The objectives of the research: by pass problems experienced by patients obtaining public health’s services in Phukhieo hospital, Phukhieo district, Chaiyaphum province, were to show the causes of this: (1) the factors of by pass problems experienced by patients obtaining public health’s services, (2) the problems occurring to the patients both inside outside of the hospital occupying when they obtained the by passed public health services and (3) to study a referral system and it’s problems for standard management of the hospital. The study focused on the qualitative research method. Data were obtained from document review, in-depth interview and focus group, and also the participant observation and non-participant observation. The study covered the period of February to September, 2003.The results of this study showed that: 	1. The factors leading to the bypassing experienced by the patients obtaining public health services were the inconvenience in transportation, inreliance of the clinical  service quality, the seriousness of the disease, the character of the servant, the contact and information obtaining from the service, service system, mode of clinical service right, the clinical referral, and the non-understanding of the card holders under the universal coverage insurance. 	2. Most of the patterns and conditional problems were described as following items: (1) an economic problem was caused of the loss of time, the cost of transportation, food, and health’s care. These charges had to be paid by the patients because the universal coverage insurance cannot be used. This was caused by unused referral system, (2) the physical problem was occurred from the inconvenience and no safety of life and (3) the mental problem was occurred because they were not satisfied of the service quality because of the non-understanding of the referral management system between the patient and the relative of the servant. 	3. The quality and standard of health care and referral system management in Phukhieo hospital were revealed that: (1) there was small amount of doctors that the ratio of doctors to patients was low score, general practice and most of them were funded and just graduated. They always move to several areas. So their knowledge and experience were not enough, and the inspiration to improve service system was lacked, (2) the strategy for the referral system management depended on the universal coverage insurance policy that the patients were commented to use the first register service. The patients with over cured disease) will be immediately and safely referred to higher efficient hospital, (3) the referral strategy always improved following the policy of referral system) of Chaiyaphum province,(4) the standard and quality of referral sys tem were shown that the patient was not treated in the referral standard from most doctors. The patients who can cure themselves were referred, while the patients with over cured disease were allowed to care themselves until they were coma and then were referred the secondary care, (5) Since running on the 30 baht policy, the referral system was limited by a payment. If it was not necessary, the patient was not referred because of the necessity to decrease the payment. This was differ from the previous service system and (6) The communication problem to refer the patient arise between general practice and specialists. Most general practice was graduated so far or funded. So they were not confident to ask the special doctor and they cannot contact to consult specialists when they have the problems. 	4. The policy suggestion was that, the alternate strategy for the persons relating to consider the policy was the patient choice for register with the health care service depending on their convenience. This was independent from the geographical or occupied dividing areas to solve the patient’s problem.  	5. The developmental suggestions indicate that: 		5.1  The patients should obtain the information from the various choices such as the community deputy meeting, the village health volunteer ’s meeting, civic groups and home health care, or the data will be obtained from family folder observation by the personnel’s health in the following mentions. (1) the patients are commented to obtain service from the specific health care and for the case of by passed patients, the charge of health care have to been paid by them, (2) the sheets describing healthcare efficiency of all hospital levels should be distributed to all personnel’s health of all department  and sub-district health. These are the data for the communication to the patients about the health care efficiency and for patient deciding, (3) There should be the communication to understand about the right of the universal coverage insurance, referral system and the rules of the health care obtaining in Phukhieo hospital for either government service right patients or life insurance patients. 		5.2  For the servants personnel’s health,  the improvement of the health personnel’s health is important. The strategies of this are that, (1) the seminar of services behavior should be always established and performances according to the patients’ rights  (2) services behavior should be used to consider progression and (3) the finding out and pronounce of the excellent personnel’s health should be done monthly or yearly. In the other case, there should be punishment when there are the complains about the improper service, and also the service system and personnel improvement should run to obtaining the patient’s trust. 		5.3  The service system revealed that, the quality and service system need to be developed, especially the out patients department (OPD.) that a lot of time was used for waiting to see doctor. Possession of nurse practitioner is a method that can help to increase the service efficiency. Case study showed that, there was the referral standard problem. The referral audit between doctors and all servants should be set up once a month or two months to improve the referral standard, communication between the referral concerned servants, and increase the occasion of communication between general practice and specialists. In addition, the quality of secondary care in the hospital has better be corrected, for example; conference, seminar, the deficient specialists to be the consultant once a week or two weeks. This is to develop the doctors’ knowledge and efficiency, inspire doctors to work in the hospital for a long time, therefore the service quality will be developed and the bypassed patients from Phukhieo hospital will be decrease.


Background Unprotected sex increases adolescent risk of early and unwanted pregnancy and childbirth, unsafe abortion and sexually transmitted diseases such as infection with the human immunodeficiency virus (HIV). Sexuality education serves as one means of helping young people prevent these problems and improve their future reproductive health. Development and utilization of a computer-aided instruction (CAI) on sexuality education may facilitate learning and provide additional education channel to this group of people.Methods	Contents of the CAI were organized into six key concepts including human development, relationships, personal skills, sexual behavior, sexual health and society and culture. Information and illustrations were employed and tailored to fit for Thai society and culture. Tutorial methodology was used and arranged into the following categories: introduction of the tutorial, questions and responses, judgment of responses, feedback about responses, remediation, organization and sequence of program segments and learner control in tutorials. Three phases of planning, design, and development were assigned and followed, The CAI was created in collaboration with a NECTEC staff and had been tried out in an early secondary school classroom within Roi-Et municipality. Macromedia Authorware 5.2 was used as authoring tool and the final material was written into a compact disc.	Results	A six-chapter interactive multimedia tutorial was developed, It occupied about 192 megabytes on a compact disc. While trying out in the classroom, there was some initial perplexity in using the CAI by the students, which made the beginning of the study cumbersome, In the second half of the study, however, the students could easily use the CAI. Each chapter of the tutorial took about 50 minutes to complete. A total of 8 sessions were needed to finish the CAI. In a focus group discussion at the end of the study, the students exhibited their preference to the CAI.Conclusions 	CAI seems to be one of potential methods for comprehensive sexuality education through facilitate learning and provide additional education channel. Problem underlay CAI usage is preparedness of student.


Universal coverage (UC) is a breakthrough improvement of the health system of Thailand.  Before the beginning of the UC-policy movement of the present government, the Health Systems Research Institute (HSRI) developed the proposal for the universal coverage for the drafting process of the National Health Act B.E….  It was then published in 2001.	This study aims to review the implementation, successes and opportunities of improvement of the universal coverage with reference to the HSRI proposal and to come up with feedbacks to HSRI on development processes of academic work on policy issues for future application.  Information was gathered by reviewing key relevant documents, interviews and brainstorming sessions.	Study findings on the four primary goals of UC as proposed by the 2001 proposal indicated that, firstly, equity in distributing financial burden and health care access to necessary services improved. Secondly, however, there was no study or evidence to show definitely that efficiency in the health care system increased or decreased.   Thirdly, regarding the right to choose a provider which was expected to promote quality, there has been a policy from the National Health Security Office to allow its beneficiaries to choose primary care providers in their neighborhood areas or areas around their workplaces.  Nevertheless, there was no evidence demonstrating that the right to choose led to better quality.  The fourth goal, which was to promote health for all, was realized obviously by the policy “Building health leads fixing health.”  Nevertheless, concrete outcomes of the policy were still lacking. 	Regarding the proposal on system financing which asked for alignment and adequate budget to support standard health care, it was found that the financing was still fragmented.  No mechanism overlooked the whole system, which comprised three main funds.   The funds had diverse health benefit packages.  The financial situation leads to the conclusion that total funding was not adequate.	Health security of the nation remained separated into three schemes, which were different principles, organization, benefit packages and operation.  The purchaser-provider-split concept was not evident yet.   Management within the Ministry of Public Health confuse management of activities under the universal coverage program, particularly the distinction of health promotion and disease prevention from public health activities financed by the Ministry.	Based on this study, recommendations regarding further development of UC should include the following:Review consistency and appropriateness of principles and resources, budget allocation and service arrangement under UC to be “Service of choice” or “Social safety net”.  This is under the assumption that creating choice to lead to better quality should be based on competition and informed consumers, or managed competition.Set up new policies based on long-term health and epidemiology information.   Set up concrete health promotion goals and associate them with the budget system, resource allocation and operational evaluation.Develop academically solid criteria for budget calculation.  Support a national health account study and other related studies and develop efficient and valid financial accounting and cost accounting systems for health care providers.  Monitor health status, epidemiology of illnesses, health-service seeking behaviors, and self care of the population continuously.Study cross-subsidization between health security funds at the level of health care provider. Assess financial impacts and design preventive measures for providers in case payment rates of different funds are standardized.Review needs, advantages and disadvantages of fund merging into a single national health security fund.  At the same time, develop coordinating mechanisms at three levels—policy, administrative and technical—in order to ensure alignment of principles, benefit package, budget, information requirements and operation between funds.  Change the structure of the National Health Security Committee to have the Prime Minister (or his deputy) as Chairman.  Enhance the roles of the Health Security Committee and the Quality and Standard Control Committee, and improve internal management in the National Health Security Office and its branch office to international standard.The Ministry of Public Health should spell out its human resources management and budgeting system for both salary and operating budgets.  Improve systems for estimating and allocating salary for each group of staff to ensure alignment to missions.Develop close-end payments to the disease which calculate cost on basis of quality requirement, that is set up quality-based purchasing arrangement, to reduce impact of the payment on quality of care and enable quality assurance for resource-intensive treatment.  Study and plan a risk-distribution fund or account system.Link quality requirement with resources and budget need by developing resource-based practice guidelines.  Develop quality assessment for health care and services, quality information for continuous quality improvement, and enable health care providers for self improvement.  Empower consumers for smart decision making and install quality management systems in all heath security fund administrators.


The Evaluation on Social Welfare Services to develop  the quality of Life of  the Elderly in Thailand	The study of  “the evaluation of social welfare services to develop the  quality of life of the elderly in Thailand”  has the purpose to evaluate the purpose, target, efficiency and effectiveness of the social welfare services by the government in 4 areas I.e. Homes for the elderly, the allowance, social services in the community (emphasizing the village welfare Assistance Center)  and the funeral welfare services.  The procedures in doing the research are both quantitative and qualitative research. The examples of study are the elderly in  four regions and the peripheral provinces.  The methodology in the quantitative study are the enquiries of the elderly, and the tools used in the qualitative study are the methods of interviewing, case studies, focus grouping with the elderly, observation in the village and community  concerned.  The  statistics of the study is the percentage, the mean, chi-square and the analysis of  variation.	In  this study it is found out that the context evaluation particularly the purpose of the social welfare for the elderly.  The government has the concept to manage mainly the service for the poor elderly without the relatives and supporters, by using the occupational means-test by screening them who qualified to receive the  social welfare.  The main concept of social welfare for the elderly is the concept of public assistance  except the funeral welfare services is as   the welfare services with the specific purpose in organizing the funeral for the elderly which is the welfare assisting the elderly in the community.  The result’s evaluation of the purpose of services found that the funeral welfare services is the only  welfare that giving concern the value and dignity of elderly as far as the elderly are concerned themselves and voluntary involvement of their relatives in guaranteeing for the elderly in the society, while others services  the government arranged for the elderly  has been directed through  the top-down policy	In the assessment the spending  social  resources for social welfare projects for the elderly, it is found out that the cost for Homes for the elderly is yearly high as  34,500  Baht per person, the allowance for the elderly  in  communities is 2,400 Baht  a  year (200 Baht per month in average) the cost of operation in  the village Welfare Assistance Center   in the early stages is 25,000 Baht.  While the funeral welfare the government does not allocate the budget but collects from the elderly and their families by collecting from the community’s members including the elderly 5-50  Baht per dead person.  The funeral welfare is the service concern with the dignity of the elderly and mainly counted as the cost of the community, thus the dependence on the government budget  become less.  The procedure of using the funeral welfare is flexible and adapts to the elderly’s qualification.  Thus, the potentials of social welfare services for the elderly of the organization therefore mainly depends on the strength of the community.	According to the result of this study is found out that the mechanics of the government organizations are  not so efficiency, that reflects the mechanism of the governmental organization from the evaluation of the qualified elderly, the criteria of selecting the elderly to be admitted to the Village Welfare  Assistance Center the elderly and receiving the allowance lower than the standard that will guarantee the social justice for the elderly,  lacking the suitable means-test that will lead to unfair allocation of the government budget.   The government lacks the process of  assessment, investigating, monitoring and evaluating system to accomplish the social welfare projects for the elderly efficiently, as they face the problem of disembursement process of the allowance and fund of the Village Welfare Assistance Center. The mechanism have been created according to the bureaucratic system, not by the representatives of the elderly in the community.	The result of evaluation of the effectiveness of social Welfare Services find out are the following.the operation of Homes for the elderly can respond well the the physical needs of the elderly but cannot respond spiritually.  There are enough governmental welfare Homes for the elderly, but unfair as far as the elderly with the high and medium income can be admitted to the facilities as same as the poor elderly.The system of the Allowance is divided into 3 groups as following.the poor elderly has the opportunity to get the highest allowancethe elderly with their descendants not so poor, with medium income but has good relations with the committee of the village will get the next high allowanceThe  miserable, living alone (or without relatives) elderly has the  opportunity to get the less subsistence because they are “marginal groups”  in the community.  The social welfare in terms of the allowance of the officials is intervened by the political mechanismThe  Allowance and the village Welfare Assistance Center is discentralized in terms of quantity.The official and unofficial funeral welfare services (natural groups)  responds to the elderly’s needs of the community more than other social welfare services of the government.	The  evaluation of projects of social welfare for the elderly shows that the social welfare by the government is not so functional and justice as far as the poor elderly, without relatives, cannot get access to the social welfare services because of the selection process is nepotic and unfair.  The target groups of the elderly cannot enjoy such welfare as they cannot protect their own rights as they are not participated in the management process which leads to the sustainable welfare and activities, cannot strengthen the elderly and the community for long. As far as managing the service separately i.e. handling the government welfare Homes for the elderly separately from the family and community.  Even the welfare is good but lacking the  improvement of management to develop the potentials of elderly for self-dependence, stabilization in the society, lacking the spiritual development of elderly for a long period, thus the elderly lead a “surviving-existing” rather than “well-doing” style of life.


This qualitative study aims to explore a situation of health systems for middle-aged women especially about concepts, treatment modalities, perceptions, and success. The study sites were in both rural and urban areas of Khon Kaen province. Eighty five women age 40-59 and nineteen healers participated in this study. Data was collected by using participatory and nonparticipatory observation, interviewing, and focus group discussions during March-December 1999. Triangulation and content analysis were used for validation and analysis. Major findings were as follows. Humoral theory, religion, health information, and women’s life styles are guidelines for alternative health concepts of practice. There are 30 activities that are regarded as alternative health practices to promote the well-being of the middle-aged women. They were grouped into 4 categories and energetic therapies and exercise. The meaning of health given by women are included in the well-being of physical, mental, spiritual, and social life. The success of alternative health services is related to consumers’ beliefs, providers’ self-reliance, and community participation. It is suggested that highlighting alternative health systems by setting standards of services, and establishing networking between the community and the system is needed. Keywords: alternative health, middle-aged women, folk sector, lay sector, Isaan


The consumer empowerment system synthesis research project is part of project series of the action plan of Public Health System Research Institute during 2002 - 2004. The project aims to create an empowerment system of the health community in order to achieve the academic potential and to establish a coordinating network for monitoring advantage-taking of consumers with respect to health products and services. Currently, the situation is that the consumers are greatly affected by both globalization and circumstantial factors that encourage the borderless free trade ideas, promotion of the limitless sales promotion and the exaggerate commercial advertisement. The high trade competition leads to stimulation of sales promotion without considering impact to the customers, whereas the government agencies are confronting problems and limitation of their operations. This due to the absent of clear measures and lack of checking and monitoring systems. Ignorance of the public and NGOs also causes weakness of consumer power. Apart from this, the NGOs that work in the area of consumers' rights are not prepared to work consistently with their own knowledge and clear activities, and they are limited in expanding their operation networks due to inadequacy of budgets and resources.  Furthermore, in mass media sector, which is also another party relevant to consumer affairs, it has been found that they have insufficient attention to consumers due to their dependence upon financial support from businesses. And also, for academic circles, most of scholars have very few works, researches and knowledge creating process that promote the consumer power.	Due to this situation, 5 objectives for development of The Customer Empowerment System Synthesis Research Project have been set up: 	1. To analyze and review the knowledge and situation of consumers and factors relevant to the consumer empowerment;	2. To analyze roles, responsibilities of all parties relevant to the consumer process in order to know the hard and weak points, obstructions and opportunities to empower the consumers;	3. To propose the possible roles and responsibilities of all relevant parties and to offer suitable examples for strengthening and stabilizing of the consumer process;	4. To propose mechanism, policies, tactics and guidelines, including necessary measures for developing of the consumer process to achieve practical effectiveness; 	5. To create support, promotion and development systems to empower consumers with continuity and stability;	Three goals of the Project development are: to review the knowledge with respect to consumer empowerment process and to create the know-how knowledge; to prepare plans, processes and operational techniques for consumer empowerment; and to form a coordination network in consumer process; and to establish an institution focusing consumer empowerment. 	The works include to convene meetings amongst relevant parties, i.e. the researchers who act as external coordinators, Health Systems Research Institue’s (HSRI.) researchers and co-researchers and also to hold a forum to give opportunities to consultants to opine.  In addition, a workshop will be convened in order to coordinate with relevant target organizations, to collect data in the areas and to gather academic forum. These particular works are tools necessary reaching the objectives. The works are 5 year-period programme with these following stages: Year 1 - To review the knowledge, situation with respect to both domestic and international consumers and to analyze the hard and weak points, obstructions and opportunities of consumer organizations in Thailand including to coordinate formation of the network;Year 2 - To propose vision, to stipulate policies, action plans, strategic plans and to continuously promote the collective learning process of the network organizations;    Year 3 - To develop patterns, guidelines and mechanisms, including measures and techniques of implementation in order to empower and protect consumers and to promote activities of all consumer organizations;Year 4 - To create support and promote systems to develop the processes in order to strengthen consumers with continuity and stability;Year 5 - To promote establishment of a consumer empowerment institution that allows the participation of all parties relevant to consumer affairs, especially the public sector.


Whether MDR-TB (multi-drug resistance TB) had devastated Thailand: 55 articles reviewed between 1968 and 1998Multi-drug resistant tuberculosis have been regarded as the third epidemic and become global emergency since 1993. The multi-drug resistant TB is at least resistant to 2 drugs which are isoniazid and rifampicin. The MDR-TB is uncured despite its rare occurrence. A major cause of MDR-TB is either irregular drug taking or not completing course of drug taking. In 1997, the WHO reported Thailand’s MDR-TB at around 3000 cases considered as high tendency. By December 1998, the rate of drug resistant TB was 26%, 13% to isoniazid, 12% to streptomycin, 7% to rifampicin, 7% to ethambutol and 3% to multi-drugs. Compared between 1968 and 1998, the percentages of drug resistant TB had increased for each drug. Factors related to drug resistant TB were number of lesions in lungs, family history of TB and HIV positive history while factors related to MDR-TB were history of TB treatment, TB family history and HIV positive historyThe paper recommends development of effective and continuous TB program implementation and evaluation, quality of the DOTs, quality of lab testing and its network and effective information system. In terms of research and development, factors related to treatment success for MDR-TB should be studied and treatment evaluation should be performed according to national TB control by Ministry of Public Health.


Health Impact Assessment (HIA) of Contract Farming in Thailand : A Scoping Process Objectives: 1) To define the scope of health impact assessment of contract farming policy. 2) To provide a venue for stakeholders’ participation in the health impact assessment Methods: The assessor used varieties of methods to identify the scopes of the health impact assessment. The processes were consisting of two meetings with stakeholders, in-depth interviews with farmers and seed companies’ personnel as well as government officials, direct observation at the farms and literature reviews. The definition of health used in the study was based on bio-psycho-social model. Results: The Thai government has been promoting Contract Farming practice since the 6th National Economic and Social Development Plan in 1987. Farmers will produce agricultural materials for agricultural industry companies and receive payment for the products if they comply with the standards defined in the contracts. Tomato seeds, chili seeds, tobacco leaves, vegetable seeds, chicken raising are examples of the agricultural products that are commonly defined in the contracts. Contract farming policy brings numbers of potential impacts, particularly on one that uses a lot of pesticides, on the health of farmers and villagers. Potential positive impacts are short-term financial benefits, choices of employment during dry season. Potential negative impacts are on physical health especially impacts on neurological illnesses, illnesses of endocrine systems, illnesses of reproductive systems. It has been shown that stakeholders were concerned about health impact of the contract farming practice in terms of physical health, mental health, social health, spiritual health, social impacts and environmental impacts. Literature reviews found that farmers and farm employees were affected by the heavy use of pesticides. Neurological illnesses were the most common problems. Stakeholders have identified scopes for health impact assessment including impacts on physical health, mental health, social health, spiritual health, social impact, economic impact, environmental impact. The stakeholders also proposed that assessment of impacts on illnesses of endocrine system, reproductive system and cancers were needed. Qualitative and quantitative methods of data collections with stakeholders’ involvement have been identified for the assessment. Conclusion It has been shown that early involvement of stakeholders in the scoping processes of health impact assessment is feasible and beneficial to all involved and it is more likely that the results of health impact assessment will be used.


This research on development of developmental promotion activities package for children from birth to five years old at the primary care level was aimed to analyze the policy, concepts and the current situation on developmental promotion activities for children from birth to five years old in the child daycare centers, kindergartens, well babies clinics and the primary care units; to study the developmental screening and assessment tools, and propose a package for promoting child development at the primary care level.  Data were collected from document review, the interview with the 63 administrators, teachers and the child care providers in kindergarten or in the child daycare centers and nurses in well baby clinics or in the primary care units from the Northern, Southern, Eastern and Northeastern regions of Thailand. Data from the meeting with eight experts in child developmental field.          The results is the following :Most nurses, kindergarten teachers and child care providers knew and shared the same an understanding of child developmental activities promotion. Some of health care centers or kindergarten had the written policy concerning  child development. In health care centers or kindergarten where there was no written policy. In well baby clinic, the emphasis was on vaccination, weight & height measurement and providing advice. In some places simple child developmental assessment and stimulation were conducted by involving parental participation. At well baby clinics, the maternal and child health guidebook was commonly used to assess development progress. The role of the nurse at primary level of promoting development of children from birth to five years old, comprises of the following activities:-Maintenance of a child’s developmental history record. -Screening and assessment children at scheduled times suitable for their age.-Organizing child developmental promotion activities and the corner for  child developmental promotion.-Giving advice/ consultation to parents on anticipated development and guidelines for developmental promotion.-Referring the child for proper diagnosis and help.           6. A package of developmental promotion activities was designed for the following persons:  For child care providers, For Kindergarten Teachers, Nurses at the primary care level


The study has three objectives: 1) to study the information needed for health promotion and disease prevention, 2) to study the channel to access information on health care and disease prevention, and 3) to study the factors influencing the needs of information to promote health and disease prevention. The study is under the “Universal Health Coverage Program. The technique for data and information collection include observations, interviews and focus group discussions. The four selected research sites are; Nong-Hoi and Sri Lanna Community in Chiangmai Municipality, Wat Choeng-Ta at Lopburi Municipality, Bang-Wang in Buriram and Sa-Plee in Chumpon.The study found that the sample groups from all study sites needed the information as followings: 1) the information concerning their immediate health problems, 2) the information caused by external motivation either from government or private sectors, and 3) the needs for “repetition” of the information according their daily needs. The study also found that, the information should be user friendly and easily accessible, combining of informative data and entertainment that related to their lifestyle and daily activities, that is interesting and interactive (two-way communicated).For the channel of information accessibility; all groups could access the information through to the television the most but at different time of the day according to age group and occupation group. For the children group, they could access the information through television and books in the school library and through their parents, neighbors and the elderly. For the labor group, which can be categorized into three sub-groups; 1) the labor under the 30 Baht coverage program (informal sector labor), the labor under the social security fund (formal sector labor) and  the labor under governmental health welfare (government employees). Each group has different potential to access the information on health.The study found that there are three factors associate with health information needs; firstly, personal factors which are sex, age, education, occupation, health condition and lifestyle; secondly, environmental factor which are health threat conditions in the community, the difficulty to understand the information, the ability  to access the health care unit, health problems of family members, the daily problem especially the external stimulations; and finally, health care attitudes and values of individuals on health care, the insecurity on their health condition and self-confidence on their health care.The study finding lead to the following policy recommendation: came on suggestions as followings; 1) Decentralize the production of the information under U.C. program in two levels which are at both national and provincial levels; 2) Revise the information strategies to suit the need of the community members such as: ease of use; combination of entertainment and informative data; use two-way communication by linking community members need with doctors or specialists, develop and strengthen the use of health-volunteers; and establish of a committee to be responsible for managing health promotion and disease prevention information; and 3) Use health promotion campaign to promote the need on health information by utilizing “social trend” and create health information programs that are “proactive.”


Social Organizations and Developments of the Community: a Case Study of the Community of Tambon Nakha, Amphoe Wapipathum, Mahasarakham Province	Three  major  purposes  of  this  study  were:  1) to  examine  developments  of  various  organizations  with  working  roles  in  community  characteristics,  2) to  investigate  factors  and  conditions  that  strengthened  different  organizations  in  the  community  and  had  being  community  characteristics,  and  3) to  examine  formations  and  developments  of  being  community.  The  study  was  conducted  according  to  the  conceptual  frameworks  which  were  factors  and  conditions  strengthening  different  social  organizations  or  having  being  community  characteristics.  These  included:  (1) opportunities  and  stages  which  were  placed  to  meet  and  exchange  learning  with  one  another  as  well  as  forming  groups,  (2) the  process  of  learning  and  decision – making  in  working  together  among  different  sectors, (3) leadership  styles  and  leadership  in  the  community,  (4) equipment  or  communication  techniques,  (5) feelings  and  thoughts  of  the  people,  especially  the  system  of  ideas  in  self - dependence  and  participation,  (6) activities  for  working  together  and  relationships  between  people  in  the  community  and  various  institutions  in  the  community,  and  (7) unity  and  cooperation  among  different  social  organizations  in  these  groups.	The  study  revealed  the  following.  Group  activities  that  occurred  before  1984,  as  promoted  and  urged  by  both  state  and  private  sectors,  were  in  these  aspects:  development  of  quality  of  life,  public  health,  social  welfare,  funds,  women,  youths,  careers,  community  shops,  and  rice  banks.  After  1984,  there  were  these  groups:  public  utilities,  welfare,  funds,  savings,  credit  unions,  community  rice  mills,  Bun  Khao  Chi  Merit – making  culture,  cattle  bank,  and  silk – cloth  weaving.  These  groups  were  established  by  state,  private  and  community  sectors.  Most  activity  characteristics  were  in  the  self – dependence  from  while  the  state  sector  support  partly.  However  some  groups  were  dependent  upon  the  state  sectors  such  as  village  funds.  The  private  sector  promoted  such  activities  as  cattle  banks  during  1998 – 1999  by  the  Thai  Farmers’  Foundation,  community  rice  mills,  silk – cloth  weaving  and  paper  sandalwood  flowers  groups,  and  centers  for  preschool  child  development  in  the  monastery  from  Wang  Chan  community  by  the  office  of  fund  for  community.  The  process  of  learning  and  decision -  making  included:  learning  together  within  the  group,  high  compromises,  kinship  interactions  among  persons  and  the  same  career,  and  being  dependent  on  one  another  in  the  village  and  the  community.  However,  in  width,  there  were  traditional  activities  of  Bun  Khao  Chi  merit – making  (by  offering  baked  glutinous  rice  to  monks)  and  social  funds  such  as  the  cattle  band  of  the  Lomkhom  Group  which  could  cover  all  the  tambon  (sub – district).  Youth  sports  between  these  groups  and  the  tambon  administrative  organization  could  be  found  in  the  Bun  Khao  Chi  activity.  It  appeared  that  the  tambon  administrative  organization  supported  groups  with  budgets.  In  local  politics,  it  was  in  the  kinship  type  as  a  whole  by  having  high  public  sense  together,  having  dividends  of  benefits  for  the  public  at  both  tambon  level,  i.e.  group  activities  and  the  Bun  Khao  Chi  merit – making,  and  at  the  community  group  level  which  included  saving  groups,  shops,  community  rice  mills  of  Wang  Chan  community  which  could  give  services  to  the  community,  villages  in  and  outside  the  tambon.


This research examines the contents of human rights in liberal and communitarian theories. While liberalism emphasizes liberty and equality of individuals, communitarianism claims the very rights of peoples and community. The question is whether rights holders can be both individuals and/ or a community.  The research discusses the various on-going debates between liberal and communitarian theorists relating to the issues of human rights and puts this in context with the right to health, in particular, how liberal and communitarian concepts have been used in the process of health reform in Thailand.It is evident that the present concepts and systems of human rights have been significantly influenced by Western political philosophies. In classical liberal theory, in order for the rights of individuals to be protected, the State must refrain from intervention. Negative rights – political and civil rights - must be respected. This concept has been argued against by other liberal theorists who consider that liberty brings about inequality and injustice. For the individuals to realize their very basic rights, the State must fulfill its obligations by guaranteeing some rights which enable individuals to maintain dignity and well-being. Positive rights - economic, social and cultural rights, or welfare rights – require positive action by the State. Rights are therefore indivisible and interdependent.Liberalists consider only individuals are rights holders; however, the communitarians argue that communities, groups and society can be also holder of rights; and those rights demand obligations by the State. Communities and societies, by virtue of their being a “person” by themselves, can act and have relationships to rights. In their view, insisting on individual rights is acceptable under the condition that the rights of community are recognized.The right to health, a very basic human right, is morally and legally recognized in all societies. The right to health is in general an individual’s right, arising from the sovereign right one has over one’s life and mind in particular. Well being and living standard of individuals can be realized only if both positive and negative rights are respected and fulfilled. In general, the right to health is closely related to liberal concept of rights. There is, however, an increasing trend to consider that necessary conditions for an individual’s well-being and right to health can be materialized only if community rights are respected and protected. In Thailand, the introduction of modern medicine allows the State to control the rights and life of both individuals and communities. The rights to health have been, for decades, determined by the State. The health reform process initiated some years ago is based mainly on liberal concepts, but while attempting to integrate communitarian concepts. For the success of health reform, the power relationships between the State, individuals, and community must be revisited. Rights to meaningful participation of both individuals and community should be the key to health reform. In order to achieve this a paradigm shift must occur in the health system of Thailand.


The Potentials of Mass Media in Health PromotionThe objective of the research is to review the potentials of mass media in representing health issues in Thailand.  The research are incorporated with 3 projects: The review of the status of the body of knowledge on mass media in health promotion in Thailand and other countries; the health agenda setting process of Thai mass media; The lessons-learned analysis of the health media campaign implementation in the context of campaign against AIDS, Dengue Haemorrhegic Fever prevention campaigns, Anti-Drugs campaign,  and Anti-smoking campaigns.   Documentary research, depth interviews, and ethnographic future research were implemented in order to collect data.	Research results indicate that:Mass media is one of the channels to disseminate health information to the publics.  In case of using mass media as the major communication channel, it is necessary to have a strategic plan and to consider the real potentials of mass media. Only mass media cannot lead to the desired behaviors; however, mass media need to be incorporated with other forms of media in order to achieve the goal. The health agenda setting process of Thai mass media shows that the government sector, the business sector, and the civic sector are competing to seek call attention from the media.  However, mass media are the major factor in decision making process, by considering to the movement, the hotness of agendas, and media producer factor.  Before presenting the agenda to the publics, all media will construct the reality at different degrees, dependent on the budget and information dependency, nature of mass media, and the ideology of the producer.The major components of media health campaigns include: (1) The personal/ organizational component —  leaders, partners;  (2) The process component —goals, target groups, information/themes, communication channels, communication strategies, and research;  (3) The system component — the development of the support for the potential of the community to run the local campaign, the cooperation with partners to develop other systemic measures in the society.The media health campaign in Thailand have 5 styles: A specific activity, a core and provincial teams, a main team and its partners, an office and its agents, an organization and its advocacy.The working process between a campaign team and mass media in Thailand include 7 styles: a step-by-step contact, a request for support, a partnership cooperation, a media buying, an information provider, a movement creator, and a heart-to-heart connection.Factors that lead to the effectiveness of media health campaigns in Thailand include (1) The personal/ organizational component —  a capacity of the leader to cooperate with partners, an avoidance to make foes, various partners, clear understandings about roles and responsibility of partners, proud feelings of partners to be a part of the campaign, good relationships with media and political partners. (2) The process component – A campaign without any announcement that it is a campaign,  a continuity of the campaign, a systematic planning, a smoothness of campaign implementation, measurable goals, a treatment of target groups as partners and a support for target groups to work as communicators or to run a horizontal campaign, enough information, a link between the information and Thai context, an appropriate design to save data, skills to present the information in the public,  various communication channels, a creativity to put the information in the media in a short period of time, a presentation of direct experiences of those who face the problems, uses of personal media to give information, an easy-to-understand, closed-to-the public, and concrete information, a formative research, a pre-testing process. (3) the system component – policy advocacy, the support of international movement.Factors that bring obstacles to the campaigns include:  (1) The personal/ organizational component – a treatment of the campaign as only a specific activity or an unimportant activity, an emphasis on image making, an uncooperative work between organization (2) The process component – the campaign management by depending on the top-down approach, by sticking to the budget or to the board members,  the complex information/themes, unorganized information, difficulty in thematic creation, no deep understanding of the problems, a message design without careful thought of the situation, a CEO acting as a creative, a creativity without understanding of the development of target groups, the dependency on mass media only, the emphasis on media strategies but not on message strategies, the emphasis on chic words without the real concept (3) The system component – the problem of a more emphasis of benefit side of the mass media, a restriction of the air time-sharing regulation, an agenda setting process of the media, an impact of personal arrangement in the media, a competition in media placement, and an ineffective relationship network among social members.Therefore, in order to run the effective campaign in the future, those who implement the policy should consider health campaigns as the public policy, support community-based campaigns, seek to cooperate with the partners in mobilize other policy measures and campaign measures. In terms of campaign management, partnership approach, the participatory process in intergrated campaign planning,  the development of campaign organizations and health information centers are necessary. In addition, the media buying process should be implemented under the learning process between campaign organizations and media organizations.  In terms of campaign implementation, the two-way communication with an open dialogue at all levels, the balance between communication through mass media and other channels, and the research-based decision making process are necessary.  In addition, health media advocacy campaigns should be promoted.


A study determining health performance indicator of ThailandThe research study is to determine the indicators of the performances of health system in Thailand thorough the two processes, searching input from various sources in Thailand and other countries and brain storming technique, to create the process of learning together among resource persons and academics that leads to the vital information for conducting further researches and programs. All the derived data were processed, analyzed and synthesized to determine the definition and the composition of health system, the objectives of the evaluation of the health system performance, the scope of the evaluation, the domains of indicators used in the evaluation, and the indicators appropriated to make use of in the evaluation. Besides, the suggestion of sources and the methods of which we derived the valuation of the indicators, the readiness of the implementation in investigating and collecting each indicator, and some special issues in a group of these indicators that needed to be developed and studied, were also presented in the study.The results of the study could not be used immediately and still need the process of broad considerations from academics and practitioners especially policy planners and executives which could be made by distributing all the information and receiving more opinions of all resource persons for the improvement of the outcome. However, this research has provided the scope and important guidelines, which are necessary for developing the evaluation of the health system in Thailand.Even though the suggested indicators of this study are used for health system performance evaluation; but through the way of using these indicators in the future, the development for further improvement will be needed continuously.


The condition of public sphere in Bangkok is one of research in the project of “Civil society and Public Sphere in Thai Society”. Indeed, the public sphere is an artifact of modernity’s social dynamics. This is why its ‘Structural transformations’ can be studies from a variety of socio-cultural perspective. Moreover, the notion of the public sphere keeps an essential resemblance to the notion of the political pluralisation of the public sphere in spaces of particular cultural life-forms. To study the kinds of public sphere in Thai society, especially about condition of construct the public spheres in Bangkok, there are four case studies in the research. to study the contesting of mechanisms of solving of landless policy by the center of Bangkok’s community development for poor people. to study of the role of NGOs for the emancipation of women public sphere of sex worker by the center for women empowerment.to study the independence of the rise of the public sphere upon the sexual differentiation by Krungthep rainbow group. to study of the roots of democratic politics in the private and public sphere of the middle class by Mass center of direct sale.In these four cases studies, the research find that the condition of constructions of the ‘public sphere’ in Bangkok are not only compatible with, but rather require an understanding of different mode of associations of human existence. By the same token, having a sphere of public sphere in which each case both loses itself and creates itself is depending on a condition of many cultural-historical phenomena.


The objective of this study which was on “The Development of People Sector’s Guidelines & Method of Assessment on the Health Impact from Government’s Large Investment & Development and Policy: Case-study of Assessment on Health Impact from the Pak Moon Dam Hydroelectric Power Plant Project” was to study about the impact on the health of the communities lying along the bank of the Moon River that had been affected by the Pak Moon Dam Hydroelectric Power Plant Project. The data was analyzed and used for the health impact assessment. In this study, the health impact assessment frame was used to build up a public policy on health. Four communities i.e. Ban Hua Weh, Ban Tha Phae and Ban Wang Sabaeng Tai of Khong Jiam district, and Ban Nong Pho of Phibun Mangsahan, Ubon Ratchathani province were selected as sites of the study. The criteria for community-selection were: (1) Location of community: dam-downstream community, headwork community and dam-upstream community, (2) Nature of impacts: community that lost fishing profession only; transferred community that lost both occupational land and fishing profession. Findings of the study: The villagers defined good health as, “a happy living”. By villagers’ definition, 5 factors that determined health were: (1) Natural resource stability, (2) Food stability, (3) Economic stability, (4) Environmental stability, and (5) Social stability. The study discovered that Pak Moon Dam was an important factor for the change of the factor that determined health. This was because natural resources which were the base of some portion of villagers’ production had been destroyed and become deteriorated by the construction of the dam. As a result, the villagers lost food stability, economic stability, Social culture stability  and life happiness. But, when a trial was made for the lifting of the Pak Moon Dam water-gate, the factors that determined all aspects of villagers’ health rapidly returned. However, the condition was not as good as when the dam was not yet constructed. As a result of the trial, health, by villagers’ definition, became better than when the water - gate was closed.The study on the assessment of health impacts from Pak Moon Dam hydroelectric power plant found out that the Pak Moon Dam construction had impacts on physical, mental, social and spiritual health of the villagers. Regarding physical health, some sicknesses related to itchiness, respiratory system and stress occurred to the villagers. But during the water-gate lifting period, some sicknesses i.e. itchiness started to disappear. This was because the water from the Moon River had been drained to the Mae Khong River. Besides, concerning physical health, there were some other sicknesses which were of villagers’ concern such as AIDS, diabetes, liver-related sicknesses, stomach-related sicknesses, etc. Regarding mental health, it was found out that the dam construction was a factor for the villagers’ stressfulness. The villagers became worried about livelihood. They were stressed with neighbors & relatives who disagreed with the dam construction. Conflicts occurred within family, community and the public. Due to water-gate lifting, the mental condition of the villagers became, to certain extent, more relaxed. The villagers were able to catch more fish than when the dam was closed. However, they felt not secure yet for investment on fishing or agriculture because they were not sure of the dam-opening period.Regarding social health, it was found out that dam construction was a factor of change. It decreased relationships among family-members because family members had migrated to work outside communities; joint activities decreased. Communities were in a situation where people just lived for themselves because they had to struggle for their own livelihood. As a result, sharing & caring for one another decreased; cooperation in development activities also decreased. Ideas, belief and wisdom on Moon River became less important. But, during the period of water-gate lifting for water to flow, a clear change occurred i.e. communities started to practice Moon River-related activities i.e. “Boon Nao Kaeng” and “Sao Luang Mong” festivals; families & communities together went for fishing.Regarding health in the spiritual aspect, it was found out that the dam was a factor for the change in the way of life that used to be favorable to the spiritual health of the Pak Moon villagers. They became lack of a way of life that relied on nature. Cultural diversity decreased. Generosity, caring and sharing with one another decreased. Good relationships within family and community became lacking. Transference of wisdom from parents to children became lacking. Areas for communal use such as temples and islets in Moon River became lacking. Communal activities such as religious festivals, recreation, community development became lacking. And, serene, peaceful and happy life became lacking. Consequentially, with regard to spiritual health, individuals, families, communities and the public were living in a state of craving. They were shaken & worried amidst conflicts. They did not have peace and live unhappily.This study revealed that the dam was an important factor for a change in the health aspect which represented the villagers’ and communities’ way of life. Therefore, before, during and after implementation, development projects of different aspects need to assess their impacts on health. It is necessary to have a holistic concept and view on health and to foster environmental and social relationships.


This study aims to assess the existing potentials of village health volunteers in
Thailand in the context of changes. The research process involved the review of
related situation both from relevant documents and from a technical workshop with
experienced health workers. Commissioned papers were assigned to potential
researchers in various areas of inquiry such as the changing situation in community
health, the historical evolution of the concept of health volunteers in Thailand,
community volunteer in the context of emerging diseases, as well as the review of
supporting system for village heatlh volunteers. A quantitative study was also
undertaken to identify existing performance, incentives, and obstacles of village
health volunteers. In addition, in order to identify future potential of health volunteers,
interesting volunteer works in related health fields were identified. 15 case studies
were documented and used as input for the final synthesis of developmental
strategies.
Findings of the study can be summarized in an eight-point synopsis. (1)
Concept and operational model of village health volunteer was the product of
historical development. As health situation and political landscape has changed in the
past few decades, there was a need to reconceptualize the idea of health volunteer; (2)
Village health volunteers in Thailand numbered almost a total of 800,000. It was an
extremely valuable health resource. Village health volunteers were mostly selected by
local communities. Although the recruitment of a number of them was relatively
problematic, village health volunteers were mostly well respected by local villagers.
Volunteers were generally selected because local people knew them as ones who
devoted to collective affair and people trusted them. (3) Existing system of village
health volunteer in Thailand was still very much alive and has become increasingly
famininized. More than 35% of existing volunteers were recruited in less than five
years, while the number of female volunteers rosed to almost 70%. (4) Existing
village health volunteers performed comparatively well on short-termed task such as
ad hoc health survey, periodic collecting data, or disease prevention campaign. They
did not fare well in the area of work that need long-term, continuing devotion, such as
caring of chronically ill patients.
(5) Existing volunteer workforce was recruited from comparatively low
educational and economic background. This poses the question, how could higher
quality of volunteer workforce with an economic status more prepared to dedicate be
recruited? (6) The changing supporting system and decentralization has greatly
affected the relationship between health volunteers, local administration, and the role
of Ministry of Health. Although a coordination mechanism was recently created at
various levels, local health volunteers have little participation above the district level.
(7) Village health volunteer has been apparently politicized and become instrumental
in local and national politics. (8) A number of case studies suggested an increasing
innovative roles and forms of volunteers in health development, ranging from
volunteers in hospital settings to diaster relief volunteers. This strongly indicated that
the idea of volunteer has been progressively more accepted in Thai society.
The followings are recommendation for future development of health
volunteers. (1) The Ministry of Public Health needs to shift its role from being the
possessor of health volunteers to the role of promoting the idea of health volunteers in
various appearances. (2) Support the formation of health volunteers in every field of
health activities. Each and every organization in public health should be encouraged
to create and organize its own network of volunteer workforce, rather than depending
solely on village health volunteers as the only form of people participation. (3) Creat
more spaces for volunteer work in various public health offices by promoting health
organizations to open up more opportunity for volunteer work in the organizations (4)
Pluralize forms of health volunteers in local communities. The standard operational
model of village health volunteers, while contributed greatly to last few decades’
health accomplishment, has reached its limit. (5) Encourage public health officers to
work as volunteer themselves as a way to promote volunteer spirit in public health
organization. (6) Develop self-governing mechanism to make health volunteer a nonpartisan
organization.


Macro-economic indices for measuring equity in health finance and delivery 1986-1998	Explicit policy on health equity will create demand to measure and monitor the achievements of health equity in the country.  At least three disciplines express concerns on health equity: public health, economics and social science.  This study employed the macro-economic indices to measure equity in health finance and health delivery.  The interpretation of equity in health finance was based on the principle of ability to pay.  Kakwani index of progressivity was used to reflect the ability to pay of each source of health finance.  Equity in health delivery was interpreted that health care be allocated according to health need.  Those who were sicker should seek more care than the healthier.  The concentration index was used to measure equity of health delivery.	The National Statistical Office’s socioeconomic and health and welfare surveys during 1986 to 1998 were used to demonstrate the equity trends in Thailand.  Since the health and welfare surveys contained no data on household income, the indirect method was used to map the income of the household in the socioeconomic surveys to household in the health and welfare surveys by education and occupation of household heads.	Kakwani indices proved that health finance system was regressive to income, the trend established less regressivity from 1986 to 1996.  The causes of inequity were explained by an increase trend of income disparity (by the Gini coefficient) and the regressivity of Kakwani indices for both public and private sources of finance.	Concentration indices for health problems were also regressive to income, i.e. the poor were more ill than the rich.  When compare illness with delivery (seek care from drug store, health centre, clinic, public and private hospitals), the concentration indices showed progressivity patterns, i.e. the rich were more likely to use health care, controlling for same health need.  Further standardisation removing the effects of age and sex, the inequity patterns slightly reduced.	This research suggested that the health equity policy goal in Thailand should be more explicit.  Especially, the goal of equity in health finance should be set by reducing income distribution disparity, the progressivity of the whole tax system and contribution from the social security scheme, with less emphasis on the user fee at the point of delivery.  Information system should be improved to help monitor equity in health delivery.


A study was conducted to determine the unit cost of provision of health services in all 3 levels of health care centers along the Thai-Myanmar border in Tak Province between 1 October 1996 and 30 September 1997. Health care settings included Mae Sot General Hospital (310-bed), Mae Ramat Community Hospital (30-bed), and all 29 health centers in Mae Sot District and Mae Ramat District. We used the simultaneous equation method for cost analysis in the hospital and the district distribution method for the health center. Units in the hospital were classified ad 1) non-revenue producing cost center, 2) revenue producing cost center, 3) patient service, of 4) non-patient service, Unit categories for the health center were transient cost center and Absorbing Cost Center ACC 	The ratio of labor cost: material cost for the general hospital was 59 : 41. The ration of labor cost : material cost : capital cost was 61 : 29 : 10 for the community and 43 : 42 : 15 for the health center. The unit cost for out-patient service was 122 baht for the general hospital, 96 for the community hospital, and 74 for the health center. The in-patient unit costs for the general and community hospitals were 5,734 and 1,945 baht respectively. The in-patient unit cost in the general hospital was significantly (p<0.05) lower among Thai patients (3,092 baht) than Myanmars (5,781 baht). Significant differences (p<0.05) in the unit cost by disease between Thais and Myanmars were detected for thyroid disease, malaria, ceasarean section and uncomplicated appendicitis, They were no significant differences between Thail and Myanmar patients in both out-patient (48 VS 56 baht respectively) and in-patient (1,710 vs 1,640 baht) unit costs in the community hospital. 	However, the unit cost by disease for out-patient service in the community hospital was significantly (p<0.05) different between Thais and Myanmars only in pharyngitis whereas such differences were not found for in-patient service.


After the event in October 14, 1973, the students, co-operated with the administrators of Mahidol University, arranged the seminar on “the Mahidol University Development Project.” The ideal of “personnel production to serve the disadvantaged people in the society” was made for the members of the Mahidol University Students’ Club(MUSC). The Mahidol United Party could win the election and the first Chairman of MUSC was the Medicine Student Weng ToeJirakarn. The students’ The students’ activities, formerly emphasizing on technical affairs, sports, music and voluntary camps, had been given more importance to the social and political activities of which the centre was established in the recreation building. 	In the 1974 academic year, the MUSC arranged the “edcation and development camp” which emphasized on the learning of social problems and the training to live with the villagers. In this year, a group of the Mahidol University students joined two projects which ran by the Government: the democratic dissemination and the aids to farmers. They could learn the problems of the landlords-capitalists’ oppression and exploitation against the farmers. Additionally, they could see the authoritative persons’ distortion, incrimination and serious suppression against the people. These encouraged their political alertness and they could understand the suffering of the grass-root people, untill the actively created theconsciousness of serving the people.	The activites o fthe Mahidol University students which could enthusiastically support the struggle for equity of the people were those of the Nursing Unit for Mass (NUM), Which was developed from the small nursing unit in the 14 th October event, and those of the Labourers’ Band, the string-band for life. Both them were the most popular at that time. They played the important roles and always worked together on various stages. While the songs of the Labourers’ Band encouraged the fighters, the NUM also assisted in treatment for the persons who were threatened, hurt and injured.	As to the students continually joined their activities outside the university, they were blamed as those who misunderstood of themselves, overdid their duties and neglected their classrooms. This caused more conceptual conflict among the students and the instructors administrators, as well as among themselves. Misunderstandings in various matters became more serious conflicts that the Dentistry Faculty students claimed against four of the administrators and instructors to quit, because the administration and the instruction were unsatisfactory. Finally, the students’ protest and strike were called for months.	The “Rightists VS the Leftists” Movement had been brewing since the mid-year of 1974. Going out for activities in rural areas and the gatherings of the students were threatened. The labourers, the farmers and the student leaders were assassinated, including two student leaders- Mr. Preeda Chindanondh of the Labourers’ Band and Mr. Amares Chaisa-aad, Vice-Chaimam, the coordinator for outside activities of the Mahidol University Students’ Club (MUSC) and the Treasurer of the Students’ Centre of Thailand . During the years of 1975-1976, the situation was more serious. As the students with low experience made lower evaluation of the suppressive and authoritative persons in terms of the violence and the tactics, they also could not co-ordinate in the time of crisis. The suppressive blockade event in Thammasat University, in the early morning of October 6, 1976, consequently caused the great loss. The Nursing Unit for Mass, the Labourers’ Band and a part of the Mahidol University students as the safety guard unit held their responsibilities until the last second. In that event, five of them lost their livers.	After the 6th October sanguinary conflict, many students were arrested and put into prison. The Coup d’Etat with the absolute right-wing policy seized power and Mr. Thanin Kraivichien was appointed Prime Minister. The leftists were heavily suppressed. The unsafety condition covered both the society and the universities in general. At that time the students’ movement separated into two parts. One part escaped into forest and took weapons to join the Communist Party of Thailand. While another part was still in city.	Some hundred of the Mahidol University students scattered in the different sites in forest throughout the country. A majority of them acted as the forest military doctors who played the role in the medicine and public health development, in the forest-mountain areas. They produced alcohol, saline solution, anaestheitics, liniments and other medical products, by using the raw material in localities. They opened the medical training school for general doctors and doctor assistants. The medical school with special curriculum on surgery and general medical treatment was also established. The curriculum and the textbooks were written from what they learnt in the city. Those fellows as they called themselves “sa-hai” also learnt the acupuncture treatment from China and integrated such practice with the Thai traditional wisdom on herbs. Approximately in the year 1978, some of the Mahidol University students were sent for further education in medicine, pharmacology and veterinary in China.	In city, though all of the students’ activities were forbidden, the movement was secretly carried to support their “sa-hai” in forest. The reproduction of the answer sheets of the entrance exam questions was sold for funding. They visited their fellows who were arrested in prison without fear of the State’s power. This matter brought perssure force to bear on the Governmen, both from inside and outside the country. Finally, the Coup d’ Etat was made, with more relief policy, by Gen. Kriangsak Chamanan. The Mahidol University students’ activities were revitalized with the emphasis on professional movement. They arranged the Mahidol Celebration’78 and went out to assist the flood victims in the Northeastern area, with the co-operation of 12 institutions. Later on in 1979, they gathered and formed into the Students’ Club of 18 institutions.	Since 1978, the Government allowed for the set up of Students’ Club by the indirect election. The movement for the direct election of the Students’ Club, the appeal for the Students’ Council and that for the Students’ Party were made, and they could gain success in 1980. Afterwards, the Students’ Clubs of 181 institutions made more socio-political movements such as the protests on the anti-bus fee raise, on the anti-electric fee raise and on the Vietnam attacking Cambodia. At the same time, the movement of universal socialism was declined; with addition to the Government’s policy which allowed the students who escaped into forest to return to further their education. Many survivors of the Mahidol University students could consequently return to study once again.	The growth of capitalism technology sent much effect to the overall changes. It could be said that the crisis of faith in the socialism ideal was the main cause against the weakness of the students’ movement. In 1984, the first-year Mahidol University students of all faculties had to move to Salaya, and most of the experienced key persons finished their education. The socio-political students’ activities gradually came to and end. The “recreation building.” The fostering centre for the Mahidol University activists was over. 	It could be said that the struggle for democracy of the students in that period of time has made a greater contribution to Thai society. It could foster the qualified personnel whose creative roles and movements could make progress to the medicine and public health in rural areas throughout the country up to now.


Health system reform process in Thailand is a continual process which one goal is to achieve National Health Act which has been drafted through participatory process since 2001 and submitted to the parliament sine the end of 2002. The reform is also aimed at create public awareness of health through shifting the paradigm on health to encompassed all four dimensions of health, such as physical, mental, social, and spiritual wellbeing. Thus popular process and mechanism to create such awareness need a mass movement of change. Social exchange and learning process are key component to reform health concepts and practices by expecting togetherness and collaboration from people in different sectors. Health assembly is one of a mechanism to create such participation from all sectors. As a result, people would be able to build their network and expand what they learn from assembly to their neighbor and friend. Finally they would be able to create their own civic organization or gathering to generate health practice for healthy society.	From this study it is found that the health assembly at area based level achieved limited result in bringing people together based on their local concerns/issues. Numbers of network that join in the process are the existing network prior to the reform process. Health reform process could do limited to link their existing problem to the health issues, thus awareness of health reform and shifting of health paradigm are also limited. There are numbers of issues that need to further improve the process to really create popular mechanism for people to begin to understand the reform, particularly toward more preventive health behavior and preventive social environment.	People in the urban areas like Bangkok metropolitan are the least aware of the health reform and movement for national health assembly. They are only aware of government projects  such as universal health coverage, bureaucracy reform, exercise campaign and food safety campaign. People do not have strong mechanism to change their thinking of health toward more multi-dimension concept. Health remains a matter of physical well being only. Thus there is real need to continue the movement to generate the idealistic reformation as planted in the draft of  National Health Act.


The Study of the health risk assessment management system in Map Ta Phut Industrial Estate	The objective of the study of health and environment management situation is to review the role and function of the health and environment management from relevant organizations in Thailand as well as in other countries. This study is sub – project of the study of the health risk assessment management system in Map Ta Phut Industrial Estate project.Result :The relevant organizations;The relevant organizations in Thailand  are Ministry of Public Health , Ministry  of Interior , Ministry of Labor and Social Welfare, Ministry of Industry, Ministry of Science Technology and Environment. Those ministries have the infrastructure at provincial or regional level to carry out the activities.The relevant organizations in other countries which involve to manage health and environment are World Health Organization, United State Environment Protection Agency, Occupational Safety Health Authority, other organizations in United Kingdom, Germany, Kazakhsatan and Japan.The health management in Map Ta Phut Industrial Estate;Increasing potential of Rayong hospital to be the center of occupational medicine and environmental medicine diagnosis.Develop and improve the nearby hospital or the clinics to be the networking  such as Ban Chang hospital, Map Ta Phut hospital , Pluak Daeng hospital and Klaeng hospital.Service the health promotion , family planning , disease control and nursing care  in the programme of public health service as well as in the active mobile service unit. For worker health examination and treatment , there are 2 services available ; on site service and at the hospital service . The result of the above management are reported routinely and accessible for the public.The environment management in Map Ta Phut Industrial Estate;There is the central wastewater treatment plant. The influent and effluent of  wastewater are monitored before released from the plant. The environment which  are canal , sea, groundwater and ambient air are monitored routinely.In the workplace , environmental parameters must be monitored according to  what have been defined in the environment impact assessment study.In the communities , the environment quality are monitored as well. The result  of the above activities are reported routinely. The frequency of reporting is based on the EIA and regulation which is different in  each type of factory.


The objectives of this research are to study: 1) the knowledge, understanding, and health promotion practice of  medical doctors; 2) the health promotion delivery process of public and private hospitals; 3) existing compensation and incentive measures provided medical doctors to enhance positive health promotion behavior; 4) condition for health promotion practice of medical doctors; and 5) guidelines for the development of effective compensation and incentive mechanism enhancing participation of medical doctors in health  promotion. Samples in this study are 15 central, general, community and private hospitals representing the Northern, Northeastern, Southern and Central Regions. Interviews are conducted with 26 hospital administrators and 41 medical doctors, while group discussions are organized for 106 medical personnel and 300 copies of questionnaire are administered to 300 patients.	The study finds that medical doctors have fair knowledge and understanding on health promotion. For instance, they understand that health promotion is a preventive measure, “good health” covers 4 dimensions namely physical, mental, social and spiritual, health promotion is worth as an investment and is very one’s responsibility. Most medical doctors view that the Health for All Policy which emphasizes health  promotion service in congruent with treatment is a good policy but has not yet been materialized.	Health promotion behavior of medical doctors at the time of the study is not much evident. Those who adopt the practice are found to be the ones who have been trained in family medicine or specialized doctors who are personally interested and voluntarily carry out the task, believing that  health  promotion makes people healthy and do not need to come to the hospital for treatment which helps saving the expenses. Health promotion roles of medical doctors are found to include: 1) giving health promotion service to individual patients; 2) giving health promotion information to groups of patients; 3) formulating health promotion policy; and 4) acting as good examples in health promotion for the people.	Health promotion process as practiced by general and specialized medical doctors in different categories of hospital relatively differs. Most central and general hospitals tend to introduce health promotion service in a lesser degree than community hospitals, but more than private hospitals. Generally health promotion process takes place during the treatment rather than before of after the treatment and has not been operated holistically, as physical health is more emphasized than mental, social or spiritual health. Conditions hindering medical doctor’s health promotion behavior are the lack of clarity and integrity of the policy, budget allocation which does not facilitate the process, outnumbered patients, heavy workload, long-time measurement of success, lack of spicalization, less chance for progress and social acceptance.	Compensation and incentive measures for medical doctors and other medical personnel are not visibly existed. Doctors who give health promotion service are mainly inspired by their in-born attitude, by the leaders, teamwork and spiritual support from the patients. Contributing factors as seen by the doctors are for instance appropriate and fair compensation, recognition of their dignity, opportunity for professional progress, balance between number of doctors and the workload, corresponding educational system offered in schools of medicine, upgrading of doctors’ skills and support from the administrators	Recommendation of the study are that health promotion service should be successively continue in accordance with The National Health Insurance Act, B.E. 2545. Schools of medicine’s curricula should have more contents on health promotion and appropriately integrate its body of knowledge therein. The hospitals should be prepared for health promotion  service which includes the policy consideration, plans, activities, structure, resources and public relations. Concept that doctors are the main engineers of health promotion system should be cultivated and consequently incentive measures and appropriate compensation should be established for them along with other health promotion development mechanism.


The Synthesis of Knowledge on  Informal Workers	The purpose of this study is to synthesize the body of knowledge of informal workers, funded by the Health Systems Research Institute, Thailand.  The study aims to better understand the circumstance of informal workers and the impact on their health.  Moreover, the study will be a guideline for policy recommendations and legal suggestions that are necessary for informal workers.  Previous studies included in this review are of published and unpublished documents.  	This study concluded that  there is not clear on definition and statistics of informal workers.  Informal sector provides many benefits to country both at macro and micro levels.  However, informal workers still face with a lot of problems such as unclear status, unsecured work conditions, inappropriate work environment, lack of enhancing their skill, low income, no social and legal protection, lack of responsible organization.  In addition, important health problems are risk and dangerous work, health problems related to work conditions, rush work, and long period of work, lack of adequate health information, lack of social insurance.  In terms of law, informal workers do not include in the relationship between employer and employee system.  Therefore, they could not get any benefit of social insurance.  They are applied with commercial legal system that has a weakness point since partners of agreement can agree, by themselves.  This study proposed policy recommendations and identifies areas that require further research.  These recommendations are offered to enhance, develop and protect the quality of life for informal workers, as well as a guideline for their welfare.  They may lead to improve the health care system and enhance appropriated health insurance for informal workers and their families.


Hospital Financing: Clinical Budget Holding to Increase Efficiency in Provincial Hospitals	Inpatient care is the most expensive health expenditure in almost all countries with limited measures to improve efficiency.  This action research aimed to test the model to increase hospital efficiency.  Under the assumption that if clinical directorates were given the authority to manage clinical budget, efficiency was likely to occur.  Three provincial hospitals were recruited to this action research, a purchaser-provider model was created.  This model transferred management responsibility from the hospital director to the clinical directorates.  They played the purchaser role by holding their own clinical budgets.  Pharmacy, radiology, laboratory and operating theatre acted as providers in this model.  It was expected that clinician behaviours would change, because if they could save their budget in treating their patients, the unspent money would be retained and could be used for their development plan.  However, the quality of care should not be compromised by this quasi-experiment.	Firstly, the incentives of clinical departments to be efficient focused mainly on financial measurement; i.e. the expected budget by diagnosis related group of each department and cost accounting data versus the actual spending by billing data.  After a year of implementation, the clinicians argued that other indicators should be taken into consideration because of the weakness of financial data.  Complementary data included lengths of stay compared by DRG, physician workload by length of stay and DRG relative weight.	This action research proved that the measurements for hospital efficiency were complex.  Quality audit had to be in place but the activity was still too early to be a measurement that could link to performance of each department.  Client satisfaction had not been measured in this study since the individual clients were too far from the tested model.  Physicians accepted that DRG was a good measure of efficiency but had to be complemented with other information.  	Findings of this research should be used to develop management model in the decentralised autonomous hospital.   Clinical directorates need more training in searching for hospital efficiency and manage the changes.  Information systems must give accurate and comprehensive aspects of efficiency as well as quality.


Thai Pharmaceutical Industry:Present Status and Potential-Future TrendThe purpose of this study was to find appropriate means to support and strengthen the pharmaceutical industry.  The present status and potential of the industry were analyzed and the future trend of technology was predicted.  The study comprised two parts.  The first one involved a brain storming session among 34 participants from both private and governmental sectors including one FDA personnel.  Sending a questionnaire to the pharmaceutical manufacturers asking about their activities was the second part of the study.  Twenty six factories, 2 of which did not obtain GMP certificates, responded to the questionnaire.	It could be concluded that the nature of the industry was formulation process.  The research and development dealt with formulation and process improvement.  The industry received little support in production and quality control aspects from both the government and the universities.  However, satisfactory support was received in the areas of GMP improvement and drug importation.  Approximately 90% of the raw materials was imported while only 6% of the finished products was exported.  Most formulations were generic products.  Due to a lack of technology and expensive equipment, very little products required sophisticate technique.  To develop and strengthen the industry, fair competition should be stressed.  Instead of emphasizing low pricing, the government should urge the manufacturers to concern more in the quality of the products.	The study indicated that Thai industry had a potential to develop and compete with the neighboring countries.  It was believed that both the numbers of factories and drug registration would be declined.  If the government authority supported fair and free competition and reviewed the low-priced bidding policy, in addition to the universities’ assistance, the pharmaceutical industry would be moving forward.


Title	Expectation, health seeking behavior, and impacts of universal health coverage : people’s viewsAuthor	Onchana Na RanongFund source	Health Systems Research InstituteYear Print	2005	This paper examines the impact of the 30 Baht Health Care Scheme – a part of the Universal Health Coverage Program – on Thai people. The study is mainly qualitative, employing both focus group and in –depth interviews in order to obtain views from people in the ten provinces throughout all regions of Thailand (including the Bangkok Metropolitan Area). The study sites include both urban and rural communities. 	The study finds that health seeking behaviors are determined, often concurrently, by one or more of the following factors : income, health care coverage, transportation costs, health status/ sysmptoms, age group, and the information patients have. Although the 30 Baht Scheme reduces some people’s health care expenditure, other opt out of the service because of the lengthy queues and non-confidence in the quality of care, especially high or medium income families. Moreover, unequal treatment on patients with different schemes, especially moral hazards on the provider side, are also often mentioned in the focus groups.	While the highest priority of the poor is to acquire low-cost or free health care services, respondents from other income groups place more emphasis on the adequacy of hospitals and personnel-especially doctors, or good treatment from health care personnel. However, most subject would like to have the scheme in place in order to help the poor, and to guard against their own catastrophic illnesses. In general, the 30 Baht Scheme-like other preceding schemes in the past three decades, has enhanced health security for many Thai people. Respondents from various regions noticed improvement in the services, especially that of the front ends of the hospitals. However, the quality of health care still remains an issue that clouds the scheme.


The social and health problems of construction workers in BangkokThe objective of the study was to acquire social and health-related information of workers in Bangkok construction areas.  The cross-sectional descriptive research was carried out, and the construction areas used in the study were divided into internal and external areas of Bangkok.  A simple random sampling was used to identify the sampling frame, the representative of the internal and external areas, which Klongtoey and Ladkrabang districts were chosen respectively.  The same technique was then used to randomize 10 each of large and small construction sites.  A systematic random sampling was used for the selection of the workers of each site.The study showed that 67% of workers in Bangkok were in working age.  The ratio of male to female workers was 1.4:1.  The study also found that 88% of them were from the northeastern and northern region, that 84% were married, and that 87% completed primary level of education.  Additionally, 64% were daily employee with no definite contract.  On average the workers had 2 children.  Of which, 4% aged under one year, 27% aged between 1 to 5 years, 16% aged between 6 to 8 years, and 33% aged between 9 to 15 years.  Only 13% of the children aged 6 – 15 years lived with their parents.  There were no differences on basic information of the population between those working in Klongtoey District and Ladkrabang District.  Nor were those working in a large construction area and a small construction area.  However, for other aspects, such as environment, safety, wages, and other benefits, those working in a large construction area tended to be in better condition than those in a small area.  So did the Klongtoey workers as compared to Ladkrabang workers.  Serious morbidity rate due to accident while working was 58.7/1,000 workers.  For the past 12 months, injury while working was 208/1,000 workers in Klongtoey and 180/1,000 workers in Ladkrabang.  This was probably due to the fact that the employer did not adequately provide equipment for personal protection, and the workers themselves did not pay attention to the use of such equipment as their own protection either.Working environment and residential area, including sanitation, were not in a good condition.  Most of the workers (53%), especially male, had personal risk behavior, such as drinking, smoking, using drugs and narcotics, and having stress problem.  Periodontal disease and dental caries were major problem in dental public health.  Moreover, the study showed that most of the workers lack knowledge of labor law, workers’ right and benefits.


Rationale: Increasing numbers of law suit cases against medical practitioners signal the whole Thai society to pay more attention to the problem. This study focuses on studying the nature of medical reviews as tools for monitoring and assessing the problems of adverse events (AEs) occurred in hospitals. Objectives: The study aims at 1. Evaluating inter-rater reliability of medical record reviews in detecting AEs. 2. Evaluating changes of inter-rater reliability of medical record reviews when more financial incentives are proposed to the reviewers. 3. Evaluating usefulness of medical record reviews in terms of types of quality issues identified and applicability to the decision making on patient compensation. Methods: the study is divided into 2 phases. Phase I : 279 medical records were independently reviewed by 23 auditors. Each record was examined by 3 auditors using a standardized review form. Agreements on the occurrence of AEs were assessed using Kappa statistic (κ). Phase II : Lessons learned from the first phase were used in modifying the review form and processes of medical reviews. 50 medical records were independently reviews by 13 auditors. Early in the process, 7 of the auditors were informed that they will be given 50 – 100 % extra fees if the agreement of assessing the AEs among them was high. The rest 6 auditors were informed the same message later after they had finished reviewing the first 25 records. Agreements on the occurrence of AEs were assessed using Kappa statistic (κ). Statistical differences between kappa were tested using Mann Whitney U Test. 95 % confidence interval of kappa was also calculated. Content analysis of opened questions was done to categorize the reasons for making AEs diagnosis given by the auditors. Modeling from the Norwegian system of patient compensation, the author had tested whether the results of the medical reviews can be used for the compensation decision. Results: Phase I: Agreement on determining AEs occurrence was fair (weighted κ = 0.34, 95%CI= 0.22-0.45). Agreement on determining AEs preventability was fair (weighted κ = 0.27, 95%CI= 0.16 to 0.39). Phase II: For Agreement on determining AEs occurrence was fair (κ = 0.27, 95% CI:0.24 ถึง 0.30). Agreement on determining AEs preventability was also fair (κ = 0.22, 95% CI:0.19 ถึง 0.25). Informing auditors that they would be given extra fees had no positive effect on the agreement on determining AEs occurrence and preventability (p-value > 0.05). Reasons for determining AEs occurrence and preventability have revealed a numbers of common quality related problems, for example, missed diagnosis, delayed intubation, inappropriate antibiotic, inadequate treatment, overloaded fluid, overdosed Insulin, Propanolol in the bronchospastic, inadequate electrolyte monitoring, one-lung intubation etc. 42 % of the patients were considered to have rights for compensations according to the criteria used by the Norwegian patient compensation system. Conclusions and Discussions: The reliability of medical record review to detect AEs seems to be influenced by the rate of the event occurrence as well as the variability among reviewers. Whereas, financial incentive has no effect. The use of multiple reviewers to detect AE will produce unstable rates of AE occurrence, but is a reasonable and beneficial tools to search for wide ranges of quality related problems. Reasons for AE occurrence and preventability given by reviewers can serve well as a basis for making decision on patient compensation using the Norwegian criteria. The tool developed by this study is recommended to be modified and used as a tool for voluntary AE reporting and quality improvement process.