18th DIHAC cross-cultural exchange meeting analysis report
Towards Healthy Ageing –Preparing Human Resource to Serve Health and Social Care for Older Persons in Super Ageing Thailand
Thet Htoo Pan, Siripen Supakankunti, Peerasak Lerttrakarnnon, Kanokporn Pinyopornpanish, Myat Yadana Kyaw, Myo Nyein Aung and Romdej Phisalaphong
Asia, along with the rest of the world, is experiencing rapid population ageing. By the year 2050, one out of every four individuals will be aged over 60 years old (1). In the specific case of Thailand, this translates to a staggering 26 million people (2). This demographic shift poses challenges in labor market and healthcare infrastructure. During our 18th DIHAC cross-cultural meeting organized on 29th August 2023, we engaged in a discussion regarding the pressing issue of long-term care services in Thailand with experts in global health, health economics, geriatrics and gerontology.
DIHAC study PI Associate Professor Myo Nyein Aung hosted the meeting by socializing with international participants and welcoming the chairperson Dr. Romdej Phisalaphong, PhD, Minister Counsellor, Royal Thai Embassy, Tokyo. In his opening speech, Dr. Romdej gave a brief overview of the challenging super-ageing society in the world and current demographic changes in Thailand. He highlighted the need for institutions to promote collaboration between academic researchers and stakeholders. The meeting was attended by professors, experts, program leaders, administrates, community stakeholders and PhD students from Japan, Thailand, South Korea, Singapore, Malaysia, Mexico, Indonesia, China, and UK.
Figure: Chairperson Dr. Romdej Phisalaphong, speakers, international audience and DIHAC study team at 18th DIHAC meeting
The first speaker was Professor Siripen Supakankunti, Ph.D., Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand. Professor Siripen addressed the challenges facing in long-term care and skills needed for the Thai long-term care workforce by a collaborative project conducted with International Labor Organization (ILO). This mixed-method study identified the skills need and skills gap in long-term care workforce in Thailand. Since 2018, Thai government has adopted a policy to train quality care workers. Currently, LTC is operated by coordination between 4 ministries: Ministry of Public Health (MoPH), Ministry of Social Development and Human Security (MoSDHS), Ministry of Education (MoE) and Ministry of Interior (MoI). The program focuses on community-based and home care services. The government allocated the budget to MoPH to train two caregivers in every sub-district selected by the local administrations. The Ministry of Interior (MoI) covered monthly payments for those caregivers through local administrations together with MoSDHS, including aiding home improvement for elderly with financial difficulties. Whereas MoE provided training programs for the community care givers (3). The community based long-term care initiatives include two main programs: an 18-hour training program for Home Care Volunteers for the Elderly by MoSDHS and, a 70-hour curriculum for care volunteers living in communities or people with older relatives by MoE, a 70-hour curriculum for caregivers of dependent older people by MoPH. The programs trained competencies and skills needed for a care giver.,
Professor Siripen addressed the key challenges, difficulties, and translation into policy and decision making. Skills gap for LTC at the community includes asymmetric information between the supply and demand of the LTC training program. Still, the priority challenge is insufficient human recourse and workforce for LTC. Recommendations discussed were outlined as follows. Setting incentive schemes will increase LTC supply pool and will upskill informal caregivers to be LTC-certified caregivers. Hiring international caregivers and 55-year-old retired private workers can create a new career path for them, while preserving their economic productivity. These individuals possess great potential as a valuable manpower resource. Another human resource is community volunteers, as volunteerism being a unique and well-known culture in Thailand. Well-trained and qualified community health volunteers are valuable resource in LTC labor market since they could help family caregivers in daily caregiving activities as well as organize health promotion activities for older people in the community. Guidance to policymakers will secure sufficient budget to support the development of information systems. Decentralizing local authorities as Thai Sub-District Health Promoting Hospitals (SHPH) in future will enhance the sustainability of LTC service. Although the problems regarding the LTC would not be easily solved, Thai government is remarkably making a process to ensure a healthier ageing for Thai older population and the whole Thai community.
While the community care givers act as first-line LTC providers in the community, the family care physicians are the gatekeepers of the age-related comorbidities and diseases in the community. Thus, capacity training for healthcare infrastructure is another challenge in response to the aging society. During the latter half of the meeting, Associate Professor Peerasak Lerttrakarnnon, M.D. and Associate Professor Kanokporn Pinyopornpanish, M.D., Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, shared Geriatric education in Thailand. Currently, there are 4 private and 22 public medical schools in Thailand. Among them, at least 6 medical schools offer geriatrics programs at the undergraduate level (4). On the other hand, post-graduate geriatrics education programs are provided from a wide range of institutions for different specialist doctors. Institute of Geriatric Medicine, Department of Medical Services, Ministry of Public Health, Thai Society of Gerontology and Geriatric Medicine provide short courses and conferences to general practitioners and specialist doctors . The 2-year fellowship training in geriatrics medicine equipped future geriatricians with knowledge on age-related comorbidities and rehabilitative training focused on hospital settings. Certificate courses of 1 year training in geriatric family medicine mainly train family physicians who provide services in the community. This course is focused on community-based, preventive, and health promotion services for older adults. Both courses include onsite training at caregiving institutions, in the community and academic presentations on geriatric medicine. Currently, postgraduate geriatric medicine courses produce 7 geriatricians and 12 geriatric family physicians per year.
Apart from the above courses, there are continuing medical education platforms such as Thailand Elderly Health Service Forum, which are held regularly for current updates on gerontology and geriatrics with challenging issues and the most suitable solutions. An association for healthcare professionals in the field of gerontology and geriatrics was established in 1996 as “Thai Society of Gerontology and Geriatric Medicine” (5). This continuous learning enhances health promotion and the quality of care in older population. Law enforcement further facilitates the health of older adults. The Ministry of Public Health (MoPH) adopted a policy recently in 2023 as “Year of Older Health”, which encourage hospitals at all levels to establish senior clinics. In summing up, geriatrics training programs strengthen the healthcare infrastructure, which in turn provide more opportunities for young medical students and doctors to engage in ageing care.
Dr Phisalaphong concluded the meeting by underscoring the importance of cooperation and exchanging ideas in finding solutions for population ageing. Globally, innovative policies and inter-sectorial collaborations and partnerships are essential to bridge the existing gaps in care delivery, ensuring that older adults around the world receive the quality care they deserve towards a future where older population everywhere can age gracefully, with access to comprehensive care and support whenever, wherever they need.
- Affairs UNDoEaS. Population Division World Population Prospects 2022 [Available from: https://population.un.org/wpp/Graphs/Probabilistic/POP/60plus/900.
- Pacific: EaSCfAat. Thailand: demographic indicators.Population by age group, selected years 2023 [Available from: https://www.population-trends-asiapacific.org/data/THA.
- Patcharawalai Wongboonsin YA, Naomi Hatsukano. The Ageing Society and Human Resources to Care for Older People in Thailand. In: Yuko Tsujita OK, editor. Human Resources for the Health and Long-term Care of Older Persons in Asia: ERIA Economic Research Institute for ASEAN and East Asia; 2020.
- The Medical Council of Thailand | Office of the Permanent Secretary TMoPH, Thailand Undergraduate geriatric education in Thailand [Available from: https://www.tmc.or.th/medical_school_th.php.
- Medicine TSoGaG. About the association 2015 [Available from: http://www.thaigeron.or.th/page-about_us-2/.
Thet Htoo Pan, MD, is Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Siripen Supakankunti, PhD. is Professor at Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand.
Peerasak Lerttrakarnnon, MD is Associate Professor at the Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
Kanokporn Pinyopornpanish, MD is Associate Professor at the Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
Myat Yanada Kyaw, MD, is Ph.D. student at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Myo Nyein Aung, MD, MSc, Ph.D. is Associate Professor at the Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Romdej Phisalaphong, PhD is Minister Counsellor, Royal Thai Embassy, Tokyo