The research on Medication Management for COVID-19 Infectious Diseases: Problems and Obstacles to Public, Private Sector Procurement and Solutions aimed to study the problems and obstacles in procurement of COVID-19 medicines, such as vaccines. ATK, Favipiravir by government agencies and the private sector in Thailand through comparing the processes and criteria for procurement of such pharmaceuticals abroad and to study the improvement of the government's vaccine policy and management and the role of the National Vaccine Institute in providing emergency vaccines or to enhance the public and the development of a prototype vaccine, and to obtain recommendations for improving the government's vaccine policy and management in accordance with the outbreak situation. The findings revealed that 1. The COVID-19 outbreak has greatly impacted the public health, social and economic systems around the world. The virus can mutate and spread to people of all ages. As a result, the number of infected people around the world continues to increase until the end of February 2022, with more than 440 million people infected worldwide and 6 million dead. Many governments, especially high-income countries, have partnered with leading medical companies around the world to develop vaccines to stop the epidemic. The aforementioned circumstances and conditions allow high-income countries to have access to vaccines and medical supplies before poor and developing countries. High-income countries are also home to vaccine and pharmaceutical companies such as the United States, the European Community and China, as well as Russia. These countries can reserve vaccines and pharmaceuticals, in particular, Vector vaccines of AstraZeneca and mRNA of Pfizer and J&J, with the exception of China and Russia that use vaccines tested and developed by their own domestic companies such as Sinovac, Sinopharm and Sputnik V vaccines. The World Health Organization has adopted a standard for vaccines that can be used in emergencies. The policy of most governments around the world is to provide vaccines as quickly and as possible for any cost. While vaccines on the global market are limited and becoming scarce. As a result, the manufacturing company becomes the authority to set the price itself. 2. Compared with the COVID-19 vaccine procurement process, the United States uses a vaccine reservation method by contributing budgets to AstraZeneca and Pfizer for trials, research and development of vaccines on the condition that: If the vaccine trial is unsuccessful, a refund is not required. Most high-income countries similar to the United States, such as Canada, can reserve vaccines at nearly five times the population of the country. Singapore is undisputed by procurement laws and is able to pre-order vaccines in large quantities and quickly, even though they are not endorsed by the Health Science Authority. The Philippines is in a similar context to Thailand because there are restrictions under procurement laws and cannot pay upfront to reserve vaccines, unless the president exercises his or her authority to approve or “unlock” from such legal restrictions. Furthermore, the participation of the private sector and local governments in vaccine procurement and distribution makes it possible to procure vaccines faster than in Thailand. In the case of Thailand, it was found that in the first phase of the epidemic, the government was unable to provide vaccine procurement easily because of the limitations of the Government Procurement and Supplies Administration Act, B.E. 2560, which was not conducive and a lack of clarity in practice. The relevant government agencies were unable to immediately purchase vaccines and medical supplies. 3. As COVID-19 is an emerging disease that still lacks knowledge as well as around the world, problems and obstacles in the procurement of vaccines and medicines in Thailand result from laws being designed to operate under normal circumstances. For example, the Government Procurement and Supplies Administration Act B.E. 2560 (2017). It is a limitation that governments and relevant agencies at the operational level cannot procure vaccines and medical supplies in a timely manner. The essence of the said law does not allow the purchase of unstocked items and the result is not guaranteed, and the exact delivery date of the vaccine must be specified. Even after The Comptroller General's Department, Office of the Ombudsman, and the NACC, as well as the Office of the Council of State have discussed guidelines for government agencies responsible for purchasing vaccines and medical supplies. It is adhering to the guidelines for the Government Procurement and Procurement Management Committee's letter, No. Kor Khor (Kor.Wor.Jor.) 0405.2/Wor 115 dated 27 March 2020 for greater flexibility and agility in operations. Suggestions 1) The government should amend the Government Procurement and Supplies Administration Act, B.E. 2560 (2017) to be more flexible. It may adjust from the material matter according to the letter of the Committee on for the Government Procurement and Procurement Management Committee's letter, No. Kor Khor (Kor.Wor.Jor.) 0405.2/Wor 115 dated 27 March 2020 to be any section or additional specific section to increase flexibility for the staff working and create transparency and accountability. 2) Adaptation of medical and public health organizations to respond to emergencies Organizations and relevant agencies should manage knowledge (KM) through lessons and experiences from this COVID-19 crisis for adaptation to support emerging diseases in the future. 3) The government should prioritize on the National Vaccine Institute as a research and development agency and to coordinate and seek cooperation with agencies, international organizations to ensure Thailand's vaccine security to have enough potential to develop a prototype vaccine for use in case of emerging disease in the future. 4) The government should address the crisis when emerging medical diseases still lack knowledge, prevention and treatment methods by basing the safety and benefits of the people as the base of "educating academics leading to politics" and enhance transparency and confidence among the people through the concept of Open data, Open Government.


The study entitled “The Development of Appropriate Model of People Public Private Partnership for Managing on Primary Health Care” aimed to develop an appropriate partnership model among people, public and private sectors; examine the differing service models of primary health care administration; and synthesize information received in order to suggest guideline on appropriate partnership model among those three sectors for primary health care management. The result of this study suggested that partners engaged in the partnership model of people, public and private sectors for primary health care management included 1) public sectors including community hospitals, Tambon health promoting hospitals, local administrative organizations, and other relevant public organizations; 2) private sectors including companies and businesses based in Bangkok and local areas; and 3)community sectors including, temples, schools, and community organizations/ associations founded for specific purposes. Relationship between public and people sectors is similar to family members who are concerned about each other in any issue. Relationship between public and private sectors is like partners who seek to invest to produce something together. And relationship between people and private sectors could compare to friends who help each other. Contributing factors for the partnership model for managing primary health care management included 1) national policy related to primary healthcare such as family care team policy addressed in 2560 BE. Thai constitution, 2) strong health leadership, 3) homogeneous community, and 4) natural resource and man-made environment capitals and social capital. While hindering factors are 1) red-tape system, and 2) lack of human resource, budget, other resources for working, and knowledge. Processes of developing partnership among public and private sectors for primary health care management includes 1) developing relationship among partners, 2) building trust and safety to work together, 3) having continuing communication, 4) Empowerment each other, 5) strengthern and expand network, and 6) working together under their rules and committees. This partnership model could contribute to four dominant outcomes including 1) health outcome such as better access to health services at local level, 2) economic outcome when people could generate household incomes through various projects under this partnership, 3) environmental outcome such as raiseing awareness of natural resource conservation and the management of waste in community, and 4) learning and knowledge outcome when people learn new knowledge and skills to promote primary health care management. The following are the two broad policy recommendations that could support application of the partnership model among people, public and private sectors for primary health care management: 1) integration of the partnership model in District Health System (DHS) that could benefit primary health care in term of human resource, budget and other resources efficiently; 2) all related related stakeholders and their staff should acquire knowledge, skills and positive attitude toward partnership model among three sectors for primary health care management.


The development of policy recommendation: promoting health literacy for delayed progressive chronic kidney disease (CKD) of diabetes mellitus and hypertensive patients in the 4th public health region research was the research & development by using mixed method design. Health literacy concept of Nutbeam (2000; 2008; 2009), an integrated conceptual model of health literacy of Sorensen & et al. (2012), and health literate organization of Brach et al. (2017) were used as the conceptual framework in this study. Also, literatures review and evidence-base were integrated into the conceptual framework. Data were collected from diabetes and/or hypertensive patients with 3rd CKD, healthcare providers, and community networks or related group to delay progressive CKD in eight provinces of the 4th public health region that were Nakornnayok, Nonthaburi, Pathum Thani, Phra Nakhon Si Ayutthaya Lopburi, Saraburi, Singburi, and Aungthong. The study was divided into three phases within five purposes as follows: Phase 1 was situation analysis (R1) and included 2 purposes that were to: 1) examine the levels of health literacy to delay progressive CKD among diabetes and/or hypertensive patients, and 2) study the situation of health literacy promotion, CKD, and healthcare systems to delay progressive CKD in the 4th public health region.
Phase 2 was the period of the development and testing the model of promoting health literacy to delayed progressive CKD, and developing the prototype model of healthcare service to delayed progressive CKD in the 4th public health region (D1, R2, D2, R3). In phase 2, it covered two study purposes that were to: 3) develop and test the model of promoting health literacy to delayed progressive CKD among diabetes and/or hypertension, and 4) develop the model of health literacy to delayed progressive CKD system among diabetes and/or hypertensive patients in the 4th public health region. Phase 3 was the period of the development of the policy (D3). The study in phase 3 included one purpose that was to: 5) develop policy recommendation to promote health literacy to delayed progressive CKD among diabetes and/or hypertension in the 4th public health region.
The study instruments included both quantitative and qualitative tools. The quantitative instruments were 1) the health literacy to delayed progressive CKD in diabetes and/or hypertensive patient questionnaire, 2) the health literate organization promotion to delayed progressive CKD in diabetes and/or hypertensive patient questionnaire, and 3) the assessment form of self-management to delay progressive CKD in diabetes and/or hypertensive patents. All instruments were tested for validity by five experts and CVI were .97, 1.0, and .97 respectively. Cronbach’s alpha reliability were .94, .96, and .96 respectively. Qualitative instrument included 1) the semi-structure open-end question about health literate organization to delay progressive CKD for healthcare providers, and diabetes and/or hypertensive with stage 3rd CKD patients, and 2) the semi-structure question for related person and stakeholders who related to develop policy recommendation. The experimental instrument was the model of the promoting health literacy to delayed progressive CKD in the 4th public health region. Quantitative data were analyzed by using frequency, percentage, mean, standard deviation, multiple regression procedure, and pair t-test. Qualitative data were analyzed by content analysis which was interpretation, synthetization, and analyzation as reasonable criteria for developing inductive conclusion. Study results revealed as follows: 1. Average score of the health literacy to delayed progressive CKD of diabetes mellitus and/or hypertensive patients with stage 3rd CKD in the 4th public health region was at more levels (mean = 3.59, SD = .81). The most average score was the health decision aspect (mean = 3.85, SD = .81). The lowest average score of health literacy score was media literacy (mean = 3.45, SD = 1.02). Sex, ability of listening, sufficiency of income, receiving information from various sources, participating in health activities, receiving information by group, receiving various information channel, and having social role as a healthcare volunteer were statistically significantly on levels of health literacy to delayed progressive CKD at .00 - .05 (p ≤ .01 - .05). 2. Average score of health literate organization to delayed progressive CKD in diabetes and/or hypertensive patients with stage 3rd CKD was at the more levels (mean = 2.77, SD = 1.02). The most average score was the aspect of the participation in health literate organization to delayed progressive CKD in diabetes and/or hypertensive patients (mean = 2.83, SD = .93). The lowest average score was the organization and leader of organization aspect (mean = 2.73, SD = 1.09). The total scores of health literate organization to delayed progressive CKD in diabetes and/or hypertensive patients with stage 3rd CKD were at neutral level 46.96% (n = 54). The situation of the promotion of health literacy to delayed progressive CKD of healthcare settings in the 4th public health region were found among primary, secondary, and tertiary healthcare settings, however, they did not follow the concept of health literate organization. The major activities were health education. Healthcare providers did not know the meaning of health literate organization and the method to promote health literacy. Nevertheless, they can provide healthcare services to diabetes and/or hypertensive patients to delayed progressive CKD by health education both individual and group for the patient to modify their behaviors. Additionally, healthcare providers screened for CKD and managing the problems of the patients. Few healthcare providers received training of health literate organization. Healthcare providers would like the clear methods and guidelines to develop them to be health literate organization to delayed progressive CKD in the 4th public health region. Healthcare organization leaders and leading style included 4 methods as 1) doing health literacy before they ordered, 2) did not know policy of health literacy and did not doing anything, 3) they order us to do health literacy and I do as my understanding, and 4) they ordered us to do health literacy, and I can do it because they provided us the training of health literacy. Diabetes and/or hypertension with the 3rd stage CKD patients have less knowledge about CKD, and relationship between diabetes/hypertension and CKD because these patients did not experience abnormal symptoms and they cannot access, understand, and analyze reliable data/sources of health data. Patients would like the support to have health literacy to delayed progressive CKD through the specific care, easy to understand, reliability and sufficiency media to develop knowledge, understanding, and deciding for self-management to delayed progressive CKD. 3) The model of promoting health literacy to delayed progressive CKD among diabetes and/or hypertension in the 4th public health region. The program focused on the promotion of health literacy and self-management through the training for cognitive skills, behavior skills, and social skills. The model, also, included comprehensive health education, individual counseling, training for reading skill, communication skill, knowing important number, and media literacy skill. Also, training for self-management that included goal setting, problem solving, monitoring, motivation, and evaluation were conducted to modify health behaviors for controlling diabetes mellitus, hypertension, and delaying CKD. Patients can decide to choose suitable methods that were appropriate to their contexts (tailored made intervention). The use of health information and short message that fit to delay progressive CKD was added into the model. The patients were required to interact in all activities. The program used various media, communication technique, and good relationship between patients and healthcare team both in person, by telephone, and line application. The number of activities were nine times that included five times in healthcare settings, 2 times home visit, and 2 times telephone visit through seven months. After participating in the program, diabetes and/or hypertensive patients had average score of health literacy to delayed progressive CKD (t = 11.407), and average score of self-management to delayed progressive CKD (t = 8.041) to be statistically significantly higher than the score before participating in the program at 0.01 level (p< .01). Clinical outcomes that included body weight (t = 6.951), waist circumstance (t = 6.777), systolic blood pressure (t = 6.100), diastolic blood pressure (t = 8.617), fasting plasma glucose (t = 3.745), HbA1c (t = 3.838), blood urea nitrogen (t = 3.117), and creatinine (t = 5.089) were statistically significantly lower than those clinical outcomes before participating in the program at .01 level (p< .01). Additionally, glomerular infiltration rate (t = -8.216) was statistically significantly increased more than those before participating in the program at 0.01 level. Study sample, 138 patients can delay CKD (88.46%). Patients had average decreased renal function 5% as 1.70 (SD = 0.74), the same and increased renal function 5% as 2.84 (SD = 1.41), and increased renal function over 5% as 13.49 (SD = 10.69) respectively. 4) The prototype model of healthcare system to delayed progressive CKD in primary healthcare settings included ten characteristics as follows: 1) administrators took the concept of health literacy to healthcare system for delayed progressive CKD, 2) development of health literacy skill of delaying CKD for healthcare staff, 3) the use of healthcare service for delaying CKD should be integrated by the health literacy concept, 4) preparation of environment and channel that promote the access of information and service, and sign, 5) providing media and publications related to information to delaying CKD that were simple and easy understanding, 6) opening opportunity for patients and families to participate in healthcare system for delaying CKD, 7) development of health literacy skill of delaying CKD to population in community through home, temple and school, 8) communicate the clear healthcare coverage and out of pocket, 9) preparation the channel of transfer system for continuum of care, and 10) administrators participate in planning for modifying the system to delay CKD with network server continuously. For secondary and tertiary healthcare settings, there are four characteristics out of eleven differently form primary healthcare settings as follows; 1) the use of healthcare system to delayed progressive CKD by integrating health literacy concept in all settings, 2) setting the main team and channel to providing consult to primary client team network, 3) developing the database that support patients who would like to delayed progressive CKD, and 4) providing the chance to the administrator of primary client healthcare settings to participate in planning for improving the system of care to delaying CKD. The research results suggested that the healthcare settings both primary and secondary/tertiary levels that are network should modify the plan of system together for continuous and sustainable of care. 5) The promotion of health literacy to delayed progressive CKD was complex and being necessary to have strategic plan. Also, the progressive action and the cooperation of all related person among healthcare providers, patients, health administrators, communities, society, public health region, and Ministry of Public Health are needed. The various, clear, and continuous actions and specific model for the patient problems that fit the context of the patients are needed at the first diagnosis and suitable for the context, community, and society. Additionally, the adjustment of healthcare system and working culture of healthcare providers that focus on health literacy to delayed progressive CKD, patient center, effective communication, informatics system, and network are needed to be care for the patients systemically and continuously. Furthermore, all parts should cooperate to manage social determinant of health because it is significant basic to promote health literacy, particularly the support of people to have ability of reading, education base, life-long learning, and economic that lead people to have good living and caring for themselves. Also, the preparation of environment that supports health literacy to delayed progressive CKD should be action both in healthcare settings and outside as shown in policy recommendation documents.


Lung adenocarcinoma is the most often diagnosed cancer and the primary cause of cancer death worldwide. Chemotherapy for lung cancer is still main treatment. However, a response rate is very low. In this study, we aim to identify serum protein indicator for predicting response to a platinum plus anti-metabolite regimen through integrative analysis of transcriptomics and proteomics. Methods: A total of 27 patients with lung ADC (17 non-responders, NR and 10 responders, R) receiving a combination of carboplatin and gemcitabine treatment was included. For transcriptomic study, RNA was extracted from the frozen biopsy tissue of patients. Sequencing was performed on the Illumina/HiSeq2000 platform and differentially expressed genes were converted to proteins using UniProt database. For proteomic study, serum from 6 responders and 6 non-responders was subjected to the label-free liquid chromatography tandem mass spectrometry. Blood-based proteins reflecting the tissue-specific biomarker were obtained using Venn diagrams. Candidate proteins were validated by western blotting. Results: We found that 417 genes, including 52 up-regulated genes and 365 down-regulated genes were differentially expressed. In addition, we also showed that there were 26 up-regulated proteins and 5 down-regulated proteins. Based on integrative analysis, alpha-1-acid glycoprotein (A1AG1) and fibrinogen alpha chain (FIBA) were detected in both tissue and serum of patients, with a higher level in responders than non-responders. Additionally, serum expression level of A1AG1 and FIBA was shown to be link chemotherapeutic response. Conclusion: A1AG1 and FIBA indicating as tissue-specific biomarkers may be used for identifying ADC patients who would benefit from the platinum plus antimetabolite treatment.


Cancer is the first-leading cause of death in Thailand. Cancer is caused by gene mutations that control the cell functions in cell growth and division. The genetic mutation causing cancer can be divided into two broad categories based on the tissues of origins: somatic mutation and germline mutation. The germline mutation passes directly from parent to offspring which can be detected in every cell within the body. Cancers associated with germline mutations are called hereditary cancers. Most hereditary cancer patients have similar clinical symptoms and signs to sporadic cancer, it is difficult to distinguish the hereditary cancers for the benefit of preventing, treating and screening cancer in at-risk family members. In addition, hereditary cancers account for up to 12 percent of all cancer diagnoses. Thus, genomic medicine has the potential to make the diagnosis more accurate. This project aims to utilize genome sequencing technology to identify germline mutations and diagnose hereditary cancer syndromes among Thai cancer patients, this would also create an opportunity to build large genome database for future study of the cancer susceptibility genes and polygenic risk of cancer for Thai population. Moreover, this project has created collaborative network among medical schools, large university-affiliated hospitals and cancer centers to support and share experience, exchange knowledge, and facilitate the integration of genomic medicine in cancer care. Study by next-generation sequencing (NGS) found that approximately 16% of cancer patients participated in this study harbored germline pathogenic or likely pathogenic variants in various cancer susceptibility genes. This information was useful for further expanding to identify at-risk family members with appropriate cancer screening, early detection and prevention in the future. Genetic diagnosis, genome-guided screening and prevention of cancer were also cost-effective and would be a model of the implementation of genomic medicine in national healthcare system.


This qualitative descriptive study aimed to 1) assess impacts and resilience mechanism of prison, communities and related organizations in Bangkok during Covid-19 pandemic, 2) synthesize lesson learned for community resilience towards problem solving in the Covid-19 pandemic, and 3) synthesize policy recommendation for prison and community resilience through stakeholder participation. Methods included documentary review, brain storming (n=100), focus group interviews (n=55), observation, and in-depth interviews (n=60). Through purposive sampling with inclusion criteria, participants were selected from three opened communities including Klong Toei, Thawi Watthana, Yothi Medical Innovation District, and three closed communities including Workers’ camp, Klong Prem Central Prison, and Homeless Protection Centers. Data were collected via online or onsite and were analyzed using content analysis. Subsequently, 100 stakeholders provided suggestions on the draft report presentation. Results revealed that communities were positively and negatively affected by Covid-19 including impacts on health, surveillance, referrals and quarantine, access to healthcare, communication and social stigma, travels, food security, occupation, education, economic and social support. Mechanisms of community resilience included Acceptance of the situation, the infected patients returning to communities, and the diversity; Agility and Flexibility in thinking and responding to the impacts; Belief in capacity through volunteer; Competence; Desire to learn and change; Efforts to develop skill; Further forward, and Get and give support through social networks. To promote community resilience, there were components related to healthteam and organization “SCIENCE”: Sharing resources and experiences; Communication and Connectedness for referrals; Integration, Innovation, Information Technology; Empathy; Networking; Care; and Engagement. Lesson learned included 1) Infrastructure facilitating resilience: Primary care systems for prevention and control of Covid-19 along with care provision and rehabilitation that harmoniously linked with health service systems and Information Technology, particularly Community Isolation; 2) Social responsibility and mechanisms of community volunteer that accelerate access both in healthcare and health literacy necessary for community, health team, and related parties; 3) Equity in education, socioeconomic and rights; 4) Leadership and management with agility and flexibility, teamwork with networks aiming to develop innovation that solves problems in the Covid-19 situation through community based approach. Results suggest following policy implications: Bangkok Metropolitan and local organizations collaborate with Ministry of Public Health to consider arranging primary health care systems specifically for primary prevention of Covid-19 that takes less time and resources than treatment and rehabilitation as well as consider Covid-19 vaccine management. In addition, reducing density of community housing is suggested along with strengthening community. Bangkok Metropolitan collaborates with 1) Ministry of Education to systematically consider basic education including informal education, 2) Ministry of Digital Economy and Society consider to control reliability of information with a link of information technology system, 3) Ministry of Labor continuously to monitor labor standards and Ministry of Industry to control construction sites, 4) Ministry of Transport to control standards for Minibus, 5) Ministry of Social Development and Human Security and networks to improve quality of life of communities, 6) Ministry of Agriculture and Cooperatives to support long-term cultivation of basic edible gardens, and 7) Ministry of Commerce to distribute products with fair price thoroughly to the public. Ministry of Justice considers modifying infrastructure of prison to reduce population density and promoting Covid-19 literacy. Ministry of Higher Education, Science, Research and Innovation creates a knowledge development model. While communities collaborate with local organizations and networks to modify environment, promptly prepare community volunteers for surveillance based on epidemiolgical principle, and promote literacy for caring in community, aiming at preparedness and response to Covid-19 or new emerging diseases.


Mental health has direct effects on the well-being of those who are suffering from the problems as well as indirectly affects surrounding people. Although mental health care is essential there is a limitation in accessibility to mental health care. This is because of many reasons including the inadequacy of mental health professions. The implication of mental health technology is essential because it can increase accessibility and assist mental health professionals’ work. Mental health chatbot is one of the most appropriate mental health technologies as it is convenient to use and can be used anytime, anywhere with high privacy. Although it is one of the most convenient mental health technologies, there is a huge limitation in developing mental health chatbot. It requires technology experts, AI experts, software developers, and experienced psychologists to develop one chatbot. Developing a chatbot is also time and budget consuming throughout the process. As a consequence, it is practically challenging for mental health organizations to successfully develop mental health chatbots. For this reason, this project determines to solve this limitation by developing a tool to help mental health providers to be able to develop their own chatbots without coding, AI, or software development background. This results in increasing numbers of mental health chatbots which will increase mental health care accessibility, decrease mental health problems and reduce national mental health care resources and budget. This project runs from 1 4 February 2021 to 14 February 2022. There are 21 mental health organizations take part in this project. In total, there are 53 participant consist of psychologists and technician who develop mental health chatbots using this AI Psychological Intervention Open Platform as of the following; Completely developed and published 1. Bangkok Navy Hospital has developed BNH HAPPY NAVY chatbot on Line Official to provide service to Clients for Bangkok Navy Hospital. 2. Department of Education, Suan Dusit University developed SDU Wellness Center on Facebook Page Suan Dusit University developed SDU Wellness Center to provide service to Student for Suan Dusit University 3. The Demonstration School of Muban Chombueng Rajabhat University developed งานแนะแนว รร.สาธิตฯ จอมบึง on Facebook Page งานแนะแนว รร.สาธิตฯจอมบึง to provide service to student. 4. Psychology Department, Faculty of Liberal Arts, Thammasat University developed chatbot TCAPS center on Facebook Page TCAPS center to provide service to Student for Suan Dusit University for Thamamasat University. Development in progress 1. Nan Hospital is developing Nan Sook Jai chatbot on Line Official account to provide service to Clients for Nan Hospital. 2. Chiangrai Prachanukroh Hospital is developing NongHug on Line Official account 3. Mental Health Center 7 Khonkaen is developing Mental Health Center 7 chatbot on Line Official account to provide service to people are interested in mental health care. 4. Chiangmai Neurological Hospital is developing memory clinic CMNeuro chatbot on Facebook Page to provide service to Chiangmai Neurological Hospital Clients. 5. Chiang Mai University Demonstration School is developing Hoo Kwang CMUD chatbot on Facebook Page to provide service to Chiang Mai University Demonstration School Student. 6. Student Development Division of Chiangmai University is developing Sook Jai center Chatbot on Line Official Account to provide service to Chiangmai University Student. 7. Yuwaprasart Waithayopathum Child and Adolescent is developing ‘Grow’ chatbot on Psychiatric Hospital on Line Official Account to provide service to parents or caregivers who have child behaviour management. 8. Rajamangala University of Technology Lanna is developing Mental Health Care chatbot on Facebook page ดูแลสุขภาพใจ มทร. ล้านนา to provide service to Rajamangala University student. 9. Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University is developing chatbot to provide service to Clients. ( have not connected to the platform yet) 10. Institute of Aviation Medicine, Royal Thai Air Force is developing chatbot to provide service to Institute of Aviation Medicine officer (have not connected to the platform yet) 11. Suan Prung Hospital is developing chatbot to provide service to Suan Prung hospital Client (have not connected to the platform yet) 12. Department of Education, Chiang Rai Rajabhat University is developing chatbot to provide service to (have not connected to the platform yet) 13. Kanchanaburi Juvenile and Family Court is developing chatbot to provide service to youths who get a trail. (have not connected to the platform yet) 14. Medical Services Division, Department of Corrections is developing chatbot to provide service to inmates. (have not connected to the platform yet) 15. Faculty of Associated Medical Sciences, Chiang Mai University is developing chatbot to provide service to associated medical sciences students. (have not connected to the platform yet) 16. King Mongkut's University of Technology Thonburi is developing chatbot to provide service to King Mongkut's University Student. (have not connected to the platform yet) It can be seen that this platform has successfully increase the number of mental health chatbot in a short period of time which help saving resources including budget, time and human resources. Furthermore, a randomized control trial was conducted to examine the effects of mental health chatbot applying CBT in comparison to chitchat chatbot which were developed using this platform. Participants’ stress level was measured before and after taking part. 21 participants took part in the study ( control group n= 7, experiment group n = 14). Participants were asked to use the chatbot for 14 days. Results show that after using the chatbot, the stress level of both groups were decrease. However, as this is pilot study and drop out rate was high, further study is needed. Although generalizability of the result is limited, it is still be able to point out that chatbot develop using this platform is beneficial. Mental health organizations that take part in this project can potentially conduct further research with their target groups. Based on the 21 organizations reports the result of using this platform, although there are limitations such as workload, unfamiliarity with technology, high learning curve, but most of which are satisfied with the platform and with taking part in this projects. The reasons for such satisfactions includes excellent support from the team, user friendly experience, and practicality of the platform. They also suggest that the project should be extended to support participants longer as well as support more organizations. Given the project outcomes and feedback received from the 21 organizations that take part in this projects, researchers suggest that this project has a potential for continuous development and improvement. Such suggestion can be done by inviting more organization to develop AI mental health chatbot using this platform, collecting data to develop AI models in mental health area, creating appointment system as well as sharing data for mental health big data and ecosystem in Thailand.


The COVID-19 pandemic has a serious effect on community-based care for the elderly with diabetes in terms of the health promotion campaign, and continuity of Care. This study aimed to 1) study the situation and outcomes of modified diabetic care in the elderly (DCiE) during the COVID-19 pandemic, 2) develop and evaluate the DCiE system after the COVID-19 pandemic for primary healthcare centers (PMCs) by including the stakeholders involved in the development process, and 3) analyze proposed policy for the DCiE system during and after the COVID-19 pandemic. The mixed method methodology which consisted of the critical participatory action research and the survey research were utilized to conduct the study in order to compare the effects of the DCiE system during the pre-design, design, and post-design phases. One province of each of the 11th and 12th health regions was selected to participate in the study. The findings showed that the selected PMCs adjusted healthcare services during this pandemic situation as followings: 1) the extended follow-up appointment for elderly with diabetes based on their ability to control glucose levels, 2) the community-based chronic care focused on self-care management, and 3) the establishment of home delivery of medication based on their previous regimens. The DCiE system after the COVID-19 pandemic for PMCs integrated four significant components of the chronic care model as the followings: 1) The community resource 2) The process screening system 3) the knowledge and skills 4) the tool for two-ways health communication. The DCiE system was implemented throughout three interrelated subsystems which were 1) the new normal home healthcare system (Assess, Analyze, Implement, Improve) with the Thaichana-DM application, 2) the health information system for decision making, and 3) the integration of outcomes and outcome management. The effects of the DCiE revealed that 1) the mean capillary blood glucose at the postintervention significantly reduced, compared to the mean baseline (p <.001), 2) hemoglobin A1C levels at the post-intervention in the elderly with diabetes were lower than those at the pre-intervention (p < .001), and 3) the overall quality of life score among these participants was at the average level The policies were proposed 3 levels based on the significant findings of the study that consisted of 1) Upstream management, public health authorities in the area jointly developed health literacy in diabetes management focusing on clinical severity level analysis and decision-making with participatory and the prevention of COVID-19 for patients and caregivers by using a new-normal modeled home visit (2AI) 2) Midstream management, policy-level agencies in the province and local government organizations should support undertaken to have personnel with the ability to view health information systems covering both software and peopleware competency, and access to WIFI during home visits. 3) Downstream management, PMCs should monitor and assess clinical outcomes in the elderly with diabetes, covering the severity of clinical symptoms, and quality of life and continually develop plans. These proposed policies will be the supportive and driven mechanism for developing the effective DCiE system in both normal circumstances and the COVID-19 pandemic situation.


The objective of this study was to determine the risk factors during the perinatal and the first year postnatal period that were associated with metabolic syndrome at the age of 30 of offspring. Methods: We invited offspring whose mother had participated in a study of Chiang Mai Low Birth Weight Study (CMLBWS) in 30 years follow-up. History, physical exam, and blood sampling were collected to determine whether participants have metabolic syndrome. We analyzed the association between the perinatal-postnatal risk factors and metabolic syndrome (MS). The risk factors included the history of the small for gestational age (SGA), history of rapid growth in weight during the first year of life (catch-up growth), maternal body mass index, weight gain during pregnancy, gestational age, and maternal age. The Local Research Ethics Committee approved the study and participants gave written consent. Results: Three hundred and seventy mother and 418 offspring agreed to participate in the present study. Two hundred offspring were males and 218 were females. The mean age was 30.75 years old. There were 72 offspring (17.22%) with MS and 5 offspring were SGA (6.94%). There was no statistically significant difference in the incidence of MS between offspring with SGA (19.23%) and normal birth weight (17.09%) (p = 0.780). The percentage of MS in offspring with a history of catch-up growth and without catch-up growth was 22.22% and 15.83%, respectively. However, this trend was not statistically significant difference (p = 0.503). In addition, it was also found that other factors in mothers during the pregnancy had association with occurrence of MS in offsprings. Offsprings, who their mothers had a history of high body mass index, had an association with the occurrence of MS in offsprings than those without such history. Conclusion: Maternal body mass index of mothers during pregnancy were associated with MS. There was a none statistically significant trend between catch-up growth and MS. However, no association was found between birth weight and MS.


This study is a mixed method research, collecting quantitative and qualitative data in 2 districts of Yala, Pattani and Narathiwat province, in totally 6 districts. The study aimed to determine the roles of networking in primary care systems for screening and monitoring for covid-19 risk groups. Four hundred eighty-one people were collected the quantitative data using questionnaire about knowledge of practices guideline, roles of practice and the stratification of networks on screening and preventing the risk groups of covid-19. The data collection was arranged on January – March 2021. The qualitative data were collected in 270 people, using focus group and indebted interviews, running on April – December 2021. Quantitative data were analyzed using frequency and percentage, while qualitative data were used thematic analysis by Miles & Huberman (1994) conceptual framework. The quantitative results showed that most participants were middle aged with age between 36 and 45 years old, 31.2 percent. Following by, old aged was 28.3 percent. More than a half were female, 56.3 percent. The overall knowledge on screening and monitoring on covid-19 pandemic in risk group was in the high level (M=3.01, SD=.53). However each aspect of knowledge such as patient care and infection control, Monitoring of people exposed to COVID-19 and community control of COVID- 19 pandemic, and coordination and data management were rated as moderate (M=2.99, SD=.57, M=2.98, SD=.57, M=2.91, SD=.59). The scarification of roles and work on screening and monitoring on covid-19 in risk group was found a high level (M=3.29, SD=.50). The overall in roles performance for screening and monitoring of COVID-19 at risk groups was rated the high (M=3.19, SD=.51). Qualitative findings were presented in six themes: 1) role of networks in COVID-19 screening and monitoring, 2) facilitators of role performance, 3) factors influencing the spreading of COVID-19, 4) barriers for networking, 5) needs for better performance, and 6) outcomes of networking. The networks consisted of five principal organizations: health professionals, volunteers including village health volunteers, community leaders, religion leaders, and local governments. These groups of people unified their efforts in responding to the government policies and proactively implementing COVID-19 screening and control measures in these three southern provinces. These organizations created their new and voluntary role and combined these roles into their principal functions to respond to health needs of families and communities taking into account the unique cultural and religious contexts as well as ways of life. Dedicated religion leaders provided guidance on how health measures could be observed in accordance with Islamic principles.


Budsarakhum Hospital was a large field hospital specialized in providing temporary care for COVID-19 patients, where modern technology was used in providing comprehensive patient care according to referral and treatment standards addressing both physical and mental health. However, there are still few studies in the management system of field hospitals in Thailand. Therefore, it is necessary to study the body of knowledge that leads to the development of a field hospital management system in the face of a crisis other than COVID-19. This is qualitative research. The research objectives were 1) to study the current situation of the field hospital management system in the situation of COVID-19: A Case Study of Budsarakhum Hospital, 2) to study the problems, obstacles, and recommendations for hospital management systems in the Covid-19 Situation: A Case Study of Budsarakhum Hospital, and 3) to synthesize policy recommendations for the development of field hospital management systems. The researcher collected data by in-depth interview during December 2021 - January 2022. The purposive sample composed of 43 participants who were executives in policy level as well as executives from various departments, Budsarakhum Hospital as follows: Director of the Field Hospital under the Department of Medical Services; Director of University Field Hospital; Director of Private Field Hospital; Emergency Medical Specialist; Deputy Director of Budsarakhum Hospital; Secretary of Emergency Medical Department; Executive of Administrative Staff including nurses; Team Leaders of Referral, Loading, Caring, Treatment, Medical Emergency Response Team (MERT); Information Technology staffs; medical practitioners including doctors, nurses, pharmacists, and patients who have been already admitted to Budsarakhum Hospital. Data was collected through a semi-structured interview form developed by the researchers from the literature review and it has been consistent with the objectives. Content validity was checked by experts and to determine the reliability of the tool. The research team collected data from 1) Documents related to the operation of Budsarakhum Hospital, including: documents on the operating policy of Budsarakhum Hospital; hospital structure; processes of those involved, including executives, key and supplemental practitioners in all field hospital zones; as well as documentation related to performance outcomes in the field of COVID-19 patient care; 2) Information systems related to the operation of Budsarakhum Hospital such as news in various media, various announcements, websites, and Facebook related to Budsarakhum Hospital; 3) Sample groups were then analyzed using the content from all the data, in order to categorize and interpret the data according to research objectives as follows: 1. Field hospital management model in the situation of COVID-19 from the review literature and interviews with experts consisted of input factors, including structure, (i.e. location/objectives/hospital structure, setting up working group, team and responsibilities). The process aspect, including commanding/coordinating/control, inside and outside organization communication, emergency mobilization, information technology management, risk management, infection control, and medical record systems. Staff, including recruiting manpower, roles/responsibilities, orientation/training, staffing/scheduling, morale building, compensation and benefits. Supply, including financial management, handling of medical materials/devices. Process factors, including admission/diagnosis, screening clinical care, medical record/document system, continuing care/referral system, and psychological care. Outcome factors, consisting of outcome follow up. The management of Budsarakhum Hospital was consistent when compared to literature review and experts in the management model of field hospitals in the situation of COVID-19, except for emergency mobilization and the outcome follow up. 2. Problems, obstacles, and strategies of the hospital management system in Budsarakhum Hospital were found in various aspects, including hospital structure, communication outside the organization, risk management, infection control, recruitment, medical records system, personnel stress management, handling of medical materials/devices, admission, clinical care, patient referral system, and outcome following up. 3. Policy recommendations for the development of field hospital management systems consisting of staff, system, supply, and structure. Recommendations for Staff include: develop workforce plan of field hospitals in both the central and regional areas; train health care personnel to work in emergency situations; develop a system of volunteering from both the public, private, and public sectors; develop a system to increase health literacy for people to have basic self-care in emergency situations; study and research knowledge gained from field hospital services and develop innovations that support the management system of personnel and patient care in field hospitals; add disasters course to curriculum and practicum of health care students. Recommendations for System include: develop a field hospital practice manual which include inputs, processes, and  outcomes; establish the Public Information Officer; develop a system for monitoring health outcomes and voice of customers (VOCs); develop information technology system in field hospitals; develop cooperative human resource plan among government sectors and between the government and the private sectors. Recommendations for Supply include: establish cooperation policy in sharing medical devices between public and private hospitals in emergency situation; build networks with agencies and communities to participate and support the establishment of field hospitals. Recommendations for Structure include: develop a manual for the field hospital structure which consists of place of establishment, layout of the space, zoning, and command line.


Thailand is another country affected by the coronavirus disease 2019 (COVID-19) pandemic, which has affected the public health system and its economy. Therefore, it is important to develop cognition in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as quickly as possible. Therefore, this research aims to study the kinetics of immune response patterns after SARS-CoV-2 infection both mild and severe symptoms. The information on a kinetic immune response from SARS-CoV-2 infection can help to predict prolonged immunity. Understanding antibody responses after natural SARS-CoV-2 infection can guide the COVID-19 vaccine boosting schedule in this population. The objective of this study to assess the dynamics of SARS-CoV-2 antibodies, including anti-nucleocapsid protein (N), immunoglobulin (Ig)G, anti-spike protein 1 (S1) IgG, anti-receptor-binding domain (RBD) total Ig, anti-S1 IgA, and neutralizing antibody against wild-type SARS-CoV-2 in a cohort of patients who were previously infected with SARS-CoV-2. The research method starts with RT-PCR screening to confirm the results of SARS-CoV-2 infection and performs blood collection for immunogenicity testing at 3, 6, 9, and 12 months after the date of infection or confirm the results of infection to monitor immune levels by anti-nucleocapsid protein (N), immunoglobulin (Ig)G, anti-spike protein 1 (S1) IgG, anti-receptor-binding domain (RBD) total Ig, anti-S1 IgA, and neutralizing antibody ต่อ SARS-CoV-2 against wild type. The population studied and followed during the periods was as follows: 531 volunteers in the project were divided into 420 SARS-CoV-2 infected with mild symptoms and 111 SARS-CoV-2 infected with severe symptoms, divided into 269 males, and 262 females The average age is 38. The total specimens enrolled in this study are 968 samples, divided throughout sample collection. The following: 376 samples of 3-month periods after infection, 241 samples 6-month periods after infection, 207 samples 9-month periods after infection, and 144 samples 12-month periods after infection. The results showed that seropositivity rates began to decrease during the period 6 months after infection and started to decline continuously after symptom onset 6–12 months. The seropositivity rate was significantly lower at 6, 9, and 12 months than at 3 months (p-value < 0.05), especially in SARS-CoV-2 infected with pneumonia symptoms was showed higher seropositivity rate than in SARS-CoV-2 infected with non-pneumonia/asymptomatic group at 6 months (p-value < 0.05), 9 months (p-value = 0.04), and 12 months (p-value = 0.04). At 6, 9, and 12 months after infection, the anti-N IgG levels were significantly reduced. The seropositivity rates of anti-N IgG reduced by less than 50% 6 months after infection, while seropositivity rates of anti-RBD total Ig, anti-S IgG, and anti-S IgA still had more than 80% seropositivity rate. The immunogenicity levels among SARS-CoV-2 infected with severe symptoms were significantly higher than SARS-CoV-2 infected with mild/asymptomatic. At 12 months, the seropositivity rate among SARS-CoV-2 infected with mild/asymptomatic individuals in each method of examination found seropositivity rates as follows: anti-N IgG 21.5%, anti-RBD total Ig 87.0%, anti-S IgG 59.3%, and anti-S IgA 74.1%. The seropositivity rate in the SARS-CoV-2 infected with severe symptoms was found as follows: anti-N IgG 41.7%, anti-RBD total Ig 97.2%, anti-S IgG 91.7%, and anti-S IgA 86.1%. In some cases, the immunogenicity can be found prolonged for more than 12 months. Moreover, we found no significant difference between immunogenicity response and sex. In Elder (>60 years), the immunogenicity response showed significantly lower than in adults (≤ 60 years). These data on the natural history of SARS-CoV-2 antibodies will be useful for comparing and planning the future COVID-19 vaccination. Normally, SARS-CoV-2 antibodies in infected patients can be prolonged for more than 6 months and these patients may not be necessary to receive the COVID-19 vaccine within 6 months after clearance.


Coronavirus disease 2019 (COVID-19) is a contagious disease which cause by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. COVID-19 epidemic first appeared in Wuhan, China in December 2019. The World Health Organization (WHO) declared a Public Health Emergency of International Concern and then on 11 March 2020 announced as a pandemic. Since there is no specific drug and treatment, the use of convalescent plasma (CP) may serve as an alternative treatment for patients with COVID-19. This study aims to determine the effectiveness of CP therapy in COVID-19 patients with moderate to severe pneumonia. In our trial, 186 patients were enrolled including 111: male and 75: female, age of 21-91 years, and 49 patients completed the trial. The primary outcome showed 95% (177 of 186 patients) of patients were discharged, whereas 5% died. Among the 49 patients, clinical assessment was evaluated using by Chest-X-Ray, COVID-19 antibody levels and laboratory parameters. the kinetics of anti-nucleocapsid, anti-spike and neutralizing antibody level of 49 patients were significantly increased in 3-, 7- and 14-days post-transfusions respectively. Moreover, IFN-β, IL-6, IL-10 and IFN-α have significant difference among the groups. These findings indicated that most patients with low SARS-CoV-2 antibody titers tended to higher recovery rate after receiving high antibody-titre convalescent plasma. Nevertheless, we could not conclude that outcomes were entirely due to only CP treatment.


This qualitative study aims to develop the policy recommendation in order to support reform of roles of village health volunteers and Bangkok health volunteers for sustainable development goal. Specific objectives are defined as follows: a) to determine the alternative choices of roles reform, b) analyze and synthesize the policy recommendations about these criteria or guidelines, c) assess potential choices to support this roles reform in order to achieve the sustainable goals, and d) to propose development strategies for administrative authorities in supporting this reform process and implementation. Documentation reviews, case studies investigation, participatory action research and future search are deployed, in-depth interviewing and focus group discussion of all stakeholders and health volunteers were purposively recruited and actively participating in the data collection process. Their ideas or opinions are shared and coded into themes. Participants are village health volunteers and Bangkok health volunteers, community leaders, local authorities who support health volunteer work as well as others stakeholder in community health care system. A total of 800 participants were selected from 7 provinces; Nakhon Ratchasima, Chanthaburi, Kanchanaburi, Chiangmai, Roi-et, Pattani, Surathani and Bangkok Metropolitan Administration. The findings illustrated that present role of village/ community health volunteers align and reaffirm with Astana declaration 2018. Responsibilities are defined as follows; a) providing the service and integrate to essential primary health care, b) empowering of various sectors in driving policies and activities for good health, and c) empowering people and communities to take care of their own health. In presence, roles of being primary health care providers and public health work are predominated than other two roles which are influenced by policy from ministry of public health and need for community acceptance of village health volunteers themselves. However, the future roles could be shifted or up-skilled as community health care managers who can support and promote self-care in their community and perform as caregivers. In order to create behavioral change and improve quality of life as a whole by means of community participation and work collaboratively with local administrative authority. Acting as a leader in community health care teams, working together with family doctors and healthcare networks. Nevertheless, barriers and challenges that volunteers facing are listed as follows; lack of supportive medical devices, age of volunteers, accessibility to training courses for their competency development. In urban setting like Bangkok, district health volunteers have troubles in reaching their people due to acceptance. An important challenge is Thailand become an aging society, which creates a high demand for services such as long-term care from village health volunteer, and this factor is driving the change roles, operations and management. The results of the synthesis of alternative approaches to support the role of village health volunteers and Bangkok health volunteers in order to achieve sustainable development goals offer four approaches; 1) using same approach as Ministry of Public Health implementing (no change), 2) no change but add up or enhancing village health volunteers and Bangkok health volunteers’ power and competencies, 3) relocate village health volunteers and Bangkok health volunteers to work under local administration organizations, and 4) relocate to work under the management of the Prime Minister's Office with the Act to support the work of the village health volunteers and Bangkok health volunteers. The results of the alternative assessment revealed that the current model does not respond effectively to challenging problems. The ideal model is to change to work under the management of the Prime Minister's Office so that village health volunteers and Bangkok health volunteers can manage themselves. However, there is still a lack of law to support the operation. This research concludes that the implementation of the current guidelines with improvements to enhance the potential of the village health volunteers and Bangkok health volunteers Club of Thailand and village health volunteers and Bangkok health volunteers Club/VHV club at the local level for effective self-management could be an appropriate approach that will lead to self-management of village health volunteers and Bangkok health volunteers in the future. This research presents criteria for considering 7 alternative issues, namely; 1) government policy, 2) policy of the Department of Health Service Support, 3) having sufficient budget, 4) the competency of the village health volunteers and Bangkok health volunteers; 5) efficiency of the health care management of VHVs, 6) strengthening of the village health volunteers and Bangkok health volunteers club, and 7) promoting public acceptance. This research offers a preliminary approach to development to support reform of the role of health volunteers towards achieving sustainable development goals, consisted of; 1) accelerate self-assessment report and set up effective database of village health volunteer registration system, 2) strengthening village health volunteer clubs in all level coordinate as networking, 3) Supporting authorities such as department of health service support, ministry of public health and health department of Bangkok Metropolitan Administration should implement these operational strategies as follows: 3.1) support human capacity building for village health volunteers and Bangkok health volunteers by development plan with timeframe and coverage, 3.2) establish mentoring system for village health volunteers and Bangkok health volunteers via creating networking system, and 3.3) proactive public relations acknowledging health volunteers’ services in order to motivate and improve the roles’ of health volunteers, and lastly 4) local government administrations including provincial administration organization contribute budgets and support capacity building in order to improve their competencies and work more effectively to achieve the better quality of life of people in their communities.


COVID-19 vaccine has been an important measure to support sustainable control of the COVID-19 pandemic situation and has influenced policy decisions to relax other measures that hinder the development of the country socially and economically. Monitoring and evaluation framework for COVID-19 vaccination policy in Thailand is therefore an important tool for policy planning and mitigation in response to the COVID-19 pandemic. This study aims to understand the challenges in order to develop monitoring and evaluation framework for COVID-19 vaccination policy in Thailand. The main objective of this study was to develop an evaluative standard indicators which can be used to monitor and evaluate different aspects of the COVID-19 vaccine policy in Thailand. The specific objectives are: 1) to understand COVID-19 vaccine hesitancy situation among healthcare workers in Thailand; 2) to collect and collate any related indicators for the successful evaluation of the COVID-19 vaccination policy from the experience of ASEAN countries; 3) to estimate the budget required for the monitoring and evaluation of the real world effectiveness of COVID-19 vaccine; and 4) to develop monitoring and evaluation indicators for COVID-19 vaccination after their arrival in Thailand. Multiple research methodologies were employed to respond to the abovementioned objectives. Online survey was conducted to understand the issue of vaccine hesitancy among healthcare workers, foreign migrant workers, and the general public population. Additional field work was carried out for foreign migrant workers about their views on COVID-19 vaccine hesitancy. Multivariable regression analyses were executed to analyze the survey data. In addition, a scoping review on the monitoring and evaluation framework of other existing vaccines was conducted to understand the landscape of monitoring and evaluation frameworks used in other countries and settings. Moreover, the stakeholder consultations in Thailand and ASEAN countries were organized to obtain lessons learned and to disseminate the findings on resources needed in preparation for vaccine’s monitoring and evaluation program. The results showed that all study populations had some degree of vaccine hesitancy, particularly among healthcare workers. However, the study discovered that the level of hesitation subsided when the COVID-19 vaccines finally arrived in Thailand. Furthermore, foreign migrant workers were the least reluctant group compared to the healthcare workers and the general public. Significantly, the roundtable meetings among representatives of ASEAN countries emphasized the lessons learned on COVID-19 vaccination administration guidelines of each country including COVID-19 vaccine management guideline and vaccination assessment. In addition, the results of scoping review and stakeholder consultations suggested that the indicators for monitoring and evaluation framework can be summarized into three pillars: 1) vaccine coverage indicators; 2) clinical and operational indicators; and 3) operational indicators and others. Overall, the aim of this research was to provide evidence to support policy makers in planning for the post-vaccination period on vaccine hesitancy and indicators to support the monitoring and evaluation of COVID-19 vaccine. This research project uses COVID-19 vaccine as an example with hope that the findings may support future work for other diseases and in similar settings.


Background: Acute kidney injury occurs when the kidneys lose their function over hours or days. If a pharmaceutical intervention is not available, renal replacement therapy can play an essential role in increasing patients’ survival chances. Currently, there are four methods of renal replacement therapy, and the preferred method will depend on patients’ disease indications. One of the methods is known as a continuous renal replacement therapy (CRRT), which is already included in the universal healthcare benefits package under the Universal Coverage Scheme, covered by the National Health Security Office (NHSO). However, from the annual’ s stakeholder meetings held by NHSO, there were comments regarding access and reimbursement for CRRT. Objective: The objective of this study was to analyze the incidence, cost, and budget implications for critically ill patients with acute kidney injury requiring CRRT. Specifically, this study included a survey to examine the feasibility to provide CRRT services among hospitals in Thailand and a costing exercise to investigate the unit costs of such services in selected hospitals. Methods: This study included analyses of NHSO's e-Claim databases to inform the incidence of renal replacement therapy usage, and a budget impact analysis was performed from the perspective of the public health insurance system in a 5-year timeframe. Furthermore, The feasibility and service resources survey was conducted by sending surveys to more than 280 hospitals nationwide. Results: The results showed that there were between 3,540 - 6,049 acute kidney injury patients requiring CRRT annually in Thailand, and the cost of CRRT was between 57,502 and 116,890 baht per person. As for the five-year budget impact analysis, If we are referring to the number of patients who need CRRT services at 3,540 will be between 1,017 and 2,068 million baht. In the other case, if referring to the number of patients at 6,049, the budget impact will be between 1,739 and 3,535 million baht. From the stakeholder consultation meetings, there appears to be inadequate support for hospitals to provide CRRT. Moreover, the survey results showed that 88% of hospitals currently providing CRRT could treat more patients if the reimbursement rate for CRRT were to be adjusted to more appropriate level. Conclusion: Information from this study could support policymakers to update reimbursement rate and associated processes in order to improve accessibility to CRRT among critically ill patients with acute renal injury.


The situation of the COVID-19 pandemic affects the modification of the public and the private healthcare system. The new normal emergency care system for patients with stroke in public and private hospitals during the COVID-19 pandemic research project aimed to 1) review literature specifically addressing emergency care models for stroke patients during the COVID-19 outbreak, 2) develop a new normal emergency care model for this particular patient group, and 3) study the effects of this proposed model that were implemented in public and private hospitals. This research and development project integrated a mixed-method design that included a systematic review and quasi-experimental research. The research instruments were the checklist for evaluating the model and semi-structured interviews. Each one of the public and private hospitals in Trang were purposely selected to participate in the study. Forty participants were recruited including ten pre-hospital patients with acute stroke, two heads of emergency departments (EDs), four ED physicians, twenty ED nurses, and four emergency medical technicians (EMTs). The findings showed that the common emergency care model for stroke patients during the COVID-19 outbreak was divided into three phases. The first phase was prehospital care which consisted of telestroke, modified code stroke with CORONA protocol, and transport team COVID-19 specific ambulances. The second one was in-hospital care at the ED which included the OVID-19 screening protocol and protected strike code. The last one was hospitalization which was focused on universal pandemic precautions and isolation. The selected hospitals developed three emergency stroke guidelines for COVID-19 that were 1) the stroke fast track for stroke patients with PUI/COVID-19 infection, 2) the mechanical thrombectomy for stroke patients with PUI/COVID-19 infection, and 3) the stroke unit (SU) admission during the COVID-19 pandemic. Both hospitals developed the new normal emergency stroke care which differed from the pre-COVID-19 pandemic protocol. The main differences between pre- and poststroke care models were 1) universal prevention for COVID-19: patient isolation, mandatory mask-wearing, and personal protective equipment for health care personnel, 2) medication: do not use rt-PA for stroke patients with severe COVID-19 infection and coagulopathy and be aware of antiplatelet and antiviral drug interaction, and 3) use telemedicine for minimizing in-person contact. Three specific protocols were established following these considerations which consisted of 1) the COVID-19 stroke fast track protocol, 2) the mechanical thrombectomy protocol for patients with PUI or COVID-19 infection, and 3) the stroke unit admission protocol during COVID-19. After the proposed model was implemented in both hospitals, the results revealed that ninety-nine percent of the respondents agreed on the appropriateness and applicability of the model content and process. Moreover, the proposed model increased patient and staff safety and reduced patient mortality rates. However, the time from stroke symptom onset to emergency room arrival was longer than usual due to the procedure for putting on the full personal protective equipment (PPE). The problem and obstacle in implementing the proposed model was the limitation of the mechanical thrombectomy for stroke patients with PUI/COVID-19 infection because there were a few neurointerventional radiologists and nurses who could help physicians performing the mechanical thrombectomy. In addition, there was a lack of a training program for neurointerventional radiologists in Thailand. Per the findings, the proposed policies for all stakeholders consisted of 1) the training program development for neurointerventional radiologists, 2) the development of nurses' competency in performing specific procedures for stroke patients, and 3) the diminishment of delay in hospital arrival and stroke treatment.


This research aimed to study the problem of appropriate medical dispute resolution in Thailand. The issue between the social sciences and the medical sciences is a different science that must come together to find a solution when a dispute arises, i.e., a medical conflict. Each party has reasons to claim how fair they should be received in the probation process. Or is there any way to solve the problem? It is, therefore, interesting that What is the proper procedure for resolving medical conflicts in Thailand? Which method is best depends on different situations. What are the ways in Thailand? Further steps should be developed or taken to resolve Thailand's most impacting medical disputes. Therefore, the study of civil liability guidelines Guidelines for criminal and judicial proceedings of various physicians Dispute Resolution Methods Examples of medical treatment cases in Thailand led to the study of dispute resolution methods through group meetings in 5 areas: the North, the Northeastern region of Chiang Mai; Khon Kaen Province central area Phitsanulok Province Southern area, Songkhla province and Bangkok 2 times per area and in-depth interviews with experts in the field of medicine and public health such as doctors, nurses, etc., and people who have practiced the medical profession. Legal professionals such as judges or former judges. A civil servant or an officer of the Court of Justice, a prosecutor or former public prosecutor, Government officials or employees of the Office of the Attorney General or former police government officials or employees of Police professors of law schools of various universities and lawyers, etc., who are affected or may be affected by medical errors. Until guidelines and opinions are presented to guide the resolution of appropriate medical disputes in Thailand. So far, the process of criticizing medical arguments remains a mediation process that must continuously develop according to Dispute mediation act, B.E. 2562 (2019). There should be legal measures to establish a committee. A pre-litigation committee and court to help prove the nature of a medical case that is more acceptable to all parties.


Background: Favipiravir is an antiviral agent, mechanism of action is selective inhibition of RNA-dependent RNA polymerase and maybe effective against the SARS-CoV-2 virus. While no established treatment for COVID-19 is available, epidemiological studies conducted to date suggest a risk of further increase in patient exposure in the future. Therefore, to verify that the efficacy of Favipiravir exceeds that of the supportive care (symptomatic therapy) in mild SARS-CoV-2 infected patients (COVID-19 patients) without pneumonia, using the time required to improve clinical symptoms as the primary endpoint and it will contribute immensely to the improvement of public health in the future. Methods: To verify that the efficacy of Favipiravir exceeds that of the supportive care (symptomatic therapy) in mild SARS-CoV-2 infected patients (COVID-19 patients) without pneumonia, using the time required to improve clinical symptoms as the primary endpoint. In the case of chest imaging, no new findings and turning negative in the RT-PCR test with nasopharyngeal swab were set as the primary endpoints. Since this study is an open-label study, 96 patients to be enrolled all of the following inclusion criteria. (2:1, 64 in Favipiravir group with 1,800/800 mg twice daily) for 5-14 days and 32 in control group) The treatment period is 5 -14 days in principle and 10 patients in a clinical pharmacology study of Favipiravir. Results: This study examine the superiority of treatment of Favipiravir adding to the supportive care for mild COVID-19 patients without pneumonia, compared to those treatments without Favipiravir, to efficacy improve clinical symptoms with using NEWS Score, the treatment period is 14 days , in Favipiravir group have improved clinical symptoms rate 79% and in control group rate 32.3%. (p=0.027) Half of those treatments with Favipiravir have improved clinical symptoms on Day 2. As for in control group have improved clinical symptoms on Day 14 (p<0.001) Therefore, efficacy of Favipiravir to improve clinical symptoms than the control group. Conclusions: Coronavirus disease 2019, treatment with Favipiravir 1,800 mg is orally administered twice on Day 1, and then 800 mg is orally administered twice daily on Day 2 when you have mild symptoms.


Importance: Intradermal administration of SAR-COV-2 vaccines may be the alternative route for vaccination in resource-limited settings. By given lower amount of exposed antigen, the one-fifth of regular dose via intradermal administration (ID) had shown similar immunogenicity and less systemic adverse reaction comparing to intramuscular administration (IM). Objectives : To determine adverse events (AEs) and immunogenicity of intradermal administration of primary series and booster dose of CoronaVac, ChAdOx1 and BNT162b2 in healthy population. Design: This prospective study was conducted from September 2021 to February 2022. Setting: A single center, university-based tertiary care center in Bangkok. Participants: A total of 140 healthy volunteers were 80 SARS-Cov-2 vaccine-naïve and 60 volunteers who completed primary series of IM CoronaVac, ChAdOx1 or BNT162b2. Exposure: In vaccine naïve volunteers, they were divided into 5 groups to receive following regimens (4 weeks apart): 1) ID CoronaVac 0.1 ml and ID ChAdOx1 0.1 ml (n=20); 2) ID ChAdOx1 0.1 ml and ID ChAdOx1 0.1 ml(n=20); 3) ID BNT162b2 0.05 ml and ID BNT162b2 0.05 ml(n=20); 4) IM ChAdOx1 0.5 ml and ID ChAdOx1 0.1 ml(n=10); 5) IM BNT162b2 0.3 ml and ID BNT162b2 0.05 ml (n=10). In volunteers who completed primary series, they were given ID ChAdOx1 0.1 ml or ID BNT162b2 0.05 ml as a booter. Main Outcomes and Measures: Self-reported AEs were collected for 7 days following each vaccination using electronic diary. The immunogenicity was determined by the level of IgG antibodies against receptor binding domain (RBD) of the SARS-CoV-2 spike protein (S1 subunit). The plaque reduction neutralization tests (PRNT) and Focus Reduction Neutralization Tests (FRNT) against original (Wuhan) and circulating VOCs were performed in subset of random samples at 2 weeks after the second dose or booster dose. The T-cell response was measured using ELISPOT. Participants who had positive anti-np or anti-RBD-IgG at baseline were excluded from analysis.
Results: Among 67 vaccine-naïve participants, the median (interquartile range: IQR) age was 34.5 (24.5-44) years old and 48.75% were female. Participants who received the ID administration reported less systemic reaction (58%) than the IM administration (80%). Immunogenic response following IM BNT162b2-ID BNT162b2 provided the highest IgG level with geometric means of 13,427 AU/mL and GMT 23.05 against omicron strain followed by ID BNT162b2-ID BNT162b2, ID CoronaVac-ID ChAdOx1, IM ChAdOx1-ID ChAdOx1, and ID ChAdOx1- ID ChAdOx1. A total of 58 participants were enrolled and received third dose booster. Their median age was 43 years old (IQR 35-48) and 67.24% were female. The geometric mean ratios (GRM) (post boosted/pre boosted) of ID BNT162b2 and ID ChAdOx1 following CoronaVac primary series were 33.83 and 24.89, respectively. GMRs of ID BNT162b2 and ID ChAdOx1 were 7.90 and 1.29 following primary series of ChAdOx1 and were 2.40 and 0.97 following primary series of BNT162b2. The third dose ID booster of BNT162b2 provided higher GMT against omicron and delta variants following primary series of ChAdOx1 and BNT162b2; however, ID ChAdOx1 showed higher GMT against delta and omicron following primary series of CoronaVac. Conclusions: Intradermal administration of SAR-COV-2 vaccines show less systemic adverse reaction and can increase both humoral and cellular immunogenicity. Immunogenic response following ID BNT162b2 in both vaccine-naïve participants and for booster dose are better than ID CoronaVac and ID ChAdOx1.


The coronavirus disease 2019 (COVID-19) pandemic has impacted on health and well-being of the population, particularly vulnerable groups. The purposes of this study were to explore health impact of COVID-19 regarding public health measure on people with visual impairment in Bangkok, to analyze factors affecting the impact, and to make recommendations to support visually impaired people in the situation of COVID-19 outbreak. A cross-sectional survey was conducted. Questionnaires were used to collected data between June and July, 2021. A combination of purposive and snowball technique was applied to select 140 visually impaired people to the study. Data were analyzed using descriptive (percentage, mean, standard deviation) and inferential statistics (ANOVA, t-test, chi-square). Findings revealed that the outbreak and public health measures affected visually impaired people’s daily lives, occupation, and economic and emotional stress. Moreover, they faced difficulty in using public services due to social change in the new normal era. However, the government’s measures in response to the impact of COVID-19 on visually impaired group were not inclusive in design. For instance, there was a lack of system to support the constraints of the visually impaired, and health communication was inappropriate in terms of format and channel. The government should show empathy and implement comprehensive policies for visually impaired people with empathy, such as improve access for public services, improve access to health care services, as well as increase access to COVID-19 vaccine.


The National Strategic Plan on Antimicrobial Resistance 2017-2021, which is Thailand’s first strategic plan addressing AMR issue, was endorsed by the cabinet in 2016. After halfway through the strategic plan’s implementation in 2019, a mid-term evaluation was conducted to assess the progression and develop recommendations for the next step. In this evaluation qualitative approach, including document review and in-depth interview were conducted during July to October 2019 and September to November 2019, respectively. It is suggested that the strategic plan conformed to the One Health principles and provided clearer guidance for management of AMR problems. The governance structure from the national committee, subcommittees, working groups, and coordinating team for each strategy, had a high contribution to the work progression through strong collaboration between respective organizations. Most of the activities were operated as planned. However, the evaluation showed lacks of participation efforts from some government institutes. The important factors that affected the implementation of the national AMR strategy included budget availability, executives at ministry and organizational level, coordinating personnel for each strategy, sufficient supporting knowledge, and clear framework for operation. It also found that despite well-defined monitoring and evaluation mechanisms, ineffective surveillance systems and databases were identified as crucial limitations. Moreover, many of the activities under the strategic plan needed to be improved especially those responsible by the organizations relatively new to the AMR management measures. For these organizations, persistent supports in terms of budget, capacity building, academic, and executives’ cooperation were recommended.


The Government Procurement and Supplies Management Act B.E. 2560 (2017) was published in the Royal Thai Government Gazette and has become active with government organizations since August 2017. The act allows the purchase of drugs and medical supplies to consider the price and other attributes of performance in decision-making. There has been a development of other price performance by applying multi-criteria decision analysis (MCDA) or price performance-MCDA criteria. The objective of this study was to assess the practical feasibility, problems and constraints in introducing the price performance-MCDA criteria in the practical work process. This study was a research and development. The sample group was eight pilot hospitals. Purposive sampling was performed by selecting the hospitals under the Ministry of Public Health (Office of the Permanent Secretary and Department of Medical Services), the Ministry of Defense, and the Ministry of Higher Education, Science, Research and Innovation. Researchers then organized a meeting to inform the participants about the price performance-MCDA criteria. The participants selected three sample drugs from the list of study drug groups. The results showed that 1 hospital was excluded because non-readiness to apply the criteria, and 7 hospitals exercised price performance-MCDA to evaluate drugs but not used in the purchasing process. Some hospitals adjusted the price and performance ratio for scoring and some did not adjust. Comparing the evaluation results by the price performance-MCDA criteria to current hospital criteria in 4 hospitals, 66.7% showed consistent results (2 out of 3 items). Furthermore, the comparison between price performance-MCDA criteria and current hospital criteria found that most of the similar issues were as follows: quality of manufacturing and quality of products. However, there were different concerned criteria such as experiences in using the drugs and drug availability on the list in a teaching hospital; drug specification including packaging and labelling for reducing medication errors; research data in supporting quality and efficacy of drugs; and the ethical training on drug promotion. The results found that most pharmacists who participated in the present research using price performance-MCDA were satisfied with these criteria, particularly in terms of driving the improvement of drug quality. Problems and constraints encountered in this study included understanding the details of each criterion. In summary, the results indicated the possibility of applying the price performance-MCDA criteria, but the criteria may need to be adjusted when implemented.


This study aimed to review the school food and nutrition (SFN) policy recommendations from international organizations and the SFN policy and practice in Thailand. Policy documents were collected from the Office of the United Nations High Commissioner for Refugees (UNHCR), the Food and Agriculture Organization (FAO), World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and related organizations in Thailand such as ministries of education, public health, agriculture and cooperatives, and Thai Health Promotion Foundation. Documents were analyzed based on the SFN framework, consisting of four key components; 1) healthy food environment and school food, 2) food and nutrition education, 3) inclusive procurement and value chain, 4) enabling policy, legal and institutional environment. Forty-two policy recommendations have been suggested, such as the development of a national strategy for food and nutrition in school, control of unhealthy food marketing, supporting use of local food produce for school meals, encouraging community engagement, promoting food and nutrition role models among teachers, and management of conflict of interest among involved stakeholders. Thailand has followed 34 out of 42 recommendations, such as, free school lunch, child nutritional standard, Thai School Lunch program for sustainable provision of school food, and other food and nutritional promotion programs in school. However, future SFN policies should be developed on the food/nutritional literacy among school children, teachers, and parents, conflict of interest management among involved stakeholders, and the health promotion in particular food and nutrition for all personnel in schools. Furthermore, existing SFN policies need to be strengthened, for instance, the inclusive school lunch, law and regulation to control unhealthy food marketing in school, and SFN policy monitoring and evaluation. The present study of international recommendations should be further used to guide the future SFN policy and practice in Thailand.


This analytical observational study aimed to investigate relationships between factors and contribution payments for the sickness benefit among insured workers under the Social Security Act’s Article 40 who had been registered for 3–5 months on December 31, 2019. The data used for the analysis came from 53,556 insured workers who registered with Article 40 between August – September 2019. Descriptive statistics and binary logistic regression were used to describe the overall data and investigate the relationships among the studied factors. The analysis showed that age, occupation and registration channels were significantly associated with the contribution payments to fulfill the sickness benefit, while sex, income, contribution amount and benefit options were not. Those aged 25–34 years, in service works, working in machinery factories, and registration channel through a community based - social security agent had an increased chance of losing the sickness benefit compared to their counterparts. These results suggest strategic targeting the insured workers under Article 40 to ensure access to continuous sickness benefit of the social security system.


Due to the global pandemic of coronavirus disease (COVID-19), the World Health Organization (WHO) decided to hold the 73rd World Health Assembly the first online meeting. The objectives of this study were (1) to review the online assembly and Thailand delegation’s online participation, (2) to analyze the advantages and challenges of online meeting and (3) to analyze the factors contributing to the success of the Thai delegates. The methods of this qualitative study included reviews of relevant documents, participant observations of the Thai delegates throughout the assembly meetings and opinions collection from the Thai delegates. The results showed that the 73rd World Health Assembly consisted of 3 sessions: (1) virtual de minimis – the concise virtual meeting, (2) intersessional session and (3) resumed 73rd World Health Assembly; all these sessions were participated by the Thai delegates. The online meeting was convenient as the delegates were able to connect to the meeting from anywhere with a good quality internet network. However, there was a challenge in terms of time zone difference that Thai delegates needed to attend the meeting at night and to continue their normal office hours. The factors contributing to the success of the Thai delegation were teamwork, systematic working process and adaptabilityof Thai delegates.


Article 27(3) of the National Health Act 2007 mandates the Office of the National Health Commission to conduct surveys, studies, and analyses of various data related to health systems of the nation. To assist the implementation of the National Health Act 2007, this study was conducted to assess the state of desirable Thailand health systems using a set of desirable health system indicators and to identify gaps in health system requirements. This study analyzed secondary data and conducted interviews with key informants and experts in the field to assess the status of each indicator and identify gaps in meeting the targets. This study focused on the articles of health promotion activities represented by the incidence of HIV infection, premature mortality from four major noncommunicable diseases. The articles on disease prevention included road traffic mortality and air pollution-attributable mortality. The articles on health hazards control included health systems capacity and emergency preparedness according to the International Health Regulations. The findings demonstrated the relationship between global commitments and the governance of Thailand health systems. The appropriateness of various indicators was determined by local knowledge as well as the ability to track the performance of local policies. The study findings suggested the creation of indicators should incorporate the Sustainable Development Goals both locally and regionally.


This mixed method research aimed to learn lessons leading to policy suggestions from the implementation of surveillance, prevention and control of Coronavirus Disease 2019 (COVID-19) pandemic in communities by village health volunteers (VHVs) in the north-east, Thailand. The lessons were extracted through a 5 steps process; project preparation or definition, data collection, verification and synthesis of data, storage of data and dissemination of learning. The sample size consisted of 207 VHVs from 8 provinces of health regions 7, 8, 9, and 10. Data were collected by 16 focus group discussions (12-13 members in a group) and a questionnaire survey based on practice guidelines for VHV on surveillance for COVID-19 as defined by the Department of Health Services Support, Ministry of Public Health. The questionnaire validated by 3 experts and achieved a reliability score of 0.94. The quantitative data were analyzed by descriptive statistics and qualitative by content analysis. Quantitative analysis, found 97.6% of VHVs respondents performed searching and screening of high risk groups, 89.4% conducted home visits to follow-up on sign and symptom, 87.0% prepared themselves for protection, 86.0% created performance reports and 84.5% consolidated reports of high-risks groups under observation. The VHVs were under the top-down guidance of the district-level Department of Disease Control’s policies. The qualitative analysis revealed that the VHVs were an integral part of village-level prevention strategy. The VHVs took steps to ensure self-precaution while visiting houses similar to disease control officers. The VHV also communicated with villagers regarding risks, disease knowledge including distributing protective equipment. The VHVs continuously reported to the local health professionals via LINE groups and other applications. The success of the project was attributable to the local VHVs and their dedication including their volunteer compassion, in addition, cooperation between networks and the communities, support, and monitoring. However, limitations were the knowledge, skills, technology including lack of clear operation guidelines, insufficient protective equipment, levels of cooperation between networks and citizens. Therefore, policies suggestions were on development of management infrastructure, capacity building of VHVs potential and knowledge, guideline and operation handbook, management of information technology and the network integration.


This research focuses on redesigning employment models and employment benefits in order to retain civil servant healthcare workforce. The research leverages the process of design thinking or human-centered design as a methodology. The target users of the redesign exercise in this research are 1. physicians, 2. dentists, 3. pharmacists, and 4. nurses. Taking into consideration the systems perspective of this research, the research team has also involved employers and relevant policy makers throughout the process. Starting with in-depth interviews of the stakeholders, the research team has come up with five potential employment models for further adjustment and consideration in employing future civil servant healthcare workforce. The five models are: 1. Flexible employment scheme: providing a more flexible part-time positions for healthcare workforce in city hospitals 2. Part-time employment with private sector benefits: providing private sector employment and benefits for healthcare workforce outside the civil service working hours 3. Employment through healthcare districts: providing more flexibility in handling healthcare workforce and resources by shifting the employer role from the hospitals or healthcare centers to the healthcare districts 4. Employment through non-government health units: extending civil servant health employment to cover employment in selected non-government health units, and 5. Redesigning employment restriction: allowing employers to manager their own lumpsum funds rather than strictly allocating the fund per head The research team recommends that a healthcare regulatory sandbox should be set up to design and test some of the proposed redesigning of the employment schemes so policymakers can gather feedback and leverage on the learning to revise and replicate effective schemes and models in a larger context.