Contextual attributes associated with public participation in environmental impact assessments in Thailand: Perspectives obtained from authorities and academics.

Context can enhance or hinder public participation (PP) in environmental impact assessments (EIAs). This study aimed to investigate and discuss how PP-related contextual attributes influence the quality of PP in Thai EIA processes. The study adopted the qualitative approach and interviewed 20 key informants with insightful PP-associated experience in Thai EIAs. The results showed that four major groups of contextual attributes are believed to influence PP in Thai EIAs: the legal and political frameworks, the capacities of key actors, environmental awareness and the right to participate in decision-making processes, and cultural context. The greatest strength of PP in Thai EIAs is that PP is mandated by law, followed by increased environmental awareness and the right to participate in the decision-making process. Different key actors such as project owners, consultants, non-governmental organizations, and reviewing agencies encounter difficulties in discharging their prescribed functions, which affects the quality of PP. The authoritarian culture of Thai society also prevents PP in EIAs. The study offers certain recommendations, including public communication about how civic inputs can influence decision-making processes, the employment of social sector specialists to facilitate PP in EIA, and the application of appropriate participation techniques associated with the prevailing culture.

The social impact of the COVID-19 outbreak on urban slums and the response of civil society organisations: A case study in Bangkok, Thailand.

This study examined the social impact of the COVID-19 outbreak on Bangkok slum residents and the initiatives of Civil Society Organisations (CSOs) to relieve negative impacts. A mixed-methods study was conducted based on the Social Impact framework. In June 2020, a cross-sectional survey was carried out among 900 participants from nine slums in different zones of Bangkok. In July 2020, semi-structured interviews were conducted with 19 slum residents and four CSOs to gain in-depth information on the social impact of COVID-19 and CSOs' response. Out of 900 participants, 25.9% lost their jobs during the lockdown and 52.7% lost their income. The job and income loss increased the poverty rate within the participants from 51.6% to 91.7%. Participants limited their mobility and social activities during the lockdown. Stress was increased among 42.6% of all participants and the increased stress was associated with both income loss and self-quarantine. Due to financial constraints, a significant proportion of participants had to limit their food consumption and/or their consumption of nutritious but more expensive food. Almost one-tenth of the participants relied on donated food only. The majority of the participants (61.1%) could not access the income compensation scheme. COVID-19 forced Bangkok slums residents to live below the subsistence level in multiple ways with limited access to social protections. CSOs played an important role in relieving the suffering by providing food, survival kits, jobs, and access to COVID-19 test. Their agility, skills and knowledge about slums, and social capital enabled a rapid response to the crisis. Experienced local CSOs should be engaged as a bridge between urban slums and social protections. A holistic approach to combatting the COVID-19 crisis should be implemented. It is important to find the balance between preventing death from the virus and preventing suffering and death from an economic crisis.

Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand.

Participatory and responsive governance in universal health coverage (UHC) systems synergistically ensure the needs of citizens are protected and met. In Thailand, UHC constitutes of three public insurance schemes: Civil Servant Medical Benefit Scheme, Social Health Insurance and Universal Coverage Scheme. Each scheme is governed through individual laws. This study aimed to identify, analyse and compare the legislative provisions related to participatory and responsive governance within the three public health insurance schemes and draw lessons that can be useful for other low-income and middle-income countries in their legislative process for UHC. The legislative provisions in each policy document were analysed using a conceptual framework derived from key literature. The results found that overall the UHC legislative provisions promote citizen representation and involvement in UHC governance, implementation and management, support citizens' ability to voice concerns and improve UHC, protect citizens' access to information as well as ensure access to and provision of quality care. Participatory governance is legislated in 33 sections, of which 23 are in the Universal Coverage Scheme, 4 in the Social Health Insurance and none in the Civil Servant Medical Benefit Scheme. Responsive governance is legislated in 24 sections, of which 18 are in the Universal Coverage Scheme, 2 in the Social Health Insurance and 4 in the Civil Servant Medical Benefit Scheme. Therefore, while several legislative provisions on both participatory and responsive governance exist in the Thai UHC, not all schemes equally bolster citizen participation and government responsiveness. In addition, as legislations are merely enabling factors, adequate implementation capacity and commitment to the legislative provisions are equally important.

Performance of Thailand's universal health coverage scheme: Evaluating the effectiveness of annual public hearings.

BACKGROUND: Legislative provisions in Thailand's National Health Security Act 2002 mandate annual public hearings for providers, beneficiaries and other stakeholders in order to improve the performance of the Universal Health Coverage Scheme (UCS). OBJECTIVE: This study aims to explore the annual public hearing process, evaluate its effectiveness and propose recommendations for improvement. METHOD: In-depth interviews were conducted with 29 key informants from various stakeholder groups involved in annual public hearings. RESULTS: The evaluation showed that the public hearings fully met the criteria of influence over policy decision and partially met the criteria of appropriate participation approach and social learning. However, there are rooms for improvement on public hearing's inclusiveness and representativeness of participants, adequacy of information and transparency. CONCLUSIONS: Three recommendations were proposed a) informing stakeholders in advance of the agenda and hearing process to enable their active participation; b) identifying experienced facilitators to navigate the discussions across stakeholders with different or conflicting interests, in order to reach consensus and prioritize recommendations; and c) communicating policy and management responses as a result of public hearings to all stakeholders in a timely manner.

Providing organic food to urban consumers: case studies of supermarkets in Bangkok and metropolitan area.

This study aimed to 1) explore the information flow by which supermarkets attempt to communicate with consumers, and 2) make a preliminary evaluation of the strategies used by supermarkets to promote organic food to consumers specifically within the Bangkok Metropolitan Area. Nine supermarket outlets located at the headquarters of nine supermarket chains were observed. Eleven informants from four supermarket chains were interviewed. The results found that supermarkets in Thailand provided rich information about organic food via standard certification, a Participatory Guarantee System, storylines and illustrations involving farmers. The retailers attempted to offer organic food in a way that is convenient to urban consumers' lifestyles. However, the retailers did not attempt to offer special discounts or marketing promotions since they believed that the consumers knowledgeable of organic food would be willing to pay premium price. Two valuable recommendations can be drawn from this research. Firstly, the retailers should provide more information about the formal control systems and authenticity of organic food in order to foster trust and to allow consumers to assess its benefits. Secondly, the retailers should continue offering 'ready to eat' organic food since it can be of significance in relation to the lifestyle of urban Thai consumers.

Legislating for public accountability in universal health coverage, Thailand.

Sustaining universal health coverage requires robust active public participation in policy formation and governance. Thailand's universal coverage scheme was implemented nationwide in 2002, allowing Thailand to achieve full population coverage through three public health insurance schemes and to demonstrate improved health outcomes. Although Thailand's position on the World Bank worldwide governance indicators has deteriorated since 1996, provisions for voice and accountability were embedded in the legislation and design of the universal coverage scheme. We discuss how legislation related to citizens' rights and government accountability has been implemented. Thailand's constitution allowed citizens to submit a draft bill in which provisions on voice and accountability were successfully embedded in the legislative texts and adopted into law. The legislation mandates registration of beneficiaries, a 24/7 helpline, annual public hearings and no-fault financial assistance for patients who have experienced adverse events. Ensuring the right to health services, and that citizens' voices are heard and action taken, requires the institutional capacity to implement legislation. For example, Thailand needed the capacity to register 47 million people and match them with the health-care provider network in the district where they live, and to re-register members who move out of their districts. Annual public hearings need to be inclusive of citizens, health-care providers, civil society organizations and stakeholders such as local governments and patient groups. Subsequent policy and management responses are important for building trust in the process and citizens' ownership of the scheme. Annual public reporting of outcomes and performance of the scheme fosters transparency and increases citizens' trust.

Maintenir la couverture sanitaire universelle exige une forte participation publique à l'élaboration des politiques et à la gouvernance. En Thaïlande, le régime de couverture universelle a été mis en œuvre dans tout le pays en 2002, permettant de couvrir l'ensemble de la population grâce à trois régimes publics d'assurance maladie et d'améliorer les résultats de santé. Bien que la position de la Thaïlande concernant les Indicateurs de gouvernance mondiaux de la Banque mondiale se soit détériorée depuis 1996, des dispositions en matière d'expression et de reddition de comptes ont été intégrées à la législation et à la structure du régime de couverture universelle. Nous discutons ici de la mise en œuvre de la législation relative aux droits des citoyens et à la reddition de comptes du gouvernement. En vertu de la constitution de la Thaïlande, les citoyens ont pu soumettre un projet de loi dont les dispositions en matière d'expression et de reddition de comptes ont été intégrées aux textes législatifs et transposées dans la loi. La législation rend obligatoire l'enregistrement des bénéficiaires, une assistance téléphonique 24h/24 et 7 j/7, des auditions publiques annuelles et une aide financière systématique pour les patients qui ont été victimes d'événements indésirables. Pour garantir le droit à des services de santé, permettre aux citoyens de faire entendre leur voix et s'assurer que des mesures soient prises, les institutions doivent être en mesure d'appliquer la législation. Par exemple, la Thaïlande devait pouvoir enregistrer 47 millions de personnes et les rattacher au réseau de prestataires de soins du district où elles vivaient, et réenregistrer les personnes qui changeaient de district. Les auditions publiques annuelles doivent faire participer les citoyens, les prestataires de soins, les organisations de la société civile et les parties prenantes telles que les collectivités locales et les groupes de patients. Les réponses qui en découlent au point de vue des politiques et de la gestion sont importantes pour instaurer la confiance dans le processus et permettre aux citoyens de se l'approprier. Les rapports annuels publics sur les résultats du régime de couverture permettent d'accroître la transparence et de renforcer la confiance des citoyens.

Para mantener la cobertura sanitaria universal se requiere una sólida participación activa del público en la formulación de políticas y la gobernanza. El plan de cobertura universal de Tailandia se implementó en todo el país en 2002, lo que permitió a Tailandia lograr una cobertura completa de la población a través de tres planes de seguro médico público y demostrar mejores resultados en materia de salud. Aunque la posición de Tailandia respecto de los Indicadores mundiales de gobernanza del Banco Mundial ha disminuido desde 1996, las disposiciones relativas a la voz y la rendición de cuentas estaban incorporadas en la legislación y en el diseño del plan de cobertura universal. Se discute cómo se ha implementado la legislación relacionada con los derechos de los ciudadanos y la rendición de cuentas del gobierno. La Constitución de Tailandia permitía a los ciudadanos presentar un proyecto de ley en el que las disposiciones sobre la voz y la rendición de cuentas se incorporaban con éxito en los textos legislativos y se aprobaban como ley. La legislación exige el registro de los beneficiarios, una línea telefónica de ayuda 24 horas al día los 7 días de la semana, audiencias públicas anuales y asistencia financiera gratuita para los pacientes que han sufrido eventos adversos. Para garantizar el derecho a los servicios de salud y que se escuche la voz de los ciudadanos y se adopten medidas, es necesario contar con la capacidad institucional para aplicar la legislación. Por ejemplo, Tailandia necesitaba la capacidad de inscribir a 47 millones de personas y ponerlas en contacto con la red de proveedores de servicios de salud del distrito en el que viven, y de volver a inscribir a los miembros que se trasladan fuera de sus distritos. Las audiencias públicas anuales deben incluir a los ciudadanos, los proveedores de servicios de salud, las organizaciones de la sociedad civil y las partes interesadas, como los gobiernos locales y los grupos de pacientes. Las respuestas políticas y de gestión subsiguientes son importantes para generar confianza en el proceso y en la apropiación del plan por parte de los ciudadanos. El informe público anual sobre los resultados y el rendimiento del plan fomenta la transparencia y aumenta la confianza de los ciudadanos.

Self-assessment of nursing competency among final year nursing students in Thailand: a comparison between public and private nursing institutions.

INTRODUCTION AND OBJECTIVES: Nurses play a major role in Thailand's health care system. In recent years, the production of nurses, in both the public and private sectors, has been growing rapidly to respond to the shortage of health care staff. Alongside concerns over the number of nurses produced, the quality of nursing graduates is of equal importance. This study therefore aimed to 1) compare the self-assessed competency of final year Thai nursing students between public and private nursing schools, and 2) explore factors that were significantly associated with competency level. METHODS: A cross-sectional clustered survey was conducted on 40 Thai nursing schools. Data were collected through self-administered questionnaires. The questionnaire consisted of questions about respondents' background, their education profile, and a self-measured competency list. Descriptive statistics, factor analysis, and multivariate regression analysis were applied. RESULTS: A total of 3,349 students participated in the survey. Approximately half of the respondents had spent their childhood in rural areas. The majority of respondents reported being "confident" or "very confident" in all competencies. Private nursing students reported a higher level of "public health competency" than public nursing students with statistical significance. However, there was no significant difference in "clinical competency" between the two groups. CONCLUSION: Nursing students from private institutions seemed to report higher levels of competency than those from public institutions, particularly with regard to public health. This phenomenon might have arisen because private nursing students had greater experience of diverse working environments during their training. One of the key limitations of this study was that the results were based on the subjective self-assessment of the respondents, which might risk respondent bias. Further studies that evaluate current nursing curricula in both public and private nursing schools to assess whether they meet the health needs of the population are recommended.

Health insurance for people with citizenship problems in Thailand: a case study of policy implementation.

In 2002, Thailand achieved universal health coverage through the introduction of the Universal Coverage Scheme (UCS). However, people with citizenship problems, so-called 'stateless people', were left uninsured. Consequently, the 'Health Insurance for People with Citizenship Problems' (HIS-PCP) policy was adopted in 2010 with features emulating the UCS. This study sought to examine the operational constraints faced by health providers in implementing the HIS-PCP policy. Qualitative methods were used, and a case study was conducted to explore the implementation of the HIS-PCP in Ranong and Tak provinces. Individual in-depth interviews and group interviews were conducted with a total of 33 key informants. Interview data were analysed by a thematic approach. The study found that the HIS-PCP faced several operational challenges. Inadequate communication and unclear service guidelines contributed to ineffectiveness in budget spend and service provision. Other problems included the legal instruments that permitted stateless people to live only in certain areas, when such people were in fact highly mobile. Some providers adapted their practices to cope with on-the-job difficulties, including establishing a mutual agreement with neighbouring hospitals to allow stateless patients to bypass primary care gatekeepers. The challenges were aggravated by the delays in nationality verification procedures and insufficient collaboration between the Ministry of Public Health (MOPH) and the Ministry of Interior. Policy recommendations are suggested. In the short term, collaboration with relevant authorities both within and outside the MOPH should be improved. Guidelines concerning budgeting and scope of service provision should be fine-tuned. In the long run, the nationality verification process for stateless people should be expedited. The MOPH should develop clear and practical guidelines to assist health personnel to support patients to resolve their citizenship problems.

Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens.

BACKGROUND: In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices. METHODS: A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis. RESULTS: Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants. DISCUSSION: The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice. CONCLUSION: It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.

HIV/AIDS health care challenges for cross-country migrants in low- and middle-income countries: a scoping review.

INTRODUCTION: HIV/AIDS has been one of the world's most important health challenges in recent history. The global solidarity in responding to HIV/AIDS through the provision of antiretroviral therapy (ART) and encouraging early screening has been proved successful in saving lives of infected populations in past decades. However, there remain several challenges, one of which is how HIV/AIDS policies keep pace with the growing speed and diversity of migration flows. This study therefore aimed to examine the nature and the extent of HIV/AIDS health services, barriers to care, and epidemic burdens among cross-country migrants in low-and middle-income countries. METHODS: A scoping review was undertaken by gathering evidence from electronic databases and gray literature from the websites of relevant international initiatives. The articles were reviewed according to the defined themes: epidemic burdens of HIV/AIDS, barriers to health services and HIV/AIDS risks, and the operational management of the current health systems for HIV/AIDS. RESULTS: Of the 437 articles selected for an initial screening, 35 were read in full and mapped with the defined research questions. A high HIV/AIDS infection rate was a major concern among cross-country migrants in many regions, in particular sub-Saharan Africa. Despite a large number of studies reported in Africa, fewer studies were found in Asia and Latin America. Barriers of access to HIV/AIDS services comprised inadequate management of guidelines and referral systems, discriminatory attitudes, language differences, unstable legal status, and financial hardship. Though health systems management varied across countries, international partners consistently played a critical role in providing support for HIV/AIDS services to uninsured migrants and refugees. CONCLUSION: It was evident that HIV/AIDS health care problems for migrants were a major concern in many developing nations. However, there was little evidence suggesting if the current health systems effectively addressed those problems or if such management would sustainably function if support from global partners was withdrawn. More in-depth studies were recommended to further explore those knowledge gaps.