Webinar on “The Role of Thai Village Health Volunteers in Controlling COVID-19”

Drawing on preliminary research in Chiang Mai, Northern Thailand, Dr Anjalee Cohen examined some of the reasons for this success and the vital role that primary health care continues to play in controlling COVID-19 and other infectious diseases in Thailand.


29 August 2022, Monday – Against all odds, Thailand had low rates of COVID infection, thanks to the country’s well-established and well-resourced public health system. Drawing on preliminary research in Chiang Mai Province, Northern Thailand, the webinar examined Thailand’s early success in managing the pandemic. Central to this success were Village Health Volunteers — considered the backbone of Thailand’s primary health care system. The webinar attracted the interest of 40 attendees.

Speaker Dr Anjalee Cohen, Senior Lecturer, Department of Anthropology, University of Sydney, with moderator Dr Alexandra Dalferro. (Credit: ISEAS – Yusof Ishak Institute)

Dr Anjalee Cohen mentioned that the early success of Thailand’s response to COVID-19 can be seen in the numbers. COVID-19 cases and related deaths recorded in October 2020 were remarkably low, with 3,652 total cases and a death toll of 59 according to the World Health Organisation (WHO). Thailand managed to keep the virus under control despite being the first country to detect a case of COVID-19 outside of China and despite the high volume of visitors from Wuhan, where the outbreak originated.

Dr Cohen stated that Thailand’s early success can be attributed to its prior experience managing major infectious disease outbreaks such as SARS and Swine Flu. Thai people are also used to wearing masks in regions where there is heavy air pollution from vehicular and industrial emissions and from the burning off of crop stubble. The WHO’s Universal Health Preparedness Review process concluded that Thailand’s successful pandemic response was due to a combination of factors, including its robust health system, strong community networks and high level of political commitment.

Yet Dr Cohen pointed out that a state of emergency was not declared until 24 March 2020 even though the first case of local transmission was detected on 31 January. Thailand continued to receive visitors from China until the latter country prohibited overseas travel in mid-March 2020. Military officers continued to sponsor muai thai tournaments that exposed the spectators crowding to watch them to major risks. It was thus, the speaker argued, competent healthcare officials and local communities rather than the administration and its policies that deserved credit for the successful management of COVID-19 in Thailand. Dr Cohen also mentioned that public health authorities in Thailand enjoy a degree of trust and confidence that the military-dominated state’s leaders do not have, a factor that certainly helped those authorities in their work to confront the pandemic.

Dr Cohen explained the primary healthcare system in Thailand. Up until the 1970s, the Thai medical profession was conservative, elitist, and resistant to the development of primary health care, especially in rural areas. The watershed in the successful opposition to medical elitism was the student uprising of October 1973, which was followed by an interlude of parliamentary democracy and by the flourishing of civil society organisations. Reformist doctors played a major role in the development of community-based primary health care, including the Village Health Volunteer movement. This movement was linked to communitarianism centred on Buddhist temples. During the COVID-19 pandemic, Buddhist temples and monks, especially in rural areas, would serve as a foundation for community cooperation. They received food from lay donors and distributed it to the poor and unemployed.

Dr Cohen explained the important role of Village Health Volunteers in controlling the pandemic. Officials at all levels of Thailand’s public health system believe that those volunteers serve as the backbone of community-based public health in Thailand, as they are the primary connection between the formal health system and the community. There are now over a million Village Health Volunteers, and almost all villages have volunteers, under a policy aiming to see that there is one active volunteer for every ten to fifteen households.

Dr Cohen noted that the success of Village Health Volunteers in Thailand is due to the collaboration between those volunteers and professional healthcare workers. Such collaboration has been deepened by the establishment over the course of recent decades of district hospitals, which are relatively close to and accessible to the communities in which the volunteers serve. The proliferation of community hospitals at the district level furthered the institutionalisation of the Village Health Volunteer system because the volunteers work closely with those hospitals and are supervised by health officers from them.

Drawing on field work in a village in Chiang Mai and on in-depth interviews with a veteran female Village Health Volunteer active in the village, Dr Cohen observed that cooperation in such a setting is primarily based on familiarity with and trust enjoyed by these known community members. Respected community members with good social skills are informally selected and encouraged to apply to become Village Health Volunteers by village leaders and staff from sub-district primary healthcare centres. After a formal selection process including approval by the Provincial Health Officer, successful candidates are required to undergo specialised on-the-job training in health promotion, disease prevention and health education at the district hospital, as the role of Village Health Volunteers centres on disease prevention and health promotion activities. These activities involve communicating information and mobilising community members to participate. However, during the pandemic the volunteers have had the added responsibility of regularly taking people’s temperatures and distributing face masks and sanitising gel to households. Dr Cohen recognised the dilemma posed by financial incentives associated with work as Village Health Volunteers and its implications for the genuine volunteerism that has long marked the programme. While many volunteers value their allowances because they help cover travel expenses, reduce reliance on family members and give them a sense of recognition for their work, some volunteers now worry that money could cause people to apply to the programme who did not embrace the tradition of ‘providing service’.

Dr Cohen concluded the webinar by raising questions about the Village Health Volunteer programme’s sustainability in the face of the increased governmental regulation and of the workload in which that regulation has resulted.

(Credit: ISEAS – Yusof Ishak Institute)