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- Why Setting up ThaiHealth?

- The process of setting up

ThaiHealth

- How ThaiHealth operate?

- Some of Thai Health’s first

decade achievement

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3

Thailand :1990-1995: low budget interventions on tobacco control

Enacting two comprehensive Tobacco

Control Law in 1992 (Product control &

smoke free areas).

Regular tobacco tax increases policy in

1993.

Problem faced

4

1. Government provide very little

budget for tobacco control.

2. Request for more budget through

conventional method were

unsuccessful.

The idea of setting up “health

promotion fund” originally arise from

we want to secure funding to support tobacco control

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There are other emerging non

communicable diseases

Alcohol related problem

Road traffic accident

Cardiovascular diseases

facing the same problem as with

tobacco control: no funding

6

Thailand in 1995 - 96

Per capita alcohol consumption rank no. 7th of

the world and increasing

13,000 traffic accident death per year, Half of

which age 15-35 year

26% related to drunk driving

Traffic accident cost 1,707 million US$

= 2.25-3.48% of GDP

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If health promotion efforts succeed

in reducing health care expenditure

in tobacco, alcohol, traffic accident

by 10 percent,

Thailand would save 488

million US$ per year.

Research Estimate

Ministry of Finance : Health financing reform policy (1996)

Appoint working group to study;

1. Universal Health Insurance,

- to provide health security.

2. Setting up Health Promotion Institute

/ Foundation,

- to decrease health care cost.

The 2nd policy was intended to compliment

the 1st policy.

Challenges faced when Establishing Thai Health

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Winning support from cabinet member;

Overcoming MOH’s query

- We already are conducting HP, why

set up a new agency?

- If set up a new agency, why not set it

up in MOH?

Overcoming MOF’s reluctance.

- Why a dedicated funding?

- Why not from the regular budget?

WHAT IS

“HEALTH PROMOTION ?”

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Need to clearly explain

Population Groups Classify

According to Health Status

Healthy

Having Risk behavior

Diseases but not seeking

care

Sick and seek care

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Group 1

Group 2

Group 3

Group 4

Population Groups Classify

According to Health Status

Healthy

Having Risk behavior

Diseases but not seeking

care

Sick and seek care

13

Health Promotion

Conventional

Health Care system

Population Group 1

prevent them to progress to Group 2

Educate about how to improve their

health/avoid unhealthy lifestyles

Control of unhealthy environment

- physical environment eg.

Road/air quality

- marketing of unhealthy

products/food

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“Health Promotion”

Population Group 2/3/4

Help them to;

- stop smoking/drinking

- abandon risk behavior

a) not exercise/unhealthy food

b) unsafe driving

Promote healthy behavior exercise/health food.

Regulate marketing of unhealthy products.

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“Health Promotion”

Measures (Action) to promote health

- Build healthy public policy

- in all ministries;

- Create health supportive

environment.

- Get community involve.

- Reorient – adjust health services.

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“Make healthy choice easy choice”

New approach 17

- Lifestyle

- Environment

Preventive &

Promotive care

services

Activator for

change; :

Mainly within MOH Out side MOH

Involve the whole of the

government and society

Involve MOH and those

who are sick & family

Existing approach

Targeting different groups of population

Healthy

Having Risk behavior

Diseases but not seeking

care

Sick and seek care

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Health

Promotion (ThaiHealth)

Conventional

Health

Care system (MOH)

Ministry of Finance : Health financing reform policy (1996)

MOF was the sponsor of the

Thailand Health Promotion

Foundation Bill, steering the

bill through the cabinet and

the parliament.

establishing Thai Health

Promotion Fund under an

autonomous state agency,

requiring 2% of alcohol and

tobacco surcharged (levy) to this

fund

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1. Health promotion needs regular and sustainable

budget.

2. Because health promotion concentrate on

software rather than hardware, existing funding

agencies do not understand process-based

funding priorities.

3. A dedicated/specific source of funding provide a

predictable, more stable amount of budget.

4. Less susceptible to diversion of funding for

other purposes.

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Critical proposal/Politically acceptable source of budget

- The fund to come from tobacco and

alcohol importer/producer to pay an

additional 2% of excise levy

(whenever they pay for the excise

tax)

- Key word:Government does not

have to pay

- : The polluter pay

1. The nature of the work (Health Promotion)

Development VS. Established services

Project based not Service based

2. Success is based on innovation

3. Not achievable through bureaucratic system

4. Needs flexible management

5. An autonomous agency is less susceptible to administrative interference (of programs and projects)

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Under the bureaucracy system

Difficulty (if not impossible) in working

with agencies out side MOH eg : NGOs

Tendency to subject to bureaucratic/political interferences

Instability of the budget

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2010 Budget = 100 million USD.

Thai Health Promotion Foundation Act 2001

• Promotion of good health of Thais according to National Public Health Policy

• Encouraging healthy lifestyles through social and physical

environments

• Supporting community initiatives to promote better

health conditions

• Campaign and sponsorship of sports, the arts and

popular cultures

• Development and research (D&R)

Health promotion is NOT only health education.

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The Executive Board

Prime Minister as Chairman

Health Minister as First Vice Chairman

An Expert as Second Vice Chairman

Member: Representative from 9 ministries

Health / Education / Transportation / Sport /

Interior / labor /University / Prime minister’ s office /

Socio cultural economic board

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• Eight Independent Experts in

fields of health promotion,

community development, mass

communication, education, sports,

arts and culture, law, as we all as

administration

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1. Tobacco Control

2. Alcohol Control

3. Traffic Injuries and Disasters Prevention

4. Health Risk Factors Control Nutrition

5. Health of Specific Group of Population

6. Health Promotion in Community

7. Children Youth and Family Health

8. Health Promotion in Organizations

9. Physical Activities and Sports for Health

10. Social Marketing and Communication

11. Open Grants and Innovative Projects

12. Health Promotion through Health Service Systems

13. Supportive Systems for Health Promotion

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Knowledge Social movement

Policy advocacy

ThaiHealth Funding Strategy

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Open grant = 10% of budget

Proactive program = 90% of budget

Priority health issue (By Board)

- Situation analysis

- Program development

- Strategic partners

- Program review process

- Contracting

- Implementation

Key players in tobacco control

Ministry of Health - policy development

Tobacco control Research center. Mahidol U.

NGO - ASH , THPI - advocacy ,lobbying

- public awareness campaign

Health Professional Network

- smoke free health facility

- smoking cessation

- Quitline 1600 Teacher network - smoke free school

- smoking ed program

Thai Health Promotion Foundation - funding

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Achievements on tobacco

control (2001-2010) 33

National surveillance system

Ban on banning cigarette display

Pictorial warnings

Smoke Free environment Regulation

Regular increase of tobacco tax

National quitline

Health professional/Teacher network against

tobacco

Mass media campaign

Community based programs

Key players in alcohol control

1. Alcohol Control Office : MOH

2. Center for Alcohol Study : IHPP

3. Stop-Drink Network : Community/NGOs

4. Drink Don’t Drive Foundation

5. Integrated Management for Alcohol

Problem : cessation

6. ThaiHealth : funding

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Alcohol policy outcomes

Before the establishment of ThaiHealth and triangle network

There were 6 national alcohol control policies in 50 years

national alcohol policies (1950- 2002) 1. Alcohol act 1950

2. Limited sale time (1961)

3. Prohibit sale to intoxicated person (1966)

4. Drunk driving (1979)

5. Warning message(19p97)

6. Free trade (1999)

After the establishment of ThaiHealth and triangle

network

There are 9 national alcohol control

policies in 4 years

national alcohol policies (2003- 2007)

1. Prohibit sale for under 18 (2003)

2. Partial ad ban (2003)

3. Establishing the national alcohol control

committee (2003)

4. Prohibit sale in school (2004)

5. Warning message in outdoor billboard and

movies (2004)

6. Prohibit sale in fuel station (2005)

7. Increase warning messages (2005)

8. Increase excise tax (2005)

9. Alcohol control act (2006 – 2007)

8 yrs per 1 policy 2 policies per 1 year 44

Children, Dental health and Obesity

Before 2002, no national policies or networks to reduce sugar consumption among children

2002, NSN (govt, professional orgs, academic institutes)

2004, the Sugar Consumption Reduction Plan

2007 FDA regulation: 5 highest consumed snacks must have nutritional labeling & warning slogan “eat less & exercise regularly”

2008, Regulations on sugar in infant formulae milk powder

2009, 3,250 schools free of soda soft drinks

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To have waist circumference of

male<36 inch, female<32 inch

• Media strategies.

• Health care provider’s roles.

• Community base program.

• Policy advocacy and lobbying by the

Royal College of Physician of

Thailand.

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2010( Million USD)

- Tobacco = 5.3

- Alcohol = 9.3

- Traffic accident = 6.6

- Physical activity = 6.5

- Nutrition = 4.7

- Social marketing = 6.6

- Total = 39.0

Total ThaiHealth revenue (2010) = 100.0

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1. Targeting different groups of population.

2. Work horizontally rather than vertically.

3. Multispectral collaboration across ministries

/ NGO / public / private.

4. Pilot / innovative projects.

5. Fund social marketing / mass media

campaign .

6. Flexible financing mechanism.

What has ThaiHealth done that the

government could not or did not do? 49

1. Support health promotion in accordance

with national health policy.

2. Prime Minister as chairman of the board

Work hand in hand with MOH.

Minister of Health as deputy chair of the board.

Do things that MOH can not or difficult to do.

Funding for MOH projects that can not secure

support from regular budget. ( not service base)

The relation between ThaiHealth

and government 50

Over all Health Promotion

and Prevention Budget (Million USD) 51

Source 2009

MOH 400

NHSO 309

Civil Service insurance 45

Local gov 198

Other gov agencies 7.6

International aid 13

Total 972

ThaiHealth 114

=% of total 11.7%

Preventive

Promotive

services

Health promotion

ThaiHealth Budget as % of

total health

(million USD)

2006 2007 2008

Total Gov.

Health Budget 6,365 7,421 8,780

Thai Health 74 74 94

= 1.16% 0.99% 1.07%

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Population Groups Classify

According to Health Status

Healthy

Having Risk behavior

Diseases but not seeking

care

Sick and seek care

53

Health Promotion

(1 % of health budget)

Conventional

Health

Care system(99

% of health

budget)

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Obstacles:

Securing continuity of political support

Threats from the health opposition industries

and commercial companies

Challenges:

Convincing all stakeholders of the proven

benefit of the Health Promotion Foundation

Capacity building of health promotion

manager, advocators and experts need

continuous improvement

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Health

Promotion

Foundations in:

Legislation

Year

set up

Yearly funds

2006-7

in USD

(per person)

1. Austria Health Promotion

Act

1998 9,700,000 (1.18)

2. Switzerland Health Insurance

Act

1994 14,000,000 (1.90)

3. Thailand Health Promotion

Act

2001 63,000,000 (0.96)

4. Victoria

(Australia)

Tobacco Act 1987 26,000,000 (5.10)

5. Western

Australia

Tobacco Control

Act

1990 14,400,000 (7.00)

6. Malaysia Malaysian Health

Promotion Board

Act

2006 10,000,000 (0.45)

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Associate members

1. Mongolian Health Promotion Foundation

2. Health 21 Foundation Hungarian

3. Management Centre for Health Promotion, Korea

4. Oman Health Promotion Initiative

5. Polish Health Promotion Foundation

6. Tonga Health Promotion Foundation (TongaHealth)

7. BC Coalition for Health Promotion,

8. British Columbia, Canada

9. Ministry of Health & Family Welfare, India

10. Health Promotion Initiative, Iran

THANK YOU

www.thaihealth.or.th

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