Thailand report

Welcome to Thailand

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.

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.

• 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.

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.

• 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.

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.

• 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.

National Health Indicators

Thailand will become aging society in next 10 years

Primary health care in Thailand

TraditionalMedicine

1932

1950

1964

1966

1968

1974

1975 1978 1981 1992 1996 1997 1999 2002

2001 2007

Stating Rural Health Services

TropicalDiseasesControl

Programs

Wat Boat

Project

- Sarapee Project- BanPai Project

Health Centers

Lampang Project Samoeng Project Nonetai Project

ExpandedCommunityHospitals

AdoptedHealth For

AllPolicy

Rural Doctors Movement

Community Health Volunteers

Health Card

Project

The Decade of Health Center Development(1992-2001)

1985

Health Care ReformProject

EconomicCrisis

Civil Society Movement

Universal

Coverage Policy

Thai Health Fund

Starting Primary Care Services

National Health Act

Primary Care Development

Source: Komartra Chungsathiensarp, 2551

Decentralization

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

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)

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,

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

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

Health Center – higher expectationThe 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

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

Community-based health care

2.Considerate

Society

3.Treatment of common

diseases4.Care for

Chronic Diseases

5.Care for Elderly

7.Health

Promotion

1.SufficiencyEconomy

BetterCommunity

health

StrongCommunity

6.Diseasescontrol

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)

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.

• 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)

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).

MOPH NHSO

PCMO

Com Hosp

Regional

NHSO

CommunityHealthFund

PPV

PPF/PCA/PPC OP

OP IPPP Oth

Primary Care Unit Non-

MOPH / Private

2nd/3rd Care Units

BoardPPC

CMU

HCs HCsCommunity

LocalAuthority

For contract purpose

Representatives to be Board members

Representatives to be Board members

Recommended modelFor more effective Strengthening of HCThru MOPH CUP

Recent Policy: Health Service Development

Tambon Health Promotion Hospital:Leverage HC to Tambon Hospital and

set up referral system and networking with private sector

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,

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

Possible future of THPH

• Strengthened as a subsystem with the CUP

• Evolve as CMU within MOPH network• Evolve as CMU under local

administration

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

Primary Care Development• access and coverage

• quality of care• cost-effectiveness

• efficient use of resources

CommunityParticipation

Resource Allocation

Private SectorRoles &

Regulations

InformationSystem

Human ResourceAllocation/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

Thai Traditional Massage Therapy

Drying the herbs.

The use of herbal medicine.