Health Policy Dialogue, Thailand, 2012

A number of countries have introduced significant national policy reforms to extend health coverage, with one specific objective being to include informal workers. Ghana, India and Thailand are the best known. In January 2012, WIEGO and HomeNet Thailand co-hosted a Health Policy Dialogue in Bangkok, with support from the Rockefeller Foundation.

The dialogue focused on whether and how informal workers have been included. Questions addressed were:

  1. What are the differences in perceptions between designers, implementers and informal workers?
  2. To the extent that there are barriers to access, what are these?
  3. What practically could be done to lower these barriers in the short term and medium term?

Participants

For all three countries, an attempt was made to have:

  • representatives from the government national scheme
  • informal worker organizations, including those who have been involved in the policy development, and sometimes in implementation as well
  • civil society organizations that have an interest in health
  • international agencies who are influential in health policy

Overview of the Programme

The Dialogue lasted two full days. On the first day, case studies of recent health reforms in Ghana (by Laura Alfers), India (by Kalpana Jain) and Thailand (by Boonsom Namsomboon) were presented to reflect different policy choices, in terms especially of financing and services available, and the outcomes of these choices on poorer working people.

The case studies (see links to publications, below) provided an overview of:

  • the Ghana National Health Insurance Scheme
  • the Thailand Universal Coverage Scheme
  • four schemes in India: the Rashtriya Swasthya Bima Yojana (RSBY, a national scheme); Yeshasvini Health Insurance Scheme in Karnataka state; Rajiv Aarogyasri Health Insurance Scheme in Andra Pradesh; and Vimo SEWA Health Co-operative Trust, active in nine states in India

A smaller programme, the KKPKP/SWaCH health insurance scheme, was also presented. (KKPKP is a union of waste pickers in Pune, India; SWaCH is its affiliated worker-owned cooperative.) The health insurance scheme is an unusual partnership between an informal worker’s co-operative, the private sector, and the Pune municipality.

A further example of an innovation, HomeNet Thailand’s pilot scheme in collaboration with the Thailand government health services in integrating workers’ health into national primary health care, was shared. Through panel discussions, informal workers organizations gave their experiences of involvement with policy engagement.

Presentations were followed by deeper discussions about the main barriers to access for informal workers, and then a focus on practical things that can be done to remove the barriers where possible. Two breakaway groups were established – in the first, the country groups and advisors were mixed; in the second, people met in separate country groups.

At its conclusion, the Dialogue bought together the lessons learned, and identified specific ways in which barriers to access could be lowered. All stakeholders made commitments as to how they would take the work forward.

Related Reading

Alfers, Laura. 2013. The Ghana National Health Insurance Scheme: Barriers to Access for Informal Workers.

Jain, Kalpana. 2013. Health Financing and Delivery in India: An Overview of Selected Schemes.

Jain, Kaipana. 2012. Health Insurance in India: The Rashtriya Bima Yojana.

Alfers, Laura and Francie Lund. 2012. Participatory Policy Making: Lessons from Thailand's Universal Coverage Scheme.