Background: Health equity is systematic deprivation gaps in resource allocation, accessibility and utilization of health services. The elderly people with high prevalence of chronic, and non-communicable diseases (NCDs) usually face problems with respect to high treatment cost, and if health inequity exists, they disproportionately suffer a decrease in their quality of life. Objective: The study was aimed at exploring the factors affecting health equity in Thai elderly, as well as activities that improve health equity. We focused on horizontal equity dimensions of cost, use, and accessibility to health services. Methodology: This was a systematic review, searching 5 Thai and 2 international databases. The inclusion criteria covered equity in health in elderly and related meanings (in Thai and English). Content analysis, and descriptive presentation were used in this review. Result: The affecting factors to inequity in health included external factors (e.g. socioeconomic factors) and internal factors (personal/behavioral factors on use of service). The external factors that improved equity in health in elderly included health insurance coverage and living in urban area. The external factors that decreased equity in health in elderly included education lower than high school level, low income, no occupation, no insurance and living in rural or remote area. The internal factors that decreased equity in health in elderly included 1) having disability or chronic illness, 2) stress, and 3) behavior for not using health service. All of these factors affected on 1) health status, 2) health financing, and 3) health needs (accessibility and utilization). The interventions that decreased inequity in health and improved equity in health were as follows: 1) treatment and rehabilitation activities at secondary and tertiary hospitals, 2) health promotion and disease prevention activities at the community or primary care units, and 3) public services or social welfare activities aimed at reducing inequity by decreasing health service expenditure to elderly. Recommendation: Appropriate approaches amending factors and activities affecting inequity should be implemented to achieve health equity in elderly.


The objective of this study was to estimate unit cost of services providing at the primary care cluster (PCC). Four PCCs including two urban and two rural were selected. This study was retrospective study using data from fiscal year 2017 and some data from 2018. Data on financial, services and staff workloads were gathered. Then, unit cost per activity and the unit cost per capita were calculated based on activity-based costing. The result showed that labour cost was the highest cost component in the PCC followed by material cost, whereas, capital cost was the lowest. Material cost in urban PCC was higher than in rural PCC. In addition, average unit cost per capita was 1,025.21 baht. It should be noted that all PCCs in the present study were in the stage of implementing and improving services in order to benefit their people. Therefore, the results described unit cost of initial stage of operation in the PCC.


At present, the Royal Thai Government attempts to downsize civil servant posts amongst health personnel. This approach affects not only administrative staff, but also core health professionals including doctors, dentists, pharmacists, and nurses. This study aimed to explore the current situation and new employment modalities of health personnel and the impacts on retention and budget in the next 15 years. Cross-sectional mixed-method design was used. Data collection techniques comprised document reviews, in-depth individual interviews with policy makers and health personnel users, and group interviews with health personnel. Self-administered questionnaire survey on health personnel was also performed. Thematic analysis was used in qualitative data. Descriptive and inferential statistics were used in quantitative data. For qualitative findings, policy makers and health personnel users opined that hiring health personnel in civil servant posts usually faced bureaucratic hurdle, which at times undermined the flexibility in assigning health personnel in a position that matched their expertise. However the civil servant posts should continue to exist in certain functions, for instance, executive and financial functions. From the viewpoints of health personnel, being hired in civil servant post contributed to longer retention in the public sector due to work security and attractive benefits, especially medical benefits for family members. All interviewees agreed that there should not be too many employment patterns. If the civil servant employment were to be terminated, the replaced employments should have increased start-up salary and fringe benefits not inferior to the current civil servant benefits. This is consistent with the quantitative findings, which demonstrated that civil servant employment would cause longer retention years in the public sector despite large budget burden incurred (approximately 21,632 million baht in the next 15 years). Nurses showed longest retention years than other professionals. Comparing with other employment modalities apart from civil servant employment, hiring health personnel in the fashion similar to university staff with fringe benefits not inferior to civil servants, were likely to see longest retention years despite a relatively large budget burden (the budget size in the next 15 years equating 15,208 million baht, about one quarter of the budget used in civil servant employment, while the remaining health personnel in the next 15 years would be half of the remaining health personnel in civil servant employment). In summary, downsizing the number of new civil servant posts tended to substantially decrease budget impact but there was a trade-off in losing health personnel from the public sector. Regarding policy implications, the downsizing policy of civil servants should not be hastily implemented. Lifting the remuneration and fringe benefit of new employment modalities to the level that is on par to those of civil servants is recommended. In addition, there should be an amendment in public employment laws or regulations to create a leeway for health facilities in hiring health personnel in the way that matches their local context.


Monitoring and surveillance system of unhealthy products marketing is a part of the study on the situation of unhealthy products marketing control. Unhealthy products of this study included food, breast milk substitutes, tobacco and alcoholic beverage. The objective of this study was to analyze the gaps of and opportunities for monitoring and surveillance system of unhealthy products marketing. Literature review and interview with the stakeholders were undertaken. Searches were conducted through government, academia, and civil society database from 2012 to 2017 via Google search engine. Purposive sampling was used to select the key informants from government agencies, academia, and civil society for interview. Framework of analysis was the guideline of surveillance system of the Center for Policy Development, and Non-Communicable Disease Control Strategy Program, Department of Disease Control. The study found similar monitoring and surveillance systems including active and passive monitoring systems for all 3 types of products (except breast milk substitutes), but had different participations from other sectors. The control of food marketing lacked participation from academia, and civil society. Monitoring and surveillance system of alcohol marketing did not collaborate with other ministries such as the National Broadcasting and Telecommunication Commission, Ministry of Digital Economy and Society. Monitoring and surveillance system of tobacco marketing had many actors but with no coordinating agency. Monitoring and surveillance system of unhealthy products marketing including marketing of infant and baby food was recently set up. Therefore, there should be further evaluation on efficiency of these monitoring and surveillance systems.


Exclusive breastfeeding is the most appropriate food for under-6-months old infants. However, some of them received infant formula during this first period of life. While previous studies focused on barriers to exclusive breastfeeding, this study examined when, why and what factors of initiation of breast milk substitutes (BMS) in the first 6 months. This study was quantitative research. Data were collected through a questionnaire from 1,147 mothers and caregivers of children under 3 years old at well-baby clinics in public and private hospitals. Characteristics of the sample, first exposure and reasons were presented using descriptive analysis. Factors of breast milk substitute initiation were analyzed by using binary logistic regression. The analysis used SPSS version 18. The study presented that most infants started breast milk substitutes in the first day after birth (24.1 percent), and in the first month, there was 44.5 percent of infants fed formula because mothers believed that “mothers’ breast milk was insufficient” and “mothers had to return to work or study”. The results of binary logistic regression illustrated that “education level of mothers” and “family-economic status” as well as “changing main caregivers” and “the negative attitude on breastfeeding” were associated with formula feeding before reaching 6 months.


Thailand has high burdens of tuberculosis, tuberculosis with AIDS and multiple drug resistance tuberculosis. This may be due to the lack of efficient and effective tuberculosis prevention and control at all levels. Vaccination against tuberculosis is a primary prevention measure. In Thailand, the Ministry of Public Health has designated BCG as a basic vaccine against tuberculosis that all newborns should receive. But BCG has numerous limitations, it can only prevent against severe tuberculosis in children, but not in others. Nowadays, researchers worldwide are trying to accelerate the development of effective vaccines against tuberculosis for all populations and all age groups for using in parallel with health promotion and disease control measures appropriate to each societal context. This should be an effective and important way to control, prevent and reduce transmission of tuberculosis. The objective of this article aimed to present importance of tuberculosis vaccines and guidelines for studying the vaccines in Thailand. It is expected that this article would benefit interested readers, especially researchers and relevant persons to apply this knowledge along with prevention programs for controlling tuberculosis in the future.


Background and significance: Peritoneal dialysis (PD)-related infection is a common serious complication among PD Patients leading to technical failure and a significant cause of morbidity, mortality, and healthcare costs. Yet, prevention strategies of PD-related infection are still unclear. Objective: To compare effectiveness, safety, and cost-utility of chlorhexidine gluconate (CHG)-soaked cloths to mupirocin ointment and exit site usual care with aseptic technique in prevention of PD-related infection. Methods: A double-blind, stratified randomized controlled trial to evaluate effectiveness, safety, and cost-utility; participants were randomized into three arms CHG-soaked cloths, mupirocin, and exit site usual care (normal saline with aseptic technique; control group) in a ratio 1: 1: 1. They were followed through 12 months or until a switch to hemodialysis, or death. The primary outcome was PD-related infection (exit-site and tunnel infection or peritonitis). Time-to-first PD-related infection and longitudinal rates were analyzed by multivariable Cox’s proportional hazards model and Poisson regression, respectively. Secondary outcomes were safety and adverse events related to treatments. Cost-utility analysis alongside a randomized trial will be performed. One year costs were estimated from the patient and societal perspectives and the quality-adjusted life years (QALYs) were calculated based on the responses to the EQ-5D-5L at baseline, 6 and 12 months. Guided by Thai Health Technology Assessment guideline, a markov simulation model was developed to simulate the disease progression of PD treatment. Results were revealed as an incremental cost-effectiveness ratio (ICER) in Thai Baht per QALY gained. Results: Of 184 participants during a study period between June 2016 to August 2018, 62, 61, and 61 were recruited to the CHG-soaked cloths group, mupirocin group, and usual care group, respectively. Sociodemographic and clinical characteristics among 3 groups of patients met inclusion criteria were comparable. For primary outcome, compared with usual care, CHG-soaked cloths decreased the risks of both time-to-first PD-related infection (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.26-0.69; P=0.001) and longitudinal rates (incidence rate ratio [IRR], 0.52; 95% CI, 0.36-0.74; P<0.001). Likewise, mupirocin ointment also resulted in the lower risks of both time-to-first PD-related infection (HR, 0.42; 95% CI, 0.26-0.68; P<0.001) and longitudinal rates (IRR, 0.49; 95% CI, 0.34-0.71; P<0.001). However, the outcomes were not significantly different in the CHG-soaked cloths and mupirocin ointment groups. For secondary outcomes, the incidences of serious adverse events, safety profiles and mortality rates were not significantly different among groups. For the economic analysis, both CHG-soaked cloths group and mupirocin ointment led to improved 0.11 and 0.12 QALYs compared with usual care, with the ICERs for CHG-soaked cloths and mupirocin ointment groups of 130,114 and 149,376 Baht per QALY. Both interventions are cost-effective at the ceiling threshold of 160,000 Baht/QALY gained. Conclusions: The findings of this study reveal that CHG-soaked cloths group and mupirocin ointment can be recommended as routinely for the prevention of PD-related infection in the Thai context. To guide evidence-based best practices, further studies are needed to investigate the long-term effects as well as concerns about bacterial resistance to these interventions.


Scedosporiosis in Thailand is mostly caused by Scedosporium boydii, which is known to be resisted to anti-fungal drugs resulting in death from infection. Most of the organs that shown disease pathology are cerebral edema and pulmonary disorders. Currently, there are many substances that can enhance the performance of antifungal drugs. It was found that substances that have been studied and developed for use in the treatment of many types of fungal infections are substances in the group of fungal Quorum sensing molecules. In laboratory studies, the Farnesol group at 100 µM can inhibit Scedosporium boydii infection without any toxicity effect to target cells. When confirmed the results of experiments in neutropenia-induced mice with Cyclophosphamide, it was found that the pathogenesis of the brain can be reduced clearly. The results of studies in mice that were inserted in the Catheter coated with Farnesol (F +) compared with those that were not coated with Farnesol (F-) shown that the amount of Scedosporium boydii at the hollow tube of the Catheter was lesser in F + group than F- group by Scanning Electron Microscopy. Moreover, the treated catheter was further cultured, which shown the lesser amount of infection or the formation of colony in F+ group than F- group (p <0.05). When comparing pathological examination between groups that were inserted Catheter, it was found that the F-group had symptoms of disseminated Scedosporiosis clearer than the F + group. It was found that the rats from F- group exhibited brain edema with severe damaged of alveolar septum and pulmonary edema. Based on the above study, both laboratory studies and animal studies as well as the underlying medical prototype product, the Catheter revealed that quorum sensing molecules, Farnesol, played an important role in inhibiting the growth of Scedosporium boydii. This preliminary study will help to develop a research in depth into the development of effective medical product. Moreover, study of other types of Scedosporium spp. should be further extended as well as the larger sample size of animal experiments. The interaction between Farnesol and the existing antifungal drugs including the study of pharmacokinetics in both in vitro and in vivo models need to be further elucidated.


The objective of this study was to assess health literacy and case studies of organic producers to evaluated changes in a chemical behavior risk of chemical exposure, and responsibility to consumers in the production and consumption of food from people's organic produce, and develop guidelines for educating changing behavior in order to develop health literacy for organic farmers. The study is an action research and reporting the results in phase 1 of the process and determining guidelines for the development of health intelligence for farmers The study was found that : The average score of health literacy of farmers in the production of agro-based production in basic and interactions at a moderate level, while the level of health literacy was at a low level The relationship of educational level and knowledge of self-protection of farmers is related in the same way both in self-protection. Disagree with the use of pesticide chemicals at statistical significance of 0.00 with better self-protection behaviors with statistically significant at 0.05. The study was related to the health literacy of the farmers producing the form Organic agriculture, which found that farmers with higher education levels had higher health intelligence than statistically significant at 0.00 Chemical use training has a relationship with the knowledge of self-protection of farmers. The group that used to train will have better knowledge with statistically significant significance at 0.00. Training on chemical use has a relationship with the attitude of farmers towards the use of pesticides. With statistical significance at 0.005. The study was related to the self-protection behavior of the farmers on the use of pesticides with statistically significance at 0.001. Training on chemical use had no relationship with literacy Farmers' health in the production of organic agriculture has a negative relationship with Knowledge of self-protection of farmers. The attitude of farmers towards the use of pesticides and chemicals. Health literacy of farmers in organic production with the value of the coefficient p <.01. The revenue is not related to knowledge of self-protection of farmers and health literacy of farmers in organic production and has a very low relationship with farmers' attitudes towards the use of pesticides and self-protection behaviors of farmers where the coefficient p <.01. The factors and the development of literacy building of organic farmers, consisting of social context, beliefs, attitudes, age, knowledge seeking, media training / books, awareness of family benefits and health, learning network Support from government agencies by proposing guidelines for educating and changing behavior to develop health literacy of organic producers. There should be support for knowledge sets and potential development of farmers. According to the type of production Support knowledge and management skills Build quality certification system Government support Establishment of an organic agricultural network at the sub-district level.


Background: End stage renal disease (ESRD) affects the quality of life and causes the high cost in health care system. The prevention of ESRD is the early recognition and appropriate treatment. Glomerulonephritis is the third most common cause of ESRD in Thailand. Thai Glomerular Disease Collaborative Network (TGCN) was established to evaluate the epidemiology and clinical outcomes in the glomerular diseases and helped to promote the good system to taking care of these patients. Methods: TGCN originally consists of 9 tertiary care centers and expands to 37 hospitals. We conducted a prospective cohort study in the adults’ native kidney biopsy proven glomerular diseases between July 2014 and Mar 2019. The clinical and laboratory parameters at the time of biopsy, pathologic findings, treatment regimens and clinical outcomes were recorded via on-line registry. This year, we interested in the secondary glomerular disease causing by hepatitis B, hepatitis C, and HIV including the rare and poor prognosis disease such as deposit disease. Results: We recruited 2,755 patients performed native kidney biopsy during Jul 1, 2014 to Mar, 2019. The adequate data for analysis were 2,132 cases. The average age, creatinine, albumin, and cholesterol were 44+16 years, 2.15+19 mg/dL, 2.9+1.2 g/dL, and 290+138 mg/dL in respectively. The median proteinuria was 3.68 (0.02-42.03) g/day. The renal pathological findings showed 34.5% of LN, 13% of IgAN, 11.4% of FSGS, 7.9% of membranous nephropathy (MN), and 7.4% of minimal change disease (MCD). In our data, we found HCV-ATN 2 cases and HCV-associated GN 37 from 1,871 cases performed HCV testing including diabetic nephropathy 9 (24.3%), MPGN 5 (13.5%), FSGS 5 (13.5%), MCD 3 (8.1%), IgA 3 (8.1%), ANCA 2 (5.4%), and MN 2 (5.4%). Regarding the rare Paraprotein-related kidney diseases, we found only 22 cases mostly with 18 amyloidosis, 3 light chain deposit disease, and 1 heavy chain deposit disease. Conclusion: Our study described the common renal pathological findings including LN, IgAN, FSGS, MCD, and MN. we have performed the recommendation for management in glomerular disease, FSGS and MCD in adult Thai patients 2018 and IgA, MN 2019 in this report.


Background: Integration of care among parents, teachers, and healthcare providers is crucial
for successful treatment of children with ADHD. However, parents, teachers, and healthcare
providers share limited data on caring ADHD children and lack of innovative tools to support
the integration of care among. A mobile health (mHealth) approach may bridge the gap
among parents, teachers, and healthcare providers, allowing communications with necessary
information as well as ADHD source of reliable informationto improve ADHD symptoms and
reduce stress of parents and teachers.
Method: The study sample included 41 children with ADHD and 41 parents from a tertiary
care child development hospital, 41 teachers, and 5 healthcare providers of the children.
Participants were randomly assigned to one of the following three groups: (1) a study group
in which the parents, teachers were trained to use the Integrated ADHD Care Model (IACM)
with the Application ADHD on mobile (AA); (2) a control group in which the parents and
teachers were trained to use IACM; or to (3) a control group in which participants were
treated with usual care (UC). ADHD symptoms assessed by parents and teachers using the
SNAP-IV rating scale and stress of parents and teachers were rated usingthe SPST-20 were
recorded at baseline, month 1, 2, and 3.
Results: Participants who used IACM+AA demonstrated lower ADHD symptom score over 3-
month period compared with usual care (p<.05). In addition, a significant improvement in
stress scores in parents and teachers were found among the IACM+AA group and IACM group
compared to UC group in 3 months (p<.05). No significant difference of stress scores was
found between IACM+AA and IACM groups.
Conclusions: The current study provides support for the feasibility of a new mobile app in
supporting care for children with ADHDto improve ADHD symptoms and reduce stress of
parents and teachers.


Pre-Exposure Prophylaxis (PrEP) is one of the preventive measures for HIV infection in population with substantial risk such as Men who have Sex with Men (MSM), transgender women, people who inject drugs (PWID) and heterosexual HIV-1 sero-discordant couples. In Thailand, PrEP service has been supported by governmental bodies and private sectors, from both national and international levels. This service is run as a pilot programme and is available only in certain areas. It is also not included in any health coverage schemes. For more effective prevention against HIV as well as for keeping AIDs problems under control by 2030, the Department of Disease Control, Ministry of Public Health, had proposed an inclusion of such service into the Universal Health Coverage Benefit Package (UCBP). The service was selected for evaluation with health technology assessment, in which economic evaluation and budget impact analysis were conducted. Health Intervention Technology Assessment Programme (HITAP) was assigned from the subcommittee of Health Benefit Package, National Health Security Office, to conduct an economic evaluation of the PrEP service, which covers both Tenofovir Disoproxil Fumarate (TDF) and Emtricitabine (FTC), as well as related laboratory tests. The evaluation was performed in order to aid the decision making process of whether to include the aforementioned service into the UCBP.


District health system considered as a lever point to improve the quality of life of people which mechanism of driving in the district area rely on district health board in which the development process would be sustainable successfully, the process must be consistent with the context of the area and the empirical information is needed for the decision. The objectives of this study were to develop the geographic information system for health management of the district health board and to synthesize the purposed policy of using the geographic information system to improve quality of life among population in the area. Mixed method of research and development design integrated with participatory action research (PAR) were applied in the study. The study processes divided into three phases: phase 1: the development of geographic information system to improve quality of life, phase 2: the assessment of the implementation of the system, and phase 3: the synthesis of purposed policy in the development of the system. The study was set in two districts of Nakhonsawan province. The finding showed that: 1. The development of geographic information system to improve quality of life had five steps: 1) the study of essential information, 2) the distribution of data resources both in an original database and new information, 3) the connection of essential information from the database of organizations which related to the improvement of quality of life among population in the area, 4) the creation of conditions for analyzing data and presenting in the program that called Geographic information system: GIS through website (http://118.175.82.80/dhb/web/index.php) in which general population and the district health board can access to by computer and mobile phone but in a different level, and 5) the implementation combines with decision making in determine issues for improving quality of life of people, planning and evaluation 2. The assessment of the implementation of the system revealed that the for the long term care of vulnerable group, especially the elderly is thoroughly taken planning of care, can access to essential services and social welfare, and having skills for self-care that help to reduce the risk of complication from their existing diseases. 3. The synthesis of purposed policy in the development of the system had four issues:1) having district health data center for quality of life improvement, 2) having organizational structure in geographic information system management, 3) having the potential development of the committee in using information for decision making related to public health, and 4) having an exchange process for learning from practice. Therefore, in using geographic information system for the decision making to improve the quality of life of people in the area, the district health board must use the empirical information which consistent with the context of those areas. These will lead to the management of population health which is the true concept base of the district health system as saying that “The development that use community as base and people as center”.


Although, Thailand has been committed to fight against irrational use of antibiotics since 2007, an inappropriate use of antibiotic continues to occur among Thai population. Therefore, the situation poses a significant challenge to the efficient working of the national rational antibiotic program in Thailand. The objective of this research was to examine the relationship between eHealth literacy, information seeking, knowledge, attitude and self-management of upper-respiratory infection (URI) in Thai population. The quantitative approach was employed in this study. The self-administered questionnaires were distributed to 2,708 respondents who resided in 21 provinces across four regions of Thailand. The results demonstrated that respondents reported low level of eHealth literacy on the ability to evaluate the health information on the internet. Respondents were more likely to seek information regarding the treatment of upper-respiratory infection from member of the family. The overall level of knowledge on antibiotic was moderate. Respondents had a positive attitude toward antibiotic usage and reported a low level of self-management of upper-respiratory infection. Findings of this study offer useful insights into the communication program for the reduction in antibiotic usage for upper-respiratory infection among Thai population.


Thailand has achieved Universal Health Coverage since 2002. Consequentially, almost all Thai citizens
are covered with basic oral health services by publicly funded insurance schemes. However, the
proportion of Thais who receive such services is still low with inequity patterns among different groups
of people. The purpose of this study was to analyze the equity in oral health service among Thai citizens
through patterns of oral health service uses as well as unmet oral health needs by using the 2017 Health
and Welfare Survey by the National Statistical Office of Thailand. The result revealed that 9.6 percent of
Thai population received any oral health service within the past 12 months. Most (81.6 percent) of service
uses were for treatments. The main reasons of not seeking oral health service were the delays and prolonged
waiting time. On the unmet oral health needs, 1.4 percent of the population with oral health
needs was not met. The populations with no health benefits, the aged, and the lowest socio-economic
status saw twice as many unmet oral health needs compared to other population groups. These groups
received the least oral health services. The survey showed the inequity of oral health service utilization,
particularly among populations with different health benefits and different socio-economic status. This
indicates the necessity of oral health policy that responds to the needs of the people and creates an
equitable oral health service system; in particular, promotes oral health literacy, builds harmony among
three public health insurance schemes, and expands the scope of services so that people have better
accesses to necessary services.


In Thailand, a series of National Health Examination Surveys (NHES) have been conducted every
five years since 1991. The NHES employed two approaches for data collection including basic physical
measurements and structured interviews. The NHES exclusively provided objective information on health
status and health risks of the population which cannot be obtained from other sources. Consequently,
this information has been used for development of health promotion and disease prevention policies
as well as for monitoring health indicators and policies. Throughout 25 years of the NHES, no systematic
evaluation of the survey’s management has been conducted. The present study evaluated the NHES
management system in four areas covering the role of agencies responsible for conducting the NHES;
resources used for conducting the NHES; database management and the utilization of the NHES data;
and ethical issues related to access to the NHES database with the aim to provide policy recommendations
for future developments. The present study collected data through document reviews from September
2016 to January 2019 and in-depth interviews with 26 people including personnel in funding
agencies, survey managers, researchers who were part of survey networks and potential data users from
December 2016 to April 2017. The scope of literature review and questions for in-depth interview included
the NHES I-V. The present study found that NHES I-V involved many agencies in different capacities such as responsible
agencies for conducting and managing the survey, funding agencies, and steering committees.
There were frequent changes of agencies responsible for conducting NHES reflecting the lack of long-term
policies regarding the implementation of NHES. Every NHES reported budget constraints, yet there remained
neither budget allocation from the government in the long run nor long-term funding agencies.
Hence, the agencies implementing NHES had to propose budget request for each survey. These limitations
inhibited long-term capacity building on survey practitioners and institutionalization. Furthermore, policies
and guidelines for the utilization of NHES data and other information were vague. Although there was a
guideline drafted in the IV NHES, the guideline has not been put into practice making it difficult for researchers
outside the NHES networks in getting access to NHES database and specimens, hence NHES
data have been under-used. On the other hand, some health issues investigated by the NHES might be
duplicated with those of other health surveys conducted by the National Statistical Office or other
higher education institutes granted by the same funding agencies as the NHES. Therefore, it is highly
suggested that relevant authorities should consider the integration of health surveys at the country
level in all aspects.


The Thai Peritoneal Dialysis First Policy (PD First Policy) has improved
survival of end-stage renal disease patients since 2008. However, evidence on patients’ attitudes toward
the policy and the accessibility to kidney transplantation (KT) has been lacking. This study aims to assess
PD care satisfaction and KT attitude among continuous ambulatory peritoneal dialysis patients under the
Thai PD First Policy. Methodology: A telephone questionnaire survey asking demographic data, general
opinion on PD First Policy, PD treatment satisfaction, and KT knowledge and attitude was conducted in
April 2018 among 114 randomly selected PD patients from PD centers in Chanthaburi. Results: The mean
age of PD patients was 54.21 years, and their duration of peritoneal dialysis was 3.42 years on average.
Majority of them were satisfied (79.8%) and very satisfied (4.4%) whereas only 2.6% expressed their
dissatisfaction. One hundred and six patients (93.0%) agreed with PD First Policy, of which 65.1% stated
that this policy had saved their expenses. Of the total 114 patients, only 24.6% had KT knowledge but
73.7% would like to undergo KT. The main motivation for KT was the increased chance of returning to
work and contribute to family (88.7%). Conclusions: The Thai PD First Policy has been well received.
The perceived need for KT was high. A good strategic plan to improve knowledge on and access to KT
is required.


Background & Rationale: Ministry of Public Health introduced “antibiotic use in vaginal delivery of
normal term labor” as an indicator of rational drug use (RDU) service plan with target goal of not more
than 10% use. Mahasarakham Hospital implemented this RDU policy in October 2016 via meetings,
setting a goal and practice guideline together with regular monitoring and evaluation. The objective of
the present study was to examine effects of the RDU policy on antibiotic use, expenditure on antibiotic
and infection rate after implementing the policy among vaginal delivery of normal term labor in
Mahasarakham Hospital. Methodology: A retrospective study was conducted using hospital data of
vaginal delivery of normal term labor during October 2015 to April 2018. Antibiotic use and expenditure
were obtained from the 43-file standard dataset. Infection rate was collected from readmission record
of obstetrics and gynecology department. Patterns of antibiotic use after implementing the policy were
investigated from medical record reviews between October 2017 and April 2018. Mann-Whitney U test
was performed to compare antibiotic use rate and expenditure and infection rate between before (October
2015 – October 2016) and after (November 2016 – April 2018) policy implementation. Segmented
regression of interrupted time-series analysis was applied to examine policy effects. Results: Comparing
before and after policy implementation, the antibiotic use rate and expenditure were declined significantly
(median antibiotic use rate: 100% vs 13.2%, p<0.001 and median expenditure per month: 8,368
baht vs 1,328 baht, p<0.001). The infection rates were not significantly different (median: 0% vs 0%,
p=0.222). From time-series analysis, the policy significantly decreased antibiotic use rate (-82.1%, 95%CI:
-87.3 to -76.9, p<0.001) and decreased monthly-expenditure of antibiotic use (-6,663.2 baht, 95%CI:
-8,396.7 to -4,929.8, p<0.001) but no effects on infection rate by month (0.063%, 95%CI: -0.280 to 0.406,
p=0.709). From chart review of 721 vaginal normal deliveries, 45 women (6.2%) used antibiotics. The
major reason of antibiotic use was the 3rd - 4th degree tear (14 women, 31.11%). Amoxycillin and Cefazolin
were mostly used antibiotics. Conclusion: The findings of this study indicate that implementation of the
RDU policy significantly reduced antibiotic use and expenditure and did not increase infection rate. The
policy could improve rational use of antibiotic prophylaxis in vaginal delivery of normal term labor.


Kanchanaburi province borders with Myanmar and a large number of migrants are cared for at
Phaholpolpayuhasena Hospital. Financial expenses in providing care to migrant patients were analyzed.
The study population was inpatients and outpatients at the hospital during fiscal year 2017. Data collection
techniques involved a questionnaire, interviews and document reviews of medical records for the
previous year. A convenience sampling method was employed. Total sample size was 519 (412 outpatients
and 107 inpatients). Of the 412 outpatients, 305 had no admissions during the previous year, while 107
had been admitted in the hospital. The results showed that 18.4% of the outpatients and 38.3% of the
inpatients were not medically insured. When classifying patients according to the most costly disease
group, cancer comprised the highest proportion in the outpatient sample at 63,459 (SD 82,872) baht per
person per year. For communicable diseases, the largest group in the inpatient sample cost 43,100 (SD
53,384) baht per person per year. Costs of medical treatment and expenses, as quoted by the hospital,
were averaged at 15,757 baht per person per year for outpatients, with inpatients at 35,280 baht per stay.
Results from focus group discussions with various stakeholders showed that expenditures of Phaholpolpayuhasena
Hospital, Samutsakhon Hospital, Krathumbaen Hospital, and this research study in terms
of relative weight greater than or equal to 2 units were 19.2%, 5.3%, 2.4% and 23.4%, respectively, while
in terms of relative weight greater than or equal to 4 units were 5.8%, 1.9%, 1.2% and 3.7%, respectively.
The top 5 outpatient diseases were cancer, trauma, non-communicable diseases, neonatal problems,
and obstetrics, while the top 5 inpatient medical departments which admitted high numbers of migrant
patients were medicine, surgery, obstetrics, orthopedics, and pediatrics, respectively.
Results can be used to formulate a support policy to mitigate the cost burdens incurred by hospitals
in border provinces. A policy of cooperation with neighboring countries should be proposed by the
Ministry of Public Health to develop adequate medical facility capacities and also review the cost of the
health insurance card scheme for migrants to reflect the cost of medical treatment. Most importantly, a
policy should be implemented to adjust budget allocations to border province hospitals to cover the
cost of treating migrant patients.


This mixed method research aimed to study perception and satisfaction of stakeholders towards national health security system in Health Region 10. The data were collected by questionnaire and semi-structured interview. Data analysis was done by using descriptive statistic and content analysis. The results of this study were based on interviews with 294 clients aged between 15 - 77 years old, and 304 service providers aged between 22 - 59 years old. Perceptions of all aspects of the national health security among providers and clients were high to highest, and satisfactions on national health security among providers and clients were highest. Their recommendations included: health promotion and
disease prevention should be emphasized; cross-boundary medical expenses should be allowed to
manage locally; fund should be transferred directly to health promoting hospital; personnel of the local
government organization should be trained on relevant regulations of fund management.


Objective: To determine the frequency of symptomatic hypoglycemia and its associated factors and fear of hypoglycemia in a population of elderly patient with type 2 diabetes at primary care unit of Songklanagarind Hospital. Methodology: This cross-sectional study was conducted from July to October 2018 at primary care unit of Songklanagarind Hospital. The participants aged 60 and older with type 2 diabetes were included. The socio-demographic characteristic questionnaire was interviewed by a researcher or research assistants. Baseline clinical data, included body weight, height, underlying disease, duration of diabetes, complications of diabetes (diabetic retinopathy, diabetic nephropathy, cerebrovascular, peripheral vascular, neurovascular and diabetic foot complication), HbA1c, fasting plasma glucose, type and dose of glucose lowering drugs, were reviewed from the hospital information system (HIS). The participants were asked on their experiences of hypoglycemic symptoms in the previous month. Fear of hypoglycemia was measured by the Thai version of Hypoglycemia Fear Survey (HFS) covering behavior subscale (HFS-B) and worry subscale (HFS-W). The higher scores indicate higher fear of hypoglycemia. Chi-square, Wilcoxon, and Fisher tests were applied to study significant variables. Logistic regression analyses were performed to evaluate the associations between associated factors and hypoglycemic symptoms. Results: Overall, 160 participants were involved (mean age 68.6 ± 6.1 years, 53.8% females, diabetes duration of 10.5 ± 6.4 years, 57.5% diabetic complications, 7.5 ± 1.8% HbA1c), of whom 30% reported hypoglycemic symptoms. The associated factors of hypoglycemic symptoms were diabetic
complications (aOR = 2.75; 95% CI 1.23 - 6.14; p = 0.012), glipizide use (aOR = 5.03; 95% CI 1.99 - 12.71; p < 0.001) and fasting plasma glucose (aOR = 0.97; 95% CI 0.96 - 0.99; p < 0.001). The mean of hypoglycemia fear survey score was 16.9 ± 16. The score on the fear of hypoglycemia (HFS) and
worry subscale (HFS-W) for the patients with more frequent hypoglycemia episodes in the previous month (>2 episodes) was significantly greater than another group (1-2 episodes) (p = 0.006 and 0.002), indicating a greater degree of fear of hypoglycemia in the first group. Conclusion: The occurrence of symptoms of hypoglycemia is one of complications in the elderly with type 2 diabetes and their presence is associated
with complications of diabetes and glipizide use. Frequent symptoms can have a negative impact
on fear of hypoglycemia. Minimizing the risk of hypoglycemia represents a high priority in the diabetes
treatment of the elderly people.


This research had two major objectives: 1) to determine incidence, access to treatment and clinical outcomes of patients with cerebral aneurysm who received clipping or coiling procedures; and 2) to examine whether coiling instrument should be included in the reimbursable list of beneficial package for patients under the Universal Coverage Scheme. Although coiling procedure has been performed worldwide, a slightly increasing rate of patients receiving coiling procedure in Thailand was observed during 2012-2018. In addition, increasing rate of patients under the Universal Coverage Scheme receiving clipping was significantly higher than that of those receiving coiling. Since the year 2012, survival rate among patients undertaking clipping was higher than the rate in 2006-2011. This finding did not support the hypothesis that patients receiving clipping had poorer prognosis than those receiving coiling or clipping was performed only in those who were not candidate to coiling. Survival rate of patients receiving clipping in the university hospitals was higher than those in the Ministry of Public Health (MOPH) hospitals and non-MOPH hospitals. Survival rate in hospitals with high volume of intervention (clipping or coiling >30 cases/year) was higher than the hospitals with low volume of intervention. Access to treatment and clinical outcomes varied across the health regions. Collaboration among the health regions to improve referral system for enhancing the service efficiency and patient outcomes should be addressed. Planning for neurosurgery or radiology manpower who have a specialized training for endovascular coiling should be considered, especially in the university hospitals. Based on the societal perspective, incremental cost effectiveness ratio (ICER) of coiling as compared to clipping was cost saving. Therefore, coiling instrument should be included in the reimbursable list of beneficial package for patients under the Universal Coverage Scheme.


The objective of this study was to report drinking patterns and alcohol-related health risks using Provincial Alcohol Problem Index (PAPI) of Thai population by region and province. Data from the 2017 Cigarette Smoking and Alcohol Drinking Behavior Survey, a stratified two-stage random sampling to select 120,003 Thai participants aged 15 years and over, were analyzed using descriptive statistics. The prevalence was estimated by weighted proportion and presented at national, regional and provincial levels. A composite PAPI score, ranging from 0-1, was also calculated to represent a relative level of alcohol risk problem in each province. At regional level, the Northern and Northeastern regions had the highest prevalence of adult (35.4% and 32.8%, respectively) and adolescent drinkers (19.0% and 16.8%, respectively), while the Central and Southern regions had the highest proportions of regular to heavy drinkers and drink driving. Provinces with the highest PAPI score were scattered in the Northern and Central regions, including Lampang (0.72 point), Chiang Rai (0.69 point), Phitsanulok (0.65 point), Chantaburi (0.64 point) and Sukhothai (0.63 point). This study showed that alcohol use and related problems remained significant health issues in Thailand with a diversity of specific problems that needed to be prioritized in each local area. Lampang, Chiang Rai, Northern, and Northeastern regions should urgently consider these issues. These hence warrant comprehensive measures targeting both establishment of local community actions and national alcohol policies.


Lactation consultant nurses play an important role in the promotion of breastfeeding practices and to ensure optimal age-appropriate feeding of children. Responsible for supporting mothers in overcoming breastfeeding difficulties, they also play a prominent role in providing knowledge, techniques and skills, as well as instructing mothers on appropriate behaviors and building confidence; the critical factors for successful breastfeeding. In Thailand, professional nurses assigned to lactation clinics in health facilities take on the role of a lactation consultant. To date, there have been no studies on service provisions and practices of lactation consultants in Thailand.  This study aimed to understand the situation of lactation consultants working in health facilities, including their roles, knowledge and qualifications as well as the scope of services provided, the challenges faced, and recommendations for improving competency of lactation consultants. A qualitative study was conducted by collecting data from 53 lactation consultants working in public and private health facilities, through focus group discussions and self-administered questionnaires. The results found that lactation consultants had the primary role of providing knowledge and building confidence for pregnant women, mothers and families on breastfeeding, from pregnancy until post-partum period. Lactation consultants’ scope of work was to provide nursing care without invasive interventions which required extensive knowledge focusing on breastfeeding practices, infant formula, maternal nutrition and child development. In addition, they required skills of nursing services, academic and technical skills, as well as communication and administrative capabilities. The large majority of lactation consultants faced difficulties due to their heavy workload, career path uncertainties, and insufficient knowledge of complex breastfeeding complications. These problems were resulted from national and organizational policies, management and the work environment of lactation consultants. Based on these results, in order to improve the capacity of lactation consultants, well-defined national policies and policy implementation on the guidelines and promotion of breastfeeding practices in health facilities, as well as building a network for lactation consultants and developing a mechanism for long-term capacity building and monitoring are recommended.


Reorienting health services to be more engaged in health promotion is a key health promotion
strategy that is widely accepted. The strategy has been implemented in Thailand. However, the scope
of health promotion work by Thai hospitals and its related functions were hardly known.
This research project explored health promotion activities in the hospital settings. It identified systematic
reviews of health promotion using PubMed database.
There were 10 systematic reviews that met the inclusion criteria. The reviews of health promotion
activities included body mass index monitoring during clinical consultation, individual exercise encouragement,
diet control, quit smoking and drinking, program to help release carers’ stress, and risk reduction
interventions among mental health patients.
This systematic review of systematic review can be beneficial for health promotion management
at each organization. The information can help expand work and research on health promotion activity
in hospitals in the future.


One of the missions of the Faculty of Medicine, Naresuan University is to produce medical graduates to serve the Collaborative Project to Increase Production of Rural Doctor (CPIRD). The project recruits 145 students who reside in any of the 5 provinces in Health Region 2 annually. After graduation, the medical graduates are deployed to work at rural hospitals of the five provinces. The Faculty of Medicine aims to apply outcome-based curriculum to develop the graduate’s attributes according to the expectations of all stakeholders particularly of the community hospital directors. Thus, the present study was carried out to find the expectations of the community hospital directors in Health Region 2 to provide the basis for developing a medical curriculum satisfying community needs. Method: A cross-sectional descriptive survey was done using a structured and validated questionnaire to all community hospital directors in Health Region 2. Results: Based on the expectations of the respondents, leadership skill and teamwork, patient empowerment, health promotion and disease prevention, patient-centered care, and patient safety were regarded as the top five instructional topics significant to medical practice in community hospitals. Problem-based learning (PBL) was cited as the most beneficial learning approach. On the contrary, the respondents indicated that the medical graduates did not have adequate knowledge on the community health system. Conclusion: The above specified instruction topics and PBL should be incorporated into the learning experience. Moreover, instruction topics related to the WHO 6 building blocks of a health system are useful for practicing at community hospital. As a result, there should be the health system sciences in the medical curriculum aside from basic and clinical sciences in order to produce graduates conforming to the needs of society.


The objective of this study was to estimate outpatient cost of HIV/AIDs services provided at hospitals.
The cost data for fiscal year 2015 were gathered from seven hospitals; the data consist of hospital
service statistics and financial information. Then, cost per visit was analyzed as cost-to-charge ratio using
a traditional method following the cost guideline of the Ministry of Public Health. The results show that
majority of service cost was of labor followed by material and capital cost, amounting to 52%, 42%, and
6%, respectively. The study found that an average cost per visit of the civil servant medical benefit (CS)
patients was the highest at THB 2,401. An average cost per visit of the universal coverage (UC) patients
was THB 1,778. An average cost per visit of the social security (SS) patients was THB 1,658; and an
average cost per visit of out-of-pocket (OOP) patients was THB 803. In terms of an average annual cost
per person, the study found that the CS patients also had the highest cost at THB 12,305. The second
highest was the UC patients at THB 9,483 per person per year and the third was the SS patients at THB
7,197. The OOP patients incurred the lowest annual cost per person at THB 1,570. However, it should
be noted that these seven hospitals were selected by purposive sampling with limitation on representation.
More hospitals should be involved in further research to represent actual cost by hospital types.


This study was to estimate cost of services for schizophrenia, schizotypal and delusional disorders. A retrospective analysis was undertaken. Cost data for the fiscal year 2016 were gathered using a purposive sampling. Eight hospitals were selected covering one regional hospital, three general hospitals and four community hospitals based on availability of hospital information on service and financial data. Cost per visit was calculated using the traditional method and cost to charge ratio according to the costing guideline of the Ministry of Public Health of Thailand. The result showed that labor cost was the major proportion of the total cost followed by material and capital cost. The average cost for schizophrenia, schizotypal and delusional outpatient was 831 Thai
baht (THB) per visit at the regional hospital, THB 483 - 1,030 per visit at the general hospitals and THB 189 - 567 per visit at the community hospitals. However, it should be noted that the present study was conducted in only eight hospitals of which
only one regional hospital. Generalizability of our findings was limited and might be applicable to only hospitals with similar characteristics.


There have been little empirical evidences available on a time-motion study of medical specialists,
the most vital human resources in Thailand. It is important to study the proportions medical specialist’s
workloads working in multiple units in the hospitals for greater visibility of labor distribution and cost
consistent with the actual work. The objective of the present study, therefore, was to describe the
proportion of work distribution as well as their working patterns in many tasks of specialists in public
hospitals. This would be beneficial for hospital cost allocation criteria.
A purposive sampling was employed to select eight public hospitals consisting of 3 regional hospitals,
3 general hospitals of the Office of Permanent Secretary, and 2 hospitals of the Ministry of Public
Health (with 600 and 1,000 beds). This study collected data from weekly and monthly work schedules
and direct interviews with medical specialists. The data were analyzed by descriptive statistics. Overall,
the medical specialists spent 33% to 36% of their time at inpatient department (IPD), followed by 27%
to 32% at outpatient department (OPD) and special clinics. In case of medical teachings, the medical
specialists spent no more than 4.7% of their total time, except pediatricians spent the highest 7.0% for
teaching. The administrative task took the smallest proportion of no more than 4.0%. The propotion of
time of each specialty was: otolaryngologists OPD : OR : IPD : teaching : administrative task = 27.6 : 24.8 :
41.7 : 2.6 : 3.3; ophthalmologists OPD : OR : IPD : teaching : administrative task = 30.8 : 19.2 : 42.0 : 4.6 :
3.4; internist OPD : IPD : ICU : teaching : administrative task = 28.3 : 55.8 : 11.0 : 3.2 : 1.7; pediatricians
OPD : IPD : ICU : NICU : teaching : administrative task = 32.6 : 33.8 : 10.4 : 14.3 : 7.0 : 1.9, obstetricians
and gynecologists OPD : OR : LR : IPD : teaching : administrative task = 30.4 : 15.3 : 17.4 : 33.1 : 2.7 : 1.1;
surgeons OPD : OR : IPD : ICU : teaching : administrative task = 29.1 : 16.6 : 42.1 : 7.3 : 3.7 : 1.2; orthopedic
surgeons OPD : OR : IPD : ICU : teaching : administrative task = 17.6 : 19.2 : 52.9 : 6.9 : 2.4 : 1.0; anesthesiologist
OPD : OR : ICU : anesthesia : teaching : administrative task = 2.2 : 45.2 : 13.5 : 34.7 : 1.5 : 2.9.
Proportions of work distribution in the present study may be used to assist decision makers in
hospital cost allocation criteria and human resource management. Additionally, this methodology can
be applied to other personnel who multitask and can be used to estimate the health workforce needs.


Thailand National Physical Activity Plan 2018 - 2030, the first national strategy addressing insufficient
physical activity of Thai people, was developed through a cross-sectoral cooperation processes in 2015,
led by the Department of Health, Ministry of Public Health. The development process took three years
before being approved by the Cabinet in August 2018. This article reviewed policy process since agenda
setting and policy formulation to policy adoption as well as policy content and context.
Key policy lessons were drawn from the development of the national plan. First was the identification
of principles, strategic objectives and implementing mechanisms of existing international policies
ensuring a comprehensive and effective national policy framework. Secondly, the engagement of all
relevant stakeholders in the policy process increased the ownership and the feasibility of policy adoption
despite a longer process. Lastly, capacity of central government agency and policy and strategic skills of
staffs were crucial throughout all policy processes. There should be more investment in human resource
management and development.


Rehabilitation counselling for disabled is a type of therapy that involves assisting people who are experiencing disability to encounter with the impact of disability, health conditions and disadvantage on individuals’ lives. This can be done by providing advice or counselling on personal matters, medical conditions, education, social, vocation, and assistive technologies. Rehabilitation counselling for disabled aims to help people with disability and others gain better understanding of the impact of disability and accept it. Moreover, it helps disabled people in achieving a sense of confidence to find their own solutions to problems as well as building up their decision-making skills in order to make appropriate decision on the way they live their lives. Objectives: to study 1) the scope and standard practice guideline of rehabilitation counselling in other countries 2) the access to rehabilitation counselling in hospitals 3) an appropriate service provision model and feasibility of rehabilitation counselling in hospital setting Methods: This study used both quantitative and qualitative approaches. The quantitative approach included a hospital survey on availability of rehabilitation counselling for disabled people, patient satisfaction survey, secondary analysis of quantitative data derived from National Health Security Office (NHSO) database. A mail survey was used to gather data from all public hospitals in Thailand. This was done in order to explore the availability of rehabilitation and counselling services for disabled people. Patient satisfactions survey were conducted with 150 patients who have received rehabilitation counselling in 10 hospitals as well as Sirindhorn National Medical Rehabilitation Institute (SNMRI). Quantitative data derived from NHSO database was analyzed to explore the number of patients who have received each type of rehabilitation service from fiscal year 2015 (B.E.2558) to 2017 (B.E. 2560) The qualitative approach included narrative literature review, an in-depth interview, and focus group discussion with services providers involved in providing rehabilitation services in hospital at all levels which also included medical schools and SNMRI. Results: There were rehabilitation counselling services available in most public hospitals (about 80.0% of tertiary hospitals, 69.7% of secondary hospitals, and 60.7% of primary hospitals being surveyed). Yet, most of rehabilitation counselling service reported was merely simple advice given along with usual rehabilitation activities rather than in-depth counselling. Most rehabilitation counsellors were physiatrists, physiotherapist and occupational therapist. However, necessary skills and knowledge including education and career advice, and psychological counselling techniques still find lacking in these professionals. Meanwhile, SNMRI appointed a public health technical officer who has a degree in rehabilitation counselling to act as a rehabilitation counsellor. Taking the shortage of personnel with appropriate qualification into account, this study suggests that physiotherapist and registered nurse should take up a rehabilitation counsellor role. However, additional capacity building on counselling is required. Also, additional workload for those professionals, especially in tertiary and secondary hospitals should be seriously taken into consideration. Most key informants agreed that rehabilitation counselling should be separated from usual rehabilitation activities and should be reimbursable according to NHSO reimbursement criteria. They further concurred that in order to make this service reimbursable, standard practice guideline, qualifications of service providers, and reimbursement data entry guidance should be established. Unfortunately, Thailand has no standard practice guideline for rehabilitation counselling in the present time. At patient end, most of disabled people being surveyed reported to have good satisfaction level and a medium quality of life. Conclusion: Rehabilitation counselling is essential for both disabled people and caregivers. Specific counselling technique and standard practice guideline are prerequisite conditions for providing rehabilitation counselling services. Currently, there are problems related to readiness of health facilities for rehabilitation counselling service, particularly those involved personnel and standard practice guideline matters. If this service will be fully implemented in all public hospitals or be separated from usual rehabilitation service according to the NHSO reimbursement criteria, all agencies and stakeholders involved should jointly develop standard practice guideline and code of conduct as well as support capacity building in rehabilitation counselling in order to provide such in more efficient and sustainable manners.


This descriptive predictive design aimed to employ quantitative and qualitative approaches. The quantitative study was designed to describe health workers’ attitude towards health services for migrants, compare the attitude between professional and supportive health workers, and examine correlation between personal and system factors and health workers’ attitude towards health services for migrants. For qualitative part, it focused on health workers’ attitude towards health services for migrants as well as their experiences regarding policy, health services, and facilitating factors. The sample was health workers with 6 month-experience and practice in 11 border provinces. The sample consisted of 1,356 health workers with additional 20 purposive subjects for the interview. The researchers developed the Knowledge of Migrant’s Culture and Context and the Health Worker’s Attitude towards Health Services for Migrants questionnaires based on the review of literature. The content was validated by 5 experts. The Content Validity Index (CVI) were 0.85 and 0.81, respectively as well as Cronbach's Alpha Coefficient also were 0.85 and 0.81, respectively. The data was analyzed by Mann-Whitney U Test and Spearman's rank-order correlation. Content analysis was done for qualitative data.
The quantitative results found that the majority of the health workers (91.22%) had positive attitude towards health services for migrants. There was no difference of attitude towards health services for migrants between professional and supportive health workers. Knowledge of migrant’s culture and context was statistically positively significant correlated to attitude towards health services for migrants among health workers (r= .152, p value=.000) (when controlling for age, sex, work status, work experiences, work experience with migrants, and trans-cultural training programs for health workers). The appropriateness of special health services, number of translators for migrants including handbooks, media, labels used in communication with migrants, and number of health workers for health services for migrants were statistically positively significant correlated to attitude towards health services for migrants among health workers (r=.120, p=.000; r=.063, p=.021; r=.060, p=.027; r=.133, p=.000). The results from Binary Logistics Regression revealed that the subjects have an increasing 1 score of Knowledge of migrant’s culture and context, they have an increased likelihood of positive attitude towards health services for migrants 1.32 times ((Exp(B)=1.32, p=.000).Furthermore, the subjects have an increasing 1 score of perceived number of health workers for health services for migrants, they have an increased likelihood of positive attitude towards health services for migrants 1.02 times ((Exp(B)=1.02, p=.000).
The qualitative findings revealed that 1) health workers’ attitude towards health services for migrants were both positive and negative. Positive attitudes were to be friendly, equal treatment like Thai citizens, legal workers, best regards for human rights and being responsible. The negative attitudes were that migrants are financial burden for Thailand, obstacle for hospital management, take the jobs of native workers, bring dangerous communicable disease to Thailand, increase the workload of health workers, not adherent to treatment, scary, and unfriendly and the minority group in Thailand. 2) Facilitating individual factors to improve health workers’ positive attitude towards health services for migrants based on the knowledge related to beliefs and cultures of migrants. Facilitating system factors were having health screening and health insurance policy for migrants and effective health service system. Supportive factors included media in health service and having translators. Facilitating individual factors health workers’ negative attitude towards health services for migrants were undesirable behaviors, increased number of migrants receiving health services and communication obstacle were system factors.
Hospitals executives and the ministry of public health can use the results from this study to promote health workers’ positive attitude towards health services for migrants. To alter their negative views or attitudes can lead to health services effectiveness and solve migrant health related services problem in the long run.


Study of health situations, aging society and travel problems for health services; A case of the urban community surround Sirinthorn Hospital, Bangkok has relationships with the environment in determining education, social health activities of the elderly with travel patterns in urban communities, Bangkok. From problems due to deficiencies of the body according to age and from diseases with age making the elderly need to get health services to maintain, promote, prevent and rehabilitation for the elderly to have a good quality of life. By attending health services for the elderly There are many factors involved both the hospital's service system Access to hospitals or health services, public transport travel system and personal vehicles for the elderly. Objective of the research was to study the health activities of the elderly. With travel patterns in urban communities. To study the factors related to traveling to receive health services for the elderly in the urban community lead to the reporting of health situations, social aging and travel problems for health services. In the urban community in order to make recommendations for development to relevant agencies. The methods of the study were quantitative and qualitative research, which is divided into 3 steps; Step 1: Survey data from a sample of aged 60 and over with a questionnaire traveling from the accommodation to receive health services at Sirindhorn Hospital Bangkok. The amount of 407 samples, divided by data groups 1) Good walking group, 2) Group sitting in a wheelchair and 3) Group lying on the bed. Step 2. Select the elderly volunteers from the questionnaire responses in Step 1 to interview, traveling from home to Sirindhorn Hospital by using the accompanying map to explain 154 examples. Step 3. Selection of elderly volunteers from interviews Map of the journey in step 2 in order to travel to the hospital with a sample of the elderly and use the survey to observe the travel patterns of the elderly. To study factors related to traveling to receive health services at Sirindhorn Hospital. Situation research results Elderly social health and travel problems to get health services. In conclusion; 1. Elderly social health activities Scheduled to travel to the hospital as scheduled More than other types of travel. By the majority of the elderly, there are participants traveling to receive health services. In which the traveling group already knows the route to the hospital. Therefore most travel times are between 30-59 minutes. From the survey of elderly social health activities and traveling patterns in urban communities contribute to the analysis of factors related to traveling to receive health services for the elderly. According to the research objectives, item 1. The study of health activities of the elderly with travel patterns in urban communities Bangkok. 2. Factors related to traveling to receive health services for most of the elderly รs receiving information for health care, in which the elderly listen to their own notifications. And followed by listening through the caretaker, in which the bedding group takes the time to prepare for the longest journey. Next is the wheelchair group and the group was able to walk conveniently, taking the least time to prepare before traveling. It is a decision to travel in a variety of ways. Analyze according to research objectives, item 2. The study of factors related to traveling to receive health services for the elderly in the surrounding urban community Sirindhorn Hospital Bangkok. By showing travel patterns for health services, for the elderly in the urban community, the sample consisted of 1) Travel information to receive health services from a sample of elderly people in the category of walking easily 2) Travel information to receive health services from a group of elderly people in a wheelchair 3) Travel information to receive health services from a group of elderly people in bed. Assessing the situation of traveling to receive health services for the elderly analyze according to research objectives article 3. Reporting of health situations, elderly society and problems of traveling to receive health services in the surrounding town community. Sirindhorn Hospital Bangkok lead to make suggestions for development to the relevant departments for the development of a technology model to promote health care for the elderly 1) Design of Activities for the elderly group according to the schedule of health services and public relations creates a community participation 2) Establishing supporting factors for traveling to receive health services. With basic information that is standard, will make the design of travel factors convenient and high efficiency. Especially map analysis, in a convenient travel information system save time for traveling and able to communicate basic health information of the elderly to the destination hospitals to prepare the management of appropriate areas and health services, meets the needs of the elderly most.


The main objective of this study is to develop interior environment of residential building suitable for recovery elderly with dementia. There are three main steps for this study: 1) an investigation of behavior of using, obstacle and limitation of existing building affecting dementia recovery in elderly; 2) a study of characteristics of the interior environment and facility suitable for recovery elderly with dementia; 3) a study of post evaluation of dementia symptom of elderly after environment modification according to the study results. The study explored in two types of residential building which are a private house and a hospital. The study also proposed a design guideline of residential building and facilities for elderly with dementia. Results of the study shows appropriate interior characteristics of residential building suitable for recovery elderly with dementia. The results in the last section showed that dementia symptom is not reduced, when using in examination room which environment was modified by results of this study. But, the modified examination room could give the subjects feel more navigable, more preferred, led subject feel better well-being and more interested in the examination room. However, compared to an existing house, the results in the last section illustrated that dementia symptom of subject is reduced, when living in the house that environment was modified by results of this study. The modified house can also give a better wayfinding for the subject and can give the subject a better well-being. The subject is also more interested in the modified house.


The main objective of this study is to develop interior environment of residential building suitable for recovery elderly with depression. There are three main steps for this study: 1) an investigation of behavior of using, obstacle and limitation of existing building affecting depression recovery in elderly; 2) a study of characteristics of the interior environment and facility suitable for recovery elderly with depression; 3) a study of post evaluation of depression symptom of elderly after environment modification according to the study results. The study explored in two types of residential building which are a private house and a hospital. This study, also, propose the design guideline of residential building and facilities for elderly with depression. Results of the study shows appropriate interior characteristics of residential building suitable for recovery elderly with dementia. The results in the last section showed that depression symptom is not different, when using in examination room which environment was modified by results of this study. But, the modified examination room could make the subject less anxious, more preferred, and led subject feel better well-being and more interested in the examination room. However,   the results in the last section illustrated that depression symptom of subject is reduced, when living in house that environment was modified by results of this study. The modified house made the subject less stressful, less anxious, more preferred, and led subject feel better well-being and more interested in the house.


An attempt to expand health insurance coverage to ‘everybody’ on the Thai soil has been implemented for years, including the provision of a health insurance scheme for migrants living in the Thailand. HIV/AIDS is one of the major health problems of migrants that can cause public health threats to the wider Thai populations. In 2013, the Ministry of Public Health (MOPH) expanded the benefits of HIV/AIDS prevention and treatment for migrant patients in the national health insurance for migrants; however, this caused the mark up in the insurance premium. To date, part of the migrant insurance premium (300 Baht of the total 1,600 Baht) is earmarked for high cost treatment including HIV/AIDS benefit. Besides, there are still migrants who are not enrolled in the insurance. Therefore, it is imperative to explore how Thailand will cope with the HIV/AIDS problems among migrants. This study employed mixed-methods design. The study was comprised of three objectives. The first objective aimed to explore the situation of HIV/AIDS treatment among migrants through in-depth interviews with local healthcare staff and policy makers and review of the second objective used qualitative approach (in-depth interviews and focus group discussion) to investigate the viewpoints of various stakeholders on the way forward about HIV / AIDS management for migrants. The third objective employed actuarial method to estimate the premium for the HIV/AIDS benefits for migrants based on the current use and prevalence of migrants under the migrant insurance scheme. The results show that the practice of treatment for insured migrant patients with HIV/AIDS and the uninsured migrants did not show any significant difference. The However some hospitals still shouldered unpaid debt from providing care for the uninsured migrants and the reimbursement from the MOPH was not always sufficient to recoup the cost of care. A sound referral system is considered an effective mechanism to address this issue as migrants would be able to access service from the country of origin and there would be less cost burden on the Thai side. Concerning the viewpoints of the interviewees, there were a couple of ideas for the management of uninsured HIV/AIDS migrant patients. First, the uninsured migrants should not have rights to enjoy the services in Thailand. All of them need to be referred back to receive treatment in the country of origin. Second, the second idea is that the Thai healthcare providers should continue providing services for the uninsured without overly causing financial burden on the users. This idea was based on health security maxim that health status should be considered the prime concern while financing should be placed at lower priority. The results of premium estimate for HIV/AIDS benefit for migrants showed that the premium earmarked for HIV/AIDS treatment amounted to only 11.9 to 32.5 Baht per person per year—much lower than the existing premium which was set at 300 Baht per annum per capita. However, interpretation of this figure should be made with caution as the calculation did not include management cost and was based on an assumption that the migrants’ utilization rate of the care for HIV/AIDS was still low. Key policy recommendations were suggested. Firstly, the MOPH should consider using part of the left-over fund of the national migrant insurance scheme, which was initially earmarked for HIV/AIDS, to recoup the unpaid debt of the hospitals which was originated from the providing care for uninsured migrants. Secondly, the migrant insurance scheme should adjust its premium to better reflect the actual unit cost at the hospitals. Lastly, the whole course of care for HIV/AIDS management in migrants should be strengthened. This includes strengthening measures to prevent new cases alongside the treatment for existing patients.


Migrant friendly health services including interpreting services have been implemented worldwide with an aim to reduce language and cultural barriers between healthcare personnel and migrants. Thailand has implemented migrant-friendly service initiative which includes migrant health worker (MHW) and migrant health volunteer (MHV) programs. MHWs and MHVs are expected to serve as key personnel that help relay health message to the wider migrant population. According to this role, health literacy is an essential skill of MHWs and MHVs. However, previous evidence about factors affecting health literacy of migrant workers were not specific to MHWs and MHVs and the evidence in Thailand was quite sparse. This research therefore sought to explore factors affecting health literacy of MHWs and MHVs especially in the angles of health-information access, understanding and appraisal. The researchers applied a parallel mixed method design in Samut Sakhon and Ranong, Thailand. In qualitative part, we conducted in-depth interviews with various stakeholders. The interviewees, selected by purposive and snowballing samplings, comprised MHWs, MHVs, healthcare staff in public health sectors and non-governmental organizations (NGOs) and policymakers. Document review was also employed. Data were analyzed by deductive thematic analysis technique. In quantitative part, primary survey was conducted on 235 participants (MHWs, MHVs and general migrants combined). All MHWs in each study site, MHVs under MOPH provision in Samut Sakhon and MHVs under NGO provision in Ranong were included in the survey. General migrants in the neighborhood area of MHWs and MHVs were randomly selected by a factor of one. Quantitative data analysis was composed of descriptive statistics, t-test, ANOVA, and multiple regression. The study revealed that MHWs had higher health literacy level than general migrant workers due to participating more in intensive training course, and having greater opportunities to receive health information from public health personnel. The strengths of MHW/MHV program were a support of standardized training curriculum and instructional media from the Ministry of Public Health (MOPH). Some organizations used nonfinancial incentives, such as volunteerism and health knowledge seeking behavior as selection criteria for recruiting MHWs and MHVs. However, there were rooms to be improved--including uncertainty of the budget used for employing MHWs and MHVs and a lack of monitoring and evaluation system on MHWs and MHVs. With all accounts above, three key policy recommendations came out. Firstly, the MOPH should make clear of the budget used for for MHW/MHV employment and capacity building. Required capacities for MHWs should be set up; such as communication skills, medical-term understanding, cultural competency, and health literacy. This will also shape the selection process of MHWs. For example, MHWs might be recruited from high-skilled migrant workers before entering Thailand. Secondly, the training courses and monitoring and evaluation processes should be systematically developed based on mutual agreement from all stakeholders. Lastly, non-financial incentives should be focused such as social recognition, healthcare privilege and fringe benefits regarding capacity development should be in place. This will help maintain MHWs and MHVs in the system.


Development of working system and application for report and alert the quality and safety of health care products project was conducted to develop web application TaWai for Health version 1.0 (prototype) which have been used since 2016. This application was used in communities of health region 10 and 12 to report and alert in 3 topics including 1) adverse healthcare product reactions 2) unhealthy or illegal healthcare product and 3) illegal healthcare product advertising. The aim of this research was conducted to develop the efficacy and usability of the application by TaWai network and develop healthcare product problems database for consumers communication by 4 steps of development including 1) web application research and development 2) database development 3) TaWai network development and 4) communication method and media development for consumers and patients. After 1 year of research and development in 4 steps we could obtained 1) web application TaWai for Health version 2.0 which more satisfy the need of user. For 2nd step, TaWai for Health database could display the statistic and incidents of healthcare product problems in each area better than our previous database. For 3rd step, we could increase TaWai networks though our workshop in each area and provide practical healthcare product problems management guideline in community using web application TaWai for Health version 2.0 as management tool by 8 categories of users including reporter, pharmacist, admin in district level, admin in province level, admin in region level, user in region level, user in Country level and super admin. For final step, all problems that reported in web application TaWai for Health was summarized and created in to 6 videos and 6 infographics for communicate healthcare product problems to increase healthcare product literacy of consumers and patients. For future work, we would like to develop and apply our new application and management guidelines to be the alternative tool for customer protection in country level.


This research is an evaluation of the 10th Participatory Health Region implementation using the principles of the CIPP model for collecting data from the Committee for Public Health Region 10 and stakeholders from 5 provinces. Data were collected by analyzing secondary data, in-depth interviews, focus groups, self-administered questionnaires, and practice observations. The obtained data were analyzed using content analysis together with descriptive statistics and synthesis content. This study has 4 objectives which are: 1) To assess the governance care in the area, 2) To evaluate the implementation of the 10th Participatory Health Region on issues related to governance results in health region 10, 3) To evaluate the performance of the health region committee, according to their mission by focusing on a leverage for reform issue, including solid waste problem, road traffic accident, food safety (organic farming) and early childhood development problems, 4) To assess the value of the health region committee's operations in 5 areas: co-ordinate, co-sharing, co-direction, co-integration, co-power and resource and synthesize policy proposals for implementation of the Health Region and the central government. The study indicated that every committee understands the context, roles, duties, and goals of Public Health Region 10, but it takes 1-2 years to adjust to the concept before being able to understand the roles and responsibilities. The board has a total of 44 people and is acquired through the recruitment method and selection is from 3 organizations which are government agencies, private organizations, and civil society. The number of the board who can carry out the tasks by attending the meeting regularly and able to work according to their roles and responsibilities, approximately 20 people only. More than half of the board came from Ubon Ratchathani province, which was not distributed in other provinces in the area of public health region 10. All agencies of the committee - especially the government sector - provide good support regarding the approval of personnel to attend meetings and become a part of the working committee on the local reform agenda. And also for support meeting places for the board. As for the budget and resources, there is very little support. Since this committee is responsible for the coordination of various networks, a budget is not available for operating projects or activities but only for coordination purposes. The budget received is one million baht per year which is not enough when there must be site visits in the area to support the leverage for reform issue. The performance evaluation of the board passed as planned but still did not reach the desired outcome as there is no clear goal and indicator of the success of the plan. The most obvious output was the leverage for reform issue of 4 issues, namely road traffic accidents, solid waste management, early childhood development and food safety/organic farming. All issues were met according to the plan, namely the operational committee for these issues is appointed in each province. There is a direction and working with other agencies in the area. Lessons are learned for each issue and lead to setting a target group for further expansion in other areas. Assessment of the operational value of the board found that coordinated and co-integration tasks had an average of 3.6 points, while the co-power and resource missions were of lower average value at 3.1 points. The performance evaluation of the health region 10 committees using the principles of the CIPP model found that despite efforts to use the 5 principles for coordination, it still had a lack of alignment and focus on driving work to lead to concrete changes, especially in terms of monitoring and evaluation. If it is necessary to continue this board, there should be confidence in the ideology of continuity and sustainability of cooperation from partners in the regional health network in the following areas: 1) Creating commitment and seriousness at every level - particularly from the central part - since the board has a loose mechanism and lack of common goal and pride in the organization. 2) Developing mechanisms to guide and experiment with systematic operations in area 3) Increase clarity in supporting management systems, both in terms of strengthening the secretarial team and the exchange of knowledge management to be continuous and sustainable. 4) There should be a form of learning for systematic management from foreign countries or agencies in Thailand. For example, the Sub-district Health Insurance Subcommittee of the National Health Security Office that has been in operation for over 15 years would benefit the administration of the board in the future. 5) In terms of structure, there should be a clear workplace in the health district committee for more concrete coordination. 6) In terms of the policy, the district health region committee is necessary to work with various mechanisms that existing in the areas such as the District Quality of Life Development Committee, the Provincial Elderly Committee, etc. It should create a chain of driving mechanisms in both operational planning and indicators including the knowledge management and sharing mechanisms. This will help to support solving various problems under the 5 key components of the board and will be a big improvement. The study has some limitations. The main informant is the health region 10 committee which is the main stakeholder of the area. Second is data from the secretarial team tends to give positive information to the research team. Information from non-committee members and working groups in the 10th health committee, in particular from relevant government agencies and people involved in the target areas in each agenda are small in number and therefore availability of some information is limited.


Objective: To study intraocular pressure (IOP) reduction after trabeculectomy compared with antiglaucoma medications in open angle glaucoma, including complications and evaluate the effect on quality of life and cost-effectiveness between two arms. Methods: This is a randomized controlled trial study that divided patients into 2 groups to receive trabeculectomy or antiglaucoma medications and analyze the clinical outcomes, quality of life and cost-effectiveness at 4 and 12 months. Results: There were 38 enrollment subjects, 18 eyes in trabeculectomy (Trab) group and 20 eyes in medication (Med) group. At baseline, mean (SD) IOP in Trab and Med groups were 25.86 (8.80) mmHg and 27.48 (9.85) mmHg, respectively. At 4 months, there were 17 and 18 eyes remained in Trab and Med groups. Mean IOP reduction (SD) were 19.29 (7.48) mmHg (38.67%) and 10.91 (5.51) mmHg (22.50%) in Trab and Med groups, respectively. The quality of life was assessed using visual function questionnaire-28 and found that Med group had better quality of life than Trab group at 1 year (p = 0.002). However, the results were different since baseline. The total cost was not different between 2 groups at 4 months and 1 year (p = 0.08 and 0.09). Conclusion: Trabeculectomy is more powerful than medications in IOP reduction with acceptable complications at 4 months and 1 year. The cost in Trab group was higher with similar quality of life. However, the sample size in this study is not enough, even after the recruitment strategy was modified. And therefore, may affect the final result. Further study: Evaluation of the outcomes between trabeculectomy and medications is still needed to be addressed. Gathering information about cost from hospital database in combination with an estimation of other expenses may be helpful.


The main objective of The Healthcare Healing Environment Design research project is to explore the healthcare environment and to study the design/ landscape architecture that promotes the quality and safety of service users by designing the Healing Environment Assessment Tool and developing a model hospital based on the healing environmental concept, which is a 3 years continuous research project. The first-year research had designed and developed a healthcare environmental quality assessment tool through the collection of data in 8 hospitals that participated the program and implemented the assessment tools in the second year by allowing the participating hospitals to develop the potential area and collecting research data to be a prototype model area in the Third year through the evaluation process of research. Conducting the research by integrating 3 concepts, namely the concept of Environmental Sanitation and Safety, the concept of Evidence-based Healthcare Design and the concept of Aesthetics and Spirituality towards the Healthcare Healing Environmental Design Concept through the onsite data collecting process by implementing the healing environmental quality assessment tools combined with the evaluation form of the service users' experience in research works. From the research results, it was found that development of healthcare healing environmental quality must be considered through 5 aspects of assessment, which are: 1 Function and Safety, 2 Sense and Comfort, 3 Interaction and Support, 4 Empowerment and Informed Choice and 5 Value and spirituality When considering the outpatient department, the weight of the first aspect was found between 0.835-0.793. The second aspect was between 0.707-0.692. The third aspect was between 0.829-0.743. The forth aspect was between 0.778-0.753 and the fifth aspect was 0.541. There are researches of participating hospitals that are consistent with the results, such as the Function and Safety aspect of the Maesai Hospital’s research on the reduction of carbon dioxide in the outpatient. The research found that there was a significant difference in the amount of carbon dioxide concentration at every point measured at the level of 0.05. There were also some environmental researches on many issues of Mae Sai Hospital, Pua Crown Prince Hospital, Saiburi Crown Prince Hospital, Lom Kao Crown Prince Hospital, Nong Song Hong Hospital and Huaiplu Hospital By evaluating from the average score from the experience of service recipients, it was found that after adjusting the environment, the value was higher than before adjusting the environment for healing significantly at the level of 0.01. For the development of the inpatient ward area, the evaluation of the weight of the first aspect was found between 0.825-0.736. The second aspect was between 0.696-0.631. The third aspect was between 0.709-0.691. The fourth aspect was between 0.708-0.633 and the fifth aspect was found between 0.888-0.782, with researches that is consistent with the results of function and safety aspect, Rattanaburi Hospital has conducted a research on The effect of environmental adjustment on heat reduction and perception of service users experience: case study of rehabilitation building, by studying the effects of heat and comparing the effects of environmental improvement on the perceptions of service users' experiences in Rehabilitation Building. Comparing the differences between before and after the improvement of the rehabilitation building according to the healing environmental concept and found that there were significant differences at the level of 0.05. In addition, research on aesthetic and comfort aspect, there is a study of noise exposure level and perception of risk from noise exposure affecting in male wards of Chumphonburi Hospital, the research found that changing wheel of patient bed and wheelchair, medical service tools can reduce the volume of noise to the maximum, while the survey research is to study the volume of outpatient service units in Mae Sai Hospital, Chiang Rai, by studying the noise level of the waiting area for the outpatient department, it was found that the noise level was between 57.6-84.5 dBA. By discovering the sound source from the conversation and the amplifier Which compared the noise level within the ward and the appropriate noise level according to NIOSH standards and standards of the Department of Labor Protection and Welfare which allows the average volume of Time Weighted Average-TWA not more than 85 dBA in not more than 8 hours working period per day, found that the value does not exceed the standard. While Somdejpraboromrachineenart Natawee Hospital has studied the air temperature in the ward, it was found that before and after the ventilation management had different temperatures with significantly lower temperature in the ward. Research processing throughout the 3-year period is an affirmation of the 3-concepts of the theory of healthcare healing environmental quality development through the 5 aspects of healing environmental quality assessment. The hospital can apply the model according to the difference context of each hospital in order to answer the healthcare healing environmental problems according to the 3 concepts, 5 aspects of this research.