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Tales of Unsung Heroes

How Thailand's Village Health Volunteers helped combat the COVID-19 pandemic

On 13 January 2020, Thailand confirmed the first known case of COVID-19 outside of China. As one of the world's most popular tourism destinations, with the majority of its travellers coming from China, this news came as no surprise.  

One year on, COVID-19 cases and related deaths have remained remarkably low in Thailand, and the country’s management of the pandemic has been hailed as a striking success. So what's the secret behind Thailand's COVID-19 response?

Photograph of monks and pedestrians wearing masks in Thailand

Wearing a mask in public during COVID-19 is a new normal for almost everyone.

Photo credit: ILO/Suwandee Nokpum

Thailand was the first country outside of China to detect a positive case of the COVID-19, on 31 January 2020, but continued to welcome large numbers of foreign travellers, including from China, for weeks. It was not until 24 March 2020 that the Government declared a state of emergency. This was not a rapid response.

Yet COVID-19 cases and related deaths have been remarkably low in Thailand. By mid-October 2020, Thailand had recorded only 3,652 COVID cases and 59 COVID-related deaths. And, notwithstanding a spike in December 2020, the number of cases and deaths remains low compared to most countries, including Australia. In fact, Thailand’s management of COVID-19 has been hailed as a striking success, with a recent Lowy Institute analysis ranking it 4th out of 98 countries in terms of its response to the pandemic.

So what accounts for Thailand’s success in managing the pandemic?

For me, this question is of particular interest from both a professional and a personal perspective. Not only does my research focus on medical anthropology and northern Thailand, but my mother, who is Thai, was in Chiang Mai, northern Thailand, in early 2020. As the virus began to spread around the world, my family and I found ourselves forced to make a quick decision: to bring my mother to Australia before borders closed, or to leave her in Chiang Mai with no idea when we might see each other again. We decided to put our trust in Thailand’s well-resourced and inclusive public healthcare system, a decision that has been vindicated by the country’s impressive handling of the pandemic.

Various factors account for Thailand’s success. The traditional Thai greeting, whereby one’s palms are pressed together rather than shaken, is one cultural factor that has helped reduce transmission of the virus. The widespread acceptance of face masks, commonly worn to minimise the impact of heavy air pollution, and a legacy of Thailand’s experience with SARS and other communicable diseases, has also played a role.

One of the primary factors in the Thai Government’s management of COVID, however, has been its excellent primary healthcare system, which is characterised by its decentralised and community-based nature. Once a bastion of urbanism, conservatism and elitism, Thailand’s healthcare system was overhauled in the 1970s due to the efforts of two reformist doctors, Dr Prawase Wasi and Dr Krasae Chanawongse, who sought to integrate Buddhist ethics such as reciprocity and mutual help into medical practices. They advocated for the democratisation and decentralisation of medical knowledge and for a more equitable distribution of health resources. These efforts had a profound and long-lasting effect on Thailand’s healthcare system, the benefits of which continue to be evident today.

In particular, these reformist doctors were instrumental in establishing movements such as the Folk Doctor Association and the Buddhist Bare-headed Doctor scheme, considered to be predecessors to Thailand’s unique Village Health Volunteers movement. Found in almost every village in Thailand, these volunteers have played a key role in connecting people with the formal healthcare system for over 40 years. Until 2010, and in keeping with the community-minded ethos of the program, the volunteers received no financial compensation – indeed, the introduction of payment has raised questions about the motivations of new recruits.

When COVID hit, Thailand’s Village Health Volunteers numbered well over a million. Previously responsible for general healthcare communication and promotion, they were mobilised like never before to disseminate COVID-related health information and resources, take temperatures, monitor gatherings and movements in the village, direct patients to their district hospital, and serve as a critical point of contact between the community and public health officials.

Having interviewed a number of these volunteers through my mother’s village connections, I have come to realise that their role in containing the spread of COVID-19 in Thailand has been invaluable. Yet questions abound about the future viability of the program, with changing motivations for volunteering and the severe economic impact of the pandemic in Thailand, particularly on younger people. Whether COVID will change Thailand’s Village Health Volunteers movement for the better or the worse remains to be seen. 

Photo credit: ILO / Alin Sirisaksopit

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Tales of Unsung Heroes: How Thailand's Village Health Volunteers Helped Combat the COVID-19 Pandemic

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About the author

Photograph of Dr Anjalee Cohen
Dr Anjalee Cohen
Dr Anjalee Cohen is a Senior Lecturer in Anthropology at the University of Sydney. She specialises in medical anthropology and Northern Thailand. She has published on youth mental healthcare experiences in Australia, methamphetamine use among northern Thai youth, as well as northern Thai youth subcultures. Her current research focuses on the role and success of Thailand’s village health volunteers in preventing and controlling the COVID-19 pandemic.