Governance, policy, and health systems responses to the COVID-19 pandemic in Thailand: a qualitative study

BackgroundSince 2020, Thailand has experienced four waves of COVID-19. By 31 January 2022, there were 2.4 million cumulative cases and 22,176 deaths nationwide. This study assessed the governance and policy responses adapted to different sizes of the pandemic outbreaks and other challenges.MethodsA qualitative study was applied, including literature reviews and in-depth interviews with 17 multi-sectoral actors purposively identified from those who were responsible for pandemic control and vaccine rollout. We applied deductive approaches using health systems building blocks, and inductive approaches using analysis of in-depth interview content, where key content formed sub-themes, and different sub-themes formed the themes of the study.FindingsThree themes emerged from this study. First, the large scale of COVID-19 infections, especially the Delta strain in 2021, challenged the functioning of the health system’s capacity to respond to cases and maintain essential health services. The Bangkok local government insufficiently performed due to its limited capacity, ineffective multi-sectoral collaboration, and high levels of vulnerability in the population. However, adequate financing, universal health coverage, and health workforce professionalism and commitment were key enabling factors that supported the health system. Second, the population’s vulnerability exacerbated infection spread, and protracted political conflicts and political interference resulted in the politicization of pandemic control measures and vaccine roll-out; all were key barriers to effective pandemic control. Third, various innovations and adaptive capacities minimized the supply-side gaps, while social capital and civil society engagement boosted community resilience.ConclusionThis study identifies key governance gaps including in public communication, managing infodemics, and inadequate coordination with Bangkok local government, and between public and private sectors on pandemic control and health service provisions. The Bangkok government had limited capacity in light of high levels of population vulnerability. These gaps were widened by political conflicts and interference. Key strengths are universal health coverage with full funding support, and health workforce commitment, innovations, and capacity to adapt interventions to the unfolding emergency. Existing social capital and civil society action increases community resilience and minimizes negative impacts on the population

Responding to the COVID-19 second wave in Thailand by diversifying and adapting lessons from the first wave

Thailand’s first wave of COVID-19 in March 2020 was triggered from boxing events and nightclubs in Bangkok, which spread to 68 provinces. The nation responded rapidly with strong public health and social measures on 26 March 2020. Contact tracing was performed by over 1000 surveillance and rapid response teams with support from 1.1 million village health volunteers to identify, isolate and quarantine cases. Thailand implemented social measures in April 2020 including a full-scale national lockdown, curfews and 14-day mandatory quarantine for international travellers. With a strong health system infrastructure, people’s adherence to social measures and a whole-of-government approach, the first wave recorded only 3042 cases and 57 deaths with 1.46% case fatality rate. Economic activities were resumed on 1 May 2020 until the end of the year. On 17 December 2020, a second wave was carried by undocumented migrants who were not captured by the quarantine system. As the total lockdown earlier led to serious negative economic impact, the government employed a targeted strategy, locking down specific areas and employing active case finding. Essential resources including case finding teams, clinicians and medicine were mobilised. With synergistic multisectoral efforts involving health, non-health and private sector, the outbreak was contained in February 2021. Total cases were seven times higher than the first wave, however, early admission and treatment resulted in 0.11% case fatality rate. In conclusion, experiences of responding to the first wave informed the second wave response with targeted locking down of affected localities and active case findings in affected sites

Prioritization of the Target Population for Coronavirus Disease 2019 (COVID-19) Vaccination Program in Thailand

Thailand was hit by the second wave of Coronavirus Disease 2019 (COVID-19) in a densely migrant-populated province (Samut Sakhon). COVID-19 vaccines were known to be effective; however, the supply was limited. Therefore, this study aimed to predict the effectiveness of Thailand’s COVID-19 vaccination strategy. We obtained most of the data from the Ministry of Public Health. Deterministic system dynamics and compartmental models were utilized. The reproduction number (R) between Thais and migrants was estimated at 1.25 and 2.5, respectively. Vaccine effectiveness (VE) to prevent infection was assumed at 50%. In Samut Sakhon, there were 500,000 resident Thais and 360,000 resident migrants. The contribution of migrants to the province’s gross domestic product was estimated at 20%. Different policy scenarios were analyzed. The migrant-centric vaccination policy scenario received the lowest incremental cost per one case or one death averted compared with the other scenarios. The Thai-centric policy scenario yielded an incremental cost of 27,191 Baht per one life saved, while the migrant-centric policy scenario produced a comparable incremental cost of 3782 Baht. Sensitivity analysis also demonstrated that the migrant-centric scenario presented the most cost-effective outcome even when VE diminished to 20%. A migrant-centric policy yielded the smallest volume of cumulative infections and deaths and was the most cost-effective scenario, independent of R and VE values. Further studies should address political feasibility and social acceptability of migrant vaccine prioritization

Effective coverage of diabetes and hypertension: an analysis of Thailand's national insurance database 2016-2019.

OBJECTIVES: This study assesses effective coverage of diabetes and hypertension in Thailand during 2016-2019. DESIGN: Mixed method, analysis of National health insurance database 2016-2019 and in-depth interviews. SETTING: Beneficiaries of Universal Coverage Scheme residing outside Bangkok. PARTICIPANTS: Quantitative analysis was performed by acquiring individual patient data of diabetes and hypertension cases in the Universal Coverage Scheme residing outside bangkok in 2016-2019. Qualitative analysis was conducted by in-depth interview of 85 multi-stakeholder key informants to identify challenges. OUTCOMES: Estimate three indicators: detected need (diagnosed/total estimated cases), crude coverage (received health services/total estimated cases) and effective coverage (controlled/total estimated cases) were compared. Controlled diabetes was defined as haemoglobin A1C (HbA1C) below 7% and controlled hypertension as blood pressure below 140/90 mm Hg. RESULTS: Estimated cases were 3.1-3.2 million for diabetes and 8.7-9.2 million for hypertension. For diabetes, all indicators have shown slow improvement between 2016 and 2019 (67.4%, 69.9%, 71.9% and 74.7% for detected need; 38.7%, 43.1%, 45.1% and 49.8% for crude coverage and 8.1%, 10.5%, 11.8% and 11.7% for effective coverage). For hypertension, the performance was poorer for detection (48.9%, 50.3%, 51.8% and 53.3%) and crude coverage (22.3%, 24.7%, 26.5% and 29.2%) but was better for effective coverage (11.3%, 13.2%, 15.1% and 15.7%) than diabetes. Results were better for the women and older age groups in both diseases. Complex interplays between supply and demand side were a key challenge. Database challenges also hamper regular assessment of effective coverage. Sensitivity analysis when using at least three annual visits shows slight improvement of effective coverage. CONCLUSION: Effective coverage was low for both diseases, though improving in 2016-2019, especially among men and ัyounger populations. The increasing rate of effective coverage was significantly smaller than crude coverage. Health information systems limitation is a major barrier to comprehensive measurement. To maximise effective coverage, long-term actions should address primary prevention of non-communicable disease risk factors, while short-term actions focus on improving Chronic Care Model