Universal Health Coverage Development in Thailand: How Global Ideas and a National Medical Professional Movement Made a Difference

Background: Universal health coverage is endorsed as the global development agenda in the 2015 SDGs for global achievement by 2030 and is expected to build national policymaking agendas. Common research often focuses on national processes in the rst place. For example, accounts of Thailand's health system development mostly emphasise domestic factors and inuences rather than the linkage of external/global health ideas. The paper questions how external/global health ideas inuence national health policymaking and the linkage between them in achieving Thailand's universal health coverage policy. Methods: A qualitative method was employed to capture complex and historical narratives of the national medical professional movement for Thailand's health system reform through the lens of a global social policy approach for exploring external and global health ideas transfer. Moreover, the actor- and policy entrepreneur approaches would be employed to investigate national health policymaking and examine how ideas from the external and global levels have improved national equity in health. Results: The research locates the narratives on global ideas and practices that inuence a national health system reform. This highlights the impact/role of global ideas on national professional movements, i.e. the rural doctor movement in Thailand mobilising the health system reform for all. The study found that national equity in health could not be achieved without external/global health ideas transfer. Such a case of national universal health coverage achievement in Thailand happened with the effort of the rural doctor movement and individual agency as policy entrepreneurs in translating external/global ideas and practices for their movement and mobilisation. The case contributed to a better understanding of the global process regarding ideas and practices that can be transferred directly and indirectly to the national level. Conclusions: Global ideas transfer can also happen in different aspects such as it can be seen the ideas transfer from developed to developed countries; from developed to developing countries. Besides, the author witnessed that the IOs ideas can also be transferred to developing countries or reverse, and again, between developing countries themselves.


Introduction
Global health ideas mobilise health policy transfer across national state borders. The way the global actors transfer their intention can be viewed as ideas and practices that in uence national public health reform, in many cases, led by national medical professional movements. Understanding the mentioned global phenomenon has to investigate such an evident case from below when global ideas and practices interplayed at the national and local levels. Herein, the Thailand case study will be taken as evidence of how global health policy transfer, borrowing, and adoption in the sense of a medical professional movement for healthcare reform, especially universal health coverage policymaking. Understanding Thailand's health system reform and UHC policymaking are unenviable to analyse Thailand's democratisation atmosphere closely. In some pieces of literature about Thailand's public health movement, McCargo (1) identi es it as one of Dr Prawet Wasi's networks, including Anand Panyarachun and Prem Tinsulanonda and his political thought and movement as a liberal royalist is related to "network monarchy." According to Connors (2), the word "royal liberalism" represented the extrabureaucratic networks that empower them to gain political in uence and power in political networking. As a "Senior Citizen" status, Dr Prawet played the dominant role in promoting political and social reformation and movement in 1997 constitutional drafting. However, he proclaims that the clean and moral political discourses have undermined the legitimation of electoral democracy by arguing that those politicians have long been embedded in Thai politics and tend to absolute corruption because they represent the electoral votes they can buy. Simultaneously, he attempts to create the ultimate legitimacy of monarchical moral authority (3).
Aside from the monarchy network concept, some works of literature tend to focus on the public health movement itself, such as Harris work's focuses on professional network and movement for universal health care policymaking, autonomous political networks and health system reform, and the "regulatory capture" challenge to developmental capture of the state and universal coverage policy (4)(5)(6)(7)(8)(9). In some aspects, Sapyen's work (4) discusses how the rural doctor movement had innovated a new approach of a social movement which created the duality nature of the social movement in terms of non-governmental organisations (NGOs) within the governmental organisation (GO), whereas maintaining the nature of being GO within NGOs. This is extended to Vongtangswad's work (10), investigating the dynamics of the rural doctor movement in terms of con icts, including political transformation focus on framings and mobilisation, taking with them three social movement frameworks: resource mobilisation, framing process, and political opportunity structure theories. The rural doctor movement had created a duo autonomy state in the healthcare system's structure. Political opportunity structure change is a vital factor that paves the way and allows the rural doctor movement to adjust framings and mobilisation to push healthcare system reform. Approached political elites, whether democratic or not, in practice, the movement works collaboratively to advocate public participation in some aspects. As aforementioned above, another piece of critical work proposed by Nam (11) focuses on partnering with bureaucrats and NGOs to achieve UHC, which rarely disregards external ideas and practice of the moves.
The above mentioned the existing literature on Thailand's health system reform and public health movement; still, there is a lack of global perspectives and connection as the structure of health governance ideas and practices that widely move globally. Thus, in this paper, the author explores how health policy transfers from global and IOs ideas to a national level and the diffusion of health ideas from developing countries to other developing countries. Furthermore, the author identi es how the national medical professional movement achieved equity in national health based on external and global health ideas in the Thai case study. Also, the linkage between the external/global health ideas and a national health policy and practices will be further investigated.

Methods
The article explains the global health policy transfer regarding ideas and practices as external in uences that a national medical professional movement adopted to fuel UHC in Thailand. In doing that, the author will be employing a global social policy approach and a professional movement for an in-depth investigation of how global health policy transfers by learning, in uencing, borrowing, and adopting into a national political context. Then, these global ideas and practices raised in this article will be detail described for further exploration, such as global health governance and its architecture of arguments among actors and glocalisation of global health ideas, global health ideas on universal health coverage and its debates, primary healthcare and health ideas transfer, and roles of the medical profession and associations as mediators for health ideas transfer as such. The latter part takes the policy entrepreneur, and individual agency approaches to investigate how a national medical professional movement interacts with the powerful actors in politics and ensure their implementation by working with the formal power and resource. Thus, the case study also explores the linkage between internal movement and external ideas and practices, insisting that policy changes in particular countries, in one way or another, are often related to a global context.

Results
The Thai Health System Development and Its Foundation for the Reform Modern medicine in the modern Thai state has been gradually developed since the Rama V era . Healthcare policy was viewed as a tool for strengthening national security and stability under bureaucratic polity centralisation for securing absolute monarchy and elite in Bangkok. Even though the rst hospital was built in Phetchaburi province in 1878 initiated by Dr E.A. Sturg, an American missionary, the modern medicine milestone was immensely developed when Siriraj Hospital was established in 1886 (63), department of nursing in 1888 a liated with the ministry of education. It was recognised as the beginning of a new era of modern medicine and public health in Thailand, which emerged amid various political struggles. The intention of King Rama V to reform and movement had challenged conservatism and the ruling aristocracy. Strengthening the regime stability by decreasing the mortality rate to increasing the population is a critical productive force. However, the concept of happiness that depends on national security and national interests centred on the absolute monarchy was faced with the challenge waves of democratic, constitutional and nationalist concepts that eventually led to the revolution in 1932. This created signi cant effects on the transformation and development of Thai public health.
The end of World War II envisaged the emergence of ideological tension in the cold war between the two blocs: the US and USSR, which o cially started in 1947. The Chinese civil war led by Mao Zedong tends to win over the civil war, the US support Field Marshal Plaek Phibunsongkhram's administration, the coup d'état government in 1947, ghting against the threat from communists. The Cold War paved the way for opening the global and internal political opportunity structure in which the bureaucracy-centralised power still took control over the Thai state. However, the main concept of democracy, constitutionalism and nationalism encouraged by the People's Party (Khana Ratsadon) would be faded, the Field Marshal Sarit Thanarat, the coup d'état and traditionalist-conservative group, decided to take over the power of Field Marshal Plaek Pibulsongkram. In 1942, the Ministry of Public Health (MoPH) had established a new challenge force that was dissatis ed with the core paradigm and the structure of political opportunities governing the Thai state. It has happened again under the student movement's leadership has been in uenced by socialist liberal democracy. It is a cornerstone of the later era of the public health movement. Instead of focusing on public health for national security, they emphasised inequality, centralisation of power, and resources, changing public health concepts for national security to public health for all people. Along with the rst Faculty of Public Health in Thailand under Mahidol University's a liation established in 1948 and the Faculty of Medicine Ramathibodi in 1965, the stem of the emerging education and movement activities related to rural areas' development. This was one of the factors that led to the subsequent changes in public health framing and movement.
In terms of health infrastructure, in 1947, the department of medical services started building the provincial hospitals according to a governmental policy that demand building the provincial hospitals in all 72 provinces and health centres at the district level during 1952-1957. It largely happened in the time of Field Marshal Plaek Phibunsongkhram's administration (1948)(1949)(1950)(1951)(1952)(1953)(1954)(1955)(1956)(1957) was in power, claimed as the "Golden Era of Building Provincial Hospitals." However, this would not be achieved without the US operation mission (USOM) with nancial support for medical instruments. During 1951-1957, the US government provided economic and nancial support to the Thai government for $149 million and nancial support to the military purpose for $222 million (12). Economic and nancial support has been spent on port building in Bangkok, include transportation, train and road, agriculture, education, irrigation, economic planning, public health development, and hospital system expansion.
In the second half of the 19th century, in the 1970s, the Indo-China war and con icts between communism and democracy across nations in South East Asia and the emergence of the "dominos theory" escalated the concern of communist domination over Thailand. In response, government policy sought to reduce poverty among its population through rural development and improved health, education, and agricultural extension services. Thus, health, along with education and agriculture, became cornerstones of rural development and poverty reduction. The ongoing con ict in the Vietnam War in the 1970s, the US needs to import health personnel from other countries that eventually escalated the shortage of health personnel and the brain drain phenomenon in Thailand. As a result, the Thai government initiated the rst national economic and social development plan (NESDP) (1961)(1962)(1963)(1964)(1965)(1966). In 1965, statistical data from the O ce of the Civil Service Commission identi ed that 52% of new graduate doctor students have emigrated working abroad. As a result, in 1967, the MoPH introduced a three-year mandatory rural health service placement policy, and the rst graduate medical student began working in the rural area in 1972 (13,14). The rural doctor federal established in 1976; after the 6 October 1976 event, the federal government has to stop its operation. Later, the rural doctor federal, soundly left-wing ideology, has to rename it to the rural doctor society in 1978 to avoid surveillance from the national security agency. The rural doctor society has then elevated to the rural doctor foundation in 1982 as a juristic person that could accumulate capital and mobilisation such as social, intellectual and nancial capitals.
The rural doctor movement has been growing in the career path, promoted to a higher position and connected to the senior doctor in the Ministry of Public Health. Some degree of con icts happened between the doctors who tend to serve the central government policy and the doctors who have been working in rural areas. Sampran Group established in 1986 under senior doctor's support, such as Dr Prawet Wasi and Dr Sanguan Nitiyaramphong. In the beginning, Sampran Group's main purpose is to organise the monthly academic forum for ideas exchanges and academic meetings in public health service and administration with nancial support from WHO Thailand since August 1986. Later, the Local Development Institute (15)  A Low-Income Card (LIC) program (1975) targeting the poor covered an additional 23%. Less than 2% of the population purchased private insurance coverage, and the remaining 30% went without any coverage (5,17).
According to the National Health Security Act 2002 (18, 19), a law comprises the cooperation of different sectors amid the participatory development ow under the 1997 Constitution of the Kingdom of Thailand. In Sect. 76, the constitution was given that the state shall promote and encourage public participation in policymaking, and in Sect. 303 and 304 for inspecting the exercise of state power at all levels (20). Furthermore, the rst constitution contains provisions of "the right of initiative" to propose a new law, as shown in Sect. 170, which has given at least 50,000 voters to petition the National Assembly president to propose a law. Besides, the Constitution of the Kingdom of Thailand BE 2540 (1997) also focuses on promoting and protecting the rights and liberties of the people, increasing public participation in governance and monitoring of the exercise of state power, as is evident in the Constitution of the Kingdom of Thailand 1997, part 3: Rights and Liberties of the Thai People, and part 5: Directive Principles of Fundamental State Policies. While the 8th National Economic and Social Development Plan (1997)(1998)(1999)(2000)(2001) began to differentiate the direction from the other National Economic and Social Development Plans (NESDP) formulated only by government agencies. It started with providing opportunities for all professional groups to widely express their opinions for setting the country's development direction instead of setting plans only from the government sector. This created the development paradigm shifts from economic development to a people-centred development for sustainability (17,21).
As a result, Thailand achieved UHC since 2002 (pilot phase in 2001) and provided three main categories of Thailand's Health System: the UCS covered 48.8 million people accounted for 70% of the Thai population; the Civil Servant Medical Bene t Scheme (CSBMS) covered 4.97 million accounted for 10% of the population that were government employees, retirees and dependents; and Social Security Scheme (SSS) covered 13.09 million private-sector employees accounted for 20% of the population (16).

How Global Ideas and a National Medical Professional Movement Made a Difference
The overview of the paper will present in the two main parts. The rst part reviews external and key global/transnational health ideas and how global ideas transfer to the national level. These global ideas will be raised related to the national context of health system reform and policy agenda-setting that are; architecture of arguments in and glocalisation of global health ideas, global health ideas on universal health coverage and its debates, primary healthcare and health ideas transfer, including roles of the medical profession and associations as mediators for health ideas transfer. The second part discusses internal movement in macro-level context (such as the institutional and structure faces of context) and micro-level context (such as agency-level enabling conditions) (see the similar approach of Bakir and Jarvis (22)). Then it spotlights how internal movement portrays policy entrepreneurs' roles and its networks perform in the Thai health system reform (see Fig. 1

How Global Ideas Made a Difference: External/Global Health Ideas Transfer
The Architecture of Arguments in and Glocalisation of Global Health Ideas The establishment of WHO in 1948 have underlined transnational aspects of health problems, and the states admitted as membership and committed their initiatives to their national health policy (23). Global health governance in global social policy literature as a discipline mainly investigates social policy issues perceived in the global/transnational scope (24). This larger scope in terms of policies and actors engaging in global healthcare created diverse ideas and discourses that led to a contested argument, such as a case of IOs and global social governance (see Martens, Niemann, and Kaasch (25)). According to Kelley Lee (18), this sense can be related to the contested global idea construction being classi ed as a cognitive dimension of globalisation. In this case, the thought processes are not limited to the global north initiation, but international organisations' ideas and practices like WHO, IOs as global health actors have cognitive authority over a speci c eld for global ideas and practices prescriptions. The approaches used for health, which developed at the global level steered by an international organisation like WHO, are important, but the key focal point should be national translations and local actions (26-29). These local policies impact global change through multilevel policy diffusion that demand assessment and analyses of local government effectiveness, especially in the late 1980s and early 1990s. That led to introducing the terms "glocal and glocalisation" for multilevel policy analysis (30), in which, according to Ilona Kickbusch (31), the lexicon 'glocal health', describes a reciprocal interaction and the intricate and inseparable interface between global health actors' ideas and practices and local responses for equity in health. Therefore, the glocalisation dynamic is reciprocal (32)(33)(34). Understanding global health ideas transfer, it is necessary to portray the global health ideas structure of arguments. Dealing with this matter can be seen in Deacon's work (35), global social policy consists of social policy prescriptions for national and supranational social policies regarding redistribution, regulation and rights. In line with Kaasch's work (36), which discusses the conceptualisation of global social policy in its dimension of prescriptions on national social policy on pensions and health systems reveal contesting contestation concerning notions of the 'war of positions'. In addition, Kaasch's latest work (37) proposes mapping the four main IOs in global health governance focus on the IOs matter of health care system: WHO, World Bank, the ILO, and the OECD and characterising the global health architecture based on contestation and collaborative manner between them. Similarly, this article discusses the conceptualisation of global health actors as health policy prescriptions and the attempt of global health ideas transfer to a national level.
This context, debate about and argument for Thailand's UHC initiative can be viewed as a contestation of global health ideas that witness some level of con ict among global actors and ideas. UHC matter what services are covered. How they are funded, managed and delivered to the poor and vulnerable groups. As such debate in 2001, in the time of Thailand's GNI per capita was around US$1900, WHO voices strongly support of UHC implementation from the taxation even though Thailand just recovered from the nancial crisis in 1997. On the other hand, the World Bank strongly critiqued and warned that the country would eventually face a public nancial collapse and bankrupt public hospitals. The bankrupted nancing system will dilute health care quality if Thailand is still stubborn to do so. In addition to the World Bank stance, former prime minister Chuan Leekpai, a Democrat, was aggravate by disagreement in the Parliament in 2002, emphasising that the national budget was not only for the health sector (8). Thus, the author witnessed the linkage of global ideas and discourse concerning Thailand's health system reform and created a better understanding of how the global and national linkage existing in one way or another.

Global Health Ideas on Universal Health Coverage and Its Debates
The UN post-2015 development agenda, so-called Sustainable Development Goals (SDGs), has initiated 17 goals and 169 targets. The concept of UHC is indicated in Goal 3: Ensure healthy lives and promote well-being for all at all ages, which is articulated clearly in targets 3.7 (universal access to sexual and reproductive healthcare services) and 3.8 (achieving UHC agenda) (38). The UHC in various countries worldwide witness the immense extension of the concept in the developing countries in Eastern Europe and Asian countries. WHO de nes UHC as a healthcare system that allows "all people have access to the health services they need, when and where they need them, without nancial hardship, includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care." In practice, some low and middle-income countries (LMICs), such as Brazil, Ghana, Mexico, Rwanda, Turkey, including Thailand, are implementing reforms to make health care universally available (39). In the Global South, UHC moves countries away from cost-sharing policies towards universal access to free or heavily subsidised health care and focuses on the state's obligations to its citizens. Crucial to UHC introduction are questions of nancial risk protection, whether through taxes or required prepayment and pool risk (40). Unlike the European welfare states, in most LMICs, state social protection has been limited to speci c groups such as civil servants or people in the formal economy. This limitation of state social protection raised the importance of UHC as the most powerful concept that public health has to offer for alleviation of health inequity. UHC, herein, de nes it as the right to access government medical care for all Thai people who were not covered by civil servant medical bene ts scheme (CSMBS), social security scheme (SSS) (formal sector) or other state enterprise welfare rights (41). It provided public health services, health disease prevention, diagnostic examination, and medical treatment and rehabilitation necessary for health and livelihood. For this reason, understanding how a particular country in the global south can achieve UHC for equity in national health would inspire other countries in the same range to do so.

Primary Healthcare and (Global) Health Ideas Transfer
Before the 1978 Alma Ata Declaration on primary healthcare, the community performed vital roles for healthcare as collective action in health throughout human history. Nowadays, the local actor of PHC, the so-called "Village Health Workers (VHWs)", can be traced back to Chinese barefoot doctors, the former "Soviet's Rural Feldsher", as well as "Thailand's Village Health Volunteers (VHVs)" (42,43). A narrative on a local doctor responsible for taking care of people in remote rural areas that applies local wisdom, traditional healing techniques with herbs and folk medicines has existed for a long time. But, rural doctors' actions relevant to political movements and social change are exposed as historical records in the modern state (44,45). The barefoot doctor has the main function to promote hygiene, disease prevention, and basic healthcare and family planning, treatment for common ailments (46, 47). The transnationalisation across the national border, both tangible and intangible aspects, had occurred throughout human history. That escalates the diffusion of norms and ideas in various dimensions include healthcare ideas from place to place beyond national boundaries, both from global health actors, like WHO, to nation-states and from the nation-state to nation-state themselves. In the Thai case, WHO, as a global actor, has rst introduced the PHC concept in the north of Thailand operated as a pilot project, namely the "Saraphi Project", launched in 1969 (21). The South-South health ideas transfer happening in Thailand during the malaria epidemic in the late 1950s resulted in the increasing demand for health workers to deal with the epidemic. While medical personnel were a few, community health volunteers were trained to tackle the epidemic and eradicate malaria during 1961-1962. Later on, it named Village Health Volunteers (VHVs) with the push forward of the People's Liberation Army of Thailand, which has been operated during the 1940s and the 1990s (48). However, VHVs became more concrete under the 4th National Economic and Social Development Plan (1977-1981) during the Kriengsak Chamanand's administration. In this vein, VHVs play an important role in the Cold War mass struggle; many people ed into the forest compound with the villagers, intellectuals and doctors as members of the People's Liberation Army of Thailand ght against the central government. Therefore, the so-called "Barefoot Doctor" derived from the characteristics of barefoot healthcare activities while working in the eld as such in the People's Liberation Army of Thailand. In sum, Thailand's VHVs idea has been in uenced by the "Chinese barefoot doctor" concept was transferred through the mass movement that came across the national border. In addition, the aura of barefoot doctors' success in terms of access to medical treatment of rural people in the distant areas inspired the 1978 World Health Organization Conference on Primary Health Care, where the meeting nally agreed to launch the Alma-Ata Declaration (49). Still, these global health ideas have a major impact on PHC adoption at the national level around the globe, which PHC is the foundation for UHC achievement in LMICs, as can be seen in the Thai case will be later discussed in the next part.

Roles of the Medical Profession and Associations: Mediators for Health Ideas Transfer
Related literature to professional movement, Harris's work (7) examines the effort of professional movements in expanding access to healthcare and AIDS medicine in Thailand, Brazil, and South Africa. Harris mentioned the rural doctor movement in Thailand as 'progressive doctors' who played an imminent role in UHC policymaking. In Brazil, a similar movement of medical professionals concerned with public health played key roles in drafting legislation in the Health Ministry and promoting programs to bring health care to the masses and hold the state accountable. However, South Africa made only incremental gains because the government actively obstructed professional movements seeking more transformative reform. In Thailand, the Rural Doctor Society, a national medical professional movement, does not stand alone, but they also engage with global health ideas derived from WHO, ILO, World Bank (48). Even though these global actors did not directly in uence the UHC implementation, where they were involved, the Health Minister requested the assistance of the WHO and the ILO to run a technical seminar that strongly gave positive support to the reform. Besides, the EU funded the healthcare reform program and technical and research skills the EU provided to many medical doctors through the training program at medical schools such as Antwerp University and the London School of Hygiene and Tropical Medicine (21). As mention above reveal how a national medical professional movement in particular countries has been in uenced by global health ideas and practices to move forward with national health reform.

How A National Medical Professional Movement Made A Difference
Internal Movement: Policy Entrepreneurs, Partnerships Building and Network Governance Prominent scholars in sociology and political science have pointed to the importance of changes in "political opportunity structures" (50), "windows of opportunity" (51), and "critical junctures" (52) to social and policy change. This section investigates the roles of policy entrepreneurs in the policy process and agenda-setting of health system reform related to Kingdon's Multiple-Stream Framework (MSF) (51) that outlines the policy process situated into problems, policy and politics. According to Kingdon, political entrepreneurs are most active in the policy stream to create solutions to potential problems and bring them forth to the agenda-setting process (51). In this similar vein, Brasil and Capella (53) illustrate the roles of policy entrepreneurs (individuals and sometimes small groups of people) in the public policy process in terms of agency for translating ideas into action. Thus, the concept of policy entrepreneur will be employed for exploring UHC policymaking and agenda-setting. In the rst step, the author explains the historical narrative concerning the Thai health system development as a foundation for the recent reform. Then, the later step will be the investigation of other topics such as professional movement focusing on the individual agency as policy and institutional entrepreneurs in terms of a change agent in health reform and how rural doctor movement as policy entrepreneur builds partnership with bureaucrats and advocacy coalitions, include how the networks are governed (see Fig. 1 above).

Professional Movement: Policy and Institutional Entrepreneurs in Health System Reform
In the rst place of problem stream, in this case, policy entrepreneur has played a critical role in knowledge accumulation and production related to health system reform as the basis for evidence-based policymaking to achieve the UHC. An individual agent led by Dr Sanguan Nittayaramphong, the key rural doctor movement's leader, has dedicated the working life and resources (e.g. vision, skills expertise, and leadership) to pro-poor healthcare development suitable for rural areas in Thailand. The rural doctor movement's role in achieving UHC has rooted in the rural doctors' group who faced scarcity, and di culties in their working conditions rst met in April 1976. The like-minded doctors come together to share, exchange and help each other in various matters. The rst meeting was held in Khao Yai, Pak Chong District, Nakhon Ratchasima Province, and a coalition of rural doctors was nally established. Before establishing the Rural Doctor Society in 1978, Dr Uthen Jaranasri was the society's president, while Dr Manit Prapansilp was a secretary, and Dr Suwit Wibulpholprasert was the secretary assistant. The society intends for professional development, according to the society's objectives statement as follows; being a centre for exchanging ideas of rural doctors across the country; reinventing services and academic knowledge of rural doctors nationwide; improving the e ciency in services, and raising a practising physicians status in rural areas to be well recognition (54).
During that period, the rural doctor movement has operated mainly on implementing rural hospital development and building a rural doctor society network in different regions that later become a legally registered NGO as the Rural Doctor Foundation in 1982 by conducting social movement activities. Most of the foundation's roles are mainly operated in the form of funding and publishing of journals and the society's brochures, while the rural doctor society is more exible in terms of social activism (14). The rural doctor movement is also driven based on knowledge derived from an academic forum and discussion; the Sampran Group, a rural doctor group, gathers to exchange and disseminate global ideas and knowledge transfer, with main support from WHO Thailand. It was held every month at Suan Sampran (Rose Garden) in Nakhon Pathom Province since August 1986, as Dr Prawet Wasi advised Dr Sanguan Nittayaramphong, where the forum also consulted the di culties of work condition and the rural doctor's bitter feeling. Dr Sanguan Nittayaramphong worked at the O ce of the Primary Health System Committee embedded in a bureaucratic structure with a vertical management system and a lack of autonomy; this is different from the working condition in a district hospital which the doctor could play the leading role in relation to other governmental body in the area. Therefore, Dr Sanguan Dr Sanguan Nittayaramphong, who chaired the Rural Doctor Society during 1985-1986, was a coordinator with various sectors. The rst emergence of the UHC initiative was sparkle when he has worked in rural hospitals. In the latter few decades, he started the Khun Han's operational research project at Khun Han District, Sisaket Province, during 1986-1988, with participants from the university, MoPH and health workers in the area. The aim was to observe the health service operation and provide academic assistance in solving the operational problems. This research revealed that most patients came to the hospital with common illnesses and diseases, patients could take care of themselves. As a result, the research recommended improving public health strategies and its focus directly to the community level, and villagers were encouraged to take better care of their health and their families.
Besides, it was found that the doctors' prescribing behaviour in Khun Han Hospital was not at an excessive level. Thus, the average doses of drugs cost compared with the health centres drug use for the same medical treatment help estimate the cost of services, and improve the health centre's capacity in common illness treatment. The study of such rural hospitals' situation led to the UHC prototype project, namely the Ayutthaya Project during 1989-1994, to reform the health service system at a larger scale.
The experiment created a patient-centred integrated health system and collected the treatment fee at 70 baht per visit set by the hospital and community's agreement. After the 2-year performance of the Ayutthaya Community Medical Centre at Wat Intharam, the centre still operated normally under regular support from the state budget. In addition, general hospitals, municipalities and medical centre staff are satis ed with their operations. This successful project later expanded to a national project called the Health Care Reform Project, funded by the EU at approximately US$30,000 (56). The ideas and experiences derived from the Ayutthaya Project mobilised the public health reform in terms of nancing, personnel, referral system, and then expanding operations to other provinces.
In addition to the healthcare research project mentioned above, the rural doctor movement institutionalised evidence-based knowledge production to support reforming the health system. The socalled Health Systems Research Institute (HSRI) originated from the National Epidemiological Committee forum chaired by Dr Prawet Wasi. After a meeting with the Minister of Public Health, Dr Phairot Ningsanon agreed that the reforming principle led to establishing HSRI in 1992. HSRI performs academic functions, knowledge management, and a systematic knowledge base to drive health system reform. The rural doctors relied on evidence and knowledge-based reform as the most important step to drive the health system reform, and such systematic knowledge must also acquire from an independent health systems research institute. Dr Sanguan Nittayaramphong, a key rural doctor, played a role in drafting the Health Systems Research Institute Act and pushing the Legislative Assembly to ratify it at the Last-day meeting. After establishing the HSRI, Dr Somsak Choonharas was elected as the institute's rst director, assigning a committee and laying the foundation for the HSRI to work independently in the knowledge production necessary to drive the health system's reform (57).
In addition to institutional entrepreneurship accumulated knowledge in support of public health reform, Dr Sanguan Nittayaramphong has written a yellow book to describe UHC in terms of background, possibility, and budget required for achievement approximately baht 30,000 million (58). Also, he has even engaged in social security and rights to healthcare access and the Public Health Commissioner for drafting the National Health Security Act during 1993-1994. Therefore, he attempts to expand the right of healthcare access to cover all population. However, no political parties were interested in the UHC policy he proposed, except Thaksin Shinawatra, the newcomer Thai Rak Thai Party leader. A team consisting of highly skilled doctors, for example, Dr Viroj Tangcharoensathien, who have participated with the foundation for a capitation system in social security in 1990, which was different from the CSBMS's feefor-service system, which was later developed into a social security scheme setting co-payment rate per capita 700 baht per year in the beginning. In 2001, it adopted a per-capita package for UHC at the per capita rate of 1,202.40 baht per year. Aside from Dr Sanguan Nittayaramphong, Dr Wichai Chokwiwat is also another one who plays an important role in presenting the UHC to Thaksin Shinawatra. Rural doctors' coordination based in the MoPH, Mongkol Nasongkhla, Suwit Wibulpholprasert and Dr Prawet Wasi's network was drivers to achievement (16, 21). Therefore, the rural doctor movement's essential component is a knowledgeable leader since identifying social issues concerning the nature of policy problems related to a broader population and policy agendasetting. The rural doctor movement pushes forward UHC through continuous research and experimentation that o cially started as an operational research project during 1986-1988, brought about to create the UHC prototype, the so-called "Ayutthaya project". During 1989-1994, the Ayutthaya project was introduced as the prototype for health system reform and development at a larger scale.
Later, it expanded to a national project called the "Public Health Service Reform Project", in which the ideas and practices derived from the Ayutthaya Project. These ideas and practices in public policy driven by evidence- Healthcare access does not cover the entire population tend to create problems the rural doctors have to face in the rural hospital. Therefore, knowledge was accumulated, ready for solutions. The 1997 Constitution pave the way before the rst election would be organised. In December 1999, Dr Sanguan Nittayarampong had presented the UHC to Thaksin Shinawatra, the Thai Rak Thai Party leader, with doctors who were wielding power and vital role in the party: Prommin Lertsuridet and Surapong Suebwonglee. From the political situation at that time, together with the 1997 constitution, it became a policy window of UHC. This constitution designs a political structure to promote a strong government and leadership. This makes it possible to drive a large policy and the intense demand for citizens' rights after the political reform, and all stakeholders realised the importance of advocating policies from the public sector. The 1997 constitution also ensured medical treatment as a fundamental right that the state had to provide to its people, according to Sect. 52 and Sect. 82. Gathering alliances to push forward the UHC includes the rural doctor movement, academics, and a liates; the health organisation network has actively driven the proposal. However, advocating the UHC agenda setting and implementation caused severe institutional changes of MoPH, which emerged the resistance of health personnel who claimed that the UHC would potentially destroy the public health system in the long run. Those healthcare workers insisted that the UHC create over workload and messy implementation; some medical workers wear the black armband as a symbolic protest against the system, known as "black arm doctor". The two competing ideas seem increasingly clash all the time. According to Dr Surapong Suebwonglee, making UHC matters is not a sudden agenda, which provides healthcare access for 30 baths for all treatment alone do not e cient enough. So, the national public health nancing reform as a whole must be reallocated. The public nance allocation for MOPH hospitals was changed from a supply-side based allocation to a demand-side based allocation with per-capita budgeting (61). In addition, the payroll system was centralised to ensure that healthcare workers still receiving a salary.
Many countries have been faced with transnational health issues that demand cooperation beyond the state border, and this phenomenon opens an opportunity for the global and transnational actors to play an immense role in coping with the challenges. The article has explored the linkage between external in uences of global health ideas and internal professional movement in achieving the UHC policy in Thailand and locates the narratives of the vital global ideas and practices the rural doctor movement in Thailand consider mobilising the health system reform for equity in health for all. The global trends on the UHC had endorsed in the SDGs for global achievement by 2030, especially in low-income countries.
To our knowledge on transnational policy transfer, this paper attempts to ll the gap of knowledge in the eld and identify mechanisms and communication channels for multilevel policy transfer. The paper locates the narratives on (global) health ideas transfer to a national health system reform. This highlights the impact/role of global ideas on national professional movements, as such the rural doctor movement in Thailand in mobilising the health system reform. The ndings reveal that (global) health ideas transfer perform through idea transfer instruments, mechanisms and communication channels in multilevel contexts from the global to the national, or reverse. Furthermore, global health idea transfer can happen not only from IOs to national states in a vertical sense but also happen between the national state and national state in a horizontal sense. Most literature on Thailand health system reform often focuses on national processes in the rst place (5,8,9,11,(63)(64)(65)(66)(67)(68)(69). In practice, national equity in health could not be achieved without external/global health ideas transfer, such a case of national universal health coverage achievement in Thailand happened.
In terms of health idea translation at the national level, the rural doctor movement and individual agency as policy entrepreneurs translate external/global ideas and practices for their movement and mobilisation. Some scholars investigate policy transfer and transmissions among developed countries or from developed countries to the developing world (70,71). This paper exposes the transnational policy transfer in ideas and practices across actors such as policy transfer from IOs to developing countries or reverse, and from developing countries to developing countries themselves. These global ideas related to the national context of health system reform and policy agenda-setting that are; architecture of arguments in global health ideas (37) and its glocalisation (31), global health ideas on universal health coverage and its debates, primary healthcare and health ideas transfer, including roles of the medical profession and associations as mediators for health ideas transfer. The global and national linkage exists in one way or another in different forms, such as the international forum and nancial aid for health infrastructures and project development.
On the other hand, internal movement can explore in macro-level context (such as the institutional and structure faces of context) and micro-level context (such as agency-level enabling conditions) (see the similar approach of Bakir and Jarvis (22)). The global ideas and practices transfer to national health reform must be adjusted and suitable for a particular national context. Prominent scholars have pointed to the importance of changes in "political opportunity structures" (50), "windows of opportunity" (51), and "critical junctures" (52) to social and policy change, with the roles of policy entrepreneurs in the policy process and agenda-setting that may result in high impact policy and social change. This policy entrepreneur, in this study, actively engaged in health system reform related to Kingdon's Multiple-Stream Framework (MSF) (51) that outlines the policy process situated into problems, policy and politics. In a similar vein, policy entrepreneurs (individuals and sometimes small groups of people) also play roles in the public policy process as the agency for translating ideas into action (53).
In sum, it can be seen that, in this case, the UHC could not possibly be achieved without the effort of the national social movement, as a policy entrepreneur who is selling ideas to policy-makers and steer the translation of these ideas to policymaking and implementations. In this case, the rural doctor movement as an individual agency translates global health ideas for building institutional entrepreneurs and adopted them into the national process of knowledge accumulation and production for building evidencebased policy when the political opportunity structure was widely opened. In sum, the Thai case contributed to a better understanding of the global health process of ideas and practices dissemination to the national level with the national movement's support in adopting global ideas and practices, partnering of multiple groups and governing network for achieving the initiatives the others countries can learn from this experiences.

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Competing interests Figure 1 The linkage of external Global (Health) Ideas and Internal Movement for Achieving UHC in Thailand Source: Author's compilation. NMPM = National Medical Professional Movement