Integrated strategies to tackle the inequitable distribution of doctors in Thailand: four decades of experience

Inequitable distribution of doctors with high concentration in urban cities negatively affects the public health objective of Health for All. Thus it is one of the main concerns for most health policy makers, particularly in developing countries. This paper aims to summarize strategies to solve inequitable distribution of human resources for health (HRH) between urban and rural areas, by using four decades of experience in Thailand as a case study for analysis

Government use licenses in Thailand: The power of evidence, civil movement and political leadership

This paper attempts to describe and analyse the policy processes that led to the granting and implementation of the government use licenses to enable the import and production of generic versions of medicines patented in Thailand. The decision to grant the series of government use licenses was taken despite much domestic and international controversy. The paper demonstrates that the policy processes leading to the granting of government use licenses are a successful application of the concept of "the triangle that moves the mountain". This is a well-known conceptualisation of a philosophical and strategic approach to public policy advocacy in Thailand, which propounds that the effective bridging of three powers; a.) Knowledge and evidence generated by research and analysis, b.) Civil society movements and public support, and c.) Leadership of policy makers and politicians; in a synergistic "triangle" can move "mountains", meaning the resolution of seemingly insurmountable problems. The paper provides insights into the policy context for the decision and analyses the roles of key actors, their motivations and the policy processes in the country

International service trade and its implications for human resources for health: a case study of Thailand

This study aims at analysing the impact of international service trade on the health care system, particularly in terms of human resources for health (HRH), using Thailand as a case study. Information was gathered through a literature review and interviews of relevant experts, as well as a brainstorming session. It was found that international service trade has greatly affected the Thai health care system and its HRH. From 1965 to 1975 there was massive emigration of physicians from Thailand in response to increasing demand in the United States of America. The country lost about 1,500 physicians, 20% of its total number, during that period. External migration of health professionals occurred without relation to agreements on trade in services. It was also found that free trade in service sectors other than health could seriously affect the health care system and HRH. Free trade in financial services with free flow of low-interest foreign loans, which started in 1993 in Thailand, resulted in the mushrooming of urban private hospitals between 1994 and 1997. This was followed by intensive internal migration of health professionals from rural public to urban private hospitals. After the economic crisis in 1997, with the resulting downturn of the private health sector, reverse brain drain was evident. At the same time, foreign investors started to invest in the bankrupt private hospitals. Since 2001, the return of economic growth and the influx of foreign patients have started another round of internal brain drain

Challenge and co-operation: civil society activism for access to HIV treatment in Thailand.

Civil society has been a driving force behind efforts to increase access to treatment in Thailand. A focus on HIV medicines brought civil society and non-governmental and government actors together to fight for a single cause, creating a platform for joint action on practical issues to improve care for people with HIV/AIDS (PHA) within the public health system. The Thai Network of People with HIV/AIDS, in partnership with other actors, has provided concrete support for patients and for the health system as a whole; its efforts have contributed significantly to the availability of affordable generic medicines, early treatment for opportunistic infections, and an informed and responsible approach towards antiretroviral treatment that is critical to good adherence and treatment success. This change in perception of PHA from 'passive receiver' to 'co-provider' of health care has led to improved acceptance and support within the healthcare system. Today, most PHA in Thailand can access treatment, and efforts have shifted to supporting care for excluded populations

One size does not fit all: investigating doctors' stated preference heterogeneity for job incentives to inform policy in Thailand.

This study investigates heterogeneity in Thai doctors' job preferences at the beginning of their career, with a view to inform the design of effective policies to retain them in rural areas. A discrete choice experiment was designed and administered to 198 young doctors. We analysed the data using several specifications of a random parameter model to account for various sources of preference heterogeneity. By modelling preference heterogeneity, we showed how sensitivity to different incentives varied in different sections of the population. In particular, doctors from rural backgrounds were more sensitive than others to a 45% salary increase and having a post near their home province, but they were less sensitive to a reduction in the number of on-call nights. On the basis of the model results, the effects of two types of interventions were simulated: introducing various incentives and modifying the population structure. The results of the simulations provide multiple elements for consideration for policy-makers interested in designing effective interventions. They also underline the interest of modelling preference heterogeneity carefully

Implementing the Agenda for Global Action on human resources for health: analysis from an international tracking survey

Objective: A survey was conducted to analyse the governance and policy environment for human resources for health (HRH) development in 57 priority countries, with the objective of understanding the linkages between policy and context factors. Methods: Responses to a questionnaire tracking proxy indicators were received from 51 (89%) countries. Findings are presented by frequency; correlations were investigated through cross tabulations and multiple regression analysis. Results: The results indicate uneven performance among countries and across different domains of health workforce development. The only indicator showing a significant correlation with other areas of performance was implementing an HRH plan. No significant correlation with contextual factors was found. Discussion: Progress in addressing HRH challenges appears to be independent of contextual factors, suggesting that countries can improve their performance through concerted action by stakeholders. Having and implementing an HRH plan appears to be a key factor in galvanising that action.sch_iih2pub2736pub

Stakeholders’ Perspectives of Design Options for a Rooftop Solar PV Self-consumption Scheme in Thailand

Adoption of solar photovoltaic (PV) power generation systems has been accelerating around the world, contributing to the debate about the future of policy and regulation in a high distributed energy resources future. As one of the leaders in solar investment in Southeast Asia, Thailand has recently shifted its policy framework for the support of small scale, distributed solar PV systems from subsidizing power export through feed-in tariff toward a policy that is focused on self-consumption. This paper investigates stakeholder perspectives of the detailed design options for self-consumption schemes for supporting rooftop solar PV installations. The research methodology employed questionnaires and focus group discussion in order to capture stake-holder perspectives for each element of rooftop solar PV self-consumption schemes. In all, the data derived from questionnaires and focus group discussion involved a total of 72 stakeholders. The results indicate that most stakeholder groups expressed a strong desire for compensation for excess generation of PV electricity from rooftop PV systems. While the majority of electric utilities prefer a system of net billing with real-time buyback, designed to minimize revenue losses, consumers and policymakers preferred a net-metering-based compensation scheme for supporting use of rooftop PV electricity in Thailand

Capacity of Thailand to Contain an Emerging Influenza Pandemic

Gaps exist in infrastructure, personnel and materials, and surveillance capacity to meet needs of various pandemic scenarios