Primary Care and Family Medicine

Primary Care and Family Medicine: Practical Implementation Challenges

8 – 9 June 2009 Holiday Inn, Silom, Bangkok

The Health Care Reform programme in Thailand is recognised as one of the most ambitious reform programmes anywhere. It spanned all the major aspects of the health system, with the goal of achieving universal coverage for the whole population for high quality health services. Much of the reform programme was aimed at closing the gap on inequities in access to health care. The most notable success of the health reform programme is the establishment and thriving of the Universal Coverage Scheme, a scheme which ensures health care for 47 million people, all of those not covered by other schemes.

As well as Universal Coverage, the main threads of the reform programme addressed the establishment of Family Medicine and Primary Care services in communities, close to patients homes, and the first point of contact with health services; decentralisation of authority and management; Civil Society involvement in planning and monitoring of health services; accreditation of providers; innovative financing systems; and management reform of hospitals. The reform programme has been internationally acknowledged as being based on sound research and public and professional debate.

The increased involvement and funding for local authorities provides the opportunity to address other social determinants of health, in collaboration with the health sector. Action is now being taken in some places in a much more concerted way, to link the inputs of community opinion, local authority activities and the health sector, specifically in relation to health planning. Primary care teams are being recognised in some places as the key to good primary care and family medicine delivery, and primary care networks are helping to ensure that communities have regular teams to consult on an ongoing basis.

The recent World Health Report 2008, Now More Than Ever, reiterates the need for health systems to contribute to the achievement of social justice, equity and value for money. Excessive, hospital based, specialisation discourages a holistic approach to the individual and to continuity of care. While resource allocation focuses on expensive curative care, national health systems are losing out on the health gains which could be achieved by providing qualified, professional primary care and family medicine services at much lower cost to the patient and to the health system and while addressing more than 70% of illness and diseases.

This conference will address the progress in shifting priorities towards qualified professional family medicine and the challenges Thailand faces in doing so. Experiences from other countries will be presented, so that mistakes can be avoided and progress accelerated. During the conference parallel sessions will be held to establish the basis and operating mechanism for an ASEAN network on primary care. Ambassadors from WONCA (the World Organisation of Family Doctors) will be available to meet with those interested in professionalizing family medicine.

The sessions will deal with issues such as the political will and momentum necessary to focus health service delivery on primary care and family medicine, converting strategy into real implementation, regulation of services, quality standards for family medicine, financing, human resources, primary care teams, referral between primary and secondary care, and professional standards and qualifications.

The conference is being hosted by the Health Care Reform Project, an EC-funded project which has provided technical support to the reform process for more than 10 years and which will finish in August 2009; the Ministry of Public Health, World Health Organisation, the National Health Security Office, and the ASEAN Institute of Health Development.

Version of 3.06.09 Primary Care and Family Medicine: Practical Implementation Challenges 8th and 9th June 2009

Monday 8th June 2009

09.00 – 09.05 Welcome and introduction to the conference Dr Winai Sawasdivorn, Secretary General, National Health Security Office

09.05 – 09.15 Opening remarks and welcome Minister of Public Health

09.15 – 09.30 Opening remarks and welcome Dr Samlee Plianbangchang, Regional Director, WHO South East Asia

09.30 – 09.45 Remarks from the European Commission Delegation Mr Jean-François Cautain, Deputy Head of Delegation, The Delegation of the European Commission to Thailand

09.45 – 10.00 Context of the conference Dr Thaworn Sakunphanit and Monica Burns, National Project Director and European Team leader, Health Care Reform Project

10.00 – 11.00 General practice as an essential part of a socially responsible healthcare system Dr Iona Heath, Family Doctor, Chairman of International Committee Royal College of General Practitioners, UK, and WONCA Ambassador Questions and discussion, chaired by Dr Somsak Chunharas, Director, National Health Foundation

11.00 – 11.30 Coffee DVD presentations and poster displays available all day in the foyer, with personnel available for discussion and information

11.30 – 12.15 Specialty training and career structure for family medicine in Brunei Dr Maslina Mohsin, Acting Director of Health Services, Ministry of Health, Brunei

12.15 – 13.00 Lunch DVD presentations and poster displays available all day in the foyer, with personnel available for discussion and information

13.00 – 13.05 Introduction to the afternoon sessions Dr Weerawat Phancrut, Deputy Secretary General, NHSO

Chair of afternoon sessions Dr Somsak Chunharas

13.05 – 13.45 Experiences from Sri Lanka – planning and financing of primary care development Susie Perera, Director Policy Analysis and Development, Ministry of Healthcare and Nutrition, Sri Lanka

13.45 – 14.30 Developing family medicine and primary care around the region – challenges for Thailand Dr Garth Manning, Primary Care Adviser, Health Care Reform Project

14.30 – 15.00 Coffee

15.00 – 16.00 Where primary care fits in Thailand’s health reform programme Dr Somsak Chunharas, Director of National Health Foundation

16.00 – 16.45 Questions and discussion - Dr Somsak Chunharas to chair

17.00 – 19.00 Meeting of all Health Care Reform project national consultants, secondees and study visit participants (Silom 1 Room) Version of 3.06.09 Primary Care and Family Medicine: Practical Implementation Challenges 8th and 9th June 2009

Tuesday 9th June Building on successes - and practical challenges in Thailand

09.00 - 09.15 Opening remarks Dr Siripon Kanshana, Deputy Permanent Secretary MOPH

09.15 – 09.30 DVD of the Thai – EU Health Care Reform Project and introduction to the breakout sessions Dr Weerawat Phancrut, Deputy Secretary General, NHSO

09.30 – 10.45 Crystal Ballroom Emerald Room I Emerald Room II

District planning tools Advocacy for primary care Opening remarks by Dr Amorn Nonthasut Health need assessment using Experience sharing on service data and advocacy tool implementation Regional network on primary socioeconomics data from the for primary care care – experiences in the service providers Danai Wangboonchai region Dr Samrit Srithamrongsawat Araya Chupaka Dr NilawanUpakdee Sumalee Prathoomnun Dr Amorn Nonthasut Dr Jumroon Meekanon Five steps to community Experience from Thai Health Dr Preethi Wigegoonewardene health need assessment Promotion Foundation (Sri Lanka and WONCA) Saisiri Danwattana Ur-aree Meuninkul Dr Susie Parera (Sri Lanka) Siriwan Deowsurin Dr Maslina Mohsin Pramual Sukshim Experiences from the districts (Brunei Darussalam) Pauline Ginnety Dr Siti Nasibah Pengiran (Brunei Darussalam) Experiences from the districts Dr U Than Sein (Myanmar) Dr Khamla Phouthonesy (Lao PDR) Dr Adang Bachtiar (Indonesia) Ms Yuka Iino (Japan) Ms Shrinkhala Shrestha (Nepal) Dr Tu Thanh Cao (Vietnam) Dr Marie Lucy Aska (Papua New Guinea) Mr Tshewang Nidup (Bhutan) Facilitator: Facilitator: Facilitator: Dr Supattra Srivanichakorn Saisiri Danwatanna Sumalee Pratoomnun

10.45 – 11.00 Coffee

11.00 – 12.15 Crystal Ballroom Emerald Room I Emerald Room II Applying experiences of Professionalising primary care Regional Network on primary primary care from other Perspectives from the Ministry care – brainstorming on best countries to Thailand of Public Health practice Dr Nonglak Pagaiya Dr Krishna Suvarnabhumi Dr Amorn Nonthasut Worawan Toonyasook Perspectives from Thailand Dr Jumroon Meekanon Dr Surasit Chitpitaklert Nursing Council and Midwifery Dr Preethi Wigegoonewardene Dr Arunee Tipwong Dr Somchit Hanucharurnkul (Sri Lanka and WONCA) Wandee Saengjarern Dr Nongluck Suwisith Dr Susie Parera (Sri Lanka) Dr Orawan Tawaytibhongs Dr Maslina Mohsin Perspectives from Royal (Brunei Darussalam) Facilitator: College of Family Physicians of Dr Siti Nasibah Pengiran Dr Thaworn Sakunphanit Thailand (Brunei Darussalam) Dr Somjit Prueksaratinond Dr U Than Sein (Myanmar) Dr Kidaphol Wadhanakul Version of 3.06.09 Dr Khamla Phouthonesy District Team Capacity Building (Lao PDR) Dr Somchai Panumaswiwat Dr Adang Bachtiar (Indonesia) Nattakan Muengdha Ms Yuka Iino (Japan) Ms Shrinkhala Shrestha (Nepal) Facilitator: Dr Tu Thanh Cao (Vietnam) Sumalee Pratoomnum Dr Marie Lucy Aska (Papua New Guinea) Mr Tshewang Nidup (Bhutan)

Facilitator: Dr Supattra Srivanichakorn

12.00 – 13.00 Lunch

13.00 – 14.30 Crystal Ballroom Emerald Room I Emerald Room II Networks for primary care Financing for primary care Regional network on primary care – arrangements for the Dr Panapat Tocharoenvanich Resource allocation network Dr Surasit Chitpitaklert Dr Thaworn Sakunphanit Dr Chalor Santiwarangkana Dr Amorn Nonthasut Dr Suradej Waleeittikul Health care financing for sub- Dr Jumroon Meekanon Dr Amorn Rodklai district health promotion Dr Preethi Wigegoonewardene Dr Pongthep hospital (Sri Lanka and WONCA) Wongwachirapaiboon Dr Tawekiat Boonyapaisarncharoen Dr Susie Parera (Sri Lanka) Dr Maslina Mohsin Facilitator: Health care financing for service (Brunei Darussalam) Sumalee Pratoomnun provider network Dr Siti Nasibah Pengiran (Brunei Dr Nivat Jeegungwal Darussalam) Dr Charoen Serirattanakorn Dr U Than Sein (Myanmar) Dr Khamla Phouthonesy Facilitator: (Lao PDR) Dr Thaworn Sakunphanit Dr Adang Bachtiar (Indonesia) Ms Yuka Iino (Japan) Ms Shrinkhala Shrestha (Nepal) Dr Tu Thanh Cao (Vietnam) Dr Marie Lucy Aska (Papua New Guinea) Mr Tshewang Nidup (Bhutan)

Facilitator: Dr Supattra Srivanichakorn

14.30 – 15.00 Coffee

!5.00 – 15.30 Launch of the Regional Primary Care Network Dr Supattra Srivanichakorn, Director, ASEAN Institute for Health Development

15.30 – 16.30 Lessons learned and what next Dr Pongpisut Jongudomsuk, Director, Health System Research Institute

Version of 3.06.09 Contributors and selected topics for presentations in the breakout sessions

The following people are preparing very short presentations to facilitate discussion with the participants of the break out session

District planning tools and district health needs assessments Dr Nilawan Upakdee, Faculty of Pharmaceutical Sciences, Naresuan University Saisiri Danwattana, Consultant to Health Care Reform project, District Health Needs Assessment Siriwan Deowsurin, Nurse, Social Medicine Department, Had Yai Hospital, District Health Needs Assessment team Pramual Sukshim, Health Volunteer, Baan Laempho Health Centre, Muang District, Phitsanulok Dr Samrit Srithamrongsawat, National consultant, Director Health Systems Insurance Research Office

Advocacy for primary care Ajarn Danai Wangboonchai, National consultant Sumalee Pratoomnun, Advocacy component manager, Health Care Reform Project Ur-aree Meuninkul, PR Advisor, Thai Health Promotion Foundation Araya Chupaka, National consultant on community survey on patients’ perceptions of primary care

Applying experience of primary care from other countries to Thailand Dr Krishna Suvarnabhumi, Ms Worawan Toonyasook, Dr Arunee Tipwong, Wandee Saengjarern, Nitchara Hatsaman, Sukanya Hangsapruek, secondees to UK family medicine practice Dr Orawan Tawaythibongs, study visit participant, Ratchaburi Hopsital Dr Surasit Chitpitaklert, Queen Mary’s study visit, National consultant, Social Medicine Department, Maharaj Nakhonratchasima Hospital

Professionalising primary care Dr Somchit Hanucharurnkul, Thailand Council of Nursing and Midwifery Dr Somjit Prueksaritanond, Royal College of Family Physicians of Thailand Dr Nonglak Pagaiya, Human Resources for Health Research and Development Office Nattakan Muengdha, Sompoy Health Centre, Rasi Salai District, Sisaket Dr Somchai Panumaswiwat, National consultant, Rasi Salai Hospital Director

Networks for primary care Dr Panapat Tocharoenvanich, Head of Social Medicine Department, Hat Yai Hospital Dr Nipat Kittimanon, Buddhachinaraj Hospital Dr Surasit Chitpitaklert, Queen Mary’s study visit, National consultant, Social Medicine Department, Maharaj Nakhonratchasima Hospital Dr Pongthep Wongwachirapaiboon, National consultant Dr Pakorn Tongwilai, Queen Mary’s study visit, National consultant

National developments in financing for primary care Dr Thaworn Sakunphanit, National Project Director, Health Care Reform Project Dr Tawekiat Boonyapaisarncharoen, National consultant Dr Sukit Peungketsoontorn, National consultant Dr Nivat Jeegungwal, study visit participant, National consultant, Primary care fund manager NHSO Dr Charoen Serirattanakorn, Warin Chamrab Hospital Director

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