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Country Cooperation Strategy (CCS) 2008-2011*
Thailand is a developing country that has registered impressive
successes in both economic and social development, though all regions of the
country have not registered the same degree of advancement. The country also
has a long and successful history of health 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-centred approach
and philosophy of “sufficiency economy”. The Thailand Human
Development Index has improved, inexorably aided by major contributions from
the robust health indicators. Almost all of the Millennium Development Goals
(MDGs) relating to maternal and child mortality
have been achieved.
Although considerable progress and achievement has been
registered, Thailand
still faces several challenges with the health situation and health
development. Some of the major challenges to advancement of health
development are as follow:
(1) Important communicable diseases remain key public health
concerns in Thailand. These include malaria, dengue haemorrhagic
fever, HIV/AIDS, tuberculosis (TB) and emerging diseases, particularly avian
influenza. The coordination of the disease surveillance and epidemic
response, and the efficiency of Directly Observed Therapy (DOTS) at the
peripheral level still leave room for improvement.
(2) Morbidity and mortality of major non-communicable diseases
such as injuries and mental illnesses show a rising trend. The country
requires clear and well-defined national multi-sectoral
coordination policies and strategies for the effective prevention and control
of these diseases.
(3) Environmental pollution and contamination of food by hazardous
substances are still important public health issues. Occupational safety
standards and the permissible levels of hazardous substances are yet to be
enumerated.
(4) Thailand has increasingly become prone to natural disasters.
Although the government is relatively self-reliant in disaster relief, WHO
and the UN Disaster Management Team have important roles to play to support
the country in assessing the health situation and needs as well as
coordinating joint action for health.
(5) Cross-border health risks have become important health and
political issues over the past few years. These risks include the spread of
communicable diseases and drug-resistant pathogens, and also national
security. There are many players involved in the improvement of the living
conditions and health of migrants and refugees along the border of Thailand.
Better coordination among all involved is needed.
(6) Thailand has accorded high priority to health promotion, as is
clearly reflected in the Ninth and Tenth National Health Development Plans.
The Ministry of Public Health (MoPH) has initiated
many programme and project approaches. The Thailand
Health Promotion Foundation plays an important role in financing and
advocating health promotion. However, the country’s main challenge lies in
establishing firm levels of collaboration with sectors outside of the
Ministry of Public Health.
(7) The most recent phase of health systems reform began in 2000.
Several offices and institutes were established to strengthen health systems
development and enable the reform process. For example, the National Health
Systems Research Institute (HSRI) established the Health Systems Reform
Office to function as the secretariat for the National Health Systems Reform
Committee to guide health systems development. The International Health
Policy Programme (IHPP) was established to develop and strengthen national
capacity in health policy research and international health. The National
Health Security Office (NHSO) was established in 2003 to expand coverage of
health insurance/security for those citizens who have not as yet been covered
by any government insurance scheme.
The national health budget has gradually increased from 5.8%
of the total government outlay in 1993 to 7.6% in 2004. About 60% of all
health expenditure comes from government sources compared with 40% from
private sources. In 2001 the government introduced the Universal Health Care
(UC) policy (the “30-Baht scheme”). In April the next year, the government
announced universal health care coverage and in 2007 universal coverage
without pay was introduced. In 2004, the UC scheme represented 75.2% of the
total health insurance schemes that covered a population 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 that need to
be addressed.
Thailand is gradually becoming a development partner, like other
middle-income countries, by assisting other developing countries. Therefore, in
terms of developmental assistance, Thailand has received mostly
technical support, but only limited financial support, from donor agencies
and countries. In relation to partnerships with developing countries, Thailand
is active in a number of regional and sub-regional cooperative initiatives in
many sectors including health.
The work of WHO with Thailand is based on the
WHO-Country Collaborative Programme, which is developed on a biennial basis.
The WHO Country Office focuses overall on supporting policy development,
advocacy, technical advice, and the development of norms, standards and
guidelines. In addition to the country office, there are two WHO sub regional
units in Thailand: a) the Mekong Malaria Control Project (MMP); established
to coordinate malaria control activities in the countries of the Mekong Basin
which involves two WHO regions; and for coordinating border health
activities, and b) the Communicable Disease Surveillance and Response (CSR)
regional sub-unit, established to support countries to strengthen capacities
in areas of epidemiology, disease surveillance and epidemic response. The WHO
Country Office has National Professional Officers (NPO) who work in programme planning, monitoring and evaluation,
HIV/AIDS-Tuberculosis, communicable disease control and tobacco control. All
other international technical staff are assigned to work for the above two
sub-units.
WHO has established a clear Global and Regional Framework,
under the Tenth General Programme of Work (GPW) and the Medium Term Strategic
Plan (MTSP), and all the offices will work to perform the core functions of WHO. Based on the above situation analysis and extensive
consultations, the following seven strategic agendas have been identified as
priorities for the next four years:
(1) To enhance primary prevention, surveillance and control of
communicable diseases 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
public policy;
(4) To strengthen capacity for monitoring and evaluating health
systems development;
(5) To initiate a multi-sectoral
approach to address health services for the poor and 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 existing networks within and outside the
country.
* In the context of Country Cooperation Strategy (CCS) of
2008-2011, it is important to point to the following related documents that
are being or have been prepared for the corresponding period: (a) The 10th
National Health Development Plan, 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.
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