Chapter Thai Traditional and 3 Indigenous Medicine Services Systems The systems of Thai traditional medicine (TTM) and indigenous medicine (IM) services have special features that are different from those in the modern medical system in that TTM/IM practices have been a Thai lifestyle since ancient times with the Buddhist temples (or wat) being the centres of TTM instruction or teaching/learning as well as treatment of illnesses. Besides, the story about TTM was first evidenced in the directory of feudal status in terms of farmland (or sakdina in rai, which is equivalent to 1,600 sq.m. (0.4 acre) enacted by King Trailokanat in 1455 for civil servants in various departments, i.e. Departments of Medical Services (Krom Phaettaya), Pharmacy (Krom Phaettaya Rongphra-osot), Internal Medicine (Krom Moh Ya), Massage Therapy (Krom Moh Nuad), Ophthalmology (Krom Moh Ya Ta), and Tuberculosis (Krom Moh Wannarok). Later on, Western or modern medicine was introduced during the reign of King Chulalongkorn (Rama V) when a medical school was established in 1900; and both TTM and modern medicine disciplines were taught during the first phase of the school’s operations. Until the reign of King Rama VI, the TTM teaching and learning at the medical school Health Profi 1-6.indd 73 2/10/2557 22:47 was discontinued in 1915, resulting in TTM not being supported by the government. However, some TTM practitioners assembled and got many TTM associations established for teaching or training in TTM and providing TTM services. Then the TTM system was chiefly run by the popular sector and the teaching was undertaken only for their children or grandchildren who were interested in learning the traditional practices. So, TTM services continue to be provided to those who still have faith and confidence in such services until today. When the World Health Organization (WHO) declared the “Health for All by the Year 2000” or primary health care (PHC)” policy in 1978 and Thailand also adopted the PHC policy in its national health plans beginning in 1977, the use of herbs or medicinal plants and Thai traditional medicine has been promoted and widespread across the country. Moreover, indigenous medicine has been more acceptable with a more apparent role in community health care. When Thai massage (kan nuad Thai) is widespread and highly popular at the international level, the state health-care system has turned to provide more support for TTM services particularly Thai massage for the clients. Actually, the TTM/IM services systems have taken root in the popular health sector for a long time since ancient times, and today the public sector has begun to play a greater role in the TTM system management, essentially in allocating the government budget for health services in the public sector. This chapter provides some information about: TTM/IM workforce, especially indigenous healers who are TTM practitioners as per Section 12(2)(a) and (b) of the TTM Professions Act B.E. 2556 (2013); TTM (service) facilities: accessibility/utilization of services; and TTM expenditure/ budget in the three major health insurance schemes, namely the Social Security Scheme (SSS), the Civil Servant Medical Benefit Scheme (CSMBS), and the Universal Health Coverage Scheme (UCS). 74 Health Profi 1-6.indd 74 2/10/2557 22:47 3.1 TTM/IM workforce: The workforce includes indigenous healers and TTM practitioners as per Section 12(2)(a) and (b); this section deals with: 1. Workforce situation and trends 2. Production situation 3. Workforce distribution 4. Workforce loss 3.2 TTM facilities Chapter 1. Situation and trends of TTM facilities 3 2. Distribution of TTM facilities 3. Standards of TTM services 3.3 Access to and utilization of TTM services 1. Number of service recipients 3.4 TTM programme expenditure 3.1 TTM/IM workforce According to the Practice of Healing Arts Act B.E. 2542 (1999), a “practitioner of healing arts” means a person who has been registered and licensed to be a practitioner of the healing arts by the Profession Commission”; and according to Section 33, the applicant for being registered and licensed as a practitioner in each branch of the healing arts shall have the following knowledge: (1) Branch of Thai traditional medicine (a) having been trained or passed on knowledge from the practitioner of healing arts who is permitted to pass on knowledge in the institution or medical centre certified by the TTM Profession Commission under the rules, procedures, and conditions prescribed in the Ministerial Regulation and passed the test of the TTM Profession Commission; or 75 Health Profi 1-6.indd 75 2/10/2557 22:47 (b) having been trained from the Thai traditional medical institution certified by the TTM Profession Commission; the Commission may test the applicant’s knowledge according to the rules, procedures, and conditions prescribed by the Commission; or (c) being certified by a relevant government agency and passed an evaluation under the conditions set forth by the TTM Profession Commission. (2) Branch of applied Thai traditional medicine; the applicant must have obtained a degree or certificate from an institution certified by the Applied TTM Profession Commission; and the Commission may test the applicant’s knowledge according to the rules, procedures, and conditions prescribed by the Commission. At present, the TTM Professions Act B.E. 2556 (2013) prescribes that “Thai traditional medicine profession” means a profession dealing with the practices of Thai traditional medicine profession and the practices of applied Thai traditional medicine profession”; and according to Section 4, Thai traditional medicine professions include: (1) The practices of TTM professions, i.e. the professional practices of Thai medicine (wetchakam thai), Thai pharmacy (phesatchakam thai), Thai midwifery (kanphadungkhan thai), Thai massage (kannuat thai), Thai indigenous medicine (kanphaet phuenban thai), or any other branch of Thai traditional medicine as the Minister shall announce according to the advice of the TTM Profession Commission. (2) The practices of applied TTM profession; according to Chapter 2, Section 12, a member of the TTM Council shall have the following qualifications and shall not possess any of the following prohibitions: (2) Having the knowledge of TTM profession as follows: (a) having been trained in the institution or medical centre certified by the TTM Council and by the TTM practitioner who is permitted 76 Health Profi 1-6.indd 76 2/10/2557 22:47 to pass on knowledge, and passed the test prescribed in the Bye-law of the TTM Council; or (b) having obtained a degree or certificate equivalent to a degree in Thai traditional medicine or applied Thai traditional medicine from an institution certified by the TTM Council, and passed the test prescribed in the Bye-law of the TTM Council; or (c) being a person whose knowledge of indigenous medicine is certified by a relevant government agency by passing the evaluation or Chapter test prescribed in the Bye-law of the TTM Council. 3 Thus, the licensed TTM practitioners and licensed applied TTM practitioners according to the Practice of Healing Arts Act of 1999 have become the licensed practitioners in their respective branch according to the TTM Professions Act of 2013. In addition, the practices of TTM professions have included “Thai indigenous medicine” as another branch of TTM professions; thus, the TTM professions currently include Thai medicine, Thai pharmacy, Thai midwifery, Thai massage, and Thai indigenous medicine. The TTM educational and training system is divided into two levels: one is the institutions or medical centres certified by the TTM Council with a licensed TTM practitioner who is permitted to pass on knowledge to the learners, according to Section 12(2)(a), which corresponds to Section 33(1) of the old law. The other level is the degree or certificate equivalent to the degree in TTM or applied TTM from an educational institution certified by the TTM Council as per Section 12(2)(b), which corresponds to Section 33 (1)(b) of the old law; the practice of applied TTM has been included in this Section. This Chapter deals with the TTM and applied TTM workforce according to the TTM Professions Act of 2013. 77 Health Profi 1-6.indd 77 2/10/2557 22:47 A. Indigenous healers 1. Situation and trends of the workforce An indigenous healer1 means a person who is knowledgeable and capable of providing health care using local medical wisdom or knowledge. Normally, in every village there is a villager who is known to and acceptable by the community as an indigenous healer. According to the database of the Central Registrar’s Office of DTAM’s Bureau of the Protection of Thai Traditional Medical2 Knowledge, Thailand has 53,035 indigenous healers (March 2013), classified by their healing expertise into six groups, namely ritual healers (moh phithi-kam), masseurs or massage healers (moh nuad), traditional birth attendants (moh tam-yae), bone healers (moh raksa kra-dook), and others; among them, 16,000 have had more than 20 years of experiences. Regarding the knowledge assessment and licensing of indigenous healers, DTAM’s Bureau of Thai Indigenous Medicine conducted such tasks from 2005 until 2012 and has given a license to 161 TTM indigenous healers (June 2013). 1.1 Healing expertise Among the 161 licensed TTM practitioners (indigenous medicine), each individual healer may have one or more skills in the healing practices. However, most of them (115) are herbalists (herbal healers), and some others (36) are bone healers. 1 Statute of National Health System B.E. 2552 (A.D. 2009). 2 A person who is knowledgeable and capable of providing health care as well as health promotion to local residents using Thai local wisdom, based on community culture, passed on from generation to generation and recognized by at least 10 members of the community, or certified by the local government organization (in that locality).