location: , 'Thailand year: 2003 source: HSRI

title: Human rights and health

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


location: , 'Thailand year: 2023 source: HSRI

title: Improvement of Dental Sealant Effectiveness by Using Moisture Control Innovation (Tongue and Cheek Retractor and Saliva Contamination: SS-Suction): Randomized Controlled Trial)

abstract: This research aimed to study dental nurses’ satisfaction and effectiveness of moisture control innovation (for tongue and cheek retractor, and saliva contamination (SS-suction)), toward dental sealant service without dental assistants compared to standard service; moisture control with cotton roll and dental assistant. This study was randomized controlled trial implemented among 15 dental nurses who attended a workshop on using SS-suction, recording satisfaction data toward using and safety, recording students’ data and revised dental sealing technic. Dental nurses received SS-suctions and then provided sealant service to 482 children aged 6–8 years old at sub-district health-promoting hospitals. Children were simply randomly allocated into either experimental or control groups. The children in the experiment group were 244, and in the control group, 238. Data collection on dental nurses’ characteristics, satisfaction with SS-suction for each sealed tooth during service. At 15-18 months, sealed teeth were assessed for retention and caries. Quality control for data collection was the validity and reliability of the satisfaction questionnaire and calibration on sealant retention examination. The results showed the median satisfaction level for SS-suction use was 9 out of 10, and the percentage of children with pain during insertion or removal was 17–18. The pain was from a feeling of pressure and disappeared when the suction was in place. Retention and caries were not significantly different between the experiment and control groups. Full retention on the occlusal surface were 32.5% and 31.4% and on the buccal surface were 16.8 and 18.3 in the experiment and control groups, respectively. Caries on the occlusal surface were 26.6% and 27.6% and those on buccal surface were 35.4 and 36.2 in the experiment and control groups. In conclusion, dental nurses were satisfied with SS-Suction both in function and safety. The effectiveness at 15–18 months of SS-Suction was compatible with standard procedure.


location: , 'Thailand year: 2022 source: HSRI

title: Cost-Utility Analysis of Polysomnography (PSG) for Diagnosis Obstructive Sleep Apnea in Thailand

abstract: Background: Obstructive sleep apnea (OSA) was the most common sleep-related breathing disorder. The prevalence of OSA was 15.4 in males and 6.3 in females in Thai population. OSA increased risk of car incidence and cardiovascular diseases and reduced quality of life. Level 1 polysomnography (PSG) was a precision method of OSA diagnosis. To grade the severity of sleep apnea, the number of events per hour was reported as the apneahypopnea index (AHI). Continuous positive airway pressure (CPAP) was the most common treatment for obstructive sleep apnea in patients who do not need surgery. In Thailand, PSG and CPAP were expensive and only reimbursed through the Civil Servant Medical Benefit scheme (CSMBS). Objective: To evaluate the cost-utility analysis and budget impact analysis of OSA diagnosis and treatment by PSG and CPAP compared to standard care. Method: Decision tree model and Markov model were used to estimate total costs, life years (LYs) and quality adjusted life years (QALYs) in societal perspective and governmental perspective. Relevant costs were direct medical costs and direct non-medical costs. Health outcomes were LYs gained and QALYs gained. The results were presented the incremental cost effectiveness ratio (ICER) of PSG diagnosis and CPAP treatment compared to standard care. Uncertainty analysis was conducted by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: Full-night PSG and Split night PSA and CPAP treatment were cost-effective in Thai context at 160,000 Baht per QALY compared to standard care. The ICERs of moderate to severe OSA and only severe OSA patients were 86,635 – 90,014 Baht per QALY for Full-night PSG and CPAP treatment and 85,733 - 88,877 for Split-night PSG and CPAP treatment. If the capacity of PSG diagnosis increased 30% per year, the 5 years budget impact of Full-night PSG and Split-night PSG were 2,204 – 3,730 million Baht and 2,084 – 3,631 million Baht respectively.


location: , 'Thailand year: 2018 source: HSRI

title: Non-financial incentives influencing retention in public health services among doctors in eight provinces in Thailand

abstract: The objectives of this study were to prove the effect of non-financial incentive, by the definition in Guidelines: Incentives for Health Professionals of Global Health Workforce Alliance (GHWA), to retain the physician in rural area and how to manage this kind of incentive. The study used the retention data of the physicians in 8 provinces hospitals since 2006 to 2015 , from the previous study ”The study of the labour cost of health workforce in MOPH hospital”, to predict the study area that can retain the physician in rural area. The questionnaire was developed to ask all physicians in the study area about the effect of nonfinancial incentive and the intention to work in the same hospital next year. The results showed that all categorized of non-financial incentive have a significant effect to the retention of the physicians at 95%CI. These effects were difference between the first 3 years working physicians and the physicians that have more than 3 years working experience. This study found that the hospitals can promote the non-financial incentive in the hospital working environments, so the Ministry of Public Health should to have the policy to promote these non-financial incentives.


location: , 'Thailand year: 2016 source: HSRI

title: Effects of Transformational Leadership and Good Governance on District Health Office’s Effectiveness: A Case Study in Health Region 3.

abstract: The purposes of this study were: 1) to study organizational effectiveness, transformational leadership,
and good governance of district health office, 2) to study relationships among transformational
leadership, good governance, and DHO’s effectiveness, and 3) to study impacts of transformational
leadership and good governance on DHO’s effectiveness. This study was a descriptive research by using surveys. The units of analysis were chief district health officers, administrative personnel, academic
personnel, and directors of subdistrict health promoting hospitals from all 54 DHOs in Health Region 3
for a total of 270 samples. The research instrument was a 5-point rating scale questionnaire. The content
reliability was 0.982. The analysis for frequency, average, standard deviation, and one-sample t-test was
done on SPSS for Windows, and the analysis for validity was done on LISREL 8.8.
The results were: 1) The levels of organizational effectiveness, transformational leadership, and
good governance were between 3.72 and 4.21 which were higher than 3.5 in 5-point rating scale (p < 0.01).
2) Organizational effectiveness, transformational leadership, and good governance had high pairwise
correlation coefficients between 0.745 and 0.819 (p < 0.01). 3) Transformational leadership and good
governance together influenced the effectiveness by 70.90 percent of variance (p < 0.01).
Suggestions from this research: To improve DHO’s effectiveness, one should emphasize on the
leadership development for CDHOs so that they have transformational leadership and good governance.
Moreover, Ministry of Public Health should develop a policy guidance for assessing transformational
leadership and good governance in a selection process for the position.


location: , 'Thailand year: 1997 source: HSRI

title: The 1992 private hospital census in Thailand

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


location: , 'Thailand year: 2022 source: HSRI

title: Economic Evaluation of Genetic Testings for Thalassemia Carrier Diagnosis Among Married Couple in Thailand

abstract: The prevalence of thalassemia is found in approximately 1% of the population about 30-40% of carriers of thalassemia, it is possible to estimate that 5,125 new cases of severe thalassemia in every 1 million new born babies in Thailand. The severity of this disease is that the fetus dies while in the womb or dies within hours of birth, or if the fetus does not die, will incur the burden of direct and indirect care costs including delivery. As a result, the quality of life of patients and caregivers decreases. Currently, the National Health Security Office (NHSO) has set the rate of reimbursement for the screening and diagnosis of thalassemia in pregnant women by being included in the health benefit package. However, this compensation rate does not cover all screening costs, including hemoglobin (Hb) typing and deoxyribonucleic acid (DNA) analysis, which are considered sensitive techniques. and high specificity to screening. For this reason, couples are burdened with additional screening costs as well as the waiting time for screening and diagnosis results. Moreover, the frequency of screening follow-up and the ability to access services that are only available in large hospitals. It may be a factor contributing to a decrease in the rate of visits to screening and diagnosis of thalassemia. This study was an economic evaluation by using a cost-benefit analysis through the decision-tree model. The aim of this study was to analyze the costs and benefits of married couples from a social perspective if couples at risk were given genetic testing to diagnose thalassemia. Also, Thailand’s budget impact was determined. From the cost evaluation results, it was found that genetic testing for diagnosing thalassemia in married couples according to the Thai standard guidelines is economically cost-effective. The cost savings was 23,785 THB per prevention of a thalassemia case, and the benefit-to-cost ratio was 5.38 per 1 proportion. However, the disadvantage of Thailand's practice of screening for thalassemia carriers in pregnant women and their spouses is that the process after a pregnant woman is screened by MCV/MCH and DCIP techniques and shows positive results that we have to follow up with the husband at risk to come for an examination If there is a risk, it will continue to be examined with Hb typing technique. In case, reducing the screening process to be able to perform Hb typing immediately if a pregnant woman is at risk without waiting for results from her husband. A cost savings of 6,622 THB for the prevention of a thalassemia case when compared to the standard screening guidelines of Thailand. For the results of the budget impact analysis, it was found that there will be an increase in budget burden equal to 36 million baht per year. Therefore, from the results of the study, there are policy recommendations as follows: 1. The Royal College of Obstetricians and Gynecologists of Thailand should consider revising their screening and diagnostic guidelines, suggesting that after a pregnant woman has tested positive for MCV/MCH and DCIP, Hb typing should be screened immediately without the need to wait results from husband and after Hb typing is positive, she should be suggested to genetic test if it is unable to catch up her husband for reducing waiting time and screening process. Moreover, it would increase response rate whole diagnosis. 2. The National Health Security Office (NHSO) should manage the budget to cover both screening and diagnosis of thalassemia among pregnant women and at-risk spouses. 3. The quality of private laboratory testing by the Department of Medical Sciences should be carried out in order to increase the Hb typing and genetic testing services in order to increase the accessibility of all pregnant women and husbands. 4. There should be a systematic record of the results of screening and diagnosis, such as a health link system to be used as information for pregnant women and their husbands in the event of more than one pregnancy or transfer of medical rights. Subsequently, the screening data is not lost and the cost of screening and re-diagnosis is reduced. 5. Policy and control for new cases of thalassemia should be communicated, especially in couples planning pregnancy and general population.


location: , 'Thailand year: 2020 source: HSRI

title: Integrated child health, development, and protection team for well-being promotion among children in low income and multiple deprived families

abstract: This study examined the relationship between health conditions and poverty. The study groups were selected by the community team according to their own perception of the poverty condition. Totally 458 children from 4 provinces, namely Bangkok, Samut Sakron, Samut Prakan and Nakhon Pathom, were enrolled. The study revealed that children living in low income families (< 3000 baht per person per month), in severe deprived families (deprivation index ≥4 in 9 factors), and in dysfunctional families (family dysfunction index ≥2 in 5) were associated with poor parenting leading to unmet health needs (poor grade care profiles ≥2 in 6 categories). Low income families (< 3000 baht per person per month) increased risk 2.4 times. Severe deprived families (deprivation index ≥4 in 9 factors) increased risk 1.8 times and dysfunctional families (family dysfunction index ≥2 in 5) increased risk 2.6 times. We grouped all children with family dysfunction index ≥2 and those with the combination of low income index and multiple deprivation index together as a high risk group. It was found that this group had three times more risk than those with a low risk group (the group of children with family dysfunction index <2, without or only one index of low income and deprivation family). This study developed the Integrated Health – Learning – Protection team (H-L-P team) to promote the well-being of poor children. This community based team composed of the community leaders, child care providers, health care volunteers and community development volunteer. Totally the 39 H-L-P teams were developed in 4 provinces. The integrated team has been trained in programs for building newborn childcare skills and enhancing health and promoting early childhood learning for the community, caring for a child who has had an adverse childhood experiences, children's rights and how to protect them, and how to refer for help. This training give staff members confidence in assessing and promoting poor children's health before visiting areas of their responsibility. A health promotion model for poor and needy children was developed by the H-L-P team, which consisted of 4 steps: 1) Identify the complex health and development problems by the home visit program 2) Action planning by the various members of the H-L-P team 3) Assisted operations by members of the integration team each side and connect relevant local or state departments in each area, including education and advice to empower the families. 4) Evaluation by the model development team in cooperation with the integrated health team. A total of 101 cases in the high-risk groups were followed up by the H-L-P team. It was found that only 38% of children in this high-risk group were enrolled in the government's cash transfer program for children in poor families (600 baht per month until the age of 6 years). 69 % of the high-risk groups experienced the poor parenting leading to unmet health needs (poor grade care profiles ≥2 in 6 categories). 73% were not receiving adequate emotional care, with either neglect or emotional and physical abuse. 65% had to live in the single, divorced, or separated families. 55 % experienced the domestic violence. 26 % were in families with drug abuse or drug trafficked. 31 % were in the incarcerated families. 24% had developmental delays and 9% had a severe development Even though the children were in an extremely poor, deprived, and low potential family, 64% of them were still raised by their own family without using the community early childhood learning and care services in any way. The assessment of the H-L-P team by the model development team found that the factors that promote the team's work were the specific knowledge and skill training program for the different work of the member in the team and getting them to know each other. Each member in the H-L-P team had different strengths. The child care provider had a strong role in finding vulnerable children and promoting cognitive development, learning and mental well-being of children. Public Health Volunteers strength was the expertise in home visits. This allowed children to be continuously monitored for health problems. The social development and human security volunteers (NGOs) or the community leaders had a strength to make it easy for children to have access to those welfare system. At least 2 home visitation sessions will see a positive change in results. The professional teams such as health workers, psychologists, social workers, occupational therapist, child protector, supplementing the H-L-P team in some home visits was a great addition, and might get the better results for the high-risk groups. Encouraging caregivers to enjoy giving closed supervision for children, being interest in stimulating the learning skill for children was easily starting by introducing them for the program of making-toy-yourself, practicing playing with children, practicing storytelling, supporting toys and some books as a starting point. Supporting the ongoing work processes of the the H-L-P team with the systematic quality improvement process (PDCA cycle) will enable the poor children and their families to receive real and sustainable assistance. Tackling the child in poverty and family dysfunction must be supported by a public and local policy that had an extensive understanding and practice. The power of community volunteer, in conjunction with various community based health centers and early childhood development centers, was a complementary force that was an important community capital. In caring for these vulnerable children, we need to expand our results to policy by: 1. Promote public and local support policies in establishing the H-L-P integrated team for early childhood development and protection and implementing screening mechanisms for high-risk groups with an intensive home visit for this group as a key of success. 2. Promote the investment for more physical structures related to early childhood learning and care for children in poor families and dysfunctional family to cover all early childhood age groups from birth to 6-8 years. 3. Driving innovation of early childhood education and care such as tools, process manuals, training courses to create knowledge, awareness, care and protection skills for poor children and children in adversity. Those innovations were needed for the child care-takers, community administrators, community volunteers, child care providers in nursery-daycare center kindergarten school, or other community based health centers or development learning centers established for early childhood or families. 4. Currently, early childhood development centers are systematically established in most communities. It must be the central network of the H-L-P integrated teams to work with poor children in the communities. This should be supported and invested by both local and national policy.


location: , 'Thailand year: 2017 source: HSRI

title: Developing Appropriate Tools for Hearing Screening in Preschoolers

abstract: The main objective of this project was to develop a cost effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. An android-based screening application was developed. The screening protocol involved asking the child to pick pictures corresponding to the set of predefined words heard at different sound levels offered in a specifically designed sequence. For screening purposes, the developed screening system was 100% sensitive (95% CI = 83.18% to 100%) for children with speech reception threshold (SRT) or pure tone average threshold > 25 dBHL, with a specificity 0f 79.44% (95% CI = 70.83% to 86.01%). The time taken for screening of each child was less than 2 minutes on average, compared to 12 minutes required in normal procedure.  Also, to explore other options that could suit a variety of resource settings, the secondary objective was to implement and evaluate standard pure tone audiometric measurement and tele-audiometry functions on the tablet-based system.  It was found that, with additional hardware to increase the dynamic range, function-wise both could successfully be realized. However, due to calibration difficulties especially for the bone-conduction audiometry, accuracies were found to be less than those measured with standard audiometric equipment. Still, the results were encouraging enough to warrant further research and development on this.


location: , 'Thailand year: 2022 source: HSRI

title: Essential and Urgent Policy and Research and Initial Policy Recommendations regarding the Medical Cannabis Policy in Thailand

abstract: Background and rationale: The Thai medical cannabis (or medical marijuana: MMJ) system was first established in February of 2019. This study aimed to identify the most essential and urgent policy and research and initial policy recommendations regarding the implementation and impacts of the MMJ policy in Thailand. Methodology: A narrative literature review and other qualitative methods; 18 in-depth interviews with key stakeholders, focus group discussions of nine service providers and patients, and a participant observation in the MMJ clinic at the Ministry of Public Health. Results: Our crucial findings showed that: (a) the Thai MMJ system is complex, consisting of three subsystems: modern medicine, Thai traditional medicine, and folk medicine. These subsystems are not harmonized, and have resulted in poor access to legal MMJ products. (b) MMJ is a new entity in Thailand, and a comprehensive monitoring and evaluation system is needed. (c) the MMJ movement in Thailand has “political economy” attribute, meaning that the policies may be driven by benefits beyond a medical rationale. These findings lead to six research questions. (1) What do the governance structure and plans regarding MMJ policy in Thailand look like? (2) How do we improve the complex MMJ system to best serve patients? (3) How much and how to invest in a knowledge-generation system, and a monitoring and evaluation system regarding the MMJ policy? (4) How do we build MMJ consumers’ health literacy? (5) What are the efficacy levels and cost-effectiveness of the Thai medical cannabis products? And (6) What should be the future MMJ policy in Thailand? Conclusion: The newly established and complicated Thai medical cannabis system is novel for Thai society. This system has potentials to produce both positive and negative consequences, with potentially enormous underlying economic benefits. Therefore, the government and all relevant sectors must collaboratively manage the medical cannabis system in a transparent, creative, and considerate way, to provide the best benefits for patients and the whole of Thai society, in both the short- and long-term.


location: , 'Thailand year: 2008 source: HSRI

title: A study of managing the mechanism of providing the information of health insurance system that is suitable for consumers

abstract: This report presents a study of managing the mechanism of providing the information of health insurance system that is suitable for consumers. The purpose of the study is about the organization’s mechanism and process in providing information regarding the health insurance system by considering efficiency, effectiveness of its mechanisms and management guidelines in providing the suitable information of health insurance system. The methods of the study includes both the quantitative and qualitative researches. The quantitative researches are conducted for  3,015 cases; the area of research is Bangkok and 11 provinces in 4 peripheral regions. While the qualitative researches are conducted the exclusively interviewing  59 persons. It also includes the public hearing and doing research of  5 case studies. The results of study are as follows.
	Regarding the mechanism of providing information of health insurance system, it is found out that there obviously exists the agencies who are responsible for universal coverage health insurance and social insurance system. But the welfare system for civil servants, which is additionally attached to Comptroller General’s Department, Ministry of Finance who will be in charge, does not have a clear structural mechanism to handle the system. The process of  providing information before the medical treatment (upstream) about the rights that one can receive according to rights of all three health insurance system is evaluated as fair, especially  the rights of civil servants/state enterprise staff about their registration in order not to pay the medical bills in advance. For both in-patients and out patients, they are aware of more than two health insurance systems. From the opinions about the process of providing information of  health insurance system in each stage of undergoing medical treatment (midstream) of health insurance system,  It’s also found out that the simple groups agree at a high rate, especially the cases of receiving the medical treatment at medical centers, about the data of service users’ illness. And form information providing when finishing the medical treatment  (downstream), regarding giving the clear information the sample groups also agree at a high rare, especially the case of being transferred to receive treatment at other places. Regarding the efficiency of mechanism and process of management of providing information of health insurance system, it is found out that the first two health insurance systems are not more efficient than the civil servants’ welfare system, is less efficient and lacks mechanism for systematic management. In terms of the effectiveness, the service users are quite satisfied, However, from the qualitative study it is found out that the study groups are satisfied to some extent and think that it needs to improve three systems continuously for their sustainment.
	It is advised in the study that all three systems are to be improved to guarantee fairness and equality for the basic common rights of the three systems. In case of over the eligible rights, the service users should bear the expenses as well. It should be created the participation in sharing information earnestly and continuously. It should be developed the empowerment information process (EIP) to enable everyone to realize the importance of providing information and regard that it is the beginning of building the good relations between the parties concerned. It should be regulated the structure of management of providing information, that will comprise watching, following up, monitoring and learning from the best practice. There should be the organization, that will receive and deal with complaints, and be independent. It should be built the culture of reporting the mistakes occurring in the system. It should be fixed that providing information of health insurance system will be the index of evaluating the quality of organization (HA). It should be analysed about the nature / formats / channels / contents of information of health insurance system.


location: , 'Thailand year: 2022 source: HSRI

title: Expanded antimicrobial stewardship program in hospitals in Thailand

abstract: The burden of antimicrobial resistance (AMR) has been increasing worldwide including Thailand. Global Antimicrobial Resistance Surveillance System (GLASS) and antimicrobial stewardship (AMS) are two important pillars of the global action plan on AMR launched by the World Health Organization (WHO) in 2015. Our project aimed to evaluate the impact and feasibility of customised AMS strategies implementation (GLASS antibiogram, Clinical Practice Guideline (CPG) for common infections (bacteremia or sepsis without identified source, urinary tract infections and pneumonia), and antibiotic authorization) under the support of the AMS team at the university hospital. Therefore, we conducted a quasi-experimental (pre- and postintervention) study at three participating hospitals: Sakaeo Crown Prince Hospital, Surin Hospital, and Surat Thani Hospital. Before starting the project, we conducted a national survey to identify the obstacles for AMS implementation at 399 hospitals in Thailand. The major obstacles of AMS program (ASP) implementation identified in this survey were increased workload, lack of AMS knowledge and skills of relevant personnel, and lack of hospital administrator concern. During Jan 2020-Dec 2021, the study enrolled a total of 6,625 patients from three participating hospitals. The summary results of each study are shown below. 1. GLASS antibiogram: Laboratory-based antibiograms from 2019 and GLASS-based antibiograms from 2020 were created and compared. Prevalence of multidrug-resistance in community-acquired infection (CAI)-related bacteria was higher than those in hospital-acquired infection (HAI)-related bacteria, which may have been related to misclassification of colonized bacteria as “true” pathogens and HAIs as CAIs. The results of this study on AMR surveillance using GLASS methodology may not be valid owing to several inadequate data collections and the problem of specimen contamination. Given these considerations, the related personnel should receive additional training on the best practice in specimen collection and the management of AMR surveillance data using the GLASS approach. 2. Clinical practice guideline After the CPG implementation, there were significant reductions in the mean duration of intensive care unit stay, and the mean duration of ventilator use. The CPG-implementation was independently associated with favourable clinical outcomes. These findings confirmed that the locally developed CPG implementation is feasible and effective in improving patient outcomes and reducing antimicrobial consumption. 3. Antibiotic authorization: Implementation of antibiotic authorization could reduce the amount of targeted antimicrobial consumption, the mean length of hospital stay, and increase the favourable clinical response. The study findings confirmed that implementation of antibiotic authorization at provincial hospitals under experienced AMS team’s guidance was feasible and useful. In conclusions, our studies confirmed that the implementation of GLASS antibiogram, CPG, and antibiotic authorization at non-university hospitals under the guidance of an experienced AMS team could reduce inappropriate antimicrobial consumption and improve patients’ clinical outcomes. However, the COVID-19 situation during the postimplementation period may confound the study results. It was possible that the pattern of antimicrobial use and characteristics of hospitalized patients altered by the COVID-19 situation. Therefore, we do believe that the study findings could be a good model for the implementation of customized AMS strategies at other hospitals with limited resources. The related personnel should receive additional training to strengthening the ability to perform a good practice in AMR surveillance and AMS program.


location: , 'Thailand year: 1999 source: HSRI

title: Study on family's ability to pay and financially catastrophic illness(FCI) among out-of-pocket in patients: Songkhla province

abstract: ความสามารถในการจ่ายค่ารักษาพยาบาล และสภาวะเจ็บป่วยจนล้มละลาย ของผู้ป่วยในที่จ่ายค่ารักษาพยาบาลเอง ในจังหวัดสงขลา	การศึกษานี้มุ่งวิจัยเพื่อนำผลการศึกษาไปสู่การพัฒนาการจัดระบบประกันสุขภาพที่คุ้มครองการเจ็บป่วยจนถึงขั้นล้มละลายทางเศรษฐกิจของครอบครัว  (Financially catastrophic illness- FCI)โดยมีวัตถุประสงค์เพื่อพรรณาถึงความสามารถในการจ่ายค่ารักษาพยาบาลของครัวเรือนที่ไม่มีหลักประกันสุขภาพ หรือ ครัวเรือนต้องจ่ายค่ารักษาพยาบาลเอง (pay out of the pocket) หาความสัมพันธ์ระหว่างความสามารถในการจ่ายค่ารักษาพยาบาล กับปัจจัยทางสังคม เศรษฐกิจ และประชากร วิเคราะห์พฤติกรรม วิธีการจัดการทางการเงินของครัวเรือนเมื่อประสบกับภาระในการจ่ายค่ารักษาพยาบาล และผลกระทบของการเจ็บป่วย และภาระการเงินต่อครอบครัว ศึกษาลักษณะโรคที่พบบ่อย ค่ารักษาพยาบาล วันนอนโรงพยาบาล วงเงินสูงสุดที่ครัวเรือนสามารถจ่ายได้ของผู้ป่วยที่ต้องจ่ายค่ารักษาด้วยเงินในกระเป๋าของครัวเรือน ในภาวะทั่วไป และเมื่อเผชิญกับภาระค่ารักษาที่เข้าข่ายสภาวะเจ็บป่วยจนล้มละลาย  คาดประมาณอุบัติการณ์ของการเจ็บป่วยจนล้มละลายในจังหวัดสงขลา	 การวิจัยนี้ ได้ออกแบบโดยแบ่งเป็น 2 งานวิจัยย่อย งานวิจัยแรก เรียกว่า FCI-1 Study เป็นการสำรวจเก็บข้อมูลผู้ป่วยในรายใหม่ที่อาศัยอยู่ในจังหวัดสงขลา ที่ต้องจ่ายเงินค่ารักษาพยาบาลเอง เป็นผู้ป่วยที่มานอนรักษาในโรงพยาบาลทั้งรัฐบาลและเอกชนในจังหวัดสงขลา ตั้งแต่เดือนพฤศจิกายน 2541 จนถึงเดือนเมษายน 2542 โดยการสัมภาษณ์ด้วยแบบสอบถามที่ผ่านการทดสอบแล้ว  งานวิจัยที่สอง เรียกว่า FCI-2 Study เป็นการสำรวจผู้ป่วยในอาศัยอยู่ในจังหวัดสงขลาที่ต้องจ่ายเงินค่ารักษาพยาบาลเอง และมีปัญหาในการจ่ายค่ารักษา ต้องขอรับการสังคมสงเคราะห์ของโรงพยาบาลภาครัฐสองแห่งที่เลือกอย่างเจาะจง ระยะเวลาที่ศึกษาคือ เดือนพฤษภาคม และมิถุนายน 2542 	ในการวิจัยทั้งสอง ใช้ทั้งวิธีการวิจัยเชิงปริมาณและเชิงคุณภาพ  เพื่อให้ทราบถึงวิธีการจัดการกับภาระค่ารักษาที่โรงพยาบาลเรียกเก็บ และความสามารถในการจ่ายของครอบครัว โดย เจาะลึกถึงแหล่งที่มาของเงินที่ครอบครัวใช้ในการจ่ายค่ารักษาพยาบาล ในการศึกษาวิจัย ได้ออกแบบเก็บข้อมูลเชิงคุณภาพ เสริมการวิจัยเชิงปริมาณ ดังนี้คัดเลือกผู้ป่วยในรายใหม่ที่ต้องจ่ายค่ารักษาพยาบาลเอง  ประมาณ 10% ของตัวอย่างในแต่ละโรงพยาบาลที่คัดเลือกในการวิจัยเชิงปริมาณใน FCI-1 Study แล้วติดตามผู้ป่วย  ตั้งแต่วันแรกที่นอนโรงพยาบาลจนถึงวันจำหน่าย สัมภาษณ์และเก็บข้อมูลทุกครั้งที่มีการจ่ายค่ารักษาในระหว่างที่นอนโรงพยาบาล วิธีวิจัยเก็บข้อมูลนี้ เรียกว่า  time-series data collection  เก็บข้อมูลเชิงคุณภาพ ประมาณ 40 ตัวอย่าง ซึ่งเป็นผู้ป่วยในที่จ่ายค่ารักษาพยาบาลเอง และมีปัญหาในการจ่าย ต้องขอสังคมสงเคราะห์ในโรงพยาบาล   โดยวิธีการสัมภาษณ์เชิงลึก (in-depth interview)ในหอผู้ป่วย ร่วมกับการเยี่ยมบ้าน เพื่อเสริมกับข้อมูลเชิงปริมาณใน FCI-1 Study งานวิจัยแรก: การสำรวจความสามารถในการจ่ายของครัวเรือนที่ต้องจ่ายเงินเอง (FCI-1 Study)	การวิจัยเชิงปริมาณนั้น พบว่า ผู้ป่วยที่ต้องจ่ายเงินเองที่อาศัยอยู่ในจังหวัดสงขลา และเข้าหลักเกณฑ์ในการศึกษา คิดเป็นสัดส่วนร้อยละ 4-38 ของผู้ป่วยในทั้งหมดที่นอนโรงพยาบาลในช่วงที่ทำวิจัย แสดงว่า ผู้ป่วยที่เข้ารักษาตัวในโรงพยาบาล ในจังหวัดสงขลา ส่วนใหญ่มีหลักประกันสุขภาพครอบคลุมอยู่แล้ว เพียงส่วนน้อยที่ครัวเรือนต้องจ่ายค่ารักษาพยาบาลเอง ในการศึกษานี้สามารถเก็บตัวอย่างได้ทั้งหมด 1731 ตัวอย่าง ความสามารถในการจ่ายของผู้ป่วยมีความแตกต่างกันในระหว่างโรงพยาบาล ผู้ป่วยที่ไปใช้บริการที่โรงพยาบาลเอกชน เกือบไม่มีปัญหาว่าจ่ายค่ารักษาพยาบาลไม่ได้เลย ขณะที่โรงพยาบาลรัฐ พบว่าผู้ป่วยที่มีปัญหาในการจ่าย คือไม่สามารถจ่ายค่ารักษาได้ทั้งหมดหรือบางส่วน แตกต่างกันตั้งแต่ร้อยละ 23.8 จนถึง 36.8 โดยร้อยละที่พบจะแปรผันไปตามศักยภาพ หรือขีดความสามารถในการดูแลผู้ป่วยของโรงพยาบาล จากการศึกษาพบว่า ปัจจัยทางเศรษฐกิจและสังคมหลายตัวแปร มีความสัมพันธ์กับระดับความสามารถในการจ่าย ได้แก่ ระดับการศึกษาของผู้ป่วย อาชีพ รายได้ของครอบครัว และจำนวนผู้ที่ก่อรายได้ให้แก่ครัวเรือน เมื่อวิเคราะห์ว่า กลุ่มตัวอย่างสามารถจ่ายค่ารักษาได้มากน้อยเพียงไรด้วยวิธี life-table method ปรากฏ ว่า ณ ค่ารักษาที่ 14,700 บาท ประมาณครึ่งหนึ่งของประชากรกลุ่มตัวอย่างจะประสบกับปัญหาจ่ายค่ารักษาไม่ได้  ครัวเรือนส่วนใหญ่ร้อยละ 89 จะใช้เงินสด หรือเงินออม เป็นแหล่งเงินแรกที่สำคัญในการจ่ายค่ารักษา ขณะที่ประมาณร้อยละ 8 ต้องใช้การหยิบยืมเงินเป็นแหล่งเงินแรกในการจ่ายค่ารักษา และร้อยละ 21 ของประชากรในกลุ่มตัวอย่างต้องใช้แหล่งเงินจากเงินยืม เป็นส่วนหนึ่งของค่ารักษาพยาบาลครั้งปัจจุบัน และพบว่าร้อยละ 1 ของตัวอย่าง ต้องให้เด็กออกจากโรงเรียน สืบเนื่องจากจ่ายค่ารักษาในการเจ็


location: , 'Thailand year: 2022 source: HSRI

title: Factors Associated with Contribution Payment among Insured Workers under Social Security Act’s Article 40: the Case of Sickness Benefit

abstract: This analytical observational study aimed to investigate relationships between factors and contribution payments for the sickness benefit among insured workers under the Social Security Act’s Article 40 who had been registered for 3–5 months on December 31, 2019. The data used for the analysis came from 53,556 insured workers who registered with Article 40 between August – September 2019. Descriptive statistics and binary logistic regression were used to describe the overall data and investigate the relationships among the studied factors. The analysis showed that age, occupation and registration channels were significantly associated with the contribution payments to fulfill the sickness benefit, while sex, income, contribution amount and benefit options were not. Those aged 25–34 years, in service works, working in machinery factories, and registration channel through a community based - social security agent had an increased chance of losing the sickness benefit compared to their counterparts. These results suggest strategic targeting the insured workers under Article 40 to ensure access to continuous sickness benefit of the social security system.


location: , 'Thailand year: 2021 source: HSRI

title: Factors and mechanisms related to health risk communication among migrant workers in Thailand: a case study of surveillance, public health and social measures in COVID-19 epidemic

abstract: Coronavirus disease 2019 (COVID-19) is a new emerging infectious disease that needs effective
risk communication, one of the key components of public health emergency responses. During
the pandemic, migrant workers face many significant challenges especially language and cultural
barriers hampering access to health risk information. This study aims to explore health risk
communication structure and processes, identify the communication network, and explore factors
related to the outcomes of health risk communication practices among migrant workers during
the COVID-19 pandemic in Thailand.
We conducted a mixed-method cross-sectional design on in migrant workers who lived in the
headquarter district of Samut Sakhon, Ranong, and Phuket provinces between November 2020
and June 2021. For qualitative approach, representatives from central and local public health
organisations, non-governmental organisations, local government units, and migrant community
members were purposively recruited with some additional interviewees recruited by snowball
sampling. Thirty-six key informants participated in the semi-structured interview. Deductive
thematic analysis was applied. For quantitative approach, first, we used social network analysis.
Fifty-six respondents from migrant communication were purposively recruited and were asked to
complete the questionnaire. Results from the questionnaires were used to outline sociogram to
assess how the information flew and actors that influenced the data flow most. We also surveyed
a total of 288 migrant workers to evaluate risk communication outcomes and related factors that
affected awareness toward public health measures and self-reported practices during COVID-
19. Logistic regression with robust standard errors were employed.
The findings showed that there were various activities around health risk communication. Though
health risk communication plan viewed migrant workers as a target group, there was no formal
governing body responsible for guiding communication plan. Moreover, there was no monitoring
tool or evaluation process for health risk communication. For social network analysis, migrant
health volunteers and local media were key sources of information. The centrality score was
higher in rural migrant communities compared with the urban ones-implying huge dependency
of communication within limited number of actors in rural areas. For quantitative survey on attitude
and self-reported preventive practices, most of respondents were aware of public health
measures (85%) and performed preventive practices (70%) during COVID-19 pandemic. Frequent reception of health information and having up to primary school education showed a
statistically significant association with preventive practices compared with those who hardly
received health information and the uneducated. Middle-aged migrant workers demonstrated a
significantly lower level of preventive practices than the younger migrant workers. A long stay in
Thailand was significantly related to lower degree of awareness toward public health measures.
In conclusion, clear governing body led by the government with intersectional collaboration, and
active engagement from community members such as migrant health volunteers are key to
effective communication with migrants. Dissemination of information for migrants should be done
through various channels especially local media in migrants’ languages, for instance, print and
online media with consideration of different migrant characteristics and capabilities especially.
The communication strategies should not overlook certain groups of migrants who were likely to
face difficulty in accessing health information (such as elder migrant workers and the uneducated
ones).


location: , 'Thailand year: 2015 source: HSRI

title: An implementation for use of Dried Tube Specimens as Internal Quality Control Samples at HIV Testing Laboratories

abstract: It has been well-recognized that quality control (QC) samples are essential for routine testing results, particularly HIV serology testing conducted by a rapid test. This study was to establish Dried Tube Specimens (DTS) for implementing as QC samples at laboratory networks of RMSC 1/1 Chaing Rai and RMSC 3 Nakhonsawan. DTS were delivered to 48 community hospital laboratories and were tested 1 time a week for 4 months. It was found that 1302 of 1350 (96.44%) tests and 48 of 1350 (3.55%) tests were reported positive and negative, respectively. Our study suggested that it is possible to use DTS as QC samples for HIV rapid testing. HIV misclassification might possibly be due to testing procedure, reading test results or competency of technicians. Owing to its ease of preparation and storage, DTS are alternative tools for community hospital laboratories to use as quality control materials as a requirement for routine testing in compliance with medical laboratory standards.


location: , 'Thailand year: 2007 source: HSRI

title: Epidemiology of Dengue Hemorrhagic Fever in Huai rai-Sajae Village, Mae Chan District, Chiang Rai Province

abstract: This descriptive study was conducted in Huai Rai-Sajae Village of Mae Chan district,
Chiang Rai Province in the period from May 20, 2007 to July 20, 2007 to determine
the characteristic of the dengue hemorrhagic disease in order to understand the distribution
of the disease and independent factors for outbreaks, and to identify patients in the
community for treatment and prevention the epidemic. The data were analyzed by using
the SPSS version 12 software package for Windows to calculate the percentage, ratio,
means, cross-tabulations and chi-square.
The first case of dengue hemorrhagic fever emerged on May 21, 2007. The outbreak
became progressively worse, reaching a total number of 568 cases, among whom the diagnosis
of 63 cases was confirmed by serology and 525 cases remained probable cases
according to clinical criteria. The prevalence Rate of the disease in Mae Chan district was
492.33 cases per 100,000 population; the mortality rate was 0.17 percent. Most patients
(534 cases) lived in Huai Rai-Sajae Village; the remainder lived in other villages in Mae
chan district. The mean age was 24.88 years (SD= 16.82). Patients represented all age
groups, the youngest being 1 month old and the oldest 84 years old; the male to female
ratio was 1:1.24. The frequency of clinical signs and symptoms of the patients were fever,
99.31 percent; headache, 80.1 percent; myalgia, 63.27 percent; positive tourniquet test,
62.18 percent; and maculopapular rash, 43.5 percent. Impending shock and dengue shock
syndrome were seen in 12.41 percent of the cases.
The causes of the dengue epidemic in this village were inadequate control of mosquito
larvae in the community, poor sanitation and environment, lack of knowledge, and
a poor health-care system. In recent years, public health authorities have emphasized
disease prevention and mosquito control through community efforts to reduce larval breeding
sources. Although this approach will probably be effective in the long run, it is unlikely
to have a beneficial impact on disease transmission in the near future. We must,
therefore, develop improved, proactive, laboratory-based surveillance systems that can
provide early warning of an impending dengue epidemic. At the very least, surveillance
results can alert the public to take action and physicians to diagnose and properly treat of
cases.


location: , 'Thailand year: 2001 source: HSRI

title: Oral health financing in universal coverage system in Thailand

abstract: The purposes of this study are to develop a fundamental budget system of oral care system in Thailand beneath universal overage system from the current  situation and then forecast the national oral care expenditure hen the insurance is extended full scheme. The public expenditure including welfare schemes and household expenditure were analyzed to perform the national expenditure. The two methods analyzing public oral care expenditure were presented. The first method was based on the 1996-1998 National Health Account. Another method was blowing up public oral care cost of the 6 provinces in budget year 2000 to be national level. These provinces started the Universal Coverage Scheme since April 1, 2001. The duration of this study was between June- November 2001. The important findings from the study could be divided in 6 areas:	1. Household expenditure for oral careOral care expenditure paid by the household was subject to the household income. The very low proportion of total household consumption though oral diseases are still very high prevalence among Thai people reflected the low level of utilization. Even oral care expenditure in 1996 was highest (about 26.5 Bath/person) but it was only 0.10 % of total household consumption. The 1998-2000 slightly decreasing trend (0.15, 0.13 and 0.11 %) in higher proportion than in 1996 whether the absolute expenditures in 1998-2000 were lower showed that Thai household utilized oral care as a necessary good. Even the 1997 economic crisis has effected Thai households but decreasing rate of oral care expenditure was lower and slower than overall consumption because of its necessity therefore the proportion suddenly increased in 1998 then very slightly decreased. Low level consumption may be caused of psychological cost and impression of its high cost of oral care. 	2. Public oral care utilization in six provincesIn fiscal year 2000, the average utilization rate and per capita frequency of the 6 provinces were 10.24 % and 0.16 visit/person, respectively. Notably, people in rural area such Yasothorn, Yala, Payao and Nakornsawan could access the public oral care better than in urban area such Prathumtani. In fiscal year 2001, overall the utilization rate and per capita frequency increased slightly (10.42 % and 0.17 visit, respectively). Sketchy consideration here is that other factors may affected access to oral care rather than sole dental personnel number. Public oral care provision is expected to play important role in early phase of the UCS even the productivity is limited. Average 0.17 visit of oral care utilized by a person of the six provinces in 2001 is an evidence of this situation. Therefore the provision should be productively improved as well as allowed the private sector serving the increasing demand.	3. Public oral care cost in six provincesIn fiscal year 2000, the average full cost of the hospitals was 280 Bath/visit or 413.61 Bath/recipient at utilization rate 10.24%. Among hospital size, number of dental personnel, number of recipient and number of visit, the cost variation mainly related to number of visit rather than other factors. Moreover, the number of visit did not solely varied to number of dental personnel. However, these evidences do not totally conform to general theory that the higher productivity makes the lower cost. This study could not gain type of oral care mostly provided in each hospital. Type of oral care may reflect severity of the disease and complication and directly reflected to oral care cost. Therefore it is not fair to compare the cost among hospitals when only crude utilization was gained.	4. Public and welfare oral care expenditureCalculation the 2000 national oral care expenditure of public sector and welfare schemes from the 6 provinces, two assumptions were needed. Accessibility of oral care of people in other 70 provinces of the country as well as the productivity and unit cost of oral care were assumed to be same as the 6 provinces. While the household spending was decreasing since 1998, the public and welfare expenditure increased instead. This trend reflected important role of the public policy on health insurance including oral care beneath economic stagnation. If the UCS really provides the accessibility beneath the 6-province contexts, the utilization will represent both public and private demand therefore the budget should cover both public and household expenditure which would be 59.50 Bath/person at 2000 price (the public expenditure was 42.35 Bath/person at 2000 price). But sole public facilities can not provide total oral care respond to people therefore private sector may be necessary for the provision towards efficiency. As previous oral care utilization was very low so every year adjustment for appropriate provision and budgeting is needed to serve incremental demand of society.	5. Oral care expenditureThe combination of oral care expenditure of public and welfare and householdout of pocket oral care expenditure performed national oral care expenditure. The oral care expenditure of public sector and welfare schemes was analyzed by 2 methods: to extract the expenditure from 1996 and 1998 National Health Account and to blow up from the 6 provinces. From 1996 to 1998, national oral care expenditure at 1994 price was increasing 0.17 % but only 0.01 % increasing of proportion to the Gross Domestic Product. While national health expenditure decreased 8.16 %, the oral care expenditure proportioned to the health expenditure therefore increased 0.15 % in 1998. Per capita expenditure at current price showed a different figure since national oral care expenditure decreased 1.81 % from 46.35 Bath/person in 1996 to be 50.70 Bath/person in 1998. Adjusting to be 1994 price, the per capita expenditure decreased from 43.04 Bath/person in 1996 to be 42.27 in 1998 or 1.81 % decreasing. Consideration sources of expenditure, household's direct payment was greater than public's both in absolute number and per capita. Notably, per capita household payment decreased 4.02 % from 1996 while the public expenditure increased 1.68 %. Blowing up from the 6 provinces, the per capita and absolute public expenditures were calculated then combined with household expenditure to be nation oral care expenditure. The per capita nation oral care expenditure in 2000 analyzed by this method was 64.43 Bath/person at 2000 price or 50.98 Bath/person at 1994 price.	6. Sensitivity analysis of oral care expenditureSince the UCS started in 2001 and may facilitate the access to public oralcare especially when the scheme allows public-private mixed provision to coverpopulation extensively. Therefore the expenditure may closely vary to the utilization.The sensitivity analysis was conducted to forecast the expenditure when theutilization rate changed and other factors were constant. At 2000 price, when theutilization rate were between 10.24-15.00 per 100 population, per capita nationaloral care expenditure were 64.43-84.12 Bath which were public expenditure 42.35-62.04 Bath. The expenditure would increase 4 Bath per person when the utilizationrate increasing was 1 %.Policy recommendations	There are two main areas should be intently done for oral health insurance system towards equity and efficiency :1) The information system embedded in routine working system to administer and self-monitor proper provision and financing are needed. At facilities based, the cost accounting and computerized utilization data are required to be accumulated the provincial or area information. Specific provincial data will be further used to finance the province particularly. Since oral services have various costs due to type of the care, the utilization data should demonstrate types of the care which not only provide the information of accessibility but also present qualitative aspect of the care and personnel's workload.2) To meet the equity purpose, adjusting the different schemes being close to be the same should be based on the oral health need rather than the social or work status. However the collective financing have to be based on the capacity to pay. Indeed, personal oral care seems to be only main part in oral health insurance and oral health promotion is apart considered. The inequity may explicitly exist since the care is based on the service system that tentatively avails for urban or municipal people rather than the rural. Community strengthening to participate in all dimensions (such as to direct, administer, monitor and regulate both provision the care and oral health promotion program in communities may be hopefully way for equity improvement. At least 3 expected consequences could be addressed here which are increasing accessibility to the care, the schemes would particularly respond each area and the oral health status improvement would be real and sustainable. Nevertheless, people will depend on professional care leading to the high cost problem but improper oral health.


location: , 'Thailand year: 2016 source: HSRI

title: Food and Beverages Advertising on Children’s Television Programs: a Loophole and Control Crisis

abstract: Television advertising is an effective medium for reaching young children and influencing their
food purchasing and intake. The objective of this study is to explore food and beverages advertising during children’s television programs.Methods: Records of children’s free television programs on channels 3, 5, 7 and 9 was the main data
collection method. Data was collected during March 24-April 7, 2014 on Monday-Friday at 03:00 p.m. to
08:00 p.m. and on Saturday-Sunday at 06:00 a.m. to 10:00 a.m. and 03:00 p.m. to 08:00 p.m. A total of 42
programs from top three programs that had the most food and drinks advertisement were selected into
this study. Unhealthy food and beverages advertisement was included in the analysis. Food advertisement was organized according to the food group classification from the Nutrient Profile. The study found that the majority of the advertising of food and drink is unhealthy food and drinks
advertisement. The most popular form of advertisement used by the food industry was using presenters
such as celebrity children and adults, athletes, and cartoon characters. Moreover, food and beverages industries used a loophole of regulations for advertising and did not comply with the law. Inappropriate forms and contents of the advertisement for children were observed. Considering the law enforcement, there is currently no comprehensive control of forms and contents of advertisement targeting on children. Therefore, government should seriously develop the law enforcement and should prepare including update regulations and guidelines to control forms and contents of unhealthy food and beverages advertising in order to protect the health of children and youth.


location: , 'Thailand year: 2008 source: HSRI

title: HIV Counseling System in the Antenatal Care Unit of the Pong District Health Network, Phayao Province

abstract: This research was conducted from October 2005 to September 2007 with the aim of
developing a counseling system and determining the efficiency of HIV counseling in preventing the
maternal transmission of HIV at the antenatal care unit in Pong District, Phayao Province. The first
step was undertaken in 2004, namely a situation analysis and result evaluation for planning. The
second step in 2005 developed the couple HIV counseling system, promoted project and personnel
preparation, and tried a one-stop health center approach. The third step in 2006 implemented
the system, while the fourth step in 2007 adjusted and further developed it. The device for
collecting data was evaluated, i.e. an awareness form for HIV counseling and gathering general data
for that purpose in the antenatal care unit. Analysis was by mean, percentage and standard
deviation. The result of the study showed that after counseling the mean awareness of the couples
was higher than before counseling and that success had been achieved in developing the couple
HIV counseling system in the health center of Pong District. Coverage was more 100 percent of
health centers and more than 80 percent of all such couples in 2007 in the antenatal unit; now all
health centers have a couple HIV counseling system. There was no instance of one mate infecting
another and in more than 80 percent of the pregnancies of an HIV-infected mother there was no
transmission of the virus to the child.


location: , 'Thailand year: 2007 source: HSRI

title: The Synthesis of Functions, Roles and Structure of the Ministry of Public Health as a Mechanism in the National Health Systems

abstract: This research was to study and propose functions, roles, and structure of
the Ministry of Public Health in the next decade as a mechanism of the National
Health System. The proposal was done by analysizing related documents and
research papers published in Thailand and other countries. Research methodology
also included individual and focus group interviews among those academicians
and involved partners in health. This study revealed rapid and tremendous
changes of global context re-defining health to cover physical, mental, social
and intellectual dimensions. Moreover a plenty of organizations and mechanism
related to health have emerged. The Ministry of Public Health that has
currently been responsible for health affairs of the country as the key stakeholder
is supposed to emphasize its functions and roles on collaborating and bridging
all the social sectors of the nation; it then systematically and apparently mobilizes
their resources and potential for health development.
Ten functions and roles of the Ministry of Public Health during 2007 -
2012 were proposed. 1) Play major role in formulating national health policy and
strategy. 2) Advocate knowledge generation and management. 3) Determine and
regulate health standard. 4) Build capacity of social sectors and people in health.
5) Enforce health and health-related law. 6) Superintend the control of diseases
and health hazards. 7) Superintend health care financing for people and specific
needy groups. 8) Secure and assure the integrity of health resources. 9) Implement
international health. 10) Mobilize the health-related royal initiation projects.
Therefore organizational structure of the Ministry during 2007 - 2016 would
be basically changed in comply with the aforementioned functions and roles. It
was proposed that all the health service facilities ranging from primary to tertiary
levels within the same services area would be reposed in the same authority
of command. It would also be legislatively adopted to be juristic body as a
state agency other than government agency or state enterprise but under the
supervision of the Ministry of Public Health. The status will also be applicable
to sub-specialty facilities. Meanwhile particular mechanism would be established
at the central level to coordinate those facilities in terms of policy and direction
of services as a whole.
To attain that goal, policy makers, high executives of the Ministry and
involved agencies must share policy commitment for changes. Then the establishment
of “The Bureau of Change Management for the Ministry of Public
Health” as an autonomous body under the supervision of the Ministry would
streamline and accomplish the organizational restructuring. The Bureau is supposed
to propose plan and phases of those undergoing change.


location: , 'Thailand year: 2023 source: HSRI

title: Effectiveness of COVID-19 Vaccine Three Doses in Mortality Reduction among COVID-19 Infected Elderly in Samut Prakan Province

abstract: This study retrospectively investigated the effectiveness of the vaccine in real-life situations. The objective focused on the reduction in deaths of elderly people infected with COVID-19 who received the complete 3-dose COVID-19 vaccine compared to those who did not. Data were collected from the electronic database of the Samut Prakan Provincial Health Office, linked to the Ministry of Public Health’s database on vaccination. Data were collected retrospectively from January 1, 2022 to March 31, 2022. Result: The study found that there were 5,891 COVID-19 elderly individuals resulting in 56 deaths. Of those 2,236 patients who received the complete 3-dose vaccine faced 5 deaths, while 3,655 who did not face 51 deaths; odds ratio of 0.16 (95% CI = 0.06-0.40) or an 84% reduction in mortality (p < 0.001). Conclusion: Elderly individuals who received the complete 3-dose vaccine had a reduced risk of mortality if contracted COVID-19 in real-life situations. Therefore, the results should be disseminated to encourage complete 3-dose COVID-19 vaccine in elderly individuals.


location: , 'Thailand year: 2015 source: HSRI

title: Following up of Stage 5 Chronic Kidney Disease Patients Managed with Non-dialytic Treatment

abstract: The first treatment option for end stage renal disease patients is dialysis. However, some patients
select non-dialysis treatment (NDT). Currently, data on clinical outcome of this treatment modality is
limited. Therefore, a retrospective cohort study was performed to evaluate clinical outcomes of chronic
kidney disease (CKD) stage 5 patients managed with NDT, including survival, factors affecting survival,
and hospitalization. The data was reviewed from the first date approaching to stage 5 (glomerular filtra-tion rate < 15 ml/min/ 1.73 m2) for at least 2 years, until death, or until the end of the study. A total of 72
patients who fulfilled the eligibility criteria were included to the study. The mean age was 65.4 years old.
The most common cause of CKD was diabetes mellitus (n = 35, 48.6%). The most common co-morbidity
was hypertension (n = 54, 38.6%). The most common reason for selecting NDT was lacking of a caregiver.
The median overall survival was 26.1 months. One-year and two-year survival rates were 80.0% and
59.0%, respectively. There were 307 occasions of unplanned visit, and 115 of these were related to renal
causes (37.5%). A total of 56 (77.8%) patients were hospitalized on 179 occasions. One hundred and two
(57.0%) of these were due to renal causes. This study demonstrates that the survival time of NDT patients
was approximately 2 years. There were high numbers of unplanned visits and hospitalization among
these patients. Therefore, NDT modality should be considered as a choice only for patients who are
contraindicated or not eligible for dialysis, or who would not be beneficial from dialysis.


location: , 'Thailand year: 2021 source: HSRI

title: Who Achieved 60 Kilometers in 60 Days of the First Thailand National Steps Challenge? A Cross-Sectional Study of Thai Adults

abstract: Thailand had implemented the first national steps challenge in 2020 by Ministry of Public Health with the goal to achieve the distance of walking and running at 60 kilometers in 60 days during 1 February to 31 March 2020. The challenge aimed to increase awareness on physical activity at country-wide level. This study aimed to determine the achievement of 60-km goal of Thailand steps challenge season 1. Website-based data of 203,910 records, of participants who sent distance data, was retrieved and analyzed by descriptive parameters and logistic regression. The achievement of accumulative distance of at least 60 km was analyzed by participants’ demographics such as sex, age, body mass index, region, urbanity, and type of participant. The findings revealed that around 46% of participants, who sent distance data, achieved the project goal. Men achieved the goal higher than women. Participants aged 30-59 years, not being obese, living in Bangkok, living in urban areas, and being public health officers, achieved the project goal higher than their counterparts. Being obese, living in rural areas, and being village health volunteers, were less likely to achieve the project goal (adjusted Odds ratio = 0.89, 0.83, 0.43 by multivariate analysis, respectively). The study recommended that the national steps challenge should be continuously implemented by using more strategies to engage participants with different characteristics throughout the project.


location: , 'Thailand year: 2000 source: HSRI

title: Development of alternative health systems to promote the health of middle-aged women : a situational analysis of folk and lay sector in Isaan

abstract: This qualitative study aims to explore a situation of health systems for middle-aged women especially about concepts, treatment modalities, perceptions, and success. The study sites were in both rural and urban areas of Khon Kaen province. Eighty five women age 40-59 and nineteen healers participated in this study. Data was collected by using participatory and nonparticipatory observation, interviewing, and focus group discussions during March-December 1999. Triangulation and content analysis were used for validation and analysis. Major findings were as follows. Humoral theory, religion, health information, and women’s life styles are guidelines for alternative health concepts of practice. There are 30 activities that are regarded as alternative health practices to promote the well-being of the middle-aged women. They were grouped into 4 categories and energetic therapies and exercise. The meaning of health given by women are included in the well-being of physical, mental, spiritual, and social life. The success of alternative health services is related to consumers’ beliefs, providers’ self-reliance, and community participation. It is suggested that highlighting alternative health systems by setting standards of services, and establishing networking between the community and the system is needed. Keywords: alternative health, middle-aged women, folk sector, lay sector, Isaan


location: , 'Thailand year: 2002 source: HSRI

title: Evidences of dental health service in private hospitals regarding the universal coverage of health care policy, in the selected province in Thailand

abstract: The objective of the research is to study evidences of Dental Health Service in private hospitals regarding the Universal Coverage of Health Care Policy, in the selected province in Thailand. The research has been started at June 2001. Research findings are as follow:	Preparing to participate in the Universal Coverage of Health Care, the managers of health service providers in private hospitals considerably study the policy in detail. Therefore, they can clarify their management goals, policies and strategies conforming to the policy of Universal Coverage. Generally, all health workers are trained and prepared for the new policy. Dental health practitioners, however, did not have as much information as other health practitioners. Some private hospitals even had never employed a full-time dentist according to the governmental criteria of basic essential health care service. New systems of data collection are designed conforming to the characteristics of works in private hospitals, which are different from the system that the Provincial Public Health Office need. Interestingly, since April 2001, it was the first time that a private hospital network has been established. Nevertheless, such network does not influence any decision making of each hospital to be the participant in the policy of the Universal Coverage of Health Care. In general, the reason that each private hospital becoming a part of such policy are the appreciation of the concepts and principles that based on the benefits of citizens, increasing health care accessibility with less expense, in other words, improve health at least cost. The budget managing system of the Universal Coverage provides a higher access for population than previous systems. It encourages consumers for a transparent accountability role, and provides more chance and authority for consumers to participate in deciding local health policy. In addition, the system provides a higher possibility to share resource utilization, which would decrease the nation cost of medical technology. It might be said that it is a rather disadvantage for health institutions that do not participate in the Universal Coverage policy since the beginning, for it could affected to the amount of consumers. Or, considering in a long term, there is a high tendency that finally the Universal Coverage of Health Care in the future will cover all private hospitals. Therefore, it would be wise to learn from problems of the procedure since the beginning. The faster the problems are learned the faster they could be solved and developed. Furthermore, the participation of private hospitals could influence other governmental hospitals to develop or reform their health service, which finally it is the advantage of consumers. Before the private hospitals participating in the Universal Coverage Project, the dental health management depended on the hospital managers, while dentist do not have any authority. There are various payment systems for dentist, i.e., a fixed-rate salary, a minimum rate guarantee, or the 50:50 sharing income. For some hospitals the dental health service should be developed regarding to the core package. One important point found in almost every hospital, except only one hospital, is that the health promotion and prevention in the community are ignored. After attending the Universal Coverage Policy, every hospital have re-arranged and developed their service and management. They have tried to contact and coordinate with government institutions, and find many problems in practical level about the communication and co-operating systems. Finally, many private hospitals decide to solve the problems by themselves. Therefore, the management systems tend to be centralized to the managers, in order to clarify the strategies and determine the method and approach for problems solving. Later, the authority has been distributed more to the head of each section. Each hospital considerably analyse and manage their income and expense. However, the information of financial system cannot be revealed. The dental health care service is relatively developed after entering the Universal Coverage of Health Care. For instance, hospitals pay considerably attention to dental health service to cover the core package. The working time planning for dental health service is extended further to overtime. Nevertheless, in some hospitals dental health service are controlled by the hospital managers. For example, the dental prosthetic service is limited for its high expense; each patient is limited to have only one dental health service each time; and the limitation of service time for health insurance consumers. In case of dental health care in communities, they merely assign nurses to screen oral health status in the school-children and finally refer to the hospital for further treatment. There are three types of health service networks among private hospitals: (1) the hospital that have their own primary care unit (PCU), in case of hospital that have small amount of catchment area without the primary health care institution, (2) the hospital that have PCU of their own together with another PCU in a primary health care institution, in case of private hospital that have a primary health care institution in the catchment area, (3) the hospitals that the catchment area cover a primary health care institution but they merely use it as a subcontractor rather than a PCU, and open their own PCU outside the hospital. At present there is a low possibility to extend health service network to private clinics, for there is not much catchment areas for each clinic. If a private clinic would like to be a subcontractor for a private hospital, it should received a reasonable payment. For example it should be more than 200 baht per head for at least 10,000 patients. However, the highest possibility would be that only severe cases are referred to private clinics. According to the interviewing of dental consumers from private hospitals, large amounts of the consumers appreciate with the core package and service from the health practitioners. Some of them, however, complaint that the core package is not enough and the queue for the next service is too long. The consumers’ need of health promotion and prevention are relatively ordinary; dental health education, oral health examination, mobile service, which is conforming to the planning of private hospitals. The research findings provide an important and interesting evidence of dental health and general health service in private hospitals. There are some further suggestions for the Universal Coverage of Health Care policy and practice in the future as follows: The understanding of participants are needed to be adapted conforming to the philosophy of the Universal Coverage of Health Care, in particular, the Health Insurance has a deeply meaning than a donated project for the poor. The understanding of public health practitioners regarding the difference between the concepts of health promotion and disease prevention need to be improved. In particular, the activities of dental health promotion should be more clarify. Whereas the efficiency of health promotion is the population capability of self-care, at present the primary care unit pays less attention to health promotion and prevention and work as the extended OPD instead. Therefore, in the future the roles of primary care unit should have been seriously considered. The development of community capacity should be developed. Moreover, there should be an encouragement for a consumer social network in order to examine the efficiency of hospitals. Regarding the Universal Coverage of Health Care, the health care budget will deliver directly to the hospital, thus, it is possible for consumers to estimate cost and assess local health service. In order to offer alternating to the consumers, the hospital should have an efficiency primary care unit, not merely work as an extended OPD. Particularly, the tertiary care hospital should clarify between the managing of primary and tertiary health care, otherwise the health care referral system would totally be demolished. Previous health care systems wrongly influence consumers to seek for the specialist health practitioners only thus health-seeking behaviour of the consumers should be improved. The separation of dental core package from general health core package has to be considerably concerned together with the studying of dental health cost-effective and types of dental treatment. Although it would help clarifying dental health planning, the most important point we should keep in mind is that, by separating dental core package it would possibly affect the concept of holistic approach. Thus, the question of a possibility to exclude dental health promotion and prevention from other works need to be seriously concerned. The health assessment institution should not merely finding faults and assessing, but suggesting and encouraging health institutions as well. Health expense must be carefully regulated, especially among the health providers. According to the research findings, the competition among health institutions could effect many in-appropriate health services. For instance the over expense of medical technologies and specialist employment. Consequently, the budget from the Universal Coverage of Health Care would be insufficient. At present none of private hospitals have data base of oral health status of their catchment area and lack of information about the important factors related to local oral health status. This would effect the health promotion and prevention assessment. Therefore, the data collection systems have to be re-arranged, and developed to achieve the efficiency of health care in the future.


location: , 'Thailand year: 2020 source: HSRI

title: Research and Development of Computerized Program to Prevent Therapeutic Duplicate Prescription in Mahasarakham Hospital

abstract: Background & Rationale: Duplicate medication is irrational drug use that can cause adverse drug events to patients and wasteful health expenditure. There have been a limited number of studies on duplicate prescribing in Thailand. The objective of this study was to develop a computer software to prevent therapeutic duplicate prescription and to determine its effects in Mahasarakham Hospital. Methodology: This research and development comprised three parts. Part 1 described characteristics and magnitudes of duplicate drug prescribing in the hospital using electronic database of 12 drug groups (39 drug items) during 1 October 2018 – 30 September 2019. Part 2 developed a computer software based on results of part 1 and implemented the software in November 2019. Part 3 examined effects of the software by comparing proportions of duplicate drug prescriptions during, before (November 2017 – April 2018) and after software implementation (November 2019 – April 2020). Results: Of total 218,179 prescriptions, 818 duplicates (0.37%) were found, of which 576 (0.26%) were duplicate medication at the same therapeutic groups and 242 (0.11%) at the same drug item. Moreover, 530 duplicates (0.24%) were detected in the same prescription and 288 duplicates (0.13%) detected in the same patient. The highest duplicate medication rate was found in the gastric secretion inhibitors group (378/36,495 prescriptions, 1.04%), followed by antihistamine (130/13,433 prescriptions, 0.97%) and NSAIDs (184/29,783 prescriptions, 0.62%). These duplicates costed around 19,740 – 79,591 baht/year. The software detected any duplicate medications prescribed in the same therapeutic drug, same patient and same day and alert prescribers/ pharmacists for clarification. After software implementation, the duplicate drug prescribing decreased significantly from 0.27% (266/100,367 prescriptions) to 0.08% (75/95,350 prescriptions) or a 70.3% reduction (OR 0.296, 95%CI: 0.226-0.384, p < 0.001). The excess healthcare cost declined by 4,098 – 18,360 baht/6 months or 8,196 – 36,720 baht/year. Conclusion: The developed computer software was effective in preventing duplicate prescription and reducing unnecessary healthcare cost. Future studies should determine duplicate drug prescription and prevention program at national level to support rational drug use and reduce healthcare cost in Thailand.


location: , 'Thailand year: 2008 source: HSRI

title: Lifestyle Modification in a Group at High Risk for DiabetesLifestyle Modification in a Group at High Risk for Diabetes

abstract: Accumulating evidence from randomized controlled trials have shown that diabetes mellitus can be
prevented or delayed in high-risk individuals by an intensive lifestyle modification program. However, to
be meaningful for clinical practice in the real world, the results need to be both widely generalizable and
the methods practical and affordable enough to implement in a wide variety of health-care settings. This
review described some aspects of the intensive lifestyle modification program in groups at high risk for
diabetes. Topics included epidemiologic evidence about the relationship between lifestyle factors and
diabetes risk, clinical outcomes and cost-effectiveness of the intensive lifestyle modification program, and
predicting factors for its success. Some details of the three example programs, including the Chinese Da
Qing IGT and Diabetes Study, the Finnish Diabetes Prevention Study (DPS), the US Diabetes Prevention
Program (DPP) and Look AHEAD Study, were described. The information provided could be utilized in
the development of practical lifestyle interventions for diabetes prevention in Thailand.


location: , 'Thailand year: 2014 source: HSRI

title: The Potential of Local Organization on disabled elderly care management in community

abstract: The action research was conducted to study the potential of local organizations on elderly care
management, especially for the disabled elderly in the community, and to assess their needs. The results
showed the potentials of local organizations on disabled elderly care management in 1) manpower: multidisciplinary
teams give care in community 2 ) money: there are budgets to support health promotion
activities, 3 ) materials: materials and equipments were distributed to the elderly and 4 ) management:
local organization provides peer-education programs, training for community leader and health volunteers,
communication assistance and also 24-hour mobile car for referral. Lack of trained elderly caregivers
and the cooperation of family members were the barriers on elderly care management. The elderly needs
a day-care center, trained caregivers, a suitable environment, increased welfare allowance, and 24-hour
hot-line service. Both government, private organizations and family members should therefore collaborate
on establishing an elderly care training, budget or material support, and a day-care center.


location: , 'Thailand year: 2004 source: HSRI

title: Community and Agro-Chemical use

abstract: This study of communities and the use of agricultural chemicals was conducted by gathering information through conversations with farmers engaged in production at the community level, with a particular focus on farmers who use agro-chemicals. This study presents the perspective of farmers using chemicals in community-level production systems.  Three types of production systems of three characteristics were studied: 1) the highland production system of the Hmong community of Khun Klong Village, Chomthong District, Chiang Mai Province, within Doi Inthanon National Park, 2) the intensive lowland commercial agricultural system of Ban Pong, Ban Kaad Sub-district, Mae Wang District, Chiang Mai Province, and 3) the fruit orchard production system of Huay Meng Village, Chiang Khong District, Chiang Rai Province.The study resulted in the following findings:The use of agricultural chemicals at the community level has reached a point of crisis. Chemicals are used under conditions of a total lack of control and oversight. In addition, because villagers primarily emphasize commercial production, the types of chemicals used by villagers are increasingly diverse and are being used in ever-greater quantities. This is due to market mechanisms that demand the use of designated chemicals from the first stages of production onwards.Two main factors have given rise to these changes in production, namely 1) entry into intensive commercial production systems directed by product standardization.  This leads to changes in villagers’ fundamental perceptions and life styles, including their production systems.  2) Political policies such as opium eradication on Doi Inthanon and the establishment of conservation forests that result in limitations on available land and necessitate the use of chemicals.In examining the effects of agricultural chemical use and the local response to the resulting changes, it was found that villagers are understand the impacts of chemical use from direct experience, and are well aware of the dangers that chemicals pose.  The farmers surveyed have responded to these changes in a similar pattern, however, continuing to use chemicals to attain designated production “standards.”  Although alternatives to the use of chemicals exist in each area, these alternatives remain in their infancy and have lacked serious consideration.  Government support for non-chemical alternatives has lacked continuity.  Because this study focuses on the perspectives of farmers engaged in the use of chemicals at the village level, the following recommendations target the local level, where chemical use occurs without real control.  A study of village-level chemical use should be used to create a Community Agro-Chemical Database covering all of Thailand.  The database would be available to communities in the case of chemical-related illness or environmental impacts.  The study should include the participation of farmers throughout, from the early planning stages to the testing of data collected from communities. Villagers should be given the support necessary to control and oversee the use of chemicals through a participatory forum, in consideration of the fact that each community has a different culture and production system.In creating production alternatives, planning should thoroughly cover both theory and practice in a tangible sense, rather than merely providing recommendations or trainings.  A wide variety of choices should be available for the reduction and disuse of agro-chemicals, which is the desire of the majority of the farmers.


location: , 'Thailand year: 2001 source: HSRI

title: Social innovation : definition and key features in Thailand

abstract: Social innovation: definition and key features in Thailand	This paper is based on the information obtained from related Thai documents, interviews and study visit.  Social innovation is defined as “Anything new whether in the form of ideas, imaginations, opportunities, or actions to solve problems or to make a better society. These new things include the improvement of or those based on existing things.”	Key features of social innovation include:Opening and enhancing space for wisdom and societyInitiated by individuals, organizations or communities to solve their own problems, not because of the external controlRaising public conscience for the benefit of the society as a whole preceding individual’s or group’s benefitHas dynamic development with prolong existence in which the form or pattern may change as a result of creativity, commitment and action	A review of five organizations supported social innovation in Thailand suggested that social innovators could be individuals, organizations or communities.  The supports obtained include project funding, personal allowance, academic assistance, forum or network building, and awards given.  The supports could be given at any stage of the innovation development i.e idea development, testing, implementation, expansion to a broader society.	Suggestions for the operation of the Social Innovation OfficeThe Social Innovation Office should emphasize support given to any new ideas, new methods, new strategies/models, and new opportunities including new existence or developed on what existed.Facilitate network building among related organizations to avoid duplication and to support each other.Fill in the gap of existing operation, built on current existence and integrate old and new operations including coordination with related agencies.Supports can be provided to individuals, organizations and communities focuses on those with the following five features: do not give up easily, have imagination and recreation, has public conscience, readiness to take action, ability to communicate with others.Potential activities for the office to provide the support include searching for social innovators (SIs), support SIs to develop new ideas, support SIs to implement or test the new ideas, and support expansion of the innovation to a wider society.  Support can be given in forms of financial support, technical support and network building.Three guiding principles of the office to consider when providing support are: (1) creating horizontal relationship between the office and SIs (2) working in a more proactive direction and (3) promoting enabling environment for innovative culture society.Exclude support of activities that are not social innovation including: already well-known ideas, activities or models, activities that are beneficial to individuals/groups, activities implemented on an ad hoc basis, top-down originated activities.


location: , 'Thailand year: 2019 source: HSRI

title: When, Why and What Factors of Initiating Breast Milk Substitutes in the First 6 Months

abstract: Exclusive breastfeeding is the most appropriate food for under-6-months old infants. However, some of them received infant formula during this first period of life. While previous studies focused on barriers to exclusive breastfeeding, this study examined when, why and what factors of initiation of breast milk substitutes (BMS) in the first 6 months. This study was quantitative research. Data were collected through a questionnaire from 1,147 mothers and caregivers of children under 3 years old at well-baby clinics in public and private hospitals. Characteristics of the sample, first exposure and reasons were presented using descriptive analysis. Factors of breast milk substitute initiation were analyzed by using binary logistic regression. The analysis used SPSS version 18. The study presented that most infants started breast milk substitutes in the first day after birth (24.1 percent), and in the first month, there was 44.5 percent of infants fed formula because mothers believed that “mothers’ breast milk was insufficient” and “mothers had to return to work or study”. The results of binary logistic regression illustrated that “education level of mothers” and “family-economic status” as well as “changing main caregivers” and “the negative attitude on breastfeeding” were associated with formula feeding before reaching 6 months.