Community Self-reliant Health Action Research Project has been implemented in 10 communities of the Phumpanya Thai Network, covering all the four main regions of the country. Its main aim is to study community health management system which could lead to a more self-reliant health system of the communities. This is to be based not on mono-type or ready made model but on diversified ways of learning and types of knowledge about health of the communities. This research has used a tool called “People Research and Development” (PR&D).The community is the centre of learning process. The researchers team facilitated the process of learning and interaction among the 10 communities, which share their experiences, plan and assess their action plan together. The process of learning consists of :	Search for identify. This is the process of surveying basic data of the community, identifying its resources and management, knowledge and wisdom, occupations and sources of income, expenditure, debt, illnesses and treatment of illnessess. The survey has proved that communities have potential in terms of richness of resources, knowledge and wisdom, to be developed toward self-sufficiency in health. Some communities have succeeded even to create a welfare system paying 100% of health care bills. Some communities can provide basic health care with traditional knowledge and resources, such as massage and herbs with collaboration and support of community health centres and community hospitals. This search for identify has helped communities regain their self-confidence lost during the past 40 years of “modernization”. They realize that they can take care of themselves in many ways with their local resources. Community analysis. This is a process of learning about health, about illnesses, causes and ways for self-help health scheme. It consisted of learning within the communities and by sharing experiences with other communities in the same area as well among the 10 members of this network. At the same time, the communities are exposed to other models of community health scheme and activities related. They have learned about more possibilities in developing their own health scheme. Experiment community health promotion programme. After several learning forums organized within each community and with other communities, some activities in relation to community health promotion came about, such as, food system management, massage training, herbs training for self-care, for family and community care, setting up community health fund to support extention of “health friendly” occupations. After this, each community started to implement these activities in their own community, recording the result in terms of new knowledge, and the impact on the community. Community Health Masterplan. This is the plan developed by each community as a result of learning process. This is based on data and information collected and analyzed. The plan is a guideline for self-development process of each community. Health is the main point of this masterplan. The aim is “self-reliance” in health programme. Within this programme there are “projects” which will be implemented mainly with local resources and by the community itself. At the end of this action research project it can be said that it has been a process to increase immune system of the community. It is the discovery of the “self” of the community, its strength, its potential, its alternatives for management of its health. This process is strengthened through cooperation and interaction with other communities of this network in their joint learning programme, made possible by this action research project.


The characteristics of problems on health service utilization under different health insurance schemesThis research aims at analyzing conditions and problems of health service consumers under current five insurance programs and of a group of consumers who are not covered by the systemproblems of health service delivery affecting the consumermode of health service utilization of the consumers who are not insured problems caused by weaknesses of the five schemes and the quality of service andproposing guidelines and machinery leading to the development a national health service system. The research in both quantitative and qualitative. The quantitative study involves the interviews of 2,400 consumers consisting of 400 each from the five different schemes and another 400 from non insured group in 4 provinces namely Samutprakarn, Chiengmai, Pattani, and Srisaket. The qualitative study involves the administration of 9 focus groups, 12 case studies and interviews with 9 resource persons. The objectives of the research are hereby responed: Problem encountered by all groups of consumers in clouding the non-insured are the lack of promptness on part of public providers; the long waiting for the doctors, the limited time spent for the examination and diagnosis with no explanation on symptoms of the illness; difficulty to commute to and from the designated health centers.Problems relating to the implementation which affect the consumers are lacks of sufficient information on benefits under the schemes by the insurers and lack of good      coordination among them; inappropriate subsidization for the free medical care consumers; moral hazard and adverse selection; refusal to receive reffered patients due to reimbursement difficulty; and inefficient service due to unreasonable financial incentives managed by central      administration. 3) Only the non-insured minority are capable to pay for their own medical expenses. In case of minor illness, the non-insured would go to the drug stores or private clinics. Their utilization of hospital service is less compared to all of the insured groups. Most of them can depend on themselves for out-patient charges. Most of them can depend on themselves for out-patient charges. Non-insured patients with high cost of expenditures are sometimes advised by the nurse to buy health card or to consult with hospital social workers for appropriate assistance. The number of the non-insured could be much decreased upon efficient health campaigns. Each of the health insurance schemes has its strengths and weaknesses. Collectively speaking, the duplication as well as the discontinuation of rights undermine the reliability of the data used for effective planning. Insufficient subsidization has and impact on the important factors determining provider's behavior. Good accessibility to free service enhances the beneficiaries to overuse the service. 5) The researchers have some reservations over adopting one single insurance system for the "health for all" policy. We might not be able to adopt the system that has been proved successful in many developed countries due to our people's limited ability to pay tax on the one side, and the eddiciency of tax collection on the other. The authorities should timely consider the introduction of pay mechanism by which all consumers receive free essential service and pay only for non-essential service.


Hospital Autonomy in Thailand: Operations Manual	The sharing of economic and administrative power / responsibility between the Ministry of Public Health and autonomous government hospitals would be created to improve communication, reduce administrative complexity, enhance effectiveness and efficiency of hospital management, increase accountability to the public, improve resource mobilization and local knowledge of development priorities and attain political objectives. Six main areas which would be enhanced in case of autonomous hospital should be strategic management, procurement, financial management, human resources management, administration and clinical governance.


This research reviews the notions of social concepts namely human rights and health in order to offer comparison, analysis, synthesis, integrate and bridge the link between human rights and health by applying a theoretical framework called  “a social construction of meaning” and various other social concepts.  The purpose of the review is fundamentally an attempt to understand the diverse definitions of health and human rights. The understanding of health is divided into three sections. The first notion is “individual health” which takes fragmented perspectives that aim to treat mainly the physicality.  The second notion is “public health” in which varying forces on the public health service and the improvement of the public environments that create good external conditions for health. This second notion is sometimes philosophically questioned whether it aims for good health of the majority by excluded or destroyed good health for the minority. The final notion is “social health” which is a holistic approach to health. It takes various considerations of causes and effects on health as a complex many with levels such as in the level of mode of living, in the level of economic, socio-political structure and the level of the natural environment.The notion of human right: the researcher presents six major notions 1) humanist with emphasis on the respecting of human life. 2) liberalist promote liberty and freedom. 3) universalist that see the human being are all the same. 4) egalitarianist emphasis on the equality among human being and does not accept the special privilege to particular group. 5) rationalist emphasis on reason more than emotion. 6) utilitarianist which gives important to the protection of the majority right.  However, when the human right ideal is applied in practice, it conflicts with concrete situations. For example, the conflict between the profit of the majority and the minority or the conflict in the level of philosophy and practice. The meaning of human rights is relative because it can provide possibilities of diverse interpretation in different socio-cultural contexts. Thus under the relative ambiguity of philosophy and the possibility of applying knowledge in various contexts, the process of learning about human rights takes an important role.The interrelation between the notion of health and humans right link the concept of right of health.  The application of these two concepts changes in various socio-historic contexts and in particular space and time.  In a context of high abuse of human rights, for instance in the tortured of the prisoners, the right of health would demand that the medical staff take a role to stop this human rights abuse. On the contrary, in a poor society the right of health would mainly take the issues of the right of access public health services. In the Thai context the rights to health cover a vast area of meaning. It should involve three levels of consideration. On the level of daily life it raises the issues of gender, consumers, disabled people and the Aids patients.  On a second level, it should take consideration of institutional or social structures. The research has taken the controversial issues of Mae moh, which suffer from the pollution of electric generator and lichnite industry, and the issues of the health of the immigrants. The third, the level of knowledge, the findings show clearly that the marginalization or the abuse of rights is not only influecing human beings, but also the body of knowledge, especially local knowledge.  Therefore, the understanding of right of health penetrates into issues that are more complex.In order to obtain an accurate understanding of the present world which is always on the move, we have to take a serious consideration of the constant changes. Therefore when we once examine the abuse of rights or dangers to health which take place in more complex ways, affects all levels of people, the integration of the notion of health and right takes an important role. The constructive selection of certain aspects of the health right is a means to examine the causes of temporary sufferings in order to deal with the problems proper to different social contexts.  Thus will be the way to solve the problems through more holistic sustainable and systematic approach. In addition, it aims at resolving problems in the short term and in the long run without leaving behind the weak. Therefore, in this way of proceeding we will be able to construct the powerful concept of “health rights” in order to provide means for individuals striving for the development of human capacities, to create the just society and respect for natural environment.


The purposes of this descriptive research were to study factors influencing health
promoting behavior and health utilization behavior among people under the universal coverage
project in the southern region. The sample comprised of 1200 people who were drawn by
multistage sampling technique from suratthani, pang-nga, trang and yala province respectively.
The instruments consisted of indepth-interview form, focus group form and questionnaire which
were passed the quality examination by the expert and field try out. The reliability of
questionnaires were 0.69-0.91. The qualitative data was analyzed by content analysis, the
quantitative data were analyzed by descriptive statistics, Multiple regression analysis, Multiple
logistic analysis, ANOVA and Chi-square test. The results were as follows:
1. Health promoting behavior among people under the universal coverage project was
fair level.
2. Health utilization behavior, most of the sample used health center and general
hospital. Folk medicine was not popular for the sample.
3. Factors related to health promotion behavior were age, health value, quality of care,
self efficacy and social support. The variance explanation of all factors was 32.9
4. Factors related to health utilization behavior were sex, education, type of insurance
,health need, perceived of right of universal coverage, perceived of right of government official .
health information, health need, quality of care and health service accessibility.
5. The comparison of health promoting behavior revealed that the sample of
government official group had more health promoting behavior than universal coverage group
and social security group. 6. The comparison of health utilization behavior revealed that the sample of universal
coverage group had more used health service at health center and community hospital than
government official group and social security group. The sample of government officer /private
corporation group had more used health service at general hospital than the sample of social
security and universal coverage group.


The 4 key success factors for reimbursement by diagnosis related group (DRG) system are completed medical record, corrected medical coding, accuracy of cost data, and appropriate DRG grouping. In the past, there were many errors in coding. After the Center of Health Equity Monitoring (CHEM), Naresuan University reviewed the medical record audit of MOPH hospitals on high cost-claimed data, which were sent to the Office of Health Insurance throughout the year 2000 . The report revealed errors in coding that effect the sum of DRG relative weight: 77.86%, 54.39% and 40.85% in community, general and regional hospitals respectively.   In this circumstance, there should be a study to review their real situation in all aspects and find out the problems, their causes and the recommendation to improve the coding system in Thailand.  	To achieve the objective, several tools were utilized to reach the objectives: 322 hospital survey for real situation in coding practice, focus group discussion by 34 coders, in depth interviews of 4 executives who are interested in coding system, workshop for brainstorming by experts in coding, review corresponding literature, analysis of coding errors from hospital data, and report of 3M Health Information Systems Evaluation of the Infrastructure of Casemix  company’s study. Current situation of diagnosis and procedure coding system in Thailand	75% of hospitals in Thailand use ICD10 for coding diagnosis of diseases and ICD-9-CM for procedure. In the view of hospital executives and experts, diagnosis/procedure coding was most utilized for statistical report (75%) and for reimbursement (64.19%) .59.87% of the studied hospitals had certificated medical coders in coding practices, but 46.20% of    coder in studied hospitals had to work in other jobs. 85% of coders had been trained in diagnosis/procedure coding training course. The work experience of the coders was 43.61% in 1-3 years interval and 13.66% in <1 year.The most common method of coding was using only ICD books (53.90%). The second was ICD books with computer-aided coding program(27.80%).  And using only computer-aided coding program was the least chosen method (18.31%). The study revealed that errors on coding happened in ICD book  was 5.16%, ICD book with computer-aided coding program was 7.04% and computer-aided only  was 10.47%.   Analysis of high cost claimed data from several levels of hospital in year 1998-2000 projected a trend in data quality.  Errors in coding were declined from 38.3% in 1998 to 15.6% and 8.0% in the following years.  The most common errors were deficiency of 4th and 5th code when necessary. Problems and recommendationsProblemsRecommendations in practical viewsRecommendations in policy viewsPhysician’s discharge summary (completeness, accuracy and timeliness)  fromMisunderstanding of how to write document in medical record form.Lots of workload in patient care No recognition of the value of this work and poor incentives for workingEducate the physicians inHow to write qualified medical record.Principles to write  diagnoses and procedures in summary sheetPrinciples of diagnosis/ procedure codingMedical record audit Diagnosis related groupsAlternative way in the case of empty discharge summary e.g. filling up by nurses follow by physician’s Authentication  Hospital policy and guidelines for medical record, systematic medical record audit and utilization of information from medical record documentation.Monitoring and evaluation1.  Addition of knowledge about medical record in under graduated medical curriculum included documentation, discharge summary, coding principles, medical record audit and DRGs.      2.  Steering the process of medical record audit coordinated with hospital accreditation process and feed back to every levels of executives. Coder errors from Insufficiency Of medical coders, some hospital used other personnel who had never been trained to do the coding.Lack of knowledge, experience and carefulness in rechecking codes   Lack of Motivation in their works due to inappropriated career ladder , lack of supportive measures in professional knowledge and skills Define  specification of medical coderFor short term, training  nurses to do the coding is needed Build up consulting system in coding  e.g. medical or senior nurse  consultant Coders must be supported in continuous coding education (training course, conference)Develop expert coding software program to facilitate coder works. Increase production of medical coders that may be in 2 stages.1.1  Stage  1  Short  term planning         1.1.1  There are two training courses . First is                  in  Medical coding, Medical Record                  Auditing, Code Auditng and DRG                  Grouping for the coder.  The second                  appears to be a refreshing course for                  Medical Record Librarian.1.1.2  Conference or seminars in medical           coding       1.2  Stage 2 Long term planning              1.2.1     Increase production of medical coders   to reach the optimum and upgrading to bachelor degree1.2.2   Increase quality of instructors  by             provision of additional official training.Establish coders to be professionalsDevelop appropriated knowledge that correspond to morbidity and procedure coding system in Thailand.  Set up coding standards  Qualified licensing the coders  Guidelines for physicians to complete medical record Guidelines for medical coding practice Guidelines for medical record audit Develop performance indicators in codingInstitute “National Coding and Classification           Center”   to have the following functions:        5.1 Academic function in disease classification and medical  activities       5.2  Maintenance medical coding system       5.3  Academic support for coders.


Drug utilization evaluation programme on third generationcephalosporin use in Khon Kean hospitalObjective: To assess the effect of the interventionnal programme (DUE and Education) on the inappropriate use of third generation cephalosporins in Khon-Kaen regional hospital. Design : Before-after experimental study. Setting : Three medical and six surgical of Khon-Kaen regional hospital. Partipants: Prescriptions of all hospitalized infectious patients, over 15 years of age, treated with third generation cephalosporins, were included. Intervention: The intervention programme was consisted of one educational convention, a standard criteria for appropriate cephalosporin usage and drug utilization      evaluation (DUE) programme. Main outcome measure : The percentages of inappropriate use were compared with regarding to any of the following seven categories; no indication, no evidence of infection, other alternative drugs could be use due to culture and sensitivity, possibility of toxicity,      improper dosage regimen, improper duration of treatment and economic reason. Results: Four hundred and seventeen prescriptions in pre-intervention period (1997, May-July) and one hundred and forty prescriptions in post-intervention period (1998, February-April) were evaluated for inappropriate use and compared. The percentages of inappropriate rational use all three cephalosporins were significantly decreased, from 62.6 to  40.0. And individually, cefotaxime, ceftriaxone, ceftazidime from 65.4 to 39.7, 45.8 to 39.3 and 91.9 to 41.2 respectively.However, economic crisis of the country on the physician's prescribed behavior needed to be determined. Conclusion: The DUE programme in addition to physicians education could decrease the inappropriate use of third generation cephalosporins. Therefore, this may be applicable for other drugs and useful for other clinical institutes.


Universal health care coverage (UC) is an important policy by the Thai government, 75% of population covered by the Scheme, but capitation rate did not adequately match with the utilization rate and cost of services. While rely totally on government annual budget, its long-term fiscal sustainability is a worrying problem. This study was conducted in order to provide financial reform options for UC Scheme. Long term projection of total national health expenditure of Thailand between 2004 and 2020 was constructed using four models namely Demographic and Labour Model, Economic Model, National Health Expenditure Model and Government Model. Several information from various sources were retrieved for example; population and economic information from National Economic and Social Development Board, Labour statistic from National Statistical Office, National Health Account of Thailand 1994-2001 and Government expenditure from the Comptroller General’s Department, Ministry of Finance. Moreover, many possible assumptions were applied in these models and three scenarios of reducing UC expenditure and/or ensuring adequate budget for UC were created in order to illustrate financial implication.  	The model estimates showed that the total national health expenditure was around 3.50% of GDP in 2004, it would increase to 3.64 and 3.88 % of GDP in 2010 and 2020, respectively. The first scenario simulated the effects of the suggested revenue increases by introducing personal health tax and additional excise tax on tobacco, alcohol and beer which some proportion automatically earmarked to UC Fund. This scenario resulted in substantial reductions in the government budget subsidy to the Scheme compared to status quo. The second scenario was produced based on assumptions that Social Security Office would expand its coverage to non-working spouse and dependents of the contributors. Its effects were that the expenditure of UC reduces by around 9,210 million baht in 2005. The first and second scenarios. when combined together into the third scenario suggested, it showed that UC almost fund by itself with few budget subsidy from government.   	Three policy recommendations on the Scheme financial reform was provided. First, an earmarked sin tax with or without increase in the sin tax rate. Second, the expansion social security scheme health benefit to non working spouse and dependents of the contributors. This could be done without increasing contribution. The last was the reform of Traffic Accident Protection Act (TAP). The Department of Land Transport would be outsourced to collect premium from car owners, during the mandatory annual renewal of car license, this would enhance law enforcement.  The scheme would cover all victims by either insured and uninsured cars.


This cross-sectional survey was conducted among 457 temporary constructing labors in Samuthprakharn province of Thailand to reveal  the labors migration movement factors and their health status,  health seeking behavior and places, health promotion, health care services utilities, and stake holders brain-storming provision idea for appropriate semi-package model of health promotion. (under Universal Coverage Health Assurance Policy of Thailand)	457 subjects with (UC) golden card provided were proportional  random sampling through  each six districts of Samuthprakhan Province in 2004. Found that most of labors were males(71.33%)higher amount than females(28.68%), major of age range between 21-45 years,  most of them  as the labors constructing in Suwannaphume International Airport(55.80%),  residential real-estate(19.91%),  various type factory/plant(8.75%). The labors educational level  were mostly primary school (Prathom 6 = 41.23%, Prathom 4 = 28.29%) and secondary school level(17.76%).  Most of income range 100-200 bath per day. Major factors of migration movement to be labors is no employment in their home town(48.83%), higher income (33.26%), leave from after agricultural harvested season(20.57%), and motivated(14.14%). Their self health  perception for a year rounded were healthy(73.58%), mild-moderate illness (16.92%) eg. cold, muscle body pain, and headache.  Housing style are single compartment rooms (non separation for bedroom and kitchen) in two level stair row house(55.80%), one level stair with zinc-metal-sheet roofing(33.70%). Residential environment condition still being water sewage flood, smelling, insect and other disease animal vehicles, ambient temperature/air seem to be wormy and less ventilation. Labors self medication and drinking were tonic drink(M-150 and Red bull Brand) (55.36%),  alcohol and alcoholic herb(53.61%), glossary combined medicine(30.42%) and envelop anti pain(salicylic acid)(16.85%). Incase of sickness, mostly hospital utilization(59.4%), health center(21.1%),  other left do the private clinic visiting, and quite unsatisfactory for remedy cost, long waiting time, and less quality of drugs.  Labors nutritional status (Body mass Index) mostly be normal level(71.74%), over nutrition(17.6%), and a few are lower than actual status(11.0%). Breakfast and dinner’s labors were self cooking(63.76% and 69.78%), the left were ready cooked purchasing. Males(49.8%) and some of females(26.9%) eat raw and semi-cooked food for 1-2 time weekly(p=0.03).	Most labors(84.46%)well enough sleeping, and less anxieties(52.52%) with watching television(63.7%). Incase of bad feeling and stress they do nothing(33.9%) almost every day,  go outing to entertainment  place and drinking club and smoking (24.1%). 66.65 per-cent of labors did not do physical exercise but seasonal religion practices(66.52%).  The most of working accident is pierced/tackled by pieces of material(56.52%),  injured by sharpness matters(26.96%), and eye attacked by bouncing matters(12.17%). Their general perception for health services utilization and enable to privilege when being in Samuthrprakhan are Hospital(53.85%), do not know where is(21.10%), village health center(13.19%), but most of them never(78.10%)  vise-versa ever for hospital(15.17%), village health center(6.19%),  all ever subjects had no chance to golden card declaration(44.57%) due to out of area registered, and do not know about this privilege declaration(22.17%).	Brain-storming provision idea among stake-holders by ZOPP Technique session for health promotive modeling and the theme which categorized are :  should be  setting  model of health promotion through all integration sectors and both pertain active and passive activities by counterpart of employer, health services providers, labors, local thambol bureau, social insurance provincial office, and community participatory. The local area status appropriated health promotive modeling  such as : constructing area and labors housing finding and registering system,  health promotion and active environment management welfare system, UC and golden card privilege information  and efficiency communication  system included indicate setting area of health services  place  in case of urgent situation. Finally budget sharing responsibility and fund raising should be responsible with all related sectors above mentioned.


Payment Systems, Mechanisms and Approaches for Health Service for Equity, Efficiency and Quality Various payment mechanisms for health care and their impact on equity, efficiency and care quality were reviewed in this study. Recommendation for appropriate mechanisms for Thailand was also proposed to put in National Health Bill. Development of health insurance in Thailand and experiences of using various payment mechanisms in other countries were reviewed. A number of well experienced people, health care users and providers in both public and private sectors were interviewed. The study found diverse mechanisms in Thailand which could be grouped as following; out-of-pocket payment was directly made to providers, fee-for-services was remunerated to the insured under the Civil Service Medical Benefit Scheme and private insurance (some schemes having ceiling level per year),payment was made under fee schedule for example the Social Security Scheme and the Substitution Fund, capitation payment was used under the Social Security Scheme in order to contain medical costs and expenditures but was problematic to care quality, per-case payment on the basis of DRGs (Diagnosis-related groups) was made, budgeting by capitation was solely implemented in public sector, line item budgeting was used for allocating salary, operating and capital expenditure in public sector.


This study aims to 1) to review the policy and process of implementation for provision of antiretroviral therapy, 2) to assess quality and adequacy of hospital services for ARV provision. 3) to assess the effects on health and behavior of people with HIV/AIDS receiving ARV and 4) to study costs and cost-effectiveness for provision of ARV therapy comparing between provincial and district hospitals. The study conducts the documents relevant to national HIV policy was analyzed, and in-depth interview was performed with people responsible for ATC project. The 12 provinces stratified by region were randomly selected: Ayutthaya, Lopburi, Prajinburi, Prajuabkeyrekhun, Surin, Udonthani, Aumnartchareon, Sukothai, Nan, Chiang Mai, Krabi and Songkla. In each province, a provincial hospital was purposively selected and two district hospitals were randomly selected. The total numbers was 36 hospitals. The hospital visits was performed by the research team to assess quality of services for ARV. Practice guidelines, record form, and documents relevant to ATC project were reviewed. Focus group discussions and individual interviews were conducted with hospital personnel including doctors, nurses, counselor and laboratory technician, who provide care for people with HIV/AIDS. The hospital records of people enrolled in the ATC project during the fiscal year 2003 were reviewed. Survivals, incidence of opportunistic infections, clinical failure, changes of CD4 cell count at six months after treatment initiated, were analyzed. People with HIV/AIDS who currently receives ARV treatment were interviewed for their perceptions on health status, adherence, social and behavior impacts of ARV medication. The costs and cost-effectiveness study was conducted in three hospitals in Chiang Mai province. The overall cost of ARV provision was a combination of provider cost at ARV clinic, laboratory cost, ARV drug cost and patients cost. The overall costs/person/year and cost-effectiveness were analyzed. Results found that at present, after seven months of expansion of existing ATC project to reach the target of 50,000 in the year 2004, an average enrollment of new cases was 5 percent per month. The 33,381 people with HIV/AIDS were enrolled and this was about 66.7 percent of the project target. However, a number of people were with some reason dropout from the project and 29,549 people remained in the project during this period of time  The cost of ARV drugs was approximately 60-80 percent of overall costs of ARV services. The fundamental ARV formula in the ATC project was GPO-Vir which was cheapest compared to the others.


In this study the working population was defined as Thai people aged 13-59 year old. The data showed that this population accounted for more than 50 percent of the total Thai population. The majority of them (51-56 percent) worked in agriculture. The remaining people worked in industrial sector (16 percent) or in service sector (12 percent). The study found that 85 percent of Thai working people felt they were healthy. Factors affecting health status included age, sex, behaviors, occupation, and environment. For example, health problems among elderly people were mainly degenerative diseases, such as, heart disease, hypertension, and diabetic mellitus. On the other hand, health problems among young prople were accidental injuries and AIDS.


The 30 baht universal health scheme established by Thai Government in 2001 proposed to provide welfare on health to Thai people. There are controversies whether this policy promotes equity in health.Objective: To study the ideologies of Thai people towards the universal health coverage policy.Method: Qualitative research complemented with quantitative method. Citizen dialogue technique (or weekend meeting) was applied to 100 people randomly selected in each province for the meeting. Participants gave their views in the questionnaires before and after the meeting. The meeting started with small group discussion in the morning and whole group meeting in order to reach consensus wherever possible. The study was conducted in 4 provinces: Sukhothai, Ubonratchathani, Phuket and Samut Sakhon.Results: The turn up rates of participant ranged from 22-80% of the invited guests. They supported the idea of increasing copayment of 30 baht to finance the universal health coverage because they believed that fee increased would provide coverage for more people. They were willing to pay income tax for universal health coverage because they wanted better services. They said the government should not pool in money from the social security scheme to finance universal health coverage. However, some supported that the government should pool in only particular percentage of money from social security scheme to manage the universal coverage policy. Most of participants agreed that the government universal health coverage should not focus on only the low  income people because all people should have equal right to universal health coverage. Furthermore, the government should not increase user fee for those who cross the boundary for services (or against the universal health coverage guidelines), and people whohad an accident or were ill outside their contracted hospitals should not be punished by payinghigh fee. Finally, the universal coverage policy should not limit access to high cost care, they preferred to see the policy as advertised “30 baht for all diseases”. 	Conclusions: These Thais’ Ideologies were mixed between egalitarianism, communitarianism and  utilitarianism. These ideologies represented that Thai people believed in the collective roles of the government to provide health services to all Thai people. Key words: universal health coverage, weekend meeting, egalitarianism, libertarianism, communitarianism and utilitarianism


An Evaluation on Social Services for Aging People in Communities: A Case Study of Services of  Welfare Centers in Communities	This study aims to study social services in communities; especially, which aging people reached; quality of life of aging people; and their troubles and life satisfaction.  This study also aims to study the welfare centers in communities’ operations and the relationship of communities’ strength and the welfare centers’ effectiveness. 	There were 2 types of data, primary and secondary.  Primary data were both in qualitative and quantitative forms, collected by interviewing 380 aging people, 101 heads of welfare centers, other people such as, teachers, health officers, monks, imams, merchants and other peasants including juveniles from 19 amphurs, 9 provinces of every part of Thailand.  Secondary data were documentary data; such as, handbooks, reports, official memorandum and national policies.	The results of the study are as follow:	1. Social services in communities: privilege cards service, institutional service, social group service, and service or assistance from community leaders.	- Social services which aging people could reach and were satisfied most were all kinds of health services; such as, hospitals, health centers, including the convenience in using health cards.	- Services or assistance from community leaders were fair, mostly moderately good in quantity; such as, giving foods, cloths, money or things.  Other services which could help people – in - troubles to have better life quality were low.  	- Service from social groups in communities which most aging people preferred was ‘cremation service’, a community fund which people in community raises every time one member in the village dies, both in the form of legal and illegal ones.  However, aging people preferred illegal cremation fund services to legal ones.	2. An evaluation on welfare centers in communities.	Welfare centers in communities, which their objectives were to help people from troubles, were moderately successful in doing their careers because of the insufficiency of knowledge in welfare services.	3. The study on community strength related to aging people’s life quality and life satisfaction.	Aging people in highly strengthened communities have been supported in money, foods and things, messages and visits from family members, friends, neighbors and other people more than those lived in less strengthened ones.		From the findings shown above, it leads to the following suggestions:	1. In the policy level.	- It is not necessary to implement one national policy in every part of the country.	- The national policies should be really suitable to the situation and needs of people.	2. In the operational level.	- The concepts and trends of forming welfare centers in communities should be readjusted.  Members of the centers must have, at least, basic knowledge on social welfare and social work in order to be able to help people – in  - troubles as much as possible.	- Local government officers in charge of welfare services, if they really know what and how to do welfare careers, they could be the greatest assistants in communities.


Thailand’s Aged Care in Private Sector	Thailand’s increasing number of elderly population and their longer lives are causing higher needs of aged care. While public facilities to support such needs are minimal, both business-liked facilities and non-profit organizations are increasing in number to meet unmet needs / demand.	The private aged care in Thailand was studied two major aspects which were types of care given and their service management. Types of private facilities were categorized into 6 groups and sampled for data collection. Interviewing personnel involved in aged care such as administrators, physicians, nurses, physiotherapists, other health personnel and officials in addition to their customers (patients) were made. The 6 groups were profit-liked hospitals, non-profit hospitals, well fare organizations (partly charging fees or no fees), accommodations for the aged, nursing homes and aged care teaching schools	The study found 95% of those paying fees for aged care were satisfied with the care provision whereas those being given free care commented that if only food and health care were sufficient their satisfaction would be achieved. The elderly who lived with their families and needed aged care tended to hire the certified care givers who had attended short course training from registered schools. A number of schools wishing to provide training programs were increasing based on evidence of growing number of schools or facilities being in the process of registration.	The study recommended:public clear policy guideline for aged care provision in terms of care and its provision system be developed and carried out by the government, more elderly be insured for aged care,health personnel be administrators for care provision,gerontology be supported to boost people’s interest for being care givers in order to meet rirsing demand,public health personnel be sent to help non-profit facilities to do medical checking and provide medical care for the aged patients,information on aged care be widely distributed to help out the needed for seeking care quality and just fees.


The project is aimed to review health paradigm in which death and death management is considered.  The study is supposed to encourage society and relevant organization to review their concepts and pattern of death management, the current mainstream. Research should be supported in various dimensions, helping society to perform and confront with death effectively.  Invention, recommendation of various death management and congruent with Thai society, regarding of family, community context of patients and their relatives, are importantly included. ResultsThe study in patients and relatives, totally 12, data are collected form 10 relatives (after the death of patient) and 2 patients.  They mostly live in metropolitan area (Bangkok), and environ areas,  Only 30 percents live in outer area, supporting factors, and hindered factors, as follow:There is no integrity of thinking system.  There is a combined thinking system within society; there is still different way of thinking.  However, death concept is not always stable, it depends on the confronted situations.When facing with illness condition, there is a way of thinking like “when being ill, hospital treatment is needed”.  It is irrespective of social class, or economic status, They are all influenced by the same system of thinking.  The opportunity of accessible treatment may vary.  Therefore, tendency of hospital death increases.  In other words, the treatment gap of despair patient will be widened.For medical treatment procedures, it was found that there is communication gap between medical personnel and patients and their relatives, due to different way of thinking.  As a result, patients and relatives are lacks of treatment knowledge since their knowledge body is not the same as medical personnel, which brings about the limitation of accessible knowledge necessary to decision making for doctors and medical personnel.Opportunity provision for patients and relatives to participate in decision-making procedures during medical treatment is considered satisfyingly among medical personnel, patients, and their relatives.  A chance of knowledge accessibility is revealed, resulting in contracted gap, and furthers development in the system.Religious belief and ritual, family or community, and economic status are significantly considered as major factors lead to decision making of desirable death undesirable management.Home death could be both considered as good death and bad death; it depends on components of family, community, and social conditions.  Hospital death is not necessarily considered as bad death, if the medical personnel understand, interest.  Chance of displaying attitudes and potential of appropriate death management are revealed to patients and relatives, regarding of human’s pride respect.For revision of concepts, attitudes, patterns of death management, and medical system issues are included;  it was found that there are three core concepts as:Bio-medical model is focused on mechanism of physical performance.  Therefore, it should exclude death from ordinary life.Bio-psychosocial model is focused on mental and family dimension.  It is the concept that tries to reduce gap of Bio-medical model, providing opportunity to patients and relatives to participate in medical treatment procedures.  More medical standard are involved, for example, decreasing final pain and torture of the patients, counseling provision, and fact provision of treatment procedure, etc.  Those are all from palliative care, which provides convalesce residence for final stage patients.Spiritual model is viewed, as life is part of nature, Both are interconnected, Nothing is permanent, Death is natural.  Good health is just the only way to develop life more enrichingly, Death should not be avoided or managed, however, it should be reflected, This implies that death is not separated from life, Death objective is to release oneself from adhere belief.For basic information of organization working with final patient, including a case study of 15 initiative organizations, it was found that there are 50 percents of private organization working with HIV patients and final HIV patients.  The rest is in the early stage within medical schools, general hospitals, and community hospitals.  Mostly it came form patients’ problems in which they had to face with, and then the problems were gradually developed.  In addition, Catholic hospital is now focusing on patient governance, and treatment for final HIV patients is included.  From the interviews relevant issues were found as:Thai society has a certain resource of personnel and organizations pertaining to this area and develops a particular organization to help patients and relatives.  It is established in provincial areas, both public and private sectors.  It was unofficially merged by interested people, and circulated.Private organization of development is distinctive in terms of working closely with patients and relatives, more flexible, and neutral as a connector between medical personnel, and patients and relatives. For general hospital, especially for medical nurse faculty available, Catholic hospital is likely to pay more attention to final patients increasingly since there is academic research circulated among international academic stages.  At the same time, more mainstream acceptation of patient’ right is revealed.Community hospital should play an important role in supporting family and community to confront with death and death management effectively, through house visiting, Primary Care, and the convenience of patient transfer.The provision of hospital quality development system (HA) is responsible for clearer domain and more acceptation.  The relevant organization should employ the advantages to further or develop knowledge that can be actually practiced and congruent with local context of society.  The concept circulation and concept drive to relevant personnel should be included pervasively.RecommendationsThere should be deeper research and covered with various kinds of population.  Qualitative research should be focused since it can describe death into deeper dimension and it can access to human and spirit.  In addition, quantitative research can be used as result expansion and link of systematic change.Hospital quality development system (HA) is a critical channel to be forced into systematic change pertaining to treatment of final patient.  Therefore, practical research should be promoted as a pilot project in some hospitals whose interests are their primary bases.During data collection, learning opportunity is exchanged.  The organization network is linked both public and private sectors, which their interests and experiences relevant to final patient treatment are shown, it was found that most organizations have potential and readiness to develop newly trends of taking care and aiding final patients.  In addition, widely conditions of working are opened; the research institutes- public health system should grasp this advantage to develop knowledge body or to support the necessary and usable knowledge body collection.  Furthermore, patterns and various kinds of model should be broadcasted to the public as an alternative for patients and relatives.Documents pertaining to personnel, organizations, book, and research of death and other relevant documents should be made for anyone interested in to be accessed.


Of the 21st century, new challenges to health and well-being of the Thai society are rapid aging of the population, change of disease pattern i.e. a significant from communicable diseases to non-communicable diseases, increase in number of disabled and  major  social shifts such as rapid urbanization and dispersion of support systems, substantial migration, increasing work-force participation among women and family structure transformation from extended family to nuclear family. Because rapid urbanization is one of the major social shifts, which relates to increase of non-communicable diseases and other social changes, enhancement of health and welfare systems in the city area in the face of these challenges should be focused in the first place. 	Existing community services and primary health care approach, which has been implemented after the Alma-Ata conference in 1978, were designed for essential elements particularly preventive measures against communicable diseases, promotion of food supply and proper nutrition, adequate supply of safe water and basic sanitation, maternal and child care, provision of essential  drugs and appropriate management of common health problems. Since 1978, the major strategies for implementing primary health care in Thailand are a population-based approach using community intervention/campaign, promoting community participation via community health volunteers and set up community health centres to provide services including maternal and child care, immunization and basic treatment. However, these strategies do not adequately meet new challenges from growing prevalence of non-communicable diseases and disability among the aging society, Hence, new strategies to meet new health challenges are needed.	In order to work out a new strategy, a participatory action (operational) research, called the “Bangkok 7 model”, has been conducted in a city area of Bangkok since July 2002. This project is a result of collaboration among three institutes- the Bangkok Metropolitan Administration (BMA), the Chulalongkorn University (Faculty of Medicine) and the King Chulalongkorn Memorial hospital. It was fund by the Health Systems Research Institute and the King Chulalongkorn Memorial hospital.	The main objective of the Bangkok 7model project was to establish a new model of health and welfare provision, founded on community health workers and professional health care workers who would integrate across functions of health and social care and work closely with all existing informal cares, whether family, friends or neighbors, and also with voluntary groups and individual volunteers. This model also was to demonstrate a practical way of integration between comprehensive home-based services. which requires interdisciplinary cooperation and community interventions, which requires intersectoral collaboration. (i.e. Community Health Service System)	It was hoped that this would enable a system of comprehensive and integrated health care to develop, which was more sensitive and responsive to informal care and able to mesh in with and support it more efficiently and take account of the reciprocal nature of informal care. It was also hoped that such a system would be more amenable to a degree of control by local people and enable them to participate actively in the planning and running for the health and welfare system in the city area. 	The community health service system is viewed as an expansion model of conventional community-based health care in Thailand, which bases on four basic principles of the primary health care approach including-(i) universal accessibility and coverage on the basis of need, (ii) community and individual involvement and self-reliance, (iii) intersectoral action for health, and (iv) appropriate technology and cost-effectiveness in relation to the available resources.	The community health service system is also viewed as the strategy of enhancing accessibility of individual and community to the health system. Thus it is the first level of contact of individual and community under the primary health care approach.	The community health service system is comprised of various comprehensive activities for all ages, which promote integration between formal and informal care to serve eight basis elements including -	(i)	Health promotion and education	(ii)	Prevention and control of communicable diseases and other endemic health problems such as drug addiction, accidents and injuries, alcoholic intake, occupational health problems	(iii)	Environment, water and sanitation	(iv)	Maternal and child health care and family planning	(v)	Food supply and food safety	(vi)	Management of chronic diseases, which emphasizes on adherence to treatment	(vii)	Basic treatment and rehabilitation for health problems including disabilities	(viii)	Long-term care	The community health service system has to provide integrated health and social services for needed individuals and families at their own homes (i.e. home-based services) and community interventions/activities (i.e. community-based services). These two kinds services must be integrated and complement to each other. While intersectoral collaboration is essential for success of community-based activities, interdisciplinary collaboration is vital for home-based care and its support activities.	The Bangkok 7 model was developed in 2 districts at the heart of the Bangkok Metropolitan, of which total population was around 60,000. These 2 districts are the responsible areas of the 16th public health centre of the Health department, BMA. The 16th public health centre, a community health centre, is the principle organization of the Bangkok 7 model which provides the community health service for people in its catchments area. The King Chulalongkorn Memorial hospital joins the Bangkok 7 model as a referral centre and also as a partner of model development.	The Bangkok 7 model composes of home-based service system and community-based service system. The home-based service system is comprised of activities including regular home visit, home assessment, home nursing, home rehabilitation, home education/counselling, service for treatment adherence of selected chronic diseases (diabetes mellitus, hypertension, tuberculosis), social service and palliative and end of life care. These home-based services are supported by activities/services in the 16th Public Health Centre including multidisciplinary team meeting, outpatient services, rehabilitation services, well baby clinic, ANC clinic, family-planning service, acupuncture clinic, social services and care.	Community participation is vital for both home-based service system and community-based service system. Health volunteers and community leaders are invited and encouraged to join in every step of activities and planning.	After on year, the Bangkok 7 model has been successfully developed. Its output is presented to the administrators of the BMA and the Health department. Its responsibility in term of management was fully transferred to the Health department of the BMA on the 1st October 2003 and the whole system was maintained and carried on. Its success was disseminated to the public through mass media such as newspapers and televisions. The Bangkok 7 model and its output was the main topic of several academic conferences in Thailand. However, the obvious sign of success comes from the Health department as it starts to adopt the Bangkok 7 model for implementation in other areas.	This study demonstrates that the Bangkok 7 model, the innovative community health service system for achieving the integration of health and welfare systems is a new strategy in health service system to meet new health challenges in the city area of developing countries like Thailand. It provides strengthening of formal-informal link, which is essential for long-term care, and intersectoral collaboration. Its underlined principles, system design and development management would benefit for further development focuses on the primary health care and health and welfare systems. However, it is not the ideal model that benefits with all kinds of population and areas in Thailand. Administrators and health care providers of other areas, including both urban and rural areas, should workout how to adopt or apply the Bangkok 7 model into their own practice.


Public Health Management ReformThis policy research is an action and goal oriented study. Its main objective is to outline a new framework for public health management reform. In the study, concepts on public sector management were reviewed and public health reforms in selected developed countries, namely, Canada, Austria and Singapore, as well as health reform movements in Thailand were discussed. Within an advocacy approach and a macro perspective, public health management system was treated as a unit of analysis. Under such perspective, its ultimate goal is placed on the human well-being while new roles and direction towards public health management reforms were analyzed through various qualitative techniques, including SWOT Analysis with SWOT Matrix.Based on the available sources of data relevant to the space, timeframe and actors, its findings are presented covering two main themes. Firstly, policy and structural constraints have let to the inefficient management – as witnessed from the centralized management approach and the lack of policy integration and coordination at macro level. Secondly, based on the environmental scanning, strategic issues are determined in shaping public sector roles include, among others, enhancing civil society organizations and health networks, strengthening self-reliant and healthy communities, upholding local wisdom and indigenous knowledge base for health promotion.


Presently Universal Health Care Coverage in Thailand is nearly fully financed by government general budget. UC has adopted close ended budget which come from capitation rate multiply with number of registered members. Refer to past experience, budgeting process for UC faces with annual administrative hurdle without any guarantee on adequate budget according to capitation rate calculated by cost of service and use rate. National Health Security Fund should be established by National Health Security Office and Thai citizen according to National Health Security Act B.E.2545. Major source of finance for NHSF should not be solely relied on government general budget as existing situation.Objectives of this study are to provide advantage and limitation of eight sources of finance for UC according to Article 39 in National Health Security Act B.E.2545. This study applies two methods which are brain storming of researcher team and self answering questionnaire by 20 key informants in one day workshop. The result from brainstorming of researchers indicates that contributions by local government, co-payment by patients and contributions by beneficiaries have potential to be financial sources for UC with some limitation of each source. The result from the workshop of 20 key informants reveals that political feasibility is the most important domain to decide the source of finance for UC. Other less important domains are sustainability, equity, programmatic feasibility and social acceptance the least important. The key informant workgroup have preference on Additional Taxes from Tobacco, Alcohol and Beer and clearly earmark to the fund as long as it get high score on political feasibility, social acceptance, sustainability and programmatic feasibility. On the other hand, contributions by beneficiaries are the least feasible source and it appears to be judged as social unacceptable and administrative infeasible. Increases in the VAT are deemed politically infeasible and the worst for equity reason. Questionnaires used in the workshop were originally created by researchers with foundation of knowledge and thoroughly understanding in financing of Thai health system. All key informants were fully informed in the workshop in order to have the same understanding which leads to limitation in number of valid questionnaires. However, these key informants are heath experts in Thailand from several institutions both of academic and practical organization. This study contributes new knowledge of health care financing in Thailand. Moreover, it provides fundamental information for financing the UC scheme in long run.


This research is primarily a literature review, aiming for reviewing information and academic literature related to health economics and management of medical technology in Thailand, gathering recommendations from health economic studies and policy research on expensive medical-technology equipment, statistics, opinions, as well as policy options published as academic articles.   In addition, the review includes related body of knowledge on management of the technology at the public policy level and at the system policy level that has been studied and published in international academic journals, including technology assessment, acquisition, purchasing, diffusion, costs and utilization of the medical technology.	The finding indicates that Thailand has a limited number of researches on management of expensive medical-technology equipment.   Most of the studies are specific to certain technologies.   There are some technology assessment works but they are not common.    The investment of the public and private sectors on medical equipment before the country economic crisis tended to go up all the time.   Despite imperfect data on the technology diffusion, there are evidence that access to technology is not equitable.   There is no organization or mechanism to manage comprehensively and effectively.   Responsibility on monitoring distribution is scattered among several governmental units.	The international literature provides information on technology-assessment guidelines and measures, acquisition and import of technology, management of technology diffusion and use of expensive medical-technology equipment differently.   Nevertheless, some conclusions can be drawn that management measures for management of medical technology can be classified into three phases.  First, the pre-market phase comprises steps to be taken before import and diffuse the technology for use in the country, need assessment, assessment of infrastructures to support the technology and technology assessment.  Second, the purchasing and diffusion phase includes measures after medical technology is proved to be safe and appropriate for use in the country.  This is to ensure the proper diffusion of medical technology to maximize efficiency, effectiveness and equity in the system.   Third, the use phase consists of measures affecting provider decision to utilize the technology in diagnosing or treating patients in order to warrant appropriate use.


The 1992 private hospital census in ThailandApart from MOPH Medical License Division (MLD) data on  number of hospitals and beds by province, there is a severe  lack of information on types of beds, manpower mix  (both part  time and full time), throughput (curative and preventive services), rates of room and board, exemption policy and volume of exemption by private hospitals. Moreover, pattern and  behaviour of private hospitals under various types of ownership (for profit companies, individual owned, for profit companies  registered in stock exchange merket, not for profit foundation  run hospital) has not yet been explored. The 1992 private  hospital census aims to assess number and type of beds and  trends during 1990-92; category of medical staff both part time  and full time and trends during 1990-92; throughput and trends  during 1990-92; hospital exemption policy and volum of  exemption; ownership of certain major equipments. We use the  census frame of the total 320 hospitals registered with the MLD  in 1992. Mail questionnaires were distributed to hospitals in Bangkok through MLD, hospitals outside Bangkok were distributed  through Provincial Health Offices. Hospitals were required on a voluntary basis to response the questionnaire. Follow up work consumed 12 months during October 1993-94. There were 222  hospitals responded, 69 percent response rate. Interactive validation and assessment of data quality by researchers and  the hospitals was made to  improve reliability of data. Results are presented in six sectionsa)Beds, typed of bed, geographical distribution and  three yaer trend b)Manpower by categories and three year trend. [Note : full time staff works more than 40 hours per week, and  part time staff works less than 40 hours] c)Throughput  (curative and preventive services) and three year trens d)Ratio analysis e)Room rate f)Exemption policy and volume of exemption. Hospitals are classified by researchers into four categories ; Type I : corporate, company limited of owned and  run by an individual. Type II : owned and run by not-for-profit  Foundation. Type III : public company registered in the Thai  Stock Exchange Market. Type IV : small hospitals called oneself  as clinic, polyclinic. The overall response rate in 69 percent  (Type II 85 percent, Type III 75 percent, Type I 72 percent and Type IV 58 percent respectively)


This research sets specifications of 223 active pharmaceutical chemicals for quality control. The specification of each pharmaceutical chemical is divided  into  3 parts. Part I sets characteristic of raw materials in accordance to USP24, BP1998, and/or Certificate of Analysis (COA) of the manufacturer. Part I requires  analysis of Physical Appearance, Identification, Solubility, Heavy Metal, Loss on Drying, Related Substances, Impurities and Assay etc. Part  II includes the In – House Specifications  which  are  recommended additional requirement  for  production of dosage forms. Conforming to Part II will increase the quality assurance of the raw materials.		The specifications in Part II, generally not found in the pharmacopia, include analysis such as : Residual Solvent, Impurity Profile, Particle Size, Bulk Density, Tapped Density, and Shelf Life, etc. Part III is the remark which summarized  from the comments (interviews and questionair) from pharmacists working in pharmaceutical plants. The remarks include recommendation for additional analysis such as : color, odor, Impurities, Polymorphism and Dissolution Test, etc.			These specifications if required in  registration of raw materials will result  in higher degree of quality assurance of the finished  products in both public and private sector.


Coverage and acceptance  in  spray and impregnated  mosquito   nets for  malaria  control,  Krabi 1999	The objectives of this study were to measure the coverage and the acceptance of Krabi people in spray and using impregnated mosquito  nets for malaria control, 1999. This study design were cross-sectional survey to collect quantitative data and focus group discussion  for qualitative data. The result showed that the coverage of spraying was 92.8% of target household ,however the quality of total spraying covering the household area was 58.6%. Bed room and interior were not accepted to be sprayed ,since the owner could not gather things in time and were afraid of being dangerous for human being , animals and things. People accepted the spraying for they knew more about malaria and feared to be sick. As the result they would like their houses to sprayed every 6 months. Because of the polite and reliant manner of the spray workers, people were not afraid of loosing things during their working. However, only 68.3% of reporting and marker were correct. Additionally, the spray workers did not introduce themselves ,make an appointment, and tell about usefulness to the householder before spraying. Further, the people accepted that chemical used for spraying smelled bad but not being dangerous and dirty. To spray was better than bed  nets as perceived by children and older since it could protect them from  mosquitos in the wider area and while staying out side the bed nets. Also spraying chemical decreased the number of mosquitos and other insects. Generally, 85.9% of household was given one impregnated nets and  90.8 % of them used the impregnated nets. At the same time the bed nets were usually utilized every night for 89.3 %.The acceptance was found that they were pleased to receive impregnated mosquito nets and needed it more. However, health workers did not suggest them  how to wash nets and  impregnated  nets again. They had good perception for malaria and felt fear this disease also. They thought that impregnated mosquito nets were better than normal bed nets as 78.1 % Chemical for impregnated nets had odor after it was  not dried and it was not dangerous. In addition , some people liked impregnated mosquito nets more than spray  because it could protect mosquito bite every night, tough spray could protect it in a short time.


The research “Health Information Radio and Television Media for the Public” is conducted to monitor and analyse radio and television programmes that have health elements for Thais in them. The emphasis is on the Heath programme. The study was started by a survey of the whole layout of the station to analyse proportion of its content. After that sample programmes are picked up to be studied in details about the process of producing a health programme for radio/television. The study focuses on asking producers, in this research we would like to call “Health Communicator”, about their challenges and recommendations.	To make the analysis more comprehensive, the team refers to base line data about the structure of radio and television media in Thailand and followed by interviewing managers who direct and manage the stations which are both owned by government and private, in order to illustrate the policy towards producing a health programme.   	In summary, the research will study the lay-out; study the structure of the media and health programmes and interview health communicators. The outcome will be a linked analysis that shows the whole picture of the broadcasting of health programmes through radio and televisions, particularly about challenges and recommendations that will lead to more studies or policy proposals to the state and the public such as the facilitation of health database and information for health communicators whose majority come from journalism not health background. The open channel that health communicators can access and exchange information with health agencies in both state and private sectors will give a great benefit to producers of these health programmes. Other important recommendations are Change of the government policy on mass communication of health information that will lead to full dissemination of health information to the public. The state should set a policy of supporting producers of health policy and establishing public service media or community media that focus on free service to the public so producers can have freedom in creating programmes while the public gain benefit. In the current situation, media producers face a problem of depending on income from sponsors that lead to hidden promotion of goods and service which control contents of the programme.By giving priority to non-profit programmes made for public service and supporting medium and small producers in gaining an easier access and sponsor will create better and more “health communicators” who will communicate information, knowledge, fact in lively format to the public than the present environment.


Social organization and the development of tambol civil society:a case study on Ubonrat district , Khon kean provinceThis study is a comparative study of the development of civil society in two sub-districts, Tung Pong and Kong Sung in Ubonrat District Khon kane Thailand. Using an analytic research approach, data were gathered by key informant interviews, community leaders' group discussion and compact questionnaires.     It was found that civil society have been existed at village level and closely related to cultural and mythical belief. Civil action and linkge at the sub-district or "Tambon" level  were also existed through kinship and cultural beliefs. External factors which facilitate civil society at tambon level are the country's administrative reform of decentralization and the new constitution which recognize the community rights in resource management. Internal factors are undamentally endowed and related to matri-archal kinship system, indigenous knowledge, sufficient economy, people organization, good leader and interactive learning.  In both tambons, there were similar formal groups supported by the government. Tambon organization and a group of village health volunteers were foremost accepted by the people. The two groups appeared to have good communication network above village level. Both organizations were dependent on external funding and bureaucratically supervised. The change from agricultural to industrial based community as found in Tambon Kok Sung became an importance condition the weaken traditional civil society in the area.There are exists conflicts of land and water uses. This conflict has not been concertedly solved by existing people organizations including Tambon Administrative Organization. In contrary, Tambon Tung Pong has remained agricultural based without serious resource management problem  and socially knitted by kinship. Tambon civil society in this  case was strengthened by interactive learning process, people   participation and progressive leaders. Experiences learned from  working with the NGO in the community enable Tambon leaders to modify their way of communication through series of meeting planning and evaluation. Water management system which has been totlally run by villagers was a unique example of people civil society of this Tambon. As a result it was found that Tambon Tung Pong were more serene and self sufficient as compared to Tambon Kok Sung. Example drawn from this study suggested that existing culture and mythical belief as well as kinship were supporting civil society in the rural community under normal and agricultural condition but it was not enough to tackle emerging conflicts along the path of development. Existing people organization and interest groups need to develop interactive communication systems, good management and transparency and democratic decising making. All these can only come about when people realized that public issues are, in deed, individual concerns


Training workplace health promotion	Training workplace health promotion (WHP) was a part of the national "Workplace Health Promotion" project implemented in 2001-2002 by various partners .The aimed of this study was to evaluate the input, process, output, and outcome of the training project. Progressive and summative evaluation was used as a design of this project evaluation. The sample was recruited from four provinces with major industrial parks by the Social Security Office. Subjects were composed of 60 WHP facilitators from 20 hospitals, 44 managers and worker's representatives, as well as, 4,400 employees form 44 workplaces. Quantitative data was collected by using questionnaire, interview and reviewing record. Qualitative data was gathered by using focus group, In-depth interviewed, and observation  	The results indicated that, for input evaluation, a comprehensive and integrative five day-long training contents was relevant to the project objectives, but it lacked the content of building attitudes toward working with workplace. Process evaluation showed that the participants satisfied all of learning contents, instructors, activities, and duration of training. However, the group process was viewed as time-consuming activities and could not sufficiently link to learning outcome concepts. For output evaluation, the knowledge and perceived WHP skill of the participants were significantly improved (p<0.05); but the activities according to WHP facilitator’s roles were not clearly performed. Most of them had more routinely workload and reported shortage of implementation time. For outcome evaluation at 6 months follow up, workplace policy, environment, and health promotion activities were not significantly improved. Changes in health behaviors as well as health status of employee were not significantly observed. However, increases in understanding and awareness in workplace health promotion were found.Findings suggest that the training project was useful for workplace health promotion and should be implemented further with cooperation between workplace and hospital's facilitators. The Social Security Office at provincial level should also act as coordinator and motivator to assure sustainability of the project. Meeting for sharing the learning experience should also be set up. Financial support and regulation for workplace health promotion should also be provided.


Guideline for the pharmacotheraphy of treatment-resistant schizophreniaObjectives: Treatment-resistant schizophrenia is a common problem in patients with schizophrenia that creates a huge economic burden for society. Since there has not been a guideline for the treatment of TRS, the PTRS Guideline Working Group, therefore, proposed to develop an evidence-based clinical practice guideline for the drug treatment of TRS. Method: The PTRS Guideline Working Group comprised eleven psychiatrists, a psychologist, and a pharmacologist. A MEDLINE search was performed to identify the relevant articles published between 1966-1998. The evidence presented in 163 articles was extracted and graded by the use of a system modified from that of the Agency for Health Care Policy and Research (AHCPR). The strength of recommendations was categorized into A, B, and C. Results: For a schizophrenic patient who does not respond to a classical antipsychotic, physicians should switch from the first classical antipsychotic to the second one, which belongs to a different class (A). A schizophrenic patient who does not respond to at least two adequate trials of classical antipsychotics should be classified as a TRS patient. For a TRS patient who is taking classical antipsychotic in high doses (at least 50 mg/day of haloperidol or its equivalence), a dose reduction strategy may be applied at this stage (B). In a TRS patient who is taking a usual dose of classical antipsychotic, clozapine should be considered as a first-line treatment (A). If a TRS patient does not respond to clozapine, physicians should add a classical antipsychotic to the ongoing clozapine, especially sulpiride (A) and loxapine (B). Risperidone should be considered in a TRS patient who refuses to have regular blood monitoring or have a contraindication for clozapine (A). Although there is no evidence supporting the use of olanzapine (or other atypical antipsychotics that will be available in the future) in a schizophrenic patient who resists both classical antipsychotics and risperidone, giving olanzapine (or other atypical antipsychotics that will be available in the future) may be worth a trial if the TRS patient refuses to take clozapine (C). Discussion: Physicians should regard the PTRS Guideline as a tool for assisting their practice but not for replacing their clinical judgments. Optimal management for a TRS patient requires the integration of medical treatment with psychosocial interventions. Electroconvulsive therapy may be a treatment option for schizophrenic patients who fail to show adequate improvement with classical antipsychotics. The definition of or the set of criteria for TRS still cannot reach a conclusion. In using this guideline, physicians should be aware of its limitations, e.g., the search, the patients' ethnicity, the study cites. Whether this guideline will affect treatment practice remains to be seen.


Forms and Systems of Quality Child Care Services in Thailand:An Indepth Case Study	Today most Thai families rely on child-care providers to help raise their children, often beginning at a critical stage of their brain development, particularly children under 6 year of age. But most of the settings where Thai children receive care fall short of the quality standards. The primary focus of this qualitative study is to investigate child care forms, systems and factors related to  quality child care services in Thailand. The second objective is to analyses the criteria and standards of quality child-care in both private and government setting, and compare with foreign standards in order to set (minimum) standards of care under Thai context.	Data was collected from administrators/owners and childcare providers/caregivers of the childcare settings, including children aged 0-6 years and their parents of 20 selected sample child-care centers/schools operated by government and private own in Bangkok and other provinces throughout Thailand. Both Structured and unstructured questionnaires for interviews, including observation and videotaping techniques were used to collect data.	The results showed that the forms of child-care services in Thailand were varied depending on the purpose of services (affiliated with school or not) the age group of children to be care (infants, toddlers or preschools) and t the need of children (normal or special disadvantaged children). About the system of good quality child care services, it was found that mostly composed of a better and more efficient managements in terms of accountability of financial system, low staff turnover and higher job responsibility and satisfaction; staff(s) with more formal education and specialized early childhood training in addition, a more developmentally appropriate environment with age-appropriate and child-centered activities to promote learning and foster all aspects of their development; higher standard of health, nutrition and safety provisions; including better relations with parents/and communities were evident.	For the quality improvement of all government units in Thailand, the focus was actually on standards and indicators of inputs and process of child-care services/centers more than outcome on child development. A good quality child-care center in Thai context should include some standards from foreign countries such as a clear philosophy and goals between child care staffs and parents to promote their complementary roles and to parents participation; the interactions between children and staff, the interactions between staff themselves; and also the respect of protecting child abuse. Therefore it will be worthwhile to specify that minimum acceptable standards regarding such factors in order to guarantee good quality child-care services for young children.


For some time, quality of health care and services has been the topic of major interests of policy makers, health care administrators, health care providers, and consumers and medias in Thailand, as well as abroad.   Quality assurance and improvement has gained importance as one of major mechanisms to ensure health security for the population.   Nevertheless, to improve quality of the health services system effectively and efficiently at any of the national, provincial, community or organizational levels, we need information and knowledge to guide improvement directions, as well as to determine improvement processes and techniques.   Some may be acquired from others, but the others require research, studying and searching for knowledge within our own country.   To date, there is no extensive survey on issues in quality of health care and quality improvement that are worth being set as strategies for research in order to bring about knowledge for sustainable quality improvement of our health care system in the future. 	This research project comprises two parts.  The first part is the review of experiences in researches in quality of health care and setting a preliminary proposal for research question frameworks.   The second part is a survey of situations and questions among stakeholders, namely providers and clients, regarding quality of the health services system and quality improvement and a summary of strategies to approach quality of health care research.  	This report is the presentation of the findings from the first part of the project.  The objectives were to review published research articles on quality of health care, study research experience on quality of health care in Thailand, as well as case studies in other countries.   In addition, it aimed to explore problems and doubts concerning quality of health services from the perspectives of policy makers, system administrators, academicians, hospital quality consultants, hospital accreditation (HA) surveyors as well as health care providers and clients.   A number of research techniques were applied, including literature review, in-depth interviews, focus groups, brainstorm sessions, and study visits at organizations in the United States of America (USA) and the United Kingdom (UK) during February to December 2003. 	The literature review found that research on quality and quality improvement varied a lot in topics, understanding, principles, rationale, utilization and research designs, depending upon contexts and perspectives.  There were many definitions of quality.  It could only be defined broadly.  The scope of research was wide.  Only a general framework could be defined for the benefit of review and reference in the following areas: health care provided by health professionals, service delivery, service organization and health services systems, including linkages to health insurance mechanisms and development of aspects related to consumers and service purchasers.


Diffusion and Utilisation of MRI in Thailand. MRI is one of the big ticket technology that is expensive in both its procurement cost and its maintenance. This study assesses the efficiency and equity of MRI services by looking at the patterns of diffusion and utilisation in Thailand. The study shows that, since the first introduction of MRI machine in the private facility in 1988, the number of MRI has been gradually increasing both in public and private health sectors. In 1998, Thai people have the choice of getting MRI services from 25 MRI machines in operation; 9 of them are in public hospitals and the rest are in private facilities (10 in private hospitals and 6 in private freestanding diagnostic centers). Most of the machines are located in Bangkok area (17 places). All MRI in the public hospitals have the magnetic power of 1.5 Teslas. The private machines however possess various level of magnetic strength ranging between 0.2 to 2 Teslas. Average operating time per week in the public hospitals is much lower than that in private facilities. Average number of cases operated per machine per year in 1997 is 1,233. There are 6 MRI units with less than 500 patients being examined that year. From the interview with 23 facilities' owners or hospital or center administrators we find out that the nature of technology, planning and logistics are two main stimulating factors for the MRI machine procurement while the budget for investment is the most impeding factor. From the costing studies in 8 sampled MRI units, the results show that capital depreciation cost is the major portion, over half, of total cost of MRI operation. Number of cases operated is the key factor determining their financial results. Majorities of MRI units are operating on lost while only 2 out of 8 sites have nearly 100% cost recovery. The rest are striving with the cost recovery figures between only 12 to 41 percent. The break-even points for MRI operation are calculated to be at around 1,300 cases per year for private facilities and more than 2,500 cases per year for public facilities. The utilization study reveals that there is inequitable MRI access as shown in different rate of its usage among patients from different payment scheme. We furthermore detect that many MRI units under private settings offer financial incentives to the physicians who refer cases to their sites by routing back a certain proportion of service charge acquired from the patients. This controversial way of promotion, "Kick back”, may lead to inappropriate utilisation and should be seriously addressed by regulators, professional organization, and consumer protection agencies. The research team has proposed several recommendations to counteract the problems of inefficiency, inequity and questionable quality of MRI services. We support the upcoming draft of the new Medical Device Act that will embody the regulation on number and distribution of certain medical devices using evidence based on pidemiology, demographic pattern and the distribution of existing facilities. Monitoring and assessing bodies must be empowered with skill and knowledge. Better use of the existing MRI machines will definitely be highly appreciated by all. Strengthening of the service network and referral system is one possible way. Continuing medical education for doctors, radiologists and other staffs together with more public education on the indication of use, benefit and cost of MRI technology will help. Likewise, the fundamental problems resulting from inefficient and unfair health financing and delivery system should not be overlooked.


This study was aimed at elaborating prevention behaviours from pesticide poisoning among farmers in Amphur Nonsa-aad, Udonthani province. The study was cet in 6 villages from which 293 farmers having used organophosphate and organocarbamate pesticides were recruited. Of these users, 100 used only organophosphates, 14 used only organocarbamate, 179 used both. Survey of preference of brands used was found that Decarbam 50 and Furadan 3% were the most popular pesticides(46.79% and 45.39% respectively). Others were Folidon E 605(27.3%), Spato(17.41%), Anthracil 60(12.29%). Vegetables most frequently used of pesticides were Tang-ran-yai(Curcumis sativas)(74.74%) and Tang-tai(Curcumis melo)(74.74%). Others were long bean(22.87%), waterrmelon(19.8%), chilli(10.92%). Blood cholinesterase in farmers was also tested using ‘reactive paper’ before and after spraying pesticides for 2 – 4 hours.        Prevention behavious from pesticide poisoning of farmers were categorised in this study into 3 stages of practice, i.e., preparation, spraying and after spraying. Same data were collected using 2 methods, i.e., from in-depth interview and a direct observation.         From interviewing, inappropriate practices among 293 farmers in the preparation stage were found in mixing of pesticides(2%), gloves wearing(48.1%), masks wearing(36.2%). After spraying, inappropriate practices were found such as equipment used(0.7%), clothing(11.9%), gloves wearing(35.2%), shoes wearing(39.9%), walking direction according to wind(44.4%), eating and drinking food or smoking(24.4%). After spraying, inappropriate practices were found. These were bathing(20.8%) and clothes changing(7.8%).         From direct observation, inappropriate practices among 34 users in the preparation stage were found in gloves wearing(67.6%) and mask wearing(52.9%). During spraying stage, inappropriate practices were found about clothing(11.8%), gloves wearing(61.8%), mask wearing(50.0%), shoes wearing(44.1%), walk direction according to wind(38.2%), eating and drinking food or smoking(23.5%). After spraying, inappropriate practices were found in bathing(41.2%), clothes changing(8.8%).         Deviation in percentage found between the 2 methods may have been due to practicing from different frame and2or that some farmers gave answers for an interview different from the real practices.         Blood cholinesterases found before spraying period from 239 farmers were in ‘in-risk’ and ‘not-safe’ levels for 41.0%. After spraying pesticides for 2 – 4 hours, blood cholinesterases of 43 users were ‘in-risk’ and ‘not-safe’ levels for 53.49%. When the blood cholinesterases were compared within the same users of 24 farmers, 41.6% was found in ‘in-risk’ and ‘not-safe’ levels before spraying period and the number was increasing to be 58.4% after spraying.          Symptoms after spraying were described by farmers in orderly. These were headache(43.3%), nausea2vomiting(11.3%), dyspnea(8.2%), sweating(6.8%), tremor(6.5%), saliva increasing(6.5%) and moth dryness(5.1%).          The study concluded that farmers had inappropriate prevention behaviours from pesticide poisoning in all the three stages of practice, i.e., in preparation, spraying and after spraying pesticides. The decrease in blood cholinesterases after spraying pesticides 2 – 4 hours go along with these inappropriate practices.


Modern biotechnology has developed to a very high extent, nowadays.  It was widely used in many fields of practices, such as medicine, agriculture, or environment.  This technology has assisted in creating many innovative creations, e.g., various kinds of genetically modified organisms (GMOs), especially GM plants, for example, herbicide-resistant and pest-resistant plants.  The advancement of biotechnology in terms of producing genetically modified organisms has been a subject of concern of the Convention on Biological Diversity, which Thailand is one of its members.  Article 8 (g) of the Convention stipulates that there shall be a means to regulate, manage or control the risks associated with the use and release of living modified organisms resulting from biotechnology which are likely to have adverse environmental impacts that could affect the conservation and sustainable use of biological diversity, taking also into account the risks to human health.  In this respect, Thailand has not yet had a particular legal instrument to regulate living modified or genetically modified organisms, whereas on the international level there has been an establishment of the Cartagena Protocol on Biosafety to oversee aspects under Article 8(g) of the CBD, and many countries, such as the USA, European Union, and Australia have already enacted laws that govern biosafety issues.  Thailand, therefore, is on the way of utilizing those existing laws as models or patterns to establish the law on biosafety of the country.


The Evaluation Report of Phu Luang Rural Revitalization and Conservation Project is the record of the effort to bring the integration of conservation and development concept into practice. The objective of the project is to reduce and slow down the loss of biodiversity in Phu Luang complex, which is one of the most important ecosystem areas in the country with unique wildlife species and spectacular sceneries for tourism. The integration of conservation and development is the concept accepted and widely spread around the world with objective to reduce the degradation of natural resources by offering the chance to improve the socio-economic situation of the people living around the protected area. This is implemented with the belief that if living situation of people around the protected area is improved, with so many alternatives in their development, people will recognize the importance of natural resources and the need for resource management. This practice will hopefully enable local people to participate in a more community based natural resources management and exploitation of the resources in a more sustainable approaches.Lessons learned from four protected areas applied the ICDP during 1993-94, found out that the concept was implemented with both success and failure. There were two considerable success factors. The first one is ‘trust and ownership’ among people using and managing the resources. This factor is crucial to build the sense of conservation concept to these direct stakeholders. The second factor is the administration and management of the project, whether it is effective in term of its flexibility to facilitate the diverse development activities which give appropriate responses to the need of the local communities. At the same time, the project should be able to coordinate and liaise with local organizations, both governmental and non-governmental, and people organizations to work together to support conservation initiatives in order to extend its impact to the positive change of natural resources.The evaluation of the development work under the ICDP concept of Phu Luang Rural Revitalization and Conservation Project, after more than two year-operation, came out with positive potentials, but still not comprehensive enough to cover various issues and stakeholders. However, the project has brought the new perspective of local initiations into recognition. Thus in the remaining time of the project, it is imperative to encourage local’s effort and broaden its impact by transferring the mandate to do development work to Local People Organizations and their networks. The staff of the project has to adjust their roles from implementers of the project’s activities to the supporters or facilitators and network with local organizations to work together for sustainable conservation and development in a more sustainable way.