DEVELOPMENT COOPERATION IN PUBLIC HEALTH: A CASE STUDY OF THE PREVENTION OF EMERGING COMMUNICABLE DISEASES IN BORDER AREAS BETWEEN -CLM COUNTRIES (-LAO PDR-MYANMAR) 2012-2015

BY

MISS SUPAMON INGKHAPRADIT

THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF POLITICAL SCIENCE IN INTERNATIONAL RELATIONS FACULTY OF POLITICAL SCIENCE THAMMASAT UNIVERSITY ACADEMIC YEAR 2017 COPYRIGHT OF THAMMASAT UNIVERSITY

Ref. code: 25605503040163UXQ DEVELOPMENT COOPERATION IN PUBLIC HEALTH: A CASE STUDY OF THE PREVENTION OF EMERGING COMMUNICABLE DISEASES IN BORDER AREAS BETWEEN THAILAND-CLM COUNTRIES (CAMBODIA-LAO PDR-MYANMAR) 2012-2015

BY

MISS SUPAMON INGKHAPRADIT

A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF POLITICAL SCIENCE IN INTERNATIONAL RELATIONS FACULTY OF POLITICAL SCIENCE THAMMASAT UNIVERSITY ACADEMIC YEAR 2017 COPYRIGHT OF THAMMASAT UNIVERSITY

Ref. code: 25605503040163UXQ

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Thesis Title DEVELOPMENT COOPERATION IN PUBLIC HEALTH: A CASE STUDY OF THE PREVENTION OF EMERGING COMMUNICABLE DISEASES IN BORDER AREAS BETWEEN THAILAND-CLM COUNTRIES (CAMBODIA-LAO PDR- MYANMAR), 2012-2015 Author Miss Supamon Ingkhapradit Degree Master of Political Science Major Field/Faculty/University International Relations Faculty of Political Science Thammasat University Thesis Advisor Assistant Professor M.L. Pinitbhand Paribatra, Ph.D. Academic Years 2017

ABSTRACT

In the twenty first century, challenges in international relations have changed from traditional security (TS) to non-traditional security (NTS) challenges. Among others, emerging communicable diseases have become a threatening issue, posing political, economic and socio-cultural impacts across the borders of nation-states. This paper therefore studies emerging communicable diseases in border areas between Thailand and its neighbors, namely, Cambodia, Lao PDR and Myanmar (CLM) from 2012 to 2015. The paper analyzes the Thai government‟s strategies in health cooperation by utilizing liberal perspectives of International Relations with the emphasis on the concept of human security. It argues that, with the necessity and importance of interdependences among states to resolve common human security threats, Thailand will promote health diplomacy and seek cooperation with CLM in order to prevent and control trans-border, emerging communicable diseases. The paper focuses on the roles of Thailand International Cooperation Agency (TICA), Ministry of Foreign Affairs, as it is a leading government agency whose responsibility is to carry out policies and strategies of communicable disease prevention. By pursuing a development cooperation channel with CLM, one of the leading projects under TICA is “Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the

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Thailand-Cambodia-Lao PDR-Myanmar Borders”. In the end, this paper will analyze the roles of the Ministry of Foreign Affairs and how Thailand‟s developmental foreign policy enhances the relationship between the country and its neighboring countries.

Keywords: Development Cooperation, Public Health, International Health

Cooperation, Emerging Communicable Diseases, Thailand, CLM countries, TICA

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ACKNOWLEDGEMENTS

It is my deepest pleasure to thank those who made this study possible, my thesis advisor Assistant Professor Dr. M.L. Pinitbhand Paribatra, for his encouragement and constructive suggestions as well as useful technical assistance during the research work. My success is dedicated to my thesis advisor who has sacrificed his time to take me under his wing. The door of his office was always open whenever I ran into a difficulty or had a question about my study. Special thanks should be given to the thesis committee, Assistant Professor Dr. Chanintira na Thalang, for her professional guidance and helpful recommendations and to Assistant Professor Dr. Pisanu Sunthraraks, for his enlightened comments and valuable perspectives. It is an honor to work with them. I would like to extend my appreciation to the Ministry of Foreign Affairs, Thailand International Cooperation Agency (TICA), especially Thai Cooperation Branch I for kindly contributing intensive and complete information. My thesis journey is inspired by insightful people, Miss Sayan Kongkoey, Mr. Banchong Amornchewin, Miss Pin Sridurongkatham and Mr. Arthit Prasartkul. In addition, my course work would not be smooth without Dr.Walaiporn Bangchaiyapoom and Miss Pronprom Saleekasam, my colleagues at TOT Corporation Public Company Limited, who always give me warm support and a good understanding. I would also like to express my profound gratitude to Ingkhapradit‟s family, especially, Mrs. Suwimon Ingkhapradit who provides me with a great opportunity to study at MIR and was also an expert thesis consultant. I would like to thank my motivator, Miss Phanuphan Phamornpol, who always trusted and believed in my capacity to finish my master‟s degree. Last but not least, I would like to thank Political Science Faculty‟s members and my MIR classmates who have helped me to accomplish this study.

Miss Supamon Ingkhapradit

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TABLE OF CONTENTS

Page ABSTRACT (1)

ACKNOWLEDGEMENTS (3)

LIST OF TABLES (7)

LIST OF FIGURES (8)

LIST OF ABBREVIATIONS (9)

CHAPTER 1 INTRODUCTION

1.1 Background 1 1.2 Research Question 9 1.3 Objectives 9 1.4 Theoretical Framework 10 1.5 Hypothesis 16 1.6 Literature Reviews 16 1.6.1 Background information on communicable or infectious diseases in globalization 17 1.6.2 Previous studies on the emerging outbreaks in Thailand 17 1.7 Methodology and Scope 25 1.8 Organization of the Study 28

CHAPTER 2 REVIEW OF THAILAND‟S INTERNATIONAL HEALTH POLICY 29

2.1 The Eleventh National Economic and Social Development Plan 2012-2016 31 2.2 Thailand‟s Development Strategy for National Security Reinforcement 2013-2017 and Thailand‟s Country Strategy 2013-2016 44 2.3 The Second Border Health Development Master Plan 2012-2016 48

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2.4 Thailand‟s National Strategic Plan for Emerging Infectious Disease (NSP-EID) Preparedness, Prevention and Response 2013-2016 50 2.5 Policy Statement of the Council of Ministers 53 2.6 Strategy for Project on Building Awareness and Preparedness for Communicable and Emerging Communicable Diseases along Thailand and CLM Borders 56

CHAPTER 3 THAILAND INTERNATIONAL COOPERATION AGENGY AND DEVELOPMENT COOPERATION POLICY ON PUBLIC HEALTH 60

3.1 Background 61 3.2 The Establishment of TICA 66 3.3 Principles and Rationale for Development Cooperation 68 3.4 Roles, Responsibilities, and Scope of Work 70 3.5 Institutional Structure 72 3.6 Personnel 74 3.7 Development Cooperation in Public Health 77 3.8 Case Study: A Project on Building Awareness and Preparedness for Communicable and Emerging Diseases along the Thailand- Cambodia-Lao PDR-Myanmar Borders 82 3.8.1 Target Areas 83 3.8.2 Budget 85

CHAPTER 4 POLICY IMPLEMENTATION 89

4.1 Pilot 1: Preventive Strategy: Building awareness and preparedness 91 4.2 Pilot 2: Information Exchange Centers 97 4.3 Pilot 3: Developing and maintaining Information Exchange Centers and Communication Channels 100 4.4 Pilot 4: Human Resource Development 103 4.5 Pilot 5: Service and Referral System 109 4.6 Pilot 6: Assessment and Evaluation 116

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CHAPTER 5 CONCLUSIONS AND RECOMMENDATIONS 118

5.1 Conclusion 118 5.2 SWOT Analysis 121 5.2.1 Strengths 121 5.2.2 Weaknesses 123 5.2.3 Opportunities 125 5.2.4 Threats 128 5.3 Theoretical Contribution and Policy Recommendations 130

REFERENCES 134

BIOGRAPHY 144

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LIST OF TABLES

Tables Page 2.1 The Summary of Emphasis on National Economic and Social Development Plan 32 3.1 The Summary of Organization Transformations 60 3.2 The Summary for Development Cooperation Strategy in Public Health between CLM Countries 78 3.3 Target areas of Project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand- Cambodia-Lao PDR-Myanmar Borders 84 3.4 Ministry of Public Health on Thailand Official Development Assistance in Public Health 2012-2015 86 3.5 Ministry of Foreign Affairs (exclude TICA) on Thailand Official Development Assistance in Public Health 2012-2015 87 3.6 Thailand International Cooperation Agency on Thailand Official Development Assistance in Public Health 2012-2015 87 4.1 Pilot 1: Preventive Strategy: Building Awareness and Preparedness 91 4.2 Pilot 2: Information Exchange Centers 97 4.3 Pilot 3: Developing and Maintaining Information Exchange Centers and Communication Channels 100 4.4 Pilot 4: Human Resource Development 103 4.5 Pilot 5: Service and Referral System 109 4.6 Pilot 6: Assessment and Evaluation 116 5.1 SWOT Analysis 130

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LIST OF FIGURES

Figures Page 1.1 Map of Thailand and neighboring countries 6 2.1 Thailand‟s International Health Policy 30 2.2 New Growth Model 45 2.3 Integration of New Growth Model 47 3.1 The Involvement of Organization System 62 3.2 Institutional Structure 72 3.3 Thai Cooperation Branch I Structure 76

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LIST OF ABBREVIATIONS

Symbols/Abbreviations Terms

CLM Cambodia, Lao PDR, Myanmar DTEC Department of Technical and Economic Cooperation MDGs Millennium Development Goals MFA Ministry of Foreign Affairs MoPH Ministry of Public Health NESDB National Economic and Social Development Board ODA Official Development Assistance SDGs Sustainable Development Goals SEZ Special Economic Zone TICA Thailand International Cooperation Agency

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CHAPTER 1 INTRODUCTION

1.1 Background

Globalization became a key factor in international system in the early 1990s, it continues to increase interconnection and interdependency among states. McGrew (2011, p. 16) noted “globalization-simply the widening, deepening, and speeding up of worldwide interconnectedness argue that it is bringing about the demise of the sovereign nation state as global forces undermine the ability of governments to control their own economies and societies”. The term globalization has been discussed as a double-edged sword that can have causes and effects on many different dimensions including sociology, economy and political affairs. It unquestionably leads to a lot of current global issues such as social problems, the intervention of the major power economies, and also the stability of domestic and international states. In the twenty first century, challenges in the global system have changed from traditional security challenges to non-traditional security challenges related to human security. The world has to confront new forms of non-traditional threats which are directly relevant to common human security, for example, transnational crime, information security, terrorism, climate change, etc. Among others, public health issues, especially communicable and emerging communicable diseases are highlighted in the international atmosphere. Public health is a significant issue to all mankind in every aspect which is acknowledged as one of the “transnational phenomena threatening the security of individuals and communities, including drug trafficking, environmental degradation, or disease epidemics” (Fidler, 2003, p. 807). In addition, Dennis Altman also noted this shift in observing that attempts to redefine security often added "issues of health generally, and epidemics of infectious diseases more specifically" to the list of new security threats (as cited in Fidler, 2003, p. 791). The threats to their security may differ – hunger and disease in poor nations and drugs and crime in rich nations – but these threats are real and growing (United Nations Development Programme, 1994, p. 3). It means that the public health issue becomes

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an important factor that directly and severely influences both national and international interests. Current global issues like communicable and emerging communicable diseases are the manifestation of a globalized world. Dunne (2011, pp. 100-112) applied liberal ideas to international relations today, when they found responses to the problems and possibilities posed by globalization. For example, liberalism of privilege in which liberal hegemony is one of the responses which need to be addressed by a combination of strong democratic states at the core of the international system, robust regimes, and open markets and institutions. However, international relations nowadays includes multidimensional relations which it needs to address with a liberal perspective or approach to protect or prevent human and national security at all levels. Fidler (2003, pp. 789-790) stated that “the prevention and control of infectious diseases has, therefore, been a foreign policy concern of states for a long time. Public health as a foreign policy concern is not the same thing, however, as public health constituting an issue of national security”. It is evident reflecting on the Global Agenda such Sustainable Development Goals (SDGs), as well as the framework of regional cooperation such as Greater Mekong Sub region (GMS) and Ayeyawady- Chao Phraya-Mekong Economic Cooperation Strategy (ACMECS). GMS (Greater Mekong Subregion, 2015, para.2) applies SDGs to “build regional capacity for tracking progress on SDGs and find means to enable the SDGs to become a pathway for enhancing natural capital in the sub region”. ACMECS, on the other hand, aims to promote regional development and strengthen regional cooperation. The mentioned regional cooperation enhances more connectivity in transport, especially cross border transport, trade and investment facilitation. These are further implemented in national development strategies and also initiated in Thailand‟s foreign policy. In 2012, World Health Organization (WHO) (2017c) reported a death toll of approximately 56 million people worldwide. This was generally separated into two types which were non-communicable and communicable diseases. They were responsible for 68% and 23% of all global deaths, respectively. The causes of death nowadays are due to communicable or emerging disease outbreaks reporting about two out of ten deaths which is evident for the importance of communicable disease prevention, in line with transnational issues.

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WHO (World Health Organization, 2017a, para.1) defines “an emerging disease as one that has appeared in a population for the first time, or that may have existed previously but was rapidly increasing in incidence or geographic range”. Another definition of emerging infectious disease, according to Centers for Disease Control and Prevention, under the United States‟ government, defines that a disease whose incidence in humans has increased in the past 2 decades or threatens to increase in the near future has been defined as „emerging‟. These diseases, which respect no national boundaries, include the following; - New infections resulting from changes or evolution of existing organisms - Known infections spreading to new geographic areas or populations - Previously unrecognized infections appearing in areas undergoing ecologic transformation - Old infections re-emerging as a result of antimicrobial resistance in known agents or breakdowns in public health measures

Lashley stated that the emergence and re-emergence of infectious diseases involves many interrelated factors. Global interconnectedness continues to increase with international travel and trade; economic, political, and cultural interactions; and human-to-human and animal-to- human interactions. These interactions include the accidental and deliberate sharing of microbial agents and antimicrobial resistance and allow the emergence of new and unrecognized microbial disease agents. As the 21st century begins, already new agents have been identified, and new outbreaks have occurred. Solutions to limiting the spread of EIDs will require cooperative efforts among many disciplines and entities worldwide (2006, para.1).

Laperche (2011, pp. 112-115) defines emerging infectious disease as “it can be applied to infections that newly appear in a population, or have existed but are rapidly increasing in incidence. Different mixed epidemiological and/or clinical situations can be classified as emergence events, which are usually identified in three circumstances”.

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Overall, the definition of „emerging communicable diseases‟ in this study will refer to diseases that appeared in a population for the first time, or were old infections reemerging as a result of antimicrobial resistance in known agents or breakdowns in public health measures. Also those spreading widely in incidence or geographic range with no national boundaries. The following description (World Health Organizatin (WHO), 2015; Centers for Disease Control and Prevention, 2010; Lashley, 2006; Laperche, 2011) incorporates an inclusive definition of emerging communicable diseases. In the 1600s, smallpox epidemics occurred though European countries and America that killed thousands of American tribes. A century later, a Yellow Fever outbreak in Philadelphia damaged both the domestic public health service and international economic system. In March 2003, Severe Acute Respiratory Syndrome (SARS) was a viral respiratory illness caused by a coronavirus, which was first recognized in Hanoi, Vietnam. A proportion of patients with SARS develop severe pneumonia; some of whom have needed ventilator support. Soon after in March 15, there were four deaths from SARS reported globally. Including Thailand, there were nine cumulative numbers of cases and the total death toll was two cases, based on data as of the 31 December 2003. A few years later, the world was introduced to the re- emerging disease namely H1N1 or swine flu, an infection which originated from direct contact by pigs and spread among people. The view of an epidemic caused by this influenza virus has occupied both the US media and policymakers who were concerned about the national security. Then, the preparation for infectious disease became one of the President‟s top priorities. Another important outbreak in the 21st Century, the Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in two simultaneous outbreaks, one in Sudan and the other in the Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name. It remerged with double the violence due to the speed at which the outbreak spread, in 2014. Currently, the official number of the Ebola death toll was at 11,296 mainly in Guinea, Liberia and Sierra Leone. Six infectious diseases; HIV/AIDS, tuberculosis, malaria, pneumonia, diarrhea infections, and measles- account for half of all premature deaths worldwide (WHO, 2015).

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Last but not least, the recently human-to-human transmission, called Middle East respiratory syndrome (MERS-CoV), was first identified in the Kingdom of Saudi Arabia in 2012. Globally, WHO (2015) has been notified of 1,570 laboratory-confirmed cases of infection with MERS-CoV, including at least 555 related deaths. The confirmed MERS-CoV infection cases were mostly located in the Republic of Korea. A Summary of the Current Situation, Literature Update and Risk Assessment by the WHO, arose on 18 June 2015 when Thailand reported its first case of MERS-CoV in an Omani national who travelled to Bangkok for medical treatment for an unrelated underlying condition. This case, who had travelled with three family members by plane while symptomatic, was immediately placed in isolation for reasons unrelated to MERS-CoV. To date, all identified contacts in Thailand have been isolated and followed up. No further cases have been identified in Thailand. Public health security in border areas plays a more important role in the international system in that globalization makes all actors more connected and integrated both regionally and globally. Therefore, Thailand's national policy/strategy turns to considering more on public health security as part of its master plan. Additionally, global health issues are not able to be solved by stand-alone states, it needs to have cooperation and integration at all levels consisting of domestic, regional and international cooperation. Lashley (2006, p. 29) concludes that “the solutions to limiting the spread of emerging infectious diseases will require cooperative efforts among many disciplines and entities worldwide”. Fidler (2003, p. 789) pointed out that “public health problems, especially infectious diseases, have been the focus of diplomatic activity among states since at least the mid-nineteenth century". Whilst, the Royal Thai Government started to be aware of infectious diseases at an international level in the early twenty first century since emerging and re-emerging communicable diseases were first mentioned in the national development plan. As the communicable disease incidents in the past confirm that these issues need foreign policy and cooperation in order to support, control and prevent the communicable and emerging communicable diseases. Therefore, one aspect of Thai foreign policy focuses on public health in border areas between two countries that responds to International Health Regulations 2005. Contiguous neighbors of Thailand are the Republic of the Union of Myanmar, Laos People‟s Democratic Republic, the Kingdom of Cambodia, and

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Malaysia. Thailand covers 30 provinces and an area of 514,000 square kilometers in the center of the South-East Asian peninsula and has 2,420 kilometers of coast line on the Gulf of Thailand and the Andaman Sea. Regarding the above neighboring countries except Malaysia, they still have a lower development level as well as social and economic growth.

Figure 1.1 Map of Thailand and neighboring countries. Reprinted from Thailand administrative, by Central Intelligence Agency, 2013. Retrieved from https://www.cia.gov/library/publications/resources/cia-maps- publications/map-downloads/thailand-administrative.pdf. In the public domain.

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Since the East-West Economic Corridor (EWEC) was launched at the GMS Ministerial Meeting in 1998, the logistic networking between GMS members is inevitable. They highly attempt to enhance the transportation network from east-west trade with north-south trade, increase economic competition and create a sense of community. The original strategy and action plan for the EWEC was based on the Asian Development Bank (ADB). Its strategic goal in the social and environment sustainability sector contains the project called GMS Communicable Disease Control Project Phase I which cost more than 8 million baht, sponsored by ADB. More regional connectivity in border areas leads to the higher number of people mobility. Communicable or re-emerging communicable diseases might be the consequence of uncontrolled people mobility. It has both opportunities and threats directly affecting cooperation.In addition, according to the Association of Southeast Asian Nations (ASEAN), the regional integration, has promoted ASEAN Socio- Cultural Community (ASCC) with the purpose of “to contribute to realizing an ASEAN Community…It seeks to forge a common identity and build a caring and sharing society which is inclusive and where the well-being, livelihood, and welfare of the peoples are enhanced” (ASEAN, n.d., para.1). Plus, the ASEAN Economic Community (AEC), will provide logistic connectivity, including air, marine and land, linking Thailand and CLM countries closer together. For example, Special Economic Zones (SEZs) will stimulate the economy and tie up communities of both citizens and foreign citizens in border areas. Those zones, located on Thai and CLM sides, will be developed actively with industrialized areas, infrastructure, and investment. These lead to an increasing number of labor movements that might inevitably cause the spread of communicable disease vulnerability.The Thai government is concerned with forthcoming social problems, security and stability, and including public health issues. Therefore, Yingluck Shinawatra‟s administration foreign policy strategies towards emerging communicable diseases along the border areas were launched since 2013 relating to National Strategic plans for Prevention, Control, Preparedness, and Response to Avian Influenza, Influenza Pandemic, and Emerging Infectious Disease (EIDs) 2013-2016. These strategies were aimed at increasing Thai foreign policy in international health capacity along the borders as well as promoting good relationships among others.

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In terms of Malaysia, this thesis will exclude Malaysia because its development level is similar to Thailand.Compared with CLM countries, the geographical area of Malaysia has only 4 provinces sharing a border with Thailand and also the period of health collaboration between Thailand and Malaysia has been going on longer than with CLM countries. Moreover, a case study of a project on prevention of emerging communicable diseases in border areas is targeted at CLM countries. The idea of international health cooperation in foreign policy becomes a significant mechanism.Neither economics and society nor politics is independent. Thailand adopted liberal perspectives as a mechanism for preventing and controlling infectious emerging diseases which believed that cooperation will prevent the states‟ interest and national security.The strategy relies on the development cooperation project to prevent and monitor the borders‟ health stability. Development cooperation in health security along border areas between Thailand and CLM countries is supervised by the Office of Prime Minister, Ministry of Public Health (MoPH) and Ministry of Foreign Affairs (MFA). This study selects a case study of a Project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders which was initiated by Thailand International Cooperation Agency (TICA), which is one sub-unit of MFA, and is responsible for the prevention in the neighboring borders correlated with MoPH. TICA is the selected agency in order to analyze and elaborate Thailand‟s international health cooperation along with Thailand‟s foreign policy. Its action plans, underlining non-traditional security, is to seek active health collaboration and good relations with neighboring countries. However, TICA is the other channel of the Thai government to collaborate and express international cooperation between Thailand and CLM countries. Therefore, the findings will provide confirmatory evidence that international health cooperation between Thailand and its neighbors is very important and noteworthy regarding international relations.

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1.2 Research Question

Emerging communicable diseases spread quickly across the border, region and continent. These public health issues cannot be solved without cooperation. Since the contiguous areas have been developed actively and became the Special Economic Zones (SEZs) which are aimed at stimulating economic growth, targeted at attracting foreign investment attention, promoting the development of the border areas and supporting ASEAN integration, it would rapidly increase the number of labor movements that might inevitably cause the spreading of communicable disease vulnerability. Therefore, the Thai government has an approach at the state-to-state level in order to prevent or control the spread of communicable diseases along the border of Thailand, especially, CLM countries where they share a common border and have ineffective public health management. The research questions follow: 1. Why does the Thai government pursue strategies in preventing emerging communicable diseases? 2. How does TICA, as a governmental agency, implement the Thai government‟s strategies in preventing emerging communicable diseases along the borders of Thailand and CLM countries? 3. What are the challenges of the Thai government in preventing emerging communicable diseases along the borders of Thailand and CLM Countries? 4. To what extent does TICA‟s implementation of Thailand foreign policy enhance the relationship between Thailand and CLM countries in health cooperation?

1.3 Objectives

1. To analyze the Thai government‟s strategies in preventing emerging communicable diseases in contiguous areas 2. To elaborate on the role of TICA, a Thai Government agency, in the prevention of emerging communicable diseases along the borders of Thailand and CLM Countries

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3. To identify the strengths, weaknesses, opportunities, and threats of implementing the Thai government‟s strategies in preventing emerging communicable diseases along the borders of Thailand and CLM Countries 4. To understand TICA‟s role in the development cooperation foreign policies to enhance the relationship between Thailand and CLM countries

1.4 Theoretical Framework

This study employs a liberal perspective in international relations (IR). The basic assumption of liberalism values the importance of human collaboration which proposes to maintain peace between nations. Historically, liberalism, defined by Von Mises (2002), was the first political movement that aimed at promoting the welfare of all, not only that of special groups. Liberalism is distinguished from socialism, which likewise professes to strive for the good of all, not by the goal at which it aims, but by the means that it chooses to attain that goal. Also, he argued that there are different critics of liberalism who reproach it for wanting to promote, not the general welfare, but only the special interests of certain classes. However, liberalism from his capitalism viewpoint is not a policy in the interests of any particular group, but a policy in the interests of all mankind. Clark (1953, p.V) stated that a liberal is here defined as one who believes in utilizing the full force of government for the advancement of social, political, and economic justice at the municipal, state, national, and international levels...a liberal believes government is a proper tool to use in the development of a society which attempts to carry Christian principles of conduct into practical effect. Dunne (2011, pp. 100-112) summarized that liberalism is a theory of both government within states and good governance between states and peoples worldwide. Unlike realism, which regards the term „international‟ as an anarchic realm, liberalism seeks to project values of order, liberty, justice, and toleration into international relations. He added that liberal thought at the end of the twentieth century became grounded in social scientific theories of state behavior. Cooperation among rational egoists was possible to achieve if properly coordinated by regimes and institutions.

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According to Ikenberry, the USA signaled the cooperative basis of its power in a number of ways. First, in common with liberal democratic principles, the USA was an example to other members of international society in so far as its political system is open and allows different voices to be heard. Foreign policy, like domestic policy, is closely scrutinized by the media, public opinion, and political committees and opposition parties. Second, the USA advocated a global free-trade regime in accordance with the idea that free trade brings benefits to all participants (it also has the added advantage, from the hegemon‟s point of view, of being cheap to manage). Third, the USA appeared to its allies at least as a reluctant hegemon that would not seek to exploit its significant power-political advantage. Fourth, and most importantly, the USA created and participated in a range of important international institutions that constrained its actions (as cited in Dunne, 2011, p. 108). Acharya (2001) has discussed the theoretical perspective on IR in Asia which has mainly been dominated by Western IR specialists. However, he mentions the defense of Ikenberry and Mastanduo, by saying that the relevance of Western theoretical frameworks in studying IR in Asia associated the behavioral norms and attributes with the modern interstate system. Therefore, the main idea of IR theories can be as applicable in the Asian context as anywhere else. Acharya‟s article focuses on exploring the relationship between theoretical constructs and empirical development in Asia. His perspective towards liberalism in Asia can explain that the main actors in liberalism are state, multinational corporations, and international organizations. He further states that the primary goals of states in liberal theory are to cooperate and coordinate for achieving collective goals which is World peace. In general, a collective security system mostly preferred international order with free trade, liberal democracy and institutions. Similarly, when the countries in the liberal world face transnational issues, security regimes benefit from collaboration, that arises from growing interdependence, to manage the disputes. It has no available argument. Furthermore, classical liberalism rests on three pillars stated by Acharya (2001, pp.68-73). First, commercial liberalism, or the view that economic interdependence, especially free trade, reduces the prospect of war by increasing its cost to the parties. Second, republican liberalism, or the “democratic peace” argument which assumes that liberal democracies are more peaceful than autocracies, or at least seldom fight

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one another. Third, Institutionalism, which focuses on the contribution of international organizations in fostering collective security, managing conflict, and promoting cooperation. Liberal institutionalism is also defined as neo-liberalism. It extends the definition by including regimes and formal organizations that can regulate state behavior and promote cooperation by reducing transaction costs, facilitating information-sharing, preventing cheating, and providing avenues for peaceful resolution of conflict. A growing and increasing interdependence as he mentioned above, has furthered the prospects for regional stability and security. Referring to communicable disease issues, information-sharing or exchanging is extremely important, it would pave the way towards mutual benefit. It strengthens the preventive action in any crisis. It can be said that health cooperation and collaboration will broaden human security as well as national interest. However, cooperation is permanently one essential strategy of foreign policies until now which it considers as soft power diplomacy, or development diplomacy. A Discussion Paper: Health, Foreign Policy & Security mentions that new tools of foreign policy have been debated as part of this new environment including such ideas as health as a form of "soft power" (Nye, 2002 as cited in Lee & Mclnnes, 2003) and even health as a "bridge for peace" (Vass, 2001 as cited in Lee & Mclnnes, 2003, p. 7). Later on, Nye‟s prominent notion of soft power defined as “the ability to get what you want through attraction rather than coercion or payment” (Nye, 2004, p. 34) is certainly appealing. Thus, soft power is integrated into foreign policies in terms of cooperation rather than the use of force. One selected conceptual framework for linking between health, foreign policy and security is common security, based on liberal theory which holds that international relations among states are defined by cooperative efforts. Fidler (2003) states that the common security approach broadens the security agenda to include transnational phenomena that threaten the security of individuals and communities, including drug trafficking, environmental degradation, or disease epidemics. To achieve common security, the state must redefine its security to include a wider range of threats creating insecurity for individuals and cooperate with other states to mitigate such security problems. The common security idea stresses the

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interdependence of individual, national, and international security in the same fashion as liberalism. Fidler (2003) further summarizes that from a public health viewpoint the common security perspective opens space for discussing health as a security problem. As public health histories record, infectious diseases have had a devastating impact on the quality of life of individuals in most nations. Given the nature of pathogenic microbes, states have to cooperate to mitigate the threat to individuals in their territories from infectious diseases. National security in infectious disease terms can only be achieved by states cooperating to create international security against microbial threats. The long history of international cooperation on infectious disease control then becomes relevant not only as a foreign policy but also a security issue. The common security perspective creates, thus, something akin to a collective public health security framework in which each state in the international system acknowledges that the public health security of one state is the concern of all and agrees to cooperate in a collective response to pathogenic threats. Adding up all these factors, public health problems have been shaped as transnational threats to communities and individuals that require transnational responses. Public health, thus, escapes its traditional association with the nation-state and becomes a comprehensive idea that more accurately reflects the nature of health threats in the global era, especially infectious diseases. Not only is the concept of public health reconstructed, but this ideational revision allows the new public health perspective to reevaluate traditional attitudes toward international relations. Security is seen in collective terms whereby states work together, through international organizations led by the UN Security Council, to create and maintain a peaceful order. Moreover, postwar liberal internationalism supported the creation of functional bodies of the UN system, concerned with social and economic development, as part of the collective effort to prevent security threats from arising in future from poor countries. As the then US Secretary of State stated at the San Francisco Conference to create the UN in 1945.

The battle of peace has to be fought on two fronts. The first is the security front where victory spells freedom from fear. The second is the

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economic and social front where victory means freedom from want. Only victory on both fronts can assure the world of an enduring peace (Goodrich, 1974 as cited in Lee & Mclnnes, 2003, p. 10).

As the discussion states that the creation of the WHO in 1948 was premised on the postwar liberal internationalism. It led to the creation of the UN system as a whole "to promote social progress and better standards of life in larger freedom" (United Nations, 1945, Preamble). However, recent efforts by a range of organizations to link health, security and foreign policy more directly have been distinct in their concerted attempts to locate health more centrally within these policy communities, and to provide the empirical evidence to support this. While the perspectives of these organizations can be seen to reflect elements of the three broad approaches outlined above, it is acknowledged that there are overlaps among them as thinking continues to emerge. In terms of liberalism, development cooperation is one of the mechanisms supporting the exercise, stating actions which are not only politics or security cooperation and sociocultural development, but also economic cooperation. Liberalism creates a lot of opportunities for cooperation and broader concepts of power. Thailand not only needs to cooperate and collaborate on public health issues, but also other states in the international arena need to be concerned about this issue. Accordingly, public health problems in the twenty first century create severe impacts both demographically and economically. If there is an outbreak, the situation must be controlled and solved. It influences national interest and also regional security such as ASEAN or GMS. Thus, cooperation in the regional context is needed in the liberal world in order to be aware of and prevent upcoming costs and losses. The United States of America established the Global Health Security Agenda (GHSA), a multilateral and multisectoral initiative of over four countries to enhance global capacities for preventing, detecting, and responding to future infectious diseases. Especially, the African Union Commission and US government established an African Center for Disease Control and Prevention. Moreover, the North American Free Trade Agreement (NAFTA), is an obvious case of trilateral economic cooperation, as a signed agreement between United States, Mexico and Canada. This agreement has both opportunities and risks. Although, it stimulates

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economic growth and eliminates the tariff barriers, the higher risk of infectious diseases is also enhanced along with the movement of Mexican labor forces. Since the public health system of Mexico is far behind the United States, so the US government at that time was increasingly concerned about the potential spread of tuberculosis (TB). “US foreign policies towards communicable diseases show documented and undocumented, following the NAFTA agreement”(Coker & Lambregts van Weezenbeek, 2001, as cited in Lee & Mclnnes, 2003, p. 15). Moreover, the US government establishes the core principles to guide how it engages in the global health issue domestically and internationally. Furthermore, Clinton‟s Administration (1996, as cited in Lee & Mclnnes, 2003, p. 19) puts more importance on infectious disease in US policy. Then, the protection of human health and reduction of the spread of infectious diseases became strategic goals of the Department of State's Strategic Plan for International Affairs. The Japanese government announced the Health and Development Initiative (HDI) with its objectives related to the Millennium Development Goals (MDGs). Additionally, Japan allocated budgets from 2005 to 2009 for providing assistance for health issues including measures against infectious diseases. Not only does the Japanese government provide grant assistance, but also cooperates with international and regional cooperation. It stated that the acceleration of globalization has facilitated the movement of people and goods, so infectious diseases are more likely to spread to other countries across borders. Malaysia‟s international health relations are motivated by many factors and significant in terms of health diplomacy. Barraclough and Phua (2007, pp. 161-244) explores the health imperatives evident in Malaysian foreign policy and the expansion of international health cooperation between Malaysia and neighboring countries. This study clarifies the mechanism of the Malaysian government bilaterally and institutionally. At the bilateral level, a Memorandum of Understanding (MOU) is the main tool to strengthen and formalize cooperation on health. For example, there are MOUs between Thailand, Brunei and China which are focusing on the health relationship with bordering countries and beyond the region. In the wake of the communicable disease, SARS, Brunei Darussalam and Malaysia established bilateral health meetings including laboratory facilities, health surveillance, food safety, tobacco

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control and the cross-border movement of patients. At the institutional level, the Malaysian government has involved the WHO, UN, and ASEAN in order to actively stimulate international health cooperation. For instance, the provision of the WHO's International Health Regulations, the Malaysia government has launched the Prevention and Control of Infectious Diseases Act of 1988. Also, the seventh ASEAN meeting of health ministers hosted by Malaysia in 2004 with the theme “health without frontiers” refers to the emphasis of the government.

1.5 Hypothesis

As communicable diseases have become common threats to Thailand and its contiguous neighbors, Thailand, according to a liberal perspective would promote approaches and development cooperation strategies in health diplomacy to prevent and control any public health problems with CLM countries. Cooperation and collaboration between Thailand and CLM countries are able to prevent the spread of communicable diseases along the Thai border.

1.6 Literature Review

The literature review required for this study is divided into two parts. The first part provides background information on communicable diseases in globalization that stimulates global public health security. The second part presents the previous relevant literatures towards emerging communicable diseases which have been categorized into three fields including public health, public health systems and management, as well as, communication and public relations. The review will highlight and demonstrate the chronological development of Thai consideration towards public health issues particularly with regard to emerging communicable diseases along the border area. There is some remarkable literature studied in this particular topic, however the previous literature about emerging communicable diseases barely presents in the field of international relations. This study aims to fill the literature gaps with another dimension of international health cooperation with Thailand‟s foreign policy.

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1.6.1 Background Information on Communicable or Infectious Diseases in Globalization Globalization and infectious diseases: A review of the linkages by Lance Saker, Kelley Lee, Barbara Cannito, Anna Gilmore and Diarmid Campbell-Lendrum (2004) summarizes the existing evidence about the links between globalization and infectious diseases in terms of changes in disease distribution, transmission rate and, in some cases, management of diseases. Firstly, this review concludes that globalization causes changes in the ecological, biological and social conditions that shape the burden of infectious diseases in certain populations. Moreover, at the citizen level, there are differences of gains and losses from economic globalization. It leads to differences in the vulnerability to infectious diseases. It can be said that globalization creates diverse impacts in each level of society. Epidemiology, in general, and disease surveillance in particular, offer useful analytical tools and methods for identifying and measuring trans-border patterns of infectious disease arising as a consequence of globalization. Such approaches are needed in studying how globalization may be changing the distribution of health and disease within and across countries and regions of the world. It sums up with the real risks from such communicable, emerging or re-emerging diseases which poses obvious challenges to an effective response from public health systems both nationally and internationally, it is important to consider the wide range of infection potentially affected by globalization processes. This review supports this topic by saying that the impact of globalization on infectious diseases raises the need for appropriate performance of global governance on key issues to improve the system of prevention, control and treatment. As well, its findings support the enhancement of training on prevention and a greater understanding of the potentially changing profile of infectious diseases is needed.

1.6.2 Previous Non-IR Studies on the Emerging Communicable Diseases in Thailand There are some researcher debates on preventing emerging communicable diseases in Thailand in various perspectives.Considering the chronological development of Thai thinking towards public health issues, they primarily studied about disease prevention, surveillance systems, and roles and responsibilities of

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hospitals. However, it is difficult to find literature focusing on the role of the Ministry of Foreign Affairs, especially Thailand International Cooperation Agency (TICA), in development cooperation in public health security.

Public Health Sopon Iamsirithaworn, Pasakorn Akarasewi, Thitipong Yingyong, Suthanun Suthachana, Chakrarat Pittayawonganon, and Kumnuan Ungchusa (2011) studied the Three Waves of the 2009 H1N1 Influenza Pandemic in Thailand. Nearly one half of the Thai population may have been infected by the pandemic H1N1 influenza over the 18-month period, between May 2009 and October 2010. The most affected subpopulation group, and mostly not immune to the H1N1 pandemic, was children in primary schools, followed by students in secondary schools. Within a couple of months of the rainy season, the concentration of school outbreaks was likely a major cause of widespread infection throughout the country. Intensive responses to the pandemic, including non-pharmaceutical interventions and other mitigation measures, were apparently effective in reducing pandemic influenza transmission, especially during the first wave. The reverse trend reflected a decrease in transmission rates after the comprehensive interventions. However, the lack of sustainable interventions in the population as well as the inability to prevent further transmission of the pandemic virus resulted in the pandemics second and third wave. Sanipa Suradhat (2013, pp. 5-6) researched Multi-sectoral approaches for preparedness against emerging infectious diseases. It aimed to improve the understanding, awareness and preparedness against emerging infectious diseases in Thailand, using the Nipah virus as a model. The program consisted of 3 components including human, veterinary, and wildlife research taskforces, and employed a „One Health‟ concept, on coordination, planning and implementation. The program conducted a risk analysis on the Nipah virus infection in humans, pigs, domestic animals, insects that lived near the Nipah virus which infected bat colonies as well as feeding routes. The research findings provided valuable scientific information and better understanding in biology and the disease ecology of the Nipah virus in Thailand. The multi- disciplinary research program is a proof-of-concept in applying and integration of the

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knowledge from 3 major research components for better understanding, awareness, and preparedness against the emerging diseases with zoonotic potential. Evidence in the article Three Waves of the 2009 H1N1 Influenza Pandemic in Thailand and the research on Multi-sectoral approaches for preparedness against emerging infectious diseases are borne out by research that showed the chronology of the outbreak in Thailand from 2009 to 2010. The literature shows no consensus on the importance of preventing pandemics as well as risk evaluation. However, the research relied more on the medical and scientific perspective rather than international relations.

Public Health System and Management In 2009, Kesorn Thaewnongiew, Promthet Supannee, Nilvarangkul Kessarawan, Rangsin Ram and Donald Maxwell Parkin researched on the Development of A Model for Communicable Disease Surveillance System in Health Centers in A Province in Northeastern Thailand that aimed to develop a model for communicable disease surveillance systems at health centers, by selecting to study purposively eleven health centers, one District Health Office, one community hospital and eight sub-district administrative organizations. There were two distinct sets of observations. The first was based on medical records from 11 local health centers during 2006. The second was 50 local officers from that work place. Quantitative data was collected through reviewing medical records. Qualitative data was obtained through four focus groups and 18 interviews. The results of the early stage showed health officers lacked knowledge, confidence in some disease diagnosis and using less definition in reporting. The data could explain real situations which occurred in local areas of only 50.8%. Sensitivity was low for common diseases. Moreover, the supporting system was at a low level. However, through participating, health officers gained vital knowledge in systems. They also learned how to report cases, diagnose disease in reporting systematically and continuously to provide knowledge for their work. They demonstrated a greater sense of consciousness and were able to improve the surveillance system. Moreover, they learned to communicate and cooperate with others to strengthen the surveillance networking. This study illustrated that the surveillance system at the health centers must be

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improved because it is to become an important mechanism for sustainable prevention and control of diseases. This study could be an example for health officers to apply the model to fit each particular setting. In the discussion, the researchers mentioned that the readiness of the teams (working knowledge) in preparing themselves for responding to public health emergencies must be improved. The surveillance and rapid response team (SRRT) suffer from a lack of motivation. Moreover, networking is not strong enough because related organizations have the impression that prevention and control of diseases is only the duty of health officers. Plus, resources to fulfill their duties adequately are not provided to the staff. In conclusion, the competency of SRRT at a district level needs to improve, especially in terms of working knowledge, management and leadership skills, in order to support public health action. The results of this study revealed that the existing competency of SRRT could be improved by empowerment for providing knowledge to SRRT, and working collaboratively with related organizations for strengthening the network in local areas. Phengphakeo (2011) studied Administrative Factor and Administrative Process Affecting Performance in Epidemiological Surveillance of Health Personnel at Health Centers in Khammouane Province Lao People’s Democratic Republic (Lao P.D.R.)which supported the claim that communicable diseases or emerging communicable diseases need greater effort on prevention. This study is an attempt to address health personnel at Health Centers in Khammouane province, Lao PDR as well as their performance in epidemiological prevention. This current research found that the problem and difficulty in preventing the diseases was as follows; 1) Health personnel had less knowledge about performance in epidemiological surveillance and inadequate manpower when compared with work load. 2) Budget insufficiency 3) Inadequate material supply. In conclusion, he recommended providing continuing training courses in order to utilize knowledge to develop their work and the need to supply more health personnel. Moreover, a bigger budget and greater supply of essential medical material were his suggestions. Orathai Srithongtham, Supaporn Songpracha, Wisit Sanguanwongwan and Suwaree Charoenmukayananta (2013) studied the impact of Trans-national migrants

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from Burma, Laos, and Cambodia to the burden of health care service in the community hospital at border areas of Thailand. Thai people‟s rejection of difficult or degrading, dangerous and dirty work was the major cause of trans-national migrant substitutes for these jobs. However, whilst in Thailand they have been provided with health service and the hospital where health service is provided, will carry the financial burden and various other impacts. This study aims at researching 1) the financial burden of providing health care service to the trans-national migrants and non-Thai nationals in the community hospitals in the border areas of LAO, Burma and Cambodia, 2) the impact of the financial burden of providing health care service to the trans-national migrants and non-Thai nationals, and 3) the trend of the problem and how to cope when providing regional integration, and found the following: 1) Regarding the financial burden of providing health care service it turned out that non-Thai patients have been increasing since 2009 which was approximately 40-50% of total patients and at one selected hospital the rate was up to 70-90%. Although the financial burden was not high but the workload of providing health service was quite high due to the number of patients. Additionally, at hospital, the expense does not affect hospital income since the income has been higher than expenditure but they also found the workload in providing healthcare service was the same as in the hospitals mentioned above. 2) The impact from the financial burden of providing health service discovered four different aspects that led to problems and they are leveled depending on four factors; 1) The economic situation of the area located both in Thailand and nearby country, 2) the convenience to cross the border and go through the immigration check point as well as the other ways of crossing the border with, 3) the quality of health service provided and the ability of the service provided by Thailand public health personnel, and 4) the relationship between Thai people and neighboring country people. The burden from health service provided to unregistered migrant and non- Thai patient were quite similar to each other which are explained in the following statement divided into eight aspects. 1) The hospital financial issue was done by facilitating the hospital‟s money, 2) The problem is there is no data base system of unregistered migrants and non-Thai (minority groups, ethnic groups, and stateless or displaced persons) who did not have any health insurance and cannot pay for health

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service. 3) The problem of public health manpower; the structure of manpower belonging to MoPH‟s policy of Thailand is dependent on the amount of Thai people in the area who are responsible for the hospital needing more manpower to deal with such issues. 4) The communication problem was an obstacle for access to health services for migrant and non-Thai patients. 5) The problem of prevention and control of communicable diseases in the border area. The communicable disease that was found in the study area was Malaria, DHF, TB and MDR-TB, AIDS and Sexually Transmitted Infections (STI), 6) In the provider‟s view, the trans-national migrant was crucial to the Thailand economy both at local and central levels. In contrast on the aspect of health care service this group was a high burden both in financial terms and the workload of providing service. 7) The problems of a referral system for non-Thai patients were found: referred from the community hospital to provincial hospital and referred from Thai hospital to neighboring country hospital. Orathai (Orathai et al, 2013) suggested that there should be a strategy of the health system among ASEAN members and a collective strategy in aspects of the health system between two nearby countries, especially, for the pediatric severely ill patients and emerging and re-emerging communicable disease policy. The policy issues were health insurance system, public health system, and referral system among ASEAN member countries. Also, the structure of man power of public health personnel in the hospitals in the border area should concern not only Thai citizen who lived in that area responsible for the hospital but also the trans- national migrants, minority groups and stateless/displaced persons. The crucial point is the policy maker must accept that these groups of people exist in Thailand as well because they will be provided with healthcare service in the hospital when they were sick or injured. In addition, it should develop a data base system of health service provided to trans- national migrants, minority groups and stateless/displaced persons at the community hospital level, the provincial level, and with regard to national policy, in order to use the data for developing and supporting the health service system in border areas as well as ASEAN member countries. The current literature indicates that the impacts of labor movement according to the regional economic community is a financial and manpower burden on the health service in Thailand. The researcher emphasized that the trans-national

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migrant was crucial to the Thailand economy at both a provincial and central level. There is growing support in this study for the claims that Thailand should set up a strategy for the health system among ASEAN members and a collective strategy in terms of the health system between two countries where they share contiguous borders. Nevertheless, this study is limited regarding the international health cooperation between relevant agencies, as well as the prevention and planning for emerging communicable diseases.

Communications and Public Relations Sununtha Yaemthap (2012) studied on Communicating the Hazardous Disease at the Border: A Case Study of Public Information on Avian Flu along Thai- Lao Border. She focused on media coverage of Avian Influenza (AI) across the border i.e. the coverage from state agencies, national media and local media and its effects on the people at the borders. This study aimed to 1) study patterns of AI coverage considering the role of media in social construction of the reality of the disease, 2) explore connections among coverage content, representation of the disease and borderlanders’s awareness and reaction, and 3) attempt to gather knowledge and proposed policy for effective communication regarding emerging diseases across the border including proposed policy to consider media roles in covering sensitive issues across borders. Results suggested that news media constructed the social reality of AI emphasizing avian flu as a threatening disease. Most stories made reference to the threat of H5N1 virus by using fear appeal, overemphasizing and sensationalizing virus related disaster and death. Such approaches in health communications, traditionally aim to raise awareness and action to prevent infection in the community. However, this study found that the implications from the perspective of the fear appeal message generated different effects on people at the borderland. Rather, it emphasized the boundaries among people in the study areas, demarking ‘them’ versus ‘us’. The demarcation lines emphasized among people at the Thai-Lao border appear in various planes, national boundary, cultural boundary, ethnic boundary and gender boundary. Such demarcation emphasized during the outbreak generated reactions that created greater risk for disease infection in the area. The boundaries emphasized also created different accounts of the geographies of blame for outbreaks of bird flu. Different groups of

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borderlanders blamed each other or one another for the outbreak, partly to strengthen one’s own group’s security, while being suspicious of each other. Such responses made media strategies in reporting emerging diseases in the area ineffective. It obstructed the borderlanders from changing their risky behavior, due to the belief that the problems are not us but them. Suwannee Suwannatown (2013) aims to develop a Model on Public Relations about Emerging Infectious Diseases for Health Networks, Salaphum District, Roi Et Province. Her findings were split into three phases as follow; The first phase referred to six issues of public relations situations being found. 1) The same information was sent to the village by many government sources. 2) Public relations of health information was done by one way communication, so villagers were not involved. 3) Language of government information is difficult for villagers to understand, and information did not contain enough details so villagers could not apply it in their practice. 4) Village leaders who were not trained in the field of public health had difficulties in transferring health information. 5) Village leaders and village health volunteers needed help to transfer health information . 6) Experience and ability helped lead to success in public relations in communities. The second phase of findings showed that the model on public relations about emerging infectious diseases for health networks was developed based on the preliminary model of public relations which involved data collection as well as focusing on group discussion. The result illustrated that there were four areas: sender, message, channel, and receiver, which were improved. The third phase summarized the importance of three patterns that the new model included as follows: 1) Public relations personnel of Selaphum Hospital were the coordinators for all health networks. 2) Roles, functions, and responsibilities of public relations about emerging infectious diseases were specified. 3) Four areas of public relations: sender, message, channel, and receiver were improved. The evaluation result of using the new model according to perception of health information indicated that after using the new model it was higher than before. The research on the Development of a Model on Public Relations about Emerging Infectious Diseases for Health Networks, Salaphum District, Roi Et Province and Communicating the Hazardous Disease at the Border: A Case Study of

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Public Information on Avian Flu along Thai-Lao Border are prominent in the literature in the field of communications and public relations rather than disease prevention in border areas. Also, it investigated based on communication theory which included the message sender, the information or content, communication channels, and the receiver. It does not relate directly to the border security, national interest, or the relationship among states in preventing emerging communicable diseases between Thailand and neighboring countries. The literature relating to communicable and emerging communicable diseases mostly rests upon medical and scientific, public health system management and communication perspective. However, no studies have been done to illustrate the role of domestic agencies concerning international health security in contiguous areas. As a matter of fact, surveillance systems for emerging communicable diseases relate to both national and international health security and interests. Public health organizations are mainly responsible for the prevention of emerging communicable diseases, but also the international cooperation between two states needs to deeply investigate the action plans of TICA which is one of the MFA agencies considering the development cooperation in public health.

1.7 Methodology and Scope

The methodology of this study consists of documentary research and interviews as the main approaches. First of all, the documentary information, the study will investigate secondary data both in Thai and English languages. Documentary research gives necessary background, detailed information and significant updates for the analysis. As well, the national strategies will add-up in order to illustrate the administration process in the literature reviews. For example, the Eleventh National Economic and Social Development Plan, the Border Health Development Master Plan, Thailand‟s foreign policy, etc. In addition, statistical data will also be collected and used for supporting arguments and to strengthen the point of the study. Second, interviews will be conducted to form a part of the data collection. It will focus on a few interviewees, who are responsible for implementing Thailand‟s international health cooperation strategies for the prevention of emerging

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communicable diseases along the border areas between Thailand-CLM countries. They are representatives from TICA who work at the Planning and Monitoring Branch and Thailand Cooperation Branch I under the Development Cooperation Bureau and they are project implementers. The nominated interviewees, moreover, will derive from the Department of Disease Control, Ministry of Public Health. Afterwards, a SWOT analysis, which was invented and stated the origins of the model by Albert Humphrey (Morrison, 2012), will assist in analyzing the project implementation of the Thai government towards international collaboration. SWOT is “a well-method that could make a list of ideas under each of these categories” (Gray, 2009, p. 47). SWOT identifies Strengths, Weaknesses, Opportunities and Threats of any action. What‟s more, it splits the analysis by internal factors and external factors that influence the organization‟s action so on and so forth. It is useful and supportive for the analysis part. The decision to choose SWOT instead of other mechanisms is as clear-cut as the accepted views might suggest. In terms of state collaboration, the Thai government is not able to solve the international health issue alone, it needs to have strategies/approaches in the development cooperation.In Chapter 5, it will conclude the important reasons why the Thai government is interested in international health cooperation and provide some foreign policy recommendations. This study will select three representative countries of Thailand‟s neighbors with shared contiguous borders including Cambodia, Lao PDR, and Myanmar (CLM). Although, Malaysia shares a border area with Thailand, the study excludes Malaysia as one of the representative countries. TICA‟s project which is a selected case study targeted only CLM countries and their readiness for the prevention of emerging communicable diseases of CLM moreover is far behind Malaysia. According to the Malaysian government health care policy in 1990, the Malaysian government launched a New Development Policy which shows the objectives of these policies are the roles of state which is stronger in terms of the development of health services as well as the prevention of emerging communicable diseases. As well, the period of health collaboration between Thailand and Malaysia is longer than CLM countries. Compared with CLM countries, the geography of Malaysia has only four provinces sharing a border with Thailand. Meanwhile, Cambodia shares border areas with seven . Also, twelve provinces of Thailand are shared with the Lao

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PDR. Moreover, Myanmar has both land and maritime boundaries shared with Thailand and there are ten provinces next to Myanmar border areas. Within the mentioned cases, they rely upon public health, system management, and communication perspectives. Along with some similar areas, this study will generally emphasize and investigate in the field of political science. This study is an attempt to address only on the roles of the MFA, especially TICA, in order to handle these issues. Although, the primary role and responsibility of the MFA is to maintain good relations between countries and promote international political clusters, with globalization, the MFA places more emphasis on foreign relations economic clusters than security stability. However, the MFA duty is to make good collaboration in all matters. The approach of public health security in border areas in the prevention of emerging communicable diseases cannot be a standalone policy belonging to MoPH. Current global situations shape cross-cutting roles of ministries. Hence, this study is outstanding and remarkable for investigating the case of public health in border areas from the viewpoint of foreign affairs. The research scope will focus on the period during 2012-2015. According to the Eleventh National Social and Economic Development Plan (2012-2016) targets strengthening countries in this region emphasizing on border economic development and border cities.Also, it corresponds obviously with the Second Border Health Development Master Plan (BHDMP) 2012-2016. In addition, the regional context in terms of the ASEAN Economic Community (AEC) stimulates the preparation and the readiness of ASEAN members.It aims for cooperation in many areas such as the following 1) a single market and production base, 2) a highly competitive economic region, 3) a region of equitable economic development, and 4) a region fully integrated into the global economy. The AEC has an effect on labor migration, public health services, spreading of emerging diseases, crime, drug trafficking, etc.This study will be a role model to study the approach to epidemic prevention in the border areas. The timeline shows that there were some important incidents occurring at that time. Plus, the awareness of public health in border areas was emphasized more by the Thai government. Hence, the period of this study will focus on 2012-2015 and the following important factors. In 2012, the first outbreak of MERS-CoV was recorded in Saudi Arabia.Meanwhile, Thailand launched the Eleventh National Social

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and Economic Development Plan (2012-2016) which began emphasizing on border economic development and border cities.Also, the Thai government established the second border health development master plan 2012-2016. In the year 2013, the Office of the National Economic and Social Development Board (NESDB), under Yingluck Shinawatra‟s administration, announced a national security strategy 2013- 2017 aimed at the development cooperation in security along border areas and Thailand Country Strategy aimed at creating more competitiveness and releasing Thailand from the middle-income trap. Later in the year 2014 Yingluck‟s Administration foreign policy strategies towards emerging communicable diseases along the border areas was launched. After the coup d'etat in 2014, resulted in Prayut‟s administration, at the same time, the re-emergence of the Ebola outbreak created global fearfulness again. This study chose finishing in 2015 when Prayut‟s administration agreed to establish Special Economic Zones (SEZs) covering 5 pilot provinces, district in Tak, district in Sa Kaeo, district in Trat, Mueang district in , and in Songkhla. These were in order to activate Thailand‟s border trade and prepare for the arrival of the AEC. Last but not least, the Millennium Development Goals (MDG) agreed at the UN in 2003 will be finalised at the end of 2015 aiming to combat HIV/AIDs, Malaria and other diseases. Within this study, data collection will take place during the period 2012-2015.

1.8 Organization of the Study

Chapter one introduces background, research questions, objectives, theoretical framework, review of related literature, methodology and research scope. Chapter two discusses Thailand‟s international health policy (2012-2015) and presents the policy integration. Chapter three examines policy implementation of TICA on public health cooperation. Chapter four elaborates on how TICA‟s project was implemented. Chapter five concludes a case study as well as provides theoretical contributions and policy recommendations.

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CHAPTER 2 REVIEW OF THAILAND’S INTERNATIONAL HEALTH POLICY

The public health issue, especially, emerging communicable diseases is determined as one of the non-traditional threats of the globalization era. It has become a more significant dilemma and leads to both human security and national security. In terms of geopolitics, Thailand is located at the hub of the Southeast Asia region. Thailand, accordingly, is enabled to play a leading role in the preparation and readiness for communicable disease outbreaks in order to build awareness and prevention strategy along Thailand-CLM border areas. This chapter describes the overview of the Thai government‟s policies and strategies on emerging communicable diseases during 2012-2015. The awareness or prevention of public health issues will be derived from the top-to-bottom determination of policy makers. In many countries, public health issues are included in foreign policy because diseases or emerging communicable diseases are uncontrollable impacts to all dimensions in society such as human security, economy, or state stability. The international players are concerned at both national and international levels to prevent emerging and re-emerging communicable disease. One of the most significant mechanisms is a governmental policy which gives direction to all relevant government agencies. The preventive strategy along border areas is such cross cutting policy that it needs holistic implementation. The project on Building Awareness and Preparedness for Communicable Disease and Emerging Disease along the Thailand-CLM borders is established by Thailand International Cooperation Agency (TICA) under the Ministry of Foreign Affairs, nonetheless it conglomerates many related government agencies or organizations to carry out the policy and strategy as the following chart shows.

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Figure 2.1 Thailand’s International Health Policy

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Thailand‟s international health policy involves three main governmental organizations namely Prime Minister‟s Office, Ministry of Public Health (MoPH), and Ministry of Foreign Affairs (MFA). After the Cold War, the foundation of Thai foreign policy has concentrated more on the maintaining of the state‟s relationship, strengthening cooperation as well as creating mutual interest with other countries. Public health issues interfere with human life which impacts to national stability. Since the 1990s, human security is a part of national strategy and also contained in international policy. The preliminary view of international health policy governing in Thailand starts in the Prime Minister’s Office. The Royal Thai Government has carried out the direction for all ministries which will be correlated with the National Economic and Social Development Plan from National Economic and Social Development Board (NESDB) together with Thailand‟s Country Strategy for developing the country economically and socially. The Office of National Security launched Thailand‟s Development Strategy for National Security Reinforcement 2013-2017 to support the preventive strategy of communicable diseases, in which it considers the public health issue as one of the new forms of threat impacting security issues. For the national budget allocation, Bureau of the Budget will be the main manager of country budget that audits and allocates money to the requesting organization.

2.1 The Eleventh National Economic and Social Development Plan 2012-2016

NESDB under the Prime Minister‟s Office is the main organization for developing strategy parallel with Thailand‟s Country Strategy including all aspects: society, economy, politics, so on and so forth. NESDB launched the first National Economic and Social Development Plan in 1961. Thailand was faced with numerous international compressions resulting from the problems created by World War II. After the Cold War, US economic recession led to a situation of great instability, such as, high inflation, depreciation, lowering of international reserves, and reserves assets. Thailand had to pay war compensation by money and rice according to the Formal Agreement for the Termination of the State of War that meant Thailand had a weaker economic situation. Field Marshal Sarit Thanarat, the leader of the Revolutionary

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Council, decided to lead the coup d'etat in 1957 and then became the 11th Prime Minister of Thailand, attempted to improve the situation in Thailand by modernizing the country. Prime Minister Sarit Thanarat‟s administration believed that the core factors of state modernization were to develop the economy, politics and society, so he formed foreign partnerships to develop and modernize Thai‟s society. This was the fundamental idea of the First Plan focusing on development of infrastructure and administration. From the First through to the Ninth Plan, Thailand has engaged a National Economic and Social Development Plan in order “to cope with internal and external changes” (National Economic and Social Development Board (NESDB), 2011a, p. 133). At the very beginning, the plans aimed “to expand the economy and invest in infrastructure such as transportation, communication, and dams for irrigation and to generate electricity in order to create foundations essential for private investment” (NESDB, 2011a, p. 131) and to civilize the country equivalent to others on the international stage, under Field Marshal Sarit Thanarat‟s administration. The table below demonstrates the summary of Plan 1-11 including emphasis and policy context during its period.

Table 2.1 The Summary of Emphasis in National Economic and Social Development Plans

Plan (Year) Emphasis Policy Context Plan 1 - Central Administration (Top - - Agricultural economy (1961-1966) Down Process) basically rice, rubber, - Development with growth teak, tin, etc. focusing on infrastructure - Economic expansion 8% (transportation, (Target 5%) telecommunication, dams for - Population growth rate is irrigation and electricity) and at 3 % project-oriented approach - Increasing citizen revenue - Development of administration (continued)

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Table 2.1 (Continued) The Summary of Emphasis in National Economic and Social Development Plans

Plan (Year) Emphasis Policy Context Plan 2 - Sectoral development planning - Gap of income (1967-1971) covering state enterprises and - Economic expansion local administration 7.2% - Continue developing on - Limitation or inequality of infrastructure infrastructure users - Regional development - High number of population - Support private sectors to be growth involved in country development Plan 3 - Development expansion in - Gap of income (1972-1976) social and economic sectors - Economic expansion 6.5% which aimed at growth in social - Oil price was increased fairness and increasing income fourfold (1st oil price crisis) distribution - Inflation and recession - Promotion of economic growth - Instability system of global in rural areas and the reduction economy of income disparities - High level of unemployment - Expansion of agricultural production - Involvement of education, health and welfare to promote social justice Plan 4 - Strengthening of national security - Expansion of Communism (1977-1981) management: Inter-sectoral - Low quality of agricultural planning product - Greater economic security for the - Economic expansion 7.4% nation and creating a more and inflation 11.7% equitable economic and social - Degeneration of natural order resources - Improvement of price control - Lack of social welfare policy towards exports - Became a middle-income country (continued)

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Table 2.1 (Continued) The Summary of Emphasis in National Economic and Social Development Plans

Plan (Year) Emphasis Policy Context - Decentralization of social services to reach more Thai people in the rural areas - Contribute national interest Plan 5 - Rural development in poverty - Poverty in rural areas (1982-1986) alleviation - Proactive development - Increasing living standards plan - Adjustment of economic - Economic growth 5.4% structure and raising economic - Decentralized health care efficiency service by providing sub- - Development of social structure district hospitals and distribution of social services - Reformation of the national development to administration system and deconcentration of the ownership pattern (implementation of the sectoral plan into the operational plan) - Mobilization of cooperation from private sectors Plan 6 - Implemented plan divided into - Economic expansion (1987-1991) short-term, medium-term 10.9% policies and operational plan - Higher exchange reserves - Increase the efficiency of - Higher number of national development in regard employment in the to human resources, science and industrial sector technology, natural resources - Wider gap of income and the formation of integrated systems of administration and management (continued)

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Table 2.1 (Continued) The Summary of Emphasis in National Economic and Social Development Plans

Plan (Year) Emphasis Policy Context - Improvement of the production system and marketing as well as raising the quality of basic economic factors - Increase the distribution of income and prosperity into provincial regions and rural areas Plan 7 - Bring about the pattern of - Economic expansion 8.1% (1992-1996) sustainable development and inflation 4.8% - Maintain economic growth rate - Exchange reserves level to ensure sustainability and reached USD 38,700 stability million - Economic development at regional and international level Plan 8 - Human potential strategy and - Tom-Yum-Kung Crisis (1997-2001) economic development as - Increase of foreign debt mechanism and public debt - A holistic approach to - Cooperation between development government and public - People-centered development sectors for achieving sustainability and - Low quality of life stability - Natural resource degradation Plan 9 - A people-participation basis - Implementation of (2002-2006) - Balance of development: human Sufficiency Economy resources, society, economy and Philosophy (SEP) natural resources - Coup d'etat on 19th - Strengthening national September 2006 competitiveness (continued)

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Table 2.1 (Continued) The Summary of Emphasis in National Economic and Social Development Plans

Plan (Year) Emphasis Policy Context - Establishment of good governance at all levels of Thai society Plan 10 - Five main development - Instability of domestic (2007-2011) strategies: politics 1. Strategy for development of - Decreasing economic human quality towards a growth knowledge-based and learning - Shut down Suvarnabhumi society Airport 2. Strategy for strengthening - Political crisis in April community and society as basis 2009 of national security - Regional connectivity: 3. Strategy for reforming the ASEAN+3 and ASEAN+6 structure of the economy for - Emerging communicable balance and sustainability disease, namely H1N1 4. Strategy for development of - Illegal migrants biodiversity and conservation of - Increasing oil price at the environment and natural 147USD/Barrel resources 5. Strategy for promoting good governance aiming at social justice and sustainability Plan 11 - Application of Sufficiency - Instability of domestic (2012-2016) Economy Philosophy (SEP) politics throughout the plan and its main - In 2013, the protesters concept is derived from the proposed Yingluck guiding principles of the Plan 8- Shinawatra‟s 10 administration

(continued)

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Table 2.1 (Continued) The Summary of Emphasis in National Economic and Social Development Plans

Plan (Year) Emphasis Policy Context - Holistic model of people- - The protest movement was centered development for more led by Suthep Thaugsuban, balancing in the civil society at who was formerly a all levels (i.e. people, society, member of opposition economy, environment and party. He was supported politics) by the People's - increase its connectivity to Democratic Reform regional and global economies Committee (PDRC) proactively - Coup d'etat on 22nd May 2014 - During the political crisis, business sector in tourism and service was depressed - Instability of global economies, especially in Europe and United States Note: Adapted from the national economic and social development plan by National Economic and Social Development Board (NESDB), 1961, 1967, 1972, 1977, 1982, 1987, 1992, 1997, 2002, 2007 & 2012; The national economic and social development plan 1-11[PowerPoint Slides] by Arkhom Termpittayapaisith & Thanin Pa-Em, 2009, August 7. Lecture note presented at Royal Princess Larnluang Hotel, Bangkok.

The turning point of human security in Thailand showed up in the Eighth Plan (1997-2001) under Prime Minister Chuan Leekpai. “The plan represented new values and thinking in Thai society that gave importance to participation by all elements of society, and that aimed for people-centered development” (NESDB, 2007, p. i) and it proposed to create more happiness and a better quality of life with a stronger and more stable economic situation by using human development mechanism. In terms of public health in the Eighth Plan it was mainly about providing health care service, knowledge for disease prevention and information access for

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people at all levels. Moreover, there was continuation of the development of a health service delivery system which attempted to decentralize the service to regional level. Emerging or re-emerging communicable disease was not mentioned in the Eighth Plan. Another point was that there were few disease outbreaks during this period, so disease control was a less important factor compared to health knowledge and understanding. During Prime Minister Thaksin Shinawatra‟s administration, “the Ninth Plan (2002-2006) promoted the Sufficiency Economy Philosophy (SEP) to guide the development and administration of the country, at the same time as continuing the holistic approach to people-centered development from the Eighth Plan” (NESDB, 2007, p. i). Public health issue maintained the general issues such as health service accessibility, health promotion and the highlight of the Ninth Plan was the elimination or reduction of drugs which were considered as causing state instability and decreasing the quality of life. For the Tenth Plan (2007-2011) promoted under General (ret.) Surayud Chulanont who was appointed to be the 24th Prime Minister of Thailand after the coup d'etat on 19th September 2006. The key concept of the Tenth Plan was the Sufficiency Economy Philosophy (SEP) of His Majesty King Bhumibol Adulyadej and the context of national development. The primary principle mentioned in the plan emphasized on people-centered development continuing from the Eighth Plan. The Tenth Plan analyzed the changes under the globalization context in which communicable diseases became one determination, it stated that “emerging and re-emerging diseases such as SARS, Avian influenza, flu, and so on are other health problems that require special attention and serious prevention” (NESDB, 2007, p. 104). The Public health issue became more important and emergency issues for human development, especially when there were outbreaks of SARS, Bird Flu and Influenza in 2003-2006. The Tenth Plan prioritized international cooperation for state development, it attempted to “initiate collaboration with neighboring countries for support of the production structure reform, increase of competitiveness, and social development of the country” (NESDB, 2007, p. 154). Therefore, the guideline to improve structural reform, Thailand needed to…

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Support and strengthen cooperation with other countries to solve shared problems like contagious diseases, natural disasters, energy shortages, security problems, transnational crimes, and money laundering, as well as cross-border problems including labor movement, drugs, and shared and sustainable consumption of natural resources and environment along key river basins like the Mekong river basin (NESDB, 2007, p. 155).

It was obvious that the Tenth Plan paved the way for human security in terms of a preventive strategy of communicable disease through collaborating with neighboring countries, however, people participation or people-centered was still used as the national development approach. Public health, in the Tenth Plan, increases the important supportive sector in all development dimensions including quality of human life, social welfare, economy expansion etc. The Eleventh National Economic and Social Development Plan 2012-2016 actively fosters connectivity to the regional economy. The border is a part of strategic areas. The balancing of quality of life tends to be significant as common human security, so the Eleventh Plan concentrates on public health and human security more in border areas. The relationship between the national development plan from the Prime Minister‟s Office, the public health policy in border areas from MoPH and foreign policy from MFA will influence an international development cooperation strategy. The Eleventh National Economic and Social Development Plan remarks that the Royal Government of Thailand has perceived the external risks as having a direct or indirect impact on economic and social development. One of the major global changes regarding emerging communicable diseases is that “Global warming effects climate change throughout the world… disease epidemics and outbreaks of insect pests have caused harm to human life, damage to agricultural products and threats to world food security” (NESDB, 2011a, p. iii). The Office of the Prime Minister, the Office of National Security (2013) determined the overall situation regarding security issues was divided into two form of threats including traditional security and non – traditional security. For non-traditional security, the Office of National Security emphasized on eight issues, consisted of 1) Drugs, 2) Illegal migrants, 3) Social conflict, 4) Destruction of the Environment and Natural Resources, 5) Natural disasters, 6) Infectious diseases,

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7) Terrorism, and 8) Transnational crime. It was similar to the primary concerns of security challenges defined by the Ministry of Defense stating that “pandemics and communicable diseases problem is concluded and considered as one of Thai security challenges” (Ministry of Defence, 2013, p. 9). In terms of geographical areas, infectious disease was also considered as the threat effecting both central and border areas. The vision of Thailand’s Development Strategy for National Security Reinforcement 2013-2017 is “citizen and community has immunity and preparedness for threats. Thailand promotes development cooperation with neighboring countries sustainably” (Ministry of Defence, 2013, p. 9). Communicable diseases has been brought up and remains an important factor since the Tenth Plan. Social sustainability and economic stability rely upon the well-being of people in society. Preventive strategy against epidemics and outbreaks will help the government reduce the cost of treatment or recovery. In the field of international relations, national security has a blurred line between actual contiguous areas in other words the state is growing towards interdependence. The movement of population among states, particularly neighbors, leads to vulnerability of infection with emerging or re-emerging communicable diseases. The wellness of citizens in one country is not enough for sustainability and stability, thus collaboration and cooperation on public health issues as mentioned earlier in the Tenth Plan are very much a transnational issue. The Eleventh Plan applies a holistic model of people-centered development for more balance in the civil society at all levels and desires to increase its connectivity to regional and global economies proactively. The fundamental missions of the Eleventh Plan are similar to the previous plans covering the global context and domestic changes, however they are more broad in areas saying that “to utilize the existing resilience of Thai society and economy, and to prepare both individuals and society as a whole to manage the impacts of such changes and pave the way toward well-balanced development under the SEP” (NESDB, 2011a, p. ii). The Eleventh Plan stresses the significant contribution of the international community‟s effort stating that “collaborate to prevent infection and the spread of emerging diseases through capacity building in health care preparations, and control reemerging and recurring diseases” (NESDB, 2011a, p. 107).

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The vision of the Eleventh Plan states that “A happy society with equity, fairness and resilience” (NESDB, 2011a, p. X). The Eleventh Plan has four missions hereinafter: 1) To promote a fair society of quality so as to provide social protection and security, to enjoy access to a fair judicial system and its resources, and to participate in the development process under good governance. 2) To develop people with integrity, knowledge and skills appropriate to the age of each, and to strengthen social institutions and local communities to ensure positive adaptation to changes. 3) To enhance the efficiency of production and services based on local wisdom, knowledge, innovation and creativity by developing food and energy security, while reforming the structure of the economy so that consumption becomes more environmentally friendly, and strengthening relations with neighboring countries in the region for economic and social benefits. 4) To build secure natural resource and environmental bases through supporting community participation and improving resilience that will cushion impacts from climate change and disasters (NESDB, 2011a, p. X). The development direction of the Eleventh Plan focuses more on international relations, especially with neighboring countries. Strengthening relations with neighbors is one way to not only protect economic stability in the region but also developing social benefits among states. Thailand‟s risk assessment towards non-traditional threats, which is included in the Eleventh Plan remarking that “national security remains critical. Various problems of national security have increased at an alarming rate due to political unrest, terrorism, economic crisis and international competition…the country‟s risk management, emergency preparedness, and its capacity to strengthen competitiveness in the global arena” (NESDB, 2011b, p. vi). The policy maker takes non-traditional threats into account, and the necessity to manage emergency preparedness for such things as emerging communicable diseases. According to Arkhom Termpittayapaisith (2014, p. 2), Minister of Transport under General Prayut Cha-o-cha administration and former Deputy Secretary-General of National Economic and Social Development, he stated that the Eleventh Plan is “a key

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development strategy to move Thailand forward on a more sustainable path and pave the way to achieve a high income country in the longer term”. The executive summary of the Eleventh Plan classified development into three dimensions, 1) empowering of social capital, 2) strengthening of economic capital, and 3) restoring natural resource and environment capital (NESDB, 2011b, p. viii). Integration of all dimensions will provide the promotion of international health cooperation, regional cooperation, as well as, national preparedness to forthcoming threats one way or another. In terms of development strategies, it was divided into six strategies as follows; 1. Creating a just society 2. Developing a lifelong learning society 3. Strengthening of the agricultural sector and security of food and energy 4. Restructuring the economy towards quality growth and sustainability 5. Creating regional connectivity for social and economic stability 6. Managing natural resources and the environment toward sustainability (NESDB, 2011a, pp. xii-xx). In the twenty first century, Thailand‟s current situation faces some changes: demographic structure, risky health behavior, basic human security, the global situation, etc. Strategy No. 2 concentrates on the development of human qualities towards a sustainable knowledge-based society that continues to learn lifelong-learning which is to promote the reduction of risk factors in health at individual, family and community level. This strategy fosters people to have a basic health knowledge-base for avoiding risky behavior or situations. As well, it believes that “public health services will be improved for better quality and coverage, together with the promotion of alternative medicines” (NESDB, 2011a, pp. 54-55). The public health service is one factor to improve a more healthy society, so the Eleventh Plan plans “supply of health personnel will be redistributed, while a national health database will be developed. Monetary and fiscal measures for health care will be managed in an efficient and sustainable manner” (NESDB, 2011a, pp. 54-55). It highlights that the public health issue is important at all levels to develop both the economy and society. Strategy No. 5 is directly related to international cooperation and also cross border relations between Thailand and neighboring countries. It aims at creating

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regional connectivity for social and economic stability evidently concentrating on development cooperation in public health, particularly in preventing emerging or re-emerging communicable diseases. The guideline for Strategy No. 5 specifies the significance of Thailand‟s foreign policy and the role of Thailand in order to enhance the cooperation with other states on the international stage saying that,

Constructively engage in regional and international cooperation frameworks to provide alternative foreign policies in the international arena. This should be achieved by maintaining an active role for Thailand in developing strategies for relevant cooperation structures. It is important that the country seek a balance in relations with existing and emerging superpower economies (NESDB, 2011a, p. xviii).

Besides, the essential collaboration and cooperation, Thailand needs to improve human capacity to protect themselves from new forms of threat such as terrorism, natural disasters, or disease outbreaks. The guideline provides the idea of liberalism which tries to enhance cooperation to improve well-being. The Executive Summary of the Eleventh Plan points out that,

Contribute to the international community’s efforts to improve the quality of life by fighting against terrorism, international crimes, drug trafficking, natural disasters and epidemics. Capacity and preparedness should be improved to curtail and prevent international terrorism, drug trafficking, and illegal migration. There is also a need for capacity improvement and enhanced regional cooperation in dealing with natural disasters and emergencies, and in collaborating in the prevention of infection and the spread of emerging and re-emerging diseases (NESDB, 2011a, pp. xviii-xix).

The development guideline of Strategy No. 5 leads not only to place development cooperation into foreign policy and contribution to the international platform, but also to foster all community levels and all clusters to be aware of global and domestic changes. It further encourages community partnership networking and also integrates all sectors to prepare for global changes. It explains that,

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Strengthen domestic development partners at the community level. This should be pursued by empowering communities and local governments to prepare for international and domestic changes. The development mechanism for formulating strategies should be strengthened at the provincial and cluster levels, especially at border provinces, for cross border cooperation. Support should also be provided to enhance technical capacity and networks among Thai academic institutes in order to create close collaboration with other countries in this region (NESDB, 2011a, p. xix).

2.2 Thailand’s Development Strategy for National Security Reinforcement 2013- 2017 and Thailand’s Country Strategy 2013-2016

Cooperation in public health among Thailand and neighbors is considered as a preventive strategy. New forms of threat calls for state cooperation to protect national security in the liberal perspective. Another relevant organization called the Office of the National Security Council released Thailand’s Development Strategy for National Security Reinforcement 2013-2017 that is a “Strategy for promoting cooperation with neighboring countries in security aiming to enhance and develop the cooperation in security with neighboring countries” (Office of the National Security, 2013, p. 36). The core activities are to develop and set up the integrated project/plan between Thai‟s government agencies and neighboring countries‟ agencies. In terms of national security, this plan is to solve the border issues based on bilateral negotiation. At the same time, promoting the goodwill activities and sense of appreciation for all levels, such as citizen-to-citizen, and government-to-government. It complies with TICA‟s role which supports and collaborates the cooperation between Thailand and neighboring countries, for instance, cooperation in public health, education, and border issues (Office of the National Security, 2013, pp. 36-38). The National Economic and Social Development Plan is a flagship for country development which needs policy or strategy integration to achieve the goals. Yingluck Shinawatra‟s administration released a supportive strategy called Thailand’s Country Strategy 2013-2016 (fiscal year 2014) to stimulate the country economically

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and socially. Country Strategy was framed by the Eleventh Plan implemented by all governmental organizations including the MFA and MoPH. Since the 1960s, Thailand has been stuck as a middle-income trap country for many years meaning that “the phenomenon in which economies stop growing before they become rich” (Chalise, 2016). It impacts all levels such as quality of life, financial problems, and social problems. Thailand‟s economic growth has increased less than or equal to 7 percent for more than 30 years. As a matter of fact, “per capita income increased 30-fold, from less than $100 (THB 3,000) in 1962 to over $3,000 (THB 90,000) in 1996. This growth steered the country into its current middle-income status” (Chalise, 2016). Under those circumstances, Thailand needs economic reform which will provide more opportunities, mutual interest and sustainability for overcoming economic status. Thailand‟s Country Strategy 2013-2016 attempted to enhance higher competitiveness, improve better living standards and create a more just society. The approval of the Country Strategy through the New Growth Model structures by the Thai Cabinet launched three strategies including 1) Growth and Competitiveness, 2) Inclusive Growth, and 3) Green Growth as the chart below shows;

Figure 2.2 New Growth Model

Source: Adapted from Thailand focus 2014: What‟s new in Thailand‟s economic development strategy [PowerPoint Slides] by Arkhom Termpittayapaisith, 2014. Presented at Grand Hyatt Erawan, Bangkok, Thailand.

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The rationale of the New Growth Model illustrated that 1) Growth and Competitiveness aimed to increase Thailand to a higher income country, 2) Green Growth aimed to extend and sustain the economy, 3) Inclusive Growth aimed to create economic equity with good governance as the core value. These strategies were applied in all sectors for balance and sustainable development among the people in society. As an illustration of Satit Vonganannon (2013), a professional level government official, the Secretariat of the Senate, analyzed that economic growth in Thailand averaged 4.2 percent which relied mainly on the industrial, agricultural and service sectors. The Industrial sector tended to lead the majority of overall economic growth leading to higher value exports and imports. Most Thai citizens were in the agriculture and service sector in which the labor force earned very low income. It affected directly the development of living quality that was one reason why Thailand had been stuck in the middle-income trap. Thai society has a huge gap between the rich and the poor in exposure or access to resources. Also, political instability in Thailand was weak and the ruling political party was still unaccepted by the rich. It might create conflict in society, as well as it being an obstacle to country development. State administration was an important challenge of state development. The Economic structure was backward or not advanced enough to stand up to international competition. For the external challenges of Satit Vonganannon‟s article (2013), he stated that in 2020 the world will be faced with challenges namely 1) Imbalanced Population Growth, 2) Key Resource Constraints, 3) Asian Wealth Shift and 4) Universal Data Access (p. 5). These above mentioned factors, creating internal and external challenges to Thailand‟s development were also derived from the National Economic and Social Development Plan.

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Figure 2.3 Integration of New Growth Model

Note: Adapted from Thailand‟s country strategy, by Satit Vonganannon, 2013, February, p.11.

The rationale of the New Growth Model is to boost up Thailand‟s economy. It integrates 28 sectors for releasing Thailand from being a middle-income trap country and economic and social development. It aims to construct a strong and sustainable economic system from the basic elements. Turning it into a higher income country, the Growth and Competitiveness sector focuses on agriculture, industry, tourism and service, etc. Infrastructure and regional connectivity are important sectors for enhancing the capacity and convenience for international transportation or logistics. For example, Special Economic Zones (SEZs) need good infrastructure to support future projects. For regional connectivity, the MFA is the mainly responsible organization for promoting good relations and cooperation among Thailand and its neighbors. The Inclusive Growth sector associates economic equity in Thai society. Education and public health are major concerns which aim to develop human capital, quality of life, knowledge and fairness. Public health determines the fundamentals of living, giving more accessibility to a higher quality of life. Cooperation mentioned in the Inclusive Growth focuses on preventive strategies in transnational issues namely crime, drug trafficking, natural disasters, and disease outbreaks. These parallel with

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the Eleventh Plan and Development Strategy for National Security Reinforcement in that they emphasize on regional connectivity, particularly in neighboring countries, to cooperate in national security as well as human security. Thailand‟s Country Strategy 2013-2016 was the core strategy under Yingluck Shinawatra‟s administration. The meeting to implement strategy into action plans invited all ministries to propose their projects to achieve the New Growth Model. For the Country Strategy budget separated from regular country budget, it was called “Contingency fund” by the Office of Policy and Planning under the Office of the Permanent Secretary. This budget was aimed at facing emergency issues, inclusive of emerging or re-emerging communicable diseases. TICA‟s project was one organization requesting the contingency fund by submitting the proposal to the government head-quarters. TICA proposed the project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders and this was approved by the cabinet. This project was merged between „Growth and Competitiveness‟ and „Inclusive Growth‟ which proposes regional economic connectivity and relies upon cooperation in public health. The case of communicable diseases was one of the severe causes which directly affected regional economics, as well as, the social development sector. The government assigned the MFA to be a main government agency associated with the MoPH to prevent, prepare, and support border health development and also to enhance good relations with neighboring countries.

2.3 The Second Border Health Development Master Plan 2012-2016

The Prime Minister‟s Office was concerned more about public health appearing in the National Economic and Social Development Plan and the national security reinforcement plan from the Office of National Security Council. It particularly focused on communicable or emerging diseases which corresponds mainly with the Bureau of Policy and Strategy, Ministry of Public Health which developed the Second Border Health Development Master Plan (BHDMP) 2012-2016 aiming “to develop the public health work in border areas” (2011, p. 3) due to the changing factors such as the ASEAN Economic Community in 2015. External factors are “free trade policies and border trade promotion have resulted in enhanced globalization and

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economic development along border regions” (Bureau of Policy and Stragegy, 2011, p. 10) leading to double the number of labor movements, increasing tourists, as well as, public health issues. The Second BHDMP further established its objective is “to improve the health of people residing in border areas through the development of a quality health service system, improvement of access to primary care services, and encouraging the active and sustained participation of all relevant stakeholders” (Bureau of Policy and Stragegy, 2011, p. 6) and “calls for joint cooperation among partners from national and international agencies in the border regions” (Bureau of Policy and Stragegy, 2011, p. 10). The situation and health concerns along the borders mentioned in the Second BHDMP are divided into five main factors including 1) communicable disease, 2) reproductive health and maternal and child health, 3) limitations of referral systems, 4) smuggling of illegal health products, and 5) other factors effecting the health system (the unrest situation in the three southernmost provinces, natural disasters, and irregular migration) (Bureau of Policy and Strategy, 2011, pp. 11-12). Communicable disease is the first priority situation and health issue along the border considered by the MoPH;

Major communicable diseases such as Malaria, Tuberculosis, sexually transmitted infections, HIV and AIDS, diarrhoeal diseases, emerging infections, and re-emerging diseases have been reported in border areas…The emergence and expansion of international transportation routes have also increased the risk of contact and spreading of disease in border areas (Bureau of Policy and Strategy, 2011, p. 11).

As far as communicable disease is concerned in Thailand‟s international health policy by many strategies from different sectors, the Second BHDMP addresses and develops four strategies for the border health work as follows: 1. Developing a health service system 2. Access to basic health services 3. Strengthening collaboration and participation of all sectors 4. Administration (Bureau of Policy and Strategy, 2011, p. 13). Strategy No. 1 to develop a health service system targets at developing health facilities to meet their standard criteria and strengthening surveillance systems,

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disease control and prevention. For health systems, the Strategy No. 1 plans to develop a referral system for cross border patients and/or referral and follow-up system and also an information system and exchanging information mechanism among concerned agencies to enhance disease surveillance and outbreak alerts in border regions and cross border areas. It stresses a public health Emergency Response System (Bureau of Policy and Strategy, 2011, p. 14). Strategy No. 3 to strengthen collaboration and participation of all sectors aims to implement, cooperate and participate in border health work in all sectors. The activities are not only to establish a collaborative network among communities, public agencies such as provincial and local administrations, non-governmental organizations and international organizations engaging in border areas, but also to develop networks among civil societies to respond and manage an early warning system of potential health threats and to coordinate border health work with relevant national and international agencies (Bureau of Policy and Strategy, 2011, p. 17).

2.4 Thailand’s National Strategic Plan for Emerging Infectious Disease (NSP- EID) Preparedness, Prevention and Response 2013-2016

Thailand’s National Strategic Plan for Emerging Infectious Disease (NSP-EID) Preparedness, Prevention and Response 2013-2016 was established, one year after the establishment of BHDMP, by the Bureau of Emerging Infectious Disease, Department of Disease Control. Sakda Vallipakorn (n.d.) summarized that NSP-EID refers to public health in global trends relating to current affairs, the global environment and the movement of the global community. It has references to the Eleventh Plan (2012-2016), International Health Regulation 2005; IHR 2005, Asia- Pacific Strategy for Emerging Disease; APSED, ASEAN Strategic Framework on Health Development (2010-2015) which was endorsed by the 10th AHMM. NSP-EID is further implemented by relevant ministers to create an action plan, collaborate with other sectors and raise interest in the emerging communicable diseases in the international health arena. NSP-EID was developed to respond to forthcoming global changes, …seeks to reduce the impact caused by EIDs through the development of a sustainable learning society, aiming for better health care and social

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justice, ensuring equitable access to public utilities and services, through regional and international cooperation, and proper management of natural resources and environment (Bureau of Emerging Infectious Disease (BEID), Department of Disease Control, Ministry of Public Health, 2013, p. 11). Ministry of Public Health, Bureau of Emerging Infectious Disease, Department of Disease Control stated the vision of NSP-EID that “Thailand is capable of effective prevention and control of emerging infectious diseases (EIDs) with internationally-accepted standards of practices, based on well-coordinated preparedness in management systems and personnel capacity , and with competent knowledge management” (2013, p. 14) and also “…Thailand can reduce illnesses; deaths, and the social-economic and environmental impact arising from outbreaks of emerging infectious diseases” (BEID, 2013, p. 15). The risks of EIDs reported in the plan are as follows: 1) Biological 2) Factors related to demographic structure and human behavior, 3) Factors related to international travel and trade, 4) Socio- economic factors, 5) Factors related to agricultural and animal husbandry systems, 6) Factors related to public health and animal health infrastructure, 7) Factors related to global warming, and 8) Potential risks related to the establishment of ASEAN Economic Community in 2015 (BEID, 2013, pp. 8-9). NSP-EID includes 5 strategic plans hereinafter: 1) Development of systems for disease surveillance, prevention, treatment and control under “One Health” concept 2) Management of systems to enhance disease-free animal husbandry, animal health and health of wild animals 3) Development of knowledge management systems and promotion of research and development 4) Development of integrated management systems with and preparedness for emergency preparedness and response 5) Risk communication and public relations on EIDs (BEID, 2013, pp. 20, 26, 35, 40, 45). These mentioned strategic plans of NSP-EID and BHDMP shape activities of TICA‟s project on Building Awareness and Preparedness for Communicable

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Diseases and Emerging Diseases along the Thailand-CLM borders and they guide the direction for provincial health offices in order to achieve the preventive strategy. Both plans display the role and responsibility of the Ministry of Foreign Affairs as a main supervising agency in Thailand‟s international health policy. Since the Second Border Health Development Master Plan (BHDMP) 2012-2016 needs partners or relevant governmental agencies for enhancing and implementing the strategies, Thailand International Cooperation Agency (TICA) under the MFA was assigned to carry out the strategies along with the development diplomacy. These roles and duties of the MFA that have been assigned to TICA addressed in BHDMP are as follows: 1. Responsible for inter-country collaboration with international organizations to promote uniform implementation of border health activities with neighboring countries 2. Provide support to neighboring countries in improving their border health service as well as to promote a relationship between Thailand and neighboring countries 3. Manage public relations to promote international awareness of Thailand‟s public health efforts that target border populations with the support of information from relevant agencies (Bureau of Policy and Strategy, 2011, p. 22). The MFA is also a supportive government unit responsible for Thailand’s National Strategic Plan for Emerging Infectious Disease (NSP-EID) Preparedness, Prevention and Response 2013-2016. The emerging communicable diseases are very important for international security, as well as, having national benefits during this time. That is why all sectors including the government, private sector and the community have been involved in this above mentioned plan. The roles of the MFA specified in NSP-EID are as follows: 1. Coordinates with international organizations to support international trade negotiations. 2. Conducts public relations on screening of international travelers at international airports or border crossings. 3. Strengthens international cooperation to protect, control and preserve

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Thailand‟s rights and benefits. 4. Creates correct understanding among countries with regard to the disease situation in Thailand. 5. Participates in the formulation, coordination, and implementation of concerned policies/strategies/measures through multi-sectoral collaboration to achieve the objectives of the NSP-EID. 6. Formulates internal Business Continuation Plans (BCPs) for corporate EID preparedness (BEID, 2013, p. 54).

2.5 Policy Statement of the Council of Ministers

In globalization, international issues need multi-dimensional approaches to accomplish the solution including cooperation in public health. The MFA does not only play the role of promoting international relations, but it integrates and applies public health strategy collaborating with MoPH. Therefore, the MFA‟s roles and duties are defined clearly towards international health policy. The MFA is a supportive organization and cooperates with related organizations. The main responsibility of the MFA, however, was displayed in the Policy Statement of the Council of Ministers delivered by Prime Minister Yingluck Shinawatra to the National Assembly, Tuesday 23 August B.E. 2554 (2011) stating the overview of the MFA‟s role to protect national security and national interest as well as promoting relationships and cooperation with other states in accordance with the Constitution of the Kingdom of Thailand 2007 (B.E. 2550), relevant articles cohere with Thailand‟s foreign policy in 2012 as follows:

Article 77 The State shall protect and uphold the institution of the monarchy, the independence, sovereignty and integrity of the territorial jurisdiction of the State and shall provide an armed forces, with weapons and modern technology as deemed necessary and sufficient for protecting and upholding the independence, sovereignty, national security, institution of monarchy, national interests and the democratic regime of government with the King as Head of the State; and for developing the country.

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Article 82 The State shall promote relations and cooperation with other countries, shall adhere to the principle of non-discrimination, and shall observe the treaties on human rights that Thailand has become party to, as well as other commitments made with other countries and international organizations. The State shall promote trade, investment and tourism with other countries and accord protection to Thai nationals and look after their interests in foreign countries (Ministry of Foreign Affaris (MFA), 2013, p. 2).

The related point of these articles being contained in the Thai Constitution are the protecting of national security and national interest which refers to protecting citizens from non-traditional threats. The wellness of Thai citizens in border areas as well as foreign citizens in contiguous areas is to maintain national security and mutual benefits. In this study, national security is considered as common security in the international context. Another key thing to remember is that in Article 82 claims promoting and cooperating with other countries are core activities for better understanding between states. The Government of Thailand utilizes both national and foreign policies for administering and running the country in order to prevent, protect, or prepare for forthcoming emerging diseases. Thailand‟s foreign policy is indispensable to include development cooperation which derives from liberal perspectives however it does not obviously specify or mention preventing emerging diseases. The MFA vision is “to serve, with honor and integrity, as the leading organization for the promotion and protection of Thailand‟s interests, status, and role in the international community, particularly in the fields of political stability, economic progress and social development; and ensure that Thai society can best benefit from globalization” (MFA, 2013, p. 5). The following Thailand foreign policies in Yingluck Shinawatra‟s administration are provided below: 1. Expedite the promotion and development of relations with neighboring countries by enhancing cooperation between the public sector, private sector, people and the mass media in order to cultivate mutual understanding and instill closeness among all sectors which will lead to expanded cooperation in the areas of economics, trade, investment, tourism promotion, transportation and others under sub-

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regional frameworks so as to promote good neighborly relations. 2. Create unity and promote cooperation among ASEAN countries in order to realize the goal of creating an ASEAN Community, as well as promote cooperation with other countries in Asia through various cooperative frameworks, and prepare all sectors for the move towards becoming an ASEAN Community by 2015 in the economic, socio-cultural and security areas. 3. Take on a creative role and promote the national interest in international organizations, specifically at the United Nations and regional organizations in order to preserve peace and security, promote the democratic process, human rights, humanitarianism, the environment and sustainable development, as well as cooperate to address all transnational issues that affect human security. 4. Strengthen cooperation and strategic partnership with countries, groups of countries and international organizations that play important roles in global affairs in order to boost confidence in Thailand, as well as build capacity and immunity for the Thai economy. 5. Encourage people-to-people contacts with foreign countries, as well as promote a positive image and technical assistance with developing countries so that people, governments and the international community will have positive attitudes toward the Thai people and Thailand. 6. Promote public awareness and understanding of border issues and global changes that affect Thailand so as to forge consensus in the formulation and implementation of foreign policy. 7. Support ‘People Diplomacy’ to safeguard the interests of Thai nationals, as well as protect Thai nationals and Thai workers abroad, specifically those employed and living overseas, in addition to strengthening and promoting the role of Thai communities in preserving their Thai identity. 8. Utilize regional connectivity within the ASEAN region and sub- regions in order to expand the economic base in terms of production

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and investment, prioritizing the development of provinces and groups of provinces situated along the economic corridors and border areas. 9. Coordinate the work of government agencies overseas in accordance with the „Team Thailand‟ policy in order to carry out foreign affairs efficiently, effectively and with high quality. 10. Promote close cooperation with Muslim countries and international Islamic organizations to create a correct understanding that Thailand is working on resolving the issue of the Southern Border Provinces, as an important internal issue, by following His Majesty the King‟s advice to „Understand, Reach Out and Develop‟ (MFA, 2013, pp. 3-5).

2.6 Strategy for the Project on Building Awareness and Preparedness for Communicable and Emerging Communicable Diseases along Thailand and CLM Borders

The MFA launched as an urgent policy implementation for the first year called Policy 1.6 stating that,

Expeditiously restore relations and enhance cooperation with neighboring countries and other foreign countries so as to boost economic growth in the region, in particular expeditiously address border issues via diplomatic procedures based on relevant treaties and laws, pursue the obligation to integrate into an ASEAN Community in 2015 in the economic, social and security aspects, as well as link intra-regional and inter-regional transportation (MFA, 2012, p. 3).

Overall Thailand‟s foreign policy delivered by Prime Minister Yingluck Shinawatra‟ administration in 2012 was shaped not only by the Eleventh Plan but also associated directly with her Country Strategy which attempted to increase economic growth and competitiveness by creating regional connectivity. This strategy related to the MFA‟s foreign policy which promoted the integration and enhancement of cooperation for economic expansion and social development. Furthermore, it concentrates on maintaining and restoring good relationships with neighboring

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countries. The concerns of both Thailand and neighboring countries are “such as natural resources sustainability and management, border security cooperation and migration, and development cooperation in the border communities” (MFA, 2013, pp. 15-16) that led to increasing the confidence and stability in a regional context. The importance is that “foreign policy direction has been based on cooperation with other countries in addressing new security challenges such as global warming, terrorism, disasters, human trafficking and organized transnational crime; and the promotion of global goods, such as human rights and democracy” (MFA, 2013, p. 34). This coincided with the Country Strategy and Thailand’s Development Strategy for National Security Reinforcement which all highlighted new security challenges. Foreign policy cultivated a cross cutting role and promoted national interest in international organizations, there were cooperation frameworks related to public health cooperation in border areas. Firstly, Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy (ACMECS) purpose is to "of lowering the economic development gap between Thailand and its neighboring countries” (MFA, 2013, p. 34). Public health is included within ACMECS cooperation segment. Greater Mekong Sub– region (GMS), program also emphasized on the public health area. Another cooperation framework is called Lower Mekong Initiative (LMI) an initiative by the United States collaborating under the 2011-2015 Plan of Action, public health is one of the cooperation priorities emphasized. Thirdly, on the global stage, the MFA aimed at reaching the objective of the Millennium Development Goals (MDGs) when it recently endorsed the new goals, called MDG-Plus. In order to accomplish the new goals under the United Nations, “Thailand has had an important role in assisting other countries obtaining their MDGs, with the MFA having the main role as coordinator of assistance for other developing countries, especially neighboring countries in the areas of agriculture, public health, and education” (MFA, 2013, p. 41). All cooperation frameworks rise up and are aware of public health issues especially in Southeast Asia where there is a common interest. Thailand‟s international health policy comprises the Eleventh National Economic and Social Development Plan 2012-2016, Thailand‟s Development Strategy for National Security Reinforcement, Thailand‟s Country Strategy, the Second Border Health Development Master Plan(BHDMP), Thailand‟s National Strategic Plan

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for Emerging Infectious Disease (NSP-EID) Preparedness, Prevention and Response 2013-2016, Thailand‟s Foreign Policy and Strategy for the Project on Building Awareness and Preparedness for Communicable and Emerging Communicable Diseases along the Thailand-CLM Borders. Foreign policy was implemented by Thailand in the development cooperation in public health by providing Official Development Assistance. This policy plays a role as soft power diplomacy that strengthens the relationship between Thailand and CLM countries. Roles and responsibilities are mainly conducted by Thailand International Cooperation Agency (TICA). The activities led to the following statement “Thailand has had a strong role in cooperating with other developing countries at the bilateral, sub–regional, regional levels, and also within the triangular partnership framework” (MFA, 2013, p. 51). The diplomatic channel in development cooperation delivered “through the provision of scholarships, training programs, and the sending of volunteers and experts to other countries” (MFA, 2013, p. 51). What‟s more, this policy was targeted to promote capacity building in Mainland Southeast Asia. TICA was also the main actor “to distribute the development cooperation on capacity building and human resources development focusing on agriculture, public health, and natural resource management” (MFA, 2013, p. 51). As we can see, public health tended to be more significant in the international context as well as in Thailand‟s foreign policies. TICA applied national policies in enhancing cooperation and relations with neighboring countries for having mutual trust and understanding in border areas through TICA‟s action plan. It also promotes public awareness and understanding of border issues and global changes such as the public health issue. It conducted the strategy for Project on Building Awareness and Preparedness for Communicable Disease and Emerging Diseases along the Thailand-CLM borders which integrated related national strategies corresponding with foreign policies. TICA employs the role as policy implementer as well as a project moderator. The next chapter will display how TICA implemented national policy and strategy in public health. As well, it will elaborate on the historical background, institutional structure, and its strategies towards CLM countries, particularly in public health. Moreover, it will present details of the project on Building Awareness and

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Preparedness for Communicable Diseases and Emerging Diseases along the Thailand- Cambodia-Lao PDR-Myanmar Borders including objectives, target areas, strategy, and budget allocation.

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CHAPTER 3 THAILAND INTERNATIONAL COOPERATION AGENGY AND DEVELOPMENT COOPERATION POLICY ON PUBLIC HEALTH

Promoting development cooperation in public health is a mechanism of Thailand International Cooperation Agency (TICA) strategy. TICA is one of the Thai governmental agencies under Ministry of Foreign Affairs (MFA) with responsibility for implementing foreign policy and also integrating common human security within international relations. TICA shares experience and practices in public health in the form of technical cooperation since the beginning of the organization. With its historical background started in 1963, organization transformation is significant because it indicates the change of Official Development Assistance (ODA) position in Thailand. Being a part of the bureaucracy, organization structure and policy direction involve political institutions and bureaucratic agencies. Not only internal factors influence TICA changes but also external factors affect the principle and rationale of the organization. Chapter 3 will elaborate on the overview of organizational background as well as illustrate the roles of TICA as one mechanism of the Thai government in a project called Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders.

Table 3.1 The Summary of Organization Transformations

Year Supervisor Official Name 1963 – 2003 Office of the Prime Minister Department of Technical and Economic Cooperation (DTEC) 2003 – 2004 Ministry of Foreign Affairs Department of Technical and Economic Cooperation (DTEC) 2004 – 2014 Ministry of Foreign Affairs Thailand International Development Cooperation Agency (TICA) 2015 – Present Ministry of Foreign Affairs Thailand International Cooperation Agency (TICA)

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3.1 Background

Thailand International Cooperation Agency (TICA) used to be known as Department of Technical and Economic Cooperation or DTEC which was supervised by the Office of the Prime Minister during 1963-2003. After the Cold War, Thailand was the ODA recipient country from the donors, and DTEC was in charge of the operation and management of technical cooperation and also monitoring cooperation projects with partner countries. It was further responsible for implementing the National Economic and Social Development Plan corresponding with National Economic and Social Development Board [NESDB] within the same office. DTEC‟s roles and mandates were as follows: 1) develops technical cooperation program, 2) acts on behalf of the Royal Thai Government in administering the technical cooperation programs agreed upon by Thailand and its cooperating partners, 3) appraises, monitors and evaluates proposed and ongoing technical cooperation projects, 4) provides financial support, services, facilities and equipment for technical cooperation projects and staff, 5) provides English language training and proficiency testing for Thai government officials, including candidates selected to study abroad (Department of Technical and Economic Cooperation (DTEC), 2002, p. 6). The role of DTEC focused mainly on technical cooperation and its role did not relate to Thailand‟s foreign policy. DTEC‟s Organizational system relied upon three major institutions namely Political Institutions, Bureaucratic Agencies and Private Sectors referring to Kanok Wongtrangan (1993, pp. 16-17). These mentioned institutions were considered as internal factors influencing the organization‟s position and direction. The chart below provided an idea of overall coordinating sectors in order to shape policy direction at the different levels. It can point out that DTEC had participated in all procedures in the Thai international cooperation system since the beginning. The involvements were mainly from the Royal Thai Government sectors

Ref. code: 25605503040163UXQ 62 as well as political institutions. By offering training courses and study visits to other countries in conjunction with the United Nations and other development partners (Thailand International Cooperation Agency (TICA), 2015) were the primary duties of DTEC since 1963 and also with the Royal Thai scholarship offered to foreign awardees. The position of DTEC at that time was concentrated on foreign aid management rather than integrated foreign policy as in the present time.

Figure 3.1 The Involvement of the Organizational System

Source: Adpated from the involvement of the organizational system by Kanok Wongtrangan, 1993, p. 16.

Starting with the key Political Institutions involved which included Cabinet Council, parliament, political parties, and public interest groups. Second, the key players of Bureaucratic agencies were 1) departments of Office of the Prime Minister i.e. DTEC, NESDB, Bureau of Budget, 2) Ministry of Foreign Affairs, Department of Economics, 3) Ministry of Finance, General Comptroller Department and 4) Contracting or Implementing agencies. The third sector showed the relevant key players called Private Sectors which consisted of Industry Council of Thailand, Thai Chamber of Commerce, Thai Bankers Association, Professional Associations and Contracting or Implementing agencies (Kanok Wongtrangan, 1993, pp. 16-17). DTEC had worked with the MFA which was one part of coordinating sectors, however, the role of DTEC was not clear in terms of promoting international relations.

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TICA similarly relies upon three key institutions like DTEC. The involvement of the organizational system did not change much with the organizational transformation. For external factors influencing DTEC‟s direction, Apinan Phatarathiyanon, Ambassador Extraordinary and Plenipotentiary and the former Director-General of TICA (2009-2011) remarked in his report on the direction of DTEC administration that technical cooperation with foreign countries needed to acclimatize with external situations and internal contexts. Hence, higher executives of DTEC evaluated the capacities and potential of the organization in order to manage the foreign aid more effectively. Apinan Phatarathiyanon believed that “the causes of DTEC‟s organization change mostly happened due to the international cooperation atmosphere. The global environments pushed DTEC to do better and learn more namely new public management by creating clear vision and strategic plans. At that time, he followed the principles based on global standards and aid effectiveness” (Apinan Phatarathiyanon, 2009, p. 8). The global changes influenced foreign aid management in many countries. For example, while the Soviet Union, under Gorbachev‟s administration, tried to modernize Communism in 1989 which led to the political revolution in Eastern Europe, Hungry and Poland. Also, aid assistance management in the global atmosphere influenced Germany which was considered as a huge traditional donor in Asia including Thailand. It had to encounter severe economic instability and needed to standardize the domestic development of their country. Therefore, the decline of the Soviet Union affected the economic system of aid recipient countries. In the Southeast Asian region, “Lao PDR was planning to modernize its economy, the Laos government announced the new public administration called NEM – New Economic Mechanism” (Apinan Phatarathiyanon, 2009, pp. 3-4). Regarding Japanese ODA, one of the biggest traditional donors according to the Organization for Economic Cooperation and Development (OECD) stopped grant aid in 1994 because of the international situation. The objectives of Japan based on development tended to focus more on global issues, such as, environmental concerns, HIV/AIDs, human resource development, etc. External factors, in conclusion, were the high involvement of the foreign aid management system led by DTEC. The modification of DTEC roles reflected in accordance with the political, social and economic situation. After the coup d‟état in 1991 by National Peace Keeping Council (NPKC), Anand Panyarachun (1991-1992)

Ref. code: 25605503040163UXQ 64 was appointed to be the Prime Minister. The Royal Government of Thailand administrated by Anand Panyarachun was a significant turning point of Thailand Official Development Assistance (ODA) which referred to the changes of both internal and external factors. Prime Minister Anand Panyarachun was concerned more about development cooperation as a part of foreign policy, so he allocated increased country budget to DTEC for providing technical cooperation with neighboring countries. Prime Minister Anand Panyarachun noted that,

When I became Prime Minister, we knew in advance that these major countries are about to reduce or even stop giving aid to Thailand, particularly economic aid. And I think in spite of the crisis that we were facing at that time. We were wealthy enough to afford to give something to our neighbors (Niyada Kaenket, 2016).

The role of DTEC was transformed during Prime Minister Anand Panyarachun administration regarding the aid management system. However, he did not position Thailand as an aid donor or provider. It would rather be a mechanism in foreign policy in which Thailand attempted to create mutual benefit with neighboring countries as well as good relations through technical cooperation. The concentration of development cooperation are in the following three sectors in the beginning, 1) Agriculture and rural development, 2) Education, and 3) public health, including communicable diseases. Suchada Thaibunthao, (2014-2015) states that “We focus our cooperation in agriculture, health and education. We provide based on the demands of the receiving side. We would like to make sure that our cooperating countries can stand on their own and then we work together” (Suchada Thaibunthao, personal communication with Vichit Chitvimarn & Arthit Prasartkul, 2015). Government policy added other relevant sectors 4) Development of community-based economics, 5) Natural Resource Development and Energy, 6) Tourism Promotion and 7) Human Resource Development. These aforementioned sectors are offered basically on Thai expertise.

According to Don Pramudwinai, the MFA Minister (2015-present) remarks that the emphasis of today is more on Sufficiency Economy, which we believe that it would be gaining ground in the developing

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countries. This outreach would certainly help uplift the profile of Thailand and the expertise in various fields of the country. We hope that to be appreciated worldwide (Niyada Kaenket, 2016).

As well, the direction of TICA under the MFA emphasized by Permanent Secretary Norachit Sinhaseni (2014-2015) was that “I think many countries around the world see Thailand as an example…We have been quite successful in a number of areas. TICA is in the way implementing our foreign policy of growing together, not leaving anyone behind” (Niyada Kaenket, 2016). Under Thaksin Shinawatra‟s administration, the Thai financial crisis was “to coincide with the final phase of the country's economic recovery and Thailand finally paid off its IMF debts in 2004” (Kesarin Phanarangsan, 2009, p. 85). He knew the economic situation was resumed and he embarked on his policy, so DTEC was restructured and became a part of the Ministry of Foreign Affairs at the end of 2003. He declared a stop to receiving foreign aid and promoting Thailand as an emerging donor. The definition of emerging donor according to Kimberly Smith, Talita Yamashiro Fordelone and Felix Zimmermann (2010, p. 1) “are countries that have relatively new, or recently revived, aid programs. Most are new member states of the European Union (EU), many of which were donors themselves during the Cold War… have since begun putting in place laws and institutions to co-ordinate their own new assistance programs in developing countries”, and emerging donors need to be “OECD members and participate actively in Development Assistance Committee (DAC) work…have longstanding aid programs, and are pursuing a closer relationship with the DAC” (Kimberly, Fordelone & Zimmermann, 2010, p. 1). Thailand according to the definition was not an emerging donor but considered as “a provider of South- South Cooperation (SSC) which are developing countries, middle income countries and emerging economies that share expertise and financial support with other countries” (Kimberly, Fordelone & Zimmermann, 2010, p. 1). The idea of applying ODA as a foreign policy mechanism belonged to Thaksin Shinawatra which had some opposition from MFA bureaucrats. His personality, political institution or campaign “reflected that although the strong prime minister tried to penetrate into Thailand's foreign policy-making realm” (Kesarin Phanarangsan, 2009, p. 71).

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DTEC was assigned to the MFA under Taksin Shinawatra‟s administration. The first year under the MFA, DTEC was still responsible for ODA management including technical cooperation and economic development cooperation. According to Suchada Thaibunthao, former Director-General of TICA (term ends in September 2015) she stated the principle of development cooperation framework was as follows:

Over a decade ago, Thailand reached a milestone in our development cooperation by becoming a provider of Official Development Assistance (ODA). Thereafter, Thailand International Cooperation Agency (TICA) under the Ministry of Foreign Affairs has been putting forth our best efforts to reach out to our friends from other countries (TICA, 2015) (Brochure).

3.2 The Establishment of TICA

On 19 October 2004, Thailand International Development Cooperation Agency (TICA) was introduced by a Royal Decree to serve the Royal Thai Government as a focal agency under the Ministry of Foreign Affairs of Thailand in administrating international development cooperation (Thailand International Cooperation Agency (TICA), 2012, para.1). It aimed at “linking TICA more directly to Thailand's foreign policy and encouraging this agency to adopt the role of an emerging donor” (Kesarin Phanarangsan, 2009, pp. 74-75). Organization transformation depended on Political Institutions and Bureaucratic Agencies as well as the external influence factor that was identically changed similar to DTEC. TICA transformation proposed to not only change symbolically the role of Thailand‟s development cooperation, but also to enhance the partnership with other countries. Directly and indirectly, it adjusted the roles of TICA from promoting economic and social development as the technical cooperation to support Thailand‟s foreign policy. Meanwhile, the Neighboring Countries Economic Development Cooperation Agency (NEDA) was also established in 2005 as an independent public agency responsible for financing investment projects in neighboring countries. Mark Miller and Werapong Prapha (2013, p. 11) emphasized mainly economic development by providing loans with low interest rates and grants to their partnership countries

Ref. code: 25605503040163UXQ 67 which targeted Thailand‟s neighboring countries including CLMV. Asian Development Bank (ADB, 2015) defines the forms of cooperation including co-financing, knowledge sharing, and capacity development based on common areas of interest and the expertise of each organization, as well as the priority needs of the targeted countries. TICA roles were distinguished from NEDA‟s roles. TICA has been designated as the central agency for managing „International Development Cooperation‟.

Miller and Werapong Prapha mentioned that in practice, its primary responsibilities are to act as the primary agency for administering technical cooperation with developing countries... The current institutional structure of TICA is such that it is split between a Development Cooperation Bureau that is broken down along regional lines and a Partnership Bureau that is split between multilateral organizations and bilateral organizations. At present, the organization does not have any officers responsible for specializing in certain sectors (2013, pp. 29-30).

During 2004-2014, TICA played the role as a government representative that conducted development cooperation such as technical cooperation with other countries as well as responding to endorse Thailand‟s foreign policy. The organization was an uncompleted structure and had no sovereignty referring to laws and regulations. The roles and responsibilities switched to the perspectives of international relations compared to DTEC. Cooperation projects and activities were strengthened and formulated Thailand‟s foreign policies in one way or another. No matter how varied the organization modification, TICA‟s role is involved with and supportive of international relations. Arunee Hiam (2013) studied on the review of lessons-learned from traditional and emerging donors for reconsidering and developing the direction of TICA administration.

Development cooperation was a supportive mechanism in running foreign policies that enhanced the relationship between Thailand and other countries. Moreover, the cooperation would be a bridge building for the international market, trade and investment. The management of international cooperation in Thailand was quite decentralized, however, it was necessary

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for TICA to improve the direction and guidelines relevant to international aid provider standards (Arunee Hiam, 2013, p. 55).

Until 2015, Thailand International Development Cooperation Agency rebranded and promulgated the new Act designating TICA by shortening the official name to be Thailand International Cooperation Agency (TICA) under the MFA. The word „development‟ was cut in accordance with its Thai official name as well as the agreement of a bureaucratic committee in the MFA. Thereafter, “TICA pursues this new and elevated role in forging development cooperation per the aspirations set by the government and global community” (TICA, 2015, p. 10). When the new roles have started in 2015, TICA fully participated in the international efforts on the United Nations‟ Post-2015 Sustainable Development Goals (SDGs) instead of Millennium Development Goals (MDGs) which ended in 2015. It will influence in terms of organizational visions and missions for achieving and fulfilling government foreign policy.

3.3 Principles and Rationale of Development Cooperation

The fundamental rationale of the organization establishment has existed since the first transformation to the MFA, so TICA‟s Vision is “to be an agency under the Royal Thai Government to serve as a bridge for global sustainable development” (TICA, 2015, p. 11) (Brochure) Its missions state that TICA is “the main agency to execute development cooperation with foreign governments, international organizations and intergovernmental organizations” (TICA, 2015, p. 11) and further “is the focal agency formulating strategic guidelines and policies on development cooperation to be comprehensively in line with the Royal Thai Government‟s foreign policies” (TICA, 2015, p. 11). The rationale and principle of TICA was originated based upon Prime Minister Anand Panyarachun‟s administration in order to create mutual understanding. In accordance, he confirmed that “humanitarian assistance and future returns are the core concerns of Thailand development cooperation. Since we share borders, we expect to gain good relations and mutual understanding rather than benefit” (Anand Panyarachun, personal communication with Vichit Chitvimarn & Arthit Prasartkul,

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2015). He further shared his foreign policy or foreign relations perspectives towards neighboring countries that,

I thought a part of humanitarian reasons, I had two purposes in mind. It was one way of developing called the relationship with our neighbors. I think it is important that you regulate the community. The first person you would think of is your neighbors, your next-door neighbors. Similarly, I think that as time progressing country like Lao PDR, Cambodia, Vietnam, Burma (Myanmar) would have to be good neighbor with us. In order to nurture this good relationship with neighbors, as they are less develop than we were (Anand Panyarachun, personal communication with Vichit Chitvimarn & Arthit Prasartkul, 2015)

Public health service associates are strengthening and enhancing the capability of neighboring countries which would provide good relationship and mutual trust between two countries. Cooperation in public health among Thailand and its neighbors would reduce the government expenses of trans-border patients as well as fill the gap of development inequality in the regional context that would lead to social tension in the cooperation. From the neoliberal perspective, state behavior in promoting cooperation stimulates trust between two countries. Anand Panyarachun further suggested that,

If you are in the position that helps them out, particularly in basic services like education, or medical services. Not only that we would do them a favor in terms of basic services, up-lifting the livelihood, standard of living of our neighbors. Eventually they will become good friends, we would get to know them better and they would get to know us better (Anand Panyarachun, personal communication with Vichit Chitvimarn & Arthit Prasartkul, 2015)

During 2012-2015, neighboring countries‟ relationship was included and promoted in the national strategic plan, specific plans or even ministerial plans as mentioned earlier in Chapter 2. For example, the Eleventh National Economic and Social Development Plan from NESDB together with Thailand‟s Country Strategy of Yingluck Shinawatra‟s administration took neighboring countries into account.

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Thailand‟s Development Strategy for National Security Reinforcement 2013-2017 focused on “Citizen and community has immunity and preparedness for threats. Thailand promotes development cooperation with neighboring countries sustainably” (Ministry of Foreign Affairs (MFA), 2012, p. 3). Thailand‟s foreign policy also stated TICA‟s roles and scope of work that “expedites the promotion and development relations with neighboring countries” (MFA, 2012, p. 3) as did the policy towards “strengthening cooperation and strategic partnership with countries, groups of countries and international organizations that play important roles in global affairs” (MFA, 2012, p. 3). Thailand‟s strategies attempted significantly to overwhelm the middle-income trap and expand economic connectivity in developing or under-developed countries like Thailand and neighbors shown in the Yingluck Shinawatra‟s the New Growth Model. It deliberated that the government had a policy direction in development cooperation among neighboring countries. Since the beginning, TICA prioritized target countries for development cooperation and focused on neighboring countries namely, Cambodia, Lao PDR, Myanmar, and Vietnam (CLMV). Countries in Southeast Asia and East Asia such as Malaysia, Indonesia, Singapore, Brunei, Timor-Leste, Mongolia and North Korea were collaborative partners respectively. It expanded the cooperation also in South Asia, Middle East and Central Asia (i.e. Bhutan, Sri Lanka, Maldives, India, Jordan) and in the African region (i.e. Kenya, Senegal, Lesotho, Tunisia, Burundi, Mozambique). Latin America, the Caribbean (i.e.Argentina, Brazil, Peru, Chile, Colombia) and Pacific Islands (Tonga, Papua New Guinea, Fiji Islands, Vanuatu, and etc.) all entered into a development partnership with TICA (Namtip Buachaiboon, 2015)

3.4 Roles, Responsibilities, and Scopes of Work

Suchada Thaibunthao former Director-General of TICA, explained the principle procedure of TICA in order to build up the capacity with partnership countries that “we employ a demand-driven approach in our work. The partner countries‟ needs are matched with Thailand‟s expertise, tailoring our development cooperation to their demands” (Niyada Kaenket, 2016). She believed that a demand- driven approach in the development cooperation will “respond much more effectively

Ref. code: 25605503040163UXQ 71 to the economic and social development plans and policies of each and every country with whom we work” (Niyada Kaenket, 2016). She stated the work process perspective regarding collaborating with United Nations‟ Post-2015 SDGs. She mentioned that,

TICA will continue to be your trusted partner and reliable friend. Joining the international efforts towards achieving the United Nations‟ Post-2015 Sustainable Development Goals (SDGs), we are inspired to build bridges for global sustainable development between developed and developing countries, as well as Asia and the rest of the world (TICA, 2015, p. 2).

She mainly emphasized the recipient demand (demand-driven approach) as well as the expertise and capability of Thai co-implementing agencies. Another key thing to keep in mind is that TICA‟s roles and scope of work cohere with “the aspirations set by the Government, the Thai people and the Global Community” (Niyada Kaenket, 2016). The roles of TICA highlight the following points: - To formulate an international cooperation plan, study, and analysis on cooperation policy including implementation, follow-up and evaluation of technical cooperation projects - To administer development cooperation programs provided to developing countries according to the foreign policy of the Royal Thai Government - To cooperate with various development partners, foreign governments and international organizations to formulate, implement, and assess technical cooperation projects/programs under bilateral and multilateral frameworks - To administer international cooperation in global issues and human resource development - To disseminate information regarding development cooperation to government agencies concerned and international organizations.

- To integrate development strategies plans, programs and activities of government agencies, private sectors and NGOs (TICA, 2015, para. 2-3).

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3.5 Institutional Structure

Figure 3.2 Institutional Structure

Note: Adapted from Organization chart by Thailand International Cooperation Agency, 2012.

The Institutional structure of TICA, Director-General is at the top rank of the organization chart which the position considered as the highest decision maker of TICA. Two Deputy Director-Generals who handle and respond to issues in different sectors. The First Deputy Director-General handles Development Cooperation Bureau, Human Resource Development Bureau and Project Procurement and Privileges Bureau. The Second Deputy Director-General supervises Office of Director General and Partnership Bureau. TICA consists of eleven branches all with separate duties and responsibilities.

Miller and Werapong Prapha stated that the current institutional structure of TICA is such that it is split between a Development Cooperation Bureau that is broken down along regional lines and a Partnership Bureau that is

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split between multilateral organizations and bilateral organizations. At present, the organization does not have any officers responsible for specializing in certain sectors (2013, p. 29).

Thai Cooperation Branch I and Thai Cooperation Branch II are divided by partnership countries which are from different regions. Thai Cooperation Branch I targets on countries in Asia and Pacific Islands, however, the main emphasis is Thailand‟s neighboring countries. It also works within a regional framework such as GMS, ACMECS, IMT-GT, JDS, etc. Thai Cooperation Branch II focuses on developing countries in Africa, Middle East, Latin America and the Caribbean. For the regional framework of Thai Cooperation Branch II are FELAC and BIMSTEC for example. The Planning and Monitoring Branch, the main role is to plan the development cooperation strategy towards partnership countries. It also collaborates with other related governmental organizations in terms of strategy and policy. The branches of HRD I and HRD II are responsible for Thailand‟s Annual International Training Course (AITC) and Thailand International Postgraduate Program (TIPP) which aim to promote South-South cooperation and global partnership. The Project Procurement and Privileges Branch is a supportive branch that manages and services logistical arrangements both for TICA staff and other participants. The Project Budget Branch manages all types of budget including general budget as well as the contingency fund. The General Affairs Unit correlates with Public Relations Unit to monitor TICA workforce and promote TICA to the public. The Countries Partnership Branch (Bilateral and Trilateral Cooperation) concentrates on the projects of joint development cooperation. The countries involved in bilateral cooperation are Denmark, Germany, France and Japan. The countries involved in trilateral cooperation are Germany, France, New Zealand, and United States of America. The International Organizations Partnership Branch (Multilateral Cooperation) is divided into regional cooperation and global cooperation of which Thailand is a member country. Buakaew Roundtable International is the main activity for the International Organizations Partnership Branch which proposes to share experiences on development cooperation based on Thailand‟s expertise between Thailand and all the invited countries.

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The project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders, Thai Cooperation Branch I works together with Planning and Monitoring Branch in order to form a strategic plan on development cooperation in preventing communicable disease. The roles and duties of Thai Cooperation Branch I takes responsibility for development cooperation projects in neighboring countries including CLMV, Southeast Asia, East Asia and Pacific Islands. The project was proposed to the Thai cabinet by TICA by the director of Planning and Monitoring Branch, Banchong Amornchewin. He explained that “In general, TICA is concerned with public health issues since the beginning of TICA, so this brings about the integration of Thai governmental agencies to the enhancement of collaboration and cooperation in human security in border areas. He further informed that only TICA can handle the public health issue which is a specialist issue” (Personal interview with Banchong Amornchewin, February 29, 2016). This project needs both internal collaboration and external partners to achieve and carry on the action plan. For example, Planning and Monitoring Branch proposes project strategy and direction to Thai Cooperation Branch I, so they work closely in terms of planning and organizing the project. Another example is that TICA collaborates with the Department of Disease Control to monitor the public health situation in border areas.

3.6 Personnel

The number of TICA personnel reflects the roles and responsibilities of TICA. Compared to TICA in 2005, the number of staff is little different presently. However, the number of personnel is not relevant to the number of TICA‟s projects. The role of personnel tends to be a project coordinator or a moderator at the practical level. TICA has 162 employees (as of July 2016) where the number of staff has dynamically changed depending on the demands of human resources. There are 4 main categories which are government officials (Director-General and Deputy Director-General, Development officer, Diplomatic officer, or etc.) Government officials form the largest number in the organization and are considered to take core responsibility for working and collaborating with other organizations at the level of policy and strategic planning. Also, they usually conduct all the action plans, projects,

Ref. code: 25605503040163UXQ 75 and meetings etc. The main workforce is government officials. The second category is government employees that are the smallest number of staff. The role of this category relies on the supportive arrangements such as air-ticket booking or accounting. Contract officers work on short-term contract such as one-year contract or five-year contract. They are mostly drivers and programmers. Project coordinators sign a temporary one-year contract and are responsible for a specific project. The flow chart below illustrates how Thai Cooperation Branch I internally operates or administers according to job function. The concrete operative function is divided by partnership countries. Each country always has cooperation under a regional framework, for example, Lao PDR is member of ACMECS, GMS, ASEAN, etc. The total number of Thai Cooperation Branch I personnel is 21 staff responsible for ASEAN countries with Timor-Leste plus Pacific Islands. However, the highest priority has been perceived to commit to Lao PDR for over 10 years as the percentage of budget allocation for Lao PDR is at 25%. Thus, among CLMV countries, Thai Cooperation Branch I separates Lao PRD from other sectors. Whilst, CMV is in the same sector it seems reasonable to acknowledge that neighboring countries are the dominant collaborators.

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Figure 3.3 Thai Cooperation Branch I Structure

Director of Thai Cooperation Branch I

CLM/GMS/ACMECS/MI Asia – Pacific Lao PDR

Technical Cambodia Timor-Leste Cooperation among Developing Countries (TCDC)

Singapore Myanmar Long term Scholoarships Vietnam Indonesia

Regional Framework Training Courses Malaysia - GMS - ACMECS Mongolia Project on Building Awareness of and Preparedness for North Korea Communicable Diseases and Emerging Diseases along the Thailand – CLM borders Philippines

Project on Skilled Labour Development Pacific Islands

Regional Framework - IMT - GT -JDS - ASEAN

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3.7 Development Cooperation in Public Health

Development cooperation in public health is important since the beginning of Thailand‟s ODA. To put it another way, the public health system of Thailand is advanced and has knowledge in a particular field when compared to our neighbors in South East Asia as aforementioned by the former Director-General as well as former Prime Minister Anand Panyarachun. Development cooperation in public health pushes forward soft power diplomacy in order to run foreign policy in the form of TICA implements cooperation through projects, activities, scholarship, or training courses. He declared that,

My strategy would be to help them become good neighbors, help them in education, in medical services, so that their standard living would improve and their livelihood would improve. If they become more self- sufficient, they have more money, they have more resources to develop, that is good for Thailand too (Anand Panyarachun, personal communication with Vichit Chitvimarn & Arthit Prasartkul, 2015).

From the perspective of Director of Planning and Monitoring Branch, Banchong Amornchewin, he stated that “TICA strategies implemented to foreign policies during 2011-2015. However, TICA strategies toward public health during 2011-2015 were not different from the previous year (Personal interview with Banchong Amornchewin, February 29, 2016)”. The table 3.2 will summarize the strategies with their objectives, expectations, and action plans regarding public health cooperation between CLM in 2008-2011.

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Table 3.2 The Summary of Development Cooperation Strategy in Public Health between Thailand and CLM Countries

Public Health Cambodia Lao PDR Myanmar Objective 1. To support the 1. To support the 1. To support the improvement of improvement of improvement of healthcare service as healthcare service as healthcare service as well as enhance the well as enhance the well as enhance the capability of public capability of public capability of public health human health human health human resources resources resources 2. To prevent 2. To prevent 2. To prevent and communicable communicable decrease diseases in border diseases in border communicable areas areas diseases in border 3. To promote and areas develop alternative and traditional medicines Expectation 1. Organizations and 1. Organizations, 1. Main health public health (clinics and local organizations in personnel have hospitals) and public border areas have developed and health personnel developed and increased the have developed and increased the capability of the increased the capability capability of the public health service of the public health health service 2. Decrease the number service 2. Health personnel of emerging and 2. Decrease the number have enhanced communicable of emerging and capacity in disease disease cases in communicable disease prevention and Thailand and Cambodia cases in Thailand and control in border border areas Lao PDR border areas areas by training (continued)

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Table 3.2 (continued) The Summary of Development Cooperation Strategy in Public Health between Thailand and CLM Countries

Public Health Cambodia Lao PDR Myanmar 3. Apply the 3. Decrease and knowledge in Control the number alternative and of emerging and traditional medicines communicable diseases cases in border areas Strategy 1. Capacity building on 1. Capacity building on 1. Capacity building on disease prevention disease prevention disease prevention and control for public and control for public and control for public health human health human health human resources resources resources 2. Exchange of - Doctors - Central and Local information on health - Nurses personnel and outbreaks - Health personnel - Central and Local 3.Strengthen the plan working in clinics organizations for preventing and 2. Exchange of - Quarantine office preparing for information on health according to communicable and and outbreaks International Health emerging diseases - Development of Regulations B.E.2005 hospital administration 2. Exchange of 3.Strengthen the plan information on health for preventing and and outbreaks preparing for - Support on communicable and information emerging diseases management system

(continued)

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Table 3.2 (continued) The Summary of Development Cooperation Strategy in Public Health between Thailand and CLM Countries

Public Health Cambodia Lao PDR Myanmar 4. Promoting and - Provide Information supporting the communication application of technology and alternative and devices traditional medicines 3. Strengthen the plan for preventing and preparing for communicable and emerging diseases - Launch master plan - Joint action plan

Note: Adapted from Strategic plan on development cooperation between Thailand and Cambodia 2008-2011 by TICA, 2008a; Strategic plan on development cooperation between Thailand and Lao PDR 2008-2011 by TICA, 2008b; Strategic plan on development cooperation between Thailand and Myanmar 2008-2011 by TICA, 2008c.

TICA launched a development cooperation strategy towards CLM countries during 2008-2011. Its strategy towards neighboring countries is combined in many sectors, such as, education, agriculture, economy, public health, etc. The above table has selected only the development cooperation strategy in the public health sectors of Cambodia, Lao PDR, and Myanmar for comparing commonalities and differences. This study finds that the commonality of objectives among CLM is to support the improvement of healthcare service as well as enhance the capability of public health human resources. A similar strategy is to prevent the communicable diseases in border areas arising in CLM countries. The available strategy seems that TICA is aware of and concerned about communicable disease and emerging communicable diseases and the awareness in disease prevention has appeared in

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Thailand‟s foreign policy for years. There is only one different strategy in Lao PDR which aims to promote and develop alternative and traditional medicines. The strategy expectation is concerted objectives, so TICA expects to develop and increase public health organizations and service as well as health personnel within CLM countries. The common expectation on the point of emerging communicable disease in border areas, TICA aims to decrease the number of cases. For Lao PDR, it also expects to apply knowledge in alternative and traditional medicines which differs from Cambodia and Myanmar. Regarding the strategy on public health in CLM borders, the similarity is that TICA proposes to build capacity in disease prevention for public health personnel of all CLM countries. The target group is all the same including doctors, nurses, and health personnel. Moreover, information exchange on health and outbreaks is one of the development strategies under TICA consideration. For Myanmar, TICA will give support on an information management system as well as provide communication technology and devices. Strengthening the plan for preventing and preparing for communicable and emerging diseases is another supportive strategy which applies to all CLM countries. The strategy towards Myanmar moreover will establish a master plan and joint action plan between Thailand and Myanmar. Meaning that exchanging information and fostering the preparation for disease prevention are significant activities which TICA has been considering for a long time. It finally appears in the main pilots of the project during 2012-2015. TICA‟s development strategy in 2008 focused on strengthening the plan for preventing and preparing for communicable and emerging diseases in CLM countries as mentioned above. It indicated that TICA is concerned on this particular point, on the other hand, the unpublicized strategies during 2011-2015 could be the internal working procedure or management. There was no clear strategy on development cooperation in public health during 2012-2015. In accordance with the delegated interviewee‟s, Banchong Amornchewin said that “TICA applied public health strategies 2008-2011 for the project. Emerging communicable disease has shown up in all CLM countries since 2008”. Banchong Amornchewin further emphasized “the change of Thailand‟s development cooperation in public health has transformed from being a recipient country into a dual status in Anand‟s administration” (Personal

Ref. code: 25605503040163UXQ 82 interview with Banchong Amornchewin, February 29, 2016). The Government of Thailand proposed to promote development cooperation in order to reduce the development social gap between two countries. Since the East-West Economic Corridor (EWEC) and ASEAN Community in 2015 has occurred, the MFA has concerned itself with human security regarding public health within both country and regional context. Therefore, one aspect of Thai foreign policies in the globalization era puts emphasis on health diplomacy. TICA‟s public health policies in 2011-2015 were derived from the annual official visit, the Consultation on Technical Cooperation between Thailand and neighboring countries. The supply of donors and the demands of recipients should be impelled and developed both social and economic development (Personal interview with Banchong Amornchewin, February 29, 2016). TICA collaborates with external organizations such as the Department of Disease Control, MoPH. Besides providing in depth information regarding the border health situation, MoPH staff have expertise and knowledge to support TICA‟s project directly. Surasak Thanaisawanyangkoon, Senior Professional Level Planning and Policy Analyst, under the Bureau of AIDS, TB and STIs, Department of Disease Control, MoPH said that “he has been working with Suchada Thaibanthao (former Director-General) for years, we discussed and agreed on cooperation in public health along the border area” (Personal Interview with Surasak Thanaisawanyangkoon, August 8, 2016). He is the specialist on disease control in the border area, so he is concerned about the emerging communicable diseases. The involvement of decision makers from both agencies leads to a practical action plan.

3.8 Case Study: A Project on Building Awareness and Preparedness for Communicable and Emerging Diseases along the Thailand-Cambodia-Lao PDR-Myanmar Borders

The study on development cooperation in public health selected a Project on Building Awareness and Preparedness for Communicable and Emerging Diseases along the Thailand-Cambodia-Lao PDR-Myanmar Borders as a case study. TICA initiated the project and played the role as the project owner and project moderator. Its

Ref. code: 25605503040163UXQ 83 background is that neighboring countries are TICA‟s concentration regarding social and economic development. Since the contiguous areas have been developed actively and became the Special Economic Zones (SEZs) which aims at stimulating economic growth, drawing foreign investment attention, promoting the development of the border and supporting regional cooperation, ASEAN. It would increase the number of labor movements that might inevitably and vulnerably cause the spread of communicable diseases. Therefore, TICA is one of the governmental organizations which has an approach at the state-to-state level in order to prevent or control the spread of communicable diseases along the border of Thailand and CLM countries. Project Objectives are to create awareness and preparedness for communicable and emerging diseases along border areas. As well, to be a model for cooperation between Thailand and neighboring countries. The project duration takes 3 years (2014-2016). All positions including Government Officials, Government employees, Contract Officers, Project Coordinators (Temporary) participate on the project for Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders. Thai Cooperation Branch I is the focal point of the project.

3.8.1 Target Area The target areas of the Project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-Cambodia- Lao PDR-Myanmar Borders is shown in the table below. The table shows provinces in Thailand and provinces in CLM countries

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Table 3.3 Target Areas of the Project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-Cambodia- Lao PDR-Myanmar Borders

Province in Thailand Province in CLM countries 2014 1. Sa kaeo Banteay Meanchey (Cambodia) 2. Trat Koh Kong (Cambodia) 3. (Lao PDR) 4. Mukdahan (Lao PDR) 5. Tak Myawady (Myanmar) 6. Savannakhet (Lao PDR) – PreahVihear (Cambodia) 7. Chiang Rai Bokeo (Lao PDR) – (Myanmar) 2015 8. Khammouane (Lao PDR)

This study selected only the public health sector in order to indicate how TICA performs in foreign policy for development cooperation. Types of development cooperation belonging to TICA included many forms such as contributions to international organizations, training, study visits, fellowships, projects, experts, equipment, etc. This TICA project comprises of six main pilots for collaborating and working among the MoPH agencies, particularly, Provincial Health Office. 1. Preventive Strategy: Building Awareness and Preparedness 2. Information Exchange Centers 3. Developing and Maintaining Information Exchange Centers and Communication Channels 4. Human Resource Development 5. Service and Referral System 6. Assessment and Evaluation

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3.8.2 Budget This study specifically intends to elaborate on and analyze this project. In terms of budget allocation, in 2003 TICA was allocated and received from the country budget namely a “contingency fund” by the Office of Policy and Planning under the Office of the Permanent Secretary. This fund was aimed at dealing with emergency issues, inclusive of emerging or re-emerging communicable diseases. This budget relied upon the Central Fund, managed under the Prime Minister‟s Office. Each government sector requested the contingency fund by submitting a proposal to the government headquarters. According to the Thailand: Report on Observance of Standards and Codes: Fiscal Transparency Module (International Monetary Fund (IMF), 2009), the Staff Reports defined that “the contingency fund was spent for natural disasters and other items for social and development purposes” (IMF, 2009, p. 15). The emergency project or program also allowed spending on medical care and pensions for civil servants. In the report, one of the contingency fund rules is as follows:

Mechanisms to handle within-year risks to the budget from macroeconomic and other shocks (e.g., natural disasters). Description of the contingency fund (including its size and the uses to which it can be put). Mechanisms to reallocate budget appropriations across departments and items (IMF, 2009, p. 14).

This can indicate that TICA executed short-term budget to achieve their foreign policy in development cooperation. TICA allocated or distributed its annual budget mostly in technical cooperation such as scholarships for government officials, short course scholarships or projects. This technical cooperation proposes mostly on human resource development. Regarding the 3-year project on Building Awareness and Preparedness for Communicable and Emerging Diseases along the Thailand- CLM borders adopted the total budget generated by the Country Strategy starting in Yingluck Shinawatra‟s administration. The total budget adoption was 35 million baht for 2014-2016, which was excluded from TICA‟s general budget allocation shown in the table below. Since, the project dealt with a global issue/situation, this budget was generated via the Thai government‟s urgent consideration. That means the sustainability

Ref. code: 25605503040163UXQ 86 and control of budget execution is dependent solely on the Prime Minister‟s decision or the higher decision maker. Besides the contingency fund, TICA received another type of budget adoption in order to support Thailand‟s Official Development Assistance (ODA). This type of budget is a legislative budget or central budget in other words it was more sustainable rather than the contingency fund. Also, TICA was endorsed by many donors such as Germany, Japan, USA, etc. The table below shows the amount of Thailand Official Development Assistance (ODA) spent on public health during 2012-2015 from MoPH, MFA (exclude TICA) and TICA among neighboring countries consisting of Cambodia, Lao PDR, and Myanmar.

Table 3.4 Ministry of Public Health on ODA in Public Health 2012 – 2015

Ministry of Public Health (MoPH)

Country/Year 2012 2013 2014 2015 Total

Cambodia - - - 698,204.00 698,204.00

Lao PDR 440,385.00 95,070.00 - 3,327,656.57 3,863,111.57

Myanmar 200.00 - - 3,533,028.67 3,533,228.67

Total 440,585.00 95,070.00 - 7,558,889.24 8,094,544.24

The table shows MoPH expenditure on ODA, especially, on the public health sector. MoPH, in total, spent the highest budget for Lao PDR at 3,863,111.57 THB. Myanmar is the second concentration receiving 3,533,228.67 THB and Cambodia receives the lowest budget at 698,204 THB. The biggest amount is 3,533,028.67 THB for Myanmar in 2015.

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Table 3.5 Ministry of Foreign Affairs (exclude TICA) on ODA on Public Health 2012-2015

Ministry of Foreign Affairs (MFA) (exclude TICA)

Country/Year 2012 2013 2014 2015 Total

Cambodia - - 3,000,000.00 - 3,000,000.00

Lao PDR - - - - -

Myanmar - - - - -

Total - - 3,000,000.00 - 3,000,000.00

The table shows MFA expenditure on ODA among CLM countries. In terms of ODA on public health, MFA implements the lowest action. Cambodia is the only one country that receives 3,000,000 THB in 2014.

Table 3.6 Ministry of Public Health on ODA in Public Health 2012-2015

Thailand International Cooperation Agency (TICA)

Country/Year 2012 2013 2014 2015 Total

Cambodia 26,993,200.00 8,958,900.00 30,059,600.00 31,392,500.00 97,404,200.00

Lao PDR 7,879,600.00 11,564,100.00 3,684,700.00 8,831,500.00 31,959,900.00

Myanmar 1,630,300.00 11,764,200.00 2,890,700.00 2,912,400.00 19,197,600.00

Total 36,503,100.00 32,287,200.00 36,635,000.00 43,136,400.00 148,561,700.00

The table shows TICA expenditure on ODA in the public health sectors. During 2012-2015, TICA expended the highest expenditure in total is 148,561,700 THB. MoPH is the second agency spending 8,094,544.24 THB for ODA in public health sector. MFA (exclude TICA) disbursed the lowest budget for public health assistance at 3,000,000 THB. Cambodia seems to be the highest prioritized recipient country for Thailand‟s ODA in public health sector. The total amount TICA spent in

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Cambodia is 97,404,200 THB. Lao PDR and Cambodia, TICA provides ODA at 31,959,900 THB and 19,197,600 THB respectively. Among others, the highest budget allocation is 31,392,500 THB which TICA expended for Cambodia in 2015. For the lowest ODA expenditure, TICA provides 1,630,300 THB for Myanmar in 2012.TICA executed the ODA budget on a variety of sectors including public health. It means that the development cooperation strategy in public health, TICA is the main agency to provide and run this policy. Even though, MoPH is also a supportive government organization to collaborate with TICA. The key development areas of TICA are education, agriculture and rural development, and public health. The organization transformation led to the shift of roles and responsibilities on foreign aid management, Thailand integrated aid in foreign policy since Anand Panyarachun‟s administration. TICA again was the mechanism for promoting Thailand‟s foreign policy onto international arena by stating that it became an emerging donor under Taksin Shinawatra‟s administration. The roles and responsibilities under the MFA are to formulate technical cooperation projects, administer development cooperation programs, and cooperate with international partners. TICA, in addition, provides many forms of cooperation, such as, scholarships (Thailand‟s Annual International Training Course [AITC], or Thailand International Postgraduate Program [TIPP]), training courses, dispatching experts and development projects. The next chapter will illustrate the approach to implementing the Thai government policy into action. It will elaborate on the insightful activities of a case study which consisted of six main pilots for collaborating and working with the MoPH agencies, particularly, provincial health offices in border areas.

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CHAPTER 4 POLICY IMPLEMENTATION

TICA’s approach to implementing Thai government strategies to prevent communicable and emerging communicable diseases along the borders of Thailand and CLM countries Thailand International Cooperation Agency (TICA) promotes public health cooperation between Thailand and neighboring countries. Since 2012 they launched a project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders, TICA collaborates with its expertise about public health issues with the Ministry of Public Health (MoPH). The main role of TICA was represented as a coordinator and moderator of this project. The Project‟s background originated based upon the notice of a development gap between Thailand and neighboring countries. Regional connectivity built awareness both of the economic and sociological perspective. The higher number of labor movements from neighbors to Thailand across the border caused higher demand on public health services and treatment that led to many public health issues. For example, emerging and re-emerging communicable disease from migrant workers or the lack of money for service and treatment was determined as a border health issue. It can be implied that the public health service in neighboring countries especially in border areas is neither accessible nor adequate. The migrant worker database was inaccurate that brought about ineffective management of public health. Thus, the project aimed at creating awareness and preparedness for communicable and emerging diseases along border areas. It also aimed to be a model of cooperation between Thailand and neighboring countries. TICA‟s objectives were considered from a neoliberal perspective expecting mutual action between Thailand and neighboring countries. It concentrated on policy connectivity between the economy and sociology for strengthening trust and understanding among states. TICA framed the target group of the project as both Thai citizens and migrant workers. TICA introduces the following six main pilots to the project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders.

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1. Preventive Strategy: Building Awareness and Preparedness 2. Information Exchange Centers 3. Developing and Maintaining Information Exchange Centers and Communication Channels 4. Human Resource Development 5. Service and Referral System 6. Assessment and Evaluation Six pilots are provided by TICA‟s policy of setting up the field of common interest between Thailand and CLM countries on which they can cooperate and collaborate in disease prevention together with enhancing and maintaining good relations between both countries and even trilateral cooperation. Activities under this project derived from the mentioned strategies represented in the previous chapter. Activities following the six pilots have some different and similar approaches between CLM countries in accordance with the social and political context. With regard to a three-year project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders under TICA, the duration started from 2014-2016. However, the research scope will focus on the period during 2012-2015. Provincial health offices also worked closely with TICA since the beginning of the project due to the MoPH‟s assignment. Provincial health offices designed and managed their activities, it can clarify the public health issues as well as the demands on disease control or prevention because they were located in particular places. TICA‟s flagship project is to train for emergency medical services for health officers (EMS and Refer), Surveillance and Rapid Response Team (SRRT), create border health meetings, set up an information center and development of a cooperation network to prevent emerging and re-emerging communicable diseases. In chapter 4, information derived from the meeting presentations which were hosted by the Thai Cooperation Branch I, for summarizing the project at the end of each fiscal year. The summary meetings were organized on 25th December 2014 at Golden Tulip Hotel, Bangkok and 1st September 2016 at The Palazzo, Bangkok. Representatives from each provincial health office had collected the results together, reached conclusions and provided further recommendations.

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Table 4.1 Pilot 1: Preventive Strategy: Building Awareness and Preparedness

Country Activities Meeting on Public Health Cooperation in Border Areas between Thailand-Cambodia Study Visit to Thailand on "Best Practice Border Health and One Cambodia Health" Workshop on Emergency Treatment Workshop on Experience Sharing for Human Resource Development in Public Health Workshop on Building Awareness and Preparedness for Communicable Disease and Emerging Disease along Nong Khai and Vientiane province Meeting on Public Health Cooperation between Parkngum and Nong Khai province Meeting on Food and Health Product Safety between Nong Khai and Vientiane province Development on the Safety of Food and Health Products for Export and Import Workshop on Preparedness Plan for Emerging and Re-emerging Lao PDR Communicable Disease International Conference on the Mekong Basin Disease Surveillance (MBDS) Collaboration between Mukdahan-QaungTri- Savannakhet Workshop on Experience Sharing and Team Building Network Meeting on Human Resource Development for Teachers and Young Health Volunteers between Bokeo Hospital and Somdej Phra Yupparat Chiang Khong under Princess Sirindhorn‟s Projects Meeting of Border Health Development and Networking Workshop on Development cooperation in public health between Thailand-Lao PDR Workshop on Experience Sharing and Team Building among Lao PDR/ Cambodia Health Personnel Meeting on Border Health Networking Meeting on the Development of a Twin Village for Border Health Development of a Collaboration Network for Malaria Prevention in Tak-Myawady Workshop on Strengthening the Border Health Network of the Myanmar Twin Village Meeting of Border Health Development and Networking Workshop on Development cooperation in public health between Thailand-Myanmar Training Course on Public Health Awareness for Community Volunteers

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Pilot 1: Preventive Strategy: Building Awareness and Preparedness

Building awareness and engagement into a preventive strategy for communicable and emerging diseases along the Thailand-CLM borders with the purpose of enhancing good relations between Thailand and CLM countries and strengthening networking in public health. Not only is it necessary to strengthen state cooperation, but also to build awareness at the practitioner and people levels. The mechanism of a preventive strategy is to organize meetings and workshops regularly. Meetings and workshops are two-way communication for both sides to discuss issues, share experiences, and plan a future strategy. All provincial health offices, which are responsible for the project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders, organize meetings or workshops on public health cooperation. Some provincial health offices set up a study visit instead. Those designed activities aimed at providing knowledge on health issues, to contribute to Thailand‟s objectives and procedure to strengthen the health network along border areas. For Cambodia, Sa Kaeo Provincial Health Office organized a Meeting on Public Health Cooperation in Border Areas between Thailand-Cambodia. The objectives were to promote good relations between Thailand and Cambodia and develop a public health network on the Thailand-Cambodia borders. The meeting was held for three days in at which there were 30 Cambodian participants and 40 Thai health personnel. The meeting launched a Memorandum of Understanding (MOU) on Public Health on the Thailand - Cambodia borders in August 2014. They agreed to revise a disease reporting procedure in accordance with a new term recognizing the current situation (Hand, foot and mouth disease and MERS-CoV). They decided to include some new diseases and update some disease names. Regarding a preventive strategy, both sides agreed to exchange information on vaccines and EPI systems and emphasized on the accessibility of health care service for migrant workers through distributing a Universal Health Coverage card. The meeting would support and improve a maternal and child health program. Sa Kaeo Provincial Health Office organized a Study Visit to Thailand on "Best Practice for Border Health and One Health" visiting Ayutthaya province and Bangkok, Thailand. The number of participants was 50 health personnel and it was a 3 day-

Ref. code: 25605503040163UXQ 93 study visit. It aimed to integrate Universal Health Coverage and to collaborate on public health cooperation between Thailand and Cambodia. Another activity was a Workshop on Emergency Treatment where the activity‟s objectives were the same as the meeting. The workshop, organized at Sa Kaeo hospital, included doctors and nurses from Cambodia. There were six participants and the workshop was divided into 2 phases. Each phase took a 5 day-workshop and demonstration on Emergency Treatment. Trat Provincial Health Office also organized a Workshop on Experience Sharing for Human Resource Development in Public Health aiming to promote good relations between Thailand and Cambodia and develop a public health network along the borders. Both Provincial Health Offices had the same objective direction on running the project for creating mutual trust and provide common interest with neighboring countries through development cooperation in public health. For Lao PDR, Nong Khai Provincial Health Office, in general, proposed to build awareness and preparedness for health personnel for prevention, control and surveillance regarding communicable and emerging communicable diseases in border areas and to cooperate and share experiences on border health at the district and provincial level, with neighboring countries. It also aimed to develop technical cooperation in public health among twin hospitals. It arranged a Workshop on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases within Nong Khai and Vientiane province at which there were 80 participants who were directors, doctors, nurses, and health personnel from both the Thai and Laotian sides. It highlighted on an epidemiological report and border health information between Nong Khai and Vientiane. The results of the workshop were discussion on a referral system under the standard of IHR 2005, an exercise plan for an Ebola outbreak, sharing on the systems of public health service and the management of a hospital database. Thailand-Lao PDR agreed on a cooperation network between twin cities and launched a joint website. Nong Khai organized a Meeting on Public Health Cooperation between Parkngum and Nong Khai province where they approved producing a form and SOP for a referral system following the standard of IHR 2005. They drafted MOUs on border health cooperation between Nong Khai and Vientiane. A MOU on Disease Surveillance and Communicable Disease Control along the border areas was signed on 25th September

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2012. A year later, a MOU on Food Safety between Thai-Lao PDR border was established on 31st October 2013. A MOU on border health cooperation between Nong Khai and Vientiane was signed on 3rd October 2014. The next preventive strategy activity was a Meeting on Food and Health Product Safety between Nong Khai and Vientiane province. The meeting was about the safety of food and health products which was held on 8th May 2015. They agreed on a Common Control Area (CCA) to strengthen the import and export process. Also, the plan prepared for an information network called Nation Single Window. They also developed an information sharing channel and closely checked the verification of health products with related organizations. It further developed the Safety of Food and Health Product Exports and Imports. Mukdahan Provincial Health Office‟s activity was a Workshop on a Preparedness Plan for Emerging and Re-emerging Communicable Diseases aimed at preparing and exercising for emerging and re-emerging communicable diseases domestically and internationally. The first workshop on border health collaboration between Thailand-Lao PDR-Vietnam was held during 4-8 September 2014 at Phetchaburi province, Thailand. In 2015, the second exercise on responding to emerging and re-emerging communicable diseases took place. The workshop developed a technical cooperation network in the border area which focused on treatment, diagnosis, and a referral system. There were 100 participants for Tabletop Exercises & a Drill Exercise. The International Conference of the Mekong Basin Disease Surveillance (MBDS) Collaboration between Mukdahan-QaungTri- Savannakhet was held on 1-3 June 2014 in Mukdahan province. It proposed to promote good relations between Thailand and Lao PDR. It stimulated a public health network in the region and developed Universal Health Coverage access for citizens, Thai and Laotian, who lived in border areas. The supportive Workshop on Experience Sharing and Team Building Network on border health collaboration between Thailand-Lao PDR-Vietnam was held on 15-17 July 2015. Chiang Rai Provincial Health Office set up a Meeting on Human Resource Development for Teachers and Young Health Volunteers between Bokeo Hospital and Somdej Phra Yupparat Chiang Khong under Princess Sirindhorn’s Projects which focused on public health cooperation between Thai health personnel in Chiang Rai and Bokeo. A Meeting of Border Health

Ref. code: 25605503040163UXQ 95

Development and Networking and a Workshop on Development cooperation in public health between Thailand-Lao PDR focused on the development of a surveillance and disease control system. The objectives were to support in disease prevention, to develop a public health network between health personnel at district and provincial level and to integrate a community watch for disease surveillance and prevention in border areas, particularly, in Bokeo district. At Ubon Ratchathani‟s border located next to Lao PDR and Cambodia, Ubon Ratchathani Provincial Health Office set up a Workshop on Experience Sharing and Team Building among Health Personnel in order to strengthen the international health cooperation network between Thailand, Lao PDR and Cambodia. It aimed to exchange information and knowledge on human resource development of health personnel in Ubon Ratchathani province, Champasack, Salavane, Savannakhet and Preah Vihear and they proposed to arrange a tabletop exercise for emerging and re-emerging communicable diseases at both domestic and international levels. To establish a preventive strategy for communicable and emerging diseases along the Thailand-Myanmar border, Tak Provincial Health Office created a Meeting on Border Health Networking. The objectives were to strengthen the network for prevention and control of communicable diseases and establish health risk surveillance in the border areas of Tak-Myawady, as well as, to reduce the risk of communicable diseases along the Tak-Myawady border. It was a platform to share experiences in disease control progress between Thailand and Myanmar. The discussion, which concentrated on disease surveillance and the control of communicable and emerging communicable diseases, invited 60 health personnel from both sides. It wrapped up a lesson-learned from border health networking and it also organized a workshop for Thai-Myanmar SRRT for one day. The activity was expected to create border health networking, such as, cooperating in disease reporting and a referral system. Also, a qualified contact list between the two sides was given to each other in terms of emergency situations. The meeting result showed that Thailand and Myanmar established a Minutes of Discussion (MOD) for Thailand-Myanmar Local Joint Coordination Meeting on Improving Border Health and Well-Being toward the ASEAN Community in 2015. It concentrated on 6 aspects: 1) Cooperation on health system management, 2) Strengthen collaborative mechanisms in disease

Ref. code: 25605503040163UXQ 96 surveillance, 3) Strengthening collaborative mechanisms for health information sharing at the border areas, 4) Capacity building, 5) Action plan development, and 6) Tak and Myawady will assign overall coordinators. This Minutes of Discussion mentioned Cholera, Avian influenza, Plague, Diphtheria, Rabies, and other emerging diseases. The next activity along Myanmar‟s border was a Meeting on Developing a Twin Village for Border Health which was the platform for experience sharing in disease surveillance. There were 60 health personnel from the Thai-Myanmar side. Development of a Collaboration Network for Malaria Prevention in Tak- Myawady expected that a vaccine for communicable diseases could be given to people along the Myawady border. Since Tak province is located next to the Myanmar border, the Thai population in Tak was approximately 530,000 and the number of non-Thai population was about 260,000. Also, the number of refugees was about 68,000. Foreign health volunteers is an important mechanism to improve the way of living. The total number of foreign volunteers was 595 from 6 districts. To strengthen the network for prevention and control of communicable diseases and health risk surveillance in the border areas of Tak-Myawady was very useful. A training course was set up for community volunteers and foreign health volunteers in the Twin Village for supporting health care service and controlling communicable diseases called the Workshop on Strengthening the Border Health Network of Twin Village. Chiang Rai Provincial Health Office set up a Meeting of Border Health Development and Networking and a Workshop on Development cooperation in public health between Thailand-Myanmar. Participants came from different sectors consisting of public health, education, agriculture and forestry, and livestock sector. It aimed to build capacity of human resources in Myanmar. A Training Course on Public Health Awareness for Community Volunteers expected that health village volunteers were trained. This course focused on the primary treatment of communicable and emerging communicable diseases for community volunteers. A collaboration network and cooperation were a key activity in building awareness for a preventive strategy. The opportunity of providing meetings, workshops, or training to all CLM countries supported stronger networking and stimulated awareness of health issues in the border areas. Thai Provincial Health

Ref. code: 25605503040163UXQ 97

Offices in border areas play the role of strategy implementation. They designed what a proper activity should be in each particular area. They set up meetings or workshops bilaterally or trilaterally depending on the location. These selected activities proposed to build awareness and preparedness for communicable and emerging communicable diseases. Some meetings were arranged as official meetings at the state level where the conclusions led to Memorandums of Understanding (MOU), Minutes of Discussion (MOD) or agreement on public health cooperation. MOU, MOD, or agreement was the official agreement between governmental sectors. The objectives of each activity created parallels with the project‟s objectives. All activities took place along the same direction which accomplishes TICA‟s goals. The activity differences of CLM depended on the different public health issues. Cambodia‟s issue emphasized on One Health and emergency treatment, while Lao PDR needed development cooperation in preventing communicable diseases, emerging and re-emerging communicable diseases. Myanmar, on the other hand, relied more on strengthening health networking and building awareness.

Table 4.2 Pilot 2: Information Exchange Centers

Country Activities Information Center for Cooperation between Trat-Koh Kong Cambodia Province Information Center for Cooperation between Twin Provinces Information Center for Health Cooperation between Mukdahan and Lao PDR Savannakhet via Developing Website and Data Center Lao PDR/ Cambodia Ubon Ratchathani Border Health Center Model the Establishment of a Learning Center and Networking for the Management of Epidemiology along Thai-Myanmar Border Tak Myanmar Province in Preparation for the Special Economic Zone and ASEAN Community

Ref. code: 25605503040163UXQ 98

Pilot 2: Information Exchange Centers

TICA emphasizes that information exchange is one of the most important methods to prevent emerging communicable diseases and reduce importing re-emerging communicable diseases in border areas. The establishment of information exchange centers is a primary activity for Cambodia, Lao PDR, and Myanmar. Setting up an information exchange center, the project implementer arranged the meeting on border health cooperation between Thai-neighboring countries. The mechanism for information exchange is to provide an insightful communication channel including focal points and contact person in each of the countries. Traditional communication such as fax and telephone is still used, as well as, the online communication such as Websites, E-mail, and LINE Application is becoming more popular. Some information centers recruit one specialist, one coordinator, and one accountant depending on the management of the provincial health office. In terms of Cambodia, the basic objective was to exchange information, news, and databases on public health in the border area. Trat Provincial Health Office set up Information Center for Cooperation between Trat-Koh Kong Province. Sa Kaeo Provincial Health Office set up Information Center for Cooperation between Twin Provinces. At the Information Center located at Sa Kaeo Provincial Health Office, there was one coordinator who was employed for a month. The stationary and laptop were contributed and provided for the information center. For Lao PDR, information exchange center proposed to establish a website and surveillance system and to develop the quality and accuracy of a public health database. Furthermore, it aimed to provide the effectiveness of DATA center via a reporting, monitoring and warning system. Mukdahan Provincial Health Office set up Information Center for Health Cooperation between Mukdahan and Savannakhet via Developing Website and Data Center. It established a focal point and a contact person at both district level and provincial level. The members of the information center consisted of provincial team leader, technical health officer, and coordinator. At district level, the Health Prevention Unit was a hub. At provincial level, Center for Disease Control (CDC), Epidemiology section was the main unit responsible. There was a general E-mail, telephone number, and fax number for any emergency situations. On the other hand, Savannakhet province established a focal

Ref. code: 25605503040163UXQ 99 point and a contact person as well. They correlated directly with the Thai side, developing a website named www.health-MQS.com along with LINE application (SRRTMQS). The website content included general information, MOUs, contacts, referral systems, CPG, a border strategy, and human development plan. Before launching the website, a Workshop and Discussion on Website collaboration was held at QuangTri, Vietnam. Ubon Ratchathani province, where there was a joint border with Cambodia and Lao PDR, the public health office launched Ubon Ratchathani Border Health Center Model aiming at establishing a DATA Center and developing a database system of communicable and emerging communicable diseases. The operation of Ubon Ratchathani Border Health Center was a focal point of cooperation between hospital, public health institute, and immigration center. The data was received, managed and transferred through the center to other related organizations. In terms of Myanmar, the Establishment of a Learning Center and Networking for the Management of Epidemiology along Thai-Myanmar Border Tak Province in Preparation for the Special Economic Zone and ASEAN Community was located in Mae Sot District Health Office. The committee of this center consisted of one Medical Doctor, Expert Level, two Public Health Technical Officers, one administrator, and one accountant officer. For the second year of the project, the learning centers expanded to five districts in the western part of Tak province. Information exchange centers were established at provincial health offices with some employed or outsourced coordinators to manage the centers. There were some appointed Thai health personnel to administrate the information center where members were derived from internal officers. All CLM countries applied traditional and non-traditional communication channels for exchanging information. Lao PDR had similar verbal language, so it was easier to communicate and cooperate. Cambodia and Myanmar, on the contrary, needed diplomatic channels to collaborate with governmental sectors. It was reflected that Lao PDR‟s activity centered more on database sharing.

Ref. code: 25605503040163UXQ 100

Table 4.3 Pilot 3: Developing and Maintaining Information Exchange Centers and Communication Channels

Country Activities Establish Communication Channel: E-mail, Website, Hotline Provide interpreters for hospital in Trat Cambodia Provide a project coordinator for provincial health office Provide interpreters for hospitals in Sa Kaeo Provide a project coordinator for assisting Cambodian patients Develop the database system of Thai - Lao PDR border health between Nong Khai and Vientiane Study Visit on the Management of Public Health Service and Database Development Lao PDR Meeting on Disease Control Cooperation at Practitioner Level between Mukdahan and Savannakhet Province Support for Health Promotion and Disease Prevention Campaign in Foreign Community in King Romans area Development of Collaboration Network for Malaria Prevention in Tak -Myawady Myanmar Health Promotion and Disease Prevention Campaign in Foreign Community in Mae Pah Luang District, Chaing Rai Province

Pilot 3: Develop and maintain Information Exchange Centers and Communication Channels

After the establishment of information exchange centers, TICA ensured that each center has been operating so the third pilot is to develop and maintain information exchange centers and provide appropriate communication channels. The word channel means the medium or ways that messages are delivered between the sender and the receiver. The channel includes social networking, online applications, person-to-person, interpreter and public relations material, etc. Activities varied depending on the social context. Developing and maintaining Information Exchange Centers/Communication Channels proposed to establish a communication network on

Ref. code: 25605503040163UXQ 101 border health cooperation and also to promote good relations between Thailand and neighboring countries which arose from TICA‟s objectives. For Cambodia, Trat Provincial Health Office concentrated on the reduction of any communication gap between Thai health personnel and Cambodian patients. It established a communication channel, such as, E-mail, Website, and Hotline. Along the communication channel, it provided interpreters (Cambodian- Thai) for the hospital in Trat and a project coordinator for the provincial health office. There were 5 out of 7 interpreters in general hospitals in Trat province. The hiring period was about 5-8 months. It was the same as Trat‟s activity, at Sa Kaeo Provincial Health Office who provided interpreters (Cambodian-Thai) for nine different hospitals in border areas. It aimed to develop a communication channel between Thais and Cambodians. Moreover, it provided a project coordinator for assisting Cambodian patients and established a Website. Sa Kaeo Provincial Health Office rented a website domain for three years to establish a Communication Channel through the website (www.sakaeoborderhealth. com). Establishing a website was intended to promote good relations between Thailand and Cambodia and to develop a public health network on the Thailand-Cambodia border. However, the website domain www.sakaeoborderhealth.com was not available for the public. For border health personnel, they must register as a member first. They were able to access http://team.sko.moph.go.th/healthscript/ for information sharing among members. Lao PDR has a similar verbal language to Thai language, thus Thai and Laotian people are able to communicate easily. To maintain and develop the information center, Nong Khai Provincial Health Office developed the database system of Thai-Lao PDR border health between Nong Khai and Vientiane. The committee held the first meeting on the development of a database system on the Thai-Lao PDR border on 9-10 July 2014 in Nong Khai province. They aimed to establish a communication network for public health cooperation and also exchange and develop information technology on public health in the border area. The further activity that Nong Khai provided for Laotians was a Study Visit on the Management of Public Health Service and Database Development aiming to collaborate and develop a border health database between Nong Khai and Vientiane province. The study visit was held during 5-8 August 2014. The team visited Sa Kaeo province and

Ref. code: 25605503040163UXQ 102

Samut Sakhon province. The topics were related to 1) Migrant worker registration, 2) Disease surveillance and disease control for migrant workers, 3) One Health Model, 4) Border health database system and 5) Health care service in hospitals in border areas. Mukdahan Provincial Health Office‟s activity in maintaining an information exchange center and providing a communication channel, they decided to organize a Meeting on Disease Control Cooperation at Practitioner Level between Mukdahan and Savannakhet province, Lao PDR. The meeting on health cooperation was organized in Nong Khai province for three days. The Meeting agenda was about cooperation at a practical level, public health collaboration in twin cities and development cooperation in a public health website. It aimed to promote good relations between Thailand and Lao PDR and develop a public health network on Thailand-Lao PDR borders as well as to establish a website. Chiang Rai Provincial Health Office supported a Health Promotion and Disease Prevention Campaign in the Foreign Community in King Romans Area for developing a communication channel between the Thai-Lao PDR border. The meeting was for health personnel in border areas and stimulated awareness and preparedness in preventing communicable disease for the foreign community in King Romans area. The activity also provided a training course for health personnel and other related sectors in the community. It produced community volunteers to support the health care service and to establish a database. A Training course was provided for community volunteers who were foreigners and lived in King Romans Community. The evaluation of this campaign was the number of Laotian health personnel understanding the health care service among foreign workers. A Training course on human resource development about health care for foreign workers, Laotian, Burmese, or Chinese, evaluated the number of foreign volunteers understanding and was able to inform other foreign workers. In Myanmar, a Development of Collaboration Network for Malaria Prevention in Tak-Myawady was arranged by Tak Provincial Health Office. Its objective was to ensure that vaccine for communicable diseases was given to people along the Myawady border. Thus, the Thai side distributed medical supplies and medical instruments for Malaria prevention in the border of Tak and Myawady. Also,

Ref. code: 25605503040163UXQ 103 the activity built the capacity of border health volunteers in diagnosis. The number of Malaria infectious cases during 2012-2015 showed the effectiveness of this activity. In Tak province, the total number of Malaria infectious cases in 2012 was 7,253 cases which reflected that 40.50% was Thai population and 59.50% was non-Thai population who live in border area. The number of Malaria infectious case in 2013 increased to 9,679 which reflected that 40.38% was Thai cases and 59.62. % was non- Thai cases. In 2014, the total number decreased to 5,568. The Thai population who were infected with Malaria was 39.69 percentages while non-Thai population was 60.31. In 2015, the number of Malaria infectious case was 2,732. The difference from 2012-2015 was 4,512 cases. Furthermore, Chiang Rai Provincial Health Office supported the Health Promotion and Disease Prevention Campaign in the Foreign Community in Mae Pah Luang District, Chaing Rai Province. The meeting was aimed at health cooperation for health personnel in border areas and to stimulate the awareness and preparedness in preventing communicable diseases for the foreign community in King Romans area. There were a variety of forms in developing and maintaining the Information Exchange Centers and Communication Channels. The various activities provided by provincial health offices in the border area were to hire a coordinator according to the difference of language, to set up a meeting and study visit to learn about database management, and to survey Malaria infectious statistics for giving preventive vaccine to the target group. The activity was different with reference to the border health context and demands of each country.

Table 4.4 Pilot 4: Human Resource Development

Country Activities Study Visit for Personnel Development of Koh Kong and Trat Province Cambodia Training Course on EPI system for health personnel in Koh Kong and Trat Province (continued)

Ref. code: 25605503040163UXQ 104

Table 4.4 (continued) Pilot 4: Human Resource Development

Country Activities Training Course on Emerging Infectious Diseases and Collecting, Packaging and Shipping Samples of Dangerous Pathogens Training Course for Health Volunteer Specialists Training Course for Cambodian Health Volunteers Cambodia Workshop on Experience Sharing and Team Building among Health Personnel Training Course on Dengue Diagnosis and Treatment Experience Sharing on Rabies and Promoting the Campaign on a "Rabies free zone" between Thailand and Cambodia The 1st Workshop on Border Health Cooperation between Nong Khai and Vientiane Province Training Course on prevention of HIV/AIDS, TB and STIs of Sex Workers in Border Areas The 2nd Workshop on Border Health Cooperation between Nong Khai and Vientiane Province Human Resource Development for Health Personnel in the Health Control Office following IHR 2005 Training Course on Maternal and Child Care Service Create a Community Model on Surveillance, Prevention and Lao PDR Control of Emerging Communicable Diseases Training Course on ICU, ER, and IC for Health Personnel in Nong Khai Hospital Training Course for Health Personnel, Teachers and related Communities under Princess Sirindhorn‟s Projects Training Course for Young Health Volunteers under Princess Sirindhorn‟s Projects Training Course of Health Volunteers in Kings Roman area Human Resource Development on Communicable Diseases in the Border Area

Ref. code: 25605503040163UXQ 105

Table 4.4 (continued) Pilot 4: Human Resource Development

Country Activities Cross Border Exercise for Emerging Disease Control (Ebola Virus Lao PDR Disease) between Champasack Province, Lao PDR and Ubon Ratchathani Province, Thailand Lao PDR/Cambodia Study Visit to Exchange Experiences among Health Personnel Capacity Building for Health Personnel Myanmar Training Course for Health Volunteers

Pilot 4: Human Resource Development

The fundamental element for improving well-being and reducing the risk of communicable diseases is not only the information system but also human resource development. To develop personnel in public health in Thailand-CLM border areas, TICA agreed to provide training courses, workshops and study visits for Cambodians, Laotians, and Burmese for developing human resources. The selected courses related directly to the objectives of a project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders. However, it relied upon the environmental and social contexts of each area. For Cambodia, the target group was health volunteers, public health personnel both Thai and Cambodian, and populations who lived in border areas. Trat Provincial Health Office decided to arrange 1) Study Visit for Personnel Development of Koh Kong and Trat Province, 2) Training Course on EPI system for health personnel in Koh Kong and Trat Province, 3) Training Course on Emerging Infectious Diseases and Collecting, Packaging and Shipping Samples of Dangerous Pathogens, and 4) Training Course for Health Volunteer Specialists. After the training course on EPI system, the outcome was an agreement on an EPI development system between Koh Kong and Trat Province. In terms of volunteer training courses, they educated volunteers from both Thailand and Cambodia to understand how to prevent and control communicable diseases and emerging communicable diseases. Volunteers improved capacity in SRRT and shared experiences.

Ref. code: 25605503040163UXQ 106

Furthermore, a Training Course for Cambodian Health Volunteers was organized by Sa Kaeo Provincial Health Office aiming to train village health volunteers. This course was about health risk surveillance and control of communicable diseases in the border areas. It expected 64 Twin Villages which contributed 10 health volunteers represented in the training course, so the total expected number was 640 village health volunteers. There were 523 village health volunteers attending who came from the villages located in , , , and Khlong Hat District which were located in the border areas between Thailand and Cambodia. It showed 81.72% of invited health volunteers were trained. Sa Kaeo Provincial Health Office set up a Workshop on Experience Sharing and Team Building among Health Personnel. The objectives were to develop a public health network between Thailand and Cambodia and to exchange information and knowledge on human resource development of health personnel in Sa Kaeo and Banteay Meanchey province. The Thai side organized a three-day study visit on public health management and border health issues. Participants visited Sa Kaeo province, Surin province, and Burirum province. Public health personnel from Banteay Meanchey questioned the equality of the health care service among Thai citizens and Cambodian citizens. They were interested in how to cure the patients who were bitten by poisonous animals. A Training Course on Dengue Diagnosis and Treatment and Experience Sharing on Rabies and Promoting the Campaign on a "Rabies free zone" between Thailand and Cambodia were the main activities designed by Sa Kaeo Provincial Health Office. Activities for developing human resources between Thailand and Lao PDR borders were emphasized at trainings, workshops, and meetings. The target group for Lao PDR‟s training course consisted of health volunteers and public health personnel. Nong Khai Provincial Health Office set up the First Workshop on Border Health Cooperation between Nong Khai and Vientiane Province. The objectives were to build awareness and preparedness for health personnel for preventing and controlling communicable and emerging communicable diseases in border areas. Moreover, it aimed to build health personnel capacity at the Center of Disease Control. The workshop included a tabletop exercise for emergency response (Ebola) between Nong Khai and Vientiane province. It was organized in Nong Khai

Ref. code: 25605503040163UXQ 107 province during 23-25 February 2014 and there were 150 participants. The Second Workshop on Border Health Cooperation between Nong Khai and Vientiane province was held on 25-28 May 2015 in Rayong province that aimed to enhance and cooperate at district level. The workshop discussed a SOP and a strategic plan. There were 50 participants which were broken into working groups with their partners for a specific topic. On 22-25 June 2015, a Training Course on Prevention of HIV/AIDS, TB and STIs for Sex Workers in Border Areas was created to collaborate and develop a border health database between Nong Khai and Vientiane province and to collaborate on disease control towards HIV/AIDS, TB, and STIs between Thailand and Lao PDR border. The content of the training course on HIV/AIDS and STIs prevention among sex workers was about a referral system. A three-day training course provided knowledge on HIV/AIDS, TB, and STIs. It also evaluated participants' attitude towards patients. Human Resource Development for Health Personnel in Health Control Office following IHR 2005 was another training course where its content was about the surveillance system, the control of the environment, and pathogens. The objective was to establish a communication network on public health cooperation. Nong Khai Provincial Health Office arranged a Training Course on Maternal and Child Care Service that created a community network along the border area between Sri Chiang Mai district and Sikhottabong district. The further activity of Nong Khai was to create a Community Model on Surveillance, Prevention and Control of Emerging Communicable Diseases which established a community model pairing the twin cities between Nong Khai and Vientiane province. The activity was experience sharing on surveillance, prevention and control of emerging communicable diseases. As well, it included the development of a referral system between twin cities. The meetings matched the district of Nong Khai province together with the district/city of Vientiane province. All meetings were held for two days to build capacity for health personnel and to provide information of communicable and emerging communicable diseases in border areas. Nong Khai Provincial Health Office also focused on a Training Course on ICU, ER, and IC for

Ref. code: 25605503040163UXQ 108

Health Personnel in Nong Khai Hospital. There were12 participants who worked in Mahosot Hospital and Setthathirath Hospital Lao PDR that attended this course. Chiang Rai Provincial Health Office provided an activity in the form of training courses for health personnel and other related sectors in the community. It produced community volunteers to support the health care service and to establish a database. Training courses were provided for community volunteers as a target group who were foreigners and lived in King Romans Community, Lao PDR. These were a Training Course for Health Personnel, Teachers and related Communities under Princess Sirindhorn’s Projects, a Training Course for Young Health Volunteers under Princess Sirindhorn’s Projects, a Training Course of Health Volunteers in Kings Roman Area and Human Resource Development on Communicable Diseases in the Border Area. Ubon Ratchathani, which was next to Lao PDR and Cambodia, set up a Study Visit to Exchange Experiences among Health Personnel. They attempted to develop a public health network between Thailand, Lao PDR and Cambodia. As well, they were expected to exchange information and knowledge on human resource development of health personnel in Ubon Ratchathani province, Champasack, Salavane, Savannakhet and Preah Vihear province. In order to arrange a tabletop exercise for emerging and re-emerging communicable diseases both at domestic and international level, to prepare a communication channel and management system and to develop an international referral system, Ubon Ratchathani Provincial Health Office arranged Cross Border Exercise for Emerging Disease Control (Ebola Virus Disease) between Champasack Province, Lao PDR and Ubon Ratchathani Province, Thailand. A three-day exercise organized in a community hospital at which the activities covered data analysis, reporting, and publication. The evaluation/report will be submitted quarterly and it will be publicized. This activity expected 100 participants who worked at the provincial office and community network from 10 districts on the Thai border. Also, related organizations in Lao PDR and a community network from 4 border districts. The expert came from Disease Control Office 7, Ubon Ratchathani province. The result of this exercise was a response direction/solution for emerging and re-emerging communicable diseases.

Ref. code: 25605503040163UXQ 109

There was a Minute of Discussion on information exchange at which the meeting agreed to establish the structure, role and responsibility and SOP between Ubon Ratchathani and Champasack province. For Myanmar‟s human resource development, it was unlike Cambodia and Lao PDR. The training course targeted health personnel, volunteers, and the community to inform the health care service on treatment and about how to control a disease outbreak. There was no specific diseases like the other countries. The reason for the lesser training courses compared to others was the internal process that government permission takes a much longer duration. So the activities were rather meetings or services. The activities on the Myanmar border included Capacity Building for Health Personnel and a Training Course for Health Volunteers. To develop human resources following Pilot 4, activities provided by provincial health offices in border areas were all emphasized in the form of training courses, workshops and study visits. The target groups of CLM countries were health volunteers and health personnel. In general, they collaborated on building the capacity of both health personnel and border health volunteers. However, the selected topics were different depending on the health situation. For example, Cambodia focused not only on volunteer training, but also EPI system, Dengue, or Rabies. Lao PDR was concerned about HIV/AIDS, STIs, and maternal and child care service. Myanmar, there were no specific health issues as in Cambodia and Lao PDR.

Table 4.5 Pilot 5: Service and Referral System

Country Activities Training Course on Emergency Medical Services for Cambodian Health Officials (SRRT, EPI, and EMS) Training Course on Emergency Medical System (EMS) and Cambodia Referral System for Health Personnel Training Course on Surveillance and Rapid Response Team (SRRT) for Health Personnel in Koh Kong and Trat Provinces (continued)

Ref. code: 25605503040163UXQ 110

Table 4.5 (continued) Pilot 5: Service and Referral System

Country Activities Training Course on a Border Rapid Response Team Training Course for Cambodian Health Personnel on EMS Cambodia and Referral System Training Course on Surveillance and Rapid Response Team (SRRT) for Cambodian and Thai Health Personnel Development on Disease Surveillance and Referral System between Thabi and Sisattanak district Study visit on Disease Surveillance and Public Health Service Setting up a System for Information Exchange and Referral System (Sikhottabong and Nong Khai Province) Setting up a System for Information Exchange and Referral System (Sangthong and Nong Khai) Lao PDR Pre-departure Program Workshop between Savannakhet- Nakhon Phanom-Amnat Charoen-Ubon Ratchathani Province Training Course on SRRT for Mukdahan, QuangTri and Savannakhet Health Personnel Pre-departure Program Workshop for Laotian Workers between Champasack Province, Lao PDR and Ubon Ratchathani Province, Thailand The 2015 International Consultation Meeting on Referral Service Development for all Diseases and all Systems, Ubon Ratchathani (Minutes of Meeting) between Preah Vihear Provincial Department of Health of Royal Kingdom of Lao PDR/ Cambodia Cambodia, Provincial Department of Health of Champasack, Salavane and Savannakhet, Lao People‟s Democratic Republic and Ubon Ratchathani Provincial Public Health Office of Royal Kingdom of Thailand) (continued)

Ref. code: 25605503040163UXQ 111

Table 4.5 (continued) Pilot 5: Service and Referral System

Country Activities Meeting on Referral Service Development for all Diseases Lao PDR/ Cambodia and all Systems Pre-Departure Program Workshop for Foreign Workers Myanmar Vaccine-Preventable Diseases Service in Border Areas

Pilot 5: Service and Referral System

The development cooperation on public health in border areas, the project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders provides a service and referral system as the fifth pilot. TICA believes that service and referral systems are a preventive strategy as well as benefit to both Thailand and CLM countries. World Health Organization (WHO) (2017b) mentions that “an effective referral system ensures a close relationship between all levels of the health system and helps to ensure people receive the best possible care closest to home”. Therefore, a well-organized service and system are equally important to building personnel capacity in order to prepare for emergency situations. For Cambodia, training courses were expected to educate Cambodian health personnel to apply systems and services properly. The general objective was to develop disease surveillance and disease control between Thailand-Cambodia border areas. Trat Provincial Health Office arranged 1) Training Course on Emergency Medical Services for Cambodian Health Officials (SRRT, EPI, and EMS), 2) Training Course on Surveillance and Rapid Response Team (SRRT) for Health Personnel in Koh Kong and Trat Province, 3) Training Course on SRRT for Health Personnel in Koh Kong and Trat Province, 4) Training Course on a Border Rapid Response Team. These courses were organized for doctors and health personnel from Koh Kong province. Each course included 14-20 participants and took five days. A Training Course for Cambodian Health Personnel on EMS and Referral System was also applied by Sa Kaeo Provincial Health Office. It also took

Ref. code: 25605503040163UXQ 112 three days located in Sa Kaeo with 30 Cambodian health personnel participating in an EMS and Referral System training course. A Training Course on Surveillance and Rapid Response Team (SRRT) for Cambodian and Thai Health Personnel organized Tabletop Exercises and a Drill Exercise for an Ebola outbreak in border areas on 17-18 March 2015. The target participants consisted of hospital directors and border health personnel from Banteay Meanchey province. The total number was 300 participants including the Thai side. For Lao PDR, the objectives of providing service and referral system were to build awareness and preparedness for health personnel for preventing, control and surveillance of communicable and emerging communicable diseases in the border area, and to establish a communication network for public health cooperation. A Transfer report on Tuberculosis (TB) cases in Nongkhai province during 2012-2015, showed the number of cases dynamically changed. Setting up a System for Information Exchange and Referral System (Sikhottabong and Nong Khai Province/ Sangthong and Nong Khai Province) was useful for the public health network. In 2012, the referral report showed that it found 34 TB cases. 25 out of 34 foreign patients decided to transfer back to Lao PDR which represented 73.52%. While, 26.47% decided to recover on the Thai border which was 9 TB cases. In 2013, the total number of TB cases decreased to 7 show-up cases. The patients decided to transfer 3 cases, meanwhile 4 cases decided to receive the medical treatment in Thailand. In 2014, the total number of TB cases showed 8 cases. Six patients decided to receive the medical treatment in Nong Khai hospital reflecting 75% which 2 out of 6 were registered migrant workers who had welfare for their treatment. And the other 2 cases were transferred to Lao PDR via the referral system. In 2015, there were 17 TB cases and 10 patients decided to stay in Thailand which showed 58.82%. The others transferred to Lao PDR for recovery. Nong Khai Provincial Health Office set up a follow up meeting on the Development on Disease Surveillance and Referral System between Thabi and Sisattanak district together with a Study visit on Disease Surveillance and Public Health Service as well as updating and following the progress of systems and services. Mukdahan Provincial Health Office managed a Pre-Departure Program Workshop between Savannakhet-Nakhon Phanom-Amnat Charoen-Ubon

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Ratchathani Province that invited 50 participants from three countries. The workshop took two days that provided a pre-departure network to cooperate effectively. In order to enhance and accelerate cooperation in disease control and prevention in border areas together with developing a reporting system on emerging and re-emerging communicable diseases, Mukdahan Provincial Health Office offered a Training Course on SRRT for Mukdahan, QuangTri and Savannakhet Health Personnel. The topic was related to human and animal health and the parallel activities were Tabletop Exercises and a Drill Exercise of the Referral System to strengthen Animal- Human interface under IHR 2005. They also organized a site visit for Laotians. This training and study visit on SRRT for Surveillance prevention and control Muk- QuangTri-SVK was held in September 2014. A Pre-departure Program Workshop for Laotian Workers between Champasack Province, Lao PDR and Ubon Ratchathani Province, Thailand was organized by Ubon Ratchathani Provincial Health Office. It aimed at understanding a Pre-departure Program for Laotian workers and informing Laotian workers about reproductive health, rights, and public health accessibility. Plus, it aimed at developing a database of migrant workers. The total number of participants was 50 health personnel; the number of Thai participants was 25, the number of Laotian participants was 20, and the number of Cambodian participants was 5. A Pre- departure Program workshop was divided into 3 levels. The first workshop focused on related organizations or sectors, the second targeted governmental officials, and the last workshop focused on business owners. Then, a committee was set up at the checkpoint in border areas to produce an evaluation form for the pre-departure program. Before the departure, migrant workers will ensure being educated on reproductive health, communicable diseases, HIV-AIDS, TB, and STIs as well as laws and regulations at the consulate or embassy. After the workshop, they launched three MODs and one SOP. Ubon Ratchathani Provincial Health Office was concerned more on providing a service and referral system. The 2015 International Consultation Meeting on Referral Service Development for all Diseases and all Systems, Ubon Ratchathani (Minutes of Meeting) between Preah Vihear Provincial Department of Health of Royal Kingdom of Cambodia, Provincial Department of Health of

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Champasack, Salavane and Savannakhet, Lao People’s Democratic Republic and Ubon Ratchathani Provincial Public Health Office of Royal Kingdom of Thailand) was held on 22-24 June 2015 in Ubon Rachathani province. The objectives were for developing an international referral system and strengthening the international health cooperation network. The participants understood more about each other‟s referral system, so the international referral system network would be able to work properly both in government and private hospitals. They also agreed to establish an information development center to exchange public health information. Minutes of Discussion launched in four languages (Thai-Laotian-Burmese-Cambodian-English). The meeting suggested that the international referral system between Thailand-Lao PDR- Cambodia should implement the same system/pattern. For example, the general form will be attached to patient, so he/she is able to submit to a doctor in his/her country. The general form is the main material to follow up via mail, fax or LINE application, as well as, it should be treated as a checkpoint document. In 2014, there were 60 health personnel; the number of Thai participants was 35, the number of Laotian participants was 20, and the number of Cambodian participants was 5 at a Meeting on Referral Service Development for all Diseases and all Systems. The content of the meeting was about the referral system, transfer database, and focal point. In 2015, the continued activity towards a Referral Service Development for all Diseases and all Systems was again organized to strengthen the international health cooperation network. The total number of participants extended to 90 health personnel consisting of 20 doctors from Champasack, Salavane and Savannakhet province, 5 Cambodian doctors from Preah Vihear province, and the other 65 were health personnel from Thailand-Lao PDR-Cambodia borders. The experts invited from UNAIDS, International Cooperation Bureau, Mukdahan Provincial Health Office, hospitals in Ubon Ratchathani, and Champasack, Salavane and Savannakhet/Preah Vihear Public Health offices. They drafted a MOU on public health cooperation and published a guideline for an international referral system with a standard form as the meeting results. Ubon Ratchathani had a large checkpoint, thus they were concerned more on a Pre-Departure Program Workshop for Foreign Workers. The workshop was set up to prepare and clarify the purpose of the activity. A survey located in four

Ref. code: 25605503040163UXQ 115 districts on the borders. As the result, it found that there were both legal workers and illegal migrant workers staying in four districts. This workshop was associated with improving the database of migrant workers. Along the Myanmar and Thailand border, Epidemiology report (EPI report) showed that it found 38 cases. 23 out of 38 were from the Thai population which showed 60.53% in 2013. And the other 39.47% were from the Burmese population. In 2014, the total number of EPI cases found in Tak province was 10 cases. The number had decreased dramatically and represented 7 cases from the Thai population, and 2 cases were Burmese. In 2015, the half-year report showed that there were 3 EPI cases in Tak area of which 1 case was Thai and 2 cases were Burmese. The Vaccine-Preventable Disease Service in Border Area, Tak Provincial Health Office supported 7 clinics in Myanmar. The total number of vaccine receivers was 280 cases. The service was provided to foreigners who were living in the border area. The Thai health office provided vaccine for 5 districts on the Myanmar border. Also, the activity consisted of a training course for EPI workers at which 70 workers came from Tak province and 4 workers came from Myawady. The fifth pilot provided by TICA was to develop a service and referral system along the CLM border area. Thai provincial health offices organized training courses, setting up system and service management as the topics. The activities in Pilot 5 proposed to establish a communication network for public health cooperation as well as to establish a system or health network for preventing outbreaks. The similarity of CLM activities was based on the referral system and service. Cambodia emphasized on human resource development of the referral system. Lao PDR emphasized more on a system for information exchange and database sharing. Myanmar did not emphasize on human resource development, however, it focused on a service for disease prevention.

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Table 4.6 Pilot 6: Assessment and Evaluation

Country Activities Monitoring pre/post activities Cambodia Monitoring of the referral system between Trat-Koh Kong province Assessment and evaluation of training courses Follow up SRRT on TB and HIV AIDS between Nong Khai and Vientiane province SOP activities follow IHR2005 Monitoring of Foreign Health Volunteers Lao PDR Follow up meetings under Princess Sirindhorn‟s Projects Follow up the SOP of teacher and young health volunteers under Princess Sirindhorn‟s Projects Assessment and evaluation Follow up the procedure for international health cooperation Lao PDR/Cambodia between Thailand-Lao PDR-Myanmar Monitoring by Border Health Committee Myanmar Monitoring of Foreign Health Volunteers Assessment and evaluation

Pilot 6: Assessment and Evaluation

Assessment and Evaluation are important activities to review and analyze the results of the project, thus this sixth pilot is applied to all CLM countries. Some activities need only monitoring, such as the system, some need to be followed up. For example, for Cambodia, Trat provincial health office creates an assessment at the end of each training course. As well, they monitor the international referral system on HIV/AIDS particularly. In terms of Lao PDR, assessment and evaluation will be reviewed by monthly, mid-year, and annual reports. The follow up meetings were organized for SRRT on TB and HIV/AIDS and also the projects of Princess Sirindhorn. The evaluation will be conducted by both the Thai and Laotian sides. In Myanmar, the activities of this project will be monitored by the Border Health Committee twice a year.

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In conclusion, the development cooperation in public health: A Case Study of Building Awareness and Preparedness for Communicable Disease and Emerging Disease along the Thailand-CLM Borders was considered as a short term strategy. The overall project can be proved to be a positive result of taking a proactive, holistic approach towards international health cooperation. The functions of the MFA and MoPH represent cross-cutting and supporting each other. The main role of TICA was as a project coordinator or moderator. The main role of the provincial health offices, on the other hand, as a project implementer can be considered one of the most important factors for creating awareness and mutual trust among neighbors.TICA attempted to build mutual understanding, mutual trust and strengthening the relationship through development cooperation strategies. All the activities were in accordance with six main pilots, introduced by TICA, that have proceeded at the provincial level for policy implementation. The practitioner interacts directly with health personnel from CLM countries. They cooperate and collaborate in various forms of activities, such as meetings, training courses, study visits, tabletop exercises or website establishment. There are different levels of target participants, such as, doctors, nurses, health volunteers, or health officers. Some activities involve cooperation between two general hospitals for sharing knowledge and experience. These cross border interactions can be considered as inter-agency cooperation as well as being sub-governmental agencies. In a similar way TICA synergized its project with the Department of Disease Control, MoPH. The next chapter will explore a SWOT analysis for conceptualizing the strengths, weaknesses, opportunities and threats of this project. It will also provide a theoretical contribution and policy recommendations.

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CHAPTER 5 CONCLUSIONS AND RECOMMENDATIONS

5.1 Conclusions

The Royal Thai Government integrates a holistic approach towards international health cooperation. The common threat in human security, especially, communicable and emerging communicable diseases, turned out to be a priority awareness mentioned in the national economic and social development plan as well as security stability. It is necessary for states‟ sovereignty to protect its citizens against human security threats by seeking cooperation. Awareness and preparedness in communicable and emerging communicable diseases by the government sector will be a positive way for cooperating and collaborating in public health. It is an opportunity for the MFA to strengthen relationships between Thailand and its neighbors. The results, based on a liberal perspective, provide confirmatory evidence similarly to Fidler (2003) that the common security approach broadens the security agenda to include transnational phenomena that threaten the security of individuals and communities, including disease epidemics. The common security philosophy stresses the interdependence of individual, national, and international security in the same way as liberalism. Border areas are determined as one of the most important geographical locations in terms of non-traditional threats including emerging communicable diseases. Increasing engagements of Thai government policies towards public health in border areas seems like a good response to the globalization process. The Prime Minister‟s Office, Ministry of Public Health and Ministry of Foreign Affairs collaborated in international health cooperation together with CLM countries. Lamy (2011, p. 121) claimed that “community integration is motivated to respond to regional problems”. By increasing awareness and preparedness in disease prevention, the Thai government has utilized the development cooperation strategy as a mechanism to promote health diplomacy. In the twenty first century, International Relations (IR) includes multidimensional relations both domestically and internationally. During 2012-2015,

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TICA played an important role as a government representative or mediator to promote international relations and endorse Thailand’s foreign policy. The main role and responsibility is a development diplomacy. Its activities are considered from a neoliberal perspective as expecting mutual action between Thailand and neighboring countries. The role of TICA lends support to the claim that “neoliberal institutionalists see institutions as the mediator and the means to achieve cooperation in the international system” (Lamy, 2011, p. 121). It concentrated on policy connectivity with economics and sociology for strengthening mutual trust and understanding in the border area. By pursuing a development cooperation channel with CLM countries, one of the selected projects under TICA was a project on “Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand- Cambodia-Lao PDR-Myanmar Borders”. TICA introduced the following six main pilots including 1) Preventive Strategy: Building Awareness and Preparedness, 2) Information exchange centers, 3) Developing and maintaining information exchange centers and communication channels, 4) Human Resource Development, 5) Service and Referral Systems, and 6) Assessment and Evaluation. Six pilots set up a field of common interest between Thailand and neighboring countries where they could cooperate and collaborate in disease prevention together with enhancing and maintaining good relationships between both countries and even trilateral cooperation. It is also a uniqueness of TICA‟s activity that brought together Thailand expertise and international relations in order to enhance and promote the relationship with foreign countries. TICA‟s six pilots pointed out the basis on liberal perspective meaning that the idea of disease prevention needs cooperation among states to protect their prosperity and interests. Along similar lines, Acharya (2001) states that the primary goals of states in liberal theory are to cooperate and coordinate for achieving collective goals which is World peace. In general, a collective security system is the mostly preferred international order with free trade, liberal democracy and institutions. Similarly, when countries in a liberal world face transnational issues, security regimes are a beneficial collaboration, that arise from growing interdependence, to manage disputes. All activities contributed by TICA moreover support Acharya‟s perspective towards

Ref. code: 25605503040163UXQ 120 liberal institutionalism, he hypothesised that “states nowadays a growing interdependence, so they rather emphasize on the contribution of international organizations in fostering collective security, managing conflict, and promoting cooperation than armed force or conflict” (Shambaugh & Yahuda, 2008, p. 66). Referring to communicable disease issues, information sharing and promoting cooperation are important keys, these state behaviors would pave the way for mutual benefit as well as to strengthen preventive action in any crisis. It can be said that international health cooperation and collaboration will broaden human security, national interest and regional stability. As you can see, TICA‟s activities go along in the same direction. The more cooperation between Thailand and CLM countries, the stronger the health network is in disease prevention. The awareness of the border health issue will foster the relationship between Thailand and CLM countries. TICA‟s implementation of Thailand‟s foreign policy in health cooperation has led to a greater relationship between Thailand and CLM countries. As foreign policy has multidimensional aspects, international health cooperation, according to TICA‟s project, spills over into the roles of developing relationships to promote awareness on common threats in borders that impact Thailand. It will be more beneficial that TICA has integrated public health in international relations because health issues have been prioritized as basic human security. It further responds to common human security in the global trend that will be able to create mutual trust among countries. TICA, in addition, has obvious roles and responsibilities with a great potential for budget allocation in terms of Official Development Assistance (ODA), general budget, or a contingency fund for supporting development cooperation in the health sector. From a trans-governmental perspective, TICA as a governmental organization interacts with current global issues actively, on communicable and emerging communicable diseases in particular. Its role and function in developing cooperation and relations reflect the implementation of foreign policy in health cooperation. A SWOT analysis will be applied to the Thai government‟s role towards international collaboration regarding the project on “Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-Cambodia-Lao PDR-Myanmar Borders”.SWOT will identify strengths, weaknesses, opportunities and threats of project implementation and also split the

Ref. code: 25605503040163UXQ 121 analysis into internal factors and external factors that influence the organization‟s action so on and so forth.The decision to choose a SWOT analysis instead of other mechanisms is as clear-cut as the accepted views might suggest.

5.2 SWOT Analysis

5.2.1 Strengths

The strongest point of the project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders is the response to current global issues in terms of common human security. Public health issues, particularly communicable and emerging communicable diseases, are determined as a global trend which is highlighted and aware of in the international sphere. This type of security threat is regularly prioritized in Global Goals, SDGs for example. From a liberal perspective, the project was related to human security issues needing cooperation for building awareness and preventing a common threat. The Royal Thai Government has set the public health agenda in the national plan, it points out that the government considers public health issues for long term implementation. The National Economic and Social Development Plan, for example, is a national flagship that will not be modified depending on political changes. It means that budget allocation is one of the important factors and it would continue and correlate with long term planning. The government consideration reflects more on human security shown in Thailand‟s Development Strategy for National Security Reinforcement, Country Strategy, Border Health Development Master Plan, and foreign policy, etc. Policy integration is accounted for as a strength as mentioned earlier in Chapter 2 that the project has multi-stakeholders. This project runs under governmental organizations mainly the Ministry of Foreign Affairs and Ministry of Public Health, and Office of Prime Minister. The Project background is based on creating awareness and preparedness for communicable and emerging diseases along border areas, but it has yet to be a model for cooperation between Thailand and neighboring countries. It is a cross-cutting issue in both international relations and public health perspectives. Public health policy towards disease prevention is

Ref. code: 25605503040163UXQ 122 apparent, while foreign policy toward public health is still subtext and implicit. Thailand International Cooperation Agency (TICA) plays an important role in promoting development cooperation and developing relationships between Thailand and neighboring countries. The Department of Disease Control takes account of disease prevention and provincial health offices also work as project implementers. Although, the strategic implementers are the provincial health offices in border areas, they represent the Royal Thai Government, meaning that it is a respectable and reliable organization for collaborating and developing relations. In the perspective of “trans-governmentalism refers to the intensive and continuous consultation process by which subunits of national governments form international coalitions across national boundaries” (Cutler, 2006, pp. 79-80). TICA, as well as, other stakeholders perform active roles and functions in international health cooperation and state relationships between Thailand and CLM countries. Some meetings were arranged as official meetings at the state level at which the conclusions led to Memorandums of Understanding (MOU), Minutes of Discussion (MOD), or agreements on public health cooperation. MOU, MOD, or agreements were official agreements between government sectors. The significance of TICA‟s project is multidimensional relations within governmental organizations applying inter-agency working at the ministerial and provincial level. For example, TICA staff worked closely with the Department of Disease Control staff. TICA staff also worked together with health personnel in provincial health offices along border areas for monitoring and evaluating all activities. The inter-agency working process further functions at the international level. For example, both Thai and neighboring countries‟ health personnel organized activities and trained together. Partnership and health networking among border health personnel were built up at district and provincial level, Lao PDR had good cooperation and relationships with the Thai side. As a result, border health cooperation with Lao PDR enhances other districts and matches with more twin cities. Liberal thinking believes that raising awareness derives from cooperation and then spills over to other forms of cooperation and/or sectors. The project on Building Awareness and Preparedness for Communicable Disease and Emerging Disease along the Thailand-CLM borders has involved

Ref. code: 25605503040163UXQ 123 bureaucratic perspectives which are in the Thai governing system. For instance, Director-General of TICA and policy makers of public health were concerned about a common security threat, so they established the project on health cooperation. Thai and Laotian public health directors were concerned about the importance of prevention of communicable and emerging communicable diseases along the border areas. The government of Myanmar also supports the project continuously and the Ministry of Health of the Myanmar government agrees to implement the project. In terms of geographical proximity, Cambodia, Lao PDR, and Myanmar location was a strong point for cooperation in preventing communicable and emerging communicable diseases. The physical relationship makes it unavoidable for interaction between Thailand and neighbors. The interaction leads to cooperation and interdependence. For a cooperation project, their close proximity would be advantageous to implementing and arranging activities.

5.2.2 Weaknesses

Geographical proximity is not only a strength but also a weakness in the SWOT analysis. There is no boundary on cross border health. Unclear physical borders, such as traditional customs or natural border paths, causes uncontrollable prevention. For example, Laotians cross the Mekong River through traditional customs. Another problem of unclear physical borders is the import and export of health products illegally. Therefore, the project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand- CLM borders will not be effective and able to prevent the movement of labor force or migrants where there are unclear physical borders. The weak point of this project is budget allocation efficiency. In fact, TICA provides the highest budget on development cooperation in public health in CLM countries compared to MoPH, MFA excluded TICA, and the TICA budget was allocated according to Chapter 3 (Table 3.4, 3.5, and 3.6). Since the budget of the project is a specific type, the contingency fund, which is restricted in the first place for spending in neighboring countries. The first year of the project, implementers spent only on Thailand's boundary. Thus, Thai personnel have less opportunity to exchange border health information or survey directly. Moreover, hiring a project

Ref. code: 25605503040163UXQ 124 coordinator or translator is not allowed at the beginning of the project according to the country's budget regulation. TICA, a project moderator, figured this problem out by transferring money to TICA management, so expenditure of the budget was better in the second year of the project. Time constraint is disadvantageous to this project in that all activities provided by provincial health offices must finish within three years according to the project timeline. A short period project hardly builds awareness the particular issue, as well as, time constraint leads to limitations to the working period. One piece of feedback from the project implementer is that it is hard to find a project coordinator for a short term project. For a website, the project implementer needs to rent host and domain for year-by-year. It is a management obstacle if the project ends. Since the MoPH has overlapping policies and strategies towards disease prevention in border areas, there are some activities which are duplicates of TICA‟s projects. For example, the Training Course on Public Health Awareness for Community Volunteers in Myanmar is similar to the MoPH‟s strategy in neighboring countries. According to the feedback of Thai provincial health personnel workload and complicated duties are other weaknesses. The policy maker or planner should have shown more concern to the duplication of roles and responsibilities. Communication technology is an internal weak point of this project. The communication channel tends to be an important mechanism for sharing and exchanging information which is a primary emphasis shown in Pilot 2. A Website, is one communication channel, needing more development and further discussion between the two sides. Also, the consistency and continuity of information exchange is associated with website completion. Low technology in working places especially in CLM countries causes a longer time for collaboration. For example, Lao PDR has limited budget for IT personnel and a lack of internet access, so it is difficult to work according to the timeline. Language is the main obstacle to communication in Myanmar and Cambodia.Between Thai and Cambodian health personnel, an interpreter is needed to solve this problem and also they employ some Cambodian interpreters working at the general hospital to reduce the communication gap between doctors and patients. For Lao PDR, verbal communication is easier than Myanmar and Cambodia. Also, the

Ref. code: 25605503040163UXQ 125 official language is a little bit different, so it needs more time to revise and edit information accurately. Besides verbal communication, the language usage on the website needs to be bilingual language and there needs to be an official language for publications. Ubon Rachathani province, for example, Minutes of Discussion of International Consultation Meeting on Referral Service Development for all Diseases and all Systems launched in four languages including Thai-Laotian-Burmese- Cambodian-English. A lack of integration of related organizations, such as NGOs, INGOs, or IOs, to collaborate on public health, is a weakness for international relations. For example, international organizations related to the public health sector including Global Fund, IRC, TUC, YMCA, etc. Fund raising among NGOs, INGOs, or IOs for providing aid and strengthening of issue points that TICA is one funding organization for border health issues, but there are a variety of funding sources including MoPH, NGOs, INGOs, or local organizations. Integration will extend the activity to be more sustainable and self-reliant in the future plan. The adaptation of government bureaucrats is low speed in comparison with current global issues. Some government bureaucrats are still using traditional ways of working which cannot respond to the globalization context.

5.2.3 Opportunities

By setting up the field of common interest, one of the noted opportunities in this project is the concept of Sustainable Development Goals (SDGs). A Global Agenda framework towards public health is a priority consideration for many states and international organizations, so it leads to an extension of cooperation. The United Nations stated that “Goal 3 seeks to ensure health and well-being for all, at every stage of life. The Goal addresses all major health priorities, including… communicable, non-communicable and environmental diseases” (2016, para.1). The public health issues are threat apprehensions in the international sphere which relates to human well-being, economics and social stability which needs cooperation for building awareness at many levels including individual, national, and international levels. It encourages stronger awareness and concern which would be able to draw foreign aid from IOs for developing and sustaining the project on Building Awareness

Ref. code: 25605503040163UXQ 126 and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders. From a liberal perspective, one type of cooperation will spill over to another type of cooperation similar to the phenomenon of functionalism. It is an opportunity of this project in order to broaden the development cooperation leading to international health cooperation, and so on with regard to regional connectivity and the global agenda. Public health cooperation shapes multidimensional relations in the process, both at the domestic and international level. For example, TICA and Thai public health staff have a good relationship and more understanding about working process. At the international level, health personnel in CLM countries have an inclusive communication channel with the Thai side. The enhancement of cooperation in the border health network is built up at district and provincial level. The result of some meetings illustrated that bilateral relations between two countries such as Memorandums of Understanding (MOU) on Public Health in Thailand-Cambodia borders, MOU on Disease Surveillance and Communicable Disease Control along the border areas between Nong Khai and Vientiane province, and etc. Deputy Director- General of Department of Disease Control, Ministry of Public Health and Deputy Director-General of Department of Communicable Disease Control, Ministry of Health Lao PDR participated in a Workshop on the Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases in Nong Khai and Vientiane province on 22nd September 2015, at Asawann Hotel, Nong Khai Province (Manager Online, 2015). This project had an opportunity to not only support TICA partnership countries, but also strengthen the provincial health network in the border area. It has led to an opportunity for expediting cooperation across the board and supporting Universal Health Coverage along the borders. The Project‟s spillover brings about regional cooperation, Thailand is a key player for mobilizing cooperation in South East Asia. Thailand and CLM countries collaborate in different frameworks including Association of Southeast Asian Nations (ASEAN), Greater Mekong Subregion (GMS), Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy (ACMECS), etc. Regional frameworks together implement SDGs for their action plans which are perceived as an opportunity for TICA‟s project. ASEAN (2016, para. 1) “ASEAN recognizes the

Ref. code: 25605503040163UXQ 127 importance of creating synergy between the mutually-reinforcing ASEAN 2025 Blueprints and the SDGs within the framework of ASEAN-UN cooperation”. GMS (2015, para. 2) applies SDGs to “build regional capacity for tracking progress on SDGs and find means to enable the SDGs to become a pathway for enhancing natural capital in the sub-region”. The difference depends upon the cooperation context as well as the purpose of each framework. The fundamental activities in regional cooperation are networking and information exchange that bring about mutual interest and reliability on each other. Public health is a priority issue that generates the idea of the development cooperation in preventing communicable diseases and emerging communicable diseases. In Thailand, Special Economic Zones (SEZs) (phase 1) covers five provinces including Tak, Sa Kaeo, Trat, Mukdahan, and Songkhla provinces where a project on Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-CLM borders targets four provinces except Songkhla province. The Council for the Development of Cambodia (CDC), Cambodian Investment Board (CIB) & Cambodian Special Economic Zone Board (CSEZB) (2015) listed 14 SEZs where there are three SEZs located in the target area of this project consisting of Neang Kok Koh Kong SEZ in Koh Kong Province, Poi Pet O‟Neang SEZ and Sanco Poi Pet SEZ in Banteay Meanchey Province. For Lao PDR‟s SEZs, ASEAN Briefing (2015, para. 2) noted that “there are two types of economic zones in Laos, Special Economic Zones and Specific Economic Zones.” The location of Laos SEZs called “the Savan-Seno Zone SEZ located in Savannakhet Province and the Golden Triangle SEZ located in the sub-Mekong region close to Myanmar, Thailand, and China borders…Specific Economic Zones are mostly located near the capital city of Vientiane” (ASEAN Briefing, 2015, para. 2). Myanmar also established SEZs including Dawei SEZ, Thilawa SEZ and Kyuakpyu SEZ. The area is considered as a governmental mechanism to stimulate economic development in domestic and cross border trade. All government sectors have linkage to SEZ and their policy and strategy. Special Economic Zones (SEZs) is the external factor supporting the project‟s opportunity to enhance border cooperation which will lead to awareness of the common security threat as well as promote mutual benefit in international health cooperation.

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Another opportunity derived from external factors, is regional credibility. As ASEAN has promoted ASEAN Socio-Cultural Community (ASCC) that proposes “to contribute to realizing an ASEAN Community… It seeks to forge a common identity and build a caring and sharing society which is inclusive and where the well- being, livelihood, and welfare of the peoples are enhanced” (ASEAN, n.d., para. 1). When Thailand and CLM countries reach regional health standards, it would be accepted and reliable on the global stage. For example, some activities provided an activity framework under International Health Regulation 2005 which is “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade” (WHO, 2008, p. 10). Thailand seems to be a role model in disease control by having a positive performance to international regulations.

5.2.4 Threats

The most important challenge of this project deriving from external factors is an unexpected outbreak. The outbreak of infectious diseases spread quickly due to many reasons. Some emerging diseases do not show symptoms and some re-emerging communicable diseases have doubled in violence and have no medicine for recovery. An outbreak influences severe impacts both demographically and economically. It is an uncontrollable external factor impact. Culture and tradition divergence is another external challenge for carrying this project. International relations is faced with a variety of culture and tradition. Language is considered as a cultural factor that is a channel to deliver messages and communicate with others. Thai and Laos citizens have commonality in verbal communication, however, they need an official language for document application. Some activities in Cambodia require interpreters and some are conducted in Khmer language. The lesson learned from divergence is that the meeting can create a more understandable sphere for cooperation and collaboration. They learned the way to contact with Lao PDR which was different to contacting Cambodia. Moreover, the sensitivity of culture, tradition and communication were included in the meeting agenda.

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Working culture also causes obstacles. For instance, the high ranking bureaucrats must approve the working direction of Thai governmental organizations and the governmental system takes longer time than private sector. Working with Myanmar, there was some need for diplomatic channels to coordinate. The two countries need to adapt their working process. Political will in both Thailand and neighboring countries is one of the minor external impacts on any public health project, it influences policy commitment and budget allocation. The domestic agenda in CLM countries might be rather more highlighted than cross border health issues. Since the transformation of the Myanmar governing system, domestic changes within society will be more concerned about developing economic reform and social structure. Government Change and border security dominate project development as external factors. The project continuity depends on and is decided by the governmental sector. If government changes, border health policy might be changed accordingly. All involved provincial health staff have concerns about the political situation in border areas. There are various tribes or races that live in the contiguous area, sometimes disputes or conflict happen. The uncontrolled external factor that has challenged TICA‟s project is law and regulation of CLM countries. For example, in Lao PDR, website content is monitored and enforced by national laws and regulation. Nevertheless the official information is hardly published or shared with the Thai side. Nong Khai Provincial Health Office is still negotiating regarding this issue. Special Economic Zones (SEZs) are both an opportunity and challenging factor toward TICA‟s project because the promotion of a particular area is an attractive investment sector and encourages labor movement. For the threat, SEZ brings about many impacts including the number of migrant workers who would like to work across the border. Some are infectious carriers and they also use natural resources in the Thai border area. Some work illegally which, is the cause of the following problems:

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Table 5.1 SWOT Analysis

Strengths Weaknesses Current global issues Geographical proximity Government consideration Budget allocation efficiency Policy integration Time constraints Internal Multi-stakeholder Duplication/Workload Factor Multidimensional relations Communication technology Bureaucratic perspectives Language Geographical proximity A lack of integration of related organizations Government bureaucrats Opportunities Threats Sustainable Development Goals Unexpected outbreaks (SDGs) Culture and tradition divergence External Threat Apprehensions Working culture Factor Multidimensional relations Political will Regional cooperation Government change and border security Special Economic Zones (SEZs) Law and regulation Regional credibility Special Economic Zones (SEZ)

5.3 Theoretical Contribution and Policy Recommendations

Mutual threats, in terms of public health issues, are acknowledged as a Global Agenda which draw attention and create awareness not only to domestic prevention, but also to regional cooperation and international responses. International relations today exercise multidimensional relations employing a liberal thought to protect human and national security. It is evident reflecting on a project of TICA that it applied a liberal perspective in the form of cooperation or information sharing to prevent mutual threats like communicable and emerging communicable diseases. Common threats, in addition, expanded state cooperation to governmental sub-agency cooperation regarding trans-governmentalism. States‟ sub-agencies play an active role in driving international relations. In this study, TICA and provincial health offices are

Ref. code: 25605503040163UXQ 131 important actors in implementing international health cooperation. Their functions will be more active and create greater involvement in foreign relations. The expansion of cooperation spills over to the role of maintaining good relationships among neighboring countries to build awareness of common threats. It can be said that TICA‟s project has a multi-dimensional and cross-cutting function. The MFA‟s functions enhance the roles and duties to support international health cooperation to get along well with public health agencies and sub-agencies. MoPH‟s functions are to contribute to all dimensions on public health including treatment, care, control and prevention, so it needs the MFA to fulfill its functions on international cooperation and collaboration. Last but not least, the project has a multidimensional relationship aspect towards inter-agency cooperation likely “neoliberal institutionalists see institutions as the mediator and the means to achieve cooperation in the international system” (Lamy, 2011, p.121). There have been spillovers into health issues, crossborder cooperation, international health cooperation, etc. Thailand‟s foreign policy has been implemented to ensure a development cooperation strategy in public health by TICA which has its approaches and contributions based on liberal perspectives. As Acharya (2001) states that the primary goals of states in liberal theory are to cooperate and coordinate for achieving collective goals. TICA establishes six pilots under the project which reflect also on the notion of liberalism to encourage the field of common interest. Cooperating and collaborating in disease prevention will lead to having both mutual trust and mutual understanding between countries. The weakness of this study is that it may overlook the considerations of the Thai state‟s intention. For example, realists or Marxists might argue that the cooperative health policy of Thailand towards CLM may represent its hegemonic role in the region. This paves the way for further research agenda to cover in depth the intention of the states. In addition, the overall activities of TICA‟s project could not be covered because of time constraints. As well, some aspects of this topic still remained untouched so they need to be further studied. Recommendations for further study are to investigate more on foreign countries‟ policy and strategy towards public health along border areas as well as to expand the information related to the international public health agenda such as WHO, SDGs, and etc.

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Based on the SWOT analysis, recommendations to solve weaknesses and threats will be divided into two sectors consisting of the Royal Thai Government and Thailand International Cooperation Agency (TICA). On the basis of the evidence currently available, the suggestions for the Royal Thai Government are as follows: 1. For a national plan, the Royal Thai Government should highlight a strong direction regarding international health cooperation, especially, cross border issues. As they are threat apprehensions among Thailand and neighboring countries, the government should promote policy towards development cooperation in public health related to Global Agenda (SDGs) or regional cooperation (ASCC, GMS, or EWEC) for enhancing cooperation and relations. 2. The development cooperation project in public health between Thailand and CLM countries provides opportunities both economically and socially. Thailand‟s foreign policy should be proactive and stand ready to cooperate with international actors or international organizations. Not only can governmental organizations enhance the prevention of emerging communicable diseases, but NGOs, INGOs, the provincial or private sector, can also be considered as a part of the preventive organizations. Creating awareness on communicable or emerging communicable diseases needs more integration of organizations or sectors. 3. Cooperation with international organizations will be beneficial to Thai projects in terms of government expenditure. The projects related to common threats will be able to raise aid or even share budgets with other stakeholders. As well, working together with international organizations would stimulate government bureaucrat performance and share lessons-learned with others. 4. In terms of geographic proximity, Thailand and its neighboring countries should set up permanent checkpoints or border trade checkpoints to solve unclear physical border issues to prevent the spread of communicable diseases. The recommendations for TICA are as follows: 1. A project on “Building Awareness and Preparedness for Communicable Diseases and Emerging Diseases along the Thailand-Cambodia-Lao PDR-Myanmar is a part of a TICA cooperation project. TICA currently provides a lot of projects on development cooperation in public health. The policy and strategy planning of TICA

Ref. code: 25605503040163UXQ 133 should integrate this project with other projects, such as, the Development Project of Emergency Department at Dawei General Hospital, the Development Project of Paksong General Hospital, and scholarships for health personnel from neighboring countries. This integration will contribute to more sustainability and mutual interest. 2. This project budget is allocated from a contingency fund implying that it is a short-term strategy. Time constraint has an effect on awareness and preparedness for public health issues. 3. Thai Cooperation Branch I, a project owner, should invite more participants meaning that the internal branch such as Countries Partnership Branch (Bilateral and Trilateral Cooperation), and International Organizations Partnership Branch (Multilateral Cooperation) could extend the cooperation potential with international organizations. Further participations would support TICA spilling over the project to not only sub-regional cooperation, but regional cooperation. 4. At the end of the project, TICA should regularly establish the lessons- learned meeting or experience sharing among staff for evaluation and feedback from project implementers.

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BIOGRAPHY

Name Miss Supamon Ingkhapradit Date of Birth November 24, 1989 Educational Attainment 2012: Bachelor of Journalism and Mass Communication 2015: Bachelor of Arts in Information Science Work Experiences 2016 –2016 Training Coordinator under Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration (CDC) 2014 – 2016 Project Coordinator Thailand International Cooperation Agency, Ministry of Foreign Affairs 2012 – 2013 Public relations officer TOT Corporation Public Company Limited

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