Linking Health, Environment and Community Development: Lessons from the Thai Experience
By Robert Lalasz
The driving force behind Thailand's remarkably successful family planning movement detailed for a Wilson Center audience how his NGO has broadened its mission to encompass health, development, and the environment while also becoming more self-sufficient.
Mechai Viravaidya said that his Population and Community Development Association (PDA) has succeeded through persistence, creativity, integrated programs, and entrepreneurism. "The only way to take poor people out of poverty is to the marketplace," Viravaidya said.
Cabbages and Condoms
Duff Gillespie, senior deputy assistant administrator of USAID's Bureau for Global Health, introduced Viravaidya by praising the Thai activist's energy and risk-taking.
"He thinks big thoughts and then goes the next step and does big things," said Gillespie. "There are literally tens of thousands of people alive today who wouldn't be were it not for Mechai. And because of him, many thousands more have much richer lives, figuratively and literally, than they would have had."
Viravaidya, who is also a UNAIDS ambassador as well as a senator in Thailand's parliament, next detailed how PDA grew from a family-planning NGO to a provider of integrated development and environment programs. When PDA initiated community-based family planning services in 1974, Thailand was an explicitly pro-natalist country, with an annual population growth rate of 3.2 percent and seven children per family on average. Today, those figures have declined to less than 1 percent and 2 children per family.
Viravaidya detailed how PDA spearheaded Thailand's national effort to reduce its birth rate through (a) increasing accessibility to contraceptives (especially in rural regions) and (b) making contraceptives acceptable to the public at-large, often through colorful public information campaigns that featured condom-blowing contests, free vasectomies, and primary school educational programs.
"Cabbages and condoms," said Viravaidya, repeating PDA's famous slogan. "Contraceptives have to be found as easily as vegetables in villages." PDA involved everyone from taxi drivers to the police, Avon salespeople, and Buddhist monks in the effort.
The campaign has been so successful, Viravaidya said, that PDA now spends only 10 percent of its efforts on family planning. "Everybody [in Thailand] accepts it," he said. Indeed, "Mechai" is now a Thai nickname for "condom."
Expanding Its Portfolio
In the 1980s and 90s, PDA expanded its portfolio to include health (particularly HIV/AIDS) and rural development, poverty reduction, and environmental conservation. For HIV/AIDS, Viravaidya said that PDA worked to get even more widespread distribution of condoms throughout Thailand as well as continuous public service announcements on television—an effort that has helped to reduce the country's HIV infection rates by 77 percent.
Viravaidya stressed the importance of visible high political support for such efforts. "The next World AIDS Conference [set for Bangkok in 2004] should have a leadership track," he argued. "Without political commitment at the top, it will be very difficult to make inroads against the global AIDS problem."
PDA has also developed a for-profit arm, running its own handicraft shops, resort, and restaurant (the famous "Cabbages and Condoms" in Bangkok) as well as brokering deals between rural Thai villages and corporations such as Volvo and Nike. Other rural efforts have involved collective rural microcredit and programs to empower women.
"You begin to see the wealth, the strength, the power of the village," Viravaidya said. "And it's all sustainable."
He concluded by chastising donor countries and foundations for relying too heavily on grants. "You have to help us be viable through training and resource allocation," Viravaidya said. "NGOs are expecting to live off the generosity of donors forever, and it can't work."