EQUITY GAUGE PROFILES: THAILAND

Research & Monitoring Advocacy & Public Participation Community Involvement Key People & Partners Documents of Interest

Introduction to Thailand:
Thailand, a tropical country in Southeast Asia with a total population of 61 million, has a tremendous economic growth rate at about 7-8% per year. However, there were several periods of economic crisis particularly in 1997. Inequity in income distribution is a major factor of these economic stagnation. The Gini coefficient to measure inequity in income distribution demonstrated that it has increased from 0.41 in 1962 to 0.45 in 1975, 0.49 in 1988 and 0.52 in 1999. When the distribution of health care resources has been considered, inequity of health care input can be observed from its distribution ratio between Bangkok and the Northeastern region (the poorest part in Thailand). Although the Thai government tried to redistribution of the health care resources, but the health policies did not contain any clear statement on equity until it has been mandated in the Thai constitution in 1997.

Summary:
The present areas of work for Thai Equity Gauge phase 2 involve review of health reform impact on the poor. This is the first quantitative study of its kind in Thailand, which looks at aspects of accessibility and quality of services especially for the poorest groups. Identification of poorest of the poor is another of the highlights of the work as there was a gap in information on poor groups.

The work of the Gauge, at the sub-district level, involves collection of data on resource allocation of health services and to see whether it is being done equitably. The findings will be disseminated to local leaders and those higher up in the policy arena. Also, through workshops at the sub-district level, the findings will be used to raise awareness among general population.

The work in phase 1 included assessment and monitoring the situation of inequity in health and health care at the national, regional, and provincial levels and identifying equity indicators for monitoring progress towards equity, working closely with community and local government staff in analysis and monitoring of new health policy, and facilitating the use of equity measures to monitor policy at the national level and to monitor implementation of equity policy at the regional and provincial levels. Provision of training to local government staff via networks which have been established and advocating use of equity concept in health care resource allocation.

Specific objectives include:

1. To continue assessment/monitor the situation of inequity in health and health care (including policy analysis) at the subdistrict levels, including identifying equity indicators for monitoring progress towards equity, working closely with community and local government staff in analysis and monitoring of new health policy.
2. To make an intervention for redistribution of health care resources at the subdistrict levels.
3. To assess an impact of universal health coverage program in health care utilization, accessibility and quality of care of the poor.
4. To plan for building capacity in analysis/measurement, advocacy and community empowerment related to equity issues both in Thailand and neighboring countries.
5. To provide training on equity gauge to health care and local government staff at the subdistrict level.
6. To provide forum for political & social discussion on equity issues (priorities will be given to parliamentarian health committee).

Key People:

• Siriwan Grisurapong
• Wiput Phoolcharoen
• Thaval Poblap

Key Partners:

• Mahidol University, Faculty of Social Sciences & Humanities
• Health System Research Institute
• Nakhonpathom Health Provincial Office

Documents of Interest:

• Inequity in the Quality of Care in the Thai Health Care Reform Context: The Consumer's Perspective [274kb]

A plan to link data from several national surveys has been made, therefore, collaborative working with expertise in the information system is needed. Meeting and discussion with staff from national statistical office will be made periodically so that the next round of national surveys can be adjusted to make them most useful for users. Data from primary source at the provincial level will be collected only for specific indicators. Noteworthy, to let provincial staff participate since the planning of data collection to data analysis will make the monitoring of equity gauge more sustainable.

Activities for Advocacy and Public Participation:

• Training workshops to local health care and other government staff, community leaders, women's groups.
• Seminar to discuss equity concepts and criteria of inequity.
• Mapping of the key stakeholders.
• Have done several seminars: provincial health care staff, staff from sub-district administrative organization (local government), community leaders, local community volunteers for health, education, health info distribution.
• Attended informal talks with communities.
• Hope to make factsheets for media and politicians; need to be simple, not academic.
• Dissemination of data to local politicians who need to have plan, and come to the gauge to get info.
• Trying to figure out how to best present information to politicians.

Including of all related stakeholders since the beginning of the project will be the key point to put monitoring of equity into both policy and implementation level. Views from the community and clients of health service system will also be included to establish as indicators. Findings will not only be disseminated to policy makers at the ministries level but also to the community who directly face with inequity.