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Editing and design by Inís Communication – www.iniscommunication.com Primary Health Care Systems (PRIMASYS) Case study from Thailand Overview of the primary health care (PHC) System Over the past 40 years or so, Thailand’s health system The Thailand economy has also developed over time, as requirements have multiplied as the national population reflected in the increased gross domestic product (GDP) per has grown, from 37 million in 1970 to 68 million today. capita from 700 US$ in 1970 to nearly 6000 US$ in 2014, As demonstrated in Table 1, despite increasing overall as well as a shift in the income/wealth inequality indicator population, the population growth rate has continuously (Gini coefficient) of 44.2 in 1970 compared to 40.0 in 2010. decreased from 3% in 1970 to 0.4% in 2015, largely as a Total health expenditure (THE) as a proportion of GDP also result of an effective family planning programme introduced increased from 3.5% in 1998 to 6.5% in 2014. Changes in in the 1970s. As a result of slowed population growth, the THE by financing source have also been observed: Before proportion of people aged 0–14 years decreased from the Asian economic crisis of 1997, household out-of-pocket 45.1% to 19.6% from 1970 to 2010, while the proportion payment was the major component of health care spending, of people aged 65 years and over increased continuously, but subsequently dropped from 44.5% in 1994 to 12.4% in almost tripling from 3.1% in 1970 to 8.9% in 2010. Rapid 2011 due to full implementation of the Universal Coverage population ageing has been influenced both by declines in Scheme (UCS) in 2002. fertility and in mortality. During this period, the total fertility rate declined from 4.9 births per woman in 1985–6 to 1.5 The Ministry of Public Health tackles health inequity in 2005–6. As a result of population growth, the population problems through three major policies: 1) Region-based density increased from 67.1 people/km2 in 1970 to 128.5 health services system. The aims of this policy are to facilitate people/km2 in 2010. The proportion of the rural population better sharing of related resources within each region that resides in non-municipality areas decreased from not only money but also human resources, information, 86.8% in 1970 to 56.6% in 2010. Rapid urbanization is clearly medicines/technologies, and to strengthen referral across taking place, from 18.7% in 1990 to 43.4% in 2010. By 2015, care levels within region toward more efficient services. 2) available data showed that those living in urban areas had Health services development plan or ‘Service plans’, which increased to 50.4%. comprise primary and holistic health care as one of 15 service plans that all of health facilities under the Ministry Life expectancy at birth has gradually increased in the of Public Health (MoPH) will use as their operation plan and country, reaching 70 years for males and 77 years for females implementation. Goals of this primary care and holistic care in the mid-2000s, with a period of stagnation due to the service plan include care provision by family care teams and HIV epidemic experienced in the 1990s. Life expectancy of establishment of long-term community care and health females exceeds that of males, due to a higher mortality rate promotion for elderly, disabled, and vulnerable groups. among men attributable to accidents, risk-associated work 3) District health system (DHS) that calls for multisectoral and unhealthy behaviours, though women suffer more with collaboration in the community using strategic approaches conditions of disability. In 1980, the infant mortality rate called “U-CARE”: Unity district health team; Community (IMR) was nearly 50 per 1000 live births, while the under-five participation; Appreciation; Resource sharing and human mortality rate (U5MR) was 60. These rates gradually reduced development; Essential care provision. It is also believed that to 11 and 13 respectively by 2010. The maternal mortality DHS could become an active participatory model that can ratio (MMR) was also reduced from 42 per 100 000 live births harmonize upstream and downstream processes of health in 1990 to 26 in 2010. services system in Thailand. Case study from Thailand Table 1. Key demographic, macroeconomic and health indicators in Thailand Variable Results by year Source(s) Total population of country (million) 68.147 (2016) NSO1 Sex ratio: male/female 0.967 (2014) NSO1 Population growth rate (%) 0.4 (2015) NSO1 Population density(people/km2) 128.5 NSO1 Distribution of Population (rural/urban %) 49.6/50.4 (2015) NSO1 GDP per capita (US$) 5,977.4 (2014) NESDB2 GDP per capita (PPP; US$) 8120 NESDB2 Income or wealth Inequality (Gini coefficient) 40.0 NESDB2 Life expectancy at birth (year) Male 70.6 NSO1 Female 77.4 Top five main causes of death (ICD–10 classification) 1. Malignant neoplasms (C00–C97) Thai BOD, MoPH3 2. Circulatory diseases (I00–I99) 3. Infectious and parasitic diseases (A00–B99) 4. Chronic respiratory diseases (J00–J99) 5. Transport accidents (V00–V99) Total mortality rate, adult (per 1000) Male 204.8 Thai BOD, MoPH3 Female 101.0 Infant mortality rate (per 1000 live births) 9.504 (2016) MoPH4 Under 5 mortality rate (per 1000 live births) 10 (2014) World Bank5 Maternal mortality rate (per 100 000 live births) 25 World Bank5 Immunization coverage under 1 year (%) Measles 99%, DTP3 90%, MoPH4 Hepatitis B3 46%, Hib3 90% (2013) Total health expenditure as proportion of GDP (%) 7 (2014) World Bank5 Proportion of health expenditure on prevention and public health services 6.2 (2012) Thai NHA Working Group (2013)6 Public expenditure on health as proportion of total expenditure on health 86 (2014) Thai NHA Working Group (%) (2013)6 Out-of-pocket payments as proportion of total expenditure on health (%) 12.4 (2011) MoPH4 8 (2014) World Bank5 Voluntarily health insurance as proportion of total expenditure on health (%) 10.3 (2011) MoPH4 4.7 (2012) Thai NHA Working Group (2013)6 Proportion of households experiencing catastrophic health expenditure (%) 3.9 (2009) NESDB2 NSO: National Statistical Office; NESDB: National Economic and Social Development Board; MoPH: Ministry of Public Health; IHPP: International Health Policy Programme; Thai BOD: Thai Burden of Disease; Thai NHA Working Group: Thai National Health Account working group. 1 National Statistical Office. (Available at: http://www.nso.go.th; accessed 13 February, 2017).