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Abstract
Reformist doctors in Thailand have combined to create a primary health care system in rural areas in which village health volunteers play a major role. Consistent with the WHO whole-of-society approach, these doctors have envisaged a decentralised system that emphasises volunteers as community oriented, self-reliant agents of change. Our ethnographic research in Chiang Mai, Thailand, reveals that these ideals of village health volunteer empowerment have not been realised. Rather, village health volunteers have become entrapped in a hierarchical, top-down health bureaucracy that affords them limited deliberative agency. We argue that this predicament reveals a conflict of paradigms between, on the one hand, an idealised holistic, spiritual dimension of health with village health volunteers as dedicated, self-sacrificing agents of local communities and, on the other hand, the imperatives of state authoritarian interventions in the avian influenza and COVID-19 pandemics, including rigorous public health protocols and epidemiological methods.
Acknowledgements
We would like to thank the director of the Mae Wang District Hospital, the Mae Wang municipal mayor, the Ban Kat village health volunteers, especially the two team leaders, and the epidemiologist responsible for the village health volunteers for their generous assistance with our project during our fieldwork in Chiang Mai. We would also like to thank the expert reviewers who helped to significantly improve the manuscript.
Notes
1 The Alma-Ata International Conference on Primary Health Care that took place in September 1978 is a landmark event in the history of global public health. It was attended by approximately 3000 representatives from 134 countries and 67 international organisations (Basilico et al. Citation2013).
2 Dr Sanguan later played a major role in the universal health care coverage (UHC) legislated in early 2002.
3 Joseph Harris characterises the Sampran Forum as an example of ‘epistemic communities’ and ‘autonomous political networks’ that share principles, ideas, or values and operate across different formal organisations. The Forum has been effective in influencing health legislation and the establishment of many health organisations (Harris Citation2015, 7, 10, 15).
4 Village Health Communicators were upgraded to Village Health Volunteers in 1994 (WVO Citation2014, 420).
5 The number recommended by the Ministry of Public Health is 10–15 households per VHV.
6 Or Sor Mor is an acronym for asasamak muban (‘village volunteers’).
7 VHVs were given priority for vaccination.
8 Those who tested positive were sent to the Mae Wang district hospital for a PCR test.
9 Kwanchewan Buadaeng argues that the emergency decree was disproportional to the scale of the pandemic and was instituted mainly to suppress the opposition movement (Buadaeng Citation2022, 2). This movement was centred on student-led protests in Bangkok that demanded reform of the political system (including the role of the monarchy, the dissolution of parliament, and the rewriting of the constitution).
10 This data could be reported on printed forms and later uploaded by local health officers.
11 In Ban Kat, social gatherings (such as funerals) of more than 20 persons required VHV attendance to check attendees’ temperature and mask wearing.
12 The Chit Asa 904 organisation is under the authority and control of a division of the Ratchawallop Police Retainers, King’s Guard 904. The number 904 is the police code word assigned to King Vajiralongkorn when he was Crown Prince.
13 Komatra Chuengsathiansup is now the director of the Princess Maha Chakri Sirindhorn Anthropology Centre in Bangkok, Thailand.