BP has blogged numerous times about education in Thailand, particularly in regards to the inequality of opportunitieseducation policy, and also a post noting that despite the increasing amount of money spent on education that Thailand’s results in international tests show little improvement.

Somkiat Tangkitvanich of TDRI has an op-ed in the Bangkok Post on education reform. Key excerpts:

One of TDRI’s research priorities is education reform. Our research team has found there are two fundamental problems in our education system:1) It lacks an accountability system, and

2) It does not equip students with the skills necessary for modern living.

Teachers are still paid higher salaries and can be promoted to higher positions if they can please school heads and those who evaluate them. School heads still keep their jobs even when most students fail tests.

So, we propose an accountability system be established. Teachers and principals should be made more accountable to students and parents, and we can do this by linking their remuneration to students’ learning outcomes. This should be coupled with enhancing 21st century skills for our youngsters.

The new curriculum should be lean and interdisciplinary, and incorporate an element of thinking

The Ministry of Education should stop monopolising teacher training and decentralise the role to schools, which should be allowed to choose training programmes which are most appropriate to them.

Different schools have different needs, and the government should provide autonomy at the school level, but maintain its role in providing the budget and assessing the school’s knowledge management programme.The

BP: He talks in more depth about some of the points above and others in the article so have a read of the full article.

Some comments:

1. Will it not be easier to promote thinking at schools when access to information is not limited and there are not so many restrictions on free speech? This is a societal problem and not limited to the education system. Unless people have access to information and ideas and given the space to express their thoughts, it will be hard to incorporate an element of thinking into the education system.

NOTE: Having said that, in BP’s conversations with recent university graduates they are certainly much more open to full and frank discussions about certain entities.

2. Pay for performance is a controversial issue. OECD data suggests in certain circumstances there is evidence it works (PDF):

A look at the overall picture reveals no relationship between average student performance in a country and the use of performance-based pay schemes. In other words, some high-performing education systems use performance-based pay while others don’t. But the picture changes when taking into account how well teachers are paid overall in comparison with national income. in countries with comparatively low teachers’ salaries (less than 15% above GDP per capita), student performance tends to be better when performance-based pay systems are in place, while in countries where  teachers are relatively well-paid (more than 15% above GDP per capita), the opposite is true. So for countries that do not have the resources to pay all of their teachers well, it is worth having a look at the experience of those countries that have  introduced performance-based pay schemes.

BP: See also trials in India and Brazil, but in most countries teachers have either seriously questioned or reject many, if not all, elements of the scheme.

However, teacher and bureaucrats are fairly entrenched in their positions. Just look at the what is happening in the public health sector.

The Nation:

The Public Health Ministry yesterday vowed to go ahead with its ambitious plan to restructure the country’s public-health system, which will take effect by October 1. The plan calls for reform of the structure of health-related agencies and decentralisation of the ministry’s authority to local bodies.

The massive overhaul is aimed at improving the public health system and making it more efficient, the ministry’s permanent secretary Dr Narong Sahametha said.

The Nation:

Public Health Minister Pradit Sinthawanarong has been on a hot seat since his ministry introduced the Pay-for-Performance (P4P) concept for its medical staff.

The scheme is getting full support from medical workers who work in cities and towns, as they stand to enjoy better pay for the workload they shoulder. But those working in rural areas are against it, saying many of their colleagues will be lured to work in urban hospitals.

The Rural Doctor Society, a powerful group of up-country medical workers, staged a protest against the new pay scheme on Tuesday and threatened to rally every Tuesday until the public health minister steps down.

Observers see this move [about restructuring the agencies] as an attempt to weaken or even dissolve the independent agencies under the Public Health Ministry

The public health minister’s latest move has put him on a collision course with the Rural Doctor Society, which has enjoyed a strong bargaining power in the Public Health Ministry. Nonetheless, Pradit has vowed to complete his reform mission within seven months, even if he “gets hurt” in the process.

His collision with the Rural Doctors Society is just the first round. If he goes ahead with his reform plans, he will certainly clash head-on with the more powerful independent agencies in the ministry and end up putting his ministerial seat at stake.

The Bangkok Post:

The cabinet has approved in principle a 3-billion baht performance-based payment scheme despite rural doctors staging a protest rally yesterday.

However, he [the Minister] said many areas are no longer isolated and rural doctors should receive an allowance based on workload and performance.

The hardship allowance is currently based on the degree of isolation of the area in which the doctors work and the conditions under which they work.

But from next month, most doctors who receive hardship allowances will have their rates cut in half.

The ministry has opted to pay the allowance based on doctors’ performance.

The allowance for those working in high-risk areas such as the far South, however, will remain unchanged.

Dr Kriangsak said the new system will force many doctors into private hospitals where they can earn more for doing the same amount of work.

The Nation (article has an excellent graph):

At present, the size of the rural doctors’ monthly allowance is based on the remoteness of their location and their number of years in the job. But from April 1 the remoteness allowance that now covers 736 rural hospitals will shrink to cover just 122 hospitals. Meanwhile, under the new system, the allowance will expand to cover dentists, nurses and pharmacists, as well as doctors. Doctors not on duty would also be deprived of the “currently-automatic” allowance.

The Nation on the position of the Rural Doctors Society:

But in 2008, the government offered a higher special allowance by adding up the number of years that medical workers have worked in rural areas.

….

“Pradit will drag the public health system that provided for people living in rural areas backward if he still goes ahead with his plan,” Dr Suphat Ha-Suwankit said. He is the director of a state hospital in Songkhla’s Chana district.

Dr Suphat said the current allowance based on remote area status encouraged many medical workers to work at rural hospitals.

“In 2008, there were just 1,000-something doctors in rural areas. Today, their number has jumped to over 4,000. Of them, 200 are medical specialists,” Kriengsak pointed out.

So, he insisted that the country needed to continue with the initiative launched in 2008

Although, like with any change, not everyone is opposed. The Bangkok Post:

Wichit Srisuphan, Thailand Nursing and Midwifery Council president, said nurses will support the ministry’s payment change.

Jongkon Intasarn, Community Nurse Associate president, said the hardship allowance changes did not affect nurses.

Ms Jongkon said nurses have been paid based on their performance for several years.

The payments have helped increase nursing staff efficiency, she said.

It was fair that those who worked harder should be paid more, she said.

The Nation on another doctor’s group that is not opposed:

Dr Prachum-porn Booncharoen, president of the Thai Federation of General and Central Hospital Doctors, said pay for performance would not really remove the incentives for doctors working in remote areas.

“They will still be entitled to a special allow-ance. In some very remote areas, the amount will not drop. In other areas, the amount will be adjusted to ensure all medical workers get the extra wage,” she said.

Prachumporn said the special allowance would disappear only if the rural medical workers had been in the services for more than 21 years. By that time, she said, they already held executive positions and received another type of allowance associated with those posts.

“The pay-for-performance system will mean fairer remuneration for young doctors,” she said. 

Prachumporn said at rural hospitals, those who had to work really hard were mostly young doctors. She said older doctors should not try to block pay for performance because they would lose some benefits.

Then, Voranai in an op-ed in the Bangkok Post:

Healthcare is a basic necessity that a government must provide for the people. But just this Tuesday, almost 1,000 rural doctors and dentists from across the country gathered at Government House to protest against a new public health policy to cut their hardship allowance and base payments on performance.

Rural doctors and dentists, those who make sacrifices and endure hardships, already underpaid and underappreciated, are angry and are protesting. 

According to the Public Health Ministry’s 2010 figures, in Bangkok the patient/doctor ratio was 1,052 patients per doctor, but nationwide it’s 2,893 patients per doctor – in Chaiyaphum province, 9,794 patients per doctor. The worst ratios are in the Isan region, the Pheu Thai Party’s stronghold.

If the number stands today (and yes, statistics is a tricky game, so don’t take it too literally) then 1,000 doctors protesting means 2,893,000 patients are without their doctors. The entire situation smells of a failure by the Thai government to provide sufficient healthcare for its citizens.

BP: Now, can you imagine if teachers started to protest, we may get a “nuanced argument” with a simple calculation on how many kids won’t have a teacher and criticism of the government failing to prove sufficient education. Pressure will come on the Public Health Minister to compromise more and restore some of the benefits that will be cut  and perhaps the Minister will lose his job. Reforming is difficult as entrenched interests are everywhere. Taking on both public health and education at the same time is very unlikely and the government may be stung by the likely increasing problems from the public health reforms to shy away from reforms to the education sector….

NOTE: To clarify, this post is not a criticism of what TDRI’s Somchai is proposing. In fact, find little to disagree with what he is saying although it is always the implementation of such reforms which are the difficult issue. This post is to highlight the problems of reform and how difficult it will be to reform.