2009年-世界发展银行全球_Thailands_Health_Workforce___A_Review_of_Challenges_and_Experiences_44页_2mb

Summary of Thailand's Health Workforce: A Review of Challenges and Experiences

Core Content

This document provides an overview of the challenges and experiences related to Thailand's health workforce, focusing on the distribution, production, and policy initiatives aimed at improving the system. It highlights the interplay between health policies and the workforce dynamics, emphasizing the need for a balanced and sustainable approach to health service delivery, particularly in rural areas.

Main Points

1. Thailand's Health System Context

• Country Overview: Thailand is a lower middle-income country with a population of about 65.1 million (2007), 65.7% of whom live in rural areas.
• Health Infrastructure: The health system is primarily public, operating under a three-tier structure: sub-district health centers, district hospitals, and general/regional hospitals.
• Health Facilities: By 2006, there were 725 district hospitals, 95 general/regional hospitals, and 9,765 sub-district health centers. Public facilities have expanded significantly, especially in rural areas.
• Private Sector: Private health facilities, including 16,800 clinics and 429 hospitals, are mainly concentrated in urban areas. The growth of the private sector has been influenced by economic conditions and the rise of medical tourism.

2. Demographic and Epidemiological Changes

• Population Shift: The proportion of children under 15 has declined from 42.4% in 1940 to 19.1% in 2030, while the elderly population is expected to increase to 15.9% by 2030.
• Health Challenges: Chronic and lifestyle-related diseases have become more prevalent, alongside infectious diseases such as HIV/AIDS and TB. Heart disease and cancer are now leading causes of mortality, with hospitalization rates increasing significantly over the years.

3. Public Reform and Health Policy

• Health Care Reform: The universal health coverage scheme (UHC), introduced in 2001, aimed to increase accessibility, restructure financing, and improve care quality. It covered 77.8% of the population.
• Decentralization: The 1999 Act on Decentralization transferred responsibilities from central ministries to local authorities, particularly Tambol (sub-district) Administrative Organizations (TAOs). This has encouraged local participation in health care planning and implementation.
• National Health Plans: The health system has evolved through several national health plans, with the focus shifting from infrastructure development to primary health care and community-based services.

4. Thailand's Health Workforce

• Composition: The health workforce includes doctors, nurses, and primary care workers (PCWs), along with other health providers such as traditional healers, health volunteers, and NGOs.
• Role of Professionals: Doctors are clinical experts, nurses are middle-level care providers, and PCWs are frontline workers focused on prevention and promotion.
• Distribution: Doctors are more concentrated in urban and private settings, while nurses and PCWs are more prevalent in rural areas. However, the distribution of health professionals remains uneven.

5. Health Workforce Production

• Doctors: Trained for 6 years at 14 medical schools (13 public, 1 private). Annual production is around 1,000–1,400 doctors, with plans to increase this to meet future demand.
• Nurses: Trained for 4 years at 64 nursing colleges (35 under MOPH, 19 under Ministry of Education, 10 private). Annual production is around 6,000 students, with a focus on rural areas.
• Primary Care Workers: Trained for 2 years at MOPH-run Public Health colleges. Annual production has decreased over time, from 1,600 to 1,500 PCWs. Retention rates in rural areas are high, with 60–80% still working in rural settings after 10 years.

Key Strategies for Equitable Distribution

1. Educational Strategies

• Training Locations: Health workers are trained in local institutions to encourage them to return to their hometowns.
• Curriculum Focus: Emphasis on local health needs and community-based care in training programs.

2. Compulsory Strategies

• Recruitment Policies: Targeted recruitment of health workers to rural areas to address shortages.
• Special Programs: Initiatives such as scholarships and employment incentives for nurses and PCWs in rural regions.

3. Motivation and Management Strategies

• Financial Incentives: Increased funding for rural health facilities and improved salary structures.
• Non-Financial Incentives: Improved working conditions, career development opportunities, and recognition of local health wisdom.

Challenges and Future Directions

• Inequitable Distribution: Despite efforts, health professionals remain concentrated in urban areas.
• Rural Retention: While PCWs have high retention rates, doctors and nurses are less likely to stay in rural settings.
• Economic Fluctuations: The 1997 economic crisis affected the number of private health facilities, while medical tourism has expanded the sector.
• Future Needs: The aging population and rising chronic diseases require a larger and more skilled health workforce.
• Key Gaps: There are gaps in data, especially regarding the exact number of PCWs and their roles. Further research and policy refinement are needed to address these challenges.

Conclusion

The Thai health workforce faces significant challenges in distribution and retention, particularly in rural areas. The government has implemented various strategies to address these issues, including decentralization, education reforms, and financial and non-financial incentives. However, the system still requires further improvements to ensure equitable access to health services and a sustainable supply of health workers. The future of the health workforce in Thailand depends on continued policy innovation and effective implementation to meet the evolving health needs of the population.