthy Setting Approach to all sectors.

• Support implementation of the recommendations of the Sixth GlobalConference on Health Promotion.

• Integrate concepts and principles of health promotion into the undergraduatemedical and health training school curriculum.

• Supporting demonstration and dissemination of evidence-based healthpromotion effectiveness for advocacy and policy development.

Strategic Agenda 4: Strengthening capacity for monitoring andevaluating, and for health systems development

Thailand is undergoing a transition in its health systems development. Many measureshave been initiated, especially in areas of health care financing and decentralization.To ensure effective implementation, systematic monitoring and evaluation is required.The Tenth National Health Development Plan and the National Health Act are noweffective. Indicators for monitoring and evaluation of the programme have to bedeveloped, and the programme has to be assessed as a baseline from the beginning.Important strategies include:

• Build capacity in the area of health policy development, financialmanagement, health care systems research, medical anthropology, and health-related laws.

• Support monitoring and evaluation of health systems performance, includingdecentralization.

• Support development of appropriate mechanism for national healthcarefinancing.

• Advocate for the national policy on trade and health, and for networkingwith other countries.

• Facilitate technical cooperation among countries (TCC) for global and regionalpublic health action.

• Support the development of appropriate health infrastructure to respond tohealth emergencies.

Thailand 31

• Streamline essential medicines and prevent the manufacture and circulationof counterfeit and sub-standard medicines.

Strategic Agenda 5: Multi-sectoral approach to address health servicesfor the poor and at-risk population, including those in border andconflict areas

Although Thailand shares borders with Myanmar, Lao PDR, Cambodia, and Malaysia,the health of the people on the border with Myanmar and in the conflict zones of thethree southern provinces pose the greatest concern. There are many national andinternational NGOs that deal with issues concerning migrants, labour and health inprovinces along the border of Thailand and Myanmar. Understanding and collaborationamong the key players is of primary importance. This requires training and orientationon health-related issues, particularly for all field staff. Important strategies include:

• Ensure incorporation of border health issues into the National Security Policy.

• Enhance coordination and collaboration among different partners, particularlythose related to border health.

• Facilitate collection and dissemination of health-related information.

• Build capacity in border health for all related staff

• Network for improvement of health services delivery.

• Strengthen disease surveillance in key areas.

Strategic Agenda 6: Promoting environmental health and surveillanceof environmental hazards

Thailand has increasingly shifted from an agricultural economy to an industrializedone, keeping pace with the trends and competitiveness in industry among the nationsof the world. Such a surge towards industrialization brings with it problems of migration,urbanization and environmental degradation, which sometimes assume colossalproportions. The environment can be protected most effectively through action bycommunities and local organizations. Their participation can be ensured, throughbuilding awareness and capacity. Important strategies include:

• Multi-sectoral collaboration for a healthy public policy on environmentalhealth.

• Empower local organizations/communities for environmental protection anddetection of environmental hazards.

• Support the development and implementation of environmental healthlegislation.

• Support the development, implementation and evaluation of the NationalEnvironment Health Action Plan (NEHAP).


• Build national capacity on health impact assessment (HIA) and promote theuse of the findings for policy development.

• Improve collaboration and coordination in the implementation of food safetyprogrammes among all sectors concerned across the board.

Strategic Agenda 7: Strengthening the development of human resourcesfor health through existing networks within and outside the country

During the past five years, the country has been coping with the problem of healthpersonnel migrating from rural to urban areas and from the public to the private sector.This leads to inequitable access to quality health services. Although there is less migrationof public health personnel compared to those in the medical services, the public healthworkforce is not in any better situation. There are inadequate numbers of qualifiedpublic health personnel in the health systems, largely due to economic and careerreasons. It is important that the country should identify appropriate mechanisms toaddress issues of human resources for health.

There is a clear strategy for health manpower development that serves the newhealth reform under the Ninth National Health Development Plan. This strategy shouldbe continued under the Tenth Plan. Important strategies include:

• Support networks for the development of the National Public HealthWorkforce Profile and training institutions.

• Promote studies addressing HRH development issues and generate evidence-based information for policy development.

• Support capacity building of the public health workforce in specific areasaccording to the country’s needs, within and outside the country.

• Advocate for the establishment of a producer-user forum to generate practicalrecommendations for development of national HRH.

3. Modalities of implementation:• For technical and administrative effectiveness and efficiency in programme

implementation during the coming biennium, the modality of support willbe shifted from total project support to more direct programmeimplementation support, for example, for training, workshops, consultancyand fellowships.

• The WHO Country Office will play a coordinating role in identifying andrecruiting experts required by the country, as well as a facilitating role inrecruiting Thai experts as WHO consultants to work within or outside thecountry. Rosters of Thai experts will be made available on the WHO CountryOffice website as well as the websites of the WHO Collaborating Centresand the Regional Directory of Training Institutions (RDTI) in SEARO. TheCountry Office will act as a coordinating centre for coordination to recruitconsultants after being initiated by the Regional Office and Headquarters.

Thailand 33

• WHO has a policy of long-term (of at least six months) Fellowship support,with degree, certificate, or diploma programmes, rather than short-termFellowship support. Fellowship support should be completed within the samebiennium. Considering sustainability, support will not be provided to thesame programme for more than one biennium. Exchange visits of expertsamong Member countries are also encouraged.

• WHO Collaborating Centres shall be more fully utilized for the placement ofFellowships to conduct training and research. .

• Since Thailand has been considered to be an ideal centre for hosting meetings,seminars and conferences, the WHO Country Office will continue to providesupport to the Regional Office and Headquarters in coordinating thearrangements for the same.

• WHO will continue to be actively engaged with organizations of the UnitedNations, and will participate in the implementation of United NationsPartnership Framework (UNPAF) and the health cluster of Inter-AgencyStanding Committee (IASC) on UN humanitarian response and monitoringof the progress towards the MDGs.

• Emphasis will be placed on each priority area of the CCS in relation to WHO’sCore Functions as shown in Table 6 below:

Table 6: Emphasis on priority areas of the CCS 2008-2011 in relation toWHO’s core functions


1. IntroductionCompared to the period of the current CCS (2004-2007), there are three major issuesthat may have implications for the WHO Secretariat, namely (a) Establishment of theRegional Sub-unit for Communicable Disease Control and Surveillance (CSR) attachedto the WHO Country Office, (b) Change of staff composition, (c) Change of theprogramme planning and implementation process, from setting general objectives tooutlining strategic objectives. These implications include staffing, allocation of financialresources, information support and follow-up of programme implementation.

2. Staffing: Current and futureUnlike the other countries of the SEA Regions, Thailand is nearly self-sufficient in theavailability of experts in several health fields. The roles of the WHO Country Office insupporting health development include both technical coordination and direct technicalsupport. Most of the WHO technical staff in the Country Office are National ProfessionalOfficers (NPOs) instead of internationally-recruited staff. There are six NPOs who areresponsible for (a) programme planning and management, (b) programme monitoringand evaluation, (c) endemic communicable diseases, (d) HIV/AIDS and tuberculosis(e) surveillance of tobacco control and, (f) tobacco control. One international staff hasbeen assigned for the Border Health Programme and for coordinating the MalariaMekong Project.

While CSR regional sub-unit and Mekong Malaria Programme (MMP) areadministered and use common services with the Country Office, all Professional staffare under the technical supervision of the Director, CDS, SEARO. The CoordinatorMMP is also responsible, as team leader, for the Border Health Programme.

To build the technical and managerial capacities of WHO county staff, the RegionalOffice encourages horizontal collaboration among Member countries, with technicalsupervision or support from the Regional Office, when required. Periodic training anddevelopment of country staff, particularly on programme planning, monitoring andevaluation, is needed.

Implementing the strategic agenda: Implicationfor WHO Secretariat, follow-up and next step ateach level

7

Thailand 35

While staff of the Thailand Country Office have to provide support to their nationalcounterparts in implementing WHO Country Collaborative Programmes, they alsohave to provide administrative support to HQ, the Regional Office as well as otherCountry Offices during various consultations, meetings and conferences. Whenever aprogramme requires an authority in a particular health area, a suitable national expertwould be the preference of the WHO Country Office and a few government staff maybe recruited for brief periods to collaborate on programme implementation.

3. Financial allocationIt is anticipated that there will be zero growth in the regular budget for the 2008-2009and 2010-2011 bienniums compared to the current biennium, and additional voluntarycontribution (VC) resources are therefore required. In addition to VC received fromHQ, it is important that the Country Office should build staff capacity to be able tosupport the country to mobilize resources to implement important programmes andactivities. With the advantage of the CSR Sub-unit being physically located in theMinistry of Public Health, it is expected that Thailand may obtain a substantial amountof VC to support the prevention and control of epidemic communicable diseases,particularly avian influenza.

Thailand has an open policy for multi-country activities and is ready to providecountry budget support to some countries according to their needs. This, however,requires better advanced planning to avoid uncertainty and delayed implementation.

4. Information and communication support Being the hub of coordination and collaboration activities for many WHO collaborativeprogrammes, the Thailand Country Office requires support to improve the informationand communication systems. The Country Office must regularly update and improvethe WHO Thailand website, including its technical contents.

It is expected that development of the Global Management System (GSM) will becompleted and shall be used as a central tool for all WHO information systems duringthis CCS period. Past experiences with AMS and problems in reconciling routinetechnical and financial implementation should be considered as ‘lessons learned’. Toavoid interruption of routine work, timely support for updating hardware and softwareand adequate training of country staff during the transitional period is crucial.

5. Implementation of the strategic agenda

(a) Role of the Country Office:

The WHO Thailand Country Office will provide advocacy support to governmentpolicy within the organization’s mandate, offer technical support, and coordinate


programme implementation, primarily to inform about capacity building; encouragean evidence-based approach; promote research, monitoring, and evaluation; andfacilitate inter-country collaboration. Another important role of the WHO CountryOffice would be to support the country in mobilizing resources.

(b) Role of the Regional Office:

In spite of the decentralization of authority from the Regional Office to the CountryOffice, technical support from the Regional Office, particularly in areas where nationaland Country Office expertise is not available, will still be required. This includestuberculosis programme management, NCD programme management, preparationfor the implementation of GSM, and the development of a National EnvironmentalHealth Action Plan (NEHAP) and National Health Impact Assessment (HIA) and vaccineproduction endeavours. The Regional Office should also provide support andcoordination for some MCAs and some activities that involve countries outside theSouth-East Asian Region.

(c) Role of Headquarters:

In consultation with the Regional Office, Headquarters may be requested to providesupport to the Country Office in the following areas:

• Demonstration and documentation of effectiveness of health promotion;

• Evaluation of health systems reform;

• Studies on the implications of trade on health and health systems, and

• Acquisition of new technology, production of medicines and vaccines.

Headquarters should also play a key role in mobilizing resources for importantstrategic areas where the regular budget is limited, for example, health promotion,injury, environmental health, and health systems development.

Thailand 37

Annex 1National health development data

Indicator Unit Source

Finance

General government expenditure on health as a percentage of total expenditure on health

61.6

General government expenditure on health as a percentage of total government expenditure

13.6

Per capita total expenditure on health at average exchange rate (US$) 76

Per capita total expenditure on health in dollars 260

WHR 20067

Per capita GDP at average exchange rate (US$) 2,490

Per capita GDP in international dollars 7,930

World Development Indicators Database, World Bank, 18 April

200615

Per capita government expenditure on health at average exchange rate (US$)

47

Per capita government expenditure on health in international dollars

160

Prepaid plans as a percentage of private expenditure on health 14.6

Private expenditure on health as a percentage of total expenditure on health

38.4

Out-of-pocket expenditure as a percentage of private expenditure on health 74.8

Social security on health as a percentage of general government expenditure on health

32

Total expenditure on health as a percentage of GDP 3.3

WHR 20067

Total expenditure on health as a percentage of GDP 6.12 Thailand Health Profile

(2001-2004)16

Human resources

Health workers (rate per 1000 population)

Physicians 22,435 (0.37)

Nurses 171,605 (2.82)

Midwives 872 (0.01)

Public & environmental health workers 2,151 (0.04)

WHR 20067

Service delivery

In-patient beds per 1000 population 2.13

Physician: Hospital beds 1 : 7

Report on Health Resource and Survey

Data 20046


Annex 2Strategic objectives and their scope under MTSP2008-2013

Strategic objective Scope of strategic objective

1. To reduce the health, social and economic burden of communicable diseases

The work under this Strategic Objective focuses on prevention, early detection, diagnosis, treatment, control, elimination and eradication measures to combat communicable diseases that disproportionately affect poor and marginalized populations. The diseases to be addressed include, but are not limited to vaccine-preventable, tropical, zoonotic and epidemic-prone diseases, excluding HIV/AIDS, tuberculosis and malaria.

2. To combat HIV/AIDS, malaria and tuberculosis

The work under this Strategic Objective will focus on scaling-up and improving HIV/AIDS, TB and malaria prevention, treatment, care and support interventions so as to achieve universal access, including among high-burden populations, women, infants, children, adolescents, poor and vulnerable groups; advancing related research; addressing key bottlenecks that are currently impeding intervention access, use and quality; and contributing to the broader strengthening of health systems.

3. Prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries

The work under this Strategic Objective focuses on policy development, programme implementation, monitoring and evaluation, strengthening of health and rehabilitation systems and services, implementation of prevention programmes and capacity building in the area of chronic noncommunicable conditions, including cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, hearing and visual impairment and genetic disorders, as well as mental, behavioural, neurological and psychoactive substance use disorders, and injuries due to road traffic accidents, drowning, burns, poisoning, falls, violence in the family, community or between organized groups, and disabilities from all causes.

4. To reduce morbidity and mortality and improve health during the key stages of life, including pregnancy, childbirth, neonatal period, childhood and adolescence, while improving sexual and reproductive health and promoting active and healthy ageing for all individuals using a life-course approach and addressing equity gaps

The work undertaken under this Strategic Objective will focus on action towards ensuring universal access to and coverage of effective public health interventions for maternal, newborn, child, adolescent, and sexual and reproductive health, with emphasis on addressing gender inequality and health equity gaps; development of evidence-based, gender-sensitive, coordinated and coherent approaches to addressing the needs at key stages of life and improving sexual and reproductive health, using a life-course approach; fostering synergies between maternal, newborn, child, adolescent, sexual and reproductive health along with other public health programmes, and supporting action to strengthen health systems; and formulation and implementation of policies and programmes that promote healthy and active ageing for all individuals.

Thailand 39


5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact

Joint efforts of the Member States and the Secretariat regarding this Strategic Objective encompass the following aspects: Health sector emergency preparedness, intersectoral action for risk and vulnerability reduction within the framework of the International Strategy on Disaster Reduction, response to the health needs (including nutrition as well as water and sanitation) of emergencies and crises, needs assessment of affected populations, transition and recovery health actions in post-conflict and post-disaster situations, fulfilling the mandate of WHO within the framework of Humanitarian Reform, global alert and response system for environmental and food safety- related public health emergencies, threat-specific risk reduction along with preparedness and response programmes for such emergencies.

6. To promote health and development, prevent and reduce risk factors for health conditions associated with tobacco, alcohol, drugs and psychoactive substance use, unhealthy diets, physical inactivity and unsafe sex

The work under this Strategic Objective focuses on integrated, comprehensive, multi-sectoral and multidisciplinary health promotion processes and approaches across all relevant WHO and country programmes, and the prevention and reduction of six major risk factors: Use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diet and physical inactivity and unsafe sex. The main activities involve capacity building for health promotion across all relevant programmes, risk factor surveillance, the development of ethical and evidence-based policies, strategies, interventions, recommendations, standards and guidelines for health promotion, and the prevention and reduction of the major risk factors.

7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive and human rights-based approaches

The work under this Strategic Objective focuses on leadership in intersectoral action on the broad social and economic determinants of health; improvement of population health and health equity by better meeting the health needs of the poor, vulnerable and excluded social groups; connections between health and various social and economic factors (labour, housing and educational circumstances; trade and macroeconomic factors; and the social status of various groups such as women, children, the elderly, and ethnic minorities); development of policies and programmes that are ethically sound, responsive to gender inequalities, effective in meeting the needs of the poor and other vulnerable groups, and consistent with human rights norms.

8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health

This Strategic Objective is aimed at addressing and reducing a broad range of traditional, modern and emerging health and environmental risks. Its purpose is to encourage strong health sector leadership for primary prevention of disease through environmental management as well as support strategic direction and guidance to mobilize non-health sector actors about how their policies and investments can lead to win-win development strategies that also benefit health.



The work undertaken in this Strategic Objective will focus on the assessment and management of environmental and occupational health risks, including such risks as unsafe water and inadequate sanitation; indoor air pollution and solid fuel use; and disease vector transmission. The scope of this Strategic Objective also includes: health risks related to change in the global environment (e.g. climate change and biodiversity loss); development of new products and technologies (e.g. nanotechnology); consumption and production of new energy sources and the increasing number and use of chemicals; and also health risks related to changes in lifestyles, urbanization and working conditions (e.g. deregulation of labour, an expanding informal sector and the export of hazardous working practices to poor countries).

9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development

The work under this Strategic Objective focuses on nutritional quality and safety of foods; promotion of healthy dietary practices throughout the life-course, starting with pregnant women and including breastfeeding and adequate complementary feeding, and considering diet-related chronic diseases; prevention and control of nutritional disorders, including micronutrient deficiencies, especially among the biologically and socially vulnerable, with emphasis on emergencies, and in the context of HIV/AIDS epidemics; prevention and control of zoonotic and non-zoonotic foodborne diseases; stimulation of intersectoral actions promoting the production and consumption of, and access to, food of adequate quality and safety; and promotion of higher levels of investment in nutrition, food safety and food security at the global, regional and national levels.

10. To improve health services through better governance, financing, staffing and a management informed by reliable and accessible evidence and research

The work to be undertaken as part of this Strategic Objective will enhance the way health systems perform in response to the needs and demands of the population. It is underpinned by the principles of Primary Health Care and Health for All, and a concern to reduce inequity in access to, and eliminate exclusion from the benefits of, health care. It seeks to equitably expand access across the range of services needed to improve health outcomes and respond to legitimate demand for care, by matching service response to needs and demand, by increasing organizational and managerial capacities of institutions and provider networks, and by strengthening informed demand; and covers the organization and management of all population-based and personal health services – individual providers, facilities and provider networks; public, private and voluntary; at all levels, from those within the community to tertiary hospitals and specialized services.

Thailand 41


It is concerned with the promotion of all aspects of quality in relation to service delivery: patient- and community-centeredness, responsiveness, continuity of care, as well as safety, effectiveness and efficiency; with overcoming the fragmentation that results from the multiplication of disease specific programmes and initiatives, in ways that are tailored to local and national circumstances and priorities; and anticipating how technological innovation, changing needs and evolving demand will influence service delivery.

11. To ensure improved access, quality and use of medical products and technologies

Medical products include medicines, vaccines, blood and blood products, cells and tissues of mostly human origin, biotechnology products, traditional medicines and medical devices. Technologies include diagnostic tests, imaging and laboratory tests. The work undertaken under this Strategic Objective will focus on improving equitable access (as measured by availability, price and affordability) to essential medical products and technologies of assured quality (including safety, efficacy and cost-effectiveness), as well as their sound and cost-effective use. The sound use of products and technologies focuses on evidence-based selection; prescriber and patient information; appropriate diagnostic, clinical and surgical procedures; vaccination policies; supply systems, dispensing and injection safety and blood transfusions. Information includes clinical guidelines, independent product information and ethical promotion.

12. To provide leadership, strengthen governance and foster partnership and collaboration in engagement with countries, to fulfil the mandate of WHO in advancing the Global Health Agenda as set out in the Eleventh General Programme of Work

This Strategic Objective facilitates the work of WHO vis-a-vis all other Strategic Objectives. Responding to priorities in the Eleventh General Programme of Work, it recognizes that the context for international health has changed significantly. The scope of this objective covers three broad, complementary areas: leadership and governance of the Organization; WHO's support for, presence in, and engagement with individual Member States; and the Organization's role in bringing the collective energy and experience of Member States and other actors to bear on health issues of global and regional importance. The main innovation implicit in this objective is that it seeks to harness the depth and breadth of WHO's country experience in order to influence global and regional debates – thereby to influence positively the environment in which national policy-makers work, and contribute to the attainment of the health-related Millennium Development Goals and other internationally agreed upon health-related goals.



13. To develop and sustain WHO as a flexible and learning Organization, enabling it to carry out its mandate more efficiently and effectively

The scope of this Strategic Objective covers the functions that support and enable the work of the Secretariat in countries, regional offices and Headquarters. The work under this objective is organized according to the following: entire results-based management framework and processes, from strategic and operational planning and budgeting to performance monitoring and evaluation; management of financial resources through monitoring, mobilization and coordination at an Organization-wide level, ensuring an efficient flow of available resources throughout the Organization; management of human resources, including human resource planning; recruitment; staff development and learning; performance management; and conditions of service and entitlements; provision of operational support, ranging from the management of infrastructure and logistics; language services; staff and premises security; staff medical services; to the management of information technology; ensuring that there is proper accountability and governance mechanisms in place across all areas. In addition, the Strategic Objective covers a broad institutional reform agenda that will ensure that the above functions are continuously strengthened and able to provide better, more efficient and cost-effective support to the rest of the Organization. This agenda is closely linked to broader reforms within the United Nations system at both the country and global level.

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Source: Bureau of Policy and Strategy, Ministry of Public Health, Thailand.

Notes:(1) MoPH budget figures have include the budget of other agencies under MoPH supervision, i.e. Health

Systems Research Institute and National Health Security Office.

(2) The number in ( ) includes foreign loans for health programmes in 1997-2001.(3) Since FYs 1995-2001, MoPH has received a supplementary budget for health insurance cards, called

“health insurance revolving fund subsidies” which were previously included in the MoPH’s budget.

(4) Since the FY 2002, the MoPH has received a budget as “Health Insurance Revolving Fund” instead of“Health Card Revolving Fund”. The MoPH continues to administer the revolving fund of the NationalHealth Security Office for the first three years, after the National Health Security Act came into force.

(5) a Consumer price index as of January 2004.

(6) The Health Insurance Revolving Fund does not include personnel and operating costs.

Annex 3MoPH budget in present value and real terms

(in million baht)(Extracted from Thailand Health Profile 2001–2004)

Year MoPH budget

Health insurance revolving

funds

Total MoPH budget (present value)

Consumer price index

(1994 = 100)

Budget of 2004 value

Increase/ decrease

from previous

year

Percentage of National

Budget

1992 24 640 – 24 640 92.1 36 572 – –

1993 32 898 – 32 898 95.1 47 289 +29.3 5.8

1994 39 319 – 39 319 100 53 749 +13.7 6.3

1995 45 103 730 45 833 105.8 59 219 +10.2 6.4

1996 55 236 625 55 861 112.0 68 180 +15.1 6.7

1997 66 544 1 030 67 574 (68 934) 118.2 78 150

(79 723) +14.6 (+16.9)

7.3 (7.4)

1998 62 625 1 080 63 705 (65 065)

127.8 68 141 (69 596)

-12.8 (-12.7)

7.7 (7.8)

1999 57 171 2 056 59 277

(62 787) 128.2 63 154 (66 950)

-7.3 (-3.8)

7.2 (7.6)

2000 58 426 2 215 60 641 (63 001)

130.2 63 668 (66 146)

+0.8 (-1.2)

7.1 (7.3)

2001 58 697 2 400 61 097

(61 563) 132.3 63 129 (63 610)

+0.8 (-3.8)

6.7 (6.8)

2002 43 311 27 612 70 923 133.2 72 787 +15.3 6.9

2003 41 996 32 138 74 134 135.7 74 680 +2.6 7.4

2004 45 147 32 578 77 720 136.7a 77 720 +4.1 7.6


Source: Bureau of Policy and Strategy, Ministry of Public Health, Thailand.

Note:a For FY 2003, the budget for the disease prevention/ control and health promotion decreased as the Departmentof Health had transferred its programme on environmental surveillance and analysis, and water supply provisionto the Ministry of Natural Resource and Environment, according to bureaucratic policy.b For FY 2004, budget for the disease prevention/ control and health promotion also decreased as the Departmentof Health has revised its role and thus the budget for disease prevention/ control and health promotion under thehealth service programme has been shifted to the health systems component of the Health System DevelopmentSupport Programme.

Annex 4Health budget allocation for major types ofprogrammes during the first half of the NinthNational Health Development Plan (in million baht)(Extracted from Thailand Health Profile 2001–2004)

2002 2003 2004

Type of programmes Amount Amount

Increase/ decrease

from 2002

Amount

Increase/ decrease

from 2003

Proportion (%)

1) Universal health security

53 022.9 57 697.2 +8.8 60 431.2 +4.7 77.8

2) Disease prevention/control and health promotion

7 619.9 6 292.0a NA 4 951.2b NA 6.4

3) Health systems development 1 519.6 1 674.0 +10.2 2 474.5 NA 3.2

4) Support for training and development of personnel

1 501.5 1 464.6 -2.4 1 459.9 +2.1 1.9

5) Standard and quality of health services and products

812.9 819.6 +0.8 1 085.0 +32.4 1.4

6) AIDS prevention and control 698.7 885.1 +26.7 1 355.1 +53.1 1.7

7) Drug abuse prevention and resolution

524.7 538.2 +2.6 1 100.1 +104.4 1.4

8) Thai traditional and alternative medicines

39.1 73.7 +88.5 120.1 +63.0 0.2

9) Medical rehabilitation services for patients and the disabled

65.7 79.5 +21.0 82.1 +3.3 0.1

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Annex 5Thailand’s scorecard on MDG Targets (Goal 1-7)

Source: Thailand Millennium Developemtn Goals Report 200417.

Target Scorecard Remarks

1. Halve, between 1990 and 2015, the proportion of people living in extreme poverty

Already achieved Poverty incidence reduced from 27.2% in 1990 to 9.8% 2002.

2. Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Already achieved Proportion of population under food poverty line dropped from 6.9% to 2.2% between 1990-2002, and the prevalence of underweight children under five dropped from 18.6% to 8.5% between 1990-2000.

3. Ensure that by 2015, boys and girls alike will be able to complete a full course of primary schooling

Highly likely Gross enrolment ratio and the retention rate indicate that it is likely that Thailand will achieve universal primary education well ahead of 2015.

4. Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015

Already achieved Thai girls and boys have had equal education opportunity. There is a small gender gap at the primary level. Girls are outnumbering boys in higher education.

5. Reduce by two thirds, between 1990 and 2015, the under-five mortality ratio

Not applicable Given the low starting point 1990, this target is considered not feasible and therefore not applicable. The new feasible target is adopted under the “MDG Plus”.

6. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

Not applicable Given the low starting point 1990, this target is considered not feasible and therefore not applicable. The new feasible target is adopted under the “MDG Plus”.

7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS

Already achieved Yearly new infections have dropped by over 80% since 1991. HIV, however continues to spread among some groups. Young people continue to be vulnerable.

8. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Already achieved for malaria Achieved for malaria. The disease is an area-specific problem, and has been effectively managed.

9. Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources

Potentially Principles of sustainable development, partnership and public participation have been integrated into country policies and programmes. But reversing the loss of environmental resources is still Thailand’s greatest challenge.

10. Halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation

Already achieved Very close to universal access.

11. By 2020 to have achieved a significant improvement in the lives of at least 100 million slum-dwellers (globally)

Likely Most Thai people, including slum- dwellers, have secure tenure. Various measures have been implemented and more are underway to improve the slum livelihood.


Annex 6

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uppo

rt

Dep

uty

Perm

anen

t Sec

reta

ry

Off

ice

of th

e Pe

rman

ent S

ecre

tary

– Bu

reau

of C

entr

al A

dmin

istra

tion

– In

form

atio

n a

nd C

omm

unic

atio

n Te

chno

logy

C

entre

– Pr

abor

omar

jcha

nok

Inst

itute

of H

ealth

Man

pow

er–

Dev

elop

men

t–

Bure

a of

Insp

ectio

n an

d Ev

alua

tion

– Bu

rea

of P

olic

y an

d St

rate

gy

Prov

inci

al A

dmin

istr

atio

n–

Prov

inci

al P

ublic

Hea

lth O

ffice

s–

Dist

rict H

ealth

Offi

ces

Dep

artm

ent o

f Med

ical

Ser

vice

s–

Offi

ce o

f the

Sec

reta

ry–

Pers

onne

l Div

ision

– Fi

nanc

e D

ivisi

on–

Plan

ning

Div

ision

– N

oppa

rat R

ajat

hane

e H

ospi

tal

– M

etta

prac

hara

k H

ospi

tal (

Wat

Rai

Khi

ng)

– Ra

javi

thi H

ospi

tal

– Le

rdsin

Hos

pita

l–

Prie

st H

ospi

tal

– Si

rindh

orn

Nat

iona

l Med

ical

Reh

abili

tatio

n C

entre

– In

stitu

te o

f Den

tistry

– In

stitu

te o

f Pat

holo

gy–

Pras

at N

euro

logi

cal I

nstit

ute

– N

atio

nal C

ance

r Ins

titut

e–

Than

yara

k In

stitu

te–

Che

st D

iseas

e In

stitu

te–

Insti

tute

of D

erm

otol

ogy

– In

stitu

te o

f Ger

iatr

ic M

edic

ine

– Q

ueen

Siri

kit N

atio

nal I

nstit

ute

of C

hild

Hea

lth–

Bure

au o

f Nur

sing

– Bu

reau

of M

edic

al T

echn

ical

Dev

elop

men

tD

epar

tmen

t for

Dev

elop

men

t of T

hai T

radi

tiona

lan

d Al

tern

ativ

e M

edic

ine

– O

ffice

of t

he S

ecre

tary

– D

ivisi

on o

f Alte

rnat

ive

Med

icin

e–

Inst

itute

of T

hai T

radi

tiona

l Med

icin

eD

epar

tmen

t of M

enta

l Hea

lth–

Offi

ce o

f the

Sec

reta

ry–

Pers

onne

l Div

ision

– Fi

nanc

e D

ivisi

on–

Plan

ning

Div

ision

– So

cial

Men

tal H

ealth

Div

ision

– Sr

ithun

ya P

sych

iatri

c H

ospi

tal

– M

enta

l Hea

lth R

egio

nal C

entre

s 1-

12–

Gal

yara

jana

garin

dra

Inst

itute

– So

mde

t Cha

opry

a In

stitu

te o

f Psy

chia

try–

Raja

nuku

l Men

tal H

ealth

Ret

arda

tion

Inst

itute

– M

enta

l Hea

lth T

echn

ical

Dev

elop

men

t Bur

eau

Dep

artm

ent o

f Dis

ease

Con

trol

– O

ffice

of t

he S

ecre

tary

– Pe

rson

nel D

ivisi

on–

Fina

nce

Div

ision

– Pl

anni

ng D

ivisi

on–

Bam

rasn

arad

ura

Inst

itute

– Ra

jpra

chas

amas

ai In

stitu

te–

Offi

ce o

f Dise

ase

Prev

entio

n an

d C

ontro

l 1-1

2–

Bure

au o

f Epi

dem

iolo

gy–

Bure

au o

f Occ

upat

iona

l and

Env

ironm

ent D

iseas

es–

Bure

au o

f Gen

eral

Com

mun

icab

le D

iseas

es–

Bure

au o

f Vec

tor-

Born

e D

iseas

es–

Bure

au o

f Non

-com

mun

icab

le D

iseas

es–

Bure

au o

f AID

S, T

B an

d ST

Is

Dep

artm

ent o

f Hea

lth–

Pers

onne

l Div

ision

– Fi

nanc

e D

ivisi

on–

Den

tal H

ealth

Div

ision

– Pl

anni

ng D

ivisi

on–

Nut

ritio

n D

ivisi

on–

Sani

tatio

n an

d H

ealth

Impa

ct A

sses

smen

t Div

ision

– Fo

od a

nd W

ater

San

itatio

n D

ivisi

on–

Repr

oduc

tive

Hea

lth D

ivisi

on–

Div

ision

of P

hysic

al A

ctiv

ities

and

Hea

lth–

Regi

onal

Hea

lth P

rom

otio

n C

entr

es 1

-12

– Bu

reau

of H

ealth

Pro

mot

ion

– Bu

reau

of E

nviro

nmen

tal H

ealth

Dep

artm

ent o

f Hea

lth S

ervi

ce S

uppo

rt–

Bure

au o

f Adm

inist

ratio

n–

Med

ical

Reg

istra

tion

Div

ision

– D

ivisi

on o

f Des

ign

and

Con

stru

ctio

n–

Med

ical

Eng

inee

ring

Div

ision

– Pr

imar

y H

ealth

Car

e D

ivisi

on–

Hea

lth E

duca

tion

Div

ision

– Bu

reau

of H

ealth

Ser

vice

s Sys

tem

Dev

elop

men

tD

epar

tmen

t of M

edic

al S

ervi

ces

– O

ffice

of t

he S

ecre

tary

– D

ivisi

on o

f Cos

met

ics a

nd H

azar

dous

Sub

stan

ces

– D

ivisi

on o

f Bio

logi

cal P

rodu

cts

– D

ivisi

on o

f Pla

nnin

g an

d Te

chni

cal C

oord

inat

ion

– D

ivisi

on o

f Rad

iatio

n an

d M

edic

al D

evic

es–

Regi

onal

Med

ical

Sci

ence

s Cen

tres

1-1

2–

Nat

iona

l Ins

titut

e of

Hea

lth–

Med

icin

al P

lant

Res

earc

h In

stitu

te–

Bure

au o

f Qua

lity

and

Food

Saf

ety

– Bu

reau

of L

abor

ator

y Q

ualit

y St

anda

rds

– Bu

reau

of D

rugs

and

Nar

cotic

sFo

od a

nd D

rug

Adm

inis

trat

ion

– O

ffice

of t

he S

ecre

tary

– M

edic

al D

evic

e C

ontro

l Div

ision

– D

rug

Con

trol D

ivisi

on–

Nar

cotic

s Con

trol

Div

ision

– Fo

od C

ontr

ol D

ivisi

on–

Impo

rt an

d Ex

port

Insp

ectio

n D

ivisi

on–

Tech

nica

l and

Pla

nnin

g D

ivisi

on–

Publ

ic a

nd C

onsu

mer

Affa

irs D

ivisi

on–

Rura

l and

Loc

al C

onsu

mer

Hea

lth P

rodu

cts P

rote

ctio

n

Prom

otio

n D

ivisi

on–

Bure

au o

f Cos

met

ic a

nd H

azar

dous

Sub

stanc

e C

ontro

l

Agen

cies

und

er th

e Su

perv

isio

n of

MO

PH:

– H

ealth

Sys

tem

s Res

earc

h In

stitu

te–

Nat

iona

l Hea

lth S

ecur

ity O

ffice

– Pr

abor

omar

ajch

anok

Inst

itute

of H

ealth

W

orkf

orce

Dev

elop

men

t (A

ct re

quire

d)–

Nat

iona

l Ins

titut

e of

Hea

lth (A

ct re

quire

d)

Stat

e En

terp

rise

:–

Gov

ernm

ent P

harm

aceu

tical

Org

aniz

atio

nPu

blic

Org

aniz

atio

ns (R

oyal

Dec

rees

reu

ired

)–

Hea

lth fa

cilit

ies (

Roya

l dec

ree

enac

ted

for B

an

Phae

o H

ospi

tal)

– In

stitu

te o

f Spe

cial

ity M

edic

ine

– Bu

reau

of E

mer

genc

y M

edic

al S

ervi

ces S

yste

m–

Inst

itute

of H

ospi

tal Q

ualit

y Im

prov

emen

t and

Ac

cred

itatio

n (H

A-Th

aila

nd)

Sour

ce: M

inist

eria

l Reg

ulat

ions

of t

he M

inist

ry o

f Pub

lic H

ealth

, 200

2N

ote:

Pub

lic o

rgan

izat

ions

and

age

ncie

s und

er th

e su

perv

ision

of t

he M

OPH

are

not

und

er a

ny o

f the

clu

ster

s.

Thailand 47

Annex 7

Morbidity rates of hospitalized cases (per 100 000population) due to selected NCDs, injuries and mental

illness Thailand (excluding Bangkok), 2001–2004

Sour

ce: B

urea

u of

Pol

icy

and

Stra

tegy


Annex 8

Organogram WHO Country Office Thailand

a C

SR =

Com

mun

icab

le D

iseas

e Su

rvei

llanc

e an

d Re

spon

se S

ub-u

nit i

s un

der t

echn

ical

sup

ervi

sion

of S

EARO

, usin

g W

CO

com

mon

ser

vice

sb M

MP

= M

alar

ia M

ekon

g Pr

ojec

t is

unde

r joi

nt te

chni

cal s

uper

visio

n of

SEA

RO a

nd W

PRO

, usin

g W

CO

com

mon

ser

vice

sc U

nder

pro

cess

of r

ecru

itmen

t; d Su

ppor

ted

by C

SR a

nd o

ther

VC

bud

get a

nd p

oole

d fo

r com

mon

ser

vice

s in

WC

O;

com

mon

sev

ices

* SS

A or

shor

t-te

rm c

ontra

ct.

Thailand 49

Annex 9References

(1) United Nations Development Programme. Human development report 2006: beyond scarcity:power, poverty and the global water crisis. New York, 2006. (http://hdr.undp.org/hdr2006/pdfs/report/HDR06-complete.pdf – accessed 23 July 2007).

(2) United Nations Development Programme. Thailand human development report 2007: sufficiencyeconomy and human development . Bangkok, 2007. (http://www.undp.or.th/NHDR2007/index.html – accessed 23 July 2007).

(3) United Nations Population Fund. Country profiles for population and reproductive health: policyand development indicators 2005., New York: UNFPA and Population Reference Bureau, 2005.(http://www.unfpa.org/publications/detail.cfm?ID=260&filterListType= – accessed 23 July2007).

(4) World Health Organization. Global tuberculosis control: surveillance, planning, financing: WHOreport 2007. Geveva, 2007. (http://whqlibdoc.who.int/publications/2007/9789241563141_eng.pdf (File size : 3.4Mb) – accessed 23 July 2007)

(5) Ministry of Public Health, Department of Disease Control, Bureau of Epidemiology. Morbidityand mortality rate of pulmonary TB cases from report 506 (1979-2005). (http://epid.moph.go.th/dssur/respir/pulmtb.htm – accessed 26 July 2007).

(6) Ministry of Public Health, Bureau of Policy and Strategy. Report on health resources 2004,Bangkok, 2004. (http://203.157.19.191 – accessed 26 July 2007).

(7) World Health Organization. The world health report: 2006: working together for health. Geneva,2006. (http://whqlibdoc.who.int/publications/2006/9241563176_eng.pdf (File size : 6.6 Mb)– accessed 23 July 2007).

(8) Ministry of Public Health. National Health Security Office Annual Report 2004. Nonthaburi,2004.

(9) Thai National Statistical Office. The 2003 health and welfare survey. Bangkok, 2003. (http://service.nso.go.th/agrc/health46/eng.htm – accessed 26 July 2007).

(10) Tangcharoensathien V, Teokul W, ChanwongpaisarnL. Social Welfare System in Thailand:Challenges of implementing universal coverage. Bangkok: UNRISD, 2004.

(11) Ministry of Public Health, Bureau of Policy and Strategy. Thailand health profile 2001-2004.In: Unpublished paper, (extracted from Thailand National Health Profile 2004, page 253,Table 6.7).

(12) Vasavid, Chitpranee. IHPP Research on Health Care Financing 2003. Presentation at the IHPPAnnual Conference on 14 May 2004. (http://www.ihpp.thaigov.net/research_annual04/Agenda%203%20Chitpranee.pdf – accessed 23 July 2007)

(13) Ministry of Public Health. Minister fears for hospitals. Clipping from the Nation newspaper,Friday 27 April 2007. (http://eng.moph.go.th/ContentDetails.php?intContentID=16042&strOrgID=001002002 – accessed 26 July 2007).


(14) United Nation Country Team in Thailand, UN Resident Coordinator’s Office. Thailand CommonCountry Assessment 2005. Bangkok, 2005. (http://www.undp.org/rbap/Country_Office/CCA/Cca-Thailand2005.pdf – accessed 24 July 2007).

(15) World Bank. World development indicators database . 18 April 2006. (http://devdata.worldbank.org/data-query/ – accessed 23 July 2007).

(16) Wibulpolprasert, S. Thailand health profile 2001-2004. Bangkok: Ministry of Public Health,2004. (http://www.moph.go.th/ops/health_48/index_eng.htm – accessed 23 July 2007).

(17) National Economic and Social Development Board. Thailand millennium development goalsreport 2004. Bangkok, 2004.

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