location: , 'Thailand year: 2023 source: HSRI

title: The Development of Community-Led Health Impact Monitoring, Nan Province Thailand: A Case of Transboundary Pollution from Hongsa Power Plant, Lao PDR

abstract: The case that the research team has studied operated is an area of high-risk community in Nan Province, Thailand, close to the coal-fired power plant in Hongsa, Xayaburi Province, Lao People’s Democratic Republic. Although the power plant is located in Laos, it mainly provides electrical power to Thailand about 1,500 megawatts or 78% of the total generation capacity. The term of the power purchase agreement is 25 years. The investment in the power plant is about 80% from Thai public companies and 20% from the Lao state enterprise, with financing from 9 banks in Thailand. The use of coal as a fuel for electricity generation causes many kinds of pollution, especially air pollution such as small particulate matter 2.5 (PM 2.5), nitrogen oxides, sulfur dioxide, heavy metals, mercury, etc., that can induce cross-border impacts. Even though the power plant has installed technologies to capture pollution, namely 1) Flue gas desulphurization (FGD), 2) Electrostatic Precipitator (EPS), 3) Selective Catalytic Reduction (SCR), and CEM which is a continuous emission monitoring system at the tip of the stack to measure NOx Sox TSP O2 temp. etc. Sadly, the mercury capture equipment is not installed while the lignite coal used by the power plant contains mercury. In addition, the preparation of an environmental impact assessment report does not cover risky areas in Thailand. As the power plant is located in The Lao People's Democratic Republic (Lao PDR or LPDR), there is no obligation to carry out continuous surveillance on the Thai side. Although pollution may cross borders naturally, there are no regulations or legal agreements that cross nation-state boundaries. This is the reason for the development of surveillance systems for risky areas in Nan Province. The system is set up by public participation, local initiative and co-ownership to achieve sustainability, and draws expertise from various sciences to reinforce the search for facts and reality. Community-led Health Impact Surveillance System Development Project, Nan Province, Thailand, Case of Transboundary Pollution from Hongsa Coal-fired Power Plant, Laos, is a cross-disciplinary research. Under the support of Health System Research Institute (HSRI), there are 5 research projects working together, consisting the team from the Faculty of Science, Chiang Mai University; the Faculty of Engineering, Naresuan University; the Faculty of Liberal Arts, King Mongkut’s University of Technology Thonburi; Thai Public Broadcasting Service (Thai PBS); and the Thai National Health Foundation (NHF). The basic principle of designing this surveillance system is based on participatory action research, the precaution principle, that is, considering the risk without having to wait for health problems or patients to emerge. The surveillance framework focuses on changes in determinants of health, especially social determinants of health. This framework includes changes in environmental quality affecting the agricultural sector, which will result in income, labor mobility and immigration, as well as contamination in ecosystems and food chains that are at risk of disease and illness, especially for children and women of reproductive age. This is different from disease-oriented surveillance. Concepts involved in the design of this system include risk society; co-production of knowledge; citizen scientist; and environmental justice.There are four objectives of this research: 1) Develop a system for community-led health impact surveillance from coal-fired power plants; 2) develop collaboration mechanism for various actors; 3) to develop a model and process for producing knowledge together between experts and communities on coal power plant pollution awareness; and 4) to be a case study of environmental impact assessment cross border health in the process of monitoring the impact. The results of operations can be summarized as follows: 1. The process of developing a community-led health impact surveillance system can be sequenced as follow: building trust between the research team and the community, creating a cross-disciplinary team of experts, creating citizen scientists, and creating a system for recording, processing and storing a digital data and creating a data exchange platform which brings cooperation between groups in surveillance and mobilize policy measures to solve the problem. 2. The community-led health impact surveillance system consists of: 1) Surveillance teams, divided into cross-disciplinary research teams and community teams trained to be citizen scientists. These two groups work together in a form known as Co-creation of knowledge. 2) Surveillance tools. There are tools that require advanced skills of experts in various fields, and tools for citizen scientists to measure the quality of both chemical and biological environments. including indicators to observe changes as well as a tool used to collect various evidence called MOJO. 3) Recording and storage system have cooperated with Thai Public Broadcasting Service (Thai PBS) To develop a C-site platform for storing surveillance data and continually accumulate data until it becomes a large database. When there is a certain amount of data, it can be processed, interpreted and reported in a dashboard style and will be open to various sectors to access information and use it for their own work, including developing an environmental pollution warning system and an emergency response system from environmental pollution threats. 4) Cooperation Platform, which is a digital platform, is under C-site platform and open discussion area between different groups to reduce bias and balance the power of using data to govern or make decisions about big technology risks. 3. The methods of surveillance can be divided into 9 steps, which can be applied to other areas with similar risks of environmental pollution, namely: 1) Source analysis and pollution determination. 2) Define surveillance dimensions and risk chains 3) Aerial modeling in order to see the risky areas from the accumulation of pollution. 4) Build a cross-disciplinary research team to understand the risk situation in the area and vulnerable groups. 5) Create appropriate tools for the community. 6) Build a team of citizen scientists to monitor. 7) Collect data by citizen scientists. 8) Record data on the C-site for both cross-disciplinary researchers and citizen scientists. 9) Open up surveillance cooperation areas. 4. From the air modeling, it was found that pollution accumulated in 8 villages of Huai Kon Subdistrict and Khun Nan Subdistrict, Chaloem Phra kiat District. The research team therefore sets this area as a target for building a community-led health impact surveillance system by installing sensors to measure air quality, collecting samples of soil, sediment and water in creek, rainwater, fish, and villagers’ hair for analysis in the laboratory. We also organize a learning process and practice skills as citizen scientist for villagers, including teachers and students in the targeted areas. 5. Analysis results of acid gas condition is related to agricultural crop damage such as withered rice grains, disease outbreaks in plants. Mercury contamination was found in sediments, fish, and in human hair, but not exceeding the standard. 6. Therefore, the recommendations are as follows: 1) the emission control at the source, by installing a mercury capture, improved dust collector technology efficiency, nitrogen oxides and sulfur oxides capture. This should be implemented through the National Human Rights Commission of Thailand, and the ASEAN Intergovernmental Commission on Human Rights (AICHR). 2) And in the long term, there should be a mechanism to regulate transboundary pollution in ASEAN, including the use of financial institutions’ mechanisms for auditing in accordance with business and human rights principles. 3) To have a process to prove if the impact is from Hongsa Power Plant pollution or not, and then to have fair compensation, including paying for operations to rehabilitate contaminated areas. 7. Amend the Environmental Act in the section that related to environmental surveillance and adding content on joint governance of transboundary pollution. This research was used as a case study. In short, the surveillance system in this project is a cross-disciplinary and cross-operation between experts and the public, which can adjust the balance of power in environmental justice. That is to say, traditionally there was a line between recognized experts in possession of tools and knowledge-generating production processes, and lay people who are subject to risks and consequences under unknown situation, as information and knowledge production are blocked. But the experimental initiative in this project is to create a new power from the ability to produce knowledge by themselves from the people who are at risk and affected, in collaboration with various experts. The result is, in addition to scientific knowledge, movements and social networks also emerged. And there is a set of facts that can be used as evidence in further claims. Therefore, the production process which creates shared knowledge platform is an important part in rebalance of power this case, and in other cases where there are further risks to the environment and health.


location: , 'Thailand year: 2009 source: HSRI

title: Expenditures on High-cost Drugs and the Difference in Their Use under Various Health Insurance Schemes in a Regional Hospital in North-Eastern Thailand

abstract: Background: Essential drugs in Subclass 4 are high-cost drugs (HCDs). Their use was an important factor in influencing pharmaceutical expenditure. Exploring drug items, extent of their use, and the difference in their use among health insurance schemes would provide in-depth understanding of the efficiency and equity of their use. The objectives of this study were to identify items of HCDs, to assess their impact on pharmaceutical expenditure, and to explore HCD users classified by age and type of health insurance schemes.
Methods: Retrospective data on overall drug expenditure including the top 10 HCDs in Subclass 4 of the Essential Drug List in three fiscal year (2003-2005) were obtained from the Hospital Inventory Database. Drug use data of the to 10 HCDs in 2005 were obtained from the Dispensing Database. The rates of the top 10 HCD use per 1,000 patients were classified by age and health insurance scheme, including the Universal Coverage Scheme (UC), Civil Servants Medical Benefit Scheme (CSMBS), and Social Security Scheme (SSS), and compared.
Results: In the three consecutive years, the six HCDs most highly used were human erythropoietin 4000 u. inj., atorvastatin 10 mg tab., meropenem 1g inj, imipenem/cilastatin 500 mg/vial IV, cefoperazone/salbactam 1g inj and clopidogrel 75 mg tab. The top 10 HCDs used in the hospital consumed 45.6 million, 50.5 million, and 68.8 million baht in 2003, 2004 and 2005 respectively. Expenditures on erythropoetin 4000 u., atorvastatin 10 mg., clopidogrel 75 mg and meropenem inj. 1g increased every year. In 2005, 63.8 percent or 46.8 million baht of the expenditure of the top 10 HCDs was on CSMBS. These items were the drugs used for chronic diseases: erythropoietin, atorvastatin, clopidogrel. and mycophenolate. HCD spending in UC was 32.3 percent or 23.6 million baht, but it was only 1 percent in SSS. In UC, the drug
items mainly used were anti-infectious drugs, including meropenem, imipenem/cilastatin and cefoperazone/salbactam. The rate of use of atorvastatin and clopidogrel per 1,000 patients in the aging group in CSMBS were 20.08 and 6.47 respectively. In UC, they were only 0.05 and 1.45 respectively. The rate of use of meropenem per 1,000 patients in every age group in UC was greater than in CSMBS.
Discussion: The impact of HCD use on pharmaceutical expenditure is quite high since only 10 HCDs account for 18-20 percent of overall pharmaceutical expenditure. There is a difference in HCD use based on the insurance schemes. Further studies should be focused on the evaluation of HCD use, effective measures to control HCD use, and methods to balance equity of HCD access among health insurance
schemes.


location: , 'Thailand year: 2022 source: HSRI

title: Crisis Management during the First Wave of COVID-19 Pandemic Situation

abstract: The coronavirus disease (COVID-19) is a massive pandemic crisis occurring across Thailand and the world. It has entirely affected the health system responsiveness of Thailand. The purpose of this study was to examine the governance mechanism and management processes in response to the first wave of COVID-19 in Thailand in 2020. A retrospective document review was conducted by studying the government’s management during the COVID-19 situation between January and December 2020 via online resources and websites, and summarized our research team’s lessons learnt from direct participation in academic and strategic supports for the Operation Center of the Center for COVID-19 Situation Administration (OC-CCSA) as well as key informant interview in the stakeholders from government, private and civil society sectors. The results revealed that crisis management differed at each step. From the preparatory phase to the full outbreak response phase, the policies and measures were unidirectionally implemented as “one-size-fits-all”. During the continuous phase, regional and provincial decentralization has been used in order to align with local context to balance between health and economic outcomes.


location: , 'Thailand year: 2006 source: HSRI

title: The process for the development of Thai medicinal plant products for worldwide market competition

abstract: As known, Thai folklore wisdom of medicinal plants in pharmaceutical , cosmetics
and food supplements has been used for a long time. Up till now , there is no single Thai
medicinal plant product in worldwide competition market. Infact, Thailand has advantages of
high biodiversity. There are several Thai medicinal plants which can be developed to
medicinal plant cosmetic products. Our preliminary study has indicated that the worldwide
market is very interested in Thai medicinal plants. However, because of the restriction of the
trade regulations in many countries, the development of Thai medicinal plants in the form of
cosmetics is more possible than the form of medicines and food supplements. In 2005,
Thailand has higher import value of medicinal plants and their extracts than the export value
of about 4 times. Therefore, the objective of this research project is to propose the process
for the development of Thai medicinal plant cosmetic products for worldwide market
competition , by evaluating from the searching and collecting of the information from various
sources. The result from this study will decrease the import values of the extract and
cosmetic products containing Thai medicinal plants from abroad and increase the national
incomes. The popular trends of cosmetic activities in worldwide market at present and in the
future are antiaging , whitening, hair growth promotion and body slimming, by emphasizing
on high performance and safety which are cosmeceutical products. We have proposed ten
Thai medicinal plants which have high potential to develop as raw materials in the form of
extract or as the cosmetic products containing the extract for worldwide competition which
are , Aloe barbadensis, Mill, Curcuma longa L. , Pueraria mirifica, Morus alba, Linn, Senecio alata (L.)
Roxb. , Phyllanthus emblica L. , Centella asiatica (L.) , Piper nigrum, Linn, Zingiber montanum (Koenig)
Link ex Dietr. and Andrographis paniculata (Burm.f.) Wall. Ex Nees. The technologies in trends,
which are the plantation and organic approach for the cultivation of the plants,
nanotechnology and biotechnology for the cosmetic products, are proposed to develop the
Thai medicinal plant cosmetic products. The proposed complete process for the
development of Thai medicinal plant cosmetic products for worldwide competition, includes
the strategies , goals , problems, concerned topics and the related factors. The proposed
road map for the development of the Thai medicinal plant cosmetic products for the 5 - year
project (2007-2011) is the two dimensional model, the vertical and the horizontal dimension.
The vertical dimension is composed of the important drives or input of the collaboration and
funding which will be directed to the output of the product, patents and national incomes.
The horizontal dimension is composed of factors which are linked closely including
collaboration between private and government sectors working as clusters, quality
assurance system, revision of the regulations, selection of Thai medicinal plants, production
process, marketing / advertisement and the efficient follow up system. For the proposed
further study continuing from this project, there are more research on the ten selected Thai
medicinal plants , information of the consumers in the worldwide market for importing and the
business plan for the Thai medicinal plant cosmetic products for worldwide competition.


location: , 'Thailand year: 2007 source: HSRI

title: A Study of a Refill Prescription Service System Comparing a Hospital Pharmacy and an Accredited Pharmacy

abstract: The refilling of prescriptions for patients with chronic diseases under Thailand’s Universal
Coverage Scheme (UCS) by a private community pharmacy was developed as the model for a
health-care network linking the pharmacy and primary care units under the UCS. The objective of
this study was to compare the outcomes of the pharmacy providing health-care services for stablechronic patients, including those with diabetes mellitus, hypertension and dyslipidemia, between
those of the community pharmacy and primary care units. The quasi experimental study and
qualitative study were conducted during the period from December 1, 2005 to November 30, 2006.
Data collection was performed using pluralist methodology, including patient clinical data, questionnaire,
observation and telephone interview. The percentile, mean, standard deviation were
calculated. Levene’s test for equality of variances, paired t-test, and independent t-test were used
for comparing the clinical data. The patients were divided into a treatment group (n=27) and a
control group (n=69). The treatment group repeatedly refilled their prescriptions at the pharmacy
whereas the control group obtained normal services at the Phra Samuth Jadee Hospital, the main
contractor. After six months, clinical outcomes were compared between both groups. The results
revealed that the fasting blood sugar level, systolic blood pressure and diastolic blood pressure
between the treatment and the control group were not significantly different (p-values = 0.875,
0.770 and 0.706, respectively). The results of a telephone interview with the treatment group indicated
that the overall satisfaction with the services was 63.5 percent. Interestingly, the satisfaction
in the fast and convenient services among the patients who refilled their medications at the pharmacy
was 100 percent. These results indicated that the refill prescription service by the pharmacy
is as effective as that by the hospital. This study confirms the distinct and important roles played by
community pharmacists in delivering pharmaceutical care to chronic patients. In addition, the
pharmacy could be a health-care provider serving as a subcontractor in the health-care network
under the Universal Coverage Scheme in Thailand. This could improve and develop the quality of
the overall health-care services. This health-care service model provides more access to care and
increases the treatment quality of patients.


location: , 'Thailand year: 2008 source: HSRI

title: Hand, Foot and Mouth Disease in Chumphuang District, Nakhon Ratchasima Province, 2002 -2007

abstract: Hand, foot and mouth disease is a communicable disease caused by a virus that
infects mostly preschool children. In 2006, there were 3,961 cases and seven deaths in
Thailand; Nakhon Ratchasima Province had 85 cases and 3 deaths. Enterovirus 71 was
the causative pathogen. This descriptive study conducted at Chumphuang District,
Nakhon Ratchasima Province during the period from 2002 to September 30, 2007, used
individual disease investigation forms, outpatient and inpatient records and the midyear
population data of the Ministry of Interior. There were 47 cases, no deaths, 31 males
and 16 females among them; the sex ratio was 1.9:1. Most of them were found during
June to October. Forty were treated as outpatients and only seven were admitted to the
hospital. Fever, and palm and sole rash were the common symptoms; most patients were
from Chumphuang Tambon, and no case was detected at Nontoom Tambon; only one
patient was found in each village. Stool and paired serum samples were derived from
93.62 percent of the patients and Enterovirus 71 was isolated from two stool specimens in
2006 and 2007. According to the disease surveillance system, primary health-care staff
should be trained to screen and refer the suspects to hospitals, viral isolation should be
supported and promoted among the health-care services. The disease-control measures
should emphasize community health education and the isolation of patients from other
children either in school or in child-care centers.


location: , 'Thailand year: 2020 source: HSRI

title: Viral replication inhibition activity, cross-reactivity, and epitope mapping of human monoclonal antibodies specific to dengue virus NS1 protein

abstract: Dengue fever and its severe form, dengue hemorrhagic fever (DHF) and dengue shock syndrome are one of the most important mosquito-borne tropical disease. The severe form of dengue disease was hypothesized to be correlated with high viral titer and secondary infection with heterologous serotypes, so called ADE, that caused mostly by anti-Envelop (E) and anti-premembrane (prM) antibodies. However, anti-non-structural 1 (NS1) antibodies was recently interested as one factor for severe dengue infection because of their cross-reactivity with human molecules such as plasminogen, thrombin and endothelial cells, causing some severe symptoms like vascular leakage. However, anti-NS1 antibody was also proved from several studies for their protective activity in vitro and in vivo. To clearly identify the important role of anti-NS1 human antibody, both for dengue pathogenesis and therapeutic, in this study, twelve anti-dengue NS1 human monoclonal antibodies were characterized. Cross-reactivity of those HuMAbs with human molecules, plasminogen, thrombin, and endothelial cell, were determined. Activation of plasmin formation were also investigated. Their viral replication inhibition activity in human microvascular endothelial cell (HMEC-1) were tested in some HuMAbs, which showed and not showed crossreactivity with human molecules. It was shown that all 12 anti-NS1 HuMAbs were cross-reacted with plasminogen, but not with thrombin. Among them, one HuMAbs could not activated plasminogen to plasmin. Some of them showed cross-reactivity with endothelial cell. Fortunately, it was found that one clones that is unable to activate plasminogen, could inhibit viral replication in vitro. Moreover, from epitope mapping with truncated NS1, all anti-HuMAbs were targeted to 301-352 of dengue NS1 protein. This is the first study described the generation and characterization of full IgG human monoclonal antibody specific to NS1 protein of Dengue virus. After thoroughly characterization, the mechanism how anti-NS1 HuMAbs play a role on dengue pathogenesis can be enlighten. Also, the promising role of anti-NS1 as a therapeutic candidates can be shown.


location: , 'Thailand year: 2013 source: HSRI

title: Outcome Evaluation of Diabetes Medication Therapy Management in patients with type 2 diabetes controlled by insulin at Tha Uthen Hospital

abstract: This study aimed to evaluate outcomes from Diabetes Medication Therapy Management (DMTM)
project in patients with type 2 diabetes who used insulin in Tha Uthen Hospital. The outcomes were
measured in economic and clinical aspects comparing before and after DMTM project. The follow-up
treatment continued for at least 2 times every 1-3 months during the study in July 2010 - December 2010.
Humanistic outcome evaluation was done after the DMTM project during May 2011 - February 2012 to
assess the patient’s quality of life using the World Health Organization’s quality of life questionnaire in
Thai version.
This study enrolled 115 cases but only 103 cases who completely followed up. They were female
(74.76 %) and the mean age was 60.74 years. The economic outcomes revealed that the direct costs after the
DMTM project was increased significantly (P≤0.05) from 493,105.18 to 580,791.30 Baht while the indirect
costs was reduced from 51,496 baht. Therefore, the total cost was increased from 544,601.18 to 628,351.30
Baht. Regarding the clinical outcomes, it showed that average HbA1c level was significantly decreased
after DMTM project (P≤0.05), from 9.01 to 8.18. However, the HbA1c level was still higher than the standard
level. In term of the humanistic outcomes, the overall patient’s quality of life situated in the moderate
level.


location: , 'Thailand year: 2023 source: HSRI

title: Economic Evaluation of Screening for Chronic Kidney Disease in Elderly

abstract: Background: Chronic kidney disease (CKD) is prevalent in Thialand that incure high healthcare expenditure. Screening for high risk CKD is recommended to contribute benefit. Aging is one of a CKD risk factor, though this service is yet excluded from the Universal Coveragre Benefit Package (UCBP). Objective: To propose a recommendation for elderly CKD screening to be included in the UCBP by performing economic evaluation, budget impact analysis, and feasibility of delivery such a service. Methods: A cost-effectiveness analysis (CEA) of six screening methods was carried from societal and provider perspective. Decision-tree and markov model were used to simulate screening and CKD health states. Screening methods included Serum creatinine (Scr), Proteinuria dipstick (Pro), Microalbuminuria dipstick (Micro), Albumin-to-creatinine ratio (ACR) dipstick (ACRdip), combined Pro+Scr, and combined Micro+Scr. Parameters were reviewed and analysed by meta-analysis. Sensitivity and threshold analysis were performed to identify uncertaintity of the CEA results. Budget impact analysis was conducted to estimate 5-year budget for NHSO. Feasibility of service delivery was explored by qualitative approach using telephone interview. Results: Under Thailand’s willingness to pay of 160,000 baht/QALY, the six screening methods were cost-effective. CKD screening incurred additional cost and effectiveness. ICER of the six methods were between 16,878.73 - 24,245.37 and 13,844.74-20,503.14 baht/QALY for societal and provider perspective, respectively. Protienuria dipstick had the lowest ICER and exhibited a 5-years-budget of 5,653 million baht for screening and treatment, however treatment budget was the major proportion of the budget (97-99%). Primary care practitioners agreed the benefit of CKD screening and suggest to implement a screening method that ease to use. Preparing for CKD screening before implementation should concern: human resources, training about screening, CKD related services and referral system, educate elderly about CKD to increase compliance to screening and treatment. Conclusion: Annual CKD screening for elderly is cost-effective. Although protienuria dipstick incures the lowest budget to NHSO for screening and treatment. However microalbuminuria dipstick should be selected because of its highest cost-effectiveness. Elderly CKD screening is feasible for primary care but need some prepations regarding healthcare resources: human resources, CKD related services and referral system. This study recommends that CKD Annual CKD screening for elderly should be included in the UCBP.


location: , 'Thailand year: 2001 source: HSRI

title: Improvement the continuity of hospital to home-based rehabilitation for stroke patients at Sappasittiprasong Hospital

abstract: Improvement  the continuity of hospital to home-based rehabilitation for stroke patients at Sappasittiprasong HospitalBackground and PurposeStroke management is aimed at facilitating functional independence and community reintegration. Therefore, It would be logical that the sooner the patient can be returned home following stroke, the sooner the reintegration process can commence. The purpose of this study was to improve the continuity of hospital to home-based rehabilitation for stroke patients.MethodsAction research  devised to 3 phases. This study was Phase 1 what showed situation analysis to identify problem. Prospective study  collected data of patients and patients’ family who referred to Physical Therapy Department at Sappasitthiprasong Hospital. The data was collected by interview, indepth-interview,  observation and focus group.  The main outcome measure was Barthel Index (BI) for assessment activities daily living (ADL).ResultsThe problems were identify to problem of co-ordination in interdisciplinary team,   problem of home visit service from home health care system, problem in lack of authority and  problem of patients and caregiver.  The most of patients were in rural area.  There were 8 subjects who came to follow up from 20 subjects. Barthel Index score showed improvement when comparison of hospitalization period and 3 months followed up period (4.8, 12.2, respectively).Conclusion The continuity of rehabilitation system could improvement by the patient’s family member or other caregiver participated in rehabilitation from beginning and improved the co-ordination in interdisciplinary team.


location: , 'Thailand year: 2023 source: HSRI

title: Changes in the Mask Wearing Rate in Public Areas during the COVID-19 Pandemic as Determined by Artificial Intelligence and CCTV Image Analysis

abstract: Background: The COVID-19 pandemic has caused immense health and financial loss globally. Standard health precautions, including mask-wearing reduced its spread. Compliance with these measures varied between countries, depending on the culture, the public awareness and the policies enacted by the government. A higher rate of mask-wearing was thought to be more effective in limiting the spread of the disease and methods of monitoring mask-wearing would be useful for campaigns to increase mask-wearing. Although the mask-wearing rate has been estimated with questionnaires and episodic counting studies, there were very few reports visually documenting the rate of mask wearing sequentially over time. In the present study we developed an artificial intelligence (AI) system to analyze images from public CCTV (closed-circuit television) to document the rate of mask wearing in Bangkok, Thailand, and correlate the rate with public health policies and COVID-19 events and determine factors related to improper masking. Methodology: Public CCTV cameras in the Bangkok Metropolitan Area (BMA) were selected in view of their location and camera viewpoints. Every week, 9 hours of video clips from each of these cameras were downloaded and sent for analysis by an AI that had been trained to detect mask-wearing using pictures with and without masks from public databases. A number of the images was also visually checked for accuracy. The rate of mask-wearing was analyzed and correlated to public health measures and COVID-19 infections using panel regression analysis. The images of faces without masks were reviewed to understand factors related to not wearing masks. Results: 39 cameras were selected for weekly data download from 1 April to 15 November 2021. Of these 15 were validated fortnightly by humans. Important COVID-19 events over 8 months of the study included the announcement of the mask mandate and the peak infection of the 4th wave of infection in Thailand. The overall average rate of mask-wearing across BMA in the mobile population increased after the mask mandate from 89% (SD 10%) to 92% (SD 9%) but this did not reach statistical significance (p = 0.3). However, comparing the mask-wearing rate from the mask mandate to the start of the 4th wave, and from the start to the peak of infections of the 4th wave, the mask-wearing rate increased significantly from 92% to 96% (p = 0.0039). Statistical analysis also revealed that the reported number of infections in the prior week, weekends, time of day, and type of location were significant factors associated with the mask-wearing behavior. Analyzing the images showed that males were approximately 3 times more likely to be seen without proper masking. Conclusions: The use of public CCTV and mask-detecting AI can be used for public monitoring of mask-wearing in the real-world. Bangkokians had a high mask-wearing rate in public areas with an 89% mask-wearing rate before the mask mandate. Although mask wearing increased after the mandate to 92%, the maximal rate of mask wearing (96%) correlated with the peak infection in Bangkok. Factors related to improper masking included the reported number of infected people in the prior week, weekends, time of day, and location type. These factors, as well as other factors seen from the CCTV images may be good targets for campaigns to increase proper mask wearing in the future.


location: , 'Thailand year: 2014 source: HSRI

title: Transformative Learning for Community Nurse Production: A Case Study of Boromarajonani College of Nursing, Khon Kaen

abstract: Although approximately 6,500 nurses graduate from over 80 nursing institutions each year, there
seems to be no end in sight to nursing staff shortage. This shortage is both in numbers and in terms of
essential skills to meet the complex needs of the community. In Khon Kaen province, public health care settings have also faced the nursing staff shortage problem, especially at health centers in the rural areas.
The health personnel data of Khon Kaen Provincial Office show that novice nurses prefer to work at the
hospitals more than at the health centers and the attrition rate of the nurses in all levels of health care
settings is high. To overcome the problem, the Community Nurse Production for Community and by
Community Project was launched in Nam Phong District in 2002. It was effectively run and sustained by
the collaboration of several organizations in the community. An evaluation revealed that the shortage was
decreasing while the retention rate was increasing. Thus, Khon Kaen Provincial Office, Khon Kaen Hospital,
readiness community hospitals and Boromarajonani College of Nursing, Khon Kaen agreed to expand
the project to produce 200 community nurses within seven years, from 2009-2015, to cover most areas of
Khon Kaen. After participating in the project, the college has adjusted teaching and learning activities of
both curricular and co-curricular activities by using integrated education approach to develop essential
knowledge and skills for community nursing students. Hence, it can be concluded that the Community
Nurse Production for Community and by Community Project has significantly transformed nursing education
and nursing workforce in Khon Kaen province.


location: , 'Thailand year: 2017 source: HSRI

title: Progression rate to diabetes mellitus and association between sleep factors, serum uric acid level, and HbA1c level in pre-diabetic people

abstract: Diabetes mellitus (DM) is the major public health burden in Thailand. DM is the significant risk factors of cardiovascular disease, end stage renal disease and cancer. Therefore, to decrease morbidity and mortality from diabetic complications, prevention of DM is an important issue. Insulin resistance and pancreatic β-cell dysfuction are the major mechanisms of developing DM. These 2 mechanisms lead to abnormal glucose regulation, called prediabetes that comprises of impaired fasting glucose or impaired
glucose tolerance. Previous evidences found that prediabetes is a significant risk factor of DM. Around 60% of diabetic patients had prediabetes 5 years before developing DM. Until now, there has been no study that investigate about the progression rate to DM in Thai prediabetes patients. In addition, currently, there is new proposed risk factors of DM such as serum uric acid and sleep factors. Therefore, this study aims to estimate the progression rate to DM and assess the association between sleep factors, serum uric acid, and HbA1C level.


location: , 'Thailand year: 2015 source: HSRI

title: Outcomes and Factors Influencing Access to Assistive Device for Mobility Disabled People

abstract: This study aimed to 1) investigate effects of assistive devices on quality of life (QOL) and functional
outcomes in disabled people, and 2) quantify factors affecting access to devices. From March to May 2014,
an observational study was carried out in mobility impaired individuals of ages 15 to 65 years old, who
need to use assistive devices i.e. wheelchair, handicap tricycle and prosthesis leg in 10 provinces throughout
Thailand. The sample was classified into two groups: 1) access group; and 2) without access group.
Individuals that have the assistive device, use it regularly and are satisfied with their device were classified
into the “access group” while those who did not meet the aforementioned criteria were classified into the “without access group“. World Health Organization Quality of Life (WHOQOL) - BREF was used to
elicit QOL while selected International Classification of Functioning, Disability and Health (ICF) codes
were used to measure functional outcomes. This study included a total of 308 individuals in the “access
group“ and 295 individuals in the “without access group“. Compared to those who without access,
disabled people with access had significantly better QOL in all dimensions except for the environment
dimension. Additionally, the “access group“ showed a significantly higher level of functioning than the
“without access group” in all functions with exception to the education. Factors affecting access to assistive
devices were age, health scheme, registrations for disabled people, occupation, and care from family. In
conclusion, assistive devices enhance both QOL and function in disabled population; hence, increase
access to these technologies is crucial. Furthermore, health scheme and disabled registration are government-
side factors influencing access to assistive devices.


location: , 'Thailand year: 2023 source: HSRI

title: A Scoping Review and Synthesis on Recent Developments in Cannabis Regulation and Impacts of Cannabis Legalization in Countries Using This Policy

abstract: This report is a review, synthesis, and knowledge management of cannabis control and the impacts of recreational cannabis legislation overseas to serve as basic information for evidence-based policy-making, technical development, and research in Thailand. There are five main questions: 1. What are the current forms of cannabis control in various countries? 2. What are the options and considerations in designing cannabis control measures? 3. What are the impacts of recreational cannabis legalization under the International Drug Control Conventions? 4. What are the impacts of allowing the sale or procurement of recreational cannabis, i.e., “cannabis liberalization policy” among implemented countries? and 5. What are the recommended technical and research actions pertaining to monitoring and evaluation of cannabis policy in Thailand? METHODS Due to the short period of time to produce this review (4 months), the authors started by searching for the most recent systematic reviews, followed by additional original papers to obtain recent data on each issue. The authors used PubMed as the main database to search for the literatures, followed by Google (where applicable). The authors paid more attention to peer-reviewed articles than reports or documents published by a particular group. The authors also tried to assess and select studies with proper methodology, samples that were representative of the state or country-level population, and with a comparison group. Examples include comparison of states with and without cannabis legalization laws, before and after cannabis legislation, quasi-experimental studies, and research work with interrupted time-series analysis. RESULTS Legal measures to control cannabis can be categorized into 5 types: 1. Criminalization of cannabis, including use, distribution, and possession thereof. This is the most common form of control worldwide, particularly in Asian countries such as Afghanistan, Bahrain, Brunei Darussalam, Indonesia, Japan, Iraq, and Malaysia. 2. Designation of cannabis as an illegal but decriminalized substance. This includes imposing a fine for users but without legal penalty. Vendors remain liable for criminal penalty. This form of control is practiced in some Western countries, including Belize, Bolivia, Dominica, Moldova, Paraguay, and Saint Lucia 3. Designation of cannabis as a narcotic with allowance for medical use, such as in Lebanon, Lithuania, New Zealand, North Macedonia, and Norway 4. Decriminalization of cannabis but with strict control of misuse. This form of control includes limitation of possession amount, prohibitions (of sale to youths, advertising, operating vehicles under the influence), and use of cannabis taxation. Countries practicing this form of control include Canada, the United States (in certain states), and Uruguay 5. Decriminalization of cannabis and allowance for free market competition, with free or relatively free ability to cultivate, distribute, or advertise. Currently, there are 47 countries where the laws allow for use of cannabis for legal purposes, 38 countries with depenalization for cannabis possession and use. Options in reduced control of cannabis. Cannabis control under international law. Impact of recreational cannabis policy on health and society. Health and social impacts, Social and economic impacts and Recommendations for development of cannabis policy in Thailand.


location: , 'Thailand year: 2001 source: HSRI

title: The task of Tambon Administration Organization(TAO) and the strength of Tambon Civil Society (Sub-district Community) in dealing with Tambon health problem

abstract: The Task of Tambon Administration Organization (TAO) and the strength of Tambon Civil Society (Sub-district Community) in dealing with Tambon health problems	The study on the task of Tambon Administration Organization (TAO) and the strength of Tambon Civil Society (Sub-district Community) in dealing with Tambon health problems has its objective to research the project or activities in five-year Tambon  development plan, to deal with the problems of community sanitation, to research the task of Tambon Administration Organization and Tambon Civil Society in dealing with community sanitation including with some factors creating cooperation and participation in Tambon Civil Society Approach a deal with the problems of community sanitation.	The study is the field research which having units of analyses; for example, TAOs throughout the country represented by 40 TAOs samplings in all parts of the country with studied populations; such as, TAO’s representatives who are administrative chairman, TAO administrative Committee, members of TAO Council, TAO Personal (Deputy Director of TAO) and local group’s, community organization’s representatives. Material used on this study is questionnaire in-depth and focus group discussion including 3 TAO case studies selected from the TAOs with some Community in dealing with community sanitation. The result of the study found that	The project or activity research on TAO’s Tambon Development Plan during 1998-1999 found that 36% of the projects or activities under Tambon Development Plan with community health following the Tambon Development Plan in the Regulations of Annual Budget and TAO’s Additional Expenditure during 1998-1999 and 30% of the projects under the Budget Regulation had its projects or activities made. Most of the projects are small which supported through the agency concerned by TAO’s finance.	The result on the TAO’s task and Tambon Civil Society in movement for operation is particular obligation in dealing with Community Sanitation found TAO’s task with management on community sanitation, in conclusion benefit activities management to health promotion, community sanitation, environment and public health, disease prevention, basic public service and public utility including with water resource development. In addition, the TAO’s operation is to support other organizations with finance budget in any activities performed to benefit to the public; for example, purchasing of drugs for health centers, purchasing fogger to get rid of mosquitoes, public health check, get rid of hydrophobia, lunch and nutrient support of Child Development Center as well as activities run by TAO’s in different capabilities; for example, anti-drug addict campaign, AIDS, disease prevention and control, disposal of garbage, public education for health and hygiene, hazardous material control, mobile TAO health, cooking and nutrition, medicinal plant transformation, and natural resource reservation, etc.	The task of groups and community organizations with their movement in Tambon Civil Society found that their operation is similar to the TAO’s, except, the TAO with strong community organization. Most public health activities are varied; for example, a campaign to have to elderly taken care, medicinal plant transformation, savings for occupation support, conservation of natural resources and environment, water pollution, pollution, including alternative agriculture, etc.	The result of researching for the basic needs of TAO’s, groups, and community organizations, found that they are in the same way; in addition, the problems of drug addict, disease, epidemic, collecting and getting rid of garbage, pollution, lacking of drinking water are urgently to be solved while the community organization needs additional basic knowledge of community health, caring and arranging welfare to children, elderly, handicapped and inferior opportune persons including with selective community health activity.	Some factors crated cooperation and participation in Tambon idea to get rid of the community health problems; for example, community of TAO, vision of TAO executives; idea, intention, coordination, budget and TAO income, community leaders and strength of organization, education center and community learning process.	Political suggestion to the organization concerned development of community health in Tambon should be made for sample “Tambon Health Community” showing strong collaboration among population (group, community organization), private development organization, private sector and government organization in provincial, district, Tambon levels to promote Tambon health community while the health center may become community learning center for health. Group and Tambon community may campaign together in education to those of village and Tambon as well.	Suggestion to TAO is to establish together, “TAO Community”. There should be the Public Health Section apart from TAO Organization and the particular personal skill in essential Community Health should be developed. The TAO, Health Center, Public Welfare official including group and Community Organization must cooperate and participate to create the task for Tambon community health to decentralize community health of TAO and community in the future.


location: , 'Thailand year: 2019 source: HSRI

title: Future Employment of Doctors, Dentists, Pharmacists, and Nurses in Thailand Public Sector in the Next 15 Years: Employment Patterns, Retention, and Budget Burden

abstract: At present, the Royal Thai Government attempts to downsize civil servant posts amongst health personnel. This approach affects not only administrative staff, but also core health professionals including doctors, dentists, pharmacists, and nurses. This study aimed to explore the current situation and new employment modalities of health personnel and the impacts on retention and budget in the next 15 years. Cross-sectional mixed-method design was used. Data collection techniques comprised document reviews, in-depth individual interviews with policy makers and health personnel users, and group interviews with health personnel. Self-administered questionnaire survey on health personnel was also performed. Thematic analysis was used in qualitative data. Descriptive and inferential statistics were used in quantitative data. For qualitative findings, policy makers and health personnel users opined that hiring health personnel in civil servant posts usually faced bureaucratic hurdle, which at times undermined the flexibility in assigning health personnel in a position that matched their expertise. However the civil servant posts should continue to exist in certain functions, for instance, executive and financial functions. From the viewpoints of health personnel, being hired in civil servant post contributed to longer retention in the public sector due to work security and attractive benefits, especially medical benefits for family members. All interviewees agreed that there should not be too many employment patterns. If the civil servant employment were to be terminated, the replaced employments should have increased start-up salary and fringe benefits not inferior to the current civil servant benefits. This is consistent with the quantitative findings, which demonstrated that civil servant employment would cause longer retention years in the public sector despite large budget burden incurred (approximately 21,632 million baht in the next 15 years). Nurses showed longest retention years than other professionals. Comparing with other employment modalities apart from civil servant employment, hiring health personnel in the fashion similar to university staff with fringe benefits not inferior to civil servants, were likely to see longest retention years despite a relatively large budget burden (the budget size in the next 15 years equating 15,208 million baht, about one quarter of the budget used in civil servant employment, while the remaining health personnel in the next 15 years would be half of the remaining health personnel in civil servant employment). In summary, downsizing the number of new civil servant posts tended to substantially decrease budget impact but there was a trade-off in losing health personnel from the public sector. Regarding policy implications, the downsizing policy of civil servants should not be hastily implemented. Lifting the remuneration and fringe benefit of new employment modalities to the level that is on par to those of civil servants is recommended. In addition, there should be an amendment in public employment laws or regulations to create a leeway for health facilities in hiring health personnel in the way that matches their local context.


location: , 'Thailand year: 2003 source: HSRI

title: Set up public scoping for investigation of possible health impacts from the Wieng Haeng mining project

abstract: This study was aimed to set up public scoping for investigation of possible health impacts from the Wieng Haeng mining project, using the participatory approach from public and other stakeholders. Results from literature review on possible health impacts, and data on the living styles of the affected community were used to identify the possible health impacts. Public and other stakeholders were allowed to join the study and provide suggestions for public scoping. It was found that there were four aspects of possible health impacts: physical, mental, social, and spiritual health. Physical health impacts were: 1) Accidents and injuries from mining and transportation 2) Effects from noise 3) Diseases and effects from air pollution 4) Diseases and effects from water pollution  5) Effects from explosion 6) Labor migration and communicable diseases. Mental health impacts were expected from 7) Stress and anxiety. Social health impacts were likely from: 8) Effects to community life style 9) Effects from community migration and resettlement 10) Effects from depletion of forest and agriculture land. Spiritual health impacts were likely from  11) Effects from aesthetic changes and loss of loyalty to and connection with the locality  and 12) Effects from losing their spiritual haven.


location: , 'Thailand year: 2019 source: HSRI

title: Prevalence of latent tuberculosis infection and implementation of Isoniazid prophylaxis in Thai prisons   (1st year)

abstract: Background : Tuberculosis (TB) remains a major global public health issue. Thailand was classified by World Health Organization (WHO) as one of the fourteen countries with the highest burden of TB, multidrug resistant TB (MDR-TB) and TB/HIV coinfection. Addressing latent TB infection (LTBI) is one of the key factors to achieve TB elimination by 2035. LTBI treatment should be provided especially in high risk populations in order to reduce the risk of progression to active TB. It is a major challenge to control TB in correctional facilities (prisons). Many risk factors contribute to higher incidence of TB in prisons such as overcrowding, and limited access to health care services in prison settings. Inmates with LTBI may be at risk of developing active TB due to co-morbidities such as malnutrition and HIV infection. However, the data of LTBI in Thai prisoners is limited. The aims of this study were to determine the prevalence of LTBI and to evaluate the feasibility of providing the LTBI treatment for Thai prisoners at Klong Prem Central Prison in Bangkok, Thailand. Methods : A cross-sectional study was conducted in prisoners who agreed to participate by signing the informed consent. All participants who meet the eligibility criteria were interviewed using a questionnaire. LTBI was evaluated using Tuberculin skin test (TST). TST was read after 48-72 hours and indurations of ≥5 mm and ≥10 mm were considered positive among HIV-infected and HIV-uninfected participants, respectively. Serological testing for Anti-HIV, HBsAg, Anti-HCV and VDRL were performed for all participants. Additionally, interferon gamma release assay (IGRA) were tested among subgroup of 294 participants. Participants with positive TST or IGRA were considered as having LTBI. Isoniazid prophylaxis therapy (IPT) was offered to all LTBI participants. Initiation of IPT was dependent upon the readiness of the participants. The duration of IPT was 6 months for HIV-uninfected and 9 months for HIV -infected participants at a dosage of 300mg/day. Results : From August 2018 to November 2019, a total of 1,032 participants were enrolled. Thirty participants were excluded because of abnormal chest X-rays (n=25) and incomplete TST testing (n=5). Thus, 1,002 participants were included in the analysis. TST was positive in 359 (35.8%) participants and 181 out of 294 participants (61.6%) had positive IGRA, resulting in 466 (46.5%) participants that were considered to have LTBI. Interestingly, when we decreased the TST positive cut-off to ≥5 mm for all participants, the TST positivity increased to 70.3%. The sensitivity of TST positive at cut-off of ≥10 mm was 40.9% and at cut-off of ≥ 5 mm was 76.2% compared to IGRA. The risk factors associated with LTBI were history of incarceration (aOR 1.53, 95%CI, 1.16-2.01, p=0.002) and history of prior active TB (aOR 3.02, 95%CI, 1.74-5.24, p< 0.001). Majority of LTBI participants (n=383; 82.2%) agreed to take IPT. Among 356 (92.9%) participants completed treatment and 27 (7.1%) participants discontinued IPT due to the side effects of INH. Having HBV co-infection (aOR 4.92, 95%CI, 1.76-13.78, p= 0.002) and HCV co-infection (aOR 3.56, 95%CI, 1.12-10.59, p= 0.02) were associated with adverse events after IPT inititation. Aside from this, we found the prevalence of HIV, HBV, HCV and syphilis infections were high as 2.9%, 6.1%, 5.7% and 4.9%, respectively. Conclusion : In order to reduce TB incidence in Thailand, the assessment of tuberculosis in prisons is needed. This study showed a high prevalence of latent TB infection in prisons in Thailand. Almost half of the inmates have LTBI. Therefore, this population is at high risk for developing active tuberculosis. Moreover, the cut-off of TST ≥5 mm can increase the sensitivity of TST testing compared to IGRA. Our findings demonstrated that LTBI treatment in prison is feasible because 92.9% of them have completed treatment. However, after LTBI treatment, long-term follow-up for 3 years is warranted to determine the efficacy of IPT among prisoners. Given high prevalence of LTBI and high completion rate of IPT, LTBI treatment should be provided.


location: , 'Thailand year: 1998 source: HSRI

title: Pattern of hospital delivery in Thailand 1990-1996

abstract: Pattern of hospital delivery in Thailand 1990-1996There is no comprehensive information of the pattern of hospital delivery in Thailand. The Ministry of Public Health (MOPH) statistics only report normal and abnormal deliveries. Non-MOPH and other private hospital information is totally lacking. The objective of this study is to demonstrate the  pattern of hospital delivery in Thailand during the period of  1990-96. Questionnaire survey to all public and private  hospital was done with a result of 62 percent response rate.  Important parameters include total hospital deliveries, mode of delivery (vaginal, cesarean, vacuum, forceps and others),  primary or secondary cesarean, and number of full and part time obstetricians in each hospital during the period of 1990-96. The following results are very interesting. 1.MOPH distric and  provincial hospitals got a lion share, 67 percent of total national hospital deliveries. Private hospital delivery is less  common, only 9 percent of totals. 2.In 1996, cesarean rate in distric hospitals was percent 7.2, provincial hospitals percent 22.9, other public hospitals percent 21.2 and private hospitals  51.5 percent. The national cesarean rate was 22.4 percent. 3.In 1996, vaginal birth rate was 67 percent, other type of delivery 11 percent. During 7 years (1990-96), vaginal birth rate  gradually decreased, cesarean rate gradually increase and forceps and vacuum extraction stays constant at 10-11 percent  of total hospital deliveries.    4.Cesarean rate steadily increased from 15.2 percent in 1990 to 22.4 percent in 1996 and showed a further increasing trend. 5.In 1996, of the total cesarean cases, 64.1 percent was primary and 35.9 percent was secondary cesarean  (indicating previous cesarean). 6.In district hospitals, cesarean rate in 1996 was 7.2 percent , of which 5.5 percent  was primary and 1.7 percent was secondary sections. Primary  rate increased at a higher rate than secondary in the past seven years. 7. In provincial hospitals, cesarean rate in 1996 was 23 percent, of which 14.4 percent was primary and 8.5 percent was secondary sections. Secondary rate significantly increased at a higher rate than secondary in the past seven years. 8.In other public hospitals, cesarean rate in 1996 was 21 percent, of which 14.1 percent was primary and 7.1 percent  was secondary sections. Primary and secondary rate has similar  rate of increase in the past seven years. 9.In private  hospitals, cesarean rate in 1996 was 51.4 percent, of which 32  percent was primary and 19.4 percent was secondary sections. Primary rate increased at a higher rate than secondary in the past seven years. 10.The national average, cesarean section  rate increased from 15.2 percent to 22.4 percent during the seven years. Primary and secondary rate has similar pace of  increase. 11.The number of obstetricians in sample hospitals increased from 648 in 1990 to 882 in 1996, a 36 percent increase. At the same time, number of cesarean childbirths increased from 58,183 cases in 1990 to 109,867 cases in 1996, a 89 percent increase in the same perid. 12.Casarean surgery  workload per obstetrician increased from 88 cases per year in 1990 to 121 cases in 1996.


location: , 'Thailand year: 2003 source: HSRI

title: Primary care service model development for healthy community : A case study of Eastern region

abstract: The purpose of this action research was to develop a primary care model for a healthy community in the eastern region of Thailand. The research process consisted of 5 stages: 1) exploration of primary care delivery in selected settings, 2) improved understanding of the concept of primary care unit management, 3) build community health participation, 4) maintain development of primary, and 5) evaluate and recommend. Selected settings for the study were a community health center and municipal health center in urban area of Chonburi province. Informants included administrative committees, health care providers, village health volunteers, community leaders, and people in the community, Data were collected from documents and reports by in-depth interviews, focus group discussions, brain-storming, questionnaires, and observations. Content analysis was validated by informants and experts in the community.	The results were as follows:The Primary Care Model is designed by developing and modifying structures of the previous health centers as the primary care units (PCU). The PCU activities focused on four dimensions of health care including health promotion, prevention, primary medical care and rehabilitation. The main health care providers working at the PCU were professional nurses and technical nurses. The physician worded regularly at the PCU for a half day per week. There was a health referral network. The health care networking committee was set from four alliances in order to create changes, monitor, and evaluate the development of the PCU.The process to establish effective primary care units emphasized personnel development, health service system improvement, and community potential enhancement. The keys for success included shaping ideas and enhancing knowledge as well as building community participation in the health system development. The educational institutes in the community mentored and supervised the development.The outcomes of the development process included providing four dimensions of health care services that were congruent with the health care providers’ experiences and background. Applied the concepts from anthropology to understand the potential of the community. Health care providers and community members started working together by creating sa vision and mission; building community participation in health care; setting a strategic plan, and establishing a health care networking committee. Establishing a health partnership in the community was a key for success for the primary care model. The communities were satisfied with convenient services that easily accessed, and provided service with care. Educational institutes and community agencies took responsibility to develop services. The professional nurses are the main personnel and demonstrated competencies in working at PCU.The main element to improve the quality of services included having focused health policy and qualified personnel. The qualified nurses should be Masters prepared in the field of community or family nursing. An effective budget management, quality control health networking, community data base are needed. In addition, modification of the role of community agencies and people in the communities in the communities in order to take responsibility for their own communities by establishing community health partnership.Recommendations for primary care model development are to prepare and improve the structure, the main personnel should be a professional nurse and allocate personnel based on their potential and ratio between health personnel and clients. Development of the ability of personnel and the administrator. Improvement the home health care, the holistic care. Development the budget management, the quality control and the net working. Establishing the health learning center and community volunteers in the community, And modification of the role of community agencies in the communities in order to take responsibility.Suggestions for health policy should be built by agreement of government, professional agencies, and educational intakes. Future research should study the development of a primary care model focusing on service cost analysis, decentralization and role of satisfied primary care model, and a health learning center.


location: , 'Thailand year: 2007 source: HSRI

title: On Establishing a Community-participation Model Health-promoting Village in Denchai District, Phrae Province

abstract: This was a participatory-action-research study aimed at examining a model healthpromoting
village, using community participation, conducted in three villages in Denchai
district, Phrae Province. The health-leading teams comprised 10 specifically selected persons
from each village, a total of 30 persons; representative villagers were 50 residents selected by simple random sampling from each village, a total of 150 respondents. Data
were collected by interviews, group discussion, and health leading-team conferences.
Results of the study revealed that health leading-teams were the leaders of developing,
controlling the plans and activities of health promoting villages and coordination with
other organizations. Health-promoting activities in the villages were as follows: 80 percent
of the villagers planted and consumed local vegetables, meaning that there was no
chemical contamination in food; there was one elderly social group in each village; because
of project implementation, the health knowledge of villagers was improved to 100
percent, which was statistically significant.
With regard to health problems, 49.3 percent of the villagers undertook regular physical
exercise for 30 minutes per day thrice a week; 88 percent washed their hands before
and after eating; 84 percent brought food substances approved by the Food and Drug
Administration as certified by labels and symbols; 75.3 percent eradicated mosquito breeding
sites; 73.3 percent were members of the “To Be Number One Club”, which works
against amphetamine addiction 88 percent had their blood pressure measured within
one year; 63.3 percent of the female villagers had had a pap smear examination; and 93.7
percent had performed breast examinations by themselves. Based on the results of the
study, the author suggests that community health promotion should be promoted and
models of implementation should be developed with the support of every organization
and civil society concerned. Government authorities should support community participation
in the management of health-promoting plans of the villages.


location: , 'Thailand year: 2022 source: HSRI

title: Safety and Immunological Response following Intradermal COVID-19 vaccination in The First vaccination and The Booster

abstract: Importance: Intradermal administration of SAR-COV-2 vaccines may be the alternative route for vaccination in resource-limited settings. By given lower amount of exposed antigen, the one-fifth of regular dose via intradermal administration (ID) had shown similar immunogenicity and less systemic adverse reaction comparing to intramuscular administration (IM). Objectives : To determine adverse events (AEs) and immunogenicity of intradermal administration of primary series and booster dose of CoronaVac, ChAdOx1 and BNT162b2 in healthy population. Design: This prospective study was conducted from September 2021 to February 2022. Setting: A single center, university-based tertiary care center in Bangkok. Participants: A total of 140 healthy volunteers were 80 SARS-Cov-2 vaccine-naïve and 60 volunteers who completed primary series of IM CoronaVac, ChAdOx1 or BNT162b2. Exposure: In vaccine naïve volunteers, they were divided into 5 groups to receive following regimens (4 weeks apart): 1) ID CoronaVac 0.1 ml and ID ChAdOx1 0.1 ml (n=20); 2) ID ChAdOx1 0.1 ml and ID ChAdOx1 0.1 ml(n=20); 3) ID BNT162b2 0.05 ml and ID BNT162b2 0.05 ml(n=20); 4) IM ChAdOx1 0.5 ml and ID ChAdOx1 0.1 ml(n=10); 5) IM BNT162b2 0.3 ml and ID BNT162b2 0.05 ml (n=10). In volunteers who completed primary series, they were given ID ChAdOx1 0.1 ml or ID BNT162b2 0.05 ml as a booter. Main Outcomes and Measures: Self-reported AEs were collected for 7 days following each vaccination using electronic diary. The immunogenicity was determined by the level of IgG antibodies against receptor binding domain (RBD) of the SARS-CoV-2 spike protein (S1 subunit). The plaque reduction neutralization tests (PRNT) and Focus Reduction Neutralization Tests (FRNT) against original (Wuhan) and circulating VOCs were performed in subset of random samples at 2 weeks after the second dose or booster dose. The T-cell response was measured using ELISPOT. Participants who had positive anti-np or anti-RBD-IgG at baseline were excluded from analysis.
Results: Among 67 vaccine-naïve participants, the median (interquartile range: IQR) age was 34.5 (24.5-44) years old and 48.75% were female. Participants who received the ID administration reported less systemic reaction (58%) than the IM administration (80%). Immunogenic response following IM BNT162b2-ID BNT162b2 provided the highest IgG level with geometric means of 13,427 AU/mL and GMT 23.05 against omicron strain followed by ID BNT162b2-ID BNT162b2, ID CoronaVac-ID ChAdOx1, IM ChAdOx1-ID ChAdOx1, and ID ChAdOx1- ID ChAdOx1. A total of 58 participants were enrolled and received third dose booster. Their median age was 43 years old (IQR 35-48) and 67.24% were female. The geometric mean ratios (GRM) (post boosted/pre boosted) of ID BNT162b2 and ID ChAdOx1 following CoronaVac primary series were 33.83 and 24.89, respectively. GMRs of ID BNT162b2 and ID ChAdOx1 were 7.90 and 1.29 following primary series of ChAdOx1 and were 2.40 and 0.97 following primary series of BNT162b2. The third dose ID booster of BNT162b2 provided higher GMT against omicron and delta variants following primary series of ChAdOx1 and BNT162b2; however, ID ChAdOx1 showed higher GMT against delta and omicron following primary series of CoronaVac. Conclusions: Intradermal administration of SAR-COV-2 vaccines show less systemic adverse reaction and can increase both humoral and cellular immunogenicity. Immunogenic response following ID BNT162b2 in both vaccine-naïve participants and for booster dose are better than ID CoronaVac and ID ChAdOx1.


location: , 'Thailand year: 2007 source: HSRI

title: Self Realization and Risk Behavior which Vulnerable to HIV Outbreak Current Situation in Phan District, Chiang Rai Province

abstract: This descriptive study was designed to analyze risky behavior that makes people
vulnerable to HIV infection in Phan district. Among the sample of 330 people, 48.19
percent were unaware of HIV infection, and 76.67 percent were practicing unsafe sex. Of
222 samples who were tested for anti-HIV antibodies, 11 of them were HIV-positive, producing
an HIV prevalence rate of 4.95 percent in Phan district, whereas the prevalence
rate for the country as a whole is 1.4 percent. It seems that there is a high possibility of an
HIV outbreak in the near future in view of the present situation. The basic problems are
the same as encountered in the previous era, e.g. a lack of knowledge, values, and sense
of social responsibility. These are universal concerns, not just those of HIV-infected persons.
Sustained collaboration is truly needed in order to strictly control the spread of
HIV.


location: , 'Thailand year: 2000 source: HSRI

title: Diffusion and utilization of MRI in Thailand

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


location: , 'Thailand year: 2017 source: HSRI

title: Surveillance of Antimicrobial Consumption in Thailand: A Foundation for Controlling Antimicrobial Resistance

abstract: Antimicrobial resistance (AMR) is one of the most serious health threats worldwide and it has
become more intense to day-to-day concerns. Excessive and inappropriate uses of antimicrobial are
main drivers of the emergence of resistant bacterial strains. To optimize use of antimicrobial agents in
human and animal, as recommended by the Global Action Plan on AMR, countries need to develop
and sustain the system which monitors antimicrobial consumption in human and animal and disseminate
for policy decision. Hence, national surveillance of antimicrobial consumption is an important
tool to provide these useful evidences to policy makers and relevant AMR agencies on antimicrobial
consumption in humans and animals and its distribution at the national level.
The objective of this paper is to review surveillance systems of antimicrobial consumption in
European countries and to explore the possibility of establishment of the Thai Surveillance of Antimicrobial
Consumption (Thai-SAC) in humans and animals. Developed countries, including European
countries have institutionalized capacities to sustain SAC system and ensure policy uses. In Thailand,
with the application of experiences and guidelines from the European SAC and European Surveillance
of Veterinary Antimicrobial Consumption, the national SAC covering human and animal sector
consumptions are in development process by the Thai working group consisting of multi-sectoral,
multi-disciplinary researchers and key stakeholders particularly the Thai Food and Drug Administration.
In human sector, the current estimate of human medicine consumption including antibiotics in
monetary value does not provide data on the volume of consumption hence unable to monitor the
use of antibiotics and benchmark with other countries in particular European countries. The challenges
for Thai-SAC include law and enforcement on antimicrobial regulation, and the relevant database of
antimicrobial consumption in human and animal populations in Thailand.


location: , 'Thailand year: 2013 source: HSRI

title: Models of HIV counseling and testing service for general population: a review

abstract: In spite of the policy of expanding HIV testing coverage to all adults up to 65 years of age being
recommended by international organizations, social and ethical concerns related to HIV testing exist,
including discrimination, stigma and human rights protection. The study reviewed service models of HIV
testing in the general population to identify the appropriate and effective approaches towards achieving
high uptake of testing among general population in Thailand. There are two voluntary counseling and
testing (VCT) service models: facility- and community -based services. The acceptance rate ranged from
11% - 95% for facility-based VCT and from 51% - 83% for community-based VCT. Provider-initiated VCT
was not only effective in offering VCT to general population, but also cost-effective for people aged 13-50
years. PIVCT should thus be performed in all healthcare facilities in Thailand, while further research on
other approaches are recommended.


location: , 'Thailand year: 2001 source: HSRI

title: The Implications of the market exclusivity of new drugs under safty monitoring program

abstract: Market exclusivity and drug expenditures: the effects of Thailand New Drug Registration RegulationsThe effects on hospital drug expenditures of the market exclusivity granted to innovator products by means of Thailand regulations on new drug registration were assessed.  Self-administered questionnaires were distributed by mail to 292 public and private hospitals in February 2001 to collect data on purchase volume and value of 11 generic-approval new drugs containing 4 active chemicals, namely fluconazole, clozapine, ondansetron, and ofloxacin (injection form).  The questionnaires were returned by 166 settings (56.9%).     It was found that during the first two years of generic entry, 1999 to 2000, unit prices of generic versions of all products purchased by the hospitals were lower than the prototypes’ but prices of the originals did not change significantly.  Due to lower price of generic products and generic substitution in the hospitals, substantial decreasing in drug expenditures of totally 103.5 million baht has been observed.  Tremendously increased purchase volume of some drugs, particularly fluconazole, among these healthcare settings when generic entered the market while there was no increasing in health needs, indicates significantly improved accessibility to drug.       To potentiate the magnitude of the positive effects of generic entry on drug cost containment among hospitals and the increased accessibility to drugs, promoting drug price competition and encouraging generic substitution are recommended.


location: , 'Thailand year: 2004 source: HSRI

title: Rhinosinusitis Registry in Thailand

abstract: Problems Rhinosinusitis (RS) is a common disease in Thailand and still has problems in the diagnosis and treatment. It is one of the most expensive diseases since a lot of investigations and antibiotics have been prescribed to treat this disease. It has also been shown to impair patients’ quality of life and, if not treated properly, may lead to orbital and/ or intracranial complication or development of chronic sinusitis. The data of this disease is quite limited in Thailand since it has not been studied systematically before. Objectives To investigate the natural history, clinical manifestations, practice variation of use of various instrument in the diagnosis, precipitating factors, the expense of investigation and treatment especially antibiotic, and complication of RS in Thailand. Methodology During April 2003 to May 2004, we performed a prospective study on 735 patients with acute (n=569) and subacute RS (n=43), recurrent acute RS (n=73), and acute exacerbation of chronic RS (n=47) recruited from Ear, Nose, and Throat (ENT) Department of 7 medical schools in Thailand. Results Seven hundred and thirty-five patients with RS were recruited in this study with the mean age of 34.1 years. The majority of patients’ age ranged from 20 to 50 years. There were 275 male (37.4%) and 460 female (62.6%). The average follow-up visits were 3 times. The most common clinical manifestations of RS are rhinorrhea (42.1%), followed by nasal congestion (38.6%), postnasal drip (32.3%), and facial pain (32.2%). ENT physicians used nasal speculum (91%), nasopharyngeal mirror (88%), otoscope (25%), and nasal endoscopy (11%) in the diagnosis of RS. Plain film paranasal sinus (PNS) and CT PNS were ordered in 17% and 1.6% of cases, respectively. Pus and/ or sinus tissues were sent for microbiological culture and sensitivity test in 30% of cases. The most common precipitating factors of RS is acute viral upper respiratory tract infection (62%). The majority of patients (98.6%) received medical treatment. Four percents of cases required surgical intervention. Complication was found in 11% of cases. Amoxicillin plus clavulanic acid is the most common antibiotic prescribed (31.5%), followed by amoxicillin (21.6%). Ninety-five percent of patients had favorable outcomes. Antibiotics account for the majority of the expense (74%) in the treatment of RS. Conclusion and recommendation Sinusitis is a costly disease, which needs more attention to reduce the cost of diagnosis and treatment. The Clinical Practice Guidelines (CPG) of diagnosis and treatment of RS have been developed recently. This CPG aimed to optimize the use of expensive and unnecessary investigation and to help physician in prescribing the proper treatment, either medical or surgical. The cost effectiveness of the practice according to these guidelines should be thoroughly studied before being implemented for nationwide use.


location: , 'Thailand year: 2020 source: HSRI

title: The synthesis of political suggestion for the development of health service system to delay Kidney failure : A case study at Chumphae Hospital

abstract: The objectives of the mutual collaborations action research were to 1 ) develop the model of service activities in health services system for delaying progression of chronic kidney disease in all stages of kidney damage, 2) analyze the expense of resource investment in health services system for delaying progression of chronic kidney disease, and 3) synthesize the policy suggestions for health services system development to delay progression of chronic kidney disease in community hospitals. Purposive sampling was used and study subjects were 2 3 4 patients with chronic kidney disease (CKD) in all stages of kidney damage which were coursed by diabetes mellitus, hypertension, or both, at Chumpae Health Center or Primary Care Cluster (PCC), and Kidney Clinic at Chumpae Hospital, Khon Kaen Province. Secondary target group was healthcare team in both sites including 3 physicians, 4 professional nurses, and 1 pharmacist, and primary caregiver of CKD patients. There were 1 family doctor, 1 professional nurse at PCC; 2 medical doctors, 3 professional nurses at Kidney Clinic; 1 pharmacist running in both sites. Study Process: The study period was between April 2 5 6 2 and March 2 5 6 3 , however, was extended to July 2563. Study process was divided into 3 major steps; step 1 Implementation phase: a situation review of health services system for delaying dialysis according to the model developed from study in phase 1 ; step 2 implementation phase: planning, implementing, and evaluating the outcomes of health services system for delaying dialysis (Chumphae DDCKD model obtained from step 1); and step 3 evaluation phase: clinical outcomes were an average rapid eGFR decline < 4 ml/min/1 . 7 3 m2 / year in patients in all stages of kidney damage, selfmanagement behaviors, quality of life, and feasibility outcome of applying Chumphae DDCKD model in a real situation, including patient satisfaction, economic outcome: Cost-effectiveness analysis (CEA), and policy suggestions to health services system. Result: The effectiveness of applying DDCKD model for delaying progression of CKD or dialysis was tested at 3 rd and 6 th months and rapid eGFR decline was found to be decreased, rapid eGFR decline > 2 ml/min/1.73 m2/ in 6 months was only 29.06%, Patients having rapid eGFR decline < 4 ml/min/1.73 m2/year or < 2 ml/min/1.73 m2/in 6 months were 70.94%. rapid eGFR decline ≤ 2 ml/min/1.73 m2/in 6 months of CKD Patients in stage 1-2, 3a-3b, and 4-5 was found to be 74.68%, 64.71%, and 60.0%, respectively. The efficiency of Chumphae DDCK model for delaying dialysis in CKD patients with hypertension group showed that the median of rapid eGFR decline was significantly improved (p = 0.04). The study showed that score on self-management behaviors and eGFR in different periods were correlated. Prior to implementation of Chumphae DDCK model, total score on self-management behaviors changed 1 score, rapid eGFR decline would decrease to 2. 5 7 ml/min/1.73 m2. After implementation, rapid eGFR decline in 3rd and 6th months was 1.46 and 1 . 0 0 4 , respectively. An average total score on self-management behaviors before and after implementation 6 months was not significant difference. However, score on self-management behaviors in each item was significant difference, including eat bland food or less salty, eat dehydrated food or pickle food, eat high-cholesterol food, eat offal, water intake by estimating from urine output, and eat ready meal or food bought from convenience store. CKD patients in stage 1-2, 3a-3b, and 4-5 reported their quality of life score was mostly fine in every dimensions. The majority of subjects were satisfied with the new health services system in high level, followed by the highest level, and no report on less or the least levels. Cost-effectiveness analysis (CEA): after implementation of Chumphae DDCKD model, an average cost of CKD patients was 2,392.49 baht/person, 4,248.42 baht/person, and 4,181.42 baht/person in stage 1-2, 3a-3b, and 4-5, respectively. An average cost of CKD patients in stage 3 a-3 b and 4 - 5 was increased because of medical supplies, not insulin injection. Chumphae DDCKD model could delay > 5 0 % progression of chronic kidney disease in all stages of kidney damage. Cost-effectiveness analysis in this study was calculated based on numbers of CKD patients delaying progression of chronic kidney disease by considering from rapid eGFR decline < 4 ml/min/1.73 m2/year. Chumphae DDCKD model was more worth for CKD patients in stage 1-2 than for CKD patients in stage 3a-3b and stage 4-5, with the cost effectiveness of 3203.50 baht, 6,565.74 baht, and 6969.03 baht, respectively, on delaying progression of kidney damage for 1 person. The important policy suggestion was to implement Chumphae DDCK model for CKD patients because this model could delay progression of chronic kidney disease in all stages of kidney damage. However, it was worth for CKD patients in stage 1 - 2 when compared to other stages. Therefore, implementation of this model should establish in Kidney Clinic for CKD patients in early stage of kidney damage.


location: , 'Thailand year: 2008 source: HSRI

title: Clinical audit and clinical outcome of Thawatchaburi hypertensive clinic in fiscal year 2007

abstract: Hypertension is the most common cause of preventable death in developed countries
and also an important problem in developing countries. The objectives of this study
were to evaluate clinical audits and clinical outcomes of hypertensive treatment compared
with the Thai Hypertension Society guidelines, 2007. The study population included
1,274 patients who were treated in the hypertensive clinic of Thawatchaburi Hospital from October 1, 2006 to September 30, 2007. The results showed that 492 males
(38.62%) and 782 females (61.38%) with a mean age of 64 years 5 months participated in
the study and 83.31 percent of the cases were under the universal health care coverage
system. Only some risk factors associated with hypertension were recorded, ranging
from 2.51 percent to 90.66 percent. Almost all (98.74%) of the patients’ BMI levels were
recorded; 55.57 percent of them had normal BMI. There were several co-morbidities in
the records: 53.14 percent had dyslipidemia and 35.24 percent DM. The prevalence of
nephropathy and left ventricular hypertrophy was 6.59 percent and 3.77 percent, respectively.
One- third of the medical treatments used two categories of hypertensive medicines
and the other third used only one catagory. Diuretics were used in 36.50 percent of
the cases, with 29.75 percent being ACE-inhibitors, 20.15 percent beta blockers and 12.35
percent Ca channel blockers. Follow-up adherence was 76.45 percent; 23.41 percent of
the cases had well-controlled blood pressure whereas only 3.39 percent of those with DM
were well controlled.
In conclusion, a model for the development of hypertensive care should be developed
by all stakeholders, including clinicians, other health-care professionals, patients
and their families in order to improve continuously the quality of care and its outcome.


location: , 'Thailand year: 2020 source: HSRI

title: System and Mechanism Designs to Drive Development of the 6th Health Area

abstract: Ministry of Public Health (MOPH) has continuously driven Health Area Development. However, in practice, there were many obstacles and barriers that prevented expected health area development, that is the health area development issue has become one of important agendas that the MOPH and other related authorities have paid attentions to. This issue was continuously a part of the strategic plans of the MOPH and health reform plan of the Health Reform Commission. In an attempt to define and propose solutions that could lead to health area development, this research chose the 6th Health Area of the MOPH as the pilot area to in depth collect data, analysis, and design system and mechanism to drive health area development in the 6th Health Area. The researchers collected secondary information and data including National Health Reform Plan, Heath Area Development Proposals, health area development evaluation report, health area strategic/ action plans in the National Health Reform Plan, foreign experiences regarding health system management and health area development, regulatory sandbox’s concept and experiences, and MOPH and the 6th Health Area’s works regarding health system management, and health area development. Moreover, opinions of those responsible for the 6th Health Area development were also collected during the data collecting process. This was aimed to reflect expectations, problems and obstacles in the previous development attempts, as well as suggestions of conditions solutions to achieve goals in health area development. Conceptual idea in health area development and progress evaluation referred to WHO Health System Framework with 6 Building Blocks which led to identify health area development strategies that would achieve health developments of population in health area. The strategies are comprised of (1) human resource management, (2) Information system or database that could support works and health services, (3) enhancing of productions and usage of qualified and accessible technology, (4) financial management that could enhance sustainability and support health services in the health area, and (5) work mechanism that could enhance direction, policies, strategies setting for the whole health area. Moreover, the 6th Health Area is a location of the Eastern Economic Corridor that there were plenty of investment demand in service improvement and leverage. These led to conclusions that measures to drive health area development should cover (1) Health Area and Health Area Office Management, (2) Human Resource Management, (3) Health Area Management Authorization, and (4) Efficiency Improvement and Financial Sustainability. To lead concrete action the researchers propose to make proposals for system and mechanism to drive health area development in the 6th Health Area in a manner to operate in the form of a Regulatory Sandbox by conducting experiments to improve regulatory constraints that impede the action of driving the work of health area. Which has clear terms and conditions for the trial operation and evaluate the results of the experiments conducted to support the implementation of the regulation and set concrete action guidelines in the overview. Regulatory Sandbox for experiments to drive the work of the health area, consisting of 3 field test operations, which are 1) Regulatory Sandbox 1 for restructuring of work / personnel structure of the health area and the health district office, 2) Regulatory Sandbox 2 for improvements in procurement conditions and investment to increase work efficiency and create a fiscal sustainability of health area, 3) Regulatory Sandbox 3 for collaboration in health area. In the implementation in health area, found that some parts of Regulatory Sandbox 1 and Regulatory Sandbox 2 had been performed through various mechanisms that can finalize the implementation and monitor the progress of the operation to lead the proposals for action in the next phase. Finally, all of the proposals have been put forward for trials in pilot health areas under the supervision of the National Health Reform Commission.


location: , 'Thailand year: 2016 source: HSRI

title: Estimate Unit Cost per Capita of Services Provided at CUP Network Level

abstract: The objective of this study is to estimate unit cost per capita of services provided at contracting unit
for primary care (CUP) network. The cost data for fiscal year 2014 were gathered from both main hospitals
and primary care units (PCUs), consisting of labour cost, material cost, and capital cost. Then, the unit cost
per capita was analysed by service types: curative, promotion and prevention, rehabilitation, and Thai
traditional and alternative medicine.
The unit cost per capita of CUPs was calculated by looking at six CUPs: two general hospitals and
four district hospitals. The results indicated that the unit cost per capita of outpatient services at the two
general hospitals were Baht 1,215 (SD=148). Adding all four service types together, the unit cost per capita
at these two general hospitals totalled Baht 1,581 (SD=184). Whereas, the average unit cost per capita of 4
district hospitals accounted for Baht 800 (SD=51). The total average cost for all services of the district
hospitals is Baht 925 (SD=60).
While, the average unit costs per capita of 10 primary care units were Baht 372, the average unit cost
of PCUs for all services is Baht 787 with the median of Baht 689. However, rehabilitation and Thai traditional
and alternative medicine services were not available in all PCUs. This is due to the fact that those
services require health professional with specific qualifications. Further studies are needed to confirm the
result of this study, which has limitation on a small number of samples.


location: , 'Thailand year: 2018 source: HSRI

title: Borderless Health: Crossing the Borders for Health Care in Thailand among Burmese, Laotian, and Cambodian

abstract: Border health care is a complex situation, and is becoming even more so due to the differences of socio-cultural, political-economy, and geographical context. Notably, Thailand is the heart of Southeast Asia and bordered by Myanmar, Cambodia, Laos, and Malaysia. The movement of people has been thus far featured across the border seeking the health care in Thailand which is referred to as, ‘border health’. Each year, the number of people from neighboring countries across border to receive health care in Thailand has been increasing. This study aims to explore border health care situation in 3 provinces – Ubon Ratchatani
(Thai-Lao border); Sakew (Thai-Cambodia border); Tak (Thai-Myanmar border) using qualitative research methods – in-depth interview, participant observation, and focus group discussion. The participants are divided into three groups: policy makers, health professions and NGOs, and patients who crossing borders seeking health care in Thailand. This study shows that social determinants – geography, politics, health service, belief, culture, networking and social supports. Moreover, due to the politics of neighboring countries, the Thai health services in border areas must adopt different approaches of health surveillance system. The public-private partnership between the government and NGOs enhances the effectiveness of border heath care system.