Thailand report
Public health agencies
• Ministry of Public Health (MoPH).
• Emergency Medical Institute of Thailand.
• Health Systems Res...
Disease Burden
• Thailand is witnessing both demographic and
epidemiologic transitions.
• The total fertility rate dropped...
• HIV/AIDS,tuberculosis, malaria and emerging
pathogens remain important and are
compounded with emerging drug resistance
...
Health systems
• The Universal Health Care (UHC) policy of 2002
has resulted in a 99% universal coverage among
Thai nation...
• The health system of Thailand continues to be based
on primary health care and the network of health
institutions provid...
Thailand’s role in health development
beyond its borders
• Thailand is an emerging development partner
and active particip...
• There are 34 WHO Collaborating Centers in
Thailand that
• together with other Centers of Excellence are
organized into a...
National Health Indicators
Thailand will become aging society in next 10 years
Primary health care in Thailand
Traditional
Medicine
1932
1950
1964
1966
1968
1974
1975 1978 1981 1992 1996 1997 1999 20022001 2007
Stating
Rural
Health
S...
Primary Care Development
• MOPH policies
– 1992 The Decade of Health Center
Development
• Health Center = Primary care uni...
Primary Care Development
• UC Policy (2001)
– Strongly implement primary care service = 1st
strategy – equity in accessibi...
Community Hospital
• Medical care provider at district level, 120-150 beds
• Roles:
– Provide medical services: diagnosis,...
Community Hospital under UC
• CUP – contracting unit for primary care
– Main contractor = purchaser (but also be
provider)...
Health Center
• Care Provider at village/tambon level 1,000-5,000
population
• Personnel: Health officer, Midwife, Technic...
Health Center – higher expectation
The Decade of Health Center Development:
Strenghtening primary care services, reduce
wo...
Health Center under UC
Strengthening primary care service
• PCU – catchment 10,000 pop, working 56 hrs/week,
easy access
•...
Community-based health care
2.
Considerate
Society
3.
Treatment
of common
diseases4.
Care for
Chronic Diseases
5.
Care for...
At the Cross Roads
• PCU = HC with no medical doctors (lessons
from Ayudhaya)
• PCU = HC with medical doctors on rotation
...
Key concerns
• Do we need “medical doctors” for a PCU?
– will be very difficult to realise at present.
HC=PCU=10,000 more ...
• Whatever they are, they are not the same
as European GP’s,
• they will not provide only clinical services
(so called PMC...
3 major lines of development
• Strengthening PC thru CUP => applicable
mostly thru CUP within MOPH (CH, GH,
RH)
• Directly...
MOPH NHSO
PCMO
Com Hosp
Regional
NHSO
Community
Health
Fund
PPV
PPF/
PCA/
PPC OP
OP IPPP Oth
Primary Care Unit
Non-MOPH /
...
Recent Policy: Health Service Development
Tambon Health Promotion Hospital:
Leverage HC to Tambon Hospital and set up
refe...
Tambon Health Promotion Hospital
• Catchment area - tambon level and
networking with other health centers,
• 24 hrs servic...
Tambon Health Promotion Hospital
• Coordinate with other partners - central
government + local authority +
community + pri...
Possible future of THPH
• Strengthened as a subsystem with the
CUP
• Evolve as CMU within MOPH network
• Evolve as CMU und...
Next
• Strengthen MOPH-PC network through
Tambon Hospital (CUP-based)
• Redefine Private PC (service models, budget,
capac...
Primary Care Development
• access and coverage
• quality of care
• cost-effectiveness
• efficient use of resources
Communi...
Thai Traditional Massage Therapy
Drying the herbs.
The use of herbal medicine.
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  1. 1. Thailand report
  2. 2. Public health agencies • Ministry of Public Health (MoPH). • Emergency Medical Institute of Thailand. • Health Systems Research Institute. • Healthcare Accreditation Institute. (Public Organization) • National Health Commission Office. • National Health Security Office. • Thai Health Promotion Foundation.
  3. 3. Disease Burden • Thailand is witnessing both demographic and epidemiologic transitions. • The total fertility rate dropped from 2.1 in 1990 to 1.5 in 2012. • Non-communicable diseases comprise nine of the top ten burdens of disease. • Injuries, particularly those related to road crashes, represent one of the highest causes of morbidity and mortality in Thailand and extract a high economic toll on the country.
  4. 4. • HIV/AIDS,tuberculosis, malaria and emerging pathogens remain important and are compounded with emerging drug resistance particularly among mobile/border populations. • Many current public health challenges require multi-sectoral and multi-stakeholder collaboration as well as efforts to address their social determinants.
  5. 5. Health systems • The Universal Health Care (UHC) policy of 2002 has resulted in a 99% universal coverage among Thai nationals using a mix of health protection schemes. • The National Health Act of 2007 established a solid foundation for stronger civil society participation in health with the National Health Assembly as the key instrument.
  6. 6. • The health system of Thailand continues to be based on primary health care and the network of health institutions provides good overall coverage with solid evidence of its ‘propoor’ effect. • Challenges remain to strengthen disease prevention and health promotion, ensure adequate and high quality primary care, address some allocative inefficiencies due to incomplete system reform, and extend health care to migrants.
  7. 7. Thailand’s role in health development beyond its borders • Thailand is an emerging development partner and active participant in a number of international initiatives. • Thailand plays an active role in the governance of WHO, global funds, alliances and partnerships, and in regional collaborations such as ASEAN. • Thailand is increasingly involved in technical and financial cooperation with other countries.
  8. 8. • There are 34 WHO Collaborating Centers in Thailand that • together with other Centers of Excellence are organized into a network. • These centers are valuable sources of expertise in Thailand and beyond its borders.
  9. 9. National Health Indicators
  10. 10. Thailand will become aging society in next 10 years
  11. 11. Primary health care in Thailand
  12. 12. Traditional Medicine 1932 1950 1964 1966 1968 1974 1975 1978 1981 1992 1996 1997 1999 20022001 2007 Stating Rural Health Services Tropical Diseases Control Programs Wat Boat Project - Sarapee Project - BanPai Project Health Centers Lampang Project Samoeng Project Nonetai Project Expanded Community Hospitals Adopted Health For All Policy Rural Doctors Movement Community Health Volunteers Health Card Project The Decade of Health Center Development (1992-2001) 1985 Health Care Reform Project Economic Crisis Civil Society Movement Universal Coverage Policy Thai Health Fund Starting Primary Care Services National Health Act Primary Care Development Source: Komartra Chungsathiensarp, 2551 Decentralization
  13. 13. Primary Care Development • MOPH policies – 1992 The Decade of Health Center Development • Health Center = Primary care unit • 2 types: general HC and large HC; upgraded infrastructure and facilities • Capacity building – nursing care – 1997 “Good Health at Low Cost” • Strengthening primary care services – accessibility and efficient
  14. 14. Primary Care Development • UC Policy (2001) – Strongly implement primary care service = 1st strategy – equity in accessibility + efficient health services + increase health promotion and disease control – Promote family medicine/family practice in PC unit (Community Medical Unit) – 2 main types of providers managed by NHSO to effect PC – CUP, private clinics in cities (BMA)
  15. 15. Community Hospital • Medical care provider at district level, 120-150 beds • Roles: – Provide medical services: diagnosis, treatment both inside/outside the hospital, and also integrated health services: PP and rehabilitation, and mobile clinic – Technical center and supervisor – Support community participation, self care, promote QOL with PHC, psychosocial support, human right protection,
  16. 16. Community Hospital under UC • CUP – contracting unit for primary care – Main contractor = purchaser (but also be provider) – one PCU – Provide medical care to the registered – Set up supporting system for PCU in the network: personnel, medicine, medical devices/ Communication system / monitoring- evaluation system / technical support and quality control
  17. 17. Health Center • Care Provider at village/tambon level 1,000-5,000 population • Personnel: Health officer, Midwife, Technical Nurse • Roles: – Integrated Public Health Services: Disease Prevention, Health Promotion, and treatment for common diseases – Support Primary Health Care and Community Development – Technical support and administration – Health Education
  18. 18. Health Center – higher expectation The Decade of Health Center Development: Strenghtening primary care services, reduce workload from hospitals • Selected urban health centers 1:5 • Acting as “node” - take care of other HCs in the network, referral center • More personnel: – Rotated physician from near-by hospital / Routine Medical service (CMU) – Registered nurse, dental hygienist • More services – basic dental care, treatment
  19. 19. Health Center under UC Strengthening primary care service • PCU – catchment 10,000 pop, working 56 hrs/week, easy access • Personnel: one physician, 2 registered nurse, 3 health sciences officers, etc. • Roles: – PP services, continuity of care – Curative care: diagnosis/curative – acute / chronic care, primary care, EMS – 24 hrs. / coordinating care – Dental care – Home visit • Autonomous PCU in urban area
  20. 20. Community-based health care 2. Considerate Society 3. Treatment of common diseases4. Care for Chronic Diseases 5. Care for Elderly 7. Health Promotion 1. Sufficiency Economy Better Community health Strong Community 6. Diseases control
  21. 21. At the Cross Roads • PCU = HC with no medical doctors (lessons from Ayudhaya) • PCU = HC with medical doctors on rotation (implemented in selected HC) • PCU = upgraded HC (CMU) – manned by a “non-rotating” medical doctor (FP) working in “large HC” with additional facilities • Private Clinics with additional functions, mainly outreached community-based, (lessons from urban HC under UC)
  22. 22. Key concerns • Do we need “medical doctors” for a PCU? – will be very difficult to realise at present. HC=PCU=10,000 more GP’s!!!!! – Nurses or public health graduates with curative training can do as well. Should we stick to MOPH structure or go for private GP/FP? Whatever they are, they should be able to provide community-based health care.
  23. 23. • Whatever they are, they are not the same as European GP’s, • they will not provide only clinical services (so called PMC), • should be more proactively working with community and • should be concerned with and play active roles to tackle health as a wholistic concept (PHC and health promotion concept)
  24. 24. 3 major lines of development • Strengthening PC thru CUP => applicable mostly thru CUP within MOPH (CH, GH, RH) • Directly contracted CMU => for HC that can meet the NHSO requirement (whether they are MOPH’s or outside of MOPH) – Actual implementation not yet start • Modified private clinics (adding community-based care).
  25. 25. MOPH NHSO PCMO Com Hosp Regional NHSO Community Health Fund PPV PPF/ PCA/ PPC OP OP IPPP Oth Primary Care Unit Non-MOPH / Private 2nd/3rd Care Units BoardPPC CMU HCs HCs Community Local Authority For contract purpose Representatives to be Board members Representatives to be Board members Recommended model For more effective Strengthening of HC Thru MOPH CUP
  26. 26. Recent Policy: Health Service Development Tambon Health Promotion Hospital: Leverage HC to Tambon Hospital and set up referral system and networking with private sector
  27. 27. Tambon Health Promotion Hospital • Catchment area - tambon level and networking with other health centers, • 24 hrs services, under supervision from the hospital and referral system, • Polyvalent - skill mix and team work in PP services, • Community participation and internal audit,
  28. 28. Tambon Health Promotion Hospital • Coordinate with other partners - central government + local authority + community + private sector, • Working in community – home ward, • Proactive, outreach services based on community health needs, • Care coordination – horizontal and vertical levels and case management system
  29. 29. Possible future of THPH • Strengthened as a subsystem with the CUP • Evolve as CMU within MOPH network • Evolve as CMU under local administration
  30. 30. Next • Strengthen MOPH-PC network through Tambon Hospital (CUP-based) • Redefine Private PC (service models, budget, capacity and HR) • More flexible “performance assessment” framework – too many detailed items at present • Redefine “how to commission” for PC in the future – directly contrating with PCU? – MOPH - Local Administration – Private Sector - Other Public Providers
  31. 31. Primary Care Development • access and coverage • quality of care • cost-effectiveness • efficient use of resources Community Participation Resource Allocation Private Sector Roles & Regulations Information System Human Resource Allocation/Financing Referral Network & Excellent Center Technology & Pharmaceutical Benefit PC Model and EMS Model Area health board Local Authority PC development and relationship with major system issues
  32. 32. Thai Traditional Massage Therapy
  33. 33. Drying the herbs.
  34. 34. The use of herbal medicine.

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