The cross-sectional survey research was conducted to study the situation of employment of retired nurses in hospitals under the Permanent Secretary Office of the Ministry of Public Health. The data on employment of retired nurses were surveyed from regional hospitals, general hospitals and community hospitals during fiscal year 2019-2020. The results show that there were 31 of 116 regional and general hospitals (26.7%) that employed retired nurses in 2019. In the fiscal year 2020, there were 28 hospitals (24.1%) that employed 162 retired nurses. For community hospitals, 20 of 780 hospitals (2.6%) employed 32 retired nurses in 2019 and reduced to 18 hospitals employing 20 retired nurses in 2020. Hospitals in the central and the eastern regions had the highest employments of retired nurses. There were 2 types of job characteristics (nursing work and non-nursing work such as health information management and health record). The pattern of employment was either full-time or part-time. Many payment arrangements were reported, such as daily payment (at a rate of 600-800 baht a day), monthly payment, and performance compensation. However, all payments were based on the regulations of the Ministry of Public Health. As for community hospitals, 20 hospitals employed 32 retired nurses (2.6%) in 2019, and reduced to only 18 hospitals employing 20 nurses (2.3 %) in 2020. During the fiscal year 2019-2020, hospitals in the central and the eastern regions (Health Region 4, 5 and 6) reported the highest employment rate than other regions. Regarding the 2 types of employment: 1) the nursing work employment was reported at the outpatient department, inpatient wards, special clinics and antenatal care clinics, accident and emergency department, central dispensing unit, breast feeding clinic, orthopedic department, primary and community care unit, and diabetes clinic. 2) The non-nursing work employment was reported in other departments such as in the medical records audit, the outreach health check unit, the patient complaint services, the health insurance center, and the public relations. The monthly payment was approximately 13,000-20,000 baht a month. The time-based payments varied as 100 baht an hour for working in the central supply unit, 80 baht an hour for other units, 450-600 baht a day for the patient complaint services, and the public relations, respectively. The results revealed the situation of employment of retired nurses, the characteristics and the patterns of employment. These results should be useful for policy development on human resource planning. Moreover, employment of retired nurses at different levels of health sectors should be further researched.


This literature review aimed to investigate clinical outcomes and physical therapy indicators in 4 physical therapy fields, i.e. 1) musculoskeletal system, 2) neurological system, 3) pulmonary and cardiovascular system, and 4) pediatrics. Systematic reviews were searched from start to 15 July 2019 in several databases, including PubMed, ScienceDirect, Web of Science, Scopus, and PEDro. Relevant systematic reviews with full report published in English were retrieved. Data from included studies were extracted, analyzed, and synthesized. The results showed that 151 papers were included in this study. Clinical outcomes and physical therapy indicators were categorized into 22 groups. In general, assessing patient’s clinical outcome required more than one clinical tool or form to cover all aspects of patient’s problems, including signs and symptoms, functional ability, and social participation. Most common clinical outcomes and physical therapy indicators used were pain, body movement, functional ability, and quality of life. Physical therapists can apply this information to set treatment goal, planning treatment program, and evaluating treatment progression in order to improve quality of service to patients and to establish goals for service from a multi-professional team.


Walking and cycling are common physical activities if performed regularly in daily life will return health, environmental and economic benefits. This study aimed to 1) assess built environments that encourage walking and cycling in communities, 2) assess levels of physical activity and energy consumption, and 3) investigate the amount of carbon dioxide emission and cost of transport. Quantitative method was employed. Data collection techniques comprised direct observation and questionnaire survey in three communities: 1) King Taksin community in Bang Khla district, Chachoengsao province, 2) Suksabaijai community in Mueang Kalasin district, Kalasin province, and 3) Ban Thatsopwaen community in Chiang Kham district, Phayao province. The results showed that King Taksin community had the highest scores on walking, cycling and use of public transport as the community center was close to the district shopping center with a well-managed public transport system. Samples from King Taksin and Ban Thatsopwaen communities had the highest levels of physical activity due to frequent walking and cycling in their daily life. Suksabaijai community had the highest level of carbon dioxide emission from motorcycles and cars, and the highest transport cost as the community center was far from the shopping center with its built environments of having a high-speed road passing through the community center hence discouraged walking and cycling. This study recommends that all agencies promoting physical activity should work with local community in designing built environments and evaluating effectiveness of walking and cycling promotion programs that fit with each community.


Thailand national steps challenge policy has been developed in 2019 by the physical activity policy development subcommittee according to Thailand Physical Activity Strategy 2018-2030. The policy has been implemented through Thailand Virtual Run Season 1 Fiscal Year 2020 by the Division of Physical Activity and Health, Department of Health, Ministry of Public Health. This article reviewed details of the policy formulation and implementation in order to get deeper understanding on the process of policy development, implementation gaps, and to make further recommendations. Lessons learnt led to deeper understanding on policy formulation at national level that required concurrent assembling of problem, policy, political streams with proper window of opportunity. Policy implementation needed context and situation adjustment for smooth management. Lastly, learning policy gaps from the past could shape better policy implementation in the next stage.


The world is in the grip of the novel coronavirus or COVID-19 pandemic. Since it was first identified in Wuhan, a city in China at the end of 2019, the disease has rapidly spread to countries around the world. This pandemic is likening to occur once in a century. In Thailand, there were 3,000 accumulative cases from 68 out of 77 provinces. This article reviewed the essence of COVID-19 prevention and control activities by Angthong municipality in Angthong province from 1 February to 12 May 2020 that led Angthong as 1 out of 9 provinces that had no provincial inhabitants infected. The aim of the study was to understand COVID-19 prevention and control highlighting collaboration of community-level stakeholders. Lessons learnt from this study provided an insight on Angthong provincial disease control committee mechanism, the arts of implementation of Angthong municipality, importance of local leadership, and dynamic of daily life shifting of local people for further development on disease control policy at both local and national levels.


Introduction: The work of the Family Medicine Clinic (Primary care cluster) is limited, that is, the pharmacist is not enough. Pharmacies as a co-service unit should therefore complement a complete pharmaceutical system. Method: Participatory action research in the area of Khon Kaen, Phetchabun Phitsanulok and Songkhla under the project to reduce hospital congestion by the drug store mechanism. The study period consisted of 3 research phases in Phase 1 to develop a model for the pharmacy that is a unit in conjunction with a family medicine clinic and establishing guidelines. In phase 2, putting them into practice in the area. And the research in phase 3 is to evaluate the outcome of drug use problem management. Satisfaction and opinions of pharmacists, patient and health care provider in the family medicine clinic and economic results. The objective is to develop a service model of a pharmacy that is a joint unit with a family medicine clinic. Evaluating the management of drug problems of the people who come to the pharmacy. Evaluate the satisfaction of patients and healthcare workers with the developed models and assess the economic results of the developed models. Results: The service model of quality pharmacies and GPP pharmacies as a joint service was developed. Additional pharmacy services which developed in this study are Medication therapy management (MTM) as well as waste drug management and health promotion for patients who come to receive services in the project to reduce hospital congestion by the drug store mechanism. The results of the development have resulted in the management of drug use problems. Behavioral problems, and residual medicine, found a total of 14,211.22 baht, most of which cause 55.03% of patients who did not comply in drug use, followed by 38.48% of over prescription. Most common drug related problem is noncompliance and the most common health behavior problem is diet problem. For the results of assessing the satisfaction of the clients in various areas, a full score of 5 found that the clients were satisfied at the highest level in all aspects. Both the service procedures, which consisted of the appropriateness of the service procedures by community pharmacists (4.77 ± 0.46) and the appropriateness of the duration of service from community pharmacists (4.77 ± 0.47). Pharmacists, which consisted of service etiquette of pharmacists (4.88 ± 0.33) and pharmacists, can help resolve drug use problems of patients (4.81 ± 0.44). Knowledge of disease and self-received drugs (4.72 ± 0.51) applied knowledge gained from community pharmacists to apply for self-care (4.75 ± 0.48) and reduce the time to wait for service compare with hospital (4.86±0.37) and overall satisfaction (4.87±0.36). The results of the satisfaction assessment of pharmacists were the highest (4.27 ± 0.69). Except for the appropriateness of compensation which was satisfied at a high level (3.84 ± 0.86). It was found that the total cost per time of service in the model 1 was 104.24 baht per time of service. It can be seen that the cost of drugstores in Model 1 is greater than the remuneration paid by the NHSO to the pharmacy, which is 70 baht per time of service. In addition, when the cost per item of drug is 31.03 baht per one item of medicine dispensed by the pharmacist and giving advice on drug use. For model 2, it was found that the cost per time of service was 176.73 baht per time, it can be seen that the cost of Model 2 is 106.73 baht higher than the remuneration paid by the NHSO to the pharmacy. Conclusion: The drugstore in the project to reduce hospital congestion by the drug store mechanism should be provide Medication therapy management (MTM) and health promotion services to patients, in addition to prescribing and giving medication advice because people are benefiting and satisfied. The National Health Security Office should increase the remuneration for pharmacists in Model 1 to at least 100 baht per visit and Model 2 to at least 170 baht per visit and to develop the potential of all pharmacies in the project to be able to provide services to manage drug use problems and health promotion to the patients.


Background: Technology transfer involved the transfer of knowledge and technical know-how, as well as physical devices and equipment. There have been several factors influencing success. Objective: This study aimed to draw the lesson learned from the Government Pharmaceutical Organization (GPO) and Mylan technology transferring to achieve accreditation by the WHO Prequalification Programme (WHO PQ). Methods: Qualitative research was used. The information was collected by studying the documents published officially and non-officially, and in-depth interviews were conducted with selected key informants relevant to this technology transfer. Then a content analysis was performed. Results: GPO has inherited technology from Mylan, India's leading generic company. Until GPO can produce and control the quality of antiretroviral drugs Efavirenz and certified by the World Health Organization. The important conclusions of this study were as follows 1) The important policy decisions included the policy that impels GPO to be accredited by WHO PQ and the one that GPO decided to collaborate with the Mylan. 2) The success factor was the good relationship between the technology transferor (Mylan) and the technology transferee (GPO). This relationship motivated the intent teamwork between GPO and the Mylan in production as well as quality control that led to accreditation by WHO PQ. The country's supporting factors included the universal health coverage policy, the support of AIDS problem solving by producing HIV antiretroviral drugs in the country, GPO's capacity, and implementing the ‘Sustainable Potential Development Plan in Thailand, Section: WHO Pre-qualification Scheme ’in B.E. 2554. The international context also contributed. For instance, WHO has the Global Fund's approval to support the developing countries with a pharmaceutical production capacity in terms of technical assistance. So those countries can enhance the quality to the level recognized to provide antiretroviral drugs for the projects in several countries in which the procurement can be made using the Global Fund budget. 3) The obstacles that made GPO spent over 17 years to be accredited by WHO PQ, including the GPO's lack of readiness in several aspects. Such as locations, new facility procurement process, designs, technology choice, human resources as well as the GPO management system, causing the executives and committee in some periods paid attention to other issues. According to the lesson learned, forming a new team combining with a new work culture that developed effective teamwork where every member harmoniously works towards goal as well as the support from executives in several periods have contributed to the eventual WHO PQ project accomplishment. That momentum empowers GPO to set up high quality and vigorous work system for pharmaceutical products in the overall appearance of the organization and its personnel until GPO can create an image in the international market for earning trust in the GPO’s products.


Background: An electronic tuberculosis (TB) registry, accessible over the internet is useful to accumulate all TB-related patient data and apply best practice standards to produce accurate treatment decisions. The study aims to develop the electronic case-based MDR-TB registry that can be used to improve patient care by systematically monitoring the treatment response and drug adverse events following the design schedule. Methods: This is a pre-and post-intervention study, conducted at Makarak hospital, a district of Kanchanaburi province located in the west of Thailand. This hospital was selected based on a higher rate of MDR-TB reported over the past decade since 2002. The primary objective was to increase success rate of MDR-TB treatment after using eMDR-TB registry. Eligible patients were adult > 18 years, diagnosed with MDR-TB since October 2015. Electronic MDR-TB registry was developed in the cooperation with Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS) and Ministry of Public health in data management software. The sample size needed to determine the outcome was 112 patients or 56 patients in each group, comparing between those already completed or starting treatment before using eMDR-TB registry and those who were newly diagnosed after using eMDR-TB registry. Results: A total of 164 MDR-TB patients were diagnosed between October 2015 and June 2020: 148 cases who were already treated MDR-TB before using registry and 16 cases who were using assessment and monitoring with eMDR-TB registry. The median duration of treatment of those do not use (no registry) and use registry were 18.7 months and 6.6 months, respectively since the treatment of use registry group is still ongoing. The median age of all patients was 55 years and 58% of patients were male and 56% of patients had at least one comorbidity in which diabetes mellitus was the most common and also more common in use regisytry than no registry group. The proportion of smear and culture conversion within 6 month were 77% and 79.4%, respectively. Time to smear and culture conversion of all patients was 69 days and 77 days, respectively. The patient in use registry group had a significant shorter time to sputum conversion than no registry group (67 days vs. 81 days, p=0.029). Among 148 cases in no registry group who had the outcome at the end of treatment available, only 45% were cure or complete treatment, 28% died mostly within 6 months and 10% were lost to follow-up. A higher proportion of use registry group are still receiving treatment than no registry group (81% vs. 69%) and had a lower proportion of death within 6 months (12% vs. 22%). The treatment duration of survived and death patients were 610 days and 70 days, respectively. There were 70% of patients experienced hypokalemia, 37% had hypothyroidism, 31% had acute renal injury and 20% had abnormal audiometry. Laboratory parameters have been checked as planned for at least 80%. Hypokalemia and hypothyroidism had been observed more commonly in no registry group whereas hyperuricemia and abnormal audiometry were found more commonly in registry group. Factors associated with mortality were older age, low body weigth, HIV infection and stroke. Body mass index less than 18.5 kg/m was an independent factor of death from cox regression. Conclusion: A more comprehensive and holistic approach in management of MDR-TB particularly in the first few months or in patients with high risk of death are needed to reduce the mortality and possibly improve the patients’ adherence until the end of treatment.


Background: Tuberculosis preventive therapy (TPT) among HIV-infected patients are not well established in Thailand and may be due to multifactorial reasons. One of the most crucial reasons is because most physicians are convinced that antiretroviral therapy (ART) alone can decrease the incidence rate of active tuberculosis (TB) to the incidence rate of the general population. However, the incidence of TB data among Thai HIV-infected patients on ART is also scant. This information is very important because HIV-infected patients can have latent tuberculosis infection (LTBI) which can later progress to active TB. Therefore, TPT is crucial among HIV-infected patients to prevent active TB. Method: We conducted a cross-sectional, multi-center study in HIV-infected patients from 14 hospitals throughout Thailand between 2009 and 2018. This study compared the incidence of active TB among HIV-infected patients with different CD4 cell count after ART has been initiated. Results: A total of 9,179 HIV-infected patients were enrolled; 442 (4.8%) were diagnosed with active TB after ART was initiated and 8,738 had HIV mono-infection. According to the multivariate analysis, the significant risk factors associated with active TB post ART initiation were the male sex, CD4 less than 350, body weight less than 50 kg and have a prior history of active TB. When ART was initiated at low CD4 cell count, the incidence of active TB was high (Table) compared to the general population (about 150-200 per 100,000 persons-year). Furthermore, when ART was started when the CD4 count was more than 500, the incidence rate of active TB was 2-3 times higher than the general population (394 per 100,000 persons-year). The incidence of TB for the first 2-5 years after ART was initiated decreased to 7,251, 4,083, 2,661 and 1,957 per 100,000 persons-year, respectively. However, these numbers were much higher than the general population in Thailand even when these patients were on ART for many years. Conclusions: The incidence of TB among HIV-infected patients with various CD4 cell count and on ART were high. The incidence of active TB was 2.5 times higher than the general population even when ART was initiated when CD4 was more than 500. For this reason, HIV-infected patients who have had TB infection should benefit from TPT which can decrease the incidence and mortality rate of TB.


This research aim to 1) investigate risk perceptions and preventive behaviors as well as the control of work-related risks among latex pillow processing workers, 2) study the factors affecting risk perceptions and preventive behaviors as well as control of work-related risks among latex pillow processing workers, and  3) establish the guidelines or measures and prepare manuals on the development of hazard prevention to address the occupational health and safety problems among latex pillow processing workers in Nakhon Si Thammarat. The sample size for the survey on risk perception and hazard prevention from working with latex pillow processing were a total of 10 community enterprises and SME groups for latex pillow processing in Nakhon Si Thammarat, with a number of 74 workers. The research adopted the Participatory Action Research (PAR) through the qualitative study and participatory learning technique during November 2019 to December 2020. The research was conducted by studying the baseline data of occupational health hazards, survey the working condition, and monitoring the physical working environment.  Researchers apply work improvement in small enterprises (WISE) and job safety analysis (JSA) techniques that points out hazards in every working process. It is also required for their participation in determining the procedures and methods in each procedure to ensure collaborations between researchers and latex pillow processing workers. Data analysis were analyzed using descriptive statistics and Inferential statistics by multiple regression analysis to analyze the correlation of factors influencing risk perceptions and preventive behaviors as well as work-related risk control among latex pillow processing workers in Nakhon Si Thammarat. The study found that top five rankings of risk factors exposed to latex pillow processing workers were working positions with lowering/raising their heads, positions with body bending, repetitive working positions for a long time, chemical exposure, and moisture exposure, accounted for 3.29, 3.10, 2.94, 2.78 and 2.70 mean, respectively. The correlation between personal factors and risk perceptions among latex pillow processing workers through an analysis of correlation between variables found that females had statistical significance (p-value = 0.006; 95%CI: 3.75 – 21.55), working periods of latex pillow processing with statistical significance (p-value = 0.001; 95%CI: (-1.05) – 7.36), and receiving the trainings of safe and proper latex pillow processing with statistical significance (p-value = 0.0001; 95%CI: (-29.72) – (-12.96)). An adjustment of possible influences from other covariate variables found that females (p-value = 0.006; 95%CI: 3.75 – 21.55) with working periods for latex pillow processing approximately 8 hours/day (p-value = 0.014; 95%CI: (-19.35) – (-2.31)), having the records of allergies (p-value = 0.003; 95%CI: (-38.61) – (-8.47)), and receiving the training of safe and proper latex pillow processing (p-value = 0.0001; 95%CI: (-33.91) – (-2.31)) showed statistical significance. The results of the development from the application of Work Improvement in Small Enterprises (WISE) and Job Safety Analysis (JSA) techniques to improve the working environment were found that after the implementation, community enterprises had a better working environment in several areas based on the WISE Technique elements, such as improving work posture, chemical safety, and personal safety equipment, etc. The steps for successful work improvements among workers used by the researchers include 1) understanding the problems, 2) providing knowledge of safe working conditions, 3) collaboratively finding the guidelines for improving the work environment, 4) jointly improving the work environment, and 5) doing follow-up and supporting the operations. The hazard-prevention models are regarded as the primary prevention strategies developed by collaborations of latex pillow processing workers and relevant agencies in the local area, which will result in the prevention for health impacts and improve the quality of working life in a concrete and sustainable way.


Central Medicines Procurement for National Health Insurance System began in 2008 after the National Health Security Office (NHSO) has set reimbursement for medical used in public hospitals. Starting from reimburse for medication that is used to treat diseases with high treatment costs (through the High-Cost Disease Fund), disease  prevention vaccine  (through the EPI Vaccine Fund  which is in the normal budget) and  medication for  AIDS patients (through the AIDS fund) and others, currently NHSO has gone through the pooled-procurement process and distribution of these pharmaceuticals from central inventory to all public hospital all over the country. Government audit agency. Few years ago, a sudden change in purchasing unit by take into consideration of auditor recommendation that the purchasing unit should be independent from funds holder to comply with good governance practice. The medicine procurement committee has established of a group of public hospitals, a public hospital network (NPHs), as a temporary purchasing unit and under the process of determining what is the appropriate structure and characteristics of purchasing unit should be and how the technology could help solving this issue. Demand forecast. Under the overall procurement and distribution cycle, pooled-procurement supply chain processes, NHSO is responsible for preparing procurement plans by using last year medicine consumed as the baseline to forecast items and quantities to be purchased. Purchasing Unit.  Purchasing Unit is responsible for the procurement processes − biding, tendering, or buying, etc. in accordance with government procurement policy − and then the Pharmaceutical Organization is responsible for managing and monitoring central stock as well as manage to deliver according to the hospital order. Public Hospital. Under this scheme, each public hospital must manage its own medical stock and under this policy, they are not allowed using government budget to buy such the items that that policy restricted to be in pooled purchase. Replenishment and drug quality are issues within the supply chain processes. Tracking medicines lot number those are delivered to hospitals all over the country is needed in the case that any lots found expired or unmet quality, it must be replenished, return, or claim to the supplier who sell them. Central Procurement Monitoring System-CPMS will be implemented to track procurement planning, purchasing and distribution of medicines to the users (public hospital), but still one last mile problem. This research emphasizes on the studies and analysis of procurement and distribution processes for Central Medicines Procurement in UC Scheme to seek for adjustment for concrete execution, and design and develop pilot system to monitor the medicine procurement and distribution. This includes studying and suggesting the integration of IT system development and procedure that are relevant to procurement and distribution for Central Medicines Procurement. The study results are as followed: Study results in guidelines for process adjustment: According to the comparison study between the process in nowadays and before 2017 fiscal year, the procurement and processes for Central Medicines Procurement are being under control of the fiscal year cycle, and sourcing in accordance with the Government Procurement Act in 2017. Some medical and supply lists have an inconsistent condition in supply chain that make them inconsistent with their operations, resulting in congestion. Take an example, as the temporarily drug shortage occurs, the demands in supplies from the market or the seller’s drug storage will augment. Along with the impact on the balance of the fiscal year procurement, and demand planning and the drug storage administration of the next cycle. Analytical results in the gap between procurement and distribution processes for Central Medicines Procurement in UC Scheme: The supply chain downstream is an untraceable system. It begins as hospital receive medical supplies all the way to dispensing medicines to the patient. Due to the Central Medicines Procurement in special project is one of the tremendous supply chains, each hospital has a distinguish drug management system. Despite the medical records are individually recorded, tracking the source of the medicine dispensation are inaccurate, which highly affected the qualitative management, for instance, drug lot tracking, expiration date on borrowing, returning, and changing medicine. Moreover, the drug codes that do not meet the similar standards and agreements are not contributed in every process in managing and monitoring level. Analytical results in the comparison of a general practice and IT potentiality that needs to be developed: When contrasting the IT potentiality of an organization in the procurement and distribution of medicine, the are 3 major agencies are all possessed the nation-leading in IT potentiality. They can analyze, adapt, and develop IT system to accommodate the new arisen demand on time. Whenever the problem in medicine procurement and distribution processes have been discussed, IT system is the essential drive to resolve all the conflicts. Despite its explicit role and a lot of co-operated agencies, it was discovered an ambiguous conclusion on the selection of the IT system’s owner. This will affect the sustainability of system along with the usage expansion, development, and maintenance. Analytical results in design and develop pilot system to monitor the medicine procurement and distribution: Research team have developed the sample screen of pilot system and represented the original screen to 3 dominant agencies, which are consisted of NHSO as a planner in medicine demand forecasting, Rajavithi Hospital as a procurement agency, and GPO as a seller agency. The design for 3 interrelated agencies can monitor the planning and procuring status, and also check the report overview. It has been recognized as a highly benefit function especially in cutting the delayed procedure from communication and confidential exchange of information with each other. Nevertheless, the pilot system has not been assigned to any agencies, it was temporarily installed at NHSO server, which situated in NGO office. Policy Recommendation: The major problem is lack of host to implement IT, and information for management and monitoring. Hence, determining the stakeholder in different level of IT system explicitly will generate confidence for examination and evaluation of the medicine procurement and distribution cycle. Along with expanding the results of pilot system and conducting as mechanism to drive and administrate the cycle of procurement and distribution processes for Central Medicines Procurement in UC Scheme. It is done by regulate the approach and method in directing information in every single process in order to ensure that exchanged data are precise, trustworthy, compliant with the law, regulations, and notices that would shorten and smoothen the procedure, simultaneously. Additional research topics: 1) Applied Global standard Pharmaceutical Product Code: GS1 Automatic Identification and Data Capture Standards in Healthcare.  2) Blockchain-based solution: A new ecosystem should be introduced to enable all stakeholders to share single trusted source of information on the procurement and distribution of the Central Medicines Procurement in UC Scheme using permissionless blockchain to solve the last mile problems within the procurement and distribution processes reconciliation.


Thailand becomes ageing society. The Thai government officially implemented long-term care (LTC) for dependent elderly in 2016. Sa-ard sub-district of Namphong, Khon Kean has provided LTC services program by family care team and LTC center since August 2017. However, impacts of this program particularly social impact have not been assessed. This study aimed to examine the impacts of dependent elderly care program by the family care team, Nampong district, Khon Kaen province. Specific objectives include; describing elderly care delivery, examining program outcomes, and social return on investment (SROI), exploring opinions and recommendations to improve the program in the future. A mixed-method was used: both quantitative and qualitative. The Sa-ad sub-district's primary care cluster (PCC) was a study setting, where the dependent elderly care program is well established and managed by the local council and the community. Quantitative data include: clinical outcomes and cost due to geriatric care provided by the program; cost of the program delivery from provider’s perspective; impacts on social cost from elderly and caregivers’ perspectives. We compared clinical, humanistic and economic outcomes using the data of Nong-Kung sub-district where no program was provided. Qualitative data include: documentary review of the program delivery; stakeholder’s interviews and focus groups to investigate the social impacts of the program; stakeholder interviews to identify recommendations for future development. Findings are as follow: The dependent elderly care program by family care team (the program) Sa-ad sub-district has the dependent elderly care program, which is collaboratively managed by the community hospital and the local council. Sa-ad sub-district has great potential in providing an integrated day care and home care services program. The family care team, composed of a family doctor and other health professionals, provides a home visit to home-bound patients every week. There is a day care center (or called LTOP) located at the community center. Here, a community nurse is acting as a care manager and some trained care givers assisting in elderly care daily service. A Japanese organization, JICA also supports this program. Dependent elderly patients are divided into three groups: social-bound, home-bound, and bedridden. Two options of the care plan are possible: home-care or walk-in center, for each individual depending on the patient’s conditions. Moreover, the community involves running this service by raising funding to advocate the elderly and dependent people to get jobs and thus earn money. Program outcomes Outcomes of the dependent elderly care program were evaluated by three methods: first, comparing clinical outcomes of elderly living in Sa-ad sub-district – the program group and Nong-Kung sub-district – the comparison group. The pre-program data collection time was during May 1, 2016 – July 31, 2017, and the post-program was during August 1, 2017 – October 31, 2018. The comparison within the program group shows a significant improvement in increasing Barthel ADL from 6.78±3.20 to 10.68±6.08 (p<0.01), indicating the program can promote elderly independence. No difference was observed in clinical outcomes, quality of life, and healthcare cost, compared between the program and the control groups. The multivariate regression analysis reiterates no difference between groups. Being in aging health conditions similarly affects the elderly themselves and their care givers in a low to moderate level. Social return on investment of the program The social return on investment (SROI) analysis was performed for a one-year time frame. The dependent elderly care program impacted multiple stakeholders such as older people, care givers, staff, community residents, relevant organizations, and society. However, changes in health and independent status were the program highlight. The monetary value impacted by this program was 15,853,919 Baht, proposed by 37 patients. The program was invested by 2,138,704 Baht. Therefore, the program's SROI ratio equates to 7.4 which means every one Baht of program investment can return 7.4 Baht to society. In sensitivity analysis, SROI ratios ranged between 2.9 and 20.5. Willingness-to-Participation and Willingness-to-Pay for the program General population survey revealed proportion of willingness to participation in the program (92.06%), willingness to pay for the program (91.35%) and average wiliness to pay for one service at 443.12 ± 427.416 Baht (median 300 Baht). From this willingness to participation and willingness to pay information, there would be pooling money to the LTC fund around 3 million bath per sub-district. Opinions and recommendations to the program development Opinions toward the dependent elderly care program were drawn from various stakeholders; patients, care providers, the general public, relevant organizations, and stakeholders. All had prioritized the importance of elderly health, mainly the bedridden group. The program set up in the Sa-ad sub-district has been seen as the best model and should be shared with other localities. However, several points have been raised that still needs further work: 1. Long term support to the day care center and care givers should be discussed. 2. Local authorities or other relevant organization should guarantee that appropriate welfare and safety during work hours are provided for care givers. 3. Financials and other resources should be sought to support this program. In conclusion, this study indicates that the dependent elderly care program directly impacts the elderly and care givers, which is valuable to society. The program has 7.4 times the return to the investment. Therefore, it should be supported continuously and expanded to other areas.


Although the Thai Government shows a clear intention towards improving the health care of migrant workers and dependants, healthcare measures for urban refugees and asylum seekers (URAS) have not materialised. At present, approximately 5,000 URASs live in Greater Bangkok. The main authority responsible for the registration and the screening of URASs is the Office of the United Nations High Commissioner for Refugees (UNHCR). The objectives of this study are to: (i) review policies related to the health care and well-being of URASs; (ii) analyse views of stakeholders related to the health care and well-being of URASs in Thailand; and (iii) explore the health status and health access of URASs through the perspective of unmet need for health services. This study employed both qualitative and quantitative methods. Data collection comprised a review of academic documents from both domestic and international sources, multi-lateral agreements or international covenants, and domestic laws related to human rights and health of URASs; in-depth interviews with 30 stakeholders and 7 URASs; a Delphi survey among 13 experts and key informants; and a primary survey on unmet need among 181 URASs. Data from the unmet-need survey were collated with data from the previous Health and Welfare Survey (HWS) in 2019 with 2,941 Thai participants. The findings revealed that academic literature concerning the health care of URASs in Thailand was extremetly sparse, relative to the same kind of literature on refugees in other settings. In terms of international covenants, Thailand is not yet a party of the 1951 Refugee Convention. However, the Thai Government always allows UNHCR to implement screening measures and take action for the well-being of URASs in Thai territory. Recently in 2019, the Government endorsed the ‘Regulation of the Office of the Prime Minister: Screening process for aliens entering the Kingdom of Thailand and incapable of returning to their home country’. However, there has not been any tangible change of healthcare policies for URASs after this Regulation was promulgated. The interviews and Delphi-survey suggested that the ideology of national security and international relations influenced the concept of human rights for URASs. The ambiguity of the policy direction from central authorities to take care of URASs causes varying legal interpretations and incoherence of practice among frontline officers regarding the care for URASs. Nevertheless, the majority of the key informants agreed that URASs should be granted the right to work in the country lawfully and should be able to acquire health insurance. The quantitative survey on unmet need for health services demonstrated that the prevalence of unmet need in URASs was significantly greater than in Thais. Factors that were significantly associated with greater odds of unmet need were increasing age, below-bachelor educational background, and the lack of health insurance. Being uninsured tended to yield the largest degree of association with unmet need in both outpatient and inpatient care. URASs from Arab countries were found to face a greater degree of unmet need, compared with URASs from other nations. Policy recommendations include the following proposals. Firstly, as grantingURASs rights to work lawfully in Thailand is the most agreeable issue in the perspective of many stakeholders involved in this study and there exists legal mechanisms to push this agenda forward (for instance, Article 17 of the 1979 Immigration Act and Article 63 of the 2017 Royal Ordinance Concerning the Management of Employment of Foreign Workers), the Ministry of Labour should work closely with relevant authorities to advocate a Cabinet Resolution to permit URASs to acquire a work permit. Such a proposal will not only increase the stock of labour to boost the Thai economy, but also reduce the financial burden of the state that is used to take care of this population. Secondly, theThai Government should demonstrate a clear strategic direction to ensure the wellbeing of URASs in all related areas, especially health, education, and employment. The clear policy direction of the Government will translate into concrete actions at the operational level in respective agencies. Thirdly, though at present URASs are still uninsured, the Ministry of Public Health (MOPH) should launch a clear policy message to guarantee URASs the right to enjoy basic healthcare for diseases that may cause public health threats and the related right to acquire necessary health promotion and disease prevention services without excessive personal expense burdens. Fourthly, as the MOPH has already introduced health insurance for non-Thais who are not yet covered by the Social Security Scheme (SSS), the MOPH should ratify rights to access this insurance scheme for URASs as well. The MOPH should officially issue a letter to notify all affiliated facilities about this right. In terms of insurance management, the MOPH should consult with UNHCR and relevant agencies to come up with solutions that are acceptable for all parties. The consultative points should include who should pay for the insurance and mechanism to ensure that all URASs will be enrolled in the insurance, not just the unhealthy ones. Fifthly all authorities in the health sector, particularly the MOPH and the National Health Security Office (NHSO), should actively take part in the screening process of URASs as specified by the 2019 Regulation of the Office of the Prime Minister on ‘Screening process for aliens entering the Kingdom of Thailand and incapable of returning to their home country’. Though representatives from the MOPH or the NHSO are not enlisted as the screening committees, the committees may set up sub-committees or working groups to work on specific issues if necessary. Hence, an early discussion with the committees is indispensible. Lastly, to take a clear stance to promote wellbeing of URASs, the Thai Government should consider becoming a party of the 1951 Refugee Convention and withdrawing a reservation to ratify Article 22 of the 1989 Convention on the Rights of the Child. However, additionals studies to gauge benefits, drawbacks, and limitations, should be conducted if the Government decides to ratify these agreements. This would complement the progress og the abovementioned recommendationsand help demonstrate a long-term commitment to the wellbeing of URAS.


Mobile application development for aging society during health services; A case of the urban community surround Sirinthorn Hospital, Bangkok is studied from the study of health situations, aging society and travel problems for health services; A case of the urban community surround Sirinthorn Hospital, Bangkok. They are related to the environment and problems from the deterioration of the body with age and disease by age as making the older person need to receive health services for the older person to have a good quality of life. There are factors related to the service system of the hospital which access to nursing homes public transport and personal vehicles of the older person themselves Including technology to promote travel. The objective of mobile application development for aging society during health services; A case of the urban community surround Sirinthorn Hospital, Bangkok are to develop applications on mobile phones Promote health service travel skills for the older person in urban communities and to assess the effectiveness and efficiency of mobile applications for travel, health services for the older person in urban communities. Methods of conducting the study were quantitative and qualitative research processes. Which is divided into 3 steps which are; Step 1 Design tools, applications and interviews 4 professionals in the production of media applications on communication devices. Step 2 Develop and evaluate application tools by 5 experts in content and technical production Step 3 Develop and evaluate applications for testing and evaluation by selecting older person volunteers from the phase 1 research as develop and evaluate instruments, test and evaluate application tools. By traveling from home to Sirindhorn Hospital, 30 samples. The results of the research on the development of mobile applications to promote health service travel for the older person in urban communities can be concluded that; 1. Factors Related to Getting to Health Services The travel patterns of the older person include 1) The older person group can walk easily 2) The older person group on a wheelchair 3) The older person group sleeps on the bed It is a key factor in mobile application design and development to promote health service travel skills for the older person in urban communities. 2. The convenience of data transmission in the application on the mobile phone. It is a key component used to assess the effectiveness and efficiency of mobile applications to travel to receive health services for the older person in urban communities Mobile application design and development are a factor supporting traveling with ease and quality. Especially map analysis in the information system for convenient travel save traveling time and able to communicate preliminary health information of the older person to the destination sanatorium, prepare the area management which health services that are most suitable for the needs of the older person group.


The incident that the National Health Security Office (NHSO) terminated primary care contracts with the private clinics, so called “Ob-Oon” community clinics, around the end of the fiscal year B.E.2563 as a result of suspected frauds raises a key question if there is any system solutions to correct and prevent a similar incident in the future. This report, therefore, aims to analyze how Ob-Oon community clinics are managed under the NHSO system and propose options for future management. Mixed qualitative research methods over the period of two months were applied, including literature and document reviews and a modified focus-group discussion organization by the Health Systems Research Institute. It is found that participation of the private sector in providing healthcare under the universal coverage scheme (UCS) has been there and developing almost since the beginning of the scheme. Having Ob-Oon community clinics contributed to increasing healthcare access in the Bangkok area. However, other areas of performance, including quality of care and satisfaction, were not as impressive. In addition, there lacked continuous systematic monitoring and evaluation of the private-sector participation, resulting in shorting of information needed for thorough investigation of advantages and disadvantages of the roles of the clinics as key primary care providers in the Bangkok area. There are three possible system management solutions proposed by the study: Solution # 1: Cancel all private sector participation in the UCS as Ob-Oon community clinics; Solution #2: Allow private Ob-Oon community clinics to become full-scale main primary-care providers; Solution #3: Only permit private Ob-Oon community clinics to be network primary-care providers, given the “free-provider choice” policy In considering preferred solutions, the following set of criteria were used: (1) Support for achievement of the balancing and competing goals of universal health coverage, including accessibility of primary care, cost containment and resource efficiency, quality improvement of healthcare and services, and choice; (2) Execution possibility, based on availability of primary care providers, financial and service network management, Information technology, governance and civic participation, and support for future learning and service innovation. Based on the criteria, the most preferred solution is the combination of Solution #2 and Solution #3 as shown in detail in Table 6.4. Nevertheless, there are certain actions that need to be done regardless of which of the solutions for primary care in the Bangkok area is selected. These include the use of the information technology system to enhance capabilities in service arrangement and management, Utilization review by NHSO, Regional 13 Bangkok office, development of the indicator system for key primary care performance along with health management for information system that allow feedbacks to providers and area managers for performance review and improvement, area-based knowledge management to support the development of primary-care service network, review and design for area-based collaborative management platform for planning and improvement of health services and patient referral to ensure quality primary care for all regardless of their registered providers, review and improvement of provider costing and payments based on service requirements and service targets including value-base healthcare programs, urgent review and planning to enhance capabilities of referral centers in Bangkok, and effective implementation of monitoring and evaluation of progress and accomplishment of all operational plan.


Scedosporium spp. are human pathogenic fungi causing infections among non-Aspergillus spp. especially in immunocompetent and immunocompromised individuals. Moreover, these pathogenic fungi are highly resistant to standard antifungal drugs whereas effective drugs are highly expensive and give several side effects. Co-treatment drugs have begun to be developed to increase the effectiveness of treatment against Scedosporium infections. One of them is the quorum sensing molecules (QSMs). These QSMs are produced from fungi and play a role in reducing the growth of fungi, especially in the drug resistance group. One of the substances that are increasingly being studied for their role in fungi is Tryptophol (TOH). This research aimed to investigate the role of TOH in the inhibition of fungal infections that were common in Thailand including Scedosporium apiospermum, S. boydii, S aurantiacum, and Lomentospora prolificans. Our study revealed that TOH exhibits an MFC of 8 mM, which is able to stimulate THP-1(Macrophage) and Jurkat cells (T cells) at different time point, 3 and 6 hours post treated respectively. The up regulated cytokines after co-culture with TOH including M1 cytokine , which play a role in the elimination of microorganisms as IL-6 (2, 2.2 folds). T-helper cells cytokines such as คือ IL-17 (4.2, 1.9 folds) and IL-23 (3.8, 2.1 folds), as well as the specific eumycetoma IL-1β (1.7, 2.7 folds), IL-12(3.2, 3.2 folds), IL-37(3.0, 2.6 folds), and IL-35(2.7, 1.9 folds), but not induce apoptosis in both fibroblasts and macrophages. Instead, TOH induced fungal apoptosis as determined using Ethidium bromide/Acridine orange, which corresponded to a 2.2-fold decrease in CARD-9 and a 2.6-fold increase in BCL-2 expressions. After obtaining the laboratory results, our research team began a series of experiments to develop a prototype of neutropenic mouse model of eumycetoma. To produce neutropenic mice, injection of cyclophosphamide at 150 mg/kg were administered. Then, eumycetoma formation was observed in day 3 after intradermal injecting 1x106conidia of Scedosporium spp. at the back of neutropenic mouse. Moreover, our team also developed a prototype emulsion-gel product containing TOH and tested the effectiveness against Scedosporium spp. infection. Our study revealed that the tumor size was reduced after treating with TOH emulsion-gel in infected mice. Moreover, we also expanded our study using an invertebrate in vivo model of Caenorhabditis elegans. Our preliminary results revealed that life span virulence tests and the efficacy of TOH against all four Scedosporium spp. infections exhibited similar promising results to neutropenic mouse model of eumycetoma, suggesting that C. elegans can be used as a powerful alternative model for researchers in microbiology, pathology, and pharmacology in the future.


Thailand’s education strategy focuses on developing all Thai children to have skills in the 21st century, including children in areas at risk due to the effects of heavy metal industries. A study in 2016 found the incidence of non-organic arsenic in children’s urine to be 36.1%. Heavy metals such as arsenic are toxic substances with effects causing intellectual impairment, which led to the objective of this study to monitor the situation of intellectual, cognitive and learning impairments among children in addition to studying familial and social factors related to the aforementioned impairments in order to lead to rehabilitation of children’s intellectual and learning impairments with teacher participation in addition to raising awareness and knowledge about self-protection from toxins among children in Grade 4-6 from 6 schools which were originally located in risk areas with heavy metal industries of Pichit, Phitsanulok and Phetchaboon.
The findings revealed the children’s family characteristics to be medium-sized families with parents not living with children in the village because the parents worked outside the village (82.60%). Most of the children were raised by grandparents (38.70%) and most of the parents had primary education levels. The families were in poverty with a mean monthly income of 5,000 – 10,000 baht (49.60%). In the area of media use, the children played with mobile phones for more than 1 hour per day (67.10%). When the children were happy, sad or had problems with learning, friends or teachers, the children were found to neither reveal nor consult parents (34.30%). Furthermore, the parents (45.80%) responded that the environments of homes and communities included the use of chemicals, toxins or heavy metals. From health examinations of 199 children, the incidence of contact with non-organic arsenic in the urine was found to be higher than usual (4.5%), a reduction by nearly 12 times in boys and girls of every class and school when compared to a previous survey in 2016. Furthermore, incidence of contact with manganese in blood was higher than normal criteria (41.2%). Cyanide was not found in the sample’s blood and no association was found between contact with non-organic arsenic, manganese and intellectual, cognitive and learning impairments (P-value > 0.05). According to assessment of cognitive and learning skills in 212 students, students were found to have learning impairments in 4 areas, namely reading, spelling, sentence comprehension and mathematic calculations. The sample had learning impairments in one or more areas (81.60%). Of 126 children with normal intelligence quotients (IQ) (IQ > 90), 28 children were found to have learning impairments (22.22%) in 4 areas, namely reading, spelling, sentence comprehension and mathematical calculations (50.0%). Survey results in 2016 found learning impairments at a rate of 38.9%, which was higher than in 2019. When the results following rehabilitation among children with learning impairments were compared before and after rehabilitation, the children who had rehabilitated were found to have higher reading, spelling, sentence comprehension and mathematical calculation skills with statistical significance. In the area of intelligence assessment, the children were found to have normal intelligence (average criteria) (59.4%) and lower intelligence than normal criteria (40.6%). After the rehabilitation of 106 students, students were found to have a mean score of 85.43 for intelligence before rehabilitation, which was below average. After rehabilitation, however, the children were found to have higher mean scores for intelligence with statistical significance. According to assessments of executive function behaviors and skills among children by teachers, the children were found to be in need of promotion (68.2%). From rehabilitation, the executive function skills of more children were found to be normal in the areas of accurate memory, concentration and speed of response in tasks. Results from the assessment of visual-motor perception showed the sample to meet criteria (58.49%) with some of the sample having results lower than criteria (41.51%). When results were compared before and after rehabilitation, no differences were found. Furthermore, in asking the children about knowledge on self-protection from toxins in the environment, most of the children (64.2%) were found to have low knowledge about self-protection from arsenic, manganese and cyanide. After participation in environmental awareness skill promotion activities, most of the sample (41.9%) was found to have higher knowledge on self-protection from toxins at a medium level. After rehabilitation, the sample had significantly different levels of knowledge. Concerning attitude about self-protection from toxins, more of the sample was found to have changed from “Not Sure” to “Agree”. Furthermore, the project disseminated research findings and expanded effects for society on a broad scale with announcements of news, research findings and conclusions of preliminary research findings for 15 government agencies and the societal sector in order to push work at the policy and social levels, which will lead to monitoring, prevention, problem-solving, rehabilitation of intellectual skills and learning in children, thereby giving children awareness about self-care and protection, which will solve problems with sustainability.


Extravasation is a condition of extravasated drug was leaked and potentially damaged the site of infusion. In serious injury cases can cause permanent loss of tissue organ. As a clinical workflow in Thailand, nurses have to define the grading and management of extravasation after intravenous (IV) infiltration. But this procedure also has a limitation by the traditional nurses’ shift schedule, which is make the grading and management of extravasation not continuously by the same person. So, this research project proposes an automated screening of extravasation for surveillance, assessment and monitoring during IV therapy. These included 4 steps: data collection, image labeling, convolution neural network modeling, and application development. Total of 1,084 extravasation images were collected from 5 hospitals: Rajavithi Hospital, Nopparatrajathanee Hospital, Rayong Hospital, Songkhla Hospital, and Thammasat Hospital using our own data collecting application. All images were labeled by three dermatologists by locating the skin lesion and rating the severity of extravasation. If no majority vote of any images, the fourth dermatologist will decide the severity of extravasation. After image labeling, all of image data was used to train a densely connected convolutional neural network (DenseNet-121) model, using five-fold cross validation and transfer learning with data augmentation technique. The results from hold-out testing set have a sensitivity and specificity of 96.30% and 93.90% in normal control images, 80.00% and 88.41 in mild extravasation images, 83.33% and 74.12% in moderate extravasation images, 90.91% and 86.74% in severe extravasation images, and 71.43% and 78.43% in others images, respectively. The results from the model were combined to the final application for surveillance, assessment and monitoring extravasation during IV therapy for providing an ease of extravasation management and increasing the efficiency of clinical workflow to reduce the economic cost spent on patient with extravasation in Thailand.


A series of research projects to develop a model of the information technology system to provide a service of diabetes and hypertension in the primary healthcare system in Thailand has an operational plan for 3 years. In this first year, the study is divided into 2 parts. The first is studying the situation and the need for health information to provide a service for diabetes and hypertension patients/risk groups. Another is developing a model of the information technology system by using standard health information and connecting such information between primary care units and community hospitals in a specific area where there is good data management. The team studied the need for the information on diabetes and hypertension from different groups namely family physicians, patients/risk groups, policy makers and technical officers, and found that they all required the same kind of information including medical records, a display in the form of a time series to reflect and analyze the patients’ behaviors, as well as an effective data transmission system between primary care units and community hospitals which is essential to long-term care and treatment. The team also developed the information technology system model to provide a health service in Kamphaeng Phet Hospital and its primary care units using HL7 FHIR. The program was used to set a standard of data for the users to be able to exchange and access the patients’ information while the patients can also reach their own health records from different places.


Background: Type 2 diabetes metallis (T2DM) is one of the public health problem that burden worldwide including Thailand. Presently, T2DM patients were 4.6 million and health expenditures for T2DM treatment were 35 – 84 billion Baht. SGLT-2 inhibitor was new hypoglycemic drug and clinical studies reported that SGLT-2 inhibitors reduce cardiovascular mortality and cardiovascular events. SGLT-2 inhibitor has not been included in National List of Essential Medicine (NLEM) in Thailand. Economic evaluation studies of SGLT-2 inhibitors showed cost effective of SGLT-2 inhibitor in other countries but there was no study in Thailand. Method: The objectives of this study were to evaluate cost-utility and budget impact analysis of SGLT-2 inhibitors for T2DM treatment in high risk cardiovascular disease patients. Markov model was conducted to estimate costs and health outcomes for life time horizon with 1 year cycle. Parameters were derived from literature reviews, meta-analysis, standard costing guideline and data collections. The results were presented as incremental cost effectiveness ratio (ICER) in Thai Baht per LY or QALY gained as societal perspective. One-way sensitivity and probabilistic sensitivity analyses were performed to investigate effects of model variable uncertainties on the results. Result: The results showed that life year (14.32) and QALYs (11.88) of patients who received SGLT-2 inhibitors were longer than patients who received placebo (life year 13.83 and QALYs 11.46). The ICERs showed that SGLT-2 inhibitors were not cost effective in Thailand at willingness to pay 160,000 Baht per QALY gained. Empagliflozin was most cost-effective compare to Cangliflozin and Dapagliflozin which the ICERs were 259,000, 485,000, 921,000 Baht per QALY respectively. Moreover, SGLT-2 inhibitors group compared to placebo, the ICERs was 475,000 Baht per QALY. Policy recommendation: 1. The price of SGLT-2 inhibitors should reduce to be cost-effective at willingness to pay at 160,000 Baht per QALY gained for 63% reduction. 2. Empagliflozin Cangliflozin and Dapagliflozin were not cost-effective at willingness to pay for 160,000 Baht per QALY gained) but should be negotiated to be costeffective by 38%, 64% and 79% reduction, respectively.


BACKGROUND: Patients with advanced Parkinson’s disease (PD) usually experience motor complications including dyskinesia and on-off fluctuations or off-state, defined as the amount of time spent with poor or absent motor function per waking hours, which substantially impact on the quality of life and cost of treatments. Current treatment guidelines included dopamine agonist or monoamine oxidase B (MAO-B) inhibitors or catechol-o-methyl transferase (COMT) inhibitors as adjunct treatment to Levodopa. The benefit of these treatments could affect to reduce the amount of time spent in off state and physical disabilities. Because of those treatments are still expensive and there was a limited cost-effectiveness study of anti-Parkinson drugs in advanced PD in Thailand, the cost–effective study is an important tool to inform policy decision making. Moreover, the results of this study will be used to support policy makers to determine whether the treatments should be included into the National list of essential medicines (NLEM). OBJECTIVES : The objectives of this analysis were to evaluate cost-utility of continuous subcutaneous apomorphine infusion (Apomorphine) + Levodopa tablet (tab.) and Rasagiline tab. + Levodopa tab. compared with Entacapone tab. + Levodopa tab in advanced PD patients and to estimate budget impact for providing drug treatment in next 5 years. METHODS: Markov model was used to estimate relevant costs and health outcomes using a lifetime horizon from societal and government perspectives. Direct medical and direct nonmedical costs were collected. Health outcomes were life years (LYs) and quality adjusted life years (QALYs). The results were presented as the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per LYs and QALYs. Costs and outcomes were discounted by 3% per year. Oneway and probabilistic sensitivity analyses were performed to investigate effects of model variable uncertainties on the results. RESULTS: Base on societal perspective, Apomorphine + Levodopa could reduce off-time and delay disability which resulted in increasing life years and quality of life compared with Entacapone tab. + Levodopa tab. The ICER value of lifetime treatment was 3,532,143 THB/QALY. In case that dropout rate was 55% and lifetime treatment was assumed, the ICER value was higher than that of providing 5-year treatment (3,426,000 and 2,997,588 THB/QALY, respectively). In those receiving treatment for 4, 3, 2 and 1 years, the ICER were 2,952,609, 2,944,111, 3,280,817 and 4,966,960 THB/QALY, respectively. Moreover, Rasagiline + Levodopa treatment could decrease off-time the same as Entacapone + Levodopa, whereas the cost of Rasagiline was higher than Entacapone (ICER value=1,551,447 THB/QALY). The additional budget required for providing Apomorphine for recent patients (18 cases) and new case (10 cases) was 6.9 million THB per year. Moreover, providing Rasagiline for recent patients (25,322 cases) and new case (595 cases) was 138 million THB per year. CONCLUSIONS: Based on the willingness to pay threshold 160,000 THB/QALY, Apomorphine + Levodopa and Rasagiline + Levodopa would not be cost-effective compared with Entacapone tab. in Advanced PD patients, in recent drug price. However, based on the cost-effective threshold, the price of Apomorphine and Rasagiline should be reduced by 90% and 25%, respectively.


The aims of this study were: First, to review the experience of health insurance management for non-Thai including migrant workers, refugees, stateless and people with citizenship problems. Second, to explore the organization of health insurance and benefit sets for non-Thai living in Thailand. Giving highlights on problems, obstacles, and the direction of future development in both general cases and C188 Case. Third, a synthesis of alternative forms and reforming the public and health insurance systems to cover to those people. Qualitative research has been applied along with documentary survey, in-depth interviews with semi-structured, and focus group to collect and analysis the data. The results indicated that the major problems for health insurance management for non-Thai derived from structural problem, politics and attitude. The structural problem caused by the identifying status inequitably of non-Thai. And the lack of national regulations to unite the status of non-Thai and health insurance legally, leading to the work fragmentation with no “authority” from central coordination to supervise. Besides, the status of non-Thai has been considering at the dimensions of nation state rather than an “individual”. Consequently, there is imbalance between security issues and human rights. This research has suggested 4 alternative policies to create sustainable health coverage for non-Thai citizen as follows: 1) Discontinuing health insurance system provided by Ministry of Public Health. All non-Thai must register to the social security system. 2) Applying both health insurance card and social security system as the parallel system. 3) Proposing inclusively health care law for non-Thai in the form of new public funding. 4) Amending or reinterpreting National Health Security Act B.E.2545 article 5 in order to cover Thai and non-Thai.


This research aims to develop the village health volunteers (VHVs) and community participation for prevention and surveillance of Covid19 infection by using the geographic information system (GIS) to the policy option for promoting the VHV’s role in strengthening community on Covid19 screening. The participatory action research was introduced to study in 2 districts in Nakhon sawan province and divided into 2 phases: 1) A model development for promoting the VHVs and community involvement on prevention and surveillance of the Covid19 by using the GIS and 2) Evaluation the model effectiveness and synthesis the policy options. Samples were community dwellers, VHVs, health personnel in subdistrict health promotion hospital (SDHPC) or primary care unit (PCU), subdistrict health boards (SDHB), provincial health administrators, and academic officers. Tools were questionnaires, interview guidelines, focus group guidelines, and GIS. Data analysis employed content analysis for qualitative data and percent, mean, and standard deviation for quantitative data. The results show that: 1) the model of VHV and community involvement for prevention and surveillance of the Covid19 infection was composed of the method of promoting the VHV and community involvement and the activities of prevention and surveillance the Covid19. 2) The GIS as a tool for prevention and surveillance of the Covid19 infection called “EpiScanCovid19”. It worked on the internet and composed of 2 application: Mini application on a smartphone (for VHV collect data, analyze the individual risk, health education, and situation report) and Web application on the computer (for health personnel or health board review the risk situation and monitor the VHV’s work). 3) the effectiveness showed VHVs perceived the risks, educated their community member, timely report events to SDHPC or PCU, and health personnel frequently monitor the VHV activity. They were satisfied with the application at a good level and over about 85%. The outcomes were early detection of the contact cases and rapid control of the spread. 4) the policy options were promoting the VHV and community involvement for active surveillance by using EpiScanCovid19 application, training for building the data management capacity of health personnel, providing the specific area or local quarantine, and supporting the expenditure of community-based surveillance and disease prevention by using this application especially the internet charge. Community-based surveillance and prevention by using the EpiScanCovid19 application were necessary interventions on waning the Covid19 infection spread. It was a health services and their network challenge for promoting the continuing and suggesting for applications in all areas or especially pandemic area. It is a good opportunity for people if this model is applied for non-communicable diseases or other infectious diseases.


Dengue fever and its severe form, dengue hemorrhagic fever (DHF) and dengue shock syndrome are one of the most important mosquito-borne tropical disease. The severe form of dengue disease was hypothesized to be correlated with high viral titer and secondary infection with heterologous serotypes, so called ADE, that caused mostly by anti-Envelop (E) and anti-premembrane (prM) antibodies. However, anti-non-structural 1 (NS1) antibodies was recently interested as one factor for severe dengue infection because of their cross-reactivity with human molecules such as plasminogen, thrombin and endothelial cells, causing some severe symptoms like vascular leakage. However, anti-NS1 antibody was also proved from several studies for their protective activity in vitro and in vivo. To clearly identify the important role of anti-NS1 human antibody, both for dengue pathogenesis and therapeutic, in this study, twelve anti-dengue NS1 human monoclonal antibodies were characterized. Cross-reactivity of those HuMAbs with human molecules, plasminogen, thrombin, and endothelial cell, were determined. Activation of plasmin formation were also investigated. Their viral replication inhibition activity in human microvascular endothelial cell (HMEC-1) were tested in some HuMAbs, which showed and not showed crossreactivity with human molecules. It was shown that all 12 anti-NS1 HuMAbs were cross-reacted with plasminogen, but not with thrombin. Among them, one HuMAbs could not activated plasminogen to plasmin. Some of them showed cross-reactivity with endothelial cell. Fortunately, it was found that one clones that is unable to activate plasminogen, could inhibit viral replication in vitro. Moreover, from epitope mapping with truncated NS1, all anti-HuMAbs were targeted to 301-352 of dengue NS1 protein. This is the first study described the generation and characterization of full IgG human monoclonal antibody specific to NS1 protein of Dengue virus. After thoroughly characterization, the mechanism how anti-NS1 HuMAbs play a role on dengue pathogenesis can be enlighten. Also, the promising role of anti-NS1 as a therapeutic candidates can be shown.


Thailand has “the National List of Essential Medicines (NLEM)” as an important tool of the drug
system. It is a referenced pharmaceutical benefit package of the public health insurance systems of
accessing to essential medicines. This retrospective review aimed to review access to high-cost essential
medicines through a drug selection process of subcategory E (2) during 2007-2019, to analyze the developments
of drug selection process including stakeholders, and to provide suggestions to stakeholders
further developments of the NLEM process. The results found that the subcategory E (2) process enhanced
access to high-cost essential medicines through the drug selection process developed and designed
specifically for subcategory E (2). The guideline for regulating drug use and the process of determining
the affordability and the budget capacity were included to subcategory E (2) selection process. Despite
stricter control in drug use and reimbursement of subcategory E (2) compared to other subcategories,
many challenges were found. Drug items and indications listed under the subcategory E (2) have been
increased with an annual increase of budget. However, the monitoring and evaluation (M&E) of drug use
in subcategory E (2) were lacking. Therefore, it is important to suggest development of the national M&E
system to be beneficial for policy decision making of access to high-cost essential medicines through the
drug selection process of the NLEM.


Monitoring and evaluation (M&E) is one of crucial functions in the national drug policy. Performance
indicators ensure that priority actions are successfully implemented and produce desirable outcomes.
Performance indicators should have clarity, usefulness, measurability, reliability, and validity as well as
gain acceptance by key stakeholders. It is observed that international M&E frameworks and those existed
in Thailand applied common concepts and gave priority to similar components of drug systems. In Thailand,
the Thai Drug Watch has once developed 7-dimension drug systems indicators, namely governance,
self-reliance, safety, equity, drug quality, accessibility and affordability, and rational use, and analyzed
the situation in 2009. Nonetheless, they have not been routinely monitored ever since. Hence, definitive
and widely agreed indicators are still lacking apart from the Sustainable Development Goal indicator 3.b,
which supports the research and development of vaccines and medicines for the communicable and
non-communicable diseases that primarily affect developing countries and provides access to affordable
essential medicines and vaccines for all. SDG 3.b.3 monitors the proportion of health facilities that have
a core set of relevant essential medicines available and affordable on a sustainable basis. The indicators
developed and prioritized by the World Health Organization have potentials to be adapted to the
Thailand drug system contexts. The National Drug Policy group of the Food and Drug Administration has
institutional responsibility to develop and monitor the drug system performance; for which information
systems play an important supporting role.


The National Health Security Act 2002 provides health coverage to only “Thai citizens”. The new
universal coverage scheme (UCS) in 2002 deprived people with citizenship problem (mainly stateless
minority around 700,000) of the previous coverage under the low income card scheme. In the past five
years, many attempts from stakeholders were carried out to solve this issue. Eventually, the people with
citizenship problem scheme (PCPS) was approved by the cabinet in 2010 to provide essential health care
for people with citizenship problems. The aim of this study was to compare differences in management
of and benefit packages between the PCPS and the UCS in 2020. We applied a descriptive study to review
and analyze related documents as of 1st January 2020. Results indicated that more than 600,000 children
and students of stateless minorities withheld by the cabinet resolution since 2016 were waiting for the
approval of identity to get health benefit. The budget for PCPS did not cover 7 additional items as the
UCS’s budget, including the no-fault compensation to the users and providers of health care. Only three
public hospitals provided health care to the PCPS beneficiaries in Bangkok. In addition, there were 33
different benefits between the PCPS and the UCS. The UCS covered 21 more health interventions and
services than the PCPS. The similar 12 benefit items had different management. Three items in the health
benefit package had different reimbursement rates. The UCS had 9 special management programs more
than the PCPS. Moreover, the PCPS reimbursed 227 items of equipment and prosthesis while the UCS
reimbursed 316. The policy recommendations include increasing the budget for specific service gaps and
items of reimbursable prosthesis and no-fault compensation in health care, increasing provider networks
in Bangkok, and improving management capacity. Further studies on access, efficiency and quality of care
of the PCPS were recommended.


Background: The World Health Organization recommends exclusively breastfeeding (EBF) for the
first 6 months of life. However, infants undergo WHO EBF for 6 months may have an increased risk of
anemia. Evidences regarding anemia associated with EBF are limited in the Northern part of Thailand.
Objective: To investigate the incidence of anemia at 6 months of age among EBF infants and non-EBF
infants, and risk factors of anemia at 6 months of age. Materials and Methods: The retrospective cohort
study was conducted in term-healthy infants at a well-baby clinic, Nakornping Hospital in 2019. Mothers
answered a questionnaire regarding history of breastfeeding. Hematocrit (Hct) level of infants was retrospectively
recorded at birth and 6 months of age. Infants with Hct less than 40% at birth were excluded.
Anemia was defined as Hct less than 33%. Data were analyzed comparing Hct between 2 groups of infants:
the EBF in the first 6 months of age and the non-EBF. Multivariable linear regression and exponential risk
regression were performed to investigate an effect of EBF. Results: Of 259 infants, 137 cases (52.9%) were
male, the overall incidence of anemia was 61 cases (23.6%). Prevalence of 6-month EBF infants was
45.9%. Incidence of anemia in the EBF and non-EBF infants was 24.4 and 22.9%, respectively. When
compared to the non-EBF group, no statistically significant differences were revealed, adjusted RR
0.98(0.61-1.58), p = 0.934. The mean of Hct in EBF and non-EBF infants were 34.18±3.23 and 34.57±3.38,
respectively. There was no statistically significant between mean of Hct of the two groups with adjusted
beta coefficient equals to -0.21(-1.09, 0.66), p = 0.631. Factors predicted anemia in infants at 6 months
of age included maternal age <20 years (adj. OR 3.88, 95%CI 2.68-5.60), >35 years (adj. OR 2.26, 95%CI
1.44-3.53), mothers with HbE positive (adj. OR 3.01, 95%CI 1.62-5.60). Conclusion: Overall incidence of
anemia in infants at 6 months of age was 23.6% classified as a moderate public health problem that
urgent investigation is needed. There was no statistical significance between incidence of anemia in the
EBF and non-EBF infants. EBF for the first 6 months of life does not increase the risk of anemia in healthy
infants compared with non-EBF.


During the COVID-19 pandemic, infants and young children living in poor income families suffered
from food shortage, especially non-breastfed children. The government, civil societies and various organizations
have raised funding and projects calling for the donation of breast-milk substitutes (BMS) in
order to support the affected infants and young children. This article reviewed documents from literature
and news from the Thai media to explore; (1) the situation of infant and young child food shortage in
Thailand, (2) the guidelines on infant and young child feeding during COVID-19 pandemic, focusing on
breastfeeding and formula feeding, (3) the responses from government, and (4) civil society’s contribution
to solve the problem of food shortage. The literature review indicated that breastfeeding was recommended
to all infants and children of COVID-19 positive mothers requiring precautious interventions.
For non-breastfed children from income deficit families, the donation of BMS was urgently needed,
however, the government should plan for long term management on infant and young child feeding
support. This article recommended that relevant stakeholders should closely follow the guidelines for
breastfeeding among COVID-19 positive mothers, draw the lesson learnt from the phenomena of BMS
donation in order to make a better future plan for infant and young child feeding support, and advocate
the promotion, support, and protection of breastfeeding practices in Thailand.


This qualitative study aimed to explore the implementation and key success factors of intermediate
care on patients with stroke, traumatic brain injury, and spinal cord injury according to the Ministry of Public Health’s policy. Seventeen hospitals providing intermediate care to older adults were multi-stage purposively sampled from the MOPH’s provider sampling frame of 897 hospitals covering 4 regions from the north, northeast, central and the south. Key participants comprised 30 executives at the ministry and provinces and 236 intermediate care providers of 17 hospitals. Data were collected by using in-depth interview, group discussion, field study, and were analyzed by content analysis. The findings revealed that: 1. Seventeen hospitals in 8 provinces were categorized based on service activities into 3 groups: 1) the intensive intermediate care provision (6 hospitals), 2) the moderate intermediate care provision (6 hospitals), and 3) the moderate intermediate care with limited evidence on provision (5 hospitals). Constraints were lack of staff’s understanding on policy and practice, specialist staff inadequacy, non-supportive reimbursement system, lack of logistics (budget, space, equipment, medicine and consumable), and inefficient referral and information system, and others. Key success factors of intermediate care were listed: 1) executives with visions, plan, clearly set goal and constant result monitoring, 2) service provider commitment with good teamwork, and 3) service system preparedness, and effective multidisciplinary network. 2. Policy recommendations include clear policy communications cascading with localized flexibility, seamless system integration with adequate health workforce fit with intermediate care demands (which should extend to cover more health problems), high-performance information platform facilitating referral of data among providers and payers, and appropriate and comprehensive payment systems.


Dental caries prevalence was approximately 50% among school-aged children. The permanent
molars had a greater risk of caries than other permanent teeth. The effective measure to prevent caries
on pit and fissure was dental sealant. The objective of this study was to investigate the effectiveness of
three proactive sealant service deliveries implemented in Hat Yai Dental Health Service Network. This
study was a cross-sectional study. The samples consisted of 342 grade 1 students who received the
sealant on 2017 academic year recruited by multistage sampling. The methods were dental examination
for sealant retention and caries on the sealed surfaces and questionnaire survey asking tooth brushing
and eating behaviors. Data were analyzed by using descriptive statistics and logistic regression. The result
showed a 10.1% complete sealant retention rate and a 7.3% caries on seal surfaces after one year. There
was no association between type of service delivery and the sealant retention but the association with
caries on sealed surfaces was found. The probability of getting caries among children who received
dental sealant at sub-district health promoting hospital were 3.7 times (95% CI 1.9-7.3) compared with
hospital clinic and 2.6 times (95% CI 1.4-4.8) compared with mobile dental clinic. Overall, the effectiveness
of the sealant in this study was very low. All three proactive service deliveries had to be improved
to provide the good quality of dental sealant services.


Thailand had implemented the first national steps challenge in 2020 by Ministry of Public Health with the goal to achieve the distance of walking and running at 60 kilometers in 60 days during 1 February to 31 March 2020. The challenge aimed to increase awareness on physical activity at country-wide level. This study aimed to determine the achievement of 60-km goal of Thailand steps challenge season 1. Website-based data of 203,910 records, of participants who sent distance data, was retrieved and analyzed by descriptive parameters and logistic regression. The achievement of accumulative distance of at least 60 km was analyzed by participants’ demographics such as sex, age, body mass index, region, urbanity, and type of participant. The findings revealed that around 46% of participants, who sent distance data, achieved the project goal. Men achieved the goal higher than women. Participants aged 30-59 years, not being obese, living in Bangkok, living in urban areas, and being public health officers, achieved the project goal higher than their counterparts. Being obese, living in rural areas, and being village health volunteers, were less likely to achieve the project goal (adjusted Odds ratio = 0.89, 0.83, 0.43 by multivariate analysis, respectively). The study recommended that the national steps challenge should be continuously implemented by using more strategies to engage participants with different characteristics throughout the project.


This report is part of a research project, funded by Health System Research Institute (HSRI), for developing primary care and end-of-life care performance measuring systems in Thailand, including operational definitions and key components of a patient-centered model of primary care, a framework and a set of key performance indicators (KPIs), guidelines for KPI analyses and identification of opportunities for improvement. The study was conducted during October 2018 to December 2020, using mixed-methods methodology consisting of roundtable events and workshops with key stakeholders, including physicians, nurses and policy makers from the Ministry of Public Health and from the National Health Security Office, twelve rounds of focused-group discussion amongst service users from six participated pilot primary care providers, and a pilot application of the selected KPIs as a part of the value-based payment initiative of the National Health Security Office (NHSO), Region 13 Bangkok. As one of the key study conclusions, primary care is defined a type of health care services that a person, when having queries regarding their health, facing health problems or risks, suffering from illnesses, or in need of continuous follow-up and rehabilitation services refers to as his or her first contact and should pay regular visit to. It also includes any proactive health service which is provided on basis of participation by networks of providers and users. The conceptual framework of primary care performance comprises four groups of performance, which could be subcategorized into 13 key result areas. First, the outcome group comprises three areas, including health outcomes, patient acceptability, and cost. The process group consists of accessibility, effectiveness, continuity, safety, and patient-centeredness. The structural group covers coverage and availability. And, lastly, the other key system performance group includes efficiency, equity and value. The pilot KPIs for primary care include 49 KPIs, which are grouped into eight sets, as follows: (1) processes and outcomes for the healthy group, such as Index of women aged 15-49 who received five antenatal quality care visits, Effectiveness average score of children aged 5 years Immunization completeness by vaccine for each vaccine in the national schedule, Health promotion and disease prevention effectiveness index in adults; (2) processes and outcomes for the risk group, such as Effectiveness average score of health promotion and disease prevention in the elderly; (3) processes and outcomes for the chronic-care group, such as Average point of Diabetes effective care bundle score, Ability to control blood pressure of patients with hypertension, and Inappropriate drugs used index in patient with chronic kidney diseases; (4) processes and outcomes for the dependent groups, such as Average number of days to receive long-term care after screening; (5) processes and outcomes for the end-of-life group, such as Percentage of terminal cancer patients received quality of life assessment at least 10 days in the last 30 days of life; (6) overall primary care services, such as Average primary-care physician service hours per week per 10,000 population (PCPH per 10k pop); (7) patient experience in primary care, such as Patient Acceptability index of primary care services, and Patient-reported accessibility index of primary care services; and (8) Primary care value, which is Primary care value index. The KPI sets were found useful, and mostly feasible to apply in the real setting. However, there were number of problems and obstacles including (1) perception of staffs, (2) consistency between healthcare service systems, service processes and data-recording practices, (3) additional burdens of data collection, (4) many and fragmented databases and needs to link and integrate many databases to get an overview of the personal health care, health service utilization, and KPI results in the given time. In addition, there were needs for simple statistical analyses and presentation of KPI results, guidelines for root-cause analysis and the needs to develop staff competencies on these matters. Nevertheless, the piloted KPI initiative with the NHSO Bangkok-area office demonstrates possibility for implementing KPIs to improve primary care using Value-base healthcare concept. Based on the findings, some key policy recommendations include that the Primary Care System Committee and the Ministry of Public Health should collaborate with other agencies related to primary care development, such as HSRI, NHSO, the Thai Health Promotion Foundation, The Healthcare Accreditation Institute (Public Organization) and primary care providers in (1) using the proposed operational definition, framework, components and perspectives of primary care performance to review and improve policies, related law and regulations, and roadmaps for developing primary care systems to respond to population health needs given changing social contexts, (2) applying the proposed set of KPIs, reviewing and improving details and develop additional KPI as needed, and using at least four selected KPIs for long-term system monitoring—including Average primary-care physician service hours per week per 10,000 population (PCPH per 10k pop), Charlson Comorbidity Index for selected chronic conditions (CCI), Patient Acceptability index of primary care services, and Primary care value index—in order to manage the overall systems, to balance quality of care with resource efficiency, and to reduce disparities between areas, (3) urgently defining health data standards, data file structure and databases, and data-exchange standards to support primary care, (4) developing survey systems and patient experience questionnaires from the proposed prototypes, (5) upgrading management information systems, and (6) improving staff competencies to support data collection, analysis, review and improvement of primary care.