location: , 'Thailand year: 2022 source: HSRI

title: Management of medical supplies for Coronavirus Disease 2019: Problems, obstacles and solutions for public and private sector procurement

abstract: The research on Medication Management for COVID-19 Infectious Diseases: Problems and Obstacles to Public, Private Sector Procurement and Solutions aimed to study the problems and obstacles in procurement of COVID-19 medicines, such as vaccines. ATK, Favipiravir by government agencies and the private sector in Thailand through comparing the processes and criteria for procurement of such pharmaceuticals abroad and to study the improvement of the government's vaccine policy and management and the role of the National Vaccine Institute in providing emergency vaccines or to enhance the public and the development of a prototype vaccine, and to obtain recommendations for improving the government's vaccine policy and management in accordance with the outbreak situation. The findings revealed that 1. The COVID-19 outbreak has greatly impacted the public health, social and economic systems around the world. The virus can mutate and spread to people of all ages. As a result, the number of infected people around the world continues to increase until the end of February 2022, with more than 440 million people infected worldwide and 6 million dead. Many governments, especially high-income countries, have partnered with leading medical companies around the world to develop vaccines to stop the epidemic. The aforementioned circumstances and conditions allow high-income countries to have access to vaccines and medical supplies before poor and developing countries. High-income countries are also home to vaccine and pharmaceutical companies such as the United States, the European Community and China, as well as Russia. These countries can reserve vaccines and pharmaceuticals, in particular, Vector vaccines of AstraZeneca and mRNA of Pfizer and J&J, with the exception of China and Russia that use vaccines tested and developed by their own domestic companies such as Sinovac, Sinopharm and Sputnik V vaccines. The World Health Organization has adopted a standard for vaccines that can be used in emergencies. The policy of most governments around the world is to provide vaccines as quickly and as possible for any cost. While vaccines on the global market are limited and becoming scarce. As a result, the manufacturing company becomes the authority to set the price itself. 2. Compared with the COVID-19 vaccine procurement process, the United States uses a vaccine reservation method by contributing budgets to AstraZeneca and Pfizer for trials, research and development of vaccines on the condition that: If the vaccine trial is unsuccessful, a refund is not required. Most high-income countries similar to the United States, such as Canada, can reserve vaccines at nearly five times the population of the country. Singapore is undisputed by procurement laws and is able to pre-order vaccines in large quantities and quickly, even though they are not endorsed by the Health Science Authority. The Philippines is in a similar context to Thailand because there are restrictions under procurement laws and cannot pay upfront to reserve vaccines, unless the president exercises his or her authority to approve or “unlock” from such legal restrictions. Furthermore, the participation of the private sector and local governments in vaccine procurement and distribution makes it possible to procure vaccines faster than in Thailand. In the case of Thailand, it was found that in the first phase of the epidemic, the government was unable to provide vaccine procurement easily because of the limitations of the Government Procurement and Supplies Administration Act, B.E. 2560, which was not conducive and a lack of clarity in practice. The relevant government agencies were unable to immediately purchase vaccines and medical supplies. 3. As COVID-19 is an emerging disease that still lacks knowledge as well as around the world, problems and obstacles in the procurement of vaccines and medicines in Thailand result from laws being designed to operate under normal circumstances. For example, the Government Procurement and Supplies Administration Act B.E. 2560 (2017). It is a limitation that governments and relevant agencies at the operational level cannot procure vaccines and medical supplies in a timely manner. The essence of the said law does not allow the purchase of unstocked items and the result is not guaranteed, and the exact delivery date of the vaccine must be specified. Even after The Comptroller General's Department, Office of the Ombudsman, and the NACC, as well as the Office of the Council of State have discussed guidelines for government agencies responsible for purchasing vaccines and medical supplies. It is adhering to the guidelines for the Government Procurement and Procurement Management Committee's letter, No. Kor Khor (Kor.Wor.Jor.) 0405.2/Wor 115 dated 27 March 2020 for greater flexibility and agility in operations. Suggestions 1) The government should amend the Government Procurement and Supplies Administration Act, B.E. 2560 (2017) to be more flexible. It may adjust from the material matter according to the letter of the Committee on for the Government Procurement and Procurement Management Committee's letter, No. Kor Khor (Kor.Wor.Jor.) 0405.2/Wor 115 dated 27 March 2020 to be any section or additional specific section to increase flexibility for the staff working and create transparency and accountability. 2) Adaptation of medical and public health organizations to respond to emergencies Organizations and relevant agencies should manage knowledge (KM) through lessons and experiences from this COVID-19 crisis for adaptation to support emerging diseases in the future. 3) The government should prioritize on the National Vaccine Institute as a research and development agency and to coordinate and seek cooperation with agencies, international organizations to ensure Thailand's vaccine security to have enough potential to develop a prototype vaccine for use in case of emerging disease in the future. 4) The government should address the crisis when emerging medical diseases still lack knowledge, prevention and treatment methods by basing the safety and benefits of the people as the base of "educating academics leading to politics" and enhance transparency and confidence among the people through the concept of Open data, Open Government.


location: , 'Thailand year: 2022 source: HSRI

title: Total Solution for Early Screening of Chronic Kidney Disease using Albuminuria Test Kits in Primary Care

abstract: Chronic kidney disease is one of a major health problem both nationally and globally due to the tendency of the patient has been increased annually. At an early stage of chronic kidney disease, the patient has no symptom, but the diagnosis is possible by analyze an amount of microalbumin in urine and combine with serum creatinine. However, this process is allowed at the hospital only. To enable an effective and extensive access for a high-risk of chronic kidney disease population, this project focuses on using a urine microalbumin screening test kit for screening the chronic kidney disease at an early stage and including data storage in an online database for easily follow up and proper treatment planning. From the screening of a high-risk of chronic kidney disease population and asymptomatic at Ban Phaeo District in Samut Sakhon province, the 595 volunteers or 25.72% out of the 2,313 volunteers in total was suspected of chronic kidney disease. After 3 months follow-up, 178 patients (out of 260 volunteers) still had renal dysfunction that met the criteria for diagnosis of chronic kidney disease. The estimated prevalence of chronic kidney disease was 17.5%, which is similar to the prevalence in a general population from the Thai-SEEK project. The urine microalbumin screening test kit provides 96% accuracy, 86% sensitivity, and 98% specificity that indicated an efficient, highly accurate, convenient to use, and the results can be read rapidly. It can be used outside the laboratory which enable to reach high-risk populations. Moreover, it also possesses the potential for further commercial use.


location: , 'Thailand year: 2018 source: HSRI

title: Options for Urban Health Services System Development in Thailand: A Case Study of Health Region 3

abstract: This qualitative study aimed to propose options to develop urban health services system in Health Region 3. The study’s scope involved only primary care systems in urban areas of Nakhon Sawan and Kamphaeng Phet provinces. Literature review, case studies, in-depth interviews, and focus group discussions were administered to collect the data, which focused on 260 participant’s recommendations and collaborative decision-making. The data were analyzed by thematic and content analysis. The Social Medicine Departments of the Regional and Provincial Hospitals were the major organizations responsible for management of primary care services delivery in urban areas. Though public, private, and local government sectors also provided these services. However, under the primary care cluster policy, primary care service planning was done mainly by those under the management of the Ministry of Public Health (MOPH). At present, despite the improvement of curative service quality, it cannot cover all areas nor create a sense of ownership for those in other sectors. The major challenge both at present and in the future is the increasing service demand due to the increase in the number of aging population and patients with non-communicable diseases. Also, there is a problem of not being able to use the budget to effectively promote health and disease prevention because of incomprehensible understanding between the service units and the Office of the Auditor General and the lack of policy communication focused on the development of urban health services. The result showed that there could be three major options for urban health services system development: (1) Management through single leadership of the MOPH (the current model), (2) Management by collaboration between sectors through District Health Board (DHB), and (3) Management through transfer of health mission to the local government. The assessment of the options showed that the current model may not be able to respond to the challenge effectively. The ideal option proposed by the key informants is management through the transfer of health mission to the local government, mainly because they are close to the people and can understand the context of the area well, and encourage the people to take responsibility for their health effectively. However, limitations were identified as: the unclear government policy to transfer health services mission from the MOPH to the local government; the lack of local administration and personnel capacity to manage health services; and the leadership of local government executives. The present study proposes that a model of collaboration between sectors through DHB is the best option to move forward. This option can encourage all sectors to become involved in the development of the primary care system in an urban setting. It can encourage all related sectors, including the people, to have a better understanding of the roles and responsibilities of each sector and lead to better self-management of the people in the future.


location: , 'Thailand year: 2022 source: HSRI

title: Inequity by the Universal Coverage Cube: Findings from the 2020 Household Socio-Economic Survey

abstract: Thailand could achieve the goals of the universal health coverage (UHC). But there are some remaining challenges on inequities in cost protection and quality of services. This study endeavored to report the country’s inequity situation in terms of coverages of population, cost, and services. Using the 2020 Household Socio-Economic Survey, the analysis covered disparities across health insurance schemes, household wealth quintile, sex, age group, region, and urban/rural area. The results show that the highest inequity was among different health insurance schemes of the UHC system. Therefore, it is essential to implement national health reform to solve the disparity issues by integration of the health insurance schemes.


location: , 'Thailand year: 2004 source: HSRI

title: Factors influencing health promoting behavior and health utilization behavior among people under the universal coverage project

abstract: The purposes of this descriptive research were to study factors influencing health
promoting behavior and health utilization behavior among people under the universal coverage
project in the southern region. The sample comprised of 1200 people who were drawn by
multistage sampling technique from suratthani, pang-nga, trang and yala province respectively.
The instruments consisted of indepth-interview form, focus group form and questionnaire which
were passed the quality examination by the expert and field try out. The reliability of
questionnaires were 0.69-0.91. The qualitative data was analyzed by content analysis, the
quantitative data were analyzed by descriptive statistics, Multiple regression analysis, Multiple
logistic analysis, ANOVA and Chi-square test. The results were as follows:
1. Health promoting behavior among people under the universal coverage project was
fair level.
2. Health utilization behavior, most of the sample used health center and general
hospital. Folk medicine was not popular for the sample.
3. Factors related to health promotion behavior were age, health value, quality of care,
self efficacy and social support. The variance explanation of all factors was 32.9
4. Factors related to health utilization behavior were sex, education, type of insurance
,health need, perceived of right of universal coverage, perceived of right of government official .
health information, health need, quality of care and health service accessibility.
5. The comparison of health promoting behavior revealed that the sample of
government official group had more health promoting behavior than universal coverage group
and social security group. 6. The comparison of health utilization behavior revealed that the sample of universal
coverage group had more used health service at health center and community hospital than
government official group and social security group. The sample of government officer /private
corporation group had more used health service at general hospital than the sample of social
security and universal coverage group.


location: , 'Thailand year: 2018 source: HSRI

title: Preparedness of Participatory Community’s health impact assessment from development project locating in borderlands: a case study of Hongsa Coal project in Nan province

abstract: This research has been initiated and emerged from the results of baseline assessment conducted, towards “the trans-border risks with impacts to health and environment” of the mega project carried out, in case of the Hong Sa power plant. The research methodologies comprises two main components, as: (i) the first – the research for development of self-monitoring system through the Community Health Impact Assessment (CHIA) as a tool; (ii) the second – the review of laws and policies of Thailand and of Laos PDR in aspects of supervision and management of trans-border impact (pollution); and (iii) the recommendations made. It could be summarized with finding as follows. The research team also identified that the most serious concern of villagers was the impacts incurred to their cash crops, as the agricultural products might be damaged and declined and causing of the economic loss, since they would be principal incomes gained for their necessities. The second serious concern of villagers was the health impacts incurred from the contamination of poisonous substances and pollutions accumulated in soils, water and air including food crops, e.g. rice and vegetable. These would cause the chronic and emerging sicknesses and diseases with harm induced in the long run. And although the majority of villagers were entitled to the healthcare schemes with social security and with accessibility to sub-district healthcare services centers and hospitals nearby the villages, but these were only for the basic and primary healthcare services provided with first aids or emergency incidents. Thus, the making of risk map of communities, it would be the vital work with further backing-up and supportive needs and such map would cover aspects of environment and health, especially towards the abnormality with agricultural productivity; the vulnerable groups with health problems and those with respiratory system and blood vessels, including those with pregnancy and maternity (mother and infant) whom might be more sensitive than people in general for the design of impact monitoring system toward the community furthermore. And this was relating to multi-sector entities and it deems expedient to cooperate among the government agencies and people. The agencies shall take part with information received and sharing for finding solutions are: those in charge with agriculture, health, irrigation and local administration, as this would be necessary for having more and wide cooperation with all sectors.


location: , 'Thailand year: 2022 source: HSRI

title: Lessons Learnt from the Prince Mahidol Award Conference 2021 from the Rapporteurs’ Perspectives

abstract: Prince Mahidol Award Conference (PMAC) is a well-known international conference organized annually by the Prince Mahidol Award Foundation and the Royal Thai Government with collaboration from multiple partners to share experiences focusing on policy-related public health issues among the global community. Due to COVID-19 pandemic, the PMAC 2021 under the theme “COVID-19: Advancing towards an Equitable and Healthy World” was held virtually with significant changes made to its program and management. The rapporteur system, a main component of the program conference synthesis, was also adjusted to fit with an online platform. This paper aimed to draw lessons learnt from the PMAC 2021 by the viewpoint of the rapporteur team, including lead rapporteur, rapporteur coordinator, and session rapporteur, covering three main points; (i) the structure of rapporteur team, (ii) the process of work, and (iii) the output of the rapporteur system. This paper provides useful ideas to any organization that organizes an international conference requiring accurate and comprehensive conference synthesis.


location: , 'Thailand year: 2011 source: HSRI

title: The Political Process of Public Health Decentralization in Thailand: studying the Case of Primary Care Units

abstract: This project is a study of political process, both at the central and the local levels, in the evolution of the primary health care units from the Ministry of Public Health to the local administrative organizations. The result demonstrates irreconcilable visions on decentralization between the central and the local administrations. The central administration, in this case the Ministry of Public Health, proves reluctant to transfer its authority to the local administration, while the local administration grasps the new opportunities from the public health management. For the local administrative organizations, the health care management can be a valuable means to respond to the citizen’s needs which will significantly lead to secure the votes for the next elections. The health care service, thus, empowers the local administration although it apparently became an interest seeking for some local politicians.
In the process of public health evolution, obstruction and difficulties are found both at the central and the local levels. At the central administration, some difficulties are indicated as follows. (1) Although the decentralization process had been completed by the legal statement and organization structure, policies following the law were not implemented, thus, showing the failure of law enforcement even by the government agencies themselves. (2)  The central administration emphasizes more on the expertise and profession than the decentralization doctrines do. The Ministry of Public Health has long been recognized for its capability to keep the professional standard, therefore, the officers do not see the necessity of decentralization. (3) The decentralization process that is engendered at the central administration gives rise to a deadlock. That is because it is fundamentally impossible for the power holders, particularly at the central administration, to relinquish their power to the others.
	From the 5 case studies at the local administration, the difficulties are evinced as follows. (1) The local administrative organizations lacks of autonomy. (2) The local administrations are facing politicians’ corruption which in return had become liability for decentralization although there are only some cases of corruptions. (3) The local administrative officers and elected officers do not have skill and knowledge in the public health care.

	However, this study discovers the distinguished dynamics at the local administration amid all those difficulties. Firstly, the way the local administrative organizations solve the particular issues at their localities is remarkable as this will lead to innovative governance. Secondly, the electoral politics makes accountability possible since the voters’ satisfaction became the focus of political power. Thirdly, despite some corruption cases, the local administrations are exposed to the challenge from the opponents and the civic groups alike. Eventually, all these dynamics will bring about better service providing by the local administrative organizations in the long term.


location: , 'Thailand year: 2018 source: HSRI

title: Retailer Factors Related to Tobacco Sale to Minors in Health Region 2

abstract: Youth smoking remains to be a major public health problem of Thailand that partly as a result of a law violation of tobacco retailer in the sale of cigarettes to youth or minors. This research aimed to explore associated and predicting factors of retailer related to tobacco sale to minors in Health Region 2. Independent variables were based on previous systematic review and qualitative research. This study gathered data through questionnaires asking opinions of a sample of 658 tobacco retailers taken through a multi stage sampling in Health Region 2. Data were analyzed by using descriptive statistics, chi-square and multiple logistic regression analysis. The findings revealed 58.7 percent of tobacco sale to minors. The associated and predicting factors of tobacco sale to minors included duration of performing the retailer occupation (ORAdj=2.099), motivation about revenues from tobacco sales. (ORAdj=2.620), defined a youth differed from the law (ORAdj=1.993), conforming to social norms regarding the sale tobacco to minors (ORAdj=2.955), selling individual cigarettes or small packages (ORAdj=11.504), selling tobacco by self-service (ORAdj=3.825), facilitating customers to buy and smoke cigarette (ORAdj=2.392), and not asking buyer age before selling tobacco (ORAdj=1.734). The independent variables have a predictive value of 67.2 percent of the variance (Pseudo R2 = 0.672) in the behavior of selling tobacco to minors. These findings suggested that government agencies involved should strictly enforce the law in particular the ban on selling individual cigarettes or small packages and selling tobacco by self-service, together with enhancing retailer understanding on the content of tobacco control law.


location: , 'Thailand year: 2015 source: HSRI

title: Situation and Causes of Ambulance Crash in Thailand

abstract: The emergency medical personnel in Thailand are always challenged by the task difficulty in working
with limited resources and spaces, as well as the high risk of encountering traffic accidents. This study
aims to elaborate situation and analyze the causes and factors of the ambulance crash in Thailand.
This was a retrospective analysis of all fatal ambulance crash on Thailand public roadways in 2014, from the secondary data in three main sources, including the database of Information Technology for
Emergency Medical System (ITEMS), the records of surveillance ambulance accident of EMS from
January to December 2014, and the report of ambulance accident investigation collected from the local
network in 2014, using the Haddon’s matrix approach. The study was conducted from January to March
2015. The results are presented using descriptive statistics
According to the ambulance accident surveillance data, 61 ambulance accidents occurred in 2014,
resulting in 130 injured victims and 19 deaths. The accidents happended more frequently during June to
August (25 times). The accident rate was 0.05 with the mortality rate of 0.02 per 1,000 operations. From the
nine accident investigation reports, factors related to accident and safeness of the ambulance could be
concluded into human factors, vehicle and equipment factors, and road environment factors. Human
factors included lack of ambulance driving training, unfastened seat belts, and high speed driving exceeding
90 km/hr. Unregistered ambulance and missing GPS installation contributed to the lack of vehicle
standard. The disparity in each local road environment such as speed curve, crowded site, and missing
directive signs led to higher risk of accident.
This study found that ambulance accidents was increased, resulting in an increasing of injury and
death in emergency medical personnel. The causes of ambulance accidents and risk from the above three
factors were still prevalent. Therefore, it is necessary for the related organizations to implement new policies
and take actions towards preventing future ambulance accidents.


location: , 'Thailand year: 2003 source: HSRI

title: The development of people sector's guidelines & method of assessment on the health impact from govermment's large investment &development and policy : Case-study of assessment on health impact from the Pak Moon Dam Hydroelectric Power Plant Project

abstract: The objective of this study which was on “The Development of People Sector’s Guidelines & Method of Assessment on the Health Impact from Government’s Large Investment & Development and Policy: Case-study of Assessment on Health Impact from the Pak Moon Dam Hydroelectric Power Plant Project” was to study about the impact on the health of the communities lying along the bank of the Moon River that had been affected by the Pak Moon Dam Hydroelectric Power Plant Project. The data was analyzed and used for the health impact assessment. In this study, the health impact assessment frame was used to build up a public policy on health. Four communities i.e. Ban Hua Weh, Ban Tha Phae and Ban Wang Sabaeng Tai of Khong Jiam district, and Ban Nong Pho of Phibun Mangsahan, Ubon Ratchathani province were selected as sites of the study. The criteria for community-selection were: (1) Location of community: dam-downstream community, headwork community and dam-upstream community, (2) Nature of impacts: community that lost fishing profession only; transferred community that lost both occupational land and fishing profession. Findings of the study: The villagers defined good health as, “a happy living”. By villagers’ definition, 5 factors that determined health were: (1) Natural resource stability, (2) Food stability, (3) Economic stability, (4) Environmental stability, and (5) Social stability. The study discovered that Pak Moon Dam was an important factor for the change of the factor that determined health. This was because natural resources which were the base of some portion of villagers’ production had been destroyed and become deteriorated by the construction of the dam. As a result, the villagers lost food stability, economic stability, Social culture stability  and life happiness. But, when a trial was made for the lifting of the Pak Moon Dam water-gate, the factors that determined all aspects of villagers’ health rapidly returned. However, the condition was not as good as when the dam was not yet constructed. As a result of the trial, health, by villagers’ definition, became better than when the water - gate was closed.The study on the assessment of health impacts from Pak Moon Dam hydroelectric power plant found out that the Pak Moon Dam construction had impacts on physical, mental, social and spiritual health of the villagers. Regarding physical health, some sicknesses related to itchiness, respiratory system and stress occurred to the villagers. But during the water-gate lifting period, some sicknesses i.e. itchiness started to disappear. This was because the water from the Moon River had been drained to the Mae Khong River. Besides, concerning physical health, there were some other sicknesses which were of villagers’ concern such as AIDS, diabetes, liver-related sicknesses, stomach-related sicknesses, etc. Regarding mental health, it was found out that the dam construction was a factor for the villagers’ stressfulness. The villagers became worried about livelihood. They were stressed with neighbors & relatives who disagreed with the dam construction. Conflicts occurred within family, community and the public. Due to water-gate lifting, the mental condition of the villagers became, to certain extent, more relaxed. The villagers were able to catch more fish than when the dam was closed. However, they felt not secure yet for investment on fishing or agriculture because they were not sure of the dam-opening period.Regarding social health, it was found out that dam construction was a factor of change. It decreased relationships among family-members because family members had migrated to work outside communities; joint activities decreased. Communities were in a situation where people just lived for themselves because they had to struggle for their own livelihood. As a result, sharing & caring for one another decreased; cooperation in development activities also decreased. Ideas, belief and wisdom on Moon River became less important. But, during the period of water-gate lifting for water to flow, a clear change occurred i.e. communities started to practice Moon River-related activities i.e. “Boon Nao Kaeng” and “Sao Luang Mong” festivals; families & communities together went for fishing.Regarding health in the spiritual aspect, it was found out that the dam was a factor for the change in the way of life that used to be favorable to the spiritual health of the Pak Moon villagers. They became lack of a way of life that relied on nature. Cultural diversity decreased. Generosity, caring and sharing with one another decreased. Good relationships within family and community became lacking. Transference of wisdom from parents to children became lacking. Areas for communal use such as temples and islets in Moon River became lacking. Communal activities such as religious festivals, recreation, community development became lacking. And, serene, peaceful and happy life became lacking. Consequentially, with regard to spiritual health, individuals, families, communities and the public were living in a state of craving. They were shaken & worried amidst conflicts. They did not have peace and live unhappily.This study revealed that the dam was an important factor for a change in the health aspect which represented the villagers’ and communities’ way of life. Therefore, before, during and after implementation, development projects of different aspects need to assess their impacts on health. It is necessary to have a holistic concept and view on health and to foster environmental and social relationships.


location: , 'Thailand year: 2022 source: HSRI

title: The Integration of GIS into a Health Information System for Policy Development and Management of Migrant Health: A Case Study During COVID-19 Pandemic Situation in the 6th Health Region of Thailand

abstract: This project developed the database system for health service management and health status of migrant workers in Health region number 6th of Thailand. The database was developed from public health folder of 43 health databases from the Ministry of Public Health's health information system. The result presents the information through a dashboard which can be accessed through a web browser (http://www.r6-health.info). The display consists of 5 main categories; site of health care center, time to access to health care center, demographics of migrant workers, spatial data of disease distribution, and data of COVID-19. Dashboard is friendly to user and easily for understanding. Example, a case study of COVID-19 situation, found that the prevention measures implemented by the Ministry of Public Health were able to control the outbreak of COVID-19 in the first and second wave of outbreaks. In addition, the developed database may use to show the location of medical facilities and distance to hospital which can be used for further planning of health services. There are still problems on data input to the system. Ministry of Public Health should pay attention on data input process to improve the accuracy of the dashboard.


location: , 'Thailand year: 2023 source: HSRI

title: Impact of COVID-19 Pandemic and Occupational Therapy Telehealth in the “New Normal” Situation

abstract: This mixed-method study aimed to investigate the impacts of the coronavirus pandemic on occupational therapy (OT) services in Thailand and to explore the feasibility of adapting international service models into the Thai context from OT’s perspective. One hundred fifty-three occupational therapists were asked to complete the questionnaires, and 45 OTs were invited to participate in focus group discussions. The lockdown measures and the increasing number of COVID-19 patients in Thailand meant that rehabilitation services were classified as non-urgent. Many patients endured irregular service for an extended period affecting their recovery and performance. Three types of OT services were developed to deliver services in the “new normal” situation: on-site; telehealth; and hybrid. OTs redesigned the services according to patient demand and need: orofacial motor skill training; outcome measurement and follow up; home program counseling; screening and history taking; functional assessment and telephonic monitoring; Line application; material or equipment delivery to home; social skills group training as a hybrid service; and educational video production. OT telehealth remains a challenge for efficiency implementation. Policy recommendations include developing clinical practice guidelines for efficacious and cost-effective OT telehealth services. Upskilling and reskilling training courses should be available to occupation therapist. The government should provide telecommunication infrastructure for equal access to OT services to all who need.


location: , 'Thailand year: 2000 source: HSRI

title: HIV infection and AIDS in Thailand

abstract: HIV  Infection  and  AIDS  in  ThailandThe Acquired Immune-deficiency Syndrome(AIDS) was recognized in 1991 when a cluster of pneumocystis carinii pneumonia was reported in the United States. Disease surveillance systems were sets up in several countries including Thailand so that the first case in Thailand was reported in 1994. Because the epidemic was confined to special groups ie. Homosexual men, injecting drug users, and commercial sex workers during the first year, health authorities misunderstood that AIDS was disease of the foreigners and interventions for the Thais were not necessary. Control measures started in late 1980's, from Veneral Disease (STD) division using epidemiological data to propose justified control measures. The AIDS Division was extablished in 1990 to coordinate national activities. During the 1990's, the epidemic expanded to general population through heterosexual people especially those who visited commercial sex establishments and through casual sex later. The median infection rates among women attending ante-natal care (ANC) clinics and 21 year old Thai men were 1.5 The essential control measure now is to reduce risk per act among sex and drug related population through condom promotion and needle exchange with bleach supply. Long term goal is to promote and maintain safe behaviors which will enable individuals, families, and society to protect themselves and their society. Biomedical, epidemiological, and social research studies allow as to understand patterns and determinants of the epidemic that there had been two distinct  epidemics among sex and drug acquired populations. Studies also allow us to learn the difference of normal ranges of CD4 between Thai and Caucasian people. More studies are in great need for rapid and effective control measures.


location: , 'Thailand year: 2011 source: HSRI

title: Forecasted expenditure due to the use of expensive drugs in Civil Servant Medical Benefit Scheme: a comparison with Universal Health Coverage Scheme

abstract: Therapeutic drugs, a major component of outpatient care have made the utilization pattern in the
Civil Servant Medical Benefit Scheme (CSMBS) different from the Universal Health Coverage Scheme
(UCS). This study analyzed a time-series of 57 months during 2003-2007 for drug prescriptions in 6 Regional
Hospitals and General Hospitals and forecast the overall expenditure. Four therapeutic classes
with high expenditure or frequent use, including angiotensin-converting enzyme inhibitors (ACEI) and
angiotensin-2 receptor blockers (ARB); antilipids; proton pump inhibitors (PPI) and histamine-2 receptor
antagonists (H2RA); and non-steroidal anti-inflammatory drugs (NSAID) plus COX-2 inhibitor were analyzed
with respect to two expenditure components; (1) propensity to use the target drugs, which are not
covered by the National Lists of Essential Medicines or are the single-source products, and (2) the utilization
quantity. Results from the expenditure forecast before and after the CSMBS’ direct billing policy and
the UCS’ 30-Baht copay abolition policy using a segmented regression analysis revealed that the use of the
following target drugs, including ARB, non-essential antilipids, single-source PPI and COX-2 inhibitor
was associated with the total and expenditures growth of the four classes. The close-end method of provider
payment currently employed by the UCS, if applied to the CSMBS would be able to reduce 40
percent of the expenditures for PPI-H2RA and NSAID-COX-2 inhibitor to 100 percent of the expenditure
for antilipids. For the substitution measure, the degree of cost-saving would depend largely on the policy
compliance levels. With the 20 percent compliance, 8 percent of the expenditures for PPI-H2RA and NSAIDCOX-
2 inhibitor and 20 percent for antilipids could be saved. With the 80 percent compliance, the costsaving
would range from 30 percent to 80 percent.


location: , 'Thailand year: 2009 source: HSRI

title: The Survey on opinions and popularity of a documentary program "Design for Life"

abstract: “Design for Life” is a documentary program about the health system in Thai society produced by Health Systems Research Institute (HSRI). This program of 47 episodes in total was broadcast every Friday, 11.30 am to 12.00 pm on Thai PBS.  Some of the audiences requested additional information as well as commented on the content and the production of the program. This research aims at surveying the opinions and popularity of the program so as to improve the production in the next phase.
	This study used 3 methodologies as follows: 1) a telephone survey of the program’s popularity conducted with 400 samples in all regions 2) a questionnaire survey for the audiences’ comments and suggestions conducted with 40 samples, representing 80 percent of the audiences who have given feedback to the program 3) a focus group discussion to check the audiences’ comprehension of the program content conducted with four groups of seven samples.
	The popularity survey indicates that eight percent of the samples know this program. The number of subjects who have known and seen this program is only three percent, mostly females, married with children, holding Bachelor’s Degrees, aged over 50 years, business owners, with 5,000 – 15,000 baht per month income. They have accessed to television and it is convenient to watch the program at home. Most of the audiences know the program by chance and they do not watch the program regularly. Their watching behaviors to one episode are discontinuous. They also switch to other programs back and forth. They also do not know the sponsor of the program.
	The samples think that the program gives more knowledge and creates health awareness, provides health information and leads to health behavior changes. The program is interesting, reliable and relates to the audiences. The documentary format is appropriate but the television station, broadcasting time and the length of the program are inconvenient for broad audiences to watch.


location: , 'Thailand year: 2021 source: HSRI

title: Policy Analysis and Policy Design for the Transfer of Subdistrict Health Promotion Hospitals to Provincial Administrative Organizations (PAOs)

abstract: Despite the adoption of the 1999 decentralization legislation, Thailand has made limited progress in devolving public service functions to local government. Primary care in particular remains largely centralized. However, upon the end of the current operational plan on decentralization, it is required that ownership and management of the subdistrict health promotion hospitals must be transferred to provincial administrative organizations. To help inform government officials and policymakers in Thailand on how to expedite the decentralization process and ensure the smooth transfer of the primary care services to local government authority, this research has three primary objectives. First, it seeks to analyze the management system and performance of subdistrict health promotion hospitals that have already been devolved to municipalities and subdistrict administrative organizations. Second, future scenarios for the transfer of primary care functions to provincial administrative organizations are formulated, using a double-variable scenario method. Third, based on findings from the first and second objectives, policy recommendations are presented. Qualitative and quantitative techniques were used to analyze data that were collected from multiple sources, including documentary review, a citizen perception survey, a survey of subdistrict health promotion hospital personnel, interviews with 27 key policymakers and subdistrict health promotion hospital directors, and focus group discussions with 58 officials from provincial administrative organizations and citizen representatives. In total, 6,304 citizens responded to the survey. Personnel from 70 subdistrict health promotion hospitals that have already been devolved to municipalities and subdistrict health promotion hospitals participated in the survey. This research finds that although small in number, the subdistrict health promotion hospitals that have successfully been transferred from the public health ministry to local administrative organizations have shown significant progress in primary care quality. Intermediate health outcomes—particularly citizens’ behavioral changes in physical activity and eating habit—in the decentralized areas continue to improve, while citizens harbor more positive attitudes towards the devolved subdistrict health promotion hospitals than those not devolved to local administrative organizations. However, there are mounting concerns among local government officials about personnel recruitment and retention, as well as continuity of the intergovernmental grants. Based on the future scenario analysis, a desirable scenario depicts a devolved primary care system in which the provincial administrative organizations have adequate management capacity, while the central government agencies proactively provide technical advice and effectively perform their regulatory function. The major policy recommendations for the relevant government agencies include: 1) accelerate the transfer of subdistrict health promotion hospitals to the provincial administrative organizations; 2) establish citizens’ consultative councils at the provincial, district, and hospital levels to facilitate citizen engagement in local health policy making; 3) develop explicit criteria for determining the amount of intergovernmental grants for the devolved primary care functions; 4) generate a list of essential primary care services and associated costs based on the Primary Care System Act of 2019 and collaborate with the National Health Security Office in reforming the health financing system by separating primary care from secondary and tertiary care; 5) strengthen citizens’ consultative councils and develop it into a central decision-making body charged with providing linkage and referrals between provincial administrative organizations and the public health ministry’s hospitals, preparing the provincial health strategy, and integrating different health databases and; 6) propose to the Ministry of Interior that it should enable the provincial administrative organizations, municipalities, and subdistrict administrative organizations to share resources, budget, and personnel in providing primary care services and financial assistance for the subdistrict health promotion hospitals


location: , 'Thailand year: 2019 source: HSRI

title: Perception and Satisfaction of Stakeholders towards National Health Security System in Health Region 10

abstract: This mixed method research aimed to study perception and satisfaction of stakeholders towards national health security system in Health Region 10. The data were collected by questionnaire and semi-structured interview. Data analysis was done by using descriptive statistic and content analysis. The results of this study were based on interviews with 294 clients aged between 15 - 77 years old, and 304 service providers aged between 22 - 59 years old. Perceptions of all aspects of the national health security among providers and clients were high to highest, and satisfactions on national health security among providers and clients were highest. Their recommendations included: health promotion and
disease prevention should be emphasized; cross-boundary medical expenses should be allowed to
manage locally; fund should be transferred directly to health promoting hospital; personnel of the local
government organization should be trained on relevant regulations of fund management.


location: , 'Thailand year: 2008 source: HSRI

title: Occupational Therapy - Mahidol Clinic System in Stroke Patients

abstract: Stroke is increasingly found without regard to sex and age in the Thai population. Thus, it is mandatory
that the Occupational Therapy (OT) service be directed at either improvement or maintenance with
regard to individual skills of occupational performance. This OT service was systematically developed in
further support of an increasing number of patients. In section I, Occupational Therapy – Mahidol Clinic
System (OT-MCS) was created as an operational service for the OT Mahidol Clinic. This study was
conducted in order to compare the number of patients who attended the OT Mahidol Clinic in the 30-day
study period, before and after attending the OT-MCS. In section II, the patients studied comprised a group characterized as maintained performance (comparison of repeated therapeutic activities via descriptive
statistics) and a group characterized by improved performance (comparison of levels of activity
approach via Wilcoxon Test in the period of 30 days before and after the use of OT-MCS). After the use of
OT-MCS, the number of patients increased although the number of supervised occupational therapists
remained the same. The therapists also differentiated 40 activity items according to the levels of satisfaction
and importance. Moreover, the maintained performance group had moderate and high levels of
satisfaction with the importance of occupational performance. The improved performance group managed
different levels of activity regarding international concepts of occupational therapy. The patients
could express their existing potentials through meaningful activities, proper activity analysis and synthesis,
learning the importance of occupational performance, and gaining satisfaction with the choices of
occupational performance. The practice may be implemented in the patients’ realistic environment.


location: , 'Thailand year: 2019 source: HSRI

title: A Time-Motion Study of Medical Specialists: a Case Study in Eight Public Hospitals

abstract: There have been little empirical evidences available on a time-motion study of medical specialists,
the most vital human resources in Thailand. It is important to study the proportions medical specialist’s
workloads working in multiple units in the hospitals for greater visibility of labor distribution and cost
consistent with the actual work. The objective of the present study, therefore, was to describe the
proportion of work distribution as well as their working patterns in many tasks of specialists in public
hospitals. This would be beneficial for hospital cost allocation criteria.
A purposive sampling was employed to select eight public hospitals consisting of 3 regional hospitals,
3 general hospitals of the Office of Permanent Secretary, and 2 hospitals of the Ministry of Public
Health (with 600 and 1,000 beds). This study collected data from weekly and monthly work schedules
and direct interviews with medical specialists. The data were analyzed by descriptive statistics. Overall,
the medical specialists spent 33% to 36% of their time at inpatient department (IPD), followed by 27%
to 32% at outpatient department (OPD) and special clinics. In case of medical teachings, the medical
specialists spent no more than 4.7% of their total time, except pediatricians spent the highest 7.0% for
teaching. The administrative task took the smallest proportion of no more than 4.0%. The propotion of
time of each specialty was: otolaryngologists OPD : OR : IPD : teaching : administrative task = 27.6 : 24.8 :
41.7 : 2.6 : 3.3; ophthalmologists OPD : OR : IPD : teaching : administrative task = 30.8 : 19.2 : 42.0 : 4.6 :
3.4; internist OPD : IPD : ICU : teaching : administrative task = 28.3 : 55.8 : 11.0 : 3.2 : 1.7; pediatricians
OPD : IPD : ICU : NICU : teaching : administrative task = 32.6 : 33.8 : 10.4 : 14.3 : 7.0 : 1.9, obstetricians
and gynecologists OPD : OR : LR : IPD : teaching : administrative task = 30.4 : 15.3 : 17.4 : 33.1 : 2.7 : 1.1;
surgeons OPD : OR : IPD : ICU : teaching : administrative task = 29.1 : 16.6 : 42.1 : 7.3 : 3.7 : 1.2; orthopedic
surgeons OPD : OR : IPD : ICU : teaching : administrative task = 17.6 : 19.2 : 52.9 : 6.9 : 2.4 : 1.0; anesthesiologist
OPD : OR : ICU : anesthesia : teaching : administrative task = 2.2 : 45.2 : 13.5 : 34.7 : 1.5 : 2.9.
Proportions of work distribution in the present study may be used to assist decision makers in
hospital cost allocation criteria and human resource management. Additionally, this methodology can
be applied to other personnel who multitask and can be used to estimate the health workforce needs.


location: , 'Thailand year: 2013 source: HSRI

title: Medico-legal evidences in poisonous patients

abstract: All poisonous patients presenting to the hospital always have medico-legal aspects. The medicolegal
evidences in forensic toxicology are very important for the legal viewpoint concerned especially
with reference to concepts of “proof“, “causality” and “blame“. The health care providers must concern
their role and responsibility to protect the medico-legal evidences obtained from the poisonous patient as
well as treatment especially in the primary care hospital. The knowledge with technique in forensic toxicology,
chain of evidence, and related legal rules should be applied to deal with all poisonous patients for
reliability, accuracy, and legal fairness.


location: , 'Thailand year: 2023 source: HSRI

title: Development of Maternal Mode of KhunLook Mobile Application for Promotion of Maternal and Child Health

abstract: Background: Childhood is an important age for growth and continuing development. Early investment, especially during pregnancy increases quality antenatal care and can prevent complications, providing the child with their highest health potential for the future. In Thailand, pregnant women will receive the maternal and child health handbook (MCHH), a comprehensive guide used for recording and communicating important health information between the pregnant woman and health care provide (HCP), from pregnancy till the child is 6 years old. Despite the potential, not so many people read the MCHH, many hold the misunderstanding that the MCHH is for communication between HCPs. As a hardcopy, the MCHH bears a printing cost, once provided to the user, the content and functions cannot be upgraded simultaneously, and is at risk for wear and tear or loss of the book. KhunLook mobile application (KhunLook app) was developed in 2015 for parents, childcare providers, and HCPs to use as an interactive electronic MCHH intended to assist parents in child health supervision from 0-18 years. The content can be easily updated, data can be backed, minimizing the risk of loosing data. KhunLook application is found to be well accepted and easy to use. Using KhunLooK application can also increase parent health literacy. Currently, KhunLook app has been downloaded more than 550,000 times. KhunLook yields potential for further development of a maternal mode for pregnant women, for even more potential of Thai people. Objectives: We aim to develop the maternal mode of KhunLook app for promotion of Maternal and child health then to pilot the use of the application at the antenatal clinic in 2 groups of users, pregnant women, and HCPs. Methods: This study has 2 phases 1) Development of KhunLook maternal mode and 2) Pilot use of KhunLook maternal mode at the antenatal care clinic. The study was conducted during August 2021 to May 2023, we studied user requirements and incorporated feedback from pregnant, post partum women and HCPs who provide antenatal care. Content was developed and verified by maternal-fetal medicine specialist. Then the final application was piloted at the antenatal care clinic Srinagarind hospital and the Faculty of Medicine, Khon Kaen University. Ethics approval for this study was obtained from the Research Ethics Committee, Khon Kaen University.Results: Development of KhunLook Maternal mode. After brainstorming within the team for a prototype, the prototype was presented to participants for user requirements and feedback. Eighteen pregnant and post-partum women, and 27 HCPs participated in this phase of the study. The functions within the app and the content were well accepted for usefulness and understandability, the app was easier to use than the MCHH. The content was rated good to very good by the specialists. We incorporated the suggestions and feedback to develop the final application and tested it for functionality. The final application had a family, gestational age, information, health records, and a summary page. Pilot use of KhunLook maternal mode at the antenatal clinic. Forty-five pregnant women and 13 HCPs participated in this phase. The pregnant women’s mean age was 30.1 (20-40) years, and 33.3%, 31.3% and 35.6% were in their 1st, 2nd and 3rd trimester of pregnancy. The HCP’s mean age was 44.4 years. All the participants rated the functions and content to be very good and good. The app was rated easier to use than the MCHH on all items, with statistical significance on all items for pregnant women, and for some items for the HCPs. Users rated the app 9.0 and 8.7/10 versus 7.5 and 7.9/10 for the MCHH, which was statistically significant in both user groups (p=0.000, p=0.0205). KhunLook is intended to be complementary to the MCHH, but if only 1 mode was to be chosen, 86.7% of pregnant women and 30.8% of HCPs chose KhunLook app over the MCHH. Pregnant women stated that they preferred KhunLook due to the ease of use, completeness, and understandability of the content, and since they already have a mobile phone, there is no hassle of carrying a book around. Those who weren’t sure which mode to pick stated that they were worried that the information could be lost and preferred to use both methods together. All HCPs would introduce KhunLook app to their patients because it has quality information, it is very useful, convenient, easy to use. The maternal mode of KhunLook app is well accepted, in pregnant women and HCPs. We suggest using it in complementary of the MCHH. More promotion is needed for its use to reach potential.


location: , 'Thailand year: 2017 source: HSRI

title: Molecular Alteration Profile and Metabolomic Biomarker Discovery of Lung Cancer in Thai Population

abstract: Currently, lung cancer treatment has been developing in several approaches such as; conservative chemotherapy or novel targeted therapies which increase the overall response rate, survival rate with good quality of life for the patients. Thus this research project’s goal is to explore the molecular alterations in Thai lung cancer patients which could be different from the other ethnicities. The result of this research will lead to targeted drug development in Thailand for Thai lung cancer patients which the investigators will co-operate with ECDD (Excellence Center of Drug Discovery). This center was established in July 2016 by the co-operation and commitment between Faculty of Science, Mahidol University and Faculty of Medicine Ramathibodi Hospital, Mahidol University. The preliminary result of molecular alterations in 56 Thai lung cancer patients from this research project by NGS method from both FFPE and fresh frozen tumor tissue (initial analyzed only the common mutations in lung cancer) showed EGFR mutation 39%,
BRAF mutation 13%, KRAS mutation 20%, and MET mutation 2%. We also found 9 patients (16%) whom had more than one mutation. These preliminary results were very interesting and different from the other countries’ results, but we need to wait for the further analysis in larger sample size including deeper analysis for novel and uncommon mutations in Thai lung cancer patients in the second and third year for this research project. Even though we explore the diagnostic technique and the approach for lung cancer treatment as mentioned above, but the cancer prevention is also very important for the oncology world right now. The previous literatures reported the role of Metformin (anti-diabetic drug), Aspirin (anti-platelet drug), and Statins (lipid lowering agents) in decreasing cancer incidence rate, but the results were not homogenous and most of studies were small population based studies only. These 3 groups of drug involve in the metabolism of human body, thus cancer metabolism is the important and interesting field which could
lead to cancer prevention in the future. This research project also focuses in cancer metabolism and cancer prevention by studying the largest and longest follow-up of population based study in Thailand (EGAT database: Electricity Generating Authority of Thailand). The preliminary results showed Statins had statistically significant decreased the cancer incidence rate with the hazard ratio of 0.42 (P <0.001). Aspirin and Metformin also had the trend of lowering the cancer incidence rate but they were not statistically significant. Although this report is only the initial result, but it is very interesting and
fascinating to explore more in term of cancer prevention and wait for the deeper analysis in the next report. In conclusion, the study of molecular alterations in Thai lung cancer patients is very important for targeted drug development in order to drive the innovative lung cancer treatment. However, the other important issue and concern is cancer prevention. Nowadays cancer is the most leading cause of death in Thailand and cancer also causes a lot of burdens in Thailand and Global public health. We believe that cancer metabolism is one of the key factors for cancer prevention in the future which could probably help to prevent and decrease the cancer incidence rate and solve the cancer burden in Thailand.


location: , 'Thailand year: 2003 source: HSRI

title: Forum on a new learning paradigm to healthiness

abstract: The “Forum on a New learning Paradigm to Healthiness” project emerged from the impression that the current health-care system emphasized solely on the aspect of  medical treatment after people falling ill. The learning process on health care is strictly in a vertical line, that is from “the learned ” to “the unlearned” and the general belief is that whenever one falls sick, one must go see a doctor. Hence one’s life and health focuses around one’s body, illness, and dependence on doctor, with regardless of other aspects of life and how they may affect one’s health. It currently comes to light that a number of diseases cannot be cured by modern medicine alone. Thoroughly regarding other aspects of health and life is likely to be the answer. The existing learning process, however, barred any other thinking frameworks. Nevertheless, when health problems increase, new learning outside the mainstream system occurred to cope with such problems in broader aspects of health, education, medicine, and lifestyle. The new learning process is acquired by both individuals and groups through various means such as using media, namely radio, book, and internet as well as taking action and practicing by oneself.	It is interesting to study how these people have changed their views in taking care of their health and lifestyle. How they can cross over the old thinking framework. How they learn to view all things as a related whole. And how they come up with a new way in health-care based on self-reliance through various means and not clinging to any single approach.	This research is divided into two parts. Part one is comprised of a framework of concept and an analytical observation. The framework includes the definitions of “paradigm”, “health”, “learning” and how they are related to one another. Also included here are what the old and new paradigms in health care and the working process of the research team. As for the analytical observation, it is the conclusion drawn from the case studies, that is learning process is quite unique and fit for each person’s way of life. There is no clear-cut pattern of learning. Part two consists of eleven letters written to a friend telling the detailed stories of each case study. They are as follows:	Letter No. 1 explains the project’s background, objectives, and studying methods.	Letter No. 2 tells the story of the case studies Kaew’s diary and Ae. Both are inflicted with HIV, but with different medical indications. They come from different family backgrounds, yet they lead a rather happy life. Kaew develops her learning process through the cyber world, while Ae learnt from a real life of suffering experiences.	Letter No. 3 tells the story of a group of parents who use unconventional learning systems to solve their kid’s educational problems. Through this process they change their ways of life and gain a new idea about health.	Letter No. 4 tells the story of special-need people and their families as well as doctors and therapist who work with them. The problems of this group are very complicated involving the aspects of medical, educational, and social status.	Letter No. 5 is the story of two doctors, one suffered lethal disease, changes her way of thinking in health care in order to live peacefully with the serious illness. The other frustated with her working life, strengthens her mind to overcome the suffering by learning Enneagram.	Letter No. 6 the learning process of a people who highly regards and inner life and practices dharma as a mean to change the way of thinking at Sathien dharmasatham and Chewakasem.	Letter No. 7 is the story of a middle-class person who also focuses on an inner life, yet using yoga and, dharmayatra, a spiritual walk through the nature, to educate oneself.	Letter No. 8 tells the lives of two folk scholars living in the countryside and with no conventional education. They use their wisdom to change a life crisis into an opportunity to learn new things and share their learning experience with others.	Letter No. 9 is the story of a community-based social worker cum teacher, Kru Surin; and another story of a middle-class city woman who has the courage to lead a totally different life of a farmer.	Letter No. 10 tells the story of two people with nothing in common. One is a “sick” person who seems to lack everything; another is a well-to-do middle class who dedicated his life to heal other people’s sufferings by MOA.(Mokighi Okada Association)	Letter No. 11 is a unique life of a person who was born in primitive surroundings yet becomes a learnt man by studying with many scholars in various skills and become to be a holistic healer.	In all, what presented here in form a conversation between two friends is and idea compiled from all the case studies. The research team can eventually says that the changing of each person’s thinking paradigm on good health care occurred in accordance with certain factors in each person’s way of life. Moreover, they need some practice to attain and insight to understand things as they really are. And this helps elevate them to a new paradigm of thinking.


location: , 'Thailand year: 1998 source: HSRI

title: Unit cost analysis in health care centers in Tak province, fiscal year 1997

abstract: A study was conducted to determine the unit cost of provision of health services in all 3 levels of health care centers along the Thai-Myanmar border in Tak Province between 1 October 1996 and 30 September 1997. Health care settings included Mae Sot General Hospital (310-bed), Mae Ramat Community Hospital (30-bed), and all 29 health centers in Mae Sot District and Mae Ramat District. We used the simultaneous equation method for cost analysis in the hospital and the district distribution method for the health center. Units in the hospital were classified ad 1) non-revenue producing cost center, 2) revenue producing cost center, 3) patient service, of 4) non-patient service, Unit categories for the health center were transient cost center and Absorbing Cost Center ACC 	The ratio of labor cost: material cost for the general hospital was 59 : 41. The ration of labor cost : material cost : capital cost was 61 : 29 : 10 for the community and 43 : 42 : 15 for the health center. The unit cost for out-patient service was 122 baht for the general hospital, 96 for the community hospital, and 74 for the health center. The in-patient unit costs for the general and community hospitals were 5,734 and 1,945 baht respectively. The in-patient unit cost in the general hospital was significantly (p<0.05) lower among Thai patients (3,092 baht) than Myanmars (5,781 baht). Significant differences (p<0.05) in the unit cost by disease between Thais and Myanmars were detected for thyroid disease, malaria, ceasarean section and uncomplicated appendicitis, They were no significant differences between Thail and Myanmar patients in both out-patient (48 VS 56 baht respectively) and in-patient (1,710 vs 1,640 baht) unit costs in the community hospital. 	However, the unit cost by disease for out-patient service in the community hospital was significantly (p<0.05) different between Thais and Myanmars only in pharyngitis whereas such differences were not found for in-patient service.


location: , 'Thailand year: 2007 source: HSRI

title: Elderly Health Problem 2547

abstract: As part of the National Health Examination Survey III, the objectives of
this study were to determine the health problems of Thai elderly in 4 dimensions; self-reported health status, prevalence of behavioral risks, biological risks
and examine an awareness, treatment and control of the leading chronic
diseases.
The samples of 19,372 respondents aged 60 years and over were drawn
from those included in the multi-staged sample national survey during JanuaryAugust 2004.  Methods of data collection were interview, physical examination
and laboratory findings. Descriptive analysis was used to estimate the size of the
conditions and prevalence at the national level, base on standard criteria for diagnosis of chronic diseases and levels of their effective control.
With regard to behavioral risks, prevalence of cigarette smokers decreased
with ages, the rate among males was nine times over that of females. Alcohol
drinking decreased in a small proportion. Insufficient physical activities as well
as fruit and vegetables intakes based on standard criteria were observed at high
rates (80-90percent), increased with advanced ages and the oldest females were
the worst.  For biological health risks, anemia and underweight appeared to increase with advanced ages and lower proportion of obese elderly respondents
with advanced age was observed.  Selected chronic diseases were hypertension,
hypercholesterolemia and Diabetes Mellitus, of which known as high risks associated with major cardiovascular events for example, stroke, ischemic heart, and
long- termed diabetic consequences.Age-adjusted prevalence of hypertension
were at 51.6 percent, diabetes 14.8 percent and high cholesterol 25.4 percent.  While
overall proportion of unawareness of those chronic diseases were reported to be
56.8 percent for hypertension, 41.2 for diabetes and 81.5 percent for high cholesterol.  The proportions of those treated and control of blood pressure, blood sugar
and blood cholesterol were12.4, 26.4 and 10.3 percent respectively.  Women were
found to be more aware of their illnesses, received treatment with effective control than their men counterparts. An ineffective control group was observed
among the oldest - 80 years and over- of both genders.
In conclusion, there were high prevalence of hypertension and diabetes
in the Thai elderly with high percentage of unawareness and inadequate control
of those treated.Screening program for early detection was essential.  Treatments
of these diseases to maintain adequate control should be improved


location: , 'Thailand year: 2020 source: HSRI

title: The Distribution of Community Pharmacies in the Context of Health Need in Thailand

abstract: Community pharmacy is a health service that provides drug distribution and primary health services in the community. Proper distribution of community pharmacies in each area will allow people to access pharmacy services resulting in safe drug use. This study aimed to examine the distribution of community pharmacies in relation to health needs by health region of Thailand. Secondary data obtained from relevant government agencies:  the number of population, the number of patients with ambulatory care sensitive conditions (ACSC), gross provincial product (GPP) per capita, modern pharmacy (type I), accredited pharmacy and type II pharmacy along with other public and private health establishments, were analyzed using descriptive statistics. The results showed that in 2016, there were 16,053 community pharmacies in Thailand. Health region 13 (Bangkok) had the most community pharmacies (4,774 stores), representing 29.74 percent of the country total. In provincial area, Health region 4 had the highest number of community pharmacies (1,780), representing 11.09 percent and Health region 3 with the least community pharmacies (333) representing 2.07 percent. When considering the distribution of community pharmacies in relation to health needs, Thailand had 2.47 stores per 10,000 population and 2.72 stores per 10,000 cases of patients with ACSC. The number of community pharmacies was positively correlated with gross provincial product (GPP) per capita. In provincial area, majority of community pharmacies located in municipal area. The study showed unequal distribution of community pharmacies in Thailand. These may affect unequal access to medicines and pharmacy services.


location: , 'Thailand year: 2020 source: HSRI

title: Screening and treatment of obstructive sleep apnea in High-Risk Pregnancy: A multicenter randomized controlled trial

abstract: Accumulating data indicate that obstructive sleep apnea is an independent risk for gestational hypertension, preeclampsia, gestational diabetes, and preterm delivery. Preliminary studies demonstrated the benefits of early nasal continuous positive airway pressure (CPAP) treatment in high risk pregnant women to prevent adverse maternal and fetal outcomes. Highrisk pregnant women such as those with obesity, chronic hypertension and prior history of preeclamsia should be evaluated for diagnosis and treatment of sleep-disordered breathing given the potential benefit of early CPAP treatment. The pathophysiological evidence linking preeclampsia and sleep-disordered breathing supported the rationale for CPAP treatment in addition to conventional antenatal care. However, currently there is no standard guideline that systematically screens and treats for sleep-disordered breathing during pregnancy. The situation of sleep-disordered breathing is in the state of “clinical equipoise”, where strong evidence is needed to make any treatment recommendation during pregnancy. It is an urgent need to conduct a randomized controlled trial that can demonstrate the efficacy of CPAP treatment.


location: , 'Thailand year: 2001 source: HSRI

title: Situation analysis of home and community based care for people living with HIV/AIDS in Southern Thailand

abstract: Situation analysis of home and community based care for people living with HIV/AIDS in southern Thailand	The study aims to review and analyse the situation of home and community based care for people living with HIV/AIDS in southern Thailand. Data from three collected and analyzed to examine the way in which people living with HIV/AIDS are managed and taken cared at home and communities. The strategies and factors affected the systems of care were also investigated to present the extent to which care has been changed or modified for sustainability or discontinuity, Results showed the significant findings as follows. 	1.  The current AIDS situation in Southern Thailand is similar to other parts as the number of new case has been increased particularly in reproductive age. The increasing number of AIDS patients were seen both in and out of hospital. The national case report showed that the proportion of people who were sick with AIDS in a hundred thousand population was higher than the country rate. The report also revealed that the high epidemic areas were from provinces with a large number of fisherman, labor migration, and tourists, Data from fields study were also confirmed. 	2.  The situation of AIDS care in southern Thailand has been changed since last two years. People were more awareness of HIV/AIDS and perceived it as their own problems particularly when one of their of family members sick with AIDS. However, the level of understanding of HIV/AIDS care at home and community among general population was still low. Stigma and rejection were remained high in community level. Various activities in relation to enhancing care for patients at home and community were then supported by several organizations both government and private sectors.	3.  AIDS care management in southern Thailand were mainly individual and family level, partly because of fear and social rejection, Patients and families with AIDS generally conceal their status. They would requires some assistance and support when necessary without disclosing to the public, Although the community was taking the significant role by expressing the value and cultural care, the positive response has currently been low compared to overall projects.	4.  The strategies applied for managing care at home and communities wree both active and passive methods. The significant strategies were involved with active community participation, having good leader with scarify or having better knowledge, home visiting, community aceptance, seeking funds to support activities, and using a holistic approach.  	5.  Several activities were conducted particularly in enhancing the strength of community participation. Training of difference groups was the most common activities, The content was related to AIDS prevention and psychological care for people living with HIV/AIDS and their families. The herbal and tradition medicine had also been promoted and used as the main mode in supplement of lack access to antirrtroviral therapy.	6.  The role of individual, family and community are increasing especially in the high epidemic area. The role of temple is one of the community care which represents of active participation. The role of government organization has been less than other in terms of accessing to home visiting and providing psycho-spiritual support. However, people with AIDS who concealed their status would have less assistance. 	7.  Several models of home and community based care have been found. These were included: model of empowerment of patients and their families, model of strengthening and promoting active community participation, care and support from family and community, development of a temple or religion organization as a center of care. Recommendations	Strengthening home and community based care can reduce the impact of HIV/AIDS on individual, families and community. To ensure effective care and support provided for people living with HIV/AIDS, these issues must be stimulated and plan for the future. To apply AIDS home care model, the meaning of care and component of cultural care at home and community must be clearly defined. The findings showed that the best practice model has currently existed, but it required systematic study and further publication.Sharing knowledge and experience about caring for people living with HIV/AIDS at home and community in southern Thailand has been low. The specific skills are required for effective intervention and enhancing care by their family and community. These skills are included community management, effective health and nutrient counseling, and caring of dying at home.Although the role of government, private and community organization continue to increase, the good governor and co-ordination has been necessary to promptly respond and managed. The direction of policy must be clear and focus on sharing resource as much as possible. Development and integrating of the traditional medicine on home and community based care is required. AIDS is a psychosocial and cultural problem related to daily living and survival. To solve the problem effectively, it requires the multidisciplinary knowledge and team.To encourage people living with HIV/AIDS in living longer with less suffering, continuing plan and self care management must be educated. In addition, the alternative therapies and positive thinking strategies should be supported and integrated to their living for better quality of life.Further research on development of a cultural appropriated model for people living with HIV/AIDS is essential. The independently system of care particularly in people who conceal their HIV status should be further explored. Nevertheless, a follow up study on impact of disclosure to patients and their families which affect quality of life and quality of care at home and community level.


location: , 'Thailand year: 2007 source: HSRI

title: Lessons Learned from Flooding and Landslides in Lablae District, and Planning Development for Disaster Relief by the Lablae Public Health Team

abstract: The study took a phenomenological approach to qualitative research, aimed at
studying disaster management following the destructive flooding and landslides in Lablae
district of Uttaradit Privince, and the development planning for disaster relief conducted
by the Lablae Public Health Team.  Specific data were collected from 69 persons who
experienced the disaster, members of the rescue team and persons on whom the flooding
and landslides in Lablae district had an impact, 32 persons from an in-depth interview
and 47 persons from a focus group discussion as well as participants and non-participants, observers during the disaster, development of a disaster scenario for disaster relief
by the Lablae Public Health Team based on 90 participants, and analysis by data triangulation, using the Excel software program for category and data content analysis.
We was found that the flooding and landslide disaster that occurred during the
period May 22-24, 2006 adversely impacted the people of Lablae, Mange, and Thapla
districts and the surrounding province.  Most people in Lablae suffered severe effects on
their lives and property. Many houses in the area of heavy flooding and landslides were
destroyed.  Electricity, communication and transport systems were cuts making evaluation of the affected area impossible.  The rescues were made only during the first stage;
they were delayed and not comprehensive.  Also, the disaster relief plan of every office
involved was ineffective.  The emergency team was unable to operate during the crisis.
The primary response was only to provide a safe area for the surveyed patients and medical
supplies.  After the incident, although many organizations and volunteers rushed to the
area, they could not implement the relief plan, which resulted in incomplete data collection and the inefficient provision of security welfare.
The relief disaster plan of the health team must be operated in coordination with
public health and other relevant offices at all times: before, during and after such incidents, both at the district and provincial levels.   The defined roles of the command post
and volunteers during the incident, together with the development of an emergency medical system, care-giving, epidemic prevention, psychotherapy, the readiness of the rescue
team, data on risky areas, rehearsal of integrated relief plans in all areas at risk of natural
disasters, and relief networks as well as the coordinating system and data collection must
be seriously considered before such incidents occur.


location: , 'Thailand year: 2022 source: HSRI

title: Modeling Cancers with Patient Derived-Organoids for Determination of Anticancer Effects of Small Compounds on Solid Tumor of Children and Women

abstract: The disease model is crucial for discovering a new drug and therapy. Currently, organoid technology allows the generation of a self-assembled, 3-dimensional cellular structure. We aimed to use innovative tissue culture to create cancer organoids from cancer tissues of retinoblastoma and breast cancer patients. The success rate was 80 and 32 % for retinoblastoma and breast cancer organoids, respectively. Cancer organoids faithfully recapitulated genetics, gene expression, and histogenesis in the parental cancer tissues. For retinoblastoma, a candidate cancer drug exhibited high efficacy and potency for all subtypes of retinoblastoma in drug screening. The drug signature of retinoblastoma organoids suggested that the candidate drug had dual inhibition of retinoblastoma and angiogenesis. Retinoblastoma growth was inhibited via drug-induced cell cycle arrest and apoptosis. Of note, the candidate drug for retinoblastoma exhibited low toxicity to the retina compared with clinically used drugs. For breast cancers, the drug response profiles were alike between breast cancer organoids and the patients. Nine candidate drugs were more effective for killing cancer cells when compared with the drugs that failed to cure breast cancer of the patients. Generating and collecting cancer organoids would benefit the discovery of universal or personalized therapeutic agents for cancer treatment.


location: , 'Thailand year: 2018 source: HSRI

title: Situation on Antimicrobial Use and Knowledge on Antimicrobials: A National Health and Welfare Survey in Thailand 2017

abstract: The antimicrobial resistance (AMR) crisis is rising continuously, which has accelerated by the inappropriate use of antimicrobials either unnecessary or overuse and misuse. To better understand about the appropriate use of antibiotics and monitor as well as evaluate of implementing the National Strategic Plan on Antimicrobial Resistance 2017-2021, the National Statistical Office (NSO) and the International Health Policy Program (IHPP) jointly developed a module to assess the levels of knowledge on antimicrobials and awareness of antimicrobial resistance among the Thai population. The 27,762 adults older than 15 years were asked to self-administer this module. The module was integrated into the decade long National Health and Welfare Survey (HWS) conducted by the National Statistical Office. HWS 2017 was the first time in Thailand that introduced a modified version of the Eurobarometer antimicrobial resistance module into the survey. The module consisted of four sections including antimicrobial use profiles, antimicrobial literacy, public information on proper use of antimicrobial and antimicrobial resistance, and awareness on the use of antimicrobial in farm animals. The key findings showed that 7.9% of Thai adults older than 15 years received antimicrobial drugs in the last month. The majority of Thai people (70.3%) obtained antimicrobial drugs from health facilities (both private and public sectors at all levels), followed by drug stores (26.7%). Respiratory track symptoms were the most commonly reported reasons for taking antimicrobials; 62.7% of the total. In addition, the antimicrobial literacy is probed using five true and false statements. Poor level of knowledge on antimicrobials was alarmingly found in Thai population, only 3.1% gave correct answers to all statements and the most misunderstood statements were “antimicrobials kill viruses” and “antimicrobials are effective against colds and flu”. Moreover, only 17.8% of Thai people received information about proper use of antimicrobials in the last 12 months. Three common sources of the information were doctors (36.1%), other health professionals such as nurses and health workers (24.8%) and pharmacists (17.7%). Almost two-thirds of respondents were not aware of antimicrobial use in food producing animals and about 68.2% of adults did not know that Thailand had banned the use of antimicrobials as growth promoters in food animals. The Ministry of Public Health and the relevant authorities need to steward appropriate use of antimicrobials by health professionals, pharmacists and veterinarians (supply side) as well as create effective public communication and awareness program on antimicrobials use and AMR in general population through new channels such as social media for increasing the potential reach of the information (demand side). The progress of antimicrobials use and literacy should be monitored continuously as part of improving knowledge on antimicrobial resistance and awareness of appropriate use of antimicrobials and monitoring the progress of the National Strategic Plan on Antimicrobial Resistance.


location: , 'Thailand year: 1999 source: HSRI

title: The lessons and experiences in AIDS solution of apper northern communities

abstract: Lessons and Experiences in AIDS Solution of Upper Northern Communities	As Northern communities were highly affected HIV/AIDS, many-years experiences from AIDS takling in such communities were picked up to synthesize lessons learned. This study covered the experiences from 6 upper Northern provinces including provincial administrative bodies involved in AIDS programs in both public, private organizations and NGOs, and community organizations. The study was based on secondary data e.g. project documents and various reports on AIDS programs implementation, data from in-depth interview on a number of key informants, data from group participation processes. 	The study found obvious advantages derived from the development of matrix organizations which were from public, private and NGOs leading to well-cooperative and coordinated system. Core people in communities were the key players to initiate the programs; nevertheless, they must act on their voluntary with sufficient supportive matters like budgets and knowledge either from internal or external communities. Local administrative organizations were the key player while large amount of budgets should be from the public sector via direct allocation to communities or local administrative organizations as the administrative body. Importantly, communities’ knowledge must not be underestimated as they tended to be more practical and acceptable for them.


location: , 'Thailand year: 2020 source: HSRI

title: Drug Procurement in Public Hospitals under the Public Procurement and Supplies Administration Act B.E. 2560 (2017)

abstract: The Public Procurement and Supplies Administration Act, B.E. 2560 (2017) came into force on 23
August 2017 to replace the Rule of the Office of the Prime Minister on Procurement, B.E. 2535 (1992).
This Act aims to promote worthiness, transparency, efficiency, effectiveness, and accountability of government
procurement. However, in practice, the Act introduces many more processes and details and
lacks clear guidelines for operational compliance. This has impacted drug procurement in numerous ways
such as longer procurement time, an increase in workload for staff, and the risk of drug shortage due to
delays in the procurement process. The purpose of this study was to determine the current situation,
issues faced, and impact on hospital workload by using a qualitative descriptive design. The data collection
approach included reviews of various orders, regulations, and consequences affected by this Act,
and in-depth interviews with drug procurement staff in 7 public hospitals, policymakers, and other stakeholders.
Content analysis was employed for data analysis. The results revealed that one year after the
Public Procurement and Supplies Administration Act, B.E. 2560 (2017) came into effect, drug procurement
practices between hospitals varied depending on individual hospital policies and interpretations of the
Act. In terms of hospital workload, procurement based on this Act led to an increase in overall workload
such as the number of procured drugs, documentation, and operating expenses. Meanwhile, the number
of hospital staff tasked with the procurement process was inadequate, and many aspects of the public
procurement system and within hospitals themselves lacked readiness. Therefore, the Comptroller General’s
Department and the Office of the Auditor General, as the agencies responsible for supervising
operational compliance with the Public Procurement and Supplies Administration Act, should cooperate
with public hospital management and public and private drug manufacturers and distributors to determine
the optimal amount of staff required for procurement tasks. They should also support the use of
information technology to develop a procurement document management system, and continuously
monitor and assess the drug procurement process.


location: , 'Thailand year: 2011 source: HSRI

title: Views of Health Professionals on Herbal Medicine and Policy for Promotion of Herbal Medicine Use in Healthcare Settings

abstract: The policy on the promotion of herbal medicine has not yet achieved the target. To achieve the goal,
knowing health care professionals’ views on herbal medicinal products and on the national policy which aims to promote the utilization of herbal medicine in health care facilities is crucial. This study used
qualitative methods. Focus group interview among the frequent user group and in-depth interviews among
occasionally user group were conducted. The results of this study can be divided into 3 parts. 1) Views on
herbal medicinal products: lack of confidence on the effectiveness and safety of herbal medicinal products
is found, the appearance and other characteristics of herbal medicinal products are not attractive, herbal
medicinal products are more expensive than western medicine. 2) Views on the national policy to promote
the utilization of herbal medicinal products in healthcare facilities: The set target in terms of expenditure
of herbal medicine products of 25% of the total drug expenditure for every healthcare facility is
difficult to accomplish. Furthermore, there are no practice guidelines and clear strategic plan to support
the policy. 3) Views on impeding and facilitating factors influencing the utilization: key impeding factors
were the criteria on reimbursement of herbal medicinal and confidence in the quality and manufacturing
standards. The key facilitating factor was the presence of key person who was able to promote the use of
herbal medicine in hospitals. Findings from this study would be used to develop the effective strategies to
accomplish the policy aims at promoting the use of the herbal medicine in the future.


location: , 'Thailand year: 2009 source: HSRI

title: Global Warming: Effect on Plants

abstract: Global warming is the term used to describe the increase in the average temperature of the earth’s surface, air and oceans. High temperature increases due to global warming can cause injury and may finally lead to the death of plants by many mechanisms. Although plants have natural defense mechanisms for their survival under high temperature stress, some of them are sensitive to high temperature stress and cannot adapt themselves. Current advances in science and technology enable the application of molecular biology techniques helful for studying the effects of high temperature on plants related to their gene expression. The knowledge gained from research can help us to understand sensitive and tolerant plants in respect of high temperatures with control provided by multigene families. Cloning gene(s) responsible for the heat tolerance of plants and the transfer to other plants sensitive to heat stress can increase heat tolerance in transgenic plants. This results from doing basic research. Therefore, it is necessary for scientists to use advanced science and technology to reduce the adverse effects of global warming on plants, especially economic and medicinal plants.


location: , 'Thailand year: 2023 source: HSRI

title: A Research and Development Program on Developing of Value-Based Health Care for Diabetes Prevention Service Package and Payment

abstract: Background: The global rise in non-communicable diseases (NCDs), particularly type 2 diabetes, is a major concern. Existing literature highlights the effectiveness of non-pharmaceutical interventions, such as weight reduction, in reducing the risk of diabetes among pre-diabetic individuals. Grounded in the integrated people-centered care concept and recent behavior change theories, researchers developed a peer-coaching program led by health professionals. Methods: The program was implemented across primary care settings in four districts, representing four regions of Thailand. A total of 423 pre-diabetic patients were enrolled in the experimental group, while 443 were assigned to the control group. Participants in the experimental group engaged in five behavior change activities. To evaluate the program's effectiveness, BMI, waist circumference, blood pressure, health behaviors, and blood glucose levels were measured pre- and post-activity. Satisfaction and perspectives were collected from healthcare professionals and patients using quantitative and qualitative methods. Program delivery costs were assessed, and a cost-benefit analysis was conducted. Results: A 97.2% attendance rate was recorded for the experimental group, who demonstrated statistically significant reductions in BMI, waist circumference, blood glucose levels, and diabetes risk scores compared to the control group. The 10-year diabetes risk score for the experimental group decreased by 12.65% after attending the program. The benefit-cost ratio was 2.96, indicating the program's value. High satisfaction levels were reported among both healthcare professionals and patients. Discussion and conclusion: The behavior change program designed for pre-diabetic patients, emphasizing people-centered care and modern behavior change concepts, proved effective and worthwhile for primary care settings. After minor revisions, the diabetes prevention program package should be included in benefit package of Thailand health insurance schemes to promote its widespread adoption and utilization.


location: , 'Thailand year: 2016 source: HSRI

title: Priority, Prevalence and Geographic Distribution of Unsafe Products in Thailand

abstract: Objectives: To examine the prevalence and geographic distribution of unsafe products using risk
and possibility assessments of problem-solving using prioritizing unsafe products at provincial level in 2014. Methods: A cross-sectional descriptive study was undertaken to rank the top 5 unsafe products
using risk and possibility assessments of problem-solving principles under Unsafe Product Issue
Prioritization Project in 4 Regions (60 provinces), during January to August 2014. The data were collected
by a health consumer protection pharmacist in each provincial public health office. Descriptive statistics
for the analysis, prevalence and geographic distribution of the unsafe products were employed. Results:
Thirty-one unsafe products were found. As for the prevalence of the top 5 unsafe products assessed at
national level, they were agricultural chemical residues in fruits, vegetables and salted fish, hazardous
chemicals in cosmetics, repeatedly-fried oil, steroids adulterated in health products and drug sole in the
community, and formalin contaminated food. Based on geographical conditions and public health services,
it was found that the prevalence of the most unsafe products in 4 regions was similar to that of the
national level. However, there were some slight differences in certain regions. Besides, it revealed that the
top 5 unsafe products at national level were distributed geographically in each province. Conclusions:
There were some similarities and differences among the conditions of unsafe products in different areas.
The differences could be due to the different factors in the areas such as consumer behavior, geographical
conditions affecting the distributions of goods, etc. These factors affected the selection of unsafe products,
as well as the risk and possibility assessments. Therefore, any relevant organizations should set appropriate
policies, measures or plans to solve such problems in all aspects.