Evolution of primary health care in Thailand: what policies worked?

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Abstract
Thailand has a long history of primary health care (PHC) development which started before the Declaration of Alma Ata in 1978. The National PHC programme was implemented nation-wide as part of the Fourth National Health Development Plan (1977–1981) focusing on the training of ‘grass-root’ PHC workers consisting of village health communicators and village health volunteers. Since then PHC has evolved through many innovative health activities: community organization, community self-financing and management, the restructuring of the health system and multisectoral co-ordination. Many of the essential elements of PHC have been achieved. Improvements in the nutritional status of children under five households accessiblity to clean water, immunization coverage, and the availablity of essential drugs have been observed. PHC has been successful in Thailand because of community involvement in health, collaboration between govermment and non-govermment organizations, the integration of the PHC programme, the decentralization of planning and management, intersectors collaboration at operational levels, resource allocation in favour of PHC, the management and continuous supervision of the PHC programme from the national down to the district level, and the horizontal teaining of villagers to villagers.

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