Thai Drug System and Women Health: A Case Study of Contraceptives	This study is aimed to be integrative research. Its objectives are to study on Thaicontraceptives policy and their situation under the drug system framework namely selection, procurement, distribution, and use. In doing this the project looks at thestructure and process of drugs system by analyzing roles and collaborations of relevantsectors to gather critical information for women health development. The result is thusproposed in order to protect health of Thai women using contraceptives.	Methods include multi-disciplinary techniques such as documentary study, interview, simulated case survey, observation, and questionnaires. Data collections are conducted at various levels from policy maker, professionals, practitioners, and consumers.	Various studies show that Thai health status has changed dramatically, with longer lifespan (life expectancy = 75 years) but still face complex health problems. These came from multipart social phenomena and over utilization of technology. Sources of illness and death  are changed from complicated delivery and infectious diseases to accident, committed  suicide, killed, and cancers of breast and vagina. Sexually transmitted diseases (STD),  AIDS, rapes as well as unwanted pregnancy and abortion are the rising problems. These situations occur in younger girls as low as 14 years old. However, numbers of abortion practices in married women are also prevalent from failed contraception together with social norms and economic constraints.	Thailand is recognized as success in population control shown by the decline in growth rate as being less than one. Nonetheless, women have the most responsibility in this job (more than 90% of all contraception used). Oral contraceptives are gradually less preferred than injectables. The potent and the longer hormones used the more harmful women received.  But there is less policy to motivate men involvement for family planning program showing  by very few and decreased rate of men sterilization and condoms used.	Thai policy on family planning focused merely on birth control hence ignored safety of hormone use for women. Lots of irrational contraceptives with unclear evidence were approved while the post marketing surveillance, re-evaluation, and improvement of package insert were worked at slow pace.	Data were gathered from 14 public health facilities – one university hospital, one public provincial hospital near Bangkok, 10 health centres from Bangkok MetropolitanAdministration (BMA), and 2 health centres from Ministry of Public Health (MoPH) byinterviewing health providers and their clients together with the observation. It was foundthat services of these facilities are delivered to response more on birth control policy than on  women health needs, reproductive rights, and women integrity. This reflexes by the simple services that are convenient to personnel such as contraceptives both orally and injectably. However the quality of services is questionable on the understanding, and knowledge of providers result in various forms of practices. Thai women of poverty are thus face less  choice and have to accept the circumstances.  	Simulated cases in 23 pharmacies in Bangkok and vicinity are intended to study family  planning provision, standard of practices, and dispensing behaviours. Interestingly, there  was no difference between practices of pharmacist and non-pharmacist in this setting. Not  enough information was given to clients asking for contraceptives in 3 various scenarios. The only useful information is probably derived from labelling and package insert. By comparing this information with legal requirement, WHO criteria, and recent academic information, we found that information from labelling and package insert were not conformed to the law and not enough for safety consumption. There was no information mentioning that contraceptives can not about STD and AIDS. The most important thing it unclear whether the package insert is intended for health professionals or consumer and lead to inadequate utilization.	Post-coital contraception is currently popular among adolescent. The study done in one public university in Bangkok showed that they know this product quite well and sometimes  introduces to their friends.	The result from this study provides some policy implications toward reproductive health in  Thailand. First, the MoPH needs to adjust their direction on reproductive health by  acknowledging women rights and providing enough information for women to decide, as we  as recruiting women in the policy process.


Nowadays, The government has concerned about the health system by using the policy of universal health care coverage as “ 30 Baht health care”, which emphasize on advance-service system and management of particular area. The problem seen in Amphur Muang Buriram is there are a lot of  workload in dental clinic,  Buriram Hospital. So dental staffs have to take time and partial budget for management, and dental services in community health center, especially the dental public health in school. Thus the management of dental public health in Amphoe Muang  Buriram, has to have an effective  management in human resources, time, and budget, through the co-operation of associated organizations for the appropriate service pattern in that area  and the most benefit for people.The purpose of this study is to develop the proper pattern of dental service in Amphur Muang Buriram, according to the health policy under the condition of resources limitation in this area. The methods are 1. Collecting the historical data of dental public heath projects in Amphur Muang Buriram, 2. Reviewing project patterns of other provinces, 3. Brainstorming for determining the proper model of process in clinic and community, and 4. Evaluating the indicators (i.e., dental services in clinic, waiting time for special treatment, the coverage of dental health in school, and the satisfaction of dental patient and staff) after implement  the developed  model  for 6 months.The results from brainstorming showing that there are the development of services:1.Expand the network of dental service subcontractor for people with UC card at  Buriram Provincial Public Health Office.2. Development of dental service system in Community Public Health Centers that have  dental nurse3.Begin  the mobile car of Buriram Hospital for dental services in school.4.Initiate system and format of oral health  report  in school, which developed by staff. 5. The results from change evaluation show that quantity of overall dental services is raised in every dental clinic, increased waiting time of some special treatments  (since there are movement and/or resign of dentists), and the satisfaction of patients  and staff is increased.In conclusion, the development of dental services by participating of staff can create the pattern of process accordance with the situation area. Moreover, the evaluation should be taken and continuously modified for suitable dental service according to variations of situation.


Epidemiology and Health Behavior on Malaria of  Foreign Labour in High risk Area,  Ranong Province	At the borderland ,a  lot of   foreigner  migrated   to work in illegal in  frontier country.    and they have a poor health.. The most common  of the endemic problem in the boarder of Thailand is Malaria and  it make a problem to Thais people who live  at the boarder of Thailand. 	This study  aimed to  compare  1)  malaria sick  rate  2) rate of malaria carrier 3) health behavior in prevention and curative . The  multiple stage  stratified method was used to select a  representative sample and divided in 3  groups and 200 subjects in each group.: Thais , Thais who habit closed to the foreign  labor and   pure foreign labor in Kra buri and la-oon district , Ranong Province . Data was collected by interview and focus group discussion.  	The results were:  60.3 % were male ,  40 %  worked in  a  rubber farm, 36.2  %  in  coffee  farm and also 13.7 % in the fruit farm and average age was 3730 years (sd.12.84), 15% of  subject got Malaria ,who 2 of 15 were Thais and 5 from 15 were Thais who habit closed to the foreign  labor and also 8 of 15 were foreign labor. Comparison of sick rate in  3 groups is not significantly different . Rate of carrier in the  foreign  labor  was 3.5 .Health behavior in  prevention and curative  were  significant different. In addition  ,the person who were not good in preventive behavior  more risky ( OR = 3.97 C.I. 0.12 – 12540) .the foreign labor  were more risky than Thais ( OR = 4.18 , C.I. 0.08-197.43) , age group upper than 45 were more risky than the lower ( OR 2.24 ,C.I. 0.08 –197.43) and  area of worked in  fruit farm was more risky (OR 2.04 C.I. 0.11 – 39.44)


Perception and behaviors Thai people toward smoking in public place	This study researched the perceptions that Thai people have of smoking in public places and their behavior in relation to it, including smokers willingness to abide by laws      restricting smoking and non-smokers in voicing their objections to smokers breaching these laws. The results were analyzed using SPSS to find percentages, means, the standard deviation, and Pearson's product moment correlation co-efficient was significant at 0.01. A sample group of 600 adults, 300 of which were smokers and 300 of which were non-smokers, were used in this study. Both smokers and non-smokers had a high level of  knowledge about the dangers of smoking to one's health. The study found a high level of compliance to the ban on smoking in public places, noting that smokers look for non-smoking signs prior to smoking to ensure that they do not annoy people. Non-smokers displayed a low level of action in advocating their frustrations with smokers. The study found that the level of knowledge of both smokers and non-smokers directly correlated smokers: compliance with smoking bans and non-smokers avoidance of smoking or smokey areas.


The purpose of this research was to compare the effects of medication related problems by community hospital pharmacists in hypertensive patients before and after the patients attending physicians by control-group time series design. The patients who attended pharmacist before physicians will be call "group 1" and the patients who attended physician before pharmacists will be call "group 2". The study was carried out at 7 community hospital in Songkla Province; Satingpra Hospital, Krasasin Hospital, Rattapoom Hospital, Jana Hospital, Tepa Hospital, Kuanniang Hospital and Padangbesar Hospital. The number of patients who could be followed-up for 3 visits were 123 in control group, 108 in group 1 and 113 in group 2. The results showed that medication related problems be found in 74.8, 63.9 and 69.0 in control group, group 1 and group 2 respectively. The medication related problems were found as 1 – 7 problems per patient and the number of medication related problems in experimental groups were less than in control group significantly (p = 0.004) but there was no different between the both experimental groups. Additionally, number of medication related problems and diastolic blood pressure were reduced in both experimental groups (p <0.05) when the patients attended pharmacist at 2nd and 3rd visits but it was not different between group 1 and group 2. Patients satisfied to pharmacy practice at high level (median = 4 points from 5 point full scale) but no difference was found between group 1 and group 2. Physicians and nurses also satisfied to pharmacy practice at high level and no difference was found between the pattern which patients attend pharmacists before and after physicians. However, pharmacists spend more time in group 2 patients (median = 10 minutes) than group 1 patients (median = 10 minutes), especially in the patient’s first visit but it was not different in the later visits (median = 5 minutes in both groups) We can concluded that medication related problem resolving by pharmacists could reduce medication related problems in hypertensive patients but it was not different between the two experiment groups. Patients, physicians and nurses satisfied to pharmacist practice but there was no different between the two experimental groups. The community hospital pharmacists can choose the suitable patterns of medication related problem resolving as this study for doing the pharmaceutical care in their hospital.


This qualitative study aimed to identify people's concepts, values, perceptions, practices, expectations on health, health system reform process and its effects on people. It also focused on the formation of people involvement and participatory mechanism in health system reform process in the Northeast of Thailand. There were 2 phases of data collection, First, was during the Northeast People Health Assembly on Breaking the Impasse!, from Chemical Agriculture towards Alternative Agriculture of the Northeast, organized in Sakolnakorn.  Second phase focused on people health assembly networks and general population in Sakolnakorn, Mahasarakham and Nongboulumpu. Key informants were, people organizations, people, people assembly regional coordinators, governments officers and NGOs.  Document reviews, in-depth interviews, focus group discussion and observation were applied for data collection. The Information from various sources was undergone content analysis.The results revealed that, people had different concepts on health. People who did not or seldom participated in any people health assembly viewed health as an absent of disease, physically fit and could continue their work. Those who involved in people health assembly defined health in a wider aspect as, the state of well being not only physical but also psychological, conscious, spiritual as well as environment and life style which is similar with those identified by coordinators and NGos. People who did not involve in the process thought health is individual responsibility, whereas those who involved suggested that it should be a share responsibility of individual, community as well as government and other sectors.  It was found that people health assembly had effects on people perception on health, however it was limited within those who continuously involved in the process.  People attentions were on alternative (organic) agriculture, organic fertilizer, people rights protection, environmental development, traditional life style, and herbs.  They linked the issues with the Health Bill, which hoped to be the main mechanism in creating a system, which would facilitate good health of the people.  People were not familiar and understand some terms used in the health assembly and health system reform process, since they were new and rather academic. The common terms used were health, spiritual, holistic health, health system reform, health assembly, Health Bill, vision, health strategy, focusing on health promotion not curative and quality care at hand. People involved in health assembly in various meetings of groups, organizations, and networks. Agendas in the meetings were based on community problems. They shared information, brain stormed for appropriate strategies in problem solving in the assembly especially on alternative agriculture, environment, local wisdom, traditional medicines and supports for the Health Bill.   Most of the groups and networks were formed before the initiation of the health system reform process such as the forest protection groups, herbal groups.  After joining the health assembly they could relate their activities with health and develop activities on health. They strengthen their groups by leading and participation of members, identifying problems and strategies in solving them, as well as requested for outside financial supports. Groups and networks, which formed after the health system reform process, were mostly exercise and consumer groups.  There were loosely integrated, they just joined activities but not involved in identifying problems or strategies.  Some of them join the process from being directly told or invitation letters by coordinators or organizers.  People who continuously joined or followed the process had similar concepts with the health system reform and had insight on holistic health.  Those who never or seldom joined the process had different perceptions.  They could not relate health determinants, some perceived that exercise was the only method of health promotion.  People main concern was how to make health, health assembly and health system reform widely known to the public.


The study of impact of the autonomization of a public hospital on health services (The third section) Year 2 – 3 is a section of the study series of the Health Systems Research Institute to evaluate the impact of the autonomization of Banpaew Hospital (Public organization).  The first-part objective is to assess the impact of the autonomization of Banpaew Hospital on quality of health services by medical record review, comparing processes and outcomes of care during the one-year period before the autonomization—the “before” period—and the year after the autonomization—the “after” period—in five disease groups.  The outpatient setting includes diabetes mellitus (DM), hypertension (HT) and tuberculosis (TB).  The inpatient setting includes appendicitis (AP) and acute myocardial infarction (AMI).  The second-part objective is to develop a set of system performance indicators of an autonomous hospital, and to try to evaluate the performance of Banpaew Hospital using the indicator set, by studying in Banpaew and two other community hospitals.	The findings in the first part of the study are mixed.  There are certain differences in processes and outcomes of care in the five diseases between the before and the after period in both directions—better and worse results.   In the DM group, there is a tendency for better process of care, whereas patients during the after period show a slight increase in short-term complication.  However, the changes are not statistically significant (p’s >0.05).   In the HT group, there is significant reduction in completeness of physical examination records while there are more information on recommended laboratory investigations (p’s <0.01).  In the TB group, there are evidences of deterioration in recording processes of care and outcome of treatment (p’s <0.05).   In the appendicitis group, there is a slight reduction in completeness of progress notes, but there is no change in outcomes. In the AMI group, there is no overall difference in processes and outcome of care.	In the second part of the study, we identify the indicator set for monitoring the autonomous hospital with respect to the conceptual framework of health care reform to have two levels—the organizational and the district levels—and consists of 67 indicators in seven dimensions


The Health Impact Assessment of Map Ta Phud Industrial Development and Its Vicinity is a retrospective case study and successfully carried out with support of the Research and Development Program on Healthy Public Policy and Health Impact Assessment (HPP-HIA) under the Health Systems Research Institute. The study is also done in response to the Program’s approaches towards the health systems reform. Industrialization of Map Ta Phud has been carried out based on the policy to promote the Eastern Seaboard program since early 1980’s. Map Ta Phud is assigned to serve heavy industries of petrochemical, oil and gas refinement, iron and steel for the period of 50 years.  Industrialization here stemmed from hopes and dreams that economic propensities were being brought to the country, and that it would uplift Thailand to the status of a Newly Industrialized Country, in particular promising exploitation of natural gas.  Map Ta Phud was touted as the most modern industrial estate in the making. Public was promised that with its high standard of management and control, there would be no pollution problems. However, in the last two decades, accumulated pollution and environmental problems as well as mysterious diseases have begun to emerge as very much linked to each other, and hugely affected small people in the area. At present Map Ta Phud People suffer hard the air pollution especially the bad smell while Rayong province boasts the highest number of patients suffering from respiratory diseases. The province is also known as having one of the most highest numbers of AIDS infected people and AIDS-related deaths as well as a great number of mentally ill patients and commit suicide cases. Similarly, the number of industrial incidents and accidents on roads is dramatic due to rapidly increasing chemical use and  transports. Drastic changes in the exploitation and quality of natural resources and production of rural sector are obviously akin to the uprooting of the way of life of individuals, families and communities which directly affects to their livelihood.This study, therefore, put on exploring impacts at Map Ta Phud in various forms, in particular through the issue of “health” under a much broader definition than the conventional one. According to the essence of the drafted National Health Act, “health” is defined as the state of human integrated well-being in four aspects of physical, mental, social and spiritual health.  Consequently, the outcomes revealed in this paper are rather vogue and pioneering, as there has been none of such study on industrialization with this particular focus.  In addition, this paper also applies the WHO’s health and environment analytical  framework (or DPSEEA model) to  analyze the causes and effects of industrial development at Map Ta Phud. The framework divides the analytical process into five levels of Driving force, Pressure, State, Exposure, Effects and Actions. Based on the process, each specific development programs will be recognized as the driving force of the overall potential health impacts and risks. This driving force can lead to increasing in environmental and social pressures. Such pressures might cause drastic changes in the state of environmental and social quality,  after which it leads to  exposure to the industrial pollution and social problems and finally ends up with various forms of health effects. Apart from the WHO’s model, the conceptual framework of healthy public policy process is also partially applied in responding to some complicated aspects of the existing problems as well as to propose proactive approaches at different levels to improve those health effects.


Ecotourism : The study area, the Khiri Wong community, Tambon Kamlon, Amphoe Lan Saka, Nakhon Si Thammarat Province	The objectives of  this research were to study the new aspect of loval tourism management i.e. ecotourism, which refers to tourism in natural areas with local identity and culture that has been related to the ecological system. In ecotourism, all related parties share a common learning process under the enviromental and tourism management , which focuses on local participation. It is intended to encourage awareness towards sustainable preservation of the eco-system. The study area, the Khiri Wong Community, Tambon Kamlon, Amphoe Lan Saka, Changwat Nakhon Si Thammarat, was selected as a site for a case study on ecotourism potential, the needs as well as attitudes of the community, various possible impacts, and guidelines for the development and conservation ot the  communtiy to be further refered to as a model for other communities with similar potential.	The data were collected from the study area through questionnaires, which were distributed to local people totaling 346 samples. More information was gained from  observation and specific interviews of local leaders and natural interpreters as well as other related agencies in the public and private sectors totaling 50 samples. All data were then processed and analyzed by statistical methods.	The result of this research indicates that Khiri Wong is of high potential for ecotourism development and promotion both at present and in the future. The people, the community, as well as the visitors had a certain level of satisfaction for ecotourism at Khiri Wong. The impacts to the community  were caused mostly by physical factor  rather than economic, social, cultural, as well as health and life quality factors. The community's guidelines for development and conservation were based on  systematic ecotourism management which had been well participated and cooperated by the local community, both at the community level and the bi-lateral level with other bodies outside the community. The guidelines con be exchanged with other communities with similar concept for ecotourism management.


An Assessment of Social Welfare System for Women with Family ViolenceThe study is to explore the overview of social welfare service system provided for women who experienced family violence covering both governmental and non-governmental organizations, to assess social welfare service system including philosophy, operating process, practitioners, and clients, to assess the potentiality and limitations of the system, and to generate policy recommendations. The study has been conducted in qualitative research method. The researcher used in-depth interview, participatory observations, focus group discussion, case study, along with the documentary research. The agencies involved are such as Emergency Home for Children and Families, Child Welfare Protection Division, Department of Public Welfare, Kredtrakarn Protection and Occupational Development Center or commonly known as Kredtrakarn Home, Center for the Protection of Children Rights Foundation (CPCR), Friends of Women Foundation (FOW).  The agencies involved have realized that myths are the major reasons obstruct the women from accessibility to the social welfare service system. They therefore have continuously launched series of societal-wide campaigns. The myths such as “Privacy against Publicity” existed among not only the general people but also the professional practitioners involved. These practitioners, the police in particular, could actually help prevent women from repeatedly hit, but then over-looked the incident because of their mis-understanding about the dominance of privacy rights over public and professional concerns. Therefore the prevention of the repetition cases of violence was inappropriately conducted. Collaboration among related agencies covering both GOs and NGOs was moderate progress when compared with the former study. This is evidenced by the increasing in collaborative responsibility, interdisciplinary approach, the clients-centered approach, as well as collaboration in social movement activities among the agencies. Even in the level of project activities, both GOs and NGOs personnel worked together as seen in the Home for Children and Family, the Center for Children, Women, and Seniors of BMA and the Kredtrakarn Home. GO administration pattern has been shifted from a traditional bureaucratic to be a professional bureaucratic model which is more flexible to interdisciplinary approach. NGO administrations have continuously maintained its nature of “alternative organization” with increasing maturity of collaboration. In addition, the agencies involved try to push an atmosphere of “learning organization.” GO practitioners gain more positive attitudes towards collaboration with any NGO while NGO workers feel the open-wider opportunities GO officials arranged for them. Working directly with the violence experienced women, the practitioners firmly believe in “clients centered approach.” They avoid a decision-making for the women but encourage their clients to change the structure of power relations by themselves. The practitioners and the women who had obtained an experience of overcoming family violence crisis are significant empowerment activators.       GO operations are under policies legitimated by laws while NGOs follow their original ideology and values. Policy resources came from both inside and outside country supports as well as government budget.     For the clients, the women experienced with family violence were from various economic and social statuses. They got stuck in “deterministic view” as they often blamed themselves for the reason of being abused. They gave up to the dominated patriarchy value surrounding them. Those who overcame the family violence crisis were the women who finally won their struggle against the structure of dominated power, created their new identity, and redefined the “new meaning of life” by themselves.The potentials of the system are: (1) the positive changes in government administration, (2) the opportunities opened for the women who had an overcome of family violence experience to be para-professional workers, (3) the maintaining of “alternative organization” quality with increasing maturity of collaboration among NGOs, (4) the increasing progress of networks building and development, (5) the political and administration reform which encourages the increasing roles of local administrations and community organizations in surveillance, protect, and help women with family violence, and (6) the increasing public support to the children and women rights movement.    The limitations found are: (1) the different basic concepts towards women issues, (2) the failure to building-up a one stop service, and (3) the misunderstanding and unawareness of the problem among local administrations and community organizations.Regarding the service coverage, lots of abused women in the family have been left without any assistance because of the unawareness of the problem among neighbors and related professions. In addition, the women felt powerless by the myths and self- blaming attitudes. The existing welfare service is able to respond to the women problems appropriately in the case that they access to the service system. However the major obstacle is that they were unable to reach the gate of the system. The policy recommendations are (1) Continuously and assiduously campaigning to increasing the awareness and understanding of family violence among public, (2) Implanting the concepts of gender relations and awareness of family violence into every level of education curriculum, (3) Implanting the same concepts and awareness into related professions curriculum, (4) Accelerating the empowerment of the community surveillance and prevention for family violence, (5) Encouraging the learning together environment among related agencies in order to uplift the progress and advance of social surveillance, prevention, and assistance to the women, (6) Supporting the one-stop service for the women with family violence in social welfare system, (7) Restructuring the social insurance and social assistance schemes of the country in order to respond more appropriately and effectively to the women’s needs and problems, and (8) Supporting the agencies to employ the women overcome family violence crisis as the para-professional workers for being an effective and efficiency mechanism in the helping process.


The victory of China at the beginning of the decade 1947 has made the Asian Region and the group of Indo-China countries become one of the important strategic points of the world in the cold war age.  Thailand has been determined by the Western power nations to be the significant outpost to blockade and to conquer the Socialism which was expanding.  The United States of America gave supports to the military dictatorship Government which responds to the interests and the policy of the United States.  They governed the countries in this Region, including Thailand.	The Government of Field Marshal Sarid  Thanarat has seized power by the coup d’etat.  Responding to such policy, the Government dominated and suppressed the students’ and people’s movements.  The mass medias were also dominated so sternly and violently that all the movements could effectively be surrendered.  In the universities, the students’ organizations and activities were strictly controlled and inspected.  Only the activities based on sports, entertainment and the activities for praise of the national, religious and monarchic institutions could receive the permission.	Besides the impact from the Government’s political check policy, there were also  the internal factors caused by all faculties in the University of Medicine different campus.  The confusing system in recruiting the medical students  and the heavy curricula were also the complex conditions prevented the students from  attending the political activities and from creating the joint awareness of the same institute.  Only the activities based on sports, entertainment and music were arranged and caused the luxurious habits among the students.	Such conditions continued until the time of the Government of Field Marshal Thanom  Kittikachorn.  At that time there was an important international event.   The United States had completely launched the war in Vietnam in 1965.  Thousands upon thousands of soldiers were sent to Vietnam, and Thailand was also pulled to join the fight without avoidance.  This causes the problems on the aspects of national, social and cultural sovereignty  in consequence.  The large number of soldiers which were sent by the United States to such battle field causes the serious impact of the shortage of doctors in the United States.   The doctors from all the developing countries over the world were attracted by the United States in order to solve such    problem.  This measure remarkably sent the serious and consecutive impact on the shortage of medical doctors in Thailand.  Therefore, the measure that forces the graduates have to work in return was applied and the school of military doctor was to be started.	 Since the military governed the country in 1966 and many events caused discontentments in the society, a group of instructors and students arranged the first seminar at the Christian Student Center.  The Center was utilized as a place for  exchanging ideas until many activity groups were formed, such as the group that published the Social Science Review for students and that for the graduates, the Club for Discussion Review and the Student Group for Rural Area Reform.  This is the starting point of the student groups in different universities, including the University of Medicine, who work independently with the systematic concepts different from the Government.	The conflicts and the compromises within the military power groups allowed Field Marshal Thanom  Kittikachorn to relieve the political atmosphere, by proclaiming the constitution of the longest - day draft and providing the election in 1969.  Such factors engendered all of the students’ and the people’s movements, including the students of the University of Medicine.  They dare to use the right of expression, to assemble openly in public, as well as to establish the new students’ organizations to bargain with the official authorities.  The first protest was made by the medical students of the Faculty of Medical Technology, Siriraj Hospital.  The measure of working in return after graduation was the reason of the students to establish the Medical Student Center of Thailand (MSCT).  This Center has afterwards taken so much an important professional role that the praise was given to in the 3rd Workshop on Thai Medical Sciences Study.  The relation and co-operation have been promoted among the groups of instructors and doctors from different institutions in finding the recommendations of the resolution for national public health.	At the same time, the new Faculty of  Medical Sciences was established (the present Faculty of Sciences) and Mahidol University was founded to replace the University of Medicine.  The enrollment of its students was absolutely split from Chulalongkorn University.  The 1st and 2nd year students of all faculties came to learn together here, including the 3rd and 4th year Pre-Clinic students of the Faculty of  Medicine, Ramathibodi Hospital.  This concept could much contribute to promote the institutionism.  The Mahidol University Students' Club and other new clubs were established other than the Sports Club.  They became the new activity centers keeping abreast with the former activities of the Faculty of  Medicine, Siriraj Hospital.  Such characteristic could also form the various groups of activists spreading into different faculties, and four years later, they became the important force in the party-list election of which the Chairman of the Mahidol University Students' Club, came from  the Faculty of  Medicine, Ramathibodi Hospital.  from then.	The independent groups rooted from each individual who went out to seek  for  outside activities could now start to broaden the concepts to the younger generation of the same school and the same professional line.  The library group was established in the Faculty of Sciences, and two periodicals were issued - Medical Student Relations from the Medical Students Center of Thailand (MSCT) and Medical Journal Relations or Mahidol Bulletin from Mahidol University.  These platforms were used to pass on their systematic social and political concepts to the fellow students.  At the same time the formal activities and different clubs, supported by most  instructors according to the Government's policy which would like to see fruitfully spending their free time,  the students with different ideas were encouraged to join the activities therein,i.e. Speech and Debate Club, Buddhism study and Tradition  Club, Girl Guide Club, Ecology Club, Rotaract Club  and so on.At that period of time, the universal  tide of movement, which appealed to the civil liberty against the Vietnam War, also had an influence over the Thai students.  Such tide has also happened in Mahidol University.  The seniority system was opposed in 1970.   The demonstration was staged for the equal working in return of the male and female medical students.  There has been the opposition against the privilege system for the enrollment of the instructors’ and the benefactors’ child.  The movement has been in efforts against the acceptance of the pre-military students to study medicine, but  such effort was not much success.  Another protest occurred in 1973 and the result was effective in 1974.  All of the events entirely happened in the Faculty of Sciences, while “Mahidol Bulletin” was used as the important platform.  	As Field Marshal Thanom  Kittikachorn demanded for own interest in exchange with the support of the members of the National Assembly of the government party, he then made another revolution in order to prolong his dictatorship.  However, democratic movement grew unceasingly.  The Student Center of Thailand (SCT), of which Mr. Thirayuth  Boonmee was the Secretary-General, started its political role through these following means, i.e. by grasping economic issue, expressing its vision on solving the problem of trade balance with Japan, and managing the campaign against the exploitation made by foreign nations, in the forms of activities which well accepted by the students and the people.  These performances could give credit to the students’ movement which would be the leading movement of the society.  Some members of  Mahidol University Student Club who were intimate with the Student Center of Thailand (SCT) led a large number of the Mahidol University students to join in the movement.In efforts to control and centralize the State power, the Government, therefore, proclaimed the Revolution Announcement No.299 in order to put the justice power under the administration power.  The mistaken principle of power in democracy caused the widespread object by the people and the medical students.  The people’s discontentment with the military dictatorship continuously accumulated, especially with the extension of a term of office for two field marshals.  In addition, the case of hunting in Tung Yai had most undisguishedly violated the law.  The latter case had  pureheartedly been disclosed to the public by the groups of environment preservation which belonged to the ecology clubs of all universities, including Mahidol University.  They took the important roles in fact-finding in order to protect the national interests.  However, the Government’s behaviors were on the contrary.  So the students of the New Generation Club, Ramkamhaeng University, wrote the books to satirize the Government.  The result was that nine of them were dismissed from the University.  This situation was something like pouring oil on a fire.  The network of independent groups which were interconnected among the universities, as well as the Students’ Center of Thailand (SCT), was so much influential as it could persuade thousands upon thousands of the students and the people to make the assembly and protest that the Government was forced to retreat.  The appeal was also made to the Government to give the constitution with joint civil contract.	Later on, the movement was made by the groups of the students and the people to appeal for the constitution according to the civil contract, and in turn they were arrested.  Such arrest caused the movement of the students throughout the country, in order to  appeal to relieve the groups of appellants for democracy.  The movement of Mahidol University students grew unceasingly in strength, and almost every faculty came to join hands, especially the Faculty of Medicine, Siriraj Hospital, which participated in this  movement the first topmost in history.  The group of instructors as professionals gave support behind the scene.  And as they admired the equity, they assisted to take care of the wounded both at Thammasat University and at Siriraj Hospital.  The instructors and their students harmoniously worked to protect and help all the wounded and the escapees.	Although the movement on 14th October 1973 could change the Government  and the people won, some parts of the history have not yet revealed, especially the real causes of death and violence.  Some informations indicated various factors, one of which pointed out as an accident, while another collection mentioned that it happened  from the intention of the persons who could benefit from the situation.  However, the conclusion from various sections of Mahidol University students who participated in this event was the lack of communication between the leading center of the Students Center of Thailand (SCT) and the mass controller.  They had no modern tools for communication and the electric generator was forgotten to move along with the movement in order to assist in live broadcast.  While the Government and the official authorities concerned had the modern communication tools, but they let the event occur.


This is a descriptive cross-sectional study. The aim of this study is to find the cost-effectiveness of giving AZT to prevent the transmission of HIV from mother to child and to compare the result of this study to previous studies in the aspect of provider and consumer perspective. The information summarized from this study would be a policy implication for Bangkok Metropolitan Office for properly administration of AZT to HIV-infected pregnant women to prevent the transmission of HIV.	Overall, 80 percent of mother received AZT before delivery. Normal delivery was accounted for 63.5% and 130 mothers (24.6%) were appointed for cesarean section and/or having cesarean section. In mother with normal delivery, average cost on procedures, medicines and medical consumables was 2,900 TBH, average cost on labor cost and all cost was 3,250 and 6,150 TBH respectively. In mother with cesarean section, average cost on procedures, medicines and medical consumables was 6,000-11,050 TBH, average cost on labor and all cost was 3,550-4,500 and 9,550-14,400 TBH respectively.	Overall, 7 of 103 (6.8%) children were HIV positive. The administration of AZT in overall was not related to cost on procedures, medicines and medical consumables but was accounted for the increasing of labor and all cost by 420 TBH. The difference of having AZT once and twice before delivery was accounted for the increasing of all cost by 1,900 TBH, whilst there was no difference of all cost between giving AZT for one time and no AZT. So, it is suggested that the budget of giving AZT is not only for the cost of drug but also for the administration of drug such as PCR testing.


Benchmarks of Fairness for Evaluating the Thai Health Care ReformsThis study aims to test the adapted benchmarks as a tool to assess the ADB' s proposal on health system development published in 1999 and to evaluate the achievement of health care reform activities in two provinces supported by EU, Payoa and Yasothon. 0The adaped benchmarks compose of 9 benmarks. The first benchmark concerns with intersectional public health or intersectional efforts to improve social determinants. Benchmarks 2-5 relate to equity issues and benchmarks 6-7 intend to evaluate efficiency of the system, Benchmarks 8 concerns with democracy, accountability, and empowerment, provider and consumer autonomy are the final benchmarks.  The tool is aimed to use as a framework for policy analysis, indentifying strengths and weaknesses of the reform proposal, ensuring that appropriate inputs, mechanisms, and strategies are existed to achieve equity. To use the benchmarks, a scoring system is applied as a ranking on complex dimensions, not cardinal measures of some quantity, in addition to an explanation for it's rationale of score provided. In testing  the adaped benchmarks, it shows that the benchmarks could be used as a tool to assess both achievement of reform and assess reform proposal. However, assessment of reform proposal may be more appropriate in use since there were large variations of score in assessing achievement in both proviness.In testing the adapted benchmarks, it shows that the benchmarks could be used as a tool to assess both achievement of reform and assess reform proposal. However, assessment of reform proposal may be more appropriate in use since there were large variations of score in assessing achievement in both provinces. Background and perception of evaluators determine the different of score provided, therefore, interpretation of the result should be made with caution especially, when it has been used to assess achievement of the reform. Providing information before scoring process would reduce deviation and improving reliable of the score. The details of each benchmark should be adopted to fit with the contexts of particular country or province.


This research examines the idea of civil society in Thai community. The important themes are running through the rise and the existing of social groups as the institutionalization of the concept of civil society. This study aims to display the communicative actions of Thai village’s civil society, how this approach becomes institutional organizations, and also, how this approach has any impact in our community. The community groups in this study have emerged at the beginning of community. They are differently occurred and taken to various forms; depend on the environmental conditions, social contexts and life world in their localities. The social actions of civil society might be different, for example in the form of various communicative actions; the place for addressing problematic situations in community; the social institutions or organizations that share taking action and responsibility in public activities with the state sector.	There are three actors of civil society in public sphere of Banphaew District. Firstly, the civil society in the sphere of state-market sector, these fundamental groups are found mostly in all villages of Thailand. They are formed by the state policy to enlarge the growth of market sector, and they are subordinated the budget and the means of production by the state sector. The social relationship in these groups is formally organized, such as the village fund, the cooperatives, and the women groups. The leader members mostly have closely relationship with the officials and also have former social capital to influence collective actions legitimately. The social relations in this group based upon kinship networks, neighborhood relation and reciprocity in patron and client relationship. This group is a kind of the state sector in sharing of public sphere in the name of civil society, influence more opportunity in state-resources distribution.Secondly, the civil society in the sphere of social sector that refers to meditating sphere between the state (as the range of activities organized and legitimated by formalized coercive powers); and the market (as the range of profit-oriented activities). Its important role is basically the free place for exchange and discussion about cultural interests and social health. This kind of civil society is different and has variations in each locality. For example, it is the public place of community groups as known as “Sapa Cafe”. Sometimes these communications are institutionalized and organized in the form of voluntary organizations that work for the better public life, such as education, the quality of public life, public health etc.The community groups or “Sapa-Cafe” mostly occur in the form of small shops in the village. The important social role of these shops is the flow of various informations, such as the product prices, their agriculture knowledge, the movement update of the village fund or the community cooperatives, and also activities in everyday life. These communicative actions sometimes lead to the social movements of community or the decision making of social policy, rely on their problematic social situations. Another kind of the social sector is in the form of the formal structured institutions, social organizations, social clubs, foundations etc. Their members need to take action in voluntary activities, being free of formal coercion and the distribution of profits. Their activities in civic engagement are the participation in decision making and sharing responsibility with the state sector; addressing the problems and needs of community; and the negotiation with the state.	Thirdly, the civil society in the sphere of private sector is the group of people that have the same interests. It functions individual utility more than collective utility. Sometimes these groups are in the organized groups to take more opportunity in the redistribution of resources, especially the supporting budget from the state sector. 	The concept of civil society approaches into the village community. It brings changes in many aspects, especially the adjustment of all sectors in public sphere. The state sector is required to reduce its size and de-centralized its authority to the social sector. But it becomes a part of civil society by create and support the budget for organizations in the village. In the meanwhile, even if the social sector is more significant, it’s dispersedly in the various forms. The new social meanings of civil society or gathering into group are new opportunity in the redistribution of public resources, and also the new performing in negotiation with the state. These conduct to the change of public or civic consciousness, more or less.


This research has been conducted in 4 dimensions of health namely, physical, mental, social and spiritual health in both positive and negative impacts.  The research design was a participatory action research with rapid appraisal and survey. Activities included two workshops one for academics and the other one for stakeholders to discuss and advise indicators to be used in the assessment. After the questionnaire was constructed, a survey was conducted in 2,744 samples comprising in-building, around-building, and general residents.The literature reviews showed that building constructions in the past in Muang Chiang Mai were not well planned and managed, specifically lack of city vision to guide the direction of development. Most of the times, they depended on the administrators’ policies without people participation resulting in Muang Chiang Mai’s vague direction of development. The results show that the around-building and general residents had more physical health impacts than the in-building. This might be the indirect effects of highrises. i.e., the urban heat island phenomenon that causes more air pollutants deteriorating the respiratory system. The hypertension and cardiovascular diseases might be the results of anxiety due to mental and social health problems. The assessment of other dimensions of health also showed that the around-building and general residents had more health impacts than the in-building. The older and longer-living tended to have more health effects than the others.It is suggestive that:The highrise construction permissions for those non-constructed should be cancelled.The height of highrises should be revised in accordance with the context of Chiang Mai not that of the Act, which enforces nationwide.The highrise constructions should be controlled more stringent, and buffer zone should be re-considered.The areas that are allowed for highrise constructions should not those that can potentially be threatened to ecology, urban heat island and historic conservation.The Ministerial Laws enforcing the town planning should be amended that land uses in each zone should take the vertical dimension into account and the percentage scheme of land use should be cancelled.


This study reviews a  variety of documents and lessons on home/community care (HCC) for AIDS in the central region of Thailand, including research , thesis , NGO’s annual reports, discussions with NGOs delegates, and case studies from fieldwork observation as well as home visits. Compared to the northern region of the country, studies on HCC for AIDS in the central region are rather few. Despite of this limitation, a number of studies figures out the same problem that many HIV/AIDS patients are confronting with : community’s rejection and negative attitude towards people living with AIDS (PWA) . Besides, many patients and family care-providers still do not have adequate  knowledge and skills in self care or caring the patients at home. However, rarely few studies have deeply gone into details about the needs of these PWA, such as up-date health information about treatments and practical caring techniques for daily fife in the household setting.	The present study concludes that in the central region, most HIV/AIDS patients are normally cared for at home by their family numbers. Hospitalization is only for those in critical or terminal stage. Buddhist temples, Christian’s charity  homes and NGO’s emergency or temporary shelters are alternatives for most poor or abandoned ones. For PWA, self-help groups organized by public hospitals’ or  NGOs’ staff are crucially needed and helpful. Home visits performed by these staff  are also appreciated. These are the only two successful models of community care in the socio – cultural context of the central region. Some regional strategies are suggested for HHC development: 1). The restoration of the humane traditional Thai cultural-traits together with the acculturation of caring culture and practice in the family and community in order to promote and support HCC by “to stop AIDS by caring people with AIDS”.  2).  The empowerment of community organizations, self-help groups, voluntary groups to support PWA to get access to better health care services as will as social welfare from both public  and private sectors  3). Reformation and development of AIDS counselling service, inter-personal health education and public health education through the mass media, both in the content and technical aspects in order to transfer modest health information on AIDS and to bridge up good relations between PWA and their families/ communities.  4). The prejudice wall against PWA should be dissolved through the new nation-wide campaign, ”Living with AIDS is the way to save our families/communities and society” in order to support PWA to live with dignity as human-beings. And 5). The strengthening of collaboration among all HCC stakeholders (PWA, family ,community, NGOs and Gos) in order to improve the efficiency of the whole health care system.


Social innovation: definition and key features in Thailand	This paper is based on the information obtained from related Thai documents, interviews and study visit.  Social innovation is defined as “Anything new whether in the form of ideas, imaginations, opportunities, or actions to solve problems or to make a better society. These new things include the improvement of or those based on existing things.”	Key features of social innovation include:Opening and enhancing space for wisdom and societyInitiated by individuals, organizations or communities to solve their own problems, not because of the external controlRaising public conscience for the benefit of the society as a whole preceding individual’s or group’s benefitHas dynamic development with prolong existence in which the form or pattern may change as a result of creativity, commitment and action	A review of five organizations supported social innovation in Thailand suggested that social innovators could be individuals, organizations or communities.  The supports obtained include project funding, personal allowance, academic assistance, forum or network building, and awards given.  The supports could be given at any stage of the innovation development i.e idea development, testing, implementation, expansion to a broader society.	Suggestions for the operation of the Social Innovation OfficeThe Social Innovation Office should emphasize support given to any new ideas, new methods, new strategies/models, and new opportunities including new existence or developed on what existed.Facilitate network building among related organizations to avoid duplication and to support each other.Fill in the gap of existing operation, built on current existence and integrate old and new operations including coordination with related agencies.Supports can be provided to individuals, organizations and communities focuses on those with the following five features: do not give up easily, have imagination and recreation, has public conscience, readiness to take action, ability to communicate with others.Potential activities for the office to provide the support include searching for social innovators (SIs), support SIs to develop new ideas, support SIs to implement or test the new ideas, and support expansion of the innovation to a wider society.  Support can be given in forms of financial support, technical support and network building.Three guiding principles of the office to consider when providing support are: (1) creating horizontal relationship between the office and SIs (2) working in a more proactive direction and (3) promoting enabling environment for innovative culture society.Exclude support of activities that are not social innovation including: already well-known ideas, activities or models, activities that are beneficial to individuals/groups, activities implemented on an ad hoc basis, top-down originated activities.


This research is aimed at synthesizing the knowledge to create the process of combined city plan and public participation in stage. Bangkok combined city plan is chosen as a case study because of its location at center of the country administration and the only local administrative unit in Thailand. It is to be highlighted of the stages of people’s participation in making the combined city plan. It will lead to the problem analysis and the limitations of policy process in making the city plan .The people’s participation in making the city plan is reflected in the Thai constitution law also so this an excellent opportunities and ways to allow people to join in the process of city planning in every stage. The people opinions and suggestions in making the city plan can be value addition and can enhance the ultimate outcome. The research result indicates that the process of creating the city plan in Thailand allowed people to participate in many stages. This whole process will depend on Thai city planners whether they can let people successfully participate in the process. As per the available data, reflect that people were allowed to participate in making the city plan .The stages of Bangkok City Plan (2nd edition) in the City Plan Act (1975 ) justify the above given statement. The whole process been divided in 3 main stages. The 1st stage of survey in order to plan and design the combined city plan, The 2nd stage of creating the combined city plan; And the last stage deals with enforcement and implementation of the combined city plan. The sample plan to develop specific community, which was quoted in the study, was a good example of the process to create the city plan for community development. The city planning which truly allow people to play a key role at every stage can enhance the ultimate result. Actually the city is going to plan for people, so they should be the architects for their city. In the conclusion the main challenge and limitations of process and stages in creating the combined Bangkok city is people’s knowledge and understanding for it. The lack of true and healthy corporation of government officials is also a big obstacle to achieve a healthy city plan. The limitation of rights to participate under the constitution law is not a constrained in city planning. The officials do not promote enough to people’s participation in the government activities. Regarding the failure of the combined city plan, it was caused by other factors in the stage of implementing the plan. However, the factor was beyond the process of people’s participation.


The  Musculoskeletal  Pain  Behaviours  and a Model for Solving the Problem  in  the  Community: Study  in  2  Villages,  Northeast  ThailandThe study aimed to investigate the behavior of the people who got experienced from musculoskeletal pain (puad - muay) in 2 villages (Ta Poo and Ta Ma-daur), NE Thailand.  The study group was 15 years and over and voluntarily interviewed by structured questionnaires to compare between 2 villages (N=101 and N=100). The study found that most of the respondents perceived musculoskeletal pain as recurrent, work ralated and work problems (71.2 and 78.0 percent). Waist was the highest percentage in both area. Occasionally treatment and no treatment in Ta Poo 57.0 and 27.0) was higher than Ta Ma-daur (37.0 and 20.8) which were significant differences (p <0.05). The locus of control of general health and musculoskeletal pain was assessed using a forced 6 point scale with a conbach' s alpha coefficient 0.5426 in the pilot study. The samples were selected by systemetic sampling (N=175 in Ta Poo and N=165 in Ta Ma-duar). The result showed that in both villages the respondents was internal control for health prevention but external control if they were already sicked. The external control referred to others (doctors). The control of the beliefs for musculoskeletal pain was internal in both villages. The motivational orientations by health team were designed through educational programme for the health officers and the people. Thai massage practicing and exercising was includes in this programme. 6 months after training programmes, the massage and self-help groups were collaborated in one village. The other village was developing in the preparatory step. The were regular meetings between the health officers and the health volunteer to communicate about musculoskeletal pain issues. 	The conclusion was that the people in both villages had the capability to solve musculoskeletal pain by themselves if they got the reliable information and was motivated by the knowledge health officers.


This study of communities and the use of agricultural chemicals was conducted by gathering information through conversations with farmers engaged in production at the community level, with a particular focus on farmers who use agro-chemicals. This study presents the perspective of farmers using chemicals in community-level production systems.  Three types of production systems of three characteristics were studied: 1) the highland production system of the Hmong community of Khun Klong Village, Chomthong District, Chiang Mai Province, within Doi Inthanon National Park, 2) the intensive lowland commercial agricultural system of Ban Pong, Ban Kaad Sub-district, Mae Wang District, Chiang Mai Province, and 3) the fruit orchard production system of Huay Meng Village, Chiang Khong District, Chiang Rai Province.The study resulted in the following findings:The use of agricultural chemicals at the community level has reached a point of crisis. Chemicals are used under conditions of a total lack of control and oversight. In addition, because villagers primarily emphasize commercial production, the types of chemicals used by villagers are increasingly diverse and are being used in ever-greater quantities. This is due to market mechanisms that demand the use of designated chemicals from the first stages of production onwards.Two main factors have given rise to these changes in production, namely 1) entry into intensive commercial production systems directed by product standardization.  This leads to changes in villagers’ fundamental perceptions and life styles, including their production systems.  2) Political policies such as opium eradication on Doi Inthanon and the establishment of conservation forests that result in limitations on available land and necessitate the use of chemicals.In examining the effects of agricultural chemical use and the local response to the resulting changes, it was found that villagers are understand the impacts of chemical use from direct experience, and are well aware of the dangers that chemicals pose.  The farmers surveyed have responded to these changes in a similar pattern, however, continuing to use chemicals to attain designated production “standards.”  Although alternatives to the use of chemicals exist in each area, these alternatives remain in their infancy and have lacked serious consideration.  Government support for non-chemical alternatives has lacked continuity.  Because this study focuses on the perspectives of farmers engaged in the use of chemicals at the village level, the following recommendations target the local level, where chemical use occurs without real control.  A study of village-level chemical use should be used to create a Community Agro-Chemical Database covering all of Thailand.  The database would be available to communities in the case of chemical-related illness or environmental impacts.  The study should include the participation of farmers throughout, from the early planning stages to the testing of data collected from communities. Villagers should be given the support necessary to control and oversee the use of chemicals through a participatory forum, in consideration of the fact that each community has a different culture and production system.In creating production alternatives, planning should thoroughly cover both theory and practice in a tangible sense, rather than merely providing recommendations or trainings.  A wide variety of choices should be available for the reduction and disuse of agro-chemicals, which is the desire of the majority of the farmers.


The  Evaluation  of The Funeral  Welfare  ServiceFor The Improvement  of Quality of Life of the Elderly  People	The study on "evaluation of the funeral welfare service for the improvement of quality of life of the elderly people" aimed to evaluate the work on the local funeral welfare, as well as to propose an appropriate operation of a local funeral welfare which will assist in the improvement of the quality of life of elderly people. The study was conducted in April - May 1999 by interviewing 383 elderly people, 81 local funeral welfare committee, and 9 responsible government officials.  The study sites covered 9 provinces which included 36 localities in 18 districts.  Below is the description of the brief results.	Local people cooperatively initiated the local funeral welfare based on the existing cultural concept. The cooperation was formed not very long ago following other localities and having believed that this would increase a financial aid for the funeral. This service was formed in most localities.	Concerning the service, there were classified into 2 categories which were official and unofficial funeral welfare. The former was established outside a locality but provided its services to cover localities, however, elderly people could not be its members. The latter was established to provide service to only members in that locality and its neighbors.   It did not have a legal form of organization but provided the service based on needs. Most organizations were in this category and mot elderly people were the members.	Regarding the location, the official funeral welfare had its organization located outside the locality, while the unofficial service had its organization located at a local welfare center and did not register legally. Its objective was to provide the funeral welfare and it had very flexible roles.	The administration structure was composed of elected committees, including at least 2 village committees, out of which most of them  were in a middle age and one fourth was the elderly. These committees had a very positive attitude toward the funeral welfare.  The committees would assign a committee to be responsible for a funeral with a team of other 2 - 4 people. The funeral procedures were based on the legal process but no clear written procedures were recorded.  However, the criteria for membership were set up clearly. There were 2 categories of members, in person and in a group. Most elderly people were in the former. The members needed to pay a membership fee of 20 Baht per person according to the law, however, this could be flexible depending on their financial status.  It could be collected varies from 5-50 Baht and when a death occurred, the money for funeral welfare will be given within a day.	After evaluating the services, it was found that the services were implemented in compliance with the legal standards. However, the local unofficial service was not in a good standard though it followed the legal procedures but the elderly people were satisfied with the services.  This was because the services were in their needs, covered the entire locality, based on equality and elderly people could participate in the services.  This service was potentially sustained.  In term of problems, there was a problem associated with the funeral welfare service in some members' opinions as well as problems with the roles of the members and service procedures.	The recommendations for the better funeral welfare service for the improvement of the quality of life of elderly people are that the quality of life of elderly people is developed by providing employment for local elderly people; that opportunity supporting a better relationship among elderly people and family is developed; and that health insurance for elderly people is thoroughly provided.	In addition, an organization providing the local funeral welfare should be improved through the development of the knowledge resource and the better service system; and a policy is formulated to ensure the insurance after death for all elderly people.


This   participatory   action   research  aimed  to study model for the   to development of a primary health care service system at NhongTong Primary Care Unit, Hangdong  District, Chiang  Mai  Province.  Data  were  collected from health  personnel  and clients (community leaders  and  people), by  focus  group  discussion,  in-depth interview, and  observation.The participatory approach was focused by brain-stroming, reflecting on problems and needs, capacity building of health personnel, and development of the health care service system. Content analysis was used for data analysis.  Results:  It  was  found  that the  health  care service system did not reach the standard for a primary care service system. For example, the management system did not function well, equipment was inadequate, and office space was not well organized, health personnels lacked of confidence in providing proactive services and primary medical care and participation from local authorities and village health volunteers was limited. As the result of the findings, health personnel were trained, health service management was conducted and office space was organized and equipment provided. Furthermore, understanding was created and empowered  the community,  attitudes were changed  towards the health service among people in the communities, learning from best practice communities, the village health volunteers were encouraged  to be more confident, and was provided  support for  health promoting activities of the people. As a result, health personnel have developed their potential as follows: office space was better organized, cooperation from local  authorities,  village health volunteers, and community leaders has been increased in terms of budgeting and participating in community activities such as elderly clubs,  health promoting clubs, Thai massage clubs, mobile clinics, training of drug-users, and the prevention of hemorrhagic fever. Suggestion: The results of the study suggested that the development of a health care service system will be successful  by using a participatory approach and integrated methods such as  training, supervision, conducting forums, suggestions and learning from best practice communities.


A Study on Basic Structure of Accounting Information System for Thai HospitalThe Office of Health Insurance, Ministry of Public Health needs hospital cost information for various Diagnostic Relate Groups (DRGs) to set standards (or guidelines) for the payment of compensation for the high medical costs borne by medical service units and hospitals under the authority of Provincial Health Office and the Bangkok Metropolitan Administration. However, DRGs information is not currently available for use in evaluating the medical costs of hospitals since the current basic structure of the hospitals’ information systems, their cost information and their data collection systems are not complete and up to standard. To improve this situation it was felt that a re-evaluation and re-designing of hospital accounting information systems might be required.To re-evaluate the basic structure of the hospital accounting information systems, academic papers were reviewed, public and private hospitals selected by the Office of Health Insurance visited, through which basic information about hospital accounting was gathered. After analysis and evaluation, the data gathered was submitted to local and foreign specialists, including stakeholders. There were then numerous discussions, and exchanges of ideas, and views, as a result of which a recommendation paper was drawn up on ways and means to upgrade the basic structure of Thai hospitals’ accounting information systems. The current basic structure of hospital accounting information systems and the recommendations for their development are below discussed in 5 areas.Accounting Principles and Accounting PolicyAccounting Principles There are 3 ways in which the accounting transactions of public hospitals are recorded. Cash basis accounting. (most public hospitals except the 92 hospitals under the Provincial Health Development Bureau – as pilot hospitals)Cash basis accounting, with preparation of some additional documents or activities apart from the transaction recorded on a cash basis. (as pilot hospitals except Saruburi hospital) Both a cash basis and an accrual basis. (pilot hospitals - only Saraburi hospital)Private hospitals record accounting transactions on an accrual basis, in compliance with Thai Accounting Standard. Accounting PolicyPublic hospitals have to comply with the regulations imposed by the Comptroller’s General Department of the Ministry of Finance. Private hospitals follow the policies and guidelines laid down by the Institute of Certified Accountants and Auditors of Thailand and must get approval from the Department of Commercial Registration, Ministry of Commerce.  The differences in accounting principles and accounting policies mentioned above affect the correctness and reliability of the data used to prepare financial reports. Because most public hospitals record all information on a cash basis and do not accrued expenses, income, etc., their management and the relevant departments do not receive sufficient information on which to base management decisions. Moreover, the differences in accounting principles between public and private hospitals mean it is not possible to compare hospital costs.As part of the development of accounting principles and policies, both public and private hospitals should be applying the same accounting principles, especially with regard to the assumptions used for the recording of transactions. In fact, the Comptroller’s General Department has already changed the accounting policy for public hospitals from a cash basis to an accrual basis and this issue will therefore hopefully soon be resolved. Financial and Managerial Accounting SystemMost public hospitals recognize revenue and expenses when cash is received or paid. Although they keep a budgetary control register in order to monitor budget movement, they do not record the hospital transaction costs for management. The 92 pilot hospitals are already switching from a cash basis to an accrual basis so that the hospitals’ expense can be audited and evaluated efficiently. Also hospitals would be able to calculate the service cost for each patient using the Excel program launched by the International Health Policy Program. However, hospitals do not systematically collect data, which may result in incomplete and incorrect information.Private hospitals, however, record their financial and managerial accounting transactions systematically based on accounting standards, laid down by the Institute of Certified Accountants and Auditors of Thailand. However, cost information from each private hospital is different due to differences in management policies.  An analysis of financial and managerial accounting, revealed differences in accounting policies between the public and private hospitals. With regard to budget information, the public hospitals do not focus on the analysis and evaluation of performance, but only on control of budget movement. Moreover, the data collected by public hospitals does not support the calculation of cost of services. Private hospitals meanwhile use traditional costs, which do not show the real service cost. The following improvements in the areas of financial and managerial accounting are recommended:Public hospitalsThe financial accounting system of public hospitals should basically follow the conceptual design report for hospitals under the Office of Permanent Secretary of Ministry of Public Health (shown as Appendix - F), adjusting some parts to comply with the Accounting Principles and Policies for State Agencies Vol. 1 prepared by the Comptroller General’s Department (shown as Appendix - E).Managerial accounting should consist of a budgeting system and a cost accounting system as follows:Budgeting systemThe Bureau of the Budget has changed the budget system in order to change the existing government management system to a performance-based budgeting system. The new system is much more concerned with outputs and outcomes.Cost Accounting system There are two different approaches for a cost accounting system: Traditional Costing and Activity-Based Costing (ABC). In Traditional Costing, overhead costs are assigned to cost pools (departments) before being assigned to products or services.  However, in Activity-Based Costing costs are assigned to products based on the activities required by that product. As a result, the real cost of a product can be determined with much more fidelity than Traditional Cost. The specialists from 3M Health Information Systems recommended that to ascertain real service costs, it is appropriate to use Activity-based Costing (ABC).  ABC should be introduced as pilot project in medical schools because they have complicated data. However, Saraburi hospital may be more suitable as a pilot hospital than medical schools because the complicated data of the latter may cause problems with the allocation of certain expenses.There are two suggested ways to implement Activity-based costing:Applying the ABC in a pilot hospital;Applying Traditional Costing for 3-5 years, and after that changing to ABC.Private hospitalsPrivate hospitals will upgrade only their managerial accounting systems, especially in the area of cost accounting. To select the most appropriate cost calculation method, costs and benefits should be compared and all hospitals are required to utilize the same method so that stakeholders can use the data generated in analysis and for comparison. In order to calculate the real costs of services and to better meet the stakeholders’ needs, it is recommended ABC be used by the hospitals. Information Technology SystemAlthough some of the public hospitals visited used computer systems in some parts of their accounting work, such as inventory, medical service and managerial systems, most did not use computer systems at all. Moreover only 2 or 3 public hospitals have the same type of system integration which links the medical service and accounting systems. In contrast, computer systems have already been introduced in many private hospitals, and some have full system integration between the medical service system and the accounting system.Private hospitals have invested more in information technology, such as accounting application software, than public hospitals have, providing management with more correct, complete and reliable information.Moreover, implementation of accounting information systems results in a change of the accountants’ role from bookkeeper to performing a review and analysis of accounting information. As a result, management has more up-to-date information to enable efficient running of the hospital operations.Due to the large amount of data involved, if hospitals do not use computers for data collection, this may impact on the correctness, the completeness of information and the convenience of its preparation for use by the management in making decisions and running the business.Guidelines for developing information technology system are as follows:Study the needs for financial information integration at each hospital in order to establish a Hospital Accounting Information Center.Study the accounting information systems, including the links between clinical and other aspects of patient care, in order to design computer systems and application software which produce complete and efficient managerial information systems. This process should start with a pilot hospital which is already following the new budget system.  Human Resources Accounting staff at private hospitals generally have degrees in accounting, while most accounting staff at public hospitals do not. Staff’s lack of knowledge of accounting procedures and accounting principles, changes in accounting principles, and the use of computer systems to collect data can cause problems with the preparation of the financial statement.In addition, during the period of change from accounting on a cash basis to an accrual basis, it was found that accounting staff at pilot hospitals still lacked knowledge and understanding of the accrual basis principles. As a result, the Finance Department of the Principal Health Development Bureau was unable to prepare all financial statements for submission to the State Audit Office. Moreover, hospital management and the relevant authorities, such as the Principal Health Development Bureau, have still not be able to resolve the problems with recording accounting transactions on this basis. Training and education programs for both management and staff should be introduced so that the Finance Department is able to answer questions and solve problems for accounting staff, and hospitals are able to prepare their financial statements on an accrual basis for submission to the Finance Department and resubmission to the State Audit Office. Guidelines for developing Human resources are as follows:In the short term, management and accounting officers of public hospitals should be trained and educated to give them a solid grounding in basic accounting.In the long term, the Office of the Civil Service Commission (OCSC) should set new positions and job descriptions, and lay down guidelines for recruitment of staff. Also, OCSC should set procedures for dealing with current staff who lack proper qualifications. The OCSC should co-ordinate with the Rajabhat and Rajamankala Institutes to obtain accounting interns to serve apprenticeships because these two institutes have campuses in almost every province throughout Thailand. After the training is over, the accounting interns could take a post-training test and if they passed such test would be appointed accountants in hospitals. The minimum number of accountants for each hospital should be determined based on the number of transactions or significant events occurring. For example, in the conceptual design report, as shown in Appendix-F, the average number of accountants for each pilot hospital where computerized systems are introduced is stipulated to be not more than 12.MonitoringUnder the Law and Ministry of Finance regulations, public hospitals have to prepare monthly financial statements and submit them to the State Audit Office. Private hospitals, which are under the Bureau of Business Supervision of the Department of Commercial Registration at the Ministry of Commerce, have to prepare and submit financial reports yearly. Listed private hospitals also have to prepare and submit financial reports to the Stock Exchange of Thailand (SET).The Government should set up a Hospital Accounting Information Center under the National Health Insurance Committee (after announcing the National Health Insurance Act) in order to prepare an accounting system for Thai public hospitals.Providing hospitals with correct, complete and auditable accounting information systems will be an important factor in bringing about specific and transparent improvements in administration and development in the provision of medical services. However, accounting information systems cannot be used alone to set compensation payment for medical costs. This will require the use of, DRGs and medical coding as well.


Geographic Information SystemThe problems of primary health care shortages in Bangkok and its vicinity has been intensified due to the explosion of population, resulting from rural urban migration. The concentration of medical facilities within Bangkok’s CBD further complicates the patients’ traveling problems. Such dilemmas could be solved by careful spatial planning of primary health care service facilities. Patients’ pattern of travelling to health care facilities depends primarily on the decision making process, by which the patient choose his/her primary health care service. This research comprises two phases. The first phase aims to elucidate the factors affecting the patients’ choice towards the type of facilities, to model the spatial pattern of the patients’ travelling behavior from the collected data, and to reach the service catchment areas for each type of primary health care facilities, using Geographic Information System (GIS).   	The second phase of this study attempts to experiment, using GIS and the data obtained from phase I of this study, the modeling of spatial pattern of primary health care, in accordance with the current government’s “equal access to primary health care” program. The model is bound to be utilized as a tool to assign patients to their nearest respective facilities and to build a patient referral network. 	The study is based on Walter Christaller’s Central Place Theory, which attempts to explain the consumer’s purchasing behavior vis-à-vis the spatial pattern of retail facilities. The theory looks at three primary factors—distance of retail facilities from consumer’s home, range of goods (the center’s hierarchy), and the spatial location of facilities. Applying Christaller’s theory to health facility consuming behavior, this research assumes three primary variables affecting the travelling pattern of patients. First, the range of treatment in a particular facility, which comprises two indicators: public/private run hospital, hospital size, and its specialization of treatment. The second factor has been the patients’ attributes, which indicators are sex, income level, occupation, state of being able to be reimbursed, state of being insured, and the acquaintance to the medical personals. The final factor has been the types of sickness, which can be categorized as acute sickness, chronic sickness, and accident.  	This research integrates the primary and secondary data, by which the GIS model is achieved to explain the patients’ travelling pattern.  Structured questionnaires is utilized to obtain the primary data while locational data from the Bangkok Metropolitan Administration is used to identify the spatial location of each health care facility. 	The questionnaire survey based on a random sampling of 4464 patients from private and public hospital, health care centers, and medical clinics, which are drawn form 13 districts in Bangkok. The result is used to represent the patients’ decision making pattern toward the choosing of primary health care. 	Factors such as range of treatment, patients’ attributes, and types of sicknesses are found significantly related to each other, and therefore, determining the pattern of journey to health facilities. Low income patients and civil servants, who cannot afford to pay and who are able to be reimbursed, have the constraints to use only government run facilities, and therefore, must travel longer distance to get there. Higher income patients have the choice to travel shorter distance to private run facilities in their local areas. Age also found significantly related to travelling distance due to the factor of dependency and acquaintance to medical personals.  The younger cohort (0-19 years of age) travels the shortest distance, while the independent group (20-60 years of age) travels a little longer than the first group. Elderly patients travel the longest distance due to the need of specialized care and the acquaintance to medical personals. In terms of sickness types, chronic patients travel the longest distance in viewing that they are in no hurry and are already assigned a medical doctor. Acute patients travel the shortest distance due to urgency, while accident patients must balance between short distance and reliable medical care, and therefore, travel a little longer than the second group.   	From the above finding, the research then models the patients’ travelling pattern by means of GIS buffering, to obtain the catchment areas of public / private hospitals, health care centers, and medical clinics.  The out of reached areas are then identified. Modeling according to the type of sickness and patients personal attributes are also charted to identify the respective groups’ pattern of traveling.  	The second phase of study aims to experiment the modeling of patients assignment to the most proximal health care facilities in accordance to the current government’s “equal access to primary health care” campaign. Using the Bangkok Guide base map and the data obtained from phase I, the study compare the carrying capacity of health care facilities and the spatial organization of population (population density) to sort out the out of service areas and the patient assignment. 	Since the present health care policy predetermine the travelling pattern to health care facilities, ignoring the factor of range of treatment and other factors, a referral network is therefore needed for cases beyond the capability of the local facility enable them to be transferred to a higher order hospital. A referral network is also charted using the existing GIS information gained from the previous phase to optimize the travelling distance to their respective host hospitals. 	In short, this research applies Chistallers’s approach using GIS as a tool of health care facility planning. One can conclude from this experimentation that modeling could be helpful for the prediction of health care sufficiency and the planning of the spatial organization of the facilities in the future.


Autonomize Process of Banphaew Hospital	The autonomization process of Banphaew hospital is a long continuous evolution process. Initiated by community participated in hospital administration in the past to organization reform recently.	The objective of this study is to observe and analyze the interaction between each stakeholders with system transformation process. The data was obtained by literature review, questionnaire, focus group interview and in depth interview. The study revealed that there was the delay of the autonomization process and there are many important episode occurred between the process. Six issues were taken into consideration in the following aspects:Decrease administration complexity new national gazette that would establish new organization structure that is more efficient. The inventory process is to be kept easy and the organization can initiate new innovative according to the need of the population. Ex: the join venture with pharmaceutical company to manage the drug procurement and delivery process, the join venture with Banphaew municipal to construct public swimming pool.Improve resource allocation As an autonomous hospital, Banphaew hospital has freedom to manage its own human resource according to need. There was a sharply increase in accountants, public relation. There was a sharply decrease in cook, and low skill labors. The hospital is financed with capitation budget 782 baht per registered person. This excludes civil servant and people who are in social security scheme. The hospital is the main contractor of the budget; therefor the hospital allocates the budget to health centers.Increase effectiveness and efficiency As an autonomous hospital, Banphaew has freedom to design the remuneration processes that relates with performance. This maximizes organization effectiveness.  Before being autonomous, the hospital was in depth, compared to after being autonomous which the profit from four month operation was around 4 to 6.4 million baht. However, after investigation we found that there was some revenue from special ex-province project; such as physical examination of the immigrant, which brought 6.7 million baht to the hospital.Increase accountability the autonomization process included the commitment to service with continuous quality improvement. The public acknowledgement about the new autonomous hospital commitment was due to universal coverage policy of the government that emphasizes the evaluation process. Because of the delay of the whole process, the executive board accountability cannot be evaluated as intended. The accountability that the other supported government agency should commit to the autonomization process of Banphaew was related to political agenda.Political compliance before the gazette was approved there was a split between the pro and the con, which create the day of the whole process. However, the hospital was autonomized by the support from several public agencies. At district level, there formed controversial groups and there was a demonstration at district level due to autonomous process. The chaos period within the hospital during the transformation was also related to the ex-hospital controversial. However, after the 6th of January election, the government that was led by Tasking Chinawatra announced health policy that highly supported autonomous hospital and the other stakeholder pay more attention as well as being more supportive to Banphaew hospital.Increase community participation Banphaew community was participated a hospital administration board even before autonomization process and there was a good relation between the hospital and the Rotarian. Four months after autonomization, the executive board from community is still under searching and appointing process. The uncertainty of the other stakeholder prohibited Banphaew hospital from running the public campaign about the change. The change of the government to government that won landslide vote by universal health coverage campaign created public health concern in the country, which was the best propaganda for Banphaew hospital.The autonomization process Banphaew hospital should be investigate more to follow the change systematically to answer the question whether the change to autonomous hospital was really good for the organization, policy, and the health of the whole population.


Chronic obstructive pulmonary diseases and risk factors: present status and future trendsThis report to review cases of COPD and risk factors has been sucessfully obtained by gathering data from hospitals in various part of Thailand, data of smoking behaviors and populations in each province. From these, we can estimate the incidence and prevalence rate. Eighty-five percents were male and fifteen percents were female. Most of the patients' ages were between 60-80 years old. Severity of the diseases progressed according to their increasing ages. So did the mortality rate. The mortality rate was 1 percent at age 40-50 and become 4 percent at age 70. The expense escalated when one got older due to the progression of the disease. We recommend preventive measures, antismoking, quit smoking activities and      control of air pollution to be planned and implemented in the 9th Natinal Health evelopment plan to cintrol COPD cases and lower economics loss. The future prevalence rate is predicted      to increase due toi the smoking rate, air pollution and increasing population number.