Assessment of primary health care resources in Thailand.

Abstract

In response to a perceived lack of graduate-level training in Public Health (the ultimate goal being improved primary health care, PHC) in the Asia-Pacific region, the US agency for International Development and the University of Hawaii entered a cooperative agreement to assist institution of the Asia-Pacific Consortium for Public Health improve their PHC training and other aspects of institutional development. Research performed for the initial phase of the project in Thailand is presented. In collecting data on human resources, the concentration was on public health colleges and regional training centers for PHC in 4 regions, midwifery schools (6), nursing colleges (10), community medicine and nursing and (in 1 case) public health in 3 universities. Out of 121 instructors, 33 had masters degrees or the equivalent. The rest had Bachelors degrees in specialties such as Education, Nursing, Sanitation. 48 had ever attended PHC training programs run by the Training Center for PHC development at Mahidol University. 87 instructors reported needing more training. Only 9.9% of instructors thought that teaching methods (consisting mostly of lectures, and less frequently of discussion, guest speakers, reports, and projects) were adequate. 89.3% said that textbooks used for PHC teaching were inadequate. Some further problems and obstacles to PHC development included a lack of emphasis on field training of instructors, unclear lines of authority, and a high rate of trained village health communicator migration to jobs abroad, indicating a poor reward system. Recommendations include improved training on management topics needed for PHC, problem-centered as opposed to subject-oriented training and standardization of university curricula.