2.1.1
Shortage of Medical Services in Rural Areas is a major problem.
There are considerable differences between services provided by the Government
to urban and rural inhabitants. This can be shown by the radio of hospital
beds to the number of population which at present is 1: 150 in urban
areas and 1 : 900 in rural areas. The number of physicians to the population
size in the Central region is 1 : 1,621 persons while the corresponding ratio
in rural areas is 1 : 30,863 persons.
Due
to the shortage of medical services, illnesses are rampant in rural areas.
Records indicate that about 51 per cent of the total number of sick people in
rural areas buy medicine themselves without getting prior advice from a
doctor. Also, only 15 per cent of the total number of people who are sick in
rural areas use government health facilities such as hospitals and health
centres. The rest receive treatment from private clinics or traditional
doctors or witch doctors. The main reason for this is that most of the medical
service centres such as hospitals are located only in urban areas or in the
larger districts, while the number of first class health centres is still
inadequate. The radio of the number of districts to the number of health
centres is only 1 to 0.39 which is still a long way away from the 1 : 1 ratio
which is what it should be.
2.1.2
The Quality of Medical Services provided to the rural population is
still far inferior to that provided for the population in Bangkok. This is due
to the shortage of medical personnel in comparison with the number of
patients. Thus, doctors cannot spare enough time to examine and diagnose
patients. In addition, there is also a shortage of equipment, medicine,
medical supplies and specialized doctors. Medical care in rural hospitals in
general is inferior to the services provided in urban areas. The ratio of
doctors and nurses to hospital beds can be summarized as follows: in the
Central region, on average, one doctor and 2.8 nurses are assigned to 6 beds
whereas in rural areas, on average, one doctor and 3.1 nurses must tend to 24
hospital beds. This is the reason why patients from rural areas prefer to come
for treatment in Bangkok hospitals. This results in unnecessary waste of time
and expense.
Technical
support is lacking, especially medical investigation and research. These
facilities still have not been improved or expanded to any degree. Technical
improvements to an extent have been provided in medical schools, but in rural
areas medical personnel has almost no chance to learn about new medical
techniques, to receive in-service training and to benefit from proper
supervision. Moreover, high-level personnel usually have to spend most of
their time doing administrative work rather than technical and so have a
limited amount of time to keep up with development in their profession.
2.1.3
Problems of Shortage and Distribution of Public Health Personnel.
At present, 385 doctors are produced each year and this figure will be
increased to 500 during the Fourth Plan period. Nevertheless, this rate of
increase in the number of doctors each year is still too low and a situation
in which there is a shortage of doctors will continue for some time. During
the Fourth Plan, para-medical personnel will be trained to help doctors
provide medical care and to help alleviate problems stemming from the shortage
of doctors in rural areas.
2.1.4
Problems of Environmental Health. The high population growth rate
together with the expansion of industry and trade which encourages the
migration of rural people into the big towns has brought about a situation in
which a large number of people are crowded into a very limited area. At
present, there is a housing shortage of about 110,000 units among low-income
urban population. In other words, about 20 per cent of the urban poor live in
slum. The slum areas with poor sanitation are spreading in several areas in
the bigger towns. This is one of the main sources of infectious diseases,
illnesses and malnutrition among preschool children.
The
expansion of industry and trade without effective planning relating to land
utilization, the construction of sewage disposal systems and similar matters
mean further environmental deterioration. The main environmental problems that
result from the lack of effective planning include water pollution, air
pollution and the pollution of food such as vegetables and drinking water due
to the increasing use of poisonous chemicals and insecticides.
2.1.5
Lack of Public Participation. Government public health personnel
have not received full cooperation from villagers relating to such matters as
the reporting of infectious diseases. Even now, there are communication
problems between government officials and villagers, the diffusion of public
health information is very limited and primary health instruction which is to
be given to villagers is not all that effective. Further work may have to be
done through village health volunteers.
2.1.6
Coordination problems and the Failure to Integrate Various Public Health
Services. This heading can be split into two parts. First, there is
the problem of coordinating operations which stems largely from
over-centralization of administrative powers. As a result, there are
unnecessary delays in the delegation of work and field officers have to work
under various constraints resulting from such an inflexible system. Secondly,
the public health development plan has not been properly integrated into the
overall plan for the country as a whole. An example of the first problem is
the lack of coordination between government officials working to prevent and
control diseases and those responsible for medical care and treatment, even in
the same region or province. This is largely because the administrative
procedure is so rigid and the fact that field officers are responsible to
supervisors of different government units. As a result, the people who should
benefit from a number of services are inconvenienced by such uncoordinated
government effort.
2.1.7
Lack of Public Health Services for Certain Group of People. Certain
groups in Thailand deserve special attention. These groups include the
hilltribes people of the Northern region, the Islamic Thais in the four
southern- most provinces of the Southern region, inhabitants in sensitive
areas, members of various land settlement colonies and the poor. Each group
has its own specific problems which must be solved, for instance, living
conditions, economic status, tradition and culture, language and income level.
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