location: , 'Thailand year: 2019 source: HSRI

title: Muslim Women’s Social Space and Health Empowerment through Physical Activities amid Unrest  Situation in Southernmost Provinces (Phase II)

abstract: This quantitative study on “Muslim Widows and Physical Activity Spaces: Health Promotion in the Deep South Unrest” aimed to investigate collaborations of the Provincial Islamic Councils, the Mental Health Center 12, and other relevant authorities on Muslim widows’ physical activity spaces in the unrest context through the views of 348 sample Muslim widows. Their suggestions for their health promotion activity were also to be proposed. The obtained data were analyzed by using the SPSS program. The findings indicated the following. Collaborations of public authorities and private sectors were most found at a moderate degree on giving an opportunity to widows to join community activities (30.5%), followed by a high degree (30.2%). The collaboration on support of Muslim widows’ physical activities, such as attending religious lectures, were most found at a high degree (39.1%), followed by a moderate one (31.6%). A majority of views on collaborations in building Muslim widows’ awareness of physical activity engagement was at a high degree (33.3%). The collaborations covered public relations forms and provision of physical activities suitable to their ages and Muslim femininity. Collaboration in provision of physical activity tools was the most reported at a moderate degree. Provision of single sex spaces for physical activity were mostly found at the lowest degree (41.1%). Below are suggestions for promotion of Muslim widows’ physical activity. 1) Provision of a specific space for Muslim widows’ physical activity is needed to promote both their physical and mental health. 2) A policy should be specifically made for improvement in Muslim widows’ life quality focusing on their physical and mental health, promotion and development their living, and providing female physical activity spaces suitable to all ages in the Deep South. 3) Assistance covering promotion and development should be provided for both widows and their children. 4) Continuous mental health rehabilitation is required by integrating into usual public health services. Continuation is essential for healing them. 5) More activities and greater promotion of doing both voluntary and collaboration activities among Muslim women are required.


location: , 'Thailand year: 2018 source: HSRI

title: Expenditure of Diabetes Mellitus According to Classification Systems for Outpatient Payment at Bangbuathong Hospital

abstract: This research aimed to analyze the expenditure in patients with diabetes mellitus. This study was a retrospective descriptive study. Data was collected from electronic medical record by HOSxP of Bangbuathong Hospital in Nonthaburi since 1 January 2012 to 31 December 2014. Cost analysis was based on 2 concepts of disease classification. The concept 1 was chronic disease group system and the concept 2 was complication risk assessment system. Descriptive statistics such as frequency, percentage, mean, was performed for baseline characteristics, and analytical statistics such as coefficient of variation (CV) and reduction in variance (RIV) for testing of classification. The results showed that there were 1,066 patients with diabetes mellitus. Most of them were women (71.95%). The average age was 65.42 ± 10.29 years and most were covered by the universal health coverage scheme (86.87%). The average expenditure was 6,442.26 baht per person per year (SD = 3,904.78). Disease classification by both concepts had CV lower than 150% and decrease RIV. The concept of chronic disease group system had clarity in the pattern of payment, pattern of disease and items of medication. The concept of complication risk assessment system had clarity only on the pattern of payment, but not on the pattern of disease or items of medication. Further research and development on outpatient disease classification should focus on the concept of chronic disease group system.


location: , 'Thailand year: 2012 source: HSRI

title: Physicians’ attitudes, obstacles, and sources about the use of cost-effectiveness information in clinical practice in Thailand: a cross-sectional survey

abstract: Efficiency in clinical practice has become of increasing concern in the healthcare system in Thailand.
Cost-effectiveness analysis is a concept that helps in the efficient allocation of healthcare resources; however,
evidence showing the use of the cost-effectiveness (CE) information in clinical practice in Thailand is
limited. The aim of this study is to assess physicians’ attitudes towards the use of CE information in
clinical practice.
A cross-sectional survey was carried out to collect information from 140 physicians at Suratthani
Hospital, a central hospital in Southern Thailand, during 12-26 March 2012. The questionnaire consisted
of 3 main parts: physicians’ attitudes, obstacles in the use of CE in clinical practice, and sources of CE
information.
The results showed that the sample response rate was 52.1%. Concerning physicians’ attitudes, 68.5%
of physicians agreed that it is appropriate to consider CE information in the clinical decision-making
process. 76.7% of physicians agreed that cost containment in current healthcare system is necessary. The
main obstacles in the use of CE in clinical decisions are: 1) unwillingness to accept that healthcare resources
are limited by the public; and 2) social expectation for medical services exceeding the capacity of
public health system. Results pertaining to the source of CE information showed that 96% of physicians
attributed CE results to clinical practice guidelines. In addition, CE information from the same source
gains more attention from physicians when presented verbally rather than in written form.
Increasing the use of CE information in clinical decision-making is one way to improve efficiency in
resource allocation in the healthcare system. Findings from this study can be used to inform policies that
promote more efficient utilization of healthcare resources.


location: , 'Thailand year: 2001 source: HSRI

title: Study of group process in diabetic patients at Phapak hospital Nakhonphanom province

abstract: A study of group process in diabetic This study is an application of action research to improve diabetic outpatient service at Plapak Hospital, Nakhonpanom Province.	The existing service was run through general outpatient service every Wednesday 8 -12 am.  The regular services for diabetic patients included; weighing, blood pressure taking, fasting blood sugar testing, and seeing a physician for medication. While waiting for seeing physician,  group health education was conducted by health personnel. 	In situation analysis, The first step of conducting action research, limitations of the existing service were defined. Firstly, it took times since patients had to do many stops, this might cause them hypoglycemia. Secondly, health education as such was not  applicable for patients’ problems.	The second stage, 17 insulin-independent diabetic patients were purposively selected to join as research  participants. Group discussion technique was introduced to encourage patients’ participation to share their problems as well as ways to solve such problems.	The following stage was evaluation. Results from research participants were the feedback of the new service system developed. The service system was rearranged as following: diebetic clinic was seperatety set up from general outpatient clinic; the service was run in every Wednesday and Friday morning; and patient-driven health education which based on self-help group concept was used.  The scores of fasting blood sugar, body weight as well as self-care practice on dietary control, pesonal hygiene and foot care, exercise, medication and help-seeking behavior before and after new service system intervention were found statistical  significant at 0.05 level by paired-T-test. Patients’ satisfaction in terms of  having a say and being recognition were much higher.	Consequently, patient were aware that it was their responsibility in living with diabetes. This enabled them to arrange their own self-help group at their villages. The outcome of this  research also provided the lessons for health personnel. They changed their way of viewing patients, listened to them more and worked with them as equal partners.


location: , 'Thailand year: 2003 source: HSRI

title: Community health service system: Bangkok 7 model

abstract: Of the 21st century, new challenges to health and well-being of the Thai society are rapid aging of the population, change of disease pattern i.e. a significant from communicable diseases to non-communicable diseases, increase in number of disabled and  major  social shifts such as rapid urbanization and dispersion of support systems, substantial migration, increasing work-force participation among women and family structure transformation from extended family to nuclear family. Because rapid urbanization is one of the major social shifts, which relates to increase of non-communicable diseases and other social changes, enhancement of health and welfare systems in the city area in the face of these challenges should be focused in the first place. 	Existing community services and primary health care approach, which has been implemented after the Alma-Ata conference in 1978, were designed for essential elements particularly preventive measures against communicable diseases, promotion of food supply and proper nutrition, adequate supply of safe water and basic sanitation, maternal and child care, provision of essential  drugs and appropriate management of common health problems. Since 1978, the major strategies for implementing primary health care in Thailand are a population-based approach using community intervention/campaign, promoting community participation via community health volunteers and set up community health centres to provide services including maternal and child care, immunization and basic treatment. However, these strategies do not adequately meet new challenges from growing prevalence of non-communicable diseases and disability among the aging society, Hence, new strategies to meet new health challenges are needed.	In order to work out a new strategy, a participatory action (operational) research, called the “Bangkok 7 model”, has been conducted in a city area of Bangkok since July 2002. This project is a result of collaboration among three institutes- the Bangkok Metropolitan Administration (BMA), the Chulalongkorn University (Faculty of Medicine) and the King Chulalongkorn Memorial hospital. It was fund by the Health Systems Research Institute and the King Chulalongkorn Memorial hospital.	The main objective of the Bangkok 7model project was to establish a new model of health and welfare provision, founded on community health workers and professional health care workers who would integrate across functions of health and social care and work closely with all existing informal cares, whether family, friends or neighbors, and also with voluntary groups and individual volunteers. This model also was to demonstrate a practical way of integration between comprehensive home-based services. which requires interdisciplinary cooperation and community interventions, which requires intersectoral collaboration. (i.e. Community Health Service System)	It was hoped that this would enable a system of comprehensive and integrated health care to develop, which was more sensitive and responsive to informal care and able to mesh in with and support it more efficiently and take account of the reciprocal nature of informal care. It was also hoped that such a system would be more amenable to a degree of control by local people and enable them to participate actively in the planning and running for the health and welfare system in the city area. 	The community health service system is viewed as an expansion model of conventional community-based health care in Thailand, which bases on four basic principles of the primary health care approach including-(i) universal accessibility and coverage on the basis of need, (ii) community and individual involvement and self-reliance, (iii) intersectoral action for health, and (iv) appropriate technology and cost-effectiveness in relation to the available resources.	The community health service system is also viewed as the strategy of enhancing accessibility of individual and community to the health system. Thus it is the first level of contact of individual and community under the primary health care approach.	The community health service system is comprised of various comprehensive activities for all ages, which promote integration between formal and informal care to serve eight basis elements including -	(i)	Health promotion and education	(ii)	Prevention and control of communicable diseases and other endemic health problems such as drug addiction, accidents and injuries, alcoholic intake, occupational health problems	(iii)	Environment, water and sanitation	(iv)	Maternal and child health care and family planning	(v)	Food supply and food safety	(vi)	Management of chronic diseases, which emphasizes on adherence to treatment	(vii)	Basic treatment and rehabilitation for health problems including disabilities	(viii)	Long-term care	The community health service system has to provide integrated health and social services for needed individuals and families at their own homes (i.e. home-based services) and community interventions/activities (i.e. community-based services). These two kinds services must be integrated and complement to each other. While intersectoral collaboration is essential for success of community-based activities, interdisciplinary collaboration is vital for home-based care and its support activities.	The Bangkok 7 model was developed in 2 districts at the heart of the Bangkok Metropolitan, of which total population was around 60,000. These 2 districts are the responsible areas of the 16th public health centre of the Health department, BMA. The 16th public health centre, a community health centre, is the principle organization of the Bangkok 7 model which provides the community health service for people in its catchments area. The King Chulalongkorn Memorial hospital joins the Bangkok 7 model as a referral centre and also as a partner of model development.	The Bangkok 7 model composes of home-based service system and community-based service system. The home-based service system is comprised of activities including regular home visit, home assessment, home nursing, home rehabilitation, home education/counselling, service for treatment adherence of selected chronic diseases (diabetes mellitus, hypertension, tuberculosis), social service and palliative and end of life care. These home-based services are supported by activities/services in the 16th Public Health Centre including multidisciplinary team meeting, outpatient services, rehabilitation services, well baby clinic, ANC clinic, family-planning service, acupuncture clinic, social services and care.	Community participation is vital for both home-based service system and community-based service system. Health volunteers and community leaders are invited and encouraged to join in every step of activities and planning.	After on year, the Bangkok 7 model has been successfully developed. Its output is presented to the administrators of the BMA and the Health department. Its responsibility in term of management was fully transferred to the Health department of the BMA on the 1st October 2003 and the whole system was maintained and carried on. Its success was disseminated to the public through mass media such as newspapers and televisions. The Bangkok 7 model and its output was the main topic of several academic conferences in Thailand. However, the obvious sign of success comes from the Health department as it starts to adopt the Bangkok 7 model for implementation in other areas.	This study demonstrates that the Bangkok 7 model, the innovative community health service system for achieving the integration of health and welfare systems is a new strategy in health service system to meet new health challenges in the city area of developing countries like Thailand. It provides strengthening of formal-informal link, which is essential for long-term care, and intersectoral collaboration. Its underlined principles, system design and development management would benefit for further development focuses on the primary health care and health and welfare systems. However, it is not the ideal model that benefits with all kinds of population and areas in Thailand. Administrators and health care providers of other areas, including both urban and rural areas, should workout how to adopt or apply the Bangkok 7 model into their own practice.


location: , 'Thailand year: 2000 source: HSRI

title: A study of folk and popular health care system for promoting health of among middle-aged women in Lanna Society

abstract: The main focus of this qualitative research was to explain folk and popular health care systems concerning promoting health of the middle-aged women residing in Lanna society. Study settings included an urban community, a semi-urban were 55 women, aged between 40 and 59 years old, and nine practitioners working in folk medicine. Data were obtained through the use of focus group discussions, in depth interviews, and participation and non-participation observation. Data were analyzed using content analysis, indicating the main themes, categorization, and mapping the connections. The major results of this study indicated that there were three alternative health care systems for middle-aged women: popular, traditional, and modern health care systems. Regarding the definition of health, the middle-aged women defined ‘health’ as a multi-dimensional aspect including the dimension of physical, mental and physiological function. Therefore, good health, according to these women, was referred to the state of physical fitness, being free from disease, good and happy mind, and being able to function activities. It is also interesting to note that marital status and child bearing was indicated to influence women health. In the period of middle-aged, the women preferably called as “golden age”, a period of various changes had been occurred physically, mentally and emotionally. Some women might call this age as “confusing age” because of uncertainty concerning whether the way they acted was appropriate. Further, the middle-aged women perceived that their age was high risk of developing disease and was irritability. Regarding the management of the physical changes, it was found that the management was depending on the severity of the symptoms. For mild symptoms, there was no special activities performed. Some women used daily activities, traditional herbal sauna, and Thai traditional massage. In case of having severe symptom, the women preferred to seek help from modern health care services, either public or private sector. It the treatment was unsatisfied or ineffectiveness, they would further seek help from traditional practitioners. Concerning the management of mental and emotional changes, almost all middle-aged women stated that they preferred to do mediation, hobbies and listen to Buddha teaching. It worth to note that the concept of health promotion among the middle-aged women was not clearly defined. Nevertheless, they pointed out many activities leading to good health. These were taking good nutrition, exercise, doing leisure activities, and taking tonic medicine or folk medicine. Hence, the results indicate that to promote health of the middle-aged women, it is of great important to modify health care service policy from curation to health promotion and disease prevention. This is anticipated to develop the concept of health responsibility among the middle-aged women. The modern health care services, therefore, should focus on primary or secondary prevention rather tertiary prevention, and such services should be in accordance with culture, beliefs and lifestyle of middle-aged women.


location: , 'Thailand year: 2013 source: HSRI

title: Review of National Civil Registration and Vital Statistics Systems: A case study of Thailand

abstract: Vital statistics provide essential information for monitoring the progress towards achieving the United
Nations Millennium Development Goals (MDGs). Well-functioning and reliable civil registration and
vital statistics systems (CRVS systems) are not only needed for national development, monitoring and
evaluation systems, but also for organizations to plan and manage their operation and programs. Wellfunctioning
civil registration systems are the best data source for reliable vital statistics. However, more
than half of the countries around the world do not have CRVS systems or, if they do, they do not function
well. The United Nations (UN) and the World Health Organization (WHO) recognize and are aware of this
issue and are facilitating member countries to evaluate and improve their CRVS systems.
In 2011, WHO and the University of Queensland, Australia, developed a standard tool called,
“Strengthening practice and systems in civil registration and vital statistics: A Resource Kit ”, in order
to strengthen CRVS systems. WHO and many UN organizations, such as the United Nations Economic
and Social Commission for Asia and the Pacific (ESCAP), encourage and assist member countries to use
this tool.
CRVS systems have existed in Thailand for many decades, but have not been systematically evaluated.
Therefore, an assessment was a key step to understanding the status of the current system and
identifying areas that need improvement. The Thai Health Information Standards Development Center
(THIS) and other key stakeholders, such as the Ministry of Public Health, National Statistics Office, and
Ministry of Interior, came together to evaluate the CRVS system using the WHO Rapid Assessment of
National Civil Registration and Vital Statistics Systems tool.
This report outlines the methodology and findings from this rapid assessment. It contains three main
sections: chapter one describes the background and history of Thailand’s CRVS system; chapter two
describes the assessment objectives, the tool and evaluation process; and the final chapter provides an
analysis of results and recommendations.
It is hoped that the assessment will be informed Thai policy makers, administrators and others
involved in CRVS of the system’s strengths and weaknesses and hope to gain their support for further system improvement.


location: , 'Thailand year: 2008 source: HSRI

title: Medical Hub of Asia

abstract: Thailand’s government has initiated a plan to make the country the Medical Hub of Asia. The plan has been aimed to increase numbers of foreigners coming into the country for medical services, which, as a result, will bring in as much as 80,000 million baht in the year 2008. Private hospitals around the country have been readily carrying out the promising plan, making it seem even more agreeable. However, in spite of the expected good outcomes, this plan is also creating,
in public hospitals and medical schools, numerous problems which themselves will trigger many more in the future of the country’s public health. This Medical Hub of Asia plan will rapidly damage Thailand’s noble medical and healthcare service systems.


location: , 'Thailand year: 2008 source: HSRI

title: Diabetes Mellitus Problem Solved by Health Volunteer Community

abstract: Diabetes mellitus is a chronic disease and a major health problem in Thailand. The objective
 of this study was to develop a problem-solving model for diabetes mellitus in a community, in the
 hope that it could reduce hemoglobinA1C and increase the quality of life of diabetes mellitus
 patients. The diabetes mellitus problem-solving activity was operated in six villages of Ubonratana
 District in Khoan Kaen Province. Fifty-two diabetes mellitus patients participated for six months in
 the problem-solving activity, which was operated by health volunteers; it involved promoting exercise,
 controlling diet and optimizing drug compliance. The problem-solving patterns were monthly
 meetings, home visits and health education. The average hemoglobinA1C of the diabetes mellitus
 patients was 9.9 percent, but after their participation it dropped to 8.7 percent. The quality-of-life
 score (WHO QOL short form 26) was 88.7; it increased to 101.1 after the activity. The changes in
 the average HbA1C and quality-of-life scores are statistically significant. The conclusion of this study
 was that a diabetes mellitus problem-solving activity in a community may be able to reduce HbA1C
 and increase the quality-of-life score.


location: , 'Thailand year: 2008 source: HSRI

title: Non-thai laborers attending Klaeng hospital, Rayong province

abstract: This was an exploratory and retrospective study, the objective of which was to study
the medical treatment provided to aliens availing themselves of remedial services, medical privileges, and the expenses paid for such services at Klaeng Hospital in Rayong
Province.  The data were collected using the HIM Pro. program, which extracted data
from the medical records of this group of patients and their families who sought medical
treatment in the previous year (from October 1, 2006 to September 30, 2007). The total
6,165 cases comprised 5,792 out-patients and 373 in- patients. The analysis used percentages and means. The results of the study found that the majority of the non-Thai laborers and their families were Cambodian, aged 21-25 years, with mean age being 26.5 years
old.  With regard to the medical privilege, they paid the fee concerned by themselves, the
cost of which exceeded the privilages obtained.  The majority of alien laborers were using
the services for medical check-ups for employment purposes, health promotion, antenatal care (ANC), immunization, family planning, etc. The major diseases or illness found
were injury, and gastro-intestinal tract and respiratory tract problems, 13.37, 7.10, 5.94
percent, respectively. The infected diseases found in the out-patient section were diarrhea, tuberculosis, syphilis, HIV, and food poisoning in 1.19, 0.22, 0.19, 0.10, 0.07 percent
of the cases, respectively.  Admitted patients had diarrhea, dengue hemorrhagic fever,
HIV, appendicitis and viral hepatitis in 2.86, 1.07, 1.07, 0.54, 0.27 of the cases, respectively.
As for the expenses for the medical treatment of the alien laborers that did not have such
privileges, the study found that 54.49 percent of the patients were able to pay the fees.
The out- patients had a greater capacity to pay the fees than the patients admitted to the
hospital.


location: , 'Thailand year: 2004 source: HSRI

title: Epidemiology and clinical outcomes of the patients with hematologic malignancy : Thai Society of Hematology

abstract: According to advance technology now the patients who suffered from hematologic malignancy can be cured or at least live longer with better quality of life. However the standard treatments that were used internationally are costly and it is impossible to give best treatment to every Thai patient who suffered from hematologic malignancy due to shortage of budget and man power involved in this problem. In routine practice there are variation on investigations and treatments depend on the patients socio-economical status and health insurance scheme leading to difference cure rate and survival time of the patients. The suitable clinical practice guideline (CPG) for treatment of this group of disease in Thailand can not establish at present because of lacking basic data about the situation of these disease in our country. To establish disease registry of hematologic malignancy would give the information about epidemiology, variation of practice and clinical outcome which is useful for developing suitable CPG for treatment of hematologic malignancy in Thailand.The study was performed by establish the network of hematologist form 9 leading institute in Thailand who deliver treatment to this group of patients working together to create case record form. System of data collection and quality control concurrent with development of web base data entry system was done in the first 6 months of the project, starting on January 15, 2003. Then the process of data collection and data entry on web was performed during July 1, 2003 to March 30, 2004. The quality controlled and monitoring was performed concurrently. It was planned to register the patients and follow up them for at least 3 years.During the first 9 months of data collection there were 1,124 patients registered to the system. The diagnosis were malignant lymphoma 51.2%, acute leukemia 20.3%, CML 10.7%, multiple myeloma 7.7% . About the expense of treatment, 56.5% of the patients using universal health coverage or “30 baths” scheme, 26.3% using government welfare, 6.8% under social security scheme and 8.7% pay out of pocket. The patients who are under government welfare have tendency to receive more effective and expensive treatment than patients under other scheme. There is an interesting data that 12.2% and 8.3% of lymphoma patients infected by viral hepatitis and HIV consecutively.There are some problems about using web based data entry system. Even though it is good to get data on real time but it is rather difficult to manage because the internet system and local network of the participate institutes were attacked by virus computer several times. And some research assistants are not familiar to computer program. After first phase of study, the data entry will be changed to sending case record form to the center fordata entering instead of using web base system.


location: , 'Thailand year: 2011 source: HSRI

title: Construction Workers’ Drinking and Smoking Behavior: Research for Health Communication Planning

abstract: This study is aimed at exploring the current situation concerning risk factors and behaviors that
construction workers were facing at both individual and community levels as well as to examine existing
health promotion interventions. This information was expected to be used for constructing useful recommendations
for the development of existing and new interventions employing “social marketing” principles.
Methods: The study began by employing qualitative methods. The research team was assigned to
stay in a purposively selected construction camp for two months to collect data concerning lifestyles,
social values, as well as risk behaviors and risk factors. Afterwards, a cross-sectional survey on issues of
concern was implemented. Finally the data were analyzed and presented to the community representatives
in focus group discussions. This was to verify and investigate explanations underpinning the findings;
moreover, it was expected that such a payback method, including findings, would be beneficial to
people in the communities. Results: It was found that one of the major risk behaviors observed in the
study community was alcohol and tobacco consumption. Although the target group had a number of
constraints in terms of purchasing power and time, they received relatively low payments for these excessive
workloads; however, they were offered convenience and motivation to access alcohol and tobacco
products. It was observed that legal interventions, i.e., restriction on alcohol-selling times did not perform
effectively as the study population usually purchased these unhealthy products from small community
groceries where there was a lack of inspections from police officers; besides, these workers rarely knew
about this regulation. For those who had seen or known about the law, they still did not understand the
reasons behind such a restriction on selling times. Strengthening law enforcement was therefore recommended
by academics as a strategic solution. On the contrary, this study pointed out that the use of social
marketing principles to communicate with the target group regarding the true purposes and relevant
facts of the interventions tended to help increase the effectiveness of legal interventions. Conclusions: In
order to develop suitable health promotion interventions for the target groups, health promoters needed
to understand the context and develop ways to limit their access to unhealthy products. It was recommended
that social marketing should initially be applied for promoting behaviors that are easy and require
low cost to change, such as to stop drinking in certain periods of time. This is to offer reachable
targets to the target group and once they achieve such a goal, they would be empowered to believe in their
abilities, and this would help them to step up to overcome more difficult goals, such as to stop drinking or
smoking altogether. The application of social marketing principles to existing legal interventions could
help facilitate prompt behavior change, as well as maintain desired behaviors in the target populations.


location: , 'Thailand year: 2008 source: HSRI

title: Risk Factors Associated with Newborn Birth Asphyxia Observed at Panomsarakham Hospital, Chachoengsao Province

abstract: A case-control study was carried out in Panomsarakham Hospital, Chachoengsao Province
 from October 1, 2001 to September 30, 2006 to determine the risk factors associated with birth
 asphyxia. The study group comprised 107 women who delivered asphyxiated neonates (1-minute
 Apgar score ≤ 7); the control groups comprised 107 mothers who delivered non-asphyxiated neo-
 nates (1-minute Apgar score >7). The control group was selected by systematic sampling. The data
 were analyzed by univariate and multiple logistic regression analyses, which revealed the following
 significant risk factors prevalent for asphyxiated newborns: thick meconium-stained amniotic fluid
 (OR 8.82; 95% CI: 1.35-57.45), drug-induced labor (OR 8.63; 95% CI: 2.80-26.63), vacuum
 extraction (OR 4.66; 95% CI: 1.28-16.90), and dystocia (OR 4.43; 95% CI: 1.33-14.78). In
 recognizing that the most common risk factors in birth asphyxia are antepartum and intrapartum
 incidents, early recognition of these factors followed by prompt and appropriate management would
 reduce the incidence of birth asphyxia.
Key words: risk factors, birth asphyxi


location: , 'Thailand year: 2019 source: HSRI

title: Performance and Roles of Family Physicians: Synthesis of Policy Recommendations

abstract: Background This study aimed to synthesize policy recommendations for future planning in family physician training and effective primary care cluster policy implementation with regards to actual needs and responsive to the situation Methods Situation review and value chain analysis were done in 8 primary care clusters in Central, Eastern, Southern, and Bangkok Metropolitan areas in 2018. A national survey in all 13 health services areas was deployed during the second and the third trimesters of 2018 in order to assess major stakeholders’ perceptions and opinions; including administrators, academics, and family physicians, on national primary care cluster policy implementation as well as the performance and roles of family physician in their settings. The data from primary and secondary sources were analyzed and policy recommendations were synthesized accordingly. Results 213 subjects were participated in the study. 50.7% was female, and median age was 38 years (range 24-84 years). Regarding performance and roles, all groups of the stakeholders indicated that expectable performances of family physicians had not been achieved yet in accordance with 6 performance dimensions of Royal College of Family Physician of Thailand. For primary care cluster policy implementation, there were significant hurdles from frequent changes in policy contents, unclear messages, incongruencies with community situation, rigid specifications, lack of positive retention strategies on healthcare personnel, misunderstanding and acceptance problems among healthcare professionals as well as community, imbalance between demand and supply, lack of policy advocacy at local areas, and problems in family physician training system including trainers, trainees, and related resources. Policy recommendations 1) The Ministry of Public Health should allow those in local areas to propose their own operation plans as well as appropriate and feasible performance indicators. 2) The Ministry of Public Health should modify their policy contents by allowing any physicians to perform as family physician without the necessity to train in family medicine program. 3) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should develop self-directed learning system for the physicians and other health professionals to gain knowledge and experience in family medicine. 4) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should discontinue their diverse approaches in family medicine training, and preserve only a standard training program. Moreover, they should develop specialty training programs that are in needs for the society such as longterm care, elderly care, etc. 5) The Ministry of Public Health should develop networking system in the local areas that can effectively link specialists with family physicians by using “Shared care and responsibility”.


location: , 'Thailand year: 2016 source: HSRI

title: Spatial Distribution and Risk Behaviors of Parasitic Helminth Infection among Students in the Schools under the Border Patrol Police Sub-division 21

abstract: Parasitic helminth infection remains to be a public health problem of the students and children in
remote rural areas, especially in the Northeastern part of Thailand. This survey was aimed to find out the
parasitic helminth infection rate, to analyze the spatial distribution with the application of geographic
information system (GIS), and to study the risk behaviors of parasitic helminth infection amongst students
in eight schools under the responsibility of the Border Patrol Police (BPP) Sub-division 21. The
survey was conducted during October 2014 to July 2015. The instrument for the survey was modified Kato-Katz technique for examining stool samples, and in-depth interview. The results showed that the
infection rate of helminth parasites was 8.27% (72 cases from overall 871 cases). The most common species
of helminth parasites found was hookworm at 51.39%. Others were Opisthorchris viverini 25.00%, Echinostoma spp. 12.50%, Enterobius vermicularis 5.56%, Trichuris trichiura 2.78%, Ascaris lumbricoides 1.39%, and co-infections of O. viverrini and hookworm 1.39%. When applying the GIS to analyze the parasitic helminth infection’s spatial distribution of the 8 BPP schools, the results showed that the parasitic helminth infection was higher than target limit of less than 5% in every school (14.71%, 12.30%, 10.00%, 8.96%, 6.43%, 6.14%, 6.00% and 5.41%). The distribution and the concentration of helminth parasite species were different in each habitat of the students. Most of the infections were caused by soil-transmitted helminths (STHs). Bad sanitation and inappropriate food consumption habits increased risk of infections. The findings of this research can be used to estimate helminth infection situation of the community and also can be applied to create strategic plans which focus on changing behaviors of students, their parents and their teachers to solve this problem.


location: , 'Thailand year: 2001 source: HSRI

title: A study of collective opinions regarding some aspects of childcare center management in Thailand

abstract: A Study of Collective Opinions Regarding someAspects of Childcare Center  Management in ThailandThe objectives of this study were to find  collective opinions about childcare centers services regarding the following: 1) purposes of childcare centers and goals of child development, 2) the main organization responsible for coordinating childcare centers, 3) roles of community, private organization, and government  in childcare centers services, and 4) activities for quality control and evaluation of  childcare centers services.Sample consisted of  four groups of  people. The first group consisted of academics, politicians,  chief executives of  private  and governmental organizations  providing childcare services.  The  second group consisted of officials coordinating between central  government  and local organizations providing the services in Chiengmai, Khonkan, Songhkla, Chonburi, and Bangkok.  The third group consisted of  workers  at  childcare centers from top level such as heads of schools to bottom level such as care providers.  The last group consisted of  parents of children at the childcare centers.  The total subjects were 1,663.	There was a  collective agreement on the purposes of the childcare centers.  They  were  to promote the correct practices of child development ,and to provide basic social habit training for children.  The results showed also the collective agreement  on goals of  child development for the 0-3, and 3-6 years children.  These  were  good physical health, balance  of psychological, emotional, and social development, and happiness. Moreover  creative thinking  was selected as child development goal for the 3-6 years old children.  As a result, we recommended that the government should  take  actions in  collecting ideas from experts and practitioners on standard of practices for childcare centers in order to achieve the above purposes and goals.  At the same time childcare centers,  related organizations, the general public, and other stakeholders should  be informed.  Their roles and functions should also be identified.


location: , 'Thailand year: 2004 source: HSRI

title: Patterns and meanings of holism

abstract: This essay on “Patterns and Meanings of Holism” is the product of a research on “holism”, which is part of a project on “The Synthesis of Knowledge: Thai Society under Reform Currents”.  The research aims at an understanding of and a commentary on holism, a concept widely used in the reform currents in contemporary Thai society.  It relies on the following concepts and theories, namely:-  Gregory Bateson’s metamessage, logical type and ecology of mind, Immanuel Kant’s focus imaginarius or projected unity, Alfred North Whitehead’s abstraction, identity and background, Stephen Rothman’s critique of strong reductionism, Erwin Schrodinger’s objectivation, quantum physics’ non-locality and interrelationship, David Bohm’s implicate order, explicate order and soma-significance interrelationship, Carl Jung’s synchronicity, and discussions of related subjects in Milindapanha (Milinda’s Questions) as well as other major texts such as those of Rene Descartes, Isaac Newton and Martin Heidegger.As a result of the studies, analysis and synthesis of various concepts and theories, the research arrives at the following conclusions.Holism is “a meaningful connecting pattern of all components in a given context”.Holism is a subject concerning with the working process of human thought, which has to rely on a connecting pattern.  Wholes and parts are thus inseparable; and the thing that makes it possible for them to “hang together” in a certain way is a connecting pattern that depends on a certain meaning.Fragmentation and reduction are not the same thing.  And once many ideas, commonly regarded as reductionism, have been seriously considered, it will be found out that they are, in fact, based upon wholes and meanings as well.Various ideas of holism share a common ground in emphasizing the importance of meanings and contexts, and a common attempt to reinstate them in the construction of knowledge.The key issue of holism should thus be an awareness of wholes inherent in contemporary trends in the construction of knowledge; and the emphasis should be on the “meaning” or “value” that defines whole entities, components and contexts of the search for knowledge.  This may be called a “meta-methodology,” which is -- the awareness, selection and application of a type of meaning to define a whole entity, its parts, the context, and to construct a connecting pattern of the thing being mentioned, observed and studied.  This will also include an understanding or argument concerning the choice of meaning.


location: , 'Thailand year: 2021 source: HSRI

title: Mechanism of proteins involved in signal transduction and pathogenesis of dengue virus infection

abstract: Antibody-dependent enhancement (ADE) has been considered as one of the mechanism that leads to the development of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). During secondary dengue infection monocytes can be infected by the ADE phenomenon. This study aimed to investigate the proteins involved in ADE of DENV infection in the primary human monocytes isolated from volunteers. The phosphoproteins were used to perform and analyze for protein expression using mass spectrometry (GeLC-MS/MS). The differential phosphoproteins revealed 517 altered proteins compared between isotype- and DENV-specific antibody-treated monocytes. The altered proteins revealed 253 upregulated proteins and 264 downregulated proteins. Approximately 70-80% of altered proteins was classified into binding and catalytic activity proteins, while 20-30% was proteins with molecular function regulator, molecular transducer activity, structural molecule activity, transcription regulator activity or translation regulator activity and transporter activity. Protein disulfide isomerase (PDI), which is an enzyme that had a high-ranking fold change and that catalyzes the formation, breakage, and rearrangement of disulfide bonds within a protein molecule, was selected for further study. PDI was found to be important for dengue virus infectivity during the ADE model. The effect of PDI inhibition was also shown to be involved in the early stage of life cycle by time-of-drug-addition assay. These results suggest that PDI is important for protein translation and virion assembly of dengue virus during infection in human monocytes, and it may play a significant role as a chaperone to stabilize dengue protein synthesis. Moreover, other proteins were further performed by interaction network analysis and found that most structural proteins were interacted together. Alpha-actinin was observed to be altered and may be associated to play important role in viral replication and viral infection in monocytes.


location: , 'Thailand year: 2001 source: HSRI

title: Comparative study the effect of medication related problem resolving by community hospital pharmacists in hypertensive patients before and after the patients attending physicians

abstract: The purpose of this research was to compare the effects of medication related problems by community hospital pharmacists in hypertensive patients before and after the patients attending physicians by control-group time series design. The patients who attended pharmacist before physicians will be call "group 1" and the patients who attended physician before pharmacists will be call "group 2". The study was carried out at 7 community hospital in Songkla Province; Satingpra Hospital, Krasasin Hospital, Rattapoom Hospital, Jana Hospital, Tepa Hospital, Kuanniang Hospital and Padangbesar Hospital. The number of patients who could be followed-up for 3 visits were 123 in control group, 108 in group 1 and 113 in group 2. The results showed that medication related problems be found in 74.8, 63.9 and 69.0 in control group, group 1 and group 2 respectively. The medication related problems were found as 1 – 7 problems per patient and the number of medication related problems in experimental groups were less than in control group significantly (p = 0.004) but there was no different between the both experimental groups. Additionally, number of medication related problems and diastolic blood pressure were reduced in both experimental groups (p <0.05) when the patients attended pharmacist at 2nd and 3rd visits but it was not different between group 1 and group 2. Patients satisfied to pharmacy practice at high level (median = 4 points from 5 point full scale) but no difference was found between group 1 and group 2. Physicians and nurses also satisfied to pharmacy practice at high level and no difference was found between the pattern which patients attend pharmacists before and after physicians. However, pharmacists spend more time in group 2 patients (median = 10 minutes) than group 1 patients (median = 10 minutes), especially in the patient’s first visit but it was not different in the later visits (median = 5 minutes in both groups) We can concluded that medication related problem resolving by pharmacists could reduce medication related problems in hypertensive patients but it was not different between the two experiment groups. Patients, physicians and nurses satisfied to pharmacist practice but there was no different between the two experimental groups. The community hospital pharmacists can choose the suitable patterns of medication related problem resolving as this study for doing the pharmaceutical care in their hospital.


location: , 'Thailand year: 2012 source: HSRI

title: Impacts of financial measures on retention of doctors in rural and public health facilities

abstract: This study aimed to assess the impact of a financial measure on public and rural facility retention of
physicians in Thailand. It used a retrospective approach using secondary data from the Ministry of Public
Health (MoPH). The study population included all physicians who graduated and entered the workforce
during 2001-2007, and the data were retrieved from 2001-2011. Survival analysis was used.
Results showed that the high turnover rate of young physicians was still persistent. Large proportions
of physicians, at about 30%, resigned before the 3-year compulsory contract ended, and this trend
repeated even after the financial measure was implemented. Resignations from MoPH have increased
since 2001, and the rate remained high after the increase of special allowance. Rural retention was low,
especially after 3 years of compulsory public services. The proportion of physicians retained in the rural
area after the 3-year compulsory period was about 20-24%, and this trend repeated even after implementation
of the financial measures in 2009.
The results suggested that to retain physicians in the rural area we need both the financial and nonfinancial
measures in an appropriate combination. Non-financial measures such as, working close to hometown,
opportunities for specialist training, improvement of work environment and infrastructure would
be important for rural retention of physicians as well.


location: , 'Thailand year: 2021 source: HSRI

title: The preparedness and responses of the health services system to the COVID-19 crisis in Thailand: Hospital operation and economic and social impacts within the boundary of the health services system

abstract: The research project on the preparedness and responses of the health services system to the COVID-19 crisis in Thailand: Hospital operation and economic and social impacts within the boundary of the health services system consisted of 6 main parts using mixed research methods, pursuing the following key objectives: (1) To study overall research areas and topics for health services system to prepare and respond to the COVID-19 situation focusing on hospital systems, and economic and social impacts within the boundary of the system by reviewing key literature and expert panel suggestions, and by piloting data collection based on the framework. (2) To study key characteristics of hospital wards and innovation in hospital services for COVID-19, and to synthesize recommendations for hospital accreditation processes by making case studies on selected hospitals, and sharing discussions in focus groups. (3) To study challenges, problems, obstacles, preparedness, adaptation and new normal in key service offerings by hospitals in response to the COVID-19 situations, and synthesize new normal that may persist after the crisis by surveying hospitals and surveyors of the hospital accreditation programs in Thailand, organizing online focus groups and case study of the Bangkok area. (4) To estimate cost and opportunity costs of a hospital in responding to the COVID-19 situation involving all kinds of activities in a hospital by working with a case-study hospital. (5) To study and monitor operations of universal health coverage schemes in Thailand in responding to the COVID-1 9 situations, including reimbursement in the fiscal year B.E.2563 by reviewing documents and analysis of the reimbursement databases of the universal coverage scheme (UCS) and (6) To study governmental mechanisms in responding to the COVID-19 situation in Thailand, including key features in different phases of the situation, policies and measures to prevent and control the pandemic situation, related factors, and consequences by examining overall situations and making case studies of selected key events.


location: , 'Thailand year: 2007 source: HSRI

title: Academic Capacity of the Research Manager

abstract: The research manager is an essential component of the research system. This article describes the
academic capacity of the research manager, which should at least comprise 1. neutrality, 2. program
evaluation skills, 3. knowledge of research methodology, 4. ability to systematically review existing
knowledge, 5. research mapping skills, and 6. ability to conduct research on research management.


location: , 'Thailand year: 2004 source: HSRI

title: Acute coronary syndrome registry

abstract: Objective: To establish a national registration of acute coronary syndrome (ACS) registry in Thailand in order to study clinical epidemiology, determine the demographic, management practices and in-hospital outcomes of patients with ACS.Methods and results: Thai ACS registry is a multi-center prospective project of nationwide registration in Thailand. The enrollment of the patients started in August 2002. After one year, records of 3025 patients were collected from 16 hospitals. The patients were classified as ST elevation myocardial infarction (STEMI) (38.9%), non-ST-elevation myocardial infarction (NSTEMI) (35.6%) and unstable angina (UA) (25.5%). The mean age was 64.5 years old with 59.8% of male and 40.2% of female. The cardiovascular risk factors were 44.8% of diabetes mellitus, 62.1% of hypertension, 68.9% of dyslipidemia, and 31.9% of smoking. About 52% of the STEMI patients received reperfusion/revascularization therapy. The median time of door to needle was 100 minutes in patients received thrombolytic treatment and only 11% of them were received within 30 minutes after admission. The most complication of congestive heart failure was found 42.1% in ACS group. The total mortality rate was high in STEMI (16.2%) followed by NSTEMI (11.7%) and UA (3.1%) respectively. The mean length of hospital stay was 10 days.Conclusion: Thai ACS registry provides a detail of demographic, management practices and in-hospital outcomes of the patients with ACS. These data may have an impact on our health care system and alert the government to make a policy for these problems


location: , 'Thailand year: 2007 source: HSRI

title: Foot Care for Diabetics in the Prevention of Lower Extremity Amputation in Bangbo Hospital

abstract: Objective : To compare the outcome among patients using the diabetes foot care
program and those who did not use it.
Material & Methods : This quasi-experimental research focused on the effects of
using the diabetes mellitus foot care program in terms of sensory receptor score. The
controlled patients were non-insulin-dependent cases of diabetes mellitus. They had been
treated in the diabetes mellitus clinic of Bangbo Hospital, Samutprakarn Province. There
were 100 cases divided into experimental and control groups. They were followed up
using the diabetes mellitus foot care program. The data were analyzed by the method of
percentages, means, descriptive statistics and compared means by t-test.
Result : In the experimental group, their foot problems decreased and there was an
improvement in their sensory receptor score better than that of the control group (95%
confidence interval; p-value <0.05).


location: , 'Thailand year: 2002 source: HSRI

title: The model development of safety promotion in the school buses at Chiang Rai province

abstract: The Model Development Of Safety Promotion In the School Buses at Chiang Rai Province	The purpose of  this participatory action research was to develop the model to find out the suitable strategy  to develop the safety promotion system for the school buses in Chiang Rai province by the process of actively participation from all related sectors in Chiang Rai included :- the Police Units, Transportation Offices, schools/colleges, Public Health Offices, Mass media offices, and Chiang Rai School bus Club. The study population were 388 school bus drivers who were the members of the Chiang Rai  school bus club. The study period took one and a half year long from March 2001 to August 2002. It was divided into 2 phases. In the first phase, 213 school bus drivers were random sampling for interviewing by questionnaire to identify the important problems related to the safety of the school bus. The focus group discussion with the key members of the school bus Club were conducted to provide the qualitative data related to the same problems. Surveillance for the risk behavior, brain storming and setting up the action plan were developed. In the second phase, all school bus drivers were invited to participate in the action plan for promoting the safety condition in the school bus transportation such as training program on safety driving, checking up and improving the school bus condition to meet the standard requirement, educational media production, driving behavior surveillance, campaigning a good behavior driving competition, etc. The study tools included : structure questionnaires, guideline for focus group discussion, behavior observation of drivers, accident report of schools, hospitals, and the school bus club. The percentage, mean and standard deviation were used as the descriptive statistics for data analysis. 	The results of this study in Phase one showed that 87.7 % of the school bus drivers were male, 51.1% had completed a primary education level, 11.7% had a history of smoking, 8.0% had a history of alcohol drinking, 42.7% had a regular physical check up, 52.1% put on seat belt during driving, 90.1% of the school bus was a van-type, and 93.0% owned the school bus. By average, the cars were used for 9 years, the experience in driving a car was 14.7 years and driving a school bus was 6.2 years. One school bus carried the students around 4.9 schools per car. One year before this project started, there were 16 vehicles (7.5%) got the traffic accidents.  A number of activities were introduced to solve the problems. A training course for all school bus drivers was organized. The 16 standard conditions for the school bus were applied to check all 257 school buses and 39.7% of them could not pass in the first round but after improving the vehicle conditions within one month, all school bus were met the requirement. All school bus drivers received the health examination from health personnel. The results showed that 6 drivers (0.3%) had hypertension and all of them had gingivitis. Urine test for amphetamine was done for 301 drivers. Twelve (3.9%) of them found positive by the screening test. Confirmatory test was rechecked and only 1 (0.3%) urine specimen provided positive result for amphetamine. The system development for safety promotion of school buses was quite success by the collaboration of public and private sectors in Chiang Rai. Many things had much improved such as better driving behavior follow the traffic regulations, improving the school bus condition, taking care of their health, development of injury surveillance system, driving behavior observation, referral system for emergency and accident, and educational campaign for traffic safety promotion through public medias. During the study period, 3 school buses had accident [0.8%], 10 students were injured, and nobody died. These number of accidents was much less when compared with the previous year. 	This new approach model which actively participate by all sectors had showed the great impact for preventing the accident caused by the school buses. The lesson learn from this study should be used as a prototype for other provinces to modify for solving their own problems.


location: , 'Thailand year: 2010 source: HSRI

title: Legislation and Health Promotion

abstract: In Thailand, legislation which concerns health promotion ranges from the National Health Act
(B.E.2550), and the Supporting Fund for Health Promotion Act (B.E.2544) to the most important of all, the
Thai Constitution, B.E. 2550. The constitution guarantees the rights of individuals on this issue as follows:
(a) the right to public health and welfare services; (b) the right to access information on certain activities
and/or programs which may affect their environment, health and quality of life; and (c) the right to be
protected from environmental health hazards. Furthermore, the Constitution also states that health policies
must emphasize health promotion, which would lead to sustainable health of the population, and
that local government should be given the responsibility and authority in the management and provision
of public services for the local people. Even though other related laws which concern the roles of local
government in public health service provision may not have included health promotion as one of the
responsibilities of local government, the responsibilities of local governments could be extended. Legislation
such as the Public Health Act (B.E.2535) and the Tambon Council and Tambon Administrative Organization
Act (B.E.2537) has given power to the ministers in charge to allocate extra responsibility to local
government as allowed by those laws. The latter especially has given the tambon administrative organization
the role of managing basic environmental control services. This is relevant to the function of health
promotion. The Second Action Plan and Protocol for Decentralization to Local Government clearly states
that health promotion responsibility, along with basic health services and disease control, are to be the
responsibilities of the local government, with a certain level of “readiness.” These will be transferred
together with funding, the existing staff and infrastructure (health centers). However, as local government
needs to undergo assessment and other processes in the devolution of health centers, there is a need
for specifying the roles of local government in health promotion in order to clarify the issue and to make
the roles conform to Thailand’s health promotion strategy.


location: , 'Thailand year: 2020 source: HSRI

title: Health status and healthcare access amongst urban refugees in Greater Bangkok, Thailand, 2019-2020: policy analysis and unmet need survey

abstract: Although the Thai Government shows a clear intention towards improving the health care of migrant workers and dependants, healthcare measures for urban refugees and asylum seekers (URAS) have not materialised. At present, approximately 5,000 URASs live in Greater Bangkok. The main authority responsible for the registration and the screening of URASs is the Office of the United Nations High Commissioner for Refugees (UNHCR). The objectives of this study are to: (i) review policies related to the health care and well-being of URASs; (ii) analyse views of stakeholders related to the health care and well-being of URASs in Thailand; and (iii) explore the health status and health access of URASs through the perspective of unmet need for health services. This study employed both qualitative and quantitative methods. Data collection comprised a review of academic documents from both domestic and international sources, multi-lateral agreements or international covenants, and domestic laws related to human rights and health of URASs; in-depth interviews with 30 stakeholders and 7 URASs; a Delphi survey among 13 experts and key informants; and a primary survey on unmet need among 181 URASs. Data from the unmet-need survey were collated with data from the previous Health and Welfare Survey (HWS) in 2019 with 2,941 Thai participants. The findings revealed that academic literature concerning the health care of URASs in Thailand was extremetly sparse, relative to the same kind of literature on refugees in other settings. In terms of international covenants, Thailand is not yet a party of the 1951 Refugee Convention. However, the Thai Government always allows UNHCR to implement screening measures and take action for the well-being of URASs in Thai territory. Recently in 2019, the Government endorsed the ‘Regulation of the Office of the Prime Minister: Screening process for aliens entering the Kingdom of Thailand and incapable of returning to their home country’. However, there has not been any tangible change of healthcare policies for URASs after this Regulation was promulgated. The interviews and Delphi-survey suggested that the ideology of national security and international relations influenced the concept of human rights for URASs. The ambiguity of the policy direction from central authorities to take care of URASs causes varying legal interpretations and incoherence of practice among frontline officers regarding the care for URASs. Nevertheless, the majority of the key informants agreed that URASs should be granted the right to work in the country lawfully and should be able to acquire health insurance. The quantitative survey on unmet need for health services demonstrated that the prevalence of unmet need in URASs was significantly greater than in Thais. Factors that were significantly associated with greater odds of unmet need were increasing age, below-bachelor educational background, and the lack of health insurance. Being uninsured tended to yield the largest degree of association with unmet need in both outpatient and inpatient care. URASs from Arab countries were found to face a greater degree of unmet need, compared with URASs from other nations. Policy recommendations include the following proposals. Firstly, as grantingURASs rights to work lawfully in Thailand is the most agreeable issue in the perspective of many stakeholders involved in this study and there exists legal mechanisms to push this agenda forward (for instance, Article 17 of the 1979 Immigration Act and Article 63 of the 2017 Royal Ordinance Concerning the Management of Employment of Foreign Workers), the Ministry of Labour should work closely with relevant authorities to advocate a Cabinet Resolution to permit URASs to acquire a work permit. Such a proposal will not only increase the stock of labour to boost the Thai economy, but also reduce the financial burden of the state that is used to take care of this population. Secondly, theThai Government should demonstrate a clear strategic direction to ensure the wellbeing of URASs in all related areas, especially health, education, and employment. The clear policy direction of the Government will translate into concrete actions at the operational level in respective agencies. Thirdly, though at present URASs are still uninsured, the Ministry of Public Health (MOPH) should launch a clear policy message to guarantee URASs the right to enjoy basic healthcare for diseases that may cause public health threats and the related right to acquire necessary health promotion and disease prevention services without excessive personal expense burdens. Fourthly, as the MOPH has already introduced health insurance for non-Thais who are not yet covered by the Social Security Scheme (SSS), the MOPH should ratify rights to access this insurance scheme for URASs as well. The MOPH should officially issue a letter to notify all affiliated facilities about this right. In terms of insurance management, the MOPH should consult with UNHCR and relevant agencies to come up with solutions that are acceptable for all parties. The consultative points should include who should pay for the insurance and mechanism to ensure that all URASs will be enrolled in the insurance, not just the unhealthy ones. Fifthly all authorities in the health sector, particularly the MOPH and the National Health Security Office (NHSO), should actively take part in the screening process of URASs as specified by the 2019 Regulation of the Office of the Prime Minister on ‘Screening process for aliens entering the Kingdom of Thailand and incapable of returning to their home country’. Though representatives from the MOPH or the NHSO are not enlisted as the screening committees, the committees may set up sub-committees or working groups to work on specific issues if necessary. Hence, an early discussion with the committees is indispensible. Lastly, to take a clear stance to promote wellbeing of URASs, the Thai Government should consider becoming a party of the 1951 Refugee Convention and withdrawing a reservation to ratify Article 22 of the 1989 Convention on the Rights of the Child. However, additionals studies to gauge benefits, drawbacks, and limitations, should be conducted if the Government decides to ratify these agreements. This would complement the progress og the abovementioned recommendationsand help demonstrate a long-term commitment to the wellbeing of URAS.


location: , 'Thailand year: 2022 source: HSRI

title: Proposal for a Digital Health Platform Synthesis Project in Pilot Health Regions Based on National Public Health Reform Policy: Addressing Emerging Infectious Diseases and Noncommunicable Diseases (NCDs)

abstract: There are many health information systems in Thailand and various project indicators. Many of them are redundant and unable to integrate both the reporting system and the medical expense reimbursement. has not yet been fully utilized This study is an analytical study. To study and find a suitable management model and approach for the whole ecosystem that affects the drive of the digital health system. It was carried out in three parts: 1) digital health system review; The study found a digital health governance model requires collaborative governance. have a strong leadership, has authority and constantly in position There is a central agency that drives the development of digital health systems. and to focus on the standardization of the health data system There are good examples of Australia, England, Finland, and India. 2) Developed prototype tools of personal health information system; Personal health data from multiple database sources is integrated and automatically linked directly from the hospital to the central, can display health information through mobile applications and link between hospitals to use in medical treatment and 3) synthesize recommendations; to reform data management from Silo Base to Authority Base for sustainable. Therefore, there are proposals in 5 mission and it is necessary to have an agency directly responsible for the digital health system. There is a proposal for an action plan to establish National Digital Health Authority.


location: , 'Thailand year: 2018 source: HSRI

title: Automatic Brain Hemorrhage Volume and Midline Shift Detection as Decision Assistance before Surgery

abstract: Stroke or brain bleeding is a disease occurred when the blood vessels inside of the brain or between skull and brain burst. Common causes are injury due to accident or high blood vessels. This disease requires an immediate diagnose whenever a patient has an abnormal signs such as severe headache, acute fatigue of arms and legs, nausea, vomit, loss of balance, cannot communicate with other people or cannot understand other people, or have an indication that there may be an injury to the brain. The patient when gets hospitalized is usually taken to CT scan to get the slides of the brain images because CT scanning is quick and also less expensive than any other method. The neurosurgeon considers these slides of images to detect any abnormality in the brain and gives appropriate actions. However, as the number of expert neurosurgeons who know how to read the images throughout the country is very low and the majority of them works in Bangkok and vicinity or major provincial hospitals, this makes a big obstacle to effectively save lives of people who live in the rural area. This project aims to develop pilot software that can automatically detect patients who have stroke, for the patient who have a hemorrhage, it automatically makes a 3D model of a brain hemorrhage, compute midline shift, compute a volume of a hemorrhage, and classify patients with emergency condition. This program will be helpful as a supporting tool for doctors especially those who are inexperience to know the condition of stroke of the patients.


location: , 'Thailand year: 2017 source: HSRI

title: Humanitarian Services Behaviors: Patients’ vs. Providers’ Perspectives

abstract: A cross-sectional survey research aimed to compare the humanitarian behaviors between patients’
and providers’perspectives. The samples were out- and in-patients and staff of Queen Savang Vadhana
Memorial Hospital, The Thai Red Cross Society. The sample sizes were estimated by Krejcie & Morgan
table. Data were collected by the generated questionnaire with Likerts’ scale from 1 to 5 scores. Its
indexes of item objective congruence were 1.7-2.0 from range 0-2 scores, and its reliability was 0.95
by Cronbach’s alpha. One-way analysis of variance and independent t-test were used to compare the
humanitarian behavior scores among the three groups, and between the two groups including patients and provider. A p value less than 0.01 was defined as significant difference.
Five hundred out-patients, 630 in-patients, and 1250 staffs answered the questionnaires. The
average age of in-patients was the highest, followed by of staffs, and of out-patients (mean (SD) =
41.4 (16.1), 36.9 (10.3), 33.9 (9.6) year old (p<0.001), respectively). The humanitarian services behavior
scores among the three groups were significant different, and the scores from lowest to highest were
in-patients, out-patients, and staffs (mean (SD) = 80.8 (14.4), 82.0 (10.4), 85.3 (10.9) from 100 scores
(p<0.001), respectively).
The suggestions for quality improvement of the out-patient service were to emphasize on the
humanitarian services behaviors of the general service staffs; such as, explaining the choices of treatments,
participating in decision making, being presence and encouraging when the patients faced
suffering, providing opportunity for patients’ compliance to their religious activities.


location: , 'Thailand year: 2021 source: HSRI

title: Policy Options for Strengthening District Committee on Improving Quality of Life (District Health Board)

abstract: Background: The district is an important strategic point in the development of the health system based on the concept of area-based and people centred. It is consistent with the principles of Primary Health Care (PHC) in the Alma Ata Declaration 1978 and the Astana Declaration 2018. Key components of PHC include people-centered services delivery of essential primary health care, multi-sectoral policy and actions, and empowering people and community for self-care. District Health Board (DHB) or “Por Chor Or” (in Thai) is a model and mechanism that expedites health and improves quality of life of local people. The mechanism was initially introduced as a few pilot districts in B.E. 2558. Later, in B.E. 2559 and B.E. 2560, participating districts were increased to 73 and 200 districts respectively. In B.E. 2562, this management model was implemented nationwide. This study aims to assess how Por Chor Or is implemented in different districts and whether it follows the IPCHS concept as well as propose policy recommendations for future development. Method: The study employed mixed-method study design. Purposive sampling was used for selection of study areas in 8 provinces including Chumporn, Nakhon Panom, Nakhon Sawan, Nan, Ratchaburi, Srisaket, Songkla, and Saraburi. Three districts categorized in each province were selected according to a suggestion from responsible health officers at provincial level who categorized each of the proposed districts into three implementation levels: ‘good’, ‘moderate’, and ‘initiating’. For qualitative research, in-depth and focus group interviews were conducted with 891 participants using semi-structured interview guidelines. Thematic analysis was used for qualitative data analysis. For quantitative research, 8,562 participants answered online questionnaire adapted from WHOQOLBREF. One-way ANOVA was used for quantitative data analysis on SPSS. Results: Qualitative data analysis showed that Por Chor Ors in ‘good’ and ‘moderate’ implementation levels demonstrated learning organization features including building multi-sectoral collaboration, shared ownership, and co-implementation of Por Chor Or’s policy. In terms of working process, ‘good’ and ‘moderate’ Por Chor Ors emphasized on informal monitoring, regular and two way communication, and creating structures or bodies that linked policy implementation from subdistrict to village level. They also had integrated health services that shared Por Chor Or’s policy emphasis including focuses on health promotion and disease prevention as well as enhancing quality of life. This work had been implemented through Sub-district committee on quality of life improvement or “Por Chor Tor” (in Thai), a sub-district mechanism for Por Chor Or’s policy implementation. Also, leadership to implement the policy was stronger in other sectors outside public health. Locals in ‘good’ and ‘moderate’ Por Chor Ors also had better perception and participation in health development and quality improvement related activities. For ‘initiating’ Por Chor Ors, they relied on bureaucratic working system to implement Por Chor Or’s policy. Multisectoral collaboration and co-ownership of Por Chor Or’s policy implementation was scarce or unclear. Public health sector remained leading sector in policy implementation. However, public health services were shifting towards health promotion and disease prevention in ‘developing’ Por Chor Ors and locals had minimal perception and participation in health development and quality of life related activities. Quantitative findings showed that overall quality of life score was the highest in ‘good’ Por Chor Ors (97.1, S.D. 11.1); followed by ‘initiating’ Por Chor Ors (96.0, S.D. 11.8) and ‘moderate’ Por Chor Ors (95.8, S.D. 10.6) respectively. Enhancing factors for Por Chor Or’s success included competency and leadership of District Chiefs and Por Chor Or’s secretary teams, particularly for District Health Officer, multi-sectoral participation, clear working structures that linked policy implementation between district and sub-district levels, supports from provincial administrative bodies, and visits from provincial and regional health bodies to empower Por Chor Ors. Additionally, the study showed that using UCCARE for Por Chor Or evaluation might not accurately reflect the mechanism’s level of implementation or development due to ambiguity of criteria interpretation of UCCARE by the stakeholders. Conclusion: District Health Board or Por Chor Or is a mechanism that encourages multi-sectoral and local individual collaboration to empower health management and self-care that leads to an improvement of individual’s quality of life. The success of Por Chor Ors comes from integration of bureaucratic administration and ‘bottom-up’ approaches which can explore and respond to people’s health needs. The change is galvanized by District Chiefs and other stakeholders whose leadership and understanding of local needs can support a work culture of learning organization. All Por Chor Ors work in consistent with policy and health system development which is based on primary health care principle and concept. Further improvement of system and tools to support Por Chor Ors needs to align with capacity, amount, difficulties, and strategic issues of each Por Chor besides having existing tools for self-assessment. The success of implementing those tools will result in more effective strategy formulation and better development for Por Chor Ors.


location: , 'Thailand year: 2017 source: HSRI

title: An Analysis of Medical Care Charge for the Outpatient of Migrant Workers at Khao Chakan District, Sa Kaeo Province in the Fiscal Year of 2014 - 2015

abstract: Thailand has a large number of the migrant laborers working both legally and illegally. In 2014 the
government set a strong policy to officially register migrant workers for providing health insurance. This
research aims to analyze the costs of medical care and health services of the registered migrant workers at
Khao Chakan District, Sa Kaeo Province. This was a descriptive study using secondary data from the
accounting and finance on HOSxP database of the hospital and JHCIS database of Subdistrict Health
Promoting Hospitals in fiscal 2014 and 2015.
The results showed that there were 54 registered migrant workers receiving 90 health care services visits in the fiscal year 2014. In 2015, the number of registered migrant workers increased to 983 people
receiving 596 health care services. The total cost of outpatient in fiscal 2014 and 2015 was 22,588 baht and
145,482.92 baht. The average cost per visit was 250.98 ± 352.18 and 244.10 ± 301.82 baht. The average cost
per registered person was 418.30 baht and 148.00 baht respectively. The percentages of people who turned up for services to the total registered workers were 38.9% and 25.5% respectively. The total revenue of the outpatient from health insurance card for migrant workers in fiscal 2015 was 642.40 baht per person per year.


location: , 'Thailand year: 2009 source: HSRI

title: Pharm. System Research Network

abstract: This proceeding summarizes discussion points and implementation proposals from a consultative workshop on “Research Framework on Pharmaceutical Systems and Access to Medicines”, hosted by Health Systems Research Institute (HSRI) during 26-27 August 2009 at Siam City Hotel, Bangkok.  An opening remark by Professor Dr. Vijarn Panich, the HSRI Board shed light on an urgent need for quality research framework on pharmaceutical systems that are relevant to the national policies.  The framework may cover around 5-6 project  packages that address research strategies in-depth through the holistic picture of Thai society.

A panel discussion on “Current Situation of Pharmaceutical Systems in Thailand: Catching up with the Global Trends” began with an elaboration on impacts of the global drug patent systems on the domestic generic drug industries. Health service behavior related to drug utilization like over-prescribing of the single-source, non-essential, and expensive drugs under Civil Servant Medical Benefit Scheme (CSMBS) is an obvious contention between the responsiveness and efficiency goals of the health systems.  Other systems issues included drug pricing that does not reflect the true cost structure.  The discussion ended with description of influencing factors to pharmaceutical systems and knowledge management tasks related to pharmaceutical systems research.

The current situation of pharmaceutical systems research presented was based on a rapid review of peer-review  publications during the past 5 years by the HSRI and a summary from the ThaiHealth’s Plan on Mechanism for Monitoring and Development of Pharmaceutical Systems (Kor Por Yor)’s databases.  The conclusion was scarcity of the research at the national level and the research weakness due to the use of non-systematic approaches and under-utilization of the study results.

Two sessions of small group discussion proposed some better approaches to pharmaceutical  systems research management.  These include (1) a precondition of the clear research direction, (2) a facilitating channel for access to research funding agencies, (3) a platform of consultation with stakeholders or policy makers for upgrading and translational research, (4) building research teamwork within and between academic institutes, central organizations and service organizations, to learn from senior mentors, and establishing knowledge sharing networks, (5) developing pharmaceutical systems research network, and (6) setting up an information center of  pharmaceutical systems by HSRI coordination to facilitate researchers access to national databases.

The concluding discussion resulted in a proposal of establishing a coordinating body between available networks of pharmaceutical systems research for knowledge generation and management, which includes capacity building missions based on the UNDP’s Individual-Node-Network-Environment model for translating knowledge to changes.

The pretest and post test feedback by the participants revealed the research priority in the following areas: (1) formulation and implementation of drug distribution and utilization policies; (2) study of rational drug use behavior; (3) drug reimbursement and payment under health insurance systems; (4) monitoring of drug expenditures; (5) evaluation of clinical outcomes of drug use.  The HSRI as the host for the meeting should lay out a clear research framework related to the above mentioned areas to prevent fragmentation and duplication.  This can be fulfilled by orientating the pharmaceutical systems research towards the health systems strengthening framework and arranging the mentorship platform for junior and senior researchers.


location: , 'Thailand year: 2022 source: HSRI

title: Economic evaluation and feasibility study of expanded newborn screening for inborn errors of metabolisms by tandem mass spectrometry

abstract: Inborn errors of metabolism (IEM) are rare genetic (inherited) disorders comprising hundreds of diseases. The signs and symptoms of IEMs can mimic almost any pediatric disease. The symptoms may be similar to infectious diseases such as lethargy, not suckling, vomiting, convulsions, panting, etc. Therefore, it is difficult for non-specialist physicians to detect the disorders resulting in delayed diagnosis and treatment which may further lead to mental retardation, permanent disabilities, or death during infancy or childhood. Currently, there is a technology called Tandem Mass Spectrometry (MS/MS) that can detect more than 40 IEMs in a single blood spot. MS/MS is therefore being used for screening and diagnosis of IEMs in newborns and sick infants in many countries. In 2013, an economic study to evaluate value for money of expanded newborn screening for 6 IEMs with MS/MS was performed. At that time, it was found that such screening was not worthwhile. But now the situation has changed, such as the willingness to pay threshold for Thailand, the number of IEMs that can be screened, cost of medical care and quality of life of patients, etc., thus leading to a recent study on economic evaluation and feasibility assessment of expanded newborn screening for IEMs using MS/MS technology. There are four specific objectives of this study: 1) to assess cost utility of the expanded newborn screening using MS/MS (cost-utility analysis) and treatment of patients with IEMs; 2) to study the cost of illness (cost-of-illness) of IEM patients 3) To analyze budget impact of expanded newborn screening and treatment of IEM patients and 4) To study feasibility of including expanded newborn screening using MS/MS for all Thai newborns in the benefit package of the Universal Coverage Scheme. The study used a combination between Decision tree analysis model for simulation of screening scenarios and the Markov model for simulating the health status of IEM patients. A total of 41 IEMs that can be screened by MS/MS were included. The study estimates costs and outcomes in terms of life year and Quality-Adjusted Life-Year (QALY), reported as incremental cost-effectiveness ratio: ICER in baht per QALY gained, comparing the situation between providing expanded newborn screening and current situation without expanded newborn screening. A comparison of the outcome and cost of treatment before and after clinical presentations were also analyzed to illustrate the potential benefit of early treatment for affected children. A lifetime time horizon and societal perspective were applied. For budget impact analysis, provider’s perspective was used. In addition, the study employed survey and in-depth interviews with key stakeholders to explore the feasibility and current capacity of proving expanded newborn screening. The study found that providing early treatment before clinical manifestation is cost effective compared to providing late treatment. The ICER was between dominant ICER to 120,995 THB per QALY gained, depending on the disease groups and its complications, except for Tyrosinemia Type I, with an ICER of 1,073,540 THB per QALY gained. The ICER of expanded newborn screening using MS/MS ranged between 259,824 – 576,711 THB per QALY gained depending on cost of screening and incidence of IEMs. The cost of illness for a patient is as high as 3.6 million up to 8.7 million THB because the patient needs a lifelong treatment by medical professionals. The additional budget for screening and treating patients in the first year is at 30 million THB. The total budget for 5 years is 283 million THB. Currently, there are 2 MS/MS providing services in Thailand that can serve up to about 60,000 patients per year. In order to cover all newborn nationwide, 14 MS/MS should be put in place. Therefore, 12 MS/MS is still needed and trainings for staff should be also provided. Policy recommendations 1. NHSO should consider including expanded newborn screening with MS/MS technology as a benefit package under the Universal Coverage Scheme. Although the expanded newborn screening was not cost-effective, it is the only accurate method of early detection and providing pre-clinical treatment that improves health outcomes and prevents complications leading to permanent disabilities. Providing early treatment was cost effective. In addition, IEMs cause huge economic burden to patients and their relatives and were regarded as a catastrophic illness. Furthermore, treatment for IEMs is already covered by the UCS, but identify potential patients for treatment remains a major obstacle that prevents these patients from accessing the services. 2. Recommend NHSO to 2.1 Negotiate the price of screening that the government can afford with the participation of responsible government agencies and service providers. If the expanded newborn screening is operated throughout the country, the cost of supplies from private firms may be negotiated. 2.2 Collect information about screening service utilization, incidence of IEM, following-up for diagnosis, as well as problems and obstacles for further development and expansion of the program 2.3 Assign the rare disease working group under UCS to develop an action plan for providing expanded newborn screening in order to achieve universal service access as quickly as possible. This will include establishing guidelines for registration of rare disease screening centers, guidelines for providing screening services and information systems (software) and adding representatives from the Ministry of Social Development and Human Security, Thailand (PMO) to join the rare disease working group. 2.4 Coordinate with the Food and Drug Administration to speed up the registration process of drugs and metabolic formula for the treatment of IEM patients. 3 . Relevant agencies should discuss and establish an effective system to deliver blood specimen to the MS/MS Screening Center within 24 hours. 4. A National Newborn Screening Advisory Committee should be established to provide advices and recommendations on the integration of Thailand's newborn screening system, newborn screening database, accreditation of newborn screening centers, and monitoring and evaluation of newborn screening in the country.