Health Services

The Fifth National Economic and Social Development Plan (1982-1986). Part V, Chapter 3, p.213-219.

Date:     1982-1986

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

Subject:     health services, public health development targets, health policies, immunization, communicable diseases, health education, nutrition, local diseases

2.  Public Health Development Targets

The main public health improvement targets that have been set in the Fifth National Economic and Social Development Plan are as follows:

2.1  The prevalence and mortality rates of preventable diseases will be reduced by the end of the Plan period, as follows:

1. To reduce diphtheria, whooping cough and tetanus morbidity and mortality rates by 60 per cent.

2. To reduce polio and typhoid morbidity and mortality rates by 50 per cent.

3. To reduce diarrhea morbidity and mortality rates by 25 per cent.

4. To reduce rabies morbidity and mortality rates by 25 per cent.

5. To reduce morbidity and mortality rates of respiratory infection diseases by 25 per cent.

6. To reduce malaria morbidity rate in the area under control covering 9 million population by 25 per cent and reduce mortality rate by 20 per cent on a nationwide basis.

2.2  Third degree protein-calorie malnutrition among children below five years of age will be totally eradicated and second degree protein-calorie malnutrition will be reduced by 50 per cent.

2.3  The rate of population growth will be reduced to 1.5 per cent by the end of 1986. Family planning services will be expanded to cover 4.5 million new acceptors and 4.1 million old acceptors by the end of the Plan period.

2.4  Immunization services will be provided to various target groups covering in particular children under one year of age as follows:

1. DPT (3 doses), increased from 49.2 per cent to 70 per cent.
2. Polio (3 times), increased from 12.9 per cent to 70 per cent.
3. BCG, increased from 67.7 per cent to 70 per cent.
4. Tetanus (twice for pregnant women), increased from 25.2 per cent to 50 per cent.

2.5  The number of hospitals will be increased so that by the end of the Fifth Plan, there will be at least one hospital for each district of the country. In order to achieve this target during the Plan period, 252 community district hospitals will be constructed and 75 community district hospitals renovated.

2.6  The number of Tambon health centres will be increased so that by the end of the Plan, there is at least one health centre for each Tambon. In order to achieve this target 1,000 health centres will be constructed and 1,031 midwifery centres will be renovated.

2.7  Training of 24,000 health volunteers and 240,000 communicators at the community level will be completed in order to expand the service coverage to all villages by the end of the Plan period.

2.8  An adequate supply of public health personnel will be produced to meet the demands of the rural population. To this end 3,972 doctors, 19,450 nurse aids, 15,923 nurses, 3,950 midwives, 5,000 sanitarians will be increased together with other types of public health workers.

2.9  A central fund for village medicine operated by health volunteers will be set up in 10,000 villages.

3.   Policies and Measures

3.1  Policy guidelines.  In order to solve problems on public health and improve the health status among the rural Thai population, the public health development policies during the Fifth Plan are, as follows:

1. Work on primary health care services will be accelerated with the encouragement of public participation and the support given in terms of the allocation of budget and other resources to public health servicing units at the district, Tambon and village levels in an appropriate proportion for providing proper quality services to the rural population.
   
   

2. The coverage of integrated public health services will be extended to urban and rural population with particular emphasis on the eradication of preventable diseases and improving nutrition, maternal and child care, family planning and dental health as well as solving and controlling environmental hazards.
   
   

3. The improvement of public health servicing units at the district level and below will be accelerated to ensure more service coverage to the majority of the rural people. The expansion of large scale service units in urban areas will have to be limited.
   
   

4. The public health administrative system in both urban and rural areas will be developed and improved with special emphasis on the strengthening of planning and policy formulation, decentralization of power to rural areas, the development of management information systems and improved coordination among various government agencies and the private sector.
   
   

5. Special assistance will be provided to low income and old aged people in receiving medical services according to stipulated rules and regulations.
   
   

6. Work on consumer protection, particularly in the areas of food, pharmaceutical products, and agricultural material and equipment, will be improved to ensure safety and fair treatment for all consumers.
   
   

7. The production, procurement and distribution of drugs will be organized to meet the needs of the people. Unnecessary and wasteful use of drugs will be reduced through various methods e.g., the preparation and management of national drugs registration system and the promotion of research on an application of traditional medical and herbs which are safe and suitable.
   
   

8. Rain water will be adequately provided to all rural families by 1986.
   
   

9. Public relations activities on health education will be improved to disseminate more public health information which is useful for daily living of the people.
   
   

10. Production of health personnel will be increased and their quality improved with particular emphasis on the solution of rural health problems.
    
    

11. Research diverted toward promoting self-reliance and the development or support of rural health activities will be encouraged with particular emphasis on improving public health systems and applying appropriate technology to the provision of medical services and public health.

3.2   Development measures. Development of public health under the Fifth Plan will be based on the provision of primary health care which involves the development of a public health structure at various levels to ensure wider coverage of such services to the general public, households, and communities. This will be accomplished by the following measures:

3.2.1   Develop the system of primary health care which involves the provision of integrated services allowing for the people’s participation in planning, operating and monitoring of work and which is linked to the public health system undertaken by the Government. Under this system, local resources, e.g., health volunteers, communicators and community leaders will be mobilized for public health service activities. A system will also be set up to support the supervision of work and the provision of continuing education for volunteers in basic public health activities. In addition, support will also be given for the utilization of these volunteers in the implementation of projects which provide direct or indirect economic benefits to the local population e.g., the establishment of central pharmaceutical fund for villages where there is potential for further development and expansion into other types of cooperative systems. This will require the people’s participation and cooperation of other agencies concerned.

3.2.2   The implementation of primary health care consists of at least of eight major components. A changing strategy and approach for each component is required to assure that the substantial aspect can be realized within the primary health care structure.

3.2.3   The role of government agencies will be revised to support primary health care activities with particular emphasis on the district level and below. To this end an urgent effort will be exerted on providing of hospitals in all districts and health centres in all Tambons. These public health service units will also be allowed to major roles in the provision of services to the rural majority. The role of other government agencies at the provincial level or above will be reviewed so that they can provide support to the primary health care activities. In addition, support will also be given to the increase of treatment efficiency in the government services stations e.g., the development of a referral system; the transfer of patients to be rehabilitated outside the service stations under the care of relatives or volunteers under the primary health care structure; and standard controls on materials equipments and supplies, equipments, drugs, and pharmaceutical products; and the adoption of proper treatment techniques which are suitable with service stations and consistent with national economic conditions.

The eight policies and measures for the implementation of primary health care are as follows:

(1) Health education

Efforts will be intensified to promote a better understanding among the people and households on local diseases; how to prevent and control such diseases; and the maintenance of basic health of each individual.

- Health volunteers will be utilized to disseminate knowledge on health education. Cooperation with other government agencies will also be undertaken on the provision of health education.

- The mass media will be utilized to arrange programmes which can directly influence public behaviour on health, e.g., the arrangement of radio programmes directed to the public or target groups e.g., health volunteers, mothers and children.

- A system will be devised for government officials to support volunteer work in terms of the provision of technical data, media and training.

(2) Nutrition

The following measures will be undertaken to reduce malnutrition problems among newly born infants and other children up to five years of age.

- Nutrition surveillance will be undertaken to identify people with deficient nutrients through the provision of nutrition education to primary health care volunteers and mothers.

- Support will be given to the production of food in villages to serve as a source of cheap and economical supplementary diet.

- Support will be given to bring about changes in the behaviour on the preparation of clean food for their own consumption.

- A free luncheon service will be provided to children for experimental purposes but it is not to be considered a direct measure for solving malnutrition problems.

(3) Immunization of communicable diseases

- Immunization services will be provided by means of vaccination with the necessary support given to the government officers by health volunteers in various forms.

- Systems for logistic support of vaccine distribution will be developed to ensure an adequate supply of quality vaccines to all villages.

(4) Treatment of common diseases at the local level

- Information on method for solving intestinal diseases particularly diarrhea, will be disseminated. A surveillance system on these diseases will also be organized through the utilization of volunteers under the primary health care structure.

- Drugs for these diseases will be produced and distributed on a nation-wide basis.

(5) …

(6) Supply of necessary drugs for village use

(6.1) A pharmaceutical fund operated by volunteers will provide services to all households in each village.

(6.2) The utilization of herbal medicine will be promoted for the treatment of simple diseases. To this end the following steps will be undertaken.

- Selection of herbs of good quality and which are not poisonous.

- Distribution of herbal seeds, procurement of herbs and production of herbal medicine.

- Promote knowledge on the application of herbal medicine via health volunteers.

(6.3) Production, procurement and distribution of drugs to the local level will be improved by the development of an agency responsible for the supply of pharmaceuticals and private sector participation in drug distribution will be encouraged.

(7) …

(8) Control of local diseases

The prevention and control of diseases prevalent at the local level will be integrated as a part of the general public health services and primary health care. To this end, the following course of actions will be taken:

- Training will be provided to public health officers so that they can understand their roles and be able to integrate their work on prevention and control of diseases with general public health services.

- Research on the form and method for the prevention and control of local diseases will be undertaken along with the development of appropriate technology.

- A management system will be established and public health officers will be encouraged to be better prepared to support primary health care service on the prevention and control of local diseases.

3.2.4   The necessary number of district hospital will be constructed so that by the end of the Plan period all districts will be covered. New health centres will also be constructed and the existing midwife centres renovated so that by the end of the Plan period there will be health centres in all Tambons. In undertaking these construction activities priority will be given to the poverty areas.

3.2.5   A coordination system will be provided at all management levels related to the improvement of development plan and policy by:

1. Undertaking surveys and studies on the processes and methods of planning and policy formulation.
   
   

2. Decentralizing authority for planning/management and promotion of community participation through the development of the necessary organization and related machinery and the provision of training, programme budgeting will be initiated and improved technique in project management applied.
   
   

3. Undertaking research on the provision of public health services and the application of improved techniques on planning methods and management. Recommendations will also be made on revising existing laws, rules and regulations. Improved policies, plans and management techniques will be implemented to effectively evaluate public health development projects.

3.2.6   Assistance in medical care will be provided to low income people living outside the Bangkok Metropolitan Area by:

1. Identifying of low income target groups.

2. Issuing welfare cards to low income people and their families.

3. Informing low income target groups on the procedures to be followed in obtaining free medical services.

3.2.7   To protect consumers, controls will be imposed on the quality, standards, business practice and advertisements for food products, drugs, cosmetics and toxic materials by:

1. Revising various laws for more effective control over the quality standard, business practice and advertisement as related to food products, drugs, cosmetic and toxic materials.

2. Improving management methods, personnel development and coordination at various levels.

3. Upgrading the standards on the production of foods, drugs, cosmetic and toxic materials in accordance with acceptable criteria.

4. The strict inspection and surveillance of raw materials and products imported into Thailand.

5. Collecting and disseminating information on food and drugs to the public.

3.2.8    Production of public health personnel will be expanded together with developing public health personnel at all levels. Appropriate technology suitable to economic and social conditions will be explored for the development of public health and medical services provided to rural population by:

1. Establishing either a central agency or a national public health development committee to coordinate planning, policy formulation and monitoring.
   
   

2. Increasing the supply of medical and public health personnel at all levels to meet requirements. Improved work performance will be promoted through the provision of training for medical and public health personnel and the development of training curricula and teaching and learning processes in order to overcome national public health problems.