location: , 'Thailand year: 2020 source: HSRI

title: Policy Options to Develop Model of Primary Care Services for Caring Patients with Stroke:   Bangkok Metropolitan Administration

abstract: Primary care service development to improve quality of life for stroke patients in the community is considered a major service activity for promoting health, reducing body impairment and disability along with promoting good quality of life. Several models for providing primary care services and care for patients are used in Bangkok communities where the factors promoting quality of life differ from rural societies. Furthermore, no clear assessments have been conducted to assess the effects of primary care service models on quality of life in Bangkok. This study was aimed at studying model of care, personal factors, social networks influencing quality of life, test causal correlations of service provision models with quality of life and discover problems and needs of associated persons in order to modify and improve the service provision model before testing model as a pilot study in Bangkok for functional recovery and quality of life. The sample was 450 patients who had survived ischemic or hemorrhagic stroke for no more than two years and were discharged from the hospital to return to the community along with primary care unit service providers. This study used quantitative and qualitative research methods. Data were collected by using questionnaires, focus groups and implementation of appropriate primary care service models. According to the findings, stroke patients in Bangkok (68.2%) were found to have not recovered after being discharged and returning home with medium-level quality of life (Mean + SD = 3.40 + 0.93). Most of the patients had access to care at home provided by Registered nurses (RN), followed by physical therapists and community nurses with social network support from village health volunteers or Care Givers (CGs) trained care of bedridden patients by Nursing Division Public Health BMA Department at 3 9 .6 percent. Patient’s factors most an effect on quality of life (QOL) was high functional disability score (ß = .57, p = .000), followed by depressive (ß = -.22, p = .000) cognitive impairment (ß = .20, p = .000) unable return to work after stroke (ß = -.12, p = .000) and hours to care for stroke patients (ß = -.07, p = .000), respectively. The results showed that 4 model of care such as Continuing care with nurse expert model provides the best recovery and quality of life for patients, followed by the Bangkok Metropolitan Administration (BMA) Home ward was a primary care service that can serve a large group of patients in community and use the most of community's resources for benefit of care. Continuing care from hospital to home was occurred by family management, and received necessary equipment of care which supported from the hospital. While family care has family supported and provided care to patient. The causal relationship model of the factors influencing functional recovery and quality of life among stroke patients was consistent with the evidence-based data (χ2 = 4.688, df = 6, p value = .584, χ2/df = .78, GFI = .997, RMR = .014, RMSEA = .025). Stroke patients’ quality of life was most influenced by functional impairment (ß = -.79, p = .000), followed by the continuing care model with nurse experts (ß = .13, p = .000) and the BMA home ward model (ß = .10, p = .008). Patients who received care support from only family members and community members were unable to reduce disability and improve quality of life. Concerning healthcare service needs and barriers, the recovery goals of patients and healthcare providers were found to be inconsistent. Patients looked at the destination and chances of survival, while healthcare providers looked at the process on the way toward self-management, stabilization of control over complications and comorbidities. Therefore, the services provided for stroke patients in the community were care for bedridden patients rather than care to stroke patients with neurological impairments return to a condition similar to before illness. Accurate recovery processes are needed for the development of clinical nursing practice guidelines for stroke patient in community and trial implementation with selective models. Synthesis new model of care by nurses and health personnel involved in trial implementation of the home ward for stroke care which has clinical nursing practice guidelines for stroke patient in community, patients were found to have less physical impairment and higher quality of life with statistical significance. Therefore, community nurses can implement service provision models and care guidelines for stroke patients in the community to improve quality of life among patients in the community for positive health outcomes. In the future, primary care services for Bangkok will be faced with population structure changes, different social determining factors from rural societies, few family care roles and distant social networks. Nurses are the crucial health personnel as consultants, help and take role play closely of nursing care at home. Meanwhile Bangkok Metropolitan Administration is unable to resolve shortage of nurses to support patients in hospitals and communities. Freelance nurses can provide solutions in promoting health among patients in communities to meet needs by developing freelance nurses and implementing good practice guidelines in communities to create quality care practices and support correct decision-making with stroke patients. Moreover, supported by volunteers in place of patients with family caregiver whose relatives have no time or readiness to provide care and volunteers who serve as patients’ family members with nurses while maintaining close relationships and care consistency can help reduce disability and improve quality of life. Therefore, policy-makers need to develop volunteer with knowledge and readiness to care for patients with complex conditions disease in the community in addition to creating new volunteers to replace old volunteers.


location: , 'Thailand year: 2023 source: HSRI

title: Nursing Workforce Management and Competencies for Secondary and Tertiary Care during the COVID-19 Crisis in Health Region 10

abstract: The increasing number of COVID-19 patients during the pandemic posed a great challenge for health care services. Nurses have a vital role, not only in providing care, but also in managing other health care services, in regard to the varied hospital resources challenges. This qualitative research aimed to synthesize lessons learned from the COVID-19 crisis experiences regarding nursing competencies and workforce management in Health Region 10 of Thailand. Document analysis, in-depth interviews, and focus group discussions were used to collect data from October 2021 to April 2022. The 293 key informants included the Ministry of Public Health (MOPH) inspector of Health Region 10, representatives of the Thailand Nursing and Midwifery Council, representatives of the Nursing Division of the MOPH, the provincial chief medical officer, a group from the emergency operation center (EOC) committee, hospital directors, heads of nursing departments, physicians, infection control (IC) nurses, and nurses engaged in COVID-19 patient care. The data were analyzed using content analysis. The study revealed that: 1) workforce management in response to the crisis included 1.1) implementation of nursing staff pooled from different units through nurses volunteer co-operation or direct command; 1.2) modifying working hours from 8-hour shifts to 12-hour shifts; and 1.3) assigning head nurses of lower workload units as supervisors to the COVID-19 cohort wards. And 2) strengthening nursing competency focusing on: 2.1 designing educational modules on nursing care for COVID-19 patients with regard to infection control and prevention; 2.2) on-the-job training; 2.3) training self-directed learning skills to nurses to independently online search available COVID-19 knowledge resources; and 2.4) the IC nurses played a major role in infection control competency of the hospital staff, as well as informing the most update COVID-19 practice guidelines. The most common training sessions included the donning (putting on) and doffing (removing) of personal protection equipment (PPE) and the powered air purifying respirators (PAPR), intubation in COVID-19 patients, automatic cardiopulmonary resuscitation (auto-CPR), prone positioning in ARDS (acute respiratory distress syndrome) COVID-19 patients, and mechanical ventilation care. The key success factor for coping the crisis was the collaboration from all partners and stakeholders. The policy recommendations for the present study included setting measures for comprehensive nursing workforce management and essential competency to handle crisis situations, developing the nurse workforce system and mechanisms in order to retain nurses in the system, implementing education and training programs to promote nurses’ competency, continuously, and creating working environments conducive to nurses providing direct patient care professionally.


location: , 'Thailand year: 2018 source: HSRI

title: The Development of Thai Mental Health Casemix Classification (TMHCC) Version 3

abstract: Mental health service is an important health service system with increasing resource consumption due to social and economic changes. The objective of this study was to develop Thai Mental Health Casemix Classification (TMHCC) for inpatient payment method. This research and development employed 4 steps to develop TMHCC: 1) standard data identification, 2) data collection and edit, 3) cost calculation 4) classification, calibration and evaluation. Eighteen hospitals with inpatient beds for psychiatric care and 2015 top-down cost accounting data joined the study organized by the Department of Mental Health. Data for TMHCC development included administrative data, clinical data, resource uses and mental problems. The Thai version of the Health of the Nation Outcome Scales (HoNOS) and the Health of the Nation Outcomes Scales for Child and Adolescent mental health (Thai-HoNOSCA) were used for adult and children psychiatric assessment. Prospective data collection was conducted in the second half of fiscal year 2016. The total inpatient data for classification were 15,417 cases. The statistics to explain performance of the TMHCC were coefficient of variation (CV) for homogeneity of cases within each group and the reduction in variance (RIV) for overall performance of the casemix classification. Results: TMHCC classification provided 39 disease groups (34 for adult and 5 for children). The highest number of adult cases was for Schizophrenia, Age <= 50, with cognitive problems, with problems from reactive/aggressive/ agitated behavior (2,088 cases, 17.1% of all cases). About 83.4% of children patients were grouped into Other Child Psychiatric Conditions (2,463 cases). Mental Health Disease, Ongoing type had the highest cost per admission (200,817 Baht) and Mental Health Disease, Same-day type had the lowest cost per admission (590 Baht). The result of CV on cost showed that only one group had CV higher than 100%. Most TMHCCs had high homogeneities within groups. The results also confirmed good overall performance of TMHCC that RIV on cost after the classification was as high as 39.9%. Moreover, RW of TMHCC better predicted cost than RW of the current Thai DRG version 5. In summary, the performance of this casemix is good enough based on homogeneity within groups and high heterogeneity of resource uses between groups. Recommendations: The payment based on TMHCC was an option for payment. However, payers should prepare budget for psychiatric inpatient care benefit package that needed longer stay service in hospital than acute inpatient. Moreover, mental health measurement data should be put into addition¬al routine electronic databases of all hospitals that provided care to psychiatric inpatients.


location: , 'Thailand year: 2013 source: HSRI

title: Cervical Cancer Screening In Thailand: A Model-Based Economic Evaluation

abstract: As cervical cancer is the second most common cancer in Thai women, it is important for policy
makers to effectively implement the screening program. The aim of this study was to assess the incremental
cost-effectiveness of the current 5-yearly screening practice for all women aged 30-60 years, compared
with the alternative options that differ in the screening interval and target age groups. The study adopted
a Markov model conducted in 2007 under the Thai healthcare setting. All costs were estimated under
societal perspective and converted to the year 2012 values using the Thai consumer price index. Utility
score was calculated based on the Thai scoring algorithm. We found that screening cervical cancer in Thai women was cost-effective compared to no screening. The current practice showed a certain benefit of 40
percent reduction in incidence and mortality. The second most efficient strategy was a 3-yearly screening
for women aged 30-60 years, with the incremental cost-effectiveness ratio -73,300 baht per quality-adjusted
life year gained and the expected prevention of 900 cervical cancer cases and 450 deaths per year.
Treatment cost was reduced to 1.2 billion baht per year. But more than 180 cytologists and pathologists are
needed to cope with increasing demand. Strengthening the current program by increasing the number of
women for screening to reach the targeted coverage rate of 80 percent is the most cost-effective and pragmatic
option in Thailand.


location: , 'Thailand year: 2008 source: HSRI

title: Outcome of Having an HIV Clinic in Sawangdandin Crown Prince Hospital, Sakon Nakhon Province

abstract: A clinic for HIV-infected patients was set up at the Sawangdandin Crown Prince
Hospital, Sakon Nakhon Province in October 2002. This study was conducted during the
period from October 2002 through September 2007 to collect clinical as well as administrative data from the outpatient and inpatient medical records of all HIV patients who
attended the Clinic during the period October 2002 to September 2007. Descriptive data,
i.e., frequency, percentage, means and standard deviation, median, minimum and maximum
values, derived from the use of the Mann-Whitney U test and Kruskal Wallis test
were obtained.
The results showed that the HIV-infected patients were 54.4 percent male and 45.6
percent female, their average age 35.5 years, education status 72.3 percent primary school,
agriculture 73 percent, and heterosexual infection risk 93 percent. There were significant
differences in the median amounts of CD4 when they started taking anti-HIV drugs (p
value= 0.035). There was no statistically significant difference in the median duration
from contracting HIV infection to the treatment period (p = 0.113). The most common
drug regimen used was Nevirapine, Lamivudine and Stavudine during the periods 2002-
2004 and 2005-2007 (75.8%), and the response rate was 81.7 percent. There was no statistically
significant difference in median duration of response to anti-HIV drugs depending
on the amount of CD4 (p= 0.088). Side effects of anti-HIV drugs included skin rashes,
neuritis and cheek lipoatrophy. The most common of the opportunistic infections was
pulmonary tuberculosis. The initial time to receive drugs was quite delayed when a CD4
level of lower than 100 cells/ml was used as an indicator. When acute symptoms subsided,
the majority of patients moved to new working areas and received drugs via relatives.
The result was inconsistent taking of drugs and drug resistance usually developed
thereafter. In such a context, the author has suggested that HIV patients should be given
information about opportunistic infection and CD4 levels. Regular care and medications
for the patients would be effective if high-quality networks are set up. Finally, it is
importanct to pursue the cooperation of organizations offering work and proper income
for the patients after their condition has been improved by treatment with anti-HIV drugs.


location: , 'Thailand year: 2008 source: HSRI

title: A Study and proposal for developing vertical health services purchasing arrangement for the national health security office

abstract: Since its establishment, the National Health security Office (NHSO) has been developing a variety of systems and mechanisms for purchasing health care. The purchasing operations vary by types of  health services with differing advantages and limitations. They affect access to care, quality of care and resource efficiency.
	This study, therefore, aimed to examine current concepts, models, along with problems and obstacles off vertical purchasing arrangements of NHSO. In addition, it intended to explore reasons behind health care purchasing initiatives and criteria for selecting conditions suitable for vertical purchasing arrangement from foreign experiences published in academic journals or other sources. The study purposes also included developing recommended purchasing models comprising appropriate selection criteria, disease or service groups, requirements for health services and organizations, systems and mechanisms framework, and systems and mechanisms for monitoring and evaluation for vertical health care purchasing arrangement. And, Finally, it planned to assess feasibility of the recommended model. The 11-month study period was from June 2007 until April 2008, and could be divided into two phases:
	Phase 1 Collection of preliminary data and details of operating vertical health care purchasing arrangement of NHSO by document review, stakeholder interviews and system analysis.
	Phase 2 Assessment of systems and mechanisms of NHSO, as well as contracted providers, according to a proposed “Disease management” purchasing model in order to explore results and adjust the models and requirements proposed using results from the phase 1 of the project.
	The study findings suggest that NHSO has many health care purchasing approaches. They can be organized into two major systems:
1.	Basic care purchasing
2.	Vertical purchasing arrangement (VPA), comprising purchasing contracts  that are separately done from basic care purchasing by well-defined customer groups, service provider requirements, payment mechanisms, billing and system administration operated by the central office of NHSO.
Findings from the phase 1 and 2 of this study show three groups of problems and obstacles in vertical purchasing systems:
•	Principle-level and conceptual problems of the health care purchasing systems unclear and inconsistent principles or concepts applied by NHSO teams and staffs lead to inconsistent planning and decision making, as well as problems and obstacles in operations.
•	Problems in designs of systems and mechanisms of health care purchasing: Unclear and defective system design and mechanisms, particularly practice guidelines, budgets, payment mechanisms, communications and information systems. These adversely impact actual practices.
•	Deployment problems: problems in deployment and implementation of design systems to inconsistent planning and decision making, as well as problems and obstacles in operations.
•	Problems in designs of systems and mechanisms of health care purchasing: Unclear and defective system design and mechanisms, particularly practice guidelines, budgets, payment mechanisms, communications and information systems. These adversely impact actual practices.
•	Deployment problems: problems in deployment and implementation of design systems and practice guidelines. These were caused by limitations of internal management systems of NHSO, inadequate supports from information systems, providers or other external factors, such as beneficiaries’ behaviors.
Taking into account all study findings, therefore, the systems purposes for developing health care purchasing may include:
•	Increase ability to access services
•	Create care standards
•	Improve continuity of care
•	Stimulate and promote disease prevention, delay disease progression and complications
•	Respond to specific requirements of target populations
•	Enhance efficiency in resource utilization
•	Increase management efficiency using information systems
Considering characteristics of health services and purposes of purchasing systems, health care purchasing can be divided into five systems:
		1)  Disease management system for chronic diseases
		2)  Disease management for acute diseases and high-cost procedures
		3)  Vertical purchasing arrangement for health–risk control projects
		4)  Purchasing systems for health promotion and disease prevention services provided by health care providers
		5)  Purchasing systems for emergency medical services

Management  of the vertical purchasing arrangement should emphasize proactive services to reach target populations, application of clinical practice guidelines and health services guidelines, provider standards, strong networking and referral systems, information system linkages, attractive payment which also provides incentives for efficiency, monitoring and performance reviews, economy of scale, responses to local needs, and participation. All may differ by systems.

	Selection criteria for suitable conditions, disease groups and service types for vertical purchasing arrangement consist of three categories:
1)	Criteria related to burden of diseases, including high-cost care, diseases with high probability for emergency care in care of controls, diseases with high utilization of inpatient services or extended length of stay, chronic diseases or conditions that need ling-term care, diseases that outcomes or complications can significantly affect quality of life, preventable high-burdening diseases, diseases with high community impacts which require special attention and management
2)	Criteria related to national opportunities for improvement, including diseases that quality care can control disease progression or cure, prevent or reduce service utilization, including emergency services and inpatient care, which can decrease cost of patient care, disease groups that require multi-disciplinary team and networks of care to increase access and quality of care, disease groups with significant practice variations, diseases or health conditions that community participation in health care can enhance effectiveness and significantly reduce requirement for medical resources, diseases that standardized treatment approaches can increase resource efficiency, access and effectiveness, and diseases or procedures with cost-increasing new technology which requires close monitoring and evaluation against existing ones before becoming standard practices.

The study team, therefore, propose the prototype model for vertical health care purchasing arrangement that consists of five major steps, including (1)  Need assessment and selection of services suitable for vertical purchasing arrangement, (2) Design and contracting for purchasing services, (3)  Development of management systems and service networks,  (4) Piloting and preliminary assessment of the systems, and  (5) Performance review and implementation as normal operations. Details of all steps are shown in following picture:


location: , 'Thailand year: 2019 source: HSRI

title: The Evaluation of the implementation of 10th Participatory Health Region

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


location: , 'Thailand year: 2011 source: HSRI

title: Alcohol Consumption Control: From Cost-of-Illness Study to Policy Recommendation

abstract: According to the cost-of-illness studies, economic impact of alcohol consumption is substantial. Impact
of alcohol and smoking on productivity loss due to premature mortality and morbidity is enormous and clearly affect economic system of the country. According to the cost-of-illness studies, the followings
are policy recommendation; 1) Alcohol control policy should be set as the national priority; 2) collaboration
from all related organizations not only those from the health care sectors but also other economic
organizations both government and private as well as enterprises at all levels are needed; 3) Policy/
intervention aims at preventing new drinker as well as encouraging drinker to quit at the early age are
essential. However, policy/intervention targeting at prevention of adolescent from start drinking are more
cost-saving than policy encouraging drinker to quit. In addition, encourage drinker to quit at early age is
more cost-saving than at the older age; 4) Policy/ intervention targeted at preventing new responsible
drinker or encouraging responsible drinker to quit is still important, as responsible drinkers accounted
for the highest proportion in the country; and 5) All related organizations should collect data in term of
the number of new drinkers or quitters attributable to the policy/intervention in order to use them to
conduct cost-effectiveness of such policy/intervention in the future.


location: , 'Thailand year: 2022 source: HSRI

title: Multicenter Registry of Patients with Severe Cutaneous Adverse Reactions (SCARs) to Drugs in Thailand (Year 2)

abstract: One-hundred-five patients diagnosed with drug-induced severe cutaneous adverse reactions (SCARs) were recruited for this study. The results demonstrated that Steven-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptom (DRESS) were caused by similar culprit drug groups, which were different from acute generalized exanthematous pustulosis (AGEP). SJS/TEN phenotype, advanced age, high neutrophil/lymphocyte ratio (NLR) and systemic infections independently increased the risk of in-hospital mortality. The application of NLR to predict mortality in SCARs should be reconfirmed in a large-scale study. The combined measurement of drug-induced IFN-gamma (IFN-γ), granzyme B and IL-22 releasing cells could confirm the causative drugs in 77.8% of SCAR subjects, while α-GalCer supplementation significantly increased the frequencies of drug-induced IFN-γ releasing cells. The appropriate in vitro test panel yields optimal diagnostic values, and cost-effectiveness should be determined. Although SJS/TEN and DRESS are caused by similar drug groups, clinical manifestations and long-term prognosis are clearly different. Our study suggested that keratinocyte death observed in SJS/TEN was partly due to drug-specific exosomes released from peripheral blood mononuclear cells upon stimulation with the culprit drugs in SJS/TEN, but not in DRESS. Five exosomal microsomal RNAs (miRNA-486-5p, miRNA-183-5p, miRNA-96-5p, miRNA-132-3p and miRNA4488) were confirmed statistically different between SJS/TEN and DRESS by microRNA sequencing. The regulatory roles of these exosomal miRNAs on keratinocyte death in SJS/TEN and might be used as the therapeutic roles of exosome inhibitors to prevent SJS/TEN progression warrant further study. The different fates of regulatory T cells (Treg) were observed between SJS/TEN and DRESS patients. While Treg functions in DRESS were stimulated during the acute drug allergic phase, the regulatory/suppressive functions of Tregs in DRESS were subsequently diminished compared to SJS/TEN when followed up during the recovery phase. According to the comparative analyses of Treg mRNA profiles during the acute drug allergic phase, genes regulating T cell differentiation and genes regulating interleukin-10 production were found downregulated in DRESS patients who developed autoimmune consequences compared to healthy individuals and might be used as prognostic factors for long-term complications in DRESS subjects.


location: , 'Thailand year: 2022 source: HSRI

title: Integrated Community-Based Care for Dependent Older People Community Participation in Preparation for Recurrent Outbreaks of COVID-19

abstract: Older people with dependency are those who have limitations in daily activities. It affects physical and mental ability, social participation, and the need for help caring for the family and the community. Descriptive research aims to study the context of integrated care for the dependent older people with community participation by community participation in preparation for the re-epidemic of the coronavirus disease 2019. In addition, develop policy proposals for integrated care for the older people with dependency on community participation in preparation for the re-emergence of the coronavirus disease 2019. They have selected random samples from 6 provinces across the country. According to the inclusion criteria, 440 households of primary caregivers assessed the functioning ability of the older people, primary caregivers, and 440 families involved in older people's care. There were 154 community dependencies. Data were collected from the tools tested for the content quality of the research tools. From 3 qualified health experts, the content accuracy was 0.91, and the confidence value (Reliability) Cronbach's alpha coefficient was 0.69. There were both quantitative and qualitative. The study results were based on the principle of "Trust, Stay at home, Keep distance" and perceptions of COVID-19, impacts, problems, obstacles, and the need for care. Results In terms of quality, there are four preventive principles in mind: "Trust, Self Care, Stay at Home, Keep Distance" and guidelines for preventing COVID-19 at the family level. The gathering data is expected to form the information for planning, operating, and organizing training to provide knowledge and training in caregiving skills. It refers to preparing guidelines for caring for the dependent older people with dependency conditions in the personnel health, social workers, local government organizations, and related agencies.


location: , 'Thailand year: 2008 source: HSRI

title: Tuberculous Meningitis

abstract: Tuberculous meningitis (TM) is associated with high morbidity and mortality. The early diagnosis
and treatment of tuberculous meningitis saves lives. Diagnosis is based on clinical features, cerebrospinal
fluid changes, and imaging characteristics. The clinical features of TB meningitis sometimes are initially
non-specific, although clinical meningitis with cranial neuropathies, cerebral arteritis, hydrocephalus and
spinal arachnoiditis are well recognized by most physicians. Bacteriological confirmation, such as microscopy
for acid-alcohol-fast bacilli, polymerase chain reaction and culture, is not possible in all cases as
those tests do not have sufficient sensitivity; however, this depends on the volume of CSF examined.
Brain imaging should be performed if the patient deteriorates. The complications of hydrocephalus, infarction,
and tuberculoma are common complications of tuberculous meningitis and a neurosurgical opinion
should be sought in those who are failing medical therapy. Early treatment with four drugs (isoniacid,
rifampicin, pirazinamide and etambutol) prevents death or disability. Adjunctive treatment with corticosteroids
improves survival but probably does not prevent severe disability.


location: , 'Thailand year: 1999 source: HSRI

title: Chronic Obstructive Pulmonary Diseases and Risk Factors : present status and future trends

abstract: Chronic obstructive pulmonary diseases and risk factors: present status and future trendsThis report to review cases of COPD and risk factors has been sucessfully obtained by gathering data from hospitals in various part of Thailand, data of smoking behaviors and populations in each province. From these, we can estimate the incidence and prevalence rate. Eighty-five percents were male and fifteen percents were female. Most of the patients' ages were between 60-80 years old. Severity of the diseases progressed according to their increasing ages. So did the mortality rate. The mortality rate was 1 percent at age 40-50 and become 4 percent at age 70. The expense escalated when one got older due to the progression of the disease. We recommend preventive measures, antismoking, quit smoking activities and      control of air pollution to be planned and implemented in the 9th Natinal Health evelopment plan to cintrol COPD cases and lower economics loss. The future prevalence rate is predicted      to increase due toi the smoking rate, air pollution and increasing population number.


location: , 'Thailand year: 2022 source: HSRI

title: Evaluation of the Effectiveness on COVID-19 Prevention Measures in Educational Institutions Located Border Areas, Chiang Rai Province, Thailand

abstract: A cross-sectional study was applied to assess the effectiveness of COVID-19 prevention and control measures in different kinds of schools (public schools, private schools, day care center, foreign language teaching schools, and religion teaching schools) located in border areas of Mae Fah Luang, Mae Chan, Mae Suai, Mae Sai, Muang, Wiang Pa Pao, and Chiang Saen Districts, Chiang rai Province. The study population were school directors, teachers, caregivers, students, and their parents. Validated questionnaires were used to collect data. Descriptive and inferential statistics were used to test the associations at the α = 0.05. A total of 2,240 participants were recruited into the study. Among 168 school directors, 50.50% were female, and working at the schools that belonged to the Office of the Basic Education Commission. Majority of teachers and caregivers were female (84.13%). While 66.18% of parents were female, and 21.75% were Akha. While 57.55% of students were female. 64.57% of primary schools and 64.29% of high schools were detected in the level of “pass but required improvement” according to the standard protocol of COVID-19 prevention and control measures which was able to operate their schools. While 78.29% of day care centers were detected in the level of “non-pass the safety level and could not operate their schools”. A large proportion of parents (97.43%), 93.81% of all primary schools, 92.86% of high schools followed the national COVID-19 prevention and control procedures to an excellent level. The size of day care centers and school, and types of administration departments were associated with the effectiveness of COVID-19 prevention and control of organization level significantly. Parents’ knowledge and practices related to disease control were associated with the effectiveness of COVID-19 prevention and control of organization level significantly. In implementation for COVID-19 prevention and control, it needs to focus on the size and their administration departments of schools including knowledge and practice in COVID-19 prevention and control of parents.


location: , 'Thailand year: 2022 source: HSRI

title: Development of Management Guideline for the Health Security Funds to Allocate Budget for the District Health Promoting Hospitals Transferred to the Local Administrative Organizations

abstract: Background: Decentralization plan and Action plan of local government organization (LGO) indicate that the Office of the Permanent Secretary Ministry of Public Health (MoPH) transfers the mission regarding primary care services at Chaloem Phrakiat Health Center (CPHC) and health promotion hospital (HPH), in which the transfer should be transparent in terms of fiscal management, equity, and equality. Objectives: 1) to explore the present situation and pattern of the financial management between CPHC and HPH and public insurances, and possible patterns in the future; 2) to propose practical guidelines concerning the financial management for CPHC and HPH after transferring to the LGO, together with comparing subsequential impacts respecting to different public insurances; and 3) to develop recommendations for public insurances regarding budget allocation to CPHC and HPH after transferring to the LGO. Methods: A qualitative research to explore the pattern of financial management was conducted from the provider and healthcare payer perspectives, including both government subsidy budgets, non-government subsidy budgets, and budgets from other sources. The process consisted of 3 steps: 1) we explored the present situation and pattern of the financial management between CPHC and HPH and public insurances, and possible patterns in the future, by interviewing 48 stakeholders. Content analysis was performed afterward; 2) we proposed practical guidelines concerning the financial management for CPHC and HPH after transferring to the LGO, together with comparing subsequential impacts respecting to different public insurances, by analyzing research documents in respect to concepts and theories relating to budget allocation after decentralization; and 3) we developed recommendations for public insurances regarding budget allocation to CPHC and HPH after transferring to the LGO, using the content analysis technique. Results: 1) Health service provisions of CPHC and HPH were financed by many insurances, with the biggest contribution from the National Health Security office (NHSO). Budgets from each insurance were managed following to the regulation of the respective source. For example, the condition to allow/ not allow to use budgets for the purposes of particular activities, pharmaceuticals/non-pharmaceuticals, employment, and personnel work support in CPHC and HPH. This depends on the financial status of the service providers or contracting hospitals. 2) Suggestions for budget allocation should be divided into 2 phases. For the early phase, CPHC and HPH should deal with the current contracting hospitals to transfer budgets due to the flexibility of management and the economy of scale. Experiences from CPHC and HPH, which were already transferred to LGO several years ago, shows the consistent connection with the previous contracting hospitals; this is to minimize the effect of decentralization action to the patients during the first phase. For the late phase, there should consider finding the contracting providers under LGO to improve management flexibility in the long run. Nonetheless the selection of contracting providers should not affect access to healthcare of the patients in the area. 3) Recommendations for managing per-capita-payment for health services during the transition, MoPH should provide support to the transferring units to LGO pertaining to the regulations of how to use subvention. Supports for pharmaceuticals/non-pharmaceuticals should consider the purpose to provide services to the patients. Regarding the employment, LGO may be considered as the funder role.


location: , 'Thailand year: 2022 source: HSRI

title: Efficacy, Safety and Pharmacokinetics of Dolutegravir 50 mg once daily with food versus Dolutegravir 50 mg twice daily in HIV/TB co-infected patients receiving rifampin based antituberculosis therapy (1st Year)

abstract: Concurrent use of rifampicin (RIF) and dolutegravir (DTG) reduces DTG exposure, thus, DTG 50 mg twice-daily is currently recommended. Food increased DTG concentrations in healthy volunteers by 33 – 66%. We therefore investigated the effect of RIF on DTG exposure when dosed at 50 mg once daily with food, which would be more convenient than 50 mg twice daily in resource limited settings, where generic fixed dosed combination of TDF/ 3TC/DTG (TLD) is widely available. Method: We conducted a single-center, randomized control trial study in Bangkok, Thailand to evaluate efficacy, safety and pharmacokinetics of dolutegravir 50 mg once daily with food versus dolutegravir 50 mg twice daily in HIV/TB co-infected patients receiving rifampin based antituberculosis therapy. TB/HIV coinfected adults, ART naïve, stable on RIF containing regimen for drug-susceptible TB were randomly assigned to receive DTG 50 mg OD with food (study arm; TLD 1 pill/day) or DTG 50 mg twice-daily (control arm; TLD 1 pill plus additional DTG). Intensive PK was scheduled at week 4. Blood samples were collected pre-dose, 1, 2, 4, 6, 8, 12, and 24-hour post-dose (by study arm). HIV-RNA, liver and renal function tests were monitored. DTG concentrations were determined by validated LC-MS/MS. PK parameters were estimated (nonparametric; WinNonLin). The primary endpoint was DTG geometric mean ratios (GMRs) of DTG 50 mg QD vs DTG 50 mg BID (90%CI) and percent of participants with DTG minimum concentrations (Cmin) above the required protein-adjusted 90% inhibitory concentration (IC90) of 0.064 μg/mL. Results: Totally 20 study arm and 20 control arm participants completed PK analysis. The majority were male (87.5%); with median age 35.6 years, and median body weight 57.5 kg. At baseline, median CD4 was 170 (IQR 45.5-302) cells/μL and median HIV RNA was 4.96 (IQR 4.23-5.61) log10 copies/mL; 43% had HIV-RNA> 100,000 copies/mL. GMR (90%CI) maximum concentration (Cmax) and area under curve (AUC0-τ) not within the bioequivalence range of 0.8-1.25: 0.84 (0.57-1.25) and 1.07 (0.72-1.59), respectively (Table 1). Cmin GMR was 0.3 (0.18-0.49); however, the geometric means in both arms were above the required IC90: 0.18 (0.11-0.28) in study arm and 0.59 (0.44-0.79) in control arm. At week 12, 83% and 83% of participants in study arm and control arm, respectively had HIV-RNA <50 copies/mL. At week 24, 83% and 100% of participants in study arm and control arm, respectively had HIV-RNA <50 copies/mL Both arms were well-tolerated. Conclusion: Although there were substantial reductions in DTG concentrations when co-administered with RIF, Cmin levels were mostly above the protein-binding-adjusted IC90 of 0.064 μg/mL and majority of participants had high efficacy and >85% had VL suppression at week 12 and 24. Dolutegravir based ART can be used safely with rifampin based antituberculosis.


location: , 'Thailand year: 2022 source: HSRI

title: Effective Coverage and Its Application in the Thai Context

abstract: Effective coverage is a concept of measuring health gain which incorporates health needs, utilization of health services, and the benefits to patients from using them into a single metric. In the past two decades, the World Health Organization and other agencies advocated the use of effective coverage as a way to assess health systems performance and track outcomes of universal health coverage. Two main objectives of this paper were to review literature relevant to definition, methodologies, and international and domestic experience; and to synthesize the recommendations for effective coverage assessment in the Thai context. The literature review found discrepancies of definition and measurement across various studies which caused confusions in communication, comparison and interpretation of the results. The authors proposed that Thailand should apply the definition of ‘the proportion of a population in need of a service that had a positive health outcome from using the service’. This definition communicated clearer meaning and reduced methodological complexities. Selection of proxy interventions should be guided by national health priorities, the possibility of making a positive change in the coverage and health gain, and reliable data sources. Key challenges of measuring effective coverage include defining operational criteria, understanding data requirement and results of low coverage as well as inequity dimensions across sub-population groups. Stakeholder participatory process of effective coverage monitoring should improve policy usefulness.


location: , 'Thailand year: 2021 source: HSRI

title: International Political Economy and Tobacco Control Policies: A Case Study of European Union, France and Germany

abstract: Tobacco control is one of the most contentious political-economic issues at present. The Framework Convention on Tobacco Control (FCTC) of 2003 was crafted to be a global mechanism for tobacco control. However, the degree of tobacco control differs greatly among countries. FCTC has faced strong resistance because tobacco markets are globalized and highly profitable. This study employed global health governance (GHG) as an analytical framework and argued that the FCTC was not sufficient as an effective tobacco control instrument. It required a regional mechanism such as the European Union as well as national level actors, both state and non-state, for effective tobacco control. This research study used the European Union, France, and Germany as case studies. Findings show that France had strict tobacco control measures because political actors, non-governmental organizations, and medical personnel had strong influences on shaping tobacco control policy and took stance against transnational tobacco companies and retailers. In contrast, Germany encountered significant delays in developing effective tobacco control policies because of both the ignorance of political actors, and the weakness of the anti-tobacco civil society network. Moreover, powerful and profitable international and national tobacco companies stood firm against Germany’s tobacco control policies. This research study discovered that the European Union performed a significant role in harmonizing member states’ tobacco control policies, and ushered them in developing their own tobacco control policy measures, especially in the case of Germany. Tax measures had a positive impact on people’s health. They helped reduce the number of deaths from tobacco consumption, as well as reduce tobacco consumption rates among smokers. However, tax harmonization measures respected national jurisdiction and minimized economic impacts. Tobacco tax still remained a national source of income. This research study proposes that ASEAN and its member countries adopt the EU’s harmonization of tobacco-related legislations in order to develop ASEAN’s tobacco control mechanisms and to minimize the gap between members’ tobacco control policies.


location: , 'Thailand year: 2003 source: HSRI

title: Buddisht paradigm on health and healing in Thai society

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


location: , 'Thailand year: 2017 source: HSRI

title: Prevalence of Antimicrobial Resistant Bacteria in Dogs Resided in Central Region of Thailand

abstract: Humans and companion dogs have directly been in close contacts which may pose an important
risk of transmitting pathogens and infections. The domestic animals may contribute to antimicrobial
resistance problem because antimicrobial resistant bacteria and antimicrobial resistant genes were increasingly
found in pets. Thus, the aim of this study was to survey fecal carriage of antimicrobial resistant
bacteria in dogs resided in the central region of Thailand. The rectal swabs were taken from 100 apparently
healthy dogs (50 stray dogs and 50 household dogs) for bacterial cultures and antibiotic susceptibility
testing. The results revealed that an overall prevalence of extended-spectrum beta-lactamase (ESBL)-
producing Enterobacteriaceae in dogs was 35%. ESBL-producing Enterobacteriaceae in fecal carriage
in the stray dog samples (62%) was significantly more than the household dog samples (8%), (p<0.001).
Methicillin-resistant Staphylococcus aureus was also isolated from a household dog. Escherichia coli
isolated from the household dogs tended to be more resistant to some antibiotics than those from the
stray dogs. These observations imply that the dogs resided in the central region of Thailand are also the
reservoir of antimicrobial resistant bacteria.


location: , 'Thailand year: 2016 source: HSRI

title: Development Model of the Type 2 Diabetes Mellitus Prevention in High Risk Group

abstract: The aim of this research and development study was to develop model of lifestyle intervention for
preventing type 2 diabetes mellitus (DM) among the high-risk population. The Diabetes Prevention Program
(DPP) was designed to modify the lifestyle through seven meetings (in 16 weeks) organized by the
researcher team and the public health nurses of the Sub-district Health Promoting Hospitals. The education
and the empowerment program consisted of healthy diet, physical activity, stress management, DM
risk assessment, and goal setting of health behaviors. The participants were selected from the diabetes high-risk group in the local community, Kudjub district, Udonthani province, Thailand. The intervention
participants were encouraged to match a buddy for coaching each other for 16 weeks of the applied DPP.
Quasi-experimental study was used to evaluate the effectiveness of the model. The outcome measures
were the body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), health behaviors,
and the satisfaction of the applied DPP. Sixty participants that consisted of 30 intervention participants
and 30 controls were included. After 16 weeks of the intervention, the adjusted mean difference of the FBS
(90.1 mg/dl for the intervention group vs 95.3 mg/dl for the controls) and the BMI (25.7 kg/m2 vs 29.1
kg/m2) were not statistically significant between the two groups. The WC was significantly decreased
among the intervention group compared to the controls (mean difference = 5.9 cm; 95% CI = 2.4-9.4).
Health behaviors (mean difference = 3.6 score; 95% CI = 0.3-6.9 ) and the knowledge (mean difference = 2.0
score; 95% CI = 0.6-3.4) were significantly increased among the intervention group compared to the controls.
Collectively, 96.7% of the intervention group was satisfied with the applied DPP at the high to the
highest levels. The lifestyle program indicated significant improvement of the WC and the health behaviors
and could contribute to prevent the type 2 DM in the local community.


location: , 'Thailand year: 2013 source: HSRI

title: The study on the operational management and the performance of the 'Health Insurance Policy for People with Citizenship Problems: the Cabinet Resolution on 23rd March 2010'

abstract: This study aimed to better understand the management and the operation of health
facilities under 'Health Insurance Policy for People with Citizenship Problems: the Cabinet
Resolution on 23rd March 2010', which enabled the target population to access to essential
health services, through a case study in Ranong and Tak province.
This study suggests that HIS-PCP successfully reduced the expenditure from receiving
healthcare services in the target population and also made health facilities gain more revenue. However, it did not signifcantly change the utilizations of the target population and the service
burdens at health facilities. Futhermore, there remain unsolved problems in managing the
system. A comprehensive review on advantages and disadvantages of the operation of HISPCP
as status quo comparing with other alternatives in managing the system is recommended.


location: , 'Thailand year: 2015 source: HSRI

title: Cross-subsidization of Healthcare Financing at the Hospital Level: Case Studies of Selected Public Hospitals in Thailand

abstract: Objective: This empirical study investigates hospital’s incentives in responding to the difference in
reimbursement policies. Specifically, it seeks to identify and analyze possible cross-subsidization across
health schemes within the public hospitals in Thailand.
Methods: This observational study employed a mixed-methods research design. Qualitative
contents were collected from focus-group interviews of 30 hospital administrators in three selected public
hospitals, and content analysis was primarily used to synthesize a mental model of how hospital
administrators making decisions related to the concept of cross-subsidization. Quantitative data analysis
was used to compliment the qualitative contents on the issues of unit-cost difference, difference between
charge and cost, and difference between reimbursement and cost across health schemes.
Results: Content analysis reveals four emerging themes. First, the concept of cross-subsidization
is perceived differently among hospital administrators. Second, payment policies create obstacles to
hospitals’ financial management. Third, organizational factors also create obstacles to hospitals’ financial
management. Lastly, hospitals respond to payment policies of health schemes by various measures. These
findings are supported by quantitative results, which suggest the unit costs and the differences between
reimbursement and cost vary across health schemes after controlled for other patient characteristics.
Nonetheless, no evidence suggests that hospitals cost-shift by increasing prices charged to out-of-pocket
payment patients to compensate for the loss.
Discussions: Despite no strong evidence of cross-subsidization, we found three patterns of
decision-making of hospital administrators related to cross-subsidization, including implementing no
management practices for cross-subsidy, initiating organizational practices to reduce negative financial
impacts, and attempting to negotiate with health schemes on a fair reimbursement rate. Hence, policymakers
should adjust financing policies to adequately pay for health services provided. When evaluating the
impact of any payment policies, policymakers should consider not only an impact to patients of any
particular health scheme, but also an impact to other patients groups within the hospitals. Future studies
should utilize time-series data to determine a causational relationship between payment policies and
cross-subsidization at the hospital level.


location: , 'Thailand year: 2023 source: HSRI

title: Use of Chemical and Biological Indices for Air Pollution Monitoring and Development of Community Tools for Air Quality Measurement Chaloem Phra Kiat District, Nan Province

abstract: This research aims 1) To measure the air quality in Chalerm Phra Kiat District community using chemical and biological indicators 2) To develop chemical indicators as a tool for monitoring air quality for the community 3) To convey basic information obtained from studies and measurement techniques to the community. So that communities will be able to monitor and keep track of air quality by themselves. At Chaloem Phra Kiat District, Nan Province, there are many communities that are located about 20-30 kilometers southwest away from the Hogsa Lignite Power Plant, Lao People's Democratic Republic, which may be affected by air pollution emissions. Within the community still lack tools to measure and monitor air quality impact that may come from the power plant. Therefore, in this research we created a tool to monitor both chemical and biological air pollution by passive air sampling and measuring small dust in the air using low-cost sensors, analyzing surface water, and collecting rainwater samples for analyzing the chemical composition. Coupled with observing changes in lichen, this method does not require complicated or expensive equipment. This technique can be share to the communities, youth groups and teachers, or Health and environment related agencies, so that the communities can used this method to monitor the quality of the environment in the area that might affects their health. The area of this research covers 2 districts, Chaloem Phra Kiat District and Thung Chang District. Consists of 4 study areas: Thung Chang District (S1), Huai Kon Sub-district, Chaloem Phra Kiat District (S2), Ban Nam Ree Phatthana, Khun Nan Sub-district, Chaloem Phra Kiat District (S3) and Ban Ngompao, Khun Nan Sub-district, Chaloem Phra Kiat District (S4). Install the PM2.5 measuring device starting in 2 areas (using AirEnvi in Huai Kon Subdistrict, Chaloem Phra Kiat District, Nan Province, Nam Ri Subdistrict, Chaloem Phra Kiat District, Nan Province) then increased to 9 areas (using DustBoy in 9 schools in Thung Chang District and Chaloem Phra Kiat District area). During the smog season (February to April) concentration of PM2.5 are significantly higher than usual. From observing both stations it was found that the air quality monitoring station in Huai Kon Subdistrict, Chaloem Phrakiat District, Nan Province (S2) had a higher PM2.5 dust value than the air quality monitoring station in Khun Nan Subdistrict, Chaloem Phrakiat District (S3). From all 14 samples it founds that during April 2022, the average PM2.5 concentrations was 64.89 μg/m3, higher than the average of 45.20 μg/m3 in June 2022, with the main ion content being SO42- and NO3- in both months. The samples were collected rainfall in 4 areas, 36 samples. It was found that the total rainfall was 201.1 mm. and the maximum was 33.4 mm.. The average pH values was 6.17, and the average conductivity was 0.86 mS/m., with the main negative ion component. The dominant anions are NO3- and SO42- and the ion cations are NH4+ and Ca2+ in all 4 areas. Ban Ngam Pao, Khun Nan Sub-district, Chaloem Phra Kiat District (S4) had the highest accumulation of ions in rainwater. Thung Chang District (S1) had the lowest ion accumulation in rainfall. As for the monitoring of nitrogen dioxide using the NO2 test kit, Wat Huai Kon had the highest NO2 concentration with an average concentration of 72.47 μg/m3 by subdistrict and Thung Chang district. The concentration of NO2 was the lowest (37.12 μg/m3). For water quality monitoring, it was found that the lowest DO value at Huai Kon Reservoir was found. All areas SO42-, NH4+ and Ca2+ have the highest values. Biological monitoring by surveying lichen on mango tree trunks in all four were studied areas. A total of 13 families, 22 genera, and 51 species were identified, including folios and crustoses. Fruticose lichens were not found. The most common families were Graphidaceae and Lecanoraceae, respectively. The average pH of bark from lichen mango stems was in the range of 5.4 to 6.5, with Ban Huai Kon < Ban Nam Ri Phatthana < Ban Ngom. Pao < Ban Thung Chang when analyzing diversity index The Shannon- Weiner index of lichens found the highest diversity of lichen at Ban Ng Pao, with the lowest value (1.58) found at Ban Thung Chang. As for the analysis of the concentration of heavy metals accumulated in the bark, it was found that Ban Ngam Pao > Ban Huai Kon > Ban Nam Ree Phatthana > Ban Thung Chang. The monitors were surveyed and measured air quality in all tools within the community Ban Huai Kon area, there is a risk of harm to be affected the most. Ban Thung Chang has the least risk of being affected due to its distance from the source of air pollution that are further from the HongSa Power Plant. In this research, we also transfer the basic information obtained from the study and the measurement techniques to the communities, so that communities can monitor and measure air quality by themselves. By organized training activities to provide basic knowledge to teachers, students and people in the community. Increasing the area and network of 9 schools including Ban Huai Kon School, Ban Sop Puen School, Nam Ree Pattana School, Ban Fueilung Community School, Mom Chao Charoenjai Chitphong School, Nam Chang School, Huai Sai Khao School, Kew Chan School and Ban Dan School In which the research team can conduct continuous research and the community has a network that can monitor and measure air quality sustainably.


location: , 'Thailand year: 2020 source: HSRI

title: Impact of physical activity and diet on the development of dementia, chronic kidney disease, diabetes and   cardiovascular disease in a Thai general population in Ubon Ratchathani

abstract: Background: Dementia, diabetes, chronic kidney disease and cardiovascular disease (CVD) share common pathophysiology, possibly through metabolic stress. Multifactorial individual-level interventions including lifestyle modification have been reported to reduce risk of diabetes and CVD, mainly in high risk population and many done in clinic settings. Attempts to prevent dementia / Alzheimer’s disease (drugs and supplements) in individuals have not been successful. Little evidence exists to describe the effect of community-based lifestyle interventions on risk of dementia and such NCDs in intermediate risk middle-age and elderly populations. The objective of the project in Year 3 was to investigate the impact of community-based lifestyle modification program on health behaviors, physiologic and biochemical variables and the risk of diabetes, chronic kidney disease and CVD over 2 years of follow-up. This study also aimed to examine the economic impact of such the intervention. Methods: In this cluster randomized controlled trial, 60 villages were selected using multistage stratified random sampling from 25 districts of Ubon Ratchathani. Men and women aged 45-75 years without the above preexisting diseases were invited to participate. A sample size of 4,000 individuals is required to attend screening at baseline to assure approximately 3,600 individuals enrolled in the study (1,800 individuals in the Intervention and Control groups). Main interventions to enhance physical activity and healthy diet were developed and tested before enrollment of participants. After baseline assessment, multi-module multi-level Interventions to address four health behaviors (physical activity, diet, smoking and alcohol consumption) at four different levels (individual, household, group/ knowledge management and community levels) were given in the Intervention group. Site monitoring visits were performed to assure the quality of data collection and intervention. Primary outcome was incident dementia at 10 years. In Year 3 (Follow-up Year 2), we investigated the impact of the above interventions on health behaviors, physiologic and biochemical variables and the risk of diabetes, chronic kidney disease and CVD, reporting relative risk (95%confidence interval) and relative risk reduction. Intention-to-treat data analysis was performed. Incremental cost-effectiveness ratio (ICER) were calculated. Results: Based on multi-stage stratified random sampling (described in Year 1), a total of 60 villages were selected for this trial and randomly divided into two groups: Intervention group which received the above-mentioned 4x4 lifestyle modification intervention and Control group which received healthcare in normal practice. In Year 3 refresher course for key research assistant team from 60 villages, which included 60 nurses and health care officers, 120 health volunteers and 60 community leaders, were undertaken. Enrolment started on 1st March 2016 and, up to July 2017, a total of 3,983 individuals aged 45-75 years were screened, with 3,505 participants meeting the inclusion/ exclusion criteria. There were 1,767 and 1,738 participants in the Intervention and Control groups respectively. Participants in both groups were comparable according to their socio-demographic characteristics, personal and family history, and key laboratory results (e.g. fasting plasma glucose, HbA1c, and LDL cholesterol). Due to unexpected changes in central laboratories and severe flooding, Year 3 data collection were delayed. A total of 3,314 participants (94.5%) attended Year 3 follow-up, including 1,650 and 1,664 participants in the Intervention and Control groups. Over 2 years of follow-up, participants in the Intervention group reported better health behaviours (physical activity, diet and smoking) than the control group. Although there was no difference in anthropometric indices and physiologic variables, i.e. blood pressure, between the two groups, those in the intervention group had lower fasting plasma glucose and HbA1c than those in the control group (Fasting plasma glucose 84.4±13.0 vs 85.6±14.3 mg%, p=0.015 and HbA1c 5.58 (0.57)% vs 5.63 (0.58)%, p=0.021 respectively) They had lower total cholesterol and triglyceride than those in control group (Total cholesterol 186.6±37.1 vs 189.6±37.1 mg%, p=0.028 and Triglyceride 147.0±80.6 vs 160.0±102.7 mg%, p<0.001) Overall the Intervention and control groups had comparable risk of diabetes. However, in the very high risk defined as having family history of diabetes and pre-diabetes blood sugar levels, participants in the intervention groups had a 37% reduced risk compare to the control groups (2-year incidence of 14% and 19%, relative risk 0.63 (95%CI 0.35-1.09), one-tailed p-value 0.041). In all participants, there was no difference in risk of worsening kidney function (defined as >25% reduction of eGFR) between two groups. In a subgroup analysis in female participants, the intervention group had 59% reduced risk of worsening kidney function (2-year incidence of 1.1% vs 2.6%, Relative risk 0.41 (95%CI 0.20-0.87)). The risk of mild cognitive impairment was lower in the intervention than control groups, with 2-year incidence of relative risk of 2.1% และ 4.0% respectively (relative risk 0.53 (95%CI 0.36-0.78), p=0.003). There was no difference in CVD risk over 2 years. In base case scenario of cost-effectiveness analyses, community-based 4x4 lifestyle modification program resulted in an ICER of 21,196 Baht per one case of diabetes prevented compared to normal practice. The ICER was 145,721 Baht per one case of worsening renal function and 129,530 Baht per one MCI case prevented. Further, a qualitative study suggested that key success factors of the project included community leaders, healthcare officers and common interest and engagement of community members. Participants strongly suggested the project to continue. Discussion: Albeit some delay, key milestones in Year 3 data collection, provision of the designed interventions and outcome ascertainment were achieved. In this short follow-up, With changes in key health behaviours and metabolic variables, this community-based multi-module and multi-level lifestyle modification was effective in prevention diabetes, worsening kidney function and MCI in high risk and some other particular groups and this might be cost-effective. Lessons learned from this community-based disease prevention project may be extended and adapted for other communities in Thailand. Crucially, the sustainability of this kind of project may be enhanced by more community engagement and continuing financial and non-financial supports from local administrative organizations.


location: , 'Thailand year: 2023 source: HSRI

title: Thai’s Health Behaviors and Their Associated Factors among Three Age Groups during COVID-19 Pandemic

abstract: Background and Rationale: COVID-19 control measures impacted on stress, alcohol, and tobacco consumption, including physical inactivity and sedentary lifestyle among populations. As age is a factor in the health belief model that affected individual beliefs throughout life-course, this study aimed to explore health-related behaviors by age groups during the COVID-19 pandemic, compared to the pre-pandemic. Methodology: A cross-sectional study was done among 7,731 Thai people aged 15 years and older, through multistage sampling of the total 13 health regions and proportionate to population size of selected provinces by three age groups (adolescent: 15-24 years, working age group: 25-59 years, and elderly: 60 years and older). Face-to-face interview captured changes in health-related behaviors (increase, no change, and decrease) then analyzed by ordinal logistic regression. Results: During the COVID-19 pandemic 33.3% of Thai people were current drinker, 18.3% were current smoker, 73.5% had sedentary behavior, 6.8% were physical inactive, more than 70% had vegetable and fruit in some meal/day, 77.0% had sugar drink, and 57.7% ate fast-food. Compared to pre-pandemic, 3 out of 8 behaviors were going in positive direction - alcohol consumption (27.0%), sugar drink (11.1%), and fast-food eating (12.7%) - whereas tobacco consumption, sedentary life, physical activity, and eating vegetable and fruit were going in the opposite direction. Negative directions happened among age group 15-24 years the most, followed by the 60 years and older. Taking the 15-24 years as the reference group, the working age and the elderly had less sedentary and physical inactivity, the working age ate fast-food more frequently and the elderly even more than among adolescent group. Also, elderly group had higher risk of eating less vegetable and fruit compared to adolescent group. The 15-24 years had the most 4 highest negative health behavior changes compared to pre-pandemic including sedentary life, less physical activity, more sugar-drink (p < 0.01), and more fast-food. Conclusion: During the COVID-19 pandemic, the adolescent had most negative health-related behaviors, whereas the working age and the older persons had higher risk of having fast-food than the adolescent. Government should further develop interventions specific to age groups. New interventions should create enabling healthy environments to adolescent and the vulnerable groups during the pandemic.


location: , 'Thailand year: 2022 source: HSRI

title: A Model of a New Normal Lifestyle of The Student in Late Elementary School in The Covid-19 Outbreak with School-Based Management in Seven Provinces, Upper Southern Thailand

abstract: Schools are places that are at very high risk of the spread of the COVID-19 virus and are made up of large numbers of people, including students, teachers or caregivers, and parents. Therefore, there is a risk of spreading the virus easily. In light of the COVID-19 pandemic, the subsequent closure of educational institutions has caused more than 1.5 billion students, or more than 90% of all students in the world, to be affected in the learning process. Objectives: to present educational management guidelines in preparation for the new normal that will occur after the COVID-19 crisis. Reasons for the importance of conducting research on a new normal living model of upper elementary school students in the COVID-19 outbreak with school-based management in the upper southern provinces This research model uses mixed methods, both quantitative and qualitative research methods. and qualitative research methods. The project started from June 1, 2021 to May 31, 2022. A participatory action research study was conducted. Participatory Action Research (PAR) together with qualitative data collection. by group chat the operation was divided into 3 phases by using the educational institute area to represent the upper primary schools in the upper southern provinces, totaling 7 provinces, one for each province using the selection criteria from the primary schools under the jurisdiction. According to the context and size of the school, OBEC or the municipality may apply for participation. It is a large school and teaches from kindergarten to upper elementary school in 7 provinces in the upper southern part of Thailand. Based on the above criteria, the 7 participating schools were: Kindergarten in Phang Nga Province and Kindergarten in Ranong Province. Chumphon Kindergarten Krabi Kindergarten, Phuket Kindergarten, Surat Thani Province and the Municipality International School Nakhon Si Thammarat, Thailand Sample calculation and sample selection (Sample size and sample selection) The study population consisted of primary school students in grades 4-6 and teachers in teacher schools in large primary schools in the 7 upper southern provinces; 4,635 grade 4-6 students and 712 teachers. A total of 5,347 people were included in the sample group. with qualitative data collection by group discussion with teachers and related people of students and schools, such as parents, Sub-District Administrative Organization health workers, health promotion hospitals, and parents, a total of 15 people per school. The sample group was calculated using the Kracy & Morgan formula, totaling 1,530/235, using a simple random sampling method, totaling 1,765 students. The objectives were to study the following data in upper primary schools in 7 provinces in the region. Thailand's Upper South 1) to evaluate the situational experience of adjusting to a new normal lifestyle during the COVID-19 outbreak 2) To develop and evaluate a new normal life model for upper elementary school students affected by the COVID-19 outbreak with school-based management, and 3) To pass on a new normal life model for upper elementary school students affected by the COVID-19 outbreak with school-based management. The majority of the students who received this research were female (54.5%), aged 11 years (29.28%), and in grade 6 (36.4%). Overall preparedness for management on the overall COVID-19 outbreak was high (74.0%) across all components, according to the DMHT-RC measure. Overall, 75.5 percent of students' health literacy was found. The average of all 6 components, which were at a relatively high level (60-80 percent), showed that the teachers had average scores in literacy and cognitive health, and the overall picture was at the most correct level (mean 4.97, SD = 0.86). Practices against the COVID-19 outbreak are at a high level (Mean = 93.24, SD = 15.41). In the second phase, the model school development activities were conducted by a participatory workshop for 10 hours, totaling 2 days of operation. Nakhon Si Thammarat volunteered to participate. There were 330 students in grades 4-6, 49 administrators and teachers to develop an epidemic prevention management model. COVID-19 to the new normal by using the school as a base, it was found that there were 3 development patterns, namely the full development model. full and standard. The program provides knowledge using four components: school management, Health Literate School (HLS) development, environmental management, and school safety (EH&S) and Participation and Partnerships The productivities including Handbooks policies model, measures model, and response plans of schools in the form of electronic media, posters, and e-books, it was found that in the second phase, the schools that developed the literacy program had the effectiveness of the program with the mean scores of the two groups that differed significantly higher than the other two formats. COVID-19 prevention behaviors and average knowledge score After the training using the school program, statistically significantly higher than before the program. In the third phase, from the study of factors affecting school readiness for school reopening using Binary logistic regression statistics, it was found that factors affecting school reopening of the primary school is the management of the school environment. by a school with a better managed environment is twice as likely to reopen as schools with poor environmental management (B = 2.047, CI = 1.428-2.934, P-value = .000). Due to the qualitative study results found under the theme requirements, new normal life (New Normal); risk communication. (Communication); Stakeholders and Networks; Disease prevention and control (Caution and Control); Health Literate School; Countermeasures to respond to incidents (Operating); organization management (Organizational practice); and policies, measures (Legislation) which can bring the development program to 3 The model can be applied in the school according to the school context in a variety of ways. and create sustainability by utilizing participatory development in four key elements to mitigate the potential negative impacts of future changes in the communicable disease situation. Survey information system for learning readiness in schools must be improved. Four areas must be addressed: policy implementation, management measures, health literacy development, environmental management and school safety. Spatial information for educational advancement, access to technology and preventative care for security and cleanliness should be used.


location: , 'Thailand year: 2010 source: HSRI

title: Working and Social Life of Informal Workers and Impacts on Health: A Case Study of the Sewing Group of Ban Meng Subdistrict, Nong Ruea District,Khon Kaen Province

abstract: The purpose of this study was to explore the quality of working life among workers in Ban Meng
subdistrict. This included career initiation, finding jobs to work at home, the working environment, and
coping with health and other problems concerning informal working conditions. The main data of this
qualitative research were collected from a community survey, observation, interviews, and in-depth interviews.The study revealed the local value placed on the sewing vocation, which had been transmitted to
people in the community from previous generations. The condition of employment, which was influenced
by their economic situation, competition in production supply, and external trading, had strong
impacts on the vocational security of the workers in the context of exploitation, negotiation, and resistance
regarding employment. These impacts included health and social problems resulting from bad working
conditions and environment, as well as improper health behaviors. The study also found that the
family, the community, and working network were the most important parties that participated in the
health care of the workers.
This study recommends a model of quality-of-life improvement among the workers in the community.
This will be accomplished through group creation, strengthening the capacity of local organizations,
community, and other agencies in order to gain skills in management regarding career, health, and social
welfare suitable for each situation and necessity.


location: , 'Thailand year: 2020 source: HSRI

title: Efavirenz WHO PQ: A case study of a public-private collaboration for technology transfer in production and quality control

abstract: Background: Technology transfer involved the transfer of knowledge and technical know-how, as well as physical devices and equipment. There have been several factors influencing success. Objective: This study aimed to draw the lesson learned from the Government Pharmaceutical Organization (GPO) and Mylan technology transferring to achieve accreditation by the WHO Prequalification Programme (WHO PQ). Methods: Qualitative research was used. The information was collected by studying the documents published officially and non-officially, and in-depth interviews were conducted with selected key informants relevant to this technology transfer. Then a content analysis was performed. Results: GPO has inherited technology from Mylan, India's leading generic company. Until GPO can produce and control the quality of antiretroviral drugs Efavirenz and certified by the World Health Organization. The important conclusions of this study were as follows 1) The important policy decisions included the policy that impels GPO to be accredited by WHO PQ and the one that GPO decided to collaborate with the Mylan. 2) The success factor was the good relationship between the technology transferor (Mylan) and the technology transferee (GPO). This relationship motivated the intent teamwork between GPO and the Mylan in production as well as quality control that led to accreditation by WHO PQ. The country's supporting factors included the universal health coverage policy, the support of AIDS problem solving by producing HIV antiretroviral drugs in the country, GPO's capacity, and implementing the ‘Sustainable Potential Development Plan in Thailand, Section: WHO Pre-qualification Scheme ’in B.E. 2554. The international context also contributed. For instance, WHO has the Global Fund's approval to support the developing countries with a pharmaceutical production capacity in terms of technical assistance. So those countries can enhance the quality to the level recognized to provide antiretroviral drugs for the projects in several countries in which the procurement can be made using the Global Fund budget. 3) The obstacles that made GPO spent over 17 years to be accredited by WHO PQ, including the GPO's lack of readiness in several aspects. Such as locations, new facility procurement process, designs, technology choice, human resources as well as the GPO management system, causing the executives and committee in some periods paid attention to other issues. According to the lesson learned, forming a new team combining with a new work culture that developed effective teamwork where every member harmoniously works towards goal as well as the support from executives in several periods have contributed to the eventual WHO PQ project accomplishment. That momentum empowers GPO to set up high quality and vigorous work system for pharmaceutical products in the overall appearance of the organization and its personnel until GPO can create an image in the international market for earning trust in the GPO’s products.


location: , 'Thailand year: 2003 source: HSRI

title: The potentials of mass media in health promotion

abstract: The Potentials of Mass Media in Health PromotionThe objective of the research is to review the potentials of mass media in representing health issues in Thailand.  The research are incorporated with 3 projects: The review of the status of the body of knowledge on mass media in health promotion in Thailand and other countries; the health agenda setting process of Thai mass media; The lessons-learned analysis of the health media campaign implementation in the context of campaign against AIDS, Dengue Haemorrhegic Fever prevention campaigns, Anti-Drugs campaign,  and Anti-smoking campaigns.   Documentary research, depth interviews, and ethnographic future research were implemented in order to collect data.	Research results indicate that:Mass media is one of the channels to disseminate health information to the publics.  In case of using mass media as the major communication channel, it is necessary to have a strategic plan and to consider the real potentials of mass media. Only mass media cannot lead to the desired behaviors; however, mass media need to be incorporated with other forms of media in order to achieve the goal. The health agenda setting process of Thai mass media shows that the government sector, the business sector, and the civic sector are competing to seek call attention from the media.  However, mass media are the major factor in decision making process, by considering to the movement, the hotness of agendas, and media producer factor.  Before presenting the agenda to the publics, all media will construct the reality at different degrees, dependent on the budget and information dependency, nature of mass media, and the ideology of the producer.The major components of media health campaigns include: (1) The personal/ organizational component —  leaders, partners;  (2) The process component —goals, target groups, information/themes, communication channels, communication strategies, and research;  (3) The system component — the development of the support for the potential of the community to run the local campaign, the cooperation with partners to develop other systemic measures in the society.The media health campaign in Thailand have 5 styles: A specific activity, a core and provincial teams, a main team and its partners, an office and its agents, an organization and its advocacy.The working process between a campaign team and mass media in Thailand include 7 styles: a step-by-step contact, a request for support, a partnership cooperation, a media buying, an information provider, a movement creator, and a heart-to-heart connection.Factors that lead to the effectiveness of media health campaigns in Thailand include (1) The personal/ organizational component —  a capacity of the leader to cooperate with partners, an avoidance to make foes, various partners, clear understandings about roles and responsibility of partners, proud feelings of partners to be a part of the campaign, good relationships with media and political partners. (2) The process component – A campaign without any announcement that it is a campaign,  a continuity of the campaign, a systematic planning, a smoothness of campaign implementation, measurable goals, a treatment of target groups as partners and a support for target groups to work as communicators or to run a horizontal campaign, enough information, a link between the information and Thai context, an appropriate design to save data, skills to present the information in the public,  various communication channels, a creativity to put the information in the media in a short period of time, a presentation of direct experiences of those who face the problems, uses of personal media to give information, an easy-to-understand, closed-to-the public, and concrete information, a formative research, a pre-testing process. (3) the system component – policy advocacy, the support of international movement.Factors that bring obstacles to the campaigns include:  (1) The personal/ organizational component – a treatment of the campaign as only a specific activity or an unimportant activity, an emphasis on image making, an uncooperative work between organization (2) The process component – the campaign management by depending on the top-down approach, by sticking to the budget or to the board members,  the complex information/themes, unorganized information, difficulty in thematic creation, no deep understanding of the problems, a message design without careful thought of the situation, a CEO acting as a creative, a creativity without understanding of the development of target groups, the dependency on mass media only, the emphasis on media strategies but not on message strategies, the emphasis on chic words without the real concept (3) The system component – the problem of a more emphasis of benefit side of the mass media, a restriction of the air time-sharing regulation, an agenda setting process of the media, an impact of personal arrangement in the media, a competition in media placement, and an ineffective relationship network among social members.Therefore, in order to run the effective campaign in the future, those who implement the policy should consider health campaigns as the public policy, support community-based campaigns, seek to cooperate with the partners in mobilize other policy measures and campaign measures. In terms of campaign management, partnership approach, the participatory process in intergrated campaign planning,  the development of campaign organizations and health information centers are necessary. In addition, the media buying process should be implemented under the learning process between campaign organizations and media organizations.  In terms of campaign implementation, the two-way communication with an open dialogue at all levels, the balance between communication through mass media and other channels, and the research-based decision making process are necessary.  In addition, health media advocacy campaigns should be promoted.