Called an honorarium

Around 1.07 million people in Thailand are village health volunteers, by the government’s own count.

The ministry regulation that constitutes them lists what they are for. Campaigning and teaching primary health care. Providing health services under ministry rules. Running surveillance and prevention suited to local conditions. Leading changes in health behaviour. Telling people what care they are entitled to and how to reach it. Working alongside state and local-government health staff. During the pandemic, they were how national instructions reached a particular lane.

Each of them is paid ฿2,000 a month by the state.

And the money is not wages. It is called ค่าป่วยการ.

What that word is doing

ค่าป่วยการ translates roughly as compensation for trouble — an honorarium. It is a term of art, and the thing it is not is ค่าจ้าง, wages.

The ministry’s own announcement defines it: money the government pays a volunteer to support the performance of their duties.

Now look at how it is paid. To qualify, a volunteer must be on the Department of Health Service Support’s national register of volunteers, must have fixed hours in the activities assigned to them, and must file a monthly performance report, certified by the chairs of the village and subdistrict volunteer clubs. District health offices check the reports every month. The department confirms who is entitled. The Comptroller General’s Department transfers the money into each volunteer’s own bank account. The ministry decides, each fiscal year, how many volunteers nationwide are entitled to be paid. And on anything the announcement does not cover, it applies the government’s rules for paying salaries and wages — by analogy.

Registered, counted, assigned hours, reported on monthly, paid monthly under salary rules applied by analogy — and defined as not a wage.

That distinction is the article.

A wage would make them somebody’s employees. An employee, as article 89 The wrong way round established at length, is the category to which Thai protection attaches. An honorarium makes no one an employee. The 2011 regulation defines a volunteer as a person chosen by their village or community who has completed a standard training course, and nothing in it makes them a civil servant, a government employee or anybody’s employee. What it gives them is short and specific: help with special-room and food costs at ministry hospitals, reimbursement of expenses incurred in the role, an honorarium at a rate the ministry announces, and eligibility for recognition.

So the largest workforce in the Thai health system sits outside the category that the Thai health system’s own staff sit inside.

This is not an accusation of bad faith and the article does not suggest anyone is being cheated. The arrangement is public, the volunteers join it knowingly, and the role genuinely is voluntary in origin. The observation is structural: article 89 The wrong way round found that Thai protections attach to a category drawn around people the administration can already see, and here is a million-person cadre that the state registers, trains, assigns duties to and pays every month — and has placed outside the category anyway.

The instrument

Here is the second fact, and it is stranger than the first.

The cadre is constituted by a Ministry of Public Health regulation — ระเบียบกระทรวงสาธารณสุข ว่าด้วยอาสาสมัครสาธารณสุขประจำหมู่บ้าน — made in 2011. The honorarium rests on an announcement made under that regulation’s clauses 6 and 30, most recently re-issued in February 2023.

A departmental regulation. Not an Act of Parliament.

Compare that to what they deliver. The universal healthcare scheme article 36 ฿4,298 a year: how Thailand covered everyone described has had its own Act since 2002. The Social Security Fund article 179 Thirty years at fifteen thousand described has an Act. The doctors article 73 One set of doctors counted are licensed under an Act.

The million people who carry the system’s last mile are constituted by a regulation that a minister can amend on the ministry’s own authority.

The money

The honorarium was ฿1,000 a month until September 2023. The Cabinet approved doubling it to ฿2,000 a month from 1 October 2023, and the new rate reached bank accounts on 15 May 2024: that month’s payment plus ฿6,000 of back pay, ฿8,000 in one transfer. The government put the programme’s cost at about ฿25 billion — which is what ฿2,000 a month for about 1.07 million people comes to.

The article will not compare ฿2,000 to a monthly wage, because that comparison assumes a full-time role and the role is not full-time. What can be said is narrower and more useful: whatever the amount, it is structured as an honorarium, and the structure — not the amount — is what determines what attaches to it.

Raising it to ฿4,000 would change the amount. It would not make anyone an employee.

The Act that keeps nearly arriving

There has been a draft Act for the cadre for some years, and the House of Representatives’ own consultation report states its purpose plainly: to raise the rules on village health volunteers from the 2011 ministry regulation to the level of an Act. The draft’s third section would simply repeal the regulation.

Several bills went before the last House, and reporting in October 2025 had them through committee and heading for a third reading. They did not become law before the House was dissolved.

In May 2026 the Department of Health Service Support said it was revising a draft — raising the maximum age for registering as a volunteer from 60 to 65, cutting the years of service needed for the draft’s benefits from 20 to 10, and adding protection for older volunteers who leave because their health fails — to put to the Cabinet in June 2026. By late September this article had found no record of the Cabinet approving it.

What every version shares is the purpose: to move the cadre from a ministerial regulation to a statute, and to improve what attaches to the role.

Which is a tacit acknowledgement of everything above. You do not legislate to raise the status of a group that already has one.

Why this matters beyond the volunteers

Thailand’s universal healthcare system is internationally admired and deserves to be. Article 36 ฿4,298 a year: how Thailand covered everyone set out how it reaches everyone. Part of why it reaches everyone is that a million people carry it into places a hospital cannot go.

That last mile is held in place by an arrangement with no statute behind it, paid under a name that is not wages.

Article 92 The first toll added a clause to this archive’s second structural finding: universal provision must also be adequate. This is a different clause and it points at the delivery side. A universal system can be delivered by people who are themselves outside the protections the system’s own staff enjoy — and if that arrangement ever stops working, the thing that fails is not a budget line but the part of the system that knows which house to visit.

None of which means the current arrangement is failing. By every account it works. The article’s point is that it works on a regulation, and a regulation is the easiest kind of instrument to change.

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Common misconceptions

“They are government health workers.” They are volunteers paid an honorarium. Nothing in the regulation that constitutes them makes them civil servants, government employees or anybody’s employees.

“฿2,000 a month is their salary.” It is ค่าป่วยการ — an honorarium — not wages, and the role is not full-time. The distinction is legal, not merely linguistic.

“There is a law governing them.” The governing instrument is a Ministry of Public Health regulation made in 2011. Bills to replace it with an Act did not become law before the last House was dissolved, and a revised draft was being prepared for the Cabinet in 2026.

“There are a few thousand of them.” Around 1.07 million, by the government’s own count.

“The honorarium has never changed.” It was ฿1,000 a month and was doubled to ฿2,000 from 1 October 2023.