This research aimed to study the cost of health service model for COVID-19 inpatient care that hospitals provided according to the level of inpatient’s condition. The data were from a 5-hospitals case study in Thailand, employing a standardized top-down cost analysis and the micro-costing method based on provider perspective. Three regional and two general hospitals participated by providing hospital data of the fiscal year 2021. There were 7 health service models under study: 1) cohort ward 2) intensive care unit-cohort ward 3) hospitel 4) field hospital 5) field hospital for prisoners 6) home isolation and 7) community isolation. The average cost of treating COVID-19 patients was 31,342 baht per case for the average length of stay (aLOS) of 10.9 days. The cost at the ICU-cohort ward was the highest at 187,257 baht per case, followed by the cost at the cohort ward at 62,033 baht per case and the lowest cost at community isolation at 4,532 baht per case. For COVID-19 patients who experienced more than one service models due to clinical condition change, the average total cost was 91,568 baht per case for aLOS of 11.0 days for those cared in community then moved to hospital; and 149,844 baht per case with aLOS of 12.1 days for those cared in cohort ward then moved to ICU-cohort ward. The results of this study demonstrating different resource uses by service models could be used to evaluate the amount of COVID-19 budgets that health insurance funds made available and paid for service delivery of the hospital compared to the actual cost by service model.


Budsarakhum Hospital was a large field hospital specialized in providing temporary care for COVID-19 patients. The research objectives were to describe the current situation, problems, constraints, and administrative strategies of Budsarakhum Hospital and to develop policy recommendations for field hospital administrative systems. This is qualitative research and documentary review with a purposive sampling on directors of field hospitals from public and private sectors; emergency medical specialists; administrators and health care providers; including patients who were admitted to Budsarakhum Hospital. Data were collected from participants through in-depth interview and analyzed using the content analysis. Results: 1) From literature review and interviews with experts, administrative system of Budsarakhum Hospital was compliant to administrative model of field hospital for COVID-19, in the scope of input, process and output. However, the emergency human resource mobilization and outcome monitoring were unclear. 2) Problems, constraints, including hospital administrative strategies were identified on hospital structure, extra-organizational communications, risk management, infection control, personnel recruitment and stress management, medical record system, handling of medical materials/devices, admission process, clinical care, patient referral system, and outcome monitoring. 3) Policy recommendations on administrative system of field hospital focused on the information for the public, private, and people sectors to prepare themselves to deal with the epidemic particularly field hospital administrative system if facing future crises.


The COVID-19 outbreak greatly disrupted healthcare systems and made it more difficult for patients to access treatment, ultimately affecting the quality of life of patients and society. This paper highlighted the issues and importance of policy management and examined the financial cost and social benefits of treating allergic rhinitis and allergic asthma caused by house dust mites (HDM) amid an outbreak of COVID-19. A comparative analysis was executed between HDM sublingual immunotherapy (SLIT) as an intervention and subcutaneous immunotherapy (SCIT) as a comparator. It was found that HDM SLIT provided a better return on investment from the perspective of society during the COVID-19 pandemic in 2021 than HDM SCIT. The benefit to cost (B/C) ratio of the HDM SLIT to HDM SCIT was 1.72 and likely to be less than 1.00, respectively, which were statistically different. Policymakers could use these results to establish strategies for treating allergic rhinitis with and without asthma by choosing between HDM SLIT and SCIT, particularly during the pandemic.


This research developed tools and data systems to collect field data and evidence for monitoring health and vocational impacts from transboundary air pollution from a coalfired power plant in Lao on laypeople in 8 villages in Huai Kon subdistrict and Khun Nan subdistrict, Chaloem Phra Kiat district, Nan province. This research applied the principle of community citizen science (CCS), starting from formulating research questions to address the community’s concerns and negative direct experience potentially caused by transboundary air pollution. Next, these concerns and experience were used to design relevant environmental indicators for field monitoring to verify the association between community’s concerns and transboundary air pollution. Next, air pollution dispersion and deposition models were used to create risk maps illustrating health risk from PM2.5 and PM10, agricultural land degradation risk from acid deposition from SO2 and NO2 , and child’s IQ development risk from consumption of Hg-elevated fish, all of which are caused by major transboundary air pollutants from a coal-fired power plant. These risk maps helped us identify risky areas and receptors as well as environmental indicators to prove the effects from these pollutants. Low-cost air pollution sensors, soil acidity, Hg in fish and human hair were assessed. We found that every village except Ban Dan village started to get impacts from acid deposition already as confirmed by acidic soil pH in every village from pH 4.20 to 5.09 much lower than natural, non-acidic soil with pH of 5.5. Also, Huai-kon, Nam-ree, Kewchan, and Sop-Puen villages were likely affected from transboundary Hg already because Hg in fish was relatively high (0.16 mg/kg) even though this is still lower than the acceptable level (0.3 mg/kg), but Hg in hair of women in the area with elevated Hg in fish was abnormally high in comparison to normal Thai people. We roughly estimated the health and vocational cost from transboundary Hg and acid deposition to be around 975 million THB in 30 years. This serious problem should be properly managed using CCS to establish a database which reflects actual current and future impacts from transboundary air pollution. Moreover, the owner of the coal-fired power plant should join force with this CCS effort to design prevention, mitigation, and compensation measures. A risk management fund of 1,000 million THB should be established together with a clear protocol to use this fund for community in the fairest and the most community-engaging manner.


This research project is a research and development design. The objectives of this study were to 1) assess the outcomes of patient care through home isolation 2) develop a health management system platform for disease prevention and risk management in Long COVID-19 syndromes for a cohort of 608 people in the community and 3) assess Health management system platform for disease prevention and risk management in Long COVID syndromes for a cohort of 608 people in the community. The population and sample included: multidisciplinary professions which was consisting of physicians, registered nurses, pharmacists, medical technicians, physical therapist and 26 District Health Board and 30 patients in group 608. Data were collected between 1st November 2022 and 30th June 2023. The research method consisted of four steps: 1) the collection stage. Problems 2) model building stage, 3) model development stage, and 4) validation stage. Data were collected from in-depth interviews and analyzed by content analysis. Software development was tested by connoisseurship and tested the software system from the users among the staff of the subdistrict health promotion hospital, Village Health volunteer and group 608. The results found that: 1) Outcomes of patient care under home isolation were 1) factors that delayed work; management, materials, and misunderstandings in communication and lack of awareness 2) the key factors to success during the quarantine period; joining together and help each other from all sectors, teamwork and the use of technology to coordinate. 2) The prototype of this platform, named “608 Prompt@Home” or “608 Prompt@Home”; consisted of seven functions for staff of sub-district health promotion hospitals; consisting of 1) Viewing map data via Dashboard 2) Viewing patient information 3) Receiving notification upon patient request 4) Consultation recording 5) Coordinating village Health volunteers to provide 608 group care 6) Live chat and 7) Viewing summary reports. There were three functions for Village Health Volunteer groups: 1) Viewing 608 patient information 2) Assessing 608 according to the standard assessment form received from the staff of the sub-district health promotion hospital and 3) Live chat. There were 608 functions for the 608 group; four functions consisted of 1) viewing public relations information and selfcare 2) Self-assessment and assessment form from sub-district health promoting hospitals 3) Making an appointment to see a doctor and 4) Live chat. 3) The results of the evaluation of the use of the System Usability Scale (SUS) platform showed that the test results of 608 Prompt@Home received the average SUS Score from all three groups as follows: 1) received an average score of 73.75 points. 2) Village Health Volunteer Group received an average score of 80.62 points, and 3) group 608 received an average score of 55.00 points. The average from all three groups was 69.71 points. The development of this prototype 608 prompt@Home has received significant recognition from the user in community. In addition, the design and development of the system is in line with the needs of users. Furthermore, the platform needed to develop to be able to cope with other epidemics and emerging diseases in the future.


An integration of pharmaceutical management, under limited budget, for sustainability and security of national supply would lead to equity in accessibility. The objectives of this study were 1) to explore the international pharmaceutical management patterns at the national levels 2) to analyze current Thai pharmaceutical management system to find gaps and opportunities to improve 3) to propose policy options for Thai national pharmaceutical management system. The qualitative method was employed to present descriptive and analytical information from primary and secondary data. The population and samples were organizations related to national pharmaceutical management in Thailand and abroad. Data were collected by documentation search, interview in-depth, and focus group discussion. Analysis of qualitative data was performed by the content analysis. The results comprise of 3 parts: 1) international pharmaceutical management patterns at the national levels of Singapore, England, Taiwan, PHARMAC of New Zealand and Thailand. 2) comparative analysis of Thai pharmaceutical management patterns and abroad in 6 dimensions as: Entry points, Horizon scanning, Health technology reassessment, Procurement/Negotiation method, Monitoring and evaluation. 3) propose the appropriate pharmaceutical management system for Thailand. Finally. the policy proposal to deal with stakeholders’ 3 pain points (national medium price, information system, and procurement regulations and laws) was presented.


The objective of this study was to determine the duties and powers of Phitsanulok Provincial Administrative Organization regarding jurisdiction of sub-district health stations. Attention was focused on rules and regulations relevant to the transfer of control over sub-district health stations in the province. Solutions were proposed on how to amend rules and subordinate legislations conducive to efficient transfer of operation of those health stations. Special attention was paid to promoting the healthcare system. The final outcomes were 27 recommendations for national and local policy and measures necessary for public health law reform, especially the operation of universal health coverage scheme. Analyses were carried out on duties and powers of a given provincial administrative organization in dealing with transferring of parts of its missions. Relevant laws, rules and regulations, and subordinate legislations required to achieve any transfer of its mission were also analyzed. Also included were announcements made by the Decentralization Committee, standard operating procedures in managing manpower, budgeting, materiel, and office space. Relevant management systems analyzed included information, drug and medical supplies, patient referral, cooperation and coordination of local and central administrative bodies, and collaboration among primary healthcare units in each province. In short, research findings included a lack of urgent measures to ensure implementation of relevant laws and guidelines provided by the Decentralization Committee. Consequently, problems and issues, and misunderstanding among relevant workers in the field, particularly in the public health sector and provincial administrative organization. Dealing with these issues in a timely manner could potentially lead to reform and improvement of the system by implementing recommendations from this study.


In Thailand, the Cabinet has outlined the national reform plan (public health) for the year 2021, which emphasizes the concept of "Health Promotion" in alignment with the sustainable development goal of the United Nations, specifically Goal 3: Good health and well-being. The plan focuses on policies and measures within the workplace, setting a goal to establish "workplace health policies". Despite this, there is presently a paucity of research on management, implementation, and workplace health promotion, and Thailand has yet to establish a national policy framework. This study aims to investigate the management and implementation, as well as provide policy recommendations at both organizational and national levels, by organizational leaders and human resource executives, concerning health promotion and non-communicable disease prevention in workplaces. Methods This study employs a cross-sectional study to procure data from personnel in the human resources domain across organizations situated in Thailand during the period spanning January to March 2023. The collection of data encompassed a questionnaire, featuring three distinct sections addressing organizational demographics, health promotion execution, and health promotion policies. The acquired data were analyzed via the application of advanced statistical techniques including descriptive statistics, bivariate analyses, and multiple linear regression. A qualitative study, specifically an exploratory research design, utilizing conventional content analysis with an inductive approach was undertaken. The interviews were conducted from May to November 2022. The data for analysis were collected through in-depth interviews conducted with senior-level executives from prominent organizations and human resource managers affiliated with influential bodies such as the Federation of Thai Industries (FTI), the Thai Chamber of Commerce and Board of Trade of Thailand (TCC & BoT), the Thai Bankers’ Association (TBA), the Personnel Management Association of Thailand (PMAT), industrial estates, and various workplaces. The data collection for this study involved conducting interviews with key informants, totaling 35 individuals, representing 27 organizations, units, and businesses. Results In this quantitative study, the implementation of health promotion initiatives within the workplace demonstrated a statistically significant association with key factors including organizational operations exceeding 19 years and the allocation of financial resources for health promotion. The workplace health promotion policy exhibited a statistically significant correlation with various budget allocation factors across all domains. These factors encompassed collaborative decision-making within the workplace, a conducive physical work environment, psychological well-being in the workplace, employee engagement and trust, effective leadership and supervision, job design, as well as monitoring and evaluation practices. In the qualitative study, the findings of the study can be categorized into four main categories. The first category, "Management," consists of organizational policies and guiding principles. The second category, "Implementation," includes budget allocation, activities, and operational tips. The third category, "Barriers," comprises operational challenges and individual factors. Lastly, the fourth category, "Groups, Clubs, Associations," encompasses collaborative policies and joint activities. Conclusion The findings of this study indicate that the duration of organizational operations, the size of the organization, and the allocation of budgetary resources for health promotion play crucial roles in determining the successful implementation and feasibility of workplace health promotion policies within organizations. This study has outlined strategies for management and operational measures to enhance workplace health promotion and synthesized policies for health promotion in Thai workplaces. These policies encompass both monetary and nonmonetary approaches.


Background: Since the 1970s, Thailand has recognized the irrational use of medicine in both public and private healthcare delivery, as well as in self-medication from unreliable sources. Various governments have attempted to address this issue. During the last decade, the Rational Drug Use (RDU) hospital policy was systematically implemented nationwide; however, RDU remains a big challenge. With no paucity, Thailand is moving forward with the "RDU Country" policy for the next decade. The goals of this policy are to make RDU as a social norm, a basic right, and a quality of healthcare service in Thailand. Purposes: To develop a mechanism for implementing the "RDU Country" policy and to create a model for achieving it by focusing on a health systems approach, monitoring and evaluation, and developing mechanisms for cooperation in the development of national indicators. This includes studying the form and structure of the central agency responsible for rational drug use (the RDU Center) and analyzing its working mechanism with the concept of political economy. Methods: A 4 steps with 1- cycle of action research was employed to gather data using qualitative methods. The principal investigators, who are embedded as practitioners within the central government agency responsible for promoting rational drug use, collected the data between May 2021 and October 2022. The development of mechanisms for implementing national policies on rational drug use using an integrated theoretical framework to put policy into practice. The action research began with a review of the problem situation, past actions, set goals, operational definitions, principles, and guidelines were established for implementing the "RDU Country" policy, and plans were made to put these guidelines into practice at both the central and regional levels. At the central level, this was achieved through the efforts of the Sub-Committee for the Promotion of Rational Use of Drugs and related working groups, using the concept of a triangle that moves mountains. At the regional level, the development of a "Rational Drug Use Province" (RDU Province) was proposed as a policy package. The goal of an "RDU Province" is to enhance the quality of services to promote rational drug use in both public and private sectors and to solve drug problems in the community sustainably through the development of mechanisms at the provincial level. This would involve achieving propulsion in each district through the participation of all sectors, in line with the concept of developing a district health system using the six-building block health system development concept according to the guidelines of the World Health Organization. This is also relevant to the development of healthy communities to make rational drug use a new social norm. There were four research areas distributed in each region with different contexts. Lessons were learned from operations in these areas, and observations and evaluations were conducted to provide feedback to the research areas. Results: The development of systems and mechanisms for implementing the country's policy on rational drug use and monitoring its implementation requires a system governance mechanism for effective policy implementation at both the central and regional levels. This relies on an efficient mechanism among policy makers, policy actors, and those affected by the policy. There is a mechanism for the central agency responsible for rational drug use (the RDU center), which is a sub-government mechanism that acts as a "connection" between policy makers and practitioners. In addition, provincial and district agencies have a coordinator or responsible person (the RDU coordinator) with appropriate capacity in terms of both leadership and technical competency. An important leverage point for the development of an "RDU Province" is the presence of policy actors at the local level who need direction and support from executives at both the provincial and regional levels. One of the policy actors responsible for promoting rational drug use (RDU coordinator) at the provincial and district levels must be competent in collaboration with the stakeholders. Developing RDU Province faced several significant challenges such as the cooperation with private healthcare settings, limited understanding of healthcare practitioners and health workers about rational drug use literacy, and RDU information systems in hospitals and communities. Furthermore, a study and development of the implementation model of an RDU Center under the structure of the National Drug Policy Division of the Food and Drug Administration is necessary to enable it to perform its role as the resolution of the National Drug System Development Committee. This includes the development of mechanisms to drive policy implementation in both central and regional areas, as well as the development of monitoring and evaluation systems and information systems for monitoring and evaluation in collaboration with related agencies. This is being driven by a "superstructure” with bureaucracy that represents the power of the state, using the concept of “a triangle that moves the mountain” and extending the work system between government agencies using the concept of political economy with 3 main mechanisms as follows: firstly, health care service quality supervision through professional councils, quality system mechanisms, regulatory mechanisms from the ministry that oversees public health facilities, and legal mechanisms; secondly, a mechanism for regulatory activities of pharmaceutical manufacturers/companies through law; and thirdly, a financial mechanism through the government health insurance fund, which is the positive reinforcement. However, the RDU Center also needs to make decisions and seriously take action on proper management of structures and roles under the mission of the Food and Drug Administration, including both its consumer protection role for health products and its mission as a government agency at the department level in implementing national drug policy to routine work system. Conclusion: An important and challenging issue for Thailand's health system in achieving rational drug use, which have been persisting for more than four decades, is finding a solution to drug problems in the community. Therefore, the design of the superstructure of the health system is required to provide alternative access to basic essential medicines from reliable drug distribution sources for people in all districts, regardless of differences in education, income, or area of residence. People should have access to necessary and reliable information to make informed decisions about their own health or that of their families when they are ill, including information for the use of drug and non-drug products. This includes a system for creating health literacy about taking care of one's own health, with and without the use of drugs, using technology such as telemedicine or telepharmacy, or having a health service system that everyone in the community can access with RDU as quality of health care services.


Diagnosis and proper management of latent tuberculosis infection (LTBI) are important components in reducing the number of patients and deaths from tuberculosis (TB). The diagnosis of LTBI using the interferon-gamma release assays (IGRAs) to detect interferon-gamma in bloods sample has advantages over the tuberculin skin test (TST), but the currently used test kits are expensive and require enzyme-linked immunosorbent assay (ELISA), making it complicate and unsuitable for a district or provincial laboratory use. The QIAreach QuantiFERON-TB (QIAREACH-TB) is a novel blood-based test that uses lateral flow immunoassay (LFA) and digital fluorescence signal measurement to detect interferon-gamma. This study aimed to evaluate the QIAREACH-TB for the diagnosis of LTBI using a whole-blood sample compared to the QuantiFERON-TB Gold Plus (QFT-Plus). Blood samples were collected from 154 healthcare workers (HCWs) and tested for LTBI using the QFT-Plus and QIAREACH-TB. The results showed that the overall percentage agreement (OPA; accuracy) between the QIAREACH-TB and QFT-Plus was 93.46% (95% confidence interval [95% CI]: 88.31-96.82), the positive percent agreement (PPA; sensitivity) was 88.46% (95% CI: 69.85-97.55), and the negative percent agreement (NPA; specificity) was 94.49% (95% CI: 88.97-97.76). In conclusion, the QIAREACH-TB has high agreements with the QFT-Plus, but requires fewer laboratory resources and does not require ELISA, thus making it allows for the expansion of efforts to detect individuals with LTBI following the national TB control strategy.


This report is a review, synthesis, and knowledge management of cannabis control and the impacts of recreational cannabis legislation overseas to serve as basic information for evidence-based policy-making, technical development, and research in Thailand. There are five main questions: 1. What are the current forms of cannabis control in various countries? 2. What are the options and considerations in designing cannabis control measures? 3. What are the impacts of recreational cannabis legalization under the International Drug Control Conventions? 4. What are the impacts of allowing the sale or procurement of recreational cannabis, i.e., “cannabis liberalization policy” among implemented countries? and 5. What are the recommended technical and research actions pertaining to monitoring and evaluation of cannabis policy in Thailand? METHODS Due to the short period of time to produce this review (4 months), the authors started by searching for the most recent systematic reviews, followed by additional original papers to obtain recent data on each issue. The authors used PubMed as the main database to search for the literatures, followed by Google (where applicable). The authors paid more attention to peer-reviewed articles than reports or documents published by a particular group. The authors also tried to assess and select studies with proper methodology, samples that were representative of the state or country-level population, and with a comparison group. Examples include comparison of states with and without cannabis legalization laws, before and after cannabis legislation, quasi-experimental studies, and research work with interrupted time-series analysis. RESULTS Legal measures to control cannabis can be categorized into 5 types: 1. Criminalization of cannabis, including use, distribution, and possession thereof. This is the most common form of control worldwide, particularly in Asian countries such as Afghanistan, Bahrain, Brunei Darussalam, Indonesia, Japan, Iraq, and Malaysia. 2. Designation of cannabis as an illegal but decriminalized substance. This includes imposing a fine for users but without legal penalty. Vendors remain liable for criminal penalty. This form of control is practiced in some Western countries, including Belize, Bolivia, Dominica, Moldova, Paraguay, and Saint Lucia 3. Designation of cannabis as a narcotic with allowance for medical use, such as in Lebanon, Lithuania, New Zealand, North Macedonia, and Norway 4. Decriminalization of cannabis but with strict control of misuse. This form of control includes limitation of possession amount, prohibitions (of sale to youths, advertising, operating vehicles under the influence), and use of cannabis taxation. Countries practicing this form of control include Canada, the United States (in certain states), and Uruguay 5. Decriminalization of cannabis and allowance for free market competition, with free or relatively free ability to cultivate, distribute, or advertise. Currently, there are 47 countries where the laws allow for use of cannabis for legal purposes, 38 countries with depenalization for cannabis possession and use. Options in reduced control of cannabis. Cannabis control under international law. Impact of recreational cannabis policy on health and society. Health and social impacts, Social and economic impacts and Recommendations for development of cannabis policy in Thailand.


This research aims 1) To measure the air quality in Chalerm Phra Kiat District community using chemical and biological indicators 2) To develop chemical indicators as a tool for monitoring air quality for the community 3) To convey basic information obtained from studies and measurement techniques to the community. So that communities will be able to monitor and keep track of air quality by themselves. At Chaloem Phra Kiat District, Nan Province, there are many communities that are located about 20-30 kilometers southwest away from the Hogsa Lignite Power Plant, Lao People's Democratic Republic, which may be affected by air pollution emissions. Within the community still lack tools to measure and monitor air quality impact that may come from the power plant. Therefore, in this research we created a tool to monitor both chemical and biological air pollution by passive air sampling and measuring small dust in the air using low-cost sensors, analyzing surface water, and collecting rainwater samples for analyzing the chemical composition. Coupled with observing changes in lichen, this method does not require complicated or expensive equipment. This technique can be share to the communities, youth groups and teachers, or Health and environment related agencies, so that the communities can used this method to monitor the quality of the environment in the area that might affects their health. The area of this research covers 2 districts, Chaloem Phra Kiat District and Thung Chang District. Consists of 4 study areas: Thung Chang District (S1), Huai Kon Sub-district, Chaloem Phra Kiat District (S2), Ban Nam Ree Phatthana, Khun Nan Sub-district, Chaloem Phra Kiat District (S3) and Ban Ngompao, Khun Nan Sub-district, Chaloem Phra Kiat District (S4). Install the PM2.5 measuring device starting in 2 areas (using AirEnvi in Huai Kon Subdistrict, Chaloem Phra Kiat District, Nan Province, Nam Ri Subdistrict, Chaloem Phra Kiat District, Nan Province) then increased to 9 areas (using DustBoy in 9 schools in Thung Chang District and Chaloem Phra Kiat District area). During the smog season (February to April) concentration of PM2.5 are significantly higher than usual. From observing both stations it was found that the air quality monitoring station in Huai Kon Subdistrict, Chaloem Phrakiat District, Nan Province (S2) had a higher PM2.5 dust value than the air quality monitoring station in Khun Nan Subdistrict, Chaloem Phrakiat District (S3). From all 14 samples it founds that during April 2022, the average PM2.5 concentrations was 64.89 μg/m3, higher than the average of 45.20 μg/m3 in June 2022, with the main ion content being SO42- and NO3- in both months. The samples were collected rainfall in 4 areas, 36 samples. It was found that the total rainfall was 201.1 mm. and the maximum was 33.4 mm.. The average pH values was 6.17, and the average conductivity was 0.86 mS/m., with the main negative ion component. The dominant anions are NO3- and SO42- and the ion cations are NH4+ and Ca2+ in all 4 areas. Ban Ngam Pao, Khun Nan Sub-district, Chaloem Phra Kiat District (S4) had the highest accumulation of ions in rainwater. Thung Chang District (S1) had the lowest ion accumulation in rainfall. As for the monitoring of nitrogen dioxide using the NO2 test kit, Wat Huai Kon had the highest NO2 concentration with an average concentration of 72.47 μg/m3 by subdistrict and Thung Chang district. The concentration of NO2 was the lowest (37.12 μg/m3). For water quality monitoring, it was found that the lowest DO value at Huai Kon Reservoir was found. All areas SO42-, NH4+ and Ca2+ have the highest values. Biological monitoring by surveying lichen on mango tree trunks in all four were studied areas. A total of 13 families, 22 genera, and 51 species were identified, including folios and crustoses. Fruticose lichens were not found. The most common families were Graphidaceae and Lecanoraceae, respectively. The average pH of bark from lichen mango stems was in the range of 5.4 to 6.5, with Ban Huai Kon < Ban Nam Ri Phatthana < Ban Ngom. Pao < Ban Thung Chang when analyzing diversity index The Shannon- Weiner index of lichens found the highest diversity of lichen at Ban Ng Pao, with the lowest value (1.58) found at Ban Thung Chang. As for the analysis of the concentration of heavy metals accumulated in the bark, it was found that Ban Ngam Pao > Ban Huai Kon > Ban Nam Ree Phatthana > Ban Thung Chang. The monitors were surveyed and measured air quality in all tools within the community Ban Huai Kon area, there is a risk of harm to be affected the most. Ban Thung Chang has the least risk of being affected due to its distance from the source of air pollution that are further from the HongSa Power Plant. In this research, we also transfer the basic information obtained from the study and the measurement techniques to the communities, so that communities can monitor and measure air quality by themselves. By organized training activities to provide basic knowledge to teachers, students and people in the community. Increasing the area and network of 9 schools including Ban Huai Kon School, Ban Sop Puen School, Nam Ree Pattana School, Ban Fueilung Community School, Mom Chao Charoenjai Chitphong School, Nam Chang School, Huai Sai Khao School, Kew Chan School and Ban Dan School In which the research team can conduct continuous research and the community has a network that can monitor and measure air quality sustainably.


The objective of this research is fourfold as follows: 1) to study and analyze the various dimensions of organizations established by special acts, which enables them to manage and respond to crises effectively, 2) to study the management effectiveness and crisis responsiveness of organizations established by special acts, 3) to identify the unique characteristics of organizations with special acts that are highly capable of managing and achieving their missions in the context of Thai society, and 4) to synthesize policy proposals for improving the management of organizations established by special acts to be more flexible and responsive to the needs of the country and its people. This research employs qualitative methods through document analysis, in-depth interviews, and focus group discussions with a purposive sample of nine organizations. The data analysis involves creating summaries of data to find patterns and relationships between variables to understand and synthesize the findings in a meaningful and appropriate manner. The results of the study indicate that: 1. Characteristics in various dimensions of organizations established by special acts that enable them to manage and respond to crises: From studying the organizations, the important characteristics are as follows: 1) The work management structure and format of organizations established by special acts are clear, and most organizations are adaptable and flexible in their operations. 2) The objectives of the establishment, roles, missions, and overlap are generally in accordance with the objectives of the establishment stated in the special acts. 3) The supervision, monitoring, and evaluation of organizations established by special acts have evaluation systems specified in the law. However, the state also creates regulations to monitor these organizations. 4) There is a continuous trend of organizations established by special acts in the future, as the state has new missions that arise from changes in the economy and society. 2. Effectiveness in crisis management and respond (i.e. COVID-19 pandemic) of organizations established by special acts: The lessons learned indicates that these organizations are equipped with: 1) Readiness to receive and respond to crisis situations, with a continuous management plan that can be promptly adjusted. 2) Adjustment of work processes, using more technology, as the pandemic situation has accelerated the transition to digitalization. 3) Adjustment of operations to be more efficient and effective, focusing on solving problems and providing effective solutions. 4) Capability of Coordination and collaboration with relevant organizations and stakeholders, utilizing and sharing resources and knowledge to overcome the crisis. 3. The distinctive features of an organization that has a special act in the context of Thai society, which are important factors that make it a high-performance organization in managing to achieve the organization's mission are as follows: 1) Organizational structure - the organization has the ability to quickly adapt to changes (Adaptability), is flexible (Agility), responds to stakeholders, and develops work processes and technology. 2) Organizational culture - the organization aims to make its personnel aware of the quality of service, emphasizes continuous learning, focuses on competencies and values that adhere to the country's benefits. 3) Importance of responding to stakeholders - this will help understand the real needs of the service recipients, and gain strength from the public and networked communities. 4) Member behavior in the organization - members must respond to external factors and recognize the importance of stakeholders. If this response aligns with the organizational culture, the behavior of each person in the organization will go in the same direction towards achieving the goals. 4. Policy proposals for improving the management of organizations with specific acts to be more flexible and responsive to the needs of the country and its people. From the study, the following suggestions are made: 1) Develop a database system to enable organizations to efficiently set directions and strategies. 2) Establish mechanisms or guidelines to ensure that chartered organizations have flexibility in achieving their objectives. 3) Promote communication and publicize the achievements of the organizations. 4) Ensure that organizations are ready for evaluations of their value. 5) Encourage each organization to understand its Core Mission, Core Asset, and Core Competence, and adhere to these principles. 6) Promote data sharing and collaboration. 7) Encourage employees to work together to create shared values, culture, and mindset that align with the organization's identity and goals. 8) Apply new concepts of public sector management to the organization. In addition to this, based on the results of the study, it is possible to synthesize the environmental success system of the organizations established by special acts, which consists of internal and external factors. For internal factors, both individual and organizational levels are involved. At the individual level, effective collaboration and ethical conduct are required. At the organizational level, the structure should be flexible, adaptable, and seek cooperation and opportunities for involvement from other stakeholders. As for the external factors, the organization should be free from politics and receive support from the government and network partners.


Dengue disease is an important problem in global public health. Annually, 390 people are infected with dengue virus. The majority of infections results in asymptomatic cases. For symptomatic cases, patients will develop either mild dengue fever (DF) or severe dengue hemorrhagic fever (DHF). DF is a self-limiting disease meaning the patients will recover within 4-7 days without any significant intervention. However, DHF patients will eventually develop plasma leakage which may progress into potentially fatal hypovolemic shock known as dengue shock syndrome (DSS) without prompt and adequate fluid management. Dengue disease is caused by dengue virus which belongs to the genus Flavivirus. There are four serotypes of the virus including dengue virus 1, 2, 3 and 4. The virus is transmitted by Aedes mosquitoes. There is no antiviral drug against dengue virus and the only available vaccine has limited efficacy and elevates the risk of hospitalization from dengue disease in seronegative vaccines. Dengue infection is usually confirmed by assaying patient’s blood obtained by invasive procedures, such as venipuncture or fingertip pricking. Qualified personnel are required to effectively and safely collect and process blood specimen. In addition, the blood specimen processing is usually costly in terms of budget and personnel. However, previous studies reported the presence of dengue virus, NS1 protein, and anti-dengue virus antibodies in non-invasively obtained clinical specimens such as saliva and urine. Recently, oral fluid was interestingly used for detecting anti-virus antibodies and virus genomes for HIV, hepatitis viruses (HAV, HBV, HCV). We believe oral fluid specimen could be an alternative for study dengue virus. Oral fluid is non-invasively obtained so the specimen collection and processing are inexpensive and simple. Minimally trained personnel should be able to collect, handle and process oral fluid specimen safely and effectively. In addition, oral fluid could be obtained from people in the household or workplace of the index case to capture asymptomatic dengue cases. Therefore, we tested whether oral fluid specimen could be used to detect virus genome, NS1 protein and anti-dengue IgM/IgG. We also compared the accuracy for assaying oral fluid specimen to that of blood specimen. Consequently, we evaluated whether oral fluid could be an alternative to blood specimen. We found that although viral genome and NS1 antigen were rarely detected in oral fluid, anti-dengue IgM and IgG were dramatically detected for 3 day of illness and still completely detected until 1 -2 months after illness. Efficiency of anti-dengue IgM and IgG detection in oral fluid specimens was not statistically different with plasma specimens after analyzed by Fisher’s exact test. Thus, oral fluid could be a suitable specimen for screening of asymptomatic infection in dengue season or screening of immune response after vaccination.


Introduction: Transgender people are well recognized in Thai society nowadays and need specific care. There are challenges in the transgender medical health system in Thailand. Aims: This study aims to assess the current situations of a transgender health care service from providers' and patients’ perspectives and to evaluate the effect of a gender-affirming hormone therapy on health in general, mental health and sexual transmitted diseases in order to provide recommendations to improve the transgender medical health system in Thailand. Methods: The study is divided into 4 sub-studies. The sub-studies 1, 2, and 3 assessed the effects and complications from hormone therapy on general health, HIV and sexually transmitted diseases (STI), and mental health among Thai transgender people. The sub-studies 4 assessed the current situation of the health care system through panel discussions. Results: The hormone therapy effectively induces body changes in all transgender people. Complications in transgender men include elevated systolic and diastolic blood pressure, elevated uric acid levels without gouty attack, elevated hematocrit levels, and a decline in the glomerular filtration rates. There is no effect on liver function and blood sugar. In transgender women, decreased blood pressure was found without adverse effects on liver function, blood sugar, uric acid, and lipid profiles. There is no HIV or STI in this study. However, there is a low rate of protection in sexual activity among transgender men, and hepatitis B immunity is low among transgender people. Regarding mental health, there is a trend of higher depression and anxiety scores but improved gender dysphoria, attention deficit, and internet gaming disorder scale. The assessment of the current Thai transgender health systems demonstrated several barriers and challenges from providers' and patients’ perspectives. The main issues include unsupported laws involving the fundamental right, discrimination, access to medical care, health care insurance regarding gender-affirming treatment, funding for developing transgender clinics, education for medical providers, mental health care, health data gathering, lack of support for the transgender community and transgender law. Summary: Transgender people have specific physical and mental changes with gender affirming hormone treatment. Most are consistent with international data, apart from the minimal decrease in depressive and anxiety scores, which should be monitored closely. The medical professional should recognize the changes along the treatment process. Several barriers in transgender care are present from providers' and patients’ perspectives. Therefore, a strategy supporting the development of transgender clinics should be designed to ensure that transgender people receive high-quality care without discrimination.


Coronary artery disease (CAD) is the leading cause of death and disability in Thailand. The incidence of CAD has constantly been increasing. Percutaneous coronary intervention (PCI) is the standard and mainstay of CAD treatment. In Thailand, PCI has been performed for more than 20 years. Because of the benefit of PCI in reducing mortality, morbidity and symptom, it is recommended by many clinical practice guidelines as a standard treatment of CAD. Since the Ministry of Health realized the benefit of PCI and support the opening of new catheterization laboratories (cath lab) in all parts of the country, the number of cath lab and the number of PCI cases in Thailand has rapidly increasing for the last ten years. PCI registry is very important, as it provides many useful information (e.g. baseline demographic data of the patients, practice pattern, device and equipment use, outcome of treatment, complications, success rate, emergency CABG rate), as well as information regarding health care system (e.g. prevalence of referral cases, waiting time of the system, appropriateness of PCI, cost of PCI, cost-effectiveness/cost-utility which could be compared to treatment of other diseases (such as cancer, etc.). The information is essential in improving the outcomes of PCI, in preventing complications, in increasing the efficacy and safety of PCI, which may lead to more effective national resource allocation and proper reimbursement. With the reasons given, many countries have conducted their own data collection and PCI registry. The good examples include SCARR registry of Sweden, NCDR of USA and NCVD PCI registry of the National Heart Association of Malaysia. Cardiovascular Intervention Association of Thailand (CIAT) realized the importance of having our own data, therefore initiating the project “Thai PCI Registry” in order to collect the data of patients undergoing PCI in current clinical practice in our country. The project received financial support from Health System Research Institute (HSRI). This report is the full report of the finalize of Thai PCI registry project which received financial support from HSRI. There were 22,741 patients participating in Thai PCI registry. Approximately 70% were male with the mean age of 63.85 years. Two third of all patients use Universal Coverage (UC) scheme. Most common presentation was stable CAD (37.6 %) and most common procedures were performed electively (61.3%). More than half of all patients were referral cases. In terms of coronary anatomy, most patients were classified as triple vessel disease (33.0%) follow by double vessel disease (28.7%) and single vessel disease (26.4%), respectively. Twelve percent of all patients had left main stenosis. The main vascular access was femoral approach (12,199 cases; 53.6%). When we categorized the patients into their presentation of acute coronary syndrome and stable coronary disease, we found that 27.6% was STEMI, 29.8% was Non STEMI, 37.6% was Stable CAD, and others was 5.1%. The In-hospital mortality rate was 6.7%, 2.0%, 0.3%, and 3.4%, respectively. with overall in-hospital mortality was 2.7%. The overall success rate of PCI in this registry was 96% which was very good and comparable to data from other countries. The factors that were independently associated with procedural failure included older age, referral cases, hypertension, history of heart disease, complex lesion, long lesion, and poor TIMI flow. The incidence of procedural complications was approximately 5%. The common complications reported included coronary dissection, side branch occlusion, no reflow, coronary perforation, device dislodge, acute stent thrombosis. The factors that were independently associated with procedural complications included older age, female, health care coverage, hypertension, history of heart disease, cardiogenic shock, requirement of IABP/mechanical support, unsuccessful vascular access, long lesion, thrombotic lesion, complex lesion, bifurcation and abnormal TIMI flow. The common clinical complications included post-PCI MI (1,856 cases, 8.5%), bleeding within 72 hours (1,053 cases, 4.8%), stroke (83 cases, 0.4%) and emergency CABG (0.34%). In term of mortality, the in-hospital mortality rate was 2.71%. The independent factors associated with incidence of clinical complications included older age, female, referral cases, peripheral vascular disease, requirement of dialysis, emergency PCI, ACS, cardiogenic shock, requirement of IABP/mechanical support, left main stenosis, unsuccessful PCI, and procedural complication. In summary, the Thai PCI registry was completed with great success. Many goals and objectives were achieved which included 1) establishing national network which can be a platform of nation-wide collaboration of other registry in the future, 2) creating CRF in PCI cases which can be used by any participating sites even after completion of the registry or can also be used by general public by request, 3) Training the new researchers from all area of the country, 4) obtaining crucial data which will lead to improvement of PCI outcomes, prevention of complications and improvement of health care system resulting in better care of patients with cardiovascular diseases in the future.


This research and development project on Massive Open Online Course (MOOC) for teachers and carers of children under 3 is to create a set of online courses for teachers and caregivers of children under 3. This set of online courses is designed to raise awareness about the importance of nurturing infants and young children, aged between 0-3 years, a critical period that requires fostering and instilling a stable and appropriate foundation for life. The project aims to 1) upskill and reskill teachers and caregivers of early childhood development institutions accepting children under the age of 3 by creating MOOC courses, 2) evaluate the effectiveness of the created courses in the development of teachers and caregivers of early childhood development institutions, and 3) assess the efficiency of MOOC in teaching and training. The main target groups used in this study were teachers and caregivers of early childhood development institutions and students in the field of early childhood education. Evaluation of course effectiveness was conducted in three key areas: learning, reaction, and attitude. The assessment of the efficiency of MOOC was achieved by analyzing learners’ video clip traffic, because video clips are the most important medium of MOOC courses. The results showed that assessment of the learning and reaction effectiveness of the MOOC courses yielded markedly positive results. As for the attitude, there was no difference between before and after learning the courses. In the evaluation of the efficiency of the MOOC system, it was found that creating learning content in the form of video clips should be made into a short clip. Each clip should not exceed 5 minutes. This set of courses can be revised and expanded to develop into a non-degree program, as they are licensed under Creative Commons CC: BY-NC-SA.


Background: In addition to the economic evaluation and budget impact information of dialysis in patients with end-stage renal disease (ESRD) obtained from sub-project 1, social impact and problems related to dialysis would be very useful information which can be applied as evidences for policy decision making. Objective: To study the social impact and problems related to dialysis in patients with ESRD using (1) continuous ambulatory peritoneal dialysis (CAPD) (2) CAPD using icodextrin one cycle per day of icodextrin plus glucose (CAPD+ICO) and (3) automated peritoneal dialysis (APD) methods as well as in all stakeholders providing care for ESRD patients. Methods: This study applied a mixed method which quantitative data of all patients participating in sub-project 1 were collected using a self-administrative questionnaire and qualitative data were obtained using in-depth interviews and focus group discussion among patients/relatives, healthcare personnel in service units related to dialysis services for ESRD patients. Results: According to the results of surveys using questionnaires, it was found that ESRD patients were relatively well equipped with reagent storage sites. In addition, CAPD patients undergoing peritoneal dialysis had more limitations in their daily lives than those receiving APD, however, there was no statistically significant difference. CAPD+ICO dialysis patients were reported to be statistically significantly more complicated than APD and CAPD dialysis. This may be due to a shorter pre-dialysis period for patients undergoing CAPD+ICO dialysis (51.9 months) than those undergoing CAPD (65.3 months). Most ESRD patients receiving APD reported that the absence of fluid during the day resulted in feeling better and more independent to the greatest degree. For patients undergoing CAPD+ICO, icodextrin was found to improve hyperhydration and decrease fatigue. Conclusions: APD is appropriate for pediatric patients, working adults, people who cannot perform dialysis during the day and old people who are unable to do dialysis on their own, but will have a caregiver to do it. However, if APD is included in the benefit package, the expansion of services with APD will require more healthcare personnel, especially peritoneal dialysis nurses and training. The system should be developed in conjunction with the service provider to provide an efficient service system for providing services to the patient.


This research aimed to study the policy proposal for monitoring and evaluation of the Sub-district Health Promoting Hospital (SDHP) where have been transferred to Mahasarakham Provincial Administrative Organization (MPAO). The mixed methods research was conducted in 2 phases. Phase 1 was a survey in 500 samples and phase 2 was action research. The target samples were the stakeholders from 175 settings of Health Center in Honor of His Majesty the King’s 60th Birthday Nawamintrachini (HCN) and the SDHP. Data was collected by questionnaires, focus group discussion and commenting record. The results reveled factor affected the health service following the six building blocks of health system framework. The factors related the health services significantly were married status (p-value<0.001), work position (p-value=0.019), committee (p-value=0.023), and information sources (p-value=0.024). The factors affected the monitoring and evaluation of the HCN and the SDHP who transferred to the MPAO statistically significant were transferring (p-value=0.027), personal transferred status (p-value=0.006), gender (p-value=0.014), married status (p-value<0.001), education (p-value=0.0043), work position (p-value<0.001), work type (p-value<0.001), and training experiences (p-value=0.001). The comparing between a transferred group and a non-transferred group found the statistically significant difference (p-value<0.001) in the improved health, the responsiveness and the improved efficiency. The policy proposals will be implemented in 4 domains. First, the improved health domain should involve all stakeholders participate in the evaluation. The format depends on each district and should have a sharing forum. The first phase should evaluate the people impacts rather than outputs, according to the changes of health service system. Second, the responsiveness domain should select the indicators which can be performed under the situation of transferring to the MPAO. Third, the social and financial risk protection domain should monitor and evaluate the health impacts covering manpower, materials and network coordination. The facilities should be flexible for good health services. Lastly, the improved efficiency domain should increase the human resources for the effective coordination and performance. The assessors for the monitoring and evaluation should be the delegates of the health networks of the Ministry of Public Health, Provincial Administrative Organization, and stakeholders. The manual should be development for assessing guideline and improving performance.


The case that the research team has studied operated is an area of high-risk community in Nan Province, Thailand, close to the coal-fired power plant in Hongsa, Xayaburi Province, Lao People’s Democratic Republic. Although the power plant is located in Laos, it mainly provides electrical power to Thailand about 1,500 megawatts or 78% of the total generation capacity. The term of the power purchase agreement is 25 years. The investment in the power plant is about 80% from Thai public companies and 20% from the Lao state enterprise, with financing from 9 banks in Thailand. The use of coal as a fuel for electricity generation causes many kinds of pollution, especially air pollution such as small particulate matter 2.5 (PM 2.5), nitrogen oxides, sulfur dioxide, heavy metals, mercury, etc., that can induce cross-border impacts. Even though the power plant has installed technologies to capture pollution, namely 1) Flue gas desulphurization (FGD), 2) Electrostatic Precipitator (EPS), 3) Selective Catalytic Reduction (SCR), and CEM which is a continuous emission monitoring system at the tip of the stack to measure NOx Sox TSP O2 temp. etc. Sadly, the mercury capture equipment is not installed while the lignite coal used by the power plant contains mercury. In addition, the preparation of an environmental impact assessment report does not cover risky areas in Thailand. As the power plant is located in The Lao People's Democratic Republic (Lao PDR or LPDR), there is no obligation to carry out continuous surveillance on the Thai side. Although pollution may cross borders naturally, there are no regulations or legal agreements that cross nation-state boundaries. This is the reason for the development of surveillance systems for risky areas in Nan Province. The system is set up by public participation, local initiative and co-ownership to achieve sustainability, and draws expertise from various sciences to reinforce the search for facts and reality. Community-led Health Impact Surveillance System Development Project, Nan Province, Thailand, Case of Transboundary Pollution from Hongsa Coal-fired Power Plant, Laos, is a cross-disciplinary research. Under the support of Health System Research Institute (HSRI), there are 5 research projects working together, consisting the team from the Faculty of Science, Chiang Mai University; the Faculty of Engineering, Naresuan University; the Faculty of Liberal Arts, King Mongkut’s University of Technology Thonburi; Thai Public Broadcasting Service (Thai PBS); and the Thai National Health Foundation (NHF). The basic principle of designing this surveillance system is based on participatory action research, the precaution principle, that is, considering the risk without having to wait for health problems or patients to emerge. The surveillance framework focuses on changes in determinants of health, especially social determinants of health. This framework includes changes in environmental quality affecting the agricultural sector, which will result in income, labor mobility and immigration, as well as contamination in ecosystems and food chains that are at risk of disease and illness, especially for children and women of reproductive age. This is different from disease-oriented surveillance. Concepts involved in the design of this system include risk society; co-production of knowledge; citizen scientist; and environmental justice.There are four objectives of this research: 1) Develop a system for community-led health impact surveillance from coal-fired power plants; 2) develop collaboration mechanism for various actors; 3) to develop a model and process for producing knowledge together between experts and communities on coal power plant pollution awareness; and 4) to be a case study of environmental impact assessment cross border health in the process of monitoring the impact. The results of operations can be summarized as follows: 1. The process of developing a community-led health impact surveillance system can be sequenced as follow: building trust between the research team and the community, creating a cross-disciplinary team of experts, creating citizen scientists, and creating a system for recording, processing and storing a digital data and creating a data exchange platform which brings cooperation between groups in surveillance and mobilize policy measures to solve the problem. 2. The community-led health impact surveillance system consists of: 1) Surveillance teams, divided into cross-disciplinary research teams and community teams trained to be citizen scientists. These two groups work together in a form known as Co-creation of knowledge. 2) Surveillance tools. There are tools that require advanced skills of experts in various fields, and tools for citizen scientists to measure the quality of both chemical and biological environments. including indicators to observe changes as well as a tool used to collect various evidence called MOJO. 3) Recording and storage system have cooperated with Thai Public Broadcasting Service (Thai PBS) To develop a C-site platform for storing surveillance data and continually accumulate data until it becomes a large database. When there is a certain amount of data, it can be processed, interpreted and reported in a dashboard style and will be open to various sectors to access information and use it for their own work, including developing an environmental pollution warning system and an emergency response system from environmental pollution threats. 4) Cooperation Platform, which is a digital platform, is under C-site platform and open discussion area between different groups to reduce bias and balance the power of using data to govern or make decisions about big technology risks. 3. The methods of surveillance can be divided into 9 steps, which can be applied to other areas with similar risks of environmental pollution, namely: 1) Source analysis and pollution determination. 2) Define surveillance dimensions and risk chains 3) Aerial modeling in order to see the risky areas from the accumulation of pollution. 4) Build a cross-disciplinary research team to understand the risk situation in the area and vulnerable groups. 5) Create appropriate tools for the community. 6) Build a team of citizen scientists to monitor. 7) Collect data by citizen scientists. 8) Record data on the C-site for both cross-disciplinary researchers and citizen scientists. 9) Open up surveillance cooperation areas. 4. From the air modeling, it was found that pollution accumulated in 8 villages of Huai Kon Subdistrict and Khun Nan Subdistrict, Chaloem Phra kiat District. The research team therefore sets this area as a target for building a community-led health impact surveillance system by installing sensors to measure air quality, collecting samples of soil, sediment and water in creek, rainwater, fish, and villagers’ hair for analysis in the laboratory. We also organize a learning process and practice skills as citizen scientist for villagers, including teachers and students in the targeted areas. 5. Analysis results of acid gas condition is related to agricultural crop damage such as withered rice grains, disease outbreaks in plants. Mercury contamination was found in sediments, fish, and in human hair, but not exceeding the standard. 6. Therefore, the recommendations are as follows: 1) the emission control at the source, by installing a mercury capture, improved dust collector technology efficiency, nitrogen oxides and sulfur oxides capture. This should be implemented through the National Human Rights Commission of Thailand, and the ASEAN Intergovernmental Commission on Human Rights (AICHR). 2) And in the long term, there should be a mechanism to regulate transboundary pollution in ASEAN, including the use of financial institutions’ mechanisms for auditing in accordance with business and human rights principles. 3) To have a process to prove if the impact is from Hongsa Power Plant pollution or not, and then to have fair compensation, including paying for operations to rehabilitate contaminated areas. 7. Amend the Environmental Act in the section that related to environmental surveillance and adding content on joint governance of transboundary pollution. This research was used as a case study. In short, the surveillance system in this project is a cross-disciplinary and cross-operation between experts and the public, which can adjust the balance of power in environmental justice. That is to say, traditionally there was a line between recognized experts in possession of tools and knowledge-generating production processes, and lay people who are subject to risks and consequences under unknown situation, as information and knowledge production are blocked. But the experimental initiative in this project is to create a new power from the ability to produce knowledge by themselves from the people who are at risk and affected, in collaboration with various experts. The result is, in addition to scientific knowledge, movements and social networks also emerged. And there is a set of facts that can be used as evidence in further claims. Therefore, the production process which creates shared knowledge platform is an important part in rebalance of power this case, and in other cases where there are further risks to the environment and health.


Background: Thailand has continued to develop strategies and actions to promote rational drug use. In 2019, a policy in promoting Rational Drug Use Country was issued and implemented nationwide. It is therefore necessary to develop national rational drug use country indicators (RDUCI) to monitor progress and assess national levels. Objectives: The objectives of this research were to develop a framework for developing RDUCI indicators and to develop a set of RDUCI indicators according to the specified framework for relevant agencies to use these indicators for monitoring progress and evaluation of RDU at the national level. The development of the indicator development framework and the development of a set of indicators were conducted by using desk review, literature reviews, conducting several meetings of experts for drafting and reviewing process. A survey of experts from different agencies involved in the policy and implementation of rational drug use promotion in Thailand was conducted. Content validity and usefulness of the indicators were rated by the experts. RDUCI templates had been developed and tested for their feasibility for data collection and processing from two sources, one from hospital databases of medium and large hospitals under the Ministry of Public Health (MOPH), and another from the Health Data Center of MOPH. Results: A set of 24 RDU Country indicators was selected based on the RDUCI Development Framework, addressing the National Strategy on RDU and the directions of RDU Country. The selected RDU Country indicators were consisted of 4 drug system structure indicators; a national body responsible for the development of RDU guidelines, establishment and action of pharmacy and therapeutic committee responsible for RDU in public and private healthcare settings, continuing education for prescribers and healthcare providers, and the establishment of RDU Province based on specific criteria. The RDU Country output indicators consisted of 14 indicators related the rational drug prescribing in health facilities, including prescribing of medications in the NLEM, antibiotic prescribing in outpatients, antidiarrhea drugs prescribing in children age <5 years, and prescribing of necessary drugs for treatment and prevention of disease complications in diabetes, cerebrovascular and cardiovascular diseases, and prescribing of non-necessary medicine. Health outcome indicators consisted of 4 indicators, 3 indicators suggesting the effectiveness of medicine in disease control, and 1 indicator for hospitalization related to preventable adverse event related to medicine in diabetes type 2. RDU Country indicators for impact of RDU consisted of 2 indicators, antimicrobial resistant rates, and equity of health expenditure among health insurance schemes. The RDUCIs consisted of the existing indicators of the Ministry of Public Health, the RDU Service Plan and the new indicators developed in the process of this study. The validity test of the data from the 43 standard report data from public hospitals indicated issues of inaccurate and incomplete drug codes. The feasibility test of the selected RDUCI templates on the Open Data of the Ministry of Public Health on RDU Service Plan indicators and AMR suggested that it was feasible to use the data from these sources for national RDU monitoring using the selected RDUCIs. Conclusion: This set of RDU Country indicators developed in this study focuses on the use of drugs in humans and the drug prescribing in hospitals, representing the ongoing RDU policies that have been implemented and have the most concrete results in Thailand. However, there is still a lack of financial indicators, pharmaceutical manufacturer and distributor, and drug information resources. Regarding the availability of the NLEM, it appears to integrate in the NLEM prescribing indicator. Another indicator that should be considered to add to the set of the RDUCI is the coverage of necessary pharmaceutical services such as medication counselling, medication reconciliation, and medication review, responsiveness, and efficiency of RDU. To improve the coverage of RDUCI, additional indicators should be considered, such as monitoring of ethical drug promotion of drug manufacturers and distributors, drug registration, availability of drug information for public, drug distribution control in community, self-medication behavior and its safety, and drug use in farms and agricultures. For the development of RDCI in the next phase, it is suggested that data collection using RDUCI, determination of the target goals, and the application of the RDUCI data for promoting RDU Country should be conducted.


From the Ministerial Regulations on Government Divisions in the Office of the Permanent Secretary Ministry of Public Health 2017 stipulates that the Office of the Permanent Secretary Has a mission regarding strategic development and transforming the Ministry's policies into government action plans, as well as allocating resources and administering the ministry's general affairs. In order to achieve the goals and achieve the missions of the Ministry which covers management transfer the policy drive to personnel both in the central and provincial areas. By the Office of the Permanent Secretary, there are driving agencies divided into 16 centrals administration agencies, 2 provincial administration agencies, and 17 internal agencies. However, from changes in the context of the economy, society, environment, and various policy issues affecting the structure of the Permanent Office at present. Some of which may be similar to the roles of existing divisions of government or there may be unclear while some parts have changed according to policy causing the work of some agencies to be established within some parts may be inconsistent with what is being done at present In this regard, the results of the analysis of the roles and structure of internal agencies under the Permanent Office led to the proposed structure, which was divided into 4 central administration agencies directly under the Ministry of Public Health, 15 central administration agencies, 1 central administration agencies located in the region, 2 provincial administration agencies, and 5 internal agencies. It is proposed to divide into 1 independent agency and dissolve 1 agency. In addition, it is proposed to analyze the context and roles of agencies under the structure of the Permanent Secretary on a regular basis, such as every 5 years in order to be consistent with changing contexts, including requiring that the establishment be assessed internally every year.


The critical period for growth and development is during childhood and adolescence. In Thailand, the number of children 0-5 years with delayed development is an important issue tracked annually by the Ministry of Public Health. If appropriate health promotion is provided during this critical period, children will grow up to be happy adults, able to realize their full potential, and become strong contributors to society. Health care providers, parents, and teachers all have important roles in providing health care supervision. Notably, amongst these three groups, parents spend the most time with their children. If parents are equipped with information on how to support and promote healthy physical, mental, emotional, and behavioral development, they can track their children’s development and detect problems earlier. Since 2013, we have set on a mission to research and development a mobile and web application called KhunLook that serves this purpose with funding from the Healthcare Systems Research Institute (HSRI) and the National Research Council of Thailand (NRCT). KhunLook provides up-to-date information and healthcare assessments based on standard best practice and clinical guidelines in an easy-to-use and convenient mobile and web application. More than 500,000 people have downloaded the mobile application on iOS and Android operating systems, and more than 3,000 people have registered and used the web application www.khunlook.com. The KhunLook mobile application’s key strength when released was its ability to work completely offline, disconnected from the Internet, which was required in 2013 because the majority of users at that time could not afford Internet access on their mobile phones. Today, Thailand is amongst the top countries in the world with mobile Internet access. Therefore, in this project, we have updated the KhunLook mobile application to be an online application that can work in both online and offline mode. With users’ consent, we store user data on the KhunLook Platform and use that data to provide healthcare data analytics. After the first six months of deployment, we have access to more than a million healthcare-related records that can be used for healthcare data analytics, such as data on development, growth, vaccination, and oral health. If KhunLook were to be promoted widely, there could be a large amount of data comparable to the data collected by the Ministry of Public Health to track their KPI’s, leading to valuable data-driven insights that could influence health care policy. Furthermore, the granularity of data in the KhunLook platform is more fine-grained than data tracked by healthcare service providers, so there is potential to leverage KhunLook data to perform in-depth health assessment of individuals. Lastly, the KhunLook platform can be used to broaden the reach of healthcare innovations by adding such innovations into the mobile application. We have conducted a pilot study to leverage the KhunLook platform to support parents of children with delayed development by providing them access to the Department of Mental Health’s Thai Early Developmental Assessment for Intervention (TEDA4I). Parents can use the KhunLook mobile application to stimulate and track their children’s development. As future work, other innovative assessments may be added, and their usage may be tracked through the KhunLook platform.


Common illness is the most symptoms sickness in people. Since they are less severe and less complicated, people could do initial selfcare to recover from these symptoms. Receiving services at drug stores is therefore an option for people. This is the first study to estimate the cost savings of common illnesses that cover 16 symptoms as announced by the National Health Security Office (NHSO) in conjunction with the Pharmacy Council in the new Common Illness pharmacy project at drug stores to cost of Thailand's health system. This study gathered retrospective secondary data from several studies those reported the number of visits for treatment 16 symptoms common illnesses, direct medical costs direct nonmedical costs, and indirect costs. The cost of illness of treatment for 16 symptoms common illnesses at a pharmacy compared with outpatient treatment at a hospital from 3 perspectives: government perspective, patient perspective and social perspective were estimated. This study assumed that patient is responsible for cost of drug and health care services. The average number of hospital visits of treatment for 16 symptoms common illnesses was 2,356 visits per month. The first most 3 symptom groups that patients received services were sore throat, fever, and abdominal pain. The average number of hospital visits were 529, 442 and 394 visits. The estimation of the cost savings of treatment for 16 symptoms common illnesses at drug stores to cost of Thailand's health system from 3 perspectives including government, patient, and societal at tertiary care hospital were 446 – 683, 665 – 901, and 742 – 927 Baht per visit, respectively. When calculating from the amount of service received in a year, it was found that the average cost saving per year were 16.49 – 25.23, 24.56 – 33.30, and 27.39 – 34.26 million Baht, respectively. At secondary care hospital, cost saving per visit were 212 – 448, 430 - 667, and 507 - 692 Baht, respectively. Cost saving per year were 7.81 – 16.56, 15.88 – 24.63, and 18.72 – 25.58 million Baht, respectively. In conclusion, every 1 Baht reimbursed for treatment 16 symptoms common illnesses at drug stores will save additional costs in Thailand's health system if people choose to receive treatment services for 16 symptoms common illnesses at drug stores instead of receiving outpatient services from tertiary care hospitals saving ranged from 1.41 – 8.58 Baht and secondary hospitals savings ranged from 0.67-5.63 Baht. This savings comes from the fact that people do not have to take time off work to wait for receiving health care services at the hospital. It can be concluded that the treatment for 16 symptoms common illnesses at drug stores can clearly save costs.


Genetic testing for identifying genetic factors underlying diseases or their correlations with disease development is widely used in medical research. It can be employed to search for elusive disease-causing genes or genes contributing to complex diseases, leading to treatment and prevention strategies. The concept has been applied to investigate the causes of sudden unexplained nocturnal death within the young population, particularly in Thais. Studying the exome of deceased individuals is valuable for identifying potential gene factors that may be related to or responsible for their demise. Previous studies have focused on single gene, such as those associated with channelopathies related to sudden cardiac death. These genes were found to be interconnected and systematically organized. However, due to the unique nature of sudden unexplained nocturnal death, the causative factors might differ from the previously studied groups. This forms the basis of the current research. In this study, blood samples were collected from a sample group of 98 deceased individuals and 2 deceased relatives. Comprehensive genetic analysis was performed on whole exomes study. The results were then compared against medical databases and classified according to bodily systems, such as the cardiovascular system, nervous system/brain, and metabolism. The study presents genes identified within Thai population, categorized based on various factors that could potentially contribute to their demise. Additionally, novel genes were discovered, both within the nervous system and brain, as well as the cardiovascular system, which could be significant contributors to fatalities.


Research project entitled ‘Developing and using community surveillance database to prepare for dealing with cross border pollution problem Project’. The objectives were to study the community way of life, socio-economic status and health, to define the villagers' concerns in regards with pollution and to determine risk areas and activities of villagers in risk areas. This project aims to prepare the villagers for applying local information systems and monitoring systems to cope with transboundary pollution. The study sites were Ban Huaikon, Ban Nam Chang, Ban Dan, Ban Phu Kham and Ban Wang Pha, where possibility to be in risk of exposure to transboundary pollution from the Hongsa power plant, Lao People's Democratic Republic. Due to their proximity to the Thai-Lao PDR border, Ban Huaikon, Ban Nam Chang, and Ban Dan might encounter transboundary pollution. Ban Wang Pha and Ban Phu Kham are farming communities. The most common crop is the Si-thong orange, which is the geographical indicator. In recent years, yields and agricultural productivity have declined significantly, with the villagers still unsure of what are the roots of yields and productivity reduction. The research methodology includes a questionnaire survey, focus groups, community mapping, risk maps, and in-depth interviews with community leaders, members of vulnerable groups, and experts from governmental organizations, which are the Pollution Control Department and the Department of Industrial Works. With this methodology, it leads to establish a surveillance network within the community. The study's findings showed that while the villagers' ways of living varied in terms of geography, ethnicity, and regional culture, their primary economic activity was agriculture, which is heavily dependent on natural resources. Health is influenced by daily tasks and surrounding factors. The villagers also observed that respiratory ailments such allergies, asthma, dry cough, and the common cold were more prevalent. It has been found that each village has regulations in place for managing and conserving its natural resources, such as communal forests and restrictions for the usage of local forests. The villagers' way of life is heavily reliant on natural resources including water, soil, and air, which are essential for agriculture. Since the environment is vulnerable, it will have an impact on villagers’ way of life and their agriculture. The community data system is pursued via community map and risk map. If pollution occurs, the villagers can understand the physical context of their own area and correlate with occurrences of activities and types of hazards. The risky area may be restricted for community activities, especially outdoor activities (e.g. plantation, fishing, swimming). However, the preparedness to response with transboundary pollution, the community data and monitoring systems are essential. The internal consensus of community, they agree that the government must support the knowledge in areas of agriculture, public health and environment, as well as local administration should participate with community in monitoring and surveillance. The villagers are familiar with line application and local announcement, these can be employed for risk communication. Finally, the representatives from Hongsa power plant should participate with the surveillance network. The villagers would like to receive the data of power plant, budgets for surveillance network and for remediation. The participation should be routine, which can keep the awareness in transboundary pollution and can bring the harmony in sharing the resources between the communities and Hongsa power plant.


The main objective of this study was to determine the people’s perspectives and expectations on devolution of health promoting hospital to local administration organization. The alternative aims of this study to impact of devolution of health promoting hospital to local administration organization, health database management system, problem and obstacles on devolution. Conceptual framework based on system theory and six building blocks. The study design was conducted Mixed methods. Study areas were regional health 1 and 4. Data collection method both questionnaire and in-depth interviews from health promoting hospitals both devolution and not devolution. Study subjects composed of 3 groups: 1) executives in the area, including both ministry of public health and local administrative organizations (n=48), 2) Officer of health promoting hospitals (n=104), and 3) people in each area (n=3,912). Results found that people whose experiences services of all 46 health promoting hospitals had perspectives and expectations do not difference between devolution and non-devolution. They would doctor home visit, drug quality, receipt drug from health promoting hospitals and do not need got drug at hospital, laboratory in community, and staff enough to services. Although, the satisfaction of people towards the service of between health promoting hospitals that devolution was higher than non-devolution with statistical significance (P value <0.05). Impact of health promoting hospitals devolution found that local administrative organizations were affected in terms of personnel that were not transfers as well, budget issue was not clear to use, and issue of the land and buildings that need process with another organization, and including health database management system, referring, there were no clear guideline. Problems and obstacles encountered in operation due to unclear communication, distrustfulness, untrustworthiness, and the recently started responsible office for public health in local administrative organizations make the devolution are many obstacles to implementation. Therefore, clarifying communication and trustfulness between the Ministry of Public Health and local administrative organizations will make the transfer. able to meet the expectations of the people.


This research studied on manpower management of Chaloem Phrakiat 60 th Anniversary Nawaminthrachini Health Station and Subdistrict Health Promoting Hospitals in a case of transferring to the local government organization using the mechanism of the Primary Health System Act 2019 . The aims of this research were to study the situation of manpower management and manpower management needs. This research also proposed to develop manpower management policy proposals after transferring missions to local government organization. Qualitative research was conducted and divided into 3 phases. Data was collected in the provinces transferred to local government organization (Subdistrict Administrative Organizations and Municipalities) and provinces transferred to Provincial Administrative Organizations. The key informants were administrators from the Provincial Administrative Organizations and Provincial Health Offices which formed the policies for health manpower management and health personnel who were practitioners in teaching and Subdistrict Health Promoting Hospitals that have been transferred. This included representatives of village health volunteers and representatives from the public sector that used healthcare services Results The comparison of the health manpower after transferring to local government organization (Subdistrict Administrative Organizations and municipalities) indicated that there were an increase numbers of teaching professionals and Subdistrict Health Promoting Hospitals everywhere. However, the numbers of health manpower were not yet covered in full capacity. After transferring, a variety of health services were organized to cover both modern medicine and alternative medicine focused on people access to the services by "close to house and close to the heart". People were easier and more convenient than in the past. The services responded to the needs of clients. There were fast communication channels, modern equipment, decreasing the costs and having fairness. This was a quality primary health service. Administrators provided opportunities to create innovations in health service models based on the problem conditions in each area. which made the people satisfied. In overall, health manpower of teaching professionals and Subdistrict Health Promoting Hospitals transferred to Provincial Administrative Organizations revealed that all professional personnel were not transferred and there was less manpower than before transferring. As a result, health personnel were not enough for healthcare services, especially teaching professionals and small or medium sized health care hospitals. In addition, it was found that some teaching institutes and Subdistrict Health Promoting Hospitals had transferred their missions to Provincial Administrative Organizations. However, no health personnel were transferred. Policy recommendation for health workforce management to relevant parties were the issues as follows: 1) The Ministry of Public Health should play a key role on supporting necessary professional personnel for teaching and Subdistrict Health Promoting Hospitals to have a similar number of personnel before transferring and can provide seamless health services. There is no interruption in service provision. For government personnel who do not wish to transfer, they can temporally work on duty in the government service not more than 2 years and can receive the rights and welfare benefits the same as or more than in the past for the morale and encouragement of the workers. In addition, The Ministry of Public Health should create a personnel information system by connecting with the information systems of local government organizations. Further, The Ministry of Public Health should take responsibility for controlling and supervising the quality standards of the service unit as well as creating a curriculum for human resource development in collaboration with localities to develop competencies and capabilities of personnel that are standards for health service provision. 2) The Ministry of Public Health must consider an urgent agenda for preparation in order to adjust the structure, roles, missions and develop the skills of personnel in the District Health Office. This action is for adjusting their role on coordination in the future and to develop quality standards and supervise primary care units in accordance with the policy of the Ministry of Public Health that has established the Primary Care Division as a new unit to supervise the quality and standards of primary care units throughout the country. The Ministry of Public Health should accelerate the development of personnel, including mechanisms for supervision, monitoring, and evaluation of the performance of teaching and Subdistrict Health Promoting Hospitals, as well as providing opportunities for the public sector to participate fully. 3) The Ministry of Public Health should join with the Department of Local Administration to expedite the preparation of performance standards for teaching staff and Subdistrict Health Promoting Hospitals under the local government organizations throughout the country. The propose is to develop the quality and standards of local primary health care services and to respond to the overall health policy of the country. Further, it also solves the complex problem operations between primary and secondary healthcare services, and the separation of primary and secondary management including referral systems. 4) The Decentralization Committee to local government organizations should provide regulation in considering the readiness of teaching staff and Subdistrict Health Promoting Hospitals for personnel to be transferred. This helps to protect the impact on public services, especially teaching and Subdistrict Health Promoting Hospitals that can be transferred. The process should have voluntary personnel to be transferred at least 70 percent including professional personnel such as public health academics, professional nurse who are ready to work and provide health services to the people. 5) The Department of Local Administration should accelerate to study regulations and various rights that professional personnel previously received from the Ministry of Public Health. Additionally, Department of Local Administration should speed up the issuance of regulations to support the various benefits of the transferred personnel in order to receive various benefits that are not different from the original Transfer Act. This encourage to build confidence for personnel transferred to the local government organizations, especially career advancement, rights and welfare that they will receive as well as creating plan to promote position of personnel to the senior professional level. 6) The Department of Local Administration and Provincial Administrative Organization need to urgently formulate the appropriate PCU or NPCU, including (1) the manpower framework, chain of command, a clear progression of career path and resource support system, (2) fields of work in PCU or NPCU, (3) the maximum population that can provide quality care, personnel structure framework and appropriate population proportion in each area such as at the remote areas. 7) Provincial Administrative Organization needs to provided family physician services in primary care units and primary care networks to take care of the people in an appropriate proportion. The network of family doctor clinics must be expanded to cover all primary care units transferred. This enhances to create service access, increase service quality appropriately to the context in each area with the cost that the system can afford under the time frame specified in the Primary Health System Act 2019. 8) Provincial Administrative Organization should expedite to formulate health development plan, determine the strategy of the service system as well as recruiting knowledgeable personnel to serve as the director of the Public Health Division.


This research aimed to evaluate situations of primary care services and to examine influencing factors towards providing desirable primary care in 7 dimensions: service delivery, health workforce, health information systems, accessibility to essential medicines, financing, leadership/governance, and community participation. A total of 468 respondents from the community health centers and subdistrict health promoting hospitals in the Northeast of Thailand responded to the questionnaires based on guidelines for health service systems improvement. The data were analyzed using descriptive statistics (frequency, percentage, mean and standard deviation); and inferential statistics (binary logistic regression). The results showed that the overall mean score in providing desirable primary care services was 2.29 (SD = 0.39) from full score 3. Service delivery and health workforce had the lowest scores at 1.73 (SD = 0.51) and 1.92 (SD = 0.68), respectively. Of these respondents, 66.0% reported that their patients were cared for by family doctors, 52.4% was the proactive care service provided by the 3-healthcare teams (family doctor, public health professional and village health volunteer) and 50.2% by village health volunteers. Ten of the 76 primary care providers had doctors working after office hours, 96 primary care providers had no doctors even on the rotating schedule. Village health volunteers were reported to be an active health information sender by 78.0%. Moreover, 73.7% requested for improvement of the 3-healthcare team service. The five lowest-score services needed improvement were rehabilitation, consumer protection of the health products, physical activity promotion, emergency medical service, and sanitation. Influencing factor towards the provision of desirable primary care services was the registered primary care unit (adjusted odds ratio = 5.16, 95%CI 1.33 to 20.12, p value = 0.018), while the factors of health region, size of population, size and standard of primary care units were not statistically significant. To improve primary care services, the adequate human resources as the requirement for registered primary care unit according to the Primary Care System Act should be adhered. This would help provide essential primary care services entirely, adequately, and appropriately for Thais.