Universal healthcare, Aids fight a triumph for Thailand

Just as Thailand’s successes in Aids prevention and treatment were not inevitable, neither was its quest for universal health coverage. In fact, it seemed quite unlikely at the time of its inception in 2001. Faced with powerful opponents, some might have lost faith and walked away. Not the Thai people.

Thais have shown a deep commitment to economic justice. They have worked for decades to provide universal coverage. In fact, the Thai Constitution guarantees the right of every citizen to healthcare, even the poorest. 

By 2001, when Thailand introduced its universal coverage scheme, nearly a third of its people were still uncovered. Many of these were poor people whose families could be made destitute by a serious illness. It took a collective effort by civil society activists, civil servants and health professionals to build broad grass-roots support for reform. The Universal Coverage Scheme, or UCS, has remained a top priority through several changes in government. Thailand’s health professionals have made smart choices and used evidence-based decision-making to build a system that works for its people.

One key reason for Thailand’s success was the acceleration of a two-decade-long shift of resources and health staff from urban to rural areas, where more of the poor and uninsured lived. Successive governments have provided strong and positive incentives for health workers to work in these previously unserved areas, and to increase their motivation, skills and effectiveness. They even paid them more than their urban counterparts.

We should acknowledge the contributions of Prawase Wasi, the great haematologist who established the rural doctors’ movement in Thailand and who wrote a seminal guide entitled “The Triangle That Moves Mountains”. The “triangle” referred to three points of engagement that are critical in enacting reforms: wisdom, state and society. This combination of forces certainly provided strong stewardship for universal coverage in Thailand.

When UCS was launched, Thailand had the lowest per-capita income of any nation ever to achieve universal coverage.

It’s not a perfect system. It faces growing pains as more people use its services, as people age and as injuries from road accidents and non-communicable diseases like diabetes rise. This is normal. Managing healthcare systems is like tending a tropical garden. There will always be more weeds to pull, flowers to plant and branches to prune. I have faith that Thailand will succeed in its pursuit of greater quality and equity in its healthcare. As it stands now, UCS is a remarkable, living legacy of many dedicated civil servants, activists and health workers, all of whom were committed to justice in healthcare.

As I travel across the world, I tell the Thai UCS story as an example to other nations who aspire for the same results.

So, what are the lessons from the fight for Aids treatment and universal health coverage?

First, we’ve learned that investing in people is not just the right moral choice. It also results in real economic and political benefits. I have dedicated my life to demonstrating that failing to provide health, education, food and social protection is fundamentally unjust – and that it is also a bad economic and political strategy. 

The Lancet Commission on Investing in Health estimates that up to 24 per cent of economic growth in low- and middle-income countries is due to better health outcomes. The payoffs are immense: health spending yields a 9-to-20-fold return on investment.

The second lesson is that ambitious reforms require skilful balancing of competing demands. They also require continuous learning and adaptation, based on the best global knowledge and evidence. The achievements of Thai health workers and activists in universal coverage and in fighting Aids demonstrate important elements of what we at the World Bank Group call the science of delivery.

They paid careful attention to all the factors that affected success – everything from the cold chain for vaccines to financial management of their health system, from roads and electricity for clinics to girls’ education.

Two days ago I visited Myanmar, which has just launched its own effort to achieve universal health coverage. Myanmar can learn from Thailand’s approach to effective healthcare reform.

To achieve such complex reforms, an unrelenting focus on results is imperative.

The third lesson is that even a handful of committed people with vision have the power to change the world. Believing in the possibility – but not the inevitability – of a better world is the first step in achieving it.

The global fight against Aids was a triumph of a bold vision for fundamental human rights combined with scientific progress and global solidarity.

Here in Thailand, through the tenacity and grit of thousands of health workers and activists, you showed all of us how to pursue a vision for health equity. You built movements that saved lives, changed your nation, and offered the contagion of hope to millions.

These lessons are universal and timeless. They can guide us as we work for a better world, a world where everyone – rich and poor – has a right to quality healthcare, a world where everyone has a right to treatment for Aids.

All are entitled to a life of dignity and opportunity. To deny this right – to take away that hope – is to deny their humanity, and our own. 

We can achieve great things if we follow the light of a moral vision, if we have a daring spirit, if we learn from history, and contribute to a lasting evidence-based wisdom.

Our work is unfinished. Yet, as I look out at all of you here, I have an abiding faith that, together, we can build a world with greater opportunity, equity and justice.

 

Jim Yong Kim is president of the World Bank Group. This article is based on a speech he gave at the 2014 Prince Mahidol Award Conference, in Pattaya on Wednesday, where Kim shared the award with a distinguished group of individuals who have spent many years fighting to end the HIV-Aids epidemic.