HSS Bottleneck areas Thailand

HIV Governance: Law on drugs (IDUs) Lack of representation in national and local levels Lack of participation or representation of affected population (also community/client involvement) Political view is weak for three groups Funding going to provincial level instead of central level (Decentralization)

HIV Strategic planning & policy development: National AIDS plan – a lot of planning, no budget, commitment, policy support Lack of central stakeholders Missing link between planners and budget makers No policy on NSP HIV Co ordinations / partnerships: Lack of policy involvement No coordination among police, private sector, health system people Integration of civil society and government program

HIV Monitoring and evaluation: Inefficient and poor quality of data; SW, MSM IDU Size estimation figures are unclear M&E system doesn’t allow specific data on the 3 groups HIV Community & client involvement: Not enough involvement Stigma in the community Few linkages among Ministries on health issues

Malaria Governance: Political commitment –access to services for migrant workers Human resources: Provision of training and human resources for malaria surveillance Diagnostic services and Treatment services Essential meds: problem of quality assurance of rapid diagnostic tests – remote areas; guidelines on storage and use Health Financing: absence; decentralization; cuts

TB Governance: lack of commitment at provincial level (measured by staffing and budget, etc). M&E: willingness and capacity; lack of annual plan, lack of supervision at difficult level (health system has other priorities) Human resources: lack of training, capacity, retention and motivation of workforce Coordination and partnerships: no coordination mechanism of health system partners

Commonalities for cross-cutting Governance: legal aspects of vulnerable populations, political commitment (in terms of financing, representation) Coordination and partnerships: absence of mechanisms among various partners and among those that can fill in action plan gaps; –TB/HIV coordination – lack of ongoing coordination leads to break down of activities and problems at service delivery level –Government structure separates HIV and TB into different units, funding is split – reinforces people not to communicate, coordinate –Need holistic approach, integration –Civil society involvement: TB historical path is new while HIV was NGO-driven

Human resources: –Existing program staff, management –Build decentralized treatment services – Training health staff Community client involvement: –Networks of civil society –Reflect better on the needs of groups than NGOs themselves Commonalities for cross-cutting (cont.)