location: , 'Thailand year: 2022 source: HSRI

title: Policy Recommendation for Model Development of Health Services System and Appropriated Environment for Elderly People in Town Municipality

abstract: The research objective of project “Policy Recommendation for model development of health services system and appropriated environment for elderly people in Town Municipality” were to 1) develop the health and environmental services for the elderly in Pathum Thani municipality and Khelang Nakhon Municipality, 2 ) evaluation of health and environmental service arrangements for the elderly in Pathum Thani Municipality and Khelang Nakhon Municipality and 3) synthesize policy recommendations on providing appropriate health and environmental services for the elderly in urban communities. Study design was conduct with AIC- Participatory Action Research. Qualitative data was collected from community leaders, health volunteer’s worker and government workers. Quantitative data was collected from 1,399 elderly people from Pathum Thani Municipality and 1,912 in Khelang Nakhon Municipality. The results showed that the development of health services system and appropriated environment for elderly people in Town Municipality are difference between Pathum Thani Municipality and Khelang Nakhon Municipality. The model proposed by Khelang Nakhon Municipality are to proactively organize health services for the elderly, organize recreational activities regularly, educating the elderly, setting up funds for elderly, establishing goodness banks, promoting the careers of the elderly care for the neglected or unsupervised elderly, improve the home environment, reshape and lighting of the house, provide suitable and safe shelters such as railings. While Pathum Thani Municipality proposes a model for patient referral system, EMS emergency operations centers express health volunteers to check in regularly with bedridden patients, creating value for the elderly by exchanging learning activities and earning money, find a model for sale promote the ability of caregivers to be elderly at home, organize communities, provide a conducive environment for learning for the elderly, such as online learning and assessing the environment in the elderly's home to be safe. The result of evaluation of health and environmental service arrangement models for municipal elderly found that blood glucose levels, blood pressure, body weight, body Mass Index in elderly people of Pathum Thani Municipal higher than the municipality of Khelang Nakhon, except muscle mass. Elderly people in Pathum Thani Municipality could normally defecation and urination around 90-94%, while the elderly of Khelang Nakhon Municipality the ability to defecation and urine normally 96-97 % Mental health problems in the elderly of both municipalities showed 56-62% of elderly people had the same mental health as the average, 17-21% better mental health than the average person, 19-21 % lower mental health than the average person. For depression problem in the elderly found 97% of elderly people are satisfied with their lives right now. Around 14-15% of elderly feel empty life, 12-15% feel frequently bored, 14-17% are constantly anxious and unthinkable, 21-23% have anxiety about life ahead, 17-21% is feel not as good memory as others, 7-8% feel discouraged or sad, and 5-6 % feel life is worthless. Quality of life status result found that elderly people are satisfied with their health now to a considerable extent. Around 6 2 - 6 7 % were most satisfied with sleep. 68-72% feel moderated satisfied in life (e.g. happiness, peace, hope). 65-81% feel a very high level of self-satisfaction and 65-68% as well as high satisfaction in other quality of life. Satisfaction on the appropriate health and environmental service model for the elderly of both municipalities is satisfied with the development process of the service model, but the implementation of the service model has not been fully implemented due to the complexity of the operation and requires public participation. This includes integrating work from different sectors, which must be conducted continuously. Religiously relevant activity patterns can incentivize older people to come out and participate. For environmentally safe housing arrangements in Kalen Nakhon Municipality Seven elderly people received municipal funding to repair toilets and stairs. For the municipality, Pathum Thani has not yet undertaken to explore a safe housing environment for the elderly. The Policy recommendations on providing appropriate health and environmental services for the elderly in urban communities including development of local government potential, integration of health information between local governments and health authorities for the development of the elderly services system, specify of qualifications and potential of public health volunteers, promoting supports public participation in elderly people and providing safe housing. Moreover, enhancing the use of health insurance fund budgets at the local level and push the role of educational institutions in creating initiative-taking changes in healthcare provision for local elderly people.


location: , 'Thailand year: 2012 source: HSRI

title: Increasing access to high-cost medicine under the 2008 National List of Essential Medicines (NLEM): from policy to practice

abstract: Objectives: to study the process of implementation of the increasing access to high-cost medicine
listed in the Category E2 of the 2008 NLEM policy to practice under public health insurance systems: the
Universal Health Coverage scheme (UC), Civil Servant Medical Benefit Scheme (CSMBS), and Social Security
Scheme (SSS) and in hospitals as well as to explore factors that promote policy achievement and
problems occurred during policy implementation. Methods: A qualitative approach was employed including
review and analysis of relevant documents. In-depth interviews and focus group discussions
with stakeholders, who involved in the Category E2, were conducted. Results: 1) The policy implementation
under public health insurance schemes: The NLEM subcommittee created the Category E2 guidelines
including other rules and regulations for the three public health insurance schemes to follow. However,
the UC was the only scheme which developed its internal regulations related to the Category E2.
Moreover, it was also found that the three public health insurance schemes had implemented some projects
to increase access to some medicine listed in the Category E2 before the policy initiation. Also, these
projects were, in some respects, managed differently from the rules and regulations of the Category E2
policy. 2) The implementation of the Category E2 policy in hospitals: Most administrators, clinicians and
pharmacists who involved in this study agreed with the policy of increasing access to expensive medicines.
The implementation of this policy would reduce hospital expenditure on medicines particularly
medicines for patients who were covered under the UC and promote a rational use of the medicine under
the clear guidelines. However, the rules and regulations regarding the Category E2 that developed by the
NLEM subcommittee and the three public health insurance schemes could cause problems in practice
because it may introduce confusion and various management systems in hospitals. There were also some
problems of compliance with the rules and regulations of the UC and prescription for people under the
CSMBS coverage. These problems were obstacles for patients’access to medicines listed in the Category
E2. Conclusions and suggestions: Policy implementation of increasing access to the Category E2 to practice
faced many barriers. Coordination among the NLEM subcommittee, public health insurance schemes,
and hospitals as well as policy monitoring and evaluation were necessary and facilitated the success of
policy implementation.


location: , 'Thailand year: 2001 source: HSRI

title: Process and outcomes study on rehabilitation service for hemiplegic patient causing by stroke at the Sirindhon National Medical Rehabitation Center

abstract: Process and Outcome Study on Rehabilitation Service for Hemiplegic Patient Causing by Stroke at the Sirindhorn National Medical Rehabilitation Center Stroke or Cerebrovascular disease (CVD) is the main leading cause of health problem among Thai population.  The advance medical technology help the stroke victims to survive longer with another kind of problem, physical impairment and disability.  Rehabilitation is another health care intervention which play a major role in restoring physical function and supporting them to return to their own home.	The study objective is to analyse the process and outcomes of the in-patient stroke rehabilitation of the Sirindhorn national Medical Rehabilitation center.  It was found that stroke with hemiplegia took about 25 percent of the total nuber of admission.  One hundred and thirty-seven stroke victims were admitted 166 times within five years (fiscal year 1995-1999) while 111 admissions (cases) was recruited.	Among 111 cases, the ratio of male:female was 3:2 whereas the mean age was 60.67+11.96 years (95%CI.= 58.42-62.92 yrs.).  Those were left hemiplegia 2-3 times more than right hemiplegia.  Seventy-five percent of those could be determined the type of CVD which showed that infarction is 2 times over than haemorrhage.	The average length of stay (LOS) was 44.22+28.36 days (95%CI. = 38.88-49.55 days) while 7 and 150 days were used as the trimming points.  When the trimming points were substituted with 13 and 84 days, the average LOS became 42.31+19.11 days (95%CI. = 38.18-46.43 days)	According to the outcomes study, 13/48 cases of the year 1999 were recruited.  It was shown that 10/13 cases were partial independent in performing the activities of daily living while 7/13 cases could walk independently.  Moreover, the qualitative data of 4 selected cases pointed that they are still seeking for the treatment and rehabilitation which might cure the disability.  Most of the costs for such a health care process were the family's out of pocket money.	The results of the study revealed the deficiency of the health care system such as; lacking of the standard of stroke rehabilitation service, non-systematic and unreliable medical record, lacking of the outcome measures for monitoring and evaluation etc..  It was suggested that the quality improving process should be implemented especially at the Sirindhorn National Medical Rehabilitation center, the only national medical rehabilitation institute in Thailand.


location: , 'Thailand year: 2013 source: HSRI

title: Development of Thailand’s population-based screening package

abstract: Population-based screening is one of the public health services that attempt to identify people at risk
of, or are already affected by, a disease. A number of health screening tests have been publicly funded in Thailand without rigorous assessment of scientific evidence. This study aims to develop an appropriate
population-based screening package in Thailand through a transparent, systematic, and participatory
process. Health problems were prioritized through a consultation meeting among stakeholders and reviewed
for their screening tools. The results were appraised and deliberated for consensus. The final
recommendations for appropriate population-based screening package include screening hepatitis B surface
antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) for hepatitis B virus infection; complete
blood count (CBC) or hematocrit level (Hct) for anemia in infants; fasting plasma glucose for diabetes;
global risk scores for coronary heart diseases; pulse palpitation for atrial fibrillation; body mass index for
malnutrition; Pap smear or VIA for cervical cancer; ASSIST for alcohol dependence; provider-initiated
voluntary counseling and testing for HIV infection; and visual acuity for traffic accident. Two screening
tests were recommended for self-examination: measurement of weight and height for malnutrition; and
calculation of waist-to-height ratio for obesity.


location: , 'Thailand year: 2022 source: HSRI

title: Understanding the challenges to develop monitoring and evaluation framework for COVID-19 vaccination policy in Thailand

abstract: COVID-19 vaccine has been an important measure to support sustainable control of the COVID-19 pandemic situation and has influenced policy decisions to relax other measures that hinder the development of the country socially and economically. Monitoring and evaluation framework for COVID-19 vaccination policy in Thailand is therefore an important tool for policy planning and mitigation in response to the COVID-19 pandemic. This study aims to understand the challenges in order to develop monitoring and evaluation framework for COVID-19 vaccination policy in Thailand. The main objective of this study was to develop an evaluative standard indicators which can be used to monitor and evaluate different aspects of the COVID-19 vaccine policy in Thailand. The specific objectives are: 1) to understand COVID-19 vaccine hesitancy situation among healthcare workers in Thailand; 2) to collect and collate any related indicators for the successful evaluation of the COVID-19 vaccination policy from the experience of ASEAN countries; 3) to estimate the budget required for the monitoring and evaluation of the real world effectiveness of COVID-19 vaccine; and 4) to develop monitoring and evaluation indicators for COVID-19 vaccination after their arrival in Thailand. Multiple research methodologies were employed to respond to the abovementioned objectives. Online survey was conducted to understand the issue of vaccine hesitancy among healthcare workers, foreign migrant workers, and the general public population. Additional field work was carried out for foreign migrant workers about their views on COVID-19 vaccine hesitancy. Multivariable regression analyses were executed to analyze the survey data. In addition, a scoping review on the monitoring and evaluation framework of other existing vaccines was conducted to understand the landscape of monitoring and evaluation frameworks used in other countries and settings. Moreover, the stakeholder consultations in Thailand and ASEAN countries were organized to obtain lessons learned and to disseminate the findings on resources needed in preparation for vaccine’s monitoring and evaluation program. The results showed that all study populations had some degree of vaccine hesitancy, particularly among healthcare workers. However, the study discovered that the level of hesitation subsided when the COVID-19 vaccines finally arrived in Thailand. Furthermore, foreign migrant workers were the least reluctant group compared to the healthcare workers and the general public. Significantly, the roundtable meetings among representatives of ASEAN countries emphasized the lessons learned on COVID-19 vaccination administration guidelines of each country including COVID-19 vaccine management guideline and vaccination assessment. In addition, the results of scoping review and stakeholder consultations suggested that the indicators for monitoring and evaluation framework can be summarized into three pillars: 1) vaccine coverage indicators; 2) clinical and operational indicators; and 3) operational indicators and others. Overall, the aim of this research was to provide evidence to support policy makers in planning for the post-vaccination period on vaccine hesitancy and indicators to support the monitoring and evaluation of COVID-19 vaccine. This research project uses COVID-19 vaccine as an example with hope that the findings may support future work for other diseases and in similar settings.


location: , 'Thailand year: 2021 source: HSRI

title: Quality improvement of management of multidrug resistant tuberculosis (MDR-TB) using electronic MDR-TB registry

abstract: Background: An electronic tuberculosis (TB) registry, accessible over the internet is useful to accumulate all TB-related patient data and apply best practice standards to produce accurate treatment decisions. The study aims to develop the electronic case-based MDR-TB registry that can be used to improve patient care by systematically monitoring the treatment response and drug adverse events following the design schedule. Methods: This is a pre-and post-intervention study, conducted at Makarak hospital, a district of Kanchanaburi province located in the west of Thailand. This hospital was selected based on a higher rate of MDR-TB reported over the past decade since 2002. The primary objective was to increase success rate of MDR-TB treatment after using eMDR-TB registry. Eligible patients were adult > 18 years, diagnosed with MDR-TB since October 2015. Electronic MDR-TB registry was developed in the cooperation with Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS) and Ministry of Public health in data management software. The sample size needed to determine the outcome was 112 patients or 56 patients in each group, comparing between those already completed or starting treatment before using eMDR-TB registry and those who were newly diagnosed after using eMDR-TB registry. Results: A total of 164 MDR-TB patients were diagnosed between October 2015 and June 2020: 148 cases who were already treated MDR-TB before using registry and 16 cases who were using assessment and monitoring with eMDR-TB registry. The median duration of treatment of those do not use (no registry) and use registry were 18.7 months and 6.6 months, respectively since the treatment of use registry group is still ongoing. The median age of all patients was 55 years and 58% of patients were male and 56% of patients had at least one comorbidity in which diabetes mellitus was the most common and also more common in use regisytry than no registry group. The proportion of smear and culture conversion within 6 month were 77% and 79.4%, respectively. Time to smear and culture conversion of all patients was 69 days and 77 days, respectively. The patient in use registry group had a significant shorter time to sputum conversion than no registry group (67 days vs. 81 days, p=0.029). Among 148 cases in no registry group who had the outcome at the end of treatment available, only 45% were cure or complete treatment, 28% died mostly within 6 months and 10% were lost to follow-up. A higher proportion of use registry group are still receiving treatment than no registry group (81% vs. 69%) and had a lower proportion of death within 6 months (12% vs. 22%). The treatment duration of survived and death patients were 610 days and 70 days, respectively. There were 70% of patients experienced hypokalemia, 37% had hypothyroidism, 31% had acute renal injury and 20% had abnormal audiometry. Laboratory parameters have been checked as planned for at least 80%. Hypokalemia and hypothyroidism had been observed more commonly in no registry group whereas hyperuricemia and abnormal audiometry were found more commonly in registry group. Factors associated with mortality were older age, low body weigth, HIV infection and stroke. Body mass index less than 18.5 kg/m was an independent factor of death from cox regression. Conclusion: A more comprehensive and holistic approach in management of MDR-TB particularly in the first few months or in patients with high risk of death are needed to reduce the mortality and possibly improve the patients’ adherence until the end of treatment.


location: , 'Thailand year: 2007 source: HSRI

title: Effect of Acupuncture Treatment of Diabetic Peripheral Neuropathy

abstract: The objective of this experimental study was to evaluate the therapeutic effect of
acupuncture on diabetic peripheral neuropathy (DPN) in 40 diabetic patients attending
the Diabetes Clinic of Laungpoh Pern Hospital; the methodology used simple random
sampling technique. Twenty patients served as the group studied, receiving acupuncture
and the remaining 20 cases acted as a control group. Both groups received the same
conventional treatment from the hospital. In both groups, the degree of foot numbness
was measured and recorded, using Semmes -Weinstein monofilament one week before
and one week after the study period of four weeks (equal to the twice-a-week application
of eight acupunctures). Statistical comparison of the therapeutic results in individual
groups, and between the acupuncture-treated and the control groups were made by
using the t-test.
The results showed a statistically significant improvement of the numbness symptoms
in the experimental group compared with the control group (p < 0.05). Therefore, it
was concluded that acupuncture has a supplementary therapeutic effect on DPN in addition
to the conventional treatment.


location: , 'Thailand year: 2008 source: HSRI

title: Practical Guidelines for Managing Diabetes Patients with Hypoglycemia at Phayuhakiri Hospital

abstract: The objective of this study was to create an appropriate care guideline for diabetic
patients with hypoglycemia at Phayuhakiri Hospital. The methodology included a literature
review, knowledge sharing with other community hospitals and diabetes mellitus
specialists, after which a care guideline for diabetes with hypoglycemia was developed.
All diabetic patients hospitalized for hypoglycemia during the period October 2005 - September
2006 were enrolled in this study. Mortality, readmission rates of recurrent hypoglycemia,
knowledge, self-caring behaviors and support from relatives before and after
the intervention were compared. The findings showed that these new practices reduced
the hazardous consequences of hypoglycemia, such as death or recurrent hypoglycemia;
patients and relatives developed better knowledge in preventing hypoglycemia
and had more appropriate responses to hypoglycemia symptoms. This care guideline
has been implemented in Phayuhakiri Hospital since fiscal year 2007. The pitfalls found
in this guideline will be adjusted in order to obtain more efficient care.


location: , 'Thailand year: 2017 source: HSRI

title: Health Policy Process and Success in Expanding the Health Benefit Package of Universal Coverage Scheme: A Case of Liver Transplantation in Children with Biliary Atresia

abstract: Health benefit under the Universal Coverage Scheme (UCS) in Thailand is a comprehensive
health package, with a few services on the negative list; for example, organ transplantation including
liver transplantation in children with biliary atresia.
Since 2011, liver transplantation in children with biliary atresia has been approved for UCS’s
health benefit package. All key actors involved in the health policy process of this new approval
including beneficiaries, health care providers, professional, and academics. This decision making is
an example of evidence-informed health policy explicitly including health need analysis, cost-utility
analysis, long term budget projection, and readiness of service delivery system.
As providing access to effective health care services when needed and protecting household
from catastrophic illness expenditure are key functions of public health insurance and UCS. This article
illustrated the health policy process of including the rare disease with high cost care (a case of
liver transplantation in children) into the health benefit package under UCS considering the threshold
for affordable and worth investment. Besides, critical success factors for the process of evidence-informed
health policy and enabling factors for moving health policy into implementation were discussed
in this paper.


location: , 'Thailand year: 2008 source: HSRI

title: Technical Efficiency of Community Hospitals : A Case Study in Khon Kaen Province

abstract: The propose of this study was to evaluate technical efficiency of twenty community
 hospitals in Khon Kaen Province, Thailand. The number of patients and the resources provided by
 Khon Kaen Provincial Public Health Office since 2005 were analyzed using the data envelopment
 analysis (DEA) method. The study revealed that, four medium-sized community hospitals (30-60
 beds), located in areas populated with more than 60,000 inhabitants, were highly efficient, while
 those of the small-sized community hospitals exhibited very low efficiency indices. It noted
 that the patient/resource ratios among the efficient hospitals were significantly higher than those of
 the inefficient hospitals, suggesting that they ware efficient in using the resource provided.


location: , 'Thailand year: 2014 source: HSRI

title: Factors related to data quality of outpatient services, health promotion and disease prevention (21 standard folders) of Tambol Health Promoting Hospital Officers in Chon Buri.

abstract: This study is a descriptive study (descriptive research) where qualitative data is collected (qualitative method). The objectives are to study processes, factors and obstacles related to the data quality of services provided for outpatients, health promotion and disease prevention (21 standard folders) of Tambol Health Promoting Hospital personnel in Chon Buri. Data were collected using    in-depth interviews from of 20 participants who served on the preparation of health information of Tambol Health Promoting Hospital in 10 districts. By selecting 2 personnel who prepared 21 standard folders reports with the highest and lowest data quality in each district then the data were analyzed (content analysis).
The study found that: 1) the preparation of the information; the group with high scores, recorded data in real time, recorded the required personal information, backed up data daily, checked for accuracy and completeness of the reports and gave feedback if error(s) found. If the responsible personnel were unavailable, other personnel could interchangeably export the reports within specified time. Those with low scores, some did not record data daily and recorded by temporary employee and could not take advantage of the data. 2) Factors related to data quality including; the personnel have a positive attitude towards the preparation of the information, understand the structure of the folders, received training, responsible and circumspect, a number of staff and workload were reasonable. Budgeting and up-to-date equipment were adequate. Management executives are key factors to monitor and encourage to record accurate data and check the completeness of the data. 3) The obstacles including; some data recording personnel lack of knowledge because they have not been trained, no personnel to interchangeably export data, computer break down and unable to connect to the internet.


location: , 'Thailand year: 2019 source: HSRI

title: Development of Integrated Care Model for Children with Attention Deficit Hyperactivity Disorder among Health Care_x000D_
Professionals, Parents, and Teachers (Year2)

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


location: , 'Thailand year: 2022 source: HSRI

title: Health Service Model and Experiences Towards HIV/AIDS Health Care Follow Up in Pre-and During COVID-19 Pandemic Among Infectious Disease Physicians, Nurses, and People Living with HIV/AIDS in the 5th Health Service Region

abstract: This qualitative study employed a phenomenological approach and aimed to understand experiences towards HIV/AIDS medical and nursing service during the COVID-19 pandemic among people living with HIV (PLHIV), and healthcare providers. This study also explored medical and nursing service model of HIV/AIDS follow-up during the COVID-19 pandemic. Narrative interview and group interviews were conducted among 34 participants (14 health providers (nurses, pharmacists, and public health workers), 14 PLHIV, and 6 physicians) from April 2021 to February 2022 in the hospitals of the 5th health service region, Thailand. Interviews were audio-recorded, transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis The finding was showed medical treatment in HIV-AIDS patients before the COVID-19 epidemic period. These are included a medical treatment plan in the hospital and an Out-of-hospital care plans. A medical treatment plan in the hospital is a primarily assessed from the patient's symptoms which are included patient who has an unstable or uncontrol symptoms and require a close supervision for further assessment. In addition, patients who need a follow-up appointments or clinical visits should be assessed for a period of time, such as physical examination, blood tests and other necessity examinations. An Out-of-hospital care plan is a treatment that joint decision between service providers and patient and focused in patient centered care. The finding was showed medical treatment in HIV-AIDS patients in the COVID-19 epidemic period. The result revealed that there were three primary themes, including: (1) new normal in HIV/AIDS medical and nursing service during the COVID-19 pandemic, (2) participative management of HIV/AIDS medical and nursing service during the COVID-19, and (3) factors contributing to succeed of HIV/AIDS medical and nursing service delivery. In theme 1, interview data revealed four subthemes pertaining to new normal of HIV/AIDS medical and nursing service during the COVID-19 pandemic: (1) reducing HIV/AIDS medical and nursing service step, (2) rotation of PLHIV group service, (3) using alternative methods to get medications during the COVID-19 pandemic, and (4) modification of HIV/AIDS medical and nursing service environment. During the COVID-19 pandemic, the participants stated that their quality of life has not changed. Additionally, the COVID-19 prevention measures (i.e., wearing face mask, hand washing, and avoiding crowded places) were extremely practiced. In theme 2, interview data demonstrated two subthemes regarding participative management of HIV/AIDS medical and nursing service during the COVID-19: (1) communication within the organization to reach mutual understanding, and (2) networking. In theme 3, interview data demonstrated three subthemes regarding factors contributing to succeed of HIV/AIDS medical and nursing service delivery: (1) effort of team members to deliver excellent service, (2) administrator’s support, and (3) awareness of self-management among clients. This study provides a backdrop for the implementation of nursing interventions that will be designed to reshape flexible medical and nursing service for Thai PLHIV during the COVID-19 pandemic.


location: , 'Thailand year: 2008 source: HSRI

title: Factors Influencing the Retention of Medical Graduates of Khon Kaen University in a Northeastern Community Hospital

abstract: This research was aimed at investigating the reasons for and the motivation of medical graduates of
Khon Kaen University choosing to work in community hospitals in northeastern Thailand after completing
their compulsory three-year bonded period of work. The population comprised 557 physicians who
had graduated during the years 1979-2003. A total of 233 samples were selected by stratified random
sampling and the data were collected by questionnaire. The research findings were as follows:
1. The factors that were significant in the retention of medical graduates who were working in
community hospitals in northeastern Thailand were the usefulness of knowledge of the community, the
preference for rural life and the requirement to work in/near their place of birth, respectively. To compare
the retention factors, the subjects were classified by sex, type of entrance, age range, grade and work
place. It was found that (1) male medical graduates prefer to work in administrative jobs compared with
female medical graduates, and (2) medical graduates who were working in community hospitals prefer to
work in administrative jobs rather than medical graduates working in a regional hospital.
2. The significant factors to support medical graduates who worked in community hospitals were
the extra money, improvement in hospital facilities and physical social welfare improvement, respectively.
3. The order of magnitude of the factors for choosing or changing the location of work was related
to postgraduate education, children’s education and individual factors, such as distance from home, quality
of life, etc. In making a comparison of the factors, the graduates could be classified by sex, type of
entrance, age range, grade and workplace as follows : (1) male medical graduates gave a greater priority
to their children’s education than their female peers; (2) medical graduates who had gained entrance by
quota gave greater priority to postgraduate education more than the other group; (3) medical graduates
who ranged in age from 44 to 53 gave greater priority to the management system than those in other age
groups and medical graduates who ranged in age between 34 and 43 years gave greater priority to postgraduate
education and their children’s education than any other age group; and (4) medical graduates
who were working in community hospitals gave greater priority to their task than the other group.


location: , 'Thailand year: 2013 source: HSRI

title: The cost-effectiveness of population-based screening for alcohol use disorder in Thailand

abstract: Alcohol consumption is one of the major disease burdens in Thailand, particularly in Thai male. It is
believed that screening, with a brief intervention, can reduce the prevalence of alcohol abuse. The study
aims to evaluate the cost-effectiveness of the Alcohol Use Disorder Identification Test (AUDIT) or Alcohol,
Smorking and Substance Involvement Screening Test (ASSIST) in detecting alcohol abuse disorder in
the Thai population, followed by a brief intervention, via a decision tree model. The effectiveness of the
program was expressed in terms of the number of life-years gained from the reduction of alcohol consumption.
The results show that alcohol screening, followed by a brief intervention, saved cost while
contributing to the gain of population’s life years. Screening in a younger population was more costeffective
than in an older population.


location: , 'Thailand year: 2022 source: HSRI

title: Capacity Building Programs for Street Teachers

abstract: The purposes of this project are 1) to develop the potential and train the knowledge, cognitive skills for working with children and youth, 2) to synthesize the working knowledge of street teachers and vulnerable children, 3) to identify the system constraints, and 4) to push for policy recommendations to address vulnerable children by collecting data on 30 teachers from various organizations throughout the country. Results of this study showed that the problem of vulnerable children, especially tramp children that faces with different problems than most vulnerable children, such as rights to education, rights to medical care, psychiatric problems from domestic violence, sexual harassment issues, and problems of the judicial system, etc. Therefore, the street teachers need to have assistive skills that are consistent with the quality of life of children in all aspects. The development of teachers' potential is to equip with weapons as how to make the work of street teachers to be publicized to others, and will help them when it comes to difficult problems for empowering themselves, as well as in academic dimensions, teachers should understand the complexity of these social conditions and take it for useful, build stability and career path of street teachers amid the hard work of helping vulnerable children. The life of the street teachers was also difficult as same as the children because working with the heart and physical strength requires the support that is like the wind beneath their wings for these teachers. But in facts, the street teachers are in conditions of insecurity at all, including problem of budget issues that are used to fund for working with children, budget for living on their own, and career path of teachers in the future. Therefore, the conclusions and policy recommendations of this project have as follows: 1) how to make mechanisms be recognized and developed into concrete mechanisms for organizations and their respective sectors such as local administration organizations, non-governmental organizations (NGOs), government agencies, and civil society. Moreover, the street teachers and others working like them, should have stable work spaces, having support systems for capacity building and appropriate tools in order to ensure the society will have more efficient and sustainable systems and mechanisms to address the problem of vulnerable children, 2) the development of street teachers is not only the personnel development, but also the need to connect networks to learn from various lessons. Therefore, street teachers shouldn't have to work alone but should be a strong network partners group which will help the work of street teachers are more efficient due to the problem of vulnerable children are associated with many contexts, so it requires cooperation as a support network partner. However, the network partners should take place seriously and continuously, 3) They should focus that initiating the development of street teachers will affect to the recovery, social reintegration and vulnerable children's survival. The group of street teachers is a key that able to reach this group of children the most. Therefore, it is very important to create a process of engagement with local people in order to properly implement preventive and corrective actions, and 4) problem-solving that emphasizes the role of coordinating with the community is another mechanism that street teachers must have a role to play in work integrating among local practitioners then it led to find out the problem-solving that are practical in the area. These are mechanisms of network adaptation in horizontal that will be driven in the prevention and resolution of problems of children and youth in understanding the rapidly changing situation as well as immunization before other problems will arise and able to solve the problem effectively which this will be a guideline to create sustainability in the future.


location: , 'Thailand year: 2015 source: HSRI

title: Implementation and Compliance with World Health Organization Surgical Safety Checklist in Government and Private Hospitals in Thailand for Quality Improvement and Safety among Patients Undergoing Surgery

abstract: Background: The WHO surgical safety checklist (SSC) has been globally implemented including Thailand to reduce preventable surgical adverse events. However, it has no national data of SSC implementation in Thailand. This study aimed to evaluate the use, the compliance, the satisfaction, the obstacle, and problem solving of SSC implementation.
Methods: A mixed methods, quantitative and qualitative methods, descriptive study was conducted between November 2013 and February 2015 in 61 hospitals in Thailand, 46 government hospitals and 15 private hospitals. A questionnaire eliciting on demographics, the use, the compliance, the effectiveness, the satisfaction, the obstacle, and problem solving of SSC implementation was distributed to surgical personnel for collecting quantitative data. Three focus group discussions with 39 operating room nurses and in-depth interviews with 50 surgical personnel (10 surgeons, 10 anesthesiologists, 10 operating room nurses, 10 nurse anesthetists, and 10 surgical ward nurses) were performed for gathering qualitative information. Data were analyzed using descriptive statistics and content analysis.
Results: A total 2,024 surgical personnel were recruited. The three majorities were operating room nurses (55.04 %), nurse anesthetists (23.42%) and surgeons (12.94%). Of these, 10.09% was hospital administrators. The means of the use and the compliance with the SSC were 86.98 % (+19.09) and 84.44 % (+20.59), respectively. Overall, surgical personnel satisfied with the SSC at a high level (mean=3.79+0.71). The three most satisfactions were the benefit to the patient (mean 4.11+0.69), the benefit to the organization (mean 4.05+0.68), and affected to reduce the adverse event (mean 4.02+0.69). Overall, the obstacle for implementation of SSC was rated as moderate (mean=2.52+0.99). In the sign in period, overall item was rated as weak (mean=2.41). The two major obstacles were rated as moderate including a surgical site mark (mean=2.67) and evaluating the risk of > 500 ml blood loss (7 ml/kg) in children (mean=2.62). In the time out period, overall item was rated as weak (mean=2.50). The two major obstacles were rated as moderate including the surgeon anticipated critical events (mean=2.77) and all team members have introduced themselves by name and roles (mean=2.72). In the sign out period, overall item was rated as weak (mean=2.34). The two major obstacles were rated as moderate including the surgeon, anesthetist and nurses anticipated the key concerns for recovery and management of the patient (mean=2.56) and nurse verbally confirmed the name of the procedure (mean=2.51).
The qualitative data documented that the major obstacles of SSC implementation included no policy, unclear or impractical policy, poor teamwork or individual cooperation (especially at the beginning), unsuccessful communication to surgeon, and inadequate personnel. Further obstacles were some surgical personnel lack of true understanding about the contents of SSC and process of implementation caused uncertainty, incorrectly, or ineffectively implementation. The SSC was completed before or after the surgery which was not “real time” and the processes were “cut short” to get it done quickly. Additional obstacle was patients’ tiredness of being asked and investigated for many times.
The study suggested that the strategies to improve SSC implementation were the policy enforcement and support from national level (Ministry of Public Health, Ministry of Education) and hospital level. The SSC should be added in the training curriculum for surgeon, anesthesiologist, nurse anesthetist, and operating room nurse, and added in the key performance indicators. Other key strategies were mandatory implementation with clear operational guideline, using collaborative approach, using modern media and technology, performing public relations and campaign, training using role play and station-based model, modifying the SSC suitable for hospital’s context, giving reward, imposing some rules seriously, monitoring and feedback, and patient-involvement. Potential promotion factors were enforcement SSC implementation to the residency training center by the Royal College of Surgeons of Thailand, recognizing surgical adverse events, providing information about the benefit of SSC implementation, and building self-awareness of surgical team.
Conclusion: The use and the compliance with WHO SSC in Thailand was high. The satisfaction with WHO SSC was high. The obstacles of SSC implementation were rated as weak to moderate. These included both structures and processes. The policy enforcement and support, collaborative approach, training with practice, imposing some rules, giving reward, monitoring and feedback, acknowledgement the benefit of the SSC, self-awareness of surgical team, and patient-involvement may lead to improve the use and the compliance with WHO SSC in Thailand.


location: , 'Thailand year: 2022 source: HSRI

title: Development of Health Workforce Registry and Data Sharing Platform Between Professional Councils and the Ministry of Public Health for Comprehensive Health Workforce Planning and Management in Thailand

abstract: This study focuses on establishing health workforce data sharing platform between health professional councils and the Ministry of Public Health. Minimal dataset adopted from WHO’s recommendation was created. This standard dataset was agreed by all health profession councils according to Thai’s context. This essential data for each health profession is basically required for planning and management for national and organization level. International definition was kept in mind for future global comparison. Essential personal data includes personal identification number, name and surname, birth history information, current address, contact information, and a professional license. Certification of education and training, employment status, and address of the place of employment. Moreover, the centralized platform has been created to facilitate the collection of data for supervision, monitoring, evaluation, and research between related sectors particularly health professional councils and the Ministry of Public Health. Establishing of a data link and personnel registration system Establishment of a system for registering professional personnel It complies with several operational standards regarding hardware equipment, software, and adequate vocational training. And data storage is mandated by law. The main result aims to strengthen the national health workforce core indicators to facilitate policy makers to establish proper plan, effective management, and good monitoring system on health workforce both national and sub-national level


location: , 'Thailand year: 2022 source: HSRI

title: The Proposal-Based Policy Synthesis of Social Return on Investment (SROI) in Tackling the Coronavirus Disease 2019 (COVID-19) Pandemic under the District Health Board (DHB)

abstract: “The Proposal-based Policy Synthesis of Social Return on Investment (SROI) in Tackling the Coronavirus Disease 2019 (COVID-19) Pandemic under the District Health Board (DHB)” aimed to analyze the social return on Society (Social Return On Investment: SROI) of coping with the COVID-19 epidemic situation under the District Health Board (DHB) and to synthesize stakeholder analysis for policy recommendation. There are 6 DHB studies, i.e. Na Thawi DHB, Songkhla province, Bang phli DHB, Samut Prakan province, Bang Bua Thong DHB, Nonthaburi province, Song Phi Nong DHB, Suphan Buri province, Khon Kaen Muaeng DHB, Khon Kaen province, and Mae Sai DHB, Chiang Rai province. This research, there is mixed method research using the Social Return on Investment (SROI) concept of the Coronavirus Disease 2019 Epidemic Management System under the District Health Board (DHB). The study process comprised quantitative, qualitative method and participatory action research methods, using documentary research, secondary data, focus group, in-depth interviews, and questionnaires. Moreover, we use social value, financial proxy, net present value (NPV), cost-benefit analysis, and SROI calculation using a discount rate government bond 3%. The result of SROI under the Covid-19 management system of the District Health Board (DHB): 6 Case Studies during 2020-2021 with discount rate government bond 3% showed the following results: 1) Song Phi Nong DHB, Suphan Buri province has SROI of 1.59 times meaning that every one baht invested in the management system of Covid-19 under Song Phi Nong DHB has generated social value of 1.59 baht 2) Mae Sai DHB, Chiang Rai province has SROI of 2.58 times meaning that every one baht invested in the management system of Covid-19 under Mae Sai DHB has generated social value of 2.58 baht 3) Na Thawi DHB, Song Khla province has SROI of 2.25 times meaning that every one baht invested in the management system of Covid-19 under Na Thawi DHB has generated social value of 2.25 baht 4) Khon Kaen Muaeng DHB, Khon Kaen province has SROI of 0.98 times meaning that every one baht invested in the management system of Covid-19 under Khon Kaen Muaeng DHB has generated social value of 0.98 baht 5) Bang Bua Thong DHB, Nonthaburi province has SROI of 13.59 times meaning that every one baht invested in the management system of Covid-19 under Bang Bua Thong DHB has generated social value of 13.59 baht 6) Bang Phli DHB, Samut Prakarn province has SROI of 13.39 times meaning that every one baht invested in the management system of Covid-19 under Bang Bua Thong DHB has generated social value of 13.39 baht, respectively.


location: , 'Thailand year: 2008 source: HSRI

title: Factors effective in lowering blood sugar levels of diabetes mellitus patients in the diabetes clinic of Saraphi hospital, Chiang Mai province

abstract: The purpose of this research, which is a descriptive study, was to study the relationship between effective factors to decrease the blood sugar level of the diabetes mellitus
patients who are clients of the Diabetes Clinic, and actual decreases in blood sugar levels.
The samples were 176 non-insulin-dependent type diabetes mellitus patients who were
clients of the Diabetes Clinic, Saraphi Hospital, Chiang Mai, during the period from October 2006 to December 2006, using purposive sampling according to required characteristics. The data collection method was a combination of interviews and studies of medical
records. Descriptive statistics were used for data analysis, and chi-square for hypothesis
testing.
The research results were as follows: about half (48.9%) of the samples had decreased
blood sugar levels and most samples (53.4%) had self-care at a good level. Moreover, it
was found that age, weight, and period of being diabetic were not related to decreased
blood sugar levels, but the self-care of the patients was related to a decreased blood sugar
level, statistically significant at the .05 level.
This research result is useful for the officers concerned, as guidance for enlightening
other diabetes mellitus patients formally by focusing on the self-care of diabetic patients
in order to obtain more effective services.


location: , 'Thailand year: 2016 source: HSRI

title: Cost-Outcome analysis of hypertension treatment at the out-patient department: a comparison across public health insurance schemes

abstract: Hypertension (HT) is among the most prevalent chronic diseases in Thailand which leads to a considerable amount of healthcare expenditure. Owing to its high costs, concerns about efficiency of HT treatments have been raised, especially in the context of the Thai healthcare system where 3 main health insurances are publicly available: Civil Servants’ Medical Benefit Scheme (CSMBS); Social Security Scheme (SSS); and Universal Coverage (UC). Previous research has revealed the costs and health outcomes of HT treatment; however, little is known about the comparative cost efficiency of treatment across health insurances. The purposes of this study are two-fold: 1) to perform the cost-outcome analysis of HT treatment in uncomplicated HT patients across health insurances; and 2) to explore factors associated with the rising costs of HT treatment.  Data of uncomplicated HT patients who were treated at the out-patient (OP) department at Suratthani Central Hospital in 2014 were retrieved from electronic medical records. Direct medical costs of HT treatment were estimated from resources used in the OP care of HT, including the unit cost of an OP visit, and also the costs of laboratory tests, anti-hypertensive medications (essential drugs (ED) and non-essential drugs (NED)), and other HT-related treatments. The costs of HT treatment were approximated from 4 different perspectives: societal, patients’, healthcare payers’, and providers’, with base year 2014. A treatment outcome was a patient having well-controlled blood pressure (BP), defined as having systolic BP<140 mmHg and diastolic BP<90 mmHg. Chi-square and ANOVA were used in the statistical analysis, with a significance level of 0.05. Multiple linear regression analysis was employed to assess the attributes associated with the costs of HT. To evaluate the elements affecting the use of NED, multiple logistic regression analysis was applied.  A total of 4,353 patients were identified: 2,247 entitled to UC, 149 to SSS, and 1,957 to CSMBS. Statistics indicated that the proportions of patients with well-controlled BP were not significantly different across health insurances. From all perspectives, the costs of HT treatment were much higher in CSMBS beneficiaries, compared with those in the other insurance schemes. Comparing the 3 health insurances, the CERs of HT treatment are highest in CSMBS beneficiaries. Results demonstrated that the increased costs of treatment are associated with the use of NED, and that the likelihood of using NED increases in patients with CSMBS insurance in relation to those with UC and SSS.  Inefficiency of HT treatment appears in CSMBS beneficiaries. The higher costs of HT treatment are attributed, in part, to the use of NED. While no such clear evidence reveals advantages of NED to reduce blood pressure over ED, NED are relatively much more expensive than ED. As physicians are responsible for the choice of medical treatment in hypertensive patients, a hypothesis proposed in this study to explain physicians’ selection criteria for the use of NED, is the awareness of cost burden. That is, physicians tend to avoid the use of NED when the burden of the additional costs is either the patients’ or the hospitals’, as is the case with the UC and SSS beneficiaries, respectively. In contrast, the use of NED increases when the public insurance bears the incurred costs from NED prescription, as seen in CSMBS cases.  Future research, testing this hypothesis using a qualitative study, is recommended. Furthermore, as a reimbursement mechanism could be the key to reducing the overuse of NED, future research should explore the impact of a change in the reimbursement system, from fee-for-service to capitation, on the drug costs for CSMBS patients.


location: , 'Thailand year: 2020 source: HSRI

title: Treatment of Anti-Interferon-Gamma Autoantibody Associated Acquired Immunodeficiency Syndrome with Bortezomib : Pilot study

abstract: Background: Adult-onset immunodeficiency syndrome (AOIS) due to anti-interferon-gamma (IFN-ϒ) autoantibodies has emerged in otherwise immunocompetent adults. Currently there is no specific treatment for the diseases. Immunosuppressive agents to inhbit antibody production are the mainstay treatment of several autoimmune diseases. This study aims to evaluate the effectiveness of bortezomib in decreasing level of autoantibodies (Abs) in patients with anti-IFN-ϒ auto-Abs. Methods: A pilot pre-and postintervention study of patients with anti-IFN-ϒ auto-Abs was conducted between February 2017 and June 2019 at Faculty of Medicine Siriraj Hospital. Five patients with high titer of anti-IFN-ϒ auto-Abs were selected to receive bortezomib at the dose of 1.3 mg/m2 body surface area (BSA) once weekly for a total of 8 weeks and cyclophosphamide at the dose of 1 mg/kg/day for the following 4 months. The primary outcome was the difference of autoanibody level at 8 and 48 weeks compared to baseline and any adverse event occurred during the study period. The clinical characteristics, the number of opportunistic infections (OIs) within 72 weeks of study enrollment and the inflammatory biomarker such as C-reactive protein or erythrocyte sedimentation rate were also evaluated. Results: A total 5 patients were enrolled, of which the median age was 46 years (34-53 years) and 2 patients were male. All patients had 3-5 OIs before enrollment. There was no significant difference in the mean (+SD) optical density (OD) values of autoantibody at 8 weeks (3.73 + 0.72) and 48 weeks (3.74 + 0.53) compared to baseline (3.84 + 0.49) (p=0.336 and p=0.555, respectively). No recurrence of infection was observed in the first 6 months. However, during the 72 weeks of follow-up, 4 of 5 cases had a total of 10 recurrent OIs of which Mycobacterium abscessus was the most common. Infection with Talaromyces marneffei was observed in 3 patients at approximately 1 year after bortezomib administration. Conclusions: Bortezomib appears unable to reduce autoantibody in patients with anti-IFN-ϒ auto-Abs. Although no recurrent infection was observed within the first 6 months during the study medication, recurrent OIs were observed thereafter. Bortezomib seems to increase risk of infection with T. marneffei. Long term follow-up should be considered in patients with anti-IFN-ϒ auto-Abs who received immunosuppressive agents.


location: , 'Thailand year: 2017 source: HSRI

title: Situation of Tuberculosis among Hospital Personnel of the Ministry of Public Health, Tak Province

abstract: Health personnel (HP) have higher risk of tuberculosis (TB) infection during working than people in
the community. This research aims to determine TB situation among HP working in hospitals under the
Ministry of Public Health, Tak Province, fiscal year 2008 - 2016. During the study period, of an average
of 2,956 HP per year, 46 were registered for TB treatment, giving a rate of 15.6/1,000 HP. About 69.6%
of them were female and the mean age was 33.6 years old. About 71.7% were personnel responsible
mainly for patients’ management. Of all 46 TB cases, 69.5% had pulmonary TB. Overall, physicians
had the highest TB rate (38.5/1,000), followed by pharmacists/pharmacy technicians (35.1/1,000) and
nurses (17.6/1,000). Hospital personnel working in 5 districts (along Thailand-Myanmar border) of the western region of the province had a higher TB rate of all types (17.7/1,000), hospital personnel
working in the western region had a higher TB rate of pulmonary TB (13.0/1,000) than those working
in the eastern region (6.7/1,000). It is crucial to carry out early TB detection and treatment with high
successful rates among people in the communities to reduce TB spread, particularly in the western
region of Tak Province. In addition, good TB infection control should be continuously maintained in
the hospitals.


location: , 'Thailand year: 2001 source: HSRI

title: Universal health insurance and decentralization : a feasibility for universal coverage achievement

abstract: Universal Coverage Initiation and Health Care Decentralization in Different Countries	This literature review concerns about the theory and experience on universal coverage initiation that is related to health care decentralization in different countries. The review consists of two important parts. Part one involves the concept of health care decentralization, local government administration, experiences in local government arrangements in some countries, and decentralization situation in Thailand. Part two describes universal coverage initiation in various countries to understand the concept and difficulties in universal health care provision, health care financing, and roles of local government within universal coverage. It is hoped that the obtained knowledge from the review will be the fundamental foundation for policy setting and implementation of universal coverage in Thailand.	From literature review, it can be concluded that universal coverage is very essential for health service welfare. Decentralization has no direct relation to universal coverage initiation. Universal coverage can occurs without decentralization. However decentralization has been viewed as an important strategy to achieve the effective and efficient universal coverage. The obtained knowledge can be synthesized to be some recommendations for universal coverage initiation in Thailand that there should be universal coverage policy at the national level. It should be compulsory system rather than voluntary one to prevent the coming problems such as selection bias. The roles of local governments need to be clearly defined both in health care provision and financing roles. Health sector should be accepted as important as other sectors. The universal coverage should be developed step by step to avoid the opposition from both public and private sectors. Finally, it needs to have more information from additional research studies to fulfill the gap of knowledge particularly in administrative and management aspects. At least, there should be information about the roles of local governments within universal coverage in Thailand.


location: , 'Thailand year: 1999 source: HSRI

title: Directly observed therapy, short-course(DOTS) in Thailand

abstract: Thailand’s Historical Development of TBs Control by DOTs(Directly Observed Therapy, Short-course)The DOTS (Directly Observed Treatment, Short-course is one of the alternatives considered most efficient and supported by most international health organisations including WHO. The DOTs are composed of processes of patient identification, diagnosis, short-course medication, directly observed treatment, management for drug sufficiency, quality control in lab, training and supervision, situation adjustment and public commitment for TB control. DOT is one of these potentially performed by health officials, health volunteers, community leaders and family members. Training for the DOT was started since 1996 in Thailand. In the end of 1998, 299 districts (34.1%) had the DOT program which was problematic in quality due to a number of people performing the program without being trained. The most observers were family members (47.6% - 100%). The supervision by provincial and district tuberculosis coordinators was irregular resulting in poor evaluation which was likely to assess quantity preferable to quality of the program. The patients who were registered between October 1995 and January 1998 were randomly sampled for sputum testing in every 4 months showing negative result in percentage of 79.65, 80.1%, 80.0%, 73.4% and 77.6% respectively. 	Problems of running the DOTs program in Thailand were lack of concern in people at policy administrative level, lack of interests in people who were potential to be effective observers leading to low number of people attending training course, shortage of coordination and supervision at all levels to support the DOTs, and lack of effective information system. This paper recommends establishment of research network to increase positive impact on policy direction and to develop models suitable for particular areas.


location: , 'Thailand year: 1999 source: HSRI

title: The Research and Development of Hypertensive Patient Service System at Health Centers in Phon District, Khon Kaen, Thailand

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


location: , 'Thailand year: 2013 source: HSRI

title: Cost-utility of once-in-a-lifetime breast cancer screening with mammography in Thai women

abstract: Breast cancer is the most common cancer in Thai women with the age-standardized incidence rate of
25.6/100,000. Among mammography, clinical breast examination, and self breast examination, only mammographic
screening showed efficacy in decreasing mortality rate from breast cancer. But an organized
mammographic screening has not been established in Thailand due to lack of human resource and infrastructure.
The study aimed to evaluate the cost-utility of establishing a once-in-a-lifetime breast cancer
screening with mammography in Thai women aged 40-49 years and aged 50-59 years through decision
tress. Societal perspective was used to estimate both direct and indirect costs. Incremental cost-effectiveness
ratios (ICER) were calculated and sensitivity analysis was performed by applying probabilistic sensitivity
analysis. ICERs of establishing a once-in-a-lifetime breast cancer screening with mammography in
Thai women aged 40-49 years and 50-59 years were 1,847,481 Bath/QALY and 1,368,764 Bath/QALY,
respectively. The measure was not found to be cost-effective in Thailand.


location: , 'Thailand year: 2008 source: HSRI

title: Phototype development of palliative care services for end-of-life patients through community participation in Selaphum district, Roi Et province

abstract: The purpose of this research was to study the prototype development of palliative
care services for end-of-life patients through community participation in Selaphum district,
Roi Et Province, between January and September 2008. The aim was to explore and
develop continuity of palliative care from the hospital to the community by using three
steps in a participatory process, i.e. preparation, planning and implementation phases.
Data were collected by using questionnaires and interviews. The results revealed that the
participation processes were used throughout the study by consulting and by group discussion.
The policy was developed; the palliative care unit was established and team was
formed, including hospital staff, health-care workers, volunteers, and patients’ relatives.
A total of 99 patients were enrolled in the study. The most common group, which included 35 patients, comprised those with cancer. The most common services provided
were demonstration and skill training for patients’ relatives to enable them to take care of
the patients at home. There were 18 funeral cere-monies which staff could join. Development
of the services had followed the “4S” principles: start early, stakeholders, sincerity
and suitability. Situation analysis found the strength of the service was sound policy and
good communication between stakeholders, but the weaknesses were budget schemes
which did not support the service set up. Opportunities in the participatory process were
assigned by the Constitution and the Ministry of Public Health’s policy, but there were
also threats about staff confusion concerning decentralization to the local government
level.


location: , 'Thailand year: 2019 source: HSRI

title: Development of Monitoring and Surveillance System on Marketing of Unhealthy Products

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


location: , 'Thailand year: 2001 source: HSRI

title: Specifications of active pharmaceutical chemicals for quality control part I-II

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


location: , 'Thailand year: 2020 source: HSRI

title: People’s Understanding on Severity Triage Level of Emergency Illness before Reaching the Hospital: A Pilot Study

abstract: Objectives: To evaluate people’s understanding on prehospital triage for the level of severity of
emergency illness in terms of interrater agreement compared with the Thai criteria-based dispatch, and
to assess the factors associated with people’s understanding. Study design: A cross-sectional survey of
Chiang Mai people’s perception on responses and management by call takers and dispatchers at the
call center of the emergency medical service. Methods: The survey asked people’s perceived priorities
by randomly selecting 4 out of 24 pre-set emergency scenarios of the Thai criteria-based dispatch triage
cases. The questionnaire also asked respondent’s characteristics, such as, education, previous experience
on emergency medical care, and related perceptional factors. Apart from descriptive statistics, Cohen’s
kappa coefficient to compare the agreement and logistic regression to explore associated factors with
agreement were analyzed. Results: A total of 102 participants responded to the survey, 62.7% were
female, median age was 25 years old (IQR = 21-37). Most of them were bachelor’s degree holders, a
38.2% agreement between people’s perceived priority and the Thai criteria-based dispatch was found
(k = 0.175, p < 0.005), with 42.9% under triage and 18.9% over triage. The percentage of agreement was
higher for non-urgency (49.5%), and semi urgency (40.8%), but lower for urgency (33.0%) and emergency
scenarios (29.0%). No factors associated with the agreement of people’s perceived priority and the prehospital
triage were found. Conclusions: People’s perceived priority did not match with the actual triage
category, and no people’s characteristics associated with prehospital triage agreement were established.


location: , 'Thailand year: 2022 source: HSRI

title: Analyses of Immune Responses in Resolved Coronavirus Diseases 2019 (COVID-19) Patients and in Volunteers Who have High Risk Exposure to the Patients

abstract: Since COVID-19 situation in Thailand, there is no research study of the immune responses to SARS-CoV-2 among the active COVID-19 patients and their high-risk closed-contacts individuals. The aim of this project was to study the antibody production (humoral immune responses) and the immune response mediated by T cells (cell-mediated immune responses) specific to SARS-CoV-2. The results of this study can be used as the knowledge for vaccine development for COVID-19 and the production of a monoclonal antibody for the treatment of infection in stead of using plasma-derived antibodies from the convalescent patients. Moreover, this project has evaluated the antibody production in the individuals who received the inactivated vaccine and viral vector vaccine. During that period, most of the Thai population have been vaccinated with the inactivated vaccine. The knowledge of immune responses from the inactivated vaccine is in need and should be studied as fast as possible. The results from this study showed that the best suitable technique for evaluating the immune responses among many participants is the determination of total antibody specific to spike protein by using ELISA assay. Although the detection of neutralizing antibody is better for evaluation of the protection against SARS-CoV-2 infection, this technique is expensive and low in the feasibility in lab. As for the evaluation of T-cell mediated immune responses by using ELISpot assay, this test cannot be used to evaluated T-cell responses in the individuals who received the inactivated vaccine. We found that the determination of T-cell responses among individuals who got infected with SARS-CoV-2 and individuals who received the viral vector vaccine should be stimulated with peptide from nucleoprotein and spike for ELISpot assay, respectively which does not need to use the whole protein for evaluating T-cell responses by this technique. This project provides the information of the seroprevalence among the high-risk closed-contacts individuals but not getting infected by evaluating the antibody production. We found that the seroprevalence rate among these participants is zero. Although they were identified as the closed contact, but they may not get the viral transmission, so they do not have any antigen to stimulate the immune responses. For the evaluation of the kinetics of antibody production in the individuals who received 2 doses of the inactivated vaccine, the results showed that the level of total antibody is significantly decreased after receiving the 2nd dose for a month. This could be used in the policy for providing the booster dose to them since, the gradually decrease in the antibody would not be enough to fight against SARS-CoV-2 transmission. When compared the antibody level to the individuals who received viral vector vaccine, it revealed that the viral vector vaccine is able to stimulate the higher level of antibody than the inactivated vaccine. The output obtained from this study is the knowledge of the immune response to SARS-CoV-2 in the active COVID-19 patients, the closed-contact individuals, individuals receiving the inactivated vaccine and individuals receiving the viral vector vaccine. As for the outcome and the impact, we found that the determination of the total antibody to spike is suitable for using as a test for screening the immune responses to SARS-CoV-2 resulting to the planning of the policy for the prevention of viral transmission and the recommendation for the vaccination. This result could be used for making the decision of the policy involving the prevention of SARS-CoV-2 spreading, for examples, the booster dose of the COVID-19 vaccine should be considered for the individuals who received the inactivated vaccine. In addition, the booster vaccination should be the viral vector vaccine rather than the inactivated vaccine since this study showed that the inactivated vaccine cannot induce T-cell responses and stimulate the lower level of antibody production compared to the viral vector vaccine. This would be the benefit for the policy of effective prevention of SARS-CoV-2 spreading in Thailand. Additionally, this data can be used as the information for vaccine development to prevent or control COVID-19. This project will lead to outcomes and impacts as follows: In the policy terms, the results of this study can be used to make decisions about the COVID-19 situation in Thailand in term of the stringency or easing of policy for preventing the spread of COVID-19 in Thailand. Based on the results of the analysis of immune responses mediated by the antibody production (Humoral immune responses) and T-cell responses. (Cell-mediated immune responses), these results can be used for developing the test kit for COVID-19 or developing the vaccines in the future. Additionally, the results of this study can be used to understand the immune responses against the SARS-CoV-2 infection that causes COVID-19.


location: , 'Thailand year: 2000 source: HSRI

title: Inapprapriate use of drug injection among providers and patients in Rasisalai

abstract: This  study  is  an  action  research  phase I :  situational  analysis.  The  objective   is to    study   about   the   inappropriate   behavior  to  injection   between   a   provider  and patients at  out  patient  department  of  Rasrisalai  District   Hospital.  The  study   units are  composed   of  6   doctors,   5  ER  nurses ,  and   403   patients  who  got    the  1  out  of  12  common  injection    drugs and 517 oatrenh who did not get injected dngs.  Data  collection   had  been   corrected    since   1 st    April    1998  until  30th     November  1998. The  instruments  are  the standard  criteria  for   12  injectable  drugs ,  questionnaire, medical  record  and  the  treatment  assessment  format.  Data  analysis tool are  percentage ,   mean  and  Odd  Ratio.         The  study  shows  that  48.9 %  of   the  providers  (doctors  and  nurses) have the  inappropriate  injectable   behaviors.  Gentamycin   and  Vitamin  B  complex  are  the  most  common   drug   to  be  use  (92.3%).  Over   use    is   the  most  common   pattern.  Patients  have   the  good  attitude  for  injection ;  for  instance  rapid  action  and   recovery,   comfort  and  clean.          The   study  indicate   that  there  is  the  overuse  of  injection  drug in  Rasisalai Hospital .    So  we  should  have  the  standard  process  to  treatment assessment ,  in order to   get  the   basic   data  to   change  for  good behavior.   In  the  same  time ,  we   should  create   same guidelines  to  change  the  patient, s  belief  and  value.


location: , 'Thailand year: 2010 source: HSRI

title: Risk factors for cancers : a cohort study in Khon Kaen, Northeast Thailand

abstract: Cancer is a major public health problem for Thai people. The incidence of cancer is still
high and increasing in some cancer sites. This research aimed to study risk factors for the most
common cancers i.e. cholangiocarcinoma, cervix uteri, breast, colorectum, lung, oralcavity, and
stomach cancer. This study was a cohort study, using data from the Khon Kaen cohort study
which established and recruited the cohort group during 1990-2001. The analysis was performed
as a nested case-control study design during March, 2008 to May 2010. Cohort data was linked
with the Khon Kaen cancer registry to identify cancer cases. There were 245 cholangiocarcinoma,
61 cervix uteri, 10 breast cancer, 22 colorectal cancer, 26 lung cancer, 11 oral cancer and 8
stomach cancer, 297 all sites of cancers. Those who were free from cancer and still alive until
November 2009 were selected as controls; 17,449 (5,201 males, 12,248 females).
Results from univariate and multivariate analyses were:
Cholangiocarcinoma
From the multiple conditional logistic regression and prediction model, there were 4
factors associated with cholangiocarcinoma i.e. body mass index (BMI), sex, age, and OV eggs in
stools. That is the decreasing of each 1 kg./m.2 the risk of cholangiocarcinoma is 1.05 (1/OR =
1/0.95 = 1.05) (95%CI= 1.11-1.01), male is at higher risk than female (OR= 2.45; (95% CI=1.74-
3.45), the increasing of each year of age, the risk is 1.11 (95% CI= 1.08-1.11), those who had OV
eggs in stool were at higher risk of cholangiocarcinoma (OR=1.64; 95% CI=1.16-2.34).
Considering the accuracy of prediction model of area under ROC curve; AUC is 68.70 %.
Cervix uteri cancer
From the multiple conditional logistic regression and prediction model, there were 2
factors associated with cervix cancer i.e. body mass index (BMI) and age at first sexual
intercourse. That is the increasing of each 1 kg./m.2 the risk of cervix cancer is 1.09 (95% CI=
0.99 - 1.18), each year of younger age at first sexual intercourse, the risk of cervix cancer is 1.05 (1/OR = 1/0.95 = 1.05) (95% CI = 0.94 - 1.15). Considering the accurary of prediction model of
area under ROC curve; AUC is 54.93%.
Lung cancer From the univariate analysis, risk factors for lung cancer were sex (male)
(OR=9.89; 95% CI= 3.73-26.2), age (increasing age) (p<0.001), smoking (OR=6.73; 95%
CI=2.88-15.73), and alcohol consumption. BMI 23.5 kg./m.2 or more are at lower risk of lung
cancer.
Colorectal cancer From the univariate analysis, risk factors for colorectal cancer were
sex (male) (OR=2.35; 95% CI=1.02-5.43), age (increasing age) (p<0.05), the history of having
cancer in the family (OR=2.66; 95% CI=1.13-6.27). Food consumption and BMI 23.5 kg./m.2 or
more are at lower risk of colorectal cancer.
Oral cavity cancer From the univariate analysis, risk factors for oral cavity cancer were
betel nut chewing (OR=8.88; 95% CI=1.48-53.2), age 60 year-old or more and sex (male). Male
were at lower risk of oral cavity cancer.
Breast cancer From the univariate analysis, risk factor for breast cancer was the
increasing of BMI; BMI 23.5 kg./m.2 or more compared to lower BMI (OR=1.87; 95% CI=0.36-
9.67).
Stomach cancer From the univariate analysis, the factors associated with the risk of
stomach cancer were sex (male), (OR=1.41; 95% CI=0.34-5.91), and the increasing age (p<0.05).
In conclusion; the findings in this study suggested that public health personnel should
consider and take into account that OV infestation, BMI, smoking, alcohol consumption, food
consumption for the cancer prevention and control programme.


location: , 'Thailand year: 2006 source: HSRI

title: Reliability and usefulness of medical record reviews in detecting adverse events and in making decision on patient compensation

abstract: Rationale: Increasing numbers of law suit cases against medical practitioners signal the whole Thai society to pay more attention to the problem. This study focuses on studying the nature of medical reviews as tools for monitoring and assessing the problems of adverse events (AEs) occurred in hospitals. Objectives: The study aims at 1. Evaluating inter-rater reliability of medical record reviews in detecting AEs. 2. Evaluating changes of inter-rater reliability of medical record reviews when more financial incentives are proposed to the reviewers. 3. Evaluating usefulness of medical record reviews in terms of types of quality issues identified and applicability to the decision making on patient compensation. Methods: the study is divided into 2 phases. Phase I : 279 medical records were independently reviewed by 23 auditors. Each record was examined by 3 auditors using a standardized review form. Agreements on the occurrence of AEs were assessed using Kappa statistic (κ). Phase II : Lessons learned from the first phase were used in modifying the review form and processes of medical reviews. 50 medical records were independently reviews by 13 auditors. Early in the process, 7 of the auditors were informed that they will be given 50 – 100 % extra fees if the agreement of assessing the AEs among them was high. The rest 6 auditors were informed the same message later after they had finished reviewing the first 25 records. Agreements on the occurrence of AEs were assessed using Kappa statistic (κ). Statistical differences between kappa were tested using Mann Whitney U Test. 95 % confidence interval of kappa was also calculated. Content analysis of opened questions was done to categorize the reasons for making AEs diagnosis given by the auditors. Modeling from the Norwegian system of patient compensation, the author had tested whether the results of the medical reviews can be used for the compensation decision. Results: Phase I: Agreement on determining AEs occurrence was fair (weighted κ = 0.34, 95%CI= 0.22-0.45). Agreement on determining AEs preventability was fair (weighted κ = 0.27, 95%CI= 0.16 to 0.39). Phase II: For Agreement on determining AEs occurrence was fair (κ = 0.27, 95% CI:0.24 ถึง 0.30). Agreement on determining AEs preventability was also fair (κ = 0.22, 95% CI:0.19 ถึง 0.25). Informing auditors that they would be given extra fees had no positive effect on the agreement on determining AEs occurrence and preventability (p-value > 0.05). Reasons for determining AEs occurrence and preventability have revealed a numbers of common quality related problems, for example, missed diagnosis, delayed intubation, inappropriate antibiotic, inadequate treatment, overloaded fluid, overdosed Insulin, Propanolol in the bronchospastic, inadequate electrolyte monitoring, one-lung intubation etc. 42 % of the patients were considered to have rights for compensations according to the criteria used by the Norwegian patient compensation system. Conclusions and Discussions: The reliability of medical record review to detect AEs seems to be influenced by the rate of the event occurrence as well as the variability among reviewers. Whereas, financial incentive has no effect. The use of multiple reviewers to detect AE will produce unstable rates of AE occurrence, but is a reasonable and beneficial tools to search for wide ranges of quality related problems. Reasons for AE occurrence and preventability given by reviewers can serve well as a basis for making decision on patient compensation using the Norwegian criteria. The tool developed by this study is recommended to be modified and used as a tool for voluntary AE reporting and quality improvement process.


location: , 'Thailand year: 2008 source: HSRI

title: A Comparative Study of Patients who Committed Suicide between Residents of Khanuworalaksaburi District and Khlongkhlung District, Kamphaengphet Province in 2007

abstract: This study was aimed at identifying the general characteristics and different factors
related to the commission of suicide, and the factors affecting the accomplishment of
suicide between residents of Khanuworalaksaburi and Khlongkhlung districts in 2007.
Secondary information on the patients was obtained from the report 506 DS in 2007. The
data were analyzed by descriptive statistics, t-test and logistic regression.
The study included 110 patients, 12 were successful in committing suicide, equal to
10.6 percent of the total. The death rate of Khlongkhlung’s victims was four-fold greater
than Khanuworalasaburi’s. Nearly all of the suidcides committed were Thai agriculturists,
in the working-age group and married. The prevalence in females was four times
higher than in males. For most of the subjects, it was their first attempt; of those who
survived, they were reluctant to repeat the suicide attempt. Most of the victims had two
or more precipitating factors: the most common was depression, physically chronic
diseases and having sufferred abuse; these were enabling factors but not significant.
Most of the victims received service provision two or more times. The comparative study
indicated that there was significance in the different modes of committing suicide, especially
with regard to the use of insecticide, and physically chronic illness, particularly
rheumatic diseases, as well as tobacco addiction. The types of services provision included
making suggestions to their relatives, handout distribution, medication for depressive
disorder, other supportive services such as referral for repeated suicide attempts. The
risk factors and service provision were both significant factors in decreasing the success
rate of those intending to commit suicide. Having suffered abuse was an important factor
in raising the success rate. The authors suggest that the provision of good-quality and
appropriate services would effectively decrease the success of attempts to commit suicide,
while the screening for the precipitating factors and a change in abusive behavior
would reduce the number of attempts.


location: , 'Thailand year: 2017 source: HSRI

title: Development of novel enzymatic activity assays for HIV-1 protease and integrase for drug level control and drug discovery applications

abstract: Acquired immune deficiency syndrome (AIDS) remains a major public health problem in Thailand. Treatment of HIV-infected patient using highly active retroviral therapy (HAART) can suppress viral replication and increases maintain the level of CD4+ lymphocyte cells. Adherence to HAART can improve health and prolong life of HIV-infected patients. However, non-adherence to antiretroviral drugs leads to develop of HIV drug-resistance strains. Therefore, the high costs of new generation antiretroviral drugs are needed. In this study, we aimed to develop a high throughput assay for examining the enzymatic activity of HIV-1 protease (PR) and integrase (IN). These assays will be applicable for assessing the level of HIV-1 protease inhibitors (PIs) and integrase inhibitors in HIV-infected patients who recived antiretroviral treatment. The novel immunochromatographic (IC) strip test for determining of HIV-PR activity was developed by combining proteolysis activity of HIV-PR and an immunochromatographic reaction. This IC strip could adaped to evaluate the biological activity of PI and also semi-quantify the level of PI in HIV-1 infected individual. Furthermore, we established a non-radioisotopic testing based on real-time polymerase chain reaction (PCR) assay to determine HIV-1 integrase activity. This assay has been shown to be effective and inexpensive for a high-throughput screening of novel IN inhibitors. The novel development of enzymatic activity assay of HIV-1 protease and integrase using immunochromatographic strip test and real-time PCR assay could provide as a high-throuput screening platform for discovering new synthetic antiretroviral agents or natural compounds from Thai medicinal plants by Thai reseacher. This study might be able to reduce the importion of new generation antiretroviral drugs from other countires.


location: , 'Thailand year: 2003 source: HSRI

title: Health paradigm and deep ecology

abstract: Health is a dynamic self-regulating process in a living system that is interrelated with its greater ever-changing environment and ecology in which it depends. Physical and mental health of an individual closely correlates with that of its society and ecology. This subtle and complex interconnection has been discovered and articulated in modern science. According to the ecological worldview and deep ecology, to heal ourselves is to heal our relationship with the earth. Our modern human culture is now facing a survival challenge, amidst the postmodern absence of absolute ideology and value system, to come to terms with the realization that we are parts of the whole, and the whole is within us. Without changing in our perception we have towards life and nature, our behaviors will remain unchanged, unhealthy and worsen the condition of this living planet, which in tern will have much greater effects on human health. However, in Thai society as well as in other countries, there have been emerging social and ecological movements that try to cope with this modern sickness from different perspectives and historical backgrounds. This study is to explore the philosophy and practices of deep ecology movement that can contribute to the paradigm change in the way we think about and relate ourselves to the issues of health. We hope that some insights and realizations gained from this research can be of useful and inspiring enough for readers to critically and thoroughly reexamine the way we live our lives as well as and the socio-economical structure and conditions we maintain that shape our present health condition. The local traditional wisdom obtained on a practical basis showed in this study have affirmed that ecological worldview is nothing new but have already been existed and available in its own unique cultural and ecological context. To recognize such endangered local knowledge as invaluable and relevant to our modern needs is the beginning of the healing process towards the restoration of the wholeness and health of this living planet and her members.


location: , 'Thailand year: 2010 source: HSRI

title: Health Decentralization in Five Countries

abstract: Decentralization is one of the tools for the development of a health system which can produce many
benefits, such as improvements in technical and allocative efficiency, and improvements in the responsiveness
of the health system in meeting the needs of the people. According to Rondinelli(1), decentralization has been categorized into deconcentration, devolution, delegation and privatization. In Thailand, an
increasing emphasis has been put on community participation and decentralization following the Constitution
of B.E. 2540 and the Decentralisation Act of B.E. 2542 which has led to the development of the
Decentralization Plan of B.E. 2544 and the Devolution Plan to Local Administrative Organizations in B.E.
2545. These plans dictated that the provision of public services was to be devolved to LAO, and this
includes the transfer of infrastructure and the authority to provide health and health promotion services.
This study examines these issues by reviewing the international experience of Portugal, Spain, Italy, Mexico,
and the United Kingdom in health system decentralization.
From the review, after the reform, decentralization has led to many benefits in the provision of
health services and in the health system as a whole. In Portugal, it was found that the health status of the
population improved significantly after improvements were effected in access to care. Furthermore, the
local authority has become more autonomous and more flexible in being more responsive and efficient.
Also, in Italy and the United Kingdom, the internal market and the purchaser-provider split have been
introduced in order to improve efficiency, quality and service satisfaction. However, problems related to
decentralization were also found. For example, the occurrence of political conflicts from the reform, inequity
which emerged in many forms, problems relating to responsiveness in the deconcentration system,
and problems with unfavorable conditions and contracts in the internal market system.


location: , 'Thailand year: 2014 source: HSRI

title: Evolution of Collaborations under the ”One Health” Concept in Thailand

abstract: In Thailand, the “One Health” concept emerged with the goal of strengthening the multidisciplinary
collaborations among all sectors at all levels, subsequently leading to a holistic health by recognizing the
close relationships between human health, animal health and environment health. This study aimed to
compile and understand the evolution of “One Health” in Thailand. The methods included document
review, observation, and in-depth interviews of key informants. The study found that the public health and livestock health sectors have been cooperated for over 20 years in order to prevent and to control
zoonotic diseases. It was later expanded to be a multidisciplinary collaboration to contain the H5N1 Avian
Influenza outbreak in 2004-2006. The “One Health” concept has been adopted as a key component of
national health policy, in particular in the National Strategic Plan for Emerging Infectious Diseases (2013-
2016) in 2012. However, the current recognition of “One Health” is still mainly limited to health related
sectors, with variation in interpretations of the definitions and scope of “One Health” which is based on
organization and/or individual own interest, and lack of a variety of examples for implementation. This
study recommends that “One Health” concept should be promoted to other related non-health sectors
including the general public in order to gain mutual understanding of the concept. In addition, the One
Health concept should be implemented where different agencies work together to achieve its objectives in
a sustainable way.