BASIC INFORMATION Value Year Source

Total population (million) 64.8 2014 {1}

Area (sq.km.) 514,000 {2}

Density of population (per sq.km.) 126 2014 {1, C}

Administrative divisions

DEVELOPMENT

Gross national income(GNI) per capita (US$) 5210 2012 {3}

Highest in the world - Norway 98860 2012 {3}

Highest in the Region - Maldives 5750 2012 {3}Population below poverty line - Intl.$1.25 per day (%) 0.38 2010 {3}

Lowest in the Region -Thailand <1 2010 {3}

Population below national poverty line (%) 8.1 2009 {2}

Lowest in the Region -Sri Lanka 8.9 2010 {3}

Adult literacy rate >15 years (%) 97 2010 {2}

Highest in the Region - DPR Korea 100 2010 {4}

Net enrolment rate—primary (%) 89.7 2009 {5}

Highest in the Region -Indonesia 96 2010 {5}

Human Development Index 0.690 2012 {4}

Highest in the Region - Sri Lanka 0.715 2012 {4}

Population in multidimensional Poverty (%) 1.6 2012 {4}

Lowest in the Region - Thailand 1.6 2012 {4}

Gender Inequality Index 0.360 2012 {4}

Lowest in the Region - Maldives 0.357 2012 {4}

THAILAND

75 Provinces (Chagwat) and 878 Districts (Amphoe)

Salient basics ● The Thai economy was growing rapidly untill 1997 when an economic crisis erupted. The economy contracted during 1997 and 1998, and then recovered. Again after a drop in 2009 GDP due to the 2008 global economic crisis, Thai economy is well on growth path. ● Thailand is among the well-off countries in the Region with only 8% of the people below the national poverty line and <1% population below the international poverty line of Intl.$1.25 per day . ● The Education level is high, the Human Development Index at 0.690 is one of the highest the Region, and gender inequality index at 0.360 is one of the lowest for good.

14

39

77 75 80

87

104

125 135

144 143

0

20

40

60

80

100

120

140

160

GD

P pe

r cap

ita in

Bah

t (ne

ares

t '00

0)

Trend of GDP per capita in Thai Baht

Data source : 2

20.9

14.9

11.2

9.6 8.5 8.9

8.1

0

5

10

15

20

25

Perc

enta

ge

Percentage of Population Below National Poverty Line

Data source : 2

92.6 95.7

92.6 93.5 94.1 97

50

60

70

80

90

100

Perc

enta

ge

Literacy rate of Thai population 15+ years of age

Data source : 2

POPULATION Value Year SourceTotal population (million) 64.8 2014 {1}

Annual natural growth rate of population (%) 0.4 2014 {1}

Urban population (%) 47 2014 {1,C}

AGE-SEX STRUCTURE

Sex ratio (F/1000M) 1057 2014 {1,C}

Children <15 years (%) 18.4 2014 {1,C}

Elderly ≥60 years (%) 15.3 2014 {1,C}

Highest in the world - Japan 30.7 2010 {6}

Highest in the Region - DPR Korea 13 2010 {6}

Total Dependency Ratio ((Age 0-14 + Age 65+) / Age 15-64) (%) 40.3 2014 {1,C}

Lowest in the world - UAE 17 2010 {6}

Lowest in the Region - Thailand 39 2010 {6}

FERTILITYBirth rate (per 1000 population) 11.5 2014 {1}

Lowest in the world - Germany 8.4 2005-10 {6}

Lowest in the Region - Thailand 11.8 2005-10 {6}

Total fertility rate (TFR) (per woman) 1.6 2014 {1} Data source: 1

Lowest in the world - Macao SAR (China) 0.9 2005-10 {6} Crude Death and Birth Rate by Year

Lowest in the Region - Thailand 1.5 2005-10 {6}

Contraceptive prevalence rate (%) 79.6 2014 {1}

GROSS MORTALITYCrude death rate (per 1000 population) 7.9 2014 {1}

Lowest in the world - UAE 1.0 2005-10 {6}

Lowest in the Region - Maldives 4.0 2005-10 {6}

Q.1 What are the basic demographic features?

Salient demographic features ● The success in Thailandûs family planning campaigns has led to an increase in the contraceptive prevalence rate from 14.4% in 1970 to 79.6% in 2014, resulting in a drastic reduction in the total fertility rate to below the replacement level (a couple having two children, only enough to replace themselves). And as a result, the population growth has continuously dropped from 3.2% prior to 1970 to 0.4% in 2014, below the level of 0.54% projected for 2030. Such a decrease in the population growth has affected the number and age structure of population. ● The continuous increase in proportion of adult population 15-59 years of age over last 40 years after having peaked at 67.5% in 2010 dropped to 66.2% in 2014 and with that demographic bonus which Thailand enjoyed all these years seems to have come to an end. Instead proprtion of population over 60 continuing to increase is projected to cross over proportion of children 0-14 years of age by 2020. ● In 2010, Thailand began to become an elderly society resulting in the working-age population bearing a higher burden in taking care of the elderly. (The United Nations has defined that, for a country to become an elderly society, its ratio of population aged 65 years or over to the entire population ranges from 7% to 14% and it fully becomes an elderly society when the ratio exceeds 14%.) . ● The net reproduction rate may be already less than 1, indicating that the population may stabilize in the near future.

31

24

23

21

18

62

66

66

68

66

7

10

11

12

15

0% 20% 40% 60% 80% 100%

1990

2000

2005

2010

2014

<15 15-59 60+

Trends in Percentage of Population by major age groups

Data source : 2

58

51 51 48 52

63

46

37 35 30

25 22 12

14 17 18

27

41

0

10

20

30

40

50

60

70

Perc

enta

ge

Total dependency ratio Dependency ratio of children <15 Dependency ratio of elderly 65+

Trends in population dependency ratio

Data source : 2

12.7 12.5 12.6 12.4 12.0

8.0 8.0 7.0 6.9 7.1

0

5

10

15

20

25

30

2007 2008 2009 2010 2011 2012 2013

Per 1

000

popu

latio

n

CBR CDR

Trends in birth rates and death rates

Data source : 11

1990 2000 2005 2012

2015 (National

target)

POVERTY AND HUNGER

Population below minimum national food poverty line (Prevalence of undernourishment in general population) (%)

43.8 19.6 11.2 7.3 (2011)

21.9

Under-weight (<-2SD) children (%) 41.7 (1986)

… 14.4 (2003)

8.7 (2010)

20.9

CHILD MORTALITY

Infant mortality rate (per 1000 live births) 8.0 6.2 7.6 6.8 2.7

Under-five mortality rate (per 1000 live births) 12.8 11.9 10.8 9.1 4.3

One year olds immunized against measles (%) 80 94 96 98 (2011)

>90

MATERNAL HEALTH

Maternal mortality ratio (per 100,000 live births) 50 44.5 (2004)

42 31.8 (2010)

12.5

Deliveries attended by health staff (%) 91 98 (2001)

99 99.5 (2009)

>90

HIV/MALARIA/TUBERCULOSIS

HIV prevalence in 15-49 years (%) … 1.8 (2001)

… 1.1

Malaria incidence (per 100,000 population) 520 136 49 17 130

Tuberculosis prevalence (per 100,000 population) 227 286 236 159 113.5

WATER AND SANITATION

Population with access to improved water source (%)

86.4 91.7 94.3 95.8 (2011)

93

Population with access to improved sanitation (%)

81.7 91.3 93.6 93.4 91

Q.2 What is the progress regarding some health-related MDGs?

MDG Progress ● With regard to MDG 4, Thailand already had low 1990 baseline mortality rate in children under-five and the progress in further decline has been somewhat slow .The challenge therefore now is to scale up interventions to reduce neonatal mortality as the further reduction in under-five mortality from this low baseline level will be driven mainly by reduction in deaths that occur in the first month of life of newborns. ● Related to MDG 5, progress in decline of Maternal mortality also has been slow from already low 1990 baseline, The country set target of MMR of 36 per 100 000 live births by 2011 has already been achieved in 2009. Thailand has integrated all reproductive health programmes and projects that would contribute to further reduction in MMR. The MoPH has set a policy to improve the MMR data by linking data from different sources to civil registration data. ● Except for tuberculosis, all other health-related MDG targets have been achieved or are likely to be achieved by 2015.

13 12

11 11 10 10 9

4

8

0

5

10

15

20

25

1990 2000 2005 2006 2007 2008 2012 2015

U5M

R

Year

Under-five mortality rate (per 1000 live births)

Trend Target Projection

50 45 42 42

35 32

13

21

0

15

30

45

60

75

1990 2004 2005 2006 2009 2010 2015 M

MR

Year

Maternal mortality ratio

…

Trend Target Projection

1.8

1.1

520

136 49 17

227 286 236 159

0.0

0.4

0.8

1.2

1.6

2.0

0

200

400

600

800

1000

1990 2000 2005 2012

HIV

/AID

S pr

eval

ence

(%)

Mal

aria

, TB

(per

100

000

pop

ulat

ion)

Year

Trends in HIV/AIDS, TB, Malaria

HIV Malaria TB

IN CHILDREN UNDER FIVE YEARS Value Year Source

Low birth weight (%) 8.3 2009 {2}

Lowest in the Region - DPR Korea 6 2009 {7}

Stunted children (%) 15.7 2005-06 {8}

Lowest in the world - Germany 1.3 2005--12 {9}

Lowest in the Region - Thailand 15.7 2005-12 {9}

Under-weight children (%) 7.0 2005-06 {9}

Lowest in the world - Australia 0.2 2005-12 {9}

Lowest in the Region - Thailand 7.0 2005-12 {9}

CHILDHOOD DISEASESDiarrhoeas incidence (per 1000 children <5 years) 100 2009 {2}

Pneumonia incidence (per 1000 children <5years) 15.8 2009 {2}

Iodine deficiency disorder among primary school children (per 1000 children) 6.9 2004 {2}

OTHER DISEASES

Anaemia in pregnant women (%) 10.6 2005 {2}

Tuberculosis incidence (per 100,000 population) 79 2009 {2}

Malaria incidence (per 100,000 population) 41 2008 {2}

Filariasis prevalence ( per 100,000 population) 0.25 2009 {2}

HIV prevalence (per 100,000 population) - Total population 1772 2011 {2,C}

Hypertension prevalence (per 100,000 population) 981 2009 {2}

Diabetes prevalence (per 100,000 population) 736 2009 {2}

Cancer prevalence (per 100,000 population) 133 2009 {2}

Leprosy incidence (per 100,000 population) 1 2009 {2}

Prevalence of anxiety disorders (per 100,000 population) 527 2009 {2}

Road traffic Injuries (per 100,000 population) 98 2009 {2}

COMPREHENSIVE INDICES

Healthy life lost (in years) 8.8 2010 {10}

Healthy life lost as % of expected life at birth (ELB) 11.9 2010 {10}

Q.3 What are the major health problems?

Major health problems ● Although undernutrition no longer seem to be a problem in Thai children but an increasing trend of over nutrition resulting in overweight in children indicates that obesity could become an over-riding public health problem. ● Acute diarrhoea is still a crucial public health problem among children under five years of age whose incidence is higher than that in adults. Although the incidence of pneumonia in children has fallen, it remains the number one cause of death, among all infectious diseases, in children under five. ● Risk factors for noncommunicable diseases such as hypertension and diabetes have more than tripled over last two decades.

5.7 7.2

10.0

4.5 1.6 1.6

0

5

10

15

20

25

30

1990 1995 2000 2005 2010

Diarrohoea per 100,000 children

Pneumonia (%)

Trends in incidence of Diarrhoea and pneumonia in children under-5

Data source : 2

16

12.2 11.5

6.23

0

2

4

6

8

10

12

14

16

18

1991 1997 2001 2007-08

Perc

enta

ge

Proportion of primary school children with underweight

Data source : 2

5.4

11

22.1 21.4

11.3 15.4

19.4

2.3

4.6

6.8 6.9

0

5

10

15

20

25

1991 1997 2004 2009

Perc

enta

ge

Hypertension Hyperlipidemia Diabetes

Prevalence of risk factors for NCDs among Thai people

Data source : 2

MORTALITY RATES Value Year Source

Fetal death rate (still births) (per 1000 total births) 4 2009 {12}

Lowest in the world - Finland, Germany, Iceland, Singapore 2 2009 {12}

Lowest in the Region - Thailand 4 2009 {12}

Neonatal mortality rate (NMR) (per 1000 live births) 8 2012 {13}Lowest in the world - Japan, Singapore,

Sweden 1 2011 {12}

Lowest in the Region - Maldives 6 2011 {12}

Infant mortality rate (IMR) (per 1000 live births) 10.9 2013 {1}

Lowest in the world - Finland, Japan, Iceland,Sweden 2 2011 {12}

Lowest in the Region - Maldives 9 2011 {12}

Under-5 mortality rate (U5MR) (per 1000 live births) 17.9 2013 {1}

Lowest in the world - San Marino 2 2011 {12}

Lowest in the Region - Maldives 11 2011 {12}

Maternal mortality ratio (per 100,000 live births) 31.8 2010 {14}

Lowest in the world - Estonia 2 2010 {9}

Lowest in the Region - Sri Lanka 35 2010 {9}

AGE AT DEATHExpectation of life at birth (ELB) (years) - Male / Female 71 / 78 2013 {1}

Highest in the world (combined)- Japan 83.5 2010-15 {6}

Highest in the Region - Maldives 77.7 2010-15 {6}

Deaths under-5 years (% of of total deaths) 1.7 2010-15 {6}

Number of under-5 deaths (thousands) 9 2012 {15}

CAUSES OF DEATH Ten leading causes of hospital deaths (per 100,000 population)

Neoplasms 95.2 2011 {11}

Diseases of circulatory system 68.8 2011 {11}

Certain infectious and parasitic diseases 64.6 2011 {11}

External causes of morbidity and mortality 63.4 2011 {11}

Diseases of respiratory system 49.9 2011 {11}

Diseases of genitourinary system 24.6 2011 {11}

Diseases of digestive system 22.2 2011 {11}

Endocrine, nutritional, and metabolic diseases 13.8 2011 {11}

Diseases of nervous system 8.0 2011 {11}

Diseases of blood and blood forming organs and certain disorders involving the immune mechanism

1.0 2011 {11}

Q.4 What is the mortality profile?

Mortality profile ● Life expectancy of Thai people is amongst the highest in developing countries with women living about 7 years longer than males. ● HIV/AIDS and road traffic accidents are major killers of adults. ● The cancer death rate is steeply rising in the elderly population. The death rate due to heart diseases is declining after peaking in 1995. ● After the 1997 economic crisis the suicidal rate tended to be on the rise; the rate in males being almost four times higher than that in females. In 2003, 10 males and 3 females committed suicide every day. However, after 2005, the rate has had a declining trend for both males and females

14.2

28.2

19.4 20.7 20.3 19.9 18.3 16.9

0

10

20

30

40

50

1990 1995 2000 2005 2006 2007 2008 2009

Per 1

00,0

00 p

opul

atio

n

Trends in death rates from road traffic accidents

Data source : 2

63.8 65.6

67.7

69.9 69.9 70.6 71.9

68.9 70.9

72.4

74.9

77.6 77.5 78.8

60

65

70

75

80

85

Year

s

Male Female

Life expectancy at birth (in years)

Data source : 2

95 69

65

63

50

25

22

14

8

1

0 20 40 60 80 100

Neoplasms

Diseases of circulatory system

Certain infectious and parasitic diseases

External causes of morbidity and mortality

Diseases of respiratory system

Diseases of genitourinary system

Diseases of digestive system

Endocrine, nutritional, and metabolic diseases

Diseases of nervous system

Diseases of blood and blood forming organs and certain disorders involving the immune mechanism

Per 100,000 population

2009 2010 2011

Trends in ten leading causes of hospital deaths

Data source : 11

EXPENDITURE ON HEALTH Value Year Source

Percent of GDP 4 2012 {16}

Highest in the world - Sierra Leone 20.8 2010 {9}

Highest in the Region - Maldives 6.2 2010 {9}

Per capita (US$) 215 2012 {16}

Per capita (Intl.$) 385 2012 {16}

Highest in the world - USA (Intl.$) 8233 2010 {9}

Highest in the Region - Maldives (Intl.$) 510 2010 {9}

FOODDietary Energy Supply (DES) as a percentage of the Average Dietary Energy Requirement (ADER) 120 2010-2012 {17}

SERVICESHealth centres (per 100,000 population outside municipal areas) 19 2009 {2}

Antenatal care coverage (at least four visits) (%) 79.6 2009 {19}

Pregnant women immunized with TT (%) 89.2 2008 {2}

Deliveries by qualified attendant (%) 99.5 2009 {19}

Children immunized (%)

BCG 98.0 2008 {2}

DPT-3 97.1 2008 {2}

Polio-3 97.6 2008 {2}

Measles 91.4 2008 {2}

Hospital beds (per 10,000 population) 21 2005 {18}

Highest in the world - Monaco 165 2005-12 {9}

Highest in the Region - DPR Korea 132 2005-12 {9}

HUMAN RESOURCES

Doctors of modern system (per 10,000 population) 3.1 2005 {18}

Highest in the world - Monaco 70.6 2005-12 {9}

Highest in the Region - DPR Korea 32.8 2005 {CC}

Professional nurses (per 10,000 population) 16.3 2005 {18}

Technical nurses (per 10,000 population) 2.6 2005 {18}

Highest in the world - Norway 319.3 2005-12 {9}

Highest in the Region - Maldives 58.4 2010 {CC}

Dentists (per 10,000 population) 1.4 2005 {18}

Pharmacists (per 10,000 population) 1.3 2005 {18}

Q.5 What resources are available for the health sector?

Health resources ● Although country reported total expenditure on health as shown in the graph was 6.5% of GDP in 2008, the WHO estimate for 2012 is 4% which is relatively low against the minimum 5% as a general norm. However, the per capita expenditure of 385 Intl.$ is amongst the highest in Sear countries. ● Provision of services in terms of health centres, service coverage and beds seems to be sufficient. ● Health centres are within easy reach of most people.

5.4 6.1 6.2 6.3 6.4 6.5

0

2

4

6

8

10

1995 2000 2005 2006 2007 2008

Perc

enta

ge

Trends in total health expenditure on health as % of GDP

Data source : 2

16.2 16.3 17.4

18.0 18.4 18.6 18.9

2.9 2.9 3.1 2.8 2.9 3.0 3.1

0

4

8

12

16

20

1999 2000 2001 2002 2003 2004 2005

Per 1

0,00

0 po

pula

tion

Nurses (Prof+Tech) Doctors

Trends in number of key health personnel per 10,000 population

Data source : 18

90.8

94.4

98.0 99.0

90

91

92

93

94

95

96

97

98

99

100

1990 1995 2001 2005

Perc

enta

ge

Deliveries attended by skilled health personnel

Data source : 20

Value Year Source

Out of total health expenditure (%) 75 2010 {9}

Per capita (US$) 134 2010 {9}

Per capita (Intl.$) 248 2010 {9}

Highest in the world - Luxembourg (Intl.$) 5660 2010 {9}

Highest in the Region - Maldives (Intl.$) 310 2010 {9}

PRIVATE EXPENDITURE ON HEALTHOut of total health expenditure (%) 25 2010 {9}

Lowest in the Region - DPR Korea 0.4 2010 {CC}

Out-of-pocket expenditure (% of total expenditure on health) 14 2010 {9}

Lowest in the Region - DPR Korea 0.04 2010 CC

Social Security expenditure on health (as % of total expenditure on health (%) 7.6 2010 {9}

Private prepaid plan ( as % of total expenditure on health) 7.9 2010 {9}

Other (external resources for health as % of total expenditure on health) 0.3 2010 {9}

Q.7 Who pays for health care?

GENERAL GOVERNMENT EXPENDITURE ON HEALTH

Health expenditure ● Total expenditure on health in Thailand is rising consistently and has been above the minimum US$ 44 per capita recommended by Economic Commision on health for any country to be able to deliver essential health services to all its people. At US$ 179 in 2010, It has almost tripled from US$ 66 in 2000. . ● Share of public expenditure is also rising and has been more than private share. In 2010, for every one dollar spent by households, government spent three. ● More than 10% of general government expenditure on health is on social security, over 30% of private expenditure is covered by insurance, and with that out-of-pocket expenditure by households has gone down from 77% in 2000 to 56% in 2010. If this trend continue, Thailand may soon get to the generally recommended level of OOPs of 15 to 20% of private expenditure on health.

66

179

0

40

80

120

160

200

2000 2010

US

$

Trend in per capita total expenditure on health

Data source : 9

56

75

43.9

25

0

20

40

60

80

100

2000 2010

Perc

enta

ge

Public Private

Trend in public private expenditure on health

Data source : 9

77

56

13

31

0

20

40

60

80

100

2000 2010

Perc

enta

ge

OOPs Private Insurance

Trend in components of private expenditure on health

Data source : 9

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HEALTH SECTOR REFORMS

ACHIEVEMENTS

LEGISLATION

Q.8 What are the recent reforms and achievements of the health system?

Reorientation of the mission and restructuring of the Ministry in 2002 resulted in its downsizing. Certain health facilities will become like state agencies with more flexibility in their operations.

A plan has been prepared in cooperation with all concerned for decentralization of health administrative systems in the form of an Area Health Board. In this context, the Ministry has established 52 Provincial Public Health Committees to undertake responsibility of developing a system that caters to the actual health needs of the communities.

Between 2002 and 2004, the government continued to support programmes for the poor and under-privileged but in the form of health insurance revolving fund and capitation payment, covering a population of 46 million who never had any insurance coverage.

Problems such as pollution and HIV/AIDS have social overtones that the Ministry of Public Health alone was not able to solve. There are now nearly 500 NGOs registered with the Ministry, which are working in support of the public sector. These have become a powerful force in social mobilization, aiming to achieve the highest efficiency of programme operations.

The Thai Health Promotion Foundation was established in 2001.Thailand aims to deliver health services oriented towards building health rather than treating ill-health. Among reforms are decentralization, hospital autonomy, health insurance, quality assurance and community participation, with special attention to hill tribes, internal migrants, undocumented aliens and the urban poor that have been neglected in the past.

The Ministry of Public Health initiated the Healthy Thailand strategy as a guideline to reduce behavioural health risks and solve major health problems while pursuing the MDG targets. Five key areas of this strategy are: exercise, diet, emotional development, disease reduction and environment health.

Modernizing Health Care System in Thailand is the most recent plan to enhance the development of e-health, and setting up of excellent medical services and health research centres.

The universal coverage of health care scheme now extends to all 75 districts, and covers nearly 75% of population nationwide. Some other persons are covered by other health insurance schemes. Only nearly 5% are now left with no insurance coverage.

Health promotion programmes are mostly implemented by the public sector agencies and NGOs with a variety of approaches such as health behaviour modification. THE Major achievements of such programmes are (i) preventing youth from alcohol consumING and social measures for minimizing its negative impact, (ii) organization of "Empowerment for Health" events to encourage people to participate in promoting their own health; (iii) launching projects for awareness regarding exercise; (iv) promotion of healthy food consumption; and (v) no smoking campaigns due to which THE smoking rate dropped from 30% in 1976 to 22% in 1993.

For promotion of mental health, activities have been undertaken such as ‘bonding relations within the family’, development of children emotional quotient, community programmes for removing inhibitions for seeking mental health care, and establishment of a Mental Health Crisis Centre.

Since 2003, the Ministry has implemented universal access to antiretroviral (ARV) drugs to all HIV/AIDS patients.

The National Health Security Act 2002, laid the basis for a universal health care scheme, popularly known as 30-baht (US$0.86) scheme since that is the fee for each visit or admission to hospital. The Act allows merging of civil service and social security schemes into a single universal scheme.

Under the Elderly People Act 2003, the National Commission on Elderly was established with the Prime Minister as the chair. The Act establishes a specific elderly fund to cover expenses for promotion and support of activities related to the elderly. It also stipulates the implementation of a monthly allowance scheme to destitute elderly throughout the country.

A National Health System Reform Office has been established for formulating the process leading to the passage of a National Health Act, which will be regarded as the “health constitution” of the Thai people.

A National Public Health Act has been drafted that stipulates a National Health Committee comprising representatives from the government, intellectuals and the public at large. This Act also stipulates a National Health Assembly that will provide the forum to discuss opinions and the felt-needs of the people.

Prevention and control measures for malaria and filaria, particularly in border areas, has resulted in a substantial decline in these two diseases. Polio has been eradicated and leprosy has reached the elimination level.The Ministry has launched campaigns to raise public awareness about prevention and control of cardiovascular diseases, particularly hypertension in normal and at-risk conditions, to reduce the risk. For cervical cancer, a large number of women of 35 years and above have been examined under a project launched for its prevention and control. For breast cancer, women are encouraged to do a self-breast examination every month.

For Thai traditional medicine, 28 agencies have formed a network called Federation of Thai Traditional Medicine, which works for conservation and protection of Thai traditional medicine wisdom. A museum was established 2003 to collect all knowledge and technology on this system. Experiments have been conducted on the anti-microbial and immunogenic properties of many medical herbs and extracts for their anti-HIV/AIDS properties.

Since 2005 a tool for change management called the Strategic Route Map (SRM) was developed to empower the community to proactively address their own needs by taking a more developmental, holistic, multidisciplinary and participatory approach to health.

The Thai Traditional Medicine Protection and Promotion Act 1999 The Thai Health Promotion Foundation Act 2001 promotes and encourages health promotion in all age groups in the population in accordance with the national health policy. It seeks to create awareness of risks of alcohol, tobacco, etc., conduct studies and research or encourage them, and develop the ability of the community to foster health promotion activities.

●

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SOCIAL CONSTRAINTSInequalities—Gender Value Year Source

Expectation of life at birth F:M 1.1 2013 {1}Female share in waged non-agriculture

employment (%) 45 2007 {20}

Seats held in parliament−F (%) 11.7 2007 {20}

Ratio of girls to boys in primary schools (%) 100 2009 {20}

Inequalities—SpatialMorbidity rate of leptospirosis (per 100,000

population)

— North 4 2009 {2}

— Central 1 2009 {2}

— Northeast 18 2009 {2}

— South 11 2009 {2}

Population below poverty line

— Urban 3 2009 {2}

— Rural 10.4 2009 {2}

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LIFESTYLE●

●

●

●

Prevalence of hypertension is high, particularly in urban areas, but many individuals are not aware that this problem exists. Many have a high cholesterollevel.

Although the rate of drug abuse has dropped from 2.2% in 2001 to 0.7% in 2007, the number of drug clients has increased from 43,000 in 2004 to 119,000in 2009..

Smoking is highly prevalent – 46% of males and 3% females over 15 yearsof afe were smoking in 2009. Smoking among females has considerably declinedfrom 6% in 1976 to 2% in 2009 but smoking among males has shown only marginal decline.

Unsafe sex was the highest risk factor causing nearly 13% loss of disability adjusted life years (DALYs) in 2004 up from 9% in 1999..

Consumption of snacks is increasing. During 2006-07, 81% of 5-year old children had dental caries.

CHALLENGES

Besides, Thailand faces a challenge of emeging diseases like Pandemic (H1N1) and Avian Influenza. As of 13 October 2010, there were 225 H1N1 deaths and it was reported that there might be millions of infected people nationwide

Malaria and tuberculosis have re-emerged after many years of showing decline. HIV/AIDS has declined but is still high in some risk groups. These havebecome priority health problems requiring greater attention.

Rapid implementation the Universal coverage of health care has threatened the policy sustainability to some extent since the existing infrastructure haslimited capacity to perform new roles and functions. In addition, there is the problem of under-funding and less-than-ideal quality of medical services. Thechallenge is to keep the system sustainable and to meet the people’s expectations.

HEALTH SERVICES

While considerable gains have been made against communicable diseases, there has been a steady rise in noncommunicable disease (NCD). Among the top ten conditions in the disease burden ranking in Thailand, nine are NCDs, including road traffic injuries.

Q.9 What are the constraints and challenges of the health system?HEALTH SYSTEM CONSTRAINTS

Thailand has achieved considerable gains in the health status of its population over recent decades. The MDG targets in health have mostly been reached nationally and the health system has moved from strength to strength. Despite these gains, considerable social inequities remain between different parts of the country and between urban and rural populations affecting, in particular, people living in poverty and migrant populations.

While Thai capacity is well-developed, there are technical areas such as globalization, consumer protection and environmental health where additionalhuman resources and institutional development are needed. It is also necessary to continuously upgrade knowledge to keep pace with global developments.The number of health personnel is not consistent with the increased workload. Health agencies now have to carry a greater burden of responsibility as newprogrammes and projects are launched.

Females are at some disadvantage, and area-wise inequalities are observed. The population below the poverty line in rural areas is more than three times of thatin urban areas. The Bangkok Metropolitan area has almost twice as much obesity in children as the average for the country. The North-eastern region has lessthan one-sixth of doctors per thousand population compared with the Bangkok Metropolitan area.

Many doctors resigned government jobs due to heavy workload and inadequate compensation. In addition, indirect loss occurs when duties notcommensurate with qualification are assigned. In response to the increasing demand for human resources in both the public and private sectors, thegovernment has approved a project to increase the production of doctors.

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Geographical disparity in distribution of doctors in Thailand

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- Reduce TB burden.- HIV prevention and care (including harm reduction)- Malaria control (including containment of artemisinin-resistant malaria)- Reducing teenage pregnancy- Preventing unsafe abortion- Ensuring adequate iodine intake in the population through universal salt

iodization- Ensuring equitable access to health services among migrants and mobile

populations- Environmental and occupational health

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A national mechanism would be established for planning and regulating the production and service of human resources for health.

A mechanism would be set up to support and regulate traditional and other alternative health services.

Thailand hopes to become the Wellness Capital of Asia and the Medical Hub of Asia in view of the availability of a large number of spas, massage therapies,herbal products, and many hospitals that meet the ISO standards.

Thailand's National Health Commission emphasizes the implementation of the “Health in All Policies” concept and encourages people to participate in formulating public policies to cope with political, economic, social, technological and environmental challenges.

Q.10 What does the country hope to achieve in the near future in health?

The 11th National Health Development Plan 2012-16 continues to place emphasis on a people-centred approach with the aim of improving the public healthand the overall health system. In addition, the government has placed emphasis on programmes such as food safety, exercise for health, and road safetymanagement. The Health Plan has the following main targets:

For health information system (HIS), new guidelines aim to develop electronic individual cards, which can be linked between the central and local levels.

Area Health Boards were proposed to combine different local health authorities to get the advantages of economy of scale, and allow better referral andsharing of service responsibility among various levels of health providers.

The electronic health information system would link the universal health care coverage scheme, the social security scheme and the civil servant benefitscheme. This will cover nearly 95% of the population. The system is expected to link personal medical records to financial management information system,help in developing a nationwide data warehouse, and provide an opportunity to adopt telemedicine technology including tele-consultation and appointments.

The Government has a policy to restructure the management system of all health facilities so that they are more independent and flexible yet remain underthe government system. The details are being worked out.

Emerging diseases, which include infectious diseases, noncommunicable diseases, injuries and human toxic substances, would be effectively monitoredunder the national surveillance system. The national authority would provide technical support to the local governments, as well as set up a network with other countries for disease control and prevention.

● The Country cooperation strategy (CCS) is a key instrument of the World Health Organization for technical cooperation in support of Thailand’s National health plan, policies and strategies.

● The current CCS (2012-2016) is the 4th in series. Unlike previous CCSs that identified several broad strategic agendas for the period of four years, this CCS has a five-year horizon in order to align the strategic plan with the country’s next National Health Plan (2012– 2016) and with the new United Nations partnership Assistance Framework (UNPAF) and it focuses on a few strategic priorities that will be implemented collaboratively.

● In tune with the transition from a poor developing nation to a middle-income country, WHO's technical support in Thailand is focused more on emerging healthissues such as health system reform and the HIV/AIDS epidemic.

● Thailand houses considerable individual and institutional capacity in health-related areas. For this reason there has been considerable growth in the facilitatingrole of WHO such as study tours, fellowships, group educational activities, consulting, collaborating centres and contracting of research projects.

● WHO assists in providing a forum for discussion of policy implications of monitoring and assessments; encouraging evidence-based approaches; sharing ofmost recent developments from global initiatives/other country success stories, and providing a forum for presenting Thailand’s experience to neighbouringcountries.

● WHO Thailand represents WHO at the Economic and Social Commission for Asia and Pacific (ESCAP). WHO has forged a stronger alliance with this agencyin a number of health and development areas, most notably in efforts to implement the recommendations of the Commission on Macroeconomics and Healthissued in 2001.

● WHO has sharpened its programmatic focus in the current CCS as a result of review of the previous cycle to strategically focus WHO’s collaboration with thegovernment on a limited number of public health challenges primarily the five areas with strategic priorities listed below:

(1) Empower and strengthen the subdistrict health system so that the community health system will be more effective and responsive to the health needs ofthe population.

(2) Multisectoral networking for NCD control and to strengthen national policies, plans and interventions for prevention and control of five main NCDs:cardiovascular diseases, diabetes,cancers, chronic respiratory diseases and hypertension.

(3) Strengthening national capacity and coordination in disaster management, particularly in the health area.

(4) Building national capacity in trade and health negotiation

(5) Improve national road safety programme effectiveness through multisectoral and international collaboration.

● Thailand has been actively involved, with WHO assistance, in many new regional and bilateral international health related collaborative efforts, e.g., theIntercountry Cooperation for Health Development in the 21st Century initiative, the Mekong Basin health projects, the ASEAN subcommittee on health andnutrition, bilateral cooperation agreements with neighbouring countries, and south-south collaboration.

● To benefit and contribute most to global health-related collaboration and to cope with the increased level of international politics affecting health, Thailandsees an urgent need to strengthen the country's international health capacity, particularly in human resources. WHO is actively supporting this initiative.

PROMOTION OF HEALTHY LIFESTYLE AND SETTINGS● WHO is devoting considerable resources outside the conventional health care paradigm such as in creating awareness and prevention of HIV/AIDS to people

living with HIV/AIDS, access to basic health services through social security schemes, healthy cities approach for health promotion and environmental healthas well as occupational health.

● Nongovernmental organizations (NGOs) have been very effective in tobbaco control activities and have been strong supporters of WHO's tobacoo-freeinitiatives.

● WHO assists in advocacy for integrated policies and strategies for the national plan for control of communicable diseases, contextual analysis of nationalneeds under decentralization, coordinated surveillance, exploring inter-sectoral networking, dialogue with neighbouring countries for bilateral and multi-countrysurveillance, developing national disease profiles, etc.

● In the area of noncommunicable diseases, WHO helps in assessment of effectiveness of health promotion activities, linking Thai activities to the global healthpromotion agenda, technical support for capacity building especially for mid-level staff, and linking research results to policy development.

PREVENTION AND CONTROL OF PRIORITY DISEASES

POLICY DEVELOPMENT AND PLANNING

Q.11 How is WHO collaborating with the country?

HEALTH SYSTEM MANAGEMENT

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Thailand Health Profile 2005-2007Country reported data on MDGs from "Reproductive Health Survey, 2009, National Statistical Office, Thailand"

Thailand MDG report 2009

Levels and Trends in Child Mortality, Report 2013

http://www.moph.go.th/ops/thp/thp/en/index.php?id=288&group_=05&page=view_doc

The World Bank, World Development Indicators 2013 (26 October 2013 update)

WHO, World Health Statistics 2013The Institute of Health Metrics and Evaluationwww.healthmetricsandevaluation.org (Accessed 09 May 2013)

WHO, Global Health Observatory (www.who.int/gho)

http://www.who.int/nutgrowthdb/estimates2012/en/UNICEF-WHO-The World Bank: 2012 Joint child malnutrition estimates - Levels and trends

UNDP, Human Development Report 2013

WHO Global Health Expenditure database

UNESCO, Institute for statistics data centreUN, World Population Prospects, The 2012 RevisionUNICEF, Childinfo, http://www.childinfo.org/low_birthweight_table.php

http://www.unicef.org/infobycountry/Thailand_statistics.htmlCountry reported data on MDGs from "Family Health Program Evaluation 1995, 2000, 2005, Department of Health"

Sources

Statistical Yearbook of Thailand 2013

Population Gazette Vol 23, Jan 2014, Institute of population and social research, Mahidol universityhttp://www.ipsr.mahidol.ac.th/ipsr/ (accessed 12 May 2014)

Thailand Health Profile 2008-2010

http://apps.who.int/nha/database/DataExplorer.aspx?ws=0&d=1 (Accessed 18 May 2014)FAOSTAT.http://faostat.fao.org