plueme/wizJson huggingface dataset:
The reform of human resources for health (HRH) is an essential component of healthcare reform in having adequate number of HRH to achieve good health of population. Hence, effective HRH planning is one of key elements to have proper number of competent HRH at the right time according to demand in complex and dynamic healthcare shaping from internal factor, such as educational system and labour market dynamic, and external factors, such as technology advancement and vigorous economy. This study employs “system dynamic” approach to demonstrate future healthcare services by extensive participation of related stakeholders, called “group model building” approach then future demand of HRH is developed. 47 health facilities including regional, general and district hospitals in Health region 2 are study sites. This study employs information from primary and secondary data for quantitation part and focus group discussion and in-depth interview for qualitative part. Stella Software is used to demonstrate future model of services. This study emphasizes 5 areas of services, namely eye services, kidney services, general surgery services, services for non-communicable disease and cancer services. For Opthalmological services in the next 10 years, OPD patients will increase to 270,000 visits. Patients with cataract will slightly decrease to 135,000 patients while patients with glaucoma will increase to 108,000 patients. For kidney service, patients with hemodialysis will increase to 4,400 patients while ones with peritoneal dialysis will reach 1,700 patients. Furthermore, chronic kidney disease level 4-5 will increase to 47,000 patients which exceed service capacity in health region 2. For patients with non-communicable disease, patients with hypertension in health region 2 will approach 2 million in the next 10 year while ones with DM will reach 500,000 at the same periods. For general surgery services, non-elective cases will over 40,000 patients whereas elective cases will reach 47,000 patients. Patients with liver cancer will increase. However, mortality rate will decline stemming from early detection and more effective treatment. This study demonstrates that an imbalance of supply of resources to deal with an increase service demand still exists. In summary, to tackle with an increase demand of health services in the future need proper management of health resources. This study demonstrates some effective management, for example an increase staff’s capacity, expands utilization of medical equipment and infrastructures such as operating room and pool-resource including strengthening HR development and training.
OBJECTIVES: The purpose in the first year project was to set up the multicenter registry of patients diagnosed with SCARs in Thailand and to evaluate the diagnostic values of interferon-gamma ELISpot assay (IFN-γ ELISpot) for culprit drug identification compared to skin patch test in selected cases METHODS Patients diagnosed with drug-induced SCAR over a one-year period from 6 university hospitals were analyzed for demographic data, drug allergy phenotypes, and the causative drugs. Skin patch test and IFN-γ ELISpot assay were examined in selected cases for culprit drug identification. RESULTS There were 113 SCAR patients (42 males, 71 females) with the average age of 51.7±1.8 years, comprising of 50 Stevens-Johnson/toxic epidermal necrolysis (SJS/TEN), 46 drug rash with eosinophilia and systemic symptoms (DRESS), and 17 acute generalized exanthematous pustulosis (AGEP), respectively. Drug-specific IFN- γ releasing cells were detectable in 38.9% (44/113) of SCAR cases with the average frequencies of 214.8±52.5 cells/106 peripheral blood mononuclear cells. Among 30 SCAR patients, 6 cases (20% of them) had positive skin patch test while 16 cases (53.3% of them) had positive IFN-γ ELISpot assay. CONCLUSIONS SJS/TEN contributed to almost half of patients with severe cutaneous adverse reaction in Thailand. IFN-γ ELISpot assay helped to identify the culprit drugs in nearly 40% of the cases and yielded higher sensitivity than skin patch testing.
Neural tube defects (NTDs) is a congenital syndrome which might result in severe disabilities or deaths. Folic fortification in food including rice has been proposed as a prevention of the syndrome. However, the efficacy of the intervention have to be judged based on the baseline incident of the NTDs cases. Thorough analysis of the incident of NTDs cases is needed. Therefore, we proposed an analysis on the spatio - temporal distribution of the NTDs cases in Thailand using 43 folder database and develop a software needed for NTDs surveillance. Objectives: To assess the spatio - temporal distribution of NTDs cases in Thailand and to develop NTDs surveillance system for Thailand Material and Methods: In this study, the 43 folder database of Thai National Health Security Office was retrieved. The inpatient data were filtered with ICD-10 correlated with the diagnosis of NTDs. The hospital codes were then linked to the patient data to identify the probable district that the NTDs cases lived in. The choropleth maps were generated to describe the distribution of the NTDs cases by districts and year. The clustering of cases was assessed using Moran’s I. Results: The total numbers of NTDs cases from year 2014 - 2018 was 11,296 cases, including 4,531 congenital hydrocephalus cases, 2,655 Spina bifida cases, 2,638 Microcephaly cases, 979 Encephalocele cases, 224 Anencephaly and similar malformations cases, and 269 other congenital malformations of spinal cord cases. The district with the most numbers of NTDs cases was Ratchaburana district of Bangkok. There is no temporal trend observed. The average number of cases per year was 2,259 cases per year. The calculated incidence per 10,000 livebirths was 30.67 cases. The spatial autocorrelation by Moran’ s I does not shown any statistically significant clusters except for Bangkok and neighboring area in year 2014. The prototype of the NTDs surveillance program were developed. Conclusion: The incident of NTDs cases in Thailand is relatively high comparing to the incidents in Asian countries. Therefore, continuous NTDs surveillance might be needed. The folic fortification policy did not show a promising result. Therefore, the policy to improve the rate of antenatal care visits should be a better choice to reduce numbers of the NTDs cases in Thailand.
Repeated pregnancy in postpartum adolescents is a crisis that affects their physical and psychosocial wellbeing, including the newborn, family, economic and society. This quasi-experimental study aimed to examine the effectiveness of program for promoting contraceptive behaviors to prevent repeated pregnancy in postpartum teenage mothers. The subjects were 170 postpartum adolescents attending postpartum units at Maharaj Nakorn Chiang Mai Hospital, Lamphung Hospital, Lamphun Hospital, and Phayao Hospital during August 2018 to November 2019. The subjects were purposively selected and divided into 89 as a control group and 81 as an experimental group. The control group received routine postpartum care and the experimental group received the program for promoting contraceptive behaviors. The intervention instruments consisted of 1) the Program for Promoting Contraceptive Behaviors and 2) Handbook of Contraceptive Used for Postpartum Adolescents which developed by the researchers. Instruments for data collection consisted of 1) the Intension on Contraceptive Use for Postpartum Adolescents Recording Form, 2) the Decision on Contraceptive Use for Postpartum Adolescents Recording Form, 3) the Selection of Contraceptive Uses Recording Form, 4) the Utilization Rate of Contraceptive Use for Postpartum Adolescents Recording Form, and 5) the Repeated Pregnancy Rate of Postpartum Adolescents Recording Form.  Data were analyzed using descriptive statistic, t-test for independent sample and Chi-square test. 
The results revealed that:
1) The proportion of participant intended to use contraception after the 48-hour postpartum, both groups were not different. The period intended to start contraception in both groups is statistically significant different (p<.01). The experimental group intends to start contraception before returning home or at the postpartum check up more than the control group.
2) The experimental group, which recieced the Program for Promoting Contraceptive Behaviors, has a proportion of the participants that decide to use contraception for three months statistically significant higher than the control group (p<.05), however, there are no different proportions at 6 weeks, 6 months and 12 months after birth of both groups.
3) The experimental groups and control groups have no different proportion of utilization rate of contraceptive use in the three months, 6 months and 12 months after birth.
4) The proportion of repeated pregnancies at 1 year after birth of both groups is no different. The results of this study showed that the Program for Promoting Contraceptive Behaviors to prevent repeated pregnancies in the postpartum teenage mothers is suitable to the context of teenage mothers in the Northern region. Nurse-midwives can be used as a guideline to promote contraceptive use and to prevent repeated pregnancy in postpartum adolescents
Citizen participation in policy decision making process is a key component of good governance. The
National Health Security Act (NHSA) 2002 deliberately provides legal space for civic participation in governing
the Universal Coverage Scheme (UCS). Articles 13(4) and 48(8) mandate the representation of
civil society organizations (CSO) as members in the National Health Security Board and the Quality and
Standard Board. This paper aimed to analyze the processes and outcomes of citizen indirect participation
in Thai UC Scheme through CSO representation in UCS governance. Qualitative research method was
employed. Literature review and in-depth interviews with 10 informants were conducted.
The study found that CSO representatives actively participated through three functions of the UCS
governance: 1) participating in decision making and governance through representation as committee
members, 2) supporting the decision making process through representation as sub-committee members
appointed by the two committees, and 3) interlinking between CSO representatives in the two committees
and various sub-committees and the broad-based CSO networks at grass root level, for which
problems and concerns are seamlessly transmitted from local to policy decisions (at UCS governance)
which ensure effectiveness of the UCS. The outcomes of CSO contributions included successful expansion
of services in the benefits package and building public ownership of the UCS through surveillance, protect,
promote and support the implementation of the UCS for the benefit of people. Citizen participation,
which has advanced beyond legislative provision, was the result of policy space that allowed citizens to
indirectly engage (through CSO representative) in the governing body and the active citizenship has
maximized the use of policy space provided by the Law.
Health care system development had been the global basic health need goals of world population
by the year 2000. Signatory countries to the World Health Organization agreed that the primary health
care principles were the key for the development. However, current oral health data of Thai population
show gaps to the expected goal even by 2020. This article is a review of documents related to the
primary health care, aiming to understand the original intentions of this principle together with analyzing
oral health situation of Thai population, then synthesizing challenges in the overall development of oral
health care and proposing recommendations for improving the oral health service system to ensure oral
health fairness. Three challenges are presented; 1) The oral health goals should be clarified with agreement
among stakeholders including individuals who own their oral health, 2) Revising the six building block
components of the health system and managing these driving components towards the goals, and
3) Managing other oral health determinant factors not limited to the utilization of oral health service
delivery. In the end, three recommendations are proposed; 1) The long-term oral health goals review and
revision together with service delivery system goals through periodic monitoring, 2) Integrating these
long-term goals with the current policy practice of the Ministry of Public Health (the service plan, the
regional health, and the district health system driving forces), and 3) Providing oral health personnel with
appropriate competencies for the future oral health system, including planning skill, dental practitioner
skill, and the coordination skill.
The National List of Essential Medicines (NLEM) in Thailand was first developed in 1972 and has
been revised continuously. In 2008, health economic evaluation and budget impact analysis became a
part of the development process of the NLEM, especially for high-cost or high-budget medicines
to control healthcare expenses and promote the effectiveness of healthcare services. The Health Economics
Working Group (HEWG) under the Subcommittee for the Development of the NLEM has served
an important role in health technology assessment (HTA) to the Subcommittee. No studies had ever
attempted to review the processes and outputs of the HEWG’s authority. Therefore, this study aimed
to investigate HTA processes and outputs of the HEWG between 2016 and 2018. The study design was
descriptive research employing two main approaches, namely document reviews and participant
observations as secretariat members of the HEWG. Data analysis comprised descriptive statistics and
content analysis. Results were reported in two parts consisting of the HEWG’s work processes and research
outputs. The results on work processes indicated that the HEWG’s operational procedures consisted of
three main activities: the selection of research team, the managing of research compliant to HTA
guidelines, and the quality review and appraisal of research output. As for research outputs, 30 research
topics were proposed between 2016 and 2018, with 17 topics (56%) being completed and submitted to
the Coordination and Consolidation Working Group for further action. Additionally, the composition of
the HEWG and research teams came from multiple sectors of the health systems, leading to inclusive
participation and a high degree of transparency. The research process under the HEWG had clear
procedures and timelines to support the development of the NLEM in a timely manner, and included a
rigorous appraisal of research quality. However, the HEWG should further develop and update their
operational procedures to overcome certain problems and obstacles such as the lack of human
resources and an inefficient management system, and to prepare for new future challenges.
The Public Procurement and Supplies Administration Act, B.E. 2560 (2017) came into force on 23
August 2017 to replace the Rule of the Office of the Prime Minister on Procurement, B.E. 2535 (1992).
This Act aims to promote worthiness, transparency, efficiency, effectiveness, and accountability of government
procurement. However, in practice, the Act introduces many more processes and details and
lacks clear guidelines for operational compliance. This has impacted drug procurement in numerous ways
such as longer procurement time, an increase in workload for staff, and the risk of drug shortage due to
delays in the procurement process. The purpose of this study was to determine the current situation,
issues faced, and impact on hospital workload by using a qualitative descriptive design. The data collection
approach included reviews of various orders, regulations, and consequences affected by this Act,
and in-depth interviews with drug procurement staff in 7 public hospitals, policymakers, and other stakeholders.
Content analysis was employed for data analysis. The results revealed that one year after the
Public Procurement and Supplies Administration Act, B.E. 2560 (2017) came into effect, drug procurement
practices between hospitals varied depending on individual hospital policies and interpretations of the
Act. In terms of hospital workload, procurement based on this Act led to an increase in overall workload
such as the number of procured drugs, documentation, and operating expenses. Meanwhile, the number
of hospital staff tasked with the procurement process was inadequate, and many aspects of the public
procurement system and within hospitals themselves lacked readiness. Therefore, the Comptroller General’s
Department and the Office of the Auditor General, as the agencies responsible for supervising
operational compliance with the Public Procurement and Supplies Administration Act, should cooperate
with public hospital management and public and private drug manufacturers and distributors to determine
the optimal amount of staff required for procurement tasks. They should also support the use of
information technology to develop a procurement document management system, and continuously
monitor and assess the drug procurement process.
At present, patients’ accessibility to positron emission tomography/computed tomography (PET/
CT) service in Thailand is still not feasible due to high costs of diagnosis and limited disbursement of
government health insurance schemes. The objective of this study was to study the costs and break-even
point for the use of PET/CT devices in Thailand if additional indications were covered in health coverage
schemes. Data collection of PET/CT service was performed at 2 government hospitals. Diagnosis costs,
linear prediction, and budgetary impact were then analyzed.
The study showed that the unit cost of PET/CT would significantly decrease if the number of patients
increased. The cost was approximately 367,045 baht per case if performed only 1 case a week and
continuously decreased till 40 cases per week giving the unit cost only 22,725 baht. The disbursed rate
of 40,000 baht per case would cause no loss to the hospital if performed 14 cases per week. The
budgetary impact assessment expected an annual increase of 4.65% PET/CT uses with the disbursement
of 40,000 baht per case. The annual conservative burden would amount to 24-26 million baht for new
cases of patients with 9 types of cancer, excluding cases already underwent treatments, suspicious
cases and recurrent cases that needed to be examined by PET/CT.
However, it is recommended that the disbursement for PET/CT service should be considered in
Thai health service system due to low budgetary impact of 24-26 million baht per year. Moreover, the
budgetary support for this disbursement should not be managed within the capitation payment.
Background: ITEMS (information technology for emergency medical system) is a software program
designed to help emergency medical dispatchers identify the level of emergency condition and assign
proper response team to the scene. Objective: This study aimed to explore uses and problems related
to ITEMS. Method: This was a cross-sectional survey research. Questionnaires were sent to the emergency
medical personnel working in emergency dispatch centers in Health Region 1 from 1st November
2017 to 31st December 2017. Result: A total of 114 questionnaires were returned. Mean age was 36.5
years, and 65.8% were female. In all, 36.0% of the emergency medical personnel used ITEMS promptly,
36.8% used ITEMS in delayed data recording mode, and 26.3% did not use at all. For those who did not
use ITEMS, 83.3% used their own experience, 70.0% gave the reason of staff shortage and 46.7% said
the program took too long to finish. Among those who used ITEMS with delayed data recording, 92.9%
explained staff shortage, and 40.5% too long to finish data recording. No factors were found to be associated
with the decision to use ITEMS or the use in delay mode. Conclusion: Not many emergency
medical personnel used ITEMS due to shortage of staff and long duration to complete the program.
Improvement of ITEMS program and adequate staffing were recommended to solve the problem.
Thailand’s older populations aged 60 years and over will be increased by 20 percent in 2021.
Non-communicable diseases were the main cause of deaths in Thai older people while annual health
expenditure costed the government around 200 billion baht. Health promotion through senior schools
was one of the strategies to reduce the country’s health expenditure. This study aimed to investigate
the administration of senior schools including older people health promotion behaviors of senior schools
under the Bangkok Metropolitan Administration and an educational institution, and to explore success
factors of the senior schools. The research design was a mixed method consisting of qualitative research
of in-depth interviews with senior school directors and staffs regarding the administration, and quantitative
comparative research on health promotion behaviors of older people in two types of senior schools.
Data were analyzed using independent t-test. The results showed that the management of senior schools
were different in terms of management process and budget support. Health promotion behaviors of the
older people were significantly different at 0.05 level in the aspect of spiritual development and stress
management. There was no difference in the aspect of overall health promotion behaviors. Recommendations
to promote older people’s health in Bangkok were the policy supporting older people and
budget allocation for senior schools of the Bangkok Metropolitan Administration. Policymakers should
study more on senior schools’ management including factors that influence older people’s nutrition and
exercise behavior in the communities of Bangkok.
This study reports the simulation results of area-based network allocations for the health workforce
in all hospitals under the Office of the Permanent Secretary of the Ministry of Public Health. The objective
was to understand the workforce shortage status and results from alternative network allocations
in the health regions to mitigate the shortage of health workforce.
As of September 1, 2019, the weighted shortage intensity index shows 31%, 29%, and 26% shortage
on average for nurses, dentists, and medical doctors. This study found 80% of hospitals had nurses,
dentists, and medical doctors less than the minimum manpower requirements. The weighted average
shortages of nurses were 68 per hospital, and shortages of doctors and dentists are 10 and 3 per hospital,
respectively. The total shortages were 16,000 nurses, 3,400 doctors, and 1,000 dentists. There was a
severe nurse shortage in sub-district health promoting hospitals and tertiary hospitals, but no shortage
at secondary-level hospitals. Furthermore, the medical doctor shortage was severe at the secondarylevel
hospitals.
The empirical results show that area-based healthcare networking within the same hospital level
could not mitigate the shortage due to high workforce scarcity. However, the networking of the primary-
level with the first-and middle-secondary-level hospitals in the same districts could alleviate the nurse
shortage. This decreased the weighted shortage intensity index for nurses from an average of 69% in the
primary hospitals (status quo) to an average of 25% (ex-ante). Similarly, the networking of middle and
high levels of hospitals at the provincial and regional levels could also alleviate the shortage in medical
doctors. However, the area-based networking alternatives could not mitigate the shortage in dentists and
pharmacists.