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Health Profi 2016.Indd Chapter 3 Thai Traditional and Alternative Medical Services Systems Chapter The systems of Thai traditional medicine (TTM) and indigenous medicine 3 (IM) services have been fundamental in the popular or civil sector’s health system for a long time with Buddhist temples (or wat) being the centres of TTM instruction or teaching/learning as well as treatment of illnesses. The story about TTM was first evidenced in the directory of feudal status, or sakdina, enacted by King Trailokanat in 1455 for civil servants in various departments such as Departments of Medical Services (Krom Phaettaya), Pharmacy (Krom Phaettaya Rongphra-osot), Internal Medicine (Krom Moh Ya), Massage Therapy (Krom Moh Nuad). Such systems had been continually conserved until the reign of King Chulalongkorn (Rama V) when a medical school was established in 1900; and both TTM and modern medicine disciplines were taught during the first phase of the school’s operations. Later on during the reign of King Rama VI, the TTM teaching and learning at the medical school was discontinued in 1915. However, some TTM practitioners assembled and got many TTM associations established for teaching or training in TTM, using an individual teacher-student, or mentor-apprentice, approach and providing TTM services for patients in all regions of the country. Meanwhile, indigenous or folk healers and the general public still use the knowledge of traditional and indigenous medicine as a way of life and self-healthcare. Thai Traditional and Alternative Medical Services Systems 51 Health Profi 2016.indd 51 9/19/2560 BE 22:56 When the World Health Organization (WHO) declared the “Health for All” policy in 1978 and Thailand also adopted the primary health care (PHC) policy in its national health plans beginning in 1981, the use of herbs or medicinal plants as well as Thai traditional, indigenous and alternative medicine (TTM/IM/AM) has been promoted and widespread across the country. In 2003, the Department of Thai Traditional and Alternative Medicine (DTAM – formerly known as Department for Development of Thai Traditional and Alternative Medicine) was established; and in 2009, the Second National Health Assembly passed Resolution No. 7, “Development of Thai traditional, indigenous and alternative medicine as a core health-care system for the country, in parallel with modern medicine”. In 2013, the Thai Traditional Medical Professions Act B.E. 2556 (2013), or 2013 TTM Professions Act, was enacted and, as a result, the Thai Traditional Medical (TTM) Council was set up in the same year. The draft Constitution of Thailand B.E. 2559 (2016) requires that the development of TTM wisdom or knowledge be supported for the maximum benefits: “Section 55. The State shall take actions for the people to receive good-quality and thorough public health services, educate the public to have the basic knowledge of health promotion and disease prevention, and support the development of Thai traditional medicine for the maximum benefits. The public health services prescribed in paragraph one shall cover health promotion, disease control and prevention, medical treatment, and rehabilitation. The state shall develop public health services to have better quality and standards on a continual basis.” The Ministry of Public Health (MoPH), in 2015, incorporated Thai traditional and integrative medical services into the country’s health services system, resulting in a higher level of support in terms of budget, personnel and other relevant resources. This chapter deals with the development of Thai traditional and integrative medical services system, or Service Plan, including TTM workforce, TTM services, and TTM expenditure. 52 Thai Traditional and Alternative Health Profile: Thai Traditional Medicine, Indigenous Medicine and Alternative Medicine 2014-2016 Health Profi 2016.indd 52 9/19/2560 BE 22:56 3.1 Development of Thai traditional and integrative medical services system In 2015, the Thai traditional and integrative medical services system was incorporated as the 12th system in the national health-care system. Its major aims are (1) to use the TTM services that have been outstanding with technical evidence in treating patients through a comprehensive approach together with modern medicine and the multidisciplinary team; (2) to reduce the gap between TTM/AM practitioners and modern medical doctors; and (3) to take part in the consultation on patient care. The system’s measures, guidelines and action plan are as follows: 3.1.1 Four key measures are: Chapter 1) Setting up a committee on Thai traditional and integrative medical services system development at all levels. 3 2) Organizing TTM services at three levels and getting manuals prepared: Level 1, Advanced; Level 2, Intermediate; and Level 3, Basic. 3) Promoting and supporting integrative or comprehensive services provision, using a multidisciplinary team and a patient-centred approach. 4) Developing TTM clinic models for providing Thai traditional and alternative medical services in hospitals (896 A-F3 hospitals). (1) Establishing a TTM clinic at each of state hospitals’ outpatient departments (OPD). (2) Providing full-cycle Thai traditional and alternative medicine services, including TTM services (Thai medicine, Thai pharmacy, Thai massage and Thai midwifery) and alternative medicine services (traditional Chinese medicine, or TCM, and palliative care). (3) Setting up specialty clinics for four diseases: migraine, knee osteoarthritis, stroke (paresis/paralysis), and upper respiratory allergies. 3.1.2 Levels of Thai traditional and integrative medical services are: a. Service Level 1: Advanced Thai Traditional and Alternative Medical Services Systems 53 Health Profi 2016.indd 53 9/19/2560 BE 22:56 b. Service Level 2: Intermediate c. Service Level 3: Basic For each of the service levels, the guidelines for service delivery have been prepared so that the health-care facilities can provide services according to their context; and the guidelines are intended for each service level to have a clear role for Thai traditional and alternative medicine. As a result, health services will be thoroughly distributed to cover all geographical areas in the fields of medical treatment, health promotion, disease prevention and rehabilitation. Ultimately, the people will have access to good quality and safe TTM services, and are encouraged to appropriately take care of the health of themselves and their families. The details of services are as follows: a. Service Level 1: Advanced 1) Health-care facilities at this level are regional and general hospitals. 2) Service activities at this level include: 2.1) Examination and diagnosis, based on the TTM principles and professional standards. 2.2) Procurement, storage and dispensing of Thai drugs with good quality and standards as well as the monitoring of adverse reactions of Thai drugs. 2.3) Proactive operations of Thai traditional medicine (TTM), or alternative medicine (AM), or indigenous medicine (IM) in the community such as: (1) Health care for special target groups such as stroke patients, older persons, and pregnant and postnatal or postpartum women. (2) Promotion and support for self-care of the people and their families. 2.4) Palliative care based on the TTM/AM/IM principles, using such items as Thai drugs, herbal food, and meditation therapy. 2.5) Meditation therapy for patient care. 2.6) Examination and diagnosis with the traditional Chinese medicine (TCM) principles by a licensed TCM practitioner or a licensed medical doctor who has attended the three-month acupuncture training recognized by the MoPH. 54 Thai Traditional and Alternative Health Profile: Thai Traditional Medicine, Indigenous Medicine and Alternative Medicine 2014-2016 Health Profi 2016.indd 54 9/19/2560 BE 22:56 2.7) Services at a TTM Clinic (parallel OPD) and a TCM Clinic in the outpatient department of each state hospital. 2.8) Full-cycle services at a TTM/AM Clinic for general and certain illnesses such as migraine, knee osteoarthritis, stroke (paresis/paralysis), and upper respiratory allergies. 2.9) Medical treatment using the TTM and TCM principles for inpatients together with modern medical doctors. 2.10) TTM apprenticeship or professional practical training. 2.11) TTM professional skill enhancement programmes. 2.12) TTM/AM research and development. b. Service Level 2: Intermediate 1) Health-care facilities at this level are community (district) hospitals. Chapter 2) Service activities at this level include the services prescribed for Service Level 3 (Basic), TTM/TCM services at the outpatient department, full-cycle TTM/ 3 TCM services for inpatients, and professional practical training (TTM apprenticeship), similar to those designated for Service Level 1, items 2.1 through 2.10. c. Service Level 3: Basic 1) Health-care facilities at this level are tambon (subdistrict) health promoting hospitals (THPHs). 2) Service activities at this level include basic and proactive services in the communities, and palliative care similar to those prescribed for Service Level 1, items 2.1 through 2.5. 3.1.3 Guidelines for full-cycle TTM services. For regional and general hospitals, a manual for service provision has been prepared for four diseases with definitions and descriptions. Full-cycle Thai traditional and alternative medical (TTM/AM) clinic means a unit that provides medical treatment in a regional or general (A-M1) hospital, using the TTM/AM principles for general illnesses and specific diseases [migraine (lom pra-krang), knee osteoarthritis (lom jab
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