Thailand's COVID-19: How public financial management facilitated effective and accountable health sector responses

Abstract

Effective Public Financial Management (PFM) systems are crucial during COVID-19 pandemic to ensure timely mobilisation of sufficient resources and distribution to frontline service providers. All aspects of PFM, from budget acquisition to execution and expenditure reporting and auditing are important aspects in pursuing effective pandemic responses with transparency and accountability. This commentary analyzes how PFM in Thailand adapted to support purchasing of COVID-19 health services, including laboratories and treatment, vaccines and vaccination servicing, and no-fault compensation from adverse effects following immunisation. It also discusses the limitations which delay implementation. Financing COVID-19 services was decided by the Cabinet under a State of Emergency Decree, resulting in expedited budget approval process. Though delays in budget execution were caused by bureaucratic budget spending rules, regulations and approvals, PFM adaptation allowed for services to be provided through the use of hospital revenue with rapid budget execution rules and regulations while maintaining accountability, reporting and auditing. Lastly, while reporting is mandatory with internal audit by related government agencies, and external audit by Office of the Auditor General in place, as of September 2021, report of the COVID-19 expenditure in 2020 has yet to be made publicly available for transparency and check and balance by the public. It is unclear the degree to which audit systems are fully enforced. Overall, Thailand's PFM systems have provided rapid fund mobilisation sourcing from central budget and loans and clarity in authorisation of spending; the use of hospital revenue provides more flexibility and rapid budget execution.