location: , 'Thailand year: 2000 source: HSRI

title: Benchmarks of fairness for evaluating the Thai Health Care Redorms

abstract: Benchmarks of Fairness for Evaluating the Thai Health Care ReformsThis study aims to test the adapted benchmarks as a tool to assess the ADB' s proposal on health system development published in 1999 and to evaluate the achievement of health care reform activities in two provinces supported by EU, Payoa and Yasothon. 0The adaped benchmarks compose of 9 benmarks. The first benchmark concerns with intersectional public health or intersectional efforts to improve social determinants. Benchmarks 2-5 relate to equity issues and benchmarks 6-7 intend to evaluate efficiency of the system, Benchmarks 8 concerns with democracy, accountability, and empowerment, provider and consumer autonomy are the final benchmarks.  The tool is aimed to use as a framework for policy analysis, indentifying strengths and weaknesses of the reform proposal, ensuring that appropriate inputs, mechanisms, and strategies are existed to achieve equity. To use the benchmarks, a scoring system is applied as a ranking on complex dimensions, not cardinal measures of some quantity, in addition to an explanation for it's rationale of score provided. In testing  the adaped benchmarks, it shows that the benchmarks could be used as a tool to assess both achievement of reform and assess reform proposal. However, assessment of reform proposal may be more appropriate in use since there were large variations of score in assessing achievement in both proviness.In testing the adapted benchmarks, it shows that the benchmarks could be used as a tool to assess both achievement of reform and assess reform proposal. However, assessment of reform proposal may be more appropriate in use since there were large variations of score in assessing achievement in both provinces. Background and perception of evaluators determine the different of score provided, therefore, interpretation of the result should be made with caution especially, when it has been used to assess achievement of the reform. Providing information before scoring process would reduce deviation and improving reliable of the score. The details of each benchmark should be adopted to fit with the contexts of particular country or province.


location: , 'Thailand year: 2000 source: HSRI

title: An evaluation of governmental homes for the aged: case studies of the three homes for the aged

abstract: This study is an assessment of the operation of Governmental Homes for the Aged through three case studies . The study employs both quantitative and and qualitative methods within the adapted CIPP framework utilizing gender dimensions  for data analysis.	Assessment of the environmental context  of the Homes for the Aged revealed that the space and surroundings of the Home affected the interaction and behavior of the aging residents. Meanwhile, the community adjacent to the Homes and the public were found to have no participation in and investigation of such Homes.	As far as the assessment of the aging residents in the Home is concerned, the sample population comprised the women in the lower socioeconomic strata as the majority. Most of the aging sample were admitted to the Homes due to no carer at home. The study found that the high proportion of the aging residents did not participate in any activity arranged by the Homes due to their health problems. However, the majority of the residents were of the opinion that their current lives were better off. The study also found the increasing trend of the Homes to admit the residents with better socio –economic conditions and to confront the residents’ voicing of their rights and benefits. 	The gender analysis yielded the results that the men residents had better previous socio-economic conditions and more current income than their women fellows. They also had better physical conditions, more kinship network, and participated more in the activities of the Home. The study also found that such men residents had better mental health, more psychological and spiritual needs compared with women. Regarding the potentiality, although the women residents who possessed certain skills were proportionately higher than men, men were more willing to contribute for the social goods than women . Besides, the women residents expressed the will to further live in the Homes more than men.	Assessment of the administrative resources of the Homes disclosed that the unit cost  per resident was as high as Baht 34,500 annually. In terms of policy, the policy formulated by each Home was found to be lacked of unity due to adherence to various policy orientation. Added to this, the programs and projects were extremely flexible while no mechanism was devised to monitor and evaluate them. Administratively, it was found that the Home locating in the provinces operated as independently as “the Kingdom” and was connected with the central administration than the provinces they attached. As far as the budget allocation was concerned, each Home was found to be highly dependent upon public donation. For personnel administration, the study found that the personnel  distribution in each Home  was imbalanced with those earmarked.	With reference to  the services provision, the study found that  the aging residents who were not in dire need were admitted. The fact that the main strength of the Home was its capacity to respond to the physical needs of the residents while the main weakness of the Home was its unresponsiveness to psychological and spiritual needs of the residents were also found. For personnel performance, the major problem of the Home was the low quality of the personnel at the services level were also found to be incapable of solving the problems of the residents of the Homes effectively.	As regards the operation of the Home, the study found that the services and activities provided were adequate and  that the residents were indiscriminatory treated. However, the inequality existed was that the better off residents enjoyed similar benefits of the Home with the poor and needy residents and that the declining residents were somewhat inaccessible to the services provision. Furthermore, since the residents were mere beneficiaries, the sustainability of the services and activities of the Home was far from reality. Lastly, the study found the direct impact of the Home to be the benefits the needy obtained  from the Home while the main indirect impact was the inception of the Elderly Social Service Centers in the various communities.


location: , 'Thailand year: 2023 source: HSRI

title: Experience, Barriers, Supports, and Outcomes of Pharmaceutical Care in Hypertensive Patients by Pharmacists in Primary Care Cluster, Health Region 6

abstract: The sequential embedded mixed-method research consisted of two phases. In phase 1, the qualitative phase was aimed to explore the experience, barriers and supports of the pharmacists in the primary care cluster. Focus group discussion was conducted with 24 pharmacists from 6 provinces of the health region 6. Findings of content analysis comprised three main themes: barriers and supports from the policy; colleagues; and the pharmacist. The barrier was the health information access and incomplete data flows from the primary care cluster to the hospital and vice versa. Effective patient care needed inter-professional teamwork in receiving updated medication knowledge from the part-time pharmacist in the primary care unit. Communication skills helped the pharmacist provide effective resolutions to drug-related problems (DRPs). In phase 2, the prospective, quasi-experimental study aimed to examine DRPs, blood pressure control, and physician acceptance to pharmacists’ roles, as well as, to examine relationships of patient’s or pharmacist’s factors with the effective resolutions to DRPs. Data collection form of DRPs was adopted from Cipolle et al’s classification. Quantitative data collection was performed on 1,471 hypertensive patients who were attended consecutively 3 visits by the pharmacists participated in the phase 1. Of all 379 DRPs identified, the highest problem was 164 of non-adherence (43.3%). After the primary pharmacy care, the DRPs were significantly decreased by 33.2% and 32.4% (c2(2)=46.78, p < 0.001) at visit 1 and 2, respectively. Blood pressure was unchanged. Physician acceptance rates to pharmacists’ roles were 77.8%, 70.3% and 68.4% consecutively. The factor related to the effective resolving non-adherence was the physician acceptance (rs = 0.18, p = 0.020), consistent to phase 1’s findings. This sequential embedded mixed-method research provided linkages of all findings which clearly illustrated the overview duty of primary care pharmacy.


location: , 'Thailand year: 2017 source: HSRI

title: Improvement of Clinical Outcome in Kidney Diseases via On-line Thai Glomerular Disease Registry 2nd year

abstract: Background: End stage renal disease (ESRD) affects the quality of life and causes the high cost in health care system. The prevention of ESRD is the early recognition and appropriate treatment. Glomerulonephritis is the third most common cause of ESRD in Thailand. Thai Glomerular Disease Collaborative Network (TGCN) was established to evaluate the epidemiology and clinical outcomes in the glomerular diseases and helped to promote the good system to taking care of these patients. Methods: TGCN originally consists of 9 tertiary care centers and expands to 20 hospitals. We conducted a prospective cohort study in the adults’ native kidney biopsy proven glomerular diseases between July 2014 and Mar 2017. The clinical and laboratory parameters at the time of biopsy, pathologic findings, treatment regimens and clinical outcomes were recorded via on-line registry. Results: We recruited 1,556 patients performed native kidney biopsy during Jul 1, 2014 to Mar, 2017. The female to male ratio was 1.88:1. The average age, creatinine, albumin, and cholesterol were 43.4+16 years, 2.11+19 mg/dL, 2.9+0.8 g/dL, and 294+131 mg/dL in respectively. The median proteinuria was 3.7 (0.02-25.3) g/day. The patients presented with 40% of nephrotic syndrome, 21.7% of nephritis, 19.4% of nephrotic nephritis, and 60.8% of renal impairment (creatinine>1.2 mg/dL). The renal pathological findings showed 33.9% of LN, 13.5% of IgAN, 10.5% of FSGS, 7.4% of minimal change disease(MCD), and 7.1% of membranous nephropathy (MN). The mean age of LN, IgAN, FSGS, MCD, and MN were 34.9, 39.4, 47.7, 46.5 and 52.6 years. The median creatinine at biopsy of LN, IgAN, FSGS, MCD, and MN were 1.08, 1.76, 1.65, 1.02 and 0.98 mg/dL. Conclusion: Our study described the common renal pathological findings including LN, IgAN, FSGS, MCD, and MN. The clinical outcomes and prognosis of these diseases were described in the complete report. In the second year, we have performed the recommendation for management in glomerular disease, FSGS and MCD in adult Thai patients.


location: , 'Thailand year: 2017 source: HSRI

title: Options and Guidelines for Urban Health Services System Development in Health Region 3

abstract: This qualitative study aimed to propose options for developing urban health services system in Health Region 3. The study’s scope involved only primary care systems in urban areas of Nakhonsawan and Kamphaengphet provinces. Literature review, case studies, in-depth interviews, and focus group discussions were administered to collect the data, which focused on participants’ perceptions and collaborative decision-making. 260 informants were recruited purposively, including Mueang District Health Boards, senior health executives at regional and provincial levels, senior health managers from public, private and local government sectors, representatives from community, civil society and health system experts. Thematic and content analysis techniques were used for data analysis. This study showed that the Social Medicine Departments of the regional and provincial hospitals were the major organizations which were responsible for primary care services in urban areas. Though public, private and local government sectors also provided these services. Primary care service planning under the Primary Care Cluster policy was done mainly by the organizations under the Ministry of Public Health (MOPH). This study found that despite the improvement of the services quality, the services quality could not cover all areas nor created a sense of ownership for those in other sectors including civil society. The major challenge was the increasing service demand due to the increase in the number of aging population and patients with Non-Communicable Diseases. Also, there were a shortage of health workforces and lack of health promotion skills as well as a problem of not being able to use the budget effectively for health promotion because of incomprehensible understanding between the service units and the Office of the Auditor General and a lack of policy communication focused on the development of urban health services. The result showed that there could be 3 major options for urban health services system development in Health Region 3: 1) Management through single leadership of the MOPH (Current Model), 2) Management by collaboration between sectors through District Health Board (DHB), and 3) Management through transfer of health mission to the local governments. The assessment of the options showed that the current model may not be able to respond to the challenge effectively. The ideal option was management through the transfer of health mission to the local government, mainly because they were close to their people and could well understand their people’s health problem under the context of their areas, and can encouraged people to take responsibility for their health more effectively. However, these limitations were found; the government had yet to clarify the transfer of mission in relation to health services from the MOPH to the local governments, and, the local administration and personnel lacked the capacity to manage health services. This study proposed that a model of collaboration between sectors through DHB was the best option to move forward. This option could encourage all sectors to learn together and to become involved in the development of the primary care system in an urban setting collaboratively. It could encourage all related sectors, including the people, to have a better understanding of the roles and responsibilities of each sector and to lead to better self-management of the people in the future.


location: , 'Thailand year: 1999 source: HSRI

title: Monitoring and evaluation system for organization administration and for development of public hospital management policy

abstract: Monitoring and Evaluation System for Organization Administration and for Development of Public Hospital Management Policy	In this study, the monitoring and evaluation system on public hospital management in order to improve its policy was developed through the process of reviewing the administrative system of the sampled organizations, reviewing the monitoring system of the central agency, analyzing all the data and establishing recommendations for developing monitoring and evaluation tools. Qualitative technique was used in this study. The sampled organizations were the Banpaew Hospital, Samutsakorn Province, the Prince of Songkhla University Hospital, the special clinic of the Ramathibadee Hospital, the Rajyindee Hospital (private hospital in Haadyai, Songkhla Province), the Suranaree Technology University and the Central Organizations involved in monitoring and evaluation system. Key informants were high ranked people in the organizations, those who were responsible for auditing and evaluation, the operation staff and community representatives who were purposively selected. 	The sampled organizations possessed 2 main administrative structures, one largely directed by the higher level organizations and the other setting up the committee to determine their own policy and to control all important administrative work. One of the highlights of these organizations was their development of services quality on the basis of either hospital accreditation or ISO 9002 to quickly respond to various factors e.g. community demand and increasing competitive markets. The auditing and evaluation systems were grouped into part of administration, quality and operation, finance and assets, nursing and other functioning sections. The auditing could be done through the obvious and formal system, or informally internal auditing system or quality and financing control system without internal auditing system. The central organizations in this study were the Budget Bureau mainly responsible for auditing financial and accounting system, the Social Security Office having the Medical Committee and the Medical and Rehabilitation Coordinating Committee both of which monitor the health facilities providing care for the insured and the Hospital Accreditation Units responsible for developing care standards and encouraging the accreditation system in nationwide.	The committee which determine organization policy, monitor, evaluate and audit the organization, was recommended to set up. Such a committee should have representatives from communities, public organizations, networking organizations, the hospital, and well-experienced people in public health. The hospital administration committee should also be formed, composed of 2 groups: administrative and operational representatives. While internal auditing unit should be independent and should directly report to the policy committee. The auditing system should comprise service quality auditing and professional or special service auditing. The auditing and the reporting should be systematized whereas the auditing team and the auditing tools should be continuously developed.


location: , 'Thailand year: 2004 source: HSRI

title: HSRI mission and strategy development process study for goal achievement in the future 2005-2009

abstract: This report is an outcome of the study on how the Health Systems Research Institute (HSRI) obligates and would respond to its 5-year future purposes.  It also is the product of a study process that would be put together to lay a 3-year necessity plans (2005-2007). From trends and driving forces, the researcher has used a ‘Foresight’ strategy to lay future scenarios.  In-depth interviews with 20 public health management and services experts were conducted.  The interviews were integrated and have given 3 summaries.  They are:HSRI is an organization which creates and manages knowledge for the country’s development.Although this role is taken as a systematic organization, but because of changes occurring both inside and outside of the country, HSRI should administrate more on knowledge gained, researches and its management so the information could be converted into policies and actions. Linkage between knowledge found and how they could be implemented must not be separated.  Missing linkage, which is how knowledge and research outcome should be handled so the country’s public welfare is profited, must be handled.  It is important to link and empower scholarly research before they are systematically applied or be made policies.  This links to:2.  HSRI is an organization which manages knowledge systematically. The organization signifies knowledge management by pushing for a public policy, manage its structure and find networks and partnerships along with building knowledge and research.HSRI is an organization built for the public’s strenghten knowledge.  It emphasizes on the public’s self-reliance and participation in knowledge and research buildup.  The three summaries reflect that HSRI is the country’s mechanism and think tank for the health system.  This is an organization which could accurately forecast changes or adjustment in policy.  It could supply information for those provide knowledge and research-result for the public, such as government sectors, networks or institutes so they could create specific and direct research according to the social needs.  It also acts as a well-defined information center to help reduces investment risk for the private sectors thus, could produce or add more value to the country as a whole.Moreover, other organizations could use the knowledge HSRI provides to build up understanding and manage conflicts that might arise among them.


location: , 'Thailand year: 2003 source: HSRI

title: Fosters civil society approaches for drug abuse control and problem solving in community

abstract: This study was the participatory action research intending to use the process of education and development for fostering the civil society towards drug abused protection and problem solving in the communities namely Ban Rai-Dong and Ban Daui -Naog , Tumbol Khuw Mung, Saraphi District, Chaing Mai Province. There were three objectives for this research study ; to explore the social situation of community which foster to bring about civil society concerning with drug abuse control program and problem solving , to experiment the way to foster civil society and work process between the researcher team and community for drug abuse control and problem solving program, and to examine the effect of foster civil society by observing the  changes in community development process for drug abuse control and problem solving. Researchers had worked with people in community through the process of community study,  situation analysis of drug problem, and coordination to fosters civil society by people from other government and non–government organization (NGO) in this area.	The data on social situation and the role of community to solve the variety of problems in the communities were composed with a number of study methods including living in the communities, observation, interviewing the key informants, conducting the focus group discussion, then followed with the six steps using in the participatory action research. During the intervention period, researchers had observed, recorded all activity processes and summarized. The data were analyzed and proposed the way to foster civil society for drug abuse control and problem solving in these communities .	The result of study revealed that there were a number of skill developments occurred in the communities; (1) leader have more experience in community development, (2) people have much closer relationship, (3) helping each other when facing the problems, (4) obtaining information  continuous, and (5) promoting the civil society movement of people leaded to the better experiences in solving the various problems in these communities. For drug abuse problems, community tended to improve their experience in helping drug users, families, and people who had an effect from drug abuse through the community relationship and social mechanism. 	Resulting from the promotion of civil society movement for drug abuse control and problem solving in community demonstrated that this process leaded to the great benefit for people in communities because it increased the opportunity of people to participate in the  development processes and increased their understandable of the social problem and helped each other to determine the appropriate means to solve the problems occurred in the communities.  It was also the learning process for the communities and changed their attitude to drug users and their families. Besides, foster civil society had leaded people to increase their learning abilities for solving various social problems that increased with the dynamicity of the society with a sustainable development.


location: , 'Thailand year: 2015 source: HSRI

title: A  Development of Community Participation Model to Reduce Alcohol Consumption Behavior

abstract: The  purpose  of  the  research was to investigate model and study the effects of  the  community participation model to reduce alcohol consumption behavior. The study was
research and development, included 3 phases: the first phase was  to review documents and  urban context study, the second phase was to investigate community  participation  model and the final phase was to  the effects  of  the  community participation  model to reduce alcohol consumption behavior. The sample consisted of  30 leaders and others. The  research  instrument  was   empowerment  participation  action  research. Data were analyzed by the content analysis was also used.
	The  results  indicated  that  the  process for development of community participation model of reduce alcohol consumption behavior, the  sample consisted of  village leader, headman, village health volunteers,  teachers,  health officer, health leader and  the other  have  a  top level participation and more than 80 percentage of samples  participated  in  all  processes. The result of  the  community participation model to reduce alcohol consumption behavior included social measures by community, strong of community and network, people in community to reduce alcohol consumption behavior, the alcohol free zone in school temple and official place, many shops in the community not for sale alcohol drinking, the  people have knowledge about toxic alcohol and innovation of community to reduce alcohol consumption behavior.
	It can be conclude that the community participation model to reduce alcohol consumption behavior was an effective developing ability community and  to solve behavioral problems related to drinking behavior. Family and community  to be realize about health problems and behavior problems and it were made personal and community change for cooperation of community.


location: , 'Thailand year: 2022 source: HSRI

title: Thai Liver and Bile Duct Cancer Organoid Bank and Comprehensive Genetic/Drug Response Database for Biomarkers Discovery and Development of Personalized Treatment

abstract: Primary liver cancers, including both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), is an important cause of cancer-related deaths in Thailand and worldwide due to ineffectiveness of current available treatments. The recently developed organoid technology, which allows long-term culture of patient-derived liver cancer cells in 3D while maintaining morphology, expression pattern, and the genetic heterogeneity of the original tumors, has been shown to be powerful research tool for the discovery of biomarkers and therapeutic drugs for various cancers. In this study we successfully established 31 cancer organoids line from Thai patients with CCA and HCC, and characterized in detail these organoids with whole exome sequencing, whole transcriptomics study, single-cell RNA sequencing and pharmacophenotyping with various anticancer drugs. Our data shows patient specific response in CCA organoids and supports the usage of personalized treatment strategy for CCA. Moreover, we identified new potential biomarkers and novel compounds that can be applied to CCA management. One of the candidates for CCA drugs showed promising result in 3/3 PDX models tested. For HCC, although there is high heterogeneity among patients’ sample and limited drug response to standard drugs used in HCC management, we identified new subpopulation of HCC with high stemness, unique immunogenic profiles, and treatment response which may become interesting candidate for developing new treatment option for HCC. Overall, we successfully generate database and important tools for future development of new treatment for Thai patient with liver cancer.


location: , 'Thailand year: 2002 source: HSRI

title: Unmet need for drug therapy in hospital-visited patients

abstract: Unmet Need for Drug Therapy in Hospital-Visited Patients	This research aimed to analyze the issue of unmet need for drug therapy in hospital-visited patients.  Methods used in the study varied from physician interview, hospital policy survey, analysis of hospital databases, individual patient evaluation, to medical chart review.  Based on opinions of prescribing physicians, the unmet drug need problem tended to focus on expensive or newly marketed drug products, which were considered the target group in this study.  	Results from the hospital survey showed that some of the study drugs were not covered in drug formularies of several hospitals; whereas some were listed in restricted formularies.  In ten therapeutic drug classes, hospital database analysis revealed that out-patients under Low-Income Scheme were less likely to receive and to continue receiving the drugs as compared with those covered by Civil Servant Medical Benefit Scheme.  Disparity in the unmet drug need across patient payment schemes varied widely with respect to the drug classes and study hospitals.  This study confirmed adverse consequences due to inaccessibility to certain therapeutic modalities.  A case study on patients with end stage renal disease found that accessibility to renal replacement therapy by the Low-Income patients was much lower than in the Civil Servant Medical Benefit recipients, thus the former group faced a higher mortality rate.  Inaccessibility to appropriate choice of antibiotics would increase risk of death due to the fatal infectious disease like melioidosis in another case study. 	Four major policy recommendations were generated from this study.  First, standard data sets for drug prescribing and dispensing as well as drug coding harmonization should be developed.  All three health care financing agencies: Civil Servant Medical Benefit Scheme, Social Security Scheme, and Universal Health Care Coverage Scheme should set common structures of electronic files for recording drug utilization data.  Second, prior to use of the stored information, a set of criteria for drug use quality based on up-to-date medical knowledge should be established.  Information on the quality criteria could lead to an agreement among medical communities on variables needed to be specified in the standard data sets and on the way to measure quality of care.  Third, for the issue of health equity monitoring, this study showed high feasibility to assess the extent to which a need for drug therapy was unmet, especially for the drug products that were proven in their effectiveness and efficiency.  Lastly, it is possible to evaluate a policy aiming to increase health care productivity in the future.  The approach used in this study should be disseminated through hospital networks in order that results generated from analyses of drug use databases can be used for quality of care development.


location: , 'Thailand year: 2009 source: HSRI

title: A Study on the Four Dimensions of Health

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


location: , 'Thailand year: 2014 source: HSRI

title: Medication Use Behaviors among the Older Thai Adults

abstract: Inappropriate medication use behavior is one of major causes of drug related events which lead to acute episodes and hospital visits among older adults. The purposes of this study were to investigate medication use behaviors, determine factors related to medication use behaviors, and explore means to prevent and solve problems related to medication use behaviors among older Thai adults. Using a descriptive qualitative design, this study employed an in-depth interview in 23 adults aged 60 years and older who experienced drug-related problems on a hospital visit and their caregivers. The study focus groups were conducted in 26 health care personnel.
Using a content analysis, this study revealed that medication use behaviors required capability to perform medication administration and capability to make a proper decision. Medication use behaviors involved: medication use method (medication non-adherence and unsafe self-medication), making choices of drug sources, and keeping and dispensing medication. Factors related to medication use behaviors comprised (1) pre-existing factors including individual capacity factors (e.g. knowledge, attitude, memory, and vision), and daily activity factors (e.g. working job, social activities, and caring for others) (2) precipitating factors including disease manifestation (e.g. severity, duration), and response to medication (e.g. experience relief and side effect), and (3) modifying factors including social influences (family, health care personnel, and media), medication-related factors (medication regimen complexity), physical environment (distance to hospital), and financial status.
The results of this study proposed 3 approaches to solve the problems related to medication use behaviors: reactive, proactive and systematic approaches. The results can be used in nursing education and other allied disciplines. Suggestion for future research was to test the model of factors related to medication use behaviors and to determine influencing factors. The results of the study also suggested that national and local governments develop database network system, and provide services to fulfill basic needs of the older Thai adults.


location: , 'Thailand year: 2006 source: HSRI

title: Selection of arsenic field test kit in Ronpibun district

abstract: Lack of data showing the present arsenic contamination in Ronphibun has been a matter of public
health concern. Since arsenic contamination of shallow-well water in Amphur Ronphibun, Nakorn si thamarat
Province, had been found in 1985, interventions to reduce the use of the shallow-well water especially for
drinking and cooking have been implemented. However, a large number of shallow wells still exist and the
residents continue to use this water for domestic purposes. The residents are anxious about possible health
problems and the safety of using the water contaminated with arsenic.
Although an AAS is available in Ronphibun Hospital, fast analysis and accurate results of arsenic
analysis cannot be obtained because of problems with the instrument and not enough experience of the
analytical staff. We selected a test kit suitable for use in the field in Ronphibun, tested its accuracy and
investigated the feasibility of further arsenic measurement by Ronphibun people.
The test kit developed by Mahidol University met the criteria concerning cost, availability, ease of
use and interpretation and safety. Accuracy was evaluated using standard arsenic solutions in the laboratory in
Ronphibun Hospital, but the standard color chart of the AAN kit was found to give more accurate values.
A suitable range of measurement was between 100 and 200 ppb arsenic level and optimal reaction time was
20 minutes. Comparing the test kit readings with the AAS values of well water samples, 95 % of test kit
readings were within the range of -61 and +53 ppb around the AAS value. After training, groups of public
health staffs, health volunteers in villages and science teachers of junior high school in Tambon Ronphibun
measured arsenic levels in standard solution of 200 ppb using the kit with acceptable results, with 98 % of the
determinants falling in the range 150 to 250 ppb.
The procedure and results of arsenic analysis using the test kit in the field at Amphur Ronphibun were
shown to the group of the peoples, who well accepted the demonstration of arsenic as a colored result.
Measurement of arsenic levels by the people in Ronphibun using the test kit and with higher precision might
be possible after additional training and sufficient practice, in order to screen for elevated arsenic levels.


location: , 'Thailand year: 2001 source: HSRI

title: Epidemiology and health behavior on malaria of foreign labour in hign risk area, Ranong province

abstract: Epidemiology and Health Behavior on Malaria of  Foreign Labour in High risk Area,  Ranong Province	At the borderland ,a  lot of   foreigner  migrated   to work in illegal in  frontier country.    and they have a poor health.. The most common  of the endemic problem in the boarder of Thailand is Malaria and  it make a problem to Thais people who live  at the boarder of Thailand. 	This study  aimed to  compare  1)  malaria sick  rate  2) rate of malaria carrier 3) health behavior in prevention and curative . The  multiple stage  stratified method was used to select a  representative sample and divided in 3  groups and 200 subjects in each group.: Thais , Thais who habit closed to the foreign  labor and   pure foreign labor in Kra buri and la-oon district , Ranong Province . Data was collected by interview and focus group discussion.  	The results were:  60.3 % were male ,  40 %  worked in  a  rubber farm, 36.2  %  in  coffee  farm and also 13.7 % in the fruit farm and average age was 3730 years (sd.12.84), 15% of  subject got Malaria ,who 2 of 15 were Thais and 5 from 15 were Thais who habit closed to the foreign  labor and also 8 of 15 were foreign labor. Comparison of sick rate in  3 groups is not significantly different . Rate of carrier in the  foreign  labor  was 3.5 .Health behavior in  prevention and curative  were  significant different. In addition  ,the person who were not good in preventive behavior  more risky ( OR = 3.97 C.I. 0.12 – 12540) .the foreign labor  were more risky than Thais ( OR = 4.18 , C.I. 0.08-197.43) , age group upper than 45 were more risky than the lower ( OR 2.24 ,C.I. 0.08 –197.43) and  area of worked in  fruit farm was more risky (OR 2.04 C.I. 0.11 – 39.44)


location: , 'Thailand year: 2020 source: HSRI

title: A Systemic Review on Drug-repurposing and genetic based therapies for neuromuscular diseases

abstract: Neuromuscular diseases (NMD) are chronic non-communicable disorder mostly caused by genetic abnormality. NMD are considered rare and their treatments are mainly supportive treatment. Genetic-based therapy is a promising specific treatment for the diseases. However, most of them are still in clinical trial phase 2, 3 and expected to be costly and not available in the very near future. We aimed to conduct systematic review of the medical treatments for NMD including repurposing drugs and genetic-based therapy in order to identify best available treatments and prepare for commercial genetic-based therapy. The outcomes of the study are systematic review of the treatments for NMD and a meta-analysis of genetic-based therapy as well as cost of illness in Duchenne Muscular Dystrophy that are expected to shape the treatment guideline in medical practice and contribute the regulation of national drug list.


location: , 'Thailand year: 2017 source: HSRI

title: Implementation, Obstacles and Needs of Hospitals in Thailand in Preventing Tuberculosis Transmission

abstract: Transmission of tuberculosis (TB) has a negative impact on patients, personnel and hospitals.
This descriptive study aimed to determine implementation, obstacles and supporting needs of Thai
hospitals in preventing TB transmission. Data were collected by using self-administered questionnaire
developed by the researchers from the Guidelines for Preventing the Transmission of Mycobacterium
tuberculosis in Health-Care Settings 2005 of the US Centers for Disease Control and Prevention.
The questionnaire was sent to an infection control nurse of 524 hospitals, including 93 regional and
general government hospitals, 316 community hospitals randomly selected from 45% of all community
government hospitals, 8 university government hospitals, 33 other government hospitals and 74
private hospitals randomly selected from 111 private hospitals with 100 beds and more in all regions
of the country. The study was conducted during May to September 2009. The response rate was
72.5%.
The study results revealed that 93.6%, 73.9% and 47.3% of hospitals have implemented
measures of respiratory tract disease prevention, administrative controls, and environmental controls,
respectively. The most important obstacle in preventing TB transmission in hospitals was an
insufficient number of isolation rooms (80.2%), other obstacles were having an inappropriate area to
conduct the physical examination for TB patients (51.8%) and insufficient time for screening suspected
TB patients (50.2%). Most hospitals needed technical support for their ventilation system (86.3%),
training for personnel in charge of TB patients (76.8%), guidelines for preventing TB transmission in
hospitals (71.3%), guidelines for screening TB patients in the outpatient department (69.7%) and
screening forms for TB patients (60.2%).
Relevant organization should provide guidelines for preventing TB transmission, including guideline
for educating hospital personnel on caring for TB patients and preventing TB transmission for
every hospital and support expert consultation on hospital environment, especially ventilation
system, so that the hospitals can prevent TB transmission efficiently.


location: , 'Thailand year: 2005 source: HSRI

title: Universal Health Coverage Schemes in Thailand 2002-2003

abstract: This report is part of the research project “Monitoring and Evaluating Universal Health Care Coverage in Thailand” The report summarizes major changes and adjustments in the three major schemes in the Fiscal Years 2002-2003, namely, (1) Civil Servant Medical Benefit Scheme (CSMBS), (2) Social Security Scheme (SSS) and Worker Compensation Fund, and (3) 30 Baht Scheme. The study also look into the Car-accident Compensation Scheme, which could be considered a supplemental scheme.	CSMBS provides health care benefits to government officials and their dependent (parents and up to three children) The scheme covers roughly 4 million people and the cost is 26 billion baht for 2003. The payment mechanism is retrospective fee-for-service. During the past 13 years (1988-2001), the program cost has increased six-fold, averaging 15 percent per annum. SSS is primarily a compulsory scheme that covers about 8.3 million private employees in the formal sector. The scheme imposes mandatory social security taxes from the employer, employees, and the government, to the social security fund, and provides health care benefits to the insured as one of its seven benefits. Health care cost for work-related accidents and injuries are paid for by the Worker Compensation Fund, which is also administered by the Social Security Office and collects premiums solely from the employers. Those insured by the SSS can choose a hospital listed as the main-contractor. The payment mechanism of the scheme to the health care providers is mainly prospective per capitation. (The Worker Compensation Fund pay the hospitals on fee-for-service, but with a ceiling per accident or injury). So hospital-based data suggest that the number of outpatient visits increased substantially in 2002 and continued to rise in 2003. The number of admissions and inpatient day also increased in both years. The utilization rate of outpatient for those who eligible for the 30 Baht scheme-except for those who were originally from the HWPLID—is lower than those in SSS and CSMBS (except in the Northern Region where those in the 30 Baht Scheme have the highest utilization rate for outpatients). As for inpatients, those in the 30 Baht Scheme had an admission rate higher than those in SSS, but clearly lower than those in CSMBS who had the highest rate of admission and the highest length of stay. Those in the 30 Baht Scheme had the highest referral rate, but part of their increased visits and referrals could be caused by the regulation that a patient has to seek care from the designated hospital first.	Since the three major health insurance schemes are unlikely to merge in the near future, there have been concerns on equity and overlapping coverage. Part of the overlapping coverage is due to incentive problem : multiple cardholders still benefit from having more than one card as there has been no one dominant scheme under which the benefit package is better than other schemes in every aspect. One plausible measure to solve the incentive problem is to elevate certain benefits under the CSMBS that are still below than those of the SSS and the 30 Baht scheme and also elevate certain benefit of the SSS that are still below that of the 30 Baht scheme. In addition, reform on payment mechanisms is needed to curtail health provider’s incentive in having double/multiple standards in taking care of patients under different schemes.


location: , 'Thailand year: 2016 source: HSRI

title: Factors Affecting Thai Elderly Families Hardship

abstract: This paper aimed to study the elderly families situations and factors contributing to the elderly
families hardship in 10 provinces of Thailand. The study applied quantitative and qualitative methods to
collect data; from selected 4,561 elderly families using quantitative method and another 214 using focus groups interview with community officers and families with home dwelling elderly. The collected data
was analyzed using descriptive statistics and content analysis.
Overall, the study found that half of the surveyed families were families with the elderly who looked
after children in the families, following elderly living alone and living with their spouse respectively.
There were more than half of the elderly who had ability for self-caring and moderate caring for other
members. Level of relationship among other families members were no significant different at all levels;
good/moderate/bad. There was 1 in 3 of the elderly who responded that they had poor economic selfreliance.
For the type of support, the elderly dwelling with disabled person reported the highest hardship
and the need of dietary/feeding was the most expected support; whilst the elderly dwelling with children
reported highest need on financial support. Factors having high impact on hardship of the elderly families
were residential area, family profile, income, asset, saving, debt, and burden of caring on any family
member of elderly/child/disabled (p-value <0.001), including mental state, 4 basic needs of life, family/
community relationship, ability to access rights and social welfare.
The study recommended that social welfare should be fair, systematic including enhancing community
participation in promoting health and well-being among aging people. Lastly, further in-depth study
on factors influencing family health and caring for the elderly ought to be accelerated to promote better
quality of life for the elderly.


location: , 'Thailand year: 2023 source: HSRI

title: Cost Analysis of Outpatient Services for Hypertension, Heart Attack, and Stroke among Older Adults in Community Hospitals in Thailand

abstract: The purpose of this study was to estimate the cost of outpatient care for older patients with a primary diagnosis of hypertension, heart attack, and stroke at community hospitals in Thailand. This cross-sectional study used cost information in 2014 from four community hospitals. The hospital cost information consisted of service data, hospital statistics, and financial reports. We used the International Classification of Diseases (ICD-10), the 10th revision coding system to identify hypertension, heart attack, and stroke. Traditional cost and the cost to charge ratio methods were used to estimate average cost per visit and cost per person-year. Inflation rate was used to report the average cost in 2021. Overall, the major costs were for labor (53%), followed by material (42%), and capital (6%). The unit cost per visit for older outpatients in 2014 was between 447-688 THB for hypertension (531-817 THB in 2021), 634-1,171 THB for heart attack (753-1,392 THB in 2021), and 611-1,238 THB for stroke (726-1,470 THB in 2021). Our cost analysis used actual cost data, which provided useful information for budgetary planning and management for outpatient care among older adults with a primary diagnosis of hypertension, heart attack, and stroke.


location: , 'Thailand year: 2023 source: HSRI

title: Cost of Health Service Model for COVID-19 Inpatient Care in Thailand: A Case Study of 5 Hospitals

abstract: This research aimed to study the cost of health service model for COVID-19 inpatient care that hospitals provided according to the level of inpatient’s condition. The data were from a 5-hospitals case study in Thailand, employing a standardized top-down cost analysis and the micro-costing method based on provider perspective. Three regional and two general hospitals participated by providing hospital data of the fiscal year 2021. There were 7 health service models under study: 1) cohort ward 2) intensive care unit-cohort ward 3) hospitel 4) field hospital 5) field hospital for prisoners 6) home isolation and 7) community isolation. The average cost of treating COVID-19 patients was 31,342 baht per case for the average length of stay (aLOS) of 10.9 days. The cost at the ICU-cohort ward was the highest at 187,257 baht per case, followed by the cost at the cohort ward at 62,033 baht per case and the lowest cost at community isolation at 4,532 baht per case. For COVID-19 patients who experienced more than one service models due to clinical condition change, the average total cost was 91,568 baht per case for aLOS of 11.0 days for those cared in community then moved to hospital; and 149,844 baht per case with aLOS of 12.1 days for those cared in cohort ward then moved to ICU-cohort ward. The results of this study demonstrating different resource uses by service models could be used to evaluate the amount of COVID-19 budgets that health insurance funds made available and paid for service delivery of the hospital compared to the actual cost by service model.


location: , 'Thailand year: 2022 source: HSRI

title: Policy Study for the Next Decade on Accessibility to Healthcare Services Among the Elderly in Pathum Thani Province, Thailand During the Fifth Wave of COVID-19

abstract: The impact of the COVID-19 epidemic as a result to change the service patterns at all levels of hospitals. The elderly has limited perception of the health care system. The situation of the outbreak of COVID-19 making access to health services more restrictive. This mixed method research aimed 1) to study the situation of accessibility to healthcare services among the elderly, 2) examine the factors predicting access to health services among the elderly with internal factors, interpersonal factor, and organizational factor. By using the quantitative method, the data were collected from 422 elderly persons aged 60 years and over who living in Pathum Thani Province. The data were collected from June to July, 2022 by using interview forms. The results were analyzed using descriptive statistics and Stepwise multiple regression. Aimed 3) to study the guidelines for improving accessibility to health services for the elderly in the context of the Covid-19 epidemic situation and in the next 10 years to support the emergence of new diseases, 4) to suggest policies for improving accessibility to health services for the elderly in the context of the COVID-19 epidemic situation and in the next 10 years to support emerging diseases. By using the qualitative method, the data were collected from 45 people of public health personnel and person who involved in access to health services of the elderly. The data were collected from August to September, 2022 by focus group interview. Qualitative data were analyzed by content analysis method. The results of the quantitative study revealed that the majority of the sample groups were female, 73.7%, with mean aged 68.94+6.51 years. The most service facility used by the elderly when they were sick or feeling unwell was pharmacy, accounting for 55.9%, followed by the sub-district health promoting hospital, 23.7%. As for the services that the elderly used the most to see a doctor or receiving medication by appointment was at the sub-district health promoting hospitals at 33.2%, followed by the district hospital at 28.2%. Overall accessibility to health services for the elderly was at a moderate level (19.4 percent), followed by a high level (17.8 percent). The results of Stepwise Multiple Regression statistic was found that the factors predicting the elderly's access to health services with statistical significance (p-value<0.05) were satisfaction to the health care service, perceived health status, age and income. These variables accounted for 34 percent of the elderly's variation in access to health services (R2=0.34). The results of the qualitative study on the approach to improve accessibility to health services for the elderly in the context of the COVID-19 epidemic situation and in the next 10 years to support emerging/re-emerging diseases revealed that there must be sufficient preparation in the service system which consists of personnel with potential in knowledge and skills in caring for the elderly. The location is convenient for access to services and adequate support for clients. Tools, equipment and medical supplies are always adequate and the arrangement of long-distance service systems (Telemedicine). It is also necessary to prepare the elderly to have health knowledge and technological literacy to access health information including the development of a service system that coordinates operations with local government organizations. Policy recommendations from the study consisted of 4 aspects: 1) Service aspect by developing a long-distance health service system, develop a proactive service system, applying technology to service, develop a service unit for the elderly, developing case management, develop hospital beds at home and coordinate operations with local authorities 2) Academics aspect by developing curriculum, arrange academic services, determine learning outcome according to the National Higher Education Qualifications Framework, develop curriculum identities and develop a network in educational management 3) Research aspect by researching drug and vaccine, development research and innovation toward enhancing health literacy and technology literacy; and 4) administrative policies of public health agencies and local administrative organizations to allocate budgets for producing and developing personnel, procurement of tools, medical supplies, building and expanding service units to care for the elderly.


location: , 'Thailand year: 2008 source: HSRI

title: A Survey of Health Promotion of Local Administrative Organizations

abstract: The purpose of this descriptive study was to explore health promotion processes of Local Administrative
Organizations (LAOs). Data were collected by using mail questionnaires from May to December
2007. The subjects were 950 executives of LAOs obtained by stratification and simple random sampling. Five hundred and thirty-two LAOs responded to the questionnaires (56.0 %). The results showed that the
scores of LAOs’ health promotion processes were at a moderate level (54.5 %). The majority of LAOs did
not have a division of public health in their organization’s structure (62.8 %), had a health promotion
policy (51.7 %) but the specified policy constituted a real policy for only 7.5 percent of them, had health
promotion plans/projects (95.7%), and supported budgets and materials for other institutes for health
promotion processes (89.5%). However, health promotion processes were evaluated and used for improvement
in only 38.9 percent of the LAOs. The majority of LAOs did not receive materials and budgets
from other institutes in 78.0 and 61.7 percent, respectively, but did receive mass media and knowledge in
70.3 and 65.4 percent of them, respectively. The LAOs needed support from the Thai Health Promotion
Foundation, National Health Security Office and Provincial Public Health Offices in 94.0, 91.0, and 89.5
percent, respectively. Major problems in the health promotion processes of LAOs were a lack of public
health personnel, budget and knowledge of health promotion.
The recommendations from this research are to integrate policies at the ministerial level, and to set
the standards of health processes and evaluation in the same direction for all provinces, districts and
subdistrict. The LAOs should establish a division of public health in their structure, enact local legislation
concerning health promotion, support budget and health personnel, and train the leaders of LAOs about
the vision of health promotion. Moreover, public health organizations should promote self-care, give
advice and vigorously act as advisor of the LAOs in terms of health promotion.


location: , 'Thailand year: 2008 source: HSRI

title: A case study of an experiment to transfer a health center to local administration organization, from a health center to Bangnomkho Municipality, Sena district, Phranakhon Si Ayutthaya

abstract: The study and summary of a case study of an experiment to transfer a health center to local administration organization, from a health center to Bangnomkho Municipality, Sena district, Phranakhon Si Ayutthaya.  The objectives of the study are: 1) to study the process of establishment, techniques, and the actual transfer compared with determined principles, criteria, and important conditions; 2) to follow up product, result, and impact occurring from the transfer; 3) to analyze and summarize a lesson which has been transferred by comparing the expectation and actual events, and 4) to create policy suggestion, techniques, structure, conditions, and components of the transfer.  A purposive sampling was used and consisting of provincial locals, experts, public health officers of the province, public health officers of the district,  health center officers, public health volunteers, people’s representatives, and health center’s service users from the levels of province, district, and locals, from local administration organization, public health, people from 3 villages with a total of 377 people. The study covers 3 phases: before the transfer, during the transfer, and after the transfer. Research tools were unstructured interview, After Reaction Review (AAR), and structured interview.
The result reveals that the transfer which relates to quality of life promotion follows the Royal Act which determines plans and procedures of power decentralization to local administration organizations 1998.  According to a resolution of the committee of power decentralization to local administration organizations, the main factor is law.  The reasons are: 1) the readiness of Bangnomkho Sub-district Administration Organization, which received an outstanding award in management in 2006; 2) the Organization has been appointed as a pioneered Sub-District Administration Organization in transferring missions, and 3) from the evaluation, the community is ready and has received the approval from the committee of Sub-District Administration Organization Council.  The second factor is the volunteering wills of health center officials.
	The process of transferring includes the meeting of the province’s sub-committee before the transfer.  They helped each other to study the transfer according to the mission in order to build up confidence of the officers who received the transfer. After the transfer, the Bangnomkho Sub-District Municipality gave the importance to health of people in the community by allocating the budgets to be used to promote quality of life, to support the purchase of materials, buildings, and others as well as following the plan which was set in the sub-district development plan.  Concerning the arrangement of a stage to analyze and summarize the lesson using AAR, the expectation from people concerned, their roles, and participation in the transfer of health center in the provincial level showed that Bangnomkho had a strength and also a weakness which could obviously be improved in a national level.  At a district level, it is believed that people’s ways of life did not change. After the health center was transferred, there would be more chance to take care of people’s health.  The health center officials were confident that it would be improved.  The health center’s service users hoped that the services would be better.  Regarding the change of services in health care before and after the transfer and its processes, people were interested in following the news of the transfer the health center to be under the supervision of the municipality.  They were aware of the result of the transfer of Bangnomkho Health Center.  As for the level of people’s participation in the transfer both before and after, it was found that they did not participate in any aspect.  Concerning the effect of health services, comparing before and after the transfer, both overall and in each aspect were found better.  After the transfer, the level of change was positively higher.
       The suggestions from the research in transferring public health in a district level based on the central policy are: 1) high ranking authorities should have a meeting, consultation, and discussion and work together to set up cooperative policy both from the Ministry of Public Health and Local Administration Organizations to make the transfer clearer in terms of length, clauses in law, measures which can lead to real situations; 2) the public health offices in the province and local area should initially promote the transfer to related people so that they can understand the policy and guidelines as well as providing information and consultation about administration, personnel, and budgets; 3) operational suggestions pertaining to health services in the municipality area, study of public health knowledge, lack of medical personnel, strategic plans to produce personnel, develop, promote, and support personnel in terms of knowledge, behavior, attitude in order to prevent diseases, self-caring rather than depending on medical treatment; 4) the analysis of the effect of health care services comparing before and after the transfer, the overall change indicated better condition, though it was not much because the study period was only 5 months, and 5) the participation of people in the transfer should not be only for awareness or receiving services, they should take part in the process of planning, providing more operational support so as to create more self-dependence in community health care


location: , 'Thailand year: 1998 source: HSRI

title: Whether MDR-TB(multi drug resistance TB) had devastated Thailand : 55 articles reviewed during 1968 to 1998

abstract: Whether MDR-TB (multi-drug resistance TB) had devastated Thailand: 55 articles reviewed between 1968 and 1998Multi-drug resistant tuberculosis have been regarded as the third epidemic and become global emergency since 1993. The multi-drug resistant TB is at least resistant to 2 drugs which are isoniazid and rifampicin. The MDR-TB is uncured despite its rare occurrence. A major cause of MDR-TB is either irregular drug taking or not completing course of drug taking. In 1997, the WHO reported Thailand’s MDR-TB at around 3000 cases considered as high tendency. By December 1998, the rate of drug resistant TB was 26%, 13% to isoniazid, 12% to streptomycin, 7% to rifampicin, 7% to ethambutol and 3% to multi-drugs. Compared between 1968 and 1998, the percentages of drug resistant TB had increased for each drug. Factors related to drug resistant TB were number of lesions in lungs, family history of TB and HIV positive history while factors related to MDR-TB were history of TB treatment, TB family history and HIV positive historyThe paper recommends development of effective and continuous TB program implementation and evaluation, quality of the DOTs, quality of lab testing and its network and effective information system. In terms of research and development, factors related to treatment success for MDR-TB should be studied and treatment evaluation should be performed according to national TB control by Ministry of Public Health.


location: , 'Thailand year: 2014 source: HSRI

title: The evaluation of the health promotion and disease prevention projects funded in the fiscal year 2011 by the National Health Security Office, Region 7, Khon Kaen

abstract: Worthiness of investment in the health promotion programs remains a question. The objective of
this study was to evaluate the achievement of the projects supported by the health promotion and disease
prevention fund in the fiscal year 2011. The project based evaluation following CIPP model was used.
Project documents and opinions of the program head and program participants were assessed. Two questionnaires were developed. The study was done between December 2012 and December 2013. Twentyseven
projects met study criteria. Of these, 11 projects had outcome measurements which mostly were
humanistic outcomes (68.57%). Of 577 self-administered questionnaires sent, the response rates were 59.26-
54.55%. Most scores of CIPP dimensions were at high to very high levels. The evaluation revealed the
lowest scores in the context; use of the information of the community need; the input; support from other
sources; the process; public relations; the product; continuous budget support. There was high satisfaction
of participants for an opportunity to get involved. Three out of four projects were found net benefits.
In conclusion, most projects had a high level of the achievement from 3 perspectives. Nevertheless, the
projects need to further develop for a project framework and clear defined outcomes which directly occurred
to the patients.


location: , 'Thailand year: 2003 source: HSRI

title: Building community learning process on health impact assessment from water pollution : A case study of Nakornnayok river Thailand

abstract: Local farmers who living within Nakornnayok sub-watershed daily used river waters for their household consumption, irrigations rice paddock, horticulture and aquaculture.  Those waters were abstracted and supplied through interconnected irrigation canals while the water flows controlled by many mechanical gates.  Wastewater discharged from cities, landfills, factories and others all flowed into those irrigated canals where accumulated much pollution and therefore often occurred at the riverbed downstream especially at Ban Na district and its surrounding neighbors.  Such pollution became intense since 1997 onwards, while the locals requested a helping hand from the provincial but such authority seemed rather had a limited capacity to deal with that problem.  The locals hence still widely faced critical health hazards, particularly with skin diseases when contacted with those polluted waters, while moreover the river waters could not be longer used for daily consumption.  The “perish green water” was commonly the so-called by many locals as the major cause of that  detrimental health hazards.  The locals eventually requested the Health Systems Research Institute researchers to explore any opportunities to alleviate such that problem. The research team agreed to apply the planned participatory action research type introducing to this case, while encouraged the locals to actively participate at every step of research implementation activities.  The study was conducted during January-June 2003.  The research framework was then logically organized focusing on building local learning process to exploring existing problems, rationalizing cause and effects of the problem encountered and eventually collectively finding the resolution measures.  The research activities eventually chronologically outlined were (1) exploring the scope of health impacts temporally and spatially using local health database, (2) selecting the highest health hazard prevalence within communities using focus group and in-depth interview techniques as to fine tune the impacts at individuals, family and community levels, (3) building local capacities on examination techniques on water pollution testing and its origin exploration, (4) using a mapping technique to associate water pollution occurrence and health impacts emerged, (5) organizing a local meeting to verify a study reported on fact findings, and (6) hosting the stakeholders meeting aimed to deliver the study results, and let the local representatives presented and proposed the mitigation measures, as expected to achieve a consensus agreement locally proposed to the provincial authorities to further develop policy and plan for pollution abatement.	This action research result eventually led to positive policy changed impact while the Nakornnayok provincial authority admitted to revise its environmental plan while much focused on resolving water pollution at the first priority.  The former activities listed in the environmental plan therefore has been changed and redirected in response to the local needs.  Further, the provincial also requested the municipalities, factories, irrigation authorities and sub-district administrations to revise their environmental related plan, and resubmitted to the provincial board.  The overall study result implied that the health impact assessment used by this study could be acted as a tool to further create local healthy public policy.  The learning process introduced by this study also proved to be an critical driving force, however such condition the locals still needed any organizations to helps them to develop success healthy public policy which originated from the grassroots.


location: , 'Thailand year: 2003 source: HSRI

title: Project for potential development of high risk students for drug addiction in a large secondary school of elementary education department

abstract: Project for potential development of high risk students for drug addiction in a large secondary school of elementary education department	The aim of this project is to develop student potential for avoiding drugs taking  by involving various groups of people in and outside school.  This project is just only first step of all the process.  It is just to get present situation and means to solve the problem from the various groups of people.	The project started with development of researchers of the two institutes;  Khamkaen Nakorn  secondary school  and  DRC in Khon Kaen province.  They were learned and practiced how to use PAR for data collection from the PAR experts in Khon Kaen university.  From this process,  the researchers were changed their  idea and concept for solving the problem.  They are more positive and more understanding the students’ problem and trying to help them.	Data were also collected from parents and community where students live.  This process make teachers and community  cooperate and coordinate in solving the problem.  Previously parents thought that it is not their role and it is  teacher’s duty only.  After focus group discussion, parents and community understand that they have to work with teachers.  They suggested that all should have common activities.	From this study it is found that PAR is very important tool in changing the ways of thinking in all groups but it takes time and money.  However, the process is still needed to get a suitable development.  So the second phase of the project should be developed and launched soon.


location: , 'Thailand year: 2001 source: HSRI

title: Macro-economic indices for measuring equity in health finance and delivery 1986-1998

abstract: Macro-economic indices for measuring equity in health finance and delivery 1986-1998	Explicit policy on health equity will create demand to measure and monitor the achievements of health equity in the country.  At least three disciplines express concerns on health equity: public health, economics and social science.  This study employed the macro-economic indices to measure equity in health finance and health delivery.  The interpretation of equity in health finance was based on the principle of ability to pay.  Kakwani index of progressivity was used to reflect the ability to pay of each source of health finance.  Equity in health delivery was interpreted that health care be allocated according to health need.  Those who were sicker should seek more care than the healthier.  The concentration index was used to measure equity of health delivery.	The National Statistical Office’s socioeconomic and health and welfare surveys during 1986 to 1998 were used to demonstrate the equity trends in Thailand.  Since the health and welfare surveys contained no data on household income, the indirect method was used to map the income of the household in the socioeconomic surveys to household in the health and welfare surveys by education and occupation of household heads.	Kakwani indices proved that health finance system was regressive to income, the trend established less regressivity from 1986 to 1996.  The causes of inequity were explained by an increase trend of income disparity (by the Gini coefficient) and the regressivity of Kakwani indices for both public and private sources of finance.	Concentration indices for health problems were also regressive to income, i.e. the poor were more ill than the rich.  When compare illness with delivery (seek care from drug store, health centre, clinic, public and private hospitals), the concentration indices showed progressivity patterns, i.e. the rich were more likely to use health care, controlling for same health need.  Further standardisation removing the effects of age and sex, the inequity patterns slightly reduced.	This research suggested that the health equity policy goal in Thailand should be more explicit.  Especially, the goal of equity in health finance should be set by reducing income distribution disparity, the progressivity of the whole tax system and contribution from the social security scheme, with less emphasis on the user fee at the point of delivery.  Information system should be improved to help monitor equity in health delivery.


location: , 'Thailand year: 2022 source: HSRI

title: Understanding the Impact of COVID-19 to Improve Our Health Care System Responses: Turning Crisis into Opportunities

abstract: The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe and impacted everyone, everywhere. Despite COVID-19’s negative impact in several aspects, this pandemic has created an opportunity for researchers to explore new research questions and approaches to the challenging situation which the world is facing with the overall aim to support our communities. The purpose of this study was to address policy-relevant questions arising from the COVID-19 pandemic by investigating the impact of COVID-19 on outpatient (OPD) and inpatient (IPD) service utilization, ambulatory care sensitive conditions (ACSCs), mental health, low-value care (LVC), and mortality. Literature reviews and analyses of real world data from existing administrative databases were used to achieve the overall goal of creating evidence to support the healthcare system in Thailand. In conclusion, this study can consider to be the first study that use real-world data from existing administrative databases to address policy questions. The study delivers outputs on two main areas: 1) answering policy-related questions; and 2) raising new topics for future research based on the study results. This study seeks to turn a crisis into an opportunity and our research team hope that it will help spark and create a foundation for many further studies.


location: , 'Thailand year: 2001 source: HSRI

title: Health systems reform in England

abstract: Health Systems Reform in EnglandHistory of NHS	In England, the health system is national Health service (NHS). In 1997, NHS had about one million employees with a budget of 45 billion pounds, making it one of the largest organizations in the world.	 Before the NHS,  health care was in the form of  fragmented services run by various organizations. There was no single main institution responsible for coordinating the services. 	In 1911 the government enacted  the law “ National Insurance Act” with the aim to serve the work force, but the provision did not cover their immediate family members.	In 1942 Sir William Beveridge gave a report which was the start of the policy of comprehensive health care for all people. Anerin Bevan, Secretary of State for Health of the Labour government, succeeded in negotiating with the doctors and brought about the law to start National Health Service in 1946.	 NHS was originated on July 5th 1948.  NHS  is the second institution next to the Monarchy that  the British people take pride in.  Anerin Bevan was the architect of it and was considered the best political achievement  by the Labour party.Problems and drives that led to health care reform	 The principle of  the NHS is free comprehensive health care at the point of use regardless of the status of the people, i.e. equity. NHS is funded by general taxation. The  problems and  drives to reform the NHS can be traced back to the beginning of NHS due to two original conflicts:The conflict between centralized and  autonomous  management of its organization structures.The conflict between the medical profession and the government. The government funds NHS and wants some control but the doctors give service and want professional autonomy without scrutiny from the government.NHS success became its own enemy in a few years of it running. When the government promised to give free delivery of care, the obvious problem was the inability to meet the financial obligations when faced with increasing health care cost and demand. There have been accusations all along that every government has not given enough funding to the NHS.The complaints had increased since Margaret Thatcher came into power in 1979, leading to the radical reform in 1990.	The British government spends less money for health system compared to that of other developed European countries, amounting to 6.6% of GDP whereas other developed European countries spend about 8-9% and the USA, 15-16%. NHS has produced comparative health outcomes to other countries; however, the British people are still not satisfied.Reform Process NHS changed very little during the 1950s and NHS drifted without clear direction until 1962 when strategic management was introduced to guide the development.In 1974, there was the first structural reform, introducing more planning and integration of the services. The reform was apparently unsuccessful. There was no genuine attempts to challenge the medical profession, which was the centre of real power in the NHS. Eventually the conflict between the doctors and management remained. There was no mechanism to get the doctor to account for their work to the management.In 1979, there was another attempt to reform NHS, leading to the second structural reform in 1982. However there were only a few changes to the organization.In 1983, the conservative government brought in successful businessmen as advisers. One of them was Sir Roy Griffith, who was asked by the government to report on the conditions and ways to improve the  efficiency of NHS. The 24-page report by Sir Roy Griffith was very powerful in bringing about huge changes in NHS. General managers were speedily introduced into NHS in 1984, commencing the era of bargaining with the medical profession.In 1988, Magaret Thatcher announced a radical reform, leading to the significant White Paper: Working for Patients, which proposed unprecedented radical reform of health system. It was followed by the National Health Service and Community Care Act 1990 to start the reform.One of Thatcher’s political ideals is that government institutions and bureaucracy are inefficient and need transformation into a more corporate and market system in order to be more efficient.Strategies of NHS reform 1990	The process of change was inevitable  because of mounting public pressures to the government. The main strategies used was managerialism . All kinds of management techniques were used such as quality assurance , performance indicators, management for excellence, etc. Market competition was instituted.	The strategies for this 1990 reform were as follows:Delegation of power and setting up of autonomous bodies such as NHS Trusts and GP fundholdingInternal market.New funding systemDecreasing the power of medical professionStrengthening primary care system by giving importance to GPs and creating GP fundholding.Essence of 1990 reform	 The essence of 1990 reform was the creation of the split between providers and purchasers of health care. Hospitals were encouraged to become autonomous by being a NHS trust, answerable directly to the Secretary of State for Health. At present all hospitals in England are autonomous NHS trusts.	GP fundholding would act as purchasers of health care on behalf of the patient. It received and could manage its own budgets and could enter into contracts with any provider the GP fundholder saw as giving the best deal.. If the money was saved from the efficient management of the budget. The fundholder could use the money left for developing the practice, which was a new power they never had before.	What bound the provider and the purchaser was a contract, leading to an internal market.	The process of decreasing the power of the doctors was done by having systems like medical audit and doctors’ accountability of their actions to the management. The doctors was no longer free to do whatever they like as it may cause purchasers not to buy the hospital services.Human Resources and Manpower DevelopmentPhilosophy of  human resourcesServices and human resources planning have to go together. The policy about human resources in NHS is still not clear in the midst of many changes that are taking place in NHS. Prior to 1970s there had been no clear direction of the services. Each health care  profession  was quite independent of one another. In 1980 the Medical Manpower Steering Group reported that planning for medical manpower was extremely difficult due to the uncertain future of the NHS.Future Medical Manpower	There were 102610 doctors in the NHS in 1996 which was 1.7 per one thousand population.. According to the Medical Workforce Standing Advisory Committee report by the Department of Health, a study on  future delivery patterns and needs for doctors, it  found that 76% of NHS doctors were British graduates. It also recommended that , under the present situations, the chance of  having a surplus of doctors was slim and there should be 1.7% annual increase of the number of doctors. The methods to achieve this aim were as follows:to recruit more overseas doctors.to maintain the number of present working doctors.To produce more doctors byincreasing the number of medical schools expanding the existing medical schoolsincreasing the new intake of medical students by 1,000 per year.Future Direction of Manpower Development	In 1998, the government  produced a document called Working Together: Securing A Quality of Workforce for the NHS, which stated that every  hospital trust and employer would have to complete the manpower planning by April 2000, including the plan for producing and developing  most health care professionals in the NHS   to have a link between the education of  manpower and the delivery of services.	 Because of inadequate data,  planning was very difficult. However King’s Fund had the following recommendation:There must be a long term  and realistic planning , taking into consideration the boundaries between health care professionals so that there may be ways to predict the number of professionals needed.There must be a concrete link between the training of health care professionals and the services requirement in the NHS. There should be emphasis on overall management of the NHS system and the cooperation between the managers and the professionals. There should be a comprehensive analysis and synthesis of data and research on human resources.Technology Control and Regulation	New technology has to be assessed strongly and continually for its cost effectiveness, efficiency , safety and use-appropriateness.	There has been increasing evidence that some technology is unnecessary and misused. Most western developed countries have  a system of intensive regulation of medical technology in four dimensions:SafetyEfficacy StatusEffectiveness in general practiceEfficiency England uses the budgets limit measure to regulate medical technology. An organization, called National Coordinating Centre for Health Technology Assessment at Winchester, is responsible for disseminating information about technology  assessment and distribution. In addition, the Royal Colleges of various medical specialties have their own registration of medical equipment and training of the use of medical technology. The Department of Health also has a committee called Standing on Health Technology Assessment to advise on the need for new technology.	However there is no central body to control expensive medical technology. Nor is there a law for such matter. Only through advice, cooperation, negotiation and peer pressure is control and regulation being done.Consumer Roles and ProtectionPhilosophy and evolution of the relation between NHS and its ConsumersThere are three models for health care system:Market Model: health care is treated as a kind of  goods which is regulated by  market mechanism of  demand and supply. Consumers have choice to choose the goods, but in reality health care does not seem to follow the market mechanism alone.Professional Model: This is based on the fact that doctors know best and should make the decision for the patientsBureaucratic Models: The state must intervene to provide health care  in order to have equality and to protect the best interest of the public.England uses the mixture of second and third models, although it seems that the first model has been in operation since the 1990 reform. In fact the public still have little choice. People have some choices regarding GP and hospital accessibility but once they are with the professional, they are hardly involved in making decision about the care.Compared to other public organizations, NHS lacks direct democratic accountability as there is no public representative  unlike local authorities, etc. NHS has indirect accountability through the House of Commons, which accounts for the public through health ministers.In 1974 Community Health Councils were set up to represent the public so that people and consumers were more involved in health care.In 1983 the Griffrith’s Report greatly affected the relationship between professionals and patients as market mechanism was introduced into the health care system. An example in the report: “ Businessmen have a keen sense of how well they are looking after their customers. Whether the NHS is meeting the needs of the patient, and the community, and can prove that it is doing so, is open to question”.In 1991 the government introduced the Patient’s Charter.Consumers ‘s Roles	There are three issues regarding the role of the consumer:1 Involvement in decision making process the careInvolvement in planning, developing, monitoring and auditing the servicesPublic Involvement	Consumer Protection is a big issue although the government is not very concerned gives little support with no new law. However the Department of Health has established the Centre for Health Information Quality.	In summary the public needs to be more involved and requires further developments.  The culture of “ doctors know best” is no longer acceptable by the people. People want information so that they can be more involved in making decisions.Ways of Public Involvement	1.Community Health Councils	2. Public Opinions	3. Quality Assurance4  Self- Help and Campaign GroupsComplaints and Compensations	There are several ways that consumers can voice their complaints and seek redress:Family Health Service Authorities would accept complaints about general practitioners, dentists, pharmacists that do not comply with the agreement.District Health Authorities have mechanism to accept and monitor complaints about hospitals and community services.In 1979, the Royal Commission on NHS criticized that the complaint pathways were too complicated and there should be a simple system that people could understand and consumers could voice their complaints.       In 1973 Davies Committee proposed a national practice guideline on how to manage complaints in the hospital as well as setting up the independent health ombudsman. The proposal had been ignored until 1985 the Hospital Complaints Act required health authorities to set up a system to deal with complaints. In addition to NHS mechanism, there are professional bodies like the General Medical Council, the United Kingdom Central Council for Nursing, to which people can submit their grievances directly. Ultimately people can go to court to seek redress and compensations.	The House Committee on Public Health is another place where people can voice their complaints on the condition that complainants would not go to court for compensations. The committee would deal with public mismanagement and would not interfere with clinical judgement.	In the past doctors had to pay premium to a Medical Defence Union to cover their malpractice insurance. However since the 1990 reform, health authorities would have to bear the malpractice compensations in case there is a legal case against doctors. There is evidence of increasing complaints against doctors through various organizations.Health Ombudsman	Health ombudsman could deal with any complaints about the NHS services except cases  that are in court. The main “ weapon” of health ombudsman  is publicity. Health ombudsman would publish two reports annually and these would be circulated to various media. The reports will  also be studied by the House Committee on Health with increasing publicity. Which in turn increase the power of health ombudsman. The House Committee could summon the Health Authorities to account for the management and the response to the complaints, which could be quite disconcerting despite the lack of legal power.Complaint Process	Previously the complaint process was quite complicated through several channels such as Family Health Services, General Medical Council, Hospital Trusts. Each channel has different mechanism. In 1996 , a new integrated complaint mechanism  was formally proposed:First Step: Local Resolution.Second Step: Independent Review. If the complainant is not satisfied, he or she can request an independent review.Third Step: Health Ombudsman. If the previous two steps have not brought satisfactory resolution, the health ombudsman could be requested for helpAnalysis	Any health care reform would deal with two issues:Funding mechanismDelivery of the care.In essence, the reform would aim at good quality of care at low cost, which is comprehensive and equitable.. The strategy often used is managerialism.The British government, in response to funding pressure, has brought about a policy: “ The health of the Nation 1992” in order to reduce sickness. The health targets set are such as reducing coronary heart disease and stroke by40%, breast cancer 25%, lung cancer 30%in men and 15% in women, suicide 15% in year 2000. Community becomes more important with emphasis given to prevention as it is more economical.The evaluation of the 1990 reform indicated that the reform did not achieve the objectives. Waiting list remained as long as before. People did not have more choices as promised by the reform. District Health Authorities had not changed their policy of purchasing care due to limited budget.The internal market had created its own problems like skimming, skimping and rationing. Skimming occurred when the purchasers would accept only healthy people because of cheaper investment and hence money was saved.Skimping happened mainly to the providers which want to save the money by not giving full treatment. It especially affected the disadvantaged patients who did not know their right or had no power to voice their complaints, undermining the original principle of NHS of equity. Medical audit and the patient’s charter would be ways to reduce skimping. Rationing was inevitable with limited resources and high demand. The main problem is how to prioritize and who will make decision about the priority. There is still no satisfactory answer to this question.The other objective of 1990 reform was to increase the satisfaction of the health care personnel. This had not happened as there was more resistance from the doctor and other health professional personnel had been demoralized be more and more changes without apparent benefits apart from more paper work.Professor Klein had summarized that this reform had brought about superficial changes in that hospital became more beautiful, furniture was new, receptionists were more polite. He questioned whether there was nay real change in how the doctor treated the patient. However this reform was a good start for people to demand accountability from the doctor, hoping that it would eventually lead to better services.NHS after 1997	When the Labour party took office in 1997, it announced a nee White Paper: The new NHS : Modern, Dependable. GP fundholding was abolished and GPs would form primary Care Groups. However it had not abolished the internal market. Emphasis was given to quality with more cooperation that competition amongst the health care units.Consumers’ Roles	Nowadays consumers have more power through increased information. There are more channels to voice their complaints and  to seek redress. That does not necessarily mean that the power of doctors is automatically reduced. Reduction of the power of doctors is to be achieved by various self regulation, quality assurance, peer reviews, etc.Manpower Training and Development	England still faces the problem of manpower planning and development because there has been no systematic planning since the start of NHS. Only for the last 20 years has there been an attempt for serious planning.. This is an important lesson for Thailand. Technology Control and Regulation	It is noticeable that England has no law to control and regulate technology, but uses the means of budget limits and technology assessment by several organizations with indirect pressure for technology control and regulation.Lessons for ThailandWhat we can learn from the reform in England is as follows:Reform is inevitable due to natural increasing pressures from the society.Reform will take place quicker if political parties are involved and law ensues.Reform will not make everything better but , to be fair, it has not worsened everything.What is interesting is why the British government, whether Conservative or Labour party, still uses general taxation as the main funding mechanism of NHS although other developed European countries use social insurance to fund health system. General taxation has served England well and it is interesting to see the effect if it were to be adopted by Thailand.There must be a systematic future planning for manpower development.There must be control and regulation of expensive technology with consideration of efficacy, effectiveness and efficiency and safety.Consumers and the public have to be more involved through independent organizations and increased information.There must be a simple mechanism for the public to voice complaints and seek redress.Recommendation:To study in detail the history of health system in Thailand.To decrease the power of medical profession and demand their accountability.To increase the power and information of consumers.To use politics and finance to direct reform justly.To raise awareness of health care reform to be a national agenda.To work together for the Health System Reform Law.To research on health economics more thoroughly.To set up an autonomous organization to work with the government for the health system reform.To put into practice what is agreed upon.