Kalasin Province Prepares for a Rapidly Aging Population in Thailand

Boonruan Khokpae, an 82-year-old villager with cardiovascular disease who receives a social pension stipend of 600 baht a month ($17), sits alone on an old front porch and talks about her health.

“My health is not good and I don’t see a doctor often because I have no money and there is nobody taking care of me,” she says. “Even if I go, I have to hire a taxi to take me to the hospital. The longer I stay there, the more I have to pay for the taxi to wait.”

In rapidly aging Thailand, access to health care is indispensable for older people. Despite universal health coverage in Thailand since 2002, the lack of transportation options and support for non-medical costs make access to health facilities difficult according to a World Bank study, Closing the Health Gaps for the Elderly: Promoting Health Equity and Social Inclusion in Thailand.

Jensak Ayarat, Municipal Clerk in Kalasin province, witnesses first-hand the challenges facing elderly people in his village.

“The ones living too far from public health centers have problems accessing health care,” he says. “While the government supports elderly care through social pensions and health insurance schemes, many obstacles are taking away their rights to use the services and it’s not fair.”

To promote health equity and boost social support for the most vulnerable elderly poor, several local administrative organizations in Kalasin province are implementing initiatives to help meet the rising demand of elderly care.
 

Building local capacity to provide healthcare

For bed-ridden elderly and those with mobility constraints, it can be more convenient to receive health care at home.

Staff from Kalasin Hospital and Village Health Volunteers have made it a priority to do regular home visits to provide basic health check-ups and screening, as well as organizing physical exercise and informal health education sessions.

Eighty-year-old Na Phokhongthong welcomes volunteers to her house every other day.

“I live alone and I am also blind. It is good to have someone visit me during the day,” she says. “After exercising, I am getting better. Now, I can move my feet and raise my arms too.”

Village Health Volunteers receive a 70-hour formal training course in elderly care taught by medical staff from Kalasin Hospital to ensure that services are appropriately and correctly delivered.

The Kalasin Provincial Health Office has also started the Suk Sala, or village health centers, initiative to increase access to basic health care and reduce traveling time and costs. Located in the heart of over 1,500 villages throughout the province, they are staffed by village health volunteers and can offer basic health care like blood pressure measurement and blood tests and can also prescribe basic medicines for the elderly.

Overcoming the transportation barrier

The elderly poor, especially those over 80 years old and those who live in rural areas, find it most difficult to access healthcare as public transport is very limited - particularly at night. Paying for private transportation is too expensive.

Local administrative organizations in Kalasin are promoting access to health services for the elderly through an emergency van service.

Nij Simmho, 71, has diabetes and needs to travel for regular checkups at the hospital. He used to pay 500 baht to get to the hospital, which took up almost his entire monthly social pension.

“Now I ask a Village Health Volunteer to call the emergency van for me,” he shares. “The van just picks me up every time and I don’t have to pay any service fee. I can therefore use my monthly stipend to buy food without worrying about how to get to the hospital.”

The transportation service by emergency vans is available in all of Kalasin’s municipalities. Some municipalities like Najarn Tambon, also allow the elderly poor to use the service even for normal visits to hospitals, not just emergencies.

Kalasin province’s example is something Thailand can promote and scale up to ensure that basic health care services for the elderly are available to all.