Currently, psychiatric patients classification for budgeting allocation’s purpose by employing diagnosis might be appropriate for acute disease but not implicitly to psychiatric cases. Psychiatric patients have their own special characteristics as follow: a requirement of joint symptoms’ diagnosis, less doctoral procedures, long average length of stay, various existing mental health assessments but not specifically designed for the purpose of budget allocation. The purposes of this research is to analyze various mental health assessments employed at Suan Prung Psychiartic Hospital and to study the correlation between mental health services cost and mental health assessment point given by hospital staff. The study is considered in the in-patient department by case mix method.Methods	The retrospective study collected and collated information from 1,207 out of  a total 3,715 cases from patients who came for services in in-patient department, Suan Prung Psychiartic Hospital during March to December 2002. Each selected individual patient for this study had to have 4 kinds of mental health assessments: Global Assessment of functioning Scale (GAF), Clinical Global Impressions (CGI), Brief Psychiatric Rating Scale (BPRS), and Assessment of Functioning form Mental Health Department. Individual’s information shall be periodically collected during each individual’ services stay. This study shall be employed a linear equation by categorizing costs into routine service costs, medical care costs, and individual drug costs. Results Our findings based upon 4 mental health assessments employed at Suan Prung Psychiartic Hospital show: significant correlation among individual assessment; Level of mental severity relate to level of services cost. The study shows that case mix of Schizophrenia, Paranoid and Acute psychotic disorders is the most costly, followed by Mood disorders; Mental retardation; Anxiety disorders, Eating disorders, Obsessive compulsive disorders, Personality disorders, Stress and Adjustment disorders; Alcohol Related; disorders and Drug Related, respectively. The following key factors directly affect mental health service costs in deceleration order: average length of stay, electro convulsive therapy, diagnosis, age, and gender.Conclusions After analyzing mental health assessments, our finding is health services costs are inconsistent between case mix and mental severity. Mental health assessments employed at Suan Prung Psychiartic Hospital that reflects budget allocation is GAF.


The study of health dimension and the development of small and medium scale industry (SMIs) has 4 objectives. Firstly, it is to review the situations and the trend of SMIs development towards production, employment, and consumption. The second is to review the development plan of policy, laws, promotion and support policy towards SMIs development. The third is to specify the analytical and health impact assessment framework of SMIs development. The last objective is to reveal and get feedback of setting this analytical and health impact assessment framework on SMIs development. Besides, the study aims to specify the framework of SMIs policy development in which it affects people’s health.The study uses the Health Impact Assessment (HIA) approach as the tool in order to specify the scope of factors that affect health. The methodology of the study includes literature review, the interviews with concerned organizations and five case studies; those are foods and product manufacturing industry, sub-contract production, rice mill industry, the industries affected urban environment, and ceramic and pottery industry.According to the monitoring report on Thailand’s SMEs in 2001 by the SMEs Promotion Office, it is found that during the year 1994 to 2000 SMEs had a 40% proportion of its Gross Domestic Product (GDP). The value was approximately 3.6 to 4.9 thousand billion Baht a year. The production sector had a 25% proportion in the SMEs Gross Product.In 1999, there were totally 99,568 SMIs’ manufacturers; 4,057 manufacturers were medium industry and 95,511 manufacturers were small industry. More than 40% of these firms were in the North-East, the next ranks were 18.3% in Bangkok and 13.7% in the North. More than half of all firms was foods and beverages industry. The other main industries were metallic product industry, non-metallic product industry, and machinery and equipment industry. The employment in SMIs was about 1.928 million labours: 57.0% of the total amount in manufacturing sector. In this figure, more than 78.5% was the employment in small industrial firms.The framework of SMIs development policy of Thailand has been stated in all National Social and Economic Master Plan. It is more emphasized in the government of Chatchai Chunhawan and has been pushed into practical work in the government of Taksin Chinnawat. Until 1997, the SMIs development was only a part of the industrial development. The SMIs was expected to support large scale industry in the production and to be input material suppliers. After the economic crisis in 1997 the SMIs development has been supported with many effective economic measurements. Besides, the SMIs development policy aims to (1) initiate the development of supported industries, and connect them to large scale industry development, (2) create employment for a number of labours in non-agriculture sector, (3) create the locals income, and (4) promote SMIs to play an important role in Thailand’s economic growth instead of large scale industries that are affected by the economic crisis.Before the economic crisis the process of SMIs policymaking was not in clear figure. After the crisis, the government’s policy plays its role in the SMIs development clearly. It is operated through the operations of concerned government’s organizations. It is also opened to private sector to become participants of continued policy development. Meanwhile, the laws concerned SMIs development accordance with 4 stakeholders; producer, labour, consumer, and environment; are most related to producer merely. The laws related to labour and consumer are most about the protections, but the laws related to environment are in general enforcement; not specific to the SMIs.From the review of the situations and the trend of SMIs development towards production, employment, and consumption and the review of the development plan of policy, laws, promotion and support policy towards SMIs development, the study hereby proposes 2 aspects of the analytical and health impact assessment framework on the SMIs development policy.In which way does the development policy aim to benefit for health?What are the continuous effects of the development and what are the results?In addition, there are 4 basis principal that should be considered in long term;the equity of accessibility and using policy, the stakeholder of each policy must be concernedthe fairness of resources distribution from using the policy in which it could reduce the unequal social and economic structurethe impacts of using policy towards health rather than the target to the economic growth onlythe policy-makers and people affected by policy should be co-developers of evident based and knowledge


The spread of AIDS epidemic in Thai society through some forms of sexual contact led to the policy that has been focusing on changing sexual behavior of people. Certain forms of behavior, such as teen and commercial sex, have been classified as highly risky. The policy relies on the measures to convince or force people to contain their sexual conduct in monogamous marriage. Although such measures succeeded in raising public awareness about AIDS, sex outside marriage has continued and new high-risk groups emerged. People in Thai society seem to resist the attempt of the state to discipline their sexual behavior. Based firmly on dominant system of belief about sexuality, policy on AIDS reflects and perpetuates sexual and gender inequality which has been accounting for social vulnerability to contact the HIV virus of various groups of people. The policy has been a mechanism to control sexual practices of the people. The policy process on AIDS issue has also been a site of contestation of many groups with different sexual beliefs.  Policy on AIDS has been affected, as well as a part of, sexual politics that people negotiate and resist the dominant version of sexuality in Thai society.


According to Thailand’s financial crisis many years ago, Thailand has dramatically developed new budgetary resources allocation system for public health finance through capitation payment for out-patient group and DRG relative weight to purchase inpatient care for in-patient group. However, this new system was likely to create moral hazards. For example, service providers give low quality medical service to patients, or accept only low-risk patients, and reject chronic patients like psychiatric patients. This study has a main purpose to analyze 30 baht service patterns provided by hospitals and taken by psychiatric patients in Thailand. Also, this research shall encompass to its continuing effects and adjustments by hospitals under health department of Thailand’s Northern region during budgetary year 2001-2002.Methodology	This retrospective narrative study collected and collated information from in-patients in all public psychiatric hospitals during budgetary year 2001-2002. Studying tools consist of in-patient data report, 12 file database or other compatible systems, budgetary fund & use report (Sor Jor Ro Ngor 1031), supporting fund  (Sor Jor Ro Ngor 1032), and fund from Sor Por Ro Ngor 102. Data have been analyzed by software programs e.g. SPSS/FW, Visual  Foxpro, Excel, and Arc View. Results This study has been classified into 2 parts as follows: Part I: According to psychiatric Service Pattern during budgetary year  2001-2002, there were 720 and 985 public psychiatric hospitals which have in-patient services in 2001 and 2002, respectively, In each year, there were over 70,000 psychiatric in-patients which mostly use psychiatric services in primary hospitals approximately 57 %, followed by hospitals under mental health department (36%), other hospitals with psychiatric service (6%), and medical school (1%), respectively.	In 2001, there were totally 387 Thai psychiatric doctors who approximately 80% have worked with public sector. Practical psychiatric doctors working with in-patient departments under public sector were only 211 which was accounted for MMM doctor to population ratio of 0.34:100,000 population.	Our finding reveals that psychiatric doctors are imbalance distributed evidencing from over half lived and worked in Bangkok Metropolitan. Additionally, provincial cross services were as high as 30% as public health district cross services were only 14%. Provinces with high psychiatric service record usually the ones that have psychiatric hospitals in the area. Most found diseases are Schizophrenia and Acute Psychotic Disorders, followed by Substance-Related Disorders, Anxiety Disorders, and Mood Disorders, respectively. Part II: From effect & adjustment study of hospitals under mental health department in Thailand’s Northern region during year 2001-2002, there were a total of 3 public psychiatric hospitals: Suan Prung Psychiatric Hospital, Nakornsawan Psychiatric Hospital, and Northern Child Development Center. These hospitals had a proportion of using budgetary fund of 80%-90% as capital return from service change is approximately 14-37%. In board perspective, supporting fund is likely to increase, During this study, budgetary fund support was insignificantly different. Hospitals have been adjusting their systems to 30-Baht policy by tight debt-following policy and diminishing length of stay for in-patients.Discussion	Currently, public health district cross services has recording high. This might come from the following reasons: an inequilibrium distribution of psychiatric doctors and hospital, reputation-lead-people to special hospitals. 30-Baht policy’s implementation drove changes on behavior of service  use & take pattern by pattern by patients and by service providers as follows: primary and secondary hospitals increased number of in-patients, length-of-stay, and individual service charges. Contrarily, number of patients, length-of-stay, and individual service charges in hospitals under mental health department was declined. 	Evidenced from hospitals in Thailand’s Northern Region, financial difficulties have slightly affected due to stable budgetary fund supported in year 2001-2002 even service charges collected from UC program being less in comparison with previous level. More significantly, dig-to earth practical adjustments have been implemented. Minimizing length-of-stay effect has drastically reduced service costs and expenses. However, due to short-period data collection under this study and disease not lead to death soon or immediate cure, so this research cannot be totally concluded at this stage, Further study should be extended and further study in patient’s perspective is worthy for exploration.


There has been significant improvement in distribution of human resources for health in Thailand. Historically, a shortage of health personnel in rural areas was severe. Nevertheless, the most needed group in rural areas was the physician. The doctors, dentists and pharmacists in rural areas were mostly under compulsory service program by which they were financially subsidised while studying. Nevertheless, there were high turnover rates of these groups in rural areas. The Bureau of Health Policy and Planning was responsible for determining needs for HRH (human resource for health) for utilisation while the Ministry of University Affairs (MUA) mainly produced HRH especially doctors, dentists and pharmacists. However, the Office of Civil Service Commission (CSC) controlled staffing patterns of all public health facilities. Most reasons of leaving district level given by HRH were job dissatisfaction and their need for further training especially for being specialists. However, health sciences students and their parents were not against the compulsory service program rather favouring government financing for education. The paper proposed number of doctors at the provincial level be less than that of district level which was opposite to the CSC’s requirement and the compulsory service program be remained for doctors, dentists and pharmacists. More equity of HRH distribution among provinces should be implemented and additional budget should be given to district health facilities to employ additional staff. Financial and educational incentives should also be delivered for those working in rural areas.


Lack of coordination for health policy implementation was concerned due to the fact that health policy had been largely determined and implemented by the Public Health Ministry. 	This study was aimed at synthesing alternatives to processing health policy, strategies and national health plan by reviewing health policy making process in other countries and development of other public policy in Thailand. Interviewing well-experienced people was also performed. Concepts for developing processes of national health policy determination were:firstly, the Thai Constitution in which civil involvement should be strengthened in policy making process, secondly, desirable mechanisms in which efficiency in administration, good governance, synergistic working, political accountability and evidence based implementation were created,thirdly, mission in which direction of national health policy (short to long term) was obvious,fourthly, three alternatives for processing health policy and determining health strategies were proposed. 	The first alternative was to promote coordination between public, private, community and people; nevertheless, bureaucratic implementation was likely to occur due to availability of many processes. The second alternative was to support civil society movement and to allow the cabinet to act as governing body. Even though flexibility to administration might be achieved, a number of societies were unlikely to be part in the policy making process. The third alternative was to let the mechanism under the Ministry of Public Health responsible for people health and determining national health policy. However, coordination with other organisations might be difficult to take place.


The objective of this study was to examine characteristics of non-profitable hospitals, as compared to profitable hospitals, in Thailand.  Administration national data for 640 public hospitals of fiscal year 2002 from Ministry of Public Health were analyzed.  A two-part model estimated by logistic regression and ordinary least-squares regression was used to examine the likelihood of hospital loss and the amount of loss, respectively.  The results showed that various managerial, service mix, and market variables were significantly associated with the likelihood of hospital loss.  An increase in average hospital Universal Coverage (UC) inpatient day per number of the UC and the concentration of hospital market could significantly increase the likelihood of hospital loss, while an increase in the average Civil Servant Medical Benefit Scheme (CSMBS) hospital inpatient day per number of the CSMBS inpatients and average Social Security Scheme (SSS) hospital inpatient day per number of the SSS inpatients decreased the likelihood of hospital loss.  The ratio between total patients and number of full-time employee was positively associated with the likelihood of hospital loss, but it required cautious interpretation since it was confounded by the employee salaries that was not included in this study.  Beside managerial, service mix, and market variables, the hospital characteristics also were associated with the amount of loss.  The larger hospitals and hospitals located in central area of Thailand tended to have higher amount of loss.  The results also suggested that managing the number of hospital employee, inventory, and patient hospitalization could control the amount of loss.  In conclusion, most of identified determinants of hospital loss were manageable.  The ramification of this study was to help policy makers understand the hospital loss situation in Thailand after implementing the UC scheme and design policy to resolve the hospital loss problems.


Confrontation of two concepts on human civilization has been more imminent in this era. While the west represents linear evolution, the east represents circular development of human history	But in the world with material development, the way of life of the people is not as happy as they deemed to be. The rigidity of knowledge that used for human development has become cage to imagination. Thus freezing the thought so that it is not corresponding to reality of nature. This brought about suffering on the lives of individuals and societies and also the deeper unbalance in ecology causing the problem culture that lead to the problem of health.	In this wider crisis, there struggles to find solution. This happened in various fields of knowledge and activities as in science, religion, culture, art and social movements. Whether physicists or artists both have realized the necessity to find new perspectives. They realized the necessity to find a new manner toward the world. They need new ideas and new language and new practice to suit the new reality	Surely, there will be resistance from the people and the systems of the old paradigm. But this paradigm change is not the replacement of new idea for the old one. For it will include and transcend the old  world  and integrate it to the new one. It will find new way of management and politics combining truth with beauty transcending any violence causing by the limits of the old paradigm. Combining the east and west concept of human development in the most creative way imaginable. Instead of circle or linear we will come up with spiral dynamics with corresponding to the form of life force.


This research seeks to fill the gap in knowledge on pharmaceutical registration policy in Thailand, by
using a mixture of public and health policy analysis and technical aspects, and focuses on content,
context, actor and process. The two specific questions are; (a) what is pharmaceutical registration
policy in Thailand? (b) What are the factors influencing the pharmaceutical registration policy process?
The thesis focuses on both policy development and the implementation process.
The objectives of pharmaceutical registration policy in Thailand had been found to be unbalanced;
focusing more on access and obscuring the general goal of quality, safety and efficacy. A survey of
tracer drug registration (1983-1997) found that the registration system in Thailand has double
standards between new and non-new drugs, with little success in re-evaluation of previous registered
drugs. The research showed a large variation in registration time (1-2147 days), a high number of
approved drugs, contrasted with few rejected or withdrawn. Hence the Thai registration system may
be described as ‘entrepreneurial and permissive’ or as taking a ‘laissez-faire’ approach.
This research has identified four main groups of factors that led to the failure of implementation. First,
policy on registration was not well developed because of the unbalanced influences of different actors
with varying powers; this was reflected too in the implementation process, which was also influenced
by a variety of actors. Second, there are continuing technical weaknesses in the drug regulatory
structure and process. Third, the advisory consultative process in the registration system was not well
managed. Fourth, key actors’ attitudes and perceptions, and organisational hierarchy had an important
influence on decision-making. On the basis of the understanding of these weaknesses, it may be
possible to introduce new potential measures in the future.


This research aims to study the concept and the role of NGOs in health reform. It explores NGO network which has been involved in community development, target group development or public social development. The main methodology includes focus group discussion, complied six case studies of NGOs as well as conducting in depth interview with 14 activists who have played significant roles in the health system. The research discovered that, from the NGOs’ perspective, the general health system problems arise from the national development policy that principally aim for economic growth. Health services and public health are adopted systems that are too westernized and only seek profit maximization. In the same vein, economic production and labor development are based on the principle of western education, which is rooted in self-interest attitude. Consequently, any laws related to health issues are controlled by the principle of western medicine, clinging to government administration and being influenced by private sector. Furthermore, the government is viewed as operating its public health system under centralized control, with an emphasis on curing rather than preventing. Its principle is strongly rested on non-integration and a single plan in order to solve health problem all over Thailand. NGOs have been taking part in resolving health and public health issues through various approaches. This is seen as an important role in reforming health system in particular by supporting community organization, research development and knowledge rehabilitation as well as health technology development. At the same time, herbal medicine, Thai traditional message, alternative medicine, consumer protection as well as social empowerment to answer any health-related issues. It is agreed by the NGOs that the governmental health reform only recognizes the important of institution and organizational reform. In term of health issue, a personnel development and capacity building to raise self-reliant, including the protection of consumer rights must be in the heart of government’s working operation. This is believed to be an alternative thinking against the mainstream principle. While the NGOs are viewed as one of the main stakeholders in promoting public health reform, but they do not see the importance of governmental public health reform’s approach. Suggestion emerges from the NGOs regards to the public health reform is to provide equitable access to government health service so that every group of people in the society achieve healthy livelihood and become self-reliant. Equally important, the government should support people participation, decentralization, flexible attitude, support alternative medicine, self-reliant as well as policy and legislation adjustment.


This study describers a Health Impact Assessment (HIA) to identify issues associated with the Ping River which affect public health. The first step in the project, scoping, has been conducted for 8 months, from December 2002 to July 2003. The main objectives of the project are 1) to study 4 dimensions  (physical, mental, social and spiritual) of the public health issues associated with the Ping River; 2) to identify the impacts from those public health problems; and 3) to create learning processes at the local level, which will lead to development of better public policy.	The study area was three districts in Chiang Mai Province (Mae Rim, Muang and Saraphree). Each of these districts lie on the Ping River. The main differences between them are in land use. Mae Rim, the northernmost (upstream) District, is rapidly urbanizing from a rural basis, because of its many popular tourist attractions and its position on the main highway north from Chiang Mai. Agriculture is still extensive around Mae Rim. Muang District, in the central part of Chiang Mai province, has a relatively high population density. Here the dominant uses of the Ping River are residential and leisure activities. There are many restaurants on the river banks and the scenery is quite beautiful. The southernmost and most downstream district is Saraphree. This is still a rural area and local culture has been retained. The three districts are connected by the Ping River and share a similar geography, human society and ecology. Any changes in the river’s upstream character will be transmitted to the downstream areas and may influence the physical, mental, social and spiritual dimensions of public health.	The realization of the need for effective decision making by governmental organizations which can affect the Ping River, and which can impact local communities in both positive and negative ways, produced a brainstorming seminar between researchers of this project and government representatives from the local and central levels. In the past, local government officers have conducted many missions, without approaching the public for advice, which have promoted resistance to government ideas and a lack of public participation as a consequence. There has also been overlap in the activities of some different government organizations, which has resulted in waste of time and loss of public money. After the brainstorming sessions, more than 500 questionaires were issues to the public living in the areas of study, asking them how issues related to the Ping River related to the 4 dimensions of public health described above. The results of the survey showed that the most serious for the public was loss of access to the Ping River. The river was reported to be narrower and shallower than before, because of soil erosion from the banks and intrusion of businesses into the river area. These issues affect the 4 dimensions public health as follows: 1) Social public health is affected because of fewer traditional cultural activities; 2) the mental health of the population is reduced due to irritation over poorer water quality and/or riverbank intrusions; 3) physical health is worse because of rashes from contact with river water; and 4) spiritual  health can be negatively affected by human intrusions into the common river area for private personal benefit without community agreement. Spiritual health can also be affected positively, through the retention of culture and tradition, which respects and values the river.	An analysis of the answers and responses from the questionaires was presented to the “Ping River, Environment and Public Health Meeting”, attended by many stake holders. The aim of the meeting was to inform the public, listen to the response and share ideas about the issues. The meeting concluded that the main problems were; 1) Uncontrolled urban development, which caused contamination of water, improper land use along riverbanks and loss of local cultures and traditions; 2) Lack of public participation in decisions over the usage and care of the Ping River, which allowed individuals and small groups to gain  personal  benefit, and avoid law enforcement; 3) Lack of knowledge of consequences of their actions by managers causing more problems, such as changing the direction river flow increasing bank erosion and concrete  construction that ruined river scenery.	These issues arose because some government organizations and members of the public still lack appreciation for the importance of conserving the Ping River. The three issues mentioned above could be solved by a public relations program to promote the appreciation of the value of the Ping River to  the  community. Also government must act with understanding on issues in each particular area and address the real cause of the problems. It is most important to listen to public concerns and get both public and non-governmental organizations, which can be important contributors to policy, to be involved together in the successful long term protection of the Ping River and for sustainable local development.


Financial report plays an important role in organization management. Nowadays, each hospital, however,  has its own format of financial report and provides inadequate financial information. Therefore, it is difficult to compare the managing performance of each hospital. The objective of this research is to set up the standard form of financial report, which could be used for evaluation of hospital efficiency.In this study, we developed the new financial report format and the service cost data had been filled in (accrual basis), which could be categorized into 2 groups: outpatients and inpatients. Furthermore, we calculated service cost for each group based on three types of health insurance policy, i.e. 30 baht, social welfare, government officer, using data from Bhuddhachinnarat Hospital during January-May 2003. The result showed that the average outpatient’s unit cost/visit =1, 039.20 and the average inpatient’s unit cost/head = 14,967.68. Moreover, we found that outpatient’s unit cost/visit for 30 baht and social welfare is similar, whereas unit cost/visit for government officer is relatively high. In case of inpatient, the lowest unit cost/head is social welfare, 30 baht and government officers, respectively. In addition, comparison of service cost of each health insurance policy showed that only the difference in medicine cost affected the difference in outpatient’s unit cost/visit. In case of inpatient, not only the difference in medicine cost but also other service cost affected the difference in inpatient’s unit cost/visit.The result from this study is useful for the health authority and other involved users to obtain the proper financial report in the same format. Evaluation of hospital efficiency can be readily performed and comparison between each hospital can be assessed.


Diabetes Mellitus(DM) is a chronic disease which  needs long term care. Main problems happened to the patient are complication causing decreasing in quality of life. Early deteetion can result in controlling disease. One of the main measures used is screening for DM both at peripheral health facility, so called ‘health center’, and primary health care community center (PHCC). However, the effective of this measure would rely on the number of client attending the service which is no voluntary basis. According to low reported DM cases in comparison with others, Khun Han hospital conducted a research to investigate community participation on screening for DM from March 2001 to February 2002 which place emphasis on ‘real participation’ at all step of the intervention program including situation analysis, identifying activities, implementing identified activities and conclusion and evaluation. This program involved related organizations and units. By convening group discussion, the core participants included village leaders 2 persons, representatives of village health volunteers 3 persons, member of Tambon Administrative Organization (TAO) 1 person, representatives of villagers aged 25-60 years old 8 persons facilitating by health personnel both from health center and hospital. According to the group discussion, identified obstacles or problems of low attending screening test were insufficient or wrong perception, knowledge and understanding on DM as well as wrong attitude toward the disease. For instance, ‘DM can not be cured’ so they are afraid to know or ‘we are so strong and healthy. It’s not necessary to be tested’. Furthermore, some thought that complications of diabetes are so severe. Patient will  die soon. Regarding in-corrected knowledge, some villagers believe that some kind of herbs can cure the disease. Apart from the client side, problems on services were insufficient of urine strip for testing urine sugar in addition to villagers did not trust on the capability of the village health volunteers who provided service. Based on the findings, the group defined the necessary activities including announcement of campaign of screening for DM via person to person and broadcasting on village loud speakers. To provide knowledge and activate the awareness of the villagers, a meeting were convened at the village hall. The main contributors were village health volunteers and the one who has direct experiences on caring the diabetes patients. The session was organized as group discussion and sharing experiences among the participants and ended with ‘question & answer’. This differs from the former health education activities which was mostly done by health personnel. After being motivated the awareness, campaign of screening for DM was conducted. Out of 96 risk group, 70 villagers (72.9%) were tested for DM. There were 17 persons having positive results with urine strip. These positive cases were confirmed by fasting blood sugar determination. Out of 17 cases, one was diagnosed as DM.  After finding new case, the community was aware of DM. Following activities were identified, namely, providing weekly service on screening for DM at PHCC, organizing refreshing course on diabetes  mellitus to village health volunteer, registering DM cases living in the community, screening test for diabetes in risk group at least once a year, submitting request to TAO for blood glucose testing equipment.Being conducting research emphasizing on community participation has effects on attitude of health personnel and community regarding to health matter. The community perceive that health is their own matter not the matter for health personnel only. In addition, health personnel realize on the potentials and capacity of the community in managing problem solving.


This research project has aimed at collecting, screening and translation of Lanna medical
text books and the development of a program for the data base of Thai Lanna medicinal plant recipes
and the selection of the recipes for the application in health system for the development of modern
medicinal plant products and modern phamaceuticals and for conservation. The total of 225 recipes
from Lanna medical text books and medicinal plant recipes written in Lanna religious alphabet and
recorded in palm leaves or mulberry pulp paper in seven provinces (Chiang Mai, Chiang Rai,
Pra-Yao, Lumphun, Lumpang, Phrae and Nan) in northern part of Thailand were collected from the
Institute of Social Research, Lanna Art and Culture Promotion Center, and Pharmaceutical – Cosmetic
Raw Materials and Natural Products Research and Development, Chiang Mai University, Thailand.
Only 21 copies were selected base on the completeness of the contents and the reliability of the
documents. The documents were translated into 3 steps which were step 0 : the record of the recipes
as Lanna alphabet in the computer, step 1 : the translation of Lanna language to common Thai and
step 2 : the translation of common Thai to the understandable Thai. The total recorded recipes was
7,265 formulae. A program for the data base of Thai Lanna medicinal plant recipes was developed.
This program can be used to search and print the reports by the key words : province, document
code, microfilm code, disease /symptom (Thai, Lanna, English), medicinal plant (Thai, Lanna, English,
local name and scientific name) and the active compounds in the medicinal plants. The list of 3,965
names of the medicinal plants was obtained.
The examples of the monograph of the thirty Thai Lanna medicinal plants were presented. For
the 1,781 diseases which have been found in these recipes, there are classified according to
alphabetical order, anatomical system and disease code. For the selection of recipes, the program
was used to search the highest frequency of the disease/symptoms found in the recipes. Fever gave
the highest frequency followed by “San-ni-bat”, “Khang”, “Lom“, “Mareng-kud”, head-ache, “Mahoke”, ill during pregnancy, abscess and ill after baby delivery. The total of 619 medicinal plants were
used to treat fever. The 10 medicinal plants which were used in the highest frequency were, Oi-dang,
Choom-hed-tes, Ya-kha, Ya-teen-ka, Kluay-teep, Ya-khad, Ma-kog, Ma-dua-u-thoom-porn, Krua-khaoyen and Phai-bong. These plants may contain active compounds for antipyretic. Choom-hed-tes was
found in all recipes whereas other plants were in less frequency.
We have proposed 10 steps for the research and development of the selected 10 recipes for
health system application, by further study on confirming the effectiveness and safety and the
development of the proper formulations of these recipes. The five steps of the process to perform on
Thai medicinal recipes in other parts of Thailand following the criteria of this research project, have
also been proposed.


Development of Pharmacy Vision for Health System ReformObjectives: The major objectives of the project are:To brainstorm from pharmacy-related group, their thoughts and to synthesize as vision of the new national health system;To synthesize the new role of pharmacist that can drive the new national health system; and To show an initiative of a new drug system for national health system reform.MethodologySample and sampling technique	Both pharmacists and non-pharmacists from several sectors are invited to participate in the meetings.  They are opinion leader and are stakeholders in the system, and (for non-pharmacists) have been interacted with pharmacists before.  They are drug store owners, non-governmental organizations (NGOs), physicians, nurses, journalists, community leaders, as well as the general public.  Samples are selected by judgemental sampling by the investigators.  Representatives are from all four regions, the north, northeast, south, and central.  Altogether, the ratio of pharmacists to non-pharmacists is 2.17 to 1 (152 to 70, with a ratio of 36:7 (5.14:1), 29:12 (2.42:1), 20:11 (1.82:1), 28:23 (1.22:1), and 39:17 (2.29:1) for the central, north, northeast, south, and combined 4-region, respectively.Data collection	Five meetings of brainstorming are held, each in the central, north, northeast, south, and the last one, the combined 4-region, during 28 April and July 8, 2000.  The places are Nakorn Pathom, Chiang Mai, Udorn Thani, Songkhla, and Kanchanaburi Province respectively.  Future Search Conference (FSC) technique, a participatory method for mutual learning, is used as a means to get information from the participants.  Except for the meeting at Udorn Thani for the northeast region, where the Appreciation, Influence, Control (AIC) technique is used.Health System SummaryThinking process and health problemsThe general publicAre dependent on physicians'services and drugs, not self-sufficient,Are influenced by western way of life which impacted upon all aspects of Thai society, economics, politics, social, as well as cultural.  Evidences are the changing health behavior such as eating fast food and not taking good care of personal health.Are not aware of consumer’s right.  An example is being passive when consulting with physicians.Health personnel such as physician, pharmacistFocus on treating a disease, not the person who is sick.Lack a holistic approach in treating patients, as well as lack of a team approach.Emphasize treatment rather than prevention and health promotion,Health becomes a business enterprise,Based on western thinking process, local wisdom on health and drug are neglected,Lack of professional ethics.Management systemInefficiency, particularly the centralized government bureaucracy.Under political influence.Inaccessibility to services among the population.Lack of health insurance for the general public as well as inequity to services.Pharmacy Vision for the New Thai Health SystemFour different aspects of vision will be discussed: policy, services, personnel and management system.Policy.  Priorities are: change in paradigm of all parties involved, health participation among the general public, decentralization of power, self-reliance by going back to community wisdom and heritage, and promote consumer’s right.Services.  Included are: quality assurance for consumer protection and improve quality of life, health promotion and prevention rather than treatment, optimization of health information among the population, community involvement is services provision, and a network of health services to all the people.Personnel.  Characteristics of health personnel are: public service, patient-focused care, holistic approach with bio-psychosocial and spiritual dimension, quality service, team-work, equitable distribution of personnel throughout the country, and professional ethics.Management system.  The new system should:  have universal health coverage with equity and efficiency, be an efficient drug system with a strong research and development foundations on community wisdom, be accountable, and with strong community development approach.Strategies for pharmacy toward health system reformProfessional organization.  A multidisciplinary professional organization should be established with the obligations to: policy development, promote multidisciplinary research of health service, promote the multidisciplinary health approach to the population, and serve as a center for public grievance.Pharmacy personnel.  Future pharmacists should possess the following characteristics:  have value system based on eastern culture, be a knowledgeable pharmacist with professional ethics, competent in practice skills, and act as a team of primary care provider in community health services.A community health insurance fund.  This is a community insurance scheme, funded by and for community with the goal to health provision to members.  Participation from the community in setting up the policy as well as operation decision is essential.  Primary missions are health promotion and prevention.  Services for the members are purchased from health providers such as drug stores, traditional medicine, etc.Drug system.  The new system should: be an integrated system among eastern and western philosophy, focus on research and development for self-reliance (such as herbal medicine), have standard quality assurance.  Also needed is an effective and accountable drug distribution system, promotion of rational and cost-effective drug utilization, a health information network accessible by the public,, and promotion of pharmacist as primary care provider.


This study tried to capture the process of health reform mechanism through the organization of the National Health Assembly that appeared in August, 2003. National Health Assembly is a special event that emerged collaborate efforts to bring different groups of stakeholders together to exchange their ideas, sharing of experiences, and learn from each other on different issues that influence their health, livelihood, and quality of life in general. The assembly was launched for the first time last year and expected to continue every year, once a year, according to the new National Health Bill, if the bill become enacted. The First year assembly was a good platform for drafting the National Health Bill. In this Second year, it became more of a social platform for learning, sharing, and created general awareness of what could affect the live of the people. It is important to recognize the assembly as the main “reform mechanism” to bring people participation into the health system and broaden up the health system into a more holistic approach, wider than the institutional public health system or health sector reform in general.The study recorded the process of the assembly and analyze the context that would bring reformation in to practice, particularly the idea of “prevention before cure” or health promotion. In this platform the assembly was an attempt to make practical appearance of different health dimensions: physical, mental, social, and spiritual. Organizers and people participated in the process found their own creative / or few innovative ways to express what they think as means to promoting health from physical, mental, social, and spiritual perspectives. The efforts may not be all perfect, but they generate a great interest for people to learn from each other in the process of the meeting.  The process was far more general or ordinary kind of meeting. It has more sentimental movement, symbolic activities, and compassionate deliberations. People participating in the assembly are diverse in their roles and functions. The whole process show different way of exchange ideas, shared experience and proposed a policy change. An important output of this assembly is to bring recommendation for policy changes in various areas that affect people health such as agriculture, food production, environmental public policy, local wisdom and knowledge, etc. Other outputs include providing interactions and deliberative platform for people from various backgrounds, strengthening people health organization, capacity-building of people health education and advocacy, and create general awareness to politicians, academics, and the public who has little chance to be involve in health promoting scheme.The Assembly is also function as “reform representatives” that practically present different ways of looking at ‘health.’ It also display how health could be one of the people ‘rights’ particularly ‘right to health’ rather than just health care services. It demands community and society to create healthy environment (physical and social) and healthy public policy.  The process of health assembly could generate health conscious among people in different occupations whether in medicine, in business, in agriculture, or in policy making.  Therefore the assembly could function and display this practicality of the overall health reform which makes it a unique platform for the meeting unlike other kinds of gathering. Resolutions that come out from the people and organized working group are useful for further policy implementation.


OPD Case Survey at Kon-Kaen Hospital in 1997	The survey objectives were to study information of OPD care given. The studied information was general information, information of OPD care provision, views of physicians and views of users. The data were collected through interviewing users and providers from March 17 to March 21, 1997.. Systematic random sampling was used for sampling 1228 cases. The response rate was 82.65%. 	The results showed that the majority of users lived in Muang District spending their visit time approximately 1-2 hours. 48.5% of well baby clinic users lived in metropolitan area while 60% of the pregnant visiting the hospital lived outside the metropolitan. Most receiving general practice were new patients with non-serious conditions. 40% of the users were uninsured. Most general medicine users were from Muang district. 59% of this group could be taken by general physicians whereas 31.4% needed special care. 22.3% were aged people. Only 21.1% had insurance.	Common illness presenting for pediatric care was respiratory problem. Most examiners viewed that most presenting problems could be handled by health personnel and nurses. 63.3% of users were 1-4 year-old. 21.7 % were uninsured. For general surgery, tumor, respiratory problems and accidents were most common. 63.9% could be given care by general doctors. 32.7% gave the reason of specialist availability for visiting the hospital.	33.3% seeking orthopedic care lived outside Muang district and 93.1% living outside the metropolitan. Convenient transportation were most reasoned for coming the hospital. 15.3% were uninsured. Most seeking eye care were middle aged and could be given care by general doctors. Special care was most given to those living outside the Muang district. Most users were previous patients and made appointment. Such a group spent relatively longest time at the hospital.	On average, each patient spent his or her time at the hospital about 3 hours and 25 minutes (almost half a day). 26% paid on their own pocket (14% were later remunerated). 65% agreed with exising prices while 16.7% considered expensive. Nevertheless, most said expensive if paying more than 500 Baht. 72% said they well understood their illness told by providers. The lowest rate of understanding their illness told by providers was found at general medicine and general surgery clinic. Expenditures for medicine and special examination were averaged at 215 Baht. General medicine and cardiac clinic were found larger expenditures respectively. 1/3 of payment was subsidised by the government. Average transportation cost was 85 Baht.


The results from conducting the third phase of National Health Accounts (NHA III) shown the estimation of a Total health expenditure (THE) of Thailand in 2001 of 170,203 million baht at current price including capital formation. The total health expenditure of Thailand had gradually increased during 1994-2001 with average of 1.2 percent of annual growth rate at constant price, though, there was a recession due to the economic crisis during 1997-1999. Whereas the average of annual growth rate of Gross Domestic Product (GDP) during the same period was 0.9 percent at constant price. Ratio of THE to GDP at constant price was 3.2 percent in 1994 and reached to 3.9 percent in 1997, the year which Thailand faced the economic crisis, after that period the ratios of THE to GDP had decreased continuously to 3.2 percent in the year 2001. The THE per capita accounted for 2,560 baht at constant price in 2001 which increased from 2,477 baht in 1994. The share of public sector was 45 percent of THE in 1994. However, it dominated the greater part  which was equivalent to 56 percent of THE in 2001. It was due to high average annual growth rate of 7.7 percent which was greater than that of non public sector which expanded only 0.7 percent per year. The major sources of healthcare finance in 1997 came from central government and household sector which accounted for 30.5 and 44.5 percent of THE respectively. Nevertheless, the share of these two main sources had become nearly one third of the whole health expenditure each in 2001. It was due to the high average growth rate of central government expenditure which was 5.5 percent per annum while that of the household was 0.1 percent per annum. During 1994-2001, three third of THE of the Thai health system was personal healthcare consumption. Prevention and public health services had its rather stable share of 7-8 percent, though the country had encountered the difficulty during this period. While the ratio of expense on health administration and health insurance was 4 percent during 1994-1996 and sharply increased to 7-8 percent in the year 1997 on ward. The investment on health sector reflected the impact of the economic crisis apparently, its ratios were about 14-18 percent of THE before the crisis and had declined to be 15.9 percent in 1998 and rapidly decreased to 5-6 percent during 1999-2001. The average growth rate of recurrent healthcare expenditure was 5.6 percent per annum during 1994-2001. Public hospitals earned the highest share of growth of recurrent healthcare expenditure which  was 64.8 percent of total amount or average 7.5 percent per year. Private hospitals, though occupied the second large of share, their average growth rate was only 0.3 percent per annum during this period. Private clinics and retail sale of medical goods distributors  which shared some extent of important role in the Thai health system showed the average growth 2.5 and 3.4 percent respectively. Pattern of personal health care expenditure in 2001 had been changed when compared to that of 1994. In 1994, non-government sector occupied the highest ratio of personal health care expenditures, which was 63.7 percent. Of which 51.7 percent contributed by private households mainly for ambulatory care (32.9 percent), in public hospitals 12.3 percent, in private hospitals10.3 percent, in private clinics 8.8 percent; for in patient care in private hospitals 5.8 percent, in public hospitals 4.5 percent. In addition, private households paid for over the counter medicines 8.5 percent. The government sector earned the rest of share, 36.3 percent. Of which 19.1 percent paid by central government for ambulatory care in public hospitals (10 percent), and public in-patient care (7.8 percent), the rest 1.2 percent was for provision in health centers. In 2001, non-government ratio declined to 51 percent due to the decrease of private households whose expense decreased to 40.8 percent from 51.7 percent in 1994. However, the main service consumed by private households was for ambulatory care (23.2 percent) in public hospitals 8.9 percent, in private hospitals 6.1 percent, in private clinics 7.4 percent. On the other hand, the private household utilization for in-patient care in private hospitals was increased to 6.1 percent whereas that in public hospitals decreased to 3.7 percent. The share of self prescribed medicine declined to 7.6 percent, though its portion was still high. For the government side, its share increased to be 49.1 percent, of which 24.1 percent was contributed by central government for public in-patient and ambulatory care which equivalent to 12 and 10.8 percent respectively, the rest 1.3 percent was for provision in health centers. Compared with NESDB’s SNA, the amount of the1994 NHA’s recurrent expenditures, which accounted for 110,167 million baht and increased to 161,752 million baht in 2001, less than that of NESDB which estimated for 168,244 and 277,051 million baht in the year 1994 and 2001 respectively. The discrepancy rates were 38-71 percent during that period, the discrepancy rates increased sharply especially in the last two years. It was the main reflection of the increase in non-government sector. The ratios of the NHA’s recurrent expenditures to GDP were approximately 3 percent during 1994-2001, while those of the SNA’s health care consumption to GDP were approximately 4-5 percent during the same period.


This report summarizes major findings and recommendations from the research project “The Monitoring and Evaluation of Universal Health Care Coverage in Thailand, First Phase 2001-02.” The universal coverage of health service in Thailand consists of four major schemes, namely: (1) Civil Servant Medical Benefit Scheme (CSMBS), (2) Social Security Scheme (SSS) and Workmen Compensation Fund (WCF), (3) 30 Baht Scheme, and (4) Car-accident Compensation Scheme. Both WCF and the Car-accident Compensation Scheme could be considered as supplementary schemes where funds are collected from those who liable for the workplace or traffic accidents. The study employs a mix of methods that range from gathering and analyzing secondary data from various sources—including the data that come through reporting systems, review of previous studies, in-depth interviews and focus groups, content analysis of medias, observing meetings of committees, working groups, participating in seminars organized by various groups, and field works that include using questionnaires and analyzing hospital and patient records. The findings of this study are summarized as follows:	CSMBS provides health care benefit to government officials and their dependents (parents and up to three children). The payment mechanism is retrospective fee-for-service. During the past 13 years (1988-2001), the program cost has increased by six-fold, averaging 15 percent per annum. A reform was implemented in the late 1990s that cut down certain benefits such as limiting uses of private hospitals to emergency cases only, cutting lengths of stay at public hospitals and covering only medicines in the Essential Drug List. After the reform, the program cost subdued temporary, then rebounded back to the original trend. The present reform—based on an HSRI research which was approved by the cabinet in 2000, aims primarily at changing the payment mechanism to pay the inpatient cost according to the Diagnostic-Related Groups (DRG). This new payment mechanism is scheduled to be in full force in 2004, provides a gradual four-year transition that involves IT development and setting up the Central Information Center. At present, the reform is undertaken but is about 1.5 year behind the schedule due to the late start.	SSS is primarily a compulsory scheme that covers private employees in the formal sector. The scheme is based on the Social Security Fund where the main revenue comes from social security taxes that are imposed on employers, employees, along with by-law contribution from the government. At present, SSS provides six benefits to the employees—one of which is health benefit that covers cares for illnesses that are not work-related. Health care costs for work-related accidents and injuries are paid for by the Workmen Compensation Fund (WCF), which is also administered by the Social Security Office (SSO) and collects premium solely from the employers. Each employee in SSS could choose a listed hospital as the main-contractor. SSS pays the main contractors prospectively, mainly per capitation. (WCF pays any hospitals on fee-for-service basis, but with a ceiling per accident or injury). Each main contractor in the SSS could arrange with smaller hospitals or clinics to serve as its subcontractors and with larger hospitals to be its supra-contractors. To date, SSO appears to leave these arrangements to the main contractors, which, at times, leads to having unqualified subcontractors. In some provinces, the private hospitals that are SSS’ main contractors are blacklisted by their supra-contractors because of poor payment record. This could prohibit the insured to get quality care when needed. Since April 2002, all employees in the formal sector are required to enroll in the SSS. Thus far, only one-fourths to one-fifths of the newly-required workers has enrolled. As a result, more people would be covered by the 30 Baht Scheme than the number of the truly eligible. This would have negligible fiscal implications, however, since the burden the government shoulder for both programs are almost the same for this group of workers in the FY 2002.	The 30 Baht Scheme is a new scheme that covers the rest of population who are not under CSMBS or SSS. Thus far, the Ministry of Public Health (MOPH) has been the administrator of this scheme. The scheme started as a pilot project in six provinces in April 2001 and then expanded to 21 provinces in June. Since October 2001, the scheme has consolidated all existing health insurance programs undertaken by the MOPH—including the Health Welfare Program for the Low Income and Disadvantaged and the (voluntary) Health Card Scheme (better known as the 500 Baht Health Card for Family). While the phrase “universal coverage” and the slogan “30 Baht fee for curing every disease” have been high in the government’s discourse, the major reform that affects the health care providers most in the past year has been health care financing reform with the aim to redistributing resources, and thence physicians, to the deprived areas on a more equal basis. The financing reform allocated three-fourths of the MOPH budget based on capitation, resulting in having more money go to highly-populated and under-staffed hospitals in rural areas. Larger hospitals in major cities that used to attract most physicians in the past have found themselves in trouble, as their costs are rather high compared with the budget received and they are not allowed to charge the patients the way they used to. Hospital-based data suggest that, during the first six-month of the full-scale 30 Baht Scheme, number of outpatient visits has increased substantially from the same period last year. Number of inpatients has been in line with in the past few years. Hospital death rate has decreased. However, inpatient death rate increased slightly in the first half of FY2002. There have also been concerns on effects of payment mechanism (such as inclusive capitation) on delayed treatment or referral. Contrary to popular beliefs, thus far the 30 Baht Scheme has not cost the taxpayers dearly. In FY 2002, the scheme added about 10 billion baht to the MOPH regular budget (approximately 16 percent increase from 60 billion baht in FY 2001) while providing health coverage to additional 25 million people. The outlay is expected to increase only slightly in the FY 2003, even less than the increment in the SSS. It is unlikely that the three major health insurance schemes would be merged in the near future. This has caused concerns on equity and overlapping coverage. Part of the overlapping coverage is due to incentive problem, i.e., multiple cardholders still benefit from having more than one card as there has been no one dominant scheme under which the benefit package is better than other schemes in every aspect. One plausible measure to solve the incentive problems is to elevate certain benefits under the CSMBS that are still below than those of the SSS and the 30 Baht scheme and also elevate certain benefits of the SSS that are still below that of the 30 Baht scheme. In addition, reform on payment mechanism is needed to curtail health providers’ incentive that could lead to double/multiple standard in taking care of patients under different schemes.


present, research to improve and promote health as well as well being of the populations, to reduce unnecessary health expenses, and to increase national economic opportunities in health related markets, has become a notable national health policy of the Royal Thai Government (RTG).  Discussions and debates are thus going on about an appropriate structure of the future National Health System Research. Within this structure, health research institutes in universities are hypothesized to be an important foundation of the system. The purpose of this study is to identify ways and means to support and strengthen health research institutes in Thai universities.  Document research, group discussions, a reflection technique and case studies (six health research institutes in Mahidol University and Chulalongkorn University) were adopted.Results indicate that it is necessary for the RTG to urgently draw up a road map to systematically strengthen health research institutes in universities. Action is needed in terms of significant investments in economic means, organization and human resources. An ability to adjust to changes, change management skills and leadership in health research institutes in universities, are identified as essential elements in this development process.Key development strategy is a proposal to the RTG to set up a National Network of Health Research Institutes (NNHRI), which consists of health research institutes at many levels, including those in universities, as well as families, the smallest units in society. Proposed objectives for NNHRI are: to systematically support and strengthen health research institutes in the country, to promote diversity in organizational structures and management styles leading to effective performances and good governance in health research institutes, to support proactive human resource development in both technical and management skills at all levels, to create a culture -- “Knowledge is important for health development in Thai society”-- by giving priority to effective and sustained stakeholder communication to empower health research institutes and to elevate efficiency and sustainability of health research development in Thailand.


People’s Participation in the Management of Community Garbage	Garbage problems, resulting from consumption, directly affect the people’s health, their well being, their good quality of life and the environment. Garbage volume increase is too high for local administration to handle and the problems thus aggravated.  One of several ways to tackle these problems is the reduction of garbage volume by garbage separation.  One portion of the garbage could be reused or recycled while the other portion could produce organic fertilizer thus reducing the volume of garbage to be disposed of.	It is necessary that garbage separation method be acceptable to the people and that they comply by separating garbage before disposing of it.  This research has found two approaches for this.Education Mechanism	Teachers and students participate in garbage separation activities under garbage management program.  Students bring from their homes reusable item such as paper, glass bottles to school to pool them and sell them to scavengers at their shops.  Teachers may teach students how to convert some reusable items into other useful items such as paper lampshade from discarded paper or plastic flowers from discarded plastic items.  Students who brought garbage that would later be sold would earn merit points accumulated in account in merit bank which could be exchanged for consumable items later.	  Another feature of this education mechanism is the 3 United Recycle Powers Program which requires students to separate required garbage from home and school and give it to the school for sale, the proceeds from which shall be used for school’s activities.  Garbage separation shall later be introduced to the community in which the school is situated by the students, the teachers, and community members.2. Community Mechanism	Garbage separation campaign to educate the community shall be launched continually, it is supported by local administration by the provision of separated garbage collection equipment to collect garbage that is already separated.	It is concluded by the research that garbage separation prior to disposal reduces garbage volume which helps solve garbage problems.  Participation from the people, community, students and teachers is mainly an effective element.


A Synthesis of the Role and Structure of Primary Care Service System: in the Context of Health Professional and Health Services	A Primary Care Service System (PCSS) is believed to be the system that can enhance people’s health.  However due to the unclear policy and concepts of PCSS and the policy announcement on univeral health care coverage, each health care setting creates its own management.  This synthesis was made in order to find out the role and structure of PCSS and roles of health professional personnel including physicians, nurses, pharmacists and dentists in the transition period.  The data were synthesized from 8 case studies.  The findings were as follows :	PCSS is defined as the fundamental care service aiming to provide health promotion, disease prevention, therapeutics and rehabilitation services to individual, family and community through the holistic approach and continuation.  Home health service is also included.  It is the health service place which is near, is easy to access, has needed services and the service is provided by professional persons who work as a team and coordinate with a community organization.  There is a network of service and an effective referral system.  PCSS is aimed to empower people to be health self-reliant and promote family and community participation in health building.PCU structures	1.	Establishment of a PCU as on an extended OPD.  It is located in the hospital building or hospital area or in an urban area. It has permanent staff or hospital staff taking turns to work in the PCU.	2.	Establishing the PCU in a hospital or in an urban area to be a PCU model.  Permanent staff are hired to work in the PCU.	3.	Adjusting or extending the activities of social medicine or home visit teams to be multidisciplinary teams and visit both discharged patients, chronically ill patients and general people at home.	4.	Development of a potential health center, public health center or community health center to become a PCU by changing personnel’s way of thinking and working,   emphasizing health promotion and disease prevention , providing systematic home visit and assigning health personnel from contracted units of primary care service (CUP) to work  temporarily or permanently  at PCU.	5.	A drug store serves as a PCU by providing knowledge on drug use and health promotion.	The main persons who work in PCUs are nurses and public health personnel.  Some PCSS, physicians or pharmacists may work every day or a few days per week and dentist may come occasionally. In some PCUs there are dental health worker and sanitation worker in the team.  Each profession has roles as follows:	Physicians : perform physical examination, make diagnosis, give treatment, teach and advice, do home visit and administer the PCU.	Nurses : perform child health examinations, give vaccinations, do ANC care, teach and advise, do physical examinations and primary medical care, make home visits, do data surveys and family folders, do surveillance, build community collaboration, and administer PCUs (when there is no physician).	Pharmacists: provide pharmaceutical care at PCUs and home, do drug administration, give prescribed drugs, provide suggestions or counseling on drug use.	Dentists: do dental treatment including pulling teeth, filing, polishing the enamel surface, giving pain control medicine; provide oral health promotion and prevention including dental advice, advise use of fluoride in those who risk tooth decay and provide advice for oral care.Conditions for the success of PCU include:	1.	Understanding and experience of administrators and personnel in doing similar projects.	2.	Participation of administrators and personnel in policy identification and guidelines development.	3.	Building difference and creating value to the service.	4.	Paradigm shift and change of working style among personnel.	5.	Provision of essential knowledge and skill for personnel.	6.	Building understanding and clarity in role and responsibility of each personnel building morale.	7.	Good attitude toward teamwork and respect for others.	8.	Adequate manpower and appropriate workload.	9.	Having professional people as required.	10.	Understanding  primary case concepts and commitment of administrators.	11.	Strong support from community organization.	12.	Provision of appropriate budget by the government.	13.	Building more knowledge on primary care through continuous research.


This is a literature review of chemical and organic agriculture form secondary data: academic materials, articles and reports.  These consisted of government policies related to the agricultural sector; ecological and environmental situation, pesticide and chemical usage in agriculture and agriculturists’ health.  The study refers back to before the year 1960, From the above literature review, it revealed that incidents occurred from government policies which were tremendously related to environmental changes and life-style of the N.E. people.  The death rate of infants and pregnant women decreased to a satisfactory level.  Almost all diseases that occurred from improving immunity were eliminated after public health had been in service, but these diseases were replaced with accidents, cancer, gastroenteritis diseases, skin diseases, muscle system, stress, allergies, obesity, diabetes, high blood pressure, AIDS, and lack of some nutritious substance.  These diseases are conducting one’s life which was “earn a living’ became ‘make money’.  Money was of main importance, forests were destroyed to make a living and to do the farm to increase income to meet the end needs.  From a report, production increased by expanding land was don more than increasing production effectiveness.  Lack of agricultural labour caused high wages; also not that much technology was used.  So Small Scale agriculture was not worth it.  Contracted farming was augmented gradually; and in this production system the usage of chemicals was rather high.  Chemicals and non-organic fertilizer is one of the factors that the government must give directions and see the importance of production increase and prevent damages from pests.  This is because agriculturists do not have far vision, lack potentiality assessment, do not realize the effect toward food sources, habitations environment, and health in the long term.  However, this study is a literature review.  All data were from each period but there was no concrete evidence that affected health.  There were likely to be reports about diseases symptoms such as poison, loss of life from poisons or toxins, etc. in various places, times and conditions.	Suggestions were as follows:	Data should be analysed before determining national policy including effects that might happen in the future by focussing on the public health both mentally and physically as a main issue, and collective happiness in the society.  And effects toward health, which may be created as examples of effecting health so they, can be solved promptly.


Rationale: Drugs are essential for patients. International trade agreements might affect accessibility to essential drugs for many patients.   Some would finally die because they do not have enough money to buy expensive drugs. One of the major international trade agreements is  the “Trade Related Intellectual Properties or TRIPs” . Intellectual properties include “patent” and “copy right”.  A patent is granted to inventors for any branches of industrial inventions. A copy right is granted to the owners of writings, musical composure, art works, movies and trade marks.  Protected intellectual property rights encourage innovations and innovators are fairly rewarded. It is believed that intellectual property right protection will be economically and socially beneficial to the world in the long run. Intellectual property right related to health policy is “drug patent”. There are two subgroups for drug patent i.e. one is related to “product patent” , another is related to “production process patent”. In Thailand, Patent Act has been enacted since 1979. Under this act, the protection of  “product patent” right for drugs is excluded but “process patent”.  The rationale for the exclusion is based on human health and livelihood. Unreasonably expensive drugs are the major concerns. The country’s drug industry might also be affected if the right is granted. 	 During 1984-1999, the US government put pressure on the Thai government to amend the “Patent Act” and “Copy Right Act”. The US government required that “product patent” must be included otherwise Thailand will be punished by abolishing the “GSP” granted to Thailand. The “GSP” is granted to allow some developing countries to be able to export commodities to The US with low tariff rates. It was estimated Thailand will lose $US 165 millions or  4,125 million Baht (in 1983). Other measures will simultaneously be implemented if Thailand refuse to amend the Act.  Finally, Thailand has amended the Act in 1992.	Major amendments are as follows:  	1. Extend the protection to other items including food product, beverage, drugs and drug ingredients, agricultural machinery. Extend protection period from 15 years to 20 years effective from the date of submission for patent. Compulsory licensing must be done according to the Uruguay round on trade agreements.  For instance, compulsory licensing can be used only if the owner of the patent unrightfully performed by unreasonably not producing or not selling the products.  If compulsory licensing is implemented, the owner of the patent can make an appeal to the court.Clauses related to drug patent as well as other regulations related to pricing and anti-dumping must be amended according to the Uruguay round on trade agreement.   Later in 1999, more amendments were done. The committee on “Drug Patent” was abolished.  A system of petty patent was implemented. The study aims at studying the scopes of the health impacts arising from the amendments of the Patent Acts.Study Methods: Literature reviews, In-depth interviews with government officials who have duties on the related issues, group discussions with stakeholders to outline the scopes of the impacts of the amendments to be assessed in the future.  Results of the study:	The scopes of the impacts on Thailand drug systems because of  TRIPs were found in these three areas:  1.    Rising costs of drugs and inaccessibility  to drugs especially those with AIDS Hindering the development of home drug industry	CASE STUDY: Anti-retroviral drugs for AIDSDrug manufacturers purchase license from various research institutions. They then manufacture drugs to be sell in the markets around the world under their own brand names.  For example, Bristol Meyer Squipp bought license to produce an anti-retroviral drug called “Didanosine” (ddI) from the National Institute of Health who has discovered the drug. The company has modified the ingredients of the drug by adding antacid components in order to make it acid tolerable and not being destroyed in stomach. The company submitted for new drug patent in Thailand. and		Moreover, the company was also submitting for new drug patent for the combined formula, for example,    “Indinavir” combined with “Efavirenz”  or  “AZT” combined with “3TC”. 	The company was granted protection even though it has not discovered any new drugs at all. This enables the company to extend its right for longer period of time and hinder local drug companies to produce the drugs. The progress of new drug development in Thailand is slow, although there is claims that the “Patent Act” will encourage innovations.  Since 1996 – 2000, most of the new drug patent in Thailand were granted to foreign drug companies.   	     	3.  No real technology transfer  Multinational drug companies always claim that granting drug patent is beneficial to the countries in terms of technology transfer. Because the formula of new drugs were provided therefore countries can further develop new drugs.   The former director of the Research and Development Institute of the Government Pharmaceutical Organization once said it is unlikely that Thailand will benefit from the drug patent in terms of technology transfer. Three reasons for her argument were 1) there are insufficient information in the submitted document 2) the drug companies deliberately keep essential information secret and 3) the inventions were so complicated.   In addition, the capabilities and infrastructures of Thai institutions are lacking in order to be able to check whether the submissions were really new inventions.   Conclusions and suggestions: The health impacts due to TRIPs are inevitable if applied.  Serious public health problems still remain endemic in Thailand, for example, AIDS, Tuberculosis, Malaria etc.. Drugs are essential for the patients with these diseases. Trade agreements need to be revised and reconsidered with concerns of health values, benefits and well being of all Thais.


This research report entitled “Nurses and the Health Service System at Primary Care level” aimed at conducting a process to develop concepts, design and a management system at primary care level in a socio - cultural context and the health system reform. Emphasis was placed on proposing nursing as a major tool for the development of a health services system at primary care level. The study was conducted collaboratively by nursing faculties and a nursing department of 6 universities and the Thai Nursing Council. Universities were Khon Khan, Chiang Mai, Mahidol, Burapa, Prince of Songkhla and Walailuk .The study was a participatory action research design employing epidemiological study and a qualitative descriptive approach, focused on stakeholder’s participation. The target sample were health care consumers especially community leaders, members of local authority organizations and health service providers who were nurses and other health personnel. The key informants reflected the current situation of health services for the community. Models of health service delivery systems at primary care level from different settings were critically analysed and synthesized including to roles and functions of nurses in providing health care in communities, especially for the strengthening of the self care capacity of individuals and the self-reliance of communities. Nurses roles and functions included collaboration with local authority organizations in developing health policy and appropriate strategic plans for local health care. Knowledge generated from the findings of the study provides descriptions of health service delivery systems at primary care level which includes health care demands, type of health services needed, type of health personnel required and its management structure. The findings are as follows. The desired primary care service should be a service that should be as a bridge between people and the local health service system. It should be easily accessible, cover all age groups, all dimensions of health, integrated and continuous of care including collaboration with other health services and appropriate referral systems. The service should focus on empowering individuals and families in self-care, the use of local wisdom, and encourage community participation. The structure of the primary care service management could be best designed by considering the potentiality of each setting. The underlying principles for structural design include : health service strategies, health care activities, characteristics and competencies of health service providers, financial management, availability of human resources, health units, quality of service and primary care networks. Conditions contributing to the quality of the primary care service system Government policy should be stated clearly regarding service management that covers all characteristics of the desired primary care services including the establishment of mechanisms for administration, financial systems and human resource development. To achieve the goals of health care at a primary care level, adequate numbers of health professionals should be provided in designated areas. The ideal ratio of health care providers to population should be 1 : 3,000 .Health service providers who are professional must be legally protected by professional legitimization of their practice. There must be standards or guidelines of practice in health care and service, and quality must be ensured. To encourage effective care, the services must collaborate with others institute and organizations in a networking atmosphere. Recommendations for involving authorities. Government must have clear policy and measures on health care finance, resources allocation, laws and regulations, workforce production and development, decentralization and participation in health care. Professional councils mustlegitimize the practice of health care providers. Develop standards and practice guidelines for primary care and develop systems and mechanisms for quality control, audit and assessment including promoting and sharing understanding of concepts and professional roles and functions among its members. Under the current situations of the country health care system, it is proposed that the professional nurse is the most likely person to generate quality of health services at primary care level. There are two strategic approaches to the designs of the system management structure.1). using the existing structure and modifying roles and functions of professional nurses through capacity building.2). creating new structures to implement the appropriate ratio of health service providers and population in designated areas. These two approaches must be pursued under the contracting system for networking services. Collaborative efforts with educational institutes must be made for human resource planning and development of new and existing nursing personnel to be able to provide effective services at primary care level. Health institutions and primary care units should have clear policies and plans for financial management, collaboration with educational institutes and other supporting systems. Professional organizations at all levels must work collaboratively in developing shared visions, concepts and understanding among its members, standards and guidelines for practice, quality management and the enhancing of a network of professional entrepreneurship in community health care.


The objectives of this research were to examine the quantity and to identify format of health-related contents in Thai daily Newspapers, to identify distinctive parties involving in process of health message delivery, and to study the concerning parties in terms of their preferences in delivering different health-related messages, their work limitations, their awareness of roles and functions as pressmen, as well as to study the newspaper’s readers concerning types of health information they wanted, their means in searching these information, and their responses towards  all health information acquired from the newspaper.  This research employed three methods including content analysis, in-depth interview, and focus group.  Six Thai newspapers were purposively selected as the sample for content analysis.  The total of 84 issues publicized during September 2004 were analyzed.  Thirty-three health-related personals working for the six Thai newspapers were interviewed. Furthermore, six focus groups representing newspaper readers, who were different in term of their reading behavior concerning health-related contents, ages, and genders, were conducted. In conclusion, the results from content analysis showed that the most frequent health-related topic and health-related theme found among the sample was topic concerning various deceases, and theme concerning health prevention. Moreover, the most frequent presentation format of health message was the column format. Health-related content could be found in various sections such as women, technology, health, and foreign news sections, as well as the front page.Concerning parties in delivering health-related message consisted of editors in chief, news editors responsible for health-related desks, reporters, columnists and health-related informants.  The research found that some specific parties partly shared their roles and functions.  Editors in chief, news editors, and columnists mainly acted as message screeners based on their own judgment towards the impact of each topic or content upon readers.  Reporters and columnists obviously perform their roles in rewriting and adjusting health-related contents and formats. Health-related informants including the health specialists and the information coordinators played their roles in delivering health-related information. Besides health-related informants, other information sources of the press were government and non-government organizations, documents, and various media channels, locally and internationally. Definitely, each concerning party realized the importance of their role-playing in health-related message delivery. Contents they had paid attention were contents that had tremendous effect upon the public, in term of its benefit and interest.  Obstacles in producing health-related messages obviously mentioned in the interviews were difficulties in understanding specific terminologies and particular health-related contents, the thin line between public and private interest over some health-related issues, and the press-owned company’s policy towards health-related content.From the focus group interviews, it was obvious that newspaper was still the accessible medium for different types of readers. Interestingly, attendants mentioned that to read health-related content was not their main purpose in reading newspapers. Therefore, their expectation of exposing health-related content in newspapers was relatively low.  Moreover, health-related contents or messages which the readers sought for were different among age groups, gender-based concerns, individual’s health consciousness, and individual’s and or family members’ illness.         Further, the findings demonstrated that heavy readers of health-related content were habitually exposed to health-related columns in newspapers and most of them were very active in seeking for other information they would like to know by the use of other media.  Light readers of health-related content in newspapers were passive in seeking health information unless they or their family members were ill. Some of them were identified themselves as heavy users of health-related content of other mass medium.Three patterns of responses were found among readers due to their exposure to health-related message. First, due to their own confrontation with health-related problems or concerns, the readers would immediately implement the information they just exposed. The second pattern was to advice surrounding people after considering the involvement of the content upon each person’s situation. Thirdly, the reader would gather all concerned information to build up and to maintain their personal health-related database, and would use this information later whenever needed in the future.


This study consists of five purposes: (1) to survey the states and problems of health publications of Thai publishers, (2) to examine the backgrounds of health information transformers in terms of their status, types of publication work, professional procedures, working process, and related problems, (3) to propose the guidelines for developing and supporting health information transformers, (4) to explore the use of computer and a health publication database as well as to present a health publication database format , and (5) to propose the database format of health information transformers.  The results of the study are as follows: 1. Health publishers generally have 11.95 working staff and publish 8.69 titles per year.  Publication expenses for one title include 10 percents for the copyright cost of an author and 90 percents for publishing, printing, disseminating and marketing. Most of the health publishers prepare the publication layout and original master at the publishing office but employ outside printing work. The health published contents consist of various issues such as disease knowledge, nutrition, self-health care, exercise and fitness, mental health, elderly health care, beauty care, mothers and children, child rearing, drug usage, herbs, bio-organic consumption, yoga, diet, environment, and sex education. These contents are selected in accordance with the authors’ own interest and current problem issues. The objectives of health publishing are to give readers more understanding of health knowledge that they have already known and to provide them new related information as well.   The problems of health publishing are the difficult selection of experienced authors, the high cost of printing, the inaccuracy and unreliability of content, and the limited dissemination of health publications. 2. The health information transformers are averagely 53 years old and are mainly physical doctors. Therefore, writing of health publications is not their main career. Types of their publication work are authors, compilers and editors. By average, they have been working as authors for 10.32 years, with 3.50 books and 7.55 articles since 1997.  Reasons for writing of health publications are to pursue their own interest, use their own health knowledge in practical ways, and follow the social needs. The most serious problem of writing is that the health information  transformers have no time or have limited time for writing or seeking information. Other problems are limitation of health information resources and lack of accurate, reliable, and up-to-date health information. Another problem is related to readers’ attitudes and beliefs that local folk medicines and treatments are much better than modern ones. Also, they believe that illness and death are the ways of life; therefore they pay no attention of their self-health care. 3. The proposed guidelines for developing and supporting health information transformers are providing of consulting health expert teams who can provide some advices to the authors; establishing reliable health information centers; initiating the association of health information transformers; organizing training programs for writing skills and seminars for health publications authors; arranging health publication contests; disseminating of health publications to remote readers; and promoting of self-health care to the public. In addition, private publishers should fairly return to the authors and provide them more funds to disseminate health publications to community as well as support them about writing and research work.  4. The proposed health publication database format is composed of 13 required fields with indexes for information retrieval, and 6 optional fields without indexes. 5. The proposed health publication author database format is composed of 2 required fields with indexes for information retrieval, 6 required fields without indexes, and 7optional fields.


Analysis of Health Impact Assessment System from Large Investment Projects and Public PolicyDecharut SukkumnoedSince, health is redefined in Thailand as a complete state of well – being, which is well balanced of a body of intertwined elements of the physical, mental, social and spiritual dimension. Therefore, health is dynamically linked to all factors related to the way of living. Any environmental changes in terms of physical, economic and social conditions occurred in form of development process have a potential impact on the people’s health. Health Impact Assessment (HIA) is the combination of procedures, methods, and tools, which enable a judgement to be made on the positive and negative effects of policies, programs, projects, or other development actions. The overall objective of HIA is to maintain and improve the health of entire community/population by reducing health hazards as well as providing determinants for better health.  HIA has been promoted by WHO since the 1980s, before developed and implemented in many developed countries during the 1990s. In general, HIA systems apply the common concept and steps of impact assessment, with the specific focus on human health, which are not adequately covered by existing EIA and SIA systems. Like other impact assessment process, the main steps of HIA process include screening, scoping, analyzing, review, mitigation, decision-making, and monitoring and evaluation.Since, according to Thailand’s experience, the people’s health has been seriously threatened by a series of developmental policy and projects themselves. The study found that HIA should become an essential mechanism to prevent and recover negative health impacts as well as to promote positive health impacts derived from development policies and activities in this country.HIA process and system, which will be developed in Thailand, should be (a) effective enough in health protection and promotion, (b) equally participated by all stakeholders, (c) relevant to contexts and conditions within the operational organizations and Thai society, and (d) emphasizing on participatory learning process and capacity strengthening within Thai society.During an initial stage, HIA system in Thailand should based their ground on being participatory learning process, aiming to provide better information and influence for better decision-making according to health aspects, rather than being approval mechanism. This positioning will provide more times and opportunities to build up information, knowledge, understanding, and recognition within society, which is very important for trust building within HIA system.  Therefore, in drafting National Health Act, it should be mentioned clearly that the government should support the development of HIA system by establishing an independent organization under the supervision of the supreme organization of Thailand’s health system. It is also very important to search for more details on appropriated HIA models, especially in analytical and institutional frameworks, as well as, to look for strategic partners in order to develop HIA system in Thailand.