The study aimed to forecast human resources for health (HRH) requirements for primary health care services in the next 10 year (2026). The HRH requirements covered both public and private sectors for 3 types of services, (1) curative and Thai traditional medical services; (2) health promotion, disease protection and health risk factor interventions; and (3) rehabilitation services for elderly care. HRH included in this study were: doctors, dental health personnel, pharmacists, nurses, public health personnel, physical therapists, Thai traditional medical personnel, and medical technologists. The combination of health need method and health demand method were used for HRH forecast. The results showed that when the primary health service system maintains the status quo, in 2026, the primary health care system required 9,826-12,009 doctors; 26,249–32,082 nurses; 16,797–20,530 public health personnel; 6,043–7,385 physical therapists; 5,880–7,186 Thai traditional medical personnel; 9,187–11,229 Thai traditional medical assistants; 4,757–5,814 dental health personnel; 1,997–2,441 pharmacists; and 578–706 medical technologists. However, when 25% service utilizations are shifted from secondary health care services to primary health care services and elderly care services in communities are increased in the future scenario, the system requires 23,523-28,751 doctors; 32,523-39,753 nurses; 6,695-8,182 pharmacists; 18,568-22,694 public health personnel; and 811-991 medical technologists.


The present study intended to provide information relevant to human resources for health (HRH) planning in Thailand. The objectives were to analyze and predict requirement for HRH including physicians, nurses, dentists, pharmacists, Thai traditional physicians, Thai traditional physician assistances, physical therapists, and medical technologists in the secondary care setting. We applied the utilization-based model and the approach developed by Segal. The study had 5 steps: (1) collecting utilization data by types of services (the public services under the Ministry of Public Health (MOPH), other public services and the private services); (2) forecasting the requirement for health services in the future using a change in demographics; (3) calculation of the total work hours that each HRH type spending on patients; (4) calculation of full time equivalence; and (5) conducting sensitivity analysis. We found that in 2026 Thailand would require more HRH: physicians 12,432 FTE; nurses 52,392 FTE; pharmacists 5,042 FTE; dentists 5,869 FTE; medical technologists 4,699 FTE; physical therapists 1,795 FTE; Thai traditional physicians 4,202 FTE; and Thai traditional physician assistants 3,043 FTE. However, if we add the other work (not only the health services work), the HRH will require more: an increase in physicians from 12,434 FTE to 14,297 FTE; pharmacists to 7,260 FTE; nurses to 60,251 FTE; dentists to 6,749 FTE; medical technologists to 5,404 FTE; physical therapists to 2,064 FTE; and Thai traditional physicians to 5,463 FTE. The current study confirms that Thailand will need more HRH in the future. It indicates the importance of demographic factor as an increase requirement on elderly health services. An increase in HRH production including financial and non-financial incentive policy options should be studied in details in the near future.


Previous forecasts of dental health work force demand in Thailand mostly used health need method, adopting health need data in professional view linked to demand for dentist only, contradicting the real practice which dentist works together with dental nurse. On the supply side, the loss rates especially for dental nurses were overlooked. The present study used different technique from the past, i.e., health demand technique mixed with service target. Scope of the present study was limited to dental health organizations with major service role. Task shift from dentist to dental nurse was assumed to be completely shifting, with no overlapping of duty. Supply side started with actual number of active personnel, then adding with actual number of students in production line and current loss rate. The result in 2026 showed 15,742-16,764 dentists in demand (dentist to population ratio of 1 : 4,217 and 1 : 3,960 respectively), and 8,669–12,140 dental nurses in demand (dental nurse to population ratio of 1 : 7,657 and 1 : 5,468 respectively), varying on proportion of clinical dental service of each profession. However, balancing the supply of and demand for both dentist and dental nurse by limiting all treatment services to dentist while health prevention and promotion services to dental nurse, the production rate of dentist can stay at the present rate, while retention rate of dental nurse should be paid higher attention.


Veterinarians have been recognized as the major profession providing services for animal health. Veterinary services do not affect only the animal health well-being, but also human health through the roles in food security and control of zoonotic diseases. Objectives of the present study were to analyze demand and supply of veterinary workforce in Thailand, using retrospective data and to project veterinary workforce in the next 10 years from 2015-2025. Simple linear regression analyses were used to analyze demands for veterinarians working with livestock in private sectors using data of poultry and swine farm veterinarians, and veterinarians working with companion animals in hospitals and clinics using data of members of the Veterinary Practitioner Association of Thailand (VPAT). Demand for veterinarians in government sectors was calculated directly from available data. Overall supply for veterinary workforce was analyzed using simple linear regression analysis, together with the analysis of employment status of veterinary graduates from 6 veterinary schools in Thailand. Results from analysis of demand for veterinary workforce showed that numbers of poultry farm veterinarians, swine farm veterinarians and VPAT members were increased by 123.75 ± 5.13 person/year, 122.52 ± 6.33 person/year and 453.20 ± 29.16 person/year, respectively. Overall supply for veterinarians was increased by 431 person/year. Most veterinarians work with companion animals in hospitals and clinics (49.86%), followed by veterinarians working with livestock in private sectors (21.95%) and veterinarians in government sectors (10.23%). Veterinary workforce in Thailand is still in shortage. Policy of workforce planning for veterinary profession is urgently necessary.


Thailand is encountering problems regarding the economic, social and political instability leading to inequality. Significant factors affecting the next decade health system include the complete aged Thailand, increment urban communities, more frequent and severe natural disasters, emerging infectious animal and plant diseases related to migration and increasing chronic diseases. In this regard, the National Human Resource for Health Committee has appointed a subcommittee to study public health human resources planning for the next decade. Human resources requirements can be forecasted through the demand and supply projection. The demand projection relies on a health demand approach involving only the service setting, and population ratio. The findings of the study revealed that most public health human resources are currently working for the Ministry of Public Health, i.e., sub-district health promoting hospital, followed by district public health office, and community hospital. At present, there are at least 76 educational institutes producing public health graduates by offering both 4 year bachelor’s degree program and continuing bachelor’s degree program, at a capacity ranging from 30–3,776 persons/institute/year. The public health human resources demand projection over the next decade found that if the production capacity of public health human resources remains unchanged, the human resources will exceed requirements of the health system in all scenarios as follows: scenario 1 the population ratio, 75,626-89,894 persons will exceed requirements; scenario 2 the status quo primary care system, 68,122-82,390 persons will exceed requirements; and scenario 3 the intensive primary care system (with no outpatient service at the tertiary care level and 25% transferred to the primary care system), 50,830-65,098 persons will exceed requirements. According to the present research results of a high surplus of public health human resources, the Council of Community Public Health should establish standards and core competencies of public health human resources in alignment with changing health system over the next decade, take controls and oversee quality of public health educational institutes, as well as jointly plan public health human resources requirements under the collaboration between health systems and educational institutes in order to contain number of graduates not exceeding requirements.


This mixed methods research study of workforce situation for Thai traditional medicine (TTM) in state-run health-care facilities, the production of TTM workforce in educational institutions, and TTM workforce planning for future workforce development involved a survey, focus group discussions, and workforce demand forecast using the heath demand method. All activities were involved with the multi-disciplinary and the service providers working groups from November 2015–October 2016. The results revealed that across the country there were 11,279 TTM personnel, including 2,692 TTM and applied TTM practitioners, and 8,597 TTM assistants in 2016. TTM workforce demand forecast for three levels of health services, based on the workload, showed that in 2026 there will be demand for 13,275–16,534 TTM practitioners and 14,714–18,509 TTM assistants. That will result in the service provider to population ratios of 1 : 4,015–5,000 for TTM practitioners and 1 : 3,586–4,511 for TTM assistants. Regarding the workforce production capacity at all 27 TTM educational institutions, (until 2016) 11,034 students had been admitted to the program, of whom 4,502 were studying in 2016, and 6,532 had been graduated cumulatively. According to the production plan, beginning in 2017 there will be 1,080 new TTM graduates each year, making a cumulative total of 19,080 graduates in 2026. In conclusion, currently there are shortages of 10,583–13,842 TTM practitioners and 6,127–9,922 TTM assistants. In the next 10 years, the ratio of TTM practitioner to population will be 1 : 4,454 and that for TTM assistants will be 1 : 3,996. As for workforce production in 27 institutions, there will be cumulatively 19,080 TTM graduates by 2026, resulting in a surplus of 2,546–5,805, compared with demand


Primary care cluster (PCC) is the public health policy of Ministry of Public Health for improvement in primary care. Perceptions of hospital administrators and primary care practitioners on primary care cluster policy are very important for applying policy to practices. Policy makers can know the feedback information from the practices of the practitioners for making decision, determination and direction of public health policy. The aim of this study was to explore and explain the perception of hospital admin¬istrators and primary care practitioners on primary care cluster policy focusing on their understandings, feelings, expectations, obstacles and suggestions. A qualitative study was conducted at primary care units (PCU) of Maharat Nakhon Ratchasima Hospital. Using purposive sampling strategy, hospital administrators, family doctors, dentists, pharmacists, family nurses, physiotherapists were chosen. Focus group discussions and in-depth interviews were conducted to gather data. Content analysis and thematic analysis were employed. Triangulation was used to ensure the rigor of the study. The results showed that the percep¬tions of hospital administrators and primary care practitioners were mostly built up from the messages delivered during official meetings. Their understandings were quite different, but in general, they had good feelings towards this policy because the purpose was to improve health of the people and increased value of the family doctors, so-called “the golden period of family doctor”. In addition to their previous practices, in terms of family care team (FCT), they also felt under pressure with more coming new health indicators from this new policy. From their expectations, they felt strongly agree to continue this policy and with moral and time supports from the policy makers and hospital administrators. Therefore, the organizational communications for effective policy understandings, feelings, expectations among hospital administrators and primary care practitioners are essential.


In Thailand, health system has increasing concerns on physical therapy (PT) workforce planning for aging population. The workforce projection study should also cover on attrition and retention. To determine work pattern, job mobility, satisfaction of Thai physical therapists and their determinants among public and private sector physical therapists were necessity. During January to April 2013, we conducted a cross-sectional survey on a subgroup of physical therapists (PTs) working in 360 healthcare facilities in 13 provinces of Thailand. A self-administered questionnaire was used to collect variables including socio-demographic characteristic, work status, job satisfaction, and professional mobility. Descriptive statistics such as frequency, mean, median were compared between public and private sectors. Factor analysis was also applied for 10 items of job satisfaction. Plan to leave the PT profession was compared with adjustment for the variables using logistic regression. From a total of 858 active PTs, there were 553 respondents (64.5%) in the study. Working status of private PTs was better than public one in terms of higher incomes, more permanent positions, less work load, and less involvement in prevention and research. However, PTs in the public sector had significantly higher work benefits. Job satisfaction of PTs was influenced by 3 main factors including professional fulfillment, job stress, and physical exhaustion. Within 5 years, one-quarter of the public PTs (23.5%) and one-third of the private PTs (36.1%) had a plan to leave the profession. For longer term, half of the public sector PTs (50.8%) were going to work until retirement. The private PTs were 2.4 times more likely to leave the profession after adjustment for age, income, and all 3 sub-domains of job satisfaction. In conclusion, the national health workforce planning in Thailand should improve the PT’s working conditions in consequence of fulfilling and solving the problem of inadequate PT workforce and high attrition.


The aims of the present descriptive study of foreigners being employed as hospital workforce in Thailand were to explore the characteristics of foreign hospital employees, factors influencing decision making of foreigners seeking employment in Thailand, the process of being employed as foreign hospital employees, and problems or obstacles encountered while working in Thailand. One hundred foreign hospital employees in both government and private hospitals in Thailand were recruited using snowball sampling. A questionnaire was used for data collection. The data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation. The results revealed that most participants were females with the mean age of 31.23 years. One-third of foreign hospital employees were the Filipinos. Success factors of being employed in Thailand included level of education (68%), competencies/special skills in needed fields (64%), and ability to communicate in Thai (55%). Factors influencing foreigners making decision to work in Thailand covered both push factors (such as low wages, limited career progression, unfair benefits, and high living expenses) and pull factors (including gaining new experience, job opportunities, and opportunity to improve career). The processes for being employed as foreign hospital employees included 1) preparation phase: foreigners prepared on language, working knowledge and employment laws, and health check-ups 2) application phase: most foreigners applied for a job themselves after receiving information. A tourist visa was initially granted at first arrival in Thailand and then changed to a non-immigrant visa “B”. The expenses of application phase included a visa, passport, work permit, and travel. Most participants (93%) were working as medical service assistants, such as interpreters and 7% were qualified to work as health care providers as described under the mutual recognition arrangement (MRA). Communication in Thai, adjusting to social and cultural differences, unfair wage, visa and work permit renewal were indicated as problems or obstacles encountered while working in Thailand. The recommendations from the present research were as follows: 1) stakeholders should revise the process of work permit renewal, and MRA; 2) the organization or employer should provide a basic training program in healthcare competencies, and improve workplace culture, including setting up appropriate remuneration system as international standard and equity basis.


Smartphone is used widely by children and adults. Previous studies have shown that using smartphone can lead to certain struggles, especially for university students. However, there has yet to be evaluated on the effect of muscular pain while using smartphone in other age groups. The evidence gathered from this current study could be useful in preventing adverse health problems caused by smartphone usage in all age groups. The purpose of the study was to examine pain at the neck, shoulder, upper back and arm areas after smartphone use for 20 minutes. Smartphone was used in 3 positions during the study (on the chest level, on the table, and on the lap). Seventy-five asymptomatic users aged 10-48 years old were recruited into this study. The participants were assigned to use smartphone in random orders of each position. Location and severity of pain were measured by using a body pain chart and visual analog scale (VAS), respectively. The results showed that 1) After smartphone use for 20 minutes, pain at the neck, shoulder and upper back areas increased significantly and the pain increased in all age groups (p-value<0.05). 2) Office workers had higher pain significantly in the neck and shoulder; higher than high school and elementary school students (p-value<0.05). 3) Neck pain was found 164 times in the overall 225 studies, followed by shoulder, upper back and arm pain. 4) Neck pain showed the highest severity in the lap position in high school students, whereas it showed the highest severity of pain in the chest position level in elementary school students and office worker groups. 5) Smartphone use on lap caused the highest number of participants (96-100%) reporting pain in various regions of the body. In addition, using the device on lap led to the highest intensity of pain in the marked region, and also the highest pain level, overall. In conclusion: smartphone use caused pain at neck, shoulder and upper back areas in 3 separate positions in all age groups.


Effective human resources for health (HRH) planning require evidence-based information to support the decision making. HRH requirement projection in line with desired health service system could therefore be compared with HRH supply projection in order to identify gaps. Gap analysis leads to the development of the HRH plan in order to solve those problems. HRH requirement projection could be carried out both at national level as well as at health facility level. The approaches used to forecast the HRH requirements at national level are: population ratio method, health needs method, health demand method, and service target method. Each approach has its strengths and limitations. At health facility level, the HRH forecast emphasizes on task and functional, skill mix, productivity, etc. Approaches used for the HRH projection include: skill mix, workload indicators of staffing need (WISN), task and functional analysis. Recommendations to strengthen HRH requirement projection to support effective HRH planning include: 1) HRH projection should be revised often to be in line with the changing context, 2) HRH information to support HRH projections should be updated, 3) HRH requirement projections should be done at national level as well as at facility level, 4) HRH requirement projections should not be done separately by each profession, but should be rather forecasted interrelated among health teams, 5) choosing appropriate method of HRH projection.


The Ministry of Education (MoE) and Ministry of Public Health (MoPH) have been jointly implementing the health-promoting school (HPS) program since 1998. This program aimed to improve students’ health and education simultaneously. The Department of Health established operating standards and evaluation processes for accrediting schools in four categories (from lowest to highest): bronze, silver, gold and diamond. One of the operating standards, School Health Services (SHS), required schools to maintain student health records and reports used to evaluate the performance of the schools. However, the quality and use of the health data collected as a result of implementing the SHS had not been assessed since the inception of the program. The purpose of this study was to evaluate the situation of students’ health data management system in the SHS. The study focused on data collected from four physical exams namely, growth assessment, vision testing, hearing testing and dental examination, and vaccinations for primary school students. The study design was a descriptive in nature and applied mixed-methods. A stratified sampling approach was used with three strata: the first strata comprised two provinces; the second, nine schools; and the third, 118 informants from the education and health sectors, parents, and students. The data collection approach included in-depth interviews, a questionnaire, reviews of students’ health data and related documents. Descriptive statistics and content analysis were employed for data analysis. The results indicated that the students’ health data collected in both, diamond and bronze level HPSs, was incomplete. This may be because multiple tools were used for recording and reporting students’ health data in sample schools. Furthermore, many of these tools had overlapping content thus increasing the burden of the staff. In addition, it was found that schools did not maintain students’ health data systematically and continuously after receiving the accreditation. Finally, a difference in the priorities of the data collected by the school staff and health workers was observed. While school staff only recorded weight and height data by the MoE, health workers focused on recording health data related their key performance indicators and not those specified by the operating standards of the program. Therefore, students’ health data was not clearly communicated and exchanged between the education and health sectors. This shows that there was no system for managing the data under this program, especially the system for monitoring and collecting data.


This research aimed to evaluate effective coverage in the prevention, control and treatment of type 2 diabetes, a case study from Dansai Hospital, Dansai District, Loei Province. Firstly, the diabetes longitudinal database was created to keep track of the population and patients. Secondly, the effective coverage of type 2 diabetes care was evaluated in three dimensions, including health needs, utilization and quality of care. In addition, the diabetes screening survey was conducted to find diabetes patients who did not take part in diabetes screening project in 2016 and were not yet registered in the diabetes treatment system. The purpose of this survey was to investigate the exact prevalence of type 2 diabetes in the catchment area of Dansai Hospital. . This study used quantitative research technique involving primary and secondary data. Primary data was taken from the survey to find diabetes patients from 3,214 samples. Secondary data was taken from Health Data Center and 43 Health Data Standard datasets of the Ministry of Public Health from 2014 to 2016. The criteria used for diagnosing diabetes were Hemoglobin A1c (HbA1c<7%) and Fasting Blood Sugar (FBS = 70 to 130 mg/dl). The results showed that the diabetes longitudinal database consisting of population, screening, treatment database and effective coverage results in My SQL format could be used for surveillance of 23,333 people and keep track of diabetes patients. In 2014, 2015 and 2016, 45.4%, 46.0% and 44.9% of total population aged 30-59 years, respectively. Moreover, in this 3-year period, the percentage of screening was 85.9%, 88.1% and 89.5%, respectively. This figure was 3.4% higher than it was in Loei Province, 0.6% lower than it was in Health Eight Region, and 15.5% higher than it was for the whole country. The diagnosed diabetes patients that received the treatment were 93.7%, 91.1% and 93.4%. 45.4%, 34.1% and 31.9% of the patients were able to control HbA1c. 40.5%, 41.8% and 38.0% of the patients were able to control FBS for 2 times. Moreover, the effective coverage in HbA1c condition was 31.9%, 23.6% and 23.1%; while 32.6%, 33.5% and 31.7% in the FBS condition. According to the diabetes screening survey, 33 persons with risk for type 2 diabetes were found which accounted for 1.2 % of the sample. Moreover, the risk group needs to have a re-check at the hospital to confirm the level of blood sugar. If 33 persons were diabetes patients, the prevalence would be 11 patients per 100 populations.


This collaborative action research aimed to develop a health service system for delaying dialysis in patients with chronic kidney disease (CKD). The research was conducted from January to December, 2017 at the outpatient department of Chumphae Hospital, Khon Kaen. Participants consisted of two groups: (1) the patients who had a diagnosis of chronic kidney disease (not more than stage 3b), had the underlying diseases of diabetes and hypertension, and received treatments at the study setting; and (2) The multidisciplinary team including physicians, registered nurses, and pharmacists. The process of conducting the research consisted of situation analysis, development of health service system model, and outcome evaluation. Data were analyzed through quantitative and qualitative methods. The results revealed that from the situation analysis and based on the chronic care model (CCM), the Chumphae model for delaying dialysis in CKD patients (Chumphae DDCKD model) was developed which has four components, including delivery system design, self-management support, clinical information system, and decision support. After the model was implemented at the 3rd and 6th month, the patients in a treatment group performed self-management behaviors better than before and better than those in a control group. Also, their eGFR declined only 27.1%, comparing to the control group 75% or 7.89 times of the treatment group (95% CI 4.79-12.77). Patient satisfactions of health service system in the treatment group were higher than the control group, comparing between mean 23.8 (SD 0.05) and mean 16.3 (SD 1.7). In conclusion, the Chumphae DDCKD model can help to improve self-management behaviors and effectively delay dialysis at the 3rd and 6th month in patients with CKD.


Aim/ Hypothesis: Caloric restriction in patients with type 2 diabetes mellitus and obesity can induce diabetes remission but the beneficial effects often disappear after discontinuation of caloric restriction.  Intermittent caloric restriction may be beneficial in the long term.  This study aims to examine the effects of intermittent caloric restriction by means of very-low calorie diet (2 and 4 days/week) on diabetes remission, glucose homeostasis, metabolic and anthropometric changes, quality of life, as well as beta cell function and insulin resistance.  Method: Forty-two patients with type 2 diabetes and obesity (mean age 40.6 years, BMI 36.9 kg/m2) were enrolled. Participants were randomly assigned into 3 groups (control [n=12], intermittent VLCD 2 days/week [n=14] and intermittent VLCD 4 days/week [n=14]) for 20 weeks.  They received blood tests, anthropometric measurement and answered the quality of life questionnaire at weeks 0, 2, 10 and 20.  Results: At 20 weeks, diabetes remission was found only in the intermittent VLCD 2 days/week and the 4 days/week groups (4 each).  Anti-diabetic medications were successfully withdrawn in 7, 9 and 12 subjects, representing 58%, 63% and 86%, in the control, the intermittent VLCD 2 days/week and the intermittent VLCD 4 days/week groups, respectively.  In both the intermittent VLCD 2 days/week and the intermittent VLCD 4 days/week groups, there were significant decreases in FPG, 2 hr glucose after a 75 gm OGTT, and HbA1C.  In addition, triglyceride level, body weight, BMI, body fat percentage, fat mass, fat free mass and muscle mass were significantly decreased.  Improvement in glycemic control was associated with a reduction in a decrease in insulin resistance. Quality of life was also significantly increased in borth VLCD groups.  No serious adverse events were observed.  Moreover, in the intermittent VLCD 4 days/week group, there were significant decreases in SBP, DLP, AST and ALT.  Conclusion: Intermittent dietary caloric restriction (2 days/week and 4 days/week) for 20 weeks was highly effective in rapidly achieving glycemic control without serious adverse ecvents.  Improvements in the intermittent VLCD 4 days/week were more pronounced than those in the intermittent VLCD 2 days/week.


Objectives: To evaluate the efficacy of adjuvant chemotherapy (ACT) in locally advanced stage cervical cancer after concurrent chemoradiation (CCRT) comparing to CCRT alone in terms of response rate, progression-free survival (PFS), and overall survival (OS).  Methods: Patients with FIGO stage IIB to IVA, aged between 18-70 years, had ECOG performance score 0-2, had histopathology of squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, and had no para-aortic lymph node enlargement were randomized to CCRT (arm A) or CCRT and ACT (arm B). The patients in both arms had concurrent cisplatin weekly along with pelvic radiation. After a 4-week period after CCRT, the patients in arm B had paclitaxel plus carboplatin every 4 weeks for 3 cycles.  Results: Data analysis of 259 patients showed no significant difference of complete responses: 94.1% in arm A vs 87.0% in arm B (p=0.154). With the median follow-up of 27.4 months (range 3.2 – 49.0 months), 15.5% of patients in arm A and 10.8% in arm B experienced recurrences: (p=0.123). There were no significant differences regarding the loco-regional failure but the patients in arm B had significantly lower systemic recurrences, 10.1% vs 5.4% (p=0.029). The 3-year PFS and 3-year OS of the patients in arm A were not significantly different from those of arm B: 66.6% (95% CI, 57.4-75.8%) vs 63.4% (95% CI, 54.6-72.2%) for PFS and 80.1% (95% CI, 71.9-88.3%) vs 69.5% (95% CI, 59.3-79.7%) for OS. The hazard ratio of PFS and OS arm B compared to arm A were 1.26 (95% CI 0.82-1.96) and 1.42 (95% CI 0.81-2.49) respectively.  Conclusions: Adjuvant chemotherapy with 3 cycles of paclitaxel plus carboplatin after CCRT did not improve response rates and survivals compared to CCRT alone. There were no differences of loco-regional failure but a significant decrease of systemic recurrences by adjuvant chemotherapy.


Malaria is one of the major mosquito-borne diseases especially in tropical and sub-tropical countries, including Thailand. The weather in this area is suitable for living and producing offspring for mosquito, so it causes illness and died in people, who live in that area. Although it has few cases in Thailand yearly, Malaria is difficult to get rid of from Thailand. To make more understanding of behavior and environment of the disease, computational can be utilized to study disease. This research aims to make the reputation of mosquito-borne illness, so-called mABMs-MAR, which is a hybrid of combination for computational and mathematical methods. In term of computational, Agent-Based Modeling plays as the major method of simulation with the corporation with another model, such as the Global Stochastic Contact Model (GSCM). To make the relationships between hosts, humans and mosquitos. For a mathetical method, it will be used to shorten the processing time for small objects, which is the mosquito.


Health Literacy refers to individual competences to access, understand, appraise and apply health information and services to make appropriate health decisions. Studies show that health literacy has crucial influence on one’s health status. For Thailand, there is no a standard tool to assess health literacy at the regional and national level. The present study aimed to develop and validate a Thai health literacy questionnaire for Thai people aged 15 years and above for assessing health literacy at the regional and national level. A cross sectional design was employed to collect data with a developed questionnaire in six provinces. The provinces were Chiang Mai, Nakornsawan, Nakornratchasima, Bangkok, Chonburi and Nakornsrithammarat. The questionnaire was drafted based on Nutbeam’s and European Health Literacy survey framework. It was pre-tested for plain language with experts and 35 general people. For the validation, the questionnaire was administered through face to face interviews. Focus groups were conducted for qualitative analysis. The internal consistency reliability was confirmed by the Cronbach’s alpha. The construct validity was confirmed by the confirmatory factor analysis. Correlations between health literacy scores and health outcomes were also explored. There were 722 people participating in the study. The Cronbach’s alpha was .88 for access, .86 for understanding, .90 for asking and .79 for deciding. All the Cronbach’s alphas are above .70 which indicates a satisfactory internal consistency reliability for the whole questionnaire. The confirmatory factor analysis also shows a good construct validity. Health literacy scores also correlated significantly with health outcomes which included having a chronic disease and metabolic syndrome. Those health outcomes were more prevalent among people with lower health literacy. The Thai Health Literacy Questionnaire (THL-Q) is thus appropriate to assess health literacy at the regional and national level.


Wheezing is an important health problem in Thailand. This study aimed to estimating costs of hospitalization of preschool children with acute wheezing under societal, provider and patient’s perspectives were also studied. The study recruited 240 children, aged 6 months to 5 years, who were admitted with acute wheezing at Thammasat hospital, King Chulalongkorn Memorial hospital, Bhumiphol hospital and Saraburi hospital. Data were collected from the hospital financial database and interviewing caregivers for the expenses. Cost-to-charge ratio method was employed for valuation of direct medical costs. Informal care cost was determined by human capital approach. It is found that societal, provider and patient costs per admission were 20,269±20,537, 18,126±16,898 และ 3,020±6,632 THB, respectively. The costs during hospitalization were the maximal proportion of 94.59 percents with the direct medical costs นด 88.83 percents. The main cost component in all perspective was hoteling cost during admission. The costs in medical school hospitals were higher than other type hospitals. The prognosis of these wheezing children was studied to determine the clinical outcomes including emergency visits and hospitalization due to recurrent wheeze during the follow-up period of 24 months. Patients’ characteristics and non-invasive biomarkers including serum specific IgE to common allergens, serum 25-hydroxy-vitamin D, and urinary leukotriene E4 reflecting airway inflammation were collected at entry to determine the association with the clinical outcomes. According to the results, the participants were boys (62.7 %) and having history of recurrent wheezing at entry (59.1%). According to laboratory results, atopy was found in 75.9 percent. Vitamin D insufficiency was found in 24.8 percent. The one-year incidences of emergency visits with recurrent wheezing during the first and second years of follow-up were 67.5 percent (95% confidence interval: 60.4% to 74.2%) and 12.2 percent (95% confidence interval: 7.8% to 17.9%) respectively. The one-year incidence of hospitalization with acute wheezing during the first and second years of follow-up were 32.3 percent (95% confidence interval: 25.4% to 39.9%) and 3.9 percent (95% confidence interval: 1.6% - 7.8%) respectively. Passive smoking from household (p=0.045) and atopy (p=0.038) were significant factors associated with emergency visits of recurrent wheezing.


This research has been initiated and emerged from the results of baseline assessment conducted, towards “the trans-border risks with impacts to health and environment” of the mega project carried out, in case of the Hong Sa power plant. The research methodologies comprises two main components, as: (i) the first – the research for development of self-monitoring system through the Community Health Impact Assessment (CHIA) as a tool; (ii) the second – the review of laws and policies of Thailand and of Laos PDR in aspects of supervision and management of trans-border impact (pollution); and (iii) the recommendations made. It could be summarized with finding as follows. The research team also identified that the most serious concern of villagers was the impacts incurred to their cash crops, as the agricultural products might be damaged and declined and causing of the economic loss, since they would be principal incomes gained for their necessities. The second serious concern of villagers was the health impacts incurred from the contamination of poisonous substances and pollutions accumulated in soils, water and air including food crops, e.g. rice and vegetable. These would cause the chronic and emerging sicknesses and diseases with harm induced in the long run. And although the majority of villagers were entitled to the healthcare schemes with social security and with accessibility to sub-district healthcare services centers and hospitals nearby the villages, but these were only for the basic and primary healthcare services provided with first aids or emergency incidents. Thus, the making of risk map of communities, it would be the vital work with further backing-up and supportive needs and such map would cover aspects of environment and health, especially towards the abnormality with agricultural productivity; the vulnerable groups with health problems and those with respiratory system and blood vessels, including those with pregnancy and maternity (mother and infant) whom might be more sensitive than people in general for the design of impact monitoring system toward the community furthermore. And this was relating to multi-sector entities and it deems expedient to cooperate among the government agencies and people. The agencies shall take part with information received and sharing for finding solutions are: those in charge with agriculture, health, irrigation and local administration, as this would be necessary for having more and wide cooperation with all sectors.


Study of the management of metabolic syndrome and its complications among people in Bangkok aimed at disseminating the effective and sustainable management of metabolic syndrome and feasible complications to the communities and key organizations. Moreover, evaluating and monitoring the prevalence of such syndrome in the community levels in Bangkok were also taken into consideration. The voluntary participants resided in Bangkok with no cancer, kidney failure and other types of disability were tested using the interventions from the study. The sample size of 80 participants in total was divided into 55 people as experimental group and 25 people as control group. Paired t-test was applied for statistical analysis to find the significant difference in those two groups. The result highlighted the statistical significance (p-value<0.005) in physical change between before and after the intervention such as fat percentage, basal metabolic rate (BMR) and abdominal fat. Critical changes (p-value<005) in vital sign were also observed such as pulse or heart rate. The physical fitness test including 60 seconds chair stand, sit and reach, and 3 minutes step test were all statistically different (p-value<0.05) between before and after the test. Furthermore, the evaluation and monitoring program were conducted with 530 people following Chi-Square test. The result from such test indicated significant level of 0.00 which is obviously lower than 0.05. The analysis involved body mass index (BMI) and metabolic equivalent (MET) related significantly (p-value<0.05). It could be concluded there was an increasing rate of obese people in Bangkok as well as a decreasing number of body mass index which were mainly a consequence of decrease in physical activities. It is obvious that people in Bangkok were getting more obese. Such situation was risky for non-communicable diseases such as diabetes mellitus, hypertension, and cholesterolemia. Therefore, it is essential to campaign the distribution of knowledge and intervention of metabolic syndrome and its complications as soon as possible in order to increase awareness among youth and people. Importantly, community involvement should be taken into serious account for the sustainability.


This study aimed to assess patients’ experiences on using non-contracted private hospitals and applying for eligibility under the Universal Coverage for Emergency Patients (UCEP). A telephone survey was conducted by using a semi-structured questionnaire. Populations were beneficiaries of three public health insurance schemes, Universal Coverage Scheme (UCS), Civil Servant Medical Benefit Scheme (CSMBS) and Social Security Scheme (SSS) who used non-contracted private hospitals and applying for eligibility through the Emergency Pre-Authorization program (PA) during July–October 2017. A simple random sampling was employed with an equal quota of samples for each scheme in each month for calling. Samples of the study included 212 and 210 cases who were receiving the call and willing to provide information out of 393 and 405 or 54 and 52 percent of calls made for those who met and did not meet the criteria of critical emergency respectively. Data analysis was done by using SPSSpc version 18 and weighted according to actual proportion of each scheme users was applied. Results show that the Universal Coverage for Emergency Patients (UCEP) was quite successful in the implementation. Patients with critical emergency conditions increased in access to financial protection under the program. Convenience in transportation to the hospital and being trust in regular hospital were two main reasons of getting emergency care from the private hospitals. Those with non-critical emergency conditions were more likely to choose their regular hospital than those with critical emergency conditions. The program could protect eligible patients quite well from financial risk during the critical period or the first 72 hours of admission; however, more than half of those with non-critical emergency conditions spent out of their own pocket to cover the cost of care. Furthermore, strengthening of enforcement process of the Sanatorium Act is needed to prevent patients with emergency conditions from being asking for payments prior to provision of services or during the critical period in addition to strengthening of public relations on channel for making complaints.


His Excellency Clinical Professor Emeritus Dr. Piyasakol Sakolsatayadorn, the Minister of Public Health of the Kingdom of Thailand, was invited to deliver his statement at the 70th World Health Assembly on 22 May 2018 with the theme of “Building Better Systems for Health in the Age of Sustainable Development”. This article reviews the content of the statement delivered by the Minister of Public Health in order to get deeper understanding on the key messages. Lessons learnt from the statement lead to deeper understandings on global health context of Sustainable Development Goals and World Health Assembly. In Thailand, an engagement of multiple partners, both government agencies and non-state actors, is needed. This engagement should be based on trust under good governance. In order to combat with noncommunicable diseases (NCDs) challenges, best buy intervention prevention and control of health risks should be implemented, for example, tax and marketing control of tobacco, alcoholic beverage, and sugar sweetened beverage. The next step beyond the statement delivered is to translate the content in the statement into real implementation and monitoring. Another important issue is the strengthening of global health capacity of health staff.


Social determinants of health management is proximal to health promotion of people. The organizational structure of local authorities is conducive for addressing social determinants of health management in communities. This study aims to explore local public policies that managed the social determinants of health and the role of public administration at three different tiers of municipalities. Qualitative study by using direct observations, in depth interviews, and document reviews were conducted in Chiang Rai (Metropolitan) Municipality, Ang Thong (City) Municipality, and Tha Yang (Subdistrict) Municipality. The study revealed that despite different contexts among the three municipalities, a common goal for the well-being of people was set. Those three municipalities provided sustainable public services on health, education, environment and society for their respective communities. For example, they increased the number of healthcare facilities in order to promote accessibility, build health literacy through people engagement, establish student-centered curriculum for children in pre-school to high school along with life-long learning, support and create environment conducive to physical activity (i.e. footpaths, parks and green public spaces). Local authority administration ensured implementation of policies and programs to improve health equity through project planning, building partnerships, budget management, capacity building, and monitoring health outcomes. The study concludes that local authorities should be the main agency for local health promotion. Therefore all related stakeholders should collaborate and synergize their health-promoting effort with local public administrations and regard this approach as key mechanism to address social determinants of health and promote health equity.


Migrant health is an important issue that has caught much political attention for years, particularly at the present where migrant birth rate is rapidly increasing. The objectives of this study are to 1) explore the operational system of the provision of essential vaccines for migrant children in Thailand through views of policy makers and health professionals, 2) analyze the extent to which migrant children have accessed to vaccination services in Thailand, and 3) estimate the budget impact in the provision of essential vaccines to all migrant children in Thailand. Parallel mixed methods design was employed. Data collection techniques comprised in-depth interviews for qualitative part and secondary data analysis for quantitative part. Study sites were public hospitals in four migrant-populated provinces. The results showed that although there was no explicit policy to provide basic vaccination for uninsured migrant children in Thailand but practically, health providers at the hospitals catered vaccination services free of charge for all migrant children regardless of their insured status through the leftover vaccines which were initially provided to Thai children. From migrants’ perspectives, buying health insurance is not the most important reason that influenced migrant parents to pay for health insurance for their children. Some migrant children travelled back to their country of origin when they grew up. The vaccination utilization rates amongst migrant children were quite low relative to standard utilization rate. If the government wished to provide basic vaccinations specifically for migrant children, the additional budget impact would be around 6.9-73.9 million Baht. In terms of policy recommendations, the Thai government should consider imposing essential vaccination as basic rights for all children regardless of their insured status, and such a service should be independent from nationality precondition and financial barriers. The government might consider investing more on vaccination at the cost suggested above. However adequate supporting mechanisms for the health facilities should be in place in order to ensure the country’s health system and financing sustainability.


The antimicrobial resistance (AMR) crisis is rising continuously, which has accelerated by the inappropriate use of antimicrobials either unnecessary or overuse and misuse. To better understand about the appropriate use of antibiotics and monitor as well as evaluate of implementing the National Strategic Plan on Antimicrobial Resistance 2017-2021, the National Statistical Office (NSO) and the International Health Policy Program (IHPP) jointly developed a module to assess the levels of knowledge on antimicrobials and awareness of antimicrobial resistance among the Thai population. The 27,762 adults older than 15 years were asked to self-administer this module. The module was integrated into the decade long National Health and Welfare Survey (HWS) conducted by the National Statistical Office. HWS 2017 was the first time in Thailand that introduced a modified version of the Eurobarometer antimicrobial resistance module into the survey. The module consisted of four sections including antimicrobial use profiles, antimicrobial literacy, public information on proper use of antimicrobial and antimicrobial resistance, and awareness on the use of antimicrobial in farm animals. The key findings showed that 7.9% of Thai adults older than 15 years received antimicrobial drugs in the last month. The majority of Thai people (70.3%) obtained antimicrobial drugs from health facilities (both private and public sectors at all levels), followed by drug stores (26.7%). Respiratory track symptoms were the most commonly reported reasons for taking antimicrobials; 62.7% of the total. In addition, the antimicrobial literacy is probed using five true and false statements. Poor level of knowledge on antimicrobials was alarmingly found in Thai population, only 3.1% gave correct answers to all statements and the most misunderstood statements were “antimicrobials kill viruses” and “antimicrobials are effective against colds and flu”. Moreover, only 17.8% of Thai people received information about proper use of antimicrobials in the last 12 months. Three common sources of the information were doctors (36.1%), other health professionals such as nurses and health workers (24.8%) and pharmacists (17.7%). Almost two-thirds of respondents were not aware of antimicrobial use in food producing animals and about 68.2% of adults did not know that Thailand had banned the use of antimicrobials as growth promoters in food animals. The Ministry of Public Health and the relevant authorities need to steward appropriate use of antimicrobials by health professionals, pharmacists and veterinarians (supply side) as well as create effective public communication and awareness program on antimicrobials use and AMR in general population through new channels such as social media for increasing the potential reach of the information (demand side). The progress of antimicrobials use and literacy should be monitored continuously as part of improving knowledge on antimicrobial resistance and awareness of appropriate use of antimicrobials and monitoring the progress of the National Strategic Plan on Antimicrobial Resistance.


The objective of this study was to examine role and process of care by caregivers to dependent older people in communities after the long term care (LTC) policy of the Universal Coverage Scheme was developed. This study used a purposive sampling method to select 20 caregivers who have looked after dependent older persons in communities for longer than one year. Research tools such as general information questionnaires, semi-structured interviews and voice recorders were used to collect qualitative data. The data were analyzed by content analysis. The findings illustrated that after LTC project was implemented, caregiver role and process of care to dependent elderly in communities have evidently changed. Obviously, the knowledge and practice skills of the caregivers, especially on activity of daily living (ADL) care, health issues, sanitation and environment management in the elderly’s home, have gained considerably through training. Team works, coaching and mentoring, and care buddy matching were explicitly formed, including a clear pattern of work namely a care plan. Details of elderly persons who need care, care goal planning or rehabilitation program and relevant information have been included in the care plan. Interestingly, ADL levels of dependent older persons under the guidance of care managers and multidisciplinary have been gradually improved or there was an appropriate aspect for each individual need. Caregivers have increasing important roles particularly being care assistants to dependent older people who have diseases required specific care. In order to be able to appropriately and sustainably providing care to dependent older people in the community, policies and measures to promote the advancement opportunities of caregivers and the continuous training for development of potential caregivers should be encouraged. Stimulating the proactive services enhancement of caregivers working together with multidisciplinary teams, motivating family members having the potential to provide care to elderly people having specific disease, and finally, the compensation and welfare policy should be appropriately promoted.


Background: Newborn screening for congenital hypothyroidism in Thailand was performed more than 25 years. To prevent mental retardation and delayed development, early diagnosis and treatment should be done within 14 days. Most previous studies reported from some areas or provinces, recent country data is not available. Objective: To determine the incidence of neonates with congenital hypothyroidism from newborn screening in Thailand. Methodology: During August 1, 2014-July 31, 2015, data of neonates who had positive screening for congenital hypothyroidism and confirmatory tests were recorded. Results: Presumptive positive congenital hypothyroidism was found in 1,663 cases (0.24%) from total 699,331 babies screened. Confirmatory test was performed in 1,530 cases (92%) and 348 cases (20.98%) were confirmatory positive. Among these 348 cases, transient hypothyroidism were diagnosed in 23 cases (6.6%). The incidence of congenital hypothyroidism in Thailand was 1:2009. Conclusion: Early diagnosis and treatment of positive cases are necessary for better outcome of congenital hypothyroidism screening in Thailand.


In Thailand, health promotion and disease prevention in children have been operated through school health programs with the collaboration between primary health care units and schools. This study aimed to explore the availability and quality of essential resources at school level of the Elementary School Health Services (ESHS) in Thailand. The methods used in this study were semi-structure interviews and in-depth interviews. Two provinces were purposively selected with specific sampling method, while schools were selected using simple random method. The informants included school directors and school-health teachers from 9 schools and health care workers from 3 health promoting hospitals at the subdistrict level. Although school-health teachers played an important role in this program, this study showed that most of the teachers were newly recruited with little or no experience in providing school health services and that the turn-over rate was high. This was because the unclear career path for such a position also due to inadequate training provided. Moreover, school directors mentioned about shortages of ESHS budget. Devices and equipment for health checks in most study settings were not properly maintained or regularly calibrated. As a result, health information of students was likely not accurate. Also, it was found that a lack of management and linkage between the agencies were the problems in school health services. To sum up, the school health services lacked the necessary resources in all aspects. Therefore, there was a need for knowledge development of human resources, supported budget and materials for health checks, and better management of school health services.


This study aims to determine situation of the prevalence of disabilities and the accessibility to health, education and social services of children with disabilities in the communities of Thailand. Mixed-methods of data collection were used. A community survey by a team of psychiatrists and clinical psychologists was conducted to estimate the prevalence of 7 disabilities in children aged between 2½ and 12 years in nine sub-districts of nine sampled provinces (except Bangkok) during October 2014-July 2015. Altogether, 6,334 children were investigated. Qualitative data were collected from home visit, in-depth interview, non-participant observation, and focus group discussion with parents and teachers of the children identified as having disability, and also with health care providers to explore problems of unmet demands. Results show that 66% of children aged 2½-12 were found normal, yet, 13% had at least one disability of which learning disability was most prevalent, and 21% with physical, psychological or behavioral problems. The availability of health services for children with disabilities in each area varied due to inadequacy or lack of type of health professionals. Community hospital is not allowed to recruit rehabilitation specialists, though policy on disability service provision is assigned to. The study also found that the term “disability” contained stigma connotation and was rejected by well-to-do and educated parents. When compared with the accessibility to service database of the Ministry of Social Development and Human Security, the National Health Security Office, and the Ministry of Education, this study showed much higher number children with disability in communities reflecting that there are still more unregistered children and inaccessible to necessary public services. The un-integrated and difficult-to-access service structure, poverty, cultural beliefs, and social unawareness are among factors that cause unmet demands. Main recommendations for concerned agencies are an urgent policy and program to increase access to care to reduce unmet need in children with disabilities and the integration of disability policy into the strategy to reduce poverty.


This particular research aimed to analyze spatial distribution of infectious disease patients using dasymetric method comparing with areal interpolation technique. This study used infectious disease patient statistical data between 2014 and 2016 provided by subdistrict health promoting hospital (HPH) located in Phlaichumphon, Banklong, Chomthong, Bankrang, and Watchan subdistricts. Land use was classified into 4 categories including residential, agricultural land, forest, and water resource. Furthermore, spatial infectious cases data was utilized together with classified land use data in order to investigate the infectious disease distribution using dasymetric method and areal interpolation method. The results showed that the rate of infectious patients in residential area was 25.75 per 1,000 inhabitants and the rate of non-residential area was 24.92 per 1,000 inhabitants. The highest rate of infectious disease was found in the residential area of Chomtong district. Moreover, the comparison of coefficient of variation (CV) between dasymetric and areal interpolation techniques showed significant difference. The dasymetric method had significantly lower average rate of infectious disease than the areal interpolation.


Cholangiocarcinoma (CCA) is still a major public health problem in Thailand. The major risk factor for CCA in Thailand is the carcinogenic liver fluke Opisthorchis viverrini (OV) infection. This study aimed to investigate the CCA burden attributable to OV infection using the disability-adjusted-life-year (DALY). A cross-section study was conducted using several secondary data including mortality and incidence of CCA from the National Cancer Institute and the prevalence of OV infection from the Department of Disease Control, Ministry of Public Health. The burden of CCA was estimated at 216,530 DALYs. The bur den in men was 1.5 times higher than in women. The burden of CCA attributable to OV infection was 70,745 DALYs (33% of total CCA) when adjusted for past use of praziquantel and it was 138,221 DALYs (64% of total CCA) when estimated with raw fish eating. This study reflects a considerable reduction of burden if OV infection was prevented, particularly in the northeast of which infection is the highest. Nevertheless, better information and further related research are needed to improve the estimation.


Oral valganciclovir is the alternative option for prophylaxis and treatment of cytomegalovirus (CMV) disease that is widely used in transplantation due to the equivalent safety and efficacy compared with intravenous ganciclovir. So valganciclovir was proposed for the inclusion into the national list of essential drug. The systematic review criteria were the original article of the full economic evaluation for valganciclovir or intravenous ganciclovir in various durations of therapy. Prophylaxis, pre-emptive prevention regimen and wait-and-treat regimen of only one or both of these drugs for all organ transplantation recipients were included to the study. The eligible studies showed 4 studies in the US, 2 studies compared between different duration of therapy of using prophylaxis valganciclovir, 1 study compared prophylaxis with pre-emptive therapy using valganciclovir, and the other compared pre-emptive valganciclovir with no prevention therapy. In European countries, there were 3 studies: compared prophylaxis ganciclovir among durations of therapy, compared prophylaxis with pre-emptive ganciclovir, and compared prophylaxis ganciclovir with prophylaxis valganciclovir. The studies targeted in kidney, lung, liver, pancreas, and hematopoietic stem cell transplantation in hospital, societal, or health system perspective. There were 5 of 7 studies modeled the Markov and decision tree and discounted 3-5% with 5 month to 10 year horizon to estimate costs and outcome, while 2 of 7 studies considered costs and outcome in 1 year after transplantation. The results showed prophylaxis 200 days was more cost-effective than pre-emptive and wait-and-treat regimen because of the superior outcome of longer duration prophylaxis in preventing early DNAemia, CMV disease, opportunistic infection, and graft rejection, but the costs were equally high of drug for prophylaxis, and laboratory monitoring for pre-emptive therapy. To compare the cost effectiveness between ganciclovir and valganciclovir, it could be concluded only the costs of using ganciclovir were high particularly in 1 year after transplantation due to catheter culture test, drug administration, room expenses, and intravenous caused adverse event. However, there was no the long-term costs and outcome presented. The studies from other countries were differently designed of comparator approach upon their routine practice and resource concerns. This systematic review could explore the elementary information for further economic analysis and making decision included valganciclovir into the Thai national list of essential drug.


This study was a cross-sectional survey research that aimed to study the factors related to blood sugar level among diabetes mellitus type 2 patients. The sample consisted of 400 patients who visited outpatient department at hospitals in Satun province during March until May 2017. The instruments for data collection comprised 5 parts: (1) personal information, (2) information on treatment patterns, (3) results of the treatment, (4) knowledge on diabetes, and (5) self-care behaviors of 58 items. Data were analyzed by using binary logistic regression. The results showed that 25.0 per cent of diabetes mellitus type 2 patients were able to control blood sugar levels (HbA1c <7). The occupation and self-care behaviors were significant factors correlated with blood sugar control at the 0.05 level. Diabetes mellitus type 2 patients who did not have occupation were 2.71 times more likely to control blood sugar (HbA1c <7) than those who had occupation (ORadj = 2.71, 95% CI = 1.19-6.17). Likewise, diabetes mellitus type 2 patients who had low level of health care behaviors were 0.54 times less likely to control blood sugar (HbA1c <7) than those who had high level of health care behaviors (ORadj = 0.54, 95% CI = 0.29-0.99). Therefore, public health personnel must emphasize and develop a pattern of caring for type 2 diabetes mellitus patients, especially in those with no occupation and low level of health care behaviors to better control blood sugar level.


The objectives of this study were to prove the effect of non-financial incentive, by the definition in Guidelines: Incentives for Health Professionals of Global Health Workforce Alliance (GHWA), to retain the physician in rural area and how to manage this kind of incentive. The study used the retention data of the physicians in 8 provinces hospitals since 2006 to 2015 , from the previous study ”The study of the labour cost of health workforce in MOPH hospital”, to predict the study area that can retain the physician in rural area. The questionnaire was developed to ask all physicians in the study area about the effect of nonfinancial incentive and the intention to work in the same hospital next year. The results showed that all categorized of non-financial incentive have a significant effect to the retention of the physicians at 95%CI. These effects were difference between the first 3 years working physicians and the physicians that have more than 3 years working experience. This study found that the hospitals can promote the non-financial incentive in the hospital working environments, so the Ministry of Public Health should to have the policy to promote these non-financial incentives.


Background and rationale: Diabetes mellitus (DM) is the major public health burden in Thailand. DM is the significant risk factors of cardiovascular disease, end stage renal disease and cancer. Therefore, to decrease morbidity and mortality from diabetic complications, prevention of DM is an important issue. Insulin resistance and pancreatic β-cell dysfuction are the major mechanisms of developing DM. These 2 mechanisms lead to abnormal glucose regulation, called prediabetes that comprises of impaired fasting glucose or impaired glucose tolerance. Previous evidences found that prediabetes is a significant risk factor of DM. Around 60% of diabetic patients had prediabetes 5 years before developing DM. Until now, there has been no study that investigate about the progression rate to DM in Thai prediabetes patients. In addition, currently, there is new proposed risk factors of DM such as serum uric acid and sleep factors. Therefore, this study aims to estimate the progression rate to DM and assess the association between sleep factors, serum uric acid, and HbA1C level. Methods: This study was retrospective cohort study. Prediabetes patients who visited the outpatient clinic at Department of Family Medicine, Ramathibodi hospital during September 2015 to March 2018 were recruited to this study. The independent variables was divided into 7 categories, including 1) demographic data (i.e. age, sex, education level, family history of diabetes) 2) underlying diseases (i.e. hypertension, dyslipidemia) 3) health risk behavior (i.e. smoking, alcohol drinking) 4) sleep factors (i.e. sleep duration, sleep quality, risk of obstructive sleep apnea (OSA), circadian factors) 5) depressive symptoms 6) physical examination (i.e. body weight, height, waist circumference) 7) laboratory (i.e. fasting plasma glucose (FPG), HbA1C, serum uric acid). Outcome of interest was incidence of DM defined according to criteria of American Diabetes Association 2014. Progression rates of developing DM at 24-, 48-, 72-, 96-, 120- months after diagnosis of prediabetes were calculated using Kaplan-Meier method. Multivariate Cox regression analysis was applied to explore the independent relationship between factors and risk of DM. Association between sleep factors and HbA1C was estimated using multivariate linear regression model. Direct and indirect effects of serum uric acid on HbA1c level were investigated using mediation analysis. Results: Progression rates to DM 2, 4, 6, 8, and 10 years after diagnosis of prediabetes were 4.12% (95% CI: 3.44, 4.94), 9.11% (95% CI: 8.03, 10.33), 14.71% (95% CI: 13.22, 16.35), 21.98% (20.02, 24.10) and 27.99% (95% CI: 25.57, 30.58), respectively. Participants with FPG = 110-125 mg/dL had a significant higher progression rate to DM than participants who had FPG = 100-109 mg/dL (chi-square from Log-rank test = 43.82, P-value < 0.001). Results from multivariate Cox regression analysis show that current smokers, obesity defined by body mass index ≥27.5 kg/m2 and FPG = 110-125 mg/dL were independently associated with risk of developing diabetes. Hazard ratios of current smokers, obesity and FPG = 110-125 mg/dL were 1.65 (95% CI: 1.08, 2.52), 1.79 (95% CI: 1.38, 2.33) and 1.86 (95% CI: 1.56, 2.23), respectively. Results from multivariate linear regression analysis found that later chronotype measured by mid sleep time on free day was significantly associated with HbA1C level (β-coefficient =0.014 [95% CI: 0.0002, 0.029, P-value =0.047]). In addition, patients with higher modified PSQI score had significantly lower HbA1C level than patients with lower modified PSQI score (β-coefficient = -0.011 [95% CI: -0.019, -0.003, P-value =0.010]). However, sleep duration were not significantly associate with HbA1C level. Serum uric acid had the direct effect on HbA1c level. Increased 1 mg/dL of serum uric acid was significantly associated with 0.02% (95% CI: 0.008, 0.033) increased HbA1c level. In addition, serum uric acid also had the indirect effect on HbA1c via waist circumference.


Tuberculosis (TB) is a disease of poverty and stigmatization. Thailand is one of the countries with high burdens of TB, TB/HIV and MDR-TB. Although contact investigation (CI) can reduce TB morbidity and mortality, the coverage is low and a CI operations manual was not yet available. Thus, this project aims to develop tools and collect research evidences for the development of a CI manual to increase implementation of CI by including household (HC) and other contacts (OC). The manual will also guide staff to perform non-stigmatized CI. We implemented the project between January 2017 and August 2018. The outcomes are summarized as follows: 1) Development of a geographic information system (GIS)-based computer program as a tool for CI coverage enhancement. 2) Research activities: the project implemented 4 sub-studies as follows: 2.1 A review of international CI manuals. 2.2 A survey of physicians and nurses’ TB knowledge, perceived stigma, and CI Experiences. 2.3 Knowledge, attitude and experiences related to contact investigation for tuberculosis among former tuberculosis patients and representatives from nurseries, schools, hospital and private business: A qualitative study. 2.4 The outcomes of using invitation card and providing transportation fee in CI. 3) Policy recommendations: 3.1 Contact investigation must be seriously implemented in Thailand, particularly children contacts aged under 5 years old must achieve 100% CI. The CI should cover household and non-household contacts. 3.2 Healthcare providers working for TB patients should pass training courses to obtain CI interview skills and effective communication skills for TB-stigma reduction. 3.3 In occupations like teachers/lecturers, caregivers, and hospital staff, the chest x-ray should be mandatory in health check-up system and performed before the employment and in annual health check-up. The practical guidelines should also be available in case TB occurs in teachers, students, and health staff. 3.4 Information about TB and messages to reduce TB stigma should be disseminated through the internet.


Lymphatic filariasis (LF), commonly known as elephantiasis is caused by Filaria parasite i.e. Wuchereria bancrofti, Brugia malayi, B. timori and transmitted by mosquitoes. There are about 40 million people in tropical and subtropical areas suffer from severe disfigurement and disability caused by the disease. It is estimated that more than million Myanmar migrant workers have settled in Thailand and some of them also carry Wuchereria bancrofti. Moreover, Thailand was certified by WHO for successful elimination of lymphatic filariasis and now is in surveillance phase to prevent reemergeing of the disease. Since microfilariae detection by thick blood smear staining technique need night blood collection. Thus, convenience and effective diagnositic tool is needed for the management of filarial infection both at the level of the individual treatment and disease control in populations in regions endemic for filariasis. In the present study, two recombinant proteins iPGM and SXP were produced. Then prototype two test kits, an enzyme-linkedimmunosorbentassay (ELISA) based test kit (FilariaDIAG test kit) and a chromatographic rapid test kit (FilariaDIAGRAPID), were developed, using iPGM recombinant protein and SXP recombinant protein as antigen. Efficacy of the developed test kits were validated in both laboratory condition and in field. Sensitivity of the rapid test kit using recombinant protein SXP antigen shows 97.9% sensitivity, 98.9% specificity, 95.8% positive predictive value and 99.4% negative predictive value when using microfilaria detection by thick blood smear staining as gold standard. The rapid test kit using recombinant protein iPGM antigen reveals sensitivity, specificity, positive predictive value and negative predictive value of 72.3%, 68.8%, 51.6% and 90.5% respectively. For the ELISA based test kit (FilariaDIAG test kit) showed sensitivity, specificity, positive predictive value and negative predictive value of 98.1%, 98.9%, 96.3% and 99.4% accordingly. For field validation, the prevalence of bancroftian filariasis in 509 Myanmar live in Thai-Myanmar boarder in Masod and Phoppha district, Tak province was 1.2% (6/509) while the prevalence of bancroftian filariasis in 363 Myanmar live in Thai-Myanmar boarder in SopMye district, Mahongsorn province was 1.9% (7/363). For prevalence of brugian filariasis in Thai people live in Tak Bai, Sugnai-Padee and Sugai-kolok Narathiwat province (endemic areas of B. malayi) was 0.57% (3/525). Using the ELISA based test kit (FilariaDIAG), antifilarial IgG4 was detected in 1.2% (6/509) of sera collected from Myanmar live in Thai-Myanmar boarder in Masod and Phoppha district, Tak province and in 1.9% (7/363) of sera collected from Myanmar live in Thai-Myanmar boarder in SopMye district, Mahongsorn province. In conclusion, the 2 prototype test kits are useful as tools for screening and surveillances of lymphatic filariasis in B. malayi-endemic areas as well as in Myanmar workers.


Systemic lupus erythematosus (SLE) is a clinically heterogeneous, human systemic autoimmune disease characterized by autoantibody formation. MicroRNAs (miRNA) have emerged as an important new class of modulators of gene expression and have been confirmed to regulate the lymphocyte tolerance and autoimmunity in SLE. In this study, we investigated the exosome of serum miRNA profile in SLE patients with miRNA array (nanosting). TaqMan-based stem-loop real-time polymerase chain reaction was used for validation. We also examined the serum cytokines of IL-29 and then analyzed the association of the upregulated of IL-29  and miRNA-548n. Microarray analysis of miRNA indicated 4 downregulated miRNAs and 2 upreguated miRNAs in SLE patients. Such upregulation of hsa-miRNA-181d 3p, hsa-miRNA-542 and downregulation of hsa-miRNA-548n, hsa-miRNA-16, and hsa-miRNA-122 and has-miRNA-183 was also confirmed by RT-qPCR. We also recognized the upregulation of serum IL-29 in those active SLE patients. The upregulated miRNA-548n contributed to the upregulation of inflammatory IL-29 in active SLE. Our findings demonstrate that miRNA-548n can be a novel biomarker for SLE, and help elucidate pathogenic mechanisms of SLE.


Health Systems Research Institute (HSRI) is committed to develop a guideline for the management and improvement of healthcare system for migrant workers in Thailand, by relying on knowledge and empirical data as a basis for development. The Thailand Development Research Institute (TDRI) has received research grants from HSRI to conduct research on the attitude of Thais towards migrant workers in public health, economic and security aspects of Thailand, with Dr. Yongyuth Chalermwong being the head of this project. This research aims to study and synthesize the government policies and regulations on the attitudes of Thais (and government) toward migrant workers in dimensions of public health, economic and national security. Also, to study a linkage of Thai (and government) attitudes towards management policies related to migrant worker. The study concludes that the Thais attitude towards migrant workers are diverse, both positive and negative, depending on which group of Thais, such as locals, Thai workers, Thai officers, Thai employers, and so on, and their interaction. The policy for managing migrants was established under the concept of maintaining national security which regulates policies for migrants very strictly. In addition, the concept of maintaining the country’s security is influenced by economic and public health dimensions. The feeling of Thais expressed through their actions towards migrant workers varies in different dimensions. In terms of public health, In the economic dimension, on the national security aspect. This study also pointed out the important determinant of attitudes of Thai people towards migrant workers in appropriate forms of communication. To create a contextual understanding of each dimension, it involves the coexistence of Thais and migrants. This issue is important to all parties because it will lead to situational awareness. This will be very useful for policy making. In addition, by creating a platform for Thais and migrant workers to participate together, it will create a major turning point in the perception and understanding of migrants' lives, leading to a change of attitude, and a better view from Thais toward migrant workers.


At present, the Royal Thai Government tends to instigate policies to downsize civil servant posts with a purpose to reduce its budget burden and increase system flexibility and efficiency. These policies affect not only supporting/administrative health staff, but also the health professionals themselves, including doctors, dentists, pharmacists and nurses. The objective of this study is to explore the current situation and types of employment for the Thai health personnel under the Office of Permanent Secretary of the Ministry of Public Health (MOPH). Cross-sectional mixed-method design was used. Data collection techniques comprised document reviews, indepth individual interviews with policy makers and health personnel users, and group interviews with, and self-administrative questionnaire survey on, health personnel. The interview questions focused on advantages, disadvantages, and recommendations for each employment type. The study also included analysis on health personnel retention and budget implication for paying salary to doctors, dentists, pharmacists and nurses in the next 15 years. The results revealed that according to policy makers’ and health personnel users’ perspectives, hiring health personnel as civil servants faced a number of constraints, including rigid bureaucracy and inflexibility in adjusting personnel’s positions to match their expertise. Yet civil servant posts should continue in certain functions, for instance, those dealing with legal issues and authoritative work. From the views of health personnel, civil servant employment is a crucial determinant in making them retain in the public sector because of work security and attractive benefits, especially treatment benefit for themselves and their family members. In the future, there should not be too many employment alternatives. If new civil servant posts are not available, the replaced employement choices should guarantee increased startup salary and additional benefits that are not inferior to the regular benefits for civil servants. Overall, the design of employment benefits should minimize discrepancy and inequity between employment types and between professionals. The MOPH should shift its role from being health care providers to being health policy regulators. Local health facilities should have more flexibility in designing employment benefits that suit their own staff while engaging local administrative authorities since the inception stage of the design. Besides, there should be mechanisms that provide opportunities for younger generations of health care providers to design and choose their employment benefits that fit their need before entering the labor force.


The definition of alcohol from the Excise Tax Act, B.E. 2560 requires that alcoholic beverages not more than 0.5% alcohol by volume are not considered alcoholic. So, the beverages containing not more than 0.5% alcohol by volume are not controlled by labelling, advertising, and other measures under the Alcohol Control Act, B.E. 2551 and other relevant laws. The objective of this study was to review the beverages containing not more than 0.5% alcohol by volume regulations in Thailand and foreign countries. Searches were conducted through government database from websites, MEDLINE (PubMed), and Google for ten years (from 2008-2017). Purposive sampling was used to select 6 countries; the United States, Singapore, Australia, South Africa, Norway and Thailand. All regulations were analyzed using a content analysis approach. The study of labelling found that the US, Singapore, Australia and South Africa laws stated that the beverages containing not more than 0.5% alcohol by volume must be labelled as non-alcoholic products and the beverages containing not more than 0.05% and 0.0% alcohol by volume must be labelled “alcohol-free”. For advertising control, the US, Australia and South Africa laws stated that the non-alcoholic and alcohol-free beverages were not allowed to be advertised as alcoholic product. Besides, the US and South Africa laws indicated that the beverage advertising had to show the content and intensity of alcohol on the label. Additionally, the US has a law to ban deceptive advertising techniques and strongly control brand name and brand advertising.


This qualitative study aimed to propose options to develop urban health services system in Health Region 3. The study’s scope involved only primary care systems in urban areas of Nakhon Sawan and Kamphaeng Phet provinces. Literature review, case studies, in-depth interviews, and focus group discussions were administered to collect the data, which focused on 260 participant’s recommendations and collaborative decision-making. The data were analyzed by thematic and content analysis. The Social Medicine Departments of the Regional and Provincial Hospitals were the major organizations responsible for management of primary care services delivery in urban areas. Though public, private, and local government sectors also provided these services. However, under the primary care cluster policy, primary care service planning was done mainly by those under the management of the Ministry of Public Health (MOPH). At present, despite the improvement of curative service quality, it cannot cover all areas nor create a sense of ownership for those in other sectors. The major challenge both at present and in the future is the increasing service demand due to the increase in the number of aging population and patients with non-communicable diseases. Also, there is a problem of not being able to use the budget to effectively promote health and disease prevention because of incomprehensible understanding between the service units and the Office of the Auditor General and the lack of policy communication focused on the development of urban health services. The result showed that there could be three major options for urban health services system development: (1) Management through single leadership of the MOPH (the current model), (2) Management by collaboration between sectors through District Health Board (DHB), and (3) Management through transfer of health mission to the local government. The assessment of the options showed that the current model may not be able to respond to the challenge effectively. The ideal option proposed by the key informants is management through the transfer of health mission to the local government, mainly because they are close to the people and can understand the context of the area well, and encourage the people to take responsibility for their health effectively. However, limitations were identified as: the unclear government policy to transfer health services mission from the MOPH to the local government; the lack of local administration and personnel capacity to manage health services; and the leadership of local government executives. The present study proposes that a model of collaboration between sectors through DHB is the best option to move forward. This option can encourage all sectors to become involved in the development of the primary care system in an urban setting. It can encourage all related sectors, including the people, to have a better understanding of the roles and responsibilities of each sector and lead to better self-management of the people in the future.


National Health Security Office (NHSO) has established health promotion and diseases prevention fund (P&P fund) with the primary intention of appropriately managing the P&P budget. However, P&P management approach has been changed over the years. This study reviews relevant literature, using narrative and systematic review approaches, on P&P payment mechanisms published in both domestic and international journals. Furthermore, this paper analyses strengths and weaknesses of each P&P payment mechanism. A total of 12 studies were identified for inclusion in the systematic review. Moreover, other studies gathered by narrative literature review were also included into the analysis. The results showed that P&P payment mechanisms can be categorized into five groups including fee schedule, capitation, pay-for-performance (P4P), global budget, and a blended payment method. The plausible outcomes of each payment mechanisms can be divided into three groups: volume and quality of P&P, supplier-induced demand, and risk selection. Each payment mechanism has its own strengths and weaknesses and is appropriate for different types of P&P services. For Thailand, a blended payment method may be the most appropriate mechanism for all P&P services as it naturally combines the potential benefits of each traditional payment mechanism. However, there should definitely be the consideration of the appropriateness of the list of existing P&P services.


The objective of this systematic review was to evaluate the pharmacist activities, components and effectiveness of a pharmaceutical care intervention, compared with medical treatment in patients who had been diagnosed as schizophrenia, bipolar disorder, major depressive disorder or anxiety disorder. Mesh term and relevant keywords were employed in searching of data from databases including Medline, IPA, PsycINFO, Cochrane, Thai Index Medicus, and HITAP databases. Both national and international literature published during January 2001 to February 2018 was included in this systematic review. The quality of the randomized control trial (RCT) and non-randomized control trial (non-RCT) were assessed by the risk of bias and risk of bias in non-randomized studies-of interventions (ROBINS–I) assessment tool, respectively. Twenty-six studies that met the inclusion criteria were conducted in three settings including primary care unit, drugstore, and hospital. The present study found that the pharmaceutical care intervention did not affect the economic, clinical, and humanistic outcome, however it possibly improved better adherence than that medical treatment in a hospital setting. However, using only 3 components of pharmaceutical care interventions (assessing drug problems, modifying medications and monitoring efficacy, and preventing adverse effect) does not have a positive impact on psychiatric patients. The psychiatric patients need to be cared by the multi-disciplinary approach to achieve holistic health on individual covering physical, psychological, social and psycho-spiritual dimensions.


Malnutrition from inappropriate food consumption behaviors is often found in end stage renal disease (ESRD) with hemodialysis (HD) patients. It may be a risk factor for increased morbidity and mortality in these patients. The purposes of the present study were to examine factors predicting of consumption behavior among ESRD with HD patients. Sample was 120 ESRD patients on HD in hemodialysis unit, Maharaj Nakorn Chiang Mai Hospital, by purposive sampling according to the specification. Data were collected using the questionnaire interviewing personal data, the self-efficacy, the social support and the food consumption behavior. Data were analyzed using descriptive statistics, Pearson’s correlation and multiple regression analysis. The results showed that the sample had overall food consumption behaviors at a medium level (xˉ= 2.58, SD = 0.47). Patient’s age, income, duration of hemodialysis treatment, self-efficacy, and social support could predict food consumption behavior (R2 = 0.607, p < 0.01). The finding of this study could be used as a guideline to promote the appropriate food consumption behavior along with social support to stimulate self-efficacy of the patients that enhance appropriate food consumption behavior in ESRD patients to improve their health status and quality of life.


Equity in health and health service are the ultimate goals of Universal Health Coverage. One key performance indicator for achieving that goal is about accessibility. However, Thailand in previous 10 years, while the number of dentists in service system was steadily increased, the utilization rates for dental service were nearly stable at lower than 10 percent. This study aimed to analyze utilization of dental services in 3 categories (oral health prevention, simple dental treatment, and complicated dental treatment), by using secondary data from the series of 5 Health and Welfare Surveys from 2007 to 2015. The results showed an increased number of people who received some dental service in the last 12 months. However, the number of people who did not receive any dental service were nearly the same in every survey. Moreover, people with unmet dental service need still exist. The proportion of complicated dental service use was increasing while simple level was in the contrast. Therefore, dental service productivity might be mainly from those complicated dental services. This would lead to a wider gap of accessibility to dental service among the population in the long-term. The findings from this study might be useful for planning and monitoring the future dental service system.


In 2004, the Ministry of Public Health (MoPH) introduced the nationwide Health Insurance Card Scheme (HICS) for migrants who were not covered by the Social Security Scheme (SSS). Before being insured and granted work permits, these migrants must pass the health screening procedures first. However, the health screening and benefits package of the HICS have not been changed much throughout the last 10 years. The present study was conducted with an aim to revise the health screening guideline and benefit package in accordance with current disease situation by prioritization study on health conditions among migrants in Thailand. The health conditions and non-communicable diseases were reviewed. The document sources were received from the burden of disease study, and the health screening report of the One Stop Service. Another related source was the reimbursement database of HICS for migrants on the frequency, mean, and total reimbursement of high-cost care. By using modified Delphi consensus process, the research team presented the result of documentary reviews and database analysis to stakeholder meeting before prioritization process. The top 10 health conditions and non-communicable diseases in the final round consisted of pregnancy, diabetes, neonatal abnormalities, high blood pressure, substance abuse and alcoholism, work injury, head injury, mental disorders, breast cancer and cervical cancer respectively.


Emergency Medical Service (EMS) can help increase survival rates and reduce possible disability among emergency patients. However, the number of calls for EMS is relatively low in Thailand. This study aimed to inspect the knowledge, perspective, and reasons of calling and not-calling the EMS by patients or their relatives who visited the emergency room in 45 government and private hospitals from December 2015 to February 2016. The hospitals were scattered in 9 provinces with the sample of 2,028 patients, whereby 646 patients had called EMS and 1,368 came by themselves or otherwise. The key reasons for not-calling were: the convenience of personal transportation (76.0%), avoiding waiting time for an ambulance (31.0%), and anxiety on the emergency situation (28.9%). Most misconceptions on the EMS included: (1) Ambulances were used only for casualties from accidents, and (2) Ambulance services were not free. In terms of perspective, most patients or relatives had negative views towards the EMS, especially the idea that they had to help themselves until the condition was severe or medications or relief devices were unavailable. Another view was that the EMS was slower than getting to the hospital on own-self. These perspectives were from non-users more than users. In conclusion, the study indicated that the causes of non-user involved misunderstandings, poor perspectives, and lack of awareness as well as the absence of knowledge on threats related to particular emergency conditions. Hence, regional agencies, the National Institute of Emergency Medicine, and the Ministry of Public Health should discuss the solutions to raise public awareness and to improve the perspective towards the EMS, in order to promote more usage.


The objective of this study was to estimate total cost of primary care service network. Samples with a proper primary care service system and good administration were selected based on experts’ opinion. They were three main district networks, namely, Namsom in Udonthani province, Wanornniwas in Sakon Nakhon province, and Naklang in Nong Bua Lam Phu province. The data on services and financial information of fiscal year 2015 were gathered. Total cost per network and the unit cost per capita were analyzed. The result shows that labor cost was the main cost driver in primary care system in which some networks was twice higher than material cost, followed by capital cost. The total cost of Namsom network was THB 22.9 million, of Wanornniwas network was THB 49.4 million, and of Naklang network was THB 46.2 million. The cost per capita of Namsom network was THB 612.61 followed closely by Naklang and Wanornniwas networks at THB 603.08 and 461.52, respectively. However, it should be noted that only one district network could collect all cost information needed was the main limitation of the present study. While, cost data are very different in each network, more primary care networks are needed to get more accurate unit cost.


This research aim was threefold. (1) To compare the concepts, situation, and reform patterns of the state tobacco industry in other countries in relation to tobacco control, governance, and trade agreements. (2) To analyse alternative reforms for Thailand in different scenerios of the government administration, trade agreement, and other social movements. (3) To assess the Thai tobacco control civil society’s acceptance of reform patterns of the tobacco industry. This study used qualitative research methodology through document research from domestic and foreign documents, and in-depth interviews with academic and experts from civil society on tobacco control in Thailand. The study indicated that (1) The international trade agreements were used as a tool to obstruct tobacco control policies in many countries. As a result, tobacco consumption worldwide dropped slower than the target. (2) The option for reform of the state-owned tobacco industry can be classified into 4 ways: 1. foreign direct investment, 2. joint venture, 3. privatization of state enterprises, 4. structural reform under state enterprise management. (3) Most of key informants expressed their opinions that the best approach is to manage the state-owned enterprises under the government’s control by separating roles and responsibilities between the policy makers, regulatory organization and owners.