« Parliament has a crucial role in balancing conflicts, including political ones »

Q: What significance does hosting this IPU Assembly hold for the Parliament of Thailand?
M. Chai Chidchob: The IPU Assembly, which will be held in Bangkok, is expected to bring together over 1,200 participants, so we are training a number of officers to facilitate their stay. The National Assembly of Thailand will also provide an opportunity for university students to participate in this meeting as liaison officers working with teams and delegations. The main topic of discussion is “Parliament at the heart of political reconciliation and good governance”. The Assembly will also address topics related to “Cooperation and shared responsibility in the global fi ght against organized crime, in particular drug trafficking, illegal arms sales, human trafficking and cross-border terrorism”, “The role of parliaments in developing South- South and Triangular Cooperation with a view to accelerating achievement of the Millennium Development Goals”, and “Youth participation in the democratic process”. The panel discussions will cover issues such as the rights of the child, the problem of water, child survival and maternal health, the possession and use of nuclear weapons and climate change. His Royal Highness, Crown Prince Maha Vajiralongkorn, will represent His Majesty the King in presiding over the Opening Ceremony. At the Meeting of Women Parliamentarians, there will be a seminar on “Combating violence against women, with a particular focus on women held in places of detention and imprisonment”. The guest speaker will be Her Royal Highness Princess Bajrakitiyabha. It is the third time that Thailand has the honour of hosting an IPU Assembly.

Q: The debates in Bangkok will centre around the theme of parliaments, political reconciliation and good governance. How do you see parliament's role in relation to reconciliation in Thailand and in other countries in the region?
C.C.: Since countries are composed of millions of people, there is no denying the fact that conflicts can occur in society, which are caused by divergent interests, political groups, etc. Participation of the people is a prime element of any representative democracy, which establishes a government of the people, by the people, for the people. In this context, the parliament is a key institution, which represents millions of people assembled inter alia to solve such conflicts. As a forum of representatives of the people, it has a crucial role to play in balancing conflicts, including political ones. Good governance entails holding the executive branch to account, and also encompasses gender sensitivity, consensus, accountability, transparency, effectiveness, efficiency and equitability, in conformity with the rule of law. However, in the parliamentary system, there is no clear separation between legislative and executive powers. The parliament should perform its functions of overseeing executive action in order to ensure accountability and do all in its power to minimize corruption. It should also give a voice to minorities and eradicate all threats to society.

Q: What are your hopes for the Bangkok Assembly in terms of combating organized crime, drug trafficking, illegal arms sales, human trafficking and cross-border terrorism?
C.C.: Throughout the years, IPU Member Parliaments have recognized that transnational crime has become a serious issue, in particular, drug trafficking, illegal arms sales, human trafficking, cross-border terrorism and money laundering. These problems, which are all interlinked, pose a serious threat to international peace and stability as a whole, and require the concerted action of the international community.

I hope that the parliamentarians participating in the 122nd IPU Assembly in Thailand will address these issues, assess the current situation and inform us about the progress in their country and parliamentary approaches for the future. The meeting could identify concrete parliamentary initiatives for encouraging governments to ratify relevant international conventions against transnational crime. Parliamentarians should review or amend their national laws on drug trafficking, illegal arms sales, human trafficking, cross-border terrorism and money laundering. They should also support international cooperation on international legal instruments to prevent criminals from taking advantage of legislative loopholes.

Q: How can legislators stimulate the participation of young people in the democratic process?
C.C.: We support all activities that enhance and promote knowledge and understanding about the politics, government, and democratic regime of the parliamentary system with the King as Head of State (constitutional monarchy) to young people. Through the Democratic Youth Programme, we have provided young people with an opportunity to be part of politics, express their opinions on politics and on the Government of Thailand and enable them to further their knowledge and experience by establishing democratic youth networks to spread democratic knowledge and perform public interest activities for communities, and the country as a whole. We passed the Bill to Promote National Development of Children and Youth B.E. 2550, which came into force in 2008, by establishing three levels of Children and Youth Councils in districts, provinces, and nationwide. Our purpose is to enable children and youth to participate in the democratic process by sharing their ideas about the development of children and youth with members of parliament as input for benefi cial policies and plans.

Q: We will hear a great deal about the Convention on the Rights of the Child during the Assembly. How would you assess children's rights in Thailand?
C.C.:The Convention on the Rights of the Child states that the fundamental rights of the child comprise: 1) survival, including basic health care, peace, security and development; 2) a good education, which includes a loving home and adequate nutrition; protection from abuse, neglect, traffi cking, child labour and other forms of exploitation; 3) participation, which includes the right to express opinions, be listened to and take part in making any decisions that affect them. Problems affecting children’s rights in Thailand consist of malnutrition, education disadvantage, human traffi cking, abusive labour, sexual exploitation, HIV/AIDS, violence, drug addiction or drug-related problems, limited rights for minority groups, isolation, etc. The Thai Government, together with all sectors concerned, has taken concrete steps to help solve these problems.

L.B.

Universal coverage policy development in Thailand and the role of parliamentarians in achieving Millennium Development Goals 4 and 5

Thailand is one of the South-East Asian countries that has been in the process of reforming its health sector over the past decade. The country exemplifi es application of the Millennium Development Goals (MDGs) in a middle-income country which has achieved most of the MDGs ahead of the 2015 deadline. The MDG indicators were transformed in order to prevent ceiling effects on future development into so-called “MDGs Plus” for the ultimate commitment and development of the country.

Thailand’s unique experience offers lessons learned for maternal health and child development. There have been many changes as a result of the health care reform process since 2001, which affect health care delivery and fi nancing. After many years of debates and sluggish attempts to reform the health care system, the previous government implemented the “30 Baht treat all” the way the scheme for universal access or universal coverage (UC) to subsidize health care. In 2001, there were at least three proposals on resources needed for universal coverage policy.

The first universal coverage proposal was based on the unit cost of an autonomous hospital (AH) according to studies conducted by Chunharus et al (1998) and Pitayarangsarit et al. (2000). The autonomous hospital had been proposed as an alternative management model of public hospitals to improve its effi ciency and responsiveness due to the economic crisis in 1997. It was estimated that the AH model needed 782 Baht per capita. This unit cost was used for further calculation by adding the unit cost of a health centre, which was 120 Baht per capita. Therefore, it was proposed that the resources needed for the Universal Coverage policy using the AH model was 900 Baht per capita.

The second proposal was developed by Pannarunothai et al., who used sickness episode and health service utilization of population by calculating the unit cost of health facilities at various levels of health care facilities from the national survey and the Health Welfare Survey, in 1996. Subsequently, the cost was adjusted to the change of the population structure in 2001, increase of insurance coverage, etc. It was proposed that the resources needed for UC amounted to between 1,482 and 2,397 Bahts per capita in 2001. This health service utilization model was based on the way the health care system, including provider payment method, was organized.

The third proposal was made by the Ministry of Public Health (MoPH) regarding the budget needed for the UC policy. This model used an approach similar to the second proposal, using the pattern of health service utilization but without any adjustment and unit cost of health facilities from the most updated study in its calculations. Additionally, the MoPH used the experience of high-cost care and accident and emergency care from the Social Security Scheme, which was incorporated into the calculated unit cost.

In March 2001, all three proposals were considered at a workshop organized by the Ministry of Public Health and chaired by the Prime Minister. At the end of the workshop, the sum of 1,202 Bahts per capita was used as the estimated starting budget for the UC policy in Thailand. After a six-month pilot study on UC policy in several provinces, the “30 Baht treat all” or UC policy was adopted whereby people co-pay only 30 Bahts (US$ 0.89) for each visit or admission from the outset. In the beginning, the UC budget started by pooling the MoPH’s budget for hospital and health facilities as well as low-income and voluntary card schemes and provided additional funds.

In short, the “30 Baht scheme” was established at the policy level and started being implemented in the absence of legislation in 2001. This process allowed time for the preparation and debate of subsequent legislation in support of health care reform. Currently, no co-payment is required. This UC policy serves more than 45 million persons, except those already covered by their employers or employees of private firms.

The main objectives and characteristics of UC policy in Thailand were: 1) universal coverage: regardless of socioeconomic status or religious belief, all Thai citizens are entitled and should have equal access to quality care depending on their needs; 2) Single standard: the quality of care provided for all Thai citizens should be of the same single standard; and 3) Sustainable system: in terms of policy, financial and institutional sustainability.

Legislation process

In order to ensure the policy sustainability of the universal coverage policy, the previous government drafted the relevant law and submitted it to the parliament for its consideration. A plan for personnel training was established to ensure institutional sustainability, which can be secured when the personnel in the system is well prepared and additional resources needed for this preparation were allocated. The National Health Security Act was passed by the parliament in November 2002 in order to regulate the quality and financial aspects. The Ministry of Public Health is the core agency implementing the universal coverage health care services.

In 2007, the National Health Act was adopted by parliament. It is the first health Act that refers to “health” as a “right of the people”. Similarly, the promotion and protection of women’s health is addressed in the same chapter which includes the health of children, disabled persons, the elderly, and socially deprived persons. This section demonstrates the attentiveness and the significant roles of parliamentarians in improving maternal and child health in Thailand, resulting in the country’s high achievement of the MDGs.

Attempts to achieve universal coverage have encountered several obstacles over the years, but have been steadily keeping pace during the past fi ve years. Policy development and policy decision-making was a participatory process at the beginning but was limited to MoPH personnel.

The participation of non-health actors is encouraged by the National Health Act (2007). The law stipulates that there shall be a National Health Commission, referred to as the NHC, consisting of not only the Prime Minister or the Deputy Prime Minister entrusted by the Prime Minister as Chairperson, the Minister of Public Health as Vice Chairperson, Ministers, the President of the National Economic and Social Advisory Council, the President of the National Human Rights Commission, but also representatives of local government organizations, public health professional organizations, professional committees, qualified persons of any field other than those of public health professional practitioners, and nonprofit organizations.

Under current government regulations, maternal and infant bonding and breast feeding support is allowed during the fi rst three months. A government regulation established 14 years ago offers maternity leave with pay for 90 days for women government officials. Mothers who wish to extend their maternity leave for 150 days or fewer are allowed to do so, but without pay. This regulation provides the opportunity for mothers to stay at home and care for their babies longer that the two months’ leave granted in the past.

Parliament and MDGs Plus

Thailand commits itself to a set of more ambitious targets – called the MDGs Plus – that go well beyond the internationally agreed MDGs. The country already reached the international maternal and child health MDG targets of reducing by two thirds the mortality rate between 1990 and 2015. Since the rate was low at the starting point, Thailand has set MDG Plus targets of reducing maternal and under-five child mortality rates in specific populations, because of the persistent disparities among regions and groups within the country, including marginalized and vulnerable groups. Policies and resources have been increased to tackle poverty and below-average health conditions in the North-East, the remote highland areas of the North, and the three predominantly southernmost provinces, areas that are lagging behind.

The MDG report had a major impact on the development agenda in Thailand as the Cabinet’s endorsement of the report transformed the MDG Plus targets into government policy. Regarding the health disparity problem, the Ministry of Public Health was the fi rst to act. For the benefit of keeping track of the MDGs in Thailand, the government works jointly with the United Nations country team to commission studies on maternal health improvement and decentralizing social services to local administrations.

The maternal and child bonding project received not only the government’s support for maternal and child health development, but also the significant support of the Royal Family.