Amid the disruption caused by COVID-19, Taiwan’s hospitals have turned to online tools to maintain valuable partnerships with Southeast Asian countries forged under the New Southbound Policy.
As one of the flagship programs of the Taiwan government’s New Southbound Policy (NSP), the One Country, One Center (1C1C) project enables Taiwan to share its vaunted healthcare expertise with its regional neighbors. However, the onset of COVID-19 this year has presented a serious challenge to the project by curtailing international travel and in-person exchanges. Rather than halting progress on this initiative, the Taiwanese hospitals involved in 1C1C have continued their work by moving largely to an internet-based model.
Launched in June 2018, the 1C1C program is now in its third year and covers seven NSP countries, linking them with eight hospitals in Taiwan. National Taiwan University Hospital (NTUH) focuses on Indonesia, National Cheng Kung University Hospital serves India, Changhua Christian Hospital (CCH) works with Thailand, and Chang Gung Memorial Hospital serves Malaysia. Meanwhile, Hualien Tzu Chi Hospital focuses on the Philippines, Veterans General Hospital and National Yang-Ming University serve Vietnam, while Shinkong Wu Ho-su Memorial Hospital partners with Myanmar.
Although 1C1C was initiated by the Ministry of Health and Welfare, the program is run by the Health and Welfare NSP Coordination Office at the Chung-Hua Institution for Economic Research (CIER), which oversees and manages each hospital-country partnership. Under CIER’s supervision, the program seeks to fulfill four main objectives: capacity building through training medical personnel, strengthening epidemic control by creating cooperative networks, establishing market connectivity, and cultivating supply chains involving Taiwan firms.
Each 1C1C hospital provides medical training and business matching services to its partner institutions. Despite the program’s name, multiple Taiwanese hospitals may work with the same country, making a broader range of expertise available while the designated partner hospital acts as the main coordinator for other participating institutions.
For instance, while NTU Hospital (NTUH) works with nine hospitals in its partner country, Indonesia, it also cooperates with health institutions in Vietnam and the Philippines. CCH focuses chiefly on Thailand but is also active in Myanmar and Indonesia.
The work that Taiwanese hospitals are undertaking under the NSP often builds on their previous experience in Southeast Asian countries. For example, NTUH helped Vietnamese institutions perform their first liver transplant in 2009 and has also been cooperating with Indonesian hospitals since 2014 in training doctors and holding symposiums. CCH has operated free clinics in northern Thailand with a local partner since 2009.
Participating in the 1C1C program enables hospitals to expand on their involvement with partner countries. In the Philippines, NTUH has helped perform extracorporeal membrane oxygenation or ECMO, a method of providing an artificial heart during periods when patients are experiencing severe respiratory difficulties or while undergoing heart transplants. Veterans General Hospital has assisted Vietnamese institutions in performing several types of operations, including liver transplants and cardiovascular surgery.
These exchanges had come to a halt after the outbreak of COVID-19 due to restrictions on international travel. In response, participating hospitals have started holding web-based seminars, mostly focusing on COVID-19.
Among the webinars NTUH has conducted was one explaining Taiwan’s COVID-19 management, while others covered antibody testing and critical care for COVID-19-related respiratory failure. CCH has also hosted webinars on COVID-19, including prevention and treatment of the virus and the potential use of alternative and traditional medicine.
“Webinars benefit us as well as our partners as they allow us to overcome geographic restrictions and communicate more effectively with diverse speakers,” says Nina Kao, CEO of the Overseas Medical Mission Center at CCH. “We even ran a Facebook live stream while the seminars were happening and uploaded the videos to our official YouTube platform for people who could not join in time.” On the other hand, she notes, they have also faced some challenges with this new format, such as unstable internet connection in the less-developed or remote areas of partnering countries.
Chu Chia-yu, CEO of NTUH’s International Medical Service Center, says that his hospital holds three to four webinars a week with hospitals in Mongolia, Indonesia, and Guatemala. “I hope that next year we can travel to other countries and have face-to-face meetings,” he says. “There will be more meetings conducted over the internet, but we still need in-person workshops for hands-on training.”
Following a policy change last month enabling overseas medical trainees to come to Taiwan once again, hospitals such as NTUH and CCH will resume hosting visiting doctors from Southeast Asia. They will need to undergo two weeks of government-mandated quarantine and one week of self-health management upon their arrival, and their training period has been extended from the previous one month to three months.
The second major component of the 1C1C program is to match Taiwanese medical equipment and pharmaceutical companies with interested buyers in the NSP countries, with the Taiwan hospitals acting as the intermediary. This system allows the companies to broaden their market reach while also bolstering Taiwan’s medical reputation among NSP countries. The hospitals and companies also hold forums and attend exhibitions in those countries.
“In the past, the relationship between hospitals and companies was not as partners but as buyers and sellers,” says Roy Chun Lee, Deputy Executive Director of the Taiwan WTO and RTA Center at CIER. “But through the NSP, we’re pushing hospitals to serve as a spearhead and lead trade activity. The hospitals and companies have to create a partnership.”
CIER brings together the hospitals and companies based on relevant factors. “We determined which company was interested in which country and tried to bring the right person to the right centers,” says Lee. “We encouraged hospitals to share information with interested suppliers. In 2019, you could see there was a lot of transformation.”
The export of Taiwan-made medical and pharmaceutical products to NSP countries has grown rapidly in recent years, raising the growth rate of overall exports to those countries. This trend has continued this year as the pandemic has raised demand for medical products.
Taiwan’s exports to the seven 1C1C countries fell by 12.6% in 2019, partly due to the US-China trade dispute, while exports of medical and pharmaceutical goods increased by 7.5%, according to the Ministry of Health and Welfare. In the first half of 2020, exports to the 1C1C countries fell by 12.3%, while exports of medical and pharmaceutical goods rose by 13.6%.
Lee explains that the NSP raised the profile of partnering countries among Taiwan’s suppliers and vice versa. “Our suppliers were originally not really interested in or didn’t understand the potential of Southeast Asian countries,” he says. “This program actually generated interest by sharing some of the risks and removing some of the earlier uncertainty.”
Among the pandemic-related products made by Taiwanese companies are antibody rapid tests, electronic stethoscopes, surgical face masks, and personal protective equipment.
The program is not without its challenges. The lack of official diplomatic relations between Taiwan and NSP countries is a complicating factor.
“During this COVID-19 pandemic, many of our collaborators in Indonesia asked for help in providing tests, masks, and PPE (personal protective equipment),” says Chu of NTUH. “We can’t provide that without government relationships.” While NTUH was not able to send its partners masks directly, the Taiwan government later sent shipments of masks and PPE to various countries, including those in Southeast Asia.
Chu says that these partners also asked Taiwan to supply vaccines – not just for COVID-19, but for malaria and dengue fever as well. “We cannot provide these vaccines without their government’s approval,” he says.
Nevertheless, some interaction between the health ministries of Taiwan and the NSP countries does take place. “Health ministries are professional ministries and less intertwined with foreign policy and international politics. It’s relatively easy for officials such as deputy ministers to visit their counterparts and meet with their officials,” says Lee.
Another challenge is understanding the local needs of partner countries while also making them aware of Taiwan’s healthcare strengths. “We have a lot of good stuff but it’s not necessarily matching the demand from Thailand or Indonesia or India,” says CIER’s Lee.
“For example, Taiwan’s universal healthcare scheme is one of the best, but not many people outside of Taiwan understand its advantages or the factors underpinning this success,” he says. “If they don’t understand, they won’t request further information and they don’t really know what Taiwan can do.”
Lee notes that Indonesia is building its own national health insurance scheme, but that Taiwan isn’t clued in on what they need to implement it. “For example, do they need a cloud medical system or smart medicine system? We don’t know what their exact priorities are. We have started picking this up, but we need a much broader understanding,” he says.
Despite the challenges, 1C1C has been a relative success and there are plans to widen its scope to cover more countries in Southeast Asia, as well as to increase the number of participating Taiwanese hospitals. That expansion will likely happen in 2022, when the program’s second four-year phase begins and a new budget is allocated.
Lee expresses optimism about the project’s future progress. “Out of the NSP’s five flagship programs, I’m confident the medical and healthcare program is at the top in achieving the intended goals of the NSP by creating bilateral awareness and understanding through soft power,” he says.