Health in All Policies Thailand’s National Health Assembly – a means to Health in All Policies Authors Nanoot MathurapoteA, Tipicha PosayanondaA, Somkiat PitakkamonpornA, Wanvisa SaengtimA, Khanitta Sae-iewA, Weerasak PutthasriA ANational Health Commission Office, Thailand 3 Thailand’s National Health Assembly – a means to Health in All Policies Introduction (HiAP) approach on centre stage in policy decision-making. Since the global community announced the Alma-Ata Declaration on Primary Health Care The National Health Assembly (NHA) is in 19781 with the goal of Health for All, global one of several tools that the National Health development’s direction has gradually turned Commission applies to attain Health in All from economic-led growth to development which Policies. The National Health Commission has health as an integral part. This paradigm of Office (NHCO) is responsible for coordinating health was reiterated in 1986 with the Ottawa and facilitating the work of the National Health Charter on Health Promotion.2 Since then, the Assembly from developing policy proposals to health paradigm, which emphasises the social implementation, evaluation, and policy revision. determinants of health perspective, has been Apart from laws, governance bodies and HiAP multiplied in various concepts, approaches processes, success cannot be achieved without and activities such as healthy public policy, changing people’s mind-set. The National Health multisectoral action for health and Health in Act incorporates an expanded definition of All Policies. The launch of the Sustainable health to include the broader term of well-being Development Goals requires collaboration in which the physical, mental, spiritual and across sectors and participatory governance to social dimensions of health are in balance. This achieve all goals, especially Goal 3.3 Thailand broader definition allows the non-health sector, takes this opportunity to review our past especially civil society, to join the National Health implementation and plans to move forward Assembly. by improving the existing governance body, processes and tools. Vision, aims, objectives Thailand initiated health system reform around the late 1990s driven by the fact that despite low Vision child mortality rates and high life expectancy, the Health and well-being in Thailand is improved population still faced high levels of preventable through participatory public policies which are death and relied heavily on health care services, developed from evidence-based information contributing in turn to increasing levels of national with the active participation of multiple sectors health expenditure. A National Health System (government, academia and community). Report 2000, conducted by the Senate Committee on Public Health, recommended that Thailand Objectives required new laws and governance arrangements 1. Development, formulation, progression and to tackle the structural problems impacting on implementation of participatory public policies. health. Participation of the government sector, 2. Providing platforms and coordination of academia and civil society in decision-making various sectors in society to join in exchanging and a whole-society approach has underpinned knowledge and evidence-based information subsequent health systems reform. through a systematically organised and One of the major legacies of the health systems participatory forum called the NHA in order reforms is the National Health Act 2007 that to develop and move forward participatory enabled the establishment of a new form of public policies. governance, the National Health Commission, 3. Development and capacity building of NHA to be an advisory body to the Cabinet on constituencies in deliberative participation and health policies and strategies. The National participatory democracy which are considered Health Commission is expected to coordinate key interactive processes for the development with multiple sectors across government and of public spirit and involvement of people in the community to come up with healthy public policy issues. policies. This puts the Health in All Policies page 52 Case studies from around the world Governance, reporting and To ensure effective policies, the National Health Commission set up two committees to carry on monitoring the cyclical process of the NHA: To enable implementation of HiAP in Thailand, • The NHA Organizing Committee is in charge the National Health Commission is established of developing the policy proposals including under the chairmanship of the Prime Minister. Its drawing up the rules and guidelines of composition involves three key sectors namely the the NHA process, classifying and defining government sector, knowledge sector and civil constituencies, setting agendas, drafting society sector resulting in effective interactions resolutions and convening the NHA. and joint decision-making. Each sector plays • The NHA Resolution Follow-up and Drive a different role, supplementing others. There Committee is in charge of strategizing and are six ministries in the government sector of facilitating implementation of NHA resolutions, the Commission: the Ministry of Agriculture, monitoring and evaluating the implementation, Ministry of Public Health, Ministry of Industry, reporting on the progress or outcomes at Ministry of Interior, Ministry of Natural Resources the NHA and revising the past resolutions (if and Environment and the Ministry of Social needed). Development and Human Security. Each of these has the authority and the budget to push The committees are referred to as D1 and D2. D the policies into action. The knowledge sector, 1 stands for developing policy proposals or so meaning academia and professionals, provides called resolutions and D 2 means driving policy evidence to inform consideration of policies, while of adopted resolutions in action (see Figure 1). the civil society sector raises the voice of the The composition of both committees is also people and helps transform national policies into strictly comprised of representatives of the action at the local level. The results of this joint three sectors, the same as the National Health decision-making between the three sectors are Commission. Both committees operate through submitted to either the Cabinet or directly to key multisectoral working groups. The chairperson agencies and local governments, as appropriate. of each committee is rotated, which is not the Figure 1. Thailand National Health Commission Governance National Health Commission Government sector Academic/Professional CiviI society Sector Sector NHC Chaired by the Prime Minister Appoint National Health Commission Office Works as a secretariat of the D1 commission and committees D2 The NHA Organizing Committee The NHA Resolution Follow-up and (D1 refers to developing policy) Drive Committee (D 2 refers to driving policy) Source: National Health Commission Office, Thailand. Case studies from around the world page 53 Thailand’s National Health Assembly – a means to Health in All Policies Figure 2. National Health Assembly processes Agenda setting • Draft resolution Policy Revision Policy Formulation • Consultation NHA process • Consensus making Monitoring and Policy Adoption • Submission of Evaluation resolutions to NHA Policy Implementation The role of NHA Organizing Committee The role of NHA Resolution and Follow-up Committee Source: National Health Commission Office, Thailand. case with the National Health Commission. The National Health Act stipulates that the NHA Since 2008, the NHA Organizing Committee is convened annually, normally in December. chairperson has had representatives from the As of the ninth NHA held in 2016, seventy-three health professions, academia, private sector, resolutions have been discussed and adopted. civil society and currently a government Drawing from this experience, the NHA process official from the Ministry of Public Health is can be explained in the following six steps (see the chairperson. The chairperson of the NHA Figure 2): Resolution Follow-up and Drive Committee is rotated from civil society to a public health 1. Agenda setting minister most recently. The NHA process starts from issues of concern or proposals submitted by (1) constituencies Mechanisms and processes from all sectors and (2) the National Health Commission and other commissions under ‘Health Assembly’ is defined in the National the National Health Commission, to the NHA Health Act 2007 as a process in which the public Organizing Committee for consideration. and related state agencies exchange their The selection criteria used include: urgency, knowledge and learn from each other through nationwide impacts, public interest, and an organised systematic forum with public the potential for issues to be progressed to participation, leading to recommendations on implementation. In addition, unsuccessful healthy public policy and good health for the previously submitted proposals can be public. In practice Thailand has three types brought up by the NHA Organizing Committee of health assemblies: (a) a national health for reconsideration. Similarly, the NHA assembly (b) provincial health assemblies, Resolution Follow-up and Drive Committee and (c) issue-based health assemblies. The can submit revisions to adopted resolutions for purpose of this is to strengthen multisectoral consideration. All agenda items must comply action for health and/or Health in All Policies at with the National Health System Charter. all levels. Furthermore, it nurtures