Public health pioneer ousted for big pharma

What do you do to the man who helped you win a landslide election through pioneering the 30-baht universal healthcare scheme?

What do you do to the same man who has saved the lives of hundreds of thousands of people living with HIV/Aids by providing them with a cheaper drug regimen?

This same man is also credited for making Thailand one of the few countries in Asia with ample vaccine production capabilities, while making medicines for heart disease, diabetes and hypertension much cheaper through local production of generic drugs.

What do you do to this man? Kick him out. That is what the Pheu Thai government is doing to Dr Witit Artavatkun, managing director of the Government Pharmaceutical Organisation (GPO).

When Thaksin Shinawatra was looking for reform policies for Thai Rak Thai's first general election campaign in 2001, he took up the universal health coverage idea from the progressive camp in the Public Health Ministry, led by the late Dr Sa-nguan Nitayarumphong. Few believed it was possible. Dr Witit showed it was.

Through effective management free from the Public Health Ministry's top-down control _ and from corruption _ Dr Witit's Ban Paew Hospital in Samut Sakhon was able to offer quality medical treatment to patients for just 40 baht.

Thai Rak Thai later adapted Dr Witit's 40-baht model for its 30-baht universal health coverage scheme. The historic move helped Thai Rak Thai on its way to a landslide election victory.

Last week, Dr Witit was fired by the GPO board following Public Health Minister Pradit Sintawanarong's fierce campaign to sack him over corruption and negligence charges. Why the falling out between Pheu Thai and the universal healthcare advocate?

Dr Witit's ordeal stems from his belief that many more lives could be saved if he could make the GPO a local manufacturer of affordable generic medicines, instead of importing expensive drugs from multinational pharmaceutical companies. By doing so, he has also increased the GPO's profit from 5 billion to 12 billion baht within five years.

Hurting big pharma is his crime, say health activists. They accuse Dr Pradit of trying to weaken the GPO to serve pharmaceutical giants and undermine universal health care to serve private hospitals and the drug industry.

Dr Pradit has denied those allegations. But the more I think of the various controversies he is entangled with, the more I understand why those health activists arrive at their conclusions.

You see, universal health care may have earned Thai Rak Thai and Pheu Thai votes, but they did not earn the power to manage the scheme's gigantic budget.

Before the 30-baht scheme, the public health mandarin controlled the entire health budget, which politicians found easy to interfere with. That ended with the establishment of the National Health Security Office, which directly manages the 30-baht scheme. Politicians were unhappy. So too were many public health bosses with close links to big pharma.

As soon as Dr Pradit became public health minister, he succeeded in putting his men on the GPO board. Plans are also afoot to change the budget allocation for universal health care: Instead of direct budget dispensation to hospitals, Dr Pradit wants the money to go through regional intermediaries supervised by public health officials. This will make it much easier for politicians to interfere with the health budget.

He has also stopped extra financial support for rural doctors and introduced performance-based pay incentives that put rural doctors on the assembly line. The move was criticised as a ploy to make rural doctors resign to work for private hospitals after the announcement of the government's medical hub policy.

Meanwhile, Pheu Thai wants to ink foreign trade investment treaties with the EU and US and is ready to exchange stricter drug copyright regimes _ meaning more expensive drugs _ for export privileges. Dr Witit's firm stance on compulsory licensing has made him a stumbling block that needed to be removed.

The latest controversy was the effort to introduce patient co-payment in the universal healthcare system.

Before the advent of universal health coverage, the poor were categorised as "destitute patients", or khon khai anatha, in order to get free medical treatment. The universal healthcare system has returned dignity to the poor with equal and free treatment.

Dr Pradit can't do all this without the green light from you-know-who. If Pheu Thai supporters fail to protect universal health care, they may soon have to be called destitutes to get free treatment.


Sanitsuda Ekachai is Editorial Pages Editor.

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Writer: Sanitsuda Ekachai
Position: Assistant Editor