By Shalomaigne Mapagu
In the early 1970s, Dr. Vichai Chokevivat was a young doctor angry about the state of society in Thailand. "I was from a rural area with no electricity and potable water," he recalled in a recent zoom interview.
When Chokevivat was jailed for a month for protesting the 1976 coup, he said: "I had time to consider how to spend the rest of my life. I could not fight the whole system. I decided to focus on health."
Chokevivat and thousands belonging to the Rural Doctors Movement (RDM) eventually became the driving force in the 2002 passage of the Universal Health Care (UHC) Law in Thailand, a first in Southeast Asia, which inspired Indonesia and the Philippines to move towards UHC. The RDM was recently named one of the five Ramon Magsaysay awardees for 2024, for their work of providing free health services to all Thais and securing funds to build provincial, city and community hospitals.
The Ramon Magsaysay Award Foundation recognized their "historic and continuing contribution to their people’s health — and perhaps just as importantly, to their recognition and fulfillment as citizens with basic rights. By championing the rural poor, the movement made sure to leave no one behind as the nation marches forward to greater economic prosperity and modernization."
Since 1958, the Ramon Magsaysay Award, considered the Nobel Prize of Asia, has been "given to persons and organizations who address issues of human development in Asia with courage and creativity, and in doing so have made contributions that have transformed their societies for the better." It is named in honor of Philippine President Ramon Magsaysay, who was known for his integrity in public service in the 1950s.
The doctors' journey started in 1973, when all medical graduates were required to serve in rural areas, in a bid to stop brain drain. Chokevivat and other doctors established the Rural Doctors Federation in 1976 “When I was a rural doctor, I saw many people taken ill and becoming almost penniless. They had to sell their farmland or even their daughter to get enough money to pay for their medical treatment. It was such a painful and bitter experience that we dreamed of providing free medical care to the sick,” he said.
Renamed the Rural Doctors Society (RDS) in 1978, it established the Rural Doctors Foundation (RDF), in 1982, to raise funds and implement programs in partnership with the Thai Ministry of Public Health. The group attracted more doctors like Dr. Supat Hasuwannakit, now 54, a district hospital director and the current RDS president; and Dr. Choochai Supawongse, the current president of the RDF, who received the Leadership Award in Public Health Practice from the Harvard T.H. Chan School of Public Health in 2022.
The RDS and the RDF are the two main components of the RDM, which works in compliance with the Thai Constitution that recognizes healthcare as a constitutional right. With UHC, Thailand became a social justice pioneer and a stunning example of grassroots democracy by rural doctors who became savvy political advocates.
Chokevivat said, "We now have a community hospital in every sub-district with 30 to 60 beds each. And in many districts, we now have hospitals with 400 beds." In 2002, except for a base fee of 30 baht for every hospital visit or consultation, all services in public hospitals in Thailand were free of charge. But starting in 2006, even the 30 baht fee was removed and today, all Thai citizens can avail of all types of health services free, using their national ID cards, Thailand's National Health Security Office said. District hospital doctors regularly send teams to the sub-district hospitals to boost services.
Supawongse said the RDM also backed the passage of the Primary Health Care System of 2019, which ensured funding for communities. "Now we rural doctors can participate in setting the budget," he said.
Chokevivat recalled that rural doctors moved to include a clause in the Thai Constitution in the 1970s, mandating the government to stop dangerous contagious diseases at no cost to the public, which proved prescient in beating Covid-19. Thailand was among those that succeeded in promptly controlling Covid-19 because "we had 40 years to prepare for pandemics," Chokevivat said.
Supawongse said it had isolation centers in the communities by 2020.
The RDM deployed a network of volunteers helping doctors trace infected people, isolate and treat them, said Hasuwannakit.
Through their efforts, the budget for public health services rose from one percent of the gross domestic product (GDP) to four percent, said Chokevivat. But he said the RDM would work for more funding to go near the 10 percent of US and Japan.
How did the RDM succeed? The three doctors pointed to these factors for their success:
First, the Thai government's 1973 compulsory service rule drew the best and the brightest, embedding the doctors in the state system, and enabling them to shape policies and advocate for funds.
Second, the RDM's partnership with the Thai Ministry of Public Health and support from top officials enable them to complete programs.
Third, the RDS and the RDF complement each other in RDM. The RDS discusses and monitors emerging issues, and serves as the advocate. The RDF is the formal organization that raises funds and partners with the Thai Ministry of Public Health on key programs.
"Our work is far from over," Chokevivat said. Emerging issues are the aging Thai society, global warming's impact on public health, corruption and political instability, new technologies in providing affordable health care to the public, and increasing the health budget
Chokevivat and Supawongse said the RDM would remain a catalyst for reforms, with the UHC Law energizing them. "Our work is first and foremost, for the benefit of our fellow human beings. Before, poor people get healthcare out of the compassion of people. Now, it is the duty of every health professional in the country to provide Thai citizens with health care," said Chokevivat.