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"Start simple, use evidence-based practices, and involve all stakeholders." Lessons learned from Thailand to South Africa in developing health for all.
(Bangkok, Thailand) March 11 to 15, 2024, delegates from South Africa's National Department of Health and District Health Offices visited the National Health Security Office (NHSO) for a five-day intensive course to explore Thailand's experience in managing health financing and health service delivery at the district level for Universal Health Coverage (UHC).
The visit is part of the "Health Financing Management at District Level (HFM4D)" project between South Africa's Department of Health, provincial departments, and the Japan International Cooperation Agency (JICA).
As the National Health Insurance Bill (NHI) for the Universal Health Coverage (UHC) for all Africans was passed in the National Council of Provinces in December 2023, the visit comes during the transitional period of South Africa's health system at both the national and district levels.
The five-day study covers essential aspects of financing management of the Universal Coverage Scheme (UCS), including budget formulation, fund allocation, payment methods, claim and audit systems, and Thailand's experience in developing Contracting Units for Primary Healthcare (CUP) and Primary Care Unit Management.
The program began with a welcome note from Mrs. Waraporn Suwanwela, Deputy Secretary-General of NHSO. She stated that while Thailand's path of developing UHC may differ from South Africa's, key factors common to many countries include a strong primary healthcare system, a sustainable financial framework, continued political will and governance, active community participation, and evidence-based decision-making.
The Deputy Secretary-General also provided insights into the governance of NHSO and the development of the UCS.
Later sessions explored financial risk protection for UCS, including budget planning, a look at the benefits package and Health Technology Assessment (HTA), community health fund, primary healthcare system, and how the public contributes to UHC development.
South African delegates also visited health facilities in Nakhon Pathom province to learn more about implementing CUP and PCU management, including the referral system, claim, and audit processes.
Wrap-up Session: Sharing experiences between Thailand and South Africa.
Mr. Moremi Nkosi, Chief Director of Healthcare Benefits and Provider Payments at the National Department of Health, briefed on the South African health system, which is considered a two-tier system of private and public sectors. The key challenge for the South African system is transitioning the two-tier system into a single-fund system for all populations under the National Health Insurance bill, aiming to provide healthcare for all Africans.
South African delegates reflected on a critical lesson learned from a week-long study visit to Thailand: Effective resource allocation, especially at the community health level, a stakeholder engagement process at all levels, and a robust monitoring and evaluation system are needed for the implementation of the NHI bill in South Africa.
Dr. Viroj Tangcharoensathien, an advisor on Global Health to the Ministry of Public Health and a key health economist in developing Thai UHC, joined the wrap-up session. He concluded, "What South African colleagues saw for a week is the outcome of 20 years of development. Thailand has gone through 20 years of painful adjustment and faithful contribution by all partners."
Dr. Viroj's key reflection for the SA team is that for the initial phase of UHC implementation in SA, there is a need to demonstrate concrete outcomes and measure them. He also emphasizes, "do not fail the citizen."
Dr. Walaiporm Patcharanarumol, Director of the Global Health Division at the Ministry of Public Health, Thailand, also emphasizes the importance of evidence-based support for policy implementation, monitoring, and evaluation to measure the progress of the Universal Coverage scheme.
Dr. Aquina Thular, a Technical Specialist on Health Economics for the National Health Insurance, joining online, stressed the importance of collecting evidence to demonstrate the progress of implementing NHI in SA, whether it is the development of a benefits package or the utilization of the system.
The study visit is expected to significantly contribute to the participants' understanding and capability to implement effective health financing management strategies within the context of South Africa's health reform ambitions, marking a step forward in global health collaboration.
The visit is part of the "Health Financing Management at District Level (HFM4D)" project between South Africa's Department of Health, provincial departments, and the Japan International Cooperation Agency (JICA).
As the National Health Insurance Bill (NHI) for the Universal Health Coverage (UHC) for all Africans was passed in the National Council of Provinces in December 2023, the visit comes during the transitional period of South Africa's health system at both the national and district levels.
The five-day study covers essential aspects of financing management of the Universal Coverage Scheme (UCS), including budget formulation, fund allocation, payment methods, claim and audit systems, and Thailand's experience in developing Contracting Units for Primary Healthcare (CUP) and Primary Care Unit Management.
The program began with a welcome note from Mrs. Waraporn Suwanwela, Deputy Secretary-General of NHSO. She stated that while Thailand's path of developing UHC may differ from South Africa's, key factors common to many countries include a strong primary healthcare system, a sustainable financial framework, continued political will and governance, active community participation, and evidence-based decision-making.
The Deputy Secretary-General also provided insights into the governance of NHSO and the development of the UCS.
Later sessions explored financial risk protection for UCS, including budget planning, a look at the benefits package and Health Technology Assessment (HTA), community health fund, primary healthcare system, and how the public contributes to UHC development.
South African delegates also visited health facilities in Nakhon Pathom province to learn more about implementing CUP and PCU management, including the referral system, claim, and audit processes.
Wrap-up Session: Sharing experiences between Thailand and South Africa.
Mr. Moremi Nkosi, Chief Director of Healthcare Benefits and Provider Payments at the National Department of Health, briefed on the South African health system, which is considered a two-tier system of private and public sectors. The key challenge for the South African system is transitioning the two-tier system into a single-fund system for all populations under the National Health Insurance bill, aiming to provide healthcare for all Africans.
South African delegates reflected on a critical lesson learned from a week-long study visit to Thailand: Effective resource allocation, especially at the community health level, a stakeholder engagement process at all levels, and a robust monitoring and evaluation system are needed for the implementation of the NHI bill in South Africa.
Dr. Viroj Tangcharoensathien, an advisor on Global Health to the Ministry of Public Health and a key health economist in developing Thai UHC, joined the wrap-up session. He concluded, "What South African colleagues saw for a week is the outcome of 20 years of development. Thailand has gone through 20 years of painful adjustment and faithful contribution by all partners."
Dr. Viroj's key reflection for the SA team is that for the initial phase of UHC implementation in SA, there is a need to demonstrate concrete outcomes and measure them. He also emphasizes, "do not fail the citizen."
Dr. Walaiporm Patcharanarumol, Director of the Global Health Division at the Ministry of Public Health, Thailand, also emphasizes the importance of evidence-based support for policy implementation, monitoring, and evaluation to measure the progress of the Universal Coverage scheme.
Dr. Aquina Thular, a Technical Specialist on Health Economics for the National Health Insurance, joining online, stressed the importance of collecting evidence to demonstrate the progress of implementing NHI in SA, whether it is the development of a benefits package or the utilization of the system.
The study visit is expected to significantly contribute to the participants' understanding and capability to implement effective health financing management strategies within the context of South Africa's health reform ambitions, marking a step forward in global health collaboration.
