Salute to the Underappreciated Role of Thai Local Administrative Organisations in COVID-19 Prevention

Viengrat Nethipo

Thailand’s ranking among the top countries for best COVID-19 response in 2020 came as a surprise to many. While some praised the Thai government for its achievement, many reprimanded it over various issues, leading to a constant chorus of public disapproval which exposed the government’s authoritarianism, incompetence, and self-interest. However, against all odds, in 2020, the number of COVID-19 cases in Thailand remained zero long enough to enable the young generation to voice their concerns in street protests. The country’s early success in dealing with COVID-19 was largely due to significant contributions by local administrative organisations (LAOs), although the role of local organisations, local leadership, and local networks was hardly noteworthy in the public eye, nor were these local institutions given credit by the central government, which in fact even tried to reign in local level power. This article will discuss the findings from a study that I co-conducted with Hatchakorn Wongsayan[1] about the vital role that local administrations played in curbing the spread of the coronavirus because their capability and accountability are directly related to the interests of local people and the role of democratic local governance. Indeed, despite long-delayed local elections, local government actions against the pandemic were a genuine reflection of democratic values and the public interest, although these issues remain of limited concern in Thai politics.

The role of local organisations, local leadership, and local networks was hardly noteworthy in the public eye, nor were these local institutions given credit by the central government, which in fact even tried to reign in local level power.

While the zero new cases of Covid that Thailand recorded for much of 2020 took a heavy toll on local businesses, worker health, and people’s livelihoods, this article will focus on the role played by local administrative organisations and their work practices, because otherwise their contribution would largely go unnoticed and expensive lessons would be ignored.

 This study analysed the response of two city municipalities with differing geographical features but comparable COVID-19 responses and similar budgets. The first city municipality, located next to Bangkok, has a population of around 80,000. It features a transport hub covering various modes of transport and routes, several large shopping centres, and accommodation for many middle-class and low-income people who work in Bangkok. The second city municipality has a population of around 120,000 and is located in a tourism-driven province. At the start of the pandemic, many tourists continued to visit the province, and several social gathering venues were still heavily patronised.

This study found that the most crucial factor in the successful control of the coronavirus during 2020 was the LAOs, because of the various management mechanisms they employed, utilising both formal by-law powers and informal powers through several levels of collaborative networks. Such efforts resulted in the two city municipalities being free of COVID-19. 

The most crucial factor in the successful control of the coronavirus during 2020 was LAOs, because of the various management mechanisms they employed, utilising both formal by-law powers and informal powers through several levels of collaborative networks.

COVID-19 municipal response capability analysis covered three areas: 1) institutional capacity, 2) networking and participation, and 3) pandemic response readiness. 

Institutional Capacity of Local Administrative Organisations (LAOs)

The first aspect of municipal response to the pandemic to be discussed is the institutional capacity of LAOs. Public health response provided the most accurate insight into how municipalities performed in this area, as it had a tangible impact on local communities. The most important finding was that these city municipalities demonstrated sound knowledge and expertise in the public health area as, at the start of the coronavirus outbreak, they immediately began exercising their existing authority and expertise.

Public health response provided the most accurate insight into how municipalities performed in this area, as it had a tangible impact on local communities. 

Following Thailand’s first coronavirus cases in January 2020, both these municipalities quickly responded using both their public health budget and central budget funding before the central government had given any relevant directives. Specifically, the two city municipalities in the study began educating people about preventive measures by running public relations campaigns in which they used billboards, LED screens, leaflets, community public address systems, websites, the municipalities’ official Facebook fan pages, and the most accessible and effective two-way communication tool—LINE chat groups. Notably, LINE chat groups became a very effective method of getting news and updates out to the worried public.

Similarly, both municipalities directly procured personal protective supplies, such as PPE (personal protective equipment), N95 masks, and protective glasses, through the local healthcare agencies under their chain of command. The first municipality in the study has five healthcare centres, while the second one has a municipal hospital. Through these municipal healthcare providers, the two municipalities gained ad hoc access to vital supplies while following existing municipal guidelines; however, these guidelines were later amended to align with advice from the central government’s Department of Disease Control.

Another mechanism which can reveal the municipalities’ institutional capacity building is the Local Health Security Fund, founded by the National Health Security Office (NHSO) in 2006. The NHSO allocates funds to municipal administrative organisations and sub-district administrative organisations at 45 baht per capita. These LAOs then pay their contribution to the fund in proportion to the size of their organisations. For example, a city municipality would have to contribute to the Local Health Security Fund no less than 60 per cent of the NHSO funding it gets allocated, with the fund being managed by the LAO’s committee, chaired by the president of the LAO. 

The fund’s strength comes from the importance the LAO’s leadership gives to public health and collaboration from other local stakeholders. To access the fund, public health providers (i.e. local hospitals and community health services centres) and civil society bodies (e.g. community committees, elderly clubs, and community volunteer clubs) submit a project proposal to request budget funding. Their proposed projects must serve the objectives of health promotion, disease prevention, rehabilitation, or proactive primary care. Projects commonly operating under such funding arrangements include disease education, group physical exercise activities, free health examinations, and home nursing care for bedbound patients.

Management of the fund empowers LAOs and enhances their public health capability and collaboration within their communities. Because the fund is more flexible and more readily accessible than the central government funding, local municipalities can more quickly respond to the spread of COVID-19, as evidenced by the shift in their role from giving project proposal approval to management and implementation of COVID-19 prevention projects. The NHSO also supported this development with new fund access criteria specifically for COVID-19 management, allowing LAOs to access the fund for swift and effective pandemic response. 

In using the fund to facilitate response to emerging challenges, the two municipalities held meetings with their local civil networks to discuss segregation of tasks to ensure that project objectives would not overlap. Projects supported by the municipalities included workshops for making cloth face masks, mask neck straps, face shields, hand sanitisers; work space arrangements to ensure social distancing; provision of protective gear and safe work practice guidelines for public transport providers (e.g., vans, pickup trucks, and motorcycle taxis); providing lectures about communicable diseases and hand hygiene for students at municipal schools; providing home visits for elderly patients and chronically ill patients; and training on COVID-19 prevention for elderly citizen clubs, local business workers, and the Community Health Volunteer Association. The two municipalities each spent a similar amount of between 8-9 million baht in funding.

Besides public health, city municipalities have other existing disaster relief mechanisms in place, which helped these two municipalities fund the timely relief of COVID-19 victims using their existing funding mechanisms. For instance, the first municipality interviewed local households and granted a 1,000-baht payout to over 1,000 families, giving priority to those who were found to have been more severely affected by the pandemic, while the second municipality delivered to all registered households a bag of relief supplies containing five kilograms of rice, one bottle of palm oil, ten cans of tinned fish, and a large pack of instant noodles.  

Networking and Participation

 The second municipal strength is defined as networking and participation. Village Health Volunteers (VHVs) are the most vital civil society mechanism in municipal public health, working hand in hand with the city municipalities. Indeed, this powerful mechanism was the key to success in stopping the COVID-19 spread throughout Thailand in 2020 by largely preventing super-spreader events in local communities. This positive outcome was particularly evident in the second municipality, which included several congested, low socioeconomic communities. Selected by people in their communities, these VHVs receive standard health volunteer training and are responsible for carrying out orders issued by the central government’s Ministry of Health. A VHV is typically responsible for 10-20 households in each community. With such close access to households, the VHVs play a crucial role in the overall primary care system, by helping communities understand the disease, distributing news, conducting health surveys, recording household health information, and promoting disease prevention.

Village Health Volunteers (VHVs) are the most vital civil society mechanism in municipal public health, working hand in hand with the city municipalities. Indeed, this powerful mechanism was the key to success in stopping the COVID-19 spread throughout Thailand in 2020, by largely preventing super-spreader events in local communities.

In January 2020, the Ministry of Health’s Department of Health Service Support, which sits at the top of the chain of command in relation to VHVs, established the COVID-19 Emergency Operation Centre to provide guidelines on COVID-19 response. These guidelines prompted VHVs to check and maintain a community health database in order to provide timely tracking of those who were close contacts of covid cases and expedite quarantining and medical treatment. The VHVs carried out this process through stronger collaboration with the regional administration’s hospitals, linking their work more closely with the nation-level public health. However, even without these central government directives, the VHVs already worked closely with their communities, particularly regarding preliminary monitoring and prevention of the spread of COVID-19. For instance, the VHVs in Chiang Mai monitored tourists visiting the communities while those in Pathum Thani Province’s Rangsit Sub-district monitored returned overseas travellers in their areas. 

VHV staff receive a salary and fringe benefits from the Ministry of Health; local municipalities do not directly employ them. However, VHVs work more closely and have stronger interpersonal relationships with municipal officials than with the regional administration’s hospitals or provincial health offices. This is because VHVs used to come under the local municipalities’ responsibility and project basis budget before the Ministry of Health transferred the VHVs to be under its authority in 2008. During the COVID-19 pandemic, VHVs mostly worked with the Division of Public Health and Environment’s officials, whose official duty was to control diseases. As one of the key resources, with around 300 and 1,500 VHVs in the first and second municipalities, respectively, these VHVs worked proactively around the clock in their municipal areas. One of their primary activities was to screen people at various provincial entry points, such as bus terminals and community checkpoints. In Chiang Mai, the VHVs also constantly worked with municipal police to implement social distancing measures and conduct body temperature screening at 30-40 privately organised food distribution locations. They also monitored people subject to 15-day home quarantine. Even before the hospitals informed them, they were able to keep in contact with COVID-19 close contacts through collaboration with Committee of Community Health leaders, and with Community Health Association volunteers via the LINE group chat communication channel. The Division of Public Health’s municipal officials and the Municipal Council members, who were in charge of local decision-making and updating both provincial and central governments on progress, provided support for the VHVs’ work and their collaboration with the communities. 

Another testament to the strong relationship between the VHVs and the local communities was the establishment of the Community Health Association, which occurred after the VHVs’ transfer to the Ministry of Health’s authority in 2008. For instance, a group of locals from the first municipality in the study set up their own community health association to replace the transferred VHVs, with the view of maintaining a local health network to work directly with the community. The community then provided their members with training and supported them in carrying out various activities. In fact, two-thirds of the association members were also VHV workers, meaning they took up an extra role as a community health volunteer besides VHV duties. Their strong relationships with the community produced positive outcomes by supporting effective municipal management and strong collaboration with the community. In addition, these VHVs and community health volunteers also served as election canvassers during campaigning for local elections. 

The robust networking of the VHVs and the community health volunteers also provided access to external resources. For example, in Chiang Mai, they could obtain tax deductions from the Excise Department for purchases of alcohol for making hand sanitisers. They also got free distilled water from the Electricity Generating Authority of Thailand for the same purpose, while local politicians provided them with free thermometers through the Provincial Administrative Organisation.

Response Readiness of Local Administrative Organisations in Tackling New Challenges

The third strength of LAOs is their ready response to tackling new challenges. For example, a recent Ministry of Health order issued under the Communicable Diseases Act 2015 assigned a new role to the LAOs’ personnel, including mayors, municipal clerks, directors of the Department of Public Health and Environment, and designated public health officers. This additional duty was to serve as communicable disease control officers whose main task included subpoenaing people for questioning and inspecting vehicles, buildings, and premises during daylight hours. The Act also prescribed punishment for those who failed to comply with the mandate.

While the Covid-19 outbreak was still relatively small, the central government issued three orders to give the staff of various central and regional administrative agencies the authority to act as communicable disease control officers. However, on 13 March 2020, it subsequently issued an additional order appointing municipal level officials as communicable disease control officers, which implied that the central and regional workforces were unable to control the outbreak. 

This order to appoint municipal level officials as communicable disease control officers significantly increased municipal authority, making the battling against the pandemic much more effective. By utilising their already close connections with and excellent access to local communities, municipal authorities were able to readily assume these extra duties and play an essential part in fighting the spread of COVID-19. 

This order to appoint municipal level officials as communicable disease control officers significantly increased municipal authority, making the battling against the pandemic much more effective.

Another instance of municipal staff being assigned new roles was that municipal police officers, whose regular duties would include the monitoring of hygiene and safety concerning street vendors, were given the additional task of ensuring proper social distancing practices at public places, such as food distribution locations and transport terminals. 

Conclusion

In contrast to the central government’s various failures in managing the Covid-19 pandemic and its role in the prolonged suspension of local-level democracy, LAOs, particularly city municipalities, have proven to be highly capable of handling one of the most daunting challenges faced by Thailand and the rest of the world. The strong performance of these local organisations has been reinforced by their health volunteers’ knowledge, experience, and close connection with the community, as well as by the extensive health database available. While the central government’s Centre for COVID-19 Situation Administration (CCSA) largely controlled Thailand’s COVID-19 response, especially information distribution, at the local level, voters have witnessed the impressive performance of their municipalities in successfully curbing the spread of the coronavirus in their local communities.  

This article is part of the Comparative Assessment of the Pandemic Responses in Australia and Thailand, supported by the Australia-ASEAN Council under Australia-ASEAN Council COVID-19 Special Grants Round, the Australian Department of Foreign Affairs and Trade.

References

[1] Vongsayan, Hatchakorn and Nethipo, Viengrat. “The Roles of Thailand’s City Municipalities in the COVID-19 Crisis”. in Contemporary Southeast Asia. Vol. 43/1 (April 2021) pp. 15-23.