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dTh
aila
n
Health in Asia Beyond 2015
ogra
m -T y
-Tha
iland
olic
y Pr
ocy
Pro
gram
ealth
Po
Suwit Wibulpolprasert, Vice President,
Hea
lth P
olic
onal
He
International Health Policy Program Foundation (IHPF)
h d d l
rnat
iona
l Hnt
erna
ti The 2nd JITTM, Centara Grand Hotel, December 11th, 2013
Inte
r In
Outlined • Health as well-being
Thai
lan • Health as well being
ogra
m -T
• Important health and health-related problems in Asia beyond 2015
-Tha
iland
olic
y Pr
o in Asia beyond 2015
l h / d
cy P
rogr
amea
lth P
o • Movements on Health in Post 2015/SDGs and the role of Asian countries
Hea
lth P
olic
onal
He
ASEAN Community 2015 and Health
rnat
iona
l Hnt
erna
ti • ASEAN Community 2015 and Health
Inte
r In
• Response to challenges 2
Healthd
Health
“A state of complete physical mental
Thai
lan A state of complete physical, mental,
and social (and spiritual) well-being, not
ogra
m -T
merely the absence of diseases and infirmity”
-Tha
iland
olic
y Pr
o infirmity
cy P
rogr
amea
lth P
o
How do we measure ‘health’ – morbidity and mortality composite index of BOD?
Hea
lth P
olic
onal
He and mortality – composite index of BOD?
rnat
iona
l Hnt
erna
ti
Can Asia measure ‘well-being’?
Inte
r In
3
Health and related factorsd
Economic/politicalPhysical/biological/chemical
Cultural/religiousGenetic
Behaviour
Thai
lan
Individual Environment Security
gBehaviourBelief/value
Population/educational
ogra
m -T d dua o e t Security
H l hSpirit
lueCommunication/transportation
-Tha
iland
olic
y Pr
o
TechnologiesHealth
cy P
rogr
amea
lth P
oH
ealth
Pol
icon
al H
e
Health caresystem
Quality/efficiencyP bli / i t
Equity/coverageType and level
rnat
iona
l Hnt
erna
ti system Public/privateType and levelof services
Inte
r In Dynamic4
Challenges of Asian Health Beyond 2015d
g y
Rapid population ageing – LTC and NCDs
Thai
lan
Epidemiological Transition – Double Burden
ogra
m -T Epidemiological Transition Double Burden
Technological development increasing cost
-Tha
iland
olic
y Pr
o Technological development – increasing cost
S i l d P liti l h SDH
cy P
rogr
amea
lth P
o Social and Political changes – SDH
Hea
lth P
olic
onal
He
Rising trade and economic growth – FTAs, Asian Community/AEC, TPP – IP, Food safety, HCS etc.
rnat
iona
l Hnt
erna
ti
y , , y,
Rapid expansion of UHC and health expenses
Inte
r In Rapid expansion of UHC and health expensesMore active players on Global n National Health 5
Health in Post 2015/SDGsd
Health in Post 2015/SDGs
T ll l t f P t 2015
Thai
lan • Two parallel movements of Post 2015
development agenda and Rio+20 SDGs
ogra
m -T
• Well being for all was proposed as the
-Tha
iland
olic
y Pr
o • Well-being for all was proposed as the overarching development goals and UHC as th hi h lth l
cy P
rogr
amea
lth P
o the overarching health goals
Hea
lth P
olic
onal
He
• Successes and sustainability and challenges
rnat
iona
l Hnt
erna
ti
• The Roles of Asian Countries to put UHC as
Inte
r In pthe post 2015 and the SDGs 6
Two parallel movements for post 2015 d S i bl DG
d2015 and Sustainable DGs
• The UNSG High Level Panel of Eminent Persons co-
Thai
lan • The UNSG High Level Panel of Eminent Persons co-
chaired by President of Indonesia, Liberia and PM of UK for post 2015 – reported in June 2013
ogra
m -T UK for post 2015 reported in June 2013
• The UNGA established a ‘member states’ driven
-Tha
iland
olic
y Pr
o The UNGA established a member states driven processes with 30 members working group on Rio+20 SDGs – started March 14th 2013.
cy P
rogr
amea
lth P
o S Gs s a ed a c 0 3
• The possible congruent of the two movements in 2014
Hea
lth P
olic
onal
He p g
or 2015
rnat
iona
l Hnt
erna
ti • The official negotiation period Sept 2014 – 2015 –several movements regionally and globally
Inte
r In
7
Post 2015 development agenda: well-being for allTh t ib ti f th h lth t d th t
d Sustainable wellbeing for all
The contributions of the health sector and other sectorsTh
aila
n Poverty eradication, health, education, nutrition, environment, security etc.
ogra
m -T
Healthy lives at all stagesChild survival, maternal survival,
-Tha
iland
olic
y Pr
o Child survival, maternal survival, MDG6, adolescent health, NCD burden reduction
cy P
rogr
amea
lth P
o
Universal health coverage (UHC)
Hea
lth P
olic
onal
He Health promotion, prevention,
treatment, financial risk protection
rnat
iona
l Hnt
erna
ti
Health secto
Inte
r In Health sector contribution
Other sector contributions8
The UHC – Thai’s experiencesd
The UHC Thai s experiences
• Universal access to quality comprehensive
Thai
lan • Universal access to quality comprehensive
essential health services without financial b i i l ti fi i l
ogra
m -T barriers – services, population, financial
protection coverage – three dimensions
-Tha
iland
olic
y Pr
o
• Possible targets access to qualified and
cy P
rogr
amea
lth P
o • Possible targets - access to qualified and motivated primary care health workers and
ti l t h l i fi i l t ti
Hea
lth P
olic
onal
He essential technologies; financial protection
rnat
iona
l Hnt
erna
ti
• Cover the issue of ‘right based’ approaches, health equity and all the MDGs++ targets
Inte
r In health equity, and all the MDGs++ targets.9
Thai UC – three dimensions of UC cubed
Thai
lan
Free at point of
ogra
m -T Free at point of
servicesLow incidence of catastrophic health
dit d
-Tha
iland
olic
y Pr
o expenditure and medical impoverishment
cy P
rogr
amea
lth P
oH
ealth
Pol
icon
al H
e
Essential comprehensive i d d
rnat
iona
l Hnt
erna
ti
Universal (100%) Coverage by 3
services and drugsHigh cost services are covered e.g. Renal Replacement Therapy,
Inte
r In U ve s ( 00%) Cove ge by 3public schemes
Replacement Therapy, chemotherapy, ARVs, etc
10
UHC is feasible and sustainabled
• UHC can be started and achieved at low Th
aila
n level of income – financial protection and quality services.
ogra
m -T q y
• UHC is effective for poverty reduction
-Tha
iland
olic
y Pr
o UHC is effective for poverty reduction
• Fiscal spaces and innovative financing are
cy P
rogr
amea
lth P
o • Fiscal spaces and innovative financing are possible for additional resources
bili ti
Hea
lth P
olic
onal
He mobilization
rnat
iona
l Hnt
erna
ti • Mechanisms are there to ensure value for money, sustainable financing and meeting the
Inte
r In
y, g gemerging challenges
Suwit Wibulpolprasert, IHPF, Thailand11
UHC can be started and achieved at low level of income –Economic Crisis is an opportunity not a threat
dpp y
US $
Thai
lan 4,000
1997: Asian financial crisis
apit
a
ogra
m -T
2,7
003,000
2001: 29% of population are uninsured
GD
P/c
a
The children n elderly
-Tha
iland
olic
y Pr
o
1,9
00
71%
cy P
rogr
amea
lth P
o
1490
1,
2,000
1980 CSMBS i t d d
2002 Universal Coverage for entire 20
29%
Hea
lth P
olic
onal
He
7601,000
1990 SHI introduced
introduced
1975 Low Income scheme introduced
gpopulation achieved
20%
53%
100%
rnat
iona
l Hnt
erna
ti
390
710
0
1983 CBHI introduced42
%
53%
Inte
r In 0
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
year
%
Suwit Wibulpolprasert, IHPF, Thailand12
Ensuring universal quality health services
d • Extensive expansion of rural health services in
servicesTh
aila
n Extensive expansion of rural health services in early 80s – in spite of economic crisis
ogra
m -T
• How? – Budget shifting - Freeze new capital investment in urban health facilities for 5 years
-Tha
iland
olic
y Pr
o investment in urban health facilities for 5 years and reallocate to rural health facilities.
cy P
rogr
amea
lth P
o
• Extensive production of motivated Rural
Hea
lth P
olic
onal
He Health Workers with compulsory public
services and incentives
rnat
iona
l Hnt
erna
ti
• Establishment of Hospital Accreditation
Inte
r In Establishment of Hospital Accreditation Institute
Suwit Wibulpolprasert, IHPF, Thailand13
Building up quality rural health facilities -Reallocation of budget to rural facilities and HRH
dReallocation of budget to rural facilities and HRH
3 684
Thai
lan
3.1
3.68
3.153.0132 9
3.5
4ts
)
Fast tracking rural health
ogra
m -T
2.732.43
2.272.232.15
32.92.64
2.42.5
3
n B
aht g
-Tha
iland
olic
y Pr
o 2.152.041.88
1.681 5
2
t (bi
llio
No investment in urban areas for 5 yrs.
cy P
rogr
amea
lth P
o 68
1
1.5
Bud
get
Provincial
Hea
lth P
olic
onal
He
0
0.5B
District
rnat
iona
l Hnt
erna
ti
1982 1983 1984 1985 1986 1987 1988 1989Year
Inte
r In Year
Suwit Wibulpolprasert, IHPF, Thailand 14
Adequate and appropriately manned rural health facilitieisd
Thai
lan
ogra
m -T
R l h lth t ith 3 6 CHW 2 000 5 000 l ti
-Tha
iland
olic
y Pr
o Rural health centers with 3-6 nurses n CHWs cover 2,000-5,000 population
Extensive production
cy P
rogr
amea
lth P
o Extensive production of appropriate cadres and motivated health
Hea
lth P
olic
onal
He and motivated health
personnel with mandatory public
rnat
iona
l Hnt
erna
ti
Rural community hospital with 2 8
y pworks and adequate support are essential.
Inte
r In Rural community hospital with 2-8 doctors cover 30-100,000 population
pp
Suwit Wibulpolprasert, IHPF, Thailand15
From reverse to upright triangle: From reverse to upright triangle: PHC utilization (OP visits)PHC utilization (OP visits)
dPHC utilization (OP visits)PHC utilization (OP visits)
Thai
lan
ogra
m -T
-Tha
iland
olic
y Pr
ocy
Pro
gram
ealth
Po
Hea
lth P
olic
onal
He
rnat
iona
l Hnt
erna
tiIn
ter In
Dr. Suwit Wibulpolprasert, IHPP, Thailand1616
UHC is effective for poverty reductiond
Thai
lan
UHC achievedUHC achieved
ogra
m -T achieved achieved
-Tha
iland
olic
y Pr
ocy
Pro
gram
ealth
Po
Hea
lth P
olic
onal
He
rnat
iona
l Hnt
erna
tiIn
ter In
Source: Viroj TangcharoensathienSuwit Wibulpolprasert, IHPF, Thailand
17
Fiscal Space to health from peace and economic growthFiscal Space to health from peace and economic growthd
Fiscal Space to health from peace and economic growthFiscal Space to health from peace and economic growthTh
aila
nog
ram
-T
tage
-Tha
iland
olic
y Pr
oer
cent
cy P
rogr
amea
lth P
oP
Hea
lth P
olic
onal
He
rnat
iona
l Hnt
erna
ti Year
Inte
r In
18
Source: Bureau of Budget
Suwit Wibulpolprasert, IHPF, Thailand18
Innovative Financing for Healthd
Innovative Financing for Health• Sin tax 2% additional levy on top of
Thai
lan • Sin tax - 2% additional levy on top of
tobacco and alcohol excise tax, since 2001 –Th i H lth P ti F d ti d
ogra
m -T Thai Health Promotion Foundation managed
by independent board chair by the PM – $US
-Tha
iland
olic
y Pr
o
120 millions in 2012 – support works on H1N1
cy P
rogr
amea
lth P
o
• Community Health Development Fund and i i l h bilit ti f d 50% f UC
Hea
lth P
olic
onal
He provincial rehabilitation fund – 50% from UC
and 50% from local government - $US 200
rnat
iona
l Hnt
erna
ti millions in 2012
Inte
r In
19
Mechanism to ensure Better Value for Money and Cost Control for Sustainable Financing
dand Cost Control for Sustainable Financing
• 20% of UC budget to P&P & comm H fund
Thai
lan % g & &
• Cost-effectiveness studies of health technologies IHPP HITAP etc determine
ogra
m -T technologies – IHPP, HITAP, etc - determine
National Essential Drug List (800 items) and
-Tha
iland
olic
y Pr
o benefit package• Strategic purchasing – PPP, Central
cy P
rogr
amea
lth P
o Strategic purchasing PPP, Central purchasing with VMI and use of TRIPs flexibilities
Hea
lth P
olic
onal
He flexibilities
• Close end capitation budget with mixed
rnat
iona
l Hnt
erna
ti payment mechanisms and PC gate keeper• Adequate capacity on HS/HP and
Inte
r In Adequate capacity on HS/HP and management
Suwit Wibulpolprasert, IHPF, Thailand20
Central purchasing and bargaining of drug and instrumentUnit cost (Baht)
dItems
Unit cost (Baht)Saving (Baht)Before After Number (unit)
1.Instrument
Thai
lan Folding lens 4,000 2,800 64,100 76,920,000
Unfolding lens 4,000 700 7,197 23,750,1o0
Balloon stent 20,000 10,000 26,655 266,550,000
ogra
m -T
Coronary stent 30,000 5,000 10,575 264,375,000
Drug elutent stent 85,000 17,000 33,794 2,297,992,000
DES Alloy stent 55,000 25,000 343 10,290,000
-Tha
iland
olic
y Pr
o DES Alloy stent 55,000 25,000 343 10,290,000
2. Drug (sample)ARV (AZT 300 mg caps.) 1201.22 891.23 47,000 14,569,530
ARV (EFV 600 mg tabs ) 304 89 149 51 400 000 62 152 000
cy P
rogr
amea
lth P
o ARV (EFV 600 mg tabs.) 304.89 149.51 400,000 62,152,000
ARV (LPV/RTV 200/50 mg (CL) 2139.82 1481.91 170,000 111,844,700
Botulinum toxin type A 100 IU 10,750.00 7977.74 946 2,622,557.96
Hea
lth P
olic
onal
He Docetaxel 80 mg inj 25654.32 4716.26 2,700 56,532,747.31
IVIG 5% 100 ml 9,649.62 5,479 19,200 80,075,904
Peg-interferon alpha 11,000 3,150 77,000 604,450,000
rnat
iona
l Hnt
erna
ti Influenza vaccine 200 150.28 643,319 31,985,820
Erythropoietin 671 229 1,634,239 722,333,638
CAPD fluid 200 105 19,095,657 1,814,087,415
Inte
r In CAPD fluid 200 105 19,095,657 1,814,087,415Saving 6,440,531,412.27
From: NHSO 2012Suwit Wibulpolprasert, IHPF, Thailand21
Rate of use of Lopinavir/Ritonavir (200/50 )
d(200/50mg)
C25,000
Thai
lan bottles C
L20,000
,
CL
ogra
m -T
15,000 UC Scheme
-Tha
iland
olic
y Pr
o
10,000
UC Scheme
cy P
rogr
amea
lth P
o
5,000
Hea
lth P
olic
onal
He
0
rnat
iona
l Hnt
erna
tiIn
ter In
Suwit Wibulpolprasert, IHPF, Thailand22
Satisfaction of UC beneficiaries & Satisfaction of UC beneficiaries & providersproviders
dprovidersproviders
Percent
Thai
lan
83.0 83.4 83.2 84.0 83.188.3 89.3 89.8
90.0
100.0Percent
ogra
m -T
56 5 50 760.3 78.8
60 0
70.0
80.0
-Tha
iland
olic
y Pr
o
45.639.3
47.750.9 56.5 50.7
40 0
50.0
60.0
cy P
rogr
amea
lth P
o
20 0
30.0
40.0Expand financial incentives
Hea
lth P
olic
onal
He
0.0
10.0
20.0 to Health personnel
rnat
iona
l Hnt
erna
ti 0.0
2003 2004 2005 2006 2007 2008 2009 2010
UC People provider
Inte
r In UC People provider
Suwit Wibulpolprasert, IHPF, Thailand23
Adequate capacity to generate evidences for decision and manage UHC
ddecision and manage UHC
• 1992 – Health Systems Research Institute (HSRI)
Thai
lan • 1995 – Health Care Reform Project - EU
• 2000 – International Health Policy Program and later
ogra
m -T y g
on foundation (IHPP)• 2002 – National Health Security Office (NHSO) and
-Tha
iland
olic
y Pr
o 2002 National Health Security Office (NHSO) and sin-taxed based Thai Health Promotion Foundation and Hospital Accreditation Institute (HAI)
cy P
rogr
amea
lth P
o and Hospital Accreditation Institute (HAI)• 2005 – Health Insurance Systems Research Office
(HISRO); Claim and case mix (DRG)
Hea
lth P
olic
onal
He (HISRO); Claim and case mix (DRG)
• 2006 – establish Health Intervention and Technology Assessment Program (HITAP)
rnat
iona
l Hnt
erna
ti Assessment Program (HITAP)• 2012 – all partners establish CAP UHC to support
south south collaboration workshops and on site
Inte
r In south-south collaboration – workshops and on site consultation and advocacy 24
Challenges and possible solutionsd
g p• Inequitable access : harmonization/ unification and
Thai
lan
qspecial financial incentives (P4P)
ogra
m -T
• Ageing society, NCD and chronic diseases –community and home based care and NCD funds for
-Tha
iland
olic
y Pr
o community and home based care and NCD funds for 2ry prevention
cy P
rogr
amea
lth P
o
• International trade – medical tourism n TRIPs plus
Hea
lth P
olic
onal
He
• Technology explosion – HITA and TRIPs flexibilities
rnat
iona
l Hnt
erna
ti
• Increasing expectation/demand – regular surveys,
Inte
r In
g p g y ,social motivation/financial incentives, NFCF
Suwit Wibulpolprasert, IHPF, Thailand25
The regional and global movementsd • Asian countries with UHC - Brunei, China, Japan,
Thai
lan
, , p ,Korea, Malaysia, Singapore, Sri Lanka, Thailand
• Asian countries committed – Bangladesh India
ogra
m -T • Asian countries committed – Bangladesh, India,
Indonesia, Laos PDR, Maldives, Philippines, and Vietnam
-Tha
iland
olic
y Pr
o Vietnam• Joint Statement ASEAN plus three HMM – July12
cy P
rogr
amea
lth P
o • UNGA resolution on UHC - December 2012 • UHC in the post 2015 and SDGs and ECOSOC
Hea
lth P
olic
onal
He UHC in the post 2015 and SDGs and ECOSOC
13• Many global and regional meetings on UHC
rnat
iona
l Hnt
erna
ti • Many global and regional meetings on UHC –EMRO/Dubai, JP-WB/Tokyo in December 2013!!C i b ildi JLN JP WBIn
ter In • Capacity building supports – JLN, JP-WB trust
fund, CAP UHC/Thailand, etc.Suwit Wibulpolprasert, IHPF, Thailand26
Asean +3 Joint Statement of HMMd
• Recognize significant role of UHC on poverty d ti d t th hi t f MDG
Thai
lan reduction and support the achievement of MDGs
ogra
m -T
• Commit to accelerate the progress on UHC in all countries and support the establishment of the
-Tha
iland
olic
y Pr
o ASEAN plus three UHC networks on UHC
cy P
rogr
amea
lth P
o
• Share and build capacity to assess and manage equitable and efficient health systems to support UHC
Hea
lth P
olic
onal
He q y pp
• Concur and collectively move the UHC to be
rnat
iona
l Hnt
erna
ti • Concur and collectively move the UHC to be discussed and committed at the highest regional and global development forum including ASEAN
Inte
r In and global development forum, including ASEAN plus three summit, and the UNGA
Suwit Wibulpolprasert, IHPF, Thailand27
The UNGA resolution on UHCd • Include UHC in the discussion on the post
Thai
lan 2015 development agenda
ogra
m -T
• ECOSOC consider UHC as part of its 2013
-Tha
iland
olic
y Pr
o work programs with WHO n WB
cy P
rogr
amea
lth P
o
• Continue consultation on UHC and ibilit f HLM i UNGA
Hea
lth P
olic
onal
He possibility of a HLM in UNGA
rnat
iona
l Hnt
erna
ti
• UNSG and UN agencies to give high priority to UHC WB and WHO are very clear
Inte
r In to UHC – WB and WHO are very clearSuwit Wibulpolprasert, IHPF, Thailand
28
The Role of Asian Countries to move UHCd • Move concretely and actively to achieve UHC
Thai
lan Move concretely and actively to achieve UHC
ogra
m -T
• Global advocacy movement – to put UHC as the post 2015 and the Sustainable
-Tha
iland
olic
y Pr
o pDevelopment Goals – several regional meetings
cy P
rogr
amea
lth P
o meetings
Hea
lth P
olic
onal
He
• Capacity building thru Knowledge management – the Japan-WB trust fund on
rnat
iona
l Hnt
erna
ti management the Japan WB trust fund on UHC, the ASEAN plus three UHC networks, the AAAH the HTAsiaLink and the Thai
Inte
r In the AAAH, the HTAsiaLink, and the Thai UHC CAP program 29
The Association of Southeast Asian Nations (ASEAN Community)
dNations (ASEAN Community)
Thai
lan
ogra
m -T
-Tha
iland
olic
y Pr
ocy
Pro
gram
ealth
Po
Hea
lth P
olic
onal
He
rnat
iona
l Hnt
erna
tiIn
ter In
30
ASEAN is the microcosm of the worldd
ASEAN is the microcosm of the worldPolitical – Absolute Monarchy to Democracy
Thai
lan Political Absolute Monarchy to Democracy
Religious – Buddism, Christian, and IslamicEconomy LIC LMIC UMIC HIC
ogra
m -T Economy – LIC, LMIC, UMIC, HIC
Geography – islands and mainlandP l ti ll di d l
-Tha
iland
olic
y Pr
o Population – small, medium, and large Climate – equator to temperate
cy P
rogr
amea
lth P
o
Colonization – non and used to (UK, France, Dutch, US) with China and Russian Influence
Hea
lth P
olic
onal
He utc , US) t C a a d uss a ue ce
Anything that can be agreed in consensus
rnat
iona
l Hnt
erna
ti Anything that can be agreed in consensus in ASEAN is likely to be agreed in the whole world
Inte
r In world31
ASEAN Community and Healthd
ASEAN Community and HealthTh
aila
n Securityand ASPC
ogra
m -T politics
-Tha
iland
olic
y Pr
o
Health
cy P
rogr
amea
lth P
o Health
S i l d
Hea
lth P
olic
onal
He Social and
CultureEconomic
ASCCAEC
rnat
iona
l Hnt
erna
ti AEC
Inte
r In
32
Challenges to ASEAN Communityd
Challenges to ASEAN CommunityTh
aila
n PEACE : Political – Military SecurityNon-traditional threats : Disaster
CoMMUNITYCommunity-building is an on-going
ogra
m -T
Democracy, Good Governance and Human Rights
process; beyond 2015
CONNECTIVITY
-Tha
iland
olic
y Pr
o
PROSPERITY : Economic SecurityConnecting within and to the world;
beyond ASEAN connectivity
cy P
rogr
amea
lth P
o Food SecurityEnergy Security
CENTRALITYCentral in the regional architecture;
Hea
lth P
olic
onal
He
PEOPLE : Socio-Cultural Security
in the ‘driving seat’
CREDIBILITY
rnat
iona
l Hnt
erna
ti Human SecuritySecurity and Identity
Credible to the peoples and the world
Inte
r In
33
Interests of ASEAN members in d
regional trade in health servicesTh
aila
n Mode Export Import1 Cross border Thailand Singapore
ogra
m -T
supplyg p
2 Consumption Singapore, Malaysia, All ASEAN members
-Tha
iland
olic
y Pr
o abroad Thailand, Philippines
3 Commercial Singapore, Malaysia, All ASEAN members
cy P
rogr
amea
lth P
o presence Thailand
Hea
lth P
olic
onal
He
4 Movement of natural
person
Philippines,Indonesia, Myanmar
Singapore, Brunei, Thailand
rnat
iona
l Hnt
erna
ti person
Challenge - Will the medical tourism drain limited
Inte
r In
34
Challenge Will the medical tourism drain limited human resources from developing countries?
Why Mutual Recognition Arrangement (MRAs)?
dArrangement (MRAs)?
• Pursuant to the AFAS and the ASEAN
Thai
lan • Pursuant to the AFAS and the ASEAN
Economic Community (free flow of good, services & investments)
ogra
m -T services & investments)
-Tha
iland
olic
y Pr
o
• 12th ASEAN Summit, 13 January 2007-ASEAN Economic Community by 2015 [free
cy P
rogr
amea
lth P
o y y [movement of professionals]
•
Hea
lth P
olic
onal
He •
• To facilitate movement of health f l f h f l f
rnat
iona
l Hnt
erna
ti professionals to further facilitate provision of health services
Inte
r In
35
ASEAN MRAs H lth P f i l
don Health Professionals
Thai
lan • Nursing Services
– Negotiated during 2004 - 2006
ogra
m -T ego a ed du g 00 006
– Signed on 8 December 2006 by ASEAN economic health ministers
-Tha
iland
olic
y Pr
o
• Medical Practitioners
cy P
rogr
amea
lth P
o – Negotiated during 2006 – 2009– Signed in 2009
Hea
lth P
olic
onal
He
• Dental PractitionersNegotiated d ing 2006 2009
rnat
iona
l Hnt
erna
ti – Negotiated during 2006 – 2009– Signed in 2009
Inte
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36
MRA on Nursing Servicesd
MRA on Nursing Services
ARTICLE III
Thai
lan ARTICLE III
RECOGNITION, QUALIFICATIONS AND ELIGIBILITY OF FOREIGN NURSES
ogra
m -T
3.1 Recognition of a Foreign Nurse3.1.3 Minimum practical experience in the practice of nursing
of not less than three (3) continuous years prior to
-Tha
iland
olic
y Pr
o of not less than three (3) continuous years prior to the application;
3.3 Undertaking of a Foreign Nurse3 3 1 L l d f f i l d t i d ith
cy P
rogr
amea
lth P
o 3.3.1 Local codes of professional conduct in accordance with the policy on ethics and conduct on the Practice of Nursing established and enforced by the Host Country;
Hea
lth P
olic
onal
He 3.3.2 Prevailing domestic laws and regulations of the Host
Country,…
rnat
iona
l Hnt
erna
ti Any ASEAN members that are not ready to implement this MRA can defert is required to implement it by 1 January 2010.
Inte
r In
The effect is still far away from ‘real’ movements of HRH37
Barriers to the MRAsd
Barriers to the MRAs
• Different definitions and scope of nursing
Thai
lan • Different definitions and scope of nursing
practices
ogra
m -T
• Different education
-Tha
iland
olic
y Pr
o
standards/curriculum/continuing education
cy P
rogr
amea
lth P
o
• Regulatory system and work permit/VISA
Hea
lth P
olic
onal
He
• Language and cultural barriers
rnat
iona
l Hnt
erna
ti • Language and cultural barriers
Unilateral recognition has been implemented!!!
Inte
r In
38
Unilateral recognition has been implemented!!!
Strategies for H in Asia beyond 2015d
g y
Invest more on Health and get the best health
Thai
lan Invest more on Health and get the best health
for the investment
ogra
m -T
Long term sustainable capacity building
-Tha
iland
olic
y Pr
o Long term sustainable capacity building especially on HS/HP research and management based on INNE (Individual
cy P
rogr
amea
lth P
o management based on INNE (Individual, Node, Network, and Environment) model
Hea
lth P
olic
onal
He
Triangle that moves the mountain –
rnat
iona
l Hnt
erna
ti Triangle that moves the mountain combination of Social power, power of wisdom and political power
Inte
r In wisdom and political power39
Summaryd
y
• Asia is progressing fast in economic and social development and
Thai
lan
p g g pis microcosm of the world
ogra
m -T
• Challenges include ageing, epidemiological transition, globalization especially global trade, politico-economic-socio/cultural difference
-Tha
iland
olic
y Pr
o socio/cultural difference
• Asian countries are moving fast to achieve UHC and can play
cy P
rogr
amea
lth P
o • Asian countries are moving fast to achieve UHC and can play significant roles at global level
Hea
lth P
olic
onal
He
• ASEAN Community 2015 opens a new era of collaboration but it will take more time to really affect any significant changes in H
rnat
iona
l Hnt
erna
ti
• Combing the power of wisdom, society and policy supported by l t it b ildi d i t t i h lth
Inte
r In long term capacity building and more investment in health are essential responses 40