The quest of public participation in Thailand

It is widely accepted that public participation is a fundamental contribution to any field of   development. In the field of health development, community participation was listed together with appropriate technology, intersectoral collaboration and reorientation of basic health services, as key strategies in the implementation of Primary Health Care (PHC) policy in 1970s.

Thailand has set up a village health volunteer to conduct health development activities in rural area. They play a big role in bridging between the health officers and the people. It is in this rather initial movement that laypeople are acknowledged and involved in health development. However, their role is limited to implementing activities which have been decided by  the health officers, but they are not involved in decision making on health development for their community.

  The public growingly called for participation in decision making and policy process in health development in the 1980s. This movement has come along with the concept of health promotion. Health of the population doesn’t depend on health policy solely, but also on non-health policy. Economic led growth development possibly affects the population’s health also.

  Ottawa charter gives importance to health promotion as a way to enable the improvement of their health. Building healthy public policy along with creative supportive environment, strengthening community action, developing personal skills and reorienting health care services were identified as action areas to achieve health promotion.

  For Thailand, healthy public policy is not sufficient for our context. Public participation in the policy process is indispensable. Consequently, the National Health Act in 2007 was designed as a tool to promote and facilitate the process of building participatory healthy public policy.

National Health Assembly

Thailand has innovated health assembly, under the National Health Act, as a process and space for public deliberations and participation in the policy process. The National Health Commission chaired by the Prime Minister is mandated to convene the National Health Assembly (NHA) at least once a year.  As of now, 6 NHA have been convened with a total of 59 resolutions.

Issues to be dialogued at NHA are open to any organizations or networks to propose. Since health in Thailand has a broader sense as the wellbeing, the proposed issues consequently vary from health care, and health financing, to natural resources, education and social justice. This shows that health has become an integral part of development.

Once the proposed issues becomes NHA agenda, the working group of each agenda item is set up, consisting of all possible stakeholders, to draft the resolution. The first drafts of the resolutions are distributed nationwide for public consultation. The working groups revise their drafts according to feedback and recommendations of the public and then the final draft is brought to be dialogue at the NHA.

Around 200 NHA constituencies, or around 1500 people, attend the NHA and consider the final resolutions.   NHA doesn’t use a voting system like in a parliament. Only a consensus of the constituencies can pass the resolutions. The adopted resolutions are finally submitted to the National Health Commission for further action.

The National Health Commission is not a government board, but an intersectoral one, comprising government agencies, academia/health professional institutions and the people sectorincluding civil society, NGOs and the private sector. As a result, the commission cannot apply hard power to enforce the resolutions or force anyone to comply with. The meaningful participation of all sectors in the NHA process is one of the success factors that can put the resolutions into action effectively.

Although some resolutions necessitate authority of government agencies to accomplish, the idea of NHA has created a sense of self-reliance and management. The resolutions do not call for only government agencies to implement; the health assembly network is also obliged to practice the resolutions. Soft power of the National Health Commission has generated intersectoral action rather than disruption.

Provincial Health Assembly in Trang Province

Thailand has not only the NHA, but provincial health assembly (PHA) has been convened throughout the country. Quality of NHA at the national level cannot be succeeded unless public participation at the community and provincial level are strengthened. In addition, provinces have different kinds of health related problems. PHA is hence applied as a tool to solve their specific problems and empower the public.

With the visit of Mrs. Ui Shiori to the National Health Commission Office (NHCO), 2(two) AHI alumni from NHCO –  Mr. Jaruek Chairuk and Ms Prangtip Netnoy –  arranged the field study for Mrs. Ui to learn about PHA in Trang province, which received the Health Assembly Award in 2012.

Trang province is located in the southern part of Thailand. This province is considered rich both in terms of economy and resources. The upper province is mountainous, while the lower part is low land having two main rivers run through it. The western part is a coastline of 119 kilometers.  The different resources create different cultures, among them the rubber farmers in the mountains, rice farmers in the low land, and fishermen by the sea. Trang is also an important seaport city where Chinese, Indian and Malay have migrated to do business there. They all live in harmony.

With no need to worry about the economy, the people turn to an interest in politics. Social movements have been active since the student revolution in 1973. Social activities have occurred continuously since then such as public protests against dam construction and usage of fishery equipment that destroys natural resources. Trang people also joined in pushing the National Health Bill into promulgation during 2000 – 2007. Public mindedness and a sense of ownership by  the people is a high social capital of the province.

When NHCO introduced a health assembly to Trang people, the concept was quickly accepted, but still was not easy to implement. Government agencies, academia, and the people sector rarely collaborate, although they have the same goal for good health of the people.

Gradually provincial health assembly has been acknowledged as a tool to build intersectroal collaboration and public participation in a policy process. The first PHA was convened in 2010 following the working structure and process of NHA.

 Resolution in Action

One of the resolutions of Trang’s PHA is on consumer protection. This issue came up to the PHA from a grassroots level, where village health volunteers, hospitals at a sub-district level, and consumer protection networks had been working on it in some places.  It is a common practice at funerals and cultural festivals to find hosts/sellers serving hot food in a plastic bag, not on a plate, to guests/customers.  This shows that the people are not aware of dangers from melted plastic bags. Furthermore they always use cooking oil repeatedly, which can cause cancer.

This might be a small issue in the eyes of the government, but the people are highly concerned. Because PHA opens a chance for every network or organization to propose an agenda, these people united to drive this agenda into a provincial policy.  Once the resolution was adopted, the provincial public health office put this issue into their provincial strategy on public health as the office saw the benefit of this issue, not by force. The campaign to ban plastic bags have therefore been made in parallel with building an understanding of this issue to 6,000 health volunteers of all districts.

After listening to a brief on Trang’s  PHA, Mrs. Ui and three NCHO staff visited the hospital at Ratchada district to follow up on the implementation of the resolution on consumer protection. We reached there about lunchtime.  Though we had not yet talked with them, our eyes saw many lunch boxes of the villagers. They brought them up to share food with us. No plastic bags are used here anymore.

While having spicy southern food, the public health officer told us that all the vegetables that we ate, were organically grown by the villagers. And twice a month, they bring the organic agriculture products to the hospital to exchange with other villagers. This district is also campaigning to change the villagers’ behavior by educating the villagers on the benefits of eating half a kilogramme of vegetables a day and of exercising at least three days a week.  Those who do the best get an award as an incentive.  Besides, along the street, edible trees are grown with no use of chemical fertilizers or pesticides.

The resolution has been implemented widely, but on a voluntary basis. It depends on the creativity of each local government on how to implement the resolution in the most effective way for their context.

Beyond changing consumer’s eating behavior, PHA can change people’s behavior from a recipient of the government projects/ services to a policy driver. This is a long-term goal of empowering our people and strengthening participatory democracy that Thai people are proud of.

Source: National Health Commission Office of Thailand. Date: December 9, 2014