Primary Health Care A Continuing Challenge

Publication No.
S
Research for PHC Model Dc"'cir;pillcitt
Chantaburi Prov'ince
ISBI{ 9?4-58{r-211-8
A,-i*.Atr l"ruining {.*::=€ss l{rr

Fci:*i:r1 I Ieal{h {l::r* E}r:e.:tEt}t!rrtrtr
=9.E::ai
&€::hidol L.' nir crsiq: . irtnd
Bangkok, Thailand : May l, 1987
T-TI
Illl l an effort to design
a workable model for Primary Health Care service delivery,
the ASEAN Training Centre for Primary Health Care Development in cooperation with Mahidol
University, the Ministry of Public Health, other concerned ministries, and the Japan International
Cooperation Agency launched the Research for Primary Health Care Model Development
Project in Chantaburi Province.
The thrust of the Primary Health Care Model Development Chantaburi Province project
is on the identification, training and fielding of a group of young, energetic, civic-minded and
dedicated Thai university graduates. These graduates, having been awarded the title Graduate
Health Volunteer will operationalize the model.
The project will enable the Centre to test the viability of different strategies toward
an effective Primary Health Care Delivery programme and at the same time identify the limi-
tations of these strategies while determining their replicability across the country. The project
will also highlight the role and potential of developing leadership skills in health and communitv
development, in the graduate health volunteers (GHV).
It is our hope that the GHV will significantly contribute to the resolution of many
obstacles that have impeded the full development of primary health care in Thailand. By
selection of graduates from various universities and degree programs, future leaders from all
professional walks will become knowledgeable of the intricacies of health delivery. The GHV
will likely. be sympathetic to health issues and policies as they become the nations decision
makers. Thus not only health professionals, but lawyer, teachers and engineers will be able
to make worthy contributions to health care problems in the future. This however, is long
term benefit of the program. More current benefits of the GHV are as follows :
l) Increasing the number of health workers in rural areas, thereby decreasing the
disparity between urban and rural health status. As an indicator of the differential in urban
and rural health status, current infant mortality statistics show 45,/1000 death rate for Thailand,
while only l3l1000 for Bangkok.
2) The GHV is a low cost answer to the problems of financial constraints coupled
with manpower shortages. With ll million people in Thailand living below the poverty line,
it is an insurmountable task to supply adequate health services nationwide. Through the GHV,
basic services, such as maternal health, immunizations and sanitation will be within the financial
reach of the nation's poor. The GHV, a cadre of new university graduates has been assembled
and trained in an effort to assuage the perennial problems in primary health care delivery that
have beleaguered the country for the past several decades.
In object optimism, I dare say that the Graduate Health Volunteers are Thailand's
answer to the World Health Organization's challenge of Lead-ership Development for Health
For All.
Krasae Chonawongse, M. D., Dr. P. H.

Director
ATC/PHC
Mav L 1987
I operation staff of the Research on Primary Health Care Model Development
Project - Chantaburi Province wish to acknowledge the invaluable cooperation and assistance
rendered to them by the following :
- The provincial governor, the provincial chief medical officer and his personnel
and the various related government agencies in Chantaburi Province without whose dedication
and commitment the project cannot be operationalized.
- The people in the study villages in Chantaburi for finding a place for them
both in their homes and in their hearts.
- The Ministry of Public Health for their hiehly esteemed technical advise.
- The Mahidol University in its dynamism to provide necessary back-up support,
- The ASEAN Training Centre for Primary.Health Care Development for its
unfailing guidance and direction; (operationalized, hearts, advise)
- The Japan International Cooperation Agency for the much - needed and
equally appreciated financial assistance; and, last but not the least to;
- The Graduate Health Volunteers for spending one year of their youth in the
remote villages, living under sparlan conditions in their effort to be leaders in Primary Health
Care Development.
Page
Prologue I
Acknowledgement 4
The ASEAN Training Center for Primary Health Care Development 7
The Japan International Cooperation Agency E
Introduction I
Project Overview lo
Health profile-Chantaburi Province t2
Project Activities 26
Situation Analysis of Primary Health Care and Community 27
Development Activities in Chantaburi Province
Training of Graduate Health Volunteers 43

Research and Development Activities 62
Seminars E5
Summary of the Project Activities E7
Project Milestone 93
Conclusion 96
Epilogue g7
Annexes 99
Annex l: Publications on Research for Primary Health Care rol
Model Development, Chantaburi Province
by the ASEAN Training Center for
Primary Health Care Development
Annex 2: Glossary 101
Annex 3: Project Financial Statement lo3
The Authors ro4
THE ASEAN TRAINING CENTER FOR
PRIMARY HEALTH CARE DEVELOPMENT(ATCIPHC)
IEil'l
I[S
I IASEAN Training Center for Primary Health Care Development (ATC/PHC)
was established in October, 1982 as a part of the ASEAN Human Resources Development
Project under the technical cooperation of the Government of Japan. A collaborative project
between the Mahidol University and the Ministry of Public Health, the ATC/PHC is supported
by the Royal Thai Government (RTG) and collaborating agencies. The ATC/PHC is working
closely with the ASEAN Secretariat to the Committee in Social Development, Expert Committee
in Health and Nutrition, the Japan International Cooperation Agency (JICA), the South Easr
Asia Medical Information Center (SEAMIC), the World Health Organization (WHO), the
United Nations (UN) health related agencies and concerned non-government organization (NGO)
The ATC/PHC functions as an international institution for human resources development
with the ultimate goal of serving as a fulcrum for exchange of knowledge acquired and exper-
iences gained in the field of primary health care and social development among member'countries
of the ASEAN. The Center concentrates on a manifold of specific objectives : training of all
categories of health workers (from policy makers and policy makers to-be, down to the primary
health care cadres), enhancing their managerial potentials and functions; Jesearch and model
development for primary health care in the different levels of the health care delivery system;
strengthening of infrastructure support to meet the training needs of the target population both
locally and internationally among the neighboring ASEAN countries; and, the establishment
of local and international networks of information exchange on primary health care and related
activities.
Administratively, the center operates under the Mahidol University, the forerunner
of medical and public health education in'Thailand. The Mahidol University has been named
in honour of the pioneering activities of H.R.H. Prince Mahidol of Songkhla in the establishment
of a system of medical and public health education in the country. H.R.H. Prince Mahidol
was the father of His Majesty, the King, Bhumibol Adulyadej the present King of Thailand.
The Centre's policy is guided by the Executive Board whose membership comprised of the
Ministry of Public Health, the Mahidol University and the Director of ATC/PHC amongst
others, serving as members of the Board.
Of date, the ATC/PHC is in full operation, in anticipation of the multifaceted challenge
that lies ahead; at the Mahidol University, Salaya Campus in Nakhon Pathom provincc ol'
Thailand.
Over the short span of its five-year operation, the centre has proved as the ever-dynamie
training institution, it has envisaged to be; in the development of PHC cadres and of potential
PHC development managers and policy makers both locally and in the neighboring Asean
countries. Likewise, the centre has fulfilled its committment on functioning as a springboard
for resource mobilization and in the strengthening of regional cooperation and integratron.
It has also prided itself with its role as a facilitator on technical cooperation and technological
transfer at intra-country and inter-country levels.
The ATC/PHC was established along side with four Regional Training Centres (RTC)
at the request of the Ministry of Public Health. These four RTCs are located in Khon Kaen,
Chonburi, Nakornsawan and Nakorn Srithammarat provinces.
ffiffiffi
Wffiil#ffi Ciovernment of Japan through the Japan International Cooperation Agency
(JICA) has committed itself to a dual channelled flow of support to the ATC/PHC : grant-in-aid
and technical assistance. The grant-in-aid was mainly in the form of capital costs at the initial
construction and setting of phase of ATC/PHC. The technical cooperation, on the other
hand, is concentrated on all necessary technical support in the operationalization of various
project activities conducted by the centre. This includes costs in the conduct of training
programmes and seminars, research, model development, equipment, fellowship and the
assignment of experts.
The JICA's technical assistance on model development for the PHC activities has
ushered the formulation of the "Project on Research for Primary Health Care Model Develop-
ment-Chantaburi Province", in January, 1985.
INTRODUCTION
---l
I III ltne 1978 declaration of the Alma Ata member countries of WHO have sworn and
subscribed into the attainment of the goal of Health for All by the Year 2,000 (HFA/2,000)
through primary health care approach. As a WHOmembercountry, Thailand was no exception.
The country has very slowly but very steadily made considerable progress in saturating its
villages with a variety of strategy in an effort to maximize PHC service delivery. Out of these
strategies the concept of village health communicators (VHCs) and village health volunteers
(VHVs) has evolved. VHCs and VHVs are selected members of their particular villages who
have indicated willingness, capacity and capability to facilitate health service delivery on a
voluntary basis.
After undergoing training programmes specific to their voluntary job description, a
VHC is responsible for the establishment of a network of information, communication. and'
education (IEC) for health; whereas a VHV in addition to his,/her IEC activities is expected
to render simple curative and rehabilitative medical care at the same time strengthening the
referral systems with local health authorities whenever attending to advanced and complicated
cases' Additional thrust in the field of research, specifically on model development for pHC
activities were given priority consideration, an example of such initiative has ushered the
conception of the project on Research for Primary Health Care Model Development - Chantaburi
Province, otherwise known as the Chantaburi Model Development Project. The ATC/pHC
in collaboration with the Ministry of Public Health, the Japanese Government through JICA
and WHO, and in full awareness of the urgency of the need for conceptualizing an MCH and
EMC model to enhance PHC service delivery, has launched the Chantaburi Model Development
Project in January 1985.
Located 245 kilometers Southeast of Bangkok, the Chantaburi Model Development
Project not only seeks to strengthen over-all PHC activities, but also carries the additional
mandate of provision of training for newly graduated college and university students in an
effort to prepare them as potential leaders in health and health-related activities.
Chantaburi has been specifically selected as the project site owing to its unique geo-
graphical scattering of villages and houses within its rural communities providing a greater
challenge in establishing networks for implementation of pHC activiries.
10
tffiI
I llg lproject on
.1 Research for Primary Health Care Model Development - Chantaburi
province has begun its inception in January 1985, after a series of brain-storming session and
consultative meetings among ATC staff responsible for the project, concerned officials of the
Ministry of Public Health and the local authorities from Chantaburi province.
The over all goal of the project is the conceptualization and operationalization of a
workable model of PHC service delivery which is problem - specific, neecl-based and community
oriented to the general population of Chantaburi province with a thrust on maximum utilization
of existing community resources.
The project has a four-fold objectives :
L The study and development of a model to stredgthen maternal and child health
(MCH) and essenrial medical care (EMC) activities in pHC :
2. the conduct of a feasibility study on the efficiency and effectiveness of utilizing
graduate health volunteers (GHVs) in primary health care and community development :
3' the study of management information system (MlS) applicable to the adminis-
tration, management, implementation and evaluation of pHC activities : and,
4. the study of the impact of socio-economic and cultural factors in reference
to the effective implementation of PHC services in chantaburi province.
The project has five major activities :
I ' the conceptualization and operationalization of various model in PHC service
delivery taking into consideration a comparative study in the light of utilization and non-utilization
of GHVs,
2. training of GHVs,
3. research and development,
4. seminars, and
5. monitoring and evaluation
The project has been formulated over a total project life of three years an
approximate budget of Thai Baht 1.7 million (US$65,3g4; :y l0 million) per year of
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12
E
K$ptovince of Chantaburi can rightfully claim itself as a fruit basket of Thailand.
Noted for its vast orchards of rambutan, durian, mangosteen, pineapple, a visitor is always welcome
to eat into his heart's content these tropical fruits without payment, right within the backyard of
any orchard owner. However : it will not do justice to the province to highlight only on its fruit-bearing
capability, for over and above its fruit produce, Chantaburi also abounds in colored gems,
precious rubies, sparkling toplzt midnight-blue sapphires and lush-green emeralds that attract
both tourists and traders alike. Adding to its economic potential are the rubber plantation that
abounds the province. chantaburi may therefore well be described as properous..
The Province has a total estimated population of 374,560 and an estimated land areas at
6,000 sq. kilometer. It receives approximately eight months of rainfail per year.
Geographically, the population are scattered amidst fruit orchar.ds and gem-pits rendering
communication and access to health services, difficult. People have always been trade-oriented
leaving no time for commercial{ype of activities. Livelihoods take people away from home during
the entire waking hours, hence the lack of stamina and disinterest for coqgregation and community-
oriented projects. In addition, there is a high migration rate as a result of existing job opportunites,
the migrants being not only economically disadvantaged but also ignorant as to accessibility of
health care facilities and indifferent to any participatory movement in their rew communities.
13
ORGANOGRAM OF THE PROVINCIAL ADMINISTRATION
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15
ORGANOGRAM OF THE PROVINCIAL HEALTH OFFICE
STD* : Sexually Transmitted Diseases

16
PROVINCIAL NETWORK INFORMATION SYSTEM
Provincial
I
Statistical Office
other
provincial
office unit l-
- Municipalities
I
- Sanitary District
l*Tr Districtoffice
- Village Headman
vHv/ VHC other: - Traditional Birth

Attendants
- Traditional Healer
- Tambon Doctor
MOPH Ministry of Public Heolth

PPHO Provincial Public Health OfJice
DPHO District Public Health OfJice
VHV Village Health Volunteers
VHC Village Health Communicators
17
Demographic Data
Population by Age Group and Sex (1986).
Total Population 398,937
Male 202,799
Female 196,138
Age Male (90) Female (90) Total (90)
0-4 4.57 4.44 9.01

5-9 5.32 5. l6 10.48
l0-14 5.36 5.68 I1.04
t5-24 10.19 10.93 21.12
25-M 13.55 t3.92 27.47
45-59 6.99 7.23 14.22
>60 3.27 3.39 6.66
Total 49.25V0 50,75V0 100.0090
The above table indicates that population belonging age group 25-44 comprises the highest
percentage and those belonging 60 and above comprises the smallest percentage
HEALTH PROFTLE (198s)

Health resources and health manDower
Health Regiohal District Medical Health Community

Resources Public
District Hospital Hospital Center Center Health
Office
Muang I l3
Ta-mai I I 29
Lam-singh I 6
Klung I t2
Pong-Num-Ron I l3
Ma-Kam I l3 6
Total 86
t8
Health Public Health Doctor NursePublic

Manpower Doctor Nurse Officer * Pop.n Pop.nHealth
District Officer
Pop.n
Muang 65 282 65 l:1,458 l:366 l:1,458

Ta-mai 2t2 65 l:56,207 l:9,367 l;1,729
Lam-singh l9 22 l:30,222 l:3,358 l:1,373
Klung l9 29 l:49,366 I:5,485 l:1,702
Pong-Nam-Ron 523 27 l:13,902 l:3,022 l:1,878
Ma-Kam ll0 36 l:42,639 l:4,263 l:1,184
Total /J 345 244 l:5,319 l:1,156 l:1,634
*Public health officers include ssnitarians and midwives.
PRIMARY HBALTH CARE HEALTH MANPOWER

VOLUNTEERS
Village Health Communicator (VHC) and Village Health Volunteer (VHV) Coverage
by District/Tambon/Village
VHC Coverage VH! Coverage

Districl Tambon Village Tambon Village No.of Tambon Village No,of
vHc vHv
Muang 9 92 8 78 646 8 78 78
Ta-mai 19 188 t9 r88 l4s2 to 188 193
Lam-singh 7 64 6 38 247 6 38 38
Klung l0 83 t0 83 </< l0 83 84
Pong-Nam o 68 9 67 932 9 )/ bJ
Ron
Ma-Kam 8 84 668 8 6Z 83
'lbtal 579 60
VHC coverage 95.77V0 of total sub-districts and

92.9lVo of total villages
VHV coverage 96.77V0 of total sub-districts and
9O.84Vo of total villages
Average number of VHC/village 8.3
Average number of VHV/village 1.0
T9
EXISTING HEALTH CARE FACILITIES

Table 1.3 Health Care Facilities
Type
Public Health Center 6

Health Center 83
Community Hospital f
Regional Hospital I
Pregnant women seldom avail of existing ante-natal facilities hence there is inadequate
coverage with tetanus vaccination and poor nutrition information which have negative effects to
both mother and child. This lack of utilization of existing health facilities may be attributed either
to lack of adequate information on the part of the mothers or on apparent inaccessibility of the
health facilities
Table 1.1 Nutritional Status of Children Age 0-5 Years
Cetcgory No. Vo
lst degree malnourished 4,691 20.9

2nd degree malnourished 436 1.9
3rd degree malnourished l0 0.1
Narmal 17,219 77.l
Total 22,356 100
The present nutritional status of children under 5 years of age leaves much to be desired.
Although there are statistically insignificant number of cases suffering from 2nd degree and 3rd
degree malnutrition,20s/o of these children are within the lst degree malnourished bracket.
PRIMARY HEALTH CARE ACTIVITIES BY DISTRICT

Nutrition
Nutritional Surveillance Data
Number of Taget Number of Target Percentage of

District group, under 5 group weighing by coverage
yrs.old. VHC/VHV
Muang 6,607 4,964 75.1

Ta-mai 6,',?41 6,650 98.7
Lam-singh 1,982 1,879 94.8
Klung 3,638 3,628 99.7
Pong-Num-ron 6,370 5,679 89.2
Ma-kam 2,818 2,766 98. l
Total 2E,156 25,566 90.E

20
Immunization
Percentage of Coverage as Compared with the Target Group
District BCG DPT oPv Measles Rubella TT*
Muang 258. I I 86.24 85.87 51.32 60.35 tr7.2l

Ta-mai 7 5.73 86.1 1 85.09 56.34 69.08 45.63
Lam-singh 86.69 83.37 82.48 70.9s 56.08 54. l0
Klung 67.95 9s.34 90.43 60.85 97.22 54.00
Pong-Num-Ron I 10. l4 82.19 82.99 47.24 89.84 56.1 1
Ma-kam 64.77 74.70 '73.29 42.96 64.32 30.70
Total r24.80 84.86 E3.92 49.22 75.40 43.83
* Tetunus toxoid in pregnant women

Family Planning
No.of Acceptors Rate of active

No.Target Temporary Permanent users
Districl group type type
Muang 12,239 7,455 2,341 80.0490

Ta-mai 13,005 7,249 3,519 82.8090
Lam-singh 3,753 2,300 935 86.2OVo
Klung 6,644 3,843 1,590 81.7'lolo
Pong-Num-Ron 8,867 5,194 2,154 82.87V0
Ma-kam 5,157 2,952 I,178 80.0990
Total 49,665 28,993 ll,717 82.0090
NB. Target group Married women of reproductive age (15-44 yrs.)

Temporary = IUD., Pill, Depo injection, Norplanr
Permanent = Vasectomy, Tubal ligation
Sanitation and Water supply
Total number Latrine Adequate drinking

District households (house) water
with Vo with
Muang 9,323 7,754 83. l7 5,804 62.25

Ta-mai 15,396 6,81I 44.24 3,933 25.55
Lam-singh 4,514 3,536 78.33 3,097 68.60
Klung 5,944 3,440 57.87 2,495 41.98
Pong-Num-Ron I 1,333 3,1 l5 27.49 6,227 54.95
Ma-kam 6,799 3,550 52.21 556 8. l8
Total 53,309 2E,206 52.9r 22,112 4r.4E

21
Health Education in the Village
Health l-ducation by Health Official (times)
Dislricl Ocl Nov Dec Jan l'eb Mar Apr May Jun July Aug Sep Totrl
( r9Es) ( 1986)
Muang 50 J2 55 51 52 60 58 61 59 50 52 66 666
Ta-mai t20 I2> l2t t24 109 tt2 I l8 Il5 l2o t26 tzg 183 1502
Lam-singh 38 39 37 38 39 37 26 39 35 34 53 464 464
Klung 56 )t 56 54 58 56 55 57 58 56 57 54 674
Pong-Num- 50 5l 50 51 49 52 51 53 52 51 53 4l 604
Ron
Ma-kam 54 55 53 5't 58 54 s5 56 55 55 56 47 655
Total 372 376 373 374 37E 373 381 444 4565
Health Education in the Village by ! HCl! H! (times)
Oct Nov Dec Jan I'eb Mar Apr May Jun J uly Aug Sep Tolal
( l9E5) ( l9E6)
Muang 53 sl 55 53 52 54 5l s2 53 56 52 54 63
Muang 53 51 55 53 52 54 5l 52 53 56 52 54 636
Ta-mai 104 to2 106 103 103 t06 t04 103 105 104 103 105 t24B
Lam-singh 19 20 2l 20 2t 22 20 20 2t 22 t8 t2 236
Klung 44 45 43 46 43 45 42 46 45 46 44 48 537
Pong-Num- 52 53 5l sZ 53 54 50 51 51 53 5l 57 629
Ron
Ma-kam 42 43 41 44 42 43 44 40 4t 42 4l 4t 504
Total 314 314 317 3lE 314 3ll 312 317 32J 317 37m
22
MORBIDITY AND MORTALITY RATE AMONG THE

GENERAL POPULATION
Table 1.2 Morbidity * and Mortality ** of the General Population by Etiology
1984
Disease Morbidity Mortslity
Rank No. Rate No. Rate
Malaria I 2377 .8 64t6.7 4? .l

Diarrhea 2 6460 t747.0 t4 .03
Unknown fever J 5484 1483. l I .002
Dysentery 4 l5l6 409.9 I .002
Viral conjunctivitis 5 908 245.6
Pneumonia 6 742 22.7 lt .03
Influenza 7 684 184.9
Measles 8 531 143.6
Pulmonary Tuberculosis 9 445 100.3 l8 .05
Food poisoning l0 4t6 112.5
Hemorrhagic fever ll 292 78.9 2 .005
Sexually Transmitted t2 200 54.1
Diseases
Insecticide poisoning l3 158 42.7
Hepatitis l4 157 42.5
Chicken pox l5 I 13 30.5
German measles t6 109 29.5
Typhoid l7 102 27.6
Mumps l8 60 16.3
Meningitis t9 33 8.9 .02
Pertussis l9 33 8.9
Encephalitis 20 t4 3.8
Diptheria 2l t2 3.2
Tetanus 22 l0 2.7 2 .005
Typhus 8 2.2 I .002
Rabies 24 4 l.l 4 .01
Cholera 25 2 .)
Leptospir.osis 26 2 .003 .002
Gonococcal meningitis
*Per 100,000 Population Base

**per 1,000 Population Base
23
MAP OF THB STUDY TAMBONS
o*9n'rycc
1985-1987 Research areas

in Chantaburi Province
a Areas with GHVs
o Areas without GHVs
THE MAHIDOL UNIVERSITY THE MINISTRY OF PUBLIC HEALTH
rilm,r:r] nulk"t'r
Dr. lVqtth Bhamorapravati, Rector Dr. Amorn Nondasuta, former Permanent

Mahidol University Secretory of State for Public Health who hss
given his whole - hearted support to the concept
of PHC model development
THE ATC/PHC
From left to right, Dr. Som-arch Wongkhom-

thong, project operqtion manoger, Dr. Orapin
Singhadej, associute director with Dr. Krqsae
Chanowongse, director of ATC/PHC
AND, THE JAPAN INTERNATIONAL COOPERATION AGENCY
Prof. Masami Hqshimoto, Japanese National

Team Lesder on ATC/PHC project receiving
q token of appreciation from Dr. Som-qrch
HAS l-n LJN('Hl:l) 'fFIE PROJIC'I ON RtrSI]Alt('tl l;OR I'HC MODEL DEVELOPMENT,
( HAN'l'AIIURI PROVIN('lr IN .InNUARY l9u5
i.ll:,\ ll1 i i: \ "" t.\.f$$- ${a }}$f.{}\ *,\,{:R,.
CHANTABURI . THE FRUIT BASKET OF THAILAND
An abundance of tropical fruits - durisn,mangosteen, rambutqn qnd others

TNCOME TOPOGRAPHY
Rubber trees qre also a major source of income The house are sparsely distributed
RL,LIGION MIGRATION
Buddhism is the principal religions belief A large number of poor migrants come to the
area each year
[{t,At I r{ F'A( $["fi $'${.q
The Provincisl Public Heqlth Office The Phro-Pok-Klqo Regionol Hospitol
* .. ... 'fi$*s$$tlfi $"\ l;.:. "--:,

::--. .l
*_:l@&
.L,-;;.l+...*'t '-i.. l ..;:
' l +-', -''
. .. i
The community hospital Maternity ward of the community hospital
The health center A patient being treated qt the health center

SELECTION OF GHVs
\
The candidates sitting for their written exams Interviewing the candid(ttes for t heir com-
mit tment and leadership
TRAINING OF GHVs
Successful candidqtes receive theoretical trainins

Taking notes.........
on PHC's community development at ATC
PHC
STUDY T'OUR
Exposure of the GHV with the villager during Surprised to see sppropriqte technology, ,,bio-
their study tour gqs" ........ how the villagers turn animal feces
to energy
They always work closely with the health center They also communicqte with other officers
staff
He begins his activity by conversing with the ......familiarizes herself with the community
villusers
It's time to introduce social change. ',We have Discussion with the villogers on strengthenin7
to organize our community..," com munity orgsniza t ion
()ryutti:.ittg d Iroinittg course Jitr tha villttgers Promoting efJ'ec'tive communical ion t hrough
villoge broadcosting statio n
)
I r o trt r t t i n g I o ca I a p p r o p r ia t e t ec' h tt o kt gy Explaining the necessity of cooperative move-
tnent
T'he CIIV also heals n PHC family model initiated by a CHV aJter
receiving the certificate from the governor
Dr. Som-boon Kietinun, teom leqder of MCH Dr. Som-qrch Wongkhomthong, project opero-
research in a resular visit to the heqlth center tion manager in front of the field stotion
Asst. Prof. Boonyong Kiewkqrnkq giving A dentist with the ossistance of a GHV de-
qdvice to ensure technology transfer ut the monstroting dentql educotion in the communily.
village level.
Dr. Som-boon Kietinun promoting "The Four The border soldiers also playing an important
Hesrt Chamber Community Development role on community development activities.
Campaign".
Dr. Krasae Chanawongse opening the setninar Dr. Chalong Kuan-Har and Dr. Boonchei
at RTC Chonburi Bhoomboplab from the Chantaburi provincial
public heqlth office.
Members of the research teams from the pro-

vince
Regular meeting ot the provincial public health An informal night-session among stsff at
office. Somdej hospital, C honburt
.tHF.
SENIINAR AT
KRATI\G W A'TI'R} AT,t-
Presen to t ion o f resea rc h ac t iv it ies I understqnd
Group presentation by the CHVs and a research That's funny!

teqm leader I don't think I agree with you
Recrestion at night after a long doy of dis- All work ond no play makes the teams dull
cussion and insctive.
THEY CAME TO VISIT
THE PROJECT
Dr. M. Matsuda (left) ond Mr. M. Nqkamura Japaness journalists from Mainichi Daily
(right) in site assessment visit to Chantaburi Newspaper and Tokyo Newspaper observing
GHV activities
ASEAl,l representatives joining the field MPHM students conducting field study in
acl ivit ies Chsntaburi
A group of medicol and nursing students from Dr. Msrk Belsey, chief, MCH/WHO Heud-
Japan on their way to Chantaburi qusrter Genevq giving expert advice to the
researchers.
THE END OT THE SECONI)
YEAR ACTIVITIES
Dr. Antorn Nondasulu, 7-he forrner Permunenl Dr. Nutth Bhurnarapravati and Dr. Krasae
Sec'retary of Public Health and Dr. Suchint Chunuwongse reviewing the GHVs performance
Phalapornkule, the Deputy Secretury listening und the reseurc'h uctivities
to the proje('t briefing at Chuntuburi
Presentution oJ evuluation oJ'the proJe('! A GHV receiving certificate from the Rector
uctivities by the evaluution team J'rom the oJ Muhidol University
I'-ut'ulty, oJ Publit' Health, Muhidol University
Gruduution day AJter one year oJ' being GHVs, they are reucly
to be Health For All leaders
The editoriql staff from left to right; Dr. Krasae
Chanawongse, director of ATC/PHC, Dr.
Rosa Corqzon F. Cosico, Visiting Professor
Faculty of Social Science & Humanities, Mohi-
dol University and expatriote consultant to the
Research for PHC Model Development Pro-
ject Chantaburi Province and Dr. Som-qrc'h
Wongkhomthong, the operq!ion munager of
the project.
25
PROJECT ACTIYITIES
27
SITUATION ANALYSIS OF PHC AND COMMUNITY

DEVELOPMENT ACTIVITIES IN CHANTABURI PROVINCE
ASSESSMENT SURVEY OF THE STUDY VILLAGES ON PRIMARY HEALTH

CARE (PHC), MATERNAL AND CHILD HEALTH/FAMILY PLANNING (MCH/FP),
ESSENTIAL MEDICAL CARE (EMC) AND COMMUNITY DEVELOPMENT (CD) IN THE
STUDY VILLAGES._ CHANTABURI PROVINCE
In September 1985, as the project enters its first year of operation, the first group of
Graduate Health Volunteer (GHVs) in collaboration with a team of researchers*...'...conducted
a baseline survey for data gathering on various aspects of PHC, MCH/FP, EMC and CD activitis
in the 168 villages involve in the project.
Basic information on the sample villages were collected utilizing form ATC/CMD 003
**.......and ATC/CMD 004 'r'**..... this survey covered 168 villages, 23 sub-districts and 6 districts.
An assessment of the extent and the nature of participatory activities of the village
committees were likewise studied and analyzed in an effort to measure community involvement
and community commitment in community development.
* Comprised of ATC/PHC staff, the PCMO staff and the provincial hospital staff
*'t ASEAN Training Center/Chantaburi Model Development/O03
(Data collection form Village Committee)
*tr* ASEAN Training Center/Chantaburi Model Development/OO4
(Data collection form foi Health Centre)
BASIC VILLAGE DATA IN CHANTABURI PROVINCB

The population distribution of the research areas was noted and the data according to
different categories, is presented as follows:
Table 2.1 Population in Research Areas
slo
Item
Households 14,933
Families 17,277
77 511
Population
0- I years 1,605 2.1
I- 4 years 5,477 7.1
5- 9 Years 8,274 10.7
l0 - 14 years 9,314 12.0

15 - 24 years 16,637 2t.4
25 - Myears t9,936 25.',l
45 - 49 years 5.,652 7,3
50 - 59 years 5,745 7.4

60 years 4,893 6.3
Women in Reproductive Age 17,753
(15-45 years)
Married Women ll,ln
Newborn babies 1,597
28
Item N Vo
Malg 51.3
:819
Female 778 48.7
Death 420
Male 245 58.3
Female 175 41.7
Health personnel |,692
VHC 1,339 79.1
VHV 169 10.0
Malaria Volunteers l0l 5.9
Village Health Crafrsman 42 2.5
TBA 30 l18
Monks and others t2 0.7
School Children 12,881
Pre-school children 473 5. t
Elementary t2,o9l 93.9
Secondary and up... 317 2.4
SPATIAL DISTRIBUTION OF HOUSES

As mentioned previously, one particular problem in community health development in
Chantaburi province is the scattered location of houses. The folowing table shows the distribution
of households in the sample villages:
Table 2.2: Distribution of house in the study villages
7590 as one As several Sparse No answer Total

Model 4!-----Jroups
N alo N Vo N Vo N-qo
I t4 40.0 t6 45.7 5 t4.3 35
2 4 23.5 76.8
13 t7
3 9 28.6 t2 37.5 l1 34.4 32
4 ll 6l.l 7 38.9 l8
) ; 4.6 13 29.5 21 47.7 8 18.2 44
6 7 31.8 5 22.7 l0 45.5 22
Total 32 l9.l 6l 36.3 s4 32.1 2l 12.5 168
It must be said that the majority of villages in all six categories show a pattern of houses
distributed either sparsely or as several scattered groups. ..
29
WATER SUPPLY
The villages were further studied for identification of water sources and it was observed
that less than 7090 of the study villages have sufficient water supply systems. The details
may be seen in the following table.
Table 2.3 : Water Source and Supply in Dry Season
Model No.of Natural walel Soulces Constructed \[ ater S0urce

vil- vit- Vo Suffi- Vo No.of vil- s/o Suffi- ulo No.of
lages lages cient water lages cient water
source s()urce
I 35 JI *
88.6 2l *6'7.7 )) l7 *48.6 8 +47.1 20
2 ll IJ 7 6.5 a 69.2 20 6 47.1 5 62.5 l1
3 5Z )z 100.0 8 25.0 49 t8 56.1 5 21 .8 39
l8 t8 t00.0 l0 55.6 24 l0 55.6 5 50.0 8
) 44 JO 8t.8 l9 52.8 50 ZJ 52.3 l8 78.3 Jt)
6 22 tt 77.3 o 3 5.3 l9 t2 54.6 6 50.0 Iti
Total 140 E7.5 IJ 49.7 2t7 52.4 41 53.1 |]4
The table showed that 88.690 are dependent on natural water supply of which only
of the population find their water supply adequate. This inadequency has provided a
6'l .70/o
great room for health problems. Those who can afford have to buy water from outside their
villages, whereas those who can not have to make the best out of their available supply. The
water problem may also be a great contributory factor to the high incidence of ,diarrheal diseases
among the under five age groups.
OCCUPATION/INCOME/RESOURCBS AND
ENTERPRENEURSHIP ..
Further exarnination of the communities revealed that the principal occupations were vegetable
farming and fruit growing followed by rice farming, as shown below:
Table 2,4 : Occupation of the study communities
Occupation Vo
Vegetable crops farming 27.6

Fruit growing 26.5
Rice farming 19.7
Rubber plantation/Forestry 9.1
Fisheries J. t
Cottage Industry 2.r
Others I 1.3
Total 100.0
30
On examination of the yearly income of the study population, it was found that villagers
in this region were relatively well off and prosperous. The majority of households earn more
than 10,000 Bahts a year and it was only 5.490 that have an income of less than 10,000 Baths a year.
LAND OWNERSHIP
Assessment of land ownership revealed that a large portion of the sample households have
their own land area. There are also some who had to farm on borrowed land space.
Table 2.5 : Land ownershiP

o/o
Ownership status
Own land 86.8
Owns and borrows land 4.6
Borrowed land 6.0
Others 2.6
Total 100
It may be deduced that the community values ownerships of land and property. It can
also be assumed that a great majority of the community are financially stable as the land they owned
are either farmed by them or leased out as a means of livelihood.
As regards to identification of resources and enterpreneurship in the village, the private

sector was studied and the existing type of enterprises were found to be mostly food and grocery
stores(84.9g0). Rice mills comprise 8.390, shops that retail agricultural products 5.690. The different
kinds of shops and stores are an shown below:
Table 2.6 : Types of shops in the village
Type Average no.per village
l. Crocery stores 4.4

2. Food stores 1.7
3. Motorcycle repair shoP 0.4

4. Agricultural tools shoP 0. l3
5. Electrical appliances repair shop 0.1
31
PUBLIC FACILITIES/SERVICES
Data was also obtained on the availability of public services in the study village. The
following table show that less than half have primary schools and temples. Only 23.8Vo ot
had an information center and there were assembly halls in only 16.790 amongst the
"'illages
total number of villages. Further details may be clarified in the following table:
Table 2.7: Public Services in the village.
Villages with Established duration (years)

Public Facilities facilities
l-5 6-10 l0 and more
N olo N olo N Vo
Primary School /U 41.7 J 4.3 67 55.7

Temples 69 4t.l 2 2.9 2 2.9 65 94.2
.A
Reading Centre 40 23.8 J+ 85.0 6 15.0
Village Hall 28 t6.'7 IJ 46.4 t7 .9 l0 35.7
Health Centre 27 l6.l 2 7.4 I J. t 24 88.9
Kumnan Office 18 10.8 6 JJ.J 4 22.2 8 44.4
Rice Bank 9 5.4 9 10.0
Middle School 5 3.0 2 40.0 3 60.0
Tambon 5 3.0 t
I 20.0 60.0 I 20.0
Development Center
Tambon q^ 2.4 2 50.0 2 50.0
Agricultural Center
Buffalo Bank I 0.6 I 100.0
Total r00.0 1) 26.1 E.7 180 65.2
It could well be that a combination of factors such as the scattered location of houses
and a relative lack of public facilities foster an obstacle towards communal closeness and
social organization, in spite of the apparent economic wealth of these areas.
SOURCES OF PUBLIC INFORMATION

Table 2.8 : Major source of information in the study villages'
Major source media
l. Radio 79.8
2. T.V 14.9
3. Newspaper 4.2
4. Temple 0.6
5. Villagers 0.5
Total 100.0
32
The communities were also studied in order to identify the major source of information
for the villagers. lt was found that the primary media was the radio (i.e. 79.890). This was
followed by television, representing some of the more affluent groups.' It was interesting to
observe that only a very small percentage (0.690) stated receiving information from the temple
and other villagers. In this respect, these areas may by noted as being rather atypical when
compared to the average rural society. Details are shown in the foregoing table.
Table 2.9 : Development Funds and Organization in the Study Villages
Total Established period (years)

l'undsand Organizations
N No.per l-5 6-10 l0 and more
village
l. Health (total) 210

l.l Drug Cooperatives I t3 0.7 lll 98.2 1.8
1.2 Sanitation Funds 25 0.1 25 100.0
1.3 Health Card Fund 3l 0.2 JI 100.0
1.4 Nutrition Funds 25 0.1 25 100.0
1.5 Others l6 0.02
2. Non-Health (total) 28
2.1 Agricultural Cooperatives l0 0.1 z 20.0 I 10.0 7 70.0
2.2 Savings Cooperatives 9 0.05 1 7l .8 2 22.2
2.3 Others 9 0.05
3. Organizations (total) 330
3.1 Village Committees 166 0.99 162 9'7.6 A 1^
L.+
3.2 Housewife group 88 0.5 85 96.6 2 l.l
3.3 Agricultural Youth group 0.1 r9 82.6 I 4.4 r 3.0
3.4 Funeral group l9 0.1 l8 94.7 I 5.3
3.5 Youth group 8 0.05 1 8'7 .5 I 12,5
3.6 Village Scour 26 0.2 8 30.8 't4 53.9 4 r5.3
Total number oJ villages : 168
It can be seen that the agricultural cooperatives and related groups are the oldest
organizations, as depictive of the central region. The second leading sector is the drug coop€rn:
tives which are observed as being the oldest and comprising the highest number of health I'unds.
Next, the existence and status of village development plans wcre assessed and l'indings
state that lhe majority of villages i.e. 86.3o/o has plans for four.or less, development acti\itics.
As far as completion of tasks were concerned, only 30.3olo of the plans in these groups have
been finished, and a large majority hal'e not been started yet. Unfortunately, data was not
available to examine the impact of those plans that were accomplished, in terms o1' success and
failure.
33
ILLNESS BEHAVIOUR OF THE COMMUNITY

Investigation was carried out as to the preferential attitude of the community in seeking
advise,/curative measure for common illnesses in their family.
Table 2.10 : First choice of treatment for common illnesses
l Health centre 4t.7

2. Consult VHV or drug cooperatives 26.2
3. Self-treatment or buy from drug store 2t.4
4. Private clinic/private hospitals 4.8
5. Community hospitals 4.7
6. Others 1.2
Total 100.0
The above table revealed that illness behaviour, ie, in term of first choice of consultation,
the study population had listed the health centre as their first choice, follow by the VHV or
drug cooperatives. Drug cooperatives are store outlets for essential drugs in the country. These
stores are usually supervised by the village head who is responsible for the logistics of drug
supply and distribution to the sick villager. Essential drugs for common illnesses are dispensed
at a nominal price, the proceeds of which are utilized as revolving fund to ensure availability
of drug supply in the community. The drug cooperative functions under the over all responsibility
of the Health Center within the locality.
HOUSEHOLD DISTANCE FROM THE NEAREST HEALTH

FACILITY
Table 2.11 : Distance from the nearest health centre.
Distance (kms)
<2kms 3-5 kms 6-9 kms 10 kms not specified
NVo NVo NVoN VoNVo
I 7 20 720 8 22.9 4 tt.4 9 25.7 35
2 4 23.5 9 52.9 3 17.6 I 5.9 l7
3 12 37.5 l0 31.3 9 28.1 I 3.1 32
4 l3 72.2 3 16.7 2 lt.l l8
5 23 52.3 t4 3l .8 4 9.1 2 4.5 I )? 44
6 l0 45.5 5 22.7 s 22.7 2 9.1 22
Total 4t.l 28.6 3l lE.5 10 5.9 5.9
It is noted that the majority of villagers in all six categories are less than 5 kilometers from
their respective health centre.
34
COMMUNITY PARTICIPATION
ln an effort to the extent of community participation and the amount of
assess
community involvement in the study villages, several studies were undertaken by the GHVs
and the research teams involving the village commirtee (VC). The VC is composed of village
headmen and clutstanding and dedicated villagers in service to the community. The following
table shows the frequency of cooperation given by the village committee (VC) to the VHVs
and VHCs.
Table 2.12 : Frequency of Cooperation Given by the Village Committee to VHVs and
VHCs
Full Participation Giving Support

Frequency
NVoNo/o
None 50 29.8 62 36.9
Once 43 25.6 26 15.5
Twice 29 17.3 31 18.5
Three times 20 11.9 25 14.9
Four times 15 8.9 12 7.1
Five times 2 1.2 8 4.7
Six times 5 3.0 2 1.2
Seven times 4 2.4 2 1.2
Toral 168 100 r6E r00
Subsequently, analysis showed that as the mean, one Village Committee would participate
fully in 1.7 activities and the same number was state (i.e. 1.7) also for the activities that were
given support.
COMMUNITY ACTIVITIES GIVEN SUPPORT BY THE

VILLAGE COMMITTEE
As regards to the type of activities where the Village Committee members gave support
or cooperated fully, the majority was concerning the setting up of the community financing
mechanisms (i.e. 46.40/o). ln 42.9V0 of the sample areas, Village Committee members also gave
support for nutrition surveillance. The details are as shown below:
Table 2.13 : Type of Activities Given Cooperation by the Village Committee
Activities Full Participation Supported No. Participation
l. Establishing community Funds 46.4 19.0 34.5

2. Weighing children l.9
I 42.9 45.3
3. Preparing supplementary food 5.4 19,6 75.0
4. Promotion of medicinal herbs 6.0 10.9 83.1
5. Birth survey 26.8 13.7 59.5
6. Death survey 26,8 14.9 58.3
7. Providing health information 24.1 28.0 47.7
8. Analysing and solving health problems 27.4 17 .9 54.7
Total 21.5 20.6 s7.9

35
From tl.re above table, it can be seen that with most of the villages, the Village Com-
mittees were rather inactive in health development and health promotion activities.
Consideration was also given to the frequency of Village Committee meetings and it
was observed that in most of the villages, VC meetings were held regularly, complete with a
schedule and recorded minutes. The only discrepancy noted was the irregular attendance of
some of the committee members. (see following table).
Table 2.14 : Village Committee Meeting
Yes Total
VC Meeting Information
l. Meeting schedule I 18 70.2 50 29.8 - 168 100.0

2. Meetings held according to schedule 107 63.7 48 8.6 l3 7.7 168 t00.0
3. Regular attendance 17 45 .8 86 5t.2 5 3.0 168 100.0
4. Regular recording of minutes 128 16.2 10 6.0 30 t7.9 168 100.0
The irregular attendance of some members of the Village Committee may be attributed
to either lack of time to spare owing to their busy work schedule or a lack of enough motivation
to be totally involved in community health and development activities.
On further examination of the study villages it was revealed that at the most, there is
one fund or less, for every ten villages. This typifies a lack of social organization amongst
these villages. The findings are presented as follows :
Table 2.15 : Status of Village Development Plans
No. of Village No. of Total Plans Plans still Plans not yel
Development Village No. of Acc<lmplished in process implemented
Plans Plans
I 34 (27.4) 34 13 9 t2
2 3e (3 l .5) 78 25 20 JJ
J 20 (16. l) 60 l3 9 38
4 14 (11.3) 56 l8 9 29
5 8( 6.5) 40 l0 5 25
6 4( 3.2) 24 9 I t4
2(
A
7 r.6) t4 9 I
8 l ( 0.8) 8
A
I 4
Unspecified (
2 r.6)
Sub-Total r24 (73.8) 314 l0l (32.17) sz trs.rsl rso tis.osl
Villages 44 (26.2)
with no plan
Total 314 l0l 156
Approximately,25v/o of the study villages have no development plans and therefore,

there is ample evidence signifying the lack of social organization and communal enthusiasm
for development in these study areas.
36
Lastly, the Village committee members were asked to list the number of activities that
they percieved as important for community development, and carried out within the past year.
For a vast majority, VCs stated that three or less activities were performed last year and there
were also a few who revealed that some important activities were conducted without their
participation. The details are as shown in the following table:
Table 2.16 : Number of Important Village Activities During the Past Year.
Villages Participation by VC No. Participation

No. of
Activities No.of No. of of
No. No. of
VCs Activities VCs Activities
0 l6 9.s
l *52 30.9 48 48 2 2
2 63 37.5 61 117 2 6
J 20 I1.9 20 59
4 8 4.8 832
5 J 1.8 8 15
6 4 2.4 424
7
8
9 2 1.2 2 i'
Sub-Total r52 90.5 l5l 313 4 8
Total 168 100.0 l5l 313 4 8
*NA : 2 villoges
It may be assumed that communication about and coordination of what are percieved
as important activities by Village Committee members are far from ideal and obviously needs
to be strengthened.
EVALUATION OF VILLAGE HEALTH COMMUNICATORS

(VHCs) AND VILLAGE HEALTH VOLUNTEERS (VHVs)
ACTIVITIES
In Thailand, the Village Health Communicators (VHCs) and the Village Health
Volunteers (VHVs) are considered as a most valued allies in the strengthening of the existing
network in PHC service delivery. It was therefore felt that evaluation of their activities in the
study villages is of priority importance.
The evaluation of VHC + VHV activities was carried out through the analysis of
ATC/CMD 002 *..... data collection form. Information was collected and analyzed from 368
respondents (268 VHCs and 82 VHVs)
37
ECONOMIC STATUS OF THE VILLAGES

The following table illustrates the average yearly income of the villagers under the
responsibility of the VHCs/VHVs :
Table 3.1 : Average Yearly Household Income of Villages
Baht Percentage
Less than 10,000 '7.6

10,000 - 50,000 77.4
More than 50,000 15.0
It can be seen that the majority of households have an income between 10,000 and
50,000 baht. (US$ 370-1,850, Y 58,800-294,117)
BASIC INFORMATION ON VHCS AND VHVS

3.3.1 Period of Volunteerism
Most of the individuals (89.490) have been working 0-5 years as VHCs or VHVs
3.3.2 Age
The majority of VHCs/VHVs (64.9V0) are younger than 34 years, while very
few (1.490) are aged 60 and over.
3.3.3 Highest Educational Attainment
Approximately 96.6V0 of the VHCs/VHVs have completed primary school,
while only .8% have gone beyong secondary school.
3.3.4 Occupation
Agriculture is the predominant livelihood for VHCs and VHVs. Overall, 84.890
are involved in food production : 44Vo in fruits, 20.190 in rice farming and 20.7V0 in other
crops, respectively.
3.3.5 Number of Assigned Households
Most VHCs/VHVs have either l0-14 or 5-9 households (4190 and 39.lVo
respectively) under their jurisdiction.
3.4 Flvaluation of the activities of VHCs and VHVs

3.4.1 llducating the Villagers
In this study, the educational activities of VHCs and VHVs were analyzed based
on their regular functions as recommended by the Ministry of Public Health (MOPH). Their
educational functions are classified into 25 activities within the eight components of PHC as
follows :
I. Food and Nutrition Educational Activities
l. lntroduction of nutritional supplementary food
2. lntroduction of appropriate infant feeding
3. Recommendation for weighing of all children aged 0-5 years
4. Recommendation for growing vegetables
*ASEAN Training Cente/Chantaburi Model Development/002

(Data Collection form for VH Vs/ VHCs)
38
II. MCH Care Educational Activities

5. Promotion of antenatal care
6. Recommendation of tetanus vaccination for pregnant women
7. Promotion for giving birth at the health centers
8. Promotion of child health examination
III. Family Planning Educational Activities

9. Promotion of family planning education
10. Information on various methods of birth control
I l. Information about sterilization
IV. Environmental Sanitation and Garbage Disposal Educational Activities

12. Promotion of house cleaning
13. Promotion of appropriate sewage disposal
14. Promotion of organic fertilization using garbage and feces
V. Clean Water Supply Educational Activities

15. Information on the consequences of drinking contaminated water
16. Information on water purification
17. Promotion of improvement in sewage systems
VI. ImmunizationEducationalActivities
18. Promotion of infant immunizations
19. Recommendation to behead suspicious animals for rabies examination
20. Promotion of tetanus vaccination for pregnant women
VII. Local F]ndemic Disease Control llducational Activities

21. Promotion of common disease prevention
22. Education on self-treatment for simple illnesses
VIII. Drug Cooperative Educational Activities

23. Promotion of the merits of drug cooperatives
24. Promotion of the utilization of drug cooperatives
25. Promotion of the referral system from drug cooperatives to the health centers
By analyzing the 25 educational activities of the VHCs and the VHVs according to the
eight elements of PHC, it was generally found that the VHVs have performed these activities
more often than the VHCs (see table 3.2)
39
Table 3.2 : Recommendation and Promotion of Health Activities By VHCs and VHVs
llducational Activities P-v"ru.

;lrt:''""i,;"J'
l. Food & Nutrition
I. Supplementary food 39.5 .3
51 0.0039
2. lnfant feeding 57 .7 65.9 0.3479
3. Weighing children age 0-5 years 9t.6 95.1 0.4259
4. Growing vegetables 34.3 35.4 0.288
II. Maternal and Child Health (MCH)
5. Antenatal care 69.6 8l.7 0.0623
6. Tetanus vaccination for pregnant women 67.8 82.9 0.0540
7. Deliveredat the Health Center 54.5 69.5 0.0440
8. Child health examination 78.0 84.1 0. l 858
lII. Family Planning (FP)
9. FP education 73.r 85.4 0. 1390
10. Birth control methods 72.4 86.6 0.0293
I l.
Sterilization 63.6 78.0 0.1030
IV. Environmental Sanitation and Garbage Disposal
12. House cleaning 63.6 74.4 0.2327
13. Proper disposal of sewage 68.9 76.8 0.1000
14. Organic fertilization using garbage and feces 14.0 r2.2 0.2990
V. Clean Water Supply
15. Consequences of drinking unsanitary water 61.5 13.2 0.2504
16. Water purification 55.6 61.0 0.2098
17. Improvement of lsewage systems 54.2 46.3 0.6404
Vl. Immunization
18. lnfant immunizations 19.0 90.2 0.2002
19. Beheading suspected animals for rabies examination 15.7 24.4 0.2829
20. Tetanus vaccination for pregnant women 66.1 82.9 0.03 l7
VII. Local Endemic Disease Control
21. Common disease prevention 57 .l 80.5 0.0023
22. Self-treatment for simple illnesses 54.9 70.'t 0.0553
Vlll. Drug Cooperatives
23. Merit of drug cooperatives 66.r 75.6 0. 1583
24. Utilization of drug cooperatives 67.8 72.0 0.2760
25. Utllization of the Health Center 78.3 89.0 0.1928
*Statisticaly significont ot <,: 0.05
The foregoing showed that the most common activity performed is activity no.3 that
is in reference to giving medical advise/recommendation for weighing of children. This was
done by 9l.6Vo of the VHCs and 95.190 of the VHVs.
There are some activities which were performed more often by the VHCs than the
VHVs such as activity number 14 which is the promotion of organic fertilization with garbage
and feces (l4Vo by VHCs and l2.2Vo by VHVs). Another example is activity number 17 which
is the promotion fbr the improvement of sewage systems performed by 54.2V0 of the VHCs
and 46.3V0 of the VHVs. However; on using the Chi-square test, these differences were found
to be statistically insignificant.
40
3.4.2 Participation in Health Activities

According to a recommendation by MOPH, l9 areas have been set as guidelines for
activities of VHCs and VHVs. They are :
i. Weighing all children aged 0-5 years
3. Appointements for antenatal care
4. Appointments for vaccination of pregnant women
5. Appointments for infant vaccinations
6. Establishment of the health card fund
7. Establishment of a sanitation fund
8. Establishment of drug cooperatives
9. Treatment for minor illnesses
10. Selling drugs
I l. Teaching about drugs
12. Distribution of pills
13. Distribution of ORS
14. Taking blood for malaria examination
15. Promotion of medicinal herbs
16. Birth survey
17.Death survey
18.Government information dissemination
19.Recording of activities
Table 3.3 : Participation in Health Activities By VHCs/VHVs
VHCs VHVs P-Value

Activities Always Sometimes Total Always Sometimes Total
l. Weighing all 49.3 3l.l 8l.l 75.6 20.7 96.3 0.0001*
children aged 0-5 yrs
2. Production of 13.6 20.3 33.9 19.5 20.0 47.5 0.0290
supplementary foods
3. Appointment for 22.7 28.0 50.7 26.8 35.4 62.2 0.1719
antenatal care
4. Appointment for 21.0 29.0 50.0 41.5 25.6 67.1 0.0006
vaccination of
pregnant women
5. Appointment for 3l .5 30.4 6l .9 36. I 9.6 65.7 0.0067
infant vaccinations
6. Establishment of 8.7 4.2 12.9 2.0 3.7 25.7 0.0225
the Health Card
Fund
7. Establishment of a l0.l 9.1 19.2 18.3 8.5 26.8 0.1437
sanitation fund
8. Establishment of 49.7 19.6 69.3 63.4 13.4 76.8 0.2981
Drug Cooperatives
9. Treatment for I I .5 25.2 36,7 43.9 35.4 '79.3 0.0000
minor illnesses
10. Selling drugs 8.0 I 1.9 19.9 50.0 I 1.0 61.0 0.0000
I l. Teaching about 17.8 39.2 57.0 29.3 84.2 54.9 0.0000
drugs
41
VHCs VHVs
Activities P-Value
Always Sometimes Total Always Sometimes Total
12. Distribution of pills 0.3 3.5 3.8 15.9 13.4 29.3 0.0000
13. Distribution of ORS 5.2 7.0 12.2 52.4 t7 .l 69.5 0.0000
14. Taking blood for 8.4 6.6 r 5.0 18.3 14.6 32.9 0.0012
malaria examination
15. Promotion of 3.5 7.3 10.8 6.1 t.J t3.4 0.2198
medicinal herbs
16. Birth survey t9.2 22.4 4t.6 37 .8 30.5 68.3 0.0002
17. Death survey 16.8 I 5.0 31.8 34.1 29.3 63.4 0.0000
18. Government 39.9 26.2 66. l 61.0 19.5 80.5 0.0175
Information
Dissemination
19. Recording of 27.3 29.0 56.3 35.4 42.7 78. I 0.001 5
activities
Overall, it may by deduced from the above table that VHVs have performed all of the
l9 activities more often than the VHCs. These differences are statistically significant at the
level of oC :0.05 on the Chi-square test for most of the activities except:activities number three
(appointments for antenatal care), number seven (establishment of a sanitation fund), number
eight (establishment of drug cooperatives and number fifteen (promotion of medicinal herbs).
The percentage of the VHCs who participated in the l9 activities ranges from approxi-
mately 3.890 - 8l.l9o. The activity which is performed most often is number one (weighing
all children aged 0-5 years) and the least performed activity is number twelve (distribution of
pills).
The percentage of the VHVs who participate in the l9 activities ranges from approxi-
mately 13.4Vo - 96.3V0. The most often performed activity and the least often performed
activity are the same as the VHCs, that is; weighing the children and the distribution of pills
respectively.
Conclusi on /
Recommendations on the Evaluation of VHCs and
VHVs Primary Health Care Activities in the Study Villages
Based on the foregoing findings it
was concluded that there exist a general deficiency
in the dissemination of health edu-cation information and in the VHCs and VHVs participatory
role in community and health development which may have been the result of an apparent lack
of knowledge among them on critical issues in relation to maternal and child health care. The
recording and reporting systems were not satisfactory, nor were growing importance of tradi-
tional medicine.
In general, insofar as MCH/EMC is concerned result showed that VHVs were more
informed and have better attitude about MCH compared to VHCs. Most common disease
attended to was, malaria (57 .lVo) : the least was tuberculosis (390). The three most common
complications of pregnancy were ; Abortion (l7.9Vo), Caesarien Section (17 .lVo) and Premature
delivery (9.390). Among the under five age group, the three most common diseases were;
diarrheal diseases (25.890), malaria (18.890) and laboured breathing (l4.l9o). These was a
42
reported mortality of 20Vo during the study period. Of these 61.890 were male and 38.290
female. Age specific death percentage were; below l5 (l1.2Vo), 15-69 (20.4v/o) and above 69
(31 .4Vo).
From the above conclusion it may be strongly recommended that VHCs and VHVs
knowledge, attitude and practice as regards to existing MCH problems be improved for a more
effective health promotive and curative role in the village. Likewise the system of recording
and reporting has to be periodically monitoreci to assure accuracy, and lastly, that the VHCs
and VHVs be given additional information on the extent and limitation of herbal medicines
available in their respective village of responsibility.
SURVEY OF THE KNOWLEDGE, ATTITUDE AND PRACTICE

(KAP) OF WOMEN IN THE REPRODUCTIVE AGE, GROUP
ON MCH
A total of 945 married women in the reproductive age group (15-44 yrs.) were interviewed.
83.990of the sample were less than 35 yrs. old. 77.6Vo have completed primary school. Major
occupations were rice farming (23.3V0), farming other crops (1990) and growing fruit trees
(1990). Approximately 54.3V0 of the husbands were within 25-34 yrs. Income varies from
below B 10,000 to a maximum of B 50.000 per annum. The average number of children in
the sample family were 2.
It appeared that the proportion of women who have the proper knowledge, attitude
and practice in regard to MCH care is much lower than VHCs/VHVs. Except in some aspect
of understanding child development. This phenomena could be attributed to direct experiences
by the mothers during child rearing. 72.9o/o of the respondent had taken their children for
vaccinations, however : there is an apparent lack of knowledge on the importance of immuni-
zation. 87.3V0 were alcoholic beverage drinkers. 9l .7Vo were non-smokers and 88.390 never
used insecticides during their pregnancy. Nutritional behaviour during the prenatal period
was inadequate among the majority of the respondents. Almost all professed knowledge
to the danger of the practice of induced abortions, however: majority do not understand
the life-threatening danger nor the symptomatic manifestations of toxemia of pregnancy
(97 .lVo), cervical carcinoma (9390), puerpueral sepsis (94.390) and post partum hemorrhage
(9l .7Vo) when these diseases,/manifestations were asked of them using simple terminologies.
TRAINING OF GRADUATE HEALTH VOLUNTEERS
Selection and Training of Graduate Health Volunteers (GHVs)
The recruitment of GHVs started in May 1985 by newspaper advertisements and univer-
sity bulletin announcements. It must be mentioned at the outset that preference for GHVs
selected are given to those, who are not graduated in health or health-related field. This may be
an innovative approach to the usual standard criteria for health volunteer workers. This com-
pletely new approach is based on the concept of the preparation of leaders in health. Tapping
the group of young and educated volunteers who have completed their Bachelor's degree, at
the height of their stamina and the prime of their ideology will produce a multiplier effect on
the number of potential health leaders imbued with first hand knowledge about health, health
services and ultimately health service delivery.
During the process of selection, the project implementors were constantly aware that
these volunteers will have to commit themselves over a year to serve a community whose population
they do not know, whose needs they are not familiar with and whose health problems they are
even more strangers to, hence; it becomes imperative that extreme care and a highly circumspect
attitude be excercised throughout the selection process and as the project is implemented a
constant monltoring is of priority requisite.
The Selection Process
A GHV inorder to qualify for selection should have a Bachelor's degree on any of the
following fields-political science, education, English, Geography, communications, sociology,
etc. in addition to an expressed desire and interest on health and development activities. A total
number of 675 applicants responded in 1985 and 1,024 applicants in 1986.
A written examination on the understanding of health and community development
activities, the importance of health to the population at large, civic involvement, communica-
tions ability and strength of leadership is given to the candidates, reducing the number of
candidates to 150.
Individual interviews were than conducted inorder to assess leadership potential,
maturity and extent of commitment among the candidates, from which 15 candidates and 25
alternates were finally chosen to undergo the first three week training course.
The Training Programme
The training programme may be categorically subdivided into : theoretical and practical
components for a total duration of eight weeks.
The initial three weeks is devoted to the theoretical aspect of primary health care and
health related activities including community development. The objectives of the project has
been discussed in great detail to enable the GHVs to self-assess their extent of interest and their
degree of commitment.
Of the original l5 chosen for the job during the second year of project operation, 12
decided to stay. The 3 drop-outs were then substituted with the same number of alternates.
The fourth week of the theoretical component of the training process is spent on a study-tour
of several provinces located in the eastern part of the country where the GHVs had a first-hand
experience of how community-oriented activities are carried out. They were specifically brought
to withness places with successful achievement on community-oriented activities.
The practical component of the training programme is held in Chantaburi province.
Following a formal introduction to the area, the GHVs received two weeks of instructions on
maternal and child health care and one week of training on emergency interventions at the
Community Hopital. This one week of training also incorporates knowledge on primary health
44
care activities and the proper referral channels. Their fourth and final week is spent on their
future site of assignation.
Thus the GHVs have been given a realistic job preview for each model area and as a
group were allowed to make their decision as to who will be preferable to what situation.
The Remuneration
Each GHV is given a monthly subsidy of three thousand Bath (p 3,000) equivalent to
an approximate one hundred fourty five dollars (US.$ 145.00 , Y 17 ,U7) to cover living expenses.
Likewise a motorcycle is provided to facilitate outreach to the scattered household.
The Expected Outcome
It is envisaged that through the variety of educational experience the GHVs have been
exposed to during their academic years; an interplay of social science, formal training in political
science, geography and topography and their interaction with researchers and the community;
an innovative model for PHC activities will be realized both creative and practical and tailored-
cut to meet the felt and unfelt needs of the people at the grass-roots level. Concurrently the
GHVs will be given a chance to evaluate there own orientation under an aura of complete in-
dependence. The GHVs able to develop their decision-making capabilities and identify their
own strengths and weaknesses and ultimately re-inforce their self-confidence while developing
full leadership potential in health and in their respectively chosen field of endeavors.
The Process of Evaluation
Progress of GHV activities will be closely monitored by the research team in collaboration
with the Project Manager.
The different parameters for measurement of the effectiveness of the GHVs are :
l. perception of his/her leadership role by the community
2. final written report
3. his/her productivity as perceived through process indicators by the Village Com-
mittee, village health communicators, village health volunteer and on-going health development
activities in his/her village of assignation; and through health indicators (birth weight, infant
mortality, maternal mortality, malnutrition cases). However; not all favorable perceived results
may be solely attributed to the GHVs, hence the limitation of measurement by health indicators.
Theoreticaf Training at ATC/PHC (May 1-23, 1986)

(Example of GHVs Batch II training program)
Dav Session Title Hrs. Lecturer(s)
Module l.Problems of Developing Countries
l. Orientation ATC staff
2. Mahidol University and the The Rector of M.U.
GHV training program
3. Problems in developing nations and
a
the roles of GHV's J ATC staff
4. Socials (getting to know each other) J- ATC staff
2. 5. The national health policy in the VI National 3 Health Planning
Economic and Social Development Plan Division, MOPH
6. Concepts and principles in the NESDB
integrated rural development
and concerned organizations
3. 7. Nat'l economic problems and NESDB
the necessity of rural development.
45
8. Social problems and 3 Social Science Dept.

rural developments M.U.
4. 9. Educational problems and the 3 NESDB

necessity of rural developments
10. Group activities 3 -
I l. Summary of the module l. llz ATC staff
Module 2,PHC
5. 12. Concepts and principles of pHC 3 Office of pHC
MOPH
13. PHC strategies 3 Office of pHC.
MOPH
6. 14. PHC & QoL movement 3 Representative from
QOL committee,
NESDB
15. Health educarion in pHC 3 Faculty of pH
7. 16. MCH in PHC 3 Faculty of pH
17. Health Card Fund 3 Representativer from
HCF committee.
MOPH
8. 18. Expanded Immunization in PHC 3 CDC. MOPH
19. PHC
Environmental sanitation in 3 Faculty of pH
9. 20. The provision of essential drugs in 3 Government phamaceu
the community tical Bureau
21 . Treatment of common diseases 3 Folk Doctor Magazine
10. 22. Dental Health in PHC 3 Dental public Health
Division, MOPH
23. Mental Health 3 Mental Hospital,
MOPH
ll. 24. Nutrition in PHC 3 Division of Nutrition
MOPH
25. Self-manged PHC village and 3 MOPH
Mini Thailand Project
26. Summary of Module 2 lY, ATC staff
Module 3 Rural Development
12. 27 . The utilization of BMN 7, 2, 3 3 ATC staff
forms for community survey
28. Community preparation 3 ATC staff
13. 29. Community diagnosis and 3 ATC staff

planning in the community
30. Leadership in rural development 3 The Center for
Continuing Education,
MU
46
t4. 31. Human relations for rural development 3 ATC staff

32. Summary of Module 3 3 ATC staff
Closing ceremony for the training
STUDY TOUR
The programme consist of one day study-tour in various areas of successful PHC service
delivery. The objectives of the tour is to expose the GHVs to actual implementation of PHC
and rural development programme, learn various strategies and be zible to device their own
strategies in accordance to the needs of the population in their community of assignment.
FIELD TRAINING IN CHANTABURI

Thisconsist of a one month programme of activity divided as follow :
- Two weeks training on health center activities, including; MCH and EMC, treatment,
prevention and control of common diseases, referral system and the mechanics of rural develop-
ment.
- One week training at the community hospital
- One week training at the health centre
ON THE JOB TRAINING
The longest and most important part of GHVs' training is the actual field operation.
This lasts for nine months during which the GHVs put all of his theoretical knowledge into
practice. The GHVs are expected to learn and apply the mechanics of good public relations and
maintain colaborative working relationship with the villagers, the village committees, the research
teams and with the health and other concerned government agency personnel. They will have
to face and cope with day-to-day constraints in the implementation of their activities. Moreover:
they are envisaged to formulate solutions to constraints and recommendations to the next batch
of GHVs for a more successful programme delivery.
COST OF TRAINING
An application fee of f l0 (US$ 0.37, Y 58) and and examination fee of I :O (US$ l.l l,
Y 176) has to be paid for by every applicant.
The ATC/PHC is responsible for the entire training expenditure in addition to a
monthly allowance of B 2,500 (US$ 92.59, Y 14,700) for each candidate qualifying for the post
of GHV.
MONITORING AND EVALUATION
As was previously indicated the thrust of the project is on the GHVs in their projected
role as an additional support system strengthening the existing primary level of the health care
infrastructure in an effort to optimize primary health care service delivery.
The GHVs can spell the difference between the failure and success of the project, hence
careful periodic monitoring of their activities is considered critical.
The GHVs are expected to perform a number of activities in addition to their functional
role in the delivery of preventive, curative and rehabilitative health services to the community.
Periodic reporting of their activity through written records in what is known as a GHV "diary"
(which is actually an ordinary note book provided for by the project operation staff) and formal
written reports sent to the ATC/PHC will be a good indicators of the GHVs efficiency. Per-
formance Evaluation Survey will on the other hand, enable the project staff to measure the GHVs
effectiveness as perceived by the community they serve. This method of evaluation will be a
47
good indicator as to the leadership potential of the GHV.
Much as they are vital to the sucessful project implementation, not only the GHVs are
to be monitored and,/or evaluated. Each and every component activity will be periodically
followed up. Research teams are expected to submit research reports/results. Project milestones
will be extablished for ease of surveillance of the major events related to the project implementa-
tion. The rate of project delivery will be measured in accordance to percentage of funds disbursed
per project activity as stipulated over a time plan of operation.
Monitoring and evaluation will always be a vital project component in this particular
project as they are in the successful implementations of any project.
REPORT OF THE FIRST BATCH OF GRADUATE HEALTH

VOLUNTEBRS (1986-S6)
In April 1985 : 675 young Bachelor of Science degree holder had responded to the
advertisement of ATC/PHC Mahidol University for volunteer health workers in the province
of Chantaburi. After a rigid screerting process which consisted of both theoretical examination
and personal interviews, l5 were selected for the post of GHV and 25 as alternate, to undergo
an 8 weeks training programme.
The following are the final list of GHVs who have completed their one year stay
in Chantaburi province, their final report of problem assessment and their commendable
attempt at problem solving of perceived constraints to PHC service delivery existing in their
respective areas of assignation.
Names of the first batch Graduate Health Volunters

Name Academy Working area
l. Miss Kannika Promsao Chiang-mai University Tambon Zueng
2. Miss Kanjana Prepree Suansunanta Teacher's Tambon r
College Klongnarai
3. Miss Chanalai Lertpraplut Srinakarinvirote University Tambon Slang
4. Miss Chamaiporn Srikanok Kasetsart University Tambon
Takientong
5. Miss Nareerat Samrongrak Ramkamhaeng University Tambon
Sanamchai
6. Miss Panpit Toprakone Ramkamhaeng University Tambon
Nongtakong
7. Miss Plernsiri Sirisampan Chulalongkorn University Tambon
Changkam
8. Miss Rungnapa Srisad Srinakarinvirote University Tambon
Plubpla
9. Miss Somruedee'Sarapirom Srinakarinvirote Tamboon
University Wanyao
10. Mr. Surasak Jamcharoen Ramkhamhaeng Tamboon
University Sampeenong
ll. Mr.Somsak Sriwatanatakul Chiangmai Teacher's College Tamboon
Kanghangmeaw
12. Mr.Suchat Titayanpong Chulalongkorn University Tambon
Patong
13. Miss Supis Puhin Srinakarinvirote Tambon
University Takadngao
48
14. Miss Ajima Jinwala Srinakarinvirote Tambon

University Saikao
15. Miss Usa Khiew-rod Songkhlanakarin Tambon r
University Koa-perd
As part of their theoretical training the GHVs, were guided in the presentation of
their reports to include the following salient expects :
- geography
main occupation
-
problems in primary health care development
-
perceived role of the GHV in primary health care and community development
-
activities
- accomplishments in their community of assignment
- constraints encountered during the period of assignment
- suggestions ,/ recommendation
The GHVs were provided with a notebook which serves as their diary wherein they
keep note of their activities.
The report submitted by the GHVs will be an indicator of their performance in
addition to their interaction with the researchers, the village population and the health
centre staff. An evaluation of the GHV performance will be conducted at the end of their
assignment.
Any GHV found to the highly competetive, totally dedicated and willingly committed
to his community of assignment has a chance to compete for the post of senior GHV. The
senior GHV will exercise supervisory functions over the second batch of GHVs. A senior
GHV will receive a monthly subsidy of Baht three thousand five hundred (ts 3500) which is
equivalent to US $ 129.62 Y 20,500
CONCLUSION DERIVED FROM THE GHVs REPORT
The following report has been the result of a cumulative experience during the eight
months assignation of a group of young, educated and hard working GHV in their respective
villages of assignment. The views and opinions expressed were strictly of the GHVs and not
of the project personnel.
COMMUNITY PROBLEM
It is obvious that the topographical location of houses in Chantaburi has greatly
disadvantaged the health service delivery system. This has even been compounded by an
inherent lack of interest in health and community participatory activities brought about
by ignorance, high migration rate and the villagers total absorption in their jobs. Another
great handicap is the insufficiency of water supply causing health problems to remain
unabated.
PROBLEMS THAT THE GHVs HAVE ENCOUNTERED
It is noteworthy that the report incorporated experiences that varied from lack of
identity, with the consequent feeling of insecurities and inadequacies at one extreme.; and a
total command of the community, from problem identification to problem solution; at
another.
49
There has been a general request fol a vehicle for greater outreach and requests for
a decrease in the number of assigned villages to ensure a more complete coverage. Likewise
there has been an expressed resentment for being duty-stationed in the health centre, the
lack of authority for decision-making, the poor rapport with health centre official and the
poor perception of their roles as GHVs by the health staff, by the community and by the GI{Vs
themselves. Despite resentments, solutions proposed by the group were all positive and highly
constructive. This included the request for a revision of the training curriculum towards
a greater emphasis on the practical component of the training programme and a GHV
working manual as a guide for day to day activites.
The project operations staff has benefited a great deal from the report, especially in
the re-orientation of the training programme and the provision of working guidelines.
The project operations staff has also conducted a dialogue with health center
officials i{r an effort to bridge the gap between the GHVs and the health centre officials.
The following are the reports :
Tambon sam Pee Nong. Ta Mai District. CHANTABURI

lby Surasak Jamchalern
Geography
- General area is compounded with wooden hills or hillocks near the national
park KAO CHA MAO
Border land - North - CHA CHERNG SAO province
- East - GANG HANG MEAN
- South - KAO WONG GOD
- West - RAYONG (The national park "KAO CHA MAO")
Problems in Primary Health Care Development
l. Ignorance on basic health care as a result of lack of information
2. Poor communications due to sparse distribution of households and poor roads
3. High rate of migration rendering follow-up activities on health care difficult if
not altogether impossible.
4. Poverty
5. Poor community participation by community leaders.
6. Inadequate number of health manpower
7. Lack of coordination among four major ministries involved in PHC/CD (Ministry
of Agriculture, Transportation, Education and Health)
Perceive Role of GHVs on Primary Health Care and Community Development
- as facilitators of meetings among public health officials in the study and

analyses of identified problems
- as a liaison officer between health officials and other government sector
- aS an entry point in the preparation of the community for planned health activities
by public health personnel
- as a catalyst to the implementation of existing health activities
- as an evaluator by submission of periodic assessmertt reports
50
as an adviser on the organization & management of community development fund

as an assistant in the strengthening of health center information system
as a disseminator of health information to VHCs VHVs /
/
as a supervisor to VHCs VHVs performance
as a motivator to community participation in health and health-related activities
as a participant to meetings, and other community development activities
GHV's Accomplishment in the Community of Assignment

- Participated in road and bridge repairs
- Promoted supplementary food preparation by demonstration and nutrition education
- Reviewed the neglected drug fund
- Conducted health education lecture both in the community and in school
- Facilitated communications between villagers and health centre officials
* Home visitation
- Conducted special immunization campaign in highly remote village (tetanus
toxoid to pregnant women and immunizalion against common childhood diseases to children
under five years of age)
- Sppervised VHCs / VHVs activities
Suggestions / Recommendations
- Strengthening of leadership role of village leaders
- Improvement of collaborative activities among community leaders, health authorities
and various government officials.
- Repair of roads and bridges
- Recruitment of an agricultural consultant to improve technology and produce
Tambon Koa-Perd Lamsingha District CHANTABURI

Miss Usa Khiew-rod - -
l. High rate of migration causing difficulties in disease control
2. High incidence of venereal diseases due to the presence of massage parlours / bars
3. High incidence of haemorrhagic fever. Insufficient water supply forces the village
to store rain water in container jars which are good breeding places for dengue-causing
mosquitoes
4. Poor sewage disposal
5. Poor roads
6. Poor community participation
7. Poor organization of health center staff / health centre activities
8. Inefficient supervision of health centre staff by their superior officers
Perceived Role of GHY in Primary Health Care and Community Development
l. as coordinators between the.community and the health authorities

2. as motivators in community development activities
3. as supervisors of VHCs and VHVs
51
Constraints Encountered During the Period of Assignment

l. The GHV is perceived as a fault-finder by health centre personnel
2. The GHV owing to his frequent questioning and consulting is made to feel to be
more of a liability than an asset by the health personnel as GHV tends to interfere with their
daily activities.
3. The villagers regard them as medical doctors, inability of the GHV to meet these
expectation has led to frustration and distrust of GHV by the community.
GHV's Accomplishments in the Community of Assignment

- Participated in solving managerial problems related to community funds.
- Encouraged community leaders in strengthening their roles on health and
development activities
- Surveyed and collected health statistics for use as baseline data in planning health
activities
- Liased with other health organigations in the conduct of health and health-related
activities
- Orientation of community leaders on their role on leadership for health
- Promotion of the concept of team work to strengthen cooperation and collaboration
among GHV and health centre staff
- Dissemination of information on the health significance of community organizations
- Improvement existing supervisory methodology favouring unannounced
of the
supervisory visit perceieved as more effective than the present planned visit.
- Promotion of secondary occupation during off - planting / harvesting - seasons
for income generation and as a deterrent to frequenting bars / massage parlours
- GHVs should be based in the villages and not in the health centres so as to
avoid unaccessary expectations from the villagers leading to frustration and distrust. Living
with the villagers will allow a greater interaction between the GHV and the community.
Tambon Kang Hang Meaw. Tamai District - Mr.CHANTABURI

Somsak Sriwatanatakul
Problem in Primary Health Care Development

l. Poverty
2. Poor communications
3. Crimes and assault mostly due to land dispute
4. Illiteracy
perceieved role of GHV on Primary Health Care and Community Development
- as a coordinator between the community and the government sector

- as a source of knowledge and information regarding health and community
development activities
- as a social agent of change among the villagers and the village leaders
- as a model of good health and high morale to the members of the community
52

l. Lack of public interest on health
2. Inability to perceieve GHVs role by community / government officials hence the
difficulty of coordinating activities for them
3. Communication gap due to the sparsely distributed household and the presence
of hill / hillocks
4. Lack of means of tranportaion
5. Weak performances of VHCs / VHVs
6. Lack of community participation by the community leaders themselve,
7. Frequency of migration and high mobility compounding the problems of
communications and follow-up
GHVs Accomplishments in the Community of Assigment

- Gave health education lecture on MCH / FP and PHC
- Advised on proper waste and sewage disposal
- Exemplified benefits derived from community participatory activities and community
development funds
- Liased between the village and concerned government officials on matters of health
and health - related activites
- Participated in meetings with the 4 major ministries
Suggestions /Recommedations
l. Need for a working manual for GHVs
2. Need for a vehicle for access to remote areas
3. Need for additional information on communities that are highly inaccessible
Tambon Sanamchai. Tamai District. CHANTABURI

Miss Nareerat Samrongrat
l. Lack of adequate prenatal, delivery and postnatal care including family planning
2. Maternal and child malnutrition due to lack of nutrition education
3. Lack of knowledge on the nutritional values of breast feeding, appropriate kind of
weaning food / breast milk substitiltes
4. Poverty compounded by poor communication facilities
5. Lack of community participation
6. Poor coordination of health centre activities giving rise to frustrations and distrusts
among health center clients
7. Lack of full comprehension by VHCs / VHVs on their role in health service
delivery
53
Perceived role of GHv on primary Health care and community Development
- as a participant to problem - identification and analyses

- as a coordinator between health officials and the members of the communitv
- as a coordinator for village health activities
- as a support system for a more effective perfomance by health officials
- as a supervisor and evaluator in the management of community fund
- as a supervisor and evaluator of VHCs and VHCs performance
- as a participant to meetings of health officials
- as a stimulant to community participation
- as a disseminator of health information
- as a participant to community development activities
constrainst Encountered During the period of Assignment

_ ment
I' I-ack of
decision - making authority, decision making is being relegated to
health centre personnel
2. Lack of vehicle
3. Lack of constant contact with inaccessible communities for fear of safetv
4. Lack of community participation
5. Poor perception of the GHV's roles by VHCs / VHVs
GHV's Accomplishments in the community of Assigment ment

- Gave health education lectures
- Lectured on environmental sanitation
- Lectured on benefits derived from community funds
- Acted as coordinator between the communily and government officials
- Acted as trainer in training courses held in the Tambons
- Participated in meetings among the four major ministries
l. Need for a vehicle
2. Training on curative services for GHVs
3. Decision - making authority not to be a sole prerogative of health centre officials
4. Provision of a GHV workins manual
Tambon Nong Ta Kong. Pong Nam Ron District. GHANTABURI

Miss Panpis Toprakone.
Geography :
General area is composed of hills and plains, Communications is feasible and the
houses are located in big groups. This area is a frontier near to cambodia.
People are local villagers, they speak Ka-maen language, while the others are migrants
from Northeast of Thailand.
Occupation - Agriculture and labour
54
Perceived Role of GHV on Primary Health care and community Development

Activities
- as a liason officer.between villagers and government official
- as a leader and promoter of youth group activities
- as a representative of government officials during cbmmunity meetings
- as a health educator to school children and the villagers
- as a friend and advisor to VHCs and VHVs
as an informer about the extent and limitations of a GHV's role which do not
-
include curative aspects
- as a communitY develoPer
- as a motivator of MCH / FP activities of
- as an aide during home visitation and in the follow - up cases
GHV's Accomplishment in the Community of Assignment

- Home visitation
- Attended community development,Village Committee and the Tambon Council
meetings
Relocated villagers living near the frontier of Cambodia because of the dangerous
-
border situation
- Trained VHCs / VHVs on MCH / FP and in the use of the MCH / FP survey
form
performed the duties of a health educator both in the health centre and in the
-
villages

l.Lack of knowledge on PHC activities and existing health problems in the community
2. Wrong perception of GHV role by health centre officials
3. Inadequacy of GHV's knowledge and exposure to PHC activities giving rise to
feelings of insecurity
Suggestions and recommendations

- Diminish the area of responsibility to allow GHV a more complete coverage of
health and community development activities
- Station the GHV in the village to allow better rapport and understanding with the
villagers and the village committee
- Increase the number of GHV working per Tambon
- Increase supervision of GHV by the research team
- Provision should be made for observations of other GHVs at work
Tambon Ta Kien Tong. Makam District. CHANTABURI

Miss Chamai-Porn Srikanok
Geography :
Ta Kien Tong Health centre is located in Mou l0 (Ban Klong PIu) 41 km. from
Chantaburi urban area. Response were obtained from 9 villages (Mou 3, 4,5,6,8,9, 10, 13
and l5)
Occupation : Agriculture
Problem in Primary Health Care development
l. Sparse distribution of household
2. Poor agricultural technique
3. Poverty and poor health status
4. Lack of knowledge on the importance of community development
5. Conflict between villagers and health officials responsible in the area
6. Problems between the migrants and the local residents
7. Illiteracy
8. Lack of participation from government officials
Perceived Role of GHV on Primary Health Care and Community Development

Activities
- To explain the GHV role to the villagers for better understanding of his ,/ her presence
in the community
- To make the people realize the importance of knowing their health problems
and to help them analyze and solve those problems
- To participate in community development activities
- To coordinate health and health-related activities among different categories
of government official assigned in the locality
GHY's Accomplishment in the Community of Assignment

- Participated in Tambon council and village committee meetings
- Supervised VHCs and VHVs and the drug funds
- Coordinated with the mobile medical unit of the provincial health office
- Demonstrated supplementary food preparation with agricultural officers
- Home - visitation
- Conducted school health care service
- Conducted training programme on MCH / Fp / EMC for VHCs / VHVs
- Improved the physical set-up of the health center and its surroundings

l. Misunderstanding between GHV and health centre staff due to poor delineation
of role and activities of GHVs
2. Lack of means of transport for GHV
3. Lack of interest among villagers on community development
4. Lack of understanding of GHV role by the community
5. Irresponsible performances of VHCs / VHVs
6. Poverty
- Increase the responsibilities of government officials on community development by
target - setting on important community activities
- Increase the knowledge and understanding of the community on the importance
of community development activities
- Improve knowledge of VHCs / VHVs on their role and responsibilities in health
and community development
56
- Provide GHVs with operation plan to assist them in the performance of their
daily activities
- GHV should consult health centre staff if problems arise during their performance
- Researchers should explain in detail their research activities to the health staff
- Researchers should invite participation among GHVs and health staff during their
meetings
- Researchers should give support to GHVs in the performance of their research
activities
Tambon Chang-Kham. Ta Mai District. CHANTABURI

Miss Ploensiri Sirisempan
Geography :
Health centre located far from the main road (about 8-9 km.)
Occupation : Agriculture, gardening, fishery

l. Lack of communication between the villagers and the health centre staff
2. Non - participation of health official with VHCs / VHVs activites
3. Lack of knowledge on the importance of adequate pre-natal care
4. Poor understanding of GHV role in the community
Perceived Role of GHV on Primary Health Carre and Community Development

Activities
To join the health officials in the identification, analyses and problem - solving
-
of community health problems and in the preparation of the community
- To coordinate between government and NGOs on health and health - related activities
- To coordinate PHC activities among the community and the health officers in
PHC activities
- To encourage health officials in the use of innovative approaches in health service
delivery
To motivate community participation in PHC activities
To submit periodic performance report
To disseminate knowledge on PHC to VHCs / VHVs and evaluate their performance
To participate in community development activities
To participate in follow - up and evaluation of fund management activities
To strengthen health centre management information system
To act as health educator to the villagers
To go on home visitations
To keep the health centre clean
GHV Accomplishments in the Community of Assignment

- Assisted the auxilliary health midwife in MCH / PHC activities
- Assisted in the baseline survey
- Acted as a health educator
- Participated in religious ceremonies
- Participated in supplementary food preparation and other nutrition-related
activities
constraints Encountered During the period of Assignment
l. Health centre charged fees for consultation as a result of which people are discouraged
to seek medical advise unless in extreme cases of emergency
2. Lack of means of transportation
3. Poor perception of CHV role by the health centre staff
- More frequenr home visitation for better coverage
- Provision of an outline as a guide to daily activities
- Greater emphasis on the practical aspect of the training program
- Meeting time and dates should be fixed in advance
- The format of the meeting should be based on participatory discussion and not
just presentation
- Need for a sphygmomanometer to enable GHV to take blood presure readings
- Need to function as a VHC to motivate VHC in the performance of their
activities
Tambon Wan-yao. Klung District. CHANTABURI

Miss Somruedee Sarapirom
Geography :
Health centre located beside the main road so communication is feasible
Probiems in Primary Health Care Development

l. Lack of interest in health and hygiene due ro lack of knowledge
2. False beliefs / rraditioni on matrers related to health practices
3. weak community leadership and poor community participation
4. Lack of trust on health official
5. Insufficient water supply
6. Poor family planning acceptance due to lack of interesr
Percived Role of GHv on primary Health care and community Development

- as a health educator and informer - to correct false beliefs and superstitions
about health problem
- as a supervisor to VHCs / VHVs
- as an advisor in the construction of tanks for water storase
- as a family planning motivator
- as a liason between health official and villagers to re-instore the trust of the
villagers on their health officers
- to assist in the selection of potential replacement to the present village head man
who has shown little interest in his community

- Assisted in MCH data collection
- Supervised VHCs / VHVs
58
Home visitations
School health education
FP motivations
Constraints Encountered by GHV During the Period of Assignment

l. Lack of transportation facilities
2. Lack of interest among the affluent member of the community on GHV activities
3. Disrruption of GHV activities due to frequent absence of health centre staff
- Better explanation of GHV role to health officers
- Participation of GHV in all health centre activities
- Better understanding by GHV of community development funds
Ban Ta Moon Health Centre. Tambon Sai Kao. Pong Nam Ron
Districts. CHANTABURI
Miss Ajima Jinwala
Geography :
The health centre is responsible for 5 villages, in which the houses are far apart.
The problem is in the difficulty in gathering people to organige health activities.

1. Poverty giving rise to malnutrition, disease and inability to participate health
card fund
2. Lack of information and communications due to poor media facilities
3. Poor community participation as majority of the population are migrants
4. Poor environmental sanitation
GHV accomplishment in the Community of Assignment

Explained the importance of membership to the health card fund
Participated in MCH / nutrition and other health centre activities
Supevised VHCs / VHVs
Strengthened health centre management information system
Constraints Encountered by the GHV During the Period of Assignment

l. Poor understanding of his own role resulting into confusion as to his activites and
relaticnship with the villagers
2. Oppression by health centre staff
3. Poor understanding of GHV role by health centre staff
4. Area is too wide and households are very sparsely distributed
5. Lack of self - confidence and lack of creativeness on the part of the GHV
59
Suggestions,/ Recommendations
- A need for working guideline emphasizing on GHV's duties on the villagers and not
on the health centre staff
- Freedom for GHV to choose the place he / she prefers to reside (in the health
centre or in the village)
Tambon Zueng. Klung District. CHANTABURI

Miss Kannika rPromsao
Perceived Role of GHv on Primary Health care and community Development

To produce health information materials for dissemination of pHC knowledee
To coordinate with four major ministries
To participate in community development activities
To learn from the villagers, need - based strategies in developing appropriate
community activities
To attend Tambon council meetinss

l.villagers lacked appropriate information on health card funds
2.Disagreement by GHV on the health card fund concept; feeling that its system does
not work the way it should as regards to the "green channel" aspect, and because of the
inability of the villagers to select their own doctors and hospital. The health card fund
has provision for only one docror leaving the holder no other choice.
Suggestion,/ Recommendations
- It is better for GHV not to be involved in health card fund as they are viewed
upon more as a liability than as an asset by the health card fund organizers
- GHV should concern himself / herself with the group of depressed migrants
who cannot afford to buy the health card and cannot avail themselves of basic health services
services such as immunization
- GHV should have greater awareness of the village situation inorder to be able to
supervise VHCs / VHVs more effectively
Tambon Takad-ngao. Ta Mai District. CHANTABURI

Miss Supis Puhin
Geography :
Tambon Takad-ngao health centre is 6 km. far from the district health office. The
health centre is involved in the health card project. There-are 8 officers responsible for 8 villages

l. Poverty as a result of poor industrial land agricultural technique
2. Public health problems such as ; poor environmental sanitation, high incidence of
malnutrition and inefficiency of VHCs / VHVs
60
Perceived Role of the GHV on Primary Health care and community

Development
- To disseminate public health information
- To motivate people on proper sewage disposal
- To suggest people to construct concrete water tank for warer srorage
- To give nutrition education
- To join the Tambon council in the demonstration of income-generating activities
GHV Accomplishment in the Community of Assignment
Assisted the health centre officers in their daily activities in the health centre
Disseminated public health informations
Home visitatioR and follow-up immunization activities
Conducted family health survey
Assisted in health card fund manasement
Supervised VHVs
Child weighing
Participated in community meetings

Lack of community awareness on the value of health card fund
Inability to purchase the health card due to poverty
Lack of means of transportation
Poor understanding by the GHV of his role
Poor community perception of who and what is a GHV
Lack of decision making authority on the part of the GHV
Suggestions / Recommendation
* GHV need a working outline

- GHV has to be given authority for decision - making
- The role of the GHV should be more elaborately explained to the health centre
officials
61
Tambon Salang. Mueng District. CHANTABURI

Miss Chanalia Lertprapuert
Geography :
Sa lang health centre is l0 km. far from provincial health office. The houses are
distributed in small groups
Occupation :
Gardening in their own orchards, a few are labourers
l. Lack of knowledge on medicinal drugs

2. Poor understanding of the health card fund project
3. Inefficient VHCs / VHVs
4. Inability of the villager to generate community activities
5. Poor environmental sanitaion (sewage disposal)
Perceived Role of the GHV in Primary Health Care and Community

Development
- To disseminate public health information

- To participate in meetings among the four major ministries
- To participate in community development activities

- Disseminated public health information
- Participated in village committee and rambon council meetinss
- Supervised VHCs / VHVs
- Assisted health centre officials in school health activities
- Assisted health centre officials in their daily health centre activities
constraints Encountered During the period of Assignment

l"Lack of self -confidence in associating with health centre staff
2. Poor leadership role by health centre officials
3. Training course was mainly theoretical and the practical aspect is insufficient
4. Lack of adequate supervision of GHV
Suggestions,/ Recommendations
l. Boost self -confidence of GHV by allowing him / her to give suggestions to health
centre staff
2. Health officers should be made aware of their leadership for health role
3. Revision in the training curriculum to give more emphasis on the practical aspect
4. Better supervision of GHV
62
RESEARCH AND DEVELOPMENT ACTIVITIES

Research Models
A number of PHC research models were conceptualized following a series of discussions
held among policy - makers and implementors in the Mahidol University, the Ministry of Public
Health and the officials of the province of Chantaburi. The activities to be studied are; maternal
and child health (MCH) essential medical care (EMC), the health card fund (HCF), primary
health care (PHC) and community development (CD).
lnitially,six models were outlined :
Model I The strengthening of maternal and child health (MCH) and essential medical
care (EMC) activities by utilizing graduate health volunteers (CHVs);
Model II The strengthening of MCH and EMC activities without the use of the GHVs;
Model III The strengthening of health card fund (HCF) by utilizing GHVs;
Model IV The strengthening of HCF without the use of the GHVs;
Model V The strengthening of PHC and community development (CD) activities by
utilizing GHVs; and,
Model VI The strengthening of PHC and CD activities without the use of GHVs
At this stage, it becomes imperative to expound on the HCF concept. Launched by
the MOPH in the early past of 1982, the health card fund provides free medical services to the
villages that avail of the HCF. For a fee of ts 100-300 (US$ 3.70- ll.ll, + 588 - 1764) per
family, the beneficiaries are entitled to a number of visits to the health facilities for different
illnesses. The concept of HCF strengthens the existing network of referral system in the country
as the HCF beneficiary has to be ref'erred by VHCs / VHVs to the next level of the health care
infrastructure.
In hierarchical order, ability to produce the health card (HC) by the beneficiary is a
gateway to the health personnel without having to fall into queue. In addition to the strengthening
of the referral system the HCF has been a measure to encourage family planning practice.
On the second year of the project life an additional two model were conceptualized;
*Model VII The Strengthening of Urban PHC Utilizing GHVs; and,
Model Vlll The Strengthening of Urban PHC Without the use of GHVs
The initial six models had been launched in 24 subdistricts (Tambon) which comprised
cf a total number of 179 villages.
The following is the distribution of the models and the GHVs in the study Tambon
during the initial life of project operation:
Models I ll Ilt lv VI Total

No. of GHVs 5 0 4 0 6 0 l5
No. of Tambon 5 J aA J 6 J 24
The following is the distribution of the models and the GHVs in the study Tambon
during the second year of the project life.
Models ll lll tv VI vIt VIII Total

No. of GHVs 5 0 3 0 5 0 2 0 15
No. of Tambons 5333531124
*The additional two model were added based on a previous agreement with the Japanese Go-
vernment to replicate PHC service delivery strategies in the rural area in the urban commu-
nity. This two models are : Model VII and Model VIll.
63
ORGANOGRAM OF THE FIELD OPERATION ON

RESEARCH AND DEVELOPMENT
Project Management in the Field (19E6 - l9E7)
MCH + EMC Team U PHC Team PHC + CD
Senior GHV Senior GHV

Office : Regional Hospital Office : Provincial Health Office
Note Supervision
Administration
64
Team for Maternal and Child Care and Essential Medical Care Ac -
tivities (MCH and EMC) Model | - 2
Team Leader Dr. Som - boon Kietinun

Team Merirbers Stalf from Phra - Pok - Klao Hospital
Staff from Community Hospitals
Staff from Health Centers
Rationale
One of the objectives in MCH research in the first year of the project was aimed at
promoting ante-natal care (ANC) and post-delivery care, including vaccinations of the
mother and child through community efforts. In the absence however; of improvement in the
functions and capabilities of the VHV/VHC, community organizations and community finan -
cial management, promotion of MCH activities by the community is unlikely to be successful.
In the second year activities, the research team had tested several alternatives in this aspect.
Moreover, several clinical studies were also carried out simultaneously with EMC activities.
The following are different projects included in this activity:
Project I The Training for GHV in MCH and EMC. Similar training program in MCH and
EMC which had been developed at the first year was carried out and modified. All l5 GHVs
received the training. More sessions on medical care and emergency treatment were added.
However, the performances of the second batch of GHVs concerning health education and
statistical collection were still unsatisfactory.
Project 2 the Training for Volunteer Students in MCH.
15 primary school students(dn grade) from Wat-Nam-Kun were trained for 6 days
at Phra - Pok - Klao hospital to test their interest and capability in understanding MCH edu -
cation. The post test showed satisfactory result. After the training, the students seemed to be
able to convey the message among the other students, but very unlikely to convey the message
to their parents. The training kit for primary school students in MCH are in the process of
development.
Project 3 "Itre Training for School Teachers in MCH.
l3 teachers from 3 primary schools from the research areas were trained for 5 days at
Phra-Pok-Klao hospital in MCH and EMC. The result turned out to be satisfactory since
the trained teachers were found to be effective communicators in MCH care and EMC in the
community. Moreover, they teach and give advise as on MCH and EMC to the school children.
Project 4 tfre Promotion of Appropriate Ante-Natal Care and Delivery for Pregnant Women.
ldentified high - risk pregnant women who periodically attended ANC at the health
center will be delivered at low cost as an incentive to regular pre - natal check - up, ie forceps
extraction, vacuum extraction or cesarean section. However. there were no such case en -
countered during the research period.
Project 5 Essential Medical Care
Project 5.1 vobite Clinic for MCH and EMC
The mobile clinic for promoting MCH and EMC has been tested. There were 3 visits
to the 3 research areas. Certain conditions have to be met for the people to receive the services.
They are :
65
l) People have to organize themselve to receive the service

2) People have to pay for the drugs and laboratory cost
3) Collected money will be paid back to the village fund to be used on health or de -
velopmental purpose.
The trial seemed to be a good strategy in stimulating community health awareness and
developmeqt, besides epidemiological survey of people in the research areas
Project 5.2 Anemia Detection and Treatment Program in the Rural Areas
During home visits by the mobile clinic, the research team had conducted a simple
method of hematocrit determination among pregnant women. 79 patients from 3 villages were
examined and 2l of them were found to be anemic. There was no correlation of anemia with
food intake but significant correlation was established between anemic conditions and the lack
of sanitary latrines and diagnosed cases of malaria.
Project 5.3 fne Study on Leukorrhea and Cervical Cancer in the Rural Community.
184 patients were examined by the mobile clinic. No single case of cervical cancer was
detected. However, 3 cases of Trichomoniasis vaginalis and I I cases of negative atypical smear
were detected. More cases of leukorrhea were found, but 25Vo of them were physioiogical.
Most of the abnormal leukorrhea cases were due to NSV (Non Specific Vaginitis), fungal in -
fection and trichomoniasis.
Project 6 the Promotion of Nutritional Status in the Rural Community
A village with approximately 40 Children aged 0 - 5 years old was selected as research
areas. 22 from 39 children were found malnourished (first degree), but no children suffered
from second and third degree malnutrition. A set of activities, for example guidance to the
village committee, promotion of nutritional supplementary food and close monitoring for the
village nutritional fund have been performed. However, due to the short period of intervention
(approximately 6 months) and difficulties in the integration of works at several level, very little
improvement has been observed. (19 from 44 children were found malnourished).
Project 7 Dental Health in Preschool Children.
Study on severity of tooth carries was performed in preschool age child (3 - 6 years
old[ 43 children were examined by the dentist. Severity of tooth carries were indicated by
number of D.M.F.T. (decayed, missing and filling teeth)
The average of tooth carries on deciduous tooth is ll.2/ child and permanent tooth
is0.2/ child. Aftercampaign,theseverityof toothcarriesincreasetoll.5/childand0.3/
child respectively. lt is indicated that the parents and children themselves are not aware of
dental health. In order to reach the "Health For All by the Year 2000" goal, primary health care
education, prevention and surveillance on dental disorders in the community is necessary.
Project 8 ttre Surveillance of Community Health Status by Health Calendar.
Each VHV/VHC in the research area will be given the monthly calendar with stickers
depicting certain symptoms of local common diseases. The VHV/VHC are supposed to dis-
tribute the calendar with stickers to the people and collect them back at the end of the months.
This will enable simple periodic self - monitoring on common diseases and community health
status. However, the volunteers were very busy with their daily scheduled activities, hence
the rate of returned calendar was very low. When the researchers distributed the calendar
through primary school students, the returned rate was much better. The research findings
revealed another possible channel of communications with the villagers.
Project 9 ttre Project on Four Chamber's of the Heart
lntersectoral collaboration among the 4 main ministry officials (health, agriculture,
education and interior) has been called for in the past several years, but little has been achieved
66
in terms of actual implementation. The project tried to mobilize the officials at both district
and sub-district level in the training of the village committees, VHVs/VHCs and housewife
groups at the same time. The training lasted for 5 days, comprised of 106 villager represen-
tatives. The result was satisfactory and the activity was found to be replicable in other villages.
Research Team for Health Card Fund (HCF) (Model 3 - 4)

Project 10 fne Research and Development for Health Card Fund Model
l. Research Team Leader Dr. Chalong Kuan-har
Chief Provincial Medical Office;
Chantaburi province
2. Research Team
l. Staff of the provincial medical office
2. Staff of Phapokklao Hospital
3. District health officers
4. Health center staff
5. The GHV
3. Rationale
Since 1984, the MOPH has expanded the HCF to cover every province in Thailand
(except Bangkok Metropolitan area). In Chantaburi the HCF has covered all districts (6 dis-
tricts),7sub-districtsand5Tvillage. TheconstraintsintheexpansionofHCFare:
1. Poor understanding by the population of the purpose of HCF and its benefits
2. Some conditions of HCF are not in harmony with the need of the people
3. Services are still unsatisfactory
4. Socio - cultural factors
It was felt that there is an urgent need to devise an appropriate model in HCF which is
specific for Chanraburi.
Objectives
l. To conduct feasibility studies on appropriate models in community preparation
2. To study appropriate models in improving people's KAP towards HCF
3. To study model for coordination in the community for promoting HCF
4. To study model for communication network in the community
5. To study the impact of socio - cultural factors on HCF
6. To study the roles of GHV in promoting HCF
5. Research Methodology
5.1 Research Process
5.1.1 Situation Analysis in the research areas by
A. Data collection from
VHVs, VHCs household leaders and village committee by structured
interview
B. Anthropological study by the GHV
5.1 .2 Data Analysis to find out the problems, needs and other variables concerning
HCF
5.1.3 Formulation of models according to the survey results in
A. The model in community preparation
B. The model in improving people's KAP towards HCF
C. The model for coordination among the officers from the four main
ministries in the communities
67
D. The model for communication network in the community

E. The model for community development based on the principles of "The
Land of Morality, the Land of Prosperity"*
5.1 .4 Monitoring and evaluation of the impact of the above models on HCF
5.1.5 Final data analysis and testing statistics by
l. F - test
2. Chi - square test
3. MCA (Multiple Correlation Analysis)
5.2 Research tools
A. Questionnaires, KAP testing form, data feed back form
B.Educational cassette tapes produced for the project
C. Vol unteers
D. Motivators
5.3 Research areas
A. Bang - Sra - Klao sub - district
5 villages, I GHV, 378 households, 448 families,
2,032 population
B. Ta-Kad-Ngao sub - district
2 villages, I GHV, 274 households,
284 families , 1,251 population
C. Tung - Ben - Cha sub - district *r
4 villages, 132 households, 145 families, 566 population
5.4 Variables used in the research project
5.4.1 KAP on HCF
5.4.2 Socio - cultural determinants
5,4.3 Information on the method of community preparation leader selection pro-
cess, mobilization of community resource
5."4.4 Diseases and the utilization of medical services
5:4.5 Information on HCF, low-income card, and other type of medical insurance.
5.4.6 Information on the knowle{ge dissemination in the community
*The concept originated from Nakornsawan province to motivate the community to participate
in income - generating activities and improve their moral standards.
ttdiscontinued
because the GHV resigned after 2 months operation
68
6. Work Plan (June 1986 - March 1987)
Months
Activities 6 7 E 9 l0 ll t2 I , 3
Design questionnaires
Pre - test
Orientation interviewers 3,5,6
Data collection 8,9,1C
Data Analysis of
Model Formulation
Testing models
Model I (C+E)
Model 2 (B)
Model3 (D)
Model4 (A)
Study tour to
Nakornsawan province 14,15
Monitoring &
Supervision
Data Collection
Conclusion
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70
Research Results
1. The research team had collected the data on socio - economic conditions of the
community and the people's attitude towards HCF.
2. Intervention on communiry preparation and promotion of community participation
by reformation of community leaders, TCDV in Nakornsawan provincer 5 Ministry
coordination project and other field study had been carried out.
3. Interventions on improvement of people's knowledge by using educational cassette
rape among community leaders, VHVs/VHCs, and the villagers had been tried.
4. Post evaluation had been carried out. Even in the short period of intervention,
there are significant improvement in knowledge, attitude and the number of card
holders
Moreover, there are ccrtain items which did not appear in the questionnaires which
was perceived by the researchers as benefits from the research project.
Research Team for PHC & CD (Model 5-6)

Project l1 The Promotion of Environmental Sanitation
by the Community (organization)
l. Research Team Leader Dr. Boonchai Bhumbgilub
Director, Technical & Health Services
Promotion Office. PCMO
2. Research Team
l. Staff of the provincial medical offices
2. The assistant district health officer
3. Health center staff
4. The GHV
3. Rationale
The Royal Thai Government has been promoting environmental sanitation for 20 years
but the majority of rural population still lack clean drinking water and sanitary sewage dis -
posal.
Since the 4 National Health Development Plan, the RTG has employed PHC as a main
strategy in promoting environmental health by emphasizing on community participation,
appropriate technology, intersectoral collaboration etc. However. the results remains unsatis-
factory due to the poor community participation and community organization.
4. Objectives
Objective To derelop the model on environmental sanitation by community
organization
Expected outcome
After the community has been sensitized the following sanitary
provement is anticipated:
l. Every household will perceive the importance of having clean drinking water.
2. Every household will perceive the importance of having sanitary toilet.
3. Every household will perceive the importance of having sanitary kitchen
5. Hypothesis
The improvement of community organization will contribute to the success of the
promotion of a sanitary enrironment.
71
6. I Research process
l. Community preparation .
2. Survey of sanitary conditions in the village by VHVs/VHCs and the health cenrer
sta I'l'.
3. Survey of the knowledge & understanding of the community organization (mainly
the village committee) towards its roles and functions and sanitary improl.emcnt.
4. The promotion of organizational development by training, guidance, study tour
and seminar among the lillage committee and the officers .
6.2 Evaluation
l. Survcy of the understanding ol'the concept of'village committee befbrc and alicr
ion .
inte rr cnt
2. Observe the changing roles and functions ol- r'illage committee al'ter intervention .
3. Survey the change ol'sanitary conditions in the community on:
3. I community rc'source mobilization
3.2 thc construction of clean water storage facilities
3.3 the construction and utilization of sanitary toilets
3.4 the improvement of sanitary conditions in the kirchen
3.4.1 Storage of food in the cupboard or undcr bamboo covers.
3.4.2 Keeping dishes on clean racks
3.4.3 Keeping spoons upside down in the basket
3.4.4 Cleaning dishes by the 3 cleaning process
3.4.5 Keeping kitchens in sanitary and tidy conditions
7. Plan of Operation (July 1986 - March 1987)
Activities
Community preparation
Surley of sanitation
conditiorr
3. Questionnaire design
4. Inter'"'icw of VC
5. Data Analysis
6. Setting direction I'or
problem-solving
7. Organizational
development
8. Repeat inter,''iew of
VC
9. Supervision
10. Eraluation
l l. Report preparation
72

Project 12. The Promotion of Environmental Sanitation by Community Organization -
1. Reseach Team Leader Dr. Boonchai Bhumboplab
Director. Technical & Health Services
Promotion Office, PMO, Chantaburi
2. Research Team Chantaburi Health Officers
3. Rationale
The study envisaged to promote community understanding on the importance of en-
vironmental sanitation in an effort to generate community participation in sanitation activities.
Research Results
l. The team had conducted the survey on
I .1 rhe knowledge (21 items) and the attitude (10 items) of the VC, VHV/VHC on
sanitary conditions.
2.2 sanitary condition on the village.
2. The team had been assisting the understanding of the VC through training and close
monitoring and supervision for the period of six months.
3. The results showed that there are some improvement in the knowledge & attitude of
the VC and VHV/VHC. However, no improvement in sanitary conditions have
been observed.
Discussions
Failure in sanitary improvement is sometimes caused by the weak and loosely organized
VC, as has been observed in the research area. The research team perceived the absolute need in
improvement of the VC and believes that this will eventually contribute to the sanitary improvement.

Project 13 The Strengthening of PHC Supervision System
1. Research Team Leader Dr. Boonchai Bhumboplab
Director, Technical & Health
Services Promotion Office, PCMO
,,
Research Team
l. Staff of the provincial medical office.
2. The assistant district health officer.
3. Health center staff.
4. The GHV.
3. Rationale
Initiated in 1978 as a part of national programe, PHC activities in Chantaburi have
progressed to a certain extent. However; due to the Chantaburi socio-economic and geographic
characteristics, several problems about the health volunteers were noted and one of them was
the poor supervision by health center staff of the volunteers. This research envisages to design
an appropriate model in PHC supervision system.
4. Objectives
l. To develop and test a model on appropriate supervision in PHC.
2. To study the impact of the model on VHV/VHC activities and its acceptance by
VHVs/VHCs.
73
l. Community preparation.
2. Survey of basic village data.
3. Survey of the satisfaction of VHVs/VHCs in performing their tasks.
4. Formation of a supervisory team to supervise the volunteers in the research area
once a week,
5. Short term evaluation at six months interval and lone term evaluation at the end of
the project on;
5.1 PHC activities in the village before and after intervention.
5.2 Capabilities and satisfaction of VHVs/VHCs after systematic supervision.
Operation Plan (July 1986 - March 19S7)

Activities
Community preparation
Survey basic village
data
3. Survey the satisfaction
of VHVs/VHCs by
questionnaires
4. Data analysis
5. Problem analysis
6. Setting direction for
problem solving
7. lntroduction
8. Evaluation on the
satisfaction of
VHCs/VHVs
9. Monitoring and
supervision from the
research team (weekly)
0. Evaluation
l Report preparation
Research Results
l. Certain basic village data were collected.
2. Knowledge & satisfaction of VHV/VHC before and after intervention had been
surveyed (total 9 persons).
3. Intervention by close monitoring & supervision through planned regular data of visit
(according to the VHV/VHC suggestion) and the use of the new type of recording
system.
4. Results
74
Results After
Correct knowledge of VHV/VHC 9.28 Vo

(on 15 items, I item I score)
Civing health education to the 100.00 9o 00.00 9o
community
Recording vital statistics 14.29 Vo 50.00 9o
Satisfaction to be the volunteer 14.29 Vo 50.00 9o
The precentage of water sealed 20.00 vo 34.3 Vo
toilet
Discussion
ln Chantaburi where households are scattered and most of the volunteers spend their time
in the fruit orchards, unscheduled and too frequent visit by the health personnel with tedious
job assignments will add to the failure of PHC in the community. The planned and regular
visits with simplified recording system seem to be the desirable scenario for the volunteers to
work satisfactorily.

Project 14 The Study on "PHC Family Model"
1. Research Team Leader Dr. Boonchai Bhumboplub
Director. Technical & Health Services Promotion
Office. PCMO
2. Research Team
2. Assistant district officers.
3. The GHV.
3. Rationale
The current PHC activities in Thailand have focussed on training of VHVs/VHCs and
community funds. In certain part of Thailand such as Chantaburi, these present activities were
not always successful. This study has tested a new approach in PHC by using the "PHC Family
Model" in promoting PHC among the villagers.
4. Objectives
l. To study the possibility of formulating "PHC Family Model" in the village.
2. To study the necessary indicators of behavioral impact of the PHC Family Model
on other families.
3. To study the roles and functions of the GHV in promoting PHC by PHC Family
Model.
l. Survey of the household data.
2. Selection of the candidate families (l-3 families per village).
2.1 has lived in the village for not less than 3 years and has their occupation in the
village or in the near-by village.
2.2 the woman is in the reproductive age and is living with her husband.
2.3 at least one child 0-5 years old.
2.4 moderate income.
/D
3. Upgrading the candidate families to be the model families.

4. Promotion of the model families throughout the village by VHVs/VHCs.
5. Re-survey and analysis of data.
6. Preparation of report.
6. Operation Plan (July 1986 - March 1987)
Activities
Survey of village data

Data analysis
Selection of candidate
families
4. Upgrading the candidate
families
5. Promotion of the
model families
6. Monitoring and
Supervision
7. Re-survey
8. Report preparation
Appendix : The criteria for PHC Family Model
l. If there are any children under five year in the family, there should be no malnourished
children.
2. Birth weight of the new born should not be less than 3,000 gm
3. Every child under 5 years of age should receive full dose of vaccinations against
common childhood diseases,
4. At least one member of the household should have basic knowledge in the following
common diseases:
4. I Haemorrhagic fever.
4.2 Malaria.
4.3 Tuberculosis.
4.4 Diarrheal diseases.
4.5 Intestinal parasitic diseases.
4.6 Diptheria, Pertussis, Tetanus and Poliomyelitis.
5. The mothers and members of the family were benificiaries of following basic health
services:
5.1 Received ante-natal care, including tetanus vaccination, when pregnant.
5.2 Birth delivery attended by the public health nurse or trained traditional midwife.
5.3 Post-partum check up by the public health nurse or trained traditional midwife.
5.4 Received appopriate medical treatment when sick.
6. Participation in the community activities.
- A member of the village drug cooperatives.
- Participants in community development activities.
- Participants in other village activities.
- Others.
7. Living environment.
7.1 Have enough clean drinking water throughout the year (3000 l/family/year).
7.2 Have water - sealed toilet.
76
7.3 Have garbage container and employ appropriate garbage disposal methodology
such as burning or burying.
7 .4 Arranging the household in tidy and sanitary manner such as
7 .4.1 no garbage littering around the house.

'7.4.2 have waste water treatment.
7.4.3 no animal cage beneath the house.
7.4.4 keep sharp blade facilities in the safe place.
7.5 Have sanitary kitchen.
7.5.1 keep spoons, forks and chopsticks in upside down manner.
7.5.2 keep kitchen utensils in tidy manner.
7.5.3 keep food away from rats and cockroaches.
7.5.4 wash dishes by three steps, ie.
step one : wash by soap.
:::i lil:. ; ffi:l i; :l!1] ffilll

8. Control the spacing and number of children as desired.
Reserch Results
The research area consisted of 99 household. Within the period of 6 months,3 families
have been selected and promoted to be the PHC family model, and have been awarded the certi-
fication by the provincial governor. Impact on their neighbours are still undetermined.
Discussion
The family model on PHC might be one of the alternatives in promoting PHC in the
communities by using the concept of horizontal technical cooperation among the villagers. In
this research, certain sriteria for PHC family model have been developed, and tested. However,
the spread of the family rnodel to their neighbours are equally important. This will be studied
in the next phase of the research.
aa

Project 15 The Study on the Expansion of the Provision of Essential Drugs
in the Community
l. Research Team Leader Mr. Methe Chanjarnporn
Director, RTC/PHC Chonburi
2. Research Team
l. RTC/PHC Chonburi staff.
2. The GHV.
3. Rationale
The provision of essential drugs is one of the PHC elements. In Thailand, this has been
done by promotion of medicinal herbs and promotion of the village drug cooperatives. The
promotion of the village drug cooperatives are highly successful in the village where households
are clustered in one group and communication within the village can be made on foot. The
promotion of village drug cooperatives can be very difficult in the village where households are
sparsely distributed, and communications within the rritage is poor. It becomes extremely ne-
cessary that some modified types of the village drug cooperatives suitable for sparsely populated
villages be studied and tested.
This research will study and test the model on the "Extended Drug Cooperatives". The
extended drug cooperatives are the drug cooperatives which branches from the village drug
cooperatives for an increase accessibility in the procurement of essential drugs in the village. The
extended drug cooperatives will be situated and managed by a VHV or VHC, or by the candidate
villager.
Schematic Representation of the Concept on the Extended Drug Cooperatives
lEpcl <- The village drugs cooperatives + I EDCI

neighbours neighbours
neighbours g Extended Drug Cooperatives neighbours

by VHV/VHC or a villager -)
v
neighbours
4. Objectives
l. To conduct a pilot study on the possible model of "Extended Drug Cooperative" in
a sparsely populated village.
2. To study the impact of the model in terms of management, acceptance from the
community, behavioral changes and other obstacles
5. I Collecting basic village data by the GHV on the human behavior of the villagers on
drug use.
5.2 Setting the extended drug cooperatives at various appropriate locations.
5.3 Observing and recording the impact of model in every aspect in the village by the
GHV.
78
5.4 Monitoring and supervision at least once a month by the teams from the Chantaburi
provincial medical office and from the RTC/PHC Chonburi.
5.5 Subsequent data collection at the end of the project.
5.6 Data analysis and conclusion of the model
Indications for the success of model
l. Acceptance of the VHV/VHC or the villagers in setting the extended drug
cooperatives at his/her house.
2. Increasing coverage of the provision of the essential drug in the community.
Research Results
l. The GHV had conducted the survey on the people drug use behavior in 72 households.
Z. The research committee had prepared a package of essential drugs (10 kinds) for 33
Baht (US $ 1.20 Y 194) for distribution to the community.
3. The GHV promoted using of the essential drug package in the community. 58 house-
holds were the drug buYers.
4. The GHV resurveYed the data.
4.1 About the es.sential drug package
l. Paracetamol l0 Tabs
2. Chlorpheniramine l0 Tabs
3. Paracetamol SyruP I Bottle
4. Antacid Mixture I Bottle
5. Tincture Iodine I Bottle
6. Oral Rehydration I Bottle
Salt (ORS)
7. Analgesic Balm I Bottle
8. Cotton I Pack
9. Cauze I Pack
10. Plaster I Pack
66.7 percent of the households indicated that the quantity is not enough but most of
them were satisfied with the kinds of essential drugs.
4.2 96.29V0 thought that this package is very essential.
4.3 Impact to undesirable drug use behavior after the promotion of essential drug
package.
Undesirable Never Do not use decreasing Total

buy anymore use
Tam-Chai 37.0 Vo 27.8 Vo 13.0 9o 22.2 o/o 100 9o
ANT 33.3 9o 59.3 Vo 3.7 Vo 3.7 Vo 100 9o
Apagua, Novalgin 53.7 Vo 42.6 Vo 100 9o
Snake band 53.7 Vo 42.6 Vo Vo 100 9o
antipyretic,
Comysin
"Set drug" 24.1 Vo 70.4 olo 1.8 9o 3.7 Vo 100 9o
79
Discussion
The provision of essential drugs in the community can be done not only in the form of
drug cooperatives but also in other forms. Distribution of essential drug package is one of the
alternatives. The study sho_ws the acceptance b)' the community and obvious change in terms of
"negative attitude" to use of undersirable drugs, however; the t'ollowing topics should be
addressed:
l. The right kind and amount of essential drugs'
2. Support system for drug procurement.
3. CommunitY PreParation'
4. Continuous education for those concerned'
80
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81

Project 16 The Study on Strengthening VHVs and VHCs Capability in pHC and Com-
munity Development.
1. Research Team Leader Mr. Methe Chajarnporn
Director. RTC/PHC Chonburi
2. Research Team
2. The RTC/PHC Chonburi sraff.
3. The district and sub-district health officers.
4. The GHV.
3. Rationale
Since the Fourth and the Fifth Economic and Social Development Plan (1978 - lg87)
the MOPH has been training the VHVs and VHCs to work for attaining eight elements of pHC
in the villages. But since 1985, there emerged a big social movement in Thailand to use Basic
Minimum Needs (BMN) as the basic indicators and means for the village committee to promote
"Quality of Lives" of the people.
Therefore, it is necessary to integrate the Quality of Life (QOL) movement with the
PHC activities. This research tries to set a model on how to strengthen and integrate VHV/VHC
health activities in line of QOL movement, as illustrated here.
The concept on strengthening and Integrating vHv/vHc

Health Activities in Line with the eOL Movement
Household attained standard
BMN Survey
Household did not attain standard
in health in other aspects
Record in VHV/VHC Set the goals of

activity guidebook VHV/VHC activities
Guidance to
the family
Assistant in
problem
Problem solving solving
Cooperate with VC
82
Objectives
l. To construct and test a model in strengthening and integrating VHV/VHC health
activities in line with the QOL movement.
2. To study the impaci of the model on sblving health problems and promoting com-
munity development in the village.
Research Steps and Methodology
l. Setting up of certain details on how VHVs/VHCs can use the data from BMN survey
in their work.
2. Collecting basic village data by the GHV
3. Survey and analysis of the BMN in the village and definition of specific items which
will be integrated in VHV/VHC activities.
4. Monitoring and supervision, at least once a month from the provincial medical office
and the RTC/PHC Chonburi.
5. Observation and record of any change in the community concerning VHV/VHC
activities, people attitude, VC activities and others by the GHV.
6. Research by structured interview with the VC, VHVs/VHCs and the villagers
Indicators for the success of the model
l. On going BMN survey in the village being conducted by the VC and villagers,
assisted by the officers and the GHV
2. Continuation of activities after BMN survey performed by both the VHVs/VHCs
and the VC, such as guidance to the family etc.
3. Indication of special efforts in daily activities of individual households to improve
the unattained BMN items.
Research activities
l. Basic village survey by the GHV
2. Training on Basic Minimum Needs (BMN) for the VC and VHV/VHC
3. Posting BMN data at the shops in the center of the village
4. Defining health problems from BMN survey results.
5. Recording by VHC/VHV of health problems from BMN sur\ey utilizing results as
their guidelines for working
Results
l. There is participatory action from VC and the villagers on BMN Surrey
2. Problem definition from BMN data was not successful due to :
2.1 very few health volunteers participated at the start of the project.
2.2 recording takes too much time for the volunteers.
2.3 the volunteers get used to "habitual memory" rather than liewing health
problems''numerically.''
Discussion : The VC function on BMN and VHV/VHC function on PHC needs to be
integrated and several improvments are required.
l) The form for recording health problems from BMN has to be reformulated
2) The concept of recording problems has to be emphasized to VHV/VHC
83
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84
Research Team for Urban Primary Health Care (LJPHC) Model 7-8
Project 17 urban Primary Health Care
1. Research Team Leader Dr.Banthit Chaowagul

Director of Phra-Pok-Klao Hospital
2. Research Team Staff of Phra-Pok-Klao Hospital
3. Rational
Although Thailand has been using PHC as a main strategy for health development since
1977, most of the PHC activities were mainly focussed in rural areas. As a result, urban
communities have been left out with the urban specific health problems. The research team,
based on the experience in rural primary health care, has initiated the urban primary health
care in the urban areas of Chantaburi province since 1985. With the cooperation from ATC/
PHC, the research team has conducted further'study on urban PHC utilizing 2 GHVs to study
a model in urban PHC concerning every aspect of the urban PHC, ie, community preparation,
selection of volunteers, training and supervision of volunteers and others.
4. Objectives
l. To promote the PHC activities inthe2 urban areas in Chantaburi province.
2. To compare the PHC development in those areas with and without the CHVs.
3. To study the feasibility of managerial model on urban PHC which has been developed
by the research team.
5. Research methodslogy
l Literature review on PHC in Thailand.
2. Data collection from the heads of the households and volunteers in those 2 areas
concerning KAP in PHC before and after the project.
3. Systematic monitoring and supervision of the activities in the communities.
6. Results
A study was conducted between July 1986 and March 1987 in 2 urban communities,
Vat Phra Khlong Kung Community and Technical College Community. The GHVs were the
research assistants working in the Vat Phra Khlong Kung Community. These are no GHVs
assigned in Technical College Community. Both communities were under the supervision of
the members of the research team. The assumption was that the Vat Phra Khlong Kung Com-
munity should have more achievement of PHC activities than the Technical College Community
as a result of the presence of GHVs. The outcome of the study was contrary to the hypothesis.
The Technical College Community achieved more'PHC activities than the Vat Phra Khlong
Kung Community because of the following : First, the Technical College Community received
better supervision than the Vat Phra Khlong Kung Community owing to the small community
size, the supervisors of the Technical College Community had more time in doing supervision
activities than the supervisors of the Vat Phra Khlong Kung Community.Second, the VHVs
of Technical College Community by average have better knowledge and attitude on PHC
activities than the VHVs of the Vat Phra Klong Kung Community. Third, community partici-
pation in Technical College Community was better than in Vat Phra Klong Kung Community
and fourth, the GHVs needed more time to understand and get familiar with their community
of assignment inorder to foster better PHC practice. The research team concluded that the
next most important thing to do was a study to find out the suitable model for recruitment of
VHVs for the Urban area.
85
SEMINARS/MEETING
The conduct of seminars has been envisaged during the project tbrmulation as a major
project activity. Seminars will open a productive venue for discussion among the grass-root
implementors, the Chantaburi health officials, the GHVs, the research teams and the project
operation staff.
The seminars will serve as a forum for a free exchange of experience, constraints,
suggestions/recommended solutions during the different stages of project implementation. The
outcome of these discussions will elucidate the project operations staff as to what and when
intervention strategies are called for.
Two seminars were planned per year over the three years of project life.
In 1986-87 the first has been planned to take place in l5-17 September, 1986 at the
Regional Training Center of the Chonburi province;
The second, l8-21 January, 1987 at Chantaburi province; and,
Two meetings were likewise scheduled March'86 and March'87 respectively; to be
devoted to the presentation of research results. During these annual meetings, certificates of
service acknowledgement will be given to the GHVs.
Participants for the first seminar will comprise of the VHCs, VHVs, VCs, the health
center officials of Chantaburi province, the CHVs, research teams and the project operations
staff.
The second seminar will include only the GHVs the health center officials and the
researchers together with the project operations staff.
Participants for the third and final seminar will consist of the GHVs, the researchers
and the project operations staff.
l. FIRST SEMINAR (15-17 SEPTEMBER 1986 VENUE; ATCIPHC)
1.1 Objective:
l.l.l To report on on-going research in PHC Model Development Project -
Chantaburi Province
l.l.2 To analyze result of training of GHVs
1.1.3 To analyze District Health Officials activities on MCH and EMC; ind,
l.l.4 To analyze the nature and extent of community participation in MCH
and EMC.
1.2 Seminar Participants
1.2.1 MOPH official - 2
1.2.2 Health Officers from Chantaburi Province - 6
1.2.3 Health officer from Prapokklao Hospital - l0
1.2.4 Community leaders - l3
1.2.5 Community Hospital Staff- l5
1.2.6 Tambon Level Health Officer - l5
1.2.7 Ampher Level Health Officer - l2
1.2.9 Regional Training Centre Cholburi Staff _ l0
1.2.9 Japanese Experts - 3
1.2.10 Mahidol University and ATC/PHC Staff - I I
1.2.11 GHVs - 17
86,
1.3 Presentation of Research Progress Report

1.3.1 Urban PHC Development
1.3.2 GHV Training Programme
1.3.3 School Teacher Training Programme
1.3.4 Midwife Training Programme
1.3.5 Follow-up on Pregnant Women
l.3.6 Family Planning Among the Hardcore Group
1.3.7 Mobile Medical Unit and EMC Project
1.3.8 Sticker Calendar Project for PHC Development
1.3.9 Health Card Fund Project
1.3.10 Environmental Sanitation Development
1.3.1 I PHC Supervision Development
1.3.12 Study on Model of Essential Drug Service Extension
1.3.12 Model of Role and Performance Strengthening for VHCs/VHVs in
Chantaburi Province
2. SECOND SEMINAR (I8-2I JANUARY, 1987 VENUE : KITCHAKUD NATIONAL
PARK, CHANTABURI PROVINCE)
2.1 Objectives
2.1.1 To follow-up research progress;
2.1 .2 To follow-up result of community development activities;
2.1.3 To discuss constraints encountered during the project operation; and,
2.1 .4 To discuss future plans and direction in reference to strategies, selection
and training of GHV and research development
2.2 Seminars Participants
The same group as those who participated during the first seminar
2.3 Presentations/Discussions
2.3.1 Presentation on the progress of different research projects discussed
during the first seminar
2.3.2 Presentation on the constraints encountered and solutions formulated
2.3.3 Presentation on the Health Card Fund Model Project
2.3.4 Presentation on short-term evaluation of the Urban Primary Health Care
Model
The participants were divided into 4 sub-groups in the discussion of alternative strategies
for consideration during the year 1987-1988. The topics for discussion includes future direction
of the project, selection procedures and training of CHVs, additional areas of research for
PHC developmenr and future final eraluation of the Research for PHC Model Development-
Chantaburi Province Proiect.
87
SUMMARY OF THE PROJECT ACTIVITIES
Activities Performed During the First Year of the Project Life

l. Training of GHVs and midwives from 8 Tambons on MCH and EMC by the
research team.
2. Training of VHCs and VHVs from 8 Tambons on MCH and EMC by the GHVs
and the midwives.
3. Provision of equipment to 8 health centers with corresponding technical supervision
4. Health promotion and setting-up of the surveillance system of community medical
problems through "Self-Monitoring Health Calendar"
After one year of continuous monitoring and periodic supervision of the project activities
an assessment has been made by the management committee, the field coordinating committee
and the research team.
Their finding were presented and discussed during the First Annual Conference on the
Research tbr PHC Model Development, Chantaburi Province which was held at the ATC/PHC
on 7-8 May 1986. The committee had arrived at the following conclusions :
l. Thetrainingof GHVsarehighlysuccessful bothintermsof theoreticaltrainingat
ATC/PHC and practical field training in Chantaburi province.
2. lnspile of the population's high sociodconomic status, the result of the situation
analysis showed that health and health care are at unsatisfactory level. Statistically, there are
few second or third degree malnourished children, however; 25Vo of those aged one to five
years are considered to be first degree malnourished. Pregnant women seldom obtain proper
antenatal care which includes a tetanus vaccination and nutritional information. The infant
mortality rate remains at approximately forty per one thousand live births. The most common
illnesses are still malaria, diarrhea, dysentery, food poisoning, hepatitis and typhoid as typical
in most of the rural areas. More than 4090 of the population do not have adequate drinking
water nor proper latrines.
3. The community's a high economic but poor health status, has been attributed by
mosr of the GHVs to inactirc community participation (VHVs, VHCs, village headmen, village
committee, Tambon councils and others) and passive attitude of the government officials,at
all lerels (health center personnel, community delelopment workers, agricultural extentionists,
district olficers, provincial officers, physicians, nurses and others) towards both PHC activities
and PHC strategies.
4. The basic health problem in Chantaburi is aggravated by three factors. First, the
scattering of house amidst fruit orchard in the rural communities resulting into long travelling
distance from health centre and even amongst the villagers themselves; hence the problem of
inefficient communication and poor accessibility to health services. Second, due to long history
of self-dependent life style, people neither have time nor are appreciative of the intrinsic value
of communal activ'ities. People concentrate on their livelihoods which take them away from
their houses during daylight whereas the dark and insurmountable distances makes it less f'easible
tbr them ro congregate. Finally, there is a high migration rate into the area, particularly from
the porerty-stricken northeast region of the country. The migrants are usually self-contained
and ignorant of the accessibility of health facilities.
5. In view ol'the above, it is a GHV with only a 9 months stay in the community is
highly unlikely to contribute to any significant improvement towards PHC or community
delelopment. As an alternati!e strategy towards an increase in the effectiveness of the GHV
the following remedial measures ha\e to be considered favourably.
88
5.1 decrease in the size of assigned arealincrease in the number of GHV for a more
coflcentrated output
5.2 provision of motor bicycles for adequate mobility.
5.3 closer supervision on both technical aspects and individual activities
5.4 training to provide medical trearment at a certain level inorder to foster the
confidence of community on the GHVs.
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9'1
As 4 GHVs had only 7 months and one GHV had only 3 months in the district and
their work covered the whole district : so it is not yet possible to evaluate the result of inter-
vention particularly on MCH; but one obvious thing we can definitely say is that this research
has built up better cooperation among provincial health centre, district hospital, subdistrict
health centres and specialists from regional hospitals. Referral system is improving, specialists
have the opportunity to supervise district hospitals and district health centres technically. Another
good example is when the regional hospital has found that syphilis was causing high perinatal
death it was reported to the provincial health director, who has taken immediate action. From
thence on, the number of death from syphilis has come down satisfactorily. At present only
numerical data are available from the regional hospital (e.g perinatal mortality rate are coming
down, number of PRMN from syphilis has gone down). Number of normal delivery are in
decline in the regional hospital. The situation will be re-analyzed on February.
92
(APRTL 1986 - MARCH 1987)
The second year activities had been laid out by the committee at the end of the annual
conference at ATC/PHC during May 7-8, 1986, and were reformulated by the researchers at
the conference held at Prapokklao Hospital during August I l-13, 1986.
The committee had realized the need for leadership training of GHVs, the urgency of
full participation in the project by the local health staff, the vital necessity of interactions among
GHVs, the communities, and all level of health personnel and the researchers, and the strong
relationship of MCH activities with other PHC activities.
Therefore, it has been deemed as inappropriate for the project to confine itself to the
study of MCH model alone, instead the project should make an attempt for a more appropriate
combination of training moduleS for GHV's, research in MCH and other PHC activities, and
development of the local staff and the involved communities.
Emphasis of the Second Year Activities
l. Leadership training of Graduate Health Volunteers.
2. Model development in primary health care and community development through
the training of Graduate Health Volunteers.
3. Feasibility study and development of a model to strengthen maternal and child health
and essential medical care activities in primary health care.
93
:.:.::::::::::.:
January l9E5-March 1986

January
7-8 Field visit by ATC staff to Chantaburi
February
14-16 Field visit by ATC staff and researchers to Chantaburi
26-27 The first consultation meeting at ATC/PHC among ATC staff, Chantaburi
provincial health officers, Phra-Pok-Klao Regional Hospital medical doctors,
members of MOPH, member of RTC Chonburi and other researchers.
March Formulation of the research proposal by the researchers.
April
10-12 The Second Consultation Meeting on Research Contents, Research
Areas, Research Methodology at Phra-Pok-Klao Regional Hospital Chantaburi
Province
May Application and Selection of Graduate Health Volunteers
5-15 GHV applicarion (585 person applied).
20 GHV written examination (50 persons passed).
30-31 GHV oral examination (15 persons passed).
June Preparation of the GHV training program and training materials.
July GHV training & preparation for data collection.
l-22 GHV theoretical training at ATC/PHC.
23-26 GHV field study at Nakornrajsima and Khonkaen provinces,
29-30 Meeting at ATCIPHC with representatives of MCH/EMC team, data processing
team, ATC team, RTC team, MOPH team on the drafts of questionnaires and
data collection methodology.
August Continuation of the GHV field training at Chantaburi and pre-test of
questionnaires.
l-30 GHV training at Chantaburi
9-10 Pre-test of questionnaires at Tambon Ta-Luang, Klung district.
ll-12 Conference on the reformulation of the final questionnaires and data collection
procedures.
l3-30 Printing of final questionnaires and data collection sheets.
September Start of field work and data collection.
I GHVs begin work in the field.
2-30 Data collection by researchers and GHVs.
0ctober
9-l I Data analysis and conference on work plans by researchers, GHVs, health
center staff and others at RTC Chantaburi.
20-26 Conference on community leaders, ATC/PHC. participated by GHV and
community leaders from Chantaburi province.
November Preparation and printing of the reports on :
l) Introduction to ATC/PHC project on Chantaburi Model Development
project.
2) The Manual for Training of Craduate Health Volunteers.
3) The Situation Analysis and Community Assessment on Primary Health
Care, Maternal and Child Health, Family Planning, Essential Medical Care
and Community Development in Chantaburi province.
14-15 Visit to the project site in chantaburi by Dr. Mark Belsey, chief, MCH
division, WHO. Geneva.
94
December
26-27 Seminar in the field among GHV's and the researchers at Ban-Som-Dej
Hospital, Chonburi Province.
January 1986
30-3 l GHV's monthly meeting.
February
24 Consultative meeting on the selection of GHVs batch 2, ATC/PHC.
27-28 GHV's monthly meeting at Chantaburi.
March
3-5 Seminar in the field among GHV's and the researchers at Kitchakoot Natural
Forest, Chantaburi Province.
t7 -28 Acceptance of application for the second the batch of GHVs at ATC/PHC.
April 19E6-March 1987
April Selection of GHVs.
I Orientation training for the applicants and written examination.
2t-25 Oral examination.
29-30 Monthly GHVs meeting at Chantaburi
May Training of New GHVs.
2-30 Training of new GHVs at ATC/PHC.
7-8 Annual Conference on the Research for PHC Model Development Chantaburi
provincle at ATC/PHC.
z.J GHV's batch 2 finished theoretical training.
26 l5 Motor bicycles were transported to Chantaburi for GHV field operation.
June GHV Field Training in Chantaburi.
2-22 GHVs continuous training at the Provincial Public Health Office, Phra-Pok-Klao
Regional Hospital, and communities hospitals.
l7-20 Japanese experts surveyed the research areas.
J GHVs began to work in the field.
26-27 Seminar among GHVs, health center staff, and local researchers at The
Provincial Public Health Office.
30 GHV's batch I graduation day.
July GHV's field operation and intervention in PHC and MCH activities
9 Presentation of the project activities to Dr.H.Mahler, Director General WHO
and WHO staff at ATCIPHC.
29-30 Monthly GHV's meeting, Chantaburi province.
August
l0- 13 Televised record of the Research for PHC Model Development at
Chantaburi province by Japanese Television Team.
I l-13 Reformulation of the annual plan among the researchers at the Phra-Pok-Klao
Hospital.
30 Submission for first report on situation analysis and plan of by
GHVs
September
8-10 Visit of Chantaburi Model Development Project, Chantaburi province, by
Japanese and Thai journalists
l5-17 The first annual conference of health center staff, GHVs, research teams and
community leaders at RTC Chonburi.
29-30 Second visit the project site in Chantaburi by Dr. Mark Belsey, Chief, MCH
division, WHO, Ceneva.
95
October
6-9 Regular supervision of GHV by ATC staff
ll-17 Conducted of a field study at the project site in Chantaburi by the participants
of III International Training Programme in PHC Development from ATC/PHC
23-24 Observation tour of a village in Nakornsawan province under the "Land of
Morality, Land of Prosperity" campaign by The research team and community
leaders from Bang-Sra-Klao village.
November
4-5 Visit to the project sites, Chantaburi province by Dr. Amorn Nondasuta, the
Permanent Secretary of the Ministry of Public Health, Dr. Suchin Palapornkul,
The Deputy Secretary of the Ministry of Public Health, Dr. Krasae Chanawongse,
the Director of ATC/PHC
30 Submission of GHV second reports.
December
8-12 Training programme for VHV/VHC and local officers at Ban-Plang sub-district,
Pong-Nam-Ron district, Chantaburi province.
9 Presentation of the project activities to Prof. Natth Bhamarapravati, the Rector
of Mahidol University at ATC/PHC.
l7-19 Evaluation on the project activities by Prof. Masami Hashimoto, the chairman
of Japanese National Committee on ATC/PHC Project, ATC/PHC.
25-26 Visit to the urban PHC model areas and other project activities at Chantaburi
by Bangkok Metropolitan Health Officers.
January l9E7
9-10 Movies on the Chantaburi model development project taken by Iwanami
Production Inc.
18-21 Seminar for the second mid-year project appraisal and preparation for the
annual conference, Krating Natural Forest, Chantaburi.,{pproximate participants -
80, from ATC/PHC, Chantaburi provincial health office, the CHVs and the
Research Team.
February
17-22 Study tour to the northeast by the local research teams and GHVs to observe
successful PHC activities. The study team comprised of 40 persons.
March
2-24 Data collection in the model villages by the GHVs and the research teams.
March
3-20 Data analysis at the ATC computer facility.
Selection of senior GHVs.
Acceptance of applications for new GHVs.
The end of present GHVs activities. Annual conference.
96
The study has demonstrated a macro model on the integration of academic and field
expertise into the consumer community with the addition of an innovative catalytic factor -
the GHVs in an effort to strengthen PHC service delivery.
The fulcrum of the study is undoubtedly the GHVs - their recruitment, training, field
practice, supervision and ultimately the measurement of their capability to effect a change
favourable to existing primary health care service delivery.
Several important aspects of the research which has to be grasped in totality has become
evidently visiblti during the course of the study. These are:
- The imperative need for exercise of meticulous care in the selection of GHVs not-
withstanding academic excellence as manifeSted by examination results, personal interviews
are even more crucial to give way to more intimate assessment of the values, the determination,
the extent of responsibility and the level of emotional maturity.
-The determination of the ideal number of GHV per province. ln this particular study,
it was analyzed that l5 GHVs were ideal for Chantaburi. A lesser number will give rise to
indifference and an increase to confusion. Hence the right number of GHVs has to be carefully
studied to bring about a satisfactory group dynamics; This is the reason why the number of
recruited GHVs remained constant throughout despite capability of the project to increase
recruitment.
-The interplay of time factor in sounding the concerned health officials at the different
tiers of the health system infrastructure for acceptance, complete understanding and full
cooperation is another very sensitive point for consideration'
-The actual research studies were initiated only during the second half of 1986, so this
report has been based only on a one year research implementation. This could will explain the
poor statistical correlation.
Despite of a number of short comings, it is felt that the most important finding that
the study has to share with all public health workeis is that the graduate students given the
proper training and the chance to prove their capabilities may well be the future resource to
health service delivery. During the entire course of project implementation, each and every
GHV has been appreciative of the importance of primary health care approach in providing
an optimum quality of life to each and every Thai citizen and was even more appreciative of
the role they have to play in the attainment of this goal.
97
EPILOQUEm
As in any treatise of this kind, a number of subjects of interest to decision - makers
could not altogether be precisely illucidated. lnstead, the report has concentrated on tri-factorial
issues that were deemed vital to project viability the Graduate Health Volunteers, the research-
able areas, the consistent supervision, and the interplay of their ever-continuing tri-factorial
re-enforcement on community development.
While it is not clear that CHVs may well be the long-sought for solution to the perennial
problem of shortage of health manpower, it has been well-documented that they will to some
extent favourably alter'the pattern of health service delivery, in the study area. Whether the
concept of the utilization of GHVs as a support system to the health service infrastructure
may be replicable in other Thai villages not to mention the entire country, is a question that
the study is not prepared to answer. For one, it should be remembered that Chantaburi is
considered prosperous, despite and inspite of the sparse distribution of the households causing
poor communications among the villagers inavailability of safe drinking water and the prolifera-
tion of both wanted and unwanted migrants.
How many of Thailand's promising graduate students are prepared to render health
services under a much economically depressed condition, compounded with socio-cultural
distress and more complex health problems? Granted that they are, will their number suffice
to quench the country's thirst for an improved system of health serVice delivery? How will
these group of young, idealistic, impetus-driven academicians merge into and be absorbed
within a network of matured, mellowed and mostly conservative health staff?
The problems may rightfully well be anticipated as reflected in the reports of the CHVs.
How will the GHVs relate to the VHCs,/VHVs, the representatives of Thailands' pioneering
drive to the primary health care approach?
There are palpable differences in intellectual capabilities, social values, norms and
concepts between the GHVs and the VHCs/VHVs. Will they be mutual,ly complimentary?
Or, far from being skeptical, mutually destructive? An in-depth analyses becomes mandatory
before initiating steps that will build one support system (which may well be) at the expense
of another. What will be the extent of acceptability of the GHV - a total stranger-to the
community? How much time-frame is to be allocated for the GHVs to establish identity, and
more important, their credibility? And, just as they are beginning to gain respect, acceptance
and trust, their one year assignment is completed to be replaced by a new group of "graduated
strangers". Will the scenario trigger chaos in the existing community structure? Hcipefully,
it will not, but then again - it may. A number of researcheable topics may well emerged from
the concept of the role of GHVs in primary health care service delivery.
The research attempts were multi-dimensional directed towards comprehensive coverage
of the essential elements of primary health care. The apparent weakness of the research
methodology employed in somb of the research studies may well be attributed to an interplay
of time, resource constraints and inexperience. The insignificance of some of the research
result is highly understandable as most of the research studies were impact-oriented and the
time factor involved for this publication is not permissive of impact-measurements.
Altogether, the study has been a practical application of theories and concepts, a guide
to future attempts in the design of models for primary health care development and a highly-
rewarding public health endeavor.
/t".---/)
Rosa Corozon F. Cosico, M.D., M.P.H
Visiting Professor
Faculty of Social Scie4ces & Humenities
Mahidol Univercity
I May, 1987
r":ltllr"lll;ll tlt
ANNEXE,S
:
101
ANNEX I
PUBLICATION ON RESEARCH I.'OR PHC MODEL DtrVELOPMENT.
CHANTABURI PROVINCE OF THE ATC /PHC
l. GHV Monthly Newsletrer (in Thai)

2. lntroduction to the Research for Primary Health Care Model Development project (in
Thai and English)
3. A Manual for the Training of GHVs (in Thai)
4. A Manual for the Training of GHVs in MCH and EMC (in Thai)
5. Situation Analysis and Community Assessment on Primary Health Care, Maternal ancl
Child Health, Family Planning, Essential Medical Care and Community Development in
Chantaburi Province (in Thai and English)
6. The Reports of GHVs (1985-1986) : Problems Obstacles and Recommendations for pHC.
MCH and Community Development in Chantaburi province (in Thai)
7. The study on the Interest of Thai University Cracluates in PHC and Community Develop-
ment (in Thai)
8. Progress Report (January l985-December 1986): Research for Primary Health Care Mo<iel
Development, Chantaburi Province (in English)
9. The GHVs Short Stories (in Thai)
10. The Reports of CHVs (1986-1987) : Problems, Obstacles and Recommendations for pHC.
MCH and Community Dev'elopment in chantaburi province (in Thai)
I l. A Manual for the Training of cHVs in primary Health Care (in Thai)
12. ATC/PHC Research and Development Monthly Newsletter (in Thai)
ANNEX II
GLOSSARY
ASEAN - Association of South-East Asian Nations

ATC/CMD/0O2 - ASEAN Training Centre,/Chantaburi Model Developmenr Projecr,/Dara
collection form for VHCs/VHVs
ATC/CMD/O03 - ASEAN Training Centre,/Chantaburi Model Developmenr Project,/Data
collection form for Village Committee
ATC/CMD/004 - ASEAN Training Centre,/Chantaburi Mo<lel Development Project,/Data
collection form for Health Centre
ATC/PHC - ASEAN Training Centre for Primary Health Care Derelopmenr
BMN - Basic Minimum Needs
CD - Community Derelopment
DMFT - Decayed Missing and Filling Teeth
DPHO - Districr Public Heahh Office
EMC - Essential Medical Care
FP - Family Planning
CHV - Graduate Health Volunteer
HCF - Health Card Fund
HFA/2000 - Health For ALL by the year 2000
IEC - lnformation, Education, Communication
JICA - Japan lnternational Cooperation Agency
102
KAP - Knowledge, Attitude, Practice

MCH - Maternal and Child Health
MOPH - Minlstry of Public Health
MPHM - Master in Primary Health Care Management
NGO - Non-Government Organization
NSV - Non - Specific Vaginitis
ORS - Oral Rehydration salt
PPHO - Provincial Public Health Office
PHC - Primary Health Care
QOL - Quality of Life
RTG - Royal Thai Government
SEAMIC - Southeast Asia Medical lnformation Centre
STD - Sexually Transmitted Disease
TBA - Traditional Birth Attendant
TCDV - Technical Cooperation among Development Villages
UPHC - Urban Primary Health Care
UN - United Nations
VC - Village Committee
VHC - Village Health Communicator
VHV - Village Health Volunteer
wHo - World Health Organization
103
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104
THE AUTHORS
l)r. Krasae Chanawongse
Dr.Krasae has dedicated himself in the pursuit of public health goals for the under-
privilcgcd majority. It may well be deduced that the empathy has flourished from the fact
that he once belonged to the less advantaged population sub-group in his birthplace Muang
Phon, Khon Kaen, which is location about 365 km. northeast of Thailand.
Armed with dedication and perseverance he has worked his way through the medical
school if only to prov'e that poverty is not a deterring tactor to any form of intellectual pursuit.
ln 1960 he was awarded his medical degree by the Faculty of medicine, Siriraj Hospital,
Unirersity of medical sciences (now, the Mahidol University), in Bangkok
Immediately after graduation, he went back to his native district turning a deaf ear
to the lucrarire life that thc capital city has to offer to promising young physicians. Instead,
Dr.Krasae concentrated on the application of his newly-acquired expertise to expand and
strengthen the existing health service tacility in Muang Phon, through community participation.
In 1968, Dr.Krasae received a Colombo Plan grant to pursue a course at the London
School of Hygiene and Tropical Medicine. On completion of his post-graduate studies, again
he returned to Muang Phon to resume his public liealth career.
A recipient of a number of awards both locally and internationally; among them the
prestigious Ramon Magsaysay Foundation Award 1'rom the Philippines in 1973; Dr.Krasae
was appointed Deputy Minister of Health by the Royal Thai Government in recognition of his
pioneering el'fort on health and community derelopment acti!'ities from 1975 rc 1977.
ln 1980 Dr.Krasae received his Doctoral Degree in Public Health (Dr.P.H.) lrom the
Columbia University, New York, USA.
Ar presenr, Dr.Krasae is the Director of the ASEAN Training Center for Primary
Health Care Developmcnr. Despite his hectic schedule both as an administrator and as a
resource person for the Center, he ncl'er fails to go home every weekend to visit his beloved
Muang Phon, listen to his people's tale of woe and offer alternative solutions to existing health
problems.
Dr.Krasae is the Projcct Director ol'the Research on Primary Health Care Model
Derelopment, Chantaburi Pror,ince.
Dr.Krasae is married with two children.
l)r.Som-arch Wongkhomthong
Dr.Som-arch has left Thailand at the tcnder age ol'18 after qualifying for a Japanese
Gorernmenr scholarship. He received his medical degree from the University of Tokyo in 1975.
He then pursued his training in Clinical Surgery.
In 1980, Dr.Som-arch receired his Master Degree in Public Health from Harvard
University in Boston, Massachussetts. Then, he went back to Japan to pursue a Doctoral Degree
in Health Sciences. In 1982, the Unirersity ot'Tokyo awarded Dr.Som-arch his second doctoral
degree.
ln 1984, after l6 years ol' absence, Dr.Som-arch was homeward bound is eager antici-
pation ro be of service to his own people. He joined the Mahidol University Faculty of Public
Health as a lecturer in the Department of Health Services Administration. Simultaneously,
he joined the ASEAN Training Center for Primary Health Care Development as a lecturer to
the Master in Primary Health Care Management course and as the Assistant Director to the
Cefiter.
105
Whenever he is asked if
he should ever leave his country again, Dr.Som-arch's answer
with his characteristic disarming smile is - NEVER.
Dr.Som-arch is the Project Manager of the Research on Primary Health Care Model
Development, Chantaburi Province.
Dr.Rosa Corazon F. Cosico
Dr.Cosico received her degree on Doctor of Medicine from the University ef Sto.Tomas,
Manila, Philippines, in 1966.
She started her public health career as a volunteer Puericulture Center physician in her
native town of Pulo Bulacan (now, Valenzuela, Metro Manila) She later joined the Manila
Health Department and was awarded the South-East Asean Minister of Education Organization
(SEAMEO) Fellowship Grant on Master Degree in Public Health at the Mahidol University
in Bangkok, Thailand. In 1978, she received her degree ranking as First, in the MPH Interna-
tional Course from Mahidol University.
Shortly after her return her Government has awarded Dr. Cosico a second scholarship on
Master Degree in Government Management, major in Human Resources Development. She
was unable to complete the course as fate destined her for an even greater challenge by way of
a WHO recruitment as a short term consultant in MCH/FP with duty station in Thailand, in
1980 and later on as Medical Officer in Family Health at the WHO Regional Office for South
East Asia in New Delhi. India.
In November, 1986; on completion of her WHO assignment; Dr.Cosico set foot on
what she claims as her second country-Thailand, to join Mahidol University as a Visiting
Professor to the Faculty of Social Sciences & Humanities.
Dr.Cosico is the short-term consultant to the project on Research on Primary Health
Care Model Development, Chantaburi Province.
Dr.Cosico is married with three children.
ASEAN TRAININC CENTRE
FOR
PRIMARY HEALTH CARE DEVELOPMENT
Mahidol Universitv, Salaya Campus
25/5 Puthamonthon 4. Salava
N ak h oncha isri, Nakh on path om
Thailand

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Publication No.

A,-i*.Atr l"ruining {.*::=€ss l{rr

Krasae Chonawongse, M. D., Dr. P. H.

Training of Graduate Health Volunteers 43

ORGANOGRAM OF THE PROVINCIAL ADMINISTRATION

ORGANOGRAM OF THE PROVINCIAL HEALTH OFFICE

STD* : Sexually Transmitted Diseases

PROVINCIAL NETWORK INFORMATION SYSTEM

vHv/ VHC other: - Traditional Birth

MOPH Ministry of Public Heolth

Age Male (90) Female (90) Total (90)

0-4 4.57 4.44 9.01

Total 49.25V0 50,75V0 100.0090

HEALTH PROFTLE (198s)

Health Regiohal District Medical Health Community

Health Public Health Doctor NursePublic

Muang 65 282 65 l:1,458 l:366 l:1,458

*Public health officers include ssnitarians and midwives.

PRIMARY HBALTH CARE HEALTH MANPOWER

VHC Coverage VH! Coverage

VHC coverage 95.77V0 of total sub-districts and

EXISTING HEALTH CARE FACILITIES

Public Health Center 6

lst degree malnourished 4,691 20.9

Total 22,356 100

PRIMARY HEALTH CARE ACTIVITIES BY DISTRICT

Number of Taget Number of Target Percentage of

Muang 6,607 4,964 75.1

Total 2E,156 25,566 90.E

District BCG DPT oPv Measles Rubella TT*

Muang 258. I I 86.24 85.87 51.32 60.35 tr7.2l

Ma-kam 64.77 74.70 '73.29 42.96 64.32 30.70

Total r24.80 84.86 E3.92 49.22 75.40 43.83

* Tetunus toxoid in pregnant women

No.of Acceptors Rate of active

Muang 12,239 7,455 2,341 80.0490

Total 49,665 28,993 ll,717 82.0090

NB. Target group Married women of reproductive age (15-44 yrs.)

Total number Latrine Adequate drinking

Muang 9,323 7,754 83. l7 5,804 62.25

Total 53,309 2E,206 52.9r 22,112 4r.4E

Health Education in the Village

Health l-ducation by Health Official (times)

Health Education in the Village by ! HCl! H! (times)

MORBIDITY AND MORTALITY RATE AMONG THE

Disease Morbidity Mortslity

Rank No. Rate No. Rate

Malaria I 2377 .8 64t6.7 4? .l

*Per 100,000 Population Base

MAP OF THB STUDY TAMBONS

1985-1987 Research areas

Dr. lVqtth Bhamorapravati, Rector Dr. Amorn Nondasuta, former Permanent

From left to right, Dr. Som-arch Wongkhom-

AND, THE JAPAN INTERNATIONAL COOPERATION AGENCY

Prof. Masami Hqshimoto, Japanese National

CHANTABURI . THE FRUIT BASKET OF THAILAND

An abundance of tropical fruits - durisn,mangosteen, rambutqn qnd others

The Provincisl Public Heqlth Office The Phro-Pok-Klqo Regionol Hospitol

* .. ... 'fi$*s$$tlfi $"\ l;.:. "--:,

The community hospital Maternity ward of the community hospital

The health center A patient being treated qt the health center

Successful candidqtes receive theoretical trainins

A,-i.Atr l"ruining {.::=€ss l{rr