Abstract
Rapid social changes and the structural reform of health systems in Thailand in the past two decades
have posed new challenges relating to how the governance of the national health system operates. Following
the establishment of the Health Systems Research Institute (HSRI) in 1992, a number of new national
health organizations were created. The emergence of these new national bodies within the old structural framework and institutional practices of the Ministry of Public Health has created ambiguity of
roles and difficulties in national health system governance.
This study was aimed at formulating a conceptual framework for National Health System Governance
(NHSG) and using this framework to analyze the system and synthesize a proposal for its improvement.
The study was conducted using document analysis, in-depth interview and participatory observation,
all of which were carried out during the period from August 2008 to July 2009.
The study found the following crucial roles for NHSG: policy guidance, intelligence and oversight;
collaboration and coalition-building; regulation; system design; and accountability. It also found that a
multi-dimensional approach was useful for making more unambiguous analysis of NHSG in contemporary
society.
The study argues for a new system to create a more effective NHSG in the Thai context. In so doing,
the Cabinet has a vital role to play in improving the structural framework and institutional practice of
government actors in NHSG, and in considering the three dimensions of governance: (1) build a strong
“governance network“; (2) develop ”good governance” for each actor, the main obstacles to which are the
crony system and bureaucratic culture; and (3) develop processes and mechanisms which engage stakeholders
from all sectors in system governance, by using a “reflexive governance“ framework.
