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Thailand: context, health achievements, and challenges
Thailand has become internationally known for its success with universal health coverage (UHC) policy and health development.1 In this Review, we analyse the historical evolution of health systems development that culminated in the implementation of UHC in 2002, focusing on the primary health-care infrastructure, health workforce training and distribution, and the extension of financial risk protection to different target populations. We also analyse the achievements of UHC and factors contributing to these achievements. Although the six building blocks of health systems2 are interlinked and contribute collectively to the successful im-plementation of UHC, here we focus on the important elements of the health delivery system, health workforce development, and financing reforms towards UHC.
We draw on an extensive review, analysis, and synthesis of evidence from published and grey literature (eg, government reports) in the areas of health systems development, health workforce, financial risk protection, outcomes of UHC, and health and health systems challenges. Lessons drawn from this Review will aid policy makers in low-income and middle-income countries in their quest to achieve UHC as part of their commitment to the Sustainable Development Goals (SDGs).
The Kingdom of Thailand is at the centre of the Indochina peninsula, with land bordered by Myanmar, Laos, Cambodia, and Malaysia (figure 1). In 2017, the total surface area of 513 120 km2 hosted a population of 68·9 million people.3,4 Politics have been quite unstable, with frequent military takeovers since the 1932 democratic revolution. The current military government has been in power since 2014. According to the Worldwide Governance Indicators, political stability has deteriorated, with the percentile rank down from 58% in 1996, to 16% in 2015 (the higher the rank, the better the governance). Ranking for control of corruption is low and deteriorated from 55% to 43% between 1996 and 2015. Although the Thai Government has been relatively stable, the ranking of its effectiveness only increased from 60% to 65% during the same period.5
Economic and health development
Periods of rapid economic growth between the 1960s and 1990s resulted in a 7·5% per annum increase in gross domestic product (GDP). However, Thailand had three macroeconomic crises and related structural adjustments between the 1970s and the 2000s: the first (1973-75)...