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•Thailand and Indonesia are similar in many ways.
•Thailand has about 500,000 sq.km. in area and 67
million of population, a quarter smaller than Indonesia.
•The economy has performed well in recent years, and
was then upgraded to an upper-middle-income country
by the World Bank in 2011.
•The GDP per capita in 2010 was a little bit more than 5
thousand USD with 3.9% of total health expenditure.
•Life expectancy at birth was 71 years in male and 76
years in female.
•HIV prevalence in adult is approximately 1.3%.

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•More than one thousand hospitals are operated within
the government sector with more than one hundred
thousand beds, distributed from urban metropolitan
level to rural district area. The service bed per
population ratio is approximately 1 to 600.
•The health units which take responsibility in sub-district
level are primary care units and community health
centers.
•Currently, there are more than ten thousand primary
care unit and fifty thousand community health centers
cover all over the country.

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•Ratio of health personnel can be shown in this table.

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•There are three main health protection scheme in
Thailand:
1. Civil servant medical benefit scheme for government
employee,
2. Social security scheme for private sector employee,
3. Universal health coverage scheme for the rest of Thai
people.
•Each scheme still has its own history and
administration.

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•Firstly, Civil Servant Medical Benefit Scheme, which is
provided for government employees, contributes around
8% of total population and totally funded by
government.
•Secondly, Social Security Scheme, which is provided for
private sector employees, contributes around 15% of
total population. It is funded by tripartite contribution
between government, employees and employers.
•Lastly, Universal Health Coverage Scheme, which is
provided for the rest of population, contributes around
15% of total population. The budget is totally funded by
government.

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•This table demonstrates benefit packages which are
provided free of charge to all HIV people.
•They are classified into 4 categories:
1. Asymptomatic PWHA with CD4 more than 350,
in this group no ART is needed, just provides
regular CD4 check up every 6 m.
2. Symptomatic or asymptomatic PWHA with CD4
350 or less, this group of people needs ART as
well as routine lab monitoring such as blood
chemistry, CD4, viral load and drug resistance.
3. HIV positive mother, in this group, ARV for HIV
prevention from mother to child is provided as
well as CD4 monitoring.
4. Babies who born from HIV positive mother, ARV
for prevention and infant formula are supplied
as well as DNA PCR for diagnosis.

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•First Thai AIDS case was reported in 1984.
•Before 2000, Anti-retroviral treatment was under
research settings.
•PMTCT program was first implemented in 2000.
•A pilot study on national access to ART was started in
2001 in order to prepare for the system.
•In 2003, National Health Security Act was issued, still,
ART was not included in the benefits.
•Not until 2006 that Universal access for ART has been
implemented.

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•Before universal access to ART, HIV/AIDS contributed
the highest DALY loss and the leading cause of death
among Thai population.
•It infected young and middle generation who are still in
working age especially laborers and agriculturists who
are in the poorest and least educated groups.
•HIV/AIDS still overwhelms these vulnerable group of
people by decreasing household income but increasing
personal health expenditure.

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•Aims of HIV social health protection in Thailand consists
of 3 parts:
1. To promote accessibility to standard health
services by reducing inequity access to standard
HIV/AIDS services
2. To restore household incomes by earning
personal incomes and saving out-of pocket
payment
3. To retain family and national work force by
decreasing illness and death in HIV people
Together, these would intensify personal and family well
being, and eventually enhancing the national
economic growth

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•Before implementing the national ART program, some
economists predicted that the total resources needed
would touch at least 200 mUSD within 2012, or even
more than 460 mUSD in case of good adherence to
treatment
•This made policy makers hesitated to invest for the
project for some time.
•Fortunately, this assumption was proved untrue soon
after.

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•This graph shows the number of PWHA is increasing
over time.
•It is estimated that the number of PWHA receiving ART
in next coming year will increase up to 174,400, which is
50% increase compare to 2009.
•Despite of that increasing, during 2009 to 2013, the
average ART budget remains stable at around 100 mUSD.
•How could we make it ?

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•The major components of ART budget is ARV drugs.
•In Thailand, about 75% of ART program contributes to
ARV drugs, 20% to lab, and the rest 5% to others.
•Normally, the global ARV prices itself continue to drop
gradually.
•As a result of TRIP’s flexibility, the cost of ARV in
Thailand falls dramatically.
•Average unit cost of first and second line ARV falls to
nearly 50% during past 5 years.
•Accordingly, central procurement and flexibility of TRIPS
Agreement are the most important mechanisms in
controlling ARV prices.

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National AIDS Program under UHC

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