Health Services

The Third National Economic and Social Development Plan (1972-1976). Chapter 15, p.224-227.

Date:     1972-1976

Source:     Office of the Prime Minister, National Economic and Social Development Board, Bangkok, Thailand

Subject:     health services, public health, medical care, health personnel, health centres

3. Important Results of Programmes undertaken during the First and Second Development Plans:

(a) Health promotion and expansion of public Health Services. Improvement and expansion of activities in the first and second class health centres and midwifes centres; construction during the First Development Plan of 70 first class health centres, 216 second class health centres, and 647 midwife centres. During the Second Development Plan another 73 first class health centres, 1,054 second class health centres, and 600 midwife centres were established. There will be by the end of the Second Plan period 290 first class health centres, 1,936 second health centres, and 2,003 midwife centres.

To improve sanitation and environment during the Second Plan period 23,800 villages water supplies have been developed, approximately 300 small scale water supply units and 4,370 units of water supply for schools have been installed. A rural nutrition project, initiated in 1971 in the Northeastern Region, has been expanded to other regions, totalling 19 provinces.

Projects for the prevention and control of contagious diseases, such as plague, smallpox, and cholera have been conducted and have so far been successful, While other programmes to fight communicable diseases, such as tuberculosis (medical examination and treatment, and B.C.G. vaccination) have been expanded to the rural areas. The tuberculosis mortality rate per hundred thousand population has been reduced from 31.5 in 1961 to 27.2 in 1969.

With regards to malaria, the mortality rate has been reduced from 24.5 per hundred thousand population in 1961 to 10.4 in 1969.

(b) Expansion and Improvement of Medical Care: The ratio of physicians, nurses, and hospital beds to population has been improved from 1961 to 1969 as follows:

(c) Training of Different Categories of Medical Personnel: During the First and Second Plan periods, increases in the number of personnel of different categories is as follows:

Physicians-totalled approximately 1,450. After the completion of the Second Plan it will be possible to train approximately 360 physicians per year.

Nurses-2,125 were trained by seven hospitals under the control of the Ministry of Public Health, and approximately 2,625 more were trained by other institutions, including the military and the private sector.

Practical nurses-approximately 410 were trained annually by six hospitals under the control of the Ministry of Public Health. A total of 2,000 persons were trained.

Midwives-the rate of training by the Ministry of Public Health expanded to 3,000.

(d) Studies and research work: During the First and Second Plan period, studies and research have been carried out as follows:

1. Medical studies and research work in the fields of viruses, Thai indigenous medicinal herbs, and drug standardization and control.
   
   

2. During the Second Plan period 40 public health laboratories in 40 provinces were improved. Research has been included in their work, both in the centre and in the regions through the combined public health and medical laboratory services of the Medical Sciences Department.

(e) Public Health Development Budget during the First and Second Plan period: The public health development budget during the First and Second Plan period was 3.6 per cent and 3.4 per cent of the total national budget. The reduced budget percentage for public health development in the Second Plan is due to the increase in the budget for administration and national defense which affected the economic and social development funds. However, in comparing the public health development budget and the total national development budget, in the First Plan it accounted for 4.8 per cent of the total and increased to 5.7 per cent in the Second Plan.

During the Second Plan period, the budget for public health totalled 3,558.43 million baht, of which about 90 per cent was allocated to development expenditure in the rural areas. It is divided into various projects as follows:

Foreign aid for public health during the Second Plan amounted to 191.97 million baht, almost all of which was devoted to health services and prevention of diseases.

Present and Future Problems

The programmes envisaged in the First and Second Plan have not yet been fully implemented due to administrative and technical problems. The obstacles to completely successful implementation can be summarized as follows:

1. Administrative Problems: The main problems are:

(a) The activities of each department and division of the Ministry of Public Health can further be improved by eliminating duplication of work, by better coordination and utilization of manpower, money, and equipment.

(b) Coordination and cooperation between Government agencies, particularly the municipal level, is not yet sufficiently organized both at the central and local levels. Especially at the local level, cooperation and coordination seem to work out smoothly if the physician in charge of the municipal work is also the provincial health officer.

(c) There are no definite and adequate arrangements to assign medical personnel according to demand. The ratio between physicians and population in the distant rural areas is thus disproportionally low.

(d) There is insufficient communication between private medical practitioners and the Government. If their activities were better coordinated prevention and control of diseases would be more efficient.

2. Technical problems

(a) Directly concerned with diseases: After consideration of the data on the cause-specific death rate^1/ and the number of patients admitted in 60 regional hospitals^2/ and 9 hospitals in Bangkok and Thon Buri, it may be concluded that various diseases are a public health problem. Their priority is as follows:

1. Certain diseases of early infancy and ill-defined diseases of children under 1 year of age, and diseases of pregnancy, childbirth and postpartum.
2. Diseases of the digestive system.
3. Tuberculosis.
4. Malaria.

(b) Factors involved in aggravating the severity of diseases

1. The rapid increase of population, at a rate of 3.1 per cent annually (one of the highest birth rates in the world)
2. Most of the people in the rural areas lack knowledge and understanding of disease prevention methods and are likely to neglect and ignore hygiene and health building practices.
3. People do not cooperate with the various Government health projects and lack a sense of participation in those projects.

3. Operational problems :

(a) Several programmes for communicable disease control and health promotion in rural areas are at present conducted as single projects, thus causing an excessive waste of money, time, and manpower. They should not be operated as specialized campaigns and should become the responsibility of the general health services as soon as possible.

(b) Consideration should be given to ways and means of improving the existing prevention programmes, especially by increasing the number of health centres and enabling them to offer better services to people in the remote rural areas, and by improving at the same time the efficiency of personnel.

(c) Improvement of medical care. The provincial hospitals, particularly, should provide efficient medical care, comparable to that available in the central area.

(d) The inadequate number of personnel in various categories is the major problem in both preventive programmes and medical care, and is the major obstacle to the expansion of the services. Therefore, training of more physicians, nurses, midwives, health workers, as well as paramedical personnel, should be encouraged.

(e) Improvement of activities in health education to enable the people to better understand and cooperate more readily with public health activities.

(f) Transfer of the allocated budget is not in accordance with the time schedule and programme. Several projects cannot proceed as planned. As actual expenditures for a given project in any fiscal year will only be about 70 per cent of the allocated budget, it should be possible to shift a substantial amount of budget for the development of other projects.