Towards realising primary health care for the rural poor in Thailand: health policy in action

We present the findings of a descriptive case study of a primary care unit (PCU) in rural Thailand five years after the introduction of Universal Health Coverage (UHC) in 2001. The aim was to access the quality of primary health care (PHC) in rural Thailand and to make recommendations to Thai stakeholders for its improvement within current resource constraints. The PCU was evaluated based on previously established standards and protocols. A theoretical perspective of PHC and its evaluation informed the attributes to be described; sources of evidence; methods of data-gathering; and approach to data analysis. The PCU was located in Nakhon Ratchasima ('Khorat') province, Thailand, and was considered by Thai stakeholders to be typical of the 9,738 PCUs in rural Thailand in terms of health profile of its patients and the health resources available to it. We found that PCU service providers were knowledgeable of the way of life of their patients and their health problems; PHC programs (immunisations, ante and post natal care) were being conducted and common infections and minor injuries were being treated. On the other hand, inadequate resources were devoted to problem recognition and definition and health services for individuals were poorly coordinated. Because of lack of training and supervision for PCU staff, PHC services needed to be supplemented by the District Hospital. As a result, patients sometimes received inadequate care because information between services was not available in a timely manner. The evaluation identified strengths and weaknesses in the quality of the delivery of PHC in rural Thailand by a careful study of one PCU. Thai stakeholders, including study participants, considered the recommendations appropriate for application in this setting and possibly other rural PHC settings in Thailand.