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Country Overview

For the past decades, overall physical health status of Thai people has maintained a promising trend. During 1964-1996, in fact, Thai people’s life expectancy at birth had increased from 55.9 to 69.9 years in male and 62.0 to 74.9 years in female.

In 2020, life expectancy of Thai citizens will reach 72.2 years for males and 76.5 years for females. Infant mortality rate has been decreasing from 84.3 in 1964 to 40.7 in 1984 and to 23 per 1,000 live birth in 2002. The maternal mortality ratio, or MMR, on the other hand, had declined from 374.3 in 1962 to 12.9 per 100,000 live births in 2001. The under-5 mortality rate has fallen from 58 per 1,000 in 1980 to just 26 per 1,000 in 2002.

Recently, the Thai Government adopted and implemented a new policy of universal health coverage, known as the 30 Baht Scheme or Universal Coverage Scheme (UCS). Since April 2002, UCS has replaced all previous health financing schemes for the poor and uninsured, namely the LIC (Low Income Card), the MWS (Medical Welfare Scheme), HCS (Health Card Scheme) and the fee exemption system.
The universal coverage scheme combines capitation funding with a shift to delivery led by primary care to help keep costs under control. A typical province, therefore, will have five to seven district primary care networks, each led by a contractor unit with one or two networks in the provincial city.

This is a radical change from the social security scheme, which typically uses large hospitals (over 100 beds) as the main contractor. When the social security scheme was set up, primary curative care was largely delivered in hospital outpatient departments or by government doctors working out of hours in private clinics. The health reform appears to have born positive results on the Thai health system. A recent study, for example, indicates that expenditure on district hospitals benefits poorer people more than expenditure on provincial and teaching hospitals (P Hanvoravongchai et al, paper presented at Manila meeting, May 2003).

Furthermore, Thailand has been launching numerous local pilot projects against HIV/AIDS, including 100 percent condom programs and treatment or home-care programs, before applying them nationally.

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• Project: P056269 - Social Investment Fund Project
  Approval date: 9 July 1998, Closing Date: 30 Apr. 2004
  The primary objectives of the SIP were to (a) respond to the crisis through the rapid creation of employment opportunities and the provision of essential social services to the unemployed and poor and (b) use the crisis as an opportunity to support bottom-up service delivery by financing locally identified and managed development initiatives and by promoting decentralization, local capacity building, and community development. One of the channel is to provide financing for locally generated projects in the program called the Social Investment Fund (SIF), which financed small-scale subprojects across a range of sectors as proposed by community groups, community organization networks, and local government entities based on pre-determined eligibility criteria. 
    Implementation Completion Report
   
• A program in HIV/AIDS was called "Thai NGOs support for Community-Based HIV/AIDS Prevention, Care and Support Activities." Ministry of Public Health managed the fund by contracted private/ NGOs counterparts to provide AIDS activities at the community level. The program cost 90 million Baht (2.2 million USD) and took 24 months to complete.

The evaluation showed that 387 projects were provided across the country. By using NGOs, they could provide technical support, in addition to financial support to communities. The program also strengthened NGOs and PLWHA networking, with enhanced cooperation and support among and across group. On the other hand, it is difficult to monitor the projects closely. The by-product of this program is reduce level of discrimination.  

• Project: P004693 - Population Project
  Approval Date: 7 Feb. 1978, Closing Date: 31 Dec 1984
  The project main components were (a) strengthening and extending the delivery of family planning services and supplies to rural areas; (b) increasing the supply of nurses, auxiliary midwives, and practical nurse/midwives, all of whom are key personnel in providing family planning services; and (c) strengthening family planning evaluation and research as well as information, education and communication activities. While supporting the nationwide expansion of the Government's ongoing family planning program, the project also concentrated on strengthening the rural health delivery system in 20 relatively disadvantaged provinces, thereby bringing the level of service up to national standards.

• Costs and Consequences of Expanding Access to Antiretroviral Treatment (ART) for HIV/AIDS in Thailand
  This is an on-going study collaborated with the Government of Thailand with a practical framework for strategically evaluating, monitoring and planning its program of expanding the availability of ART. The work would support the modification of one of the existing epidemiological models of HIV in Thailand, to allow for an evaluation of the impact of alternative ART intervention scenarios on the course of the epidemic. The study would develop assessment criteria and methodologies to determine both the positive and negative consequences of the policy. It would examine the fiscal and financial costs of expanded ART scenarios (under alternative forms of financing and provision) and would attempt to evaluate how public money could be used most effectively to control the epidemic and ensure treatment for those affected.  The study would also explicitly examine the behavioral implications of markedly increased funding for ART.

In Thailand, this study will complement monitoring and evaluation processes that are currently in place for donor funded provision of ART, which focus entirely on measuring individual clinical outcomes. It will also provide a critical policy framework for RTG decisions on provision of ART to selected populations as the Thai budget for ART is depleted and more people require treatment. Moreover it will add a further dimension to the predictive epidemiological modelling program that is already being conducted by the MOPH and the Monitoring the AIDS Pandemic (MAP) group.

• Stimulating VCT and Early Recruitment into ART in Thailand:
  This study analyzes how to stimulate demand for voluntary counseling and testing services (VCT) and facilitate early recruitment into antiretroviral therapy (ART) for people living with HIV/AIDS (PLWHAs). The Thai Government recently approved a large-scale expansion of public funding for provision of antiretroviral treatment to patients with HIV/AIDS.   Joint analysis by the Ministry of Public Health and the World Bank of this policy decision suggests that integration of treatment and prevention efforts is critical to the success of the Government’s policy of expanding ART. Treatment benefits can be maximized, and cost-effectiveness of ART increased, if ART is implemented in a way that stimulates VCT and early recruitment into ART, and hence strengthens prevention efforts. This research suggests that institutional arrangements to support the expansion of ART need to be adequately designed so as to integrate prevention and treatment. Thailand’s VCT system is a lynchpin in this effort; yet to date, the system remains one of the least studied and understood parts of Thailand’s HIV/AIDS program.

The objective will be addressed through four  project components, namely (a) assessment of the demand for VCT among the general population and high risk groups of population for HIV infection, (b) assessment of demand for antiretroviral treatment (ART) enrolment among symptomatic and asymptomatic HIV infection, (c) estimation of demand function for VCT, and (d) assessment of supply side capacity of VCT and ART delivery and gap between demand potential and supply side capacity.

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• Pro-poor health financing schemes in Thailand: a review of country experience, Vol. 1 of 1 (2003), Working Paper No. 31009
  Thailand has considerable experience in financing health care for the poor. The first pro-poor health-financing scheme covered approximately one-fifth of the total population and has since expanded to one-third of the Tai people. An economic crisis in 1997 triggered reforms to make the pro-poor health-financing scheme more efficient. Out of those efforts came new provider payment methods and a new way on managing public hospitals on a pilot basis. When a new government was elected in 2001, one of its major public policy initiatives was universal health care coverage. The following year, a comprehensive universal health care plan was implemented nationwide, based on experience gained from the pilot project. At that time, the Universal Coverage Scheme (UCS) replaced all previous pro-poor health financing schemes.
   

• Thailand - addressing HIV/AIDS, proven solution and new problems (2004), Working Paper No. 30786
  The East Asia and Pacific region of the World Bank has an estimated 2.3 million adults and children living with HIV/AIDS, out of the global total of 42 million. In such a large and diverse area, the HIV/AIDS epidemic is as varied as the countries-from 12 fishermen with HIV in Tuvalu, with potentially devastating consequences for the country's fishing-based economy, to an estimated 1 million people infected in China at the end of 2002, with profound implications for the health system there. HIV threatens progress towards achieving the Millennium Development Goals and related poverty targets in the region and around the world. Although the situation varies greatly from country to country and even among provinces within countries, the situation is urgent.
  
  Thailand has acted decisively in the face of this challenge, leading the way in prevention programs, mobilizing civil society and building political commitment. At the beginning of the AIDS epidemic, the initial standard public health approach did not discover many cases, leaving Thai officials with the perception that HIV affected only marginal groups. In 1989 HIV testing of injecting drug users revealed the explosive spread of infection. By 1992, 31 percent of commercial sex workers were HIV-positive, and there were signs of HIV spreading to the heterosexual population. Thailand implemented good serological surveillance of the general population, sentinel surveillance of groups whose member practice high-risk behavior, and surveillance of risky behavior. The national response to the crisis was strong, swift, and comprehensive, thanks to strong political commitment from the King and Prime Minister.

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