Reproductive Health and

Current Issues in Thailand

Assoc. Prof. Dr. Chokchai Munsawaengsub

BSc., M.D., DTM & H.,
Dip. Thai Board of Pediatrics,
Dip. Thai Board of Family Medicine
Department of Family Health
Faculty of Public Health
Millennium Development Goals (MDGs) 2000-2015
 SDGs - Thailand
Thailand attaches great importance to the concept of
sustainable development which has long taken root in the
country. The country has been guided by the Sufficiency
Economy Philosophy (SEP), conceived by His Majesty the
Late King Bhumibol Adulyadej.
SEP has been adopted as the core principle of National
Economic and Social Development Plan since 2002.
The current constitution has integrated SEP and
sustainable development as integral parts.
The development approach based on SEP is in conformity
with the core principle of the 2030 Agenda and can serve
as an approach to support the realization of the SDGs..
 SDGs – Thailand
SEP promotes sustainability mindset and provides
guidelines for inclusive, balanced and sustainable
development.
SEP will continue to be our guiding principle in
completing the unfinished MDGs business and
achieving the SDGs.
The cabinet has decided on 25 October 2016 to
promote the application of SEP for SDGs in all areas and
at all levels.
Thailand has also been actively sharing SEP as a
development model to the international community
especially since her G-77 chairmanship in 2016.
MAIN HIGHLIGHTS
MAINSTREAMING THE SDGS
SEP and SDGs have been integrated in the
20 – Year National Strategy Framework and
the 12th National Economic and Social
Development Plan (2017 – 2021). As a
result, plans and budgeting of all
government agencies will be in line with
SEP and SDGs.
NATIONAL MECHANISM FOR SUSTAINABLE
DEVELOPMENT
The National Committee for Sustainable
Development (CSD), chaired by the Prime
Minister, is Thailand’s main and highest
mechanism responsible for the country’s
sustainable development. It has 37 members
from public, private academia and civil society,
with the Secretary-General of National Economic
and Social Development Board (NESDB) as the
secretariat.
NATIONAL MECHANISM FOR SUSTAINABLE
DEVELOPMENT
The main task of CSD is formulating polices and
strategies on national sustainable development
and oversight their implementation, including the
SDGs. It has established three sub-committees to
advance the three inter - connected processes
namely mobilizing the SDGs, raising awareness on
sustainable development and the application of
SEP, and compiling data and statistics to support
the implementation and monitoring of the 2030
Agenda.
NATIONAL MECHANISM FOR SUSTAINABLE
DEVELOPMENT
Three taskforces were established and respectively
tasked with
(1) reviewing and recommending legal, economics
and social measures necessary for achieving the
SDGs;
(2) coordinating works by numerous agencies, and
priority setting; and
(3) preparing report on Thailand’s progress,
challenges, and recommendation in
implementing the 2030 Agenda
THE PROGRESS
Goal 1: Thailand has achieved the MDGs target
on poverty and hunger, reducing the number of
people living in poverty and hunger by half.
However, poverty remains in many
manifestations and inequalities persist. Around
7.2 per cent of population lives under the
national poverty line, the number could reach
15.5 per cent if we include those who are slightly
above the line.
THE PROGRESS
Measures such as SEP villages seek to increase
income and reduce expenditure for those in the
rural area.
The government has started a registration scheme
to provide support to the poor. In 2016, 17,469
million baht (approximately 485 million US Dollar)
was provided to 7.5 million registered low income-
earners through the national e-payment system to
further support their livelihood. It is expected that
the scheme will benefit around 12 million
qualified registrants in 2017.
Goal 2: Thailand, also known as “Kitchen of the
World”, has successfully reduced the proportion
of undernourished population from 34.6 per cent
to 7.5 per cent during the MDGs era.
Efforts to provide the poor and vulnerable groups
with access to adequate, safe and nutritious food
will be further highlighted in the 20 – Year
National Strategy Framework on healthcare.
Measures, including law, have been taken to
reduce stunning and wasting in children under 5
year of age.
Goal 2: Thailand strives to ensure sustainable
food production system through promoting
practice of sustainable agriculture in the forms of
organic farming and the “New Theory Farming”
under the SEP concept, with the target to
increase the area of sustainable agriculture
farming at 80,000 hectare per annum.
Goal 3: Universal Health Coverage (UHC) has
been a crucial factor in the improvement of
healthcare service in Thailand with current
coverage stands at 99.87 per cent. We also
attach great importance to preventive medicine.
As a result, maternal and neonatal mortality
rates are well below the global targets thanks to
99.6 per cent of birth attended by skilled health
personnel. New cases of pandemic diseases are
also on the decline.
Goal 3: The government is determined to reduce
the number of road traffic accident through legal
measures and promoting safe driving behavior to
bring down the second most cause of death.
Goal 4: More than 90 per cent of school age
children are enjoying subsidized 15- year basic
education available to all children in the land,
regardless of their nationalities or migrant
status. The government is promoting vocational
study in particular dual education with an aim to
increasing quality workforce in real sectors. We
are working harder to advance the quality of
education at all levels under the 12th Education
Plan (2017-2021) and the National Education
Plan 2017-2036.
Goal 5: Gender equality
Girls enjoy equal access to quality education as
boys do. In fact, they even do better in higher
education. Female are now accounted for 60 per
cent of the workforce and hold a handsome share
of 38 per cent of executive level in private sector.
The current constitution calls for gender
responsive budgeting, on which a pilot project is
being implemented in Surat Thani province.
Elements of SDG 5 will be incorporated in the
Women Development Strategy 2017-2021.
Thailand: Taking Action for Sustainable Development

What are the bold actions being taken by the

Government to achieve the Sustainable
Development Goals in Thailand?
Good sexual and reproductive health is a state
of complete physical, mental and social
wellbeing in all matters relating to the
reproductive system.
Thailand demonstrated its commitment to
preventing unintended pregnancy and halving
adolescent childbearing by enacting the Prevention
and Solution of the Adolescent Pregnancy Problem
Act A.D. 2016 (in effect July 2016).
The Act guarantees five sexual and reproductive
health rights for young people:
1. the right to make a decision by oneself;
2. the right to information and knowledge;
3. the right to reproductive health service;
4. the right to confidentiality and privacy;
5. the right to social welfare provision, that are equal
and non-discriminative.
Why do the above actions matter to people in
Thailand?
Thailand faces a demographic change into an
ageing society with low fertility, yet with the
presence of high unintended adolescent
pregnancies. The proportion of the population
aged over 60 years has increased while that of
young people has dropped.
However, a high number of them become teen
mothers. This has become a significant national
social and economic development concern.
An increasing trend of adolescent births
happened during 2000-2012:
a 73 percent increase from 31 to 54 births
per 1,000 adolescents aged 15-19.
It came down to 44 per 1,000 in 2015.
In number, about 100,000 to 130,000 of
women aged 15 to 19 years old become
mothers each year.
Therefore, over one million babies were
born to teen mothers since 2000.
Many researches find that adolescent pregnancy
is a major contributor to social and economic
exclusion and poverty.
What SDGs have been particularly advanced
through the enactment of the Act?
The Act focuses on Goal 3 on good health and
well-being with Indicator 3.7.1: Proportion of
women of reproductive age (aged 15-49 years)
who have their need for family planning satisfied
with modern methods,
and Indicator 3.7.2: Adolescent birth rate (aged
10-14 years; aged 15-19 years) per 1,000 women
in that age group.
It also contributes to Goal 5 on gender equality
with Indicator 5.6.1: Proportion of women aged
15-49 years who make their own informed
decisions regarding sexual relations,
contraceptive use and reproductive health care,
Indicator 5.6.2: Number of countries with laws
and regulations that guarantee women aged 15-
49 years access to sexual and reproductive health
care, information and education
Office : Bureau of Health Promotion
Project Name : Health Promoting Hospital Project
Rationale :

The hospital is an important base for health promotion

activities, involving a significant number of individuals
working together on a daily basis. Thus, the hospital is not
simply a place for high-quality medical and clinical services.
Adopting a new image and structure, the "health promoting
hospital” concept has helped to create organizations which
emphasize a participatory role of the patient and all staff of
the institution.
In this model, the hospital staff set the example of good
health promotion behaviors and extend this from care for
in-patients all the way to services in the home community.
Project Name : Health Promoting Hospital Project
The hospital environment is modified so that it reflects a
health promotion mentality. Thailand has adapted the policy
of the World Health Organization for the health promotion
hospital across 11 dimensions including:
policy, management, budget planning, health
promotion activities for the patient and relatives, hospital
staff, creating a health promoting environment in the
hospital, community strengthening, providing
comprehensive (holistic) care, network of partners, on-going
quality control, and innovation.
The goal was to integrate health promotion principles and
activities into the routine hospital functions.
Objective :

To establish a system of health promotion in the hospital setting

to meet the criteria for becoming a certified "Health Promoting
Hospital.” Prevention, curative, and rehabilitative services are
integrated under a process of quality control and universal health
insurance.
Target Beneficiaries
MOPH hospitals at every level including community, provincial
and regional hospitals;
Hospitals under the authority outside of the MOPH.
Key Features of Project Implementation
Develop a master plan for the health promotion hospital to clarify
how policy is converted into action. Targets are specified and
development milestones are established for guiding and tracking
the integration of services, while building capacity and quality of
hospital services.
Objective :
Establish standards for the health promotion hospital. These
standards enable the hospital to assess its own progress and are
used for determining whether the hospital has achieved the
criteria of a "health promoting hospital”. There are seven
elements of the standards which have their foundation in
organizational development and health promotion:
Element 1: Organizational leadership and management
Element 2: Mobilization of resources and human resource
development
Element 3: Modifying the institutional environment so that it is
conducive toward a health promotion hospital
Element 4: Health promotion for hospital staff
Element 5: Health promotion for hospital clients and their families
Element 6: Health promotion for the community
Element 7: Outcomes of the health promotion activities
Mobilize teams to help with the development of the
project and with oversight/evaluation of the results. These
teams are comprised of individuals from the central and
zonal offices.
These teams have the responsibility for guiding the health
promotion integration activities, and evaluating the
process and outcomes of this to certify whether the
hospital has achieved "health promotion hospital” status.

The evaluation process includes review of records, listening

to presentations, and visitations with hospital staff and
clients over a period of 1 to 2 days. After completing the
visit, the team provides a summary of findings and
recommendations to the hospital administrators.
 Next, the team prepares an evaluation report for the
central office which scores the hospital across the 11
elements (from a low of 1 to a high of 5; with a score of
2 or above as passing).
Establish forums for exchange of knowledge and
experience at the provincial, zonal and national level.
These forums allow the discussion and comparison of
project experience and innovation in different
hospitals and from different perspectives. These
forums also help to build a multi-level network. These
forums have been convened regularly for five years
and include 1,200 – 1,800 participants per year.
Integrate the standards for the health promotion hospital with the
quality control standards for institutions under the HPHA. In
addition, integrate the standards of the health promotion hospital
with the activities under the administration of the Department for
Disease Control, particularly in the areas of prevention,
occupational risk, mosquito larvae control, control of consumption
of drinking water, alcohol, and tobacco. These expanded standards
are labeled HPH Plus, and the standards of MBNQA are
synchronized with the Health Promoting Hospital National Quality
Award standards.
Results :

Quantitative Results : Of all the MOPH hospitals, 98% (820

institutions) achieved a score of at least 2 or more as evaluated
against the standards for a "health promoting hospital”.
Qualitative Results : Assessment of the expanded role of hospitals
achieved the criteria of HPHA and other qualitative assessments.
Project : Healthy Child Care Center
Rationale :
Ensuring quality of life for young children is one element of ensuring
development and progress of the community, society and the nation.
Naturally, the individuals most directly involved in the care and
upbringing of the child are the father, mother and other family
members. However, the socio-economic challenges of modern Thailand
are forcing changes to the traditional family structure. For example,
parents increasingly must work outside the home, leaving some of the
responsibility for child care to someone who may not be part of the
immediate family. Thus, it is clear that day-care institutions will become
a more common feature of Thai society in the future and will have an
important role to play in child development. National population
census data for 2014 found that approximately 44% of pre-school-age
children were enrolled in government or private nursery schools; 17%
were in child day-care centers; and 39% were being taken care of by
relatives of neighbors at home.
Project : Healthy Child Care Center
Objectives :
1. To support and encourage the adoption of standards for child day-
care centers by the local administrative organizations and the
responsible government agencies.
2. To help the day-care centers to arrange activities and services
which promote the health and development of the children enrolled
at the centers. This includes the provision of clean and safe food,
drinks and environment, and capacity building for the day-care
center staff so that they provide quality services.

Target Population : Child day-care centers, both public and private,

including those established by the local administrative organizations
themselves and those transferred to them by government agencies
Key Aspects of Implementation :
1. The project created a sense of participation among the child care
center managers and the staff of the local administrative organization
in acquiring knowledge, understanding, and policy formulation for
developing the child, staff and environment in the day care center.
The project studied and researched the setting of standards for child
care centers, and supported the development of standard plans for
these centers.
2. The project sponsored national competitions among centers to be
recognized as a "best practice model” which could be emulated by
others.
3. The project developed the capacity of relevant staff and child care
providers by imparting knowledge and skills in developing a child care
center and in methods of quality child care.
4. The project arranged forums for the exchange of knowledge and
experience of members of the network of child care centers, and
supported the development of printed materials and an internet web
site for sharing information.
Project Name : Parents School
Rationale :
Most parents have hope that their child will develop a strong and healthy
body, have a good mind, have sound morals and happiness, and is successful
in his or her adult life. In order to achieve these goals children need to be
well-trained and cared for by their parents, who themselves need to provide
good examples of these goals. The first five years is the most critical period
for child care since that is when most formative development takes place.
Beyond these years, the parents will never have another chance to have as
great an impact on their child’s development. Thus, in order to be quality
parents to produce quality children, the parents need to have the requisite
knowledge, understanding, and concern for contributing to early child
development, and have the child-care skills that are appropriate at each
phase of a child’s life. It is also the role of the medical and public health staff
to educate parents so that they acquire the knowledge and skills to rear their
child successfully. Thus, the Department of Health conceived of the "Parents
School” Project to provide a formal structure for educating parents and those
personnel who assist parents in the important aspects of raising a child during
the ages from birth to 5 years.
Objectives :
1.Develop the attitude of parents so that they see the importance of
their role in their child’s early development.
2.Help parents prepare for early child care during the pre-marital
phase, during pregnancy, and after delivery.
3.Provide educational information and advice for parents so that they
are able to train and care for their children age 0 to 5 years, in a
quality way, by themselves and with other members of the
household.
4.Provide a learning space for parents to self-educate in the aspects
promoting the health and development of children age 0 to 5 years.
5.Build the capacity of health staff to transmit knowledge and skills for
parents in how to properly raise their pre-school-age children.

Intended Beneficiaries
1.Parents and guardians of children age 0 to 5 years
2.Medical and public health staff at every level
Key Features of Project Implementation
Increase participation of parents in training and raising their
children
Strengthen the role of medical and public health staff in
transmitting knowledge and skills to parents so that their
children will grow up to be strong and healthy, and
successfully pass through each stage of development.
Achievements
1. This activity has become an important part of the Sai Yai
Rak Hospital program
2. This activity has created "parent schools” in the ANC,
post-natal, and well baby care sections of hospitals and
health centers for parent clients.
Project Name : Nutrition promotion for children and youth
in remote locations in accordance with the Royally-
inspired development initiative for children and youth in
remote areas.
Rationale :
Princess Maha Chakri Sirindhorn has pointed to the need to give
attention to the health status of the populations in remote areas
without good road access and who lack access to basic services,
especially in the case of mothers with young children. These
individuals lack adequate information on maintaining their own and
their child’s proper health status during pregnancy, delivery, in the
post-partum period, infancy, and school-age periods. Accordingly, the
Department of Health (DOH) has implemented nutrition and
maternal-child health (MCH) promotion programs for remote
communities since 1996. These programs provided essential MCH
services appropriate to the local context and customs to raise MCH
awareness and reduce the severity of health problems that occur.
From data provided by the national Youth Development
Fund (under Royal Patronage) for the year 2014,
the infant mortality rate was 12 per 1,000 live births,
the proportion of underweight births (less than 2,500
grams) was 4.7%,
children from birth to age 3 years were developing at a rate
of 99.7% of the standard. In any event, children in some
remote areas are higher risk than others due to lack of
access to public health services.
Many problems are related to poor or inadequate nutrition
resulting underweight, stunted development, goiter, and
intestinal parasites.
-Fully 8% of pre-school-age and 5% of primary school-age
children were underweight according to the standard;
-11% of pre-school-age and 10% of primary school-age
children were shorter than the standard;
-slightly over 1% had goiter and diarrheal disease;

-10% of pre-school-age and 11% of primary school-age

children had cold/flu;

-6% had been exposed to the malaria parasite,

- 4% of pre-school-age and 7% of primary school-age
children had intestinal parasites.
The DOH also arranged training in general
and environmental health promotion
through the schools through the capacity
building of Border Patrol Police instructors
every year. At present, of 183 Border Patrol
Police schools in the targeted remote areas,
163 (89%) have developed health
promotion units.
Objectives :

To promote health from the time of pregnancy, infancy, pre-school,

school-age and adolescence, of children in remote areas through
provision of appropriate health care. To provide information on
food and nutrition, and build general and environmental health
behaviors to help children and youth acquire good nutritional and
health status, so that they can develop properly to achieve their full
potential. This is accomplished in the context of a supportive school
and community environment.

Target Population :

Children and youth, from the time of existence as an embryo to adolescence who
live in disadvantaged remote areas.
The target locations for implementation include
- schools administered by the Border Patrol Police,
- schools under the Basic Education Commission,
- Community Education Centers for Ethnic Minorities –
Mae Fah Luang (under the Non-formal/adult Education
Bureau),
- private Islamic schools, Phra Piratham schools, and other
schools as recommended by the Royal Foundation.
Achievements as of 2009 :
1.Built the capacity and strength of the network of project partners through
technical meetings on developing child and youth health in remote areas for 183
schools administered by the Border Patrol Police; and trained teachers from nine
Community Education Centers in Mae Hong Son Province and 22 Centers in Tak
Province.
2.Developed a model, standards and educational principles for service delivery
based on research of the health status of students in the R2R Border Patrol Police
schools.
3.Built capacity of school children through peer leader associations under the
"Yes, Thai Children Can” theme in 100 Border Patrol Police schools and in select
Phra Piratham schools.
4.Supported growth development and monitoring of children from the stage of
embryo to early development through provision of iron supplements for 1,000
pregnant women and for 4,000 children age 0 to 3 years of age.
5.Built the capacity of administrators through participatory development of the
strategic plan.
6.Conducted participatory evaluation of the implementation and process of
interventions for health development among ethnic minority Karen in Tak, Hmong
in Payao, and Museur in Chiang Mai.
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