Dr. Stephen Zuellig Memorial Public Health Lecture Highlights Thailand’s Journey to Universal Healthcare

Text by Charmaine A. Lingdas

Photo by Joseph A. Bautista

The University of the Philippines Manila College of Public Health (CPH) hosted the second Dr. Stephen Zuellig Memorial Public Health Lecture on November 12, 2024, at the Ramon Ang Auditorium, Henry Sy Sr. Hall. Themed “No One Left Behind: The Leadership Journey of Thailand’s Rural Doctors Movement Towards Universal Health Care,” the lecture focused on Thailand’s transformative journey toward universal health coverage, particularly in rural areas. The speakers were representatives from the Thailand Rural Doctors Movement (RMD), which recently won the 2024 Ramon Magsaysay Award. Dr. Supat Hasuwannakit, current president of the Rural Doctors Society; Dr. Vichai Chokevivat, the prime mover of the Rural Doctors Movement; and Dr. Kriengsak Wacharanukulkiet, past president of the Rural Doctors Society, represented their organization.

“The relentless work of the Rural Doctors Movement has helped Thailand build one of Southeast Asia’s best healthcare systems, with universal health coverage,” said Dr. Fernando B. Garcia, Jr., Dean of the College of Public Health and SEAMEO TROPMED Center Director. “We hope to gain inspiration from their experience as the Philippines advances its own universal health care efforts.”

The Thailand Rural Doctors Movement

Founded in the 1970s with a commitment to social justice and addressing rural healthcare disparities, the Rural Doctors Movement has driven reforms and innovations, providing healthcare to millions in underserved and remote areas of Thailand and inspiring policies such as Thailand’s universal health coverage. 

Dr. Vichai Chokevivat, a key figure in the movement, described their journey, highlighting challenges in recruiting rural doctors and addressing health disparities. “The Rural Doctors Movement is not just an organization, but a persistent force that works tirelessly to bring healthcare to all Thai citizens,” he shared. The movement began in response to a shortage of healthcare services in rural Thailand, linked by U.S. recruitment of doctors, prompting the Thai government to require compulsory rural service for doctors. This, combined with the pro-democracy movement of the early 1970s, inspired many doctors to address rural healthcare inequities and support student-led initiatives in impoverished areas. 

Dr. Chokevivat discussed that the RMD were able to influence the establishment of a new constitution in 1974, enshrining public health in Article 92, committing the government to promote and protect citizens’ health, including provisions to control infectious diseases. This commitment proved critical during the COVID-19 pandemic, enabling early detection, contact tracing, and isolation to prevent disease spread.

In ending his message, he shared the words that have guided Thailand’s healthcare journey. “Let personal gain be secondary and the benefit of your fellow humans be your primary concern. Wealth, assets, and honor will come to you naturally if you uphold the moral principles of your profession with purity,” he said, quoting Prince Mahidol Adulyadej of Songkla, the founder of modern medicine in Thailand.

Message from the Philippines

In reaction, Mr. Joram P. Manio, Vice Chairperson for Externals of the UP College of Public Health Student Council, emphasized that “providing students with data, facts, and figures in school is not enough; it cannot fully capture the severity of the problem. We need to not only see but also immerse ourselves fully in these communities” to understand their struggles and create long-term solutions. He highlighted how the Rural Doctors Movement’s history shows the importance of medical students collaborating to address healthcare inequities.

Dr. Manuel Dayrit, former Secretary of Health and board member of the Zuellig Family Foundation, drew historical parallels between the healthcare systems of Thailand and the Philippines. He explained that both countries faced a brain drain leading to migration of doctors. Both nations implemented policies, like the Rural Health Practice Program, to retain doctors. Dr. Dayrit discussed how the Thai Rural Doctors Movement addressed systemic healthcare issues by galvanizing doctors to collaborate with the government, even under a military dictatorship. They prioritized primary care and institutionalized universal healthcare, creating a financing system through the National Health Security Office and placing a five-year moratorium on hospital construction. In contrast, the Philippines in the 1970s focused on building tertiary hospitals leading to a tension between developing primary and tertiary care. Economic constraints made it difficult to fund a balanced system, with many doctors opting to specialize abroad, neglecting primary care.

“If we can’t get our act together—DOH working with PhilHealth, working with local governments—it’s going to be very difficult to achieve universal healthcare,” Dr. Dayrit stated.

Dr. Jaime Galvez Tan, former Secretary of Health and Chairman of the Health Futures Foundation, praised Thailand’s efforts and proposed creating a similar movement in the Philippines. He suggested making the Doctors to the Barrios program to become a movement like Thailand. 

He also challenged UP Manila to rethink its curriculum, noting that despite efforts, the current curriculum remains heavily influenced by American practices, with a focus on specialization and hospitals. He emphasized the importance of expanding the UP School of Health Sciences curriculum, the first stepladder health sciences curriculum in Asia which allowed high school students to train as midwives, nurses, and later doctors.

“I’m proud that the graduates from this rural-oriented, community-focused curriculum are all serving the Philippines. This is the approach we need to expand if we are serious about addressing our public health needs.”

Dr. Galvez Tan concluded by urging CPH graduates to become public health managers in rural areas and be assigned to every municipality in the Philippines.

The event concluded with a call to action to adopt the lessons learned from Thailand’s Rural Doctors Movement. By reinforcing grassroots advocacy, prioritizing primary care, and strengthening collaborations, the Philippines can advance its progress toward achieving universal healthcare.

The Dr. Stephen Zuellig Memorial Public Health Lecture serves as an ongoing tribute to Dr. Stephen Zuellig’s legacy in public health, fostering dialogue and collaboration to improve healthcare access for all. #