Health Systems Reform in MalaysiaMalaysia had been recognised as one with the best economy and healthcare system in the region.  The health services were subsidised by the governmental budget as social welfare.  The poor or needy received the services free-of-charge.  Without a national health insurance scheme, the consequence is economic burden of the country.  This forced the government to set up a healthcare reform policy during the 4th Malaysian Plan (1981-1985).  It started from non-medical services, such as laundry, catering, and hospital maintenance at selected hospitals were contracted out.  A hospital was leased to a private company.  A following policy was that the government support the setting up of private medical facilities, such as hospitals and clinics, to cater for those who can afford such services.  As the private sector expanded, it has drawn upon the staff resources of the public sector where wages were less attractive.  In 1992, the National Health Institute was established as a corporatised organisation.  The aim was to create a good working environment with attractive payment when comparing to those of private sector.  Two year after this corporatisation, the goverment medical store was privatised.  In 1997, non-medical services at 71 hospitals were privatised.  The rest was the target of the year 2000 (the end of the 7th Malaysian Plan).  In spite, a national health insurance scheme is a part of the national plans but it is not placed yet.  To gather with no clear evaluation and control programs of those organisations reformed,  the consequent negative effect is higher medical fee.  Some of patients are enable to pay.  People and relating organisations have complained via mass media.  Ad hoc advocated body was formed up against the government  reform plan and request people participation.  Finally, in the end of 1999, the health minister declared to stop the planned privatisation and to revise the reform particularly the national health insurance scheme.	Experiences of Malaysia could be raised as a concern of the healthcare reform in Thailand.  Participation of both providers and consumers, and evaluation of the program have to be priorities  These would be guaranteed that the proposed healthcare reforms would adhere to the fundamental principles of equitable, accessible, effective, and sustainable healthcare.


Synthesizing Knowledge Underlying the Development of Position Paper on the Definitions of Levels in Health Service System in ThailandThis research aims at synthesizing knowledge underlying the development of position paper on the definitions of levels in health service system in Thailand by exploring service systems in 7 countries including; South Korea, Japan, New Zealand, Malaysia, Singapore, Australia, and Thailand.  The study identified scope and functions of each level in the system and analyzed factors that differentiated all levels of health services and other supportive systems.  Documents analysis was conducted priori to interviews with experts in health system designs and forums of academics and researchers in health system.  Reflections from National Forum on the National Health Act were analyzed.  Results indicate the following.  	1. Lessons learned from other countries indicate that 1)factors influencing health service system design included; population structure and illness pattern, health care expenditures, social demands on quality health services; 2) two concepts defining levels, scopes, functions, and levels referrals were technical and professional explanation through levels of sophistication of treatment, severity of illness, and specialization of care; and management concept of ownership and networking, and 3)health insurance played a major role in making the health service system able to be implemented as planned.  Roles and scopes of the health services at each level would be functioning well upon the regulations stated in the health insurance system and others related such as financial, health manpower development, and health promotion systems.   	2. Concepts explaining scopes of care in the health service system of Thailand must be based on technical and professional and management reasons.  “High Touch-High Tech” is the principle of the technical and professional concept of which “High Touch” be used when social and humanistic knowledge are vital and “High Tech” be used when medical treatment and cure are central to the services.  Health services could be differentiated into two types; community care and institutionalized care.  The institutionalized care could be ranged in four levels, which are; primary, secondary, tertiary, and specialized care.  Supportive mechanism must be designed accordingly especially health insurance system, hospital accreditation system, and technology appraisal system.  Through management concept, the emphasis is on ownership and networking, which community care could be governed by the local authorities and the community.  While the institutionalized care should be governed by own board and controlled by the health insurance system.  Networking relationships among authorities and service units must be equal on contractual basis of which benefits could be shared.  Health services on this management basis include 1)individual and family care, 2)community care, 3)primary care and 4)hospital treatment.  	3. It is suggested that the involving parties including the local authorities, the government, and the health professions play vital roles in managing all factors influencing the design of health services system.


Local farmers who living within Nakornnayok sub-watershed daily used river waters for their household consumption, irrigations rice paddock, horticulture and aquaculture.  Those waters were abstracted and supplied through interconnected irrigation canals while the water flows controlled by many mechanical gates.  Wastewater discharged from cities, landfills, factories and others all flowed into those irrigated canals where accumulated much pollution and therefore often occurred at the riverbed downstream especially at Ban Na district and its surrounding neighbors.  Such pollution became intense since 1997 onwards, while the locals requested a helping hand from the provincial but such authority seemed rather had a limited capacity to deal with that problem.  The locals hence still widely faced critical health hazards, particularly with skin diseases when contacted with those polluted waters, while moreover the river waters could not be longer used for daily consumption.  The “perish green water” was commonly the so-called by many locals as the major cause of that  detrimental health hazards.  The locals eventually requested the Health Systems Research Institute researchers to explore any opportunities to alleviate such that problem. The research team agreed to apply the planned participatory action research type introducing to this case, while encouraged the locals to actively participate at every step of research implementation activities.  The study was conducted during January-June 2003.  The research framework was then logically organized focusing on building local learning process to exploring existing problems, rationalizing cause and effects of the problem encountered and eventually collectively finding the resolution measures.  The research activities eventually chronologically outlined were (1) exploring the scope of health impacts temporally and spatially using local health database, (2) selecting the highest health hazard prevalence within communities using focus group and in-depth interview techniques as to fine tune the impacts at individuals, family and community levels, (3) building local capacities on examination techniques on water pollution testing and its origin exploration, (4) using a mapping technique to associate water pollution occurrence and health impacts emerged, (5) organizing a local meeting to verify a study reported on fact findings, and (6) hosting the stakeholders meeting aimed to deliver the study results, and let the local representatives presented and proposed the mitigation measures, as expected to achieve a consensus agreement locally proposed to the provincial authorities to further develop policy and plan for pollution abatement.	This action research result eventually led to positive policy changed impact while the Nakornnayok provincial authority admitted to revise its environmental plan while much focused on resolving water pollution at the first priority.  The former activities listed in the environmental plan therefore has been changed and redirected in response to the local needs.  Further, the provincial also requested the municipalities, factories, irrigation authorities and sub-district administrations to revise their environmental related plan, and resubmitted to the provincial board.  The overall study result implied that the health impact assessment used by this study could be acted as a tool to further create local healthy public policy.  The learning process introduced by this study also proved to be an critical driving force, however such condition the locals still needed any organizations to helps them to develop success healthy public policy which originated from the grassroots.


Assessing and Improving the Quality of Care of Hypertensive Patients	Action research methodology was applied in this project which was carried out at Khoaksamroanng District (Lopburi Province) and Uthai District (Ayutthaya Province). At first, community survey was carried out at the two districts (2 subdistricts for each). It was found that the prevalence of hypertension among population aged 40 and above were 14.1%-24.6% (averagely 19.7%), and 59.8-78.5 (averagely 64.1%) of them had the history of hypertension before the survey. Among those knownn cases, 37.3%-48.5% (averagely 41.4%) had regular visits to health services during the last 3 months; and among those who had regular visits, 29.2%-46.0% (averagely 39.9%) had blood pressure below 140/90 mmHg. 	Among those knownn cases, 78.8% got the information about hypertension from physicians, 16.7% from health center personnels, and 8.8% from nurses. 51.8% of them got the information related to selfcare behaviors, 27.3% related to etiology and symptoms, and 24.1% related to complications. However, most of them actually have not much knownledge of the disease.  48.4% of those knownn cases had  > 25 Kg/M2 . 23.3% of them smoked and 30.4% of them drank alcohol. And 54.7-61.7% of them would do nothing when they had stress. 53.4%-70.0% (averagely 62.6%) of them were first diagnosed the disease at the governmental health services, and 22.4%-37.3% (averagely 30.0%) were diagnosed at private clinics. For the first diagnosis, 49.5%-65.9% (averagely 58.4%) of them had the presenting symptom of headache; 14.0%-28.4% (averagely 23.5%) were diagnosed when they went to see doctors with other diseases; and only 1.6%-6.0% (averagely 3.9%) were detected during health checkup. 27.1%-48.0% of the patients had modification in their dietary and 10.8%-24.0% (averagely 15.3%) in physical exercise.	The qualitative study found that most of the patients adjusted the dosage of antihypertensive drugs by themselves, according to their own perception. And those who could control the blood pressure were always due to the capability in weight control, salt restriction and stress management. 	After the situation analysis, the health services at both districts had been improved by developing standard practice guideline, information system, health education system, appointment and follow-up system, and referral system. The evaluation, after 6 month of implementation, found that 70.4%, 45.0% and 56.3% of the hypertensive patients who attended the service at Khoaksamroang Hospital, Uthai Hospital and Pho-sao-harn Health Center (Uthai District) respectively had the regular visits during these 6 months. And among those who had regular visits, 12.3%, 16.7% and 0.0 respectively had blood pressure <140/90 mmHg at every visit; and 43.9%, 44.4% and 44.4% respectively had BMI <25 Kg/M2 at every visit.


Infection control development in Sappasitthiprasong HospitalObjective : 1) To develop an appropiate surveillance and infection control  system for Sappasitthiprasong Hospital 2) To implement the developed surveillance and infection control  system in every inpatient ward 3) To determine the problems and constrained in running the developed system and the method used for solving the problems 4) To determine the sustainability of the system and associated factors.Design : Research and development.Setting : Sappasitthiprasong Hospital, UbonratchathaniMethadology : The activities performed in order to improve the developed surveillance and infection control  system are as follow : 1) The situation analysis of infection control 2) The re-structure the organization and the  line of command of infection control unit. 3) To educate the hospital personnel. 4) Training courses for ICN and ICWN 5) To develop new surveillance data record forms, to establish criteria for diagnosis of hospital acquired infection, guideline for hospital infection control and outbreak investigation. 6) The guidelines for hospital acquired infection surveillance, were created and implemented, in 33 inpatient wards. Periodic monitoring was done. 7) To evaluatie of  surveillance system, effectiveness of infection control and the sustainability  of the whole system.Result : The surveillance system and present report of infection rate in every inpatient ward were set up. The surveillance data were analyzed and audited by the infection control division. During the implementation period the infection problems ,such as the personnels’ confidence, the doctors’ cooperation and duration of culture and sensitivity report, were found. These problems were solved by conference and seminars.  The topic  established criteria  for diagnosis of hospital acquired infection, among infection  control working groups.  All quantitative data such as completeness, accuracy and timeliness, were 99, 98 and 53 % respectively.  The effectiveness of surveillance system was improved. The administrator team’s committee was interested and used surveillance data  for solving the infection control problems.Conclusion To develop an appropriate surveillance and control system , that  will predict trends of hospital acquired infection. Hospital personnel piad attention and used the data to solve the infection problems. Finally, the factors that affected the sustainability of the system were characteristics of the hospital personnels’ : concern , stimulation and participation in surveillance and control systems.


อัตราการดื้อยาต้านจุลชีพที่เพิ่มขึ้นอย่างต่อเนื่อง เป็นปัจจัยคุกคามการควบคุมโรคติดเชื้อ เมื่อเชื้อเกิดการดื้อยาขึ้นในกลุ่มประชากรหนึ่ง มันสามารถแพร่ระบาดไปทั่วภูมิภาคได้ ปัญหาเชื้อดื้อยาต้านจุลชีพมีความรุนแรงโดยเฉพาะในประเทศที่กำลังพัฒนา ซึ่งประชาชนไม่สามารถเข้าถึง หรือไม่สามารถรับภาระราคายาที่เพิ่มสูงขึ้นกว่าการรักษาขั้นพื้นฐานเดิม เพราะการเปลี่ยนยาตามความไวของเชื้อมักต้องใช้ยาที่มีราคาสูงขึ้น ดังนั้นจึงส่งผลกระทบอย่างมากต่อภาวะเศรษฐกิจโดยรวม ภาวะเชื้อดื้อยาต้านจุลชีพเป็นความท้าทายระดับโลก ทั้งไม่ใช่เป็นปัญหาที่เกิดขึ้นใหม่ เป็นปัญหาสำคัญสำหรับรัฐบาลที่จะต้องดำเนินการ เพื่อให้มั่นใจว่ายาต้านจุลชีพที่มีใช้อยู่ในปัจจุบันไม่สูญเสียความไวในการต้านเชื้อรวดเร็วเกินไป ในประเทศไทยมีการนำโครงการและกิจกรรมมากมายมาใช้เพื่อควบคุมสถานการณ์เชื้อดื้อยา แต่มีหลักฐานของความสำเร็จที่เกิดขึ้นเพียงเล็กน้อย การศึกษานี้เพื่อบอกขนาด และแนวโน้มของปัญหาสถานการณ์เชื้อดื้อยาต้านจุลชีพในประเทศไทย ความพยายามในอดีตและปัจจุบันเพื่อแก้ปัญหา รวมทั้งพยายามสรุปองค์ความรู้ที่ยังไม่มีคำตอบ และแนวนโยบายที่พอจะเป็นไปได้ท้ายที่สุด รายงานฉบับนี้พยายามนำเสนอตัวอย่างของแรงจูงใจอันจะนำไปสู่การเปลี่ยนแปลงเพื่อให้ผู้ป่วย แพทย์ โรงพยาบาล บริษัทยาได้ตระหนักถึงปัญหา และใช้ยาอย่างเหมาะสม มีความเป็นไปได้ของการใช้นโยบายจำกัดการเบิกค่ารักษาพยาบาล เพื่อลดการใช้ยาต้านจุลชีพเกินความจำเป็น ในองค์กรที่เกี่ยวข้องกับการประกันสุขภาพ แพทย์และสมาคมวิชาชีพแพทย์ต่างๆควรยอมรับแนวทางการรักษา ที่ไม่เอื้อต่อการใช้ยาต้านจุลชีพที่ไม่เหมาะสมให้เป็นมาตรฐานเดียวกัน รัฐบาลควรส่งเสริมโครงการต่างๆอย่างชัดเจน เพื่อเพิ่มแรงจูงใจ หรือผลักดันโรงพยาบาลต่างๆให้มีการควบคุมการติดเชื้อดีขึ้น และส่งเสริมผู้ผลิตยาให้มีการวิจัยค้นคว้ายาใหม่ๆ การรณรงค์ในภาคประชาชนให้มีส่วนร่วม รับรู้ปัญหาการติดเชื้อดื้อยาต้านจุลชีพ มีส่วนสำคัญที่จะผลักดันให้เกิดการแก้ปัญหานี้


The report is a result of an ongoing process of developing manual on qualitative
research for health professionals. The process of drafting the manual was a participatory
developmental process involving researchers as well as health professionals which are
targeted as the end users of the manual. Beginning with a manuscript developed by a group
of researchers at the Society and Health Institute, the draft manuscript was used as a manual
for an experimental training workshop for a group of health professionals. Participants of the
workshop were asked to reflect and suggest ways to improve the manual. Suggestions were
used to rewrite the manual and it will be tested by further trainings before final version could
be made available. The current report is therefore in its initial stage and needs further
refinement.
The purpose of this manuscript is to serve as an introductory manual for qualitative
research. It aims at providing health personnel with basic understanding of research work
and exercise for increasing necessary research skill. The manuscript is divided into four
chapters. The first chapter provides philosophical foundation for understanding how
knowledge is created in different modes of research work. It also explains the fundamental
principles and the differences between qualitative and quantitative research. The second
chapter discusses how to relate problems in everyday working situation of health workers to
research work. The third chapter discusses the methodological aspects of qualitative
research, starting with how research questions are formulated. Methods for data collection
are extensively elaborated with examples. Research tools and exercises are also included.
The final chapter discusses how qualitative data is analyzed and interpreted. Techniques on
report writing, presentation and how to make use of qualitative research results are also
incorporated in this chapter. Useful bibliographies on research design and methodology are
provided for further study. Techniques on proposal development and how to write a good
research proposal are also provided in the annex.


The purpose of this action research was to develop the primary care service model for eastern region community , Thailand .  The process of developing was following	Step  1	To survey health status and health care service’s needs of people from 4 diversity communities including sub-urban, fishery industrial and agricultural community.  The questionnaires were administered from 1583 people and the semi-structured interview as well as in-depth interview method were carried out to gather data from 17 health care providers and community leaders.	Step  2	To analyze the primary care service that provide at 22 health care service including district health care center , community hospital metropolitan health center provincial and regional hospital 	Step  3	To synthesize the primary care service model from view of health care providers , community leaders , clients and villagers.	Step  4	To reflect the created primary care service model by villagers , health care , experts , nurse , educators , local politician and community leaders.	Step  5	To establish the primary care service model for eastern region community.   The results concluded that the people in eastern region were found non appropriate health behavior (30-50 percent) and need to be empowered in self caring.  The characteristics of the primary care service model are.1.  To should be closed to people’s house and accessible 2.  Existing district health care center should be developed to be primary care center according to this model or set up a new one.3.  Participatory management in one of key strategies in managing primary care center.  Four parties should be considered to be the committee.  They are health care team , villagers , community organization and non government organization related to the community.4.  Financial support should come from both government and local community.5.  Primary care service should provided health care across lifespan with health promotion , prevention , cure and rehabilitation focusing on promoting health learning activities.6.  Monitoring of primary care service and quality control should be continually practice and developed.7.  Qualified alternative primary care service and health net working should be established for complementary and selected service.8.  Professional nurse should be main provider at the primary care center and play role as a family nurse.


Important Factors Influencing Readiness, Barriers and Supporting Criteria for Good Manufacturing Practice (GMP) Among Pharmaceutical Manufacturers	The objectives of this project were to investigate the problems and barriers in performing the GMP encountered by local pharmaceutical manufacturers ; to follow up the GMP inspection process ; and to find out the readiness and supporting criteria for conforming to the new GMP regulations. The target group of this study was 176 local modern pharmaceutical manufacturers ( 129 GMP-approved and 47 non-approved). The sample was obtained by stratified sampling technique, and the data was collected using questionnaires, interviews, focus group discussions and brain-storming processes.   	The GMP-approved manufacturers stated that budget was the most important factor for GMP approval ; this factor covered the cost of premises, personnel and documentation. Once the GMP was obtained, as pressure was put on those manufacturers to maintain their GMP performance, inevitably an increase of budget was required. The GMP non-approved manufacturers reported that lack of GMP consultant was the most important problem. They responded that the criteria of GMP inspection was unclear and inaccurate, since each inspector followed different standards, and this resulted in the repeated correcting of the same subject matter. About 58 % of the manufacturers agreed to have GMP enforcement so that the Thai manufacturers and Thai medicines could be upgraded to international level. Those who did not agree reasoned that the current problems or limitations regarding the GMP criteria should be solved as the first priority. Moreover, the declare of GMP regulation may bring unforeseen costs.  	GMP performance in the pharmaceutical manufacturers must be supported with full process i.e. problem solving and specification of development direction. The following issues should be reconsidered : reviewing of government policy relevant to international standard GMP ; import of pharmaceuticals ; promoting the pharmaceutical market nationwide and internationally ; and the roles of the Government Pharmaceutical Organization (GPO). The suggestion for further development were as follows : to set up a GMP guideline and consultant team, and to further support and assist the manufacturers to strengthen their potential in pharmaceutical exports.


Those working in the agricultural informal sector were at disadvantage in getting access to the public service. They lacked assets and were at health risk owing to their occupations. This study was aimed at finding out their problems, needs, readiness and cooperation concerning the health insurance system in order to determine some ways to deal with their health insurance. The samples of the study were those who were engaged in farming, plantation, fruit-growing, animal-raising, and fishing. The studied areas were Chiangmai, Khonkaen, Suphanburi and Trang. The data were collected by interviewing household heads in individual occupations and holding focus group discussion with community leaders and government officers in the study area. It was found that working characteristics depended on their earning assets and land and the environment. Occupation inputs were investment funds, labor and agricultural materials. The uncontrollable external factors, such as prices of produces and fishery sources were main conditions. Those working in the agricultural informal were different from general agriculturists in that they had to follow the regulations set by others, i.e., public organizations and officers, employers or product purchasers and other influential people, such as capitalists, and local leaders. Because they had to rent land, encroached forest reserves, lacked public utilities, lived in remote areas, could not get access to current news and modern technology. They entered the occupations in either of the two ways : 1) succeeding their ancestors, and 2) seeking a new occupation because of the failure in the old occupation or in the old workplace. Moreover, it was found that most of the household members completed elementary school. They received news or information at a low level. There were not many working hours each day and the productivity was low. They lacked motivation as a result of drops in prices of goods, lack of funds, and inadequate agricultural land. Their yearly incomes ganged from 20,000 to 30,000 per household. More than half of the sample's expenses exceeded the income and they were in debt. Working problems were that they did not form a group, lack of continuing activities. It was difficult for them to solve their own problems and to do so required high expenses. They did not prevent themselves from health problems; on the contrary, they sought treatment after they were ill. They had risky behavior because they drank, stroked, and took pain killing or stain-releasing medicines. Some also encountered health problems resulting from their occupations such as fishery. Some used chemical substances to a great extent in cultivation and some suffered from pollution in the environment. To deal with these problems. It was necessary to organize a system, to identify of classify health insurance people into groups, to set criteria for evaluation, to define the scope, and to update the data every 6 months. Responsible agencies should be established and power should be decentralized to local government. Cooperation among agencies should be sought. The health system should be built, taking into consideration the area, function and participation (AFP). Emphasis should be put on providing health insurance with a charge of 300-500 baht yearly or seasonally. Also, health prevention measures should be of primary concern. Those responsible for collection the fees should be the municipality and the tambon administrative organization. The follow-up and evaluation of the health insurance project should be carried out continuously.


This action research aiming to develop primary care model in Na-Mom district, Songkhla province consisted of 4 stages: 1) Situation analysis, 2) Design health service model based on community’s needs and resources, and develop action plan, 3) Implement the plan along with reflective cycle to continuously improve the services, and 4) Evaluation and synthesize what being learnt. Settings were all government health care agencies in the district. Informants included health care providers and key persons in the community. Data were collected from documents as well as reports and by in-depth interviews and group discussion. Content analysis with the validation of study conclusion were performed.	The results were following:	1.  Na-Mom is a small district with population of 20068. It is 10 kilometers from Hat Yai where people can easily come and get access to various health care agencies.  Na-Mom people have good health and economic status. The common illnesses were mild and many of them could be prevented. Within the district, the number of health care providers and agencies met the criteria of Ministry of Health. People preferred to come to Na-Mom hospital when they were sick rather than the nearby health center. They wanted good medical care for the sick but were not much interested in health promotion and illness prevention. Despite many networks in agricultural and economic development, only few groups being actively involved in health development.	2.  Researchers, administrative team and health care providers agreed to develop four primary care units (PCU), one unit one Tambon. One was new and the three were the previous health centers. The primary health care model was designed, based on the community’s needs and available resources. The Na-Mom hospital allocated a few nurses and health workers to work regularly at PCU. Health care Networking Committee at    Na-Mom district had responsibility to create changes, monitor and evaluate the development of these 4 PCUs. In addition, the research team and the health care providers worked together and agreed on the principles of  “Near House At Heart PCU”, tools to be used, tasks and activities in health promotion, illness prevention, primary medical care  and rehabilitation, and work schedules at the units as well as in communities.The process to establish effective primary care units in Na-Mom district included:		3.1 Transforming health care policy by the administrative team to health care providers;		3.2 Shared perception of health care situation among administrative team, health care providers and community;		3.3 Experiential learning from the prior success primary care units;		3.4 Shared design of primary care model and guidelines;		3.5 Continuing personnel development such as meeting, conferences, training, study visits as well as sharing experiences;		3.6 Allocating resources; and 		3.7 Monitoring, evaluation and reflecting the progress of PCU development to continuously improve the services and systems.Outcome and learned experiences: The new established PCU was the effective one  which  accomplished the goal and plan. The others three units, the health center based had less achievement. Each unit had its own limitations such as readiness, competencies and attitudes of heads of the units as well as health care providers, work load in documentation and inadequate supports. The nurses demonstrated high competencies in working at PCU particularly in providing primary medical care and family visit.Suggestions for health care networking committee at Na-Mom district are as followed:5.1 Developing an evaluation system, which is accountable in terms of evaluators, tools, methods and impacts on persons being evaluated.5.2 Promoting community participation in health system development.5.3 Strengthening a support system.


The Survey and Baseline Data Processing about 0-6 Years Child Care Centres in Thailand		The purpose of this study was to explore Thailand’s child care centers for children aged 0-6 so as to bring the data as inputs to improve the child care centers. Secondary data were mainly used while some data were collected by interviewing responsible staff and asking a number of foundations and private organizations which had the child care centers.  The data collection process was carried out between December 1998 and February 1999. All of the data were analyzed and categorized into general information e.g. administrative, educational, nursing and information system of the child care centres. The research team also developed the computer program for database management so called Relational Database Management System composed of menu, tools for processing data, operational options, reporting and object creation in forms of table, questionnaire and texts. The team recommended Thailand’s child care centers be initially developed the less complicated system for example the children’s information system, the teachers’ information system, the inventory system and the budgeting system. Each database system should be free from each other. Tools for developing the database management system could be Microsoft ForPro, Microsoft Access, Lotus Approach. More importantly, the staff involved should be trained to be familiar with the use of various kinds of information technology.


Resource allocation for improving  quality of life of the aged: a proposed guidelineThe findings from the study  showed  that  in the year 1997 all kinds of government pensions and gratuities  totalled 24.7 billion bahts  while the medical expenses for the retired government officials added up to around 1.9 billion baths. Both items amounted to 3 percent of total governmental budget  or around 3.2 percent of governmental revenue from taxation. The study also forecasts the serie of these expenditures  until  the year 2011,  which is the last year of the Working-Plan for Welfare and Public Assistance Program to the Aged (1999-2011).  It was estimated that in the year 2011,   total expenditures for the retired public servants will amount to 2.24 , 10.85  , 11.97  , and 13.59 percents of the gross domestic products,  the total governmental budget, the total governmental revenues, and the revenue from taxation respectively.As to the amount of public welfare spent for the aging-poors  on housing and the service-centres, a much larger proportion  of the budget  go to the administrative cost. For the monthly living allowances, less than 50 percent of total needy-aging persons have accessed to it. Similarly, less than 50 percent of total budget for medical aid to the poors have been allocated to the needy aging persons who hold old-aged medical cards.  The study forecasts that welfare expenses that spend through the Ministry of Labor and Social Welfare and the Ministry of Public Health for the aging-poors  in the year 2011 will amount to 0.15  , 0.75 , 0.83 , and 0.94 percents of the gross domestic products, the total governmental budget, the total governmental revenues, and the revenue from taxation respectively.In addition, the study has analyzed factors determining the out-of-pocket expenses for  medical cares of the aging persons using  the 1994 national survey of the National Statistical Office.  The result was used for estimating the average medical expenditures of  the lowest income group in order to find out the public cost of medical assistance to the aging-poors.  If the government were to grant monthly living allowances of 300 bahts per person together with free medical assistance to all the needy-aged persons, it was calculated that the total cost will add up to 7.1 billion bahts in  the year 2011 which will amount to 0.1, 0.5, 0.56, and 0.63 percents of the gross domestic products,  the total governmental budget,  the total governmental revenue and the total revenue from taxation respectively.


Analysis of Outstanding Health Promotion Organizations: Lessons of Future Development	This study aims to describe to process and success of various outstanding health promotion organizations include describe their factors and conditions of success as well as recommend for policy and management, and infrastructure for other health promotion organizations to develop their health promotion programs. The study was conducted through quality research  strategies in 4 outstanding health promotion organizations which represent for governmental organization (Health Promotion Centre, Zone1 Bangkhen, Bangkok), private sector (The Unilever Thai Holdings Co. Ltd.), non-government organization (Mission Hospital), and civic group (The Association of Thai Bicycle for health). Most data gathered from interview the organizations’ managers and their staff, and collected from reports and questionnaired the programs participants. The results of this study were found that;1.	Major Characteristics of the 4 case studies:	1.1	Mission Hospital (Private hospital) handles many health promotion activities for their service by the participants have to pay for those services. The hospital has a clear policy to develop and service for health promotion programs. The hospital has readiness for infrastructures, personnel, models which emphasize on holistic approach and practical model under the “NEWSTART” (nutrition-exercise-water-temperance-air-rest-trust) course that has been proved for its success.	1.2	Health Promotion Centre, Zone1 (The Ministry of Public Health) is a governmental organization that respond for research and development of health promotion models. The centre itself has a clear policy and good management strategies and techniques to enhance their staff capacities and emphasize their staff’s health promotion at first. The outstanding research projects of this centre are; LAMAZ, Thai Traditional Exercise for physical therapy Clinic, and Dental Health Model for children.	1.3	The Unilever Thai Holdings Co. Ltd. (Private Sector) emphasize on workers’ health as main policy. Their health promotion program started at “Lever Smoking Free Program”. This program used civic group of non-smokers as major factors to enforce and develop other health promotion activities eg. Selection of new good-health workers who are non-smokers, non-fat personnel, including other six health promotion programs (foods-exercise-emotion-drinks-AIDS-accident).	1.4	Thai Bicycle Organization for Health (Civic group) is a civic health promotion organization which all participants are willing to participate to all activities that have been set up, which then develop to good health and other beneficial public activities.2.	Lessons and Idea from the case studies	2.1	Variety of health promotion activities in different organizations indicates that health promotion belongs to every persons’ life-style and it can be developed and applied to other organization or non-target community.	2.2	These organizations are all freely managed by themselves under difference of their success conditions and readiness which hindrance their systematic development or the holistic development and their broad success. This needed to have a co-ordination organization to make network between each parties in term of policy, strategies, budget, research and development, and exchange of their knowledge and experiences.	2.3	Health promotion policy of an organization is an essential factor for its direction and condition of success. This needs a keen leadership for management and governmental public policy to support the success.	2.4	All these outstanding organizations can be leading organizations for health promotion, however, all these organization still need concrete support from govenmental sector to develop their activities and co-ordination to exchange their technology and other existing resources of thealth promotion development.	2.5	Variety of their health promotion strategies can be applied to other organizations such as development of personal life-skill, practical model, emphasis of the staff health promotion skill as a model, create supportive environment, and making partnership on the same issues etc.	2.6	These should be motivation for the success of any person and organization such as rewards, health bonus for a good health worker, tax-decreasion for such organization, decreasion of health insurance premium etc.	2.7	Governmental sector must have a clear policy and strategies to enforce health promotion issues as social movement to make population concern of good family health, school health, healthy work place, healthy society through mass media systematically.


The decentralize budgeting system of Nonthaburi Provincial Public Health Office 	The effectiveness study of Nonthaburi Provincial Public Health Office (NPPHO) budget allocation was carried out using both qualitative and quantitative ทmethod. The qualitative study was done by indepth interview and focus group discussion with 72staffs from retrospective document analysis The study consisted of two parts :  the first part was carried on during 1997 fiscal year , the second part carries on during 1998 fiscal year. 	The outcome of the first part show that the strategy of NPPHO, which allowed multi health care worker to participate in project developing process, increased both work morale and compliance. The majority of the projects were about health promotion and human resource development. The evaluation about the appropriateness of the project by the relevant between the objectives and existing health problems, the objective and strategies used, the objective strategies and the budget show that the mean was about the middle. The project development was done by whole district health alliance team or separately done by the hospital and district health office the merge the project together to make the district major plan.	The outcome of the second part reveal that appropriateness of the projects improve and there were more health team approach to solve district health problems, and the activities of the project was initiate by the DPHC personal. The study also reveal that every district followed the activities plan of each project. The indepth study of best project of each district show that each of best projects had strong points about activities initiation that correlate with potential of the personal and the health care team.


Alternative Health System Development in Thailand:Knowledge Synthesis on Health System Reform	Alternative health system development in Thailand were studied by reviewing international literature. The contents were synthesised to find appropriate development for alternative health system in Thailand to propose contexts which should be in National Health Bill. The study recommended development of alternative health system be integrated into mainstream of health system in order to achieve comprehensive and holistic health which correspond to Thai culture. Health alliance was considered as a major mechanism for reforming. To develop alternative health system, the Committee for Alternative Health System should be set up under the National Health Council to determine policy, direction and its system structure,the Alternative Health Institute should be an entity developing knowledge, supporting its network and being the secretary for the Committee,the Sub-committee for the Committee for Alternative Health System should be responsible for consideration based on determined principles, the Sub-committee would propose contexts for amendment to either regulations or laws to insure alternative health care,alternative health should be supported to be other professional-liked organisations and be supported for research development,representatives for consumer group should be positioned in the Committee


The Task of Tambon Administration Organization (TAO) and the strength of Tambon Civil Society (Sub-district Community) in dealing with Tambon health problems	The study on the task of Tambon Administration Organization (TAO) and the strength of Tambon Civil Society (Sub-district Community) in dealing with Tambon health problems has its objective to research the project or activities in five-year Tambon  development plan, to deal with the problems of community sanitation, to research the task of Tambon Administration Organization and Tambon Civil Society in dealing with community sanitation including with some factors creating cooperation and participation in Tambon Civil Society Approach a deal with the problems of community sanitation.	The study is the field research which having units of analyses; for example, TAOs throughout the country represented by 40 TAOs samplings in all parts of the country with studied populations; such as, TAO’s representatives who are administrative chairman, TAO administrative Committee, members of TAO Council, TAO Personal (Deputy Director of TAO) and local group’s, community organization’s representatives. Material used on this study is questionnaire in-depth and focus group discussion including 3 TAO case studies selected from the TAOs with some Community in dealing with community sanitation. The result of the study found that	The project or activity research on TAO’s Tambon Development Plan during 1998-1999 found that 36% of the projects or activities under Tambon Development Plan with community health following the Tambon Development Plan in the Regulations of Annual Budget and TAO’s Additional Expenditure during 1998-1999 and 30% of the projects under the Budget Regulation had its projects or activities made. Most of the projects are small which supported through the agency concerned by TAO’s finance.	The result on the TAO’s task and Tambon Civil Society in movement for operation is particular obligation in dealing with Community Sanitation found TAO’s task with management on community sanitation, in conclusion benefit activities management to health promotion, community sanitation, environment and public health, disease prevention, basic public service and public utility including with water resource development. In addition, the TAO’s operation is to support other organizations with finance budget in any activities performed to benefit to the public; for example, purchasing of drugs for health centers, purchasing fogger to get rid of mosquitoes, public health check, get rid of hydrophobia, lunch and nutrient support of Child Development Center as well as activities run by TAO’s in different capabilities; for example, anti-drug addict campaign, AIDS, disease prevention and control, disposal of garbage, public education for health and hygiene, hazardous material control, mobile TAO health, cooking and nutrition, medicinal plant transformation, and natural resource reservation, etc.	The task of groups and community organizations with their movement in Tambon Civil Society found that their operation is similar to the TAO’s, except, the TAO with strong community organization. Most public health activities are varied; for example, a campaign to have to elderly taken care, medicinal plant transformation, savings for occupation support, conservation of natural resources and environment, water pollution, pollution, including alternative agriculture, etc.	The result of researching for the basic needs of TAO’s, groups, and community organizations, found that they are in the same way; in addition, the problems of drug addict, disease, epidemic, collecting and getting rid of garbage, pollution, lacking of drinking water are urgently to be solved while the community organization needs additional basic knowledge of community health, caring and arranging welfare to children, elderly, handicapped and inferior opportune persons including with selective community health activity.	Some factors crated cooperation and participation in Tambon idea to get rid of the community health problems; for example, community of TAO, vision of TAO executives; idea, intention, coordination, budget and TAO income, community leaders and strength of organization, education center and community learning process.	Political suggestion to the organization concerned development of community health in Tambon should be made for sample “Tambon Health Community” showing strong collaboration among population (group, community organization), private development organization, private sector and government organization in provincial, district, Tambon levels to promote Tambon health community while the health center may become community learning center for health. Group and Tambon community may campaign together in education to those of village and Tambon as well.	Suggestion to TAO is to establish together, “TAO Community”. There should be the Public Health Section apart from TAO Organization and the particular personal skill in essential Community Health should be developed. The TAO, Health Center, Public Welfare official including group and Community Organization must cooperate and participate to create the task for Tambon community health to decentralize community health of TAO and community in the future.


Geographical imbalance of physician is a globally chronic problem of health service, particularly in countries which has overall physician’s shortage. The geographical imbalance negatively affects the efficiency and equity of health system in both areas, high and low health workforce’s density. In Thailand, physician’s distribution problem plays a major role in indicating the success or failure of health insurance schemes.In 2005, Thailand has approximately 25,600 physicians who have active service status. With this figure, the overall physician shortage is around 4,500, compared with the demand forecast, which was conducted before universal coverage health insurance implementation. However, there are at least 3 main factors, currently triggering the rising of demand for physician in our country, including 1) universal coverage health insurance scheme, 2) Thailand as an Asian Medical Hub policy and 3) universal coverage for anti-retroviral treatment for HIV infected population. The additive burdens from these 3 policies are equivalent to 1,222 full time physicians’ performance.  The physician’s distribution discrepancy does not substantially change from the trend in last few decades, although Thailand has 3 significant increases in physician production in the same period. Furthermore, the mushrooming of private sector, as a result of economic recovery, severely aggravates the discrepancy, in term of internal brain drain.Incentive system is the popular tool to alleviate the discrepancy. It affects physicians, by both attraction and maintenance physician in the shortage areas. Unfortunately, the existing incentive pattern does not strike a balance among many types of incentive. Non-financial benefit is always less prioritized.  In addition, increasing of public physicians’ incomes alone is prone to have an adverse impact, in term of spurring the national health expenditure.In the macro view, Thai physicians receive less income while suffer from more workload burden, when compared with other countries in the same region. Internally, there is significant difference of total incomes between public and private physicians. A sampling phone survey shows 37,000 and 50,000 Baht in monthly incomes in resigned general practitioner and specialist physician, respectively.Implemented measures to mitigate the geographical imbalance display the irrelevance of strategies and roles of stakeholders. Therefore, it’s necessary to improve the existing policy and strategies to effectively solve with this problem, with sustainability. 	The policy recommendations, drawn from this study, are including 4 parts of policy, as followed;Supply policy: the physician supply can be improved by 1) increasing in number of physician, which are including new production and activation of service inactive group and 2) improvement of productivity by arranging the optimum skill mix and specialty mix, including establishing of flexible employment i.e. public-private mix.Distribution and utilization measures: Revisions of existing procedures are urgently need including educational contracting, physician allocation method, long term development system and migration.   Incentive measures: the physician’s incentive system should reflect the shortage situation and performance, as well as focusing on effective non-incomes incentives.Other measures: these are including 1) preparation of physician to shortage context, 2) applying of health workforce demand identification concept to both public and private investment and 3) utilization of physician as public asset, such as financial mechanism to support the optimum physician’s distribution.


Traffic Victim Protection Act was implemented since 2535. Though it is a mandatory scheme, instead of public sector, the for profit private insurance companies are the carriers of the scheme. The Scheme compensates healthcare based on fee for services and maximum liability, a lump sum death and disability compensation are also granted. Financial report in 2545 indicated a net premium of 7,003 million Baht collected, with very high administrative cost (41%) and low loss ratio (52%), and inadequate cover all traffic victims. There is a need for a major reform in the context of achieving Universal Healthcare Coverage in Thailand in 2545. 	The objectives of this study are to estimate total resource requirement (for medical care, death and disability compensation) for all traffic accident victims, to estimate how much would the government introduce additional gasoline tax to cover all traffic victims, and provide policy choices for reform. 	Based on secondary sources of information, it was estimated that total resource requirement for all traffic accident victims would be 7,158 million Baht in 2545, of which 63% for inpatient care, 16% for pre-hospital care, 15% for death compensation, 5% for ambulatory care and 1% for disability. 	Household consumption of gasoline from the 2545 household socio-economic survey conducted by National Statistical Office was used to compute total litre of different types of gasoline consumed by household categorized by income deciles. To generate the total 7,158 million Baht to cover all traffic victims, the government has to raise 0.32 Baht to a litre of gasoline, given no price elasticity of demand by all household deciles. Several scenario of raising gasoline tax was proposed. We recommend the least regressive option, 0.26 Baht per litre for all type of gasoline except Octane 95, and collection 0.55 Baht per litre of Octane 95. 	Two goals of reform are identified: to cover all traffic victims (both caused by the insured and non-insured cars) and appropriate Scheme administrative cost. 	Three reform options were proposed based on sources of finance, option one generate revenue from premium contribution by car owners, option two from general tax and option three from dedicated gasoline tax. Analysis indicates that option two and three are neither politically feasibility nor socially acceptable. Three choices of reform under option one were identified: conservative, minor and major reforms. We recommend a major reform. This is to sub-contract the Department of Land Transport to collect premium while the mandatory annual renewal of car license. The large part of premium would be transferred to the National Health Security Office (NHSO) to cover all victims for medical care, death and invalidity compensations. The second preferred choice is minor reform, sub-contracting private insurance companies to collect premium, the large part of premium would be transferred to the NHSO.


This study “ Survey of health status and drug utilization of people in Community “ is one of the studies in research series “ Role of drug store in the Universal Coverage (UC) Program” 	Since the government implemented the universal coverage policy and started the UC Program, profession is urged to improve the role of drug store. Drug store, which is a primary health care setting for community, should be able to response to people’s need under the change of national health system. University Pharmacy (UniPham) is the only drug store in Thailand that participated in the UC program as a sub-contractor of Mahasarakham Hospital.	University Pharmacy, an enterprise body of Faculty of Pharmacy and Health Sciences, Mahasarakham University, was established with an objective  to be a community practice setting that supports learning process in Doctor of Pharmacy program.	The complete role of health care setting needs to include both active and passive health services. It has accepted that drug stores preformed passive role in health services for a long time. Health promotion and health prevention are new challenge roles for them.	Mahasarakham Hospital assigned Nakkhawichai community to be a study area for University Pharmacy to implement its active health activities. In order to achieve this new role. Understanding of health status and drug utilization in community is a prerequisite for the University Pharmacy to plan an active public health intervention.


The Australian Health System:case study of health care technology assessment system, the system of health care complaints, community involvement in health policy development and the development of health manpower	The main purposes of doing the review of particular components of the Australian health system were to look into its development experiences and various features as time went by. This review was aimed at reviewing Australian health care technology assessment system, the system of health care complaints, community involvement in health policy development and the development of health manpower. 	Health care technology assessment is considered as part of doing the policy research through these following stages : determining what health care technology should be assessed, evaluating various impacts resulted from using a particular technology, reporting the results and giving policy recommendation to policy makers and disseminating them to public. 	The development of the health care complaint system in Australia is basically on the principles which are the fault-based system with avoidable injuries and the no-fault based system with unavoidable injuries. There are a number of degrees of complaints process in Australia. If the injuries caused by no one’s fault, the case would be ended after both parties, the patient and the provider, reached an agreement. If the patient wonders his or her injuries or lost benefits were caused by the wrongdoing of the provider, he or she may report to the registration board to which the provider is registered. The board will set up the Medical Tribunal composed of the judge, the representative from the same specialty of the provider and the consumer representative. The tribunal will consider the case and if the provider did the wrong action to cause harm for the patient, the penalty will impose on the provider. Nevertheless, compensation for the patient can not be sought out through this process.	Community involvement has been increasingly used for developing health policy and implementing health policy in order to increase responsiveness to communities’ needs and to support decentralised management of health system. The WHO also supported this approach by considering it as one of the important strategies of health promotion and prevention. The Australian Commonwealth Government has put that strategy into practice by setting up the Consumers’ Health Forum (CHF) as a channel for NGOs and communities to be part of health policy development. 	The last context reviewed in this report is health manpower development in which the report specifically picks up the development of general practitioners in Australia. To promote more integrated and efficient health care system, the Commonwealth Government set up the review committee to determine Australian GP’s problems. Originally, the necessity of determining GP problems was actually called out by the Australian Health Ministers’ Conference. The review committee was composed of technicians from the supply side and representatives from consumer groups and the central government and state governments. The Australian GP development was started from the trial projects in several areas around the country so as to seek suitable models and develop general practitioners’ skills and capacity to cope with changes.


The study aims to define the scope and present the guideline of research methodology for health impact assessment of Khon Kaen City Municipal solid waste policy using the literature reviews, field work study, interviewing and getting data from stakeholders’ participation of the group meeting. Results revealed that Khon Kaen City Municipality has a 100 Rai disposal site at Khum Bon Village, Non Ton sub-district, 17 km far from Khon Kaen City in Udonthani province direction. The disposal site has operated since 1968 and was latest improved in 1986. The disposal system was combination designed, consisting of a sanitary landfill, an infectious incinerator, and a composing plant. However, they could dispose solid waste occasionally and the operation was not followed to the design. Thus, these could cause to the environment impacts and human health. Moreover, the land of disposal site is nearly over because of the increasing of solid waste, about 200 tons/day. This site has to be rehabilitated for 5 years extension and it must find out the new disposal area. The stakeholders of solid waste management identified as 1) municipal solid waste workers, personnel group  2) group of communities, people who live near the disposal site  3) private occupation with solid waste group: scrap merchant, scrap collectors at disposal site, scraper using tricycle (Sa-Leng) and 4) the administrative group related to solid waste management and policy. The physical health impact from solid waste was found as gastro enteric disease, respiratory tract disease, infectious disease, skin disease, allergic disease, injury from vehicle accident, sharpen objects which occurred to the person who worked, direct contacted with solid waste. Metal and social health impacts were found as the stress, worrying, low society, dirty, etc. Spiritual health impact was indicated that lacking the responsibility, recognition on solid waste management, feeling of self-reliance. Positive impacts were found that the scrapers, workers could make money from the scrap and they were proud of reducing, recycling, reuse, renew the solid waste.     Scope and methodology for health impact assessment of Khon Kaen City Municipal solid waste management can identify as three categories. The first is health impact assessment of population studies (stakeholders): a) municipal solid waste workers, personnel group,  b) group of communities, people who live near the disposal site  c) private occupation with solid waste group: scrap merchant, scrap collectors at disposal site, scraper using tricycle (Sa-Leng) and d) the administrative group related to solid waste management and policy. Health impacts cover physical, mental, social and spiritual health such as sickness, stress, self responsibility, worrying, recognition, social relationships, morale, citizens participation etc. The second is assessment of environmental quality that impacts also to human health. These consider the air, water, soil qualities at the disposal site and the area around 2 km nearby. At the solid waste discharge point and the transfer station should consider the visual sighting, air quality. And the third is assessment of the linkage of environment and health analysis for decision-making.


The effectiveness of Health education activity with Social support from Village Health Volunteers to Preventive behaviour on hemorrhagic fever and diarrhea among Family health Leaders in Trang Province	The research aims to evaluate the effected of health education by social support of village health volunteer. The PRECEDE model to diagnose the effected of knowledge and behavior for preventing Dengue Hemorrhagic Fever and Diarrhea of the family health leader.  The results from this research aim to apply for planning and group processing for changing behavior of family health leader. The quasi experimental model is research design. The family health leaders were sampling from 4 villages of tambol Nakhaosia in Nayong district.  There are one village was a Dengue Hemorrhagic Fever preventing project and another one was a Diarrhea preventing project village. The other two villages are control area. The samples collected from 60 people of any village by interview form, observation form and social support asses form. The data were collected pre-intervention and after 6 month intervention. The media intervened are video, poster and documentary sheet. 	The results found that family health leaders have a significant changing behavior for preventing Dengue Hemorrhagic Fever and Diarrhea. They have improving in knowledge of disease, risk factors, violence of disease. The results also showed the social support are significant relation for Dengue Hemorrhagic Fever and Diarrhea prevention behavior.


The evaluation on development of a care system for children and juveniles in a child and juvenile observation and protection center was the final stage of this action research.  It aimed to evaluate the development of child and juvenile care system and to assess the changes of the children and juveniles’ behaviors, families, and personnel being in charge of the care, including, learning about development and working process.  It was a long-term study cooperated with cross-sectional study of both qualitative and quantitative research methodologies.	The project evaluation was carried out by Auto-Evaluation technique.  And the holistic assessment on development of child and juvenile care system was accomplished by qualitative and quantitative analysis.  In the assessment, the system theory had been followed as a concept paradigm.  The inputs were organization structure, policy and budget, care personnel, children and juveniles, and environment conditions.  All of these had been being processed participatorily in the development of the child and juvenile care system.  It was fruitedly on effectiveness of the child and juvenile care process.  They were appropriately well cared.  Also, there were some changes of children and juveniles’ behaviors.  They had self-reliance, pride, and self-worthiness.  As a result, they were well accepted by their families and communities.	A conclusion of the research was as follow:	1.  There were a lot of better changes in the organization structure.  For instances, there were: well-defined policy for jobs, better motivation on running work to meet the objectives, good interrelationships, better attitudes towards children and juveniles, clean, well-ordered and good scenery of environments.	2.  The participation in thinking and operation geared to successful development.  By the way this resulted from the realization and confronting bravado of the executives, cooperation between the executives and personnel of the organization, tightly relationships of the organizational personnel, and steadily hold to the ultimate goal and the objectives of the development.	3.  The development from “grass roots” to “policy” was resulted from government official reform.  It made the organization having more clear administration system.  There was a cooperative network for development between the Mental Health Department and the Department of Child and Juvenile Observation and Protection.	The outstanding aspects of this research were presented in the department and ministry level.  As a result, it fostered an opportunity for better development.  It could be also motivated the ones who had steadily willingness and active inspiration for development.	Important factors helping development of children and juveniles in the Observation and protection Center were:Cooperative participation between the researchers and Organizational stakeholders.To achieve problem solving, operation must follow the plan.Operation evaluation and improvement of the plan.Operation conclusion.Interchanging of learning.


The price comparison of US drugs inported to ThailandThe price differential of drugs, calculated by item, group and purchasing power parity (PPP), was conducted to compare drug price between Thailand and the U.S. The 209    samples accounted for 34.9 percent of the total import, or 12.9 percent of the total import and manufactured. The comparison by item showed that 17 drugs in Thailand were more  expensive than in the U.S. The total import of the 17 items was 17,491,517 US dollars. Of these drugs, four of them were AIDS/virus drugs and five were antibiotics. The comparison analysis by therapeutic group showed that AIDS/virus group were priced 6percent higher in Thailand than in the U.S. where ones of antihypertensive drugs, phychotropic drugs, anticancer agents, miscellaneous group, cardiac drugs, antibiotics, vasodilating agents and antiinflammatory agents were(percent) 18.7,  24.3, 28.1,  45.0,  49.2,  47.5,  73.1 and  73.6  differences respectively.   Comparison by registration type demonstrated higher price of the new drugs over the old drugs category with percentage of differences at(percent) 20.0 and 44.4 lower in Thailand than in the U.S.  Comparison by dosage for did not show significant differences among groups of injection, tablet and capsule; and other form which were 38.0,  37.4 and  34.4  lower in Thailand than in the U.S. respectively. Comparison by using the 1995 PPP (Thai PPP=28 and U.S. PPP=100) indicated that most imported drug were charged more in Thailand than in the U.S. expect antiinflammatory drugs and vasodilating agents.


Non-government Organizations’ Health Promotion Programs Thailand’s Case Study : Bicycle Riding Club for Heatlh	The Riding Club for Health was one of the NGOs having a number of continuous activities to encourage health promotion. This study was to review the club’s activities since its establishment to determine factors supporting its success. Large portion of information was derived through interviewing the club’s committee and members in addition to its bulletin and printed document. Additional information was collected by the use of questionnaire to ask the club participants. The analysis framework was the principles of analyzing organization, work system, organization’s strategies and human resource. The Ottawa’s Charter emphasizing partnership development to support health promotion programs was also used for analysis. 	The Bicycle Riding Club was originated from those who loved bike-riding gathering to do outdoor activities with bike-riding in addition to campaign on environment and health promotion. The club administration was in form of committee with no compensation for them. The club grew up in size of members and activities later networking with domestic and international ridging clubs. The club was a good example of encouraging tourism with bicycles prior to health promotion campaign given that health promotion was a by-product of tourism. The important strategy of the club was to seek partnerships in order to create social power for health policy development. The partnership whose interest was similar was likely to be sustainable. Nevertheless, some activities like the bike pathway and natural environment campaign did not achieve their objectives on account of lacking continuous campaign resulted from the fact that all members were volunteered. Lastly, despite the club nationally accepted as one of the health promotion organizations, the extent of the club members’ health holistic understanding which was the most important principle of promoting health, was still doubted.


Evaluation of strategy and technology for “Safer Road” projectThe study was to review knowledge and research results on various technologies used for reducing road accidents and increasing road safety to propose policy decision makers and operational offices for consideration. The 6 technologies were proposed, which were 1) red light camera for those violating traffic light and driving above speed limit, 2) motocycle lane, 3) road safety monitoring, 4) programs for relaxing bus and truck drivers, 5) annually effective vehicle check-up, 6) tax measures for promoting equipment which is used for road safety. However, the use of such technologies needs changes to existing policy and requires some preparation for example implementation of pilot projects and establishment of training programs.


This participatory action research  aimed to study and develop a primary health care  service model based on the social and cultural  context of the northern part of Thailand, roles of professional nurses and health teams as well as conditions that   reflect the health outcome of  people. This study was conducted  in the area that is the responsibility of the Khun Khong health center, Hang-dong District, Chiang Mai Province. Data were collected from health care providers and clients, who were  health personnel, community  leaders, and villagers, by observation, interview and focus group discussion. Data were  used   to  develop a primary health care service model. Data analysis was made by summarsing the developmental process and lessons learned. Results: It was found that  the primary health care unit  lacked  support in term of human resources and health personnel lacked experience in providing proactive holistic health care services and primary medical care.   Participation from villagers and the local community committee was limited.  In terms of management, financial support from the primary health care contractor was delayed. From the findings,  with cooperation from health personnel, community leaders and research team, a plan was developed  to enhance the ability of health personnel and community leaders to be more understanding and confident of providing proactive holistic health services. The developmental process was done  by reflecting on data and needs, training, learning from best practice communities and creating understanding among  villagers in the communities. As a result, health personnel had more understanding and had more ability to provide care for the villagers. However,  the guidelines and management of primary health care from the province health office was unstable therefore, the proactive health care  services at the  health center level was not well supported, which resulted  in ineffective services.Regarding  the roles of the health team in the primary health care unit, it was found that nurses had a major role  in providing care because of the number of other health professionals was still  limited even though all professions are needed  at primary health care units. Therefore, nurses are the major professionals in  providing holistic  health care services.The results from the study suggested that for enabling primary health care service to be  more effective, there was a need for  clear  policies for the development of health personnel in health promotion services by focusing on participation from the  community, planning, implemention  and continuing supervision  by the primary health care contractor. Personnel development  should have various activities such as  training, reflecting and conducting forums,  and learning from best practice communities.


Survey of risk behavior, risk environment, health information, health information perception: third issue,  Public Hospital AdministrationThe purpose of this survey is to study opinions of four groups of personnel in public hospitals. They are doctors, nurses, technicians and officials. Data collection was conducted through cluster and area sampling with questionnaire and interviews. The total respondents are 1,546 cases. Frequency, percentage, mean, standard deviation in QPS program were used for data analysis including open ended information. Results are the following. 1.Satisfaction towards services provided for people. The sampled population of public health  have found various services provided for people satisfactory at  the medium level. The first priority of satisfaction was the  condition of single rooms for in patients. Then, card services for new and old patients, seats for waiting out-patients,  pharmacy services, and patient reception were also found satisfactory. The least satisfaction was found towards  facilities such as rest rooms and drinking water. Male samples' satisfaction is higher than those of female. Moreover, the samples in rural areas have higher satisfaction compared to those in urban areas. Besides, the samples in the east have satisfaction at a higher level compared to the rest. 2.Problems  and Problems Solving in Public Health Services. The most  serious problems found are insufficient budget and too few sources of supportive budget. Apart form these, other serious  problems are insufficient supply and outdated office equipment,  patients by the services and personnel. As a result the staff work is Overloaded.Besides, the samples also  raised more problems about insufficient staffmembers. Secondly, the problems are about fringe benift, salary, insufficient  facilities, and lack of officials' morale. Moreover, bosses or administrators are non - supportive, injustice, ignorant to staff's opinions, lack of support in problems solving and not  keeping up the staff morale. Also, officials are irresponsible and inattentive. Lastly, doctors are tardy. As for problems  solving in public health services, the samples' suggestions are  the following. More budget should be allocated. More supply and  equipment should be provided. Coordination and cooperation in the organization as well as salary and fringe benefit should be  improved. In addition, the suggestions also concentrate on increasing fringe benefit and salary as the first priority. Secondly, the solution should focus on increasing personnel,  impartial administrators, more training courses for staff development and punctual working doctors. Female samples' opinions towards the problems of public health services are at  a higher level compared to those of male. The samples in urban areas think the problems are more serious than those in rural areas. Also, the samples in the north and the east think the problems are more serious compared with those in other regions. Male and female samples in both urban and rural areas and  almost all samples agree that more budget allocation should be provided as the first priority. Only the samples in Bangkok think buildings should be  extended and more spacious.Howwever, the samples in the wes  think more supply and equipment should be provided. 	3.Opinions towards Executive Agency. The majority of sampled population agree that the concept of executive agency is good, but almost  impossible in practice. The reasons are insufficient budget,  non-conductive administration system, no cooperation among  staff members, and vague concept in problems solving. The suggestions are the following. More budget and reengineering of  the administration system are needed with a clear policy and concept. More explanation and cooperation among staff members are necessary. Administrators should have vision, efficiency and responsibility. Male samples' opinions towards executive agency are at a higher level compared to those of female.  However, the latter group think there is less possibility  compared with the former because of insufficient budget. Like  the samples in urban and rural areas, almost every sample in every region, except Bangkok and the east, agree that  reengineering of the administration system should be conducted as the first priority. 	4.Recommendations for Public Hospitals. All samples agree that quality assessment for hospital services should be conducted as the first priority. Secondly, male and  female samples, urban and rural samples, a most every sample, except Bangkok, agree that a higher standard of services should  be set up as the first priority.


Health Policy Evaluation for the Elderly persons	Problems of health policy for elderly population in Thailand were the uncertainty of how well the policy has met the elderly’s health needs and covered such a group. Additionally, life quality resulted from the policy implementation and supportive system to the policy were less evaluated than the quantity of policy coverage. The elderly policy evaluation in this study was to review formal document relevant to the policy, to interview and observe key stakeholders including a number of policy makers, health administrators at provincial and district level and key health officials at community level. These key informants were sampled by multi-stage sampling technique. 	The current policy for the elderly aims at encouraging 70% or more elderly to have proper self-care behaviors, having 50% or more aged people receive comprehensive care from public health facilities and expanding free health care for all elderly. The policy comprised health care plan, health promotion plan, health behavior development plan and health insurance plan. The study found problems of putting the policy into practice for example lack of actual supportive system e.g. budgeting system and health official incentive system, lack of proper information based planning system. The policy evaluation was more likely to evaluate in terms of coverage than quality of policy implementation. Health promotion was much emphasized at the operational level while health services needs were largely unmet.


Banpaew Hospital, located in Samut Sakorn province, was the First Autonomous Public Hospital on October 1, 2543.  The hospital charged 40 baht each for outpatient visit and 100 baht for inpatient services.  A study should then be conducted to identify population in health impact in Ampur Banpaew.  The purpose of this study was to figure out the changes in health status, attitudes, awareness, healthcare behavior, social and environmental factors, and any other changes regarding to the use of Autonomous Public Hospital services.  The study will be  compared the changes before and after became an autonomous public hospital using Quasi experimental Stratified Multistage Sampling method was used to sampling the area,  Banpaew consists of 12 tambons divided into two stratus: municipal area and non-municipal area.  Within each area, a random of village (moo-baan) was selected and, within each village, 40 households were randomly picked for the total of 1,000 households, with an average number of 4-6 members per each household.  The total of 4,485 head of household both male and female participated in the study.  The data was collected through interviews and observation of  household status, environments, and its members.  The research in conducted twice.  The initial survey was performed after one year of Autonomous hospital during March to April 2001.  The second survey in the same area was done form August to September 2002.  But in October 2001, the government has launched policy of 30 baht for every disease was in effect in Samut Sakorn province. 	The results from both survey periods are at satisfactory level in all aspects.  Due to the changes in public health system that occurred during the second study period, which charges 30 baht for both outpatient and inpatient services, the medical supplies and medicines (that cannot be claimed) expenses averaged significantly lower than the first study period.  Those who attended the hospital services as inpatients and outpatients were more satisfied with the quality, effectiveness, and its staffs than the first study period (p<.05).	As for the aspect of health insurance cards for household members, during the second study period, 95 percent went to either public hospitals of health centers when they become sick,  due to the 30 baht for all disease policy, in comparison to only 49 percent during the first study period.  The overall  population health status was in a good to excellent level.  The findings from both study periods found that those patients were mostly seniors of 60 years and older with diabetes, high blood pressure, and joint diseases.  The study also found that there were more of them in the second study period than the first one (P<0.5) because there are more public health personnel to go visiting with households and giving advice and suggestions to the community, in addition to the public increased interests of better health awareness.  However, this is only the beginning phase of the study covering the period of two years.  After the status change of Banpaew Hospital along with the 30 baht for every disease policy, which was first introduced in October 2001, a longer-term study of 4-5 years should be conducted in order to yield more accurate estimates and results.


This study was the participatory action research intending to use the process of education and development for fostering the civil society towards drug abused protection and problem solving in the communities namely Ban Rai-Dong and Ban Daui -Naog , Tumbol Khuw Mung, Saraphi District, Chaing Mai Province. There were three objectives for this research study ; to explore the social situation of community which foster to bring about civil society concerning with drug abuse control program and problem solving , to experiment the way to foster civil society and work process between the researcher team and community for drug abuse control and problem solving program, and to examine the effect of foster civil society by observing the  changes in community development process for drug abuse control and problem solving. Researchers had worked with people in community through the process of community study,  situation analysis of drug problem, and coordination to fosters civil society by people from other government and non–government organization (NGO) in this area.	The data on social situation and the role of community to solve the variety of problems in the communities were composed with a number of study methods including living in the communities, observation, interviewing the key informants, conducting the focus group discussion, then followed with the six steps using in the participatory action research. During the intervention period, researchers had observed, recorded all activity processes and summarized. The data were analyzed and proposed the way to foster civil society for drug abuse control and problem solving in these communities .	The result of study revealed that there were a number of skill developments occurred in the communities; (1) leader have more experience in community development, (2) people have much closer relationship, (3) helping each other when facing the problems, (4) obtaining information  continuous, and (5) promoting the civil society movement of people leaded to the better experiences in solving the various problems in these communities. For drug abuse problems, community tended to improve their experience in helping drug users, families, and people who had an effect from drug abuse through the community relationship and social mechanism. 	Resulting from the promotion of civil society movement for drug abuse control and problem solving in community demonstrated that this process leaded to the great benefit for people in communities because it increased the opportunity of people to participate in the  development processes and increased their understandable of the social problem and helped each other to determine the appropriate means to solve the problems occurred in the communities.  It was also the learning process for the communities and changed their attitude to drug users and their families. Besides, foster civil society had leaded people to increase their learning abilities for solving various social problems that increased with the dynamicity of the society with a sustainable development.


Universal Coverage Scheme was nation-wide launched by the government in October 2001. The scheme was financed by general tax revenue with literally free access to contractor primary care unit (PCU) and registered hospitals. A nominal fee (co pay), 30 Baht per visit or per admission, was introduced for UC Pay member (UCP).  UC exempted (UCE) members who were the ex-members of Low Income Scheme, the elderly, children under 12 years, monks, war veterans, and village health volunteers were exempted from the co pay. Current policy debates focused on the appropriateness of co pay level to deter any unnecessary demand for care as well as capacity to generate some revenue to finance the scheme. 	This study examined and classified income quintiles of UCE and UCP members, service utilization rate of UCP, and total revenue generate from co pay.  The study also proposed several scenarios for reform in both directions (termination and increase of co pay). The 2003 Health and Welfare Survey (HWS) conducted by the National Statistical Office (NSO) was the dataset used for the analysis. 	There was a substantial portion of the poorest (29%) and the poor (25%) quintiles among UCP members, and a small portion of the rich (9%) and the richest (4%) quintiles among UCE members. Estimate revenue from co pay was probably negligible. This was 1,073 million Baht in FY2003 or 1.9% of total capitation budget financed by the government.  Co pay was advocated to deter unnecessary demand among users, but this study proposed that it might not be necessary for IP as admissions were clinically indicated under global budget plus DRG payment system. However, co pay might be necessary for ambulatory services as contractors were in weaker positions to contain demand. 	We would recommend that any reform of co pay should over-haul the issuance of UCE and UCP to better targeting as a pre-requisite.  Co pay was not a significant resource generation tool to finance UC scheme compared to capitation.  Co pay for IP should be terminated to abolish barrier to health services and prevent patients’ welfare loss, there was literally no moral hazard as providers have no incentive to unnecessary admit patients. Finally, co pay should be terminated at HC level in order to advocate use of primary care. In the meantime, research to provide evidence if there was a moral hazard among UC members as well as quantifying the magnitude of moral hazard is needed, prior to major revision of this policy.


Health  Management  Service  for  Informal  Sector :  Hawkers  and  Garbage  Collectors This  research  is  aimed  to 1)  know  their  working  conditions , major  health  risks,  health  problems  and  care,  2)  know  their  awareness,  understanding  and  access,  of  health  service  system  for  them,  their  selection  of  health  service,  rights  and  benefits,  their  satisfaction  and  problems  of  health  service  system  use,  their  expectation  of  health  service  system  and  their  ability  to  make  additional  payment  into  the  health  fund,  and 3)  propose  guidelines  on  provision of health service system for informal sector : hawkers and  garbage  collectors.	This  is  qualitative  research  and  data  were  collected  in 3 ways  including  1) in-depth  interview  with 165 hawkers and  garbage  collectors  in  Bangkok  and  peripheral  zones,  2) interview  with 5 officials  directing  health  service,  and  3) 2 focus  groups  of  the  health  service  receivers  and  providers. 	The  research  can  be  concluded  that   most  of  165 samples  are women  being  31-40 years  of  age  and  having  primary  education,  single  families  and  about 4 family  members.  Most  samples  migrated  seasonally  or  permanently  form  the  northeastern  region,  reside  in  rented  houses  with  about ฿ 800/month.  Most  samples  have  worked  for  over  10 years  with  daily  income  of  ฿300-400 being  equal  to  their  expenditure.  Some  have  short-term  debts  with  monthly  interest  rate  of  7-20%  being  incurred  to  be  their  revolving  fund  for  trade  or  to  be  their  expenses  for  medical  treatment.	They  work  at  kerbs  or  in  public  and  crowded  places  for 8-10 hours  a  day  without  taking  any  holiday  for  relieving  their  stress  or  exhaustion  from  hard  or  repetitious  work.  They  also  encounter  polluted  air,  dust,  strong  sunlight  and  noise  of  heavy  traffic.  So,  this  is  rather  risky  work  without  certain  income. 	As  for  their  belief  in  health  care,  they  believe  that  their  families  and  themselves  are  strong  at  this  middle  age,  so  they  are  not  aware  of  health  protection  or  improvement.   In  case  of  illness,  Most  of  them  buy  drugs  instead  of  seeing  a  doctor  for  saving  on  time  and  money  and  for  quicker  recovery.	Most  of  the samples and their  families  were  not  seriously  ill  during  the  past  year  but  they  suffered  only  from  headaches,  armaches,  legaches,  backaches, shoulderaches,  colds,  exhaustion  and  stress.   Yearly  expenses  for  health  care  are  ฿ 200-300 per  family.  More  than  half  of  them  have  health  insurance  but  the  48% remainder  have  not  because  they  know  nothing  about  health  insurance  schemes  or  think  that  such  schemes  are  not  worthwhile  because  they  have  never  been  ill  or  that  better  service  results  from  cash  payment,  not  from  the  use  of  health  insurance  cards.	As  for  their  problems  of  health  service  system  use,  those  having  no  health  insurance  must  bear  medical  expenses  or  borrow  money  if  they  are  seriously  ill.  Public  hospitals  are  open  only  during  official  hours  and  the  health  insurance  schemes  are  usually  publicized  in  announcements  or  leaflets  which  are  hardly  or  cannot  be  read  by  them.  Those  having  health  insurance  usually  face  problems  with  hospitals  being  provided  for  them  according  to  administrative  zones,  so  most  of  them  suggest  that  suitable  hospitals  should  be  chosen  in  not  only  the  social  insurance  schemes  but  also  these  health  insurance  schemes.  Moreover  they  can  willingly  make  additional  payment  into  the  health  fund  for  about ฿ 500 –600 a year.	The  guidelines  on  provision  of  health  service  system  for  hawkers,  garbage  collector  are  as  follows :	1.  Public  awareness  of  health  improvement  and  protection  must  be  more  stimulated  than  medical  treatment  which  finally  requires  high  expenses.	2.  Suitable  health  insurance  should  be  basic  health  service  system  being  provided  for  informal  sector  having  no  health  insurance.  It  should  be  the  same  rights  and  benefits  as  those  offered  by  the  schemes  of  the  poor  and  needy  relief.   The  expenses  of  this  basic  health  insurance  must  be  borne  by  the  government.  If  anybody  wants   more  rights  and  benefits,  e.g.  selection  of  hospitals,  treatment  for  chronic  diseases,  use  of  extra  drugs,  etc.,  should  be  offered  and  additionally  paid  for.  The  insurer  taking  good  care  of  himself/herself  without  using  health  service  of  medical  treatment  should  be  given  a  discount  for  continuous  insurance.  Besides,  the  health  insurance  schemes  must  be  fully  publicized  by  local health  volunteers  or  radio  and  television  programmes  for  creating  correct  understanding  of  health  insurance.


The Reform in Disease Prevention and Control	The authors present examples of damages and disasters caused by a panic of Plague in India, an epidemic of mad cow disease in Europe, an embargo on imports of seafood from epidemic-stricken countries. These damages are due to mistakes in using technical knowledge in the control and prevention of diseases. This report also points out that non-communicable diseases are important and require a lot of technical knowledge to tackle.	It is proposed that reform in disease prevention and control should be divided into two parts: intelligence and operational services.	Intelligence services an intelligence organization, namely Institutes for Heath Surveillance, should be set up to be independent of the Ministry of Public Health. It should be an autonomous body governed by a board chaired by the Minister of Public Health. The duties of the Institute are: to gather technical knowledge related to disease control and prevention, both domestic and international; to continuously develop the country database systems for monitoring communicable and non-communicable diseases; to cooperate with the international community; to conduct and support research projects on disease control, and to develop human resources. The institute must have proper strategies for management  that can coordinate resources among all domestic and international technical bodies. The institute must also be very efficient in mobilizing resources from all relevant sources. It is not necessary to have epidemiologists for all diseases, or regional branches or its own comprehensive laboratory. However, it should have budgets and the ability to make use of  academics in other institutions and to work with the network of laboratories in every part of the country efficiently.	Operational Services    The operation of disease prevention and control can be divided into two parts; firstly the clinical process such as immunization, screening, treatment and prevention of disease complications and secondly measures other than public health services, e.g. social and legal measures, improvement on safety and environment, regulation of industrial and agricultural products, etc.	The Ministry of Public Health should be responsible for disease prevention and control in the following areas: regulating rules, securing central budgets to support local needs, procuring supportive materials for local communities, providing special clinics for certain diseases, monitoring disease prevention and control activities.	Clinical control will largely be under the responsibility of the health services, whose quality is assured by hospital accreditation processes.  The Institutes for Health Surveillance would have to set standards for the quality of services related to preventive care, regardless of whether the service providers is private or under central or local governments control.