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Health Services Thailand USE ONLY AGENCY FOR INTERNATIONAL OEVELOPMENT FOR AID WASHNGTO. 0 2053 X2r-1 ARDA BIBLIOGRAPHIC INPUT SHEET A A P RIMAA kfS ISURJECT Health NA00-0000-G750 FCATON General--Thaland 2 TITLE AND SUBTITLE Patterns of health utilization in upcountry Thailand; a report of the research project on the effect of location on family planning/health facility use 3 AUTHOR(S) (100) Day,F.A.; Leoprapal,Boonlert; (101) Thailand. Dept.of Technical and Economic Cooperation 4 DOCUMENT DATE 5 NUMBER OF PAGES 6 ARC NUMBER 1977 l20p. ARC 7 REFERENCE ORGANIZATION NAME AND ADDRESS AID/ASIA/USAID/Thailand 8 SUPPLEMENTARY NOTFS (Sponsoring Organization, Publlshers, Availability) 9 ABSTRACT 10 CONTROL NUMBER 11. PRICE OF DOCUMENT PN-AAG-0 58 12 DESCRIPTORS n13. PROJECT NUMBER Family plannIng Health services 14 CONTRACT NUMBER AID-493-112-T Sites Thailand 15. TYPE OF DOCUMENT AID 520-, (4-741 PATTERNS OF HEALTH UTILIZATION INUPCOUNTROtW'LAND - A REPORT OF THE RESEARCH PROJECT ON "THE EFFECT OF LOCATION ON FAMILY PLANNING/HEALTH FACILITY USE"­ by Frederick A. Day and Boonlert Leoprapal Institute for Population and Social Research Mahldol University Bangkok 4, Thailand December, 1977, ABSTRACr Th~ 6kna~t 'tepoA-t .6e" 6o,,th the gznett data, majotr AdAJIg.3 o6 d46e6tn-t awnd teconindatkonz 6Arom a cclmptehmstve p'rojec~t on the m~e coeceted heat ptovcdtde "c Tha.(ctAnd. Fout dc66cAemt data . etz weAc qcnmltw 6u& Cy -ui the ta'tge tuvkat cipcowitAy ptovctitce 06 Suphanbu'u. 1) at opcU'clll o6 on heat-th sea'ch behavotr o6 the Zocat pecptc, 21 data arid antd 4) a heatth pct';ryocQ, 3) goveiuunen-t heathl 6acZC-EL ttf LL,5c 6tt~z'-C F4-nd4Agi ,6u'vey o6 o ut it,5 at both the aniphoc and chang9'tt hc'r.;ZafC heaeCth and showed the cink'tea-C appeaZ and u.1de uw c oA d'ruq~-tnrez 6vt the( chan(iaLt 110 )(-tx 6am2ty pbintuig nee&.5 In theL (joveAYUTftr sctot etenme .6howed h4c-1i u5c, cchkte the pAxunay lhexzftt ca'te -Aysten cxpecucncCd the motre wteutbz~~o The goveiamnnlt sectoA t cided ito citkto,,-vtd wAc'eC" Scae mcodeuitzed and u>tban poopuktton tthk& the verAu 'emote a'lca, Vts ance wkhthe s5icwce, o6 the (-nject-.on docto't and ptuiu' rtdc-viku o0 ro n ,w. shown to have a dct,-ttct cnvetze 'te tton, i-- woh tbic use A'c tize me-tt heg-Un, 'ac~le Li , ~tLZh d4&tance actcnq rmo-t a6 a do&'t'tcit ho 6ptu o6 tLhe arrphoc ;zo5pttaL, somewhtat FZe5, to u-c ol th c(tzakiut ct{~5thuii expe­ and o Zas - poqttance tCo the p.toAyat hcaPt ca9~e 6a p.!cpj' In tAkenced mo'te the p>tob'?en 06 no-t be-tng at Zccve to thc Zocat~ sev'eAa-tLea6onz the r4epoit-t a modei- o heaLth 6eoA~ch behavkt 4- p'teerited, irtocommenda­ 6omr dc6cnttaP uze o6 heal-th ptrov4-detz atre bugqm~ted, and pobtew o6 the tconz atre o66ved as poss4bte my to ametcotcate p-'tuenit heatth 6ystem. Thxz pubL~cation wevez an6 a A-naf4 'tepokbt 6o4t tie p'tojee-t, "The E6ec~t Q~ Location o4 Famte P~nn~cng/Pub&c HeatLth FaciitLC Us~e A StuLdy in Thaktaiid", ouppo'tcd byj the United Statez AID R~ant 493-112-T. Thuc jvtojeect, becau~e, oj it extensive 6cope, tnvoeved the .thoughts, time an~d e6Ko~'t u6 manq peopte The pkojct has been a co~&a­ bomtcve ellonit oK the fr.tttetc(ni Porpwtaton and SocAR P caAch a~t Alahudot Lh,,ivmstq involvcng the vem~'cn. Q~ Mbost eve1 ioc on the W66a o6 ocy 40 pcmcn5 oY cpe. tdc c't acZC the,~ We elpecil ant to thanh the pnoe6lonaP Pke2za/Lch staJ6 6oni thek't hand mo'd and 4dea-s lh-ch con­ ,tibtedo to thc siuccess ol th~is p oject Soootakee Sutpakk~t, loit iice' admttsWhvc goz~dance and advice, Chatutli 3oonyioctaya and Bencha Voddwmnu 4oti thetA wm/t uioth Vtanstatkon and pke-Mtekto1 Q the ongkat mWveijs, 't. Ajhtchat Chanta~thniworg, VL. Ptarnote P'ra6aLtkuZ~, and4 Thavksak Sv~tvcte jotz thetit adv'cc czwd hoir mo~thi the 6.2dwcozf, Chianya Sethauiut, lot a~5i~aqcv oni tukaJston and ce&ocd.Cha,,~Podh.<sida and Vokavtdh ChanonionLt, 4o hMp kn. the W~Zdaoyak and n'ui~tn the codebooWa, and Ukatiuon Katuppukhasemr, ' t ke''t5 bth to Mti-c ,tcdand cth the comptcit p1'9armicng. Wc a-k~c' thank LuA5an Navdzuf, Vq'ojec~t msa)Ldi azo tant, ai'd A14ilwciat Suti phon 'So L themcl. p, elreataM ui e 6itd, and aj-e Suniztiiia Patafajvu aWh Kitangktav. 7nd'tazuhJ~iv lo thei cex6u2 woui in chiack~np the data p'w5ocnn a~t the Instittwtc, a6 oef as t;he 4ttccmO-ui, codtng, and Weupnchong StA66 at the l" ~t~~oA' theiA~ Fut the tt~stcat doingn, an thank: DAi Boon~esJm WLeezakut o6 the Naltnaf ln~tt 60/i thc Vcvetopmentt Admcnottot-&c'n Fo'i. admnin ­ tAA'ev SpuPtt "'e tkcWuc! 2t-e to thank The o60 L4zls at the Kji<, 0'~6 PubZ~c Hea.Ctlz and the Vepattnicnt o' TcchnicaC. aid EcoHCoini Ccojoc/attofl, the Goveonment o6 Thattand. Fo/i tC4JL asststance tin 6acoltnui9 the 6NcdOOL, we wis1 to expare Ss out apptec lacbi to tic Covv~nco' and &W~ special aomstant, AN~' Th emboon Pun tunaen, the Chtv&f WOW'ca O6kcc., his as costanit anld sta~l thoughout the changwctt o6 Suphanbui Ftnatty, 6oi eoce -ecuo& hep in Suphcz'bwut, we thauJz, aft Kanan and Putiatban .in -the s~uoveij o-~qc s t~ioekcrt a vafuazbe hard. SpectaZi than&s anc Wxended to the o6 ct'ats &6 USAl-Thatand, especiaJtLu Scott Edmoncds 6ot~ lwu inttiLat ;m-etws and encotagenien-t o4 -the p'jec-t and (Iemon Scott 'ot Itus cc1tiutngi suppott Last, but not tea4t, we woudd &kc to thank Tonyi Bennett o6 the Mknktt't ol Pubi~,c Heatth 60'T hkz~ cwa.e6ut /eadAng and cnmtccai conmne&6t con an ea~'teh d/a6t 06 tlhtu k'epoJtt. CONTENTS Page Abstract i Acknowledgements iii List of Tables vi List of Figures vii List of Supplementary Tables ix Introduction x CHAPTER I Methods and Data Conception of the Project I The Model 2 The Data 5 Selection of Sample Site Suphanburl 8 Preparations for the Field Survey 9 The Sample Design 10 Field Operations II The Data Processing 12 The Quality of the Ddta 13 Problems with Information Loss on the Surveys 14 Problems with the Questionnaire Response 17 CHAPTER 2- The Health Worker and the Government Health System A General Description of the Health System 24 The Public Health System as a Hierarchy 25 The Health System of Suphanburl 28 The Health Facilities 30 The Health Personnel 33 Health Personnel's Perception of their Job 35 Referral in the Health System 39 Drugs and the Health Station 42 CHAPTER 3: The Utilization of Health and Family Planning Provide Utilization Statistics: The Government Record Books 46 Distance and Utlliz.,*ion 49 Patterns of Utilization of Health Providers J54 Patterns of Utilization of Family Planning Providers 61 CHAPTER 4: Factors Affecting Utilization Reasons for Outpatients' Use of Hospitals 66 Factors Associated with "Ever Use" of Health Providers Sex of Patients - 69 Age 71 Children-ever-born 72 Occupation of Head of Household 73 Urban/rural Place of Residence 75 Electricity 76 Literacy Status 78 Mobility 80 Travel Time to Health Facility 82 Location of Health Facility 84 Perception of Cost of Service 85 Other Factors Affecting Ever-Use 86 CHAPTER 5: Conclusions and Recommendations Conclusions ' "88 Recommendations for Planning Locations of Heath Facilities 92 Recommendations to Improve Delivery of Health Ca're to the Local Population . I i I I 93 Bibliography I: Works Specific in Thailand- 98 ~Bibliography II: Works,op,,Locati on ppd HeaIth Facility Utlilation 100 Appendix I: .Glossery of Thai Terms Used,116,the Report, 103 Appendix II: Supplementary Tables f 101 LIST OF TABLES Page Table I. Data sets from the project 7 Table 2. Health worker response rate for a multi-answer series of similar topic questions conceining evaluation of his own health center 19 Table 3. Amphoe of residence of outpatients by amphoe hospital 30 Table 4 Person responsible for decision of choose this health facility location as reported by health personnel 31 Table 5 Location cf health stat'ons in relation to transoort routes 32 Table 6 Percentage distribution of family planning acceptors in one month bv the number of years worked by midwife/nurse at health -tation 34 Table 7 Health providers' views of the strong points of the service of their facility 36 Table 8 Health providers' views of the main deficiencies with the service ojr tneir facility 37 Table 9. People' suggestions on desired changes in the health facil ty nearest their home to make service better and more conventert 38 Table 10 Case: in which health personnel usually refer people elsewhere 40 Table 11 Where health personnel refer patients they cannot cure 40 Table 12 Person who suggested the outpatient come to the changwat or amphoe hospital 41 Table 13 Health personnels' response to "Would a Ministry of Public Health porgram to have second class health centers sell 'dangerous drugs' at market prices to the local people be beneficial?' by job position 43 Table 14 Reasons why selling ''strong drugs'' at the health center would be useful, for those people with a -econd class health center nearest their home 45 Table 15.
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