Radiation therapy, an essential treatment for cancer, has been concerned over the recent years due to its enormous investment in both high technology medical devices and various specialists.  Anecdotal observation found inappropriate distribution of radiation therapy resources across the country which led to inefficient use of health care resources and possibly under-standard treatment in some radiation therapy units (RTUs).  A lack of evidence-based planning on health care services is supposed to be the major cause.  Thus, this study aims to demonstrate the current situation of radiation therapy comparing with expressed health needs and access to radiation therapy services of cancer patients.  This will bring about the policy recommendations on how to invest and distribute health care resources according to health needs.  The goal of this study is to improve efficiency of health resource utilization and equitable access to health services by using radiation therapy as the case study. Both quantitative and qualitative methods were employed in this research.  A census of 25 RTUs and 72 radiation therapists were conducted.  Cancer patients and some radiation therapists were interviewed by using semi-structured questionnaires.  Moreover, document and content analysis were also used.The results reveal that lacking of human resources, both radiation therapists and medical physicists, are more serious problems of the MOPH radiation therapy services than the shortage of radiation therapy devices.  The finding illustrates that no radiation therapy unit of MOPH passes the minimal standard amount of radiation therapists, whilst only 20% of them passes the minimal standard amount of medical physicists.  Moreover, access to radiation therapy services are inequitable among cancer patients.  Cancer patients in remote provinces tend to have poorer access to health care than those in RTUs neighboring provinces.  Factors influencing not access to radiation therapy services are physical barriers, and financial barriers in terms of medical care costs and transportation expenditure.  For socio-economic status, most cancer patients are the elderly and poor without doing any jobs.  Quality improvement on radiation therapy services as well as adequate vital human resources (radiation therapists and medical physicists) are urgent issues which the MOPH has to solve.  In the long run, the national plan of radiation therapy system which determines the amount, proportion and distribution of principle, advanced, and excellent radiation therapy centers have to be made.  For improving access to care, the improvement of health insurance coverage and the provisions of financial support for transportation are  better policy than investment in the new radiation therapy units.


This study explore grievance and compensation systems in the major public health insurance schemes, namely the Civil Servant Medical Benefit Scheme ( CSMBS ), the Social Security Scheme ( SSS ), the 30 Baht Scheme, and the Compulsory Car Accident Insurance Scheme.	The Servant Medical Benefit Scheme ( CSMBS ) has practically no grievance or compensation systems. However, its fee-for-service payment scheme coupled with eligible member’s rights to choose their ( usually public ) providers help making the scheme less susceptible to substandard care experienced in other scheme that pay providers mainly on capitation basis. The Social Security Scheme ( SSS ) was the first public health insurance scheme that set up a formal grievance system. The grievances are usually sent to the SS’s medical committee. If the committee decides that the provider is at fault, it will also recommend the penalty. The penalty ranges from warning, probation, reducing the ceiling number of insured patients, to termination of contract. However, the vast majority of grievances were lifted on the ground that they were caused by miscommunications or patient’s misunderstandings. The 30 Baht Scheme although the intention of such a compensation scheme is to provide relief/settlement that would curb the increasing trend of medical malpractice suits, medical associations view it as a vehicle that would lead to more lawsuits ( or at least complaints ) and have fought vigorously against it. Thus far, there is no convincing evidence to disprove either claim. As a result of the fighting, the scheme is now equipped with regulations that, if strictly interpreted, would allow only compensation to substandard or malpractice cases. In practice, however, many ( provincial ) compensation subcommittees still use the regulation’s ambiguity to interpret it in such a way that they could provide compensation to some other cases based on humanitarian reasons. The Compulsory Car Accident Insurance Scheme is private insurance based and is therefore using the same grievance and arbitrator systems as present in other private insurance schemes.


This study is a survey of the use of water supply by the Provincial Waterworks Authority among  resident villagers in Ronphibun subdistrict. During March-September 2003, 501 households were surveyed. The computerized data of piped water use from the Nakhon Si Thammarat Piped Water Office were extracted for the year 1999-2002 and were linked together with a survey data. The objective of this study is to evaluate the amount of piped water use per capita and per household, to evaluate the adequacy of piped water supply and to identify the factor associate with piped water use. The results revealed that piped water was used for drinking in only 5% of households and cooking in 32%. Piped water was mostly used for other consumption purposes (>90%). The total amount of water use was 89, 134 and 147 liters/person/day, respectively. The amount of piped water use depended on year of use, urbanization, household’s characteristics, owner status, satisfaction of the price and storing rainwater for using. The study showed that piped water use was highest in the year 1999 and village 13. The amount of piped water use was higher in single houses, owned houses or government accommodations, households with more than 3 persons, dissatisfaction with piped water price and storing rainwater for using.	In conclusion, the trend of piped water use among villages 2, 12 and 13 was and not high. Piped water from the Provincial Waterworks Authority was adequate. Urbanization, type of household, number of members in household, price of piped water satisfaction and use of stored rainwater influences the amount of piped water use.


The Participatory Learning of Alliance of Agricultural action to reduce pesticide using: case study in Phichit province	The opjective of this qualitative was to analysis a condition at situation, factors and system procedures affecting to abate the chemicals of agriculturist. To pick and choose 3 village in 3 subdristric of Phichit Provinec were the case study . Data were collected from the leader of villages, the leader of agriculturist, and a member of villages, using interview, observation and focus group discussion, in conjunction with the questionair. The data were interpreted and analyzed in accordance with the related literatures, theories, and narration . The detailed conclusions were introduced in form of report and the procedures for the scheme were also established.	The overall conclusion and procedures for affecting to abate the chemicals of agriculturist are as follows; Predisposing factors.To check a health of agriculturist by public health offices were to have an allergy on majority of agriculturist whom to do chemicals of agriculture, to cure a sickness always.To lose from capital of agriculture that to do chemical agriculture but price of produce to be lowly.The leader of agriculturist to training about the natural farming from government service and mon-government oganization, to training the agriculturist.An agriculturists to training about the matural farming and non-chemical agricultuer, to be convinced in effective of non –chemical agriculture.Enabling factor.The government service  and non-government oganization to support the capital and technique. An agriculturists to be participate of the learning process with the government service and non-government organization.Communication : make an agriculturists have good relationship and good understanding to one another, which leads to good incorporation in the development scheme. The quality of population are likely to have potential in self-learning and self-development, which, consequently, will influence other to seek for more development. The leader of agriculturist to be complete at the natural farming and non-chemical agriculture.The proposals of this qualitative researchThe promotion to selling or publicized of non-chemical agriculture should be search to change agents in community.The learning process ought to small group for interactive learning : the first, An interactive learning through action were to be considure.Non chemical agriculture were to increase by paticipate of agriculturist network to change the knowledge and technology to be consistent.The government service and non government organization should to increase in learning process development  the capable of change agent. The public service should be promote and development of participatory leaning process and skill to the public servant; sub-district agriculture, teacher, public health officer.The future ; should be research the appropriate process to search change agent and planing to promote non-chemical agriculture by integrate economic, society, and environment.


The objectives of this study are to review and analyze the standard setting processes both in Thailand and overseas, in order to propose recommendations regarding the appropriate and practical process for Thailand. The methodology included literature reviews both in relevant documents and Internet searching, in-depth interviews with the concerned officials responsible for standard setting in various organizations, and a workshop to brainstorm the involved experts. The results showed that many countries and organizations have the similar process, i.e., they use health risk assessment as a pivotal tool including scientific evidences to set the standards. Most of the standards are intended to be the guidelines for local authorities to modify in order to fit the public’s needs and to be enforceable. In Thailand, it was found that there are a variety of standard-setting agencies authorized under the different acts resulting in an inharmony of standard setting process, amendments, and monitoring. It is suggested that a national independent organization be set up to lay criteria and guidelines of standard setting, standard review and amendment, and people participation process and to select the standards that should be necessarily set in the Thai context in terms of studies in order to obtain an appropriate standard of Thailand. In addition, the decentralization of decision-making process of standard setting to the local areas should be considered in the future, including that the people participation in standard setting process should be imposed in the National Health Act.


This study aims to analyze and synthesize research on violence issues conducted in the last twenty years (1981-2001) and to place the information into the violence research database initiated on the World Wide Web, http://www.violence.au.edu The 190 research papers were reviewed and classified according to WHO violence classification and subsequently analyzed using qualitative data analysis methods. The content analysis was done and the essence of the research was synthesized by applying the concepts of violence research and women’s health research as the frameworks. The results reveal that most of the existing researches are quantitative and repetitive studies on the causes and factors contributing to the violence occurrences. The survey of incidence and prevalence of the issues, and the attitudes toward violence perpetrators and survivors as well as the characteristics of available services or resources are substantial. Self directed violence research was mainly focused on suicide and attempted suicide cases. Stress from unsolved family problems is the major factor contributing to the rising of suicide among teenagers and adult women. These research findings also reveal that the Thai people lack effective coping skills and seek no assistance when facing with crisis. The limitation of available resources is also problematic. The studies on child abuse and neglect found that children who are witness violence or were raised by abusive parents are likely to be abusers. Thai society lack knowledge and awareness toward this issue and have no effective legal system to isolate children from abusive family and concretely protect children’s rights. The research on violence against women in intimate relationships and/or domestic violence especially those were conducted in 1997 to date reveal that researchers have more insight about gender based violence. Nevertheless, the studies affirming the impact of sex role stereotype and gender double standard that is rampant in Thai patriarchal society are very rare although the concepts were mentioned in certain domestic violence studies. The study to develop problem solving solutions, the improvement of resources and legal systems must be sponsored as priority. Sexual violence research is the most prevalent especially on the issues of stranger rapes. The sensitive nature of this issue kept the researcher from studying about acquaintance rape and misled the extent and characteristics of the problems. Although the empirical research reveals that acquaintance rapes are more common in Thai society, the numbers of scientific research in this area are limited. The results of existing research on sexual violence reflect researcher’s rape myth acceptances and bias attitudes toward rape survivors because of the influence of sex role stereotype and gender double standard socialized in Thai patriarchal society. Gender based violence research and the study of empowerment the women to flight against violence must be continuously supported. The research on adolescent violence, social violence and other forms of violence reveal the common root of problems regarding the limitation of appropriate social and legal system in preventing, diminishing and/or eliminating of the violence issues. Beside the research findings, ethical consideration and principle of human subjects protection in violence research should be seriously enforced among research scientists and constantly pronounced by Thai scientific research community.


Incidence of childhood cancer in Thailand has been roughly determined by population-based cancer registration. All cancers have been registered retro-and prospectively by Thai Pediatric Oncology Group (TPOG).OBJECTIVE: To find the incidence of childhood cancers in Thailand.METHOD: All Thai children aged < 15 years newly diagnosed with childhood malignancies according to International Childhood Cancer Classification (ICCC)during January 1- December 31, 2003 were registered into a national database. The data were collected through a web-based registry from 20 treatment centers under a standardized format, using double entry method and under internal and external audit process.RESULTS: There were 999 new cancer cases in children; 94.0% was histologically confirmed, 566 (56.7%) were males. The male: female ratio was 1.3:1, 80 (8.0%) were under 1 year, 361 (36.1%) were between 1 and 4 years, 282 (28.2 %) were between 5 and 9 years, and 276 (27.6%) were between 10 and 15 years old. The median age at diagnosis was 5.64 years old. The age standardized rate (ASR) of childhood cancer was 79.7 per million. Leukemia was most common (ASR 42.6, male=282, 28% vs. female=247, 24%) followed by CNS tumors (ASR 7.6, male=53, 5.3% vs. female 49, 4.9%): medulloblastoma and astrocytoma being the most common comprising 3.2% (male = 13, 1.3%; female=19, 1.9% and 2.5% (male= 13, 1.3%; female=12, 1.2%), respectively. Leukemia and CNS tumors constituted 63.1% of pediatric cancers and Lymphoma was third (ASR=6.4, male=68, 6.8% vs. Female 22, 2.2%). The ratio of non-Hodgkin lymphoma to Hodgkin disease was 1.9:1. Neuroblastoma (ASR 4.6, male= 24, 2.4% vs. female= 27, 2.7%) and retinoblastoma (ASR 4.2, male=29, 2.9%; vs female=13, 1.3%) ranked fourth and fifth, respectively, followed by soft tissue malignacies (ASR 3.6, male=30, 3% vs. female= 15, 1.5%), bone tumors, (ASR 2.4, male 21, 2.1% vs female 15, 1.5% ), renal tumors (ASR 2.6, male=15, 1.5% vs. female= 14, 1.4%), liver (ASR 2.4, male= 14, 1.4% vs. female=13, 1.3%), germ cell (ASR 2.3, male= 19, 1.9% vs. female=13, 1.3%) and nasopharyngeal carcinoma (ASR 0.3, male 5, 0.5%) Among leukemia, ALL (ASR 31.8, male=213, 21.3%; female=176, 17.6%) outnumbered ANLL (ASR 9.2, male= 57, 5.7%, female=62, 6.2%). Conclusion: The incidence of childhood malignancy in Thailand is lower in comparison to Western and regional countries. Leukemia was the most common cancer in Thai children. Lymphoma is much lower than that of Western countries.


This study was a qualitative study focused on participatory process management of nurses’ opinion expression on problems of the health care system, the vision of the Thai health system, the role of nurses, and awareness-building in health system reform participation. The principal informants were 1,269 nurses working at secondary and tertiary hospitals in the Northern region. Additional information and comments were provided by health care recipients, health care providers, and experts and nurses throughout the country, through brainstorming meetings (11), in-depth interviews (29), focus group discussions (11), round table discussions (2), a national seminar (1) and a national conference(1). Activities for group work, interview guidelines, focus group discussion guidelines, and questions for discussion in all meetings, were designed by the researchers, as were content analysis and category arrangement. Results of the study were as follows: 1. The situation of the health care system is reflected in the problems of service and care-providers, and the recipients. The service was seen as ineffective, under standard, and of low quality. Care providers were hampered by high workloads, insufficient skills, stress, few opportunities for development, and insufficient participation in organizational administration. Health care recipients complained of not receiving the benefits they were entitled to, the inequities and high costs of services, poor services, and the inadequate performances of the providers’ performance. They wanted to see a good system of service and appropriate fees, as well as care providers in adequate numbers with good knowledge and offering good relationships and kindness. 2. The vision of the Thai health system as proposed by nurses was envisaged as an active health service with equity for all. They also wanted to see health service personnel displaying good quality, morality, and proper conduct. They proposed that people and communities should participate in health care, and also that government and health organizations have policies and strategies promoting good health for the people. 3. The nurses’ vision for nurses’ roles in the new health system was discussed. Nurses at all levels should provide more active service; understand human nature, behavior, culture, beliefs and local knowledge; provide family and community care, as well as nursing interventions and rehabilitative services for sick persons; conduct physical examinations, make diagnoses and provide primary medical care; protect recipients’ rights and advocate for them; provide health information and knowledge; produce academic work, innovation and research; be leaders or team-mates in health teams; administer and manage the services and units; express ideas for the health system and professional development; and perform advanced nursing practices. 4. Key issues in health system reform were identified. They consisted of the equity and quality of care service, the effective health service management and decentralization, health building by self health care, adequacy of quality and number of health manpower, health knowledge building process and research, health coverage for good health, government and people participation in health policy making, and effectiveness of other health care systems. 5. It was agreed that nurses should participate in health system reform at the personal and professional organization levels. At the personal level, nurses should have awareness and understanding of new health concepts and educate others, be knowledgeable and competent in nursing actions, be responsible for continuous self development, and have a good attitude towards their profession, and participate in professional organizational activities. At the organizational level, the organization must participate actively in health system reform and related regulation formation; identify policies and directions for nursing education and service development; lead, coordinate and build understanding towards reform among members; and draw opinions on capacity building for leaders, quality control for the performance of newly graduated nurses and nurses in the workplace, and the establishment of quality assurance systems for the nursing service.


Ayudthaya Metropolitan Peoples’ Health Utilization Behavior, Experiences, Health Care Expenditures, and their Attitudes towards ServiceDelivery of Medical Center.	People who lived in Ayudthaya Metropolitan were studied to understand their health care utilization behavior and their patterns of health expenditure so as to make comparison with the behaviors of those who lived outside the medical centers’ catchment area. Population factors for sampling in this study were various concentration, socio-economic status, distance to health facilities and whether the people were actually registered at the medical centers. 704 households or 1,794 people were chosen. According to the findings, 61.7% of the sampled population aging 14 or above were insured by any scheme of health insurance. In lower socio-economic area, the public health assistance scheme was mostly possessed. 85.6% of the selected population was insured by single health insurance scheme whereas the remaining was insured by two or more schemes. 	Self-drug use behavior was common for slight illness while convenient transportation was given for the most reason of those seeking care at the medical center. Private hospitals were largely selected as the first choice due to their specialization. Health care expenditures were various in ranges dependent upon where and what types of services were chosen; however, two-third of total expenditures were spent on private services. Chronic cases were reported highest in number at the medical centers. Most medical center users were satisfied with the providers’ communication and patient-provider relationship. 	When getting ill, 26.2%, 24.5%, and 19.7% of the population wanted to go to private clinics, the provincial hospital and the medical centers respectively. What the population firstly needed from the services was quick and convenient care. Good communication, price and well-skilled doctors came second, third and fourth respectively. The study suggested that the medical centers more closely work with both public and private facilities to provide increasingly comprehensive care and the multi-center study be taken in order to know overall health care utilization behaviors of the population irrespective of either micro or macro-scale level.


This study objective was to synthesise a number of vision, philosophy, and view regarding health reform system in Thailand in order to put these inputs into public debate. A number of social development leaders which were 3 politicians, 5 academics, 4 community leaders, 2 businessmen and 1 representative from mass communication group, were interviewed from August 1999 to February 2000. Prior to the interview, the VDO program was shown to the interviewee and the questions were previously structured. 	The study found that problems and changes in health system were complicated. The most problematic cause was ill- or un-informed people about health leading to risk living behaviour and poor health. Health system itself particularly lack of health insurance and care quality also jeopardised people’s health. In views of most interviewees, desirable health system should be composed of good cooperation in multi-groups, emphasis on health prevention and promotion, proper structure to support the system, effective political system, response to principles of equity and society’s needs Health system reform needs vision at various levels from top (policy) to individuals. Health reform should be considered as a national goal by having clear policy, strengthening public involvement, creating health insurance, administrative decentralisation, appropriate standard of care, people centred service management, support and supervision by the government, ethical providers and people’s awareness of health


Market exclusivity and drug expenditures: the effects of Thailand New Drug Registration RegulationsThe effects on hospital drug expenditures of the market exclusivity granted to innovator products by means of Thailand regulations on new drug registration were assessed.  Self-administered questionnaires were distributed by mail to 292 public and private hospitals in February 2001 to collect data on purchase volume and value of 11 generic-approval new drugs containing 4 active chemicals, namely fluconazole, clozapine, ondansetron, and ofloxacin (injection form).  The questionnaires were returned by 166 settings (56.9%).     It was found that during the first two years of generic entry, 1999 to 2000, unit prices of generic versions of all products purchased by the hospitals were lower than the prototypes’ but prices of the originals did not change significantly.  Due to lower price of generic products and generic substitution in the hospitals, substantial decreasing in drug expenditures of totally 103.5 million baht has been observed.  Tremendously increased purchase volume of some drugs, particularly fluconazole, among these healthcare settings when generic entered the market while there was no increasing in health needs, indicates significantly improved accessibility to drug.       To potentiate the magnitude of the positive effects of generic entry on drug cost containment among hospitals and the increased accessibility to drugs, promoting drug price competition and encouraging generic substitution are recommended.


Universal Coverage Initiation and Health Care Decentralization in Different Countries	This literature review concerns about the theory and experience on universal coverage initiation that is related to health care decentralization in different countries. The review consists of two important parts. Part one involves the concept of health care decentralization, local government administration, experiences in local government arrangements in some countries, and decentralization situation in Thailand. Part two describes universal coverage initiation in various countries to understand the concept and difficulties in universal health care provision, health care financing, and roles of local government within universal coverage. It is hoped that the obtained knowledge from the review will be the fundamental foundation for policy setting and implementation of universal coverage in Thailand.	From literature review, it can be concluded that universal coverage is very essential for health service welfare. Decentralization has no direct relation to universal coverage initiation. Universal coverage can occurs without decentralization. However decentralization has been viewed as an important strategy to achieve the effective and efficient universal coverage. The obtained knowledge can be synthesized to be some recommendations for universal coverage initiation in Thailand that there should be universal coverage policy at the national level. It should be compulsory system rather than voluntary one to prevent the coming problems such as selection bias. The roles of local governments need to be clearly defined both in health care provision and financing roles. Health sector should be accepted as important as other sectors. The universal coverage should be developed step by step to avoid the opposition from both public and private sectors. Finally, it needs to have more information from additional research studies to fulfill the gap of knowledge particularly in administrative and management aspects. At least, there should be information about the roles of local governments within universal coverage in Thailand.


The study looks upon recent changes of the health personnel situation in public hospitals in Thailand. The study covers four professions-physicians, dentists, pharmacists, and nurses. More emphasis is placed on physicians and dentists, the two scarcest health professionals, and those that public hospitals have faced the most problem retaining.	The recent years have seen increasing number of resignation, and many blame this on the 30 Baht Scheme. A recent study found, however, that resignations usually determined by joint factor such as work burdens, remuneration, and further training opportunities-all of which are similar to determining factor in the past. The state of economy is important, as it affects the relative compensation between the private and public sectors. Not many physicians cited political induced factors such as the 30 Baht Scheme or Article 41-42 of the National Security Act as the main factor. However, it would be prudent not to dismiss the possibility that dissatisfaction with the 30 Baht scheme might add some weight that tip the scale on their final decisions. The number of dentist training has increased at a slower pace than those of physicians and, in most cases, is resulting from founding a new dentistry department in a new university rather expanding the existing departments. In most dentistry departments, the number of graduates fluctuates significantly from year to year. The main reason is that many first-year dentistry students would reapply to a medical school and would withdraw from the dentistry department if they were admitted to the medical school. Pharmacists used to be considered a scarce health profession in which graduates were required to work for the MOPH after graduation. Such a requirement was abolished years ago and the public hospitals usually do not have problem filling the pharmacist position, although the legal requirement to have pharmacists working in drugstores could still not be enforced. Like other health professions, Bangkok and the Central Region has more pharmacists per capita than the rest of the country, but their distribution is better than those of physician and dentists. Nurses were also considered a scarce profession in which the graduates were required to work for the MOPH after graduation. Such a requirement was abolished even before the pharmacist case, partly because the government was not willing to hire all graduated nurses. Although some public hospitals still complain that they don’t have a sufficient number of nurses, the issue isn’t of great concern for the public or politicians.   	If we compare the number of health personnel with the standard that was set for the Primary Care Unit (PCU) in the 30 Baht scheme, we would find dentists to be the scarcest profession. In the Northeastern Region, even if all dentists are spread evenly throughout the region (which is currently not the case), there still would not have enough dentists to satisfy the standard requirement. While other professions could meet such a standard, it should be kept in mind that the standard itself is a bare minimum. Under such a condition, and given the situation that the 30 Baht Scheme has not successfully attracted private providers, to retain a sufficient number of personnel in public hospitals would be crucial to the success of the universal health coverage program in Thailand.


A survey on antismoking law compliance in Nongkhai municipal area	This  quasi-experimental study  aimed to find a local  preventive-smoking  model  for  the younger  group of  under 18  year-old. The  study  was done in 5 villages at Serm  Sub-district  Ponpisai District, Nongkhai Province, Thailand. Three study-stages  was  organized; (i) surveying  the  locals’ altitude (including  the  group  of  under  18  year-old), as  to  search  critical  smoking  accessibility factor, (ii) establishing a meeting(excluding  the 18  year-old group) as  to  achieve  a  collectively  smoking  prevention  model,  and  lastly(iii)evaluating  such  that  proposed  model.	The survey results showed the critical smoking  accessibility  factor  was “no hazard  understanding”. Only  60.6 %  of  the  younger  understood  health hazard and related smoking  prohibited law. The health volunteers, teachers, cigarette  retailers  sub-district  members, abbots,  polices  and  students  knew  new-enforcement  smoking law and  regulation  by  only  61.5 %, 62.5 %,  78.9 %, 66.7 %, 33.3 %, 61.9 % and  67.2 % respectively.  The  result  also  showed  79.4 % of  the students used  to buy cigarette. Other smoking accessibility factors were “new try”, broken  home,  elder-like smoking, no recreation activity available, no rigorous no-smoking  campaigns  done by local institutions, and lastly, influential from friends. The no-smoking  campaigns  introduced  by  the  study  were  through  education  mediums  as  smoking  causing  health-hazards. These were distributed  via several means. Such those non-smoking campaigns  included “the 18 year-old prohibited” signs adhered  at  the  cigarette  shops,  leaflet,  radio  spots,  local  anti-smoking clubs, playground sport arrangement, healthy student for not smoking competitions, no-smoking  classrooms, smoking-hazards  warning delivered by  abbots, 216 students  swore  for not smoking, monthly cigarette shops’ inspection by polices and  yearly  budget put forward  for no-smoking campaigns  by sub-district  administrative offices.	The achievement by the study campaigns could have the  more  number of students getting to know the non-smoking law increased from 26.6%  to  44.1%. The smoking rate reduced from 31.1% to 20.9%. Persons who gave up  smoking  during  the  campaign  project  were  42.5%, and  buying  cigarette  habits  decreased  from 79.4% to 45.6%. General  public smoking rate from 27.0% could  reduce  to  finally  quit  of  smoking  19.5%.	The  model  applied  by  this  study  was  genuinely  from  grass-root  initiatives,  any achievements was  then  originated  from  community-based  practice.  On-going  activities  following  the  model  applied  remained  next to  be  evaluated.


The  Health  Insurance  Development  for  the  Informal  Workers  and  Their  Families	The objectives of this research   are  two fold.  The first objective is to examine the health care situation and health care among the informal workers and their families.  The second objective is to develop  a  proposed guideline for health insurance plans for the informal workers  and  their families.The  study  reveals  that  informal  workers  and  their  families  still  lack  preventive health  care  and  maintenance  health  care.  The  majority  of  them  do not have health insurance and have to pay for medical care at their own expense, especially for costly severe illnesses and injuries.  However, their family members who are elderly and children are covered under the Free Medical Cards.  For these reasons, there should be health insurance plans for the underprivileged especially  the  informal workers and their families.  They should be guaranteed health care in accordance with the Human Rights Act and the Thai Constitution of 1997, stating that all citizens are entitled to quality health care, both preventive and maintenance health care.  Thus, health insurance plans provided must contain reliable long-term programs with competent and effective management.	In order to achieve effective health insurance management, four components are required namely a policy component, a fund management component, a health care network component, and a quality assurance component.  There must be a network of health care services for the people.  The network should insure cooperation among the government, the private sector, the  business  sector  and the people’s organizations.  Tax revenues must be allocated to provide basic health care services for illness, child delivery, disability, annual physical examination, and health information for informal workers.  Program monitoring mechanisms are needed  to ensure quality health care, a high standard of services, and effective fund management.  These mechanism should consist of both internal  and external examiners.  Informal workers should participate in the program, especially in preventive health care, and ensure their rights to health care services.	In addition to the components mentioned above, effective health insurance management requires supportive laws, development of an information network, ongoing public relations programs, development of an appropriate taxation system, and establishment of organizations for informal  workers.	The following  suggestions are herein proposed :Informal workers and their families should be encouraged to gain competence in preventive health care and during the time of illness or injury.The organizations concerned should take responsibility in solving health care problems for informal workers.Informal  workers and their families should be encouraged to organize themselves and to form health care networks.The government must provide quality health insurance plans for informal workers and their families on the basis of equal rights.Health  insurance management should emphasize the development and improvement of existing  organizations rather than the establishment of  new organizations unneccessarily.Health  insurance plans should provide alternative programs.A  health care database for informal  workers and   their families should be developed.


Situation analysis of home and community based care for people living with HIV/AIDS in southern Thailand	The study aims to review and analyse the situation of home and community based care for people living with HIV/AIDS in southern Thailand. Data from three collected and analyzed to examine the way in which people living with HIV/AIDS are managed and taken cared at home and communities. The strategies and factors affected the systems of care were also investigated to present the extent to which care has been changed or modified for sustainability or discontinuity, Results showed the significant findings as follows. 	1.  The current AIDS situation in Southern Thailand is similar to other parts as the number of new case has been increased particularly in reproductive age. The increasing number of AIDS patients were seen both in and out of hospital. The national case report showed that the proportion of people who were sick with AIDS in a hundred thousand population was higher than the country rate. The report also revealed that the high epidemic areas were from provinces with a large number of fisherman, labor migration, and tourists, Data from fields study were also confirmed. 	2.  The situation of AIDS care in southern Thailand has been changed since last two years. People were more awareness of HIV/AIDS and perceived it as their own problems particularly when one of their of family members sick with AIDS. However, the level of understanding of HIV/AIDS care at home and community among general population was still low. Stigma and rejection were remained high in community level. Various activities in relation to enhancing care for patients at home and community were then supported by several organizations both government and private sectors.	3.  AIDS care management in southern Thailand were mainly individual and family level, partly because of fear and social rejection, Patients and families with AIDS generally conceal their status. They would requires some assistance and support when necessary without disclosing to the public, Although the community was taking the significant role by expressing the value and cultural care, the positive response has currently been low compared to overall projects.	4.  The strategies applied for managing care at home and communities wree both active and passive methods. The significant strategies were involved with active community participation, having good leader with scarify or having better knowledge, home visiting, community aceptance, seeking funds to support activities, and using a holistic approach.  	5.  Several activities were conducted particularly in enhancing the strength of community participation. Training of difference groups was the most common activities, The content was related to AIDS prevention and psychological care for people living with HIV/AIDS and their families. The herbal and tradition medicine had also been promoted and used as the main mode in supplement of lack access to antirrtroviral therapy.	6.  The role of individual, family and community are increasing especially in the high epidemic area. The role of temple is one of the community care which represents of active participation. The role of government organization has been less than other in terms of accessing to home visiting and providing psycho-spiritual support. However, people with AIDS who concealed their status would have less assistance. 	7.  Several models of home and community based care have been found. These were included: model of empowerment of patients and their families, model of strengthening and promoting active community participation, care and support from family and community, development of a temple or religion organization as a center of care. Recommendations	Strengthening home and community based care can reduce the impact of HIV/AIDS on individual, families and community. To ensure effective care and support provided for people living with HIV/AIDS, these issues must be stimulated and plan for the future. To apply AIDS home care model, the meaning of care and component of cultural care at home and community must be clearly defined. The findings showed that the best practice model has currently existed, but it required systematic study and further publication.Sharing knowledge and experience about caring for people living with HIV/AIDS at home and community in southern Thailand has been low. The specific skills are required for effective intervention and enhancing care by their family and community. These skills are included community management, effective health and nutrient counseling, and caring of dying at home.Although the role of government, private and community organization continue to increase, the good governor and co-ordination has been necessary to promptly respond and managed. The direction of policy must be clear and focus on sharing resource as much as possible. Development and integrating of the traditional medicine on home and community based care is required. AIDS is a psychosocial and cultural problem related to daily living and survival. To solve the problem effectively, it requires the multidisciplinary knowledge and team.To encourage people living with HIV/AIDS in living longer with less suffering, continuing plan and self care management must be educated. In addition, the alternative therapies and positive thinking strategies should be supported and integrated to their living for better quality of life.Further research on development of a cultural appropriated model for people living with HIV/AIDS is essential. The independently system of care particularly in people who conceal their HIV status should be further explored. Nevertheless, a follow up study on impact of disclosure to patients and their families which affect quality of life and quality of care at home and community level.


Societal organization and development on tambol civil society : case study in Tombol Muang Jung, Nan province 	This is a qualitative study intended to examine the origins, development, role and potential of various government and non-government groups in Tambon Muang Jung, Ging Amphoe Pupieng that carry out work in the manner of civil societies. In-depth interviews were carried out with leaders, core individuals and  members of 22 out of 48 groups and organizations in Tambon Muang Jung through the use of questionnaires that were later analyzed, synthesized and summarised. 	The study found that Tambon Muang Jung originated from two villages that subsequently expanded to the present number of ten. Groups and organizations arose naturally and through establishment by the government. There are now 48 groups in 14 categories, many of  which are members of the Hug Muang Nan Network. Many of the leaders, core individuals and members of the groups and organizations have been elected to the Tambol Administration Organization (TAO). 	In the past it had suffered from the effects of encroachment and destruction of the forest for subsistence farming and then through promotion of the cultivation of cash crops and the increased immigration into the tambon. This has led to degradation of the forests, the soil, the aquatic ecosystem and aquatic life. Encroachment into the forest has increased along with an opening up to the wave of development from the outside. This has changed the quality of the community in the tambon and the balance between people and tha nature until many problems have arisen. 	The aforementioned problems have given rise to a large number of smart, honest, dedicated and committed leaders, and many groups and organizations that have spread to every  village in the tambol. The groups have also networked with non-government organization outside the Tambon. They have been able to solve their problems and those of the their communities and bring about a recovery from the conditions brough about by agricultural practices and debt and to survive the crisis. There have arisen for example 6 community forests covering an area of more than 17,500 rai, 7 fish conservation zones, which have led to a dramatic increase in the numbers and species of fish in the rivers, 2 sustainable agriculture groups, 6 community savings organizations, 5 youth groups, 2 "mueang fai" community water supply management groups, 10 housewife groups, 2 cremation fund groups, 3 occupational groups, 10 public health volunteer groups and 10 elderly groups, which together have been able to solve the problems, such as those of drug abuse, effectively.


This is a study on the management and an evaluation of the administration within the  organization  which has been conducted consecutively for the second year as a furtherance to the study in the first year  that started from the year 2001 and ended in January 2002. The study shall concentrate on  evaluation of the administration of the internal affairs for an assessment on the systems of management, the operations, materials management, information systems, accounting and finance, internal audit and control as well as a survey on the level of satisfaction of the personnel towards BanPaew Hospital’s departure from the original status of being government hospital for  reorganization into a public company under governmental supervision and conduct a survey on the level of satisfaction of the service users. The result of a study in the first year shows that many of the systems which are in  operation are not complete or fully operable and require further development and/or improvement. Moreover, the efficiency of the personnel which will handle the management and operation under the new type of organization is insufficient in certain aspects therefore modifications have been made in the second-year study for a focus on three perspectives i.e.  counseling, human resource development and evaluation of the management.   Objectives        The objectives of the study are chiefly in threefold as follows:-Provide counseling on development of the system and management, planning and benchmarking, internal audit and control, accounting and finance, human resource management, information systems, inventory   management.To develop the potentials of personnel on the levels of  executive directors  and managerial staff in various areas.To assess the management potentials within the hospital as well as conducting a survey on the level of satisfaction of the staff and the service users.Results of Study         The results of the study can be divided into three parts as follows:-Part 1 Counseling on  internal administration/ management          The results of a study on the provision of counseling on internal administration/ management appear below. Planning and BenchmarkingThe hospital had already  set  the directions and vision of its development during the year 2002 which had already been presented to the executive committee but have not yet been translated into practice concretely. The advisory board has been conducting educational seminars and workshops and transforming vision, eight-sided strategies into action plans and performance index. On the department  level, the department  has been advised to prepare the action plan and performance index, but some of the units were in the process of implementation nevertheless the preparation of the action plan and the performance index is  in compliance with the hospital’s process of generating preparedness  for implementation of Hospital Accreditation. Internal Audit and ControlThe  researchers has made an appraisal of the internal audit and control systems and given the advice on the establishment of the Audit Committee possessing knowledge on the aspects of management, accounting, techniques and  medical service, in addition, units for internal audit and risks assessment  should be set up  , offering training to strengthen the knowledge. 1.3 Accounting,  Finance and Budgeting     The  researchers  has  offered  counseling  on  finance,  the  development  and  improvement  of  the  existing  accounting  systems, account-recording  methods  i.e.  the  improvement  of  chart  of accounts,  recording of accounts receivable, petty cash, fixed assets etc. as well as  given  advice on verification of accounting data prior to the monthly preparation of  financial  statement,  offered  advice  and  training  on the application of accounting software. As regards the aspects of cost      accounting and budgeting, advice and training have been offered but have not yet been implemented hitherto. Data and Information SystemsThe researchers  have given advice on the matters concerning hardware, software and security measures on networks system and information system, surveying  and retrieval of data. Materials ManagementPolicies and objectives have been clearly defined with constant changes and improvement in the  methods of operation, the management of inventory of the pharmaceutical section which is responsible for  medicines and medical supplies that do not belong to the Ban Paew Hospital in order for the development and enhancement of efficiency in performance. During the past years modifications in the major operating procedures have been made as follows:-Purchasing of medicines with high volume of usage has been altered to a purchase sufficient for one-week usage with direct delivery to the pharmaceutical section, entailing a reduction in the work procedures and transportation procedures for  the medicines and thus a reduced inventory value. However this measure necessitates more frequent purchasing which can be witnessed from the much higher frequencies in purchasing and the increased risks for shortage of stocks. Reduction of reserved medicines in the various patient  wards  via arranging and dispensing medicines from the pharmaceutical section to each individual patient, with replenishment of medicines and medical supplies to the patients’ ward on a daily basis enabling the patient wards to be relieved from the burden of carrying a lot of reserves of medicines.  At present, stocking of tablets has been cancelled with the exception of 1-5 ampoules of injection doses. In March 2003, the system of dispensing medicines to the in-patients through the use of facsimiles for higher efficiency in servicing has been adopted in order to reduce the blunders involved in arranging and dispensing of medicines as the pharmacists could have a first-hand information on the doctor’s prescriptions.The application of  the software programs is  present in the management of the medical supplies’ inventory but the manual system has been applied in tandem because of insufficient confidence in the operation of the software programs.The management of durable articles in the hospital still lacks directly responsible persons, as a result,   it is not  systematic and has not made much progress. Presently, the hospital is adopting a policy of a combined purchasing of all materials therefore the maintenance and care of the durable articles should be added to  the scope of responsibility  of this section as well. The management of all types of materials in the hospital such as medicines and medical supplies, office supplies, household supplies including various durable articles involves a total of several thousand items and constant movement and transfer thus an up-to-date, reliable and automatic information system shall render supports for higher efficiency in supplies  management.In addition, modification in the methods of operation  including the application of new systems or technologies  must rely on collaboration and readiness on the part of the officials and the units concerned, therefore arrangements should be made for the enhancement in competency and visions of the managerial staff, as well as expanding the potentials of the operational staff in order to make concerted advancement in the same direction for the achievement of the organizational objectives. Human Resource Management      Counseling on Human Resource Management      The study reveals that the hospital’s Human Resource Management still remains at the developmental stage while attempts have been made for the introduction of information technology.  There  is  a  start  in  the        review of work in the minor units of the human resource section however  due to  a lack of competent personnel to take up  responsibility for the  job earnestly, the formulation of policy on this side could not be  efficiently effected to which the problem must be urgently addressed by raising the skills of the personnel  in order to undertake the job thereafter. There must be  coordination among the various minor units in the section  for integrated and concerted actions in accordance with the commitments and strategies of the hospital.  The study also sheds light  on some recommendations and solutions to personnel-related problems regarding the recruiting selection, training, performance evaluation and development of career paths etc.Part 2  Developing the Human Resource’s Potentials                               The study on this part has been carried out as follows:-2.1  A Study along the Line of Human Resource DevelopmentThe  researchers has conducted a survey on the training, Needs and career development,  the results of which have been used as guidelines in  determining the  curriculum for training and in  developing  human resources capabilities.2.2  Human Resources Capabilities DevelopmentTwo projects are designed for fostering and  developing the potentials of the hospital board and management i.e. program for the development of  the hospital’s executive directors and program  for the development  of the hospital’s management.Program for the development of the Hospital’s Executive Directors. 	A three-days seminar program was organized  in order to impart knowledge on the role of the executive directors, good-governance, internal audit and control, risk  assessment,  towards excellence in management, the operation of a hospital, the concept of organizational management, strategic management, and evaluation of organizational performance, reading and understanding income statements, personnel management, materials and information management.             The result of the seminars found that the topics which the executive directors had few knowledge were internal audit and control, risk assessment, strategic management,  materials management, information system, meanwhile courses with the highest applicability  were the role of executive directors and good governance, the concept of organizational management, strategic management  with linkage to implementation plan and evaluation of organizational performance,  internal audit and control and risk assessment.	Program for the Development of Hospital’s Management           Workshops on Hospital Management Seminars for the hospital’s executives cover 5 modules i.e. workshops on strategic planning and translating into action plan through the use of the Balanced Scorecard  techniques, seminars on human resource management  techniques, job-training, coordination, leadership, team-work, personality, novelties in the field of hospital management, ex. information technology in the hospital, customer relation, management, supply chain management, supplies management, accounting and finance systems for hospital, including costing of the activities, budgeting, internal audit and control systems.          The results of the seminars in the topic which are of significance are ex. team-work, planning, efficiency in work, leadership. Courses with high applicability are team-work, efficiency  in work, CRM, leadership, planning and performance indicators.Part 3 The Assessment of the Potentials of Ban Paew Hospital (Public Organization) can be broken down into 6 parts as follows:- The Survey of Management Capabilities 3.1.1 Planning and BenchmarkingThe  result of implementation of the units: on the whole, action       plans and  performance  indicators have been prepared however       some units have not  completed such process.Work in some of the units has not shown consistency between the       work plan and the company’s operation ex. in the implementation       for the Hospital Accreditation.Lack of  units responsible for the integration of plans and       follow-up.Changes and resignation of personnel have impact on the       continuity and  the specified duration for execution.3.1.2  Audit and Control  Systems     Currently, the internal control of the Ban Paew Hospital has been achieved by allowing the various units to analyze the risks in operation and arrive at the conclusive measures in  internal control in order to generate a reduction of the possible risks and  improvement in operation to attain efficient control in the future. An assessment of the above control plan shows that  the units having proper control plans  and thus efficient operation are mostly the servicing units while most of the ancillary  or supporting units should make more efforts in the improvement of internal control planning and reduction of risks.      At present, the internal audit unit has only one staff-member with managerial background and still lacks staff-members with competency and experience  in accounting, finance and medical knowledge to enable the unit to perform its duty  thoroughly in accordance with the objectives.               Appointment  of the members in the Audit Committee can be made by choosing from the hospital’s executive directors with competency and experience in accounting, finance, management, and medicine.3.1.3  Accounting and Finance    At present, the hospital has not been able to finalize its income statements which include the Balance Sheet, the Income  statement for the first and second quarters of the year 2003 due to the exposure of mistakes in the systems of finance, accounting, and the computer programs currently being applied, and is still under preparation  for the implementation of cost accounting and budgeting systems as has been planned.      3.1.4  Information Systems    The information systems of the hospital still remain broadly in the state of island of information, consequently there are repetitive collection of information, moreover, the efficiency of the hardware and software is inconsistent  with the amount of work, security measures of the network systems have been kept at low level, while the systems for data survey are inefficient and the potentials of personnel in information system have not yet been fully developed.       3.1.5  Materials System     Constant improvement in performing the jobs relating to the management of medicines and medical supplies have been made,  enabling a reduction in inventory value of the medicines and non-medicinal supplies on a continuous basis.   As a consequence, there must be more frequent purchasing resulting in the risks from shortage of materials. The benefits from full utilization of the express program have not yet been realized  by the hospital, entailing repetitive work. Besides, there is still a shortage of integrated material management systems.A considerably systematic measure for durable articles has not yet been put in place, due to a lack of the unit directly responsible for the job, thus the policy for combined purchasing of all types of materials and durable articles shall help in the  making of  the more distinct  functional lines.        3.1.6  Human Resource Management      The study shows that the major problems are the lack of personnel competent in human resource management to undertake the job in the hospital. In addition, the systems of operation have not yet been fully established and in the broad sense, it reflects a situation that the human resource management in the hospital still remains at the developmental stage for enhanced efficiency in administration.3.2  Results of the Survey on the  Level  of Satisfaction      3.2.1 The Results of the Survey on the Satisfaction of  Service Users               The study on the assessment of the level of satisfaction in the service users have been conducted  consecutively  both in the year 2001 and 2002.  In the year 2001,   321 samples were selected  (120 in-patients and 201 out-patients.) Whereas in the year 2002, 350 samples were selected (117 in-patients and 233 out-patients.) The result of the study showed  the overall level of satisfaction in 2002 is higher than that in the year 2001   i.e. in the year 2002 and 2001 the level of satisfaction had been recorded as 78.86% and 76.21%, respectively.Level of Satisfaction3.2.2  Result of the Survey on the Level of Satisfaction of the PersonnelThe assessment of the level of satisfaction of the personnel have been conducted for two consecutive years. In the year 2001,  315  questionnaires were distributed with  299 responded, whereas in the year 2002,  330  questionnaires were distributed with 266 responded  . The result of the survey is as follows:-Ranking of Personnel’s Satisfaction (5 point scale = 5 is the highest satisfaction)20012002Ranks inSatisfaction of PersonnelOn a 5-pointsOn a 5-points2001ScaleScale1Relationship between colleagues               3.963.852Capability to work among colleagues         3.943.753The chief officer has suitable qualification   3.943.394The chief officer is fair                                 3.803.285Adaptability                                                  3.733.486The supervisor support  free  development3.713.187Relationship between the staff and the superior            3.703.318Suitability of the job to one’s own ability                         3.683.609The scope of responsibility in the job                             3.583.2210Efficient tools in performing the job                                3.503.15             The above table shows that in the year 2001, the level of satisfaction was higher than 70% (3.5 marks) in 10 aspects but the same thing was true for only 3 aspects in the year 2002 i.e. the relationship between colleagues (3.85), capability to work among colleagues ( 3.76) and suitability of the job to one’s own ability (3.60) .          The aspects which the staff showed low level of satisfaction for both years        (the marks for the level of satisfaction were lower than 60% or 3 marks) are criteria in determining the escalation of wage scale, the compensations in case of removal from job, allocation of residential quarters to the staff. Apart from this, the level of satisfaction in the year 2002 was lower than that in the year 2001 in all aspects.Low Level of Satisfaction of the Personnel20012002RankMarksMarks1Criteria for promotion and salary increase                           2.83                     2.202Compensations in case of removal from  the job                                                                         2.99                      2.323Allocation of housing facilities to suitable staff members                                                            2.90                      2.39                                                    The study reveals that in the broad picture, the level of satisfaction in an overall scale and from all groupings in the year 2002  was comparatively lower than that in the year 2001 in which the overall level of satisfaction showed an average of 3.34 or 66.8% while in the year 2002, the figure was 2.90 or 58.0%.                                                      (Figure)             .RecommendationsPlanning and Benchmarking of the OrganizationA responsible unit should be set up to take up the responsibility for submission of the plan for approval and execution including reviewing and summarizing  to give an overview of operation,  the planning and implementation for Hospital Accreditation which should be integrated with budgeting.        Implementation needs to be clearly defined  in unwavering directions with follow-up as well as the performance-based remuneration. Auditing 	There should be structural improvement of the organization, appointment of the auditing unit and Audit Committee in accounting, finance and budgeting.       Further development should be made in documentation of reports, training of personnel, implementation of cost-accounting system, and activity-based budgeting.   In addition, there should be software programs which have linkage to the other systems of operation.Information SystemAs far as the development of the information systems is concerned, the management must be capable to acquire knowledge about the demand for information, access to the data, dissemination of information and be able to assess the capacity of the hardware and software suitable for application as well as responding to the needs of the users.Human Resource Management	There should be planning for the requirement in manpower, training and development of personnel, planning for the career paths of the staff, evaluation of performance, reward system, motivations, staff retention and development of information systems for human resource management.Materials Management        Materials should be properly managed with both short-term and long-term planning  distinctly laid down together with improvement in the documentation of reports, and the information systems so as to be updated, accurate and complete as well as the enhancement of knowledge and   acquisition of knowledge about the roles of the staff.Suggestions for Further Study          The study on the management in the hospital reveals that all the 6 systems i.e. planning and benchmarking, materials management, internal audit and control, data and information, personnel management , accounting and finance and budgeting have not been fully developed even in the second year, with the exception of materials management and planning and benchmarking  in which the development of both systems has been achieved. The other remaining systems such as accounting, finance, budgeting are crucial to the operation and require advice from eligible and proficient persons. The internal audit and control, the data and information and human resource management systems also need counseling from the experts in each field in order to enhance the hospital’s capacity to serve as a model of the hospital pioneering the transformation into public organization.


Care-taker behavior and Glycemic control of elderly Non-Insulin Dependent diabetic  patients , Amphur Khaowong , Kalasin Province	This Survey Research was a Cross-Sectional study. The purpose was to study the relationship between care-taker behavior and glycemic control of elderly non-insulin dependent diabetic patients, Amphur Khaowong, Kalasin Province. Quantitative data and Qualitative data were collected from 127 elderly diabetic patients and 127 care takers during November 1998-February 1999. Percentage, Mean, Standard deviation, Chi-square test, Odd ratio at 95% and Multiple logistre regression were used to analyse quantitative data and qualitative data were analysed by content analysis.	The results showed that the following five factors of care-taker had significantly related to glycemic control  of  elderly diabetic patients (p ( 0.05) :-Age : care-taker who 60 years old up had better glycemic control of elderly diabetic patient than care-taker who were 30-59 years old  for 18 times (95% CI = 1.4-136.3; p-value = 0.02).Marriage status : the single care-taker had better glycemic control of elderly diabetic patient than the married person for 1.9 times (95% CI = 1.2-94.9; p-value = 0.03).Family annual incomes: the incomes less than 10,000 bath had better glycemic control of elderly diabetic patient than the incomes between 10,000-90,000 bath for 7.4 times (95% CI = 1.6-36.3; p-value = 0.01).Duration of daily care : the duration more than 12 hours had better glycemic control of elderly diabetic patient than the duration less than or equal 12 hours for 9.6 times (95% CI = 1.7-55.1; p-value = 0.01).Attitude scores : the scores equal or higher than Mean had better glycemic control of elderly diabetic patient than the scores lower than Mean for 4.8 times (95% CI = 1.2-19.9; p-value = 0.02).	Deep interview showed that care-taker who take cared well and poorly controlled diabetic patients had inadequate knowledge about glycemic control in diabetic patients. Most of their knowledge were received from their diabetic patients and neighbourhoods. However, care-taker who take cared well controlled diabetic patients had  better care-giving than care-taker who take cared poorly controlled diabetic patients especially dietary control, exercise and appointment with the doctor.


Buddhist Paradigm on Health and Healing in Thai SocietyThe aims of this study try to consider Buddhism as a paradigm and to investigate its capability to deal with health problems especially in Thailand by using documentary and field research.  Documentary research is applied as a method for studying the Tipitaka—the three divisions of the Buddhist cannon—and other Buddhist important texts to identify its paradigm.  A field research is used for gathering lives experiences of some Buddhists to know the significance of Buddhist paradigm on their lives and health behavior.  The report composes of 8 chapters.  The first chapter gives the outline of research methodology.  Chapter 2 presents the concept of paradigm, which starts by showing that all of our global crisis including economical, environmental, social, and health crisis originate by the same foundation that is the misunderstanding of nature of our life and the world.  I demonstrate that limitations of knowledge and technologies in health come from its scientific or, more specifically, biomedical paradigm.  Another concept of health paradigm, holistic medicine, is described in this chapter as well.Chapter 3 is results from the literature review about history of Buddhism in the region what is now Thailand.  Archeologists found that Buddhism was brought into this area since the third century.  Around the 6th century, Theravada and Mahayana Buddhism as well as Hinduism were accepted through the entire region.  During the 13th century, the first Thai kingdom—Sukhothai—Theravada Buddhism from Ceylon (Sri Lanka) was selected to be the only religion of native Tai-speaking people.  After that, Buddhist worldview has been gradually integrated with local belief systems and then became the basic Thai culture and worldview.  Buddhist beliefs incorporate in all parts of Thai culture while Lord Buddha always places at the top level of all refuges.Chapter 4 focuses on Buddhist-related health culture.  I show the impacts of Buddhist paradigm on the ways of practicing health and healing in Thailand.  Buddhist temples used to be centers of all local wisdom in each community.  They were places where traditional healing techniques have been studied and practiced.  Most of Thai traditional healers get their knowledge and experiences while they were monks.  Thus, some sacred Bali words and rituals were normally used in the processes of their practices.  Some rituals relating to Buddhist monks, moreover, such as Parita Sutta and Pojchong chanting, or the offering dedicated to the Sangha (Sańghadana) are sometime specifically used for health proposes. Chapter 5 contains the essences of Buddhist paradigm extracted from the Tipitaka.  Meanings of the world, nature, and all creatures including humankind in Buddhist view quite differ from those of scientific understandings.  For Buddhism, the ultimate goal of humankind is nirvana—the extinction of all defilements and suffering.  Therefore, all of Buddhadhama—the Buddha teachings—gears to this goal while mention very few about the origins of the earth or the universe.  The condition of all things, in Buddhadhamma, is seen as an integrated form.  They are composed of and depending on various elements and their features.  In general, the composition of human can be divided in many different ways depending on a specific goal, but the most common way is separated into the physical aspect and, the more important part, mental aspect or mind.  The common characteristics of all beings are Tilakkhaņa: impermanence, suffering, and non-self.Buddhist perspectives on health and healing are presented in chapter 6.  The perfect health in Buddhist paradigm is the state of free from all mind sufferings, nirvana.  From this point, the meanings of disease, illness, or sickness include all kinds of suffering in both mind and body.  Meanwhile, aging, illness, and death are seen as commonly inescapable events for everyone.  When people have some health problems, they should not add on more mental sufferings.  Everyone has a responsibility to take care him/herself not only for plays or happiness, but also for the ultimate goal of complete health.  Many items in Vinaya Tipitaka—the codes of Buddhist monastic disciplines—were set for a comfortableness of sick monks while protecting the others from diseases.  The Buddha has never refused any healing techniques those are not harmful to the Noble Eightfold Path (Magga).  Chapter 7 presents results of my field works.  Seven people who applied Buddhist paradigm in their ways of lives were interviewed about their lives and health experiences.  I found that Buddhist paradigm has gradually changed their lives and worldviews.  Their lifestyles are easier as well as less suffering than those of people who studies and practices less in Buddhism.  Although all of them still have physical health problems as others, their attitudes on living or coping with diseases were differed.  In their views, health problems are not necessary to get rid of immediately.  They looked for appropriate ways to cure the diseases with peaceful minds while concerned nature of lives.  Their methods of healing seem to be more in natural ways and less depending on expensive technologies.  In addition, I present another case of a small hospice to severe Aids patients.  It runs by 2 monks and a few staffs.  They have applied Buddhadhamma, rituals, and some modern medicines to treat the patients.  This case shows another aspect of Buddhism on health and healing in Thai society. The last chapter, I try to conclude that Buddhism can be seen as a paradigm.  This paradigm has its own realities about life and the world differed from scientific and holistic paradigms.  By comparing with other paradigms, people who apply Buddhist paradigm into their lives seem to have less suffering when they get health problems.  In this chapter I also make an effort to show that Buddhist paradigm is still suitable, valuable, and possible to solve health problems in Thailand.  It is useful and reasonable to re-implement Buddhist paradigm to Thai society.  The strategies for re-implementation are discussed as well.


Self-medication with modern pharmaceuticals in rural Thailand: Theoretical concepts and empirical findingsThe study aims to:1) make a critical review of theoretical concepts and studies concerning self-medication practices; 2) investigate self-medication behaviors of the rural Thais and’ 3) discuss research and policy implications regarding the promotion of rational drug use by consumers. The study uses two main methods: documentary review and the analysis of empirical materials. The existing data sets collected during a research project conducted by the author- The Implications of Community Health Workers Distributing Drugs- A Case Study of Thailand-.were relied upon in the second method. The study comprises six chapters. Chapter One and Chapter Two provide backgrounds of the study and the accounts of the methodology and data used respectively. Theoretical concepts and studies concerning drug use behaviors are reviewed and discussed in Chapter Three. Highlighted are the theoretical perspectives such as modern pharmaceuticals as cultural artifacts, health commodification, cultural reinterpretation, and role of the informal commercial drug sector on self-treatment. Empirical data are presented in Chapter Four and Chapter Five. Chapter Four describes the quantitative figures and general patterns of how and what drugs are used by the rural villagers to solve their ill-health problems. Beliefs and perception associated with drug choosing and evaluating (i.e., brand, provenance, form, physical attributes etc) are also described. Chapter five moves on to the qualitative accounts of how people’s self-medication practices are shaped. Case studies are presented to demonstrate how the community’s socio-cultural and economic contexts (i.e., the availability of drugs and drug sources, the marketing practice of local drug firms, life-hardships of the rural dwellers that underlie work-related ill-health and, subsequently, determine demand for drugs) condition people’s self-treatment. In Chapter Six, the author concludes and argues that self-medication is, in fact, a cultural phenomenon. Its pattern is shaped by a complex web of causes embedding in both local and structural levels. Any attempt to elevate people’s drug use problems will hardly achieve unless such a complexity is realized and brought into consideration.


Development process of pesticides-free vegetable production systemsin Chiang Mai Province	The research has the objectives to provide better understanding on pesticide-free vegetable production systems, on process of group formation, organization and management of farmer groups and their sustainability, and to determine the roles of external institutions on the development of farmer groups.  The sites selected for case studies were the pesticide-free vegetable production in Saraphi, Mae Rim and Phrao districts of Chiang Mai province.  The research methods included semi-structured interview, where the target interviewees were farmer members, and key informants such as chairperson and committee members, farmer leaders, kaset Tambons (Subdistrict extension agents), NGOs, and retail markets of pesticide-free vegetables in Chiang Mai.	The results showed that the farmer groups in Saraphi, Ban Muang Khum of Pong Yang subdistrict were organized and assisted by the District Agriculture office.  The Doi Khum group of Pong Yang subdistrict were organized by the Doi Khum Royal Project, and the NGO was helping the farmer group at Phrao district to produce organic vegetables.	The Saraphi group intercropped vegetables in young longan orchard.  There was a tendency to cease growing pesticide-free vegetables when the fruit tree matured.  The Mung Khum and Doi Khum groups grew their vegetables in rotation with flower production.  Both open-field and closed net production practices were found.  The Saraphi group grew more vegetables.  Which the Pong Yang area (Mung Khum and Doi Khum) mainly produced vegetables on open field, consisting of both common type and sub-temperate vegetables.  All three groups practised safe-use of pesticides.  The Phrao group produce organic vegetables without using any chemicals or pesticides.  The vegetables which were mainly local, were planted on open-fields around or not too distant from the house.  The common vegetables were also grown during cool season.	The groups marketed their produce differently.  The Saraphi group, depending on one member as local trader, delivered their produce daily to various markets.  The Doi Khum was contracted to the Royal Project, but was allowed to sell their discarded products to other markets.  The Mung Khum group was further divided into six sub-groups, each handling its own marketing outlets independently.  The Phrao group sold their surplus in the Saturday market organized by NGO in Chiang Mai at Im-Boon place.	It is anticipated that the Saraphi group was not sustained due to less motivation to grow vegetables among most farmer members.  The Doi Khum group depended solely on the Royal Project for marketing arrangement and production plan without the Royal Project, the group would disintegrated.  The Mung Khum group, consisting of six subgroups working independently, could become strong if those sub groups could form alliance or network for production and marketing.  The Phrao group, developed slowly but steady, would become self-reliance when the production is more stable.


The Development of the database system for detecting and preventing drug-drug interactions in Songklanagarind HospitalThis study is aimed to develop the database system and algorithm for detecting drug-drug interactions by starting from Songklanagarind Hospital. Four databases for drug interaction detection were developed using Access 2000 Thai edition (Microsoft() operated on Windows 98, i.e. standard drug name database,  trade name database, drug group database, and drug interaction database.   Standard drug name database was a two-field table including the names of drugs available in Songklanagarind Hospital and their equivalent standard drug names.  Trade name database was also a two-field table consisting of a list of standard drug names, appeared as trade names in the standard drug name database, and their equivalent generic names.  The generic names were defined based on TIMS and Songklanagarind Hospital Formulary.  All generic names existing in the standard drug name database and trade name database were set in to their corresponding pharmacological groups and collected in the drug group database.  Certain generic drugs were arranged in to more than one group.  Any drug group was also put in the supergroup if possible.  The groups were defined based on a pharmacological textbook.  The name of the groups must be similar to those called by the drug interaction references using in database development.  The drug interaction database was an eleven-field table involved pairs of interacting drugs, significance (significance level, onset, severity, and documentation), effect, mechanism, management, title and page of reference referred.  Knowledge of drug interactions were based on three widely known reference books, i.e. Drug Interaction Facts, Evaluation of Drug Interactions, and Management Clinically Important Drug Interactions.  Only the details of effect, mechanism, and management of drug interactions were translated into Thai language.  The rest were quoted directly from the references.   Algorithm for detection of drug interactions, which was written using structured query language (SQL) for Access, were comprised of two major steps, i.e. i) an expansion of prescription, and  ii) an extraction of information.  An expansion of prescription involved with relating any drug name in a prescription to the corresponding standard name, generic name, and group name based on the databases. After the expansion, drug interactions were extracted directly by inner-joining the drug interaction table with two copies of expanded list.  Then a list of pairs of interacting drugs and related details was shown when an interaction was present.  The developed databases and algorithm were tested at Naratiwatrachanagarind Hospital in Naratiwat in order to evaluate that this database system is applicable at the other hospitals.  The concept of detection algorithm was similar to the one used at Songklanagarind Hospital.  The steps of detection was written using SQL for FoxPro operated on DOS.  The testing result showed that the database system was applicable in this hospital.In conclusion, the database system developed originally at Songklanagarind Hospital can be used as a tool to detect drug-drug interactions in hospital.  It is possible that the system is applicable for being use among the other hospitals in Thailand.


Monitoring and Evaluation System for Organization Administration and for Development of Public Hospital Management Policy	In this study, the monitoring and evaluation system on public hospital management in order to improve its policy was developed through the process of reviewing the administrative system of the sampled organizations, reviewing the monitoring system of the central agency, analyzing all the data and establishing recommendations for developing monitoring and evaluation tools. Qualitative technique was used in this study. The sampled organizations were the Banpaew Hospital, Samutsakorn Province, the Prince of Songkhla University Hospital, the special clinic of the Ramathibadee Hospital, the Rajyindee Hospital (private hospital in Haadyai, Songkhla Province), the Suranaree Technology University and the Central Organizations involved in monitoring and evaluation system. Key informants were high ranked people in the organizations, those who were responsible for auditing and evaluation, the operation staff and community representatives who were purposively selected. 	The sampled organizations possessed 2 main administrative structures, one largely directed by the higher level organizations and the other setting up the committee to determine their own policy and to control all important administrative work. One of the highlights of these organizations was their development of services quality on the basis of either hospital accreditation or ISO 9002 to quickly respond to various factors e.g. community demand and increasing competitive markets. The auditing and evaluation systems were grouped into part of administration, quality and operation, finance and assets, nursing and other functioning sections. The auditing could be done through the obvious and formal system, or informally internal auditing system or quality and financing control system without internal auditing system. The central organizations in this study were the Budget Bureau mainly responsible for auditing financial and accounting system, the Social Security Office having the Medical Committee and the Medical and Rehabilitation Coordinating Committee both of which monitor the health facilities providing care for the insured and the Hospital Accreditation Units responsible for developing care standards and encouraging the accreditation system in nationwide.	The committee which determine organization policy, monitor, evaluate and audit the organization, was recommended to set up. Such a committee should have representatives from communities, public organizations, networking organizations, the hospital, and well-experienced people in public health. The hospital administration committee should also be formed, composed of 2 groups: administrative and operational representatives. While internal auditing unit should be independent and should directly report to the policy committee. The auditing system should comprise service quality auditing and professional or special service auditing. The auditing and the reporting should be systematized whereas the auditing team and the auditing tools should be continuously developed.


This research was aimed to study the health communication of 5 types of local media; local newspapers, provincial broadcasting radios, community radios, news broadcasting towers, and cable televisions. The main objectives of this research were to study health communication content and presentations, health communicators’ procedures, audiences’ exposure and expectation of receiving health information and the tendency of local media use for health communication.  The area of this research included six provinces; Prae, Nakhonpanom, Nakhonpathom, Chantaburi, Kanchanaburi and Stun.  The sampling group of this research included five kinds of local media (16 titles of local newspapers or 95 pieces, 14 provincial radio broadcasting stations, 6 community radio stations, 6 news broadcasting towers and 5 cable television station), 45 communicators in 5 fields of media work (14 communicators of local newspapers, 14 communicators of radio broadcasting stations, 6 communicators of community radio stations, 6 communicators of news broadcasting towers, and 5 communicators of cable television stations) and 643 local media audience from 6 provinces mentioned above.   The methodology conducted for this research involved surveys and interviews.  The data of local media was analyzed by content analysis methodology and the data of communicators and audiences was analyzed by statistics methodology.	As a result of the study, it was found that the health content presented by provincial radio was mostly related to “disease”, with the aim of making the audience know how to protect themselves from getting ill.  The content was presented in 4 forms; health programs, radio spots, trifling information inserted into other programs, and advertisements.  Regarding the community radio stations, the health communication management was mostly under the control of the station committee, supported by private organizations.  The content was presented in the forms of health programs and pieces of information in other programs.  The main issues of the content were mostly related to “disease” and “food” with the objectives of disease prevention and health promotion more than disease cure and rehabilitation.  In the case of the news broadcasting towers, health content was not presented in the form of health programs but the announcement of health service and spots from official organizations were found being broadcast instead.  Most of the cable television stations presented health information through local news programs to inform or report the events.  The content was mostly related to “disease” and “food”.  While small-size medium local newspapers, published from every five days to monthly, presented every type of health content in the forms of news reports, articles and advertisements.  	Regarding the health communicators, most of them were male, aged between 25-55, with 1 to 30 years work experience holding Bachelor degrees.  They usually worked in many fields of local media and also worked as stingers for the media in Bangkok while some of them do this work as the second job.  Most of these communicators had no knowledge of health so health columns and articles were brief with the use of many sources for health information.  The local audiences, aged between 31 to 60, mostly were female, and graduated from secondary schools.  They needed all 5 kinds of local media to communicate health information especially the provincial broadcasting radios.  The audiences expected to receive health information from cable televisions least. However, they expected every local medium to increase the presentation of health content especially the continuous practical information which is easy to understand, correct and serious.  The most needed content was information about “disease”.  	Although the communicators and audiences has desired an increase in the quantity of health content presentation, due to the limitation of knowledge, information, sources, budgets and also being attached to business interests of some media, the local media has been still unable to communicate health information with full-efficiency as they should do.


This research project comprises two parts.  The first part is the review of experiences in researches in quality of health care and setting a preliminary proposal for research question frameworks.   The second part is a survey of situations and questions among stakeholders, namely providers and clients, regarding quality of the health services system and quality improvement and a summary of strategies to approach quality of health care research.  The project report presents the findings of the Phase 2 study, which aims to a survey of situations and questions among stakeholders, namely providers and clients, regarding quality of the health services system and quality improvement and a summary of strategies to approach quality of health care research.  The focus areas, which are drawn from the findings in the Phase 1 study, include problems and obstacles in quality improvement, patient safety, and expectation and perceived services from patient perspective.   Descriptive studies by questionnaires were conducted health care providers and patients in 39 public and private hospitals and 39 primary care units in 12 areas nationwide and Bangkok.  In addition, hospital accreditation surveyors were surveyed.  There were also in-depth interviews among primary-care-unit patients and a telephone survey of people in Bangkok and its vicinity area.  The studies were conducted during January 2004 to December 2004.	Major findings include 33 interesting research topics on quality improvement issues and 40 topics on patient safety issues from the studies on health care providers.  There are four topics on primary care units.   There are 12 topics identified by the surveyor group; some of which are similar to those of the provider group.  In addition, there are another 22 research topics set apart from the patient and consumer studies.   In sum, these findings are details consistent with what have been found in the Phase 1 of this research project.