auto_awesome_motionไฟล์ดิจิทัลที่เกี่ยวข้อง (1 ไฟล์)

chrome_reader_modeเรื่อง

Triangle that moves the mountain and health systems reform movement in Thailand

chrome_reader_modeคำอธิบาย

Thailand, as many other countries, has faced extremely difficult problems political, economic, social, cultural, environmental, etc., culminating in the phenomenon of social crisis, severely affecting health. The problems are interconnected, complex and extremely difficult to solve. In fact, some feel that they are too big and too difficult and beyond imagination on how to solve them. But we have to find ways and means to get out of the crisis in order to be able to move forward positively. There is increasingly well-known in Thailand an approach structure called Triangle that Moves the Mountain. The Mountain means a big and very difficult problem, usually unmovable. The Triangle consists of : (1) Creation of relevant knowledge through research, (2) Social movement or social learning and (3) Political involvement

chrome_reader_modeบทคัดย่อ

Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 1 Triangle That Moves The Mountain And HEALTH SYSTEMS REFORM MOVEMENT IN THAILAND Prawase Wasi 2 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND Triangle That Moves The Mountain And Health Systems Reform Movement in Thailand by Professor Prawase Wasi ISBN 974-299-063-8 Frist published in October 2000 Published by Health Systems Research Institute (HSRI) 5th Floor, 2nd Building, Mental Health Department, Ministry of Public Health, Tivanon Road, Nontaburi 11000, Thailand Tel. (662) 951-1286-93 Fax. 9511295 Web page: www.hsri.or.th, e-mail address: hsri@hsrint.hsri.or.th Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 3 CONTENTS Triangle That Moves The Mountain And Health Systems Reform Movement in Thailand .......................................................... 1 1. Focus on the member countries ..................................................................................... 1 2. Triangle that moves the mountain ................................................................................... 2 3. Health Systems Reform Movement in Thailand ....................................................... 5 4. Conclusion and recommendations................................................................................ 10 National Health System Reform Movement in Thailand.................................................. 13 Regulation of the Office of the Prime Minister on National Health System Reform, B.E 2543 ............................................................ 16 The National Health System Reform Committee ................................................................ 25 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 1 Triangle That Moves The Mountain And HEALTH SYSTEMS REFORM MOVEMENT IN THAILAND 1. FOCUS ON THE MEMBER COUNTRIES ○ ○ ○ ○ ○ ○ ○ ○ ç the greatest strength of WHO lies in it The World Health Organization (WHO) System is being highly ○ ○ ○ potentially a very good system. It consists of the Headquarter prestigious and ○ ○ (HQ), the Regional Offices (ROs) and the member countries. its unlimited ○ ○ ○ If all the components worked well in an interactive manner, the access to ex- ○ ○ System could be a dynamic inter-connected network vibrant pertise around ○ ○ é ○ with knowledge generation, learning and development, the world. ○ ○ benefiting the health and well-being of mankind around the ○ ○ ○ world. ○ ○ Although there are some deficiencies in WHO such as ○ ○ ○ bureaucracy and politics, the greatest strength of WHO lies in ○ ○ 2 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND it being highly prestigious and its unlimited access to expertise ç If knowl- ○ ○ around the world. The HQ and the ROs have generated and ○ edge-based ○ ○ collected a lot of concepts and methods, but the most difficult health ○ ○ part is to implement those concepts and methods in member ○ development ○ ○ countries. If knowledge-based health development cannot be cannot be ○ ○ implemented successfully in member countries, this will be the ○ implemented ○ ○ bottleneck in the otherwise very good WHO System. The successfully ○ ○ concepts and methods developed at the HQ and ROs will in member ○ ○ ○ become congested there, untested by real practice in member countries, this countries and thus provide no appropriate feedback to the ○ ○ ○ ○ ○ will be the System. The System will not be as inter-active and as vibrant bottleneck in ○ ○ as expected. Thus more attention should be focused on the the otherwise ○ ○ ○ member countries. How they can implement knowledge-based very good ○ ○ health development successfully is the crucial issue. WHO ○ ○ é ○ System. ○ ○ 2. TRIANGLE THAT MOVES THE ○ ○ ○ ○ MOUNTAIN ○ ○ ○ Thailand, as many other countries, has faced extremely ○ ○ ○ difficult problems-political, economic, social, cultural, ○ ○ environmental, etc., culminating in the phenomenon of social ○ ○ ○ crisis, severely affecting health. The problems are inter- ○ ○ connected, complex and extremely difficult to solve. In fact, ○ ○ ○ some feel that they are too big and too difficult and beyond ○ ○ Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 3 ç ○ 1. Creation of relevant knowledge There is ○ ○ ○ increasingly ○ ○ well-known in ○ ○ Thailand an ○ ○ ○ approach ○ ○ structure called ○ ○ ○ çTriangle that ○ ○ Moves the ○ ○ 2. Social movement 3. Political involvement Figure 1. Triangle that Moves the Mountain ○ ○ ○ ○ ○ ○ ○ ○ Mountain.é é imagination on how to solve them. But we have to find ways ○ ○ and means to get out of the crisis in order to be able to move ○ ○ ○ forward positively. There is increasingly well-known in ○ ○ Thailand an approach structure called çTriangle that Moves ○ ○ ○ the Mountainé. The Mountain means a big and very difficult ○ ○ problem, usually unmovable. The Triangle, as illustrated in ○ ○ ○ Fig. 1, consists of : (1) Creation of relevant knowledge through ○ ○ research, (2) Social movement or social learning and (3) ○ ○ ○ Political involvement ○ ○ Creation of relevant knowledge through research is very ○ ○ ○ crucial, but not adequate by itself ; it must interact with social ○ ○ movement or social learning. Without relevant knowledge, ○ ○ ○ social movement cannot go very strong or may deviate to ○ ○ 4 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND ç ○ something else. Knowledge derived from research must be Politics ○ ○ translated into forms and languages that can empower the ○ without knowl- ○ ○ public. Many academicians shun politicians, thinking that they edge and ○ ○ are bad people and do not wish to do anything with them. But ○ social move- ○ ○ politicians have authority over utilization of state resources ment will not ○ ○ and in law promulgation, which are very often needed in do. é ○ ○ ○ development. Thus without political involvement the working ○ ○ structure is not complete. Politics without knowledge and ○ ○ social movement will not do. In developing countries, and sometimes even in developed countries, the lack of this çtriadé ○ ○ ○ ○ ○ leads to failure in solving difficult problems. ○ ○ ○ In Thailand this triangular approach has been used ○ ○ successfully to move a few çmountainsé. The most difficult ○ ○ ○ one was to rewrite the Constitution for political reform. This ○ ○ type of political reform is usually not possible without country ○ ○ ç ○ losing a war or finding itself at the brink of a civil war. No political ○ ○ political party really wanted to undertake the reform because reform is usu- ○ ○ ○ the new Constitution would limit their power. The author of ally not pos- ○ ○ this article was responsible for recommending that Thailand sible without ○ ○ ○ needed to write a new Constitution for political reform. When country losing ○ ○ he was appointed chairman of the Democracy Development a war or find- ○ ○ ○ Committee which recommended political reform, the ing itself at ○ ○ Committee implemented the çTriangleé. Research results were the brink of ○ ○ é ○ used to empower public movement which turned the New a civil war. ○ ○ Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 5 ç ○ Constitution for political reform into a political issue that was The ○ ○ nonstoppable and which finally led to promulgation of the New çTriangle that ○ ○ ○ Constitution in 1997. The triangular approach has been Moves the ○ ○ used in drawing up the 8th National Economic and Social Mountainé ○ ○ ○ Development Plan, which was reorientated from economy approach is ○ ○ dominated development to human centered development. In now being ○ ○ ○ 1999 the National Education Act for education reform was applied in ○ ○ issued. Again this very difficult task was successful through health systems ○ ○ the application of the çTriangleé approach. ○ reform, another ○ ○ The çTriangle that Moves the Mountainé approach is mountain ○ ○ now being applied in health systems reform, another mountain ○ ○ ○ to be to be moved. This will be briefly described as follows. moved. é ○ ○ ○ ○ ○ 3. HEALTH SYSTEMS REFORM ○ ○ ○ ○ MOVEMENT IN THAILAND ○ ○ ○ ○ ○ The crisis ○ ○ ○ Thailand has a relatively good health care service ○ ○ ○ infrastructure with hospitals in all its 76 provinces and over ○ ○ 700 districts, and health stations in all its 7,000 subdistricts ○ ○ ○ or tambons. It has done well in communicable disease ○ ○ control ; plague, small pox, cholera, leprosy, diphtheria, ○ ○ ○ pertussis, yaws, poliomyelitis have disappeared or are very ○ ○ 6 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND ç ○ much reduced in prevalence. However, if looked at from a if looked at ○ ○ system dimension the Thai health system is in crisis. National ○ from a system ○ ○ health expenditure this year amounts to nearly 300,000 dimension the ○ ○ million Baht, increasing at a rate of over 10 per cent annually Thai health ○ ○ system is in ○ in the past several years. The excess of the increase in the rates ○ é ○ of health expenditure over those of income indicates that the crisis. ○ ○ ○ system is running into crisis, i.e. the country will run out of ○ ○ money while many people are ill or die of diseases or ○ ○ conditions which are preventable such as heart diseases, cancer, accidents, HIV/AIDs, drug addiction, etc. Access and ○ ○ ○ ○ ○ quality of health care are not good enough, the people are not ○ ○ ○ satisfied, while the health personnel are over-worked. In brief, ○ ○ the system is not cost-effective and is in need of reform. ○ ○ ○ ○ ○ Need ○ ç ○ The excess ○ The passive çill-health-orientedé system needs to be ○ ○ reformed to a çgood-health-orientedé system. For this, the of the increase ○ ○ in the rates ○ health promotion system needs to be fully developed and the ○ of health ○ disease control and prevention system must be reformed to be ○ expenditure over ○ ○ fully efficient. Health care finance must be developed to ○ those of income ○ guarantee access to adequate and quality health care for all. ○ indicates that ○ ○ Consumers must be adequately protected and empowered. the system is ○ ○ Health personnel development needs to be reformed as do the running into ○ ○ é ○ technology, the information and the research systems. In the crisis, ○ ○ Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 7 ç ○ reformed health systems responsibility for good health will not The passive ○ ○ solely lie with the Ministry of Public Health, but with all çill-health- ○ ○ ○ sectors of society--All For Health. Thus there is a need for a orientedé ○ ○ body to coordinate health policies for all sectors. Not all, but system needs ○ ○ ○ a good part of the reform components need to be put into law. to be reformed ○ ○ Thus a National Health Act is needed. All these are extremely to a çgood- ○ ○ ○ difficult or next to impossible. Much knowledge needs health- ○ ○ to be generated and social participation as well as political orientedé ○ ○ commitment are crucial to the process. Research and Development ○ ○ ○ ○ ○ ○ ○ ○ system. é At this point the author wishes to give credit to WHO. ○ ○ His as well as other Thaiûs involvement with WHO in various ○ ○ ○ capacities caused a lot of inspiration that have led to a variety ○ ○ of health research and development activities in Thailand. ○ ○ ○ Non-smoking campaign, health economics capacity building, ○ ○ and the idea for health systems reform, for example, are all ○ ○ ○ traceable to WHO-led inspiration. ○ ○ Health research capability building is most crucial for ○ ○ ○ making health systems reform possible. In the last two decades ○ ○ or so health research capability has been strengthened through ○ ○ ○ different means. These include TDR research strengthening ○ ○ program, Rockefeller Foundationûs the Great Neglected ○ ○ ○ Diseases of Mankind program, CDC collaborated Field ○ ○ 8 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND ç ○ Epidemiology Training program, the Rockefeller Foundation The chronic ○ ○ initiated INCLEN, the National Epidemiology Board supported ○ problem in most ○ ○ by the Rockefeller Foundation, establishment of the College developing ○ ○ of Public Health at Chulalongkorn University under the countries is the ○ ○ ○ leadership of Charas Suwanwela and Chitr Sithi-amorn and lack of good ○ ○ their, as well as other Thai academic leaderûs, involvement research man- ○ ○ ○ with the international health research movement. The Health agement mecha- ○ ○ Care Reform project under the leadership of Dr.Sanguan nisms. To over- ○ ○ Nitayarumphong, supported by EU, has pioneered research and ○ come this deficit development in health care system reform. ○ ○ ○ ○ Thailand in 1992 The chronic problem in most developing countries ○ established two ○ ○ is the lack of good research management mechanisms. To effective national ○ ○ overcome this deficit Thailand in 1992 established two ○ research pro- ○ ○ effective national research promoting and funding agencies, moting and ○ ○ namely the Thailand Research Fund (TRF) and the Health ○ funding agen- ○ ○ Systems Research Institute (HSRI). It should be pointed out cies, namely the ○ ○ that both the TRF and the HSRI have been especially designed ○ Thailand Re- ○ ○ to be effective in research management. Both were established search Fund ○ ○ by special Acts which allow them to use the government ○ (TRF) and the ○ ○ budget but be independent. They are not bureaucratic Health Systems ○ ○ organizations, but governed by independent boards. However, ○ Research Insti- ○ é ○ even though independent by law, in practice as in many tute (HSRI). ○ ○ developing countries, the organizations may suffer from creeping ○ ○ ○ in bureaucratic politics and politically motivated politics. Having ○ ○ Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 9 ç ○ senior academics respected by politicians, bureaucrats and media The HSRI ○ ○ is very crucial in helping the organizations to steer through has been ○ ○ established with ○ such a scenario. The HSRI has been established with an ○ ○ intention to be a tool for health system reform. In the past an intention to ○ ○ be a tool for ○ seven and a half years under able leadership of the two ○ health systems ○ successive directors, Dr.Somsak Chunharas the former é ○ reform. ○ ○ director, and Dr.Wiput Phoolcharoen the current director, the ○ ç ○ institute has mobilized the creation of much health system The Prime ○ ○ knowledge. Although this knowledge is not yet complete, it is Minister has ○ ○ ○ adequate to support a health system reform movement. given whole ○ ○ The Board of the HSRI has the Minister of Public Health ○ ○ hearted support as its chairman, with members comprising permanent ○ ○ and has issued the Prime Minis- ○ secretaries of relevant ministries and their equivalents and ○ ter Officeûs ○ ○ respected senior academics. Having the Minister of Public Regulation es- ○ ○ Health as its chairman the HSRI has a direct channel to the tablishing the ○ ○ National Health ○ Cabinet. When the Board agreed recently that it was time for ○ System Reform ○ Thailand to launch a health system reform movement the ○ Committee. The ○ ○ matter went to the Cabinet. The Prime Minister has given ○ Committee has ○ whole hearted support and has issued the Prime Minister Officeûs ○ the Prime Minis- ○ ○ Regulation establishing the National Health System Reform ter as its chair- ○ ○ Committee. The Committee has the Prime Minister as its man and the ○ ○ Minister of Pub- ○ chairman and the Minister of Public Health as deputy ○ lic Health as ○ chairman. A National Health System Reform Office (HSRO) ○ deputy ○ ○ has been set up to catalyse the çTriangleé, i.e. research, social é ○ chairman. ○ 10 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND ç ○ movement and political interaction, to issue a National Health an indepen- ○ ○ Act for health systems reform within 3 years. The government dent Office for ○ ○ ○ will be providing all necessary resources for the movement. Health Promo- ○ ○ Although a National Health Act is necessary for health systems tion Fund has ○ ○ already been ○ reform, not all the reform activities have to wait for the law. ○ established and ○ For example, an independent Office for Health Promotion Fund ○ ○ the Ministry of ○ has already been established and the Ministry of Finance has ○ Finance has ○ sponsored a çHealth Promotion Fundé bill, to provide 2 ○ sponsored a ○ percent of tobacco and alcohol excise taxes, amounting to 1,400 ○ çHealth Promo- million Baht per year, for the Office to support innovative ○ ○ ○ ○ tion Fundé bill, health promotion initiatives throughout the country. ○ to provide 2 ○ ○ Thus we are now witnessing the long desirable percent of ○ ○ interaction between research, social participation and political tobacco and ○ ○ alcohol excise ○ support at work for health development of all Thai people - in ○ ○ the name of health systems reform. taxes, amount- ○ ○ ing to 1,400 ○ ○ million Baht per ○ 4. CONCLUSION AND RECOM- ○ year, for the ○ ○ ○ MENDATIONS Office to sup- ○ ○ port innovative ○ ○ 1. Concepts and methods for health developed at the health promo- ○ ○ global and international level are important, but focus should tion initiatives ○ ○ ○ be at real actions in the countries. throughout the ○ é ○ The results from real actions in the countries and country. ○ ○ ○ emerging needs for more knowledge will provide a feedback ○ ○ Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 11 ç ○ into the global system, thus making the international networks The inter- ○ ○ for health research and development actively interacting in a national health ○ ○ ○ most creative manner. research pro- ○ ○ 2. In the countries special attention should be paid to motion net- ○ ○ ○ creation of functionally effective research promotion and works should ○ ○ funding mechanisms. The Thailand Research Fund (TRF) can give political ○ ○ ○ be an example. To generate health systems knowledge support in ○ ○ necessary for health system reform a research institute such as creation of ○ ○ the Health Systems Research Institute (HSRI) may be ○ effective health ○ ○ necessary. The international health research promotion research ○ ○ networks should give political support in creation of effective ○ ○ ○ management health research management mechanisms in member countries, mechanisms ○ ○ if they do not exist. ○ in member ○ ○ 3. Research is fun. But research should not just create countries, if ○ ○ more research and go on without end. Research should lead to they do not ○ ○ é ○ development and development lead to more research relevant exist. ○ ○ to development needs. Research should not be floating or ùgo ○ ○ ○ to the shelfû, but tested and receive feedback from real ○ ○ applications. ○ ○ ○ 4. Health development in the countries is extremely ○ ○ difficult. It depends on complex interactions between ○ ○ ○ knowledge, culture, politics, bureaucracy, media, society, etc. ○ ○ Expertise in any one particular academic field is not adequate ○ ○ ○ to mobilize health development. It needs leaders with systems ○ ○ 12 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND ○ perspectives and management skills with strong commitment ○ ○ and some charisma. Such persons are rare, if not lacking, in ○ ○ ○ many societies. ○ ○ 5. Thus it is recommended to the international health ○ ○ ○ research and development circles to pay more attention in finding ○ ○ and developing health policy leaders who can mobilize ○ ○ ○ resources for health development in the countries, whether it is ○ ○ to be labeled health systems reform or not. ○ ○ Regional or international courses in health policy leadership might be considered to provide opportunities for ○ ○ ○ ○ ○ interactive learning through action and network building. With ○ ○ ○ this it is hoped that health research and development will really ○ ○ take place in the countries. Interaction between the countries ○ ○ ○ and the international health research forum will form a vibrant ○ ○ global network with knowledge generation, learning and ○ ○ ○ development to benefit the health and well-being of mankind ○ ○ around the world. ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 13 National Health System Reform Movement in Thailand Health Systems Reform movement became a national agenda in Thailand in The year 2000. A Prime Minister Officeûs Regulation on National Health System Reform was published in the Government Gazette on 31st July 2000. This regulation ensures high level political support and continuity of the movement. The regulation has two main aims. The first is the knowledge-based total social movement to support health system reform. The second is to enact a National Health Act, as the main mechanism for future health system reform, within 3 years. These two main aims are expected to reform the Health Building Systems, the Disease Prevention and Control Systems and the Health Care Systems. A National Health System Reform Committee, chaired by the Prime Minister, was established. The board consists of 31 members, from various disciplines and ministries. Of the 14 non ex-officio members, there are leaders from the elderly, the disabled, profes- sionals, economists, educators, public administrations, mass communications and 14 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND Work structure for National Health System Reform Principle, Mechanisms TOR for each issue and Main issues HSRI HSRO Proposal for reform Brainstorming - Technical WG - related agencies revise Sub-committee on Technical sub-committee Partnership Building Sub-committee on Working proposal Public media - Reform options - Legislative content Sub-committee for - Further research drafting National Health Bill National Health Proposal for reform of Social movement Bill existing policy/rules/regulations National Health NHSRC Parliament Act HSRI = Health Systems Research Institute NHSRC = National Health System Reform Committee Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 15 law communities. A National Health System Reform Office was established. Its director is the secretary of the National Health System Reform Committee. Four sub-committees were appointed. A technical sub-committee to synthesizes the appropriate knowledge on options for all issues of reform. The Sub-committee on Partnership Building aims at interacting with and involving all partners to seek for their opinions and support. The Sub-committee on Public Media is responsible for wider social advocacy and movement through public media. The last is the Sub-committee established to Draft the National Health Bill. These four sub-committees work in parallel as shown in figure. 16 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND REGULATION OF THE OFFICE OF THE PRIME MINISTER ON NATIONAL HEALTH SYSTEM REFORM, B.E. 2543 Whereas the current national health system has inadequately contributed to the achievement of good health and quality of life of the people, evidenced by an upward trend of several diseases and hazards, lack of efficiency and thoroughness of health management systems, which is inconsistent with the spirit of the Constitution of the Kingdom of Thailand, it is expedient to initiate health systems reform to build up standardized, good quality and equitable health systems as well as put forward a law on national health as a master legislation for the reform of health systems. By virtue of the provisions of section 11 (8) of the Organisation of State Administration Act, B.E. 2534 (1991), the Prime Minister, with the advice of the Council of Ministers, Proclaims this Regulation as follows: Clause 1. This Regulation is called the çRegulation of the Office of the Prime Minister on National Health System Reform, B.E. 2543 (20..)é. Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 17 Clause 2. This Regulation shall come into force as from the day following the date of its publication in the Government Gazette. Clause 3. In this Regulation: çNational health systemé means all the systems which are holistically intercon- nected and affect health of the people throughout the country. It includes all factors related to health, namely, personal, environmental, economic, social, physical and biological factors as well as the health service systems; çNational health system reformé means all processes which lead to changes in the management of the national health system to achieve the systems which are aimed at good physical, mental, social and spiritual conditions of the people, as well as those aimed at the accessibility to good quality health services in an efficient and equitable manner. çCommitteeé means the National Health System Reform Committee; çOfficeé means the National Health System Reform Office; çDirectoré means the Director of the National Health System Reform Office. Clause 4. There shall be a Committee called the National Health System Reform Committee, briefly called çHSRC.é which consists of: (1) Prime Minister as Chairman; (2) Minister of Public Health as Vice Chairman; (3) Minister to the Office of the Prime Minister as entrusted by the Prime Minister as Vice Chairman; 18 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND (4) one qualified person appointed by the Prime Minister from qualified members under (18) as Vice Chairman; (5) Permanent Secretary of the Ministry of Finance as member; (6) Permanent Secretary of the Ministry of Commerce as member; (7) Permanent Secretary of the Ministry of Interior as member; (8) Permanent Secretary of the Ministry of Labour and Social Welfare as member; (9) Permanent Secretary of the Ministry of Science, Technology and Environment as member; (10) Permanent Secretary of the Ministry of Education as member; (11) Permanent Secretary of the Ministry of Public Health as member; (12) Permanent Secretary of the Ministry of University Affairs as member; (13) Secretary-General of the Council of State as member; (14) Secretary-General of the Civil Service Commission as member; (15) Secretary-General of the National Economic and Social Development Board as member; (16) Director of the Bureau of the Budge as member; Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 19 (17) Director of the Health Systems Research Institute as member (18) Not more than fourteen qualified persons, appointed by the Prime Minister, in the field of education, public health, administration, mass communications, community development, law, economics, development of specific population groups as member (19) Director of the National Health System Reform Office as member and secretary (20) Not more than two officials of the National Health System Reform Office appointed by the Prime Minister as assistant secretaries Clause 5. A qualified member may serve for only one term and shall hold office for the same term of office as that of the Committee. In the case where the qualified member vacates office before the expiration of the term or in the case where an additional qualified member is appointed while the qualified members already appointed remain in office, the person appointed to fill the vacancy or additionally appointed shall be in office for the remaining term of the qualified members already appointed. In the case where the qualified member vacates office before the expiration of the term, the remaining members shall, while appointment of a new member to fill the vacancy has not yet been made, continue their performance within the powers and duties 20 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND of the Committee. Clause 6. In addition to vacating office at the expiration of the term, the qualified member shall vacate office upon: (1) death; (2) resignation; (3) being removed by the Prime Minister; (4) being an incompetent or quasi-incompetent person; (5) being bankrupt; (6) being sentenced to imprisonment by a final judgement except for an offence committed through negligence or a petty offence; Clause 7. At a meeting of the Committee, the presence of not less than one-half of the number of existing members is required to constitute a quorum. At a meeting of the Committee, if the Chairman is not present or is unable to perform the duty, the Vice Chairman shall preside over the meeting, and, if the Chairman and the Vice Chairman are not present or are unable to perform the duty, the meeting shall elect one member to preside over the meeting. The decision of the meeting shall be by a majority of votes. In casting votes, each member shall have one vote. In the case of a tie vote, the presiding Chairman shall have an additional vote as the deciding vote. Clause 8. The Committee shall have the powers and duties as follows: (1) to give recommendations and advice to the Council of Ministers with regard Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 21 to the national health system reform; (2) to recommend revision of policies, work structures, work systems or budgetary systems relevant to the national health system reform, provided that reference shall be made to the State Administration Systems Reform Plan and regard shall be made to resolutions of the Civil Service Commission in connection with directions, emphases and adjustment of roles and affairs of the Ministry of Public Health; (3) to prepare draft legislation on national health in order for such legislation to enter into force within three years as from the date of the Committeeûs first meeting; (4) to give recommendations to the Council of Ministers for revision of relevant laws, rules, regulations or resolutions of the Council of Ministers so as to be in line with the national heath system reform; (5) to make available information and public relations for enabling public awareness and understanding of, and participation in, the national heath system reform; (6) to organise seminars, meetings, public hearings or any other activity aimed at enabling the public, agencies and interest groups which will be affected by the national heath system reform to have wide participation in presenting opinions, information and suggestions with respect to the national health system reform; (7) to arrange for studies, analyses and research for the purpose of framing directions, strategies and measures for the national health system reform and for the purpose of putting forward a law on national health; (8) to support the development of policies or the revision of structures or systems of work which may be taken as an essential component of the health system reform; (9) to co-ordinate work and solve problems and obstacles in carrying out the 22 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND national health systems reform; (10) to perform other acts as entrusted by the Prime Minister or the Council of Ministers. Clause 9. The Committee has the power to appoint sub-committees or working groups for performing any particular tasks as entrusted by the Committee. Clause 7 shall apply mutatis mutandis to a meeting of the sub-committees or working groups. In the performance of duties, a sub-committee or working group has the power to require a State agency or State official to furnish documents or information or give explanations for the purpose of consideration as necessary. Clause 10. The National Health System Reform Office shall be established as an internal agency of the Health Systems Research Institute for the purposes of serving as the secretariat of the Committee and acting as a focal point for the administration and management of work in accordance with the affairs entrusted by the Committee. Clause 11. The Office shall have the powers and duties as follows: (1) to be responsible for the administrative affairs, technical affairs, meeting affairs, public relations affairs and secretarial affairs of the Committee, sub-committees and working groups; (2) to be responsible for the administration of operations, finance, personnel and procurement as determined by the Committee; (3) to monitor situations, study and gather information related to the work of the Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 23 Committee, sub-committees and working groups; (4) to provide co-ordination for, and give recommendations to, the Committee with regard to the national health system reform; (5) to perform any other work or take any other action as entrusted by the Committee. Clause 12. The Health Systems Research Institute Board shall act as a technical adviser to the Committee in the performance of work in connection with the national health system reform. Clause 13. The Committee and the Office shall be dissolved upon the entry into force of the law on national health, which shall take place not later than three years from the date of the Committeeûs first meeting. Clause 14. Subject to the law, for the purpose of the administration of work of the Office, the Prime Minister may order a Government official of a Government agency, or the Office may request the Council of Ministers to pass a resolution requiring an official or employee of a State enterprise or other State agency, to assist in the performance of work in the capacity as an official of the Office, provided that it shall be deemed as his or her normal performance of official service or work, whether on a full-time or part-time basis or outside official hours. Clause 15. Other committees concerned and State agencies and State officials concerned shall give co-operation and support to the performance of work of the Com- 24 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND mittee and the Office. Clause 16. The provisions of the law on the Health Systems Research Institute, and rules, regulations and resolutions of the Health Systems Research Institute Board shall apply to the administration of the Office mutatis mutandis. Clause 17. The Prime Minister shall have charge and control of the execution of this Regulation. Given on the 27 Day of July, B.E. 2543 H.E. Chuan Leekphai Prime Minister NB. This regulation was published in the Government Gazette, general announce- ment issue, 117 special part 75ß., on 31st July 2000. Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 25 The National Health System Reform Committee Chairman Prime Minister Vice Chairman Minister of Public Health Minister to the Office of the Qualified Person Prime Minister as entrusted (Dr.Pirot Ningsanon) by the Prime Minister Members By Position Qualified Person Permanent Secretary of the : Ministry of Finance Mrs.Kasama Varavaran Ministry of Commerce Prof.Kasem Suwanakul Ministry of Interior Prof.Charas Suwanwela Ministry of Labour and Social Welfare Mr.Narong Patibatsarakich Ministry of Science, Technology and Environment Assoc.Prof.Tassana Boontong Ministry of Education Banrool Siriphanich Ministry of Public Health Prof.Borwornsak Uwanno Ministry of University Affairs Prof.Prawase Wasi 26 Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND Secretary-General of the : Council of State Prof.Pakdee Pothisiri Civil Service Commission Nun.Sansanee Sthirasuta National Economic and Social Development Board Mr.Somchai Krusounsombut Director of the Bureau of the Budget Prof.Ammar Siamwalla Director of the Health Systems Research Institute Prof.Aree Valyasevi Member and secretary (Amphon Jindawatthana : Director of the National Health System Reform Office) Assistant secretary (Suwit Wibulpolprasert) Triangle That Moves The Mountain And HEALTH SYSYEMS REFORM MOVEMENT IN THAILAND 27 National Health System Reform Office 2td Floor Building North of Health Park, Ministry of Public Helth, Tiwanonda Road, Muang District, Nonthaburi Province, 11000 Thailand P.O BOX 9, Talard Kwan 11002, Thailand Tel.: 66-2-590-2304 Fax : 66-2-590-2311 E-mail : hsro@hsro.or.th Homepage: http://www.hsro.or.th

shareแบ่งปันเนื้อหา