Participatory Democracy: National Health Assembly of Thailand

Author(s): C. Kanchanachitra1
Affiliation(s): 1Mahidol University, Nakhon Pathom, Thailand
Keywords: Healthy participatory public policy process
Background:

Thailand has launched the first participatory process for healthy public policy at the national level under the “National Health Assembly” (NHA) in 2008 under the mandated by the Thai National Health Act 2007. The assembly comprises of three main groups including representatives from government or politicians; representatives from academic and expert groups; and representatives from civil societies. These three groups form the ‘triangle that moves the mountain’ principle proposed by Prof. Prawase Wasi that stipulated the importance of having all three groups collaborate in order to move the difficult policies.

Methods:

The process of the Thai NHA was adapted from the World Health Assembly in terms of intervention and adoption of the resolution. However, the Thai NHA was designed to be inclusive in terms of member attendance and agenda setting to be bottom up rather than top down approach. The agenda was proposed by constituencies to the National Health Assembly Organizing Committee (NHAOC), in which committee members also come from 3 groups. The Technical Subcommittee under the NHACO has convened meetings among partner / networks and constituencies to discuss on all agenda proposed and selected the top most important agenda based on pre-determined criteria that will be put forward for the Assembly. A total of 14 agenda (from 68 proposals) in 2008 and 11 agenda (from 115 proposals) in 2009 were proposed to the NHACO for approval. The technical working group for each agenda item was formulated to draft the background documents and resolution and convene meetings among constituencies concerned to receive the opinions from different groups. The resolutions and background documents were then submitted to the NHAOC for consideration and circulated to all constituencies for their opinions and the resolution and background documents were revised according to opinions received and submitted it to the NHAOC for final documents to be adopted at the NHA.The NHA in 2009 was comprised of 2,000 members from 180 constituencies, expert groups, international representatives and observers. Each constituency has equal speaking rights and the adoption of resolution is only by consensus. If agreement cannot be reached, a working group will be convened to find the consensus in the disagreement issues. The system has set for not putting on voting to pass the resolution.

Results/Conclusions:

These participatory processes have several benefits in terms of increasing awareness of the general public on health issues and raising the level of commitment at the local level to solve the problems themselves. In the process of proposing the agenda, people at the local level realized the health problems they faced and some interventions were implemented without waiting for the government to set the policy. It also builds capacity of people to analyze and collect data to understand the situation in their areas. However, many challenges remain especially on ensuring representation of the constituencies and in bringing resolutions adopted at the NHA to implementation.

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