On Universal Health Coverage and Equity: A Conversation with Dr. Somsak Chunharas
By Sohini Mukherjee
In 2002, Thailand provided the entire population health coverage with publicly-financed health insurance schemes. At the forefront of the fight for universal health coverage (UHC), Thailand proves that universal coverage is not only attainable, but worthwhile. Dr. Somsak Chunharas, the former Deputy Minister of Health for Thailand, was one of the key players in enabling UHC in Thailand and making it a high priority on the global stage. Through his career in the Ministry of Health, Dr. Chunharas has focused on health policy, system development and facilitated international collaboration. Pioneering a team working on health economics and health financing, he led several health reform initiatives over the last 30 years, leading to the development of the Thai health care system. He currently serves as the President of the National Health Foundation in Thailand, and is a Menschel Senior Leadership Fellow at the Harvard T.H. Chan School of Public Health for Fall 2017.
To discuss the challenges and triumphs of his pursuit, the Voices in Leadership series put the spotlight on Dr. Chunharas at the Harvard T.H. Chan School of Public Health on September 14, 2017. In his interview with Dr. Ashish Jha, he demonstrated his passion for his cause, saying,
“I believe that equity and universal health coverage, especially the financing dimension, is something that countries should be working on.”
During this conversation, he shared several lessons for students who are on their own paths to making significant changes in their health systems.
Learning Along The Way
Dr. Chunharas elicited laughter from the audience when he said that he had never wanted to become a politician, particularly as a student, as he believed in the power of other people at the time. However, he said that he changed the way he looked at the world, and shared three lessons he had learned on the way to becoming minister.
First, while talking to people about policy and system change is not easy, we must learn to work with people we do not always like or agree with. This is crucial for leaders who make important decisions, as they do not always work with people who are like them. Dr. Chunharas also explained that surrounding yourself with a team that helps you, creating an “enabling environment,” is also critical to the journey.
His third lesson was perhaps the most poignant, saying that although our actions are dictated partly by our backgrounds, they are informed more by the real world and constant learning, saying, “You can’t grow yourself without learning all the time.” He encouraged students to keep learning and to dare to take different paths, stating,
“You should not be limiting yourself. You should be brave enough to venture into different fields.”
On Collective Leadership
In explaining how decisions were made and executed, Dr. Chunharas elaborated on “collective leadership.” This term, also known as participatory leadership, refers to the fact that although decisions are often made by an individual or a group who is held accountable, this leadership must filter from the top down. Even if decisions are made, there needs to be those who influence others by promoting and communicating ideas, thereby motivating them to implement decisions and policies successfully. He credited the implementation of Thai UHC to this style of leadership. He believed that it would not have happened had not those in provinces and district hospitals, the people who take action — “leadership at the implementation level”– also believed in the mission and principle of protecting people from financial bankruptcy and achieving better equity. It is also crucial that civil society participate, telling politicians what they think, what they believe, and what they have benefited form, rather than leaving it to the politician to decide. When a student had approached him and said that he wanted to take action as a minister like his teacher, Dr. Chunharas urged him not to wait, and act now, telling him “many things could happen, not because you are the minister, but because…of the leadership that you have learned and tried to express.”
