location: , 'Thailand year: 2023 source: HSRI

title: Evaluation of COVID-19 Primary Care Hub Implementation During Health System Crisis in Bangkok Metropolitan Area

abstract: Background COVID-19 rapidly spread in the middle of 2021 lead to health system crisis in Bangkok, high occupancy of hospital beds; hence, Home Isolation (HI) policy was announced by the department of health, July 1st, 2021, although home isolation services provisions were limited to hospital facility. COVID-19 infection rate rapidly progresses with Delta strain and leading to health system crisis in Bangkok. The Royal College of Family Physicians of Thailand together with the GP/FP Association of Thailand agreed upon stepping in appointing a committee on July 7th, 2021, to help resolving the situation, building capacity for primary health care via three key strategies. The first strategy is to provide academic support, adjusting home isolation guideline to be more holistic, following family medicine principle, comprehensively covered all dimension of services need for the patient, family and community. Apart from this, continuous learning environment was developed via case study learning and sharing platform as well as providing relevant learning materials to build capacity of providers in primary care setting. The second strategy is to mobilize resources, recruiting health professionals for volunteering services, providing care for COVID-19 patients in Bangkok who need to get access to medical services under home isolation services package via telemedicine. To leverage maximal resource utilization, home isolation services provision via private primary care providers are essential. Hence, co-ordination was used as the third key strategy to enable services provision in primary care. In enabling primary care providers to provide services, co-ordination was used as the third key strategy. Coordinate with stake holders at various levels to enable service provision in primary care practice, including National Health Security Office, Institute of HIV Research and Innovation and Community Based Organizations, working in the community with increased number of case, and National Science and Technology Development Agency, the developer of AMED-Telehealth program, in order to establish COVID-19 Primary Care hub as one of key mechanism to solve health system crisis. This implementation research as objects to 1) analyze the key factors for success and barriers for the implementation 2) evaluate the result from the implementation and services outcome and 3) to synthesis policy recommendation in order to response to New Emerging diseases in the future. Methods This mixed-method study was conducted between February 2022 to March 2023. Consolidated Framework for Implementation Research was used to evaluate the implementation process and used Conceptual Model of Implementation Research was used to assess the implementation output and outcome. Both quantitative and qualitative information were collected from various sources of information including document used in the implementation process, focus group interview and in-depth interview, data from patient’s experience survey conducted by Health Accreditation Institute between 7-9 September 2021. Data recorded in AMED-telehealth was also used for the analysis of the implementation outcome and services outcome. Results The implementation of COVID-19 Primary Care Hub to strengthen the capacity of primary health care in Bangkok achieved to improve access to services. Two-thousand three hundred and forty health professionals recruited to Fammed-CoCare Volunteering network and work with Pribta-Tangerine clinic, by IHRI, of these 1,544 were physicians. From July 1st to December 31st. 2021, 90,816 patients with COVID-19 received home isolation in the record of AMED-Telehealth, of these, 18,592 received treatment from Fammed-CoCare-Tangerine Clinic. There were 26 private primary care clinics, under the brand wam community clinic, agreed upon working in collaboration with COVID-19 Primary Care Hub, to receive academic support, consultation with specialist and coordination to receive needed medical supply as well as referral coordination, and 5, 285 patients received home isolation care from these 26 clinics. Overall, there were 24,237 patients with COVID-19, received services under the support of COVID-19 Primary care hub. There were 190 warm community clinics joining the program to provide home isolation, and 21,966 patients received home isolation services from these clinics. There were 68 health centers by Bangkok Metropolitan Area (BMA), considered as pubic primary care services, providing home isolation services and 35,218 patients received from these public primary care facilities. Home isolation services were eventually provided by primary care providers since the coordination of the committee to work on Strengthening Primary health Care System in Bangkok. This committee achieved to communicate with NHSO, Department of Health and the Department of Services Support, enabling home isolation services being provided at primary care service facility, through the correction of regulations that were set as barrier. Home isolation services provided by primary care provider achieved to reduce the gap of inequity, with resource mobilization, strengthening the capacity of service provision in primary care, enable critical care services, and care for patients with severe illness who need hospitalization but could not get access to. Key factors for success include the characteristic of COVID-19 primary care hub that is relevant to the established primary care infrastructure in Bangkok, in which warm community clinics play important roles, although there was challenges in the beginning as the clinic staff needs preparation and there was shortage of medical supplies during that period. Academic Support and capacity building for staff in primary care settings as well as consultations and making needed medical supply available help in building confidence the capacity for service provision. Coordination with community-based organization, community leaders and volunteers in the community has key role in providing support and coordination for the vulnerable. Most importantly, financing and re-imbursement mechanism is the most important factors for the success in the implementation of home isolation services. Health System crisis has drive private sectors and people in the society to step in and provide support inorder to overcome the challenging situation, having insufficient human resources for home isolation in Bangkok. The working culture and value that prioritize integration, patient centered approach, putting patients, family and community at the central role of services enable harmonize collaboration, working towards a common goal to reduce inequity, of people working in the field of primary health care, achieved to have demonstrated model for integrated services delivery. Horizontal integration is the key function in the process of this implementation activity which allows public-private and people partnership. Conclusion Investment and resource management in order to have sufficient primary health care staff providing services at primary care level is essential. In addition to this, Continuous learning mechanisms to enable capacity building through routine workflow is important to strengthen primary care capacity, considered as leverage point to enable integrated high quality primary care services. Telehealth has a crucial role in primary health care strengthening, especially in the situation of an epidemic or pandemic, preventing the spreading of infection. Community leaders and community-based organizations are sensitive to changes or unusual situation that occurs in community and have crucial role in coordinating needed support to the vulnerable.


location: , 'Thailand year: 2022 source: HSRI

title: Health Care System to Support the Elderly with Diabetes after the Outbreak of Emerging Infectious Disease in Post COVID-19 Situation of Primary Health Care Services in Southern Region

abstract: The COVID-19 pandemic has a serious effect on community-based care for the elderly with diabetes in terms of the health promotion campaign, and continuity of Care. This study aimed to 1) study the situation and outcomes of modified diabetic care in the elderly (DCiE) during the COVID-19 pandemic, 2) develop and evaluate the DCiE system after the COVID-19 pandemic for primary healthcare centers (PMCs) by including the stakeholders involved in the development process, and 3) analyze proposed policy for the DCiE system during and after the COVID-19 pandemic. The mixed method methodology which consisted of the critical participatory action research and the survey research were utilized to conduct the study in order to compare the effects of the DCiE system during the pre-design, design, and post-design phases. One province of each of the 11th and 12th health regions was selected to participate in the study. The findings showed that the selected PMCs adjusted healthcare services during this pandemic situation as followings: 1) the extended follow-up appointment for elderly with diabetes based on their ability to control glucose levels, 2) the community-based chronic care focused on self-care management, and 3) the establishment of home delivery of medication based on their previous regimens. The DCiE system after the COVID-19 pandemic for PMCs integrated four significant components of the chronic care model as the followings: 1) The community resource 2) The process screening system 3) the knowledge and skills 4) the tool for two-ways health communication. The DCiE system was implemented throughout three interrelated subsystems which were 1) the new normal home healthcare system (Assess, Analyze, Implement, Improve) with the Thaichana-DM application, 2) the health information system for decision making, and 3) the integration of outcomes and outcome management. The effects of the DCiE revealed that 1) the mean capillary blood glucose at the postintervention significantly reduced, compared to the mean baseline (p <.001), 2) hemoglobin A1C levels at the post-intervention in the elderly with diabetes were lower than those at the pre-intervention (p < .001), and 3) the overall quality of life score among these participants was at the average level The policies were proposed 3 levels based on the significant findings of the study that consisted of 1) Upstream management, public health authorities in the area jointly developed health literacy in diabetes management focusing on clinical severity level analysis and decision-making with participatory and the prevention of COVID-19 for patients and caregivers by using a new-normal modeled home visit (2AI) 2) Midstream management, policy-level agencies in the province and local government organizations should support undertaken to have personnel with the ability to view health information systems covering both software and peopleware competency, and access to WIFI during home visits. 3) Downstream management, PMCs should monitor and assess clinical outcomes in the elderly with diabetes, covering the severity of clinical symptoms, and quality of life and continually develop plans. These proposed policies will be the supportive and driven mechanism for developing the effective DCiE system in both normal circumstances and the COVID-19 pandemic situation.


location: , 'Thailand year: 2014 source: HSRI

title: Estimate Unit Cost per day of Long term care for Dependent Elderly

abstract: The objective of this study is to estimate unit cost per day of long term care for dependent elderly in
Lamsonthi district from government spending perspective. Long term care services comprised services
from hospital, services from formal care assistance and services from family. Unit cost of services from
hospital was calculated using data from cost accounting of Lamsonthi hospital, which used a traditional
costing method of Ministry of Public Health. Unit cost of services from local government mainly was
salary of formal care-assistants. Cost of long term care services from family member was estimated using
opportunity cost concept, which opportunity cost was assumed equal to labour cost of formal-care assistants.
Total cost of long term care of hospital services were disaggregated into 3 products; severe dependent
service, moderate dependent service and mild dependent service using allocation by labour approach.
Workload of physiotherapists using simple time motion study was used as an allocation criteria
for disaggregate 3 products of the long term care. The result showed that total actual cost of long term care
service unit in 2012 of Lamsonthi hospital was 4.5 million Baht and total actual cost of formal care assistant
was 420,000 Baht in the studied district. Unit costs per day of long term care from services of both
Lamsonthi hospital and formal care assistant without opportunity cost of family members were 41 Baht,
64 Baht, and 101 Baht for mild, moderate, and severe dependence, respectively. Sensitivity analysis for
estimation unit costs per day of long term care include opportunity cost of family members was done by
replacement of support from family members with formal care assistant using ratio of time spending for
dependent elderly among family members and formal care assistant from Siriphan Sasat et al.(9).Unit cost
per day of mild, moderate, and severe dependence increase to 41 Baht, 128 Baht, and 200 Baht, respectively.
However unit cost of long term care depends on level of dependence and level of support from
family. This study found that the cost of severe dependent elderly, who depend totally on formal careassistants,
is still only one fifth of the cost of long term care in private nursing home. However, further
studies are needed to confirm result of this study, which has limitation on statistics and came from only
one district.


location: , 'Thailand year: 2017 source: HSRI

title: Perspective of Pharmacist’s Abilities in Palliative Care according to Multidisciplinary Team’s Expectation

abstract: This study was an exploratory survey, divided in two phases. The first phase explored the
multidisciplinary team’s expectation on pharmacists’ role and characteristic during palliative care, by
purposively selecting two palliative care teams for interviews and content analysis. The second phase
surveyed pharmacist’s perspective on palliative care to pharmacists who worked in tertiary hospitals, as
against the roles and characteristics obtained from the first phase. Self-administered questionnaires were
distributed to 858 pharmacists using stratified random sampling technique. The data was analyzed with
software by using descriptive statistics. From the interview data, it was found that the main role of pharmacist
to the team was general pharmaceutical care and pain management and the important characteristics
the team needed from the pharmacist were good working attitude and the team work. The data from
questionnaires showed that the ability of pharmacist in palliative care, according to the team’s expectation
was assessed at high level. When considering the individual care, the pharmacists thought they had
very high level of caring ability in physical, and then in the field of social care. For the mental and spiritual
fields they thought they had the ability at moderate level. By the role in team, the pharmacists thought
that they had pharmaceutical care ability at the highest level. Next lower levels were the using of specific
medicine and palliative care and the lowest level was the mental and spiritual care.


location: , 'Thailand year: 0 source: HSRI

title: A Model of Primary Health Care Service Delivery Provided by the Queen Sirikit Health Centers and Subdistrict Health Promotion Hospitals After Being Transferred to the Management of the Provincial Administrative Organizations Using the Mechanism of the Primary Health System Act (B.E. 2562)

abstract: This qualitative study is about the Thai primary health system's new mission and its impacts on the Provincial Administrative Organizations (PAO). The Thai primary health system's mission is a legal mechanism and process for the provision of primary health care services under the Thai Primary Health System Act of 2019 (B.E. 2562). It has never appeared in the powers and duties of the PAO before, which leads to obstacles in management that affect the provision of health services to the public. This research had 3 objectives: 1) to study how transferring health missions to the PAO had effects on the health services at both Chaloem Phrakiat Nawaminthachini Health Center (CPNHC) and Sub-district Health Promoting Hospital (SHPH), and 2) to study how the medical staff were taught about that transition, and 3) to develop policy proposals for the primary health service model during the transition period, using qualitative research methods. The results of this qualitative research showed that the primary health service system (PHSS) of CPNHC and SHPH after the transfer to the PAO focused on providing services in 5 dimensions, namely 1) primary medical care, 2) health promotion, 3) treatment, 4) disease prevention and control, and 5) rehabilitation, and consumer protection using the concept of the Primary Care Cluster (PCC) with the seamless services following the rights under the National Health Security Office (NHSO). The PHSS after the transfer to PAOs should be strengthened under the mechanism of Primary Health System Act (PHSA) B.E.2562 (2019) and other laws related to primary health services and Health Professions Act of health care providers at the primary level. There is a governance of the health system that aims to create a relationship between various sectors in providing a network of health services rather than controlling, supervising, monitoring, but emphasizing on the management of policy networks at 4 different levels: 1) the ministry level, 2) the department level, 3) the health service area, provincial, and district level, and 4) the sub-district level, in order to be able to work in an integrated way to meet health needs at the district, provincial, regional, and national levels. Factors affecting the success of administering and managing the PHSS of the CPNHC and SHPH after transferring to the PAO under the PHSA B.E. 2562 consists of strategic implementation, monitoring, evaluation and the encouragement of strategic implementation as well as promoting the linkage of health services in response to health development policies at each level and the overall picture of the country. Key policy recommendation for primary health care (PHC) systems on the development process of policies and strategies in primary care during the transitional period after the transfer of missions as follows. 1) The Ministry of Public Health (MOPH) should be the host for policy-making and strategies for the primary care system. 2) Health Systems Research Institute (HSRI), National Board of Health (NBH), and Thai Health Promotion Foundation (THPF) collaborate in creating and synthesizing knowledge for development of primary health system in accordance with the policy of the Ministry of Public Health and creating a system and mechanism leading to the concrete implementation. 3) Strategic plan unit and primary care unit of Provincial Health Office, and PAO apply the knowledge acquired at the macro level to create a system and mechanism for learning into practice of the CPNHCs and SHPHs and to design a system to supervise and monitor the development of the PHSS continually. 4)Network node hospitals collaborate with family physicians or PHC providers in CPNHC and SHPH. 5) The CPNHCs and the SHPHs either under the jurisdiction of the MOPH or PAO conduct the strategic implementation as cascaded from the Provincial Health Office and PAO and synthesize it into practical guidelines in accordance with the context including designing a mechanism for supervising and monitoring primary health services, 6)The Provincial Public Health Office (PPHO) coordinates policy cooperation and builds a network for cooperation in collecting health indicator data with the PAO to cover the performance, policy of the country and the problems of the area.7) The responsible agencies for health information technology, MOPH analyze and design web application programing in collaboration with other agencies related to data in supporting health system governance. 8) PAO and PPHO make an agreement about an appropriate proportion of OP (basic payment). 9)MOPH set a policy for integration of resources in primary care system management and monitoring PCU and NPCU as well as coordinating the formation of a referral service network with PCU and NPCU in that area or other areas in accordance with the PHS Act B.E. 2562. Phase for strengthening the PHSS consists of 1) The MOPH sets a policy to develop the quality of primary care facilities across the country to meet standards to certify the quality of services delivered to people with equity. 2) The primary health system committee establishes a system and mechanism for developing primary care standards to be in accordance with section 24 (1), (2), (3) and (7). Sustainable development phase includes 1) The Cabinet should appoint a health system governance committee who understands the national health system as an authority to consider, supervise, monitor, inspect and direct health agencies to review the implementation and provision of health services in accordance with national health policies to continually improve the quality of health services and 2) The transferred CPNHC and SHPS under the PAO create a guideline for the participation of network partners in the local health system jointly providing health services and monitoring and evaluating to meet standards. PHS Act B.E. 2562 and in accordance with the guidelines set forth at the provincial and district levels.


location: , 'Thailand year: 2008 source: HSRI

title: A study & monitoring of the development of the transfer system of a public health center to local government organization (LGO)

abstract: This study employs both qualitative and quantitative methods. It aims to understand the process of the transfer system of a public health center (PHC) to Local Government Organization (LGO). Specifically, the study focuses on the process of setting up the transfer mechanism, monitors the product and output, analyzes and summarizes lessons learned, as well as provides policy recommendations relating to the mechanism and structure for transferring the PHC to the LGO. The research duration is from September 2007 to October 2008.
	Research results confirm that those PHC under study followed the mechanism and process of the transfer system to LGO. However, they encountered some difficulties pertinent to time constraints and communication problems at all levels. With respect to the product, we have discovered that there were four types of the transfer system: these are (๑) the whole transfer of PHC and personel, (๒) the whole transfer of PHC and parts of personel, (๓) the transfer of some PHC with all personel of those PHC, (๔) the transfer som PHC with parts of personel, of which the majority of the PHC employed the second type. Different types impacted the management of works, budget, personnel and materials differently. Relating to the output, we have learnt that ideas and paradigms of the public health decentralization to local areas were significant and made the transfer system efficient through generating people’s participation and coordinating with the network of public health consistently. In terms of policy and development strategy implemented at the local level, we have discovered that they emphasized the idea of service to all, stimulated proactive works, and improved policy, strategy and planning for public health and environment activities parallel to the development of infrastructure. Also, we have discovered some problems relating to the management of works, budget, personnel, property, material, medicine and medical supplies following the imprecision of rules and regulations from the Ministry of Public Health and the Ministry of Interior. Factors contributed to the success of the transfer included cooperation, leadership ability, having organizational vision and ability for management of the LGO.
	Recommendations for transferring the PHC to the LGO are in the following. At the policy level, the national decentralization committee should have a clear integrated policy and establish a national coordinating body to be responsible for making the public known of the value, idea and benefit of the public health decentralization. At the provincial and district level, it is necessary to have a proper academic supporting mechanism based on the participation of all parties concerned for monitoring and supporting the transfer of the PHC to the LGO smoothly and communicate with all concerned parties efficiently. During and after the transfer, it is significant to promote a sharing of experience, information and reflection of the transfer. At the community level, we suggest that the LGO and the PHC should abide by the principle of people’s participation starting from local public organizations to local civil societies in decision making for the transfer of the PHC to the LGO and the support for community health development planning.


location: , 'Thailand year: 2012 source: HSRI

title: Dietary exposure assessment of benzoic acid in Thai people estimated from the Codex General Standard for Food Additives

abstract: The use of benzoic acid and benzoates, food additives, are endorsed by the Notification of the
Ministry of Public Health No. 281. The permitted levels of benzoic acid and benzoates established in the
Notification should conform to international standards and protect consumer health. It needed to revise
the regulation according to the Codex General Standard for Food Additives (GSFA). Risk assessment tools
was employed for establishment of the maximum permitted use levels (MLs) to ensure consumers will
obtain appropriate level of health protection from over-consumption of benzoic acid. This study aimed to
assess the risk of dietary benzoic acid exposure in Thai population based on the MLs proposed in the
Codex food standard. The exposure was estimated by combining the MLs of benzoic acid in foods with
individual food consumption data received from the national food consumption surveys in 2004.
Probabilistic estimation was used to assess the exposure to benzoic acid at average and high consumption
levels. Risk was characterized by comparing the exposure with the Acceptable Daily Intake (ADI) of benzoic
acid. ADI is a safe level for human exposure to the chemical over a lifetime. The study found that the
average benzoic acid exposure in Thai population exceeded the ADI (126% of ADI). The population aged
3-5.9 years and 6-18.9 years had average exposures at 226 and 153% of ADI, respectively. This indicated
that there was an appreciable health risk for children and adolescences at long term exposure when using
benzoic acid in all food groups according to the GSFA. Long term exposure to high level of benzoic acid
can effect on liver and kidney functions. High consumption of carbonated water-based flavored drinks at
97.5th percentile in population aged 3-5.9 years and 6-18.9 years provided high exposure at 144 and 96 %
of ADI, respectively. Thus, the MLs of benzoic acid proposed in this standard should be reduced in food
categories contributed high benzoic acid exposure in children and adolescences especially carbonated
water-based flavored drinks, bakery wares, processed fruits and vegetables.


location: , 'Thailand year: 2017 source: HSRI

title: Projection of Hospital Pharmacist Workforce in Thailand for 20 Years (2015-2035)

abstract: Projection of pharmacist workforce is essential information for planning and allocating pharmacist
workforce. Hospital pharmacists accounted for the highest proportion of the pharmacist workforce in
Thailand. This study was aimed to project hospital pharmacist workforce for the next 20 years (2015-2035)
by using needs assessment models. The projection of hospital pharmacist based on two techniques: time
series and regression analysis by using 3 factors: male and female ratio, elderly age greater than 60 year
old ratio and gross provincial product (GPP). According to time series forecasting and regression analysis,
the maximum extent of FTE requirement for hospital pharmacist in 2035 based on sensitivity analysis was
123,405 (87,227-159,584) and 111,454 (79,543-143,365), respectively. While the minimum number of FTE
requirement was 69,723 and 50,502, respectively. This study showed that the shortage of hospital pharmacist
is an issue of concern that requires an effective planning to secure the future of hospital pharmacist
workforce. However, other factors might affect the results of this study such as continuing pharmaceutical
education (CPE), new technology etc.


location: , 'Thailand year: 2012 source: HSRI

title: A review of drug pricing control system in Thailand

abstract: This study focused on a review of the national system for drug price policy. Methods including
interviewing key persons in various organizations, meetings with experts, studying related documents
and literatures, were used. The study revealed that Ministry of Public Health (MOPH hospitals) had several
indirect drug price control mechanisms for government sector especially for the MOPH hospitals themselves. Drug price control has been started in the process of national essential drug list (ED) selection.
Cost effectiveness and budget impact analyses were parts of the consideration criteria. After drugs
were selected as the ED, median price would be set as the price control measure for procurement process
of MOPH hospitals. In addition, central negotiation was used for controlling price of single source nonessential
drugs in MOPH hospitals. National Health Security Office takes the leading role in price negotiating
of high cost ED to ensure accessibility for their beneficiaries. However, limited items were negotiated
in each year. Group purchasing in level of provinces and regions was not much expanded from the
past.
There exists no autonomous body and no regulation for controlling of manufacturer price setting
before drug registration processes. No regulation and system for controlling mark up in private sector
have been implemented. Selling price was controlled to not more than price list. For drug price monitoring,
only voluntary reporting of MOPH hospital purchasing price was available under the Drug and
Medical Supply Information Center (DMSIC).
As the ways to improve drug price control system in Thailand, manufacturer production cost structure
should be submitted as the condition for national essential drug list consideration. In terms of negotiation,
knowledge management of negotiation and purchasing strategies, expanding of items for central
negotiation for all three health insurance schemes are encouraged. Drug price setting for procurement
and a monitoring system should be improved. Moreover, a study on adverse effects of drug price control
system on domestic pharmaceutical industries is necessary.


location: , 'Thailand year: 2009 source: HSRI

title: Influenzal Vaccine

abstract: Influenza is one of the most important respiratory infections of humans; it is responsible for an
estimated half million deaths worldwide each year. Recently, the influenza pandemic caused by a new
strain of influenza A (H1N1) 2009 virus was declared by the World Health Organization, whereby the
pandemic level has been raised from phase 5 to phase 6, as defined by a widespread human-to-human
transmission and sustained community level outbreaks in more than one region of the world. The guidelines
for prevention include routine recommendations on basic personal hygiene and annual vaccination,
which by far is considered the best possible method of prevention especially for high-risk populations.
Influenza vaccines, mostly trivalent, are indicated for the active immunization of individuals against seasonal
influenza caused by influenza viruses subtypes A and type B contained in the vaccine. However,
the protection is transient and yearly immunization is thus necessary. In addition, the antigenic changes,
i.e., antigenic drift and antigenic shift, in influenza viruses necessitate yearly surveillance for emergent
strains and incorporation of such strains into the current year’s vaccines. At present, two types of vaccines
are available, namely, inactivated (killed) vaccines administered by injection and cold adapted, liveattenuated
vaccine administered by nasal inhalation. This mini-review provides a brief description of
influenza vaccines with respect to their types, composition, method of manufacture, indication and usage;
a list of USFDA-approved commercial vaccines is also included.


location: , 'Thailand year: 2021 source: HSRI

title: Migrant Worker Health Information System using GIS: Bueng Kan Province

abstract: The two main purposes of this research were to develop the health information system using GIS program and evaluated for migrant worker in Bueng Kan province. And the second was to use this database system for related work department. The program was evaluated by 2 group of quality staffs, 6 experts and 20 other relevant officers. The evaluated program was test in 4 areas: functional requirement test, function test, security test and usability test. The statistic uses for analyze the data were mean, standard deviation (SD). The results were as follows: 1. Functional requirement test was good with mean 3.90 and S.D. 0.32 2. Functional test: good with mean 3.89 and S.D. 0.49 3. Security test: good with mean 3.92 and S.D. 0.62 and 4. Usability test: good with mean 3.89 and S.D. 0.29 In Summary, that means this program was quite good enough to use as a main database of migrant worker for most related work department at a 95% confidence level.


location: , 'Thailand year: 2022 source: HSRI

title: Social Return on Investment of Long-Term Care for Dependent Older Persons: A Case Study of Sa-Ard Subdistrict, Namphong, Khon Kaen

abstract: Background and Rationale: Thailand becomes an ageing society. The Thai government officially implemented long-term care (LTC) for dependent older persons in 2016. Sa-ard subdistrict of Namphong, Khon Kaen, has provided an LTC service program by the family care team and the LTC center since August 2017. However, the impacts of this program, particularly social impact, have not been reported. This study aimed to determine social return on investment (SROI) of the LTC program for dependent older persons in this setting. Methodology: A mixed-methods approach was used to collect data on outcomes, program impacts, and costs of the LTC program for dependent older persons (37 people with the Barthel index of activity of daily living (ADL) ≤ 11 points) in the fiscal year 2018. We conducted a questionnaire survey among 74 program beneficiaries (dependent older persons and family caregivers) and focus group interviews among 49 program stakeholders (dependent older persons, family caregivers, family care team members, trained caregivers, and community and local government representatives). Secondary data were gathered from reports, records, and databases of the hospital, the local government, and the LTC center. SROI was calculated and sensitivity analysis was performed. Results: Outcomes of LTC program delivered better conditions (walkability or doing usual activities by themselves) to the dependent older person group, more relaxation/leisure time and saving costs from going to hospitals to family caregivers, happiness in helping other people to the family care teams and trained caregivers, and the healthy community. Of the total 37 dependent older persons, after participating in the LTC program their ADL increased significantly on average 3.9 ± 5.2 points (p < 0.001) and 73% had better outcomes. The older persons valued their better outcomes at a median of 708,432 baht (Q1-Q3 = 699,216 - 2,000,000). For a one-year investment of LTC program of 2,138,704 baht and its benefit of 15,853,919 baht, the SROI ratio of this program was 7.4 with a range of sensitivity analysis values between 1.3 and 20.5. Conclusion: This study indicated that the LTC program for older persons could effectively improve their outcomes and provide values to stakeholders and society. The LTC program provided social return higher than investment. Therefore, the LTC program should be promoted and expanded to other settings.


location: , 'Thailand year: 2012 source: HSRI

title: Recognition of Food Brand Logo in Primary 6 Students

abstract: One of the factors that contribute to obesity in children is food advertisement because it can influence
the eating behaviour of children. Advertising is a marketing strategy to build brand recognition of food. The goals are to promote the product and increase children’s food consumption. . The objectives of
this survey research were to assess the recognition of brand logos among students in primary 6and to
examine the relationship between individuals’ abilities to recognize brand logos and their demographic
eating behaviour. Methods: There were 453 children from two primary schools in Bangkok and in
Phetchaburi joined in this study by purposive sampling. A self-administered questionnaire survey was
administered to gather demographic characteristics, nutrition, and their abilities to recognize brand logos.
This study found that 64.7% (239 students) of the children demonstrated a high brand logos recognition
recognizing 14 food brand logos in the questionnaire. Among these children, the number of children who
ate unhealthy food; consumption of snack, fast foods, and soft drinks was higher than those who ate
vegetables and fruit. In addition, BMI, parent’s educational level, mother’s occupation, habit of eating
breakfast every day, eating snacks and, fast foods were associated with the abilities to recognize brand
logos. To conclude, there is a correlation between poorer eating behaviours and brand logos recognition
ability of school children. However, health promotion campaign should be emphasized among school
children to increase their awareness of how unhealthy eating habit can affect obesity


location: , 'Thailand year: 2008 source: HSRI

title: Comparison between Intraocular Pressures Measured by Non-contact Tonometer and by Standard Device in Glaucoma and Non-glaucoma Patients

abstract: This was a cross-sectional analytic study conducted to compare intraocular pressure
(IOP) measurements by non-contact tonometer (NCT) and a standard Goldmann
applanation tonometer (GAT) in glaucoma and non-glaucoma patients. One hundred and
forty-eight outpatients attending Thamuang Hospital in the period December 2007 - January
2008 were categorized into two groups: the glaucoma group comprised 48 patients
(48 right eyes, 47 left eyes) and the non-glaucoma group comprised 100 patients (99 right
eyes, 100 left eyes). None of the patients had a history of ocular surgery or corneal disease.
Their IOP were measured by two independent parallel observers using non-contact
tonometer Canon TX-F and Goldmann applanation tonometer.
The results of the study disclosed that the intraocular pressures measured by the
non-contact tonometer were significantly different from those measured by the Goldmann
applanation tonometer (paired t-test statistical analysis p < 0.05) in both glaucoma and non-glaucoma groups. Mean IOP in the glaucoma group, measured by NCT, was lower
than GAT (4.63 ±3.14 mmHg right eye, 4.33±3.50 mmHg left eye); also, the mean IOP in
the non-glaucoma group, measured by NCT, was lower than GAT (1.95±2.89 mmHg right
eye, 2.40±2.62 mmHg left eye). The pressure difference increased in cases with a higher
IOP, thus reflecting the reliability of NCT measurement only in measurement of the cases
with normal intraocular pressure range. Therefore, repeat intraocular pressure measurement
should be performed to conform with the standard Goldmann applanation tonometer,
if necessary.


location: , 'Thailand year: 1998 source: HSRI

title: Child-care situations in Thailand: s synthesis report

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


location: , 'Thailand year: 2008 source: HSRI

title: Manual Sutureless Cataract Surgery for the Underserved in a Community Hospital

abstract: This is a report of the results of a prospective series of manual sutureless extracapsular
cataract extraction on 161 eyes, performed at Taphanhin Crown Prince Hospital,
Phichit Province, in the period May 2006 - November 2007. The patients, aged 42 to 82
years (mean 68.9 years), had a preoperative visual acuity of less than 3/60 in 47.8 percent
of the cases (76 eyes). Of the 159 patients who returned for follow up, the visual acuity at
one month postoperatively was improved in 153 eyes (96.2 %), i.e., VA 6/18 or better in
42.1 percent, and 6/24 - 6/60 in 57.2 percent. When measured by pinhole, visual acuity
was 6/18 or better in 78.6 percent of the eyes. There was no major sight-threatening
complication; only minor surgical complications were encountered in 10 eyes (6.3%). In
conclusion, this intervention is cost-effective, appropriate and provides accessibility for
underserved cataract-blind patients in community hospitals. It also empowers health
personnel and should be implemented in other community hospitals or eye camps in
order to eliminate the backlog of such patients and improve the quality of life of the Thai
elderly in rural areas.


location: , 'Thailand year: 1997 source: HSRI

title: Assessment of the pilot project in service quality improvement in public Hospitals with TQM

abstract: Assessment of the pilot project on service quality improvement in public hospitals with TQMQuality improvement for hospital services currently received enormous interest. In 1993, the Health Systems Research Institute, Thailand initiated the pilot project on service quality improvement in public hospitals using the total quality management (TQM) approach. The duration of the project was 2 years. Eight public hospitals in Bangkok and nearby provinces participated. Our study aims to assess and outcomes of the TQM pilot project in public hospitals by applying criteria modified from the Malcolm Baldrige National Quality Award and to determine a set of selected knowledge, attitudes and practices perceived by the top and the middle management and operating personnel in service quality management using TQM concepts. A combination descriptive study designs were conducted by a retrospective ocumantal review with two site-visit key performances interviews and a post-intervention cross-sectional survey during July 1996 and March 1997. The results revealed that the project was systematically organized in providing 2-day TQM training for senior management and middle management and in setting structures to support TQM activities in hospitals. However, participating hospitals had different levels of progress in TQM implementation; two of them were classified as having "breakthrough" progress while the other six hospitals were classified as having "incremental" progress. The following factors were identifies as contributing to the differences: the senior and middlemanagement leadership commitment and continuity, information system and analysis, strategic plans development, human       resources training in quality tools and analytic techniques and management, involvement in patient care services process which brought about visible organizational outcome and had impact on customers. In addition, hospital personnel from the two groups of hospitals had significantly different levels of opinions towards policy deployment, hospital status, knowledge on TQM, attitudes towards quality improvement, process management and hospital outcomes. The three most important factors that contributed to success or failure of TQM project in their opinions were attitude and involvement of all personnel, the senior management attitude and strong support, and training in TQM. Consequently, we suggest a new model for effective TQM implementation in public hospitals by emphasizing changing "process first", quality policy deployment, TQM training, enhancement of strategic and tactical action planning, key services process focus, and closer to both internal and external customers and also their expectations by pre-and post-intervention customer surveys.


location: , 'Thailand year: 2005 source: HSRI

title: Right to health : From liberalism to communitarianism?

abstract: This research examines the contents of human rights in liberal and communitarian theories. While liberalism emphasizes liberty and equality of individuals, communitarianism claims the very rights of peoples and community. The question is whether rights holders can be both individuals and/ or a community.  The research discusses the various on-going debates between liberal and communitarian theorists relating to the issues of human rights and puts this in context with the right to health, in particular, how liberal and communitarian concepts have been used in the process of health reform in Thailand.It is evident that the present concepts and systems of human rights have been significantly influenced by Western political philosophies. In classical liberal theory, in order for the rights of individuals to be protected, the State must refrain from intervention. Negative rights – political and civil rights - must be respected. This concept has been argued against by other liberal theorists who consider that liberty brings about inequality and injustice. For the individuals to realize their very basic rights, the State must fulfill its obligations by guaranteeing some rights which enable individuals to maintain dignity and well-being. Positive rights - economic, social and cultural rights, or welfare rights – require positive action by the State. Rights are therefore indivisible and interdependent.Liberalists consider only individuals are rights holders; however, the communitarians argue that communities, groups and society can be also holder of rights; and those rights demand obligations by the State. Communities and societies, by virtue of their being a “person” by themselves, can act and have relationships to rights. In their view, insisting on individual rights is acceptable under the condition that the rights of community are recognized.The right to health, a very basic human right, is morally and legally recognized in all societies. The right to health is in general an individual’s right, arising from the sovereign right one has over one’s life and mind in particular. Well being and living standard of individuals can be realized only if both positive and negative rights are respected and fulfilled. In general, the right to health is closely related to liberal concept of rights. There is, however, an increasing trend to consider that necessary conditions for an individual’s well-being and right to health can be materialized only if community rights are respected and protected. In Thailand, the introduction of modern medicine allows the State to control the rights and life of both individuals and communities. The rights to health have been, for decades, determined by the State. The health reform process initiated some years ago is based mainly on liberal concepts, but while attempting to integrate communitarian concepts. For the success of health reform, the power relationships between the State, individuals, and community must be revisited. Rights to meaningful participation of both individuals and community should be the key to health reform. In order to achieve this a paradigm shift must occur in the health system of Thailand.


location: , 'Thailand year: 2008 source: HSRI

title: Reduction in Hospitalization and Expense for Diarrhea Patients by Demonstration of Appropriate Self-administration of Oral Rehydration Salt Solution

abstract: Among people developing diarrhea, some take oral rehydration salt solution, but
most did not know the proper amounts to drink. After drinking some amounts of a salt
solution without recovering, they came to the hospital. Formerly, during the hospital
visits, they never received information what amounts of the salt solution they should
take. This study revealed that, with the practice of demonstration for the 2,704 diarrhea
cases seen in the period from June 2005 to May 2006, only five patients (0.18%) needed
intravenous fluid and only 254 patients were hospitalized, while in previous years (June
2004 - May 2005)the in-patients numbered 559 (Jun 2004-May 2005), dropping to 254 admitted
cases in the following year (Jun 2005-May 2006); this saved a lot of expense for the
hospital. It is necessary for the health-care provider to demonstrate how much of oral
rehydration salt solution is needed when one has diarrhea.


location: , 'Thailand year: 1999 source: HSRI

title: The satisfaction evaluation on the re-structured system of the Food and Drug Administration(FDA)

abstract: The Satisfaction Evaluation  on the Re-structured System of the Food and Drug Administration(FDA)	In order to effectively guarantee consumers and clients of FDA the utmost satisfaction, the evaluation on the newly-designed operational system has been initiated and applied to officials in charge and clients involved with the service delivery of  FDA. During October to December 1998, a questionnaire and an interviewing on a level of officials and clients’ satisfaction had been distributed to those targeted groups, evaluated and compared with the former operational system in each individual division,  ranging from Drug Control Division, Food Control Division, Cosmetics Control Division, Medical Device Control Division, Toxic Substances Control Division to Narcotics Control Division.	In general, clients of FDA using the new system of service delivery do content with the re-structuring, especially in Cosmetics Control Division and Toxic Substances Control Division ( the range is between 3.50-4.49). More specifically, when compared with the former system, the results are as follows:The re-structuring is better off by far when applied to the Cosmetics Control Division.The re-structuring is somewhat better than the previous system when applied to Drug Control Division, Food Control Division and Toxic Substances Control Division. However, some possible adjustments would increase more efficiency and satisfaction .The re-structuring is acceptable but less satisfied clients than the previous system was when applied to the Medical Device Control Division.	In sum, the evaluation reflected overall satisfaction on the re-structured system when compared to the former one (the range is above 3.0) but was not as outstanding as it has been expected.  With regard to the level of satisfaction among officials involved in the FDA, a production division and a support division are contented with the re-structuring (the range is between 2.5-3.49). When compared with the previous system, the production division is convinced that the new one is less satisfied and is expected to be developed both in terms of the promptness of coordination and cooperation. With respect to the supporting division, the evaluation also turned out to be negative in which it implies that the new one does need a strong determination from FDA to develop in almost every sense, from coordination, efficiency, responsibility to overall effectiveness and quality of service delivery.


location: , 'Thailand year: 2022 source: HSRI

title: Cost-Utility Analysis of Endovascular Treatment in Patients with Acute Ischemic Stroke in Thailand

abstract: Introduction The Subcommittee for Development of the Benefit Package and Service Delivery (SCBP), which holds decision-making authority for the health benefit package of the Universal Coverage Scheme (UC), requested the Health Intervention and Technology Assessment Program (HITAP) to conduct a health technology assessment of “Endovascular treatment for acute ischemic stroke”. This information will be used by the SCBP to decide whether to include endovascular therapy in the UC benefit package. Objectives This study aims to determine the value for money and the fiscal burden to the Thai government of introducing endovascular treatment for acute ischemic stroke into the UC. We also review the feasibility of providing endovascular treatment in Thailand. Methods Model-based economic evaluations, consisting of a decision tree and a Markov model, were conducted to assess the value for money (societal perspective) and budget impact analysis (provider perspective) of endovascular treatment for acute ischemic stroke, either alone or in combination with intravenous alteplase. The methodology follows the Thai methodological and process guidelines for conducting health technology assessment. Model input parameters were collected locally from retrospective data and from a literature review of both national and international studies. In addition, number of hospitals and number of specialists in radiology/neurology were gathered from the relevant Royal Colleges. Results According to the Thai cost-effectiveness threshold of 160,000 THB per quality-adjusted life-year (QALY) gained, treatment with endovascular treatment as an adjunct therapy to intravenous alteplase for alteplase eligible-patients, and endovascular therapy alone for alteplase ineligible patients is cost-effective in treating patients with acute ischemic stroke. Adding endovascular treatment to intravenous alteplase was associated with an ICER of 147,000 THB per QALY gained compared to intravenous alteplase alone. For patients ineligiblefor intravenous alteplase, the ICER of endovascular treatment alone compared to supportive care was estimated at 114,000 THB per QALY gained. With an assumption that there will be 2,000 new cases per year, an additional budget of 887 million THB over a time horizon of 5 years would be incurred if SCBP decides to adopt endovascular therapy under the Thai health benefits package. Currently, in Thailand, there are 50 specialists in radiology and neurology, located across 52 hospitals with the capacity to provide endovascular treatment for acute ischemic stroke. However, most are located in Bangkok. Conclusions Endovascular treatment for acute ischemic stroke represents good value for money, when provided alone and when delivered with intravenous alteplase. Provision of endovascular treatment in Thailand is likely to be feasible in terms of government budget and provider capacity. Thus, endovascular treatment should be included in the Thai health benefits package, with the thrombectomy device priced between 73,800 and 88,100 THB.


location: , 'Thailand year: 2022 source: HSRI

title: COVID-19 Vaccine Effectiveness in Thailand: a Real World Study (1st Year)

abstract: Data on real-life vaccine effectiveness (VE) against the delta and omicron variant of COVID-19 infection among COVID-19 vaccine regimens are urgently needed to impede the COVID-19 pandemic. We conducted a test-negative case-control study to assess the VE of various vaccine regimens for preventing COVID-19 during the period when the delta variant and omicron was the dominant causative virus in Thailand. All individuals (age ≥18 years) at-risk for COVID-19 who presented for nasopharyngeal real-time polymerase chain reaction (RT-PCR) testing were prospectively enrolled and followed-up for disease development. Vaccine effectiveness was estimated with adjustment for individual demographic and clinical characteristics. Concerning the period of delta variant, there were 1,871 cases of the total of 4,589. The adjusted VE among persons receiving two-dose CoronaVac plus one BNT162b2 booster was highest (98%; 95% confidence interval [CI] 87 to 100), followed by those receiving two-dose CoronaVac plus one ChAdOx1 nCoV-19 booster (86%; 95% CI 74 to 93), two-dose ChAdOx1 nCoV-19 (83%; 95% CI 70 to 90), one CoronaVac dose and one ChAdOx1 nCoV-19 dose (74%; 95% CI 43 to 88) and two-dose CoronaVac (60%; 95% CI 49 to 69). Concerning the period of omicron variant, there were 471 cases of the total of 1,975. The diseases severity markly decreased while the vaccine effectiveness aso markly decreased, compared to the period of delta variant. Our study demonstrated the incremental VE with the increase in number of vaccine doses received. The two-dose CoronaVac plus one BNT162b2 or ChAdOx1 nCoV-19 booster regimens were highly effective in preventing COVID-19 during the rise of delta variant.


location: , 'Thailand year: 2023 source: HSRI

title: Impact of Pharmacogenomics on New Antiretroviral Drugs, Drug Concentrations and Toxicity Among HIV-infected Adults

abstract: Despite the availability of effective antiretroviral therapy (ART), tuberculosis (TB) remains the leading cause of morbidity and mortality among people living with human immunodeficiency virus (PLWH). The use of effective ART can reduce the risk of developing active TB by 65%. Additional of TB preventive therapy (TPT) to ART is shown to further reduce TB incidence by 30% and mortality rate by 35-50%. Therefore, TPT is one of the important strategies for ending TB. TPT amomg PLWH in Thailand is currently implemented in clinical practice guideline2023. The preferred TPT regimen are 3 HP (weekly isoniazif 900 mg+ rifapentine 900 mg for 12 weeks)) and 1 HP (daily isoniazid 300 mg + rifapentine 450-600 mg for 4 weeks). It is crucial to investigate the drug-drug interaction to find the optimal dose of dolutegravir (DTG), the most preferred ART when it is being used with rifampin for active TB and rifapentine for TPT. This study investigated the effect of rifampin on DTG 50 mg once daily (experimental dose) versus DTG 50 mg twice daily (recommended dose) among active TB/HIV co-infection. The study demonstrated that DTG based regimen is highly effective (90% had HIV RNA < 50 copies/ml at week 48) and the standard dose DTG may be appropriate to be concomitantly use with rifampin. The study also investigated the effect of rifapentine as 1 HP or 3 HP for TPT on DTG 50 mg once daily among PLWH. The study showed that DTG based regimen is highly effective (> 95% had HIV RNA < 50 copies/ml at week 48) and the standard dose DTG may be appropriate to be concomitantly use with rifapentine. Since, fixed dose combination of DTG/tenofovir disoproxil fumarate (TDF) /lamivudine or TLD is widely used in Thailand and other low-middle-income countries (LMICs), thus, the standard dose TLD without additional DTG is more convenient for national HIV program, it is cost saving (no extra DTG dose) and the adherence of patients is not compromised (once daily ART). In those with high risk of isoniazid related hepatotoxicity such as liver disease, alcoholism, older, N-acetyltransferase 2 or NAT2 may be beneficial. The dose of Isoniazid and rifapentine or rifampin can be adjusted. Uridine glucuronosyltransferase 1A1 (UGT1A1) is also important for DTG metabolizer. In this study, rifampin, body weight and poor metabolizer of UGT1A1 are significantly affects the DTG concentration. Poor metabolizer of UGT1A1 increased DTG trough concentration by 22.8%. In summary, this study highlighs that the standad dose TLD can be safety used with both rfampin based anti TB among active TB/HIV co-infection and rifapentine based TPT. This is simple as 1 tab a day, no additioanal DTG is required. It is good for ARV procument, and cost saving. Importantly, it can be used as once a day to improve adherence. This finding is benefit for Thai PLWH and the global PLWH at large.


location: , 'Thailand year: 2014 source: HSRI

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

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


location: , 'Thailand year: 2011 source: HSRI

title: Appendicitis of three Schemes during 2005-2008

abstract: The purpose of this study was to evaluate the service to patients with appendicitis among three
schemes: Universal coverage scheme: UCS, Social security scheme: SSS and Civil servant medical benefit
scheme: CSMBS. 401,322 records of in-patients during 2005 -2008 were utilized, and analyzed by descriptive
statistic and logistic regression analysis.
Acute appendicitis admission rate per 100,000 population between 2005 and 2008 showed that it was
highest in CSMBS, 215.4-300.4, while SSS was between 141.6-203.8 and UCS was between 165.9 and 177.6.
The trend was increasing in UCS and SSS, while it was decreasing in CSMBS. Proportion of ruptured
appendicitis to total appendicitis indicated that those of SSS, UCS and CSMBS were 12.5%, 18.2%, and
18.5% respectively. In addition, ruptured appendicitis probability were significantly different among three
schemes (P<0.00) which those of SSS and CSMBS had a lower chance compared to those of UCS, 1.48 and
1.38 times respectively. However, the trends of ruptured appendicitis to total appendicitis patients of all
schemes decreased. The trend of mortality rate of appendicitis patient in each scheme had not change
dramatically. It was highest in CSMBS and UCS (0.2%), while those of SSS were 0.02% respectively. With
regard to percentage of acute appendicitis patient receiving appendectomy, it was found that SSS patients
had a highest percentage, 89.4% while CSMBS and UCS were 83.5% and 83.0% respectively. However, the
trend of those having acute appendicitis receiving appendectomy in all schemes had been increasing.


location: , 'Thailand year: 2016 source: HSRI

title: Hospital management models for social security beneficiaries

abstract: This research aimed to propose a model for Social Security Hospital and its financial feasibility. Mixed method was used, which comprised review literatures, hospital management of the Mexican Social Security and the Kaiser Permanente of U.S.A, legal framework, in-depth interview, focus group, questionnaires survey from 519 members under Social Security Act on the new Social Security Hospital and financial feasibility study. The study found as follow : 1) Social security hospital is theoretically possible and well practice in the Mexico and the United State. Integrated care model should be used, which will provide patient centre care for all health services. 2) The Social Security Hospital should be 150 beds hospitals, which provide high quality of medical services include 12 specialty medical services. Quality of its hospitality service should be the same as private standard. Its revenue can cover expenditure since the first year of its operation. It needs ten years for break-event with low rate of return if there are 200,000 employees register with the hospital. 3) Focus group discussion with represent from employers and employees on the design of Social security hospital found that they agreed with the design and support the Social Security Office to invest for Social security hospital in the needed area, which has problems of overcrowded patients together with measures to improve standard and quality of care for current main contractors. 4) For short term intervention, the Social Security Office could be set up new Social Security Hospitals by contracting with Ministry of Public Health or Local Government, which have mission to provide health services However, amendment of the Social Security Act is needed in long term plan.


location: , 'Thailand year: 2020 source: HSRI

title: Development of the health surveillance process and data lake related to COVID-19 infection for the Thai Transboundary population in the 12th Thai health sector

abstract: From the communicable diseases in Songkhla province committee meeting, there are authorizes and duties are assigned to Prince of Songkhla University, under the responsibility of the faculty of Medicine, to operate a travel tracking program from Malaysia in which the 12ths Objective To create a database system for surveillance and monitoring of COVID-19 infectious diseases and follow to other systems for communicable diseases, as well as developing a database for surveillance and monitoring of Covid-12 from the researcher team have been developed. This research focuses on understanding the systematic overview of both the surveillance and database system of COVID-19 reporting system, it is necessary to use a combined viewpoint to achieve this objective, which divided into two subjections 1.Transcription a lesson on COVID-19 infectious disease management both Thailand and abroad 2.Qulitative data collection and stakeholder analysis to develop a database and surveillance system for COVID-19 infectious disease by specialty in Thai transborder population for Sample population. The sample population that the research team had chosen to collect data for the research and field trip was 12th health sector for the reason is there is the nearest border to Malaysia which has a different context than other health sector and essential to, there must be a system and measures for the Thai transborder population between Thailand and Malaysia. Until the data is analytically saturated. The data is divided into two parts: 1. Data analysis using the content analysis method by collecting the content from the interviewer and classifying them according to various issues according to the set concept 2. The analysis of stakeholders is divided into divisions. It is analyzed based on the stakeholder matrix, the relationship between significance and influence. After the implementation of the system that the research team has recommended and installed, there are five establishments in the 12th health sector area that have the following recommendations. 1. Immigration can be updated and displayed on the dashboard in real-time as well as telemedicine used to track the patient symptoms and such recommendations can also be applied to other people. 2. Hotels and department store (Lee garden plaza) are places that got a lot of people to enter and exit at the same time, so a thermometer camera was needed instead. However, the reason is the thermometer camera is a face recognition recording system, cannot be identified, it should be developed to establish a system for scanning RFID cards and measuring the temperature at the same time to obtain accurate and fast information. 3. The bus station (Songkhla bus station area) suggests developing a method to extract datafrom the handwriting in the photo database. 4. Train station (Hatyai railway station area) Hatyai railway station will adjust to transforming the ticket to be an RFID ticket while waiting for the RFID ticket system, part-time staff will be hired for two months to help the monthly passenger register and print a QR code and stamp be hide the ticket. 5. School (Nataweewittayakom school area) as same as Hotels and department store that have a lot of people enter and exit at the same time so that necessary to use the thermometer camera instead, the reason is the thermometer camera is face recognition recording system, cannot be identified, it should be developed to establish a system for scanning RFID cards and measuring temperature at the same time to obtain accurate and fast information.


location: , 'Thailand year: 2014 source: HSRI

title: Transformative Learning in Rural Doctors Education: A Case Study of Medical Educational Centre in Maharat Nakhon Ratchasima Hospital

abstract: Health workforce is one of the most important factors of health system. However, global society and Thailand have currently faced with shortage and maldistribution of health personnel especially rural doctors. This problem may affect the achievement of Millennium Development Goals and equity in accessing to health services. To solve the problem of rural doctor shortage, it needs systematic approach starting from medical education. Thai government has established the Collaborative Project to Increase Production of Rural Doctors: CPIRD with collaboration between the Ministry of Public Health and Ministry of Education to solve the problem since 1994. This article presents a good case study of transformative learning of Maharat Nakhon Ratchasima Hospital’s Medical Educational Center related to the activity “Medical camp for enhancing experiences of medical students”. This camp is an extra-curricular activity
using transformative learning. Outcomes of this activity are to enhance medical students to understand
rural people as a whole, be familiar with rural contexts, and be satisfied with rural work, as well as gain the skills required from the CPIRD and needed for the 21st century. This activity has also affected the development of teaching and learning processes of the medical instructors following the framework of transformative learning. Therefore, educational institutes producing physicians and other health professionals should organize this kind of co-curricular activity to enhance rural and inter-professional experiences of students who will become health professionals in the future. The Ministry of Public Health and the Ministry of Education may consider this activity to be policy for developing education of health professionals in the 21st century. However, systematic and continuous outcome evaluation of the activity is needed in order to develop a more beneficial and effective co-curriculum.


location: , 'Thailand year: 2017 source: HSRI

title: Health Care Utilization of Thai People Who Had No or Were Not Aware of Health Insurance

abstract: This study analyzed health care utilization of Thai people who did not have or were not aware of health insurance, using data from Health and Welfare Survey 2015. Demographic, socio-economic characteristics plus utilization patterns of outpatient (OP) and inpatient (IP) services were analyzed. Out of pocket payment was reported as the median amount. The results showed that 1.49% of Thai population neither had health insurance nor knew their status. Majority (38%) lived in Bangkok while 17% and 12% lived in Health Region 5 and 6, respectively. Approximately 51% were male and aged 30 years on average. Sixty-five percent completed up to the primary schools and 41% were private employees. With respect to economic gradients as measured by household asset index, the poorest quintile had a greater proportion of the primary school graduates and private employees than the rest. Of all Thai population, ten percent reported having non-hospitalized illnesses (outpatient, OP) during one month and mainly received care at private hospitals (37%) and clinics followed by drug stores or traditional healers, and public hospitals. Median paid amounts for the above OP services were 350, 80, and 2,300 baht per visit, respectively. The poorest quintile used drug stores in the largest proportion, followed by private and public facilities, and paid for a visit of 80, 300, and 200 baht, respectively. The richest quintile used private facilities the most, followed by public facilities, and drug stores. There were only four percent reporting being hospitalized during the past year, which was not different across economic quintiles. Approximately, 70% of those hospitalized were admitted to public hospitals. All people in the poorest quintile were hospitalized in the public hospitals and paid 8,000 baht per admission, while 69% of the richest quintile were hospitalized in the private hospitals and paid 40,000 baht per admission. To mitigate financial risks to health payments by households, especially among the poor, and strategies for identifying the Thai population who did not get access to the UCS registration are thekey priority issues, especially in the urban areas and big cities.


location: , 'Thailand year: 2003 source: HSRI

title: A study determining health performance indicator of Thailand

abstract: A study determining health performance indicator of ThailandThe research study is to determine the indicators of the performances of health system in Thailand thorough the two processes, searching input from various sources in Thailand and other countries and brain storming technique, to create the process of learning together among resource persons and academics that leads to the vital information for conducting further researches and programs. All the derived data were processed, analyzed and synthesized to determine the definition and the composition of health system, the objectives of the evaluation of the health system performance, the scope of the evaluation, the domains of indicators used in the evaluation, and the indicators appropriated to make use of in the evaluation. Besides, the suggestion of sources and the methods of which we derived the valuation of the indicators, the readiness of the implementation in investigating and collecting each indicator, and some special issues in a group of these indicators that needed to be developed and studied, were also presented in the study.The results of the study could not be used immediately and still need the process of broad considerations from academics and practitioners especially policy planners and executives which could be made by distributing all the information and receiving more opinions of all resource persons for the improvement of the outcome. However, this research has provided the scope and important guidelines, which are necessary for developing the evaluation of the health system in Thailand.Even though the suggested indicators of this study are used for health system performance evaluation; but through the way of using these indicators in the future, the development for further improvement will be needed continuously.


location: , 'Thailand year: 2021 source: HSRI

title: Spatiotemporal analysis of association between alcohol outlet density and teenage drinking behaviors in Thailand: 2007-2017

abstract: Nowadays, adolescents are a group that is targeted by the alcohol industry; and there is an increase of online marketing efforts. However, the main supply of alcohol is via physical availability (e.g., convenience stores, retail shops, pubs, bars). This can be monitored by the “density of alcohol sales licenses” per population. The World Health Organization (WHO) recommends a core set of alcohol best buy intervention strategies. One of them is the “restricted access to retailed alcohol”. This study explored the relationship between the density of alcohol outlets, alcohol sale licences, and alcohol drinking behaviors in Thai teenagers during the last 10 years (2007-2017). We drew data from two data sets. Firstly, alcohol drinking behavior was extracted from the 2007, 2011, 2014, and 2017 waves of the, nationally representative, Tobacco and Alcohol Consumption Survey in Thailand. Alcohol drinking behavior was categorised as: current drinker, regular drinker (≥1 time/week), and binge drinker (≥ 4-5 standard drinks in each time). Secondly, the density of alcohol sales licenses per 1,000 population in each province was calculated by the number of alcohol sales licenses from the Royal Thai Ministry of Finance, divided by the mid-year population number from the Royal Ministry of Interior. In this study, the density of alcohol sales licenses suggested alcohol outlet density. The relationships between the alcohol sales license figures and drinking behavior were analyzed by a heatmap and spatiotemporal mixed model. Our data had two levels. The upper level (i.e., provincial level) featured the density of alcohol sales licenses (spatial effect), years of survey (temporal effect) and the Social Deprivation Index (SDI). The lower level (i.e. individual level) had the demographic data of participants. We found that the density of alcohol sales licenses increased the odds for the current drinker category to be present (odds ratio [OR] = 1.08, 95% confidence interval [CI], 1.04-1.45), especially in male (OR = 1.09, 95%CI, 1.04-1.14). Furthermore, it also increased the odds for the presence of the binge drinker category but only in regards to females (OR = 1.23, 95%CI, 1.05-1.44). The number of alcohol sales licenses from 2007 to 2018 was, on average, nine licenses per 1,000 residents. In 2007 and 2008, the density of alcohol sales licenses was lower than the other years. Meanwhile, in 2015, the density of alcohol sales licenses was higher than the others. It could be concluded that the number of alcohol sales licenses showed quite steady density adjustments and no declines. Based on our results, increasing alcohol sales licenses is associated with a higher proportion of alcohol drinking from Thai teenagers. Thus, it is suggested that government organizations develop and apply strategies towards reducing the number of licenses for the sale of alcohol. Potential examples are: stricter control on the license applications and renewals process, increasing licensing fees, and using the density of alcohol sales licenses as a metric assisting the development of targets in the national alcohol control strategy.


location: , 'Thailand year: 2008 source: HSRI

title: Development of the Diabetes Mellitus Clinic of Jungharn Hospital, Roi Et Province

abstract: This study was aimed at assessing the development of the diabetes mellitus clinic of the Jungharn
Hospital’s Outpatient Department. The hospital’s management personnel together with the clinic practitioners
participated in the study in order to analyze and solve service problems, so that the clinic could be
refitted. Seventy-five diabetes patients were included in the study group obtained by systematic random
sampling technique. The data were collected by interviews, questionnaires, group discussions, and observation
in the period from October 2005 to September 2006. The data were subjected to content analysis,
frequency, percentage, means, and paired t-test
In situation analysis, the first step in this kind of study, it was found that the existing service was not
convenient for diabetic patients because too many steps were required, the time consumed was prolonged,
and health education was not at all applicable to the patient’s problems and what was needed to solve them. The following stages were conducted by the groups of managers and care providers who participated
in the planning, implementation, and evaluation of the service. Nurses were prepared for work in
the diabetes mellitus clinic service, and used OPD cards for following up diabetic patients. When such
patients made contact with the diabetes mellitus clinic, their fasting blood sugar level was assessed; they
were treated by a physician, and received drugs. The last step in the service was a group discussion.
Evaluation of each patient’s satisfaction was assessed in terms of whether they had a say and were given
recognition, which were much higher, and the means of fasting blood sugar decreased after the diabetes
mellitus clinic was developed; this was found to be statistically significant at the p-value < 0.01 by paired
t-test.
The study suggested that, clinic development requires staff participation in all processes, team work,
good patient relationships, and the availability of a service center.


location: , 'Thailand year: 2012 source: HSRI

title: Urban Primary Care System in 14 countries

abstract: People living in urban areas are growing; therefore, urban primary medical care is more crucial.
Studying urban primary care systems in various countries will make us learn from best practice in each
country which may be applied to Thai urban medical system. Objectives of this study were to analyze and
compare urban primary care systems among each country. Study design was documentary research about
urban primary care systems in 14 countries including Brazil, Canada, Spain, Cuba, Republic of Korea,
Japan, Taiwan, Hong Kong, Denmark, Sweden, Belgium, United Kingdom, United States of America, and
Australia. Primary Care Evaluation Tool (PCET) of WHO European Region was used as a framework for
analysis. From this study, countries with gatekeeper system (patients were screened by general practitioners
or family physicians ) had good continuous, collaborative, and coordinate care with appropriate
health care costs. Most of countries which governments spent budget for people’s medical care expenses
had provided general practitioners or family physicians as gatekeepers acting in patients screening. There
was no gatekeeper system in countries which people were responsible for their own medical care expenses
but co-payment system was involved to reduce unnecessary service uses.


location: , 'Thailand year: 2007 source: HSRI

title: System and Mechanism : Access to Second Opinion and Public Health Information

abstract: Second opinion is one of the efficient medical procedures to enhance
quality and reliability of health care system, particularly from the patient’s point
of view. To be applied in Thailand, this will provide evidence of Thai patient’s
rights enhancement as well as consumer empowerment, in terms of allowing
consumers to receive better quality of health care services.  The objective of this
study is to review the literatures related to second opinions and people’s access
to public health information, with the aim to find out preliminary information
required for a proper development of second opinion system in Thailand.


location: , 'Thailand year: 2008 source: HSRI

title: ชุดความรู้ที่สัมพันธ์กับมิติจิตวิญญาณ (Spiritual dimension) ที่เกี่ยวข้องกับทางสุขภาพ

abstract: An  attempt  to  include  “spiritual  health”  into  WHO  definition  of  health  has  been  made  since  1980.  It  was  proposed  by  member  states  of  WHO  in  Eastern  Mediterranean  Region.  There  were  both  proponents  and  opponents  of  the  proposal.  Finally  the  Executive  Board  of  WHO  has  concluded  to  propose  amendment  of  the  definition  of  health  from  that “the  state  of  complete  physical,  mental  and  social       well-being  and  not  merely  the  absence  of  the  disease  or  infirmity”  to  “the  dynamic  state  of  complete  physical,  mental,  spiritual  and  social         well-being  and  not  merely the  absence  of  disease  or  infirmity.”  However,  the  proposal  did  not  become  the  resolution  at  the  World  Health  Assembly. Thus  the  definition  of  health  remains  the  same  as  stated  in  the  preamble  of  the  Constitution  of  WHO.  In  Thailand  there  was  a  movement  to  include  the  “spiritual  health”  into  the  definition  of  health  during  the  campaign  on  health  system  reform  in  the  last  decade.  Such  movement  brought  about  strong  controversy  rooted  from  some  leading  Buddhist  organizations  which  rejected  the “spiritual  dimension”  as  a  concept  influenced  by  theist  paradigm  which  is  opposite  to  Buddhism.  Finally,  the  consensus  has  been  reached  to  accept  the  term  “intellectual  well-being”  as  the  fourth dimension  of  health.  The  Health  Act  B.E.  2007  has  then  defined  health  as  “the state  of  human  being  which  is  perfect  in  physical,  mental,  spiritual  and  social  aspects  all  of  which  are  holistic  in  balance.”  There  are  still  some  problems  in  the  new  definition  of  health  concerning  the exact  meaning  of  mental  and  spiritual  well-being  especially  when  translates  into  English.  This  paper  proposed  not  to  try to reach  consensus  in  this  issue  which  is  very  complicate,  since  the  four  dimensions  have  covered  all  aspects  of  health.  It  also  proposed  Buddhist  way  of  development  of  the  four  dimensions  of  health  as  an  example.  The  people  in  different  faith  can  freely  develop  or  extend  their  means  on  the  basis  of  their  own  faith.


location: , 'Thailand year: 2008 source: HSRI

title: Measuring Catastrophic Health Expenditures Using the Poverty Approach

abstract: Recent studies on catastrophic health expenditures often use arbitrary and universally cut-off shares
(e.g., 10 percent) of health expenditures on household income (or on total household expenditure) as the
main indicator of catastrophic health expenditure. However, some empirical studies in Thailand which
employed such indicators ended up with counter-intuitive findings, e.g., a substantial percentage of households
in the richest quintile were found to be prone to catastrophic health expenditures, and more often
than not, at higher rates than those with lower income.
This paper uses the same set of data to demonstrate that the counterintuitive results resulted from
such faulty indicators. Using sophisticated household-specific poverty lines as a measure of household catastrophic expenditure, the study finds that, unlike households in the two lowest quintiles, it is extremely
rare for those with higher-than-median income to have their post-health-expenditure income fall
below the poverty line, a result which is completely opposite to those derived from the former indicator.
However, since the head count of health-related impoverished households is not sentitive for those
households that are already below the poverty line, the study proposes a supplemental indicator, that is,
changes in the normalized poverty gap due to health expenditure, as an indicator that measures the healthexpenditure
impact on poverty.


location: , 'Thailand year: 2023 source: HSRI

title: Factors Influencing Employment Satisfaction of Caregivers Taking Care of Dependent Person in Thailand

abstract: The purpose of this study was to measure the satisfaction of caregivers employed by service units/centers to improve the quality of life of the elderly/local governments to give care to dependent persons in the communities; and to determine the factors that influenced caregivers’ satisfaction with the employment after wage adjustment made since 2017. This was a cross-sectional study in January and February 2022. Data were collected using questionnaires from 563 caregivers who worked under the long-term care funds for dependent elderly from the north, the south, the east, the northeast, and Bangkok. Samples were selected using the simple random sampling method. Data were analyzed descriptively and the relationships between variables were tested using multiple regression analysis. The results showed that the majority of the samples were female (95.4%), age between 40 and 59 years (62.3%), worked as a caregiver for 3 to 5 years (47.2%), and had completed 70 hours of training (89.6%). Regarding employment contracts, 31.3% contracted through service units, 30.6% contracted through local governments, and 17.6% had no contracts. In terms of frequency of payment, 25.8% were paid monthly and 17.9% paid every three months. This study revealed that 48.7% of caregivers experienced late or no payment at all. In this regard, caregivers earned an average wage of 1,620 baht per month (maximum 3,054/minimum 764), but had to pay for travel to work at 214 baht per month (maximum 356/minimum 115). In terms of satisfaction with employment, 51.6% of caregivers had a high level of satisfaction, followed by 26.3% with the highest level. The factors affecting employment satisfaction were quality of work life (B = 1.433, p < 0.01), job support (B = 0.923, p < 0.01), and wages (B = 0.001, p < 0.01). Policy recommendations on wages are: wages should not be lower than the minimum wage, or wages should be increased as step ladder based on experience of the caregivers. If wages cannot be increased, travel expenses, or opportunity losses should be covered. Policies to support the work of caregivers are: equipment such as blood pressure monitors, refresh trainings to improve caregiver knowledge and practices, and caregiver uniforms or team vests, recognition badges, or symbols should be provided to caregivers for public recognition.


location: , 'Thailand year: 2001 source: HSRI

title: Development of model on community based rehabilitation and quality of life improvement for persons affected with leprosy

abstract: Development of Model on Community Based Rehabilitationand Quality of Life Improvement for Persons Affected with Leprosy	The objective of this study is to develop appropriate model for community based rehabilitation (CBR) and to improve the quality of life of persons affected with leprosy (PALs) through the study of their life experiences, problem solving and social processes as well as mechanism that affects their lives. The research was divided into 2 phases which took altogether two years to complete.   The first phase focused on qualitative research using Anthropological tools to collect related information in two villages in Tambol Taladsai, Chumpuang District of Nakornratchasima Province.  The researchers were assigned to live in two villages for three months to learn life experiences of target population and their communities.	Overall findings of the first phase of the study revealed somewhat mild problems of PALs. In comparision with other disables, PALs at different levels of disability appearance, economic and social status, community cultures, including level of emotional and psychological development encountered varying levels of problems and solutions.  Social prejudice varied according to their relationships with relatives and friends as well as social and economic status.  Deformities of leprosy were factors that affected and changed their life style.  Their common wishes were to seek better understanding from their communities that they were completely cured and that they should have been accepted and treated like other disables.  Early findings also found that within the communities there were other disables that should have been helped and socially rehabilitated. 	The second phase focused on the development of the CBR model.  In the beginning the researchers arranged several focus group discussions for people who were interested in and wanted to help solve these problems. The researchers provided appropriate knowledge on leprosy for interested parties as well as arranged appropriate learning process for the communities.  Within a period of six months, key resource persons who had faced and understood these problems planned to find joint solutions under the support of related organizations.  Finally, each village formed a development group for  disables by conducting activities such as surveying disables, bringing them to hospital for rehabilitation, registering disables, raising funds, and organizing stores that disables worked as shop-keepers.  Both villages created disability development centers which still remain function.  	In conclusion, model of community based rehabilitation for PALs started to be concrete through the learning process of the whole communities.  The communities started to have some concerns and gave more opportunities to PALs and other disables.  To reach the solution, attitudes and skills of the disables needed to be changed towards self-reliance.  Learning process and participation of the whole community i.e. PALs, disables, families and community leaders are the key factors towards the success of community based rehabilitation.  To sustain the disables’ capabilities and groups development, empowerment and support from the government and non-governmental organizations together with community paticipation have to be forth coming on a continuous basis.


location: , 'Thailand year: 2013 source: HSRI

title: Disaster Management of Public Health Sector: Lesson Learned from the South

abstract: Thailand, especially the south, more frequently faced natural disaster with more
severity which cause loss of life and property of affected population and also have
effect on public health system. Development of disaster management system is of
paramount importance to minimize such effect, however, no study of public health
disaster management in Thailand was found. This project studied 3 southern provinces
that have past experience on disaster management namely Phuket, Nakorn Sri
Thammarat and Songkhla to learn from their direct experience in order to recommend
disaster management for public health sector. The study included disaster prevention,
preparedness, response, mitigation, recovery and development during pre-disaster,
disaster and post-disaster phases. Methodology used in the study was mixed method,
quantitative and qualitative. This study also emphasized on the participation of the
participants from public health and relevant organization to build their capacity in
disaster-related data collection, management, analysis and utilization and team learning
by sharing experience among multi-disciplinary participants. Data collection was carried
out by document review, focused group discussion, in-depth interview and questionnaire
survey among executive, practitioner and the affected people.
The study found that the 3 provinces had developed from passive disaster
management focusing on public health service to active, integrated disaster management
with collaboration with relevant organizations at various levels from local, national to
international. Phuket had its forte in disaster preparedness especially with capacity
building and resource management and collaboration with academic sector. Its strong
leaders can also mobilize resource and link to national and international authorities.
Nakorn Sri Thammarat had strength in disaster response with multi-sectoral collaboration
and civil society participation while Songkhla excelled in community engagement to
prevent and mitigate the disaster with its strong community self-sustainable identity and
participatory public policy mechanism. However the three settings still had room for
development in the area of risk communication, information and early warning system,
systematic, effective aid management, long-termed recovery that integrated with
community development and knowledge management to improve disaster management
in the future.
The challenging recommendation to public health system from the experience of
these three settings is; public health system has to shift its paradigm from “medical
disaster management” to “health disaster management”. It should be more actively
engaged in integrated multi-sectoral disaster management with the multi-disciplinary
relevant organization including the civil society. Public health system, its facility and its  human resource have to be inclusive as a part of the community in disaster
management especially in prevention and preparedness.