See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/312098459

A mini-concept paper- A Major Healthcare Problems in the Three Southern

Provinces of Thailand: Problems Identification and Suggested
Implementation Models.

Working Paper · August 2012

DOI: 10.13140/RG.2.2.15422.69449

CITATIONS READS

0 9,678

1 author:

Siriporn Pipatshukiat
Mahidol University
24 PUBLICATIONS   18 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Selective Exclusion: Some Thai kids we are not helping. View project

Lacking from within: Thai Citizenship/Identification card with gender alternative options. View project

All content following this page was uploaded by Siriporn Pipatshukiat on 06 January 2017.

The user has requested enhancement of the downloaded file.

Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

CONCEPT PAPER: A Global Health Issue in Thailand

INTRODUCTION

Background Information:

“Since the beginning of 2004, southern Thailand had become caught up in the escalating
cycle of violence. In January, Thailand has placed three provinces in the South- Pattani, Yala
and Narathiwat under martial law following a well coordinated attack on army and police
facilities. Subsequent violence, including the suffocation of around 80 Muslim youth detained
in the army trucks in October, 2004 has polarized views about the ongoing conflict.”
[APCSS, 2004]

The trends of attacks have been still ongoing, targeting from police, teacher, monks, and until
today, the trends of attack is randomly by means of anyone can be the victims of any
bombing.

Needless to say how the quality of life of the local people would be effect, which also include
the health personnel as well. With the nature instinct for survival, large population of
healthcare personnel begins to move out of the danger zone. Policy and strategies to re-
migrate the healthcare staffs have been implemented by Government and several agencies
which concern for the heath of the local people, but yet ineffective.

Thus, in this mini-concept paper, I will try to elucidate the local perspective, as well as
propose some ideas that could help ease the pain in the lack of healthcare service for the local
population living in the three southern provinces in the risky danger environment at very this
moment.

Before we start, I would like to give some caution on the limitation of accessing information

Limitation of the collaborations, information and reference sources

The violent incident remains and continues to occur at this very moment of my
writing of this report. Each day, people are still living in fear, bombing is happening
randomly in any possible areas. Lives are still being lost day and night.

1
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

The difficultly in accessing to the information will be much more complicated as this
is the on-going situations. Any leakage of information can put ones at stake. Nevertheless, we
must never give-in to the obstacles along the road to the improvement of the healthcare
standard in the three provinces of the Southern Thailand (Pattani, Yala, and Narathiwat).

My Attempt to encounter the limitation

I have designed the questionnaire for accessing some information from the local healthcare
problem. [Appendix A] The questionnaire has been distributed, among a few police units
force in Yala, and to a few nurse in the local medical units, yet still no responses. So far, as
for the time-limitation while developing this report and the collaboration has been initiated.
Further field-collection of data would be required especially under the circumstance that I am
not the local people there. A few local police, forensic scientists, nurses from local hospital,
and the social organizations have agreed to collaborate. Only one interview in person with the
local police had been done. Two interviews of family-related casualty of death had also have
been gained.

Statistics: in the three southern provinces of Thailand.

First priority step in understanding the healthcare problems in the three provinces is to find
the statistics. The key statistics were

1. The statistics the total population in the 3 provinces in the last 10 years, if possible.

2. The ration statistic of religious among the local population.

3. The statistic: Birth rate and Death rate per year

4. The statistic in the causes of death:

4.1 Death from health diseases, and identify the main diseases as cause of death

4.2 Death result as the casualty of violence events.

5. The immigrant of health personnel in and out of the Red zone.

The statistic information in the three provinces is currently unreachable. My attempt

to identify the statistics is using the indirect approaches, by looking at the National Statistic
as a whole. Based on: The 2012 Key Statistics of Thailand: provided by the National Statistic
Office, which present major statistics regarding economic, social and environment.

2
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

However, it does not reflect upon the significant information that I required for
revealing the truth problems concerning healthcare problems at all. Since the Southern
regions in this statistic reference is including all 14 provinces: Nakhon Si Thammarat, Krabi,
Phang-nga, Phuket, Surat Thani, Ranong, Chumphon, Songkhla, Satun, Trang, Phatthalung,
Pattani, Yala and Narathiwat.

Still, there may be of potential usage for further analysis with different statistical
approach, like comparing provinces to provinces among 14 provinces to get closer to the real
population statistics and main health problems in the three provinces. Some relevant Tables
and Diagrams will be put in the Appendixes. [Appendixe B – G]

HEALTHCARE PROBLEMS IN THE THREE SOUTHERN

PROVINCES OF THAILAND

PROBLEMS 1: Thai population in those three provinces has difficulty in accessing to

medical healthcare service and the standard of healthcare is very poor.

In order to increase the recruitment number of recruit medical personal to those areas, several
policies have been implemented. For instance, the requirement for the nursing examination
normally required the examinees to score above 65 out of 100. The desperate attempt to
mobilize more nurses has been substitute with the scoring of 25 out of 100. The efficiency of
this proposal may help to increase the number of health personnel, yet it leads to another
problematic issue. From the interview with the local police, he stated that

“If I need to go to hospital, I would rather travel to another province to receive the healthcare,
because the doctor or nurse at the healthcare facility around his house is unqualified”.

What his answer had indicated is that: Firstly, he has no confident in the healthcare service in
the three provinces. Secondly, he rather takes the risk in traveling a longer distance to get the
good healthcare service. According to him, …He reasoned his non-confidentiality by stating
that most sick patients died at the local healthcare. He rather takes the risk to travel, despite
knowing the fact that the longer duration before the sick patient get to the doctor’s hand may
affect the treatment, as well as the hazardous bombing or violence incident that could occur
along the travel route.

3
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

From this case scenario, it is obviously that the policy which implemented in order to attract
more health personnel is unsuccessful unless the quality of the health personnel is being
developed and maintained along together. In order to upgrade the quality of life in term of
healthcare services, policy to be implemented must considered both quantity and the quality.
Till then, we may yield a better successful rate of development in the healthcare system for
the population living in the war-related zone.

Disease burdens as the consequences of the difficulty in accessing a well-

trusted healthcare service. Direct Determinants and Indirect Determinants

At 1st stage: At the beginning stage of disease may not be out-value the hazard from traveling
through the field bomb to get the health service. From my perspective, only when the
individual has the means (cars, secure channel), as well as when the disease condition is
severe to the point that one rather die at home or along the way to the hospital have made no
more different.

Prioritize the most important determinants that should be addressed to

fight this problem and justify your choices.

The most important determinant is definitely to increase the number of qualified

healthcare personnel that are being entrust with full confident by the people in the areas of
danger zone.

Evaluating the existing implementation strategies currently addressing this

determinant? Please justify your answer.

Thailand’s instability of political issues has large impact on the implementing and
maintaining the health policy. A series of policies, whether in parallel or contradict, have
never reached the phase of productive stage. Still, Thai governments do realize the
emergency of the healthcare problem in the Southern Thailand, the three provinces, and
several attempts have been implemented with different strategies to increase the quality of
life in the healthcare service management.

For the purpose of this report, I shall give a few policies and strategies that have been
implemented. Strengths, weakness, as well as the gaps of the existing implementation
strategies currently addressing the main determinants will be analyzed and addressed.

4
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

Problem: Lack of health personnel.

Solution: To increase the health personnel.

Implementation Strategies: Lower the qualification grade for the recruitment of health
personnel into those three provinces.

Strengths: The number of the healthcare personnel increases. (The national statistic is
inaccessible to me at this very moment)

Weakness: Lower standards in the professional specialist’s skill and knowledge.

- (secondary consequences) In which leads to the inefficacy to cure the disease, and
increased the death rate that specifically due to the lack of trained/educated
knowledge of the health personnel.
- (Tertiary consequences) population has no confident in receiving the health service
locally. Stigmatize of the professions.

Lead to relocate health personnel themselves to other area where they may have no
pressure from the stigmatizing has already been culturally distributed. Also, the population
have own belief that by travelling to a non-danger zone, the health service will be much
better.

In order to encounter the stigmatized of non-professional health personnel if they are located
in the three provinces. The government has tried to challenge the qualified health personnel
with a better benefit if they are agree to locate themselves in the areas. Some of the attractive
offerings are:

Problem: Lack of qualified health personnel., implemented strategies, and

the outcomes

Solution: Increased more qualified of trained healthcare personnel trained from the
top-rank university.

Implementation Strategies 1: Offer a better benefit in exchange (Grants, financially,

benefits, etc).

5
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

Strengths: Prior the relocation to the three provinces: May attracted some of the
highly qualified medical personnel.

Justifying: Initially many qualified highly trained and skillful personnel may
outweigh the offered benefits over the risk of danger to life.

After experiences the prices of the offered benefit, protecting and securing one’s own life
may override the original expectation, and thus agreed to lose the benefit in order to relocate
back or away from the danger zone.

Weakness: Short-term of health service may leads to the loss of time and expenses,
more than that is the loss of trustworthiness of the local population, the discontinuity
in taking care of some diseases that required constant supervision of the doctors.
Cases have to be transferred to the new recruits, the trusted-relationship between
doctor-patients have to be again developed from infancy bonds.

Gaps: This implementation may be abuse its own objective by some group of health
personal in order to receive/gain the benefit in the offering condition.

Problems: Lack of medical equipments.

Solution: Equip the health facility with the modern equipments

Implementation strategies 2: Not officially, yet there are some attempts to provide the
medical equipment necessary to save human’s life.

Strengths: Availability of the equipment.

Weakness: Just the equipment is not capable to help one’s life, there is a need for the
specialist to know how to handle and utilize the availability of the resources to the
maximum outcome. Then here, arise another problem that entail in the scope of
discussion in example of implementation 2.

Gap: The corrupted government officers can find their way of taking advantages from
this type of project in term of financially. During the process, there are several gaps,
that will be and currently ongoing in the Thai’s governing system. (Simply, the
highest bet will be appointed to get the deal, more gap for corrupted parties to rob the
country).

6
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

My recommendations to improve strategies to address this determinants

and reason.

With respect to the moral code of all health personnel, as the respect to the Human’s
Rights and freedom of choice in protect one’s own life, I will not concentrate on tactic
strategies to lure medical healthcare professional into the danger zone with external benefits.
For I believed that the inner urge to put one’s self there is something much more honorable
and we must not try to put prizes on that intention, especially in the age of capitalism.

My boundaries are clear. In summarized, the human’s right, freedom of choice,

capitalism strategies are excluded from my scope of interest. (Yet, the strategy I am
proposing will provide several gaps and weakness, which will be taken as opportunity from
the capitalism definitely. What I am trying to say is that, several gaps will be detected, and
the strategy to encounter and protect the main objective will be taken in maintaining the
nature of the arising concept)

My proposing solution 1: To increase the qualified health personnel.

Educated and trained the local populations of the skill and knowledge that specified to
their main health disease problems in their living areas.

This concept arises from the concept of the (waste water system, which is learned from the
trip within this course), the concept of His Majesty’s “Nature by Nature”

Since we need to respect the human’s right in their freedom of choices, we cannot force any
individual to relocate when it is against their wills, as well as the implemented strategy in
offering benefits had proven to be ineffective.

Nature by Nature, in this context, is to utilize the local resources, for this instance, is the
manpower of the local population who has chosen to live in their origin habitants.

If we cannot transfer helps to them, then we can make them the qualified healthcare
autonomy personnel that are capable of self-health service themselves.

Equipment: As the same strategy as mentioned above, apart from providing the full medical
equipment, we will trained them the necessary knowledge and skills, some medical
equipment may be applicable to handle but the result may be difficult to analyze. The results
can be transformed into a digital data or other forms that can be transferred through

7
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

technology to the specialist in any part of Thailand, pr to any part of the World. (Of course to
make this implementation a practical theory, a well-defined system must be carefully planned
and monitored, at the consideration of the ability of the individual at local area at every step
of proceeding chain of system as well)

Finally, the fully medical equipment at the strategic location with bomb-shell. However this
may also leads to the overloading of people the wanting to be secure in the bomb-shelter.
Thus, this idea is needed to be re-designed and strategized.

Verification Objective to evaluate the success of my recommendations. Justify your

objective.

The ultimate goal is to save lives. Everybody deserves a proper healthcare. Given the
limitation of the circumstances, as well as with the fully respect for individual’s right to
secure one’s life. If we cannot transfer the means to save lives, we could make local become
one. It is not too idealistic, if we could identify exact pin-point of the problem, like what is
the most infected diseases there? We should stop over-throwing strategies and plans and
manpower in the dark of truly understand the problem. We should start by the simplest
question, asking “What do you need in the health care service?” or “What do you do when
you get sick?”

Get into the foundation of the local people. After all, we are developing strategies to improve
their quality of life, aren’t we? Not a perfect policy with every issue countered but not
practical.

“The values of idea lies in the using of it” [Thomas Edison]

8
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

References:

1. “The Key Statistics of Thailand 2012” National Statistic Office, Ministry of

Information and Communication Technology.
2. APCSS [2004] "Trouble in Thailand’s Muslim South: Separatism, not Global
Terrorism" The Asia-Pacific Center for Security Studies (APCSS) ,Volume 3-
Number 10, December 2004.

9
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

APPENDIX A

MY QUESTIONNAIRE: To Survey Healthcare situation and get overall perspectives

from local population of non-medical related profession.

มุมมองดา้นคุณภาพงานบริ การทางการแพทยจ์ากประชาชนในเขตพืนที 3 จงั หวดั ชายแดนภาคใต้

จุดประสงค์: เนืองดว้ยปั ญหาความรุ นแรงในพืนทีเสี ยง งานบริการดา้ นการแพทยแ์ ละสาธารณสุขจึงบกพร่อง และไม่มีประสิทธิภาพ เท่ากบั

พืนทีอืน ถึงกระนนั ดิฉนัมีความเชือและความหวงัใจอย่างสูงว่า นโยบายหลากหลายไดม้ กี ารนาํ เสนอ แต่ยงั บกพร่องในเชิงปฎิบตั ิ

ฉะนนั การรับรูข้ อ้ มูลจากประชาชน หรื อเจา้หนา้ทีในพืนที จึงสาํ คัญอย่างยิง เพือจะเขา้ใจปั ญหาทีดาํเนินอยจู่ริ ง ขอ้มูลเหล่านี จะนาํ ไป
ออกแบบ โครงการเพือพฒันาคุณภาพชีวิตของท่านในเชิงปฎิบตัิไดอ้ย่างจริ งจงั

ขอ้ มูลของท่านจะถูกเกบ็ เป็ นความลบั และนาํไปใชเ้พือพฒันาคุณภาพชีวิตพีนอ้งประชาชนในเขตุพืนที 3 จงัหวดัชายแดนภาคใตเ้ท่านนั ใน

กรณี ทีท่านตอ้งการประสงคจ์ะออกนาม ดิฉนัขอนอ้มรับดว้ยความยินดีอย่างยิง เพือทีพวกเราจะไดม้รคส่ วนร่ วมในการพฒันาชุมชนของเรา
ใหย้งั ยืนยิงขึน

ดิฉนัเชือว่า แมเ้ ราจะไม่สามารถควบคุมสถาณการณ์ หรือปัญหาต่างๆใดๆกต็ าม ทีคุกคามชีวติ ของเราอยู่ ณ ขณะนี แต่เรามีความสามารถทีจะ

เตรียมตวั ใหพ้ ร้อมกบั สถานการณ์ได้ ปัญหาในปัจจุบนั ไม่จาํ เป็ นตอ้ ง เป็ นปัญหาต่อลูกหลานของพวกเราในอนาคตอีกต่อไป หากเราเรียน
รูเ้ ท่าทนั และมีแนวทางป้ องกนัอย่างมีประสิทธิ ภาพอย่างยงั ยืน

ขอนอ้ มเคารพทุกความร่วมมือของทุกๆท่าน ดิฉนัขอใหค้าํมนั สัญญาว่า จะมุ่งมนั พฒันาคุณภาพชีวิตของคนไทยในพืนที3 จงั หวดั ชายแดน

ภาคใต้ และคนไทยทุกๆคน ตลอดเท่าทีดิฉนัยงัมีชีวิตอยู่

ขอขอบพระคุณอย่างยิง

สิรพิ ร พิพฒั นช์ เูกยี รติ

10
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

11
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

APPENDIX B

Life Expectancy at Birth by Region and Sex: 2010 - 2015

12
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

APPENDIX C

Area, Population, Density and House from Registration Record by Region:

200 - 2010

13
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

APPENDIX D

Population Projections (1 July) Buy Region and Sex: 2012 - 2016

14
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

APPENDIX E

Number of Livebirths and Deaths by Region and Sex: 2009 - 2010

15
Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

APPENDIX F

Percentage of Population by Migration Status, Area and Present region:

2008 - 2009

16
 Mahidol University-Duke Global Health Institute Siriporn Pipatshukiat 5537051 SHCJ/D
Short course in Global Health 2012:

APPENDIX G

Key indicators of The Population from Population and Housing Census:

2000 and 2010

17

View publication stats