RESUMO
Improving health governance is increasingly recognised as a key pillar for achieving universal health coverage (UHC). One good practice example of a participatory health governance platform is the National Health Assembly (NHA) in Thailand. This review of 9 years of the Thai NHA process attempted to understand how it works, given the paucity of such mechanisms worldwide. In addition, an in-depth look at its strengths and weaknesses allowed for reflection on whether the lessons learnt from this participatory governance model can be relevant for other settings. Overall, the power of stakeholder groups coming together has been impressively harnessed in the NHA process. The NHA has helped foster dialogue through understanding and respect for very differing takes on the same issue. The way in which different stakeholders discuss with each other in a real attempt at consensus thus represents a qualitatively improved policy dialogue. Nevertheless, the biggest challenge facing the NHA is ensuring a sustainable link to decision-making and the highest political circles. Modalities are needed to make NHA resolutions high priorities for the health sector. The NHA embodies many core features of a well-prepared deliberative process as defined in the literature (information provision, diverse views, opportunity to discuss freely) as well as key ingredients to enable the public to effectively participate (credibility, legitimacy and power). This offers important lessons for other countries for conducting similar processes. However, more research is necessary to understand how improvements in the deliberative process lead to concrete policy outcomes.
RESUMO
The World Health Organization handbook on Strategizing National Health in the 21st Century has emphasized the importance of the process of population consultation on needs and expectations. According to Thailand National Health Act 2007, three innovative social tools for participatory healthy public policy process were proposed, i.e., health assembly, health impact assessment and health system statute (charter). In practice, population consultation process is required in the process of the tools implementation. Therefore, this paper aims to illustrate how local health statute implementation supports population participation and consultation at the local level. The first local health statute owned by Cha-lae sub-district in Songkla Province had been introduced in 2009. So far, there are above 500 sub-districts or "Tambon" having their own health system statutes. Tambon Administrative Organization (TAO), health and non-health sectors, community leaders and civil society seemed to be key actors or a mechanism for the local health statute. This demonstrated three crucial elements or sectors for policy development, i.e., policy maker, evidence support and society. Contents of the local health statute are wide ranged, including social determinants, risks and diseases, life style, health services, health fund, to mental and social health in regard to the local problem and context. Therefore, it needs the process of discussion and consultation to seek their common interest and expectation. Local health statute in Thailand is an example of engagement and consultation of the population for health policy. This confirmed the process of population consultation on their needs and expectation that can be implemented both at national and local levels. This is also the strategy to improve the accountability of policy makers for health impacts at all levels of policy making. The challenges of local health statute include the mechanism to maintain and ensure the engagement and ownership for sustainable implementation. Lastly, the local government's continued commitment toward providing funding support through the implementation process and the self-assessment framework of implementation is needed.
