PH could take a page from

Thailands drug war

Hontiveros
By: Yuji Vincent Gonzales / @YGonzalesINQ
INQUIRER.net / 10:16 PM September 06, 2016

Sen. Risa Hontiveros on Tuesday said the Philippines could use some lessons
from its neighbor Thailand in dealing with the drug problem in the country, amid
the piling body count in the governments relentless war against drugs and
criminality.
Hontiveros, who went to the Thai capital of Bangkok for a study visit, said the
Duterte administration should focus not only on law enforcement but also on
rehabilitation efforts.
Theres a broad way of looking at this na mas epektibo, mas makatao, at hindi
lang mas may paiigtingin ang human rights at due process, but will actually
enable our law enforcement authorities to achieve their objectives. Ito nga
yung pagtingin sa drug problem natin through a public health lens, at pagconsider na gamitin din natin yung harm reduction strategies, Hontiveros said
in an INQ&A interview on Tuesday evening.
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(There is a broad way of looking at this that is more effective, more human, and
not only more considerate of human rights and due process, but will actually
enable our law enforcement authorities to achieve their objectives. This is by
looking at our drug problem though a public health lens and by considering
using harm reduction strategies.)
Hontiveros said the harm reduction intervention, which is being used in about
90 countries, seeks to reduce the damage inflicted by drug abuse to both the
user and to the community.
The senator and former PhilHealth director said Thailand tried a different
approach and recognized through policies that harm reduction was a more
appropriate strategy that served both health and law enforcement needs.
Hontiveros said Thailands new approach documented less incidents of drug
dependence, less number of young people in substance abuse, and less
incidents of violence against the police.
If we have this vision of a universal health care system, built in terms of
advances in health human resources, mas equipped sila (they are more
equipped) to look at drug dependence, drug abuse as a medical condition na
kailangan ding gamutin (that also has to be cured), she said.
Kailangan natin yung law enforcement for sure. Pero kung yun lang, puro
ganun ang nagiging epekto. Pero kung yung law enforcement ikinambal mo

yung public health including harm reduction, mukhang mas nagpo-produce ng

better results, Hontiveros added.
(We need law enforcement, for sure. But if that is all, the effect will be the same.
But if you couple law enforcement with public health including harm reduction,
that could produce better results.)
READ: PhilHealth eyed for drug addicts
Allergic to criticisms
Citing first-hand accounts from civil society advocates, medical practitioners,
and other insiders in Thailand, Hontiveros said there were striking similarities
between the Philippines and its Asian neighbors relentless war on drugs,
particularly the governments short time frame and its very assertive demand
on law enforcement authorities.
I think there are good lessons for us to learn from the Thai experience,
Hontiveros said, referring to the drug war spearheaded by former Thai Prime
Minister Thaksin Shinawatra in 2003.
It sounds quite familiar. Yung pushback din nila against international criticism,
na sabi ni Shinawatra noong nagpuna ang United Nations, something like the
UN is not my father. Very allergic sa puna ng ibang bansa. And more than 2,000
deaths in 3 months, na in the following administration inimbestigahan nila, they
did an assessment of the war on drugs, at nalaman nila na kalahati daw ng
napatay ay wala naman talagang kinalaman sa droga, she added.
(It sounds quite familiar. Their pushback against international criticism, where
Shinawatra said something like the UN is not my father when the United
Nations criticized him. Very allergic to the criticisms of other countries. And
more than 2,000 deaths in 3 months, which the following administration
investigated on; they did an assessment of the war on drugs and they found out
that half of those who died had no involvement in drugs.)
Duterte himself has been entangled in a word war with international observers
and rights advocates, including no less than the United Nations, to the extent of
threatening to pull the Philippines out of the world body.
READ: Yasay: PH not leaving UN; Duterte just exasperated
As of Sept. 5, the Inquirers Kill List notes 871 drug-related deaths since June
30 or after Duterte took office.
Rehabilitation, poverty alleviation
Asked about factors that contributed to the success of Thailand and other
countries in their healthcare efforts, Hontiveros said their governments were
very committed in policy-making, have enough money and willing to spend it in
the right away.
As the budget hearings in the Senate kick off, Hontiveros said sufficient funds
should be allocated in creating more rehabilitation facilities for drug
dependents, as mandated by the Dangerous Drugs Board.

Particularly babantayan ko yung budget ng DOH (Department of Health) para

sana yung priorities ng department mapondohan: dagdag na rehabilitation
centersIsa lang ito sa mga kongkretong isusulong ko, she said.
(I will keep an eye on the budget of the DOH in particular, so that all the
priorities of the department may be addressed: more rehabilitation centers
This is only one of the things I will pursue.)
While admitting that drug use is indeed a problem, Hontiveros said the deeper
crisis that needs to be resolved down to its roots is poverty.
Tingin ko oo problema yung drug use, but I think the most important,
pinakamalalim pa ring problema, kahirapan pa rin, she added.
(I believe so, drug use is a problem, but I think the most important, still deeply
rooted problem, is poverty.)

The public health approach

The principles of public health provide a useful framework for both continuing to investigate and
understand the causes and consequences of violence and for preventing violence from occurring
through primary prevention programmes, policy interventions and advocacy. The activities of VPA are
guided by the scientifically-tested and proven principles and recommendations described in the World
report on violence and health. This public health approach to violence prevention seeks to improve the
health and safety of all individuals by addressing underlying risk factors that increase the likelihood that
an individual will become a victim or a perpetrator of violence.
The approach consists of four steps:
1. To define the problem through the systematic collection of information about the magnitude,
scope, characteristics and consequences of violence.
2. To establish why violence occurs using research to determine the causes and correlates of
violence, the factors that increase or decrease the risk for violence, and the factors that could be
modified through interventions.
3. To find out what works to prevent violence by designing, implementing and evaluating
interventions.
4. To implement effective and promising interventions in a wide range of settings. The effects of
these interventions on risk factors and the target outcome should be monitored, and their
impact and cost-effectiveness should be evaluated.
By definition, public health aims to provide the maximum benefit for the largest number of people.
Programmes for the primary prevention of violence based on the public health approach are designed to
expose a broad segment of a population to prevention measures and to reduce and prevent violence at
a population-level.
The steps of the public health approach

Expanding Universal Health Care in Asia

Universal health care (UHC) is not easy to measure. It is a set of defined protocols that are usually recognized when a
combination of population coverage, services and financial protection work together to provide for people.
With China rapidly increasing its coverage since 2009, data shows that Southeast Asia contains more people without
coverage than any other region survey by the World Health Organization (WHO).
For example, India currently has 40 million pushed into poverty each year due to health care costs. Hospitals in the
country are known to simply not give health to those in need unless payment is made up front. In Indonesia, only 0.9
percent of the GDP is used to finance the public health sector.
Furthermore, only people pre-identified as being poor are entitled to be covered. This has left millions of people
impoverished each year because they just arent able to afford adequate coverage and dont qualify for universal health
care for expensive treatments.
However, coverage varies depending on the nation. South Asia has some of the most celebrated examples of countries
that have worked hard to achieve UHC. Bangladesh and Nepal have received international recognition for their expansion
of coverage of cost-effective health services.
Another country that has offered universal health care in Asia is Thailand, where health care coverage has taken the name
of a program called Universal Coverage Scheme. The plan was introduced in 2002 by pressure from civil society and is
financed solely from general tax revenue.
The scheme covers 74.6 percent of the population as of 2007 estimates. The benefits package is a comprehensive
package of care, including both curative and preventive care. Public hospitals are the main providers, covering more than
95 percent of the insured. About 60 private hospitals joined the system and register around 4 percent of the beneficiaries.
A large factor of success seems to be based on the level of government spending. The better-off countries have seen their
governments increase in public financing to fund services for previously uncovered groups. These governments have also
increased awareness among citizens and have encouraged their people to use the facilities because they are in adequate
condition.
For the five top countries in Southeast Asia, government spending has only averaged to 2.9 percent of the GDP. For
nations that are trying to build their educational institutions and economy, healthy workers are necessary.
The United States and other wealthy nations must continue to support Southeast Asia through education and funded
public health works projects. Many developed nations will be able to import American goods once their people have a
healthy standard of living.
Adnan Khalid

Advancing universal health coverage in Asia

Published on 19/05/2015

Access to healthcare is a basic human need, but efforts to provide affordable public care in many
developing nations have had mixed results. EU-funded researchers sought to find out why through a
landmark evaluation of healthcare systems in six Asian countries. The conclusions highlight the influence
of insurance schemes affordability, understanding what motivates people to take out insurance policies,
and how public money is spent.

By using an innovative methodology to compare different public healthcare strategies in Cambodia, China, Indonesia,
the Philippines, Thailand and Vietnam, the researchers indentified key factors that influence how much of the
population can access healthcare, what kind of services they receive, and how efficiently the system is funded.
Their research, conducted within the HEFPA project with the support of the European Commission, has since fed into
several follow-up initiatives aimed at improving the accessibility and affordability of care in countries where lowincome groups have inadequate coverage and face financially crippling out-of-pocket expenses for treatment.
Universal health coverage is a big buzzword in the international community. Many countries have implemented
initiatives to provide care for their population, but there are big differences in the depth of care provided, how
accessible it is and how it is funded, explains Eddy van Doorslaer, a professor of health economics and coordinator of
HEFPA at the Erasmus University Rotterdam in the Netherlands.
Socio-economic, political and demographic factors all influence how universal health coverage can be implemented.
But without it, low-income families faced with large out-of-pocket expenses will often delay or forgo treatment, or if
they seek treatment they risk being pushed deeper into poverty by the financial burden. Social insurance schemes are
part of the solution, but as HEFPAs research shows, they are not all equally successful.
Among the countries studied in HEFPA, Thailands universal health insurance system stands out as the most effective.
However, it leverages Thailands pre-existing network of hospitals and medical facilities that many other developing
nations lack and is financed through tax revenues that many other nations with large informal economies cannot
afford.
Other countries have taken alternative routes. Some, such as the Philippines and Vietnam, are attempting to combine
tax-financed coverage of low-income households with voluntary enrolment in social health insurance for wealthier
groups not covered through formal-sector employment. But succeeding in this strategy requires the acquisition and
utilisation of a good understanding of the factors that motivate people to insure themselves or not.
Two randomised studies conducted by HEFPA in Vietnam and the Philippines revealed that subsidisation of insurance
premiums by up to 25% and 50%, respectively, along with the provision of information on the benefits of insurance,
was insufficient to bring enrolment rates anywhere close to universal coverage.

Aligning supply and demand

Concerns about the affordability of insurance even with the subsidies scepticism about the benefits and difficulties
of completing forms and enrolment procedures appeared to be key factors in limiting uptake. In Indonesia, for
example, the deployment of a public insurance scheme has contributed to increased use of healthcare services,
although many people only enrol when they need treatment, resulting in the cost of claims far surpassing the revenue
generated from insurance premiums.
Where there is sufficient funding, the effectiveness of healthcare is determined by how the money is spent. In China,
where the HEFPA team looked at the staggered rollout of the New Cooperative Medical Scheme across different
regions, the researchers found that funding of inpatient care, but not outpatient treatments, led to many people being
hospitalised unnecessarily, while fee-for-service payments to providers created incentives to overprescribe drugs.
We found that access to healthcare is not only contingent on demand-side parameters, but also on how providers are
paid and managed, Van Doorslaer says.
Aligning demand and supply within the healthcare system, training professionals to manage coverage effectively,
providing incentives for enrolment in social insurance schemes, increasing awareness and educating people about the
benefits are all strategies that countries can use to effectively increase healthcare coverage, the HEFPA researchers
found.
The projects results and recommendations have been disseminated to policy-makers in several countries with the aim
of improving the implementation of universal healthcare systems. The HEFPA results are also feeding directly into new
healthcare initiatives.
In Indonesia, a follow-up project has been launched to support the training of professionals in health insurance and
finance skills to support universal health coverage implementation. Erasmus University is also involved in several
applications for funding of similar research work in low- and middle-income countries.

Health infrastructure[edit]
The majority of health care services in Thailand is delivered by the public sector, which includes 1,002 hospitals and
9,765 health stations. Universal health care is provided through three programs: the civil service welfare system for
civil servants and their families, Social Security for private employees, and the Universal Coverage scheme
theoretically available to all other Thai nationals. Some private hospitals are participants in these programs, though
most are financed by patient self-payment and private insurance. According to the World Bank, under Thailands
health schemes, 99.5% of the population have health protection coverage. [3]
The Ministry of Public Health (MOPH) oversees national health policy and also operates most government health
facilities. The National Health Security Office (NHSO) allocates funding through the Universal Coverage program.
Other health-related government agencies include the Health System Research Institute (HSRI), Thai Health
Promotion Foundation ("ThaiHealth"), National Health Commission Office (NHCO) and the Emergency Medical
Institute of Thailand (EMIT). Although there have been national policies for decentralization, there has been
resistance in implementing such changes and the MOPH still directly controls most aspects of health care.
Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income
countries to do so. Means-tested health care for low income households was replaced by a new and more
comprehensive insurance scheme, originally known as the 30 baht project, in line with the small co-payment
charged for treatment. People joining the scheme receive a gold card which allows them to access services in their
health district, and, if necessary, be referred for specialist treatment elsewhere. [3]
The bulk of finance comes from public revenues, with funding allocated to Contracting Units for Primary Care
annually on a population basis. According to the WHO, 65% of Thailand's health care expenditure in 2004 came
from the government, while 35% was from private sources. Thailand achieved universal coverage with relatively low
levels of spending on health but it faces significant challenges: rising costs, inequalities, and duplication of
resources.[3][4]
Although the reforms have received a good deal of criticism, they have proved popular with poorer Thais, especially
in rural areas, and survived the change of government after the 2006 military coup. Then Public Health Minister,
Mongkol Na Songkhla, abolished the 30 baht co-payment and made the UC scheme free. It is not yet clear whether
the scheme will be modified further under the coalition government that came to power in January 2008. [5][6][7]
In 2009, annual spending on health care amounted to 345 international dollars per person in purchasing power
parity (PPP). Total expenditures represented about 4.3% of thegross domestic product (GDP); of this amount,
75.8% came from public sources and 24.2% from private sources. Physician density was 2.98 per 10,000
population in 2004, with 22 hospital beds per 100,000 population in 2002. [8]
Data for utilization of health services in 2008 includes: 81% contraceptive prevalence, 80% antenatal care coverage
with at least four visits, 99% of births attended by skilled health personnel, 98% measles immunization coverage
among one-year-olds, and 82% success in treatment of smear-positive tuberculosis. Improved drinking-water
sources were available to 98% of the population, and 96% were using improved sanitation facilities (2008). [9]