Through the financial support of the Program of Health Promotion for People with Disabilities in Thai Society, Health Systems Research Institute (HSRI), during June 2007 to March 2008, College of Population Studies, Chulalongkorn University conducted the evaluation research of the Project on Networking of Independent Occupational Development for People with Disabilities (onward refers t the Project). This Project was initiated by Office of Empowerment for Persons with Disabilities, Bureau of Welfare Promotion and Protection of Children, Youth, the Disadvantaged, Persons with Disabilities and Older Persons, Ministry of Social Development and Human Security in response to the 2006-2006 National Plan on Improvement of Quality  of Life of People with Disabilities
The evaluation research project had four main objectives as followed: 1) To evaluate whether the Project fulfilled its objectives and its appropriateness to the capability of the people with disabilities; 2) To analyze strengths, weaknesses, needs, supporting mechanisms of the 3 major occupational groups classified in the Project: Occupational Training for People with Disabilities in the community, Occupational Support for Severe Disabilities and Mental Disabilities, Promotion of Coalition of Independent Occupational Groups; 3) To propose supporting mechanisms for occupational development to improve quality of life of people with disabilities; and 4) To propose systematic learning processes for occupational development and mechanisms for occupational promotion for people with disabilities.
	The evaluation was conducted in 5 targeted provinces; Kanchanaburi, Nakorn Pathom, Phayao, Khon Kean and Pattalung. Data collection was carried out through 2 methods including observation of activities organized among people with disabilities (onward refers to the disabled) in various occasions, in-depth interview with 16 authorities of Local Administrative Organization (LAO) and local personnel who were in charge of the Project (onward refers to LAO personnel), and Focus Group Discussion among 89 disabled and the caretakers who were the disabled’s family members (onward refers to caretakers). In addition, relevant information was gathered from existing documents and reports on the Project reported by each participation province  (including reports on learning and sharing experiences forums, and meetings on knowledge management among leaders and group members).
	The evaluation results are summarized below.

Objective 1: Whether the Project fulfilled its objectives, and its appropriateness to the capability of people with disabilities. Majority of LAO personnel, the disabled and caretakers agreed that  the Project which has started since 2002 was appropriate and suitable with capability of the disabled in each occupational group classified in this Project although some families, later on were not so successful and have given up running their occupations.
Before making decision in selecting any occupation supported by the Project, in most cases the meetings were held among stakeholders (officials of Provincial Office of Empowerment for Persons with Disabilities, LAO personnel, the disabled and caretakers) to discuss what was the most suitable or possible occupation for the disabled to take up. Therefore, the occupation was chosen to serve needs and suitable with ability of the three groups of the disabled supported by the Project.
However, it was clear that the success of the disabled in each group and the fulfillment of the Project’s objectives depended much upon many conditions such as the decision making process to select the type of occupation, background of the group members, basic knowledge and experiences about the chosen occupation, community’s social context and physical environment, timing for preparation before launching the Project in the are, personal conditions of the disabled and their caretakers.

	Objective 2: To analyze strengths, weaknesses, needs, supporting mechanisms of the 3 major occupational groups classified in the project: Occupational Training for People with Disabilities in the community, Occupational Support for Severe Disabilities and Mental Disabilities, Promotion of Coalition of Independent Occupational Groups
	1. It was clear that strengths, weaknesses and problems in running the chosen occupation of the disabled were very much depended on following factors; background of the disabled (and their care takers) in each classified occupational group, administration of allocated funding (group vs. individuals), ability of leaders, LAO personnel’s responsibility and understanding of the Project’s objectives, access to information and new knowledge to help improve products, information dissemination to the public about life of the disabled and their potentials, marketing and product outlets, attitudes of the disabled toward the chosen occupation.
	2. Possibility to scale up the Project and the expansion of the independent occupational development network for the disabled were quite slim due to limitations of funding support of the existing group, the lack of strong leadership, inability of the disabled to form up groups due to distance, intention, and time allowed for joining group activities.
	3. Needs for supports were varied in each classified occupational group (who had different types of disability). However, the most needed support identified by the majority was the working plan to support people with disabilities should be integrated into the LAO’s year plan. In addition, higher priority should be given to work plan to promote and develop capacity of people with disabilities to be able to live independently.
	4. Important mechanisms for capacity development of people with disabilities include their families, community, Government organizations, Non-Government organizations and local administration organizations.

	Objective 3: To propose supporting mechanisms for occupational development to improve quality of life of people with disabilities. In the process of independent occupational development for people with disabilities, 8 mechanisms were identified as important factors contributing to either success or failure of the Project operation. They were
	1. National policy and Government commitment to support plans for capacity development of people with disabilities, and the government organizations (at the Ministry level) where policies are translated into project implementation.
	2. Government officials at the provincial level who coordinate organizations at the Ministry and local levels, and who monitor the Project to be implemented according to its objectives.
	3. Organization and personnel at the local level (Local Administration Organization) who work closely as a “baby sitter” and who provide advice for the disabled and their caretakers.
	4. Networking of local volunteers in the community who assist the LAO personnel to gather information and collect data about the disabled, following up the Project, asses problems occurred among the disabled to report to the LAO personnel.
	5. Other organization outside the community to provide supports needed by the disabled, or to help fill gaps where the LAO was unable to provide or unable to do.
	6. Network of people with disabilities, group leaders, and experts who could help mobilizing the group to move forward.
	7. Community and society which are equally important to the national policy to support the disabled. If the community and the society are supportive, the disabled will have greater chance to be integrated into the mainstream, and learn to be independent.
	8. The attitudes of disabled and their families toward work and being independence; whether they prefer to work in order to be independent economically and socially or to live on the social welfare support

Objective 4: To propose systematic learning processes for occupational development and mechanisms for occupational promotion for people with disabilities. The project has attempted to build up the systematic learning process and mechanisms necessary for occupational development for the disabled for future use. In attempt to do so, two academic units from two universities took part. One was from Faculty of Social Work and Social Welfare, Huachiew Chalermprakiet University where the research team performed monitoring function and organized several meetings and forum (such as lessons learned, sharing and learning experiences, knowledge management, and best practice  in the 5 target provinces. The meetings provided chances for the officials and the disabled to learn and share information among each other. In addition, the information obtained from these activities were organized systematically to be used for occupational development for the disabled in the future. The other academic unit was College of Population Studies, Chulalongkorn University where the research team performed evaluation function to evaluate the performance of the Project in the same 5 target provinces. The evaluation was conducted according to the 4 main objectives as already mentioned above. Based on the monitoring and evaluation processes, both academic units have proposed the systematic learning process and important issues for consideration if the project scaling up is planned in the future


Violence is a widespread phenomenon, occurring among different genders, ages and social groups. However, some people, particularly disable people, are more likely to be victimized than able people due to social and cultural circumstances. This paper examines key issues related to violence against disabled people. It begins with an examination of how the medical model explain and gives meaning to disability by portraying disable people as abnormal, child-like, ‘damaged goods’, ‘freaks of  nature’, unattractive, dependent, in need of protection, and object of pity, unproductive, and tainted by disease/ill-health. These social representations have been fed in the ideas of deviancy from the norm and supposed inferiority. Such labels imply both a functional loss and a lack of worth, they perpetuate and legitimate offensive responses by non-disabled people including over-protection, discrimination and abuse.
	In addition, the literature review indicates that women with disabilities are at a much higher risk of being sexually abused, compared to other women. As women,
They are oppressed in a society of male domination. As disabled, they are dependent, isolated and unable to seek help. Research in Thailand concerning violence against disabled people is scarce. Thus, systematic research and interventions are needed to reduce violence against disabled people.


Title: Management of health technology assessment in foreign countries
Objective: The study aims to explore how the processes to assess the appropriateness of health technologies are managed and carried out in responsible organizations in other countries.
Methods: Literature search on MedLine, Google Scholar as well as institutes websites were employed in order to gather relevant information. The selection criteria were; (1) the institute must be the national representative and noncommercial institute (2) data must be able to retrieve via electronic database and (3) relevant information must be in English. Certain institutes with rich and
useful information were selected purposively. Content analysis of the documents was the major approach of this review.
Results: Health technology assessment institutes in 10 countries, namely England, Germany, the Netherlands, Sweden, Denmark, the USA, Canada,Australia, Republic of Korea, and South Africa are included in this study. The review suggests that the processes undertaken in these organizations can be divided into 4 main steps: (1) The selection of health interventions to the assessment: Website is a common channel for topic submission. Eligible stakeholders to propose particular technologies comprise different parties namely including healthcare professionals, government bodies, health technology users and the public. The magnitude of health problems expressed in term of ็burden
of disease้ is the most widely-employed criteria. (2) Assessment and consultation: Once the topics are selected, groups of researchers will be assigned to conduct the assessment according to their expertise. The research team generally consists of members of the institute,s advisory committee and scientists from universities, research institutes and representatives of government agencies. (3) Approval of the evaluation results: consultations are convened to obtain comments and suggestions concerning the assessment results. This stage involves experts in relevant fields, health minister, and other key stakeholders in order to ensure the reliability and acceptability of the findings and policy recommendations. (4) The appeal procedure: Concerned parties are allowed to make appeal over the disagreeable assessment results. This procedure is available in some institutes with appraisal or policy decision authority. With regard to the good governance, it is argued that such an idea should be
incorporate in the management of health technology assessment, since the results of the assessments and relating policy recommendations are undeniably affect a wide range of actors in the health sector. Concerning issues include the potential implications for the access to healthcare, government’s budget as well as business’s profits.


This study aims to provide estimate of the economic costs of alcohol consumption in Thailand
2006. It is prevalence-based (i.e. estimate the economic costs of alcohol associated with the past and
current use in the given year, 2006), using the cost-of-illness methodology. Human capital approach
is employed in estimating cost of productivity loss due to premature mortality. The estimated cost in
this study represents the gross cost, in which only the costs associated with negative effects of alcohol
consumption has been estimated.
Both direct cost and indirect cost are included in the estimation. Direct cost includes health
care cost, law enforcement and criminal justice cost, and cost of property loss due to traffic accident
while indirect consists of cost of productivity loss due to premature mortality and cost of reduced
productivity from absenteeism and presenteeism.
According to this study, alcohol consumption costs 156,105 Million Baht or 1.99% of Gross
Domestic Product (GDP), resulting in approximately 2,391 Baht per capita. Indirect cost outweighs the
direct cost, representing 95.8 % of the total cost. The largest cost attributable to alcohol consumption
is cost of productivity loss due to premature mortality (104,128 Million Baht, accounted for 65.7% of
total cost), followed by cost of productivity loss due to reduced productivity (45,464.6 Million Baht,
accounted for 30.1% of total cost), health care cost (5,491.1 Million Baht, accounted for 3.5% of total
cost), cost of property damage due to road traffic accident (779 Million Baht, accounted for 0.5% of
total cost), and cost of laws enforcement and criminal justice (242 Million Baht, accounted for 0.2%
of total cost), which consisted of court cost (156 Million Baht) and police cost (86 Million Baht.),
respectively.
In Thailand 2006, it was found that there were 3,029,427 patients attributable to alcohol
consumption. Of these amounts, 2,675,513 were male while 353,914 were female. When looking at
the number of hospitalization due to alcohol consumption, it was found that there were 218,799
admissions attributable to alcohol. Of this amount, 168,549 hospitalizations were from male while
50,250 were from female. The 5 leading causes of health care cost are road traffic accident (approx.
1,232 Million Baht), HIV/AIDS (approx. 1,088 Million Baht), alcohol abuse (approx. 574 Million Baht),
epilepsy (approx. 537 Million Baht), and alcohol dependence (approx. 430 Million Baht), respectively.
Regarding the cost of productivity loss, it was found that there were 39,459 deaths attributable
to alcohol consumption in Thailand 2006. Of these amount, 33,493 were male, while 5,966 were
female, resulting in the total number of years of life lost due to premature mortality of 1,390,899 years
(male 1,164,551 years, female 226,348 years) Among male, the 3 leading causes of productivity loss
due to premature death were HIV/AIDS (approx. 36,277 millions Baht, 10,204 deaths), traffic
accidents (approx. 26,989 millions Baht, 8,460 deaths), and cirrhosis (approx. 13,044 5,147 deaths), respectively. On the other hand, the 3 leading causes of productivity loss due to
premature death among female are HIV/AIDS (approx. 3,580 millions Baht, 1,877 deaths), traffic
accident (approx. 2,796 millions Baht, 1,848 deaths), and liver cancer (approx 706 millions Baht, 868
death), respectively. In addition, it was found that the cost of productivity loss was highest among
those who were 30-44 years old (13,622 deaths resulting in 49,827 millions Baht) followed by those
who were 15-29 years old (7,275 deaths resulting in 25,912 millions Baht), respectively.
Although this is the current best estimate for Thailand it should be interpret along with the
results of the sensitivity analyses. According to the sensitivity analyses, economic cost of alcohol
consumption ranges between 126,311 to 214,053 millions Baht depending on methodology and value
of parameters employed in the estimation. The result from sensitivity analyses found that the choice of
discount rates makes a considerable difference to the total estimated of economic cost of alcohol,
while the method used in estimating cost of reduced productivity due to absenteeism and presenteeism,
and the inclusion of cost of premature mortality among non-working population have medium effect
to the total estimated cost. On the other hand, proportion of alcohol attributable to road traffic accident
and inclusion of health benefits form alcohol consumption have only minor effect on the total
estimated cost.
This study revealed that direct cost associated with alcohol consumption in term of health
care cost, cost of laws enforcement, and cost of property damage was estimated at 6, 512 Million Baht
or accounted for about 0.1% of Gross Domestic Product (GDP). However, alcohol consumption also
led to the indirect cost in terms of productivity loss due to premature mortality and reduced productivity
which cost approximately 150,000 Million Baht. According to the statistics from Excise Department,
the excise tax generated from alcohol beverage in 2006 was 72,871 Millions Baht or accounted
for 0.93% of GDP. Based on these findings, the Thai government needs to pay more attention to the
implementation of more effective alcohol policies aimed at reducing alcohol consumption and harms
associated with alcohol, including tax policies or other related policies while balancing between
revenues and costs generated from alcohol.
millions Baht,


The objective of the study was to review ethical considerations for research in routine practices. The
main question was whether such research should undergo an ethical review. The study concluded that,
first, there is a need to distinguish among practice, experiment and research. Any work that contains a
research element in part or whole should be submitted for review by an ethics research committee, if the
research involves human subjects, and concerns biomedical, behavioral and social sciences matters. The
rationale is to ensure that human subjects or research participants are appropriately protected with regard
to their dignity, rights, safety and well-being according to internationally accepted ethical principles concerning
human research. However, the burden of ethical review should be appropriately managed. The
research should be categorized by risks. Research that involves minimal risks should be considered for
expedited review.


This study employs both qualitative and quantitative methods. It aims to understand the process of the transfer system of a public health center (PHC) to Local Government Organization (LGO). Specifically, the study focuses on the process of setting up the transfer mechanism, monitors the product and output, analyzes and summarizes lessons learned, as well as provides policy recommendations relating to the mechanism and structure for transferring the PHC to the LGO. The research duration is from September 2007 to October 2008.
	Research results confirm that those PHC under study followed the mechanism and process of the transfer system to LGO. However, they encountered some difficulties pertinent to time constraints and communication problems at all levels. With respect to the product, we have discovered that there were four types of the transfer system: these are (๑) the whole transfer of PHC and personel, (๒) the whole transfer of PHC and parts of personel, (๓) the transfer of some PHC with all personel of those PHC, (๔) the transfer som PHC with parts of personel, of which the majority of the PHC employed the second type. Different types impacted the management of works, budget, personnel and materials differently. Relating to the output, we have learnt that ideas and paradigms of the public health decentralization to local areas were significant and made the transfer system efficient through generating people’s participation and coordinating with the network of public health consistently. In terms of policy and development strategy implemented at the local level, we have discovered that they emphasized the idea of service to all, stimulated proactive works, and improved policy, strategy and planning for public health and environment activities parallel to the development of infrastructure. Also, we have discovered some problems relating to the management of works, budget, personnel, property, material, medicine and medical supplies following the imprecision of rules and regulations from the Ministry of Public Health and the Ministry of Interior. Factors contributed to the success of the transfer included cooperation, leadership ability, having organizational vision and ability for management of the LGO.
	Recommendations for transferring the PHC to the LGO are in the following. At the policy level, the national decentralization committee should have a clear integrated policy and establish a national coordinating body to be responsible for making the public known of the value, idea and benefit of the public health decentralization. At the provincial and district level, it is necessary to have a proper academic supporting mechanism based on the participation of all parties concerned for monitoring and supporting the transfer of the PHC to the LGO smoothly and communicate with all concerned parties efficiently. During and after the transfer, it is significant to promote a sharing of experience, information and reflection of the transfer. At the community level, we suggest that the LGO and the PHC should abide by the principle of people’s participation starting from local public organizations to local civil societies in decision making for the transfer of the PHC to the LGO and the support for community health development planning.


The study and summary of a case study of an experiment to transfer a health center to local administration organization, from a health center to Bangnomkho Municipality, Sena district, Phranakhon Si Ayutthaya.  The objectives of the study are: 1) to study the process of establishment, techniques, and the actual transfer compared with determined principles, criteria, and important conditions; 2) to follow up product, result, and impact occurring from the transfer; 3) to analyze and summarize a lesson which has been transferred by comparing the expectation and actual events, and 4) to create policy suggestion, techniques, structure, conditions, and components of the transfer.  A purposive sampling was used and consisting of provincial locals, experts, public health officers of the province, public health officers of the district,  health center officers, public health volunteers, people’s representatives, and health center’s service users from the levels of province, district, and locals, from local administration organization, public health, people from 3 villages with a total of 377 people. The study covers 3 phases: before the transfer, during the transfer, and after the transfer. Research tools were unstructured interview, After Reaction Review (AAR), and structured interview.
The result reveals that the transfer which relates to quality of life promotion follows the Royal Act which determines plans and procedures of power decentralization to local administration organizations 1998.  According to a resolution of the committee of power decentralization to local administration organizations, the main factor is law.  The reasons are: 1) the readiness of Bangnomkho Sub-district Administration Organization, which received an outstanding award in management in 2006; 2) the Organization has been appointed as a pioneered Sub-District Administration Organization in transferring missions, and 3) from the evaluation, the community is ready and has received the approval from the committee of Sub-District Administration Organization Council.  The second factor is the volunteering wills of health center officials.
	The process of transferring includes the meeting of the province’s sub-committee before the transfer.  They helped each other to study the transfer according to the mission in order to build up confidence of the officers who received the transfer. After the transfer, the Bangnomkho Sub-District Municipality gave the importance to health of people in the community by allocating the budgets to be used to promote quality of life, to support the purchase of materials, buildings, and others as well as following the plan which was set in the sub-district development plan.  Concerning the arrangement of a stage to analyze and summarize the lesson using AAR, the expectation from people concerned, their roles, and participation in the transfer of health center in the provincial level showed that Bangnomkho had a strength and also a weakness which could obviously be improved in a national level.  At a district level, it is believed that people’s ways of life did not change. After the health center was transferred, there would be more chance to take care of people’s health.  The health center officials were confident that it would be improved.  The health center’s service users hoped that the services would be better.  Regarding the change of services in health care before and after the transfer and its processes, people were interested in following the news of the transfer the health center to be under the supervision of the municipality.  They were aware of the result of the transfer of Bangnomkho Health Center.  As for the level of people’s participation in the transfer both before and after, it was found that they did not participate in any aspect.  Concerning the effect of health services, comparing before and after the transfer, both overall and in each aspect were found better.  After the transfer, the level of change was positively higher.
       The suggestions from the research in transferring public health in a district level based on the central policy are: 1) high ranking authorities should have a meeting, consultation, and discussion and work together to set up cooperative policy both from the Ministry of Public Health and Local Administration Organizations to make the transfer clearer in terms of length, clauses in law, measures which can lead to real situations; 2) the public health offices in the province and local area should initially promote the transfer to related people so that they can understand the policy and guidelines as well as providing information and consultation about administration, personnel, and budgets; 3) operational suggestions pertaining to health services in the municipality area, study of public health knowledge, lack of medical personnel, strategic plans to produce personnel, develop, promote, and support personnel in terms of knowledge, behavior, attitude in order to prevent diseases, self-caring rather than depending on medical treatment; 4) the analysis of the effect of health care services comparing before and after the transfer, the overall change indicated better condition, though it was not much because the study period was only 5 months, and 5) the participation of people in the transfer should not be only for awareness or receiving services, they should take part in the process of planning, providing more operational support so as to create more self-dependence in community health care


The National Strategic Plan for Development of Folklore, Thai Traditional, and Alternative Medicine B.E. 2550-2554 has been approved from the cabinet since June 12th, 2550. It was expected to be utilized as a strategy execution tool to boost up the development of folklore, Thai traditional and alternative medicine in Thailand. However the performance evaluation by means of document review and in-dept interview of executives of agencies concerned reveals failure of the national plan as there are scarcely implementation of the plan as strategic direction of program, plan, project development and resource allocation.
The drafting committee of the National Strategic Plan has tried its best to develop the plan through active participatory process. However most of the executives of the agencies concerned still perceived the image of the plan as developed by only some representatives of the agencies and did not reflect full commitment, consensus and support from the organization. The National Plan has just provided very broad guideline strategies without specific additional budget allocation and integration tool for the program-plan-project among the agencies concerned. So most of the agencies concerned implement their projects and activities according to their own priorities and neglected the National Strategic Plan. The strategy execution unit is identified as a very crucial missing part of the National Strategic Plan.
To revitalize the National Strategic Plan to be executed as an effective and efficient management tool for development of the folklore, traditional and alternative medicine in Thailand, there are major policy interventions and a draft of integrated project proposal to request for additional budget details as follow:
1	Promote active participation of agencies concerned through actions and  execution of the National Strategic Plan
2	Established Strategic Execution Unit and define strategy champion or major stakeholder for each project-program-strategy
3	Develop essential strategic execution databases and decision support system
4	Support additional budget for integrated approach project and apply project management system
The draft integrated project proposals for additional budget request for health care and health system development to promote folklore, traditional and alternative medicine in Thailand could be developed according to the 4 major strategic issues as
1.	Development of databases and strategic execution support system
2.	Strengthening of popular and community health system
3.	Integration of folklore, traditional and alternative medicine to national health system
4.	Development of service standard
There are 10 proposed integrated projects, implement within 3 years period (2552-2554 B.E.), and the total budget requested is 1,390 million baht.
The main products and expected results of the proposed integrated projects are summarized as follow:
1	Establish 4 model Thai traditional medicine hospitals in each region and 150 model Thai traditional medicine clinics nationwide.
2	Research and development of 90 standardized Thai traditional medicine services.
3	Promote technology transfer and logistic development and support of 120 Thai traditional hospitals and 720 Thai traditional clinics.
4	Develop and strengthening folklore healer network in 4 regions nationwide through knowledge sharing and promote usage of 120 folklore services in community.
5	Develop and strengthening network of village health volunteer to support sufficiency health and folklore medicine in 4 regions nationwide through knowledge sharing and promote usage of 120 folklore services in community.
6	Develop and strengthening network of health professionals, providers, healers, entrepreneurs, patients, consumers and academia to review and promote usage of 172 selected items of folklore, traditional, and alternative medicine services and products.
7	Develop and strengthening network of social marketing professionals, health professionals, providers, healers, entrepreneurs, patients, consumers and academia to review and promote usage of 172 selected items of folklore, traditional, and alternative medicine services and products through medias.
8	Research on unit cost of folklore, traditional, and alternative medicine services and use to determine reference price for reimbursement.
9	Develop essential strategic execution databases and decision support system for development of folklore, traditional, and alternative medicine services.
This proposed integrated project package need to be further scrutinized by the National Strategic Plan steering committee and the agencies concerned to get fully commitment and support through active participation. The National Strategic Plan could become an effective and efficient management tool for development of folklore, traditional and alternative medicine in Thailand and benefit to the health and quality of life of Thai population as an ultimate goal.


The cabinet has approved the National Strategic Plan for Development of Folklore, Thai Traditional, and Alternative Medicine B.E. 2550-2554 since June 12th, B.E. 2550. The National Strategic Plan could be utilized as a strategy execution tool to boost up the development of folklore, Thai traditional and alternative medicine in Thailand. However the systematic reviews by means of document reviews and in-dept interview of executives of agencies concerned shows failure of the national plan as there are inadequate implementations of the plan as strategic direction of program, plan, project development and resource allocation. The unclear direction and disintegration of Thai folklore, traditional and alternative medicine development policy are the explicit evidences of the situation.
Human resources for health as a crucial resource of Thai traditional health system need to have clear, relevant, integrative development direction and strategies. Lack of posts in health care system for the Thai traditional medicine workforce is the main concern among the universities and health care institutions concerned. The poor-management of the human resources could lead to the failure of human resource planning, production and health facility development. The National Strategic Plan could be utilized to develop concrete and integrated program, plan and projects to boost up strategic direction, coordination and strategic synergy among the organizations concerned.
The integrated project proposals for additional budget request for health workforce development to promote folklore, traditional and alternative medicine in Thailand could be developed according to the 4 major strategic issues as human resources database development, building up national mechanism for human resources development, determine HR standard and quality improvement, and development of HR management system.
There are 10 proposed integrated projects, implement within 3 years period (2552-2554 B.E.), and the total budget requested is 523 million baht. Furthermore the existing program plan projects for health workforce development are also need more budget support.
The main products and expected results of the proposed integrated projects are summarized as follow:
1	Establish national Thai traditional and alternative medicine health workforce development committee and national master plan.
2	Research and development of service model and hiring of Thai traditional health workforces in 150 Thai traditional medicine health centers or clinics with local authorities.
3	Research and development of service model and hiring of Thai traditional health workforces in 30 PPP type health centers with private sectors.
4	Determine standardized curricula of Thai traditional medicine, applied Thai traditional medicine and alternative medicine in collaboration with network of academia and network of health facilities.
5	Support human resource development, capacity building and trainings for folklore healers nationwide in collaboration with network of healers in 4 regions and promote the role of the networks to develop policy recommendations submit to the national health assembly.
6	Support human resource development, capacity building and trainings for alternative medicine healers nationwide in collaboration with network of alternative medicine healers and promote the role of the networks to develop long term financial sustainable HRD program and training courses.
7	Promote and support the role of Thai traditional and alternative medicine professional bodies in legislation, law enforcement, overseeing professional standard and ethics.
8	Develop essential strategic execution databases and decision support system for development of folklore, traditional, and alternative medicine workforces.
To get fully commitment and support through active participation, the proposed integrated project package need to be scrutinized by the National Strategic Plan steering committee and the agencies concerned. The National Strategic Plan could become an effective and efficient management tool for development of folklore, traditional and alternative medicine in Thailand and benefit to the health and quality of life of Thai population as an ultimate goal.


In mobilizing the strategy on Thai traditional knowledge protection (local medical and Thai traditional medical) under the national strategy plan, the establishment of Bio-piracy network and traditional knowledge database should be high priority targets because these will be important tools to protect and resolve the existing problem and will benefit for other targets.
The Bio-piracy network should operate in 2 levels, local area network and national network, which coordinate each other. In order to achieve the priority targets, many activities should be implemented including a pilot bio-piracy learning model in cooperation with folk medical network and local educational institutions, biodiversity laws training and bio-piracy surveillance establishment. The national bio-piracy network should operate closely with educational institutions which have thai traditional medicine curriculum in order to strengthen the existing surveillance mechanism implemented by Department for Development of Thai Traditional and Alternative Medicine.
The main activities for Thai traditional medicine database development are as following ; community traditional knowledge map survey and extension, database design and development in connection with bio-piracy network at local level and experience exchange with relevant agencies of India emphasizing on Traditional Knowledge Digital Library (TKDL.)


The research for “The Development of Indicators of Good Governance Management of the Provincial Public Health Office" was commissioned to The Center for Applied Economics Research, Kasetsart University by The Health Systems Research Institute. The objective of this research are to study a conceptual framework for a theory concerning good governance of the health system management in local areas, to develop good governance indicators regarding the
provincial public health office management which can then be implemented as a tool to evaluate and further develop the organization’s effective governance and also evaluate the level of good governance management of the provincial public health offices in the four pilot provinces: Chiangmai, Krabi, Cholburi, and Nakorn Pathom.
In the process of working on a conceptual framework and a theory concerning good
governance of the units handling health systems in the local areas, the research team has looked at extensive literature on good governance. They also arranged meetings with administrators, academics, and health personnel from the provincial public health offices. The meetings were designed to brainstorm opinions and come up with an understanding for setting up the conceptual framework on good governance of the administrative agencies handling health systems in the local area.
The conclusions for an indicator framework of good governance management are
comprised from the following ten principles: The Principles of Rule of Law (L), Ethics (E), Transparency (T), Participation (P), Accountability (A), Value for Money (V), Human Resources Development (H), Knowledge Management (KM), Management (M), and Information Technology and Communication (IT).
In the development of indicators measuring good governance management of the
provincial public health offices, the research team designed three sets of questionnaires based upon these principles. The first set of questionnaires was evaluated by internal officials within the agencies and consisted of fifty indicators. The second set was evaluated by officials with specific functions and contained eleven indicators. Finally, the third set was evaluated by related agencies and consisted of thirty-seven indicators. A range of scores were numerically assigned from 1 to 5 to evaluate good governance: 1 being the lowest, 2 low, 3 moderate, 4 high, and 5 being very high.
The findings based on the evaluations concerning management of the provincial public health office, as evaluated by the internal officials of the four provincial public health offices, revealed high levels of good governance management. The scores were 3.72, 3.43, 3.54 and 3.70 respectively. There was an especially remarkable score shown in the Principle of Information Technology and Communication. This may be due to the agencies having a data based system
and connecting the databases which helps reduce their workload and gives people the opportunity to share their opinions via the website.
The Principle of Value for Money found that their budget corresponded with the strategic plan that audited and evaluated evaluation results. It was found to improve internal management including financial support from external sources.
As for the Principle of Rule of Law, the regulation was found to be disseminated to
employees and freedom given to service recipients.
The questionnaire results indicate three principles that need to be developed: the
Principle of Management, the Principle of Knowledge Management, and the Principle of Human Resource Development. The Principle of Management could be defined as ‘incomplete’ in terms of people’s assessment. One possible cause was an institution research study that was conducted, but the results of which were not applied to their full potential, and there was no evaluation of administrative leadership. Based on the Principle of Knowledge Management, the culture of learning was shown to be lacking amongst working groups. Results indicated that continuity was deficient in the development of personnel ability. With the Principle of Human Resource Development, it was found that contingency plans
for the rationing of the workforce in some working groups were lacking.
The evaluation results for good governance management of the provincial public health offices by the agencies related to the provincial public health office of Chiangmai, Cholburi, and Nakorn Pathom revealed that good governance management was moderate. The scores were 3.36, 3.32, and 3.26 respectively.
For the Krabi provincial public health office, good governance management was rated as high, with a score of 3.61. For all four provincial public health offices, the Principle of Transparency was found to have the most significant rating. This could be due to opportunities for those concerned to give their opinions and listen to feedback from external parties; including activities to promote people’s participation. The three principles that needed to be developed were: the Principle of Management, the Principle of Human Resource Development, and the Principle of Participation. For the Principle of Management it was found that the provincial public health offices did not make a survey suitable to meet the needs and satisfaction of concerned offices. The evaluation results were not used to improve the work process and be transparent. Based on the Principle of Human Resource Development, the officials were found to have unity only among the working groups; the survey results indicated that individuals performed their work independently rather than as a group. For the Principle of Participation, there was an indication of inadequate consideration for the opinions of outside agencies and the public sectors concerned. The comparative results of the evaluation of the level of good governance management of the provincial public health offices by internal officials and related offices indicated a very significant difference for the Chiangmai and Nakorn Pathom provincial public health offices. As for the evaluation of the offices in Krabi and Cholburi, there were no significant differences. However, the distinguished principles and those needing development based on the evaluation of both the internal offices in the provincial public health offices and those related
offices, followed the same direction.


Second Opinions is one of the efficient medical procedures to enhance quality and
reliability of health care system, particularly from the patient’s point of view. To be
applied in Thailand, this will provide evidence of our patient’s rights enhancement as
well as consumer empowerment, in terms of allowing consumers to receive better
quality of health care services.
The objective of this study is to review the literatures related to Second Opinions and
people’s access to public health information, with the aim to find out preliminary
information required for a proper development of Second Opinions System in Thailand.
From the literature review, Second Opinions has been initiated and implemented
formally in the USA since 1970s. Initially, Second Opinions was used as a utilization
review technique to reduce unnecessary costs associated with overused and
inappropriate surgeries rather than used as an approach to offer additional information
or other further medical opinions to patients.
Nowadays, in most countries, Second Opinions is adopted and used based on the same
common principle, which regards Second Opinions as a fundamental right of patients to
get reassurance, additional information, as well as other treatment options from health
care service providers, except in the USA where the importance is also given to cost
benefits obtained from implementing the program. It can be seen that, in practices,
there are differences in intensity and scope of regulation imposed regarding the
application of Second Opinions among the studied countries. Some countries have
published state laws regulations to support the implementation of Second Opinions
program. On the other hand, some countries see Second Opinions as a typical issue in
medical ethics that every practitioner needs to follow, thus no need to use law
enforcement.
The methods of obtaining Second Opinions in the studied countries are similar among
each other, but the number of usage and effectiveness of each method are varied
according to various fundamental factors in each country such as education level of
population, technology development, state regulations, and local cultures.
In the present, Thailand has the declaration of patient’s rights as the main mechanism to
move forwards to the establishment of Second Opinions System. However, other
supporting mechanisms still need to be developed in order to ensure the system
effectiveness. The Second Opinions adopted for Thailand should be on a voluntary
basis, giving focus to the patient’s right to make decision, rather than on a mandatory
basis. Under this voluntary basis, patients will have an automatic right to request
second opinion directly from their attending doctors.
The recommended framework for the development of Second Opinions System are as
following 1) Driving: using laws/regulations, documented medical ethics, and public
relation to strive for public awareness; 2) Implement & Control: related public health
assurance units should be assigned to oversee the implementation as well as control the
costs incurred from operating the program; 3) Support: the proper development of
public health information system and coordination units/centers would provide
supporting infrastructure to the adopted system. Under this framework, there are
numbers of involved activities such as regulation amendments, public relation, database
set-up, further study on cost, etc. Then, after the system has been established,
concerned government agencies should relay information to the public through the
effective public relation program and then continually follow-up the implementation
closely in order to evaluate its effectiveness and eliminate the problems occurred.
Although, this report gives preliminary ideas and information required for a
development of Second Opinions System in Thailand, many further studies also need to
be conducted to give full details of pro’s and con’s of having such system prior to
making a go/no-go decision.


The purposes of this action research were three folds: 1) to develop a Health Community via Internet (HCI); 2) to analyze the key success of the HCI; and 3) to propose strategies to develop the HCI  The setting selected in this study was located in Nakonpathom province.  The study samples were 28 health-work volunteers. The research method consisted of 4 steps as follows: 1) exploring a study setting context regarding health problems and health communication, 2) developing the HCI 3) implementing the HCI for 3 months  and 4)  analyze key success for developing the HCI.  Data collections were used by questionnaires, interview and focus group discussion.
The study findings were as follows:
1. The context of study setting, Nakonpathom is located in central part of Thailand and divided into 7 districts (Amphoe) 106 locally districts (Tambol) and 930 communities  (MooBarn). The total population are 828,846.  The average income are126,510 baht/year. Most (32.09%) are agriculturist. According to health care delivery, there are sixteen public hospital and 5 private hospitals. There are 195 physicians, 1,259 nurses and 7,462 health care volunteers. A proportion of a physician and population is 1: 4,138 and a proportion of a nurse and population is 1:641.
2. Indicators deciding the project success were as follows:  (1) Input and Output indicators, researchers recorded the numbers of membership who accessed to Nakonpathom's web and of health files uploaded to the web. We found that there were 28 members participating in the web and 650 data files disseminated on the web.   (2) Process indicators, in the study, a community participation was used by inviting members to analyze SWOT of  Nakonpathom's health web, strategies and indicators for measuring product/outcome of the project.  After three months of a project implementation, we found that members reported that they were highly satisfied (mean = 4.43, S.D. = .59) with knowledge of health communication via Internet.  For the moderate satisfaction (mean = 3.29, S.D. = 1.10)) were the community participation via Internet.
Based on data conducted by using focus group discussion and interviews, we found that factors relating to develop a health community via Internet were 1) Peopleware, health personnel lack knowledge of developing health databases and  Internet access time while health care volunteers lack technological skills and computer knowledge; and 2) Hardware, there were lacks of computers and Internet connection in a selected community.  According to a problem of peopleware, community members were trained computer uses and Internet skills.  After training, the community members practiced computer and Internet use under supervision of researchers.  Finally, the members could disseminate and train others to access health information via Internet.
  3.  The proposed strategies of developing the HCI
                   Based on a focus group discussion of 12 key persons, They agreed that the HCI concept as a way of health communication. However, the good components of members were important to maintain the HCI activities.   According to a sustainability of the HCI, experts suggested that it should build a network with consultants from a public health sector and university located in Nakonpathom.  In addition, It should be an autonomous organization managed by a community and get financial support from private and public organization.


The objectives of this project were to empower “Health Communicators” (NorSorSor) who communicate information on health in Phrae and Kanchanaburi Provinces as well as to enable NSS groups to operate independently. Additional objectives were to train some NSS members as “facilitators” in order to establish a new generation of NSS, to extend the principles of local health communication to people in nearby provinces, and to analyze results in preparation for policy recommendations. This research was conducted under the principle of Participatory Action Research.
	As part of a one-year operation establishing the NorSorSor Clubs, both in Phrae and Kanchanaburi provinces, the selected committees managed the groups by focusing on understanding the objectives of the work, providing communication channels, holding meetings, conducting regular unofficial meetings, and providing the lists of NSS members. From these initiatives, the NSS members were able to work together. In addition, an opening ceremony was held to introduce the NSS group and to extend the communicator networks in the area. Some potential health communicators were additionally trained to become facilitators which will enable this group to successfully establish a new generation of NorSorSor. In addition, they disseminated their ideas and local work experiences through various media such as an advertising spot, a brochure, a video and a special meeting with relevant persons from 8 nearby provinces; Nan, Lamphun, Lampang, Uttaradit, Phayao, Nakhon Pathom, Rachaburi, and Phetchaburi. This meeting attracted much interest and encouraged coordinated expansion into other areas.
	The result from the operation shows that the features of local health communication work consist of 1) Health Communicators (NorSorSor) who pay attention and possess a sense of public spirit, including abilities to support and co-operate together and link this work with their everyday responsibilities; 2) integration of NorSorSor as a significant working force in the community; 3) information and knowledge about health; 4) communication channels through personal and local media; and 5) the support of society at large, especially at a provincial level.
	In order to communicate local health communication in Thai society, the need for local health communicators and local health communication must be recognized and established as a part of health management system. In addition, mechanism should be created to enhance the pride of health communicators by offering a chance to show their results, to provide sustainable networks which are supported by society of both local and national levels.


The Research and Development Project on Local Health Communication: Pattani was to search for those interested in and having the potential to become a “Health Communicator” in the area.  That would believably lead to good health for the locals.  The Project was conducted using a Participatory Action Research approach.

The research team embarked on the project by studying officers dealing directly with health services.  They included 477 hospital officers, public health officers and volunteers, sharing their problems and needs.  Then, a forum was organized in order to gather information and opinions from a supporting group on health communication.  The group was made of executives and members of both public and private health organizations, local media organizations, and community leaders.  Moreover, 5,000 flyers were distributed to pass on the concept of “health communicator.”  It was found that interested people regarded taking part in this project as a means to improve their communication and media production skills.

After having analyzed the needs of prospective health communicators, the research team organized two types of skill enhancing activity: (1) Radio Program Production and (2) Animated Media Production for Children.  The former was organized for health service providers while the later was specifically for child teachers and care-takers from five provinces.

The research results showed that forming a network of health communicators in the area can be achievable.  However, needed are initiative support, diffusion of health communication concept, continuous skill enhancing, communication system between areas/groups, and analysis of target groups.  It is important to clearly identify who are supporters, communicators, audiences, and connectors.  Additionally, the fair management system of benefits is also vital.


The action research on “Developing Shan Health Communicators in Chiang Mai Province” is a project under the Popular Health Communication System Research and Development (HCS) program, which aims to develop health communication system for disadvantage minorities who have different language and culture from the Thai majority. The target beneficiaries of this research are the Shan migrant workers from Myanmar, working in manual labor sectors in Chiang Mai. Illegal status, hard works in exploitative conditions and the inability to communicate in Thai prevent these migrants to access health information and services. The research project has thus developed Shan health communicators to work on health communication by organizing trainings on concept of health communication, knowledge on health protection and treatment and communication techniques, and supporting health communicators to organize health communication activities namely hosting the health promotion program via the community radios, producing radio drama and organizing public forum in various places. The results from 10 month project implementation (March-December 2008)   are 1) Shan health communicators have increased their knowledge on health problems, prevention and treatment and communication skill. 2) Health networks are expanded among the health communicators themselves and between them and government officers, non-government workers, academics whose works relate to the Shan, their health and communication.  3) Health communication systems and mechanism to support health communication among worker migrants have been initially developed especially in setting up training curriculum and process for health communicators and increasing communication channels. To promote health communication among migrant workers, the project recommends that  1) health communicators to work with migrant workers should be increased in both quantity and quality by developing health communication training institute with relevant curriculum and training programs. 2) Education related agencies should increase non-formal education classes for migrant workers to study Thai language and culture. 3)  Local governments and religious organizations should play more active role in  promoting health among migrant workers. 4)  Health communication channels should be expanded and used more efficiently in health promotion. 5) The public campaign to reduce ethnic prejudice and promote the peaceful coexistence between people from different ethnic and religious background is needed to be done.


Due to constraints of health care resources, health resource allocation decisions will increasingly rely on the results of health economic studies in particular cost-effectiveness (CE) analysis.  However, the presentation of cost-effectiveness analysis’ results as cost per unit of health outcome e.g. Quality-Adjusted Life Year (QALY) is still arbitrary for policy makers to decide whether the technology is cost-effective. By using the concept of “ceiling threshold”, if the cost-effectiveness ratio of new health intervention is not greater than the “threshold”, then the health technology is deemed to be cost-effective and is appropriatethe support using public finance.  Presently, there is no scientific standard for ceiling threshold. Furthermore, all countries are different in term of various socio-economic factors hence specific CE threshold is required for each country.
	This study aims to assess the willingness to pay per quality-adjusted life year (WTP/QALY) for use as a CE threshold in determining the cost-effectiveness of health interventions in Thailand.  This study is a cross-sectional survey. In this study, 1,191 sample aged between 15-65 years old from 9 provinces throughout the country namely Bangkok, Auanthog, Chonburi, Chiangmai, Pa-yao, Khonkaen, Surin, Trung, and Chumporn were interviewed during March - May 2008. The questionnaire consisted of three main components, namely general information, utility measure, and willingness to pay. There were 3 versions of questionnaires. Version 1 focused on scenario about blindness while version 2 and 3 were centered on scenarios about paralysis and allergy. For each version, 2 levels of disease severity were specified as follows; version 1: unilateral blindness and bilateral blindness; version 2: paraplegia and quadriplegia, and version 3: mild allergy and moderate allergy. Utility of current health state and hypothetical health states was measured using TTO and VAS while willingness to pay was measured using bidding game technique. Each respondent was asked to determine his/her maximum willingness to pay for treatment and prevention situation. For treatment situation, 5-year period of illness followed by complete recovery is assumed. For prevention situation, willingness to pay (WTP) to eliminate 40% risk (from 50% to 10%) was asked. Then, WTP/QALY is determined by univariate analysis and multivariate analysis using Mixed model.
	According to the univariate analysis result, WTP/QALY for treatment situations are all higher than WTP/QALY for prevention scenario in all three hypothetical health scenario. Median WTP/QALY thresholds for treatment ranged from 24,281 Baht           (treatment of moderate allergy) to 115, 577 Baht (treatment of unilateral blindness) On the other hand, median WTP/QALY thresholds for prevention situation ranged from 9,054 Baht (prevention of paraplegia) to 47, 563 Baht (prevention of unilateral blindness). When disease severity was taken into account, WTP/QALY for scenarios with low severity was higher than that of high severity in all three hypothetical health scenarios both for treatment and prevention. These findings indicate the exit of the ceiling effect. It could be explained by the fact that willingness to pay for treatment and prevention with higher disease severity was equal or only slightly higher than willingness to pay for treatment and prevention with lower severity disease due to the limitation of ability to pay. On the other hand, situation with higher disease severity seemed to have significantly higher negative effect on quality of life, as compared to situations with lower of severity.
	The results from multivariate analysis found that after controlling for other factors i.e. (gender, household income, hypothetical health scenario, and location of resident), WTP/QALY for treatment was estimated at 105, 669 Baht or approximately 1 time of Gross Domestic Product per capita in 2008 in Thailand. Similar to the findings from univariate analysis, WTP/QALY for treatment situation was higher than WTP/QALY for prevention scenario. In this case, WTP/QALY for prevention scenario was estimated at 53,382 Baht or approximately 0.5 time of Gross Domestic Product per capita in 2008. These findings seemed to be consistent with the thresholds derived from the thresholds currenty used in several countries e.g. the United States, Canada, Australia, and New Zealand. According to the review, the threshold used for resource allocation in those countries was approximately 1 – 2 times of Gross Domestic Product per capita in 2008. In addition, the threshold of 3 times of GDP per capita recommended by the Commission on Macroeconomics and Health[1]  seemed to be higher, as compared to the current threshold used in those countries. In Thailand, these findings also appeared to be consistent with the threshold set by the subcommittee for Development of the National List of Essential Drug (lower bound = 1 time GDP per capita / QALY, upper bound = 3 time GDP per capita / QALY). [2] On the other hand, the threshold for prevention situation found in this study was relatively low, as compared to the current threshold.   The findings also pointed out that the samples might perceive that unit cost of prevention should be less than unit cost of treatment or they might perceive prevention as less important than treatment. In the later case, policy makers and other stakeholders should pay more attention in providing knowledge, and employing effective strategy for attitude changing to increase the awareness of the importance of prevention intevention.
This is a preliminary study with some limitations. A bigger study addresses thses questions should also be conducted to ensure representativeness of the samples. Also, the future study should employ more rigorous method that could control the ceiling effect, and represented various hypothetical health scenarios.  Furthermore, WTP/QALY should be calculated in term of function of several factors such as context, age, and gender, not just only a single value.
Finally, any value of ceiling threshold should be perceived as one of the criteria in resource allocation. When making real policy decisions, other factors such as ethic, short and long-term budget impact, and availability of alternatives should also be taken into account. By using only CE as a sole criterion for resource allocation might lead to problems of unaffordability or uncontrolled growth in health care expenditure.In addition, it might cause ethical problems or lead to inappropriate health policy.


Thailand’s government has initiated a plan to make the country the Medical Hub of Asia. The plan has been aimed to increase numbers of foreigners coming into the country for medical services, which, as a result, will bring in as much as 80,000 million baht in the year 2008. Private hospitals around the country have been readily carrying out the promising plan, making it seem even more agreeable. However, in spite of the expected good outcomes, this plan is also creating,
in public hospitals and medical schools, numerous problems which themselves will trigger many more in the future of the country’s public health. This Medical Hub of Asia plan will rapidly damage Thailand’s noble medical and healthcare service systems.


This synthesis paper was aimed at sheding light on the current performance of the Road Accident Victim Protection Act, 1992. It also attempted to identify ways and means to improve the status quo. The paper drew from the literature information pertinent to the law and its enforcement in Thailand and to similar laws and their enforcement in other countries. A comparison of concepts, principles and evidence related to these laws and their performance was also made. Public interest was put ahead of private interests in the comparison. It was found that over a period of 16 years of the law’s enforcement, it succeeded to a certain extent in protecting the interests of Thai road accident victims in terms of compensation
for medical costs and loss of life. Nevertheless, success came at the expense of road accident victims and health insurance systems:
1. Hundreds of thousands of victims and their families were not covered by insurance due to ignorance, concern about legal action under the fault system of the law, and difficulties in making claims owing to the complicated extra rules and regulations set up by private insurance companies.
2. Unnecessary costs were incurred under the current compensation system operated by private insurance companies.
3. Opportunities to make use of medical care with ongoing quality improvement were lost, which could have been financed by a more efficient compensation system.
4. The burden of medical care costs on the victims was shifted to other health insurance schemes due to cumbersome access to the road victim compensation scheme.
Proposed strategies to improve the current system are the following:
1. Replace the existing law with a proposed bill so that public agencies will replace private insurance companies; hence, unnecessary costs could be cut and claim procedures could be simplified greatly.
2. Modify premium collection by point-of-sale revenue collection from the price of fuel. This would preclude the need to pay commissions and other costs related to premium collection.
3. Adopt the compensation recovery unit model of the United Kingdom to improve efficiency in processing claims.
4. Expand the scope of missions to include financing for quality improvement of medical care and road accident injury prevention.


This study was aimed at developing a framework for assessing the competencies of health research managers and conducting self-assessment of 20 health research managers working for the-Health Systems Research Institute and its affiliates. The research managers were purposively sampled and self-assessment was conducted through a self-administered questionnaire. The average age of the persons sampled was 44.16 years and the average duration of working as a health research manager was 2 years and 5 months.
The self-assessment framework was developed by reviewing relevant documents. The Health Research Management Modules produced by WHO were considered as providing the conceptual framework for drafting the self-assessment questionnaire, which was later improved by the working group comprising a number of experienced health research managers. The self-assessment framework included eight domains of competencies as follows: 1) organization analysis; 2) research program planning and management; 3) research project planning and management; 4) capacity-building of the health research system; 5) information system for research and knowledge management; 6) financial management system for research projects; 7) management for research utilization; and 8) general management.
Results show no competency domain was assessed as good or best (average score equal to or more than 3). Competency for capacity-building of the health research system was scaled as the poorest (2.40), while the competency of research project planning and management was scored as the highest (2.67). The average score of every domain was higher for more experienced health research managers (over 3 years of working in this position) than for the less experienced ones (less than 3 years’ experience).
This study helped to identify clearer roles and competencies of health research managers. However, the competency framework needs improvement since its validity and reliability have not been tested, and the number of subjects sampled in this study was small.


This study was conducted to determine the effect of changing antihypertensive drug administration time during the period January 1, 2008 to October 31, 2008 among patients who received treatment at Nongjik Hospital, Pattani Province. The 140 patients studied received antihypertensive drugs once daily. Determination of the blood pressure before and during the Ramadan period were carried out among 70 patients without changing drug administration time, compared with those 70 patients with changing the time concerned. Data were collected from OPD cards, glucose level records of the patients, and monitoring change records during the Ramadan period. The SPSS for Windows software package was used to analyze the data.
The distributions by sex, age, and items of antihypertensive drug use were comparable between both groups. Both groups had significantly lower mean weight and systolic blood pressure during the Ramadan period, compared with figures before Ramadan. There were no statistically significant differences in systolic and diastolic blood pressures between both groups.
It is suggested that before the Ramadan period, good health education about food intake, exercise, administration schedules, and hypotension should be given to Muslim patients with hypertension.


This study was aimed at estimating the economic cost of productivity loss associated with alcohol consumption in term of absenteeism and presenteeism among the Thai population in 2007.
A cross-sectional household survey was carried out among the Thai population aged 15 to 60 years from 4,330 households, who were in paid employment. The impairment rate due to absenteeism and presenteeism for each drinking category was compared using the Kruskal Wallis test for univariate analysis while the generalized linear model (GLM) was used in multivariate analysis. Cost of productivity loss was then calculated as the product of the excess impairment rate, labor force participation rate, income per year, and total number of drinkers in that category.
According to the univariate analysis, the productivity loss in former drinkers, responsible drinkers, and harmful drinkers was significantly higher than in the abstainers at 5.6 percent, 1.7 percent, and 5.7 percent respectively. According to the study, the cost of productivity loss due to alcohol in terms of absenteeism and presenteeism was approximately 26,700 million to 45,464 million baht by using a deterministic approach and univariate analysis, and probalistic approach and multivariate analysis, respectively.
Alcohol consumption is associated with high economic cost in terms of absenteeism and presenteeism in Thailand. This finding can be used to promote the public’s awareness of and draw their attention to the negative impact of alcohol in terms of productivity loss. According to the study, the government and employers should implement more effective policy aimed at reducing alcohol consumption among the working population in order to reduce the economic cost related to absenteeism and presenteeism.


This research studied the expectation of agriculturists who had to build a sustainable occupation for agricultural development that would protect natural resources and the environment, decrease the adverse effects of chemicals and produce safe food and a happy social condition, among other positive outcomes. It studied personal factors, the economy, and social aspects, compared with the expectation of sustainable development. The sample comprised 240 persons who were interviewed in order to collect data. The statistics were analyzed by percentage value, average, standard deviation, t-test, and one-way ANOVA.
The study results found that most of the sampled household heads were males, aged 41 to 50 years, with a primary education, lacking social position, living in their village for more than 5 years, and had been trained in agriculture by their parents. Farm size was 11-20 rais, family farm labor averaged 9 persons, the individuals had a yearly income of 50,000 - 99,999 baht, household expenses of 10,000 - 19,999 baht per year, made occupational investments of 20,000 - 40,001 baht per year, and were likely to be members of an agricultural group.
Their expectations with regard to technology transfer, community business development for production, processing and marketing, plant and animal breeding modification were at a moderate level. However, those expectations with regard to technology support, soil, water and environmental resource development were at a high level. As for problems, operational guidelines and suggestions, the respondents
revealed that there were many problems, such as the quality of soil, lack of rain and irrigation, plant and animal breeds, organic fertilizer, labor, knowledge of breed selection, products, markets, investment and governmental support. Agricultural institutes played only a minor role in agricultural occupation development. It was suggested that group members be allowed to participate, to submit their opinions, to plan and to make decisions.


The objective of this clinical preliminary study was to evaluate the hemostatic efficacy of a chitosan derivative-based hemostat prototype (MTEC prototype), compared with that of two commercial materials, SPONGOSTAN@ Standard and Algisite-M, in split-thickness skin graft donor sites. The study was conducted at Ang Thong Hospital in Ang Thong Province involving eight patients who underwent skin grafting during the period June-November 2008. The three tested materials were randomly put on wound sites from the direction of the patients’ toes to their heads. Gauze was placed on top of the materials. To secure the materials, they were gently pressed by hand. Bleeding was visually observed and the wound sites were photographed at 5 and 8 minutes. At each time point, the wounds were uncovered for 30 seconds for the observation of blood ooze. The wounds were photographed again at 5 1/2 and 8 1/2 minutes. At last, the materials and gauze were weighed for the determination of blood loss. The results revealed that the amount of blood loss found in the materials was in the following order: SPONGOSTAN@ Standard < Algisite-M < MTEC prototype, while the amount of blood loss found in the gauze was in the following order: MTEC prototype < SPONGOSTAN@ Standard < Algisite-M. Nonetheless, there were no significant differences in the total amount of blood loss when the wound sites were treated with these three materials. From visual observation, the MTEC prototype, however, seemed to stop the bleeding most efficiently as determined by the least blood ooze apparent at 8 1/2 minutes.


This study utilized qualitative study papers and reports on the process of decentralizing health care. The study employed a quantitative method, using questionnaires on 8,199 villagers. It was aimed at understanding the process of the transfer system of public health centers (PHCs) to a local government organizations (LGOs). Specifically, the study focused on the process of setting up the transfer mechanism, monitoring the product and output, analyzing and summarizing the lessons learned, as well as providing policy recommendations relating to the mechanism and structure for transferring the PHCs to the LGOs. The research was conducted from September 2007 to October 2008.
Research results confirmed that the PHCs under study followed the mechanism and process of the transfer system to the LGOs. However, some difficulties pertinent to time constraints and communication problems at all levels were encountered. With respect to the product, we have discovered that there were four types of transfer system: (1) the complete transfer of PHCs and personnel; (2) the complete transfer of PHCs and some personnel; (3) the transfer of some PHCs with all the personnel of those PHCs; and (4) the transfer of some PHCs with some personnel. The majority of the PHCs employed the second type. Different types impacted the management of work, budget, personnel and materials differently. Relating to the  output, we have learned that the ideas and paradigms of public health decentralization to local areas were significant and made the transfer system efficient by generating people’s participation and coordinating consistently with the public health network. In terms of policy and development strategy implemented at the local level, we have discovered that they emphasized the idea of  ervice to all, stimulated proactive work, and improved policy, strategy and planning for public health and environmental activities parallel to the development of the infrastructure. Also, we discovered some problems relating to the management of work, budget, personnel, property,  aterial, medicine and medical supplies following the imprecise rules and regulations issued by the Ministry of Public Health and the Ministry of Interior. Factors contributing to the success of the transfer included cooperation, leadership ability, having organizational vision and management ability in the LGOs.
Recommendations for transferring the PHCs to the LGOs are as follows. At the policy level, the national decentralization committee should have a clear integrated policy and establish a national coordinating body to be responsible for informing the public of the value, ideas and benefits of public health decentralization. At the provincial and district levels, it is necessary to have a proper academic supporting mechanism based on the participation of all parties concerned for monitoring and supporting the transfer of the PHCs to the LGOs smoothly and to communicate efficiently with all parties concerned during and after the transfer. At the community level, we suggest that the LGOs and the PHCs should abide by the principle of people’s participation, starting from local public organizations to local civil societies in decision-making for the transfer of the PHCs to the LGOs and in supporting community health development planning.


Public health decentralization has been an item on the national agenda in compliance with the 1997 Constitution of Thailand. In principle, the central administration of the Ministry of Public Health was responsible for decentralizing its part of public health programs and resources to local administrative organizations according to the Decentralization Plan for Local Administration. The Ministry of Public Health established the Office for Supporting Public Health Decentralization so that it could act as a policy coordinator and a preparation facilitator for transferring public health programs and activities to local administrative organizations. In 2007, the Ministry of Public Health initiated a pilot project to transfer 22
health centers to 19 local administrative organizations in 16 provinces. The individual experiences of this project indicate that community participation was necessary. Other important factors on part of local administrative organizations were their supplementary budgets for public health activities and investment, shortened command-control line, clearer pathway of health personnel positions and leadership of
community development. Good relationship between health centers and local administrative organizations were undeniably helpful for the transferring processes. Lessons learned from this project were if the transferring would carry out for more health centers, communication of the transfer vision, processes, advantages, precaution and possible contingencies and solutions should be thoroughly made from policy
to implementation level. Human resources for transferred public health programs must be carefully planned. Administrative and Consultative Office at provincial level should be established to help solve out administrative inquiries and provide technical consultation from the starting point to monitoring and continuous evaluations. Then, the lessons learned and applications from local levels would help support the better development.


This article emphasizes primary prevention and its application through physical examinations.
Physical examinations can be categorized into various types: pre-employment, pre-placement,
periodic, return-to-work, exit, post-exposure, and upon illness. This article also gives some hints on
selecting physical examination services.


An  attempt  to  include  “spiritual  health”  into  WHO  definition  of  health  has  been  made  since  1980.  It  was  proposed  by  member  states  of  WHO  in  Eastern  Mediterranean  Region.  There  were  both  proponents  and  opponents  of  the  proposal.  Finally  the  Executive  Board  of  WHO  has  concluded  to  propose  amendment  of  the  definition  of  health  from  that “the  state  of  complete  physical,  mental  and  social       well-being  and  not  merely  the  absence  of  the  disease  or  infirmity”  to  “the  dynamic  state  of  complete  physical,  mental,  spiritual  and  social         well-being  and  not  merely the  absence  of  disease  or  infirmity.”  However,  the  proposal  did  not  become  the  resolution  at  the  World  Health  Assembly. Thus  the  definition  of  health  remains  the  same  as  stated  in  the  preamble  of  the  Constitution  of  WHO.  In  Thailand  there  was  a  movement  to  include  the  “spiritual  health”  into  the  definition  of  health  during  the  campaign  on  health  system  reform  in  the  last  decade.  Such  movement  brought  about  strong  controversy  rooted  from  some  leading  Buddhist  organizations  which  rejected  the “spiritual  dimension”  as  a  concept  influenced  by  theist  paradigm  which  is  opposite  to  Buddhism.  Finally,  the  consensus  has  been  reached  to  accept  the  term  “intellectual  well-being”  as  the  fourth dimension  of  health.  The  Health  Act  B.E.  2007  has  then  defined  health  as  “the state  of  human  being  which  is  perfect  in  physical,  mental,  spiritual  and  social  aspects  all  of  which  are  holistic  in  balance.”  There  are  still  some  problems  in  the  new  definition  of  health  concerning  the exact  meaning  of  mental  and  spiritual  well-being  especially  when  translates  into  English.  This  paper  proposed  not  to  try to reach  consensus  in  this  issue  which  is  very  complicate,  since  the  four  dimensions  have  covered  all  aspects  of  health.  It  also  proposed  Buddhist  way  of  development  of  the  four  dimensions  of  health  as  an  example.  The  people  in  different  faith  can  freely  develop  or  extend  their  means  on  the  basis  of  their  own  faith.


A survey of institutional long-term care for persons, age 60 and over, in Thailand aims to study the background information on long-term care institutions. The number of personnel, competencies of care provider, types of services, and characteristics of care receivers in the north, north-eastern, central, Bangkok area, and the southern part of Thailand were investigated.
	The findings revealed that there were 138 long-term care institutions, 49.28% situated in Bangkok with 43.48% being nursing homes. While residential homes provided all levels of care needed, nursing homes offered services ranging from care assistants for service at homes and palliative care in the institutions. However, 45% of nursing home had no professional nursing staff and 45.5% of institution had not been registered. Public residential homes had the highest number of beds while long-term care hospitals had the highest cost of services.
	The majority of residents were female; ages 60-70, widowed, almost half had no adult children, and 86.8% had chronic illnesses. The most common illnesses were hypertension, arthritis, joint pain, diabetes, and heart disease. Information from health screening revealed that 41.6% had dementia and 29.5% had moderate to severe depression. From functional assessment, 15.9% were at a total dependency level. Interestingly, 52.3% of the residents had moderate to total dependency, 55.6% of them were in residential homes and need to be cared for 20-27 hours per week.
	The majority of care providers was female, age range of 15 to 30 years old, had a high school level education, and was care assistants. Helper, occupational therapist and nurses were often found in the residential homes, nursing homes and long-term care hospital respectively while only social workers were found in the residential home. Although the majority of them had been trained in care of older persons, negative attitudes toward residents were still present. Work satisfaction was found at a high level while satisfaction for salary was at a moderate level. Nevertheless, they still wanted to continue working and gave more attention to knowledge, personal development and how to improve their standards of care giving.
		The policy recommendation is: to promote collaboration between public and private sectors, encourage local authority to be a key provider, develop services to meet all level of care needs, set up care standards, and form a regulator and registration body. The practical recommendation is to promote the development of competent care providers and to provide more varieties of services. Further study using qualitative research methodology should be carried out for in-depth information.


Drug expenditure is a lion share of health expenditure and grows rapidly in the Civil Servant
Medical Benefit Scheme (CS). This research analyzed electronic databases of drugs in 5 selected
therapeutic classes, including (1) antihypertensive drugs (angiotensin-converting enzyme inhibitors –
ACEIs and angiotensin-2 receptor blockers -ARBs); (2) antilipidemics (statins and other new
products); (3) antiplatelets; (4) antiulcerants (proton pump inhibitors –PPIs and histamine-2 receptor
antagonists -H2As); and (5) non-steroidal anti-inflammatory drugs (NSAIDs, both conventional and
coxibs) that were prescribed during 2003 – 2007 from 6 provincial hospitals. The analysis focused on
a 60-month, interrupted time-series of 2 expenditure components, including propensity of use and
intensity of use, before and after the direct disbursement policy of the CS and the 30-Baht
abolishment in the Universal Healthcare Coverage Scheme (UC). The drug expenditure of each
therapeutic class was forecasted for the years 2008 and 2009 and potential cost-saving for the CS as a
result of 3 cost-containment strategies, including (1) substitution policy; (2) reference pricing; and (3)
UC-like prospective payment system (PPS) was estimated.
The study found that the drugs deemed as the cost-containment target, including ARBs,
single-source statins, clopidogrel, single-source PPIs, and coxibs had a major impact on the drug
expenditure of CS and its growth. The PPS could reduce the CS drug expenditure by approximately
40% (for PPIs-H2As and coxibs-NSAIDs) and 100% (for antilipidemics), which was comparable to
the reference pricing strategy. Potential cost-saving from the substitution policy depended on
substitutability in the real world setting, for example, the 20% substitutability would reduce the CS
expenditure by 8% (for PPIs-H2As and coxibs-NSAIDs) and 20% (for antilipidemics); whereas the
saving of 30-80% was expected, given substitutability of 80%.


The research on “Good models on the elderly care by family and community in rural areas in Thailand” aims to study formats and duplicate the models for the long term care for older persons in the family and services management for the older persons in the community from the models selected as having good service management. A case study were 8 elderly with dependency level 3 and 4 who resided in the sampling areas, namely, Mae Prik Sub-District Administrative Organization, Mae Sua District, Chiang Rai Province, Kao Suan Kwang Sub-District Administrative Organization, Kao Suan Kwang District, Khon Kaen Province, Banpaew Sub-District Administrative Organization, Banpaew District, Samutsakhon Province, and Pakpoon Sub-District Administrative Organization, Muang District, Nakhonsithammarat Province. The data analysis included the content analysis, or analyzing answers gathered from conversations and the thematic analysis. The study results were summarized as follows.
Of all samples, there were 6 females and 2 males. The minimum and maximum ages were 66 and 90 years, respectively, with the mean of 82.87 years. The religion of 7 elderly was Buddhism and another one was Islam. With regard to marriage status, 7 elderly were widow and another one was marriage. All elderly had chronic illness and were not able to rely on or slightly relied on themselves. Main caregivers were children. Methods and techniques of good careing covers 9 indicators, namely, personal hygiene care, medicine management, movement assistance, pressure ulcers care, proper food, feeding, excretion, emotional stability and spirit. Proper management for elderly of communities included 7 indicators, namely, formal and informal care system, strong team, beneficial social capital, solving by creating community recognition, complete elderly database and service evaluation system.
The recommendations from the study are that, at the policy level, the efficiency of the health and social service system at home should be enhanced and the care management system should be established. At the operational level, local services should be developed by creating qualified long-term care teams, and increasing supporting service for families and care tool alternatives. At the family level, the recommendation are seeking knowledge on elderly care and enhancing family members to participate in elderly care. The action research on integrated and proper community care should be conducted and proper indicators should be set.


“Design for Life” is a documentary program about the health system in Thai society produced by Health Systems Research Institute (HSRI). This program of 47 episodes in total was broadcast every Friday, 11.30 am to 12.00 pm on Thai PBS.  Some of the audiences requested additional information as well as commented on the content and the production of the program. This research aims at surveying the opinions and popularity of the program so as to improve the production in the next phase.
	This study used 3 methodologies as follows: 1) a telephone survey of the program’s popularity conducted with 400 samples in all regions 2) a questionnaire survey for the audiences’ comments and suggestions conducted with 40 samples, representing 80 percent of the audiences who have given feedback to the program 3) a focus group discussion to check the audiences’ comprehension of the program content conducted with four groups of seven samples.
	The popularity survey indicates that eight percent of the samples know this program. The number of subjects who have known and seen this program is only three percent, mostly females, married with children, holding Bachelor’s Degrees, aged over 50 years, business owners, with 5,000 – 15,000 baht per month income. They have accessed to television and it is convenient to watch the program at home. Most of the audiences know the program by chance and they do not watch the program regularly. Their watching behaviors to one episode are discontinuous. They also switch to other programs back and forth. They also do not know the sponsor of the program.
	The samples think that the program gives more knowledge and creates health awareness, provides health information and leads to health behavior changes. The program is interesting, reliable and relates to the audiences. The documentary format is appropriate but the television station, broadcasting time and the length of the program are inconvenient for broad audiences to watch.


It is not uncommon to encounter medical articles written by Thai authors that fail to cite the readily available, relevant and accomplished works of other Thai investigators. The reasons why they ignore the work of their countrymen may be manifold, but the lack of a local literature review may have an adverse impact on their findings. In a recent article entitled “Occupational Malignant Mesothelioma in Thailand,” published in the March-April 2009 issue of the Journal of Health Science, the researchers, perhaps unwittingly, overlooked a number of Thai publications on mesothelioma and asbestos in this country. While we accept the single reported patient of those investigators as a case of pleural mesothelioma of the malignant variety, reference to it as “occupational” in relation to asbestos exposure has yet to be demonstrated and is therefore unsound.


Global warming is the term used to describe the increase in the average temperature of the earth’s surface, air and oceans. High temperature increases due to global warming can cause injury and may finally lead to the death of plants by many mechanisms. Although plants have natural defense mechanisms for their survival under high temperature stress, some of them are sensitive to high temperature stress and cannot adapt themselves. Current advances in science and technology enable the application of molecular biology techniques helful for studying the effects of high temperature on plants related to their gene expression. The knowledge gained from research can help us to understand sensitive and tolerant plants in respect of high temperatures with control provided by multigene families. Cloning gene(s) responsible for the heat tolerance of plants and the transfer to other plants sensitive to heat stress can increase heat tolerance in transgenic plants. This results from doing basic research. Therefore, it is necessary for scientists to use advanced science and technology to reduce the adverse effects of global warming on plants, especially economic and medicinal plants.


This research was undertaken to evaluate the devolution of health centers and hospital autonomy in Thailand. The assessment team conducted literature and document review and interviews with the Provincial Health Office (PHO), District Health Office (DHO), Provincial Governor’s Office and Department of Local Administration (DLA), the Contracting Unit for Primary Care (CUP) Hospital, Tambon Administrative Organization (TAO) and health center (HC) staff in five devolved health centers and five nondevolved health centers and a hospital-owned primary care unit (PCU) in six provinces. In relation to the three stated objectives of decentralization, the team’s findings concerned changes in flexibility, responsiveness and participation following devolution of health centers to TAOs.
Findings on the devolution of health centers were as follows: (1) increased management flexibility: three of the devolved health centers had positive perceptions of improvement in management flexibility, in the sense that future decision-making is expected to be faster and there should be greater scope for initiative; (2) increased responsiveness to the community and to patients: three devolved health centers could point to a number of ways in which service delivery had improved and new services had been provided in response to the needs and preferences of the community; and (3) increased participation of the community: all five TAO CEOs and Councils were active in obtaining community input on health and health service delivery.
Findings on hospital autonomy were as follows: (1) the Ban Phaeo Hospital model was found to be well-designed, clear and consistent. Its performance in improving service quality and increasing its revenue had been highly successful; (2) community support for the hospital has been a major success factor but mechanisms for patient and community feedback on priorities and service delivery performance could be strengthened to improve accountability and better align service priorities with the needs and preferences of users; (3) this model should be replicable in other MOPH hospitals, except small community hospitals serving small, dispersed populations.