The purpose of this study was to examine effects of “The Preparatory Program” on social and inappropriate
group behavior of children with pervasive developmental disorders (PDDs). Participants comprised
20 children with PPDs, randomized into two groups of 10 children each: one in the experimental
group, and the other in the control group. The Preparatory Program was used as a research instrument,
and t-test, one-way ANOVA and post-hoc methods were utilized for statistical analysis in this study. Results:
1. After participating in the Program, children in the experimental group showed a significant increase
in social behavior (t(9) = 7.060, p < 0.001) and had significantly more social behavior than the ones in
the control group (t(9) = 4.529, p < 0.001).
2. After participating in the Program, children in the experimental group showed a significant weekly
reduction of inappropriate crying behavior and inappropriate walking behavior only between week 1 and
4 with no continuous weekly reduction.


Health problems resulting from environmental issues have recently gained greater public and offficial
attention. One of these health problems is leukemia resulting from benzene exposure. This review article
collectively describes the results of a qualitative research study aimed at introducing policy recommendations
to solve environmental issues leading to health problems among people living near an industrial
zone. Benzene exposure was considered as a surrogate for such environmental issues.


The objectives of the study of “The management of Local (Sub-district) health security
fund in Pichit province 2008” were to explore financing situation, roles of committee in manage
fund, the implementation of diseases prevention and protection, monitoring, controlling and
evaluating system of the fund that relevant to objectives of the fund. The study conducted in 16
pilot local health security funds in Pichit between October 1st and May 31st 2009.
The results found that in the management system factor, sources of fund and collected
income trend to be decrease. The central government subsidy was trend to be increase. The
specific subsidy was slightly decrease meanwhile the others were stable. Proportion of health
financing was trend to be increase. Nevertheless, proportion of subsidy from National Security
Office was tren to be decrease, meanwhile the joining budget from local government and others
communities trend to be more increasing. Buget allocation from Local health security fund, Most
of it allocated to elderly then agegroup equal to and more than 25 years, 6-25 years, handicab, 0-6
years and pregnant weman respectively.
Most of expenditure by activities was paid for health care, health promotion, subsidised
to health facilities, funding management and mangement improving respectively. The commitee’s
opinion on level of performance found that it was in the fair, good and poor level equal to 44.70,
34.85 and 20.45 percent respectively. The differentiation of the perfomances between any local
health security funds found the significantly different at 0.01 (P-value < 0.01)
The differentiation of performances between different working positions found that it
was not sigificantly different. Only one local government that had strategic planning, it was
Tambol Thayium, Saklek district. Most of local plans and projects come from community and
sub-district forum, proposal from health worker and member of local government. There were a
few projects propsed by other sectors and organizations. The less implemented activities were
public communucation, and evaluation.


This project is a study of political process, both at the central and the local levels, in the evolution of the primary health care units from the Ministry of Public Health to the local administrative organizations. The result demonstrates irreconcilable visions on decentralization between the central and the local administrations. The central administration, in this case the Ministry of Public Health, proves reluctant to transfer its authority to the local administration, while the local administration grasps the new opportunities from the public health management. For the local administrative organizations, the health care management can be a valuable means to respond to the citizen’s needs which will significantly lead to secure the votes for the next elections. The health care service, thus, empowers the local administration although it apparently became an interest seeking for some local politicians.
In the process of public health evolution, obstruction and difficulties are found both at the central and the local levels. At the central administration, some difficulties are indicated as follows. (1) Although the decentralization process had been completed by the legal statement and organization structure, policies following the law were not implemented, thus, showing the failure of law enforcement even by the government agencies themselves. (2)  The central administration emphasizes more on the expertise and profession than the decentralization doctrines do. The Ministry of Public Health has long been recognized for its capability to keep the professional standard, therefore, the officers do not see the necessity of decentralization. (3) The decentralization process that is engendered at the central administration gives rise to a deadlock. That is because it is fundamentally impossible for the power holders, particularly at the central administration, to relinquish their power to the others.
	From the 5 case studies at the local administration, the difficulties are evinced as follows. (1) The local administrative organizations lacks of autonomy. (2) The local administrations are facing politicians’ corruption which in return had become liability for decentralization although there are only some cases of corruptions. (3) The local administrative officers and elected officers do not have skill and knowledge in the public health care.

	However, this study discovers the distinguished dynamics at the local administration amid all those difficulties. Firstly, the way the local administrative organizations solve the particular issues at their localities is remarkable as this will lead to innovative governance. Secondly, the electoral politics makes accountability possible since the voters’ satisfaction became the focus of political power. Thirdly, despite some corruption cases, the local administrations are exposed to the challenge from the opponents and the civic groups alike. Eventually, all these dynamics will bring about better service providing by the local administrative organizations in the long term.


Decentralisation is a fundamental of the state policy; it is a one of main scheme that dedicated in the Constitution of the Kingdom of Thailand B.E. 2540. The plan and the process of Decentralisation to local government Act B.E. 2542, was enacted as a sub-constitution law under the Constitution Act. The important principles is a determining the procedures and timing period to transfer power from the central government to the local government organisation (LGOs). The Decentalisation plan is an important and systematic mechanism of successfully the Decentralisation policy. Although later it was announced the new Constitution in the year of 2550 the principle of decentralization is to remain unchanged additionally it is a major reason has been given the decentralised in health care reform occurs.

The concept of decentralisation in health, as shown in the decentralisation plan B.E 2543, it is the first issue states that a public health is a priority, one of which appears in the promotion of quality of life function. The mission identified several public health activities need to be transferred to the LGOs. This is part of the decentralisation of health is an important and concrete result in a major transformation of the Thai health care reform. Data from the study and follow-up operations shows that after promulgation of the decentralisation plan (first edition) in the year 2543 was the decentralisation of health, there is yet no clear and concrete progress as much. Despite there were some public health activities to be transferred to local governments. However, the evaluation was not operating in accordance with the procedures and methods set forth in the Plan. The National Board of Decentralisation-NBD as a national policy organization who’s acted as supervising and monitoring body of the policy are often and call for an operations on the issue of decentralisation in health. As a result, the Ministry of Health-MoPH has a fine way for the decentralisation of health in the year 2549, which important issues arise. The proposed models of transferring the mission to the local government on a variety of forms to suit the availability and circumstances of each area of four types: 1) transfer Split 2) transfer to Network 3. ) establish a public organisation, and 4) establishment of the Service Delivery Unit. In case of split transfer model as a separate unit has offered to transfer facilities in areas under the LGOs at different levels. This is an important turning point was an idea that is proposed to transfer the health centre to the LGOs at the different levels. The decentralization plan in Volume 2, published in the Year 2551 issue of the health centre has to transfer to the LGOs has been clearly defined in the Plan. The Health centre-HC determining the complete the final phase of the plan is that if the end of year 2553 can not proceed to completion, and then transferred to the Provincial Administration Organisation- PAO. The direction of health decentralisation is to focus on health centre transferred to local governments is critical to that time have undergone significant changes. The NBD has approved the transfer of the health center to local governments then in the late of year 2550 has been seriously driven and living an intensely driven political leadership of the senior administrators of the MoPH were successfully completed on issue of the Health Centre transfer to the LGOs. Perfectly targeted transfers by the total number of 35 and has transferred 22 of the Health Centre has completed at the first time and followed for 6 of the later included as a transfer 28 of the Health Center to the LGOs. It is an interesting and has been watching a lot of people involved. Regarding on evaluation found that in the first phase of the transfer of the obstacles in the nature of the connection that many unsettled, however, it was solved by approach manage well on a certain level. Yet the problem is a lack of planning and problem solving in a systematic way is to develop the strength and capabilities of the LGOs staff both the executive and operative level. Including uncertainty and policy advocacy that is not good enough that result of the Health Center from 7 to target the transfer of the first stage had to cancel the transfer with caused both by reason of the transferor and the transferee of the same. In later stage of the Health Centre transfers to local governments scheme has not been driven very strongly and clearly enough, especially in the central policy of the MoPH. Additionally in the local governments administrators that they are no clear in the uncertainty and ensure the sustainability of policies, there are many areas has changed the attitude of willing to transfer to the staff recruit plan by themselves. As well as find a way to produce and develop their own staff which wide affect the overall efficiency and fairness of the health resources allocation and distribution in the countries.
Overall progress on the issue of health decentralisation was beginning to change slowly and has accelerated in the late plan. Although the health decentralisation that occurred in the Thai health system will have been trying to format a variety of models, such as the Local Area Health Broad-LAHB, public organisation hospitals-POH, the Local Health Fund-LHF, etc. With regard to the Health Center under the local governments, this is a form of decentralisation by transferring a separate facility that have received attention and watch over both may have the option of decentralised system for health care appropriate to the context and reality. Due to health services that are specific, and public goods that much affect society. In this study, It is therefore proposed to review and select a form of decentralisation and careful analysis is very comprehensive. It should not be the single blueprint as a model nationwide. This is important topic that should be studied and analysed in terms of actual practice in each model carefully. Alternatively of the area health administration is one of health decentralisation it would be the alternative of interest can be integrated guidelines and form of decentralization in a variety of areas with problems and resource constraints similar. Each form of decentralization has been a body of knowledge and developed a certain level in Thai society. In the beginning, in the process of decentralisation of health, this is an issue that might be a solution that should be analysed and were taken to a form appropriate to the context of each area. The health decentralisation is based on knowledge, evidences and a participation of stakeholders at all levels.


The study on the situation of the existing researches on Thai wisdom and traditional
health care is a documentary research. The objective of this research is to study, collect and
synthesize the existing researches about Thai traditional medicine, Thai folk medicine and
alternative medicine from the year 2000 to 2009. The outcome of the research is likely to be used
as fundamental data for developing research problems and making a master plan for researching
on Thai traditional medicine, Thai folk medicine and alternative medicine. In addition, this
research is intended to be used as a reference source for relative studies for both the government
and private organizations. The research collected the abstracts from the researches which were
published in technical journals and the theses from libraries and electronic data base totaling
1,476 Titles. All of them were analyzed, synthesized and grouped into five main topics namely
Thai traditional medicine, folk medicine, alternative medicine, herbal medicine and systematic
researches for developing policies and strategy.
According to the research, during the past decade, among the selected relative researches,
most of them, 53.38 Percent, are researches on herbal medicine. The second most, percent, are
researches on alternative medicine, 17.88 percent. The rest are the researches on folk medicine,
15.98 percent and Thai traditional medicine, 12.73 percent. The researches on Thai traditional
medicine were broken down into six groups namely 1) The study on the history and status of Thai
traditional medicine textbook 2) Theory of Thai traditional medicine/ That traditional medicine
wisdom/Thai medicine 3) Knowledge and efficiency of Thai traditional massage 4) The
traditional medicine services 5) The studies for research and development and 6) Laws and
protection of Thai traditional medical wisdom. The researches on folk medicine were divided into
seven groups namely 1) Knowledge on folk medicine 2) Study on tribal groups’ medicine in
various dimensions 3) Study on medicine textbook and knowledge transfer 4) Study on folk
medical practitioners regarding their roles, existence, knowledge transfer and network groups 5)
Application in health care services 6) Study on folk herbal medicine knowledge, exploration,
preservation and diversity 7) Study on the relation between health care behavior and folk medicine. The researches on alternative medicine were divided into seven groups namely 1)
Definition of alternative medicine 2) Behavior of medical service using 3) Custom behavior of
medical service using 4)Reasons for using and not using 5) Satisfaction on alternative medical
services 6) Behavior factors 7) Situation and existence of alternative medicine. The researches on
herbal medicine were divided into four groups namely 1) Exploration of herbal medicine
knowledge from old books and local wisdom 2) Researches on herbal medicine using behavior 3)
Researches on herbal medicine knowledge management 4) Researches for creating innovations.
The afore-mentioned four main topics of the researches deal with medicine, people, products,
agriculture, food and cosmetics. The systematic researches for developing policies and strategy to
support the implementation of the national strategy to develop Thai wisdom and Thai traditional
health care for the year 2000 to 2009 were divided into five strategic groups namely 1)
Knowledge creation and management 2) Service development 3) Personnel development 4) Thai
traditional medicine and herbal medicine development 5) Protection of Thai traditional medicine
wisdom and herbal medicine.
In conclusion, this research proposed six guidelines for the future researches in support
of the five-fold strategy namely 1) To deal with the emerging problems which discourage
promotion of the acceptance and growth of Thai traditional and health care 2) To focus on the
future goals or dreams 3) To study the first priority matters or problems in order to prevent Thai
wisdom from vanishing 4) To deal with the weak points and lack of knowledge about protecting
the wisdom against legal attempts to steal 5) To do systematic researches on implementation and
application of the existing knowledge 6) To take into account the missing knowledge to drive the
national strategy and charter regarding the national health system. By the way, the proposed
guidelines should comply with the 11th National Economic and Social Development Plan and the
8th National Research Policy for the year 2012 to 2016, to achieve the country’s goal to create
health care self-dependency and the strength of the public health services.


This study reviews the management of national health strategy and policy of three countries: Canada, Australia and South Korea which have the experiences in health development including universal health insurance, health promotion and disease prevention, and risk reduction. These experiences could be examples for Thailand to apply to the management of national health strategy and policy.
	Canada, Australia, and South Korea are in the high-income country group, have progress in economic and social development especially in health development of their populations. These result in life expectancy longer than 80 years and high proportion of old age over 65 year more than 10%. Moreover, these three countries are fully decentralized, the central governments provide directive policies to the state or province or local government. The central governments might provide partial support budget to policy implementation of local governments that support the central policy.   The local governments are responsible for health service provision under the universal health insurance policy.
Canada has established a new organization for management of health strategy and policy with the same level of health ministry called Public Health Agency of Canada in 2004 under Public Health Agency of Canada Act (2006) in which the Chief Officer of this agency reports directly to the Health Minister. This agency provides health policies, health information, and capacity building for organization to sustainable health development in Canada which emphasize health promotion and protection including reduction of health threats.   This agency coordinates networks and stakeholders, enabling health promotion innovations closely collaborated with state or province or local government. However, the universal health insurance under Medicare is managed by the province and local government.
Australia likes Canada fully decentralized and governs by the states and local governments. The health system is fully managed by the states. The Medicare Australia used to be under the Minister of Health and Ageing but recently has been reorganized to be under the Minister of Human Services. Medicare Australia is the main organization that takes care of the Universal Health Insurance Policy in Australia. This policy covers the whole population in which the government pays 75% and the people pay 25% of the health services provided by both public and private facilities. While health promotion has been organized by various agencies both public and private, the central government has established called National Health Promotion Authority directly reported to Australian Health Minister’s Advisory Council in which other sectors such as Agriculture, and Education are included. The central government has put efforts in formulating national health promotion strategies to align the implementations among the central, state and local level in dealing with the three major health risks: obesity, tobacco and alcohol consumptions The national strategies will have a positive impact on the health of the Australian population as the set vision of  “Australia : The Healthiest Country By 2020.”
	South Korea is one of the Asian countries that has established the Social Health Insurance for the whole population within 12 years. It has been recognized by the World Health Organization that Korea health insurance system is the most successful system in which covers 48.7 million in which 97% of the population pay contributions to fund managed by the National Health Insurance Corporation, an independent agency established in 2000, supervised by the Ministry of Health, Welfare, and Family Affairs. This agency is responsible for administrating Health Insurance Fund, utilizing modern information technology for efficiency system management. The lately Korea health system reform focused the system efficiency in term of increase in health promotion investment, combine into single health insurance system, change in method of payment to control the medical care costs, including separation of prescribing and dispensing roles. Furthermore, the health promotion fund was established in 1995 utilizing the tobacco sale tax and health insurance fund.
	From the experiences of these three countries, there are some common crucial factors: the health ministry is responsible for directing policy and strategy while the health services are the role of state, province, and local government in which decentralization is fully developed. Therefore, the high capability of the national health policy and strategy management agency is highly crucial to the success of translation health policy and strategy into implementation.  However, in order to materialize the reorganization of the Bureau of Policy and Strategy to an “Office of Strategy Management (OSM)”, the crucial issues are the capacity of human resources, the recruitment of capable policy analysts and reduction of work not related to policy analysis. If not, it will be only changing the name of the office instead of support effective strategy implementation role of OSM.


Climate change results mostly from the activities of humans whose numbers keep growing. One of
the negative impacts of climate change is global warming. Global warming has deleterious effects on the
environment, ecology, distribution of various diseases and their vectors; this will, in turn, negatively affect
humans. One of those diseases is cholera. The present article reviews the pathogen, its distribution,
epidemiology, and the effects of climate change over distribution of cholera via the following factors:
temperature, ENSO (El NiNo/Southern Oscillation), sea rise level and salinity level, eutrophication phenomenon,
and human activities related to shipping. The authors conclude with recommendations on
research to understand and mitigate the effects of climate change


Global temperatures have risen at a faster rate in the last 50 years than at any other time since
records began to be kept in 1850. The hydrologic cycle will be altered, since warmer air can retain more
moisture than cooler air. Some geographic areas will have more rainfall, some more drought and severe
weather events including heat waves and storms. The term “climate change” is now preferred over
“global warming.” Because of rising temperatures and changing rainfall patterns, increased burdens of
vector-borne and zoonotic diseases as well as water-borne diseases have been recognized. Infections of
dengue, chikungunya, malaria, West Nile virus, Lyme disease, plague, cholera, campylobacter and
salmonella cause emerging and re-emerging diseases. It is clear that climate change endangers human
health and that good systems for surveillance and preparedness are needed


The major aims of the universal health care coverage (UC) policy initiated in Thailand in 2001 are not
only to increase the access of people to essential health services, but also to reduce the financial risk they
face due to out-of-pocket payments for health care. This study employed secondary data analysis of the
Socio-Economic Survey (SES) conducted by the National Statistical Office to estimate the number of households
becoming impoverished because of the payments for health care they had to make before implementation
of the UC policy (1996, 1998, 2000, and 2002) and thereafter (2004, 2006, 2007, and 2008), and to
compare the findings with a counter-factual UC-absent scenario, using segmented linear regression analysis.
At the national, regional, and provincial levels, the proportions of households falling below the poverty
line declined gradually during the study periods. Without the 2002-UC, a total of 100,604 households
nationwide would be impoverished by out-of-pocket payments for health care in 2008. The UC policy in
the same year could reduce the number of health-impoverished households by 37,628 (37.4%), which is
equivalent to 0.2 percent of 19 million households nationwide. The health insurance system design that takes into account both “breadth” (that is, the number of the population covered) and the benefit package’
s “depth” dimensions, provides better financial risk protection and prevents households from falling into
the poverty trap due to the necessity of making costly health expenditures


The organizations concerned with primary care have tried to develop the effectiveness of their service
for all people equally. This research has as its main objectives studying the readiness of networks for
network operations and studying supporting factors and obstacles found in three health centers, namely
Phra Pathom Chedi Community Medical Center, Sanam Chan Sanitarium and Nakhon Pathom Municipality
Health Center. The methodology utilized included semi-structured interview and participatory
observation.
The results of the study revealed that all three centers had different levels of readiness for network
operations. Phra Pathom Chedi Community Medical Center had comparatively the highest degree of
readiness. The second was Sanam Chan Sanitarium whereas Nakhon Pathom Municipality Health Center
did not show readiness. The factors affecting the readiness in network operations were community characteristics,
size, budget administration system, staff working style, executive working style, organization
regulations, knowledge and capability in responsible jobs, executives’ roles in network operations, manpower
allocation, quality assurance and control of network operations, cooperation with other organizations,
and monitoring and evaluation systems. It was also found that the obstacles to networking include
lack of policy for stakeholders’ participation, no information technology for coordination, no performancebased
direction planning, complex organizational structure and line of command, inadequate morale of
staff, insufficient stakeholders in the network, no knowledge management or learning organization practice,
and no effective unit cost management system.


Iodine supplementation is an additional intervention of the Ministry of Public Health that is used to
alleviate iodine deficiency disorder among the Thai population. This survey was aimed at examining the
opinion of obstetricians nationwide regarding vitamin and mineral supplements for pregnant women. It
can be used as input data for formulating national policy on iodine supplementation.
Over 90 percent of obstetricians prescribed folate and iron compared with 25 per cent of those prescribing
iodine. The number of participants who considered that iron deficiency, thalassemia and folate
deficiency comprised a severe or the most severe health problem in their areas of responsibility was 2-4
times greater than those who concerned iodine deficiency to be such a problem. This finding contrasts
with epidemiological data showing that iodine deficiency could be found in most of the places. Potassium
iodide plus folate and iron tablets were the preference of 90 per cent of obstetricians. Thus, we suggest
that the combination of the three minerals should be provided for pregnancies. Iodine only tablet should
be prescribed for thalassemic pregnant women. To effectively implement the administration of iodine
supplement tablets, guidelides are essential for vitamin and mineral supplementation for pregnancies
and good monitoring and evaluation systems are essential.


This study was aimed at comparing the cost-effectiveness of tuberculosis treatment strategies between
community-based DOTS (Directly Observed Therapy, Short Course) and hospital care at Maesai
Hospital, Chiang Rai Province. Data on costs were collected in terms of provider and patient perspectives.
Cost-effectiveness was calculated as the cost per patient successfully treated. The nine-month historical
cohort study from November 1, 2009 to July 31, 2010 was designed to measure outcomes of tuberculosis treatment. By matching new pulmonary tuberculosis patients aged 15 to 60 years, the study included
54 patients from community-based DOTS programs and 52 patients receiving hospital care. The
hospital cases were divided into three groups, i.e. days since admission: 1 to 7; 8 to 14; and more than 14,
totalling 38, 8 and 6 patients, respectively. The provider cost data were collected from medical records
while the patient cost data were collected in face-to-face interviews.
Results showed that the average tuberculosis treatment costs under community-based DOTS Programs
and hospital care were 9,436.84 baht and 13,540.32 baht per patient, respectively. Communitybased
DOTS reduced costs by 30.31 per cent in comparison with hospital care. Sub-group cost analysis of
hospital care of 1 to 7, 8 to 14 and more than 14 days since admission showed costs of 10,051.97, 19,168.63
and 27,969.72 baht per patient, respectively. The clinical success rates of community-based DOTS and
hospital care were 90.74 per cent and 94.23 per cent respectively. The incremental costs of a case successfully
treated in hospital were 1,175.78 baht higher than that of a community-based DOTS program.
The study suggested that community-based DOTS is a more economically attractive option than
hospital care. This is particularly important in settings where a TB clinic is implemented under the
limited resources available to Maesai Hospital.


This research was a survey of the characteristics of ideal women before and during married life from
the perspective of a group of married men. Two hundred twenty-six legally first-time married Bangkokian
men, aged 25-40 years, were surveyed using a 25-item questionnaire on the characteristics of ideal wives
in order to obtain opinions on their spouses before they got married and during their married lives. The
samples were grouped into three categories by the number of years of marriage, i.e., married for <3 years
(n=50), married 3-<5 years (n=90), and married for 5-10 years (n=86). The results were as follows:
1. The characteristics that the men considered ideal and desired their wives to have comprised the
following: honesty and loyalty; showing care for family members; loving mindfulness, with understanding
of her husband; and morality.
2. The characteristics of the ideal wife changed significantly during married life ( p<0.001, p<0.01,
p<0.05):
- Those married for <3 years were concerned less with facial appearance, general appearance,
aging, education status, and unmarried status;
- Those married for 3-5 years were concerned less with appearance, personality, intelligence, and
virginity;
- Those married for more than 5 years showed less concern about facial appearance, personality,
attractiveness, honesty and loyalty, financial prospects, social status, occupation, unmarried status, sexuality,
and virginity.
3. The characteristics considered ideal, which increased after marriage, appeared significantly
(p<0.01, p<0.05) only among those men who had been married for more than 3 years but not more than 5
years. Those characteristics were financial prospects, education, social status, and occupation, all of which related to findings of the SES.
4. The ideal characteristics that the men wanted in their wives, which had not changed from the
time before marriage to that throughout married life and were answered by all groups of married men,
were listed in descending order as follows: (1) care of family members; (2) loving mindfulness and understanding
of the husband; (3) morality; (4) emotional stability; (5) relationship with husband’s family; (6)
self-responsibility; (7) relationship with wife’s family; (8) social manners; and (9) similar hobby or activity
in leisure time. It should be noted that loving mindfulness and understanding of the husband, morality,
emotional stability, relationship with the wife’s family and care of family members were the five most
important ideal characteristics that all men desired in their wives.


In fiscal year 2009, Mae Hong Son Province suffered a severe and large outbreak of dengue hemorrhagic
fever; it has the second high incidence rate in the country for that disease. This study was aimed at
describing epidemiological data of patients at Srisangwan Hospital in Maung district, Mae Hong Son
Province, from January 1 to October 30, 2009. The study also reviewed criteria of diagnosis by physicians, and lag time of patient-access to the hospital and of disease-control in the community by a disease-control
team. Results may reveal the outcomes of diagnoses and lead to improvement of disease-control management.
It was found that complete patient files were available for 502 cases. The incidence rate in the age
groups 11-20 years, 21-30 years and 31-40 years were 1.94, 1.52 and 0.77 per cent, respectively. A high
number of cases occured in June and July. The most affected sub-districts were Jong-kum, Pang-mu, and
Pa-bong. According to the criteria of diagnosis, the study found that 37.65 per cent had no record of
abdominal examination and 32.47 per cent had no record of abnormal bleeding sign or tourniquet examination.
However, a dengue rapid test-kit was used in 59.36 per cent of the cases. In the first visit, cases
were diagnosed as dengue hemorrhagic fever or suspected cases (40.85%), acute febrile illness (36.85%),
and respiratory syndrome (17.13%). The lag time of first visit to the hospital was on average 1.91 days; the
lag time for being diagnosed as a case of dengue hemorrhagic fever or a suspected cose was on average
3.51 days, and disease control in the community was performed within 1.19 days after case notification.
Results showed the age group affected was mostly adult. Criteria for diagnosis by physicians were not
fulfilled to a certain extent; on the other hand, more rapid test-kits were used instead in a large proportion
of the cases. Therefore, indications to use the kits should be scrutinized and training courses should be set
up regularly. Though disease control was implemented shortly after notification, the number of cases still
increased continuously. Therefore, the efficiency and management of the disease control team should be
reviewed.


Thailand achieved universal health insurance coverage for the entire Thai population in 2002. However,
the health insurance system does not cover all people who live in the country because the National
Health Security Act 2002 indicates only “Thai citizenship” for eligibility under the scheme. This has made
it impossible for people with citizenship problems to get basic health care. It also caused financial problems
for health care providers that have to provide essential care for the people and disease control in
many areas.
For five years (four health ministers), there were many attempts to push forward the provision of
basic health care for people with citizenship problems. This policy was complicated, and concerned with national security. The lack of understanding of the institution concerned and the society at large are the
main obstructions. In 2010, the National Health Security Office (NHSO) employed the Moving Mountains
Triangle Theory which comprises three strategies: (1) knowledge generation; (2) social movement;
and (3) political engagement to push forward the policy. On March 23, 2010, the Cabinet approved this
policy and assigned the Ministry of Public Health (MoPH) to operate the scheme instead of NHSO.
Although the policy has been approved, some important issues need to be considered. For instance,
how well can MoPH manage when supporting systems are lacking? The budgets may not be enough
because the capitation budget was calculated by sharing risks with a population of 47 million under the
universal coverage (UC) scheme. The benefit packages also may not equal those under the UC scheme.
Thus, these aspects are challenging issues for everyone who works on this project.


Objective: The purpose of this study was to review the efficacy and cost-effectiveness of Glucosamine.
Method: A review of meta-analysis, randomized controlled trial with at least 12-month follow-up
in patients and cost-effectiveness analysis of Glucosamine between 2005-2010 was undertaken. The review
did not consider old studies because there was evidence suggesting publication bias.
Results: Compared with placebo Glucosamine was no more effective than placebo (statistical nondifference)
in people with osteoarthritis on WOMAC pain and WOMAC function, RMDQ and EQ-5D
scores also showed no or small effect on narrowing the joint space width. Both generic and innovative
Glucosamine had ICER greater than one time Thai GDP per capita.
Conclusion: Available evidence suggests that Glucosamine has low effect, therefore low cost-effectiveness.
Up until now it is still a controversial issue among prescribers and health insurers, especially the
in the Civil Servant Medical Benefit Scheme that whether it should be included the cost of treatment in
public health insurance system.


Dramatically increasing in the cost of OPD drug reimbursement under the CSMBS resulting in policies
to control and reduce the cost. The cabinet mandated Comptroller General’s Department (CGP) to
manage such policies into practice. A technical taskforce was appointed and assigned to study and propose
policy recommendations. Based on a key study by the technical taskforce, medical benefit and
pharmacoeconomic aspects of Glucosamine HCL (GS) are not well established. Thus, it was recommended
to remove GS from the list of reimbursement. This resulted in the CGP regulation announced on January 1, 2011. Affected patients and other stakeholders fight against the regulation. Conflicts and arguments
were presented in newspapers continuously for 6 months. The analysis of news coverage using 62 news
clippings compared the achievement of policy advocate and the opposition in using media to affect policy.
It clarified that the advocate seemed to be more successful in output from media both in size and PR value
of news but the outcome return to be different. Resulted from sender, message and channel strategies and
variety of alliance, the opposition successfully blocked the regulation. This article suggests on future advocacy
and media strategies for CSMBS reform processes.


Over two decades, the expenditure for Civil Servant Medical Benefit Scheme (CSMBS) which employed
the open-ended provider payment methods has a continual double-digit annual growth. In recent
years, the outpatient expenditure outpaced the inpatient one. An analysis of prescriptions and expenditures
of the outpatient drugs of 26 out of 34 large public hospitals under the direct billing system in 2009
revealed that on average 41% of total prescriptions and 67% of expenditure belonged to those not covered
by the current National Lists of Essential Medicines. The highest proportion of the non-essential (NE)
drug prescriptions occurred in university hospitals (45%), whereas the NE proportion in the Ministry of
Public Health hospitals and other ministries was relatively lower (35% and 42%, respectively). However,
the NE share of drug expenditure was similar across the three hospital types (66-68%). The top six therapeutic
classes of drugs, sharing 41% of total drug expenditure, were antilipids, anticancers, antiosteoarthritis
(nonsteroidal anti-inflammatory drugs -NSAID, COX-2 inhibitors and symptomatic slow-acting drugs
for osteoarthritis -SYSADOA), antiosteoporosis, angiotensin converting enzyme inhibitors (ACEI) and
antigiotensin-2 receptor blockers (ARB), and antisecretory/antiulcers (histamine-2 receptor antagonists -
H2RA and proton pump inhibitors -PPI). The NE drugs accounted for 86.4% of the expenditure for antilipids,
87.8% for ACEI-ARB, 93.6% for antiulcers and 97.2% for antiosteoarthritis. With respect to market status,
the single-source products accounted for 92.3, 86.0, 65.0, and 44.0% of the expenditure for antiulcers,
antilipids, ACEI-ARB, and antiosteoarthritis, respectively. A case study of university hospital with relatively
low use of NE drugs revealed that leadership of the hospital administrator and the Pharmacy and
Therapeutic committee is a key to success of cost containment that can counteract threats from market
strategies of drug industry and misunderstanding of prescribers toward the use of the NE drugs. It was
recommended the central administration of CSMBS should give priority to cost-containment policies including
reference pricing systems for drug reimbursement, monitoring and evaluation using prescriberspecific
drug utilization data. In addition, appropriate financial incentive for well-performed hospitals,
capacity building for hospital personnel in data analysis and platforms for knowledge sharing should be
introduced.


The medical expenditure for outpatients under the Civil Servant Medical Benefit Scheme’s direct
billing system continued to be very high in 2009-2010 due to the use of drugs outside the National Lists of
Essential Medicines. This study estimated potential cost-savings using the aggregate drug utilization data
from 28 large public hospitals under two scenarios of reimbursement: 1) the lowest price of generic in each
drug group, and 2) median price of each drug. If the reimbursement rate was set most restrictively based
on the minimum price of the essential drug with an equivalent Anatomical, Therapeutic, and Chemical
(ATC) code 1-3 (eg. the lowest price of simvastatin for antilipids), the expenditure for antilipids,
antiosteoarthritis (non-steroidal anti-inflammatory drug (NSAID), cyclo-oxygenase (COX-2) inhibitor, and
symptomatic slow-acting drugs for osteoarthritis (SYSADOA)), and antisecretory/antiulcers (histamine-
2 receptor antagonist (H-2RA) and proton pump inhibitor (PPI)) in 2010 would be reduced by 72.8, 85.7,
and 86.5%, respectively. If each individual hospital was allowed the drug reimbursement as is but no
higher than a ceiling determined as the median of price per prescription for the drug with the equivalent
ATC 1-5, the expenditure for antilipids and antiosteoarthritis would be reduced by 13.4 and 13.3%, respectively.
For 20 drug groups with relatively high expenditure, the reimbursement ceiling could reduce the
expenditure by 14.0%. The least restrictive reimbursement condition using a fixed rate referent to the
median price of drugs with equivalent ATC 1-5 from all hospitals could reduce the expenditure for the 20
drug groups by 2.9%. Therefore, to contain expenditure using a fixed rate of reference price based on
drugs with an equivalent ATC 1-5 would be the least restrictive policy option.


Therapeutic drugs, a major component of outpatient care have made the utilization pattern in the
Civil Servant Medical Benefit Scheme (CSMBS) different from the Universal Health Coverage Scheme
(UCS). This study analyzed a time-series of 57 months during 2003-2007 for drug prescriptions in 6 Regional
Hospitals and General Hospitals and forecast the overall expenditure. Four therapeutic classes
with high expenditure or frequent use, including angiotensin-converting enzyme inhibitors (ACEI) and
angiotensin-2 receptor blockers (ARB); antilipids; proton pump inhibitors (PPI) and histamine-2 receptor
antagonists (H2RA); and non-steroidal anti-inflammatory drugs (NSAID) plus COX-2 inhibitor were analyzed
with respect to two expenditure components; (1) propensity to use the target drugs, which are not
covered by the National Lists of Essential Medicines or are the single-source products, and (2) the utilization
quantity. Results from the expenditure forecast before and after the CSMBS’ direct billing policy and
the UCS’ 30-Baht copay abolition policy using a segmented regression analysis revealed that the use of the
following target drugs, including ARB, non-essential antilipids, single-source PPI and COX-2 inhibitor
was associated with the total and expenditures growth of the four classes. The close-end method of provider
payment currently employed by the UCS, if applied to the CSMBS would be able to reduce 40
percent of the expenditures for PPI-H2RA and NSAID-COX-2 inhibitor to 100 percent of the expenditure
for antilipids. For the substitution measure, the degree of cost-saving would depend largely on the policy
compliance levels. With the 20 percent compliance, 8 percent of the expenditures for PPI-H2RA and NSAIDCOX-
2 inhibitor and 20 percent for antilipids could be saved. With the 80 percent compliance, the costsaving
would range from 30 percent to 80 percent.


Antibiotic prescribing for acute diarrhea was common among prescribers although most for acute
diarrhea conditions were not caused by bacterial infection. The purpose of this study was to investigate
antibiotics prescribing for acute diarrhea in the outpatient department in Pua Crown Prince Hospital,
Nan province. Medical record of the targeted patients during 1 January to 31 December 2009 were evaluated
regarding antibiotic prescribing. Criteria for antibiotic prescribing for acute diarrhea included having
fever (38o C or above) and mucous or bloody stool or stool exam with red blood cell and/or white
blood cell. Result showed that of a total of 613 patients with acute diarrhea, 406 patients (66.23%) were
prescribed antibiotics. For patient who received antibiotics, 90.40% were identified as irrational antibiotics
prescribing. This data showed that clinical practice guideline was important data to make good decision
to start antibiotics in patient with acute diarrhea.


The high-risk medications used in the elderly is a pressing problem that is a concern in many countries
around the world. However, in Thailand there is still lack of studies related to this issue. Therefore,this study was aimed at surveying the high-risk medications used in the elderly at Wang Taku Subdistrict,
Nakhon Pathom based on the criteria for high-risk medications used in the elderly of Winit-Watjana W. et
al. The data of this cross-sectional study were collected by surveying and interviewing the elderly. Of 118
elderly, 72.9 % were female. Average age was 72.63 ± 5.25 years. Most medical problems found were
hypertension, (76.3%). Of 421 drug items, 92 items were high risk medication use or 0.78 item per patient.
The findings revealed 79 drug items with potentials to cause adverse reactions; 11 drug items with drugdisease
interactions and 2 drug items with drug-drug interaction. After analyzing each subgroup, angiotensin
converting enzyme inhibitors (out of 34 drug items) was mostly found in causing adverse reaction
and non-steroidal anti-inflammatory drugs (16 drug items) were subsequently found. In drug-disease
interaction subgroup, hypertension/heart disease (9 items) were found to be the most, and the other 2
items were gout-hydrochlorothiazide (HCTZ) and asthma/ COPD-benzodiazepine. The last subgroup,
drug-drug interaction, aspirin with NSAIDs and digoxin with HCTZ were found. Results of this study
can be used to develop a guideline for advising and monitoring high-risk drug use.


Background: This study focuses on an evaluation of the universal health care coverage among low
income groups by using four selected characteristics of good governance: equity, efficiency and effectiveness,
participation and transparency.
Methods: The interviews with policy makers and patient representatives were conducted. The purposive
sampling was used to select interviewees. The data was analyzed by a template analysis style, as
the templates are the four selected characteristics of good governance.
Results: After the introduction of universal health care coverage in Thailand, the Thai health care
system has improved. First, equity in Thai health care system is largely improved, which can be seen by
improvement of the accessibility to health services among low income groups. Second, the efficiency of
health care systems has enhanced. Third, people have better opportunity to participate in decision making
process of the health care systems. Fourth, the transparency of health care systems is improved due to
the shift of power to allocate health fund from the Ministry of Public Health to the National Health Security
Office.
Discussion: Despites the improvements in the health care systems, there are still several challenges
that the Thai health care system is facing. For example, the geographical barriers prevent low income
groups from accessing care for chronic conditions, this result showed insufficient allocation of resources
in health care systems. Another challenge for the Thai health care system is a shortage of medical professionals.
Conclusion: the universal health care coverage has improved the accessibility of health care services
among low income groups, efficiency of health care systems and participation of people in decision
making. However, the challenges are still occurring, for example, insufficient of human resources and
geographical barriers.


Since the section 41 of the National Health Security Act B.E.2545 has been enforced, requests for the
preliminary financial assistance under section 41 were increasing every year, but the civil litigation rate is
undetermined. The main purposes of this descriptive research are to examine the relationship between
preliminary assistance and the rate of civil litigation and to study preventable damage from medical errors.
The author retrospectively reviewed all documents related to sub-committee meeting to decide the
request for preliminary financial assistance between the year 2004 and 2010 and interviewed the relevant
personals. Data were analyzed with frequency, percentage, and Fisher’s Exact Test. The results showed
that 37 cases were included in the study, 28 cases were eligible for payment of preliminary assistance. Two
cases in Lamphun and 43 cases (0.93%) in Thailand filed a civil lawsuit against the Ministry of Public
Health. The rate of civil litigation in cases who did not receive money compared to those received in
Lamphun were not different (p-value = 1), but different (p-value = 0.031) at the national level. In conclusion,
the payment of preliminary assistance in Lamphun had no effect on civil litigation, but the filing rate
significantly reduced at the national level owing to this measure. Health care providers should review the
service process, which the most common causes were in the communication and the referral system, to
prevent any damage that may occur repeatedly in the future.


The purpose of this study was to examine the abnormality in Body Mass Index(BMI), lipid profile
and evaluate risk for develop coronary heart disease in 10 years by Framingham Risk Score in Health care
and office workers, aged more than 35 years old, in Health Promotion Center, Region 1, Bangkok at annual
health check up 2010. The results of this study indicate overall prevalence of obesity (BMI ≥ 25 kg/
m2) was 35.5, man 45.5% and woman 34.2%. The most common lipid abnormalities were LDL-Cholesterol
(≥ 100 mg/dl) 78.3%, Cholesterol (≥ 200 mg/dl) 55% and Triglyceride (≥150 mg/dl) 22.2%. Risk for develop
of Coronary heart disease in 10 years by Framingham Risk Score, the study group had low risk
98.4% and no one was in high risk group.


In the past decade, Diabetes Mellitus tends to become more and more important problem in Thailand.
Nowadays, research results clearly indicate that behavioral change strategies can decrease complications
and death among Diabetes patients. Several studies in China, Finland and USA have reported that intensive behavioral modification program focusing on exercise and weight loss certainly decreases the
risk of Diabetes in high risk group by 31-58 percent. Previous related researches in Thailand have found
that giving knowledge alone have led to negative outcome of Diabetes patient care. This research aimed to
test the effectiveness of intensive behavioral modification program for individual at risk of type 2 diabetes.
This Quasi-experimental research is to study effectiveness of intensive behavioral modification model
which focuses on diet and exercise for 24 weeks. Participants who are overweighed person (BMI > 25 kg/
m2) were divided into two groups. Forty-one participants attended the intensive model while 61 participants
received standard care. Effectiveness of the groups was compared at the end of the study. From data
analysis made through changes of both physical and biochemical indicators, there was no significant
difference found between two groups but subgroup analysis in overweight group (BMI > 30 kg/m2)
indicate that the experimental group significantly lost more weight than control group (95%CI= -1.976 - -
0.019, p-value = 0.046). This finding shows that the program is more suitable for overweight person. However,
long term study is still needed.


The purpose of this research was to study the situation and trends of sex crimes in relation to consumption
of alcoholic beverages as well as to explain the types of sexual abuse carried out while under the
influence of adolescents and youth in Thailand. The sources of information were cases related to sex
crimes which appeared in print media over the past 10 years (between B.E. 2541-2551) and from the collection
of qualitative data from in-depth interviews. The sample group consisted of 15 adolescents and youth
at the Central Observation and Protection Center, Nonthaburi who committed sex crimes.
From the research it was found that information from print media portrayed the number, violence,
and complications of sex crimes related to the increased consumption of alcohol in Thailand, at three fold
over the past ten years. The age of victims and perpetrators is greatly varied, with the age of victims
between 4-102 years old and of perpetrators between 15-76 years old. From information on the perpetrators
it was found that the ages are decreasing and are increasingly youth or adolescents. The crimes mostly
take place at night and the abuse reported in print media the most is rape. The majority of the crimes are
carried out by known people, especially family members.
From interviewing youth who carried out crimes, it was found that 13 of 15 drank alcoholic beverages
2-3 hours before committing the crime and ¯ drank with the victims. Drinking alcoholic beverages
plays a role in bringing together groups which lead to planning and thinking of committing crimes. An
interesting point found was that perpetrators did not drink to get drunk (20-30 grams of pure alcohol), but
to become confident and brave enough to carry out the crimes without any consideration.
Recommendations from this study include the need to be more rigorous and strict with using related
laws such as forbidding the sales of alcohol to people under 20 years old according to the Royal Decree on
Control of Alcoholic Beverages, B.E. 2551. Information on sex crimes and other crimes need to be collected
and there information on alcohol consumption of the perpetrators should be collected as well. This is
because alcohol is related to sex crimes and other crimes. There should be measures to publicize and
change attitudes in society regarding alcohol consumption and sex crimes are not a normal aspect in
society.


Objective: The Cigarette Smoking and Alcohol Drinking Behavior survey (CSAD) has been conducted
by the National Statistical Office every 3-4 years. In 2007, this survey added crucial questions for
alcohol policy, including quantity of drinking, binge drinking and untaxed alcohol consumption. In addition,
it has a large sample size which can represent the population at provincial level. The objective of this
study is to report alcohol consumption behaviors of the Thai population.
Methods: The 2007 CSAD was a stratified two-stage sampling. Data were collected from 79,560
households by structured questionnaire, face-to-face interview during July to September 2007. This study
analyzed data of sample aged 15 years or older [N=168,285]. The data were estimated to represent the
population using sampling weights.
Results: Prevalence of 12-month drinkers, 30-day drinkers, regular (weekly) drinkers, high-risk drinkers,
binge drinkers, and drink-driving was 30.0%, 21.1%, 16.4%, 2.8%, 4.9% and 10.1% respectively. 12.9%
of underage people (<20 years) reported consuming alcohol in the last 12 months. Alcohol drinkers were
highly prevalent in a group of people who were male, aged 20-49 years, married, low educated, middleincome
level, agriculture and labor, and living in rural area and the North and Northeast. Among all
provinces, prevalence of alcohol drinkers was highest in North provinces. The most consumed alcoholic
beverage was beer, followed by white spirits and colored spirits. Prevalence of untaxed alcohol drinkers
was 2.4% (2.3% for domestic products drinkers and 0.2% for imported products drinkers). Estimated
untaxed consumption was 4.7% of total alcohol consumption.
Discussion: The findings of this study illustrate situation of alcohol consumption of the Thai population
and critical information to be used for evaluation and monitoring in populations and provinces
with high prevalence of alcohol use.


The current system of pharmacovigilance is mainly responsible to healthcare professionals for reporting
adverse drug reactions (ADRs) which major concerns are underreporting. Many countries had
initiated patient participation to the direct reporting of ADRs resulting in increased the reporting rate
especially possible new ADRs, non- serious ADRs which affect patients’ quality of life or ADRs which
patients could play an important role in drug safety. Those patient reports provided sufficient and thorough
details of the ADR outcome. However, they could be exaggerated, resulting from the ability to
distinguish between their illness and medications that might cause the adverse effects. Therefore, to
increase the report quality and the effectiveness of pharmacovigilance, the information about drugs and
adverse effects, and encouraging the patients’ awareness of ADR reporting are required.


To this research, it is to consider the good practices of pre-hospital emergency medical
service (EMS) system. By an in-depth interview with responsible units, story telling and lessons
learnt can contribute the big picture of their EMS practices in 6 areas (provinces); KhonKhan,
Ubonratchathanee, Lumpang, Petchaburi, Phuket and Songkhla. Initially, the research team has to
choose the modeling framework. Malcolm Baldrige National Quality Award (MBNQA) is chosen;
since it represents wisely for what are key elements in the system and how those are integrated for a
holistic view. Subsequently, the practices of the EMS system in 6 areas are captured. Besides, the
summary of good practices classified by elements of MBNQA is considered prior to shorten the
learning curve or speed-up the practices in other areas.
Respectively, MBNQA is applied as a framework for ascertaining the factors contributing the
success and the key obstacles in the practices of each area. However, it is interesting that the
practices of 6 areas, which have the diverse levels of success, tend to have indifferent obstacles.
Even, the most success area in Thailand encounters the problems in ‘Process Management’,
‘Workforce Focus’ and ‘Customer Focus’, which are similar in other areas. Additionally, the survey of
people who either use or never use the EMS in 6 areas results in the same problems, which are
‘insufficient promotion for the service’ and ‘inefficient service processes’. Besides, the research
team pinpoints that by completing the data collection and analysis, the lesson learnt and practices in
all areas are all remarkable. The differences in success rate are insignificant. In other words, the
practices and lessons learnt should not be limited only the success areas. Every area puts their
attempts to improve the EMS system and their diverse practice should be valued as meaningful
knowledge.
Therefore, the results of this research are concluded as two issues. (1) The guideline for
MBNQA application in the EMS system. The modeling framework enables the responsible units to
analyze the service system for a holistic view. Indeed, the analysis can point out the elements of
underemphasized. (2) The story telling from effective practices. This is an attempt to shorten the
learning curve prior to speed-up the practices in any areas. Significantly, the effective practices,
which are not limited only in the success areas, can cheer up any areas to improve their
performances of practices.


The one of leading non communicable disease burdens around the world including Thailand are Diabetes Mellitus and Hypertension. Health delivery system in Thailand was not proactive enough even having some focal innovative good practicing around country but lack to integration as a system. The management initiative of linking between concepts of Diseases Management, Chronic Care Model (CCM) and Chronic Diseases Management Model was integrated to WHO’s “Chronic disease prevention model”. Our conceptual framework is stress on ‘continuums’ ‘integrations’ and ‘comprehensive’ aiming to developing and testing “The integration of chronic disease management system in Diabetes Mellitus and Hypertension Model: phase I ” in provincial level.
Method : Action research by purposive sampling. Develop assessment tools for assessing the situation in 4 issues.  Field testing those assessment tools was performed in the area of Sakon Nakhon province and participatory develop the provincial strategic plan.
Results : 1) The situation assessment tools was developed: a) Health service policy and community strengthening.  b) Health service delivery design.  c) Self management and self management support.  d) Performance indicators.  2) Participatory Sakon Nakhon’s provincial strategic plan.


The objectives of this study are as followed; 1) to assess financial situation of
primary care in terms of; income, expenditure, productivity, costs and production
efficiency 2) to assess management style of CUP 3) to develop information system for
management and monitoring of the development of primary care system.The study employed both quantitative and qualitative approaches. A self-administrative
questionnaire survey on financial status and supports of each CUP and its’ network was
done. In-depth interviews were conducted with the Chief Medical Officers, hospital
directors, and District health officers; in addition, focus group discussions were
conducted separately with representatives from the hospital and health center. Twelve
provinces locating in 12 NHSO regions were purposively selected according to wellestablishment
of health information system. These included Chiang Rai, Phitsanulok,
Uthai Thani, Nakhon Nayok, Samut Songkhram, Samut Prakan, Kalasin, Nong Bua Lam
Phu, Surin, Si Sa ket, Surat Thani, and Songkhla. Al least three CUP were purposively
selected; one provincial hospital CUP, one big district hospital CUP, and one small district
hospital CUP; moreover, additional private hospital or other public hospital CUP was also
included if health centers were included as their network. There were totally 44 CUPs in
the study including 270 health centers under provincial hospital CUPs, 396 health centers
under district hospital CUPs, and 5 health centers under a private hospital CUP.
Results of study show that the financial status of all hospitals and its’ networks
had been improved during 2006 – 2008, net savings of all categories of hospitals and
health centers had been increasing. This indicates that over budgets were sufficient for
the system, but allocation of budget was probably problematic. Financial management
system as a CUP impose the hospital and its’ network, health centers, have to work
closely in terms of supports, communication, and referring. However, how well they
worked together depends on vision and attitude of the hospital director and local
contexts. The itemized payments made by NHSO was criticized as it will deteriorate the
integration and holistic concept of primary care; moreover, it lets health workers putting
emphasis on these activities and entering data in order to get more budgets and may
neglect in providing other services. Average annual total costs of health centers or
primary care units (PCU) in 2008 were 2,571,535.86 Baht for those having doctor,
1,837,809.64 Baht for those having registered nurse, and 1,190,663.21 Baht for those
providing services by health workers. Average annual numbers of productivity were
17,032.24, 10,927.80, and 7,432.85, visit/unit/year for different type of PCU respectively.
The efficiency score calculated by DEA of PCU or health centers was relatively low,
0.538 – 0.593, and there were room for improvement. The result was against with the
complaints of health workers that they had high burdens of work and reports. This was
probably due to burden from reporting was not accounted as productivity of primarycare unit. Moreover, the current available data include only quantity of services
provided, not including quality dimension or non-services activities. Results from the
study illustrates that current available data within the CUP and province was able to use
for management and monitoring of the development of primary care; however, it needs
more efforts in managing the data and require training of staffs.
Policy recommendations are as follows: 1) the provincial health office is crucial
actor in the development of primary care and should not be ignore or bypass; 2) the
payment models for primary care should be designed with caution ensuring that they
will not deteriorate the concept of a holistic and integration of primary care; 3) a good
governance of CUP board should be strengthen and separation of budget for primary
care from secondary care is needed; 4) a national mechanism to monitor efficiency of
budget spending should be established in addition to incentive measures and
mechanisms to improve the efficiency of health service production; 5) strengthening
management information system for planning, monitoring, and development of primary
care.


The comprehensive knowledge management in Diabetes/Hypertension
case project is organized to integrate the two existing networks- Toward Clinical
Excellence Network-DM (TCEN-DM) and Diabetes Knowledge Management Network.
The main objective of this project is to combine the comprehensive knowledge
management in Diabetes/Hypertension case in Thai content with the specific objectives
of the followings (1) To collect and synthesize the experience, knowledge and
innovation about diabetes/hypertension prevention and health promotion in or to
develop the clinical excellence system (2) To establish the benchmark measurement in
diabetes/hypertension management and (3) To share the knowledge in comprehensive
diabetes/hypertension knowledge management among network for best practice. The
assumption of this project is that the knowledge can be extracted from the best practice
and staff. So, the knowledge management in this project is to transfer the knowledge
from the person to the others and continuous management to create, share and adapt the
knowledge.
The leader from TCEN and Diabetes KM network from 4 regions of the
Thailand was selected to be the core responsible person (Node). They were trained for
the knowledge management, TCEN indicator and outcome mapping for building the
network, planning and operating the project. The Node was then transferred the
knowledge into their area and provided the knowledge management forum “Synergy
between tacit and explicit knowledge for diabetes and hypertension patient” during Aug
03-04, 2009. Based on the output competency from 11 events of knowledge
management market in each region, the working committee had a conclusion of 9
factors and classified into 5 levels that were used to evaluate and improve the potential
of diabetes/hypertension care team in Thailand context.
For TCEN indicator, it was increased from 17 to 20 indicators to accord
with indicator of the National Health Security Office which was revised to an
appropriate template of each the indicator.
Other than the above activity, this project has published 2 books:-
“Diabetes story: learning through practicing volume 2” and “Diabetes TCEN: Pointing,
Setting the target and Developing”. The synergy tacit and explicit knowledge story was
produced in CD and made the weblog: http://gotoknow.org/blog/dmcop to distribute the
data, story and another summary from this project.
Through a year of the project implementation by using the knowledge
management tool, most of activities were conducted under the positive, friendly,
respective atmosphere with appreciation of all participants of this project. This made the
leader and the members of the network a good relationship and collaboration. It is
confident that the network can be operated in a sustainable way.


The purpose of this research was to develop the Out-Patient Service Quality
Satisfaction Indicators of Community Hospital . Applying research and development was
approached. Analytical statistics were qualtitative research methodology by Multi-Attribute
Consensus Reaching and quantitative research methodology for reliability by Cronbach’s
Alpha-coefficient and Model Validity finding by Confirmatory Factor Analysis:CFA with
LISREL 8.30. The samples were 759 cases from the Out-Patient of 8 community hospitals
in Phitsanulok Province. Eestablishing the standard for the evaluation by normative and
evaluating the handbook.
The finding of this research were as follow ; the Out-Patient Service Quality
Satisfaction Indicators of Community Hospital composed of the 5 domains TICTI 34
indicators ; 1) the Tangibles : T domain composed of 11 indicators 2) Interaction : I domain
composed of 6 indicators 3) the Convenience : C domain composed of 5 indicators 4)
the Trust : T domain composed of 8 indicators ; and 5) the Information : I domain composed
of 4 indicators. Reliability of the Out-Patient Service Quality Satisfaction Indicators of
Community Hospital was 0.77. Model of the Out-Patient Service Quality Satisfaction
Indicators of Community Hospital fit very well with the empirical data (2 =431.55 , df =
522 , p = 0.001 , GFI =0.94 and AGFI = 0.91 and root mean squared residual : RMR =
0.02). The standard for the evaluation employed in three level. The norm statistics were as <
102 scores at poor, 102 to 153 scores at fair and > 153 scores at very good. Evaluating the
appropriate of the Out-Patient Service Quality Satisfaction Indicators of Community Hospital
handbook was at good level .


Since 2005, a national strategic plan aimed at controling and preventing a future avian influenza (AI)
pandemic and/or outbreak of influenza in Thailand was established as a policy measure to tackle these
public health threats. The objective of this paper is to study the formulation process of two policy measures
for AI: vaccination of poultry and stockpiling of antiviral drugs for humans.
We used a qualitative approach with in-depth interviews of 38 key stakeholders from many organizations.
In addition, a literature review was carried out along with the interviews. After collecting data
from the literature and the in-depth interviews, we analyzed the emerging themes relevant to the policy
formulation process in Thailand.
We found that policy formulation concerning poultry vaccination is a very complex and politically
driven process since many stakeholders are involved with different special interests and powerful influences.
Small-scale poultry producers representing rural people are the ones who would rather use vaccine,
because non-vaccine measures, such as culling or using bio-security buildins and measures, are against
their rural culture. However, the majority of key stakeholders were against the use of poultry vaccine.
There are four major reasons: (a) evidence of vaccine effectiveness is not convincing and thus a public
health threat remains possible; (b) the government has confidence in the infrastructure needed to fight AI
outbreaks with non-vaccine measures; (c) the management system of vaccination (acquisition of goodquality
vaccine, finance, logistics, monitoring and exit program) is not fully effective; and (d) the government
implicitly wants to protect the poultry export industry. Thus, the government decided not to use
poultry vaccine.
Contrary to the poultry vaccine policy, building stockpiles of antiviral drugs for use in humans is
determined primarily by experts at the Ministry of Public Health, following World Health Organization
guidelines, but under budget constraints. Other factors relevant to policy analysis are: government leadership,
budget constraints, animal and human health co-ordination, scientific evidence and risk communication
for the public.


Overweight and obesity are associated with several chronic diseases. Economic costs attributable
to overweight and obesity are substantial. In Thailand, the prevalence of overweight and obesity is increasing
rapidly. It was also found that overweight and obesity were the 6th leading risk factor attributable
to Disability-Adjusted Life Year (DALY) loss in Thailand in 2004. However, there had never before
been a study which examined health-care costs due to overweight and obesity in Thailand.
This study is aimed at estimating the health-care costs attributable to overweight and obesity in
Thailand in the year 2009, employing the overweight and obesity-attributable fractions (OAFs), which are
generally defined as the proportion of a disease in a population that is attributable to overweight and
obesity. OAFs were calculated for each disease associated with overweight and obesity. OAFs can be
calculated from the prevalence of overweight and obesity and relative risk of each disease. The number of
patients in each disease category attributable to overweight and obesity was then calculated as the product
of OAFs and the total number of patients with that disease in 2009. The health-care costs of overweight
and obesity were further estimated by multiplying the number of patients in each disease category
attributable to overweight and obesity by the unit cost of treatment.
Health-care costs attributable to overweight and obesity in this study were estimated at 5,580.8 million
baht (i.e. out-patient department = 847.4 million baht and in-patient department = 4,733.4 million
baht). The top three leading causes of health-care costs were diabetes mellitus (3,386.6 million baht),
ischemic heart disease (1,070.5 million baht) and colon and rectal cancer (377.2 million baht), respectively.
The findings clearly confirmed that the economic impacts of overweight and obesity on health-care
costs in Thailand were substantial. More effective policies/interventions aimed at reducing the prevalence
of obesity should be implemented.


The aims of this study were to explore the situation of obesity among undergraduate students and to
determine the socio-economic and economic factors associated with obesity. A cross-sectional survey using
questionnaires was conducted among 398 students in 7 universities in Chiang Mai Province, Thailand. The
data were then analyzed by using a logit regression model. We found the situation of obesity in undergraduate
students as follows: 29 percent of the study sample was either overweight or obese. Of those, 64 percent
were male, 54 percent stayed in the dormitory, 35 percent failed to exercise, 27 percent were not willing to
pay for obesity treatment, 91 percent did not acknowledge themselves as obese and 38 percent had health
insurance. The socio-economic factors significantly associated with obesity among undergraduate students
were family incomes, fast food consumption, place of living, willingness to pay for obesity treatment and
sex at the 0.10 significance level. However, economic factors, such as myopic view underlying eating habits,
asymmetric information and incomplete information on nutrition and causes of obesity, did not show a
significant impact on obesity among the undergraduates. It was concluded that undergraduate students
possibly had no myopic view behavior or they knew very well concerning the information on nutrition and
causes of obesity.


This study is aimed at exploring the current situation concerning risk factors and behaviors that
construction workers were facing at both individual and community levels as well as to examine existing
health promotion interventions. This information was expected to be used for constructing useful recommendations
for the development of existing and new interventions employing “social marketing” principles.
Methods: The study began by employing qualitative methods. The research team was assigned to
stay in a purposively selected construction camp for two months to collect data concerning lifestyles,
social values, as well as risk behaviors and risk factors. Afterwards, a cross-sectional survey on issues of
concern was implemented. Finally the data were analyzed and presented to the community representatives
in focus group discussions. This was to verify and investigate explanations underpinning the findings;
moreover, it was expected that such a payback method, including findings, would be beneficial to
people in the communities. Results: It was found that one of the major risk behaviors observed in the
study community was alcohol and tobacco consumption. Although the target group had a number of
constraints in terms of purchasing power and time, they received relatively low payments for these excessive
workloads; however, they were offered convenience and motivation to access alcohol and tobacco
products. It was observed that legal interventions, i.e., restriction on alcohol-selling times did not perform
effectively as the study population usually purchased these unhealthy products from small community
groceries where there was a lack of inspections from police officers; besides, these workers rarely knew
about this regulation. For those who had seen or known about the law, they still did not understand the
reasons behind such a restriction on selling times. Strengthening law enforcement was therefore recommended
by academics as a strategic solution. On the contrary, this study pointed out that the use of social
marketing principles to communicate with the target group regarding the true purposes and relevant
facts of the interventions tended to help increase the effectiveness of legal interventions. Conclusions: In
order to develop suitable health promotion interventions for the target groups, health promoters needed
to understand the context and develop ways to limit their access to unhealthy products. It was recommended
that social marketing should initially be applied for promoting behaviors that are easy and require
low cost to change, such as to stop drinking in certain periods of time. This is to offer reachable
targets to the target group and once they achieve such a goal, they would be empowered to believe in their
abilities, and this would help them to step up to overcome more difficult goals, such as to stop drinking or
smoking altogether. The application of social marketing principles to existing legal interventions could
help facilitate prompt behavior change, as well as maintain desired behaviors in the target populations.


Free trade agreements are intended to spread high-quality goods to all member countries without
any barriers so that the standard of living and the wealth of the member countries would be heightened.
Tobacco, however, is not a typical good. On the contrary, it is detrimental to human life. The more cigarettes
are smoked, the more harmis incurred by both the consumer and the people in the same environment.
Hence, the dissemination of tobacco products should be controlled. This paper considers statistical
data and relevant articles, and then presents the negative impacts of free trade agreements. After a tariff
reduction of 5 percentage points resulting from the ASEAN Free Trade Agreement (AFTA), the production
of domestic and foreign cigarettes rose. Likewise, the tobacco consumption rate among adolescences
expanded. Despite a wide-ranging campaign to reduce smoking, the decline in the tobacco consumption
rate in other age groups was not as remarkable as it should have been. Moreover, AFTA hindered the
development of tobacco-control regulations. The government was likely to soften the new regulations to
avoid infringing on the free trade agreement, whereas the tobacco industry worked to prevent such regulations
in the first place by threatening the government with the terms of the free trade agreement. This
paper, therefore, suggests that, in order to strengthen tobacco-control schemes, tobacco products should
be put on the exclusion list of free trade agreements.


Background: Evaluation of the diabetic management programs among community hospitals is not
comparable. Therefore, it is recommended to use data analysis from EMRs in evaluating diabetic care in order to drive the quality of diabetic care at the community hospital level. Objective: To compare and evaluate the process and clinical outcomes of diabetic care. Method: EMRs from the period 2006-2009 were
retrieved from 18 community hospital database systems to evaluate the process and clinical outcomes of
diabetic care. The process of care was measured as having received at least one clinical lab test each year.
Data were encoded for patient confidentiality. Results: Process of Care Quality of the diabetic care process
increased from 2006 to 2009. The proportion of patients who received at least one HbA1c lab test, CHO,
TG, HDL, LDL, UA and Scr were determined in 3.95%, 37.85%, 39.80%, 29.40%, 34.14%, 17.61%, and 65.98%
of patients in 2006, respectively. These numbers increased to 26.55%, 56.09%, 59.30%, 52.07%, 57.52%,
32.15%, and 66.52% in 2009, correspondingly. Outcomes of care: Compared with 2006, the proportion of
patients who had LDL<100 mg%, TG <150 mg%, HDL ≥40 mg% were 39.53%, 32.88%, and 19.30% in 2009
respectively. In 2009, however, the proportion of patients whose HbA1c<7%, FBS 90-130 mg%, BP ≤130/
80 mmHg decreased to 25.63%, 11.55% and 12.01%, compared with 31.40%, 11.86% and 20.47% in 2006,
correspondingly. Conclusion: Although the process and some clinical outcomes of diabetic care improved
from 2006 to 2009, other clinical outcomes decreased. Proactive diabetic management programs should be implemented to enhance diabetic control.


The objectives of this study were to evaluate the effectiveness of health screening and education for
prediabetes and prehypertension individuals by randomized controlled trial. The samples were randomized
into an experimental group that received health education and a control group that had not received
follow-up for two months. Outcomes were the modifying of health behaviors, blood pressure, fasting blood sugar (FBS) and knowledge. There were 367 participants who attended the health-screening process;
6.56 percent were prediabetes, 33.75 percent prehypertension and 13.75 percent prediabetes and
prehypertension. Thirty-one of the prediabetes (15 in the experimental group and 16 in the control group)
and 49 of prehypertension (24 in the experimental group and 25 in the control group) were followed up.
The result showed that eating, alcohol drinking and exercise behavior of those who were prehypertensive
individuals in the experimental group were significantly changed (P-value <0.05) and that eating salt and
drinking alcohol among those who were prediabetic significantly decreased (P-value <0.05). Blood pressure
levels and FBS were significantly decreased from the baseline (P-value <0.05) in both experimental
groups but there was no difference in the control group. The knowledge scores were significantly higher
in the experimental group than in the control group (p-value <0.05). The results indicated that effectiveness
of health screening and education for prediabetes and prehypertension individuals could help subjects
realize the need to modify their health behaviors and reduce blood pressure and blood sugar levels.


This study was aimed at developing criteria and guidelines for identification and classification of
hardship areas. This was part of a study on “Reform of Financial Incentives for Public Health Personnel”
submitted to the Ministry of Public Health, Thailand. Criteria to identify hardship areas included transportation,
city-life effect and economic development. It was found that, in classification of hardship areas
using developed criteria, 69.8 percent corresponded with the opinions of the provincial chief medical
officers. A guideline to classify hardship areas using hardship scores and confirmation by using opinions
of the provincial chief medical officers and health inspectors involved some difficulties and limitations
during implementation. There is a need to improve this methodological approach.


This study is aimed at analyzing the health policies proposed by political parties during the campaign
for the general election on July 3, 2011. A review of official documents as well as information
disseminated through websites and mass media were used for analyzing their policy contents. It was
found that many health policies were proposed by the political parties, although they were not the main
policies used for the campaign. Policies on universal health-care coverage and development of healthcare
systems were given almost equal importance while there were fewer policies on health promotion.
Civic movements and mass media could introduce new policy agendas for the consideration of politicians.
There is a need to follow up these political parties to determine whether or not they will do as
promised once elected as the leading parties to form a government.


This study was aimed at analyzing cost savings, cost addition, and cost avoidance from medication
error interventions at Sawangdandin Crown Prince Hospital, Sakon Nakhon Province. A prospective
descriptive study was conducted from a provider’s perspective during the period February-July 2010.
Cost analysis data were direct medical care costs, probability of harm if the patient did not receive
pharmacist’s interventions, relative weight of the related drugs, and average cost of drugs.Results showed that the incidence of medication error involving out-patients was 7.56 per 1,000
prescriptions and inpatients was 5.01 per 1,000 patient-days. The cost saving was 6,309.21 baht. The cost
addition of interventions to dispense the right medicines was 5,676.52 baht. The cost avoidance of outpatient
treatment was 50.60 baht. The cost avoidance of inpatient treatment was 199,280.66 baht. Cost addition
for treatment of medication error category E-I was 7,361.90 baht. The net cost saving was 192,602.05
baht in 6 months.
In conclusion, medication error interventions can save the hospital budget and promote patient safety.


Older persons are an important resource of the nation; however, they previously had been viewed as
persons only receiving support from family and society. This research project was aimed at developing
friendship networks and increasing the potential of self-help groups to promote healthy aging among
community-dwelling older adults. Participatory action research was applied to older adults in
Woranakhorn subdistrict, Pua district, Nan Province. Data were collected using focus group discussion
and questionnaires. Content analysis was performed for qualitative data. For quantitative data analysis,
the mean, standard deviation, and paired t-test were used. The development of friendship networks and potential self-help groups resulted in several self-care
activities, including performing basic physical examinations and health evaluations, reciprocal caring
and taking care of each other within the community, and creating health-promoting activities applying
folk art and local wisdom. Compared with changes in older adults after developing friendship networks
and self-help groups, it was found that, after project intervention, the older adults who regularly participated
in the friendship group activities had friendship networks, friendship support, self-efficacy, healthpromoting
behaviors, and healthy aging greater than before the intervention, with statistical significance
at the 0.05 level. Therefore, promoting the potential of elderly individuals, empowering and using social
capital within the community can promote friendship group activities and self-help groups among community-
dwelling elders, thus facilitating the achievement of healthy aging.


Cancer is a major public health problem for Thai people. The incidence of cancer is still
high and increasing in some cancer sites. This research aimed to study risk factors for the most
common cancers i.e. cholangiocarcinoma, cervix uteri, breast, colorectum, lung, oralcavity, and
stomach cancer. This study was a cohort study, using data from the Khon Kaen cohort study
which established and recruited the cohort group during 1990-2001. The analysis was performed
as a nested case-control study design during March, 2008 to May 2010. Cohort data was linked
with the Khon Kaen cancer registry to identify cancer cases. There were 245 cholangiocarcinoma,
61 cervix uteri, 10 breast cancer, 22 colorectal cancer, 26 lung cancer, 11 oral cancer and 8
stomach cancer, 297 all sites of cancers. Those who were free from cancer and still alive until
November 2009 were selected as controls; 17,449 (5,201 males, 12,248 females).
Results from univariate and multivariate analyses were:
Cholangiocarcinoma
From the multiple conditional logistic regression and prediction model, there were 4
factors associated with cholangiocarcinoma i.e. body mass index (BMI), sex, age, and OV eggs in
stools. That is the decreasing of each 1 kg./m.2 the risk of cholangiocarcinoma is 1.05 (1/OR =
1/0.95 = 1.05) (95%CI= 1.11-1.01), male is at higher risk than female (OR= 2.45; (95% CI=1.74-
3.45), the increasing of each year of age, the risk is 1.11 (95% CI= 1.08-1.11), those who had OV
eggs in stool were at higher risk of cholangiocarcinoma (OR=1.64; 95% CI=1.16-2.34).
Considering the accuracy of prediction model of area under ROC curve; AUC is 68.70 %.
Cervix uteri cancer
From the multiple conditional logistic regression and prediction model, there were 2
factors associated with cervix cancer i.e. body mass index (BMI) and age at first sexual
intercourse. That is the increasing of each 1 kg./m.2 the risk of cervix cancer is 1.09 (95% CI=
0.99 - 1.18), each year of younger age at first sexual intercourse, the risk of cervix cancer is 1.05 (1/OR = 1/0.95 = 1.05) (95% CI = 0.94 - 1.15). Considering the accurary of prediction model of
area under ROC curve; AUC is 54.93%.
Lung cancer From the univariate analysis, risk factors for lung cancer were sex (male)
(OR=9.89; 95% CI= 3.73-26.2), age (increasing age) (p<0.001), smoking (OR=6.73; 95%
CI=2.88-15.73), and alcohol consumption. BMI 23.5 kg./m.2 or more are at lower risk of lung
cancer.
Colorectal cancer From the univariate analysis, risk factors for colorectal cancer were
sex (male) (OR=2.35; 95% CI=1.02-5.43), age (increasing age) (p<0.05), the history of having
cancer in the family (OR=2.66; 95% CI=1.13-6.27). Food consumption and BMI 23.5 kg./m.2 or
more are at lower risk of colorectal cancer.
Oral cavity cancer From the univariate analysis, risk factors for oral cavity cancer were
betel nut chewing (OR=8.88; 95% CI=1.48-53.2), age 60 year-old or more and sex (male). Male
were at lower risk of oral cavity cancer.
Breast cancer From the univariate analysis, risk factor for breast cancer was the
increasing of BMI; BMI 23.5 kg./m.2 or more compared to lower BMI (OR=1.87; 95% CI=0.36-
9.67).
Stomach cancer From the univariate analysis, the factors associated with the risk of
stomach cancer were sex (male), (OR=1.41; 95% CI=0.34-5.91), and the increasing age (p<0.05).
In conclusion; the findings in this study suggested that public health personnel should
consider and take into account that OV infestation, BMI, smoking, alcohol consumption, food
consumption for the cancer prevention and control programme.


The research study on “Education and Lifelong Learning of Thai Senior Citizens” is a mixed-method research. The study aims to: 1) study the overview of lifelong education management for senior citizens that includes objectives of lifelong education management, characteristics of targeted senior citizens, curriculums and content, education facilitators and instructors, education management methods, education media and learning resources, assessment methods, management and the results of education management; 2) explore demand for lifelong learning among the senior citizens also in terms of objectives of lifelong education management, characteristics of targeted senior citizens, curriculums and content, education facilitators and instructors, education management methods, education media and learning resources, assessment methods, management and the results of education management; and 3) study a scenario of education and lifelong learning management for Thai senior citizens. Finally, two different research instruments were questionnaires and group discussions.
The research findings can be summarized below:
1. Overview of lifelong education management for Thai senior citizens: The lifelong education management for senior citizens was designed mainly to maintain healthful conditions for the senior citizens aged between 60 and 64 years old. The education facilitators and instructors include local public health officers who conduct short-term training sessions where personnel media acts as the main education media as well as learning sources. The results of this education management can be assessed by means of observation. In 2010, various organizations organized a maximum of one to three projects aimed at educating the senior citizens.
	2. Demand for lifelong learning among Thai senior citizens: Similar to the aforementioned issue, the lifelong learning activities for senior citizens are also aimed at taking care of the senior citizens aged between 60-64 years old. The education facilitators or instructors are wisdom teachers or knowledgeable individuals in the communities. The leaning is also seen in a form of shot-term training sessions. The most popular education media and learning resource is personnel media.  Meanwhile, the results are assessed by the observation of the actual progress. Finally, various geriatric clubs expect to form partnership and collaboration in managing lifelong education.
	3. A scenario of education and lifelong learning management for Thai senior citizens: The major objective of the education and lifelong learning management for Thai senior citizens is to help senior citizens stay so healthy that they enjoy solid relationship with their families and are able to happily adapt themselves to the communities and society. With their healthful conditions, they are also able to participate in all activities available in the society. The education and lifelong learning is managed for Thai senior citizens in a form of the edutainment, in which the learning at the formal education system, non-formal education system and the information education system is very well integrated. Groups of senior citizen leaders are formed up and act as leaders encouraging the other fellows to participate in the learning activities which are designed mainly for two major target groups, namely a self-reliant group and a non self-reliant group. The content for the learning should suit the demand of the senior citizens as well as their abilities to learning.  Further, the content should be applied to their daily lives. Generally, the content of knowledge is divided into five aspects- sanitary, adaption to society and metal states, economy and saving, learning and the legal rights of senior citizens. There are many ways to manage the education and lifelong learning for senior citizens.  The education managers or facilitators should motivate the senior citizens to learn. In so doing, they may promote the learning activities as well as convincing senior citizens of the benefits they will gain from the learning activities. The education facilitators and instructors should ideally be those who work on geriatric development in the localities. The learning activities should vary and are organized for multi-age learners. The activities should allow learners to discuss and exchange knowledge in casual ways. Education media as well as learning resources should pay a key role in the management of education and lifelong learning for individual senior citizens. The results of the learning can be assessed by observation of the real progress of the learners. Finally, in managing education and lifelong learning for senior citizens, involved parties should also apply a partnership approach where all parties join hand to manage the learning, offer some financial aids as well as managing all resources available in the communities.