Community-Based Monitoring System on Environmental Quality and Health in the Pong RiverThis operational research was aimed to investigate socioeconomic, environment and health problems of the Pong   communities affected by water pollution, and abstract community practices on environmental surveillance systems between local communities, andadopt community-based systems on environmental quality surveillance. The investigation focussed on nine communities locating adjacent to industrial site, along the Pong River in Nampong, Khon Kaen Province Thailand. All these villages have often complained about water pollution. The study results showed local communities have been impacted by water pollution with different degrees of the magnitude. The communities located adjacent to the industry were much effected by pollution than the further upstream and downstream villages. Obvious impacts were their water supply for household uses and drinking waters. They have to buy waters instead of drinking rainwater as usual. The polluted waters from bored-well are restricted for any household uses. The irrigation waters were also polluted, which were therefore much poor and exceeding agriculture standards for rice forming. The rice paddocks were party impacted due to wastewater leaching from the industry. Major health impact due to water pollution found was skin rash when the locals contacted contaminated waters. Overall assessment initially revealed that the locals wished to use their information, and wanted to participate in watershed development decision-making process.  Two out of the three local governments could financially support the communities.  However, all three local governments still need supports technically, particularly, with practical issues of community participation on watershed management, techniques and materials on pollution assessment and community health impacts, and environmental information management system.  The locals have difficulty of using water-testing materials, in which glassware was easily broken and inappropriate.  Some spare parts were hardly found in the rural.


This Research paper presents the findings of a study on strategies for the enactment of the National Health draft Bill by applying the concept of strategic management and TOWS Matrix technique. It suggests four strategic options to enact the National Health draft Bill: 1) pushing the National Health draft Bill  through the parliament by collecting the signature of 50,000 people to support the Bill 2) modifying the draft of the Bill before pushing it through the parliament 3) change the Bill to be a policy or master plan and 4) social movement. The last option can be implemented along with other strategies. Lastly, the strengths and limitations of each strategy for implementation are discussed as well.


People participation concerning health issue in constitution writing:A case study in Khon Kean Province	Common people in Thailand in the past had never been involved in writing the Constitution.In 1997,it was the first time in the Thai history that people werw encouraged to participate the process of writing the latest constitution. The study of people participation in constitutional writing was therefore implemented using action researth approach. The study aimed at documanting the process of people involvement in expressing their opinion in the process of drafting the constitution as well as the public hearing of the constitution. In addition the project also conducted number of group discussion in order to stimulate public interest and collect people’s option and needs in various aspects including the health and medical care. The project started the implementation by organizing a working committee who became educated about the constitutional writing process. The committee menber helped organize 13 discussion group, which involved 146 people from various occuppation including disable people. Opinion from group discussion were collected, synthesized and extended to the constitutional group which involed 232 people, some were in the same discussion group before. To gater wider rang of public opintion project thin launched 7,000 concise questionnaires to people  Of 18 year or more throughtout province and got more than 70 percent reponses.	The research results indicated that people in Khon Kaen province had show their interest and were willing to share their opinion on the constitutional writing. However, threr were no existing socail mechanism to facilitate people involvement in public event within such a short time span since the public hearing hed to be done within two months. Under time constraint, most core groups in the province therefore organized one day seminar in order to get more number of participants but this method could not facilitate people interaction and indepth information gathering. On the other hand, group discuss could fill the gap of big seminar menthod, it was time consuming and required number of volunteers to facilitate the group discussion and budget management. The use of concise questionnaires was found to be effective method to gather public consensus.


This study aims at developing the standardized self-reported health state questionnaire that will serve as a tool for collecting valid, reliable and comparable population health data in Thailand. The data regarding population health which will be obtained through the use of this questionnaire will be beneficial for adjusting health policies and programs in Thailand to meet the needs and health problems of the people. In order to accomplish the task, the research team has chosen the WHO’s Health State Description developed under the WHS 2002-2003 project which is considered standardized to be translated into Thai language. After completion of the processes of translation and language adjustment, the questionnaire was tested in the samples which are representative of Thai people characterized by age, sex and socio-economic status. In addition, in order to enhance a cross population comparative quality of the questionnaire, the testing was carried out in 5 provinces where are regarded as Thailand’s cultural specific areas. They include Yala in the South, Chonburi and Bangkok in the Central, Chiang Mai in the North and Ubon Ratchathani in the Northeast. The sample size was 420 covering population in 5 age groups (age 18-29 years-old, 30-44 years-old, 45-49 years-old, 60-69 years-old and over 70 years-old). After collecting, processing and analyzing of the data, the translated questionnaire was reconsidered and adjusted in some specific questions that the given answers show low reliability and consistency. The statistical analysis of the testing indicates that a majority of the respondents gave an answer to each question in eight domains of health in a similar direction. This result shows a consistency and reliability of the translated questionnaire.  Furthermore, the correlation testing demonstrates the consistency and internal validity of questions used in the questionnaire.


Social and health problems of the construction workers in Thailand, 1995The multicenter survey of "Social and health problems of the construction workers in Thailand, 1995" aimed to describe working and health status of the labors. Multistage and       purposive sampling was applied to get 20 construction sites each from Bangkok, Chang Mai and Phitsanulok in the North, Khon Kean and Nong Khai from the Northeast Hatyai and Phuket in the South and Chon Buri province from eastern sea board area. 714 construction site were compatible with the selection criteria,  and 184 sites were selected for this study. 243 foremen and 3,623 workers were interviewed. Main collected data were general appearance of the working sites, working status, life       style, safety procedures and practices, deaths and hospitalization, health seeking behavior of the workers and sanitation of the shelters. Major findings are in the followings: Most construction workers were in low socio-economic class as well as working in the risk area. More male workers died from working related accidents, it might be from a lack of enough measures to protect and prevent accident among the workers. There were also not enough safety devices and, moreover, few workers used the safety devices habitually.  The government sectors seldomly visited the sites and usually ignored the well being of the workers. Most workers were temporary and daily employed, without written contract. These were very few insurance for the workers, especially medical insurance. So the workers usually paid for their hospitalization and other medical reatment.Only 1/3 of the workers knew and concerned about their right, especially female workers. Most employers provides the shelters for the workers in the construction sites. The sanitation were poor. There were lots of littering and wastes water around the shelters. The shelters usually had not enough light, no windows and few latrines. Pipe water was the main source of drinking and other purposes.      Most workers in Bangkok and Chon Buri province were migrated from the northeast and the north, while other provinces were local residences. There was twice of females, most in aged 20-35 years and got only primary school education.Not only the environment and working conditions had threatened the workers, but also the risk behaviors, such as, regular smoking which was high among males. In addition, they usually consumed alcohol, took analgesic drug, and some consumed amphetamine. Moreover, there were lots of social problems inshelter area, such as alcohol addiction, violence among workers or in the family, and gambling. Main activities of the workers after working hours were talking with their friends of family and watching television. Few workers admitted to the physical and mental exercises. Even though, the living condition  was quite poor, most workers still satisfied on their work.  However, they would not encourage their children and sibling to get this job.  Main recommendations from the study are: increasing the governmental role to control the safety, sanitation of the construction sites, increasing safety prodesures for the workers, regular and intensive training for the workers and foremen focusing on knowledge, safety awareness and practices,      law enforcement and regular visit by the government sectors, especially the local governors, and providing special health care for the workers and their family, and schooling services for their kids.


The purpose of this research is to explore the people’s perception and exposure to health care regarding health news and medias in ChiangRai province. especially in the district of Muang, Mae Chan, Mae Sai, ChiangSaen, WiangChai, Thoeng, Pa-Daet, and Phan.  The target groups of study were divided into 5 groups: (1) government officers, (2) private employees and general laborers, (3) agriculturalists, (4) private-business owners, and (5) school and college students. The study found that the most popular medias can be classified by media type as follow: 	Newspaper:  National newspapers namely Thai Rath, Daily News and Kom Chad Luk are most popular. Local newspapers are Chaing Rath, Chiang Rai News, and Sue Chaing Rai. Those newspapers are the sources for people to acquire health news namely, Health education column and Medical consultative feather in the newspaper at the national ones 	Health mechanize: the most popular ones are Klai Maw, Cheewachita and Maw Chaow Bann.	Television:  the most popular TV channel is channel 7, Channel 3 and channel 9 respectively. The most popular TV programs are Phu Ying Phu Ying, from Channel 3, Ban Number 5 from channel 5, Kroob Krueng Reung Phu Ying from channel 7, Maw Surapol from channel 9, Health Window from channel 11 and Health Station from ITV.	In term of which media people can be able to obtain health information and news most, the study found that they are television, newspaper, radio, personnel, journal, village broadcasting service brochure leaflet and Poster. People agreed that most effective media has to have accurate and adequate amount of health news and information in order to maintain and health self care taking. The target group of this study has their trust on health personnel most when getting sick or having health problems.  In term of the health person people consult with; the first group are medical doctor, nurse and public - health care personnel   and the second group is comprised of friend or relative document consultation, and newspaper.		In all, despite of having an influence on the health perception of public,  medias are still having limitations. Health awareness is the most effective mean to alter public behaviors in the way that changing attitude, perception, believe, value, environmental factors, experiences, and individual readiness.


Development of Alternative Health Systems to Promote the Health of Middle-Aged Women:  A Case Study of Health Services in Isaan	This qualitative study aims to explore a situation of health promotion services for middle-aged women provide by various health institutions on the aspects of concepts, management, women’s perception and obstacles and success of the services. Key informants were 57 women, aged 40-59 years living in urban and rural areas and were customers of four health institution in Khon Kaen province. In addition, focus group discussions and interviews. Content analysis was  used to analyse the data. Major themes were covered as follows.Women did trust all health promotion services but few alternative services were available and they had to depend on health providers. The meaning of health perceived by middle-aged women included physical, mental, and social aspects but existing health services did not cover all these dimensions.Educated women living in an urban areas showed more health promotion behavior compared with low educated women living in rural areas.Middle-aged women gained a lot of health information from various sources and they got confused about the information The services should be expanded and involve community participation.	It is suggested that any alternative health practices should be available in existing services. The services should be accessible and women included in organizing the services. Keywords: alternative health, health promotion, middle-aged women, health institution, Issan


Development of Juvenile delinquents Care System in the Observation
and Protection Center of Ubonratchathani : Primary Situational Analysis.
The research for development of Juvenile delinquents System in the
Observation, Center of Ubontatchathani (OPCU) was carried out by PAR technique
(Participatory Action Research). The purposes were : to study on the problem
conditions, the development of Juvenile delinquents care system, and to improve
mental health task by integrating it into the system of child care in the OPCU.
The research samples were carried out by the purposive selection
technique. There administrators and sixty-five personnel were selected. Ninety
Juvenile delinquents in the OPCU were selected by the simple random technique.
The instruments consisted of : a quideline for interview, a quideline for group
conversation, questions in the workshop conference of which being used for
researcher training and tried out in order to have the same clear concepts before
implementation. Then the content analysis was used for the data analysis.
The problem conditions analysis in the target area, it was found that
the problem of Juvenile delinquents care system of the OPCU could be divided
into five categories. Those were : organization structure, policy and implementation,
personnel, Juvenile delinquents , and environment.
From the problems, it induced to planning for problem solving. The
researchers did present the findings to the Ministry of Justice. And a seminar
was fostered to hold for administrators in order to emphasize the operative policy
direction of the OPCU synchronizingly, an operation plan with responsible
personnel was established. There was also a plan presentation in cooperation with
other organizations participating in the development of Juvenile delinquents care
system. The principal research team was a cooperation and supports of
Prasrimahabhodi Hospital. This project was carried in cooperation with both
governmental and private sectors during 2001. There various activities and subprojects inducing to the development of Juvenile delinquents care system which
covered thoroughly physical, mental, and social conditions. It could be also a
good opportunity to develop the mental health task by integrating it into the
system of Juvenile delinquents care of the OPCU and extend the project to related
organizations for various target areas in every corner of Thailand.


This study was aimed at firstly analysing and reviewing domestic and international issues of self-care for individuals and communities, secondly synthesising recommendation for developing self-care behaviour at various levels and thirdly synthesising statements which should be put in the National Health Act and National Educational Act. The study was carried out by reviewing written document and gathering views of many experienced people. All inputs were analysed, interpreted and synthesised recommendation. The results were as following:to understand the development of self-care behaviour, we must understand interrelationship of three parties which were governments, professionals and people,self-care behaviour could be classified into 5 levels, individual self-care, individual self-medication, individual self-care for chronic diseases, group self-care and health promotion, and individual self-care in form of social movement,self-care is regarded as a dimension of life,proposed statement should include the government support and promotion for proper self-care,self-medication is more likely to damage health than create health,proposed statement should include the government support for right self-medication and for consumer protection at all levels,support / self-help group is considered useful for stigmatised health problems,proposed statement should include emphasis on strengthening family institution and community,building groups for self-care is important and appropriate for current Thai society.


The research and development of hypertensive patient service system at health centers in Phon district, Khon Kean province  	This research is a participation action research. The objects of the this study were establish an appropriate service system with effectiveness, efficiency and responsiveness to the needs of the patients and their families.	The research was conducted under the action research principle, and divided into 3 phases: preoperational, operational and final analysis phase. Participants were 46 mild to moderate degree of Hypertensive  patients (treated by Hydrochlorothiazide or Methyldopa) of the Phone Hospital HT clinic. Implementation and data collection were conducted at the health centers during April-September 1999 by using focus group discussion, in-depth interviews, observation and operational card. Control of blood pressure level, compliance, expenses and satisfaction were used as indicators to compare the service quality between health center and hospital. Chi-square and T-test was used to analyze the quantitative data, and content analysis for the qualitative data.


An Integral Study and the Effects of Medical Ethics Toward the Project of Baht 30 All Medical Treatment	This study was conducted by the sub-committee of the Medical Council of Thailand in December 2002.  It was undertaken to focus the impression towards medical treatment after which could result and affect the morality of medical practitioner in the project of Baht 30 for all treatment throughout Thailand.	The subcommittee has distributed pre-test questionnaires to physicians in both the government and   private sectors working in the central region and regional areas.  Four hundred fifty questionnaires were administered and 125 sets (27.8%) responded.  	The answered questionnaires were analyzed for the content validity and test the reliability.  The reliability of the questionnaires was 27.8% (more than 15%)   which is considered to be reliable and valid according to statistical analysis.  The subcommittee therefore distributed the questionnaires by using consensus.  All questionnaires were delivered to all physicians as shown in the name-list  of  the Medilcal Council, a total of 25,885 sets. Ninety - four sets of questionnaires were returned for the reason of no recevier or respondents were not at home. Forty-one questionnaires were returned after the data have been analyzed. It was believed that 5,506 of the questionnaires reached the respondents with a total of 25,791 (21.4%) sets which is equally close to the pre-test study.Section 1 : General Information	Only 21% of total male physicians (17,095)  returned questionnaires and 8,834 (19%) were female physicians.  Both of which is proportional. Comparing to the data, the highest number of physician who returned the questionnaires were between the age qroup of 50-59 years (28.3%), 40-49 years (28.1%), 30-39 years(20.4%), more than 60 years(19.5%) and less than 30 years (least returned) or (12.5%)	Information obtained from the Medical Council was as follows : general physician (13,976), surgeons including (extended) sub specialty (3,759), internal medicine including extended specialty (3,541), pediatricians (2,188) and  obstetricians and gynecologists (1,730).  It was noted that general physicians returned most of the questionnaires (29.4%), pediatricians (10.7%) obstetricians and gynecologists (9.7%) internal medicine (8.7%) and surgeons (8.2%) Among 5,465 physicians, who responded the questionnaires, 90% still provide medical treatment of which was considered to be the target group of this survey study.	Regarding the places, which provided medical treatment, 39.7% are in the government sectors, only 21.1% worked in private hospitals. Respondents from the central region (22.7%) and in Bangkok (22.7%) answered most of the questionnaires followed by the northeast region (14.0%), northern region (13.2%), the south (8.5%) and eastern region (6.3%) respectively. Part 2 : Sharing Views Among 5,464 physicians who responded agreed in principal and policy of the Baht 30 project all medical treatment.  Those agreed most (23.2%), moderately agreed (36.2%), and few agreed (38.4%), Respondents mostly agreed (3.9%) with the present structure, 18.5% moderately agreed and very few agreed of 75.2% respectively.	To conclude, 23.2% of respondents mostly  agreed in the campaign of Baht 30 all medical treatment but 75.2% did not agreed with its structure. From the Medical Council's point of view, only 2.3% agreed that the Medical Council should stay stagnant while others reflected that the gathered opinions should be forwarded to the government and the Ministry of Public Health. Approximately, 74.6% proposed to forward through the media, 61.6% to members of the Partiament and the Senate and 58.69% to the Economic Council and 53.6% proposed to arrange a seminar for all physicians over the country. Part 3 : Administration of the  Baht  30 Project	Respondents of 59.6% have received the policy from the management team to reduce the medicine costs and suppiles and 52.9% performed according to the policy given by the administrator. A percentage of 47.8 of physicians did not change the method of treatment towards the patiens and 39.0% admitted their changes of medical treatment does not bring good results to the patient.  Only 5.4% agreed the changes were good. For further search for this administration, 50.9% responded the study did not yield good results for further investigation, 31% responded no change and only 6% reponded improved.  	Regarding the freedom to choose the method of treatment according to medical standards, 54.4%  responded lessened, 39.9%  answered the same and inquired about the result of the medical treatment, 67.3% responded it was lessened, 13.2% the same and only 6.7% improved.


Subdistrict administrative organization's role toward publichealth and environmental development in Nongkhai provinceThis study aimed to study the situation of Subdistrict Adminisrative Organization (S.A.O.) in Nongkhai Province about  Public Health and Environmental Development. 6 S.A.O. established in 1995 and 1996 were selected for this study. Data  were collected by interviewing every member of S.A.O., every local health Staff, and systematic-sampling villagers. There  were 179 member of S.A.O.,21 local health staffs and 1,065 villagers were Interviewed. The study found that all of 6 S.A.O. has no staff whom directly responsed to public Health and Environmental Development. There was no budget spent on  public health during fiscal year 1996-1997. Among 179 member of S.A.O., 11.8 percent of them were working as village health volunteer as well. 70.4 percent of them participated in health  and environment activities, especially in health information communication. More than half of them (53.1 percent) suggested that Health Centers should under supervision of S.A.O. with the  major reason of for case and convenience in co-ordination. However, 27.9 percent has controversy idea giving the readon  that S.A.O. is not well prepare in budgeting. Most of them (57.5 percent) think that health and environmental development should be share-responsibility between Health Centers and S.A.O.. 45.0 percent of them suggested that S.A.O. should  provide budget to Health Centers in Health and Environmental Development. About half of them suggested that S.A.O. should have staff directly response to health and environmental, and 31.1      percent suggested that it should have health section in S.A.O.. Among 21 local health staffs, 76.2 percent of them know about  the role and functions of S.A.O.. However, only 4.8 percent can  mention all legally role and functions of S.A.O., but only 42.7 percent know that S.A.O. has play role in Health, especially in environmental management and disease prevention. Most of  villagers (66.6 percent)  suggested that S.A.O.should play role in health, especially in environment and disease prevention. About one-third (33.5 percent) think that Health Centers should still under supervision of Ministry of Public Health, giving the reason of satisfied performance. The study revealed that S.A.O. was not ready in health and environment management. It  should still be responsibility of Health Centers, and S.A.O. provide budget support according to plan. S.A.O. might pay role in health and environmental inplementation if they are more  prepared.


Background Since cost of providing care at each level greatly differs, the implementation of universal coverage for all Thais by new allocation method is a key to smoothing the transition.  This research aimed to find better way of monitoring cost, to identify providers facing financial hardship during the pilot phase in order to suggest appropriate policy of subsidizing providers.Methods 1. Study cost by questionnaire survey to all providers in 21 provinces Fiscal years 1999-2001 by quick method, 2. Study costs of service and education of teaching hospital by reviewing budget documents from 1992-2001, 3. Fit a formula for subsidizing inpatient services by data from individual inpatient data and yearly report of community, general and regional hospitals in 21 provinces, 4. Action research changing the accounting report from cash to accrual basis in 2 hospitals.Results Response rate was low from 3-60% by type of hospital.  Cost per outpatient visit at community hospital was 100-200 baht, and cost per inpatient admission was 2,000-6,000 baht.  Cost per outpatient visit for general hospital was 200-400 baht and for inpatient was 3,000-7,000 baht.  Cost per outpatient at regional hospital was 300-500 baht and for inpatient was 5,000-8,000 baht.  Cost per outpatient for teaching hospital was 800-900 baht and for inpatient was 17,000-18,000 baht.  Huge difference in cost was a major financial risk for providers.  When fitting the model for subsidizing hospital according to efficiency, quality and equity factors, it revealed that using ranking approach could contribute only 2-4% of the total subsidy while using the real value of each factor could contribute much higher to 51-75% of the total subsidy.  Action research of accrual accounting system found that there was a lack of adequate number of personnel in finance department as well as a lack of capacity in carrying out this new task.  A good system to validate the data for both account receivable and account payable was urgently needed.Conclusions This study confirmed wide differences of costs between each level of health services, however reliability of data was a problem.  The subsidization formula to reduce financial risk was tested to include factors on efficiency, quality and equity of each level of health service.  The accrual accounting system required an urgent capacity building and adequate number of competent personnel.  The system to validate revenue and spending data was used needed urgently.


Lack of data showing the present arsenic contamination in Ronphibun has been a matter of public
health concern. Since arsenic contamination of shallow-well water in Amphur Ronphibun, Nakorn si thamarat
Province, had been found in 1985, interventions to reduce the use of the shallow-well water especially for
drinking and cooking have been implemented. However, a large number of shallow wells still exist and the
residents continue to use this water for domestic purposes. The residents are anxious about possible health
problems and the safety of using the water contaminated with arsenic.
Although an AAS is available in Ronphibun Hospital, fast analysis and accurate results of arsenic
analysis cannot be obtained because of problems with the instrument and not enough experience of the
analytical staff. We selected a test kit suitable for use in the field in Ronphibun, tested its accuracy and
investigated the feasibility of further arsenic measurement by Ronphibun people.
The test kit developed by Mahidol University met the criteria concerning cost, availability, ease of
use and interpretation and safety. Accuracy was evaluated using standard arsenic solutions in the laboratory in
Ronphibun Hospital, but the standard color chart of the AAN kit was found to give more accurate values.
A suitable range of measurement was between 100 and 200 ppb arsenic level and optimal reaction time was
20 minutes. Comparing the test kit readings with the AAS values of well water samples, 95 % of test kit
readings were within the range of -61 and +53 ppb around the AAS value. After training, groups of public
health staffs, health volunteers in villages and science teachers of junior high school in Tambon Ronphibun
measured arsenic levels in standard solution of 200 ppb using the kit with acceptable results, with 98 % of the
determinants falling in the range 150 to 250 ppb.
The procedure and results of arsenic analysis using the test kit in the field at Amphur Ronphibun were
shown to the group of the peoples, who well accepted the demonstration of arsenic as a colored result.
Measurement of arsenic levels by the people in Ronphibun using the test kit and with higher precision might
be possible after additional training and sufficient practice, in order to screen for elevated arsenic levels.


Legislation for Road Safety	Law is a tool for road accident prevention by controlling social behaviors and resources allocation. It is simply said that law shapes road users’ behaviors into more safety conscious behaviors and forces car producers to develop their products more regarding safety use. Despite having 3 Acts relating to road safety, Thailand has never reduced numbers of road accidents for the past three decades. This review was aimed at answering such problems and led to recommendations for improvement. According to the review, the three Thai Acts were similar to many developed countries’ in many ways; however, their limitations found in the review were: 	1. the Acts partly needed amendment in line with dynamic changes of road communications,	2.  lack of continuity of law enforcement and the bias of enforcement partly due to shortage of community preparation and of knowledge integration in terms of automobile engineering and financing knowledge, 	3.   lack of knowledge-based policy and law development,	4.  Thailand’s governance of strong centralization inhibitive to law enforcement,	The review recommended that contexts of the Acts be amended and related policy and law development be more accountable to social equity and efficiency.


There is growing evidence that present pattern city and transport development, in which private motorized vehicles plays a dominant role, have important health effects through, for example, accidents, emissions of air pollutants and noise and reduced opportunities for physical exercise. However, a methodology for Health Impact Assessment is presently in a beginning stage. The objective of this study is  (I) to review situations of Chiangmai City and its transport development, development policies, citizen expectations, current efforts, environments, social and health situations, and (2) to determine scope and guidelines for the evaluation of health issues or impacts  identified.	The Chiangmai’s policy “ Public Transport is not considered as a public service. PT is provided by individual operator under market mechanism “ is chosen for the study. In addition there are two relating practices involved in the area --- no restriction on private vehicle use and road construction – based policy. Through public participation during the scoping process Chiangmai civic society identifies issues or factors to be considered covering all four dimensions of health. Impact evaluation should include accessibility to activities, accidents, air quality and noise disturbance, supporting health transport modes, feeling unsafe, traffic related diseases, social network and social interactions, social severance, and  people behaviors in traffic. Tools and indicators for the impact assessment  varies, depending on the impact considered, including scientific measurements, group discussion, questionnaires,     in-depth interview, case studies, and their combinations.


Computed Tomography (CT scan) the Value and Impact on the Patient's Management & Health Care Providers in the MoPH Hospitals	Cost-effectiveness of conventional CT compared to spiral CT scanning was study in three MOPH hospitals, one in Bangkok (spiral CT), the other two in the central   (conventional  CT)  and  southern  (spiral  CT)  parts  of  Thailand   during 6-month period in 1995 - 1996.Objective:  Primary	: To study cost per CT examination and cost per accurate diagnosis comparing between conventional and spiral CT scanners and also to study indication appropriateness for CT request among three hospitals.		Secondary	: To study the rate of using spiral mode and options which are specifications of spiral CT scanner differred from the conventional CT scanner. 		To study impact of CT request on the different fringe benefit groups of patients.  Design :	Prospective cross-sectional study.Participants:  All CT requested patients during 6 months, 726 cases in the hospital with conventional CT, 436 and 432 cases in the other two hospitals with spiral CT.Main Outcome Measures:  Cost per CT examination, cost per accurate diagnosis and percentage of appropriateness for CT request.Results:  Cost per conventional CT examination is 2,928 Bht. while cost per accurate diagnosis is 3,068 Bht.  Cost per spiral CT examination in BKK. = 6,344 Bht. and in the hospital outside BKK. = 3,738 Bht.  while the cost per accurate diagnosis = 6,554 Bht. and 4,027 Bht. respectively.  The accuracies in diagnosis are almost the same, i.e., 95% for conventional CT 97%, and 93% for spiral CT with almost perfect inter-observer reliability (K = 0. 8 - 1) and 92 - 95% agreement of the abnormal findings.  The study shows tendency of some influence on decision of CT request for government officials whom full reimbursement is applicable.  The appropriateness of CT request is 92% in the conventional CT; 70%, and 75% in the other two hospitals of spiral CT.  Conclusion:  Conventional CT is more cost-effective than spiral CT in the MOPH hospitals.  The accuracies in diagnosis are not different.


Health financing in Thailand : Technical reportFor the past, Thailand’s health care system has increasingly emphasised more advanced medical technologies and the Thai have been more reliant upon health care providers than self-care. Both public and private expenditures for health services consequently increased in real terms. 75% of health expenditures (the largest portion, 66% from the Ministry of Public Health (MOPH)) was incurred in the public sector compared with 25% in the private. During 1986 to 1996, the MOPH budget increased by 258% in real terms and then dropped since 1997 because of budget constraint caused by economic crisis. From 1995 to 1999, the budget grew about 6% in real terms. In consideration of the MOPH budget in 1998, 42%, 31% and 27% were gone for salaries, recurrent inputs and capital expenditures respectively. The budgeting was based on historical requirement leading to inequity of financing among provinces. Household expenditure became a portion of revenue to public health facilities. Whether the government budget for each public health facility was sufficient remained dubious due to poor cost accounting of public health facilities. Therefore, determining either capitation rates weighted by age, sex or DRGs was inconclusive.Thailand had 5 major health insurance schemes, Civil Servants’ Medical Benefits Scheme (SCMBS), Social Security Scheme (SSS), Voluntary Health Card Scheme (VCS), Low-income Card Scheme (LICS) and Private Indemnity Insurance. Around 76% of the Thai were covered by one of these. The CSMBS covered all government employees, pensioners and their dependents. The program was financed by government tax and managed by the Ministry of Finance. Since the economic crisis, the program did cost control by abolishing reimbursement for private care and imposing co-payment for some services e.g. for non-essential drugs. The SSS was premium-based by collecting 1.5% from the employee, the employer and the Ministry of Social Welfare. Payment to contracted hospitals was on capitation from 700-1000 Baht per head per year.The VHCS was community revolving funds targeting the near poor. The premium was 500 Baht supplementary to 1000 Baht, 500 Baht from the MOPH and 500 Baht from the ADB. The most problem of the program was ineffective targeting measure. The wealthy got the cards while a large number of the near poor were not covered. The LICS basically intended to cover the poor but its objective was enlarged to cover the elderly, children under 12, veterans, religious and community leaders and the handicapped. The program also had a problem of targeting the deserved. On the demand side, the insured often bypassed to their registered hospitals preferable to registered primary care centres or health centres. The paper recommends development of universal health coverage for all.


Outstanding enterprise for operating well-organized health promotion: a case study of The Unilever Thai Holding Co.Ltd.	This study aims to elaborate process and success of an outstanding enterprise for operating well-organized health promotion programs as a case study for other workplaces to develop their health promotion activities. The Unilever Thai Holding Co.Ltd. was selected as a case study for this purpose since it has been well-recognized for the  company’s health promotion programs especially its smoking-free policy. Additionally, the study describes the systematic factors and conditions of success including recommends for policy, management, and basic infrastructures that are necessary for all enterprises or their health promotion organizations to setup their own health promotion programs. Qualitative research methodology was used for the study. Most of information gathered from literature review of relevant reports and documents including structured questionnaire a part of program’s participants. The data was analyzed by using organizational analyzed by using organizational analysis that emphasized specially on organizational structure,  work system, strategies and personal as well as the Ottwa Charter conceptual framwork for health promotion. The study found that 	1.  The Unilever Thai Holding Co, Ltd. is a larg-scale enterprise that started its health promotion program from the success of the “Smoking-free Program”. Since, the company has developed other health promotion activities more systematically  e.g. acceptation of new comer who is non-smoker, not-fat and health including developed programs to follow-up the workers’ health.	2.  The success of the aforementioned was supported by the company’s policy that emphasized on health prevention and promotion rather than curative activities, consisting with the company’s high-level executive has high-level of concern to the medical advisor’s capability as the company practical leader for health. These are important factors and well-guaranteed for success of the company’s health promotion implementation. 	3.  Implementation of the Unilever’s Smoking-free Program has been enforced successfully by using policy as its supportive factor especially during the period of conflicts between the supportive and negative group of workers. Practical implementation of the program was conducted step by step and allow the  workers to learn, participate, adopt to perceive the program.	In the other word, the program used the workers’ participation as a strategy to foster the program’s   success and use social movement to make change and perception as an important social force. 	4.  Implementation of any health promotion program can initiate from any activities without framework of health promotion as a whole for example, it can initiate from making awareness of  adverse-effect of smoking and then develop to other learning process of other health promotion activities. 	5.  Building of supportive environment is a crucial factor of success especially the external social movement for smoking-free made good opportunity for change and make less negative pressure to the program as well as get more participation from non-smokers. The company’s internal supportive environment was also important.


The problem of substance addiction in communities is a serious increasing social problem at the present time. It has a great impact through families, communities, society and countrywide. The inefficient means on prevention and control of this problem will lead to a great number of social problems in communities very soon. Therefore, the participation of the community to fight with the epidemic of substance addiction is a very crucial mean. The objectives of this study were to explore the situation of addictive substance use and develop a model for prevention and problem solving by emphasizing on the community involvement. The participatory Action Research (PAR) was applied in this study. One hundred and fifty villagers who were community leaders, health volunteers, guardians,  and youths lived in village 5th, 9th, and 11th of Patan, Khuntan district, Chiang Rai province were participated in research activities. The researchers and the community groups analyzed problems and determined the solution means by using the AIC-technique and collected information by using the participatory observation method and focus group discussion technique. The study was conducted between October 2001 and February 2002. 	The result of the study revealed that there were 40 drug users in these villages. The source of substance distribution were found in all 3 villages. Community regulations for prevention and solving the addictive substances use were setup through the village meeting. After the regulations were implemented continuously, the situation of substance addiction was decreased dramatically in these 3 villages. The local organization in each communities played a very important role to solve these social problems. The community participation need to be strengthen and continue to sustain the success of substance control in these villages.


The objectives of the study were (1) to study the situation of Thai-people health promotion (2) to study the role and the development of health promotion in popular sector, and the relationship between government sector and non-government sector (3) to analyze and to suggest the policy recommendation on the contribution of health promotion. The methods of this study were document review method, indepth interview and informal interview. 	The finding of this study was: in general, life expectancy at birth has lengthened substantially, Thai people was facing a changing pattern of health, the pattern of morbidity and motality have changed, non-communicable diseases were increasing. The Thai’s lifestyle was changing to urban lifestyle. Thai people mostly eat Thai food, but they increasingly eat saturated fat and decreasingly eat fiber foods. Thai’s daily activities are 8-9 hours of work, 6-8 hours of sleeping, watching television. Lack of exercise and inappropriate self-medication; and some people drink alcoholic beverages and smoke cigarettes. And, Thai people were coping with the stress problem and lack in the coping skill and the life-skill in the modern society. The study also concluded that Thai people were interested in ill health or illness. For the community-based health promotion, the government have had the policy of the community participation and health development for two decades, but the communities were induced by the health personnel. However, the non-government organizations and some government organization contribute the community’s initiatives, decision-making, control and health development. Some community organizations/groups were initiated the health promotion activities by themselves. If was recommended that (1) MOPH should increase the individual health potential; using the variety of methods and the appropriate methods (2) MOPH should promote community organizations and contribute the community’s initiatives, decision-making and health development (3) MOPH should promote the health personnel skill of mediation, enabling and advocacy in the health promotion process (4) MOPH should formulate the long-term master plan of health promotion.


A quasi experiment was conducted at Lampang Hospital during August 2003 to January 2005 to compare the effectiveness of the pharmacist interventions between using case-based approach and group education in promoting parenteral-oral (IV-PO) drug switching in hospitalized patients. In the mean time, the study measures the satisfaction of health care team and factors affecting physician in switching from IV drug to PO drug. Medical charts of inpatients over one year of age were reviewed prospectively by a clinical pharmacist for two consecutive weeks in three phases for each type of intervention; phase I as baseline period, phase II as intervention period, and phase III as four months post intervention. Candidates for the switching were identified according to the developed guideline. Excess days, durations of IV drug use, length of stay, and potential waste were determined. The generalized linear model was used to adjust age, sex, Charlson index, history of intensive care unit admission, and departments in the multivariate analysis. A descriptive study also was done at Khon Kaen Hospital to determine and compare the incidence of switching candidates with the same switching guideline.The results revealed that the pharmacist intervention using the case-based approach was more effective than using group education, which the case-based approach could reduce (1) the incidences of switching candidates from 36.6% to 19.6%, (2) excess days by 70.2% (p<0.001), (3) durations of IV used by 11.8% (p<0.05) and (4) potential wastes by 60.9% (p<0.001) whereas the group education could reduce only the incidences of switching candidates from 31.3% to 25.5%. No statistically significant change of the studied outcomes including potential waste was found. The case-based approach could save an average of 200,000 Baht a month. However, the majority of physicians and pharmacists preferred the intervention using group education more than case-based approach. During phase II of the case-based approach intervention, the factors affecting physicians in switching from the IV drug to the PO drug were the drug categories A or B (p<0.05) and type of intervention via verbal or written (p<0.01). With the same switching guideline, the incidence of switching candidates at the Lampang Hospital and the Khon Kaen Hospital were comparable at 36.6% and 36.3%, respectively. Thus the case-based approach was the effective strategy in promoting IV-PO switching and it was also a cost-saving program. About one-third of IV drugs in the tertiary care hospitals could switch to oral drugs, which could save drug expenditures. This case-based approach might be applied in order to reduce the incidences of switching candidates and lead to reduce health care costs.


This report is an outcome of the study on how the Health Systems Research Institute (HSRI) obligates and would respond to its 5-year future purposes.  It also is the product of a study process that would be put together to lay a 3-year necessity plans (2005-2007). From trends and driving forces, the researcher has used a ‘Foresight’ strategy to lay future scenarios.  In-depth interviews with 20 public health management and services experts were conducted.  The interviews were integrated and have given 3 summaries.  They are:HSRI is an organization which creates and manages knowledge for the country’s development.Although this role is taken as a systematic organization, but because of changes occurring both inside and outside of the country, HSRI should administrate more on knowledge gained, researches and its management so the information could be converted into policies and actions. Linkage between knowledge found and how they could be implemented must not be separated.  Missing linkage, which is how knowledge and research outcome should be handled so the country’s public welfare is profited, must be handled.  It is important to link and empower scholarly research before they are systematically applied or be made policies.  This links to:2.  HSRI is an organization which manages knowledge systematically. The organization signifies knowledge management by pushing for a public policy, manage its structure and find networks and partnerships along with building knowledge and research.HSRI is an organization built for the public’s strenghten knowledge.  It emphasizes on the public’s self-reliance and participation in knowledge and research buildup.  The three summaries reflect that HSRI is the country’s mechanism and think tank for the health system.  This is an organization which could accurately forecast changes or adjustment in policy.  It could supply information for those provide knowledge and research-result for the public, such as government sectors, networks or institutes so they could create specific and direct research according to the social needs.  It also acts as a well-defined information center to help reduces investment risk for the private sectors thus, could produce or add more value to the country as a whole.Moreover, other organizations could use the knowledge HSRI provides to build up understanding and manage conflicts that might arise among them.


Lessons and Experiences in AIDS Solution of Upper Northern Communities	As Northern communities were highly affected HIV/AIDS, many-years experiences from AIDS takling in such communities were picked up to synthesize lessons learned. This study covered the experiences from 6 upper Northern provinces including provincial administrative bodies involved in AIDS programs in both public, private organizations and NGOs, and community organizations. The study was based on secondary data e.g. project documents and various reports on AIDS programs implementation, data from in-depth interview on a number of key informants, data from group participation processes. 	The study found obvious advantages derived from the development of matrix organizations which were from public, private and NGOs leading to well-cooperative and coordinated system. Core people in communities were the key players to initiate the programs; nevertheless, they must act on their voluntary with sufficient supportive matters like budgets and knowledge either from internal or external communities. Local administrative organizations were the key player while large amount of budgets should be from the public sector via direct allocation to communities or local administrative organizations as the administrative body. Importantly, communities’ knowledge must not be underestimated as they tended to be more practical and acceptable for them.


The relationship of disease of respiratory system, disease of the skin and subcutaneous tissue and air pollution from the industries in Maptaphud Industrial estate conducted by comparing morbidity rate in Maptaphud Municipality to rate in Ban Chang and Wang Chan areas. The comparison revealed that the rate of disease of respiratory system in Maptaphud Municipality was higher 2.8 time and 1.2 time than the rate in Ban Chang and Wang Chan areas respectively. As well, the rate of disease of the skin and subcutaneous tissue in Maptaphud Municipality was 3.1 time higher than in Ban Chang and 1.2 time higher than in Wang Chan areas. And the study in Maptaphud Municipality found that the communities with higher estimated pollutants (NOx, SO2, TSP) had higher rate of disease than the communities with lower estimated pollutants. And the time series analysis also concluded that the rate of disease of disease of respiratory system was related to 3 previous days estimated SO2 (p<0.05) and 3 previous days estimated TSP    (p<0.05). While the rate of the skin and subcutaneous tissue was related to 4 previous days estimated SO2 (p<0.05).


This essay on “Patterns and Meanings of Holism” is the product of a research on “holism”, which is part of a project on “The Synthesis of Knowledge: Thai Society under Reform Currents”.  The research aims at an understanding of and a commentary on holism, a concept widely used in the reform currents in contemporary Thai society.  It relies on the following concepts and theories, namely:-  Gregory Bateson’s metamessage, logical type and ecology of mind, Immanuel Kant’s focus imaginarius or projected unity, Alfred North Whitehead’s abstraction, identity and background, Stephen Rothman’s critique of strong reductionism, Erwin Schrodinger’s objectivation, quantum physics’ non-locality and interrelationship, David Bohm’s implicate order, explicate order and soma-significance interrelationship, Carl Jung’s synchronicity, and discussions of related subjects in Milindapanha (Milinda’s Questions) as well as other major texts such as those of Rene Descartes, Isaac Newton and Martin Heidegger.As a result of the studies, analysis and synthesis of various concepts and theories, the research arrives at the following conclusions.Holism is “a meaningful connecting pattern of all components in a given context”.Holism is a subject concerning with the working process of human thought, which has to rely on a connecting pattern.  Wholes and parts are thus inseparable; and the thing that makes it possible for them to “hang together” in a certain way is a connecting pattern that depends on a certain meaning.Fragmentation and reduction are not the same thing.  And once many ideas, commonly regarded as reductionism, have been seriously considered, it will be found out that they are, in fact, based upon wholes and meanings as well.Various ideas of holism share a common ground in emphasizing the importance of meanings and contexts, and a common attempt to reinstate them in the construction of knowledge.The key issue of holism should thus be an awareness of wholes inherent in contemporary trends in the construction of knowledge; and the emphasis should be on the “meaning” or “value” that defines whole entities, components and contexts of the search for knowledge.  This may be called a “meta-methodology,” which is -- the awareness, selection and application of a type of meaning to define a whole entity, its parts, the context, and to construct a connecting pattern of the thing being mentioned, observed and studied.  This will also include an understanding or argument concerning the choice of meaning.


Sexual knowledge, attitude and behavior of primary and secondary education school studentsThis survey aimed to explore knowledge, attitude and behavior of primary and secondary education school students.  The sampled population was the students from  "pathom"  or  "po"  5 (late primary school-about 11 years old) through "matayom" or "mo" 6 (late secondary school-about 18 years old) at Phanomphrai district, Roi-Et province, Northeast of Thailand,  in academic year 1999. The subjects were stratified into 3 groups, according to education levels, i.e. po 5-6, mo 1-3 and mo 4-6. Two multiple-choice questionaries were, after approved by 4 experts in sexology and in education, used separately, one for po 5-6 and another for mo 1-6 group, for quantitative survey. Three discussion guidelines were developed and used for each group. Among a total of 5956 students, 1073 (18.0) : 	The result of attitude towards who is the most suitable for teaching sexual education reveals that most po 5-6 group prefered a doctor or a nurse. This result corresponds to mo 1-3 (62.1%, 95%Cl: 55.2-69.0)and mo 4-6Z56.9%, 95%Cl:51.5-62.2), and 62.5%Z95%Cl: 58.8-66.3) of all students think so.The attitude towards should school reproductive health services be provided, survey only among mattayom students (mo 1-6), reveals that 53.2 % of mo 1-3, 59.2 % of mo 4-6 and 56.1 % of all mattayom students did not agree. On the other hand, 18.0 % of mo 1-3, 23.6 % of mo 4-6 and 20.7 % of all mattayom students agreed. Most of the students agree that counselling clinic in school by a doctor or nurse or health personnel would be most suitable (64.1 %, 95%CI: 60.5-67.7). The attitude towards what to do first if unwanted pregnancy occurs, survey only among mo 1-6, reveals that 49.7 % of mo 1-3 group would tell their parents and 25.5 % would consult a doctor or a nurse. The same attitude was found among mo 4-6 group, 58.6 % would tell their parents and 23.0 % would consult a doctor or a nurse. For the total of mo 1-6 students, 54.0 % would tell their parents and 24.3 % would consult a doctor or a nurse. The sexual experience was 1.1 % among po 5-6 students, 1.1 % among mo 1-3 and 5.2 % among mo 4-6, and the overall experience was 2.4 %. This study suggests sexual education in school be adjusted according to the student needs. School reproductive health services by means of counselling clinic may be appropriate and there should be a survey for parental readiness in counselling an adolescent with unplanned pregnancy.


Historical dimension has been a missing aspect in studies on medicine and health development in Thailand. This was partly because the interrelation between health and its socio-political contests was not adequately appreciated. History of medicine and public health in Thai society was understood merely as a chronology of medical technological advancement and the growth of state medical service.	This study explores works in the field of Thai medical and public health history both in Thai and English languages. It aims at assessing the state of knowledge and suggesting directions for further studies in medical and public health history in Thailand. The study found that although there were a number of studies in medical and public health history done by physicians, pubic health export, and social scientists, most of the works only compiled and listed the chronologies of events. They didn’t adequately provide historical explanation or interpretation of the events. Such studies failed to create new understanding on the medical history in Thailand. Not only new historical knowledge has been absent, but there was a lacking of the development of relevant methodology in medical historical study.	Historical writings in the early period were mostly done by medical or public health professionals in an  attempt to “construct their own discourses.” The changing of Thai political landscape after October 14, 1973, has led to the new area of historical knowledge. Medical and public health history was no exception. New interpretation of health and medical history was created within the contests of pro-democratic movement. Although various new sociological and historical methodologies were gradually developed and used, it was only in the past decade that greater interest in historical methodology and historiography has gained currency resulting in a building up of new knowledge of the Thai medical past.	The current state of knowledge in Thai medical history focused on two main issues. The first concerned with the evolution and domination of modern medicine. The second issue was in the changes and discontinuity of traditional Thai medicine. The repetitive theme was mainly on the decline of traditional medicine and the success of modern medicine which has become mainstream and increasingly dominant in Thai society. There was a lack of critical scrutiny of medical institutions and historical figures. This was partly because of the adherence to writing history with the framework of the Great Man and the royal nationalism theory. There was a need to put more emphasis on understanding medical history as related to social, cultural, and political circumstances.


TB in some population groups in Thailand : 62 articles reviewed during 1958 to 1998TB has already communicated in community once a TB patient found. Then, number of TB patients is an indicator of TB communication in a community and shows a public burden to control TB infection. According to the review, children living with TB patient who is a family member, are at high risk to infection while those who are health personnel are more prone to get infected than other walks-of-life. Likewise, prisoners are at risk and male prisoners are riskier than female prisoners. Women are less likely to infect than men. Quality of information system which should be accessible and linked to relevant organisations, is recommended in addition to network building for monitoring and evaluation.


The Evolution of the Tobacco Consumption Control in ThailandThis qualitative research study entitles “the Evolution of the Tobacco Consumption Control in Thailand” was conducted with an aim to systematically chronicle the evolution of the control of tobacco consumption as well as identify the factors leading to those critical events. Moreover, the process and approaches used by the organizations of various parties and impacts from those critical events were also investigated through the methods of reviewing of all documents available in Thailand relation to the tobacco consumption control and interviewing of 15 persons. The investigators also set up an arena for two sessions of brainstorming of thoughts from academics, administrators and implementing staff involved.This study uses the critical events as the determinant units of analysis and denominators for classification of the development periods in Thailand’s tobacco consumption control that can be divided into four periods. They are 1) prior to 1986: a period of unorganized efforts without continuity; 2) 1986-1989: a period of coordination and setting up of organizations; 3) 1989-1991: a period of forced open market to the imported cigarettes; and 4) 1991-1996: a period of legislative measures and tax enforcement. The classification of periods mentioned above makes one realize that the control of tobacco consumption in Thailand has been in existence for over four decades with the initial characteristics of lack of organized activities and continuity. It was not until 1986 that a non-governmental organization by the name of a No Smoking Campaign Project was established. This organization has set up interesting strategy, process and method of working in collaboration with other agencies. Later, there was an establishment of the National Committee for Control of Tobacco Use in 1989. A setting up of the Office of Tobacco Consumption Control in 1990 has subsequently led to a formulation of a policy, plan and better coordination among all agencies from different parties concerned. In addition, during the period of 1998-1991, a critical event took place where the United States of America used the article 301 of its trade law to force Thailand to open its market to the US cigarettes. This incident at the period of time has had major impacts on Thailand in many ways. It caused  the Thai society to realize the negative impacts on the health, economic, social as well as environmental issues from opening its market to the imported cigarettes. It also accelerated the drive in campaigning against cigarette smoking in Thailand. An implementation of activities to control the consumption of tobacco during the past decade (1986-1996) has fostered a “value” in the Thai society to reject the practice of cigarette smoking in public places. This has resulted in a better protection of the right of non-smokers and a decrease in the rate of cigarette smoking among the Thai population, particularly those in the age group of over 40 years. The results of the data analysis of this study have shown the implementation procedures and methods used by individuals, offices, and organizations from many parties in the critical events. The data analysis also revealed the supporting factors leading to the success and those failing to facilitate the control of tobacco consumption in the past. Recommendations deemed beneficial to the future implementation of the tobacco consumption control have also been proposed for consideration.


Health Promotion in the Support Services Department’s Personnel and their Families	The pilot project of health promotion for the military personnel in the Support Services Department and their families is aimed for altering health behavior, physical environment and social environment. The expectations are hoping them to have better health, delightful office work, warm families and peaceful community without temptation by letting the personnel and member of their families to take part in the activities as much as possible. There were 997 personnel and 1,227 member of their families took part in this program.	The research was assessed by comparing the variation in 3 target groups which are administrators, military personnel and medical staffs, whose in charge of looking after their health, by hold on interview and answer questionnaires collaborating with the activities for brain storming in searching problems and answers, including physical environment survey around their office and their living area.	After collecting data for 1 year, the project was succeeded according to the 18 steps plan. 3 target groups were identified as follows: the military personnel has better knowledge how to keep healthy e.g., smoking was reduced from 26.90% to 24.82%; health problem survey is improving e.g., excess BMI was reduced from 18.21% to 9.43%, high blood lipid was down  from 11.27% to 10.36%; the administrators decided to improve their welfare, accident prevention and alter policy, rules and orders  facilitating healthiness. The promising result from this research can be used as a guideline promoting health to a military personnel at any other Thai Armed Forces’ units.


The purposes of this study are to develop a fundamental budget system of oral care system in Thailand beneath universal overage system from the current  situation and then forecast the national oral care expenditure hen the insurance is extended full scheme. The public expenditure including welfare schemes and household expenditure were analyzed to perform the national expenditure. The two methods analyzing public oral care expenditure were presented. The first method was based on the 1996-1998 National Health Account. Another method was blowing up public oral care cost of the 6 provinces in budget year 2000 to be national level. These provinces started the Universal Coverage Scheme since April 1, 2001. The duration of this study was between June- November 2001. The important findings from the study could be divided in 6 areas:	1. Household expenditure for oral careOral care expenditure paid by the household was subject to the household income. The very low proportion of total household consumption though oral diseases are still very high prevalence among Thai people reflected the low level of utilization. Even oral care expenditure in 1996 was highest (about 26.5 Bath/person) but it was only 0.10 % of total household consumption. The 1998-2000 slightly decreasing trend (0.15, 0.13 and 0.11 %) in higher proportion than in 1996 whether the absolute expenditures in 1998-2000 were lower showed that Thai household utilized oral care as a necessary good. Even the 1997 economic crisis has effected Thai households but decreasing rate of oral care expenditure was lower and slower than overall consumption because of its necessity therefore the proportion suddenly increased in 1998 then very slightly decreased. Low level consumption may be caused of psychological cost and impression of its high cost of oral care. 	2. Public oral care utilization in six provincesIn fiscal year 2000, the average utilization rate and per capita frequency of the 6 provinces were 10.24 % and 0.16 visit/person, respectively. Notably, people in rural area such Yasothorn, Yala, Payao and Nakornsawan could access the public oral care better than in urban area such Prathumtani. In fiscal year 2001, overall the utilization rate and per capita frequency increased slightly (10.42 % and 0.17 visit, respectively). Sketchy consideration here is that other factors may affected access to oral care rather than sole dental personnel number. Public oral care provision is expected to play important role in early phase of the UCS even the productivity is limited. Average 0.17 visit of oral care utilized by a person of the six provinces in 2001 is an evidence of this situation. Therefore the provision should be productively improved as well as allowed the private sector serving the increasing demand.	3. Public oral care cost in six provincesIn fiscal year 2000, the average full cost of the hospitals was 280 Bath/visit or 413.61 Bath/recipient at utilization rate 10.24%. Among hospital size, number of dental personnel, number of recipient and number of visit, the cost variation mainly related to number of visit rather than other factors. Moreover, the number of visit did not solely varied to number of dental personnel. However, these evidences do not totally conform to general theory that the higher productivity makes the lower cost. This study could not gain type of oral care mostly provided in each hospital. Type of oral care may reflect severity of the disease and complication and directly reflected to oral care cost. Therefore it is not fair to compare the cost among hospitals when only crude utilization was gained.	4. Public and welfare oral care expenditureCalculation the 2000 national oral care expenditure of public sector and welfare schemes from the 6 provinces, two assumptions were needed. Accessibility of oral care of people in other 70 provinces of the country as well as the productivity and unit cost of oral care were assumed to be same as the 6 provinces. While the household spending was decreasing since 1998, the public and welfare expenditure increased instead. This trend reflected important role of the public policy on health insurance including oral care beneath economic stagnation. If the UCS really provides the accessibility beneath the 6-province contexts, the utilization will represent both public and private demand therefore the budget should cover both public and household expenditure which would be 59.50 Bath/person at 2000 price (the public expenditure was 42.35 Bath/person at 2000 price). But sole public facilities can not provide total oral care respond to people therefore private sector may be necessary for the provision towards efficiency. As previous oral care utilization was very low so every year adjustment for appropriate provision and budgeting is needed to serve incremental demand of society.	5. Oral care expenditureThe combination of oral care expenditure of public and welfare and householdout of pocket oral care expenditure performed national oral care expenditure. The oral care expenditure of public sector and welfare schemes was analyzed by 2 methods: to extract the expenditure from 1996 and 1998 National Health Account and to blow up from the 6 provinces. From 1996 to 1998, national oral care expenditure at 1994 price was increasing 0.17 % but only 0.01 % increasing of proportion to the Gross Domestic Product. While national health expenditure decreased 8.16 %, the oral care expenditure proportioned to the health expenditure therefore increased 0.15 % in 1998. Per capita expenditure at current price showed a different figure since national oral care expenditure decreased 1.81 % from 46.35 Bath/person in 1996 to be 50.70 Bath/person in 1998. Adjusting to be 1994 price, the per capita expenditure decreased from 43.04 Bath/person in 1996 to be 42.27 in 1998 or 1.81 % decreasing. Consideration sources of expenditure, household's direct payment was greater than public's both in absolute number and per capita. Notably, per capita household payment decreased 4.02 % from 1996 while the public expenditure increased 1.68 %. Blowing up from the 6 provinces, the per capita and absolute public expenditures were calculated then combined with household expenditure to be nation oral care expenditure. The per capita nation oral care expenditure in 2000 analyzed by this method was 64.43 Bath/person at 2000 price or 50.98 Bath/person at 1994 price.	6. Sensitivity analysis of oral care expenditureSince the UCS started in 2001 and may facilitate the access to public oralcare especially when the scheme allows public-private mixed provision to coverpopulation extensively. Therefore the expenditure may closely vary to the utilization.The sensitivity analysis was conducted to forecast the expenditure when theutilization rate changed and other factors were constant. At 2000 price, when theutilization rate were between 10.24-15.00 per 100 population, per capita nationaloral care expenditure were 64.43-84.12 Bath which were public expenditure 42.35-62.04 Bath. The expenditure would increase 4 Bath per person when the utilizationrate increasing was 1 %.Policy recommendations	There are two main areas should be intently done for oral health insurance system towards equity and efficiency :1) The information system embedded in routine working system to administer and self-monitor proper provision and financing are needed. At facilities based, the cost accounting and computerized utilization data are required to be accumulated the provincial or area information. Specific provincial data will be further used to finance the province particularly. Since oral services have various costs due to type of the care, the utilization data should demonstrate types of the care which not only provide the information of accessibility but also present qualitative aspect of the care and personnel's workload.2) To meet the equity purpose, adjusting the different schemes being close to be the same should be based on the oral health need rather than the social or work status. However the collective financing have to be based on the capacity to pay. Indeed, personal oral care seems to be only main part in oral health insurance and oral health promotion is apart considered. The inequity may explicitly exist since the care is based on the service system that tentatively avails for urban or municipal people rather than the rural. Community strengthening to participate in all dimensions (such as to direct, administer, monitor and regulate both provision the care and oral health promotion program in communities may be hopefully way for equity improvement. At least 3 expected consequences could be addressed here which are increasing accessibility to the care, the schemes would particularly respond each area and the oral health status improvement would be real and sustainable. Nevertheless, people will depend on professional care leading to the high cost problem but improper oral health.


Study and Development of Indicators for Evaluating Risk Behaviour of Sexual Intercourse in High School and Technical College Students in Nakornrachasema ProvinceThe study objectives were to develop techniques of how to find risk behaviour indicators of sexual intercourse in high school and technical college students in Nakornrachasema. The technique which was used in this study was literature review in addition to organising brain storming meeting in order to determine the indicators. The study was grouped into 2 parts, 1) studying in high school and technical college students to find risk indicators by interviewing 1314 students sampled by multi-stage technique, 2) interviewing 12 school administrators to assess their interests in using the indicators.The study showed that 1 in 5 high school students and 46.7% of technical college students had had sexual intercourse while in female students, 10.5% of technical college students, 2.9% of high school students in Muang district and 3% of high school students in other districts had done so. Factors which were related to risk behaviour in male group, were drinking, independent living from their family, family income, age and inappropriate attitude for example having sex with their friends not risking AIDS infection. Sensitive indicators which were positive to high risk, were drinking, their living conditions, being technical college students, attitudes and family income.The results from interviewing educational administrators were some of them considered this issue as important whereas they were more interested in drug and learning problems. They expressed concern over independent living, less taken care by their family and lots of entertaining places where students were easily led to risk life behaviour. Most of them agreed with the use of indicators but felt hesitate to collect data by themselves. The study recommended that;the results of this study should be presented to all involved to promote issue awareness and process of exchanging views,high risk group which was the technical college students should be first targeted,process of data collection should be developed.


Development of indicators for the achievement of consumer protection on health products according to the eight National Socio-economic Development planThe objectives of this research were to develop reliable and valid set of indicators measuring the effectiveness and fairness of the health consumer protection activities as well      as to develop tools to evaluate the practicality and of the designed indicators prior to their application. This activity is in accordance with the Eighth National Socio-economic      Development Plan (1997-2001) on the Consumer Protection on Health Products. Sets of indicators were developed and subject to test of their validity and reliability in the field. Thus, the working group set the guideline of theoretical indicators. Suggestions from the chief of health consumer protection and pharmacy all aver the country of 76 provincial health offices regarding the indicators via questionnaire were made, after that brainstorming the stakeholders in health consumer protection and carried out empirical indicator. Then setting the questionnaire to test validity and reliability by health officers and health volunteer groups in twelve districts, of four regions and retest by consumer groups in Anything province. Effectiveness and fairness were the two areas of the seven sets of indicators which had been found. The reliability was between 0.6784 and 0.9754. The effectiveness indicators had four sets; skill to know how to consume (11 items), known how to develop themselves (8items), quality of products (8 items) and proper distribution of products (10 items). The fairness indicators had three sets; fair price (8 items), equality (10 items) and product liability (3 items). Tools for measuring were questionnaires, survey and data  collection from.


The Scoping of Health Impact Assessment of the Eastern Seaboard Development Program:A Case Study of Mab Ta Put Industrial Estates and their VicinitiesMr. Decharut SukkumnoedFaculty of Economics, Kasetsart University						decharut@hsrint.hsri.or.th	The Eastern Seaboard Development Program is the most obvious case showing “the Two Sides of the Coin” from Thai development experiences. On one hand, this development program is the most successful story of industrialization program in this country. On the other hand, it is also the most visible example of terrible environmental and health impacts in Thailand development experiences. The HIA from the Eastern Seaboard Development program aims to gain more experiences and knowledge on health impact assessment, as well as, to find the better ways in protecting and promoting local people’s health.	The WHO’s health and environment cause-effect framework has been applied to this study. According to this model, the industrial development is the driving force causing hazardous chemical uses and pollution in this area. The increasing in chemical uses and pollution becomes the pressure for local environmental quality. The air pollution and related health impacts, chemical accident, illegal hazardous waste dumping and chemical contamination in water resources and food web have been the most serious environmental problems in this area. The three epidemiological studies during 1997 to 2000 show the association between the exposure to air pollution and acute health impacts, especially in respiratory and central nervous systems. 	The state of socio-economic factors and social supports in these local communities has also been degraded. The changes in economic, social, and demographic structure cause local people to live with higher uncertainty, both in economic and social senses. The rate of out-patient per population in mental disorders, in this area, has been significantly increased, from slightly lower than regional and national average in the past to almost three times higher than regional and national average at present. The situation has become more serious after Thailand economic crisis in 1997.	The WHO’s health and environment cause-effect framework can be applied as a hypothetical model for assessing health impacts. To understand the complexity of health impacts, the combination and triangulation of qualitative and quantitative analyses are highly recommended. As a participatory learning process, it is also very important to ensure meaningful public participation within HIA process, specifically, by avoiding technical barriers.


The effectiveness of Structural Shared Care for patients with epilepsyin Nakhonratchasima ProvinceThis study aims to evaluate outcomes of treatment in terms of patient with seizure free and with regular follow-up between the conventional care and shared care with specialist's advice given to GP and letter reminder given to the patientsMaterial and Method: The study was conducted between June 1999 and September 2001. Two community hospitals were chosen: one for control and the other for intervention group. Before the beginning of the study, guideline of management for GP was created between GP and specialist. All patients with informed consent were treated and asked to fill data in the registration and follow-up form. All the data was sent to the investigator to register and audit the treatment only for intervention group. Advice (if any) would be sent to the GP and the patients would be received the letter reminder for the next coming schedule appointment. After one-year study, all data recorded in the forms and in the OPD card would be gathered for analysis with SPSS version 8. Some information not presented both in the forms and the OPD card would ask to the patients by letter. Results: The number of patients in control group and intervention group was 45 and 55, respectively. All each patient's characteristics between two groups was not different but patient's age, number of mentally retard patients and type of seizure (p-value < 0.05, 0.05 and 0.01, respectively). At the beginning of the study, patients with seizure free in the previous 3 month in control group were 46.7% (21 cases) and 56.4 % (31 cases) in intervention group. After the study, this figure has an increase to 72.7 in intervention group and 60% in control group. For follow-up analysis, the factors which might influence patient’s regular follow-up were not different between two groups including Univariate and Multivariate Analysis (Cox proportional hazards regression). There was no statistical difference in an average of the duration of follow-up (mean in control group = 9.61 months; in intervention group = 10.31 months) and in the proportion of patients with regular follow-up (64.4% in control and 67.3% in intervention) (p-value = 0.87 and 0.86, respectively). However, for survival analysis, no difference in proportion of patient with regular follow-up between two groups (p = 0.46, Log rank statistic).   Limitation and suggestion: Too small samples and few interventions might be the reason for no difference between two groups. The system should be corrected as a whole.


Child-Care Situation in Thailand: A Synthesis ReportThis reports aims at synchronizing the state of knowledge of child care situation in Thailand. The analysis is basically derived from the existing documents such as research reports, theses, the government white papers and academic articles. It was revealed that changes in child care patterns are associated with demographic factors. The most outstanding factors is change in family structure from the extended family to the nuclear family. An increase in labor force participation of women affects their domestic role and this results in child development physically, emotionally and socially. The emergence of child care centres does not help to mitigate child development problems due the inadequate experience of personnel in stimulating child development. A lack of qualified personnel and the participation from parents and community become problematic. Moreover, the influence of the media affects the development of children in both negative and positive ways.  Based on 150 research studies, it is obvious that the main points of research concentrate on the input factors of child rearing process. While the studies on output factors and the impacts are limited in numbers due to the complicated process of research design and assessment. The need of intensive research to investigate the interaction between family and child development is a priority.  An endeavor to combine the qualitative research with the the qualitative research will be the alternative to improve the quality of data for program implementation. There is a need for research at the national level ot provide useful information for action. Epidemiological research in physical      development with a strong emphasis on the preschool children in quite useful and more reliable to understanding the magnitude of the problems while research in emotional and mental development is quite limited. The only existing studies focus on the children with mental health problem who seek treatment at the the government hospitals and the mental counseling units are available but not sufficient. This research should be expanded in size in order to cover the whole population.        Research with an emphasis on skill  and intellectual development is also important. The previous research studies concentrate on  the assessment of the learning process and attitude test rather than the evaluation of the effectiveness of the teaching process and attitude test rather than the evaluation of the effectiveness of the teaching process. Those studies test do not reflect a sharp and clear direction for the effective resolution due to the improper standardized tools used for measurement. Research in policies for  implementation, law and plans for children and youth are rare. Most studies focus on evaluation and monitoring the effectiveness of law, policies and plans for child development.  Research in child investment, policy evaluation, data system for indicators of child development should be a priority.   Insofar, research in those components have been carries out by the small institutions and cannot be applies effectively for the national programs.


The study aimed to develop a new rehabilitation service system for stroke patients at Maharaj Hospital, Nakorn Ratchasima Province. The situation analysis showed some pitfalls of the existing system. For instances: there were underserved for occupational therapy services; the routine services and information given were not responsive to clients’ needs, in terms of supporting their self-concept; inadequate system to follow up discharged patients; and the increasing need for home rehabilitation service because of the inconvenience of client transportation. Participatory action research (PAR) was applied to work out among other related service providers or stakeholders to identify an alternative system. Those were physicians, physiotherapists and community nurses. Duration of the study was during The modified service was described as follows; The rehabilitation services would cover physical therapy and occupational therapy for every consulted case, even though it was not mentioned by physician. The essential rehabilitation guidelines had been set up to fit with Isan context. The follow up system was set up, and had to correspond with physician appointment date. Making linkages with community nurses to provide rehabilitation home care. Setting up the record and report systems for continuity of care between hospital and home care. Recommendations from this study were that this system should be applied for patients with other chronic conditions, such as paralysis or cerebral palsies, to whom rehabilitation services were needed. However, implementation of the recommended system should take personnel existing workloads for granted.


Information system of most hospitals in Thailand have increasingly been computerized mainly to improve administrative works without adequate concerns about quality of care. This study aims to explore major issues related with the use of computerized information system in hospital and quality of care. There were 4 phases: literature review, hospital survey, stakeholder analysis, as well as in-depth analysis of some famous systems. It was found that information system in at least 80% of the hospitals, especially private and large public hospitals were already computerized. Report production for various health insurance systems was the major reason. At least 44 different systems were available in Thailand without appropriate and effective information exchange mechanism both nationally and locally. IT-related investments by hospitals were found to be quite large despite the lack of evidence to prove their return. In addition, many problems including IT-related clinical risks were not efficiently taken care of. Nationally, the most important problem was hospital readiness, especially the inadequacy and poor competency of IT-related healthcare personnel. Moreover, the inefficiency of cooperation among central organizations forced most hospitals to solve major problems with their limited resource and comprehension.


The objective of this study is to empower subdistrict administrative committee (SAC). The concept of empowerment is interpreted as ability to solve community problems. Through the process of participatory action research (PAR), the researchers worked with the studied SAC to develop 5-year subdistrict plan on which community participation was emphasized. AIC (Appreciation, Influence and Control) and FSC (Future Search Conference) concepts were applied. Additionally, case study analysis method and study visits were conducted. Qualitative data collection techniques and were used content analysis was used in data analysis. The study period was during January – August 2001.	The result showed that by using participation concept the SAC could be empowered which was assessed by improvement of their ability in; understanding their problems and needs, causes of such problems, problem solving skill, analysis skill and self determination. Consequently, they developed positive self – esteem, self and other- acceptance and self –confidence. Case study method, dialogue, and field study facilitated the SAC to broaden their vision as well as to realize the necessary of data. Most of all, they became aware of listening to people, getting people to participate in solving community problems led to better understanding of their roles and functions. Recommendations are made in two folds. Firstly, this empowerment process goes in line with the national health care reform policy. It helps those who are involved to be reoriented about broader concept of health, holistic view of approaching community problems and community competence. Such orientation requires changing roles of health personnel working with community. The new roles should concentrate on facilitator concept, resource coordinator. Health personnel should work with and learn from community rather than imposing. However, clear guidelines to bring policy into practice as well as changing budgeting policy are needed. Secondly, it is aware that here is no one empowerment process to fit all situations. Such process is highly context-bound. Furthermore, this process needs them and continuity of activity. Suggestion for further study is on application of PAR to be implemented in monitoring the subdistrict plan.


Development and administration of community health fund were studied to explore factors and conditions which were involved in its administration. A number of major issues were;changes and development of circumstances at micro and macro level, thoughts, definitions and administrative system of community,strengths of health fund particularly financial viability,community health activities andlinkages of health funds to health benefits and development of other community activities.	Comparison of 6 community funds was used in this study. Three regions in which the sampled community funds were located were the central, the North-eastern and the Southern region. Data were collected from existing Thai and international document and research, surveying socio-economic status of communities, interviewing key persons, discussing in group and participating community activities if opportunity available. Data were grouped into three levels, individual, family and group / community. The results showed certain differences and similarities in sampled communities, which were predisposed by community circumstances, development and goals of community funds.


Diagnosis related group (DRG) has been researched and developed in Thailand since the implementation of the Traffic Accident Protection Act 1992 with support from the Health Systems Research Institute (HSRI). It was aimed to be an alternative of payment apart from fee-for-service and capitation payments. The first research in public and private hospitals in 10 provinces gave about 100 DRGs covered injuries. Later research activities expanded to cover all diseases in the low income patients and finally cover all inpatients by using electronic patient data from well developed hospitals. Success of these activities proved that Thailand was able to use DRG for health financing. In 1998, the Health Insurance Office, Ministry of Public Health adopted DRG as payment method for high cost care for the low income card scheme. This decision has stimulated the flows of individual patient data from hospitals to provincial health offices and the ministry. The information assets have increased from 1.5 million patients in 1998, to 3.0 million in 1999 and more than 3.6 million in 2000.It can be concluded that DRG has brought big changes in health care in Thailand. Information technology has been used for promoting efficiency, equity and quality in health delivery. The first Thai DRG Grouper was launched in 1998 followed by version 2 in 2000. The tests of these groupers against the international groupers showed lots of improvements. When the government made a big decision to provide universal coverage to cover all Thai population in April 2002, the researchers and developers of DRG decided to develop the third version that is compatible with the patterns of diseases in Thailand, especially the tropical diseases. This activity got financial supports from the HSRI, Thailand World Health Organization Office, the Health Insurance Office, and got technical helps from more extensive groups consisting of the royal colleges, colleges and societies of health professionals. It was hoped that the 500 DRGs in version 2 would be expanded to 1,000 DRGs to better reflect different disease severity. Since DRG is the only one case mix being researched in Thailand, DRG is good only for acute inpatient episodes. There are many complex issues in health care reforms or health system developments; e.g. information technology, increasing efficiency within public sector, health care accreditation, health care decentralization, autonomous hospital, and the universal health coverage of the new government (30 baht medical care policy), etc. In the implementation of the 30 baht policy, many issues of health care reforms have been dumped to ride the wave of change. DRG was used inadvertently with decentralization policy but with less understanding. This conflicts with the recommendations of the Working Group on Universal Coverage of HSRI. The working group recommended the split of budget between ambulatory and inpatient care. The capitation payment is good for ambulatory care and DRG for inpatient care. To increase access to efficient and good quality inpatient services to all, DRG should be managed with unity at the central level under the reasonable global budget cap.