Rajata, Narong under pressure as conflict continues bubbling

One is Public Health Minister Dr Rajata Rajatanavin, while the other is the ministry’s permanent secretary Dr Narong Sahametapat.

Both men will eventually have to take responsibility for failing to resolve the conflict that beset the country’s major health scheme, which currently covers about 48 million Thais.

Yesterday, Narong did not show up for the signing of a memorandum of understanding (MoU) on cooperation between the two sides in removing obstacles to implement the scheme.

Narong has apparently refused to accept anything less than what the ministry and medical workers have asked for. 

The ministry has demanded that the NHSO hand over the power to manage much of the scheme as well as its budget. The argument by Narong is that under NHSO management, many state hospitals have sunk into financial trouble and medical workers struggle with massive workloads. 

Narong’s stance remains firm even after Deputy Prime Minister Prawit Wongsuwan already summoned both him and Rajata to a meeting, instructing them to arrange negotiations. 

It was widely said that one of the two – Rajata or Narong – would lose his post if the negotiations failed. 

Prawit had expected the negotiations to reach a satisfactory conclusion by yesterday. While a draft for the MoU was prepared, the signing did not take place. 

The MoU was not ratified despite representatives from the ministry’s Office of the Permanent Secretary and the NHSO discussing the issue all through the past week. In fact, two committees have been set up to address problems relating to implementation of the universal health scheme. But the ministry, led by Narong, has refused to accept them. 

Narong has solid support from the Public Health Society of Thailand, the Thailand Regional and General Hospital Society, and the Provincial Public-Health Chief Society. The NHSO, meanwhile, has backing of the Rural Doctors Society and various non-government organisations. Some of these NHSO supporters have suggested that Narong should be removed. 

Under Narong’s leadership, the ministry has introduced several moves to pressure the NHSO to give in. They include state hospitals’ decision to not submit reports to the NHSO about treatment provided under the scheme and the threat that state hospitals will no longer serve as registrar for the scheme. Many people and organisations now fear that the ministry may go further and patients will be affected.

The question is, would transferring Narong be a real solution?

This conflict, in essence, is not personal. Experts in the field have noted that the problem stems largely from the fact the universal health scheme has never had an adequate budget since the NHSO was established in 2002.

According to these experts, most medical workers at the ministry disagree with the NHSO’s management approach. 

The NHSO, however, has also said that it does not have the final say on how much budget should be allocated to the scheme, because it has had to seek funding from the government. 

It has also said that its management role is vital, given it is a buyer of services protecting public interest. 

The ministry, it has pointed out, is the provider of services under the scheme. 

The best scenario for the boiling conflict over the management of the universal healthcare scheme is that all parties in the conflict talk more, to find common ground and work toward an agreement that all sides can accept. 

It may be hard to expect a happy ending after so many talks have failed. But perhaps, it’s just that all concerned parties have not tried hard enough at the negotiating table.