Primary Health Care in Action
Thailand in numbers1
- Life expectancy (both sexes, 2006): 72 years
- Gross National Product per capita (PPP in international $, 2006): 7440
- Per capita total expenditure on health (PPP in international $, 2005): 323
- Number of physicians (per 10000 population, 2000): 4
VOLUNTEERS VITAL FOR THAILAND’S HEALTH SUCCESSES2
- Thailand has cut infant mortality by over 80% in 30 years
- Thailand’s universal coverage scheme provides health care for most of its 64 million people
- Buddhist monks strongly involved in health education and promotion
- Community volunteers, including Buddhist monks, play crucial role in primary health care
“Last year I still had to sit in a wheelchair when going out. But look at me now,” says 57-year-old Suparat Chanakit as she practises Tai Chi in the grounds of the Wat Kae Nok Buddhist temple in central Thailand.
“I feel much better and stronger when coming here to exercise and meditate,” adds Chanakit, who had been using a wheelchair due to a heart condition and a problem with her legs.
Wat Kae Nok is among hundreds of Buddhist temples participating in Thailand’s Health Promotion Temple project, initiated in 2003 by the Public Health Ministry as part of the Healthy Thailand agenda.
HEATLH PROMOTION IS KEY
Thailand’s primary health care programmes – in which health promotion and disease prevention are key – have had considerable success over the past three decades, with mortality in children aged under five dropping from around 75 such deaths3 per 1000 in 1975 to 8 in 20064.
Medical advances cannot take all of the credit for this success. Much of it is due to the efforts of community health volunteers working among Thailand’s 64 million people, health officials say. Buddhist monks and temples, for example, have been strongly involved in health promotion and education, working hard to prevent people getting sick in the first place, particularly in remote, rural communities.
These activities may range from educating women on how to feed their infants to advising people about healthy life-styles and nutrition.
There are more than 800 000 health volunteers across the country. They have played a crucial role in controlling many communicable diseases. They were, for example, instrumental in the dramatic decline of protein-calorie malnutrition in preschool children.
HEALTH CARE ROOTED IN COMMUNITIES
The central role for community work was placed firmly on the international health agenda by the World Health Organization and its Member States in the Declaration of Alma-Ata in 1978. The goal these countries set themselves was to achieve universal health care, or ‘health for all’ by means of a primary health care approach by the year 2000.
The ‘health for all’ idea was not to eradicate every disease, but to attain an acceptable level of health, equitably distributed throughout the world.
For Dr Amorn Nondasuta, who heads the country primary health care programme: “Although we cannot achieve all the goals of the health for all declaration, we have been successful in our strategy of creating health volunteers,” he says. “As a result, the primary health care system today is deeply rooted in local communities."
This is an abridged version of an article published in the Bulletin of the World Health Organization in January 2008.
1World Health Statistics 2008, Online version: http://www.who.int/whosis/data/Search.jsp (accessed on 26/09/2008)
2Thailand’s unsung heroes, WHO Bulletin, Vol 86 (1), http://www.who.int/bulletin/volumes/86/1/08-010608/en/index.html
3World Health Report 2008. Chapter 1, page 2, figure 1.1
4World Health Statistics 2008