THAI HEALTH PROMOTION

FOUNDATION

ANNUAL REPORT 2003

EXECUTIVE SUMMARY
 Preface

Thai Health Promotion Foundation, or ThaiHealth, commenced its operation in April 2001,
with the objective of strengthening health promotion movements in the country through social
mobilization, knowledge building and policy development. The catalyst role taken by
ThaiHealth enables the fund to combine and facilitate efforts being carried out by various
partner organizations.

Senior Staff

Dr. Supakorn Buasai Dr. Krissada Ruangareerat

Chief Executive Officer Deputy Chief Executive Officer

Ms. Nuananan Tantigate Mr. Weeraboon Wisartsakul

Director of Internal Management Director of Monitoring and Evaluation
(Finance, accounts, personnel, IT and general
administration)

Assoc. Prof. Dr. Supreda Adulayanon Dr. Panpimol Lortrakul

Director of Population Health and Risk
Reduction Programs (I)
(Community Health Programs Healthy
communities program, public life and province
based integrated development project.)
Director Population Health and Risk
Reduction Programs (II)
(Health promotion for armed forces,
women, youth, adolescents, innovative
learning, happy schools, drugs control,
spiritual health, the disadvantage, safe
sex and consumer protection)

Ms.Ngamjitr Chantrasathit Mrs. Supavadee Thirapanish

Director of Open Grants Program (Reactive Internal Auditor
programs)
(Including the elderly program, traffic accident
program, hospital accreditation program and
emergency health system development plan.)

Dr. Yongyut Kachondham

Consultant

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 Message from Chief Executive Officer

High public expectation on the social responsibility of ThaiHealth has led to the foundation’s
rapid growth in the last two years. One important experience learnt from the operation of
ThaiHealth is that health problems are complicated and requires at least three important
measures - i.e. practical knowledge, social policies and measures, and cooperation between
various sectors of the society such as that between people and the state. A major challenge
and responsibility of ThaiHealth is, therefore, to enable Thai people to attain good health.
ThaiHealth has followed these principles by focusing on health promotion through society-
based knowledge development, administration and cooperation with various partners.

ThaiHeahlth has laid down clear work strategies on the basis of proven success in the past two
years and has been working on a wide range of issues set forth under the 11 work plans of
the fund’s Board. The fund has, however, chosen to focus on a few major issues- i.e.
reducing alcohol consumption, cigarette consumption and road traffic injuries-- in order to
maximize the use of available resources to solve these complicated and inter-related
problems. It has also chosen to concentrate on community approach in carrying out its
activities rather than spending on major campaigning and advertising.

One example of effective health promotion strategies which incurred minimum resources was
the 29 July 2003 Cabinet resolution on curbing alcohol beverage advertising, which currently
has become a key public policy. Thailand’s first Alcohol Consumption Control Commission
has also been set up at the national level.

Another example was the 4 November 2003 Cabinet resolution on use of public media for
children’s education , requiring state-run radio and television stations to consider allocating
10-15 percent of their airtime for children’s programs for the first time.

ThaiHealth was also able to push for the delay in the government’s plan to privatize
Thailand Tobacco Monopoly (TTM), which could have led to an increase in tobacco
consumption among Thai people.

What ThaiHealth is trying to do is to allow the fund’s partner organizations to have a better
understanding on their responsibilities and realize that the fund is neither a second Budget
Bureau nor a major organization responsible for carrying out public health projects .
ThaiHealth is simply a catalyst and, hence, its major challenge in coming years is to help
the public to better understand health issues.

Supakorn Buasai, M.D., Dr.P.H.

Chief Executive Officer
Thai Health Promotion Foundation

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 Board Members
Governance Board

Chairperson: Prime Minister

First Vice-Chairperson: Minister of Public Health

Second Vice-Chairperson: Prof. Prakit Vateesatokit

Members: a representative from each of the following government’s bodies

1. National Economic and Social Development Board
2. Office of the Permanent Secretary of the Prime Minister’s Office
3. Ministry of Finance
4. Ministry of Transport and Communications
5. Ministry of Interior
6. Ministry of Labour and Social Welfare
7. Ministry of Education
8. Ministry of Public Health
9. Office of the Commission for Higher Education

Technocrat Members Advisors to the Board

Prof. Dr. Udomsil Srisaengnam
Dr. Chingchai Hanchenlak
Mr. Surin Kitnitchi
Ms. Thongdee Potiyong
Dr. Saisuree Chutikul
Mr. Paiboon Wattanasiritham
Prof. Dr. Wicharn Panich
Assoc. Prof. Dr. Kanchana Kaewthep
Dr. Pairote Ningsanonda
Prof. Dr. Praves Wasi
Dr. Paichit Pawabutr
RAdm. Dr. Witun Saengsingkaew
Prof. Sumon Amornwiwat

Member and Secretary

ThaiHealth Chief Executive Officer

Evaluation Board

Chairperson: Dr. Damrong Boonyoen

Members:
Prof. Dr. Prachaya Vesaratch
Assoc. Prof. Dr. Pornpan Bunyaratapan
Dr. Somchai Ruchupan
Prof. Dr. Ammar Siamwala
Prof. Dr. Chitr Sitthiamorn
Assoc. Prof. Dr. Paiboon Suriyawongpaisan

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 Abstract

The Thai Health Promotion Foundation (ThaiHealth) has played an important role as a
catalyst by pushing forward public policies and social activities on health promotion. The
major objective of ThaiHealth is to enhance the well-being of the public through education
and community programs.

Activities carried out by ThaiHealth are based on the 11 work plans laid out by the fund’s
Board. It has, however, chosen to focus on a few issues – i.e. reduction of alcohol
consumption, cigarette consumption and road traffic injuries - because of their high impact on
public health.

ThaiHealth is a funding agency, whose role is comparable to that of lubricants which is

applied to allow engines to function smoothly. The fund works to create partnership with and
between community bodies, schools, state and private organizations by facilitating them to
work together for the benefit of public health. Major activities that have been supported by
ThaiHealth included technical support for effective project management of health promotion
activities, promotion and coordination of health-related networks, provision of grants and
resources for effective community participation, and publicity of role models of healthy
behavior.

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 Review
Background

Health awareness among the general public has risen as a key development in recent years.
However, since 1999, the Disability Adjusted Life Years (DALYs) has identified infectious
diseases such as HIV/AIDS, non-infectious disease such as stroke, cancer, diabetes, and
injuries from road accidents, as the three major causes of premature deaths, illnesses and
disabilities of Thai people.

Researches and investigations have found that the root causes of the above mentioned
illnesses are related to five major behaviors – risky and unsafe sexual behavior, tobacco
consumption, alcohol drinking, high blood pressure and non use of helmets.

The World Health Report 2002 on ‘Reducing Risks, Promoting Healthy Life’ identified ten
top risk factors in terms of health burdens globally. These included: underweight; unsafe
sex; high blood pressure; tobacco consumption; alcohol consumption; unsafe water, sanitation
and hygiene; iron deficiency; indoor smoke from solid fuels; high cholesterol; and obesity.
The report also clearly states that poverty, pattern of living, and human behavior are the
biggest health threats. It raised concern on the continued increase in global alcohol and
tobacco consumption, and sales of alcohol drinks and tobacco targeting low and middle
income countries. According to the report, more people than ever before are currently
exposed to these products which pose serious long-term health risks.

Observations show that in recent years, governments throughout the world have paid greater
attention to health issues. This is particularly true in Thailand, where the 30 Baht Health Care
Program was introduced in April 2001. Between 2001-2004, the Cabinet also endorsed a
number of resolutions leading to enforcement of measures on food safety and curbing alcohol
consumption and road accidents. Initiatives were also made to encourage social movement on
activities such as exercises and campaigns on road safety.

However, those efforts were uncoordinated due to lacking of a central body to do the job. The
Thai Health Promotion Foundation (ThaiHealth) was, therefore, set up as a catalyst to
coordinate health promotion activities carried out by various sectors of the society. The fund
works to create partnership with and between community bodies, schools, state and private
organizations by facilitating them to work together for the benefit of public health.

A lot more needs to be done to improve the understanding and coordination among the public
in order to raise the nation’s health status. There is a perception among Thai people that
hospitals are the answer to health. It is, therefore, important for policy makers to deeply
understand health issues so that appropriate measures can be worked out. It shall be realized
that existing health promotion networks remain very small and activities carried out are
considerably recent , and that only a few activities would have strong social impact on
health promotion.

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 Roles

Main activities carried out by ThaiHealth in 2003 can be summarized as follows:

1. Initiating two sets of government measures on health promotion:

• The 29 July 2003 Cabinet approval of fifteen ‘short-term measures’ to reduce

road accidents, which led to restrictions on advertisements of alcoholic drinks
on radio, television and billboards.
• The 4 November 2003 Cabinet resolution on state media programming for
children education. At least 10-15 percent of radio airtime and one hour of
television broadcasting hours between 16.00-22.00 hours should be allocated
for children’s programs.

2. Delaying government’s plan to privatize Thailand Tobacco Monopoly (TTM):

• Due to increasing concern in cigarette smoking after the TTM privatization

plan, ThaiHealth, therefore, launched a series of activities on knowledge build-
up on the issue in collaboration with the Senate Committee on Public Health.
These efforts led to a delay by the Ministry of Finance to privatize TTM.

3. Developing national mechanism on controlling cigarette and alcohol consumption

• On alcohol consumption control, ThaiHealth sponsored campaigns,

enforcement of laws, knowledge build-up, and the establishment of the
National Alcohol Consumption Control Commission after the Cabinet
approved short term measures on control of road traffic injuries.
• On tobacco consumption control, ThaiHealth supported the Diseases Control
Department to develop publicity campaigns and stricter enforcement of
existing laws.
• No Alcohol Drinking Campaigns during festive holidays. Cooperation
between ThaiHealth and 50 network organizations created campaigns to reduce
road traffic injuries caused by alcohol drinking, particularly during long festive
holidays.
• A research and development unit to support reduction of road accidents
caused by alcohol consumption began operation. In June 2003, ‘the Thai Road
Safety Management Unit’, a new organization set up jointly by Ramathibodi
(Hospital) Foundation and ThaiHealth, began functioning as a unit to develop
policies, social activities, knowledge and publicity campaigns by using
research findings from 19 pioneer provinces where pilot projects were
launched.
• National sports became alcohol and cigarette free venues. ThaiHealth took the
opportunity to campaign against cigarette smoking and alcohol drinking at a
time when Thai people became more health conscious, and sports and
exercises were gaining increasing popularity. It also coordinated with fifteen
sports and exercise organizing bodies to encourage them to include health
promotion campaigns as part of their regular activities.
• Working out innovative ideas in dealing with narcotic problems. In 2003,
ThaiHealth supported the launch of three new measures in dealing with drug
addiction. These included information gathering at a national level;

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 establishment of a working system at local levels under the ‘2002 Policy on
Rehabilitation of Narcotic Addicts’; and preparing communities in accepting
rehabilitated drug addicts.
• Emphasizing health promotion in health care services. ThaiHealth joined
hands with other organizations in developing indicators to measure the quality
of medical services. With regard to manpower development, ThaiHealth was
partly involved in adjusting course syllabuses for training public health
persons.
• Involving the private sector in health promotion activities. ThaiHealth jointly
worked with the Federation of Thai Industries in setting up standards to ensure
good quality of life for industrial workers. In addition, health security
mechanisms were also developed for workers in the informal sector.
• Helping develop a master plan on health promotion for the Royal Thai Army.
The three-year (2003-2005) Master Plan on Health Promotion of the Royal
Thai Army introduced in 2003 was a result of a joint development by
ThaiHealth. The fund supported 69 activities carried out on army people and
their families, and the general public.
• Creating model health promotion schools. ThaiHealth supported various
schools which were equipped to and interested in becoming alternative
learning places for students by promoting awareness of good quality of life. A
network of 300 health promoting schools were developed and involved about
500,000 students.
• Expanding health promotion activities through city and village communities.
These activities have led to projects involving the participation of public and
private sectors including the ‘healthy city project’, the ‘happy community
project’, and the ‘public life-healthy community project’.

Strategies and Measures

The fiscal year 2003 (1 October 2002 – 30 September 2003) marked the second year of
operation of the Thai Health Promotion Foundation. It has been able to actively function as a
state organization that is not restricted under the bureaucracy system, making effective use
of the two per cent alcohol and tobacco tax allocated.

Strategies
ThaiHealth subscribes to four strategies in carrying out its activities:

1. Support pro-active development measures.

Experienced persons from various fields were invited to join working groups. This helped
ease complicated problems that were difficult to understand.
2. Support and develop systematic development
Emphasis was made on expanding activities that would improve the structure of health
system. These included policy making, law enforcement and management system in order to
maximize efficiency of the system and to reduce health problems and losses.
3. Turning health promotion into real daily practices of the people

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Develop measures for implementation in various localities such as municipalities, schools,
and work places by focusing on family institution so that the activities became lifestyle of
the Thai people.
4. Develop and strengthen key social assets
“Social assets” mean factors that are needed for sustainable development. Social assets
needed for the country’s heath promotion are:
(a) Leaders of health promotion
(b) Basic health infrastructure such as information, networks and key institutions.
(c) Fruitful application of knowledge, and
(d) Efficient use of available resources.

ThaiHealth’s Strategy

Well-being

Physical and Social environment Values,Health culture & lifestyles

Social movement, Network development, community strengthen, communication for health

promotion, information system, knowledge management, development of public policy for
health promotion

Systematic and effective movement in .issues and contexts

Develop ‘system’ change in Increase necessary ‘social Promote ‘healthy

major health issues capital’ effectively community’ in different

• Tobacco and alcohol • Information system & • Village, city

• Accident, AIDS, drug
• Service system
• Mental health, food,
Exercise etc.
• communication for health
• Leadership and leaders
• Capacity building for
organization and personal
• Knowledge and resource
• Organization / Institution
(school, workplace……)
• Civil society networks at
provincial level

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 Plan indicating the link between the Strategies and Target of ThaiHealth

Measures

¾ Health promotion through factors which cause health risks, which are tobacco
consumption, alcohol consumption, traffic accident, exercise, and drug addiction.
¾ Health promotion activities in various organizations, which are education
institutions, work places, religious establishments.
¾ Health promotion activities in local communities, which are municipalities, rural
areas and families.
¾ Health promotion among key population groups, which are children, the youth,
the elderly, and women.

Infrastructure and Administrative Mechanisms

The infrastructure of administration at ThaiHealth comprises four sectors:

1. The policy sector
2. The administrative sector
3. The implementation sector
4. The evaluation sector

All the sectors coordinate and move towards efficiency as indicated in the plan.

1. The policy sector means the Board of ThaiHealth, which lays down policies,
strategies, management structure and other guidelines. The Board is chaired by the
Prime Minister, who, currently, has assigned a Deputy Prime Minister as chairperson.
The Public Health Minister is the first vice chairperson and a socially respected figure
is the second vice chairperson. The other members of the Board are representatives
from the National Economic and Social Development Board, the Ministry of Finance,
the Ministry of Interior, the Ministry of Transport and Communication, the Prime
Minister’s Office, the Ministry of Education, the Ministry of Labor and Social
Welfare, the Ministry of Public Health and the Office of the Commission for Higher
Education.

2. The Administrative Sector means the Office of the fund, which is responsible for
policy implementation and facilitating health promotion activities of partnership
organizations. ThaiHealth does not carry out health promotion activities by itself, but
assists partner organizations to do so. This allows the fund to efficiently carry out
activities in multidimensional manner by using minimal manpower.

3. The implementation sector means partner organizations for health promotion.

ThaiHealth cooperates with partner organizations by creating a mutual bondage in
carrying out health promotion projects, in which role and responsibilities of each party
are clearly set.

4. The Evaluation Committee is considered an important mechanism which leads to

transparency and scrutiny, and can bring about efficiency in the performance of
ThaiHealth. This committee is appointed by the Cabinet and has the responsibility of
carrying out the overall evaluation at the social, policy and administrative levels.

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 Work Process

Section 36 of the 2001 Thai Health Promotion Foundation Act states that ThaiHealth shall
report the performance of the fund to the Cabinet, the House of Representative and the Senate
once a year.

Certain adjustments were made to the ThaiHealth’s plans by the Board in the year 2003. The
work plan was increased from 9 to11 programs. These include:
1. Tobacco consumption control program
2. Alcohol consumption control program
3. Promotion of public exercise program
4. Population health and risk factors reduction program
5. Learning for well-being program
6. Health services system development program
7. Healthy workplace program
8. Healthy communities program
9. Reactive grant program (Open Grant)
10. Social marketing for wellbeing program
11. Health promotion support program

The operation of ThaiHealth in 2003 was adjusted to keep up with changing circumstances.
Key operation segments could be summarized in the following diagram:

Main Mechanisms

Policy push
Success results of the project package Success of the project
Publicity for the public

Project package
Project Project Project
ThaiHealth
Evaluation

Administrative Approved plans Approved projects

Consider approval of the work plan/project package Respected persons consider

by respected persons and outside experts approval of the project

General plans
Pro-active development of the plan (90-95% of the budget) (5-10% budget of ThaiHealth)
according to the fund commission’s 10 annual work plans ThaiHealth announces project
l

ThaiHealth calls on partners to join in Health Promotion

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ThaiHealth is open to supporting organizations of all kinds. The fund has two approaches in
cooperating with partner organizations:

1. Pro-active approach ThaiHealth indicates the agenda for health promotion in

reducing health risks and promoting healthiness, and takes the lead in its works with
potential partners.
2. Welcoming project proposals (Reactive approach) from any
organizations/individuals/groups which seek funding from ThaiHealth.

ThaiHealth, however, places more importance on the pro-active approach, on which 90-95
percent of the fund’s annual budget is spent.

Project proposals submitted to ThaiHealth have to go through several procedures before

sponsorship will be approved. These procedures include:
1. Improve the quality of project proposals. ThaiHealth invites at least three outside
experts experienced in the particular field to consider the application and make
suggestions for maximum benefit.
2. The follow-up and evaluation is done with the help of experts in various fields. It
is carried out to study the effects and identify obstacles, opportunities and lessons
learnt, in order to continuously build up knowledge.
3. Results of the activities carried out are expanded by setting pilot projects for the
public. Public policy formation on important health issues are sought for.

Monitoring and Evaluation

Evaluation is vital to the success of ThaiHealth. The mission of ThaiHealth covers

broad areas with diverse stakeholders and many changing, interacting factors. Therefore, the
system needs to be designed carefully to match with the nature of organizational operations.
This year, the Evaluation Board has commissioned the Health System Research Institute to
evaluate the strategy development process of ThaiHealth. Findings and recommendations are
as followed:
• Strategies should be communicated thoroughly to all levels of programs, projects,
ThaiHealth’s officers and partners.
• Roles and responsibilities of different parts should be clearly defined
• ThaiHealth should extend its range and capacity of partners to match the increasing
fund.
• Adequate resources and personnel should be provided to the evaluation process.
• Evaluation results should be utilized for organizational learning process.
The Office has responded to the recommendations. The Board has commissioned a project to
research and develop KPI of ThaiHealth.

The Evaluation Board evaluates the overall performance of ThaiHealth. In 2003,

ThaiHealth has supported the advocacy of many high-impact policies. Such programs use
only little resources while most of the granted funds are allocated to community and social
capital programs. Therefore, the former programs should receive more support while the latter
are monitored closely that they eventually lead to the expected result.

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Funding Analysis

ThaiHealth received a budget of 1,917 million baht, which was two percent of excise taxes
collected from sales of alcohol and tobacco products in 2003. The fund, however, spent 736
million Baht in sponsoring 656 projects, a spending that was a 16.9 percent increase from
its initial plan. The increase was possible because towards the end of the 2003 fiscal year,
the Board made adjustments to the three years plan of ThaiHealth. The ThaiHealth Board
encouraged expansion of activities, enabling the fund to take up campaigns to discourage
alcohol consumption during the Buddhist Lent festival, as approved by the Cabinet on 29 July
2003. ThaiHealth also financially supported the purchase of sports equipment aimed at
replacing sponsorship provided by alcohol businesses.

Table comparing the expected budget and the real budget spent in the fiscal year 2003

Plan Expected Real %

Budget Expenditure
Develop a system to reduce important health
problems (reduce risk factors) 80,000,000 187,501,317 234
Develop overall health of the community 80,000,000 214,920,842 269
Develop overall health (others 50,000,000 31,375,939 63
General support of the project 90,000,000 94,253,242 105
Publicity on social movements 100,000,000 43,564,300 44
Develop institutions, leaders, networks 50,000,000 59,835,419 120
Academic/research 80,000,000 60,950,036 76
Evaluation, follow-up 30,000,000 9,932,135 33
Investment administration 70,000,000 34,315,719 49
Total 630,000,000 736,648,951 117

Overview of areas-based distribution of funds

ThaiHealth has distributed its funding to all parts of the country, with the northeast receiving
the highest share of 28.1 percent, followed by the north, the central region, Bangkok and the
south , respectively.
Private
organization
6%
Community
Other N/A 3%
4% Bangkok 12%
4%
North Region Hospitals / Health
Network 22% Service
Organizations Central
Institutions
34% 7%Region
22%

Southen
RegionMedia
14% Education
2% North Institutions/
Eastern Schools 43%
Region 27%

Area- Based Dist

Organizational-Based ribut ion of
Distribution oft the
he fund
fund

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Overall distribution of the fund under the 11 major programs
Projects which received most financial support were those on controlling key health risks,
such as accidents, unhealthy food and narcotics (24.6% of the total spending ). Other
projects included health promotion campaigns in community areas (24.3% of the spending )
and social support for health promotion such as academic works and information system
(11.3%). For the sponsoring of projects submitted to ThaiHealth, as many as 300 of such
projects received the funding. However, they represented only 3.2% of ThaiHealth overall
spending.

Overview of projects-based distribution of funds

ThaiHealth attached great importance to projects that promoted overall healthiness covering
physical, spiritual, social and people’s ingenuity dimensions (47.9% of the total spending).
This was followed by exercise projects (14.1%) and consumer protection (10.1%).

Overview of fund distribution based on organizations that carry out projects

ThaiHealth allocated 56.6% of its total spending to state agencies, partly because they had
the capacity to work on the projects and to push for policy change for sustainable health
promotion. Academics followed by receiving 18.2% of the spending. Similar portion of
funding was given each to private organizations, community organizations and non-
governmental organizations.

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Overview of target groups-based distribution of funds
Schools and educational institutions received most funding from ThaiHealth, accounting for
43% of the total spending. This was consistent with ThaiHealth policy of placing children
and youth as the main target groups. Local network groups received the second largest share
of 34% from ThaiHealth.

Private
organization
6%
Community
Other
4%
4%
Hospitals / Health
Network Service
Organizations Institutions
34% 7%

Media Education
2% Institutions/
Schools 43%

Organizational-Based Distribution of the fund

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 FINANCIAL STATEMENT

For the fiscal year end, September 30, 2003, and

for the period from November 8, 2001 until September 30, 2002

UNIT : BAHT
(NEW AMENDMENT)
NOTE 2546 2545

EARNINGS 2.1
FUND DEVELOPMENT BUDGET 18, 19 1,917,974,464.67 1,532,656,569.42
ANNUAL BUDGET 20 0.00 50,000,000.00
PROJECT SUPPORT BUDGET 21 7,930,048.77 277,757.56
BANK INTEREST 22 35,634,803.31 8,930,321.33
OTHER EARNINGS 23 4,137,180.50 328,616.14
TOTAL EARNINGS 1,965,676,497.25 1,592,193,264.45

EXPENDITURE 2.1
PERSONNEL 24 15,060,873.72 10,173,717.70
IMPLEMENTATION 25 37,704,385.94 15,382,426.43
PROJECT SUPPORT *** 26 684,302,867.41 120,723,454.25
OTHER EXPENDITURE 27 2,653,140.00 1,511,438.50
DEPRECIATION 28 6,266,990.06 2,515,386.63
TOTAL EXPENDITURE 745,988,257.13 150,306,423.51

EARNINGS HIGHER THAN EXPENDITURE 1,219,688,240.12 1,441,886,840.94

DEDUCT EXPENDITURE NOT USED IN
IMPLEMENTATION
DEPRECIATION FROM SALES OF EQUIPMENTS (2,937.37) (6,879.78)

EARNINGS HIGHER THAN EXPENDITURE 1,219,685,302.75 1,441,879,961.16

INFORMATION ON ADDITIONAL BUDGET ALLOCATED TO THE FUND

*** ON SEPTEMBER 30, 2003 AND 2002, THAIHEALTH
ALLOCATED FUNDS TO PARTNER ORGANIZATIONS WHO
COMPLETED THEIR WORK AS INDICATED UNDER THE
CONTRACT (Note: Number 26)
1,112,818,716.10 228,330,234.25

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