Human Resources for Health

Country Profile
Thailand
Acknowledgement

We would like to express our sincere gratitude to the International Health

Policy Program for compiling the Thailand Human Resources for Health
Country Profile. Special thanks go to Dr Nonglak Pagaiya, manager of the
Human Resources for Health Research and Development Office (HRDO) who
dedicatedly compiled, synthesized and wrote the drafted profile. Without the
contributions from stakeholders: the Human Resources for Health Research and
Development Office, Praboromrajchanok Health Workforce Institute- MoPH,
the Personal Division- MoPH, the National Human Resources for Health
Commission, medical council, dental council, nursing council, pharmacy
council, medical technology council, and physiotherapy council; the Thailand
HRH Country Profile could not be possible. Great gratitude goes to Mr Krisada
Wongwinyu and Ms Sanya Sriratana for data collection and logistic support and
to Ms Pen Suwannarat for English editing .

Dr. Supakit Sirilak

Director, Bureau of Health Policy and Strategy
Ministry of Public Health, Thailand
October 2010
Table of Content
Executive summary
Introduction 2
Purpose 2
Methodology 2
Scope of HRH profile 3
1. Country context 4
1.1 Geography and demography 5
1.2 Economic context 6
1.3 Political context 7
1.4 Health status 8
2. Country health system 10
2.1 Governance 10
2.2 Service provision 12
2.3 Health care financing 13
2.4 Health information system 14
3. Health Workforce Situation 15
3.1 Health workforce stock and trends 15
3.2 Distribution of health workforce by category/cadre 16
3.2.1 Gender distribution by health workforce
categories/cadre 17
3.2.2 Age distribution by occupation/cadre 18
3.2.3 Region/province/district distribution by occupation 18
3.2.4 Urban/rural distribution by occupation/cadre 19
3.2.5 Distribution by occupation/cadre 20
4. HRH Production 22
4.1 Pre-service education 22
4.2 In-service and continuing education 25
4.3 Health workforce requirements 25
5. HRH Utilization 28
5.1 Recruitment 28
5.2 Deployment and distribution mechanisms 28
5.3 The work environment 28
5.4 Employment of health workers in the private sector 32
6. Governance for HRH 33
6.1 HRH policies and plans 33
6.2 Policy development, planning and managing for HRH 35
6.3 Professional Regulation 36
6.4 HRH information 36
6.5 HRH research 37
6.6 Stakeholders in HRH 40
References 45
Annexes

Annex 1: Classification of health workforce of

the WHO South-East Asia Region 47
Annex 2: Health workforce classification mapping of
the WHO South-East Asia Region 49
Annex 3: Health workforce classification mapping of (country name) 60
Annex 4: Health workforce by cadre and population ratios
at the national level 64
Annex 5: Health workforce status 65
Annex 6: Members of the taskforce 66
Acronyms

AAAH Asia Pacific Action Alliance on Human Resources for Health

BMA Bangkok Metropolitan Administration
CSC Civil Service Commission
GDP Gross Domestic Product
HRDJ Human Resources Development Journal
HRDO Human Resources for Health Research and Development Office
HRH Human Resources for Health
HSRI Health Systems Research Institute
MoPH Ministry of Public Health
MoE Ministry of Education
MoI Ministry of Interiors
NESDB National Economic and Social Development Board
NHRHC National Human Resources for Health Commission
NHSO National Health Statistic Office
PHC Primary Health Care
Table

Table 1.1 Percent Population Distribution by Age Group and year 5

Table 1.2 Population distribution by Sex 5
Table 1.3 Economic indicators 6
Table 1.4 Main causes of morbidity (per 1,000 population)
and mortality (per 1,000 population) 8
Table 1.5 Health indicators in 2010 9
Table 2.1 Health facilities in the public sector in 2010 11
Table 3.1 Health worker/population ratios at national level 15
Table 3.2 Distribution of health workers during 2006 - 2010 17
Table 3.3 Gender distribution by health workforce category/cadre 18
Table 3.4 Workers by age group and cadre 18
Table 3.5 Regional/District/province distribution of workers 19
Table 3.6 Health workforce per 1,000 population by regions 19
Table 3.7 Urban/Rural distribution of workforce 20
Table 3.8 Public/Private organization distribution of health workers 21
Table 4.1 Number of Training Institutions by type of ownership 23
Table 4.2 Number of entrants and graduates during 2007-2010 24
Table 4.3 Projections for health workforce requirements for
the next 10 years (2019) 27
Table 5.1 Turn over from community hospitals of physicians in
relation to physicians working at community hospitals,
during 2000-2009 32
Figures

Figure 1.1 Trends of Population growth rate and

economic growth rate in the past 5 years 4
Figure 1.2 Trends of Population growth rate and economic growth rate
in the past 5 years 7
Executive Summary

The Thai health system has been affected by the transitions of

macroeconomic and government policies and other contextual factors. The state
of the expansion of private health facilities, resulting from Thailand’s economic
growth and government policy to promoting Thailand as the medical hub of the
region have made an impact on the Thai health system. Moreover, the universal
coverage scheme implemented in 2001 has resulted in increasing service
utilisations. These are indicated in the expansion of health services at both
public and private sectors and that more health workforce is required.
Coincidently, the public sector reform implemented in 2001 which came with
the downsizing of civil servant positions made it difficult to attract and retain
health workforce in public sectors. The Decentralization Act implemented in
1999, prompted the Ministry of Public Health (MoPH) to prepare the delegation
of some health facilities to local authorities, though so far this does not show
much progress. Furthermore, the increase of the elderly accompanied with the
increase of chronic illness indicates an increasing in demand for health services.
These transitions have indicated an increase of health workforce requirements
both at public and private sectors.

Although the production side has produced the health workforce to meet
with the increase in demand, the distribution among regions and between rural
and urban areas has made the health workforce problem persistent. Moreover,
rural and public sectors which failed to retain health workforce to provide
services in the rural health system has made the health system become worse.
The situation that the production has not been in line with health system
requirements has been found in the cases of health auxiliaries- where the
production of health auxiliaries has declined while the requirement for a health
workforce has increased. The situation of health workforce has been affected by
several factors and is too complex for one institution to handle.

Over the past four decades, the Thai government has implemented several
strategies to solve the problem of maldistribution and rural turnover. The
supply strategies range from compulsory public service, increase in production,
rural recruitment to enter health workforce school. For the demand side,
strategies to attract and retain health workforces are: increase hardship
allowance, improve career advancement, continuing education, provide rural
awards, etc.
In addition, attempts to solve health workforce maldistribution have been
implemented during the past 10 years. Firstly, implementing financial allocation
on capitation basis in which salary is included to facilitate health workforce

1
distribution. Secondly, MoPH has approved financial regulation to delegate
authority to health facilities to hire their own health workforce using the facility
revenue. Thirdly, increase financial incentive for health workforce working in
rural areas. Fourthly, developed and implemented a project to strengthen health
centres in which the health workforce is among the prime concerns.

However, the human resources for health (HRH) problems are not only
concerned with health systems but are greatly linked with the transitions of
socio-economic situations of the country and global level. The HRH problems
thus become more complex and concern many stakeholders. The solutions for
these complex problems need the involvement from all stakeholders under the
explicit national HRH strategic plan. Therefore, the National HRH strategic
plan was developed in 2007, and the National HRH Commission was set up to
oversee, mobilise, and monitor the plan. The plan states clearly that the
evidence-based and effective HRH information system should be developed and
linked to the decision making of the development and implementation of policy
on HRH planning, management and production system. This continuing process
could therefore help improve HRH development aspects continuously and
sustainably. However, plan implementation is still a big challenge and it needs
capacity on HRH research, management and leadership. The program to rebuild
the capacity has just begun and will take some years to achieve the targets.
However, the system needs a sustainable capacity, with individuals, institutions,
and networks to ensure sustainable success on the HRH development plan.

Introduction

HRH is a key component of the health service system, therefore it is

crucial to make HRH evidence-based information available.

Purpose
Thailand HRH Country profile has been compiled in order to provide a
comprehensive picture of health workforce situations and trends. The profile
has systematically illustrated the HRH policies and management situation to
help monitor the HRH stock and trends. It could serve as a tool for policy-
makers and other stakeholders to develop measures to address HRH shortfalls
as well as strengthen the HRH information system by establishing evidence for
baselines and trends. Information sharing and a cross-country comparison could
also be facilitated.

Methodology
The information presented in this country profile was derived from a
variety of sources. First, the key informant interviews have provided some clues
in relation to HRH policy and plan situations and trends. Secondly, the review
2
of all documents concerned with policy and studies in HRH help capture the
HRH situations as well as policy development and implementations. Thirdly,
HRH database from MoPH, professional councils and the Human Resources for
Health Research and Development Office (HRD) were obtained. All
information was then compiled and analyzed.

Scope of the HRH profile

The Thailand Country Profile has firstly provided an overview of the

country context and health service system. Issues related to geography,
demography, economic situations and health service system and its governance
have been briefly described. Then, it moves to the comprehensive picture of the
health workforce situation of the country in relation to availability and
distribution of health workforce in relation to age, gender, geographically, and
rural / urban distributions. After that, HRH production and requirement
projections are presented. This is followed by the HRH utilisation- where
recruitment, deployment, measures to attract and retain health workforce as well
as rural retention is briefly discussed. Lastly, the HRH policy and plan
implementation in Thailand is presented.

3
1.Country conttext

The Kinggdom of Thailand

T iss located in
i Southeaast Asia. IIt is bordeered by
Camboodia, Lao PDR, Malaysia
M annd Myanm mar. It is the thirdd largest country
c
amongg the Southeast Asian Natioons where its territoory coverrs approxiimately
514,0000 square kilometre
k s (Figure 1).

Figuree 1.1 Mapp of Thailaand

4
1.1 Geography and demography

Geographically, there are 4 regions, namely the Central region covering

Bangkok and 33 provinces, the North region covering 9 provinces, the South
region covering 14 provinces and the North-East region covering 20 provinces.
Thailand is naturally divided into three topographic regions: plain, highland,
and mountainous areas. Most of the plain areas are in the Central regions, the
highland areas are in the Northeast region where the mountainous areas are in
the North and the South regions. Thailand is seasoned by 3 types of climates:
topical rain climate with heavy rainfalls year round, tropical monsoon climate
where there are monsoons and average rainfall, and seasonal tropical grassland
where there are plenty of heavy rainfall and dry in winter and summer time
(November to May).

As of the year 2010, the population of Thailand was 63,701, 703, slightly
increasing from 2005. Table 1.1 shows that the number of those below 14 years
has declined from 13,511,643 in 2005 to 12,672,935 in 2010. On the other hand,
the elderly (65 years and above) has increased up to 5,083,355 in 2010. The
trend suggests that Thailand has been approaching an aging society. In relation
to gender distribution, male proportion is close to that of females throughout
2007 to 2010. Growth rate in Table 1.2 illustrated the decline from 2007 to 2010
and this figure has reflected the slight increase of population in Table 1.1.

Table 1.1 Percent Population Distribution by Age Group and year

Age 2005 2006 2007 2008 2009 2010
Group
0–14 13,511,643 13,369,958 13,256,360 13,127,557 12,908,651 12,672,935
years
15–64 44,075,367 44,515,728 44,955,835 45,372,115 45,645,505 45,945,413
years
65+ years 4,608,829 4,737,730 4,826,052 4,890,058 4,970,907 5,083,355
Total 62,195,839 62,623,416 63,038,247 63,389,730 63,525,062 63,701,703
population
Source: National Health Statistic Office, 2011

Table 1.2 Population distribution by Sex

Year Total Male Female Male/Female Grow but declined
(%) in th rate (%)
2007 63,038,247 31,095,942 31,942,305 49.32 / 50.67 0.66
2008 63,389,730 31,255,869 32,133,861 49.31 / 50.69 0.56
2009 63,525,062 31,293,096 32,231,966 49.36 / 50.74 0.21
2010 63,701,703 31,372,467 32,329,236 49.25 / 50.75 0.28
Source: National Health Statistic Office, 2011

5
1.2 Economic context
The Thai economic situation slowed down during 2008-2009 and
bounced back in 2010. All important economic indicators supported the claims.
Gross Domestic Product (GDP) and Income Per Capita declined from 2008 to
2009, and increased from 2009 to 2010. Percentage of national dept in relation
to GDP and unemployment rate increased from 2008 to 2009 but declined in
2010. Proportion of population living below poverty line declined from 2008 to
2009. Inflation rate has increased from 2008 to 2010, however, budget spent in
health proportion in relation to GDP has been stable (Table 1.3).

Table 1.3 Economic indicators

Indicators 2008 2009 2010
GDP(in PPP) $557.4 billion $544.4 billion $584.7 billion
National debt as % of GDP 37.30 45.2 42.5
Proportion of budget spent on health as % 4.0 4.3 NA
of GDP
Income per capita (in PPP) $8,400 $8,200 $8,700
Proportion of population living below 9.0 8.1 NA
poverty line
Proportion of population with NA NA NA
malnutrition
Unemployment rate 1.39 1.5 1.1
Inflation rate 2.3 2.6 3.57
Note: NA = Not available
Sources: National Economic and Social Development Board, 2010
CIA World Fact Book, 2011

Figure 1.2 illustrates that while the population growth rate tended to
decline, the economic growth rate during the past 5 years (2006-2010) was in
fluctuation. The economic growth rate declined from 5.14% in 2006 to 2.5% in
2008. In 2009, the economic growth rate sharply declined to -2.3% before
significantly bounced back to 7.8% in 2010..

6
 Figuree 1.2 Trennds of Poppulation grrowth rate and econoomic grow
wth rate in
n the
passt 5 years

Sourcess: National Economic

E a Social Developmen
and D nt Board, 20010
National Health Stattistic Office, 2011

1.3 Poliitical conttext

Thailand is a demoocratic nattion with thet King as a the Heaad of the State,
S a
constittutional monarchy
m under thee Constituution of thhe Kingdoom of Th hailand,
2007. The counntry’s government system s co
omprises thhree majoor adminisstrative
categoories as folllows:
1. The ceentral admministrationn. These included
i t King - the Head
the d of the
State, the cabbinet - the gov vernment body rresponsiblle for
administrative oro governm ment functtion throuugh the parliament system,
s
and thhe central administraative systeem – theree are 15 M Ministries led by
the Priime Minisster.
2. Provinncial administrationn. There are local authorizees under central
governnments opperating att provinciaal and disttrict levelss within th
he local
governning jurisddictions foor specificc administtrative taskks. Accordding to
the prrovincial administtrative law, the provincial
p l adminisstration
consistts of 76 prrovinces and
a 876 diistricts.
3. Local administtration. The T local authoritiies are tthe auton nomous
administrative body
b posssessing jurristic persson statuss and own ning an
administrative autonomyy under the laws. Bangkook Metro opolitan
Adminnistration and
a some large citiees are amoong local aauthoritiess under
this category.
c The others inclu ude: 76 provincial
p l adminisstration
organiizations, 1,129 municipaalities, and a 6,7445 Sub--district
administration organizatio
o ons.

7
1.4 Health status
The Thai health status is burdened by both communicable diseases and
non-communicable diseases. In respect to mortality, non-communicable
diseases and diseases related to behaviors are ranked among the tenth leading
cause of death. Table 1.4 presents that malignant neoplasm, accidents,
hypertension, heart disease, pneumonia, nephritis, liver and pancreas disease,
suicide/ homicide, diabetes, and tuberculosis diseases were among the top ten
causes of death, respectively. Though communicable diseases declined,
tuberculosis has been recurring in association with HIV/AIDS prevalence. In
relation to leading causes of morbidity, diseases related to respiratory system,
circulatory system, digestive system and musculoskeletal system are among the
four leading causes (Table 1.4).

Table 1.4 Main causes of morbidity (per 1,000 population) and mortality (per
1,000 population)
Main causes of morbidity
1.Diseases of the respiratory
system
2.Diseases of the circulatory
system
3.Diseases of the digestive system
4.Diseases of the musculoskeletal
system and connective tissue
5.Symptoms, signs and abnormal
clinical and laboratory findings,
not elsewhere classified
6.Endocrine, nutritional and
metabolic diseases
7.Other external causes of
morbidity and mortality (eg :
'accdients, injuries, intentional
self-harm, assault, animals and
plants,complications of medical
and surgical care and other -
unspecified causes)
8.Diseases of the skin and
subcutaneous tissue
9.Diseases of the genitourinary
system
10.Diseases of the eye and adnexa
per 1,000 pop. Main causes of mortality per 1,000 pop.
493.20 1.Malignant neoplasm,all 0.91
forms
342.76 2.Accident,Event of 0.51
undetermined intent,
Supplemeritary factors
related to cause of
mortality
309.70 3.Hypertension and 0.31
cerebrovascular disease
309.06 4.Disease of the heart 0.28
295.69 5.Pneumonia and other 0.25
diseases of lung
286.48 6.Nephritis, nephrotic 0.21
syndrome and nephrosis
162.98 7.Disease of liver and 0.13
pancreas
130.61 8.Suicide, homicide 0.11
103.45 9.Diabetes mellitus 0.1
71.16 10.Tuberculosis,all forms 0.07

8
Source: MoPH (2010)
Up to 2010, several health indicators indicated the Thai health status has
improved. Life expectancy at birth has risen to 73.82 years, 70.59 for male and
77.54 for female. Crude mortality rate, under-5 mortality rate and maternal
mortality rate have declined to 6.5, 9.8, and 10.2 per 1,000, respectively.
HIV/AIDS prevalence rate is 1.3 per 1,000 population. Access to sanitation and
safe water is generally high. As far as gender is concerned, male crude mortality
rate is almost twice of that of the female, under-5 mortality rate of male and
HIV/AIDS prevalence rate in male are also higher than those of the female
(table 1.5).

Table 1.5 Health indicators in 2010

Indicators Both sex Male Female Source and

year
Life expectancy 73.82 70.59 77.54 MoPH (2010)
Crude mortality rate 6.5 10.3 5.5 MoPH (2010)
(per 1,000 pop)
Under-5 mortality 9.8 10.9 8.7 MoPH (2010)
rate (per 1,000 pop)
Maternal mortality - - 10.2 MoPH (2010)
rate(per 100,000
pop)
HIV/AIDS 1.3(545,371) 0.77(322,925) 0.53(222,446) BOD (2009)
prevalence rate (per
1,000 pop)
% with access to 98 NA NA CIA World
safe water Fact book
( 2008)
% with access to 96 NA NA CIA World
sanitation Fact book
(2008)

9
2. Country health system

2.1 Governance

Health facilities to provide health services are distributed throughout the

country. Although both public sector and private sector services are made
available throughout the country, public health facilities dominate.

According to Wibulpolprasert Ed (2010), for public health facilities in

Bangkok, there are 5 medical school hospitals, 26 general hospitals, 13
specialised hospitals, and 68 public health centres.

In addition to 6 medical school hospitals at the regional level, there are 25

regional hospitals and 48 specialized hospitals. In 76 provinces- in urban areas,
there are 131 general hospitals in which 69 hospitals are under MoPH, 60
hospitals under the Ministry of Defense, 2 hospitals under the Ministry of
Education (MoE) and 3 hospitals under the Ministry of Interiors. There are 214
urban health centers providing primary care services to the urban population.

In rural areas, all community hospitals and health centers are under
MoPH. Overall, there are 734 community hospitals and 9,768 sub-district health
centers providing care in rural areas. Details are in Table 2.1.

10
 Table 2.1 Health facilities in the public sector in 2010
administrative health facility Number Coverage
level

Bangkok Medical school hospitals 5

Metropolis 100%

General hospitals 26
- MoPH 4
- Royal Thai Police 1
- Ministry of Justice 4
- Ministry of Defense 5
- Bangkok Metropolitan Administration (BMA) 8
- State enterprises 4
Specialized hospitals / institutions 13
Public health centers / branches- BMA 68/76
Regional level Medical school hospitals- MoE 6
and Branches Regional hospitals - MoPH 25
Specialized hospitals- MoPH 48
Provincial level General hospitals, under MoPH 71 100%
Under MoPH 69
Under MoE 2
( 75 provinces ) Military hospitals under the Ministry of Defence 59
Under the Royal Thai Police 1
Under the Local Administration Organizations- MoI 3
878 Districts Community hospitals 734 83.60%
Municipal health centers (2009) 284
7,255 sub-
districts Health centers (2009) 9768 100%
74,954 Villages Community health posts 151
Community Primary Health Care Centers
- Rural 48049 68.45%
- Urban 3108
Source: Adapted from Wibulpolprasert Ed (2010)

11
 There is a close link among health facilities under MoPH in terms of the
referral and supervision systems. Sub-district health centres serve as the
frontline health facilities whereas community hospitals serve as referral
hospitals as well as an essential link between the lower level of health facilities
and the upper tier such as general or regional hospitals.

However, private health facilities also play an important role in the Thai
health system, particularly in urban areas. In 2010, there were 17,187 drug
stores where 4,590 stores (26.7%) were located in Bangkok. There were 1,7671
medical clinics available in 2010, where 3,878 clinics (21.9%) were located in
Bangkok. For private hospitals, only 96 out of 322 hospitals (29.8%) were in
Bangkok.

The health system has been affected by the transitions of macroeconomic

and government policies and other contextual factors. The state of the expansion
of private health facilities, resulting from Thailand’s economic growth and
government policy to promote Thailand as the medical hub of the region have
put pressure on the Thai health system. Moreover, the universal coverage
scheme implemented in 2001 resulted in increasing service utilizations.
Coincidently, the public sector reform implemented in 2001 with the zero
growth of civil servant positions made it difficult to attract and retain health
workforce in public sectors. The Decentralization Act implemented in 1999
prompted the MoPH to prepare the delegation of some health facilities to local
authorities, though not much progress has been shown so far. Furthermore, the
increase of the elderly accompanied by the increase in chronic illness indicates
an increasing of demand for health services. These transitions have indicated an
increase of health demand both from the public and private sectors, and that
more health workforce is required.

2.2 Service provision

The Thai health system has provided comprehensive care to the

population ranging from community health care to specialty care as follows.

Community health care services: The services provided at the family

level as well as at communities or villages where the people live. These services
include: health promotion and prevention for healthy people to protect and
prevent them from sickness, long-term care for elderly and chronic patients
living in communities or villages. These types of care are delivered at homes
and communities by the non-formal health workforce: trained village health
volunteers, elderly groups, trained care givers, as well as the mainstream health
workforce: primary care workers, public health generalists, nurses, etc.

12
 Primary health care services: Health centers located close to the
communities function as the bridge between community health care services
and main stream health services. The services provided include curative, health
promotion, disease prevention, and rehabilitation services. The services are
provided at health centers as well as at communities. The key health workforce
working at health centers are nurses, public health officers, and dental nurses
(posted in some health centers). Doctors are made available at urban health
centers and they also provide mobile clinics and technical support to rural health
centers once or twice a month. Private clinics have provided mainly curative
services to population in urban areas.

Secondary care services: Community hospitals function as secondary

health services in rural areas and general hospitals and private hospitals provide
such services in urban areas. The type of services mainly target curative and
rehabilitative care at individual level. Doctors and health teams are responsible
for providing care at this level. The facilities also serve as referral hospitals for
primary care facilities.

Tertiary care services: These types of facilities are located in cities, and
function as referral hospitals. These facilities include general hospitals, regional
hospitals, medical school hospitals, specialty hospitals, and large private
hospitals. The services provided at these facilities are mainly in curative care,
particularly in medical specialty services. A range of health workforce,
particularly doctors with specialty and sub-specialty trained are made available.

2.3 Health care financing

Before 2011, prior to the implementation of the national universal

coverage scheme, approximately 71 % of the Thai people were covered by a
range of health insurance, namely, revolving fund for medical services,
voluntary health insurance, social security, student health insurance, private
health insurance, civil service medical benefit and free services for low-income
groups - elderly, disable and uninsured groups. However, differences in benefit
packages covered by each type of health insurance created an inequity. The civil
service medical benefit scheme covering 12% of population was allocated with
highest proportion of government budget (2,106 Baht per person), while
medical welfare for the low-income group and voluntary health insurance that
covered the majority of rural people, or58% of population, had been subsidized
at the lowest capitation (273 Baht per person). By this scheme, the budget
allocated to health facilities was based on facility-based service or supply side
basis. A high proportion of the budget was allocated to curative care in hospitals
while there was a minimal amount allocated to preventive care at primary care
services.
13
 In 2011, Thailand implemented the national universal coverage scheme
where all people under each insurance scheme, except civil service medical
benefits and the social security scheme, were requested to register as
beneficiaries of the universal coverage scheme. General tax was chosen as the
source for financing with a small copayment of 30 Baht (USD 0.7) per visit or
admission and was then terminated in 2007. The capitation basis has been used
to allocate budget to service facilities. The total universal coverage scheme
budget equals to capitation rate multiplied by total universal coverage scheme’s
members in that budget year. Capitation rate consistently increased from
1,202.4 Baht in 2003 to 2,497.3 Baht in 2010.

2.4 Health information system

In the early1990s, the MoPH established the Health Information Center at

the central MoPH, provincial and district levels to facilitate, monitor and
centralize the health information system. A computerized information system
was developed and the capacity of the computerized system was expanded to
cover all MoPH agencies at both central and local levels. In 1993, the first
national standard data set, so called “the standard data set for health insurance”
was established. The data was related to Diagnosis Related Group (DRG).
Hospitals invested in computer systems to serve the computerized information
system. The information system, however, was centralized to support the policy
makers in order to allocate budget. A survey conducted in 2001 showed that
89% of hospitals implemented some kinds of computerized hospital information
system (Pongpirul and Sriratana, 2005). With the implementation of universal
coverage scheme in 2001, the development of a computerized health
information system grew to be full fledged. Information related to population
coverage at each health facility, patients, workload, and DRG are all developed
into the web-based system.

14
3.Health Workforce Situation

3.1 Health workforce stock and trends

According to the annual survey of health facilities with beds (MoPH 2009
and 2010) at the public and private sectors, the health workforce tended to
increase from 2009. A sharp increase was found in the case of doctors, nurses,
public health officers, dentists and dental nurses. The doctor to population ratio
increased from 0.33 per 1,000 population to 0.41 per 1,000 population, whilst
that of the nurses increased from 1.7 to 2.15. The dentist ratio increased from
0.16 to 0.19, and dental nurse ratio increased to 0.6 in 2010 whilst that of public
health officer was 0.08. Professionals showing minimal increase were
pharmacists, medical technologists, and physiotherapists. However, the health
auxiliaries, so-called medical technologist assistants and physiotherapist
assistants declined from 2009 to 2010.

Table 3.1 Health worker/population ratios at national level

Category 2009 2010

Number HW/1000 Number HW/1000
population population
Doctors 21,569 0.33 26,244 0.41
Dentists 9,926 0.16 11,847 0.19
Dental nurses 4,250 0.06 5,375 0.08
Pharmacists 8,390 0.13 8,700 0.13
Registered nurses1 109,797 1.7 138,710 2.15
Public Health Officers 27,372 0.43 37,774 0.59
Medical Technologists 2,859 0.04 2,696 0.04
Medical technologist 3,121 0.04 2,717 0.04
assistants
Physiotherapist 1,248 0.01 1,499 0.02
Physiotherapist Assistants 385 0.006 337 0.005
Source: MoPH, 2009 and 2010

In relation to migration, international migration is rare. Immigration of

the health workforce into Thailand has been averted by the Thai professional
licences- where one needs to pass the professional licence examination in Thai
language to be able to practice in Thailand. Migration within the country,

1
The majority of nurses in Thailand are nurse-midwives. The education they received is
nursing and midwifery. They also perform
midwifery functions as per job requirements.

15
particularly from rural areas to urban areas has been persistent and will be
discussed in 5.3.

3.2 Distribution of health workforce by category/cadre

From 2006 to 2010, significant increases in numbers have been found in

the cases of doctors, nurses, dental nurses and public health generalists. The
transitions of epidemiology and demographic situations accompanied by
government policy increased the demand for health workforce. However, the
plan to increase the production of doctors, dentists and nurses to meet the
demand were put in place in 2005. Resulting from this, the number of doctors,
dentists and nurses were increased in 2009 and 2010, respective to the number
of years they spent in the schools. The increase of public health schools over
2006 to 2010 has also increased the production of public health generalists into
the health system. The significant increase of dental nurses partly resulted from
the policy to develop health centers in order to serve the universal coverage
scheme implemented in 2001.

The professional found to have slightly increased include: medical

technologists, medical technologist assistants, and physiotherapists.
Interestingly, though the production of pharmacists was at about 2,200 students
per year (Table 4.2), graduates seeking work from the health service system
was minimal. This is reflected in the minimal increase in number of pharmacists
in each year. It is important to be aware that the survey conducted by MoPH
covered only the health workforce working at health facilities with beds.
Therefore, the health workforce working at private medical clinics and drug
stores were not covered in this database. This limitation has affected the
accurate number of doctors and pharmacists.

However, the trend of health auxiliaries, in this case, physiotherapist

assistants has declined each year. This is due to the production of this type of
auxiliaries was opposed by the Physiotherapy council, and the production was
then stopped.

16
Table 3.2 Distribution of health workers during 2006 – 2010

Category 2006 2007 2008 2009 2010

Doctors 18,918 19,584 21,051 22,651 26,244
Dentists 8,809 9,337 9,646 9,926 11,847
Dental nurses 3,693 3,279 3,501 4,250 5,375
Pharmacists 7,937 7,940 8,565 8,390 8,700
Registered nurses 101,664 101,143 105,398 109,797 138,710
Public Health Generalists 29,684 30,552 26,964 27,372 37,774
Medical Technology 3,023 2,728 3,025 2,859 2,696
Technicians
Medical technologists 2,886 3,351 3,226 3,121 3,349
assistants
Physio-Therapists 1,438 1,168 1,385 1,248 1,499
Physiotherapist Assistants 414 388 400 385 337
Radiology Technicians 988 1,177 1,096 1,134 NA
Source: MoPH, 2006-2010

3.2.1 Gender distribution by health workforce categories/cadre

According to databases from each professional council (at which figures

are different from those of the survey conducted by MoPH), the number of
professionals registered with the medical council, dental council, nursing
council, pharmacy council, medical technology council, and Physiotherapy
council are 41,015; 11,847; 130,306; 28,311; 11,751 and 524; respectively.
Overall, females represent the majority of the health workforce in Table 3.3.
Though there is no information on gender in nurses, it can be assumed that
almost all of them are female. The proportion of females is high in
physiotherapists, medical technologists, dentists and pharmacist, respectively.
However, in the case of doctors, the majority of doctors are male compared to
41% of female doctors. With females dominating, it is likely that it could affect
the rural retention of health workforce.

These sources of data have their limitations. Except for nursing council –
as nurses have to be re-licensed every 5 years, all other professional have life-
long licences. Therefore, the accuracy of the data is in doubt.

17
Table 3.3 Gender distribution by health workforce category/cadre

Cadre Total Female % Female

Doctors 37,396 15,153 41
Dentists 11,847 7,620 67
Pharmacists 28,311 18,967 66
Registered nurses 130,306 NA NA
Medical technologists 11,751 8,234 70
Physiotherapists 524 425 81
Note: NA = Not available
Source: Professional councils, 2010

3.2.2 Age distribution by occupation/cadre

According to the data from three professional councils, more than half of
the doctors, dentists and nurses are below 40 years of age. However,
approximately a quarter of doctors and dentists are more than 50 years old. The
majority of nurses are between 31 – 40 years of age, and only 10% of them are
more than 50 years old. This might be due to the fact that older nurses tend to
opt out from nursing jobs as the capacity to provide active care is limited.
Focusing particularly on the young health workforce, almost a quarter of all
three professions are 30 years and below.

Table 3.4 Workers by age group and cadre

Professionals Total ≤30 Yrs 31-40 Yrs 41-50 Yrs ≥51 Yrs
Number (%) Number (%) Number (%) Number (%)
Doctors 37,396 9,865 (26.4) 10,553 (28.2) 7,386 (19.8) 9,484 (25.6)
Dentists 11,847 2,974 (25.1) 3,743 (31.6) 2,534 (21.4) 2,596 (21.9)
Registered 130,306 29,301 (22.5) 50,766 (39.0) 36,354 (27.9) 13,885 (10.7)
nurses
Source: Professional councils, 2010

3.2.3 Region/province/district distribution by occupation/cadre

The data from the MoPH survey in 2010 showed the distribution of
health workforce. Concerning doctor distribution, one third of doctors worked
in the capital, Bangkok, and only 11% of doctors were in the South. A high
proportion of dentists, almost half of all dentists, were in Bangkok and the
Central region was second to Bangkok. However, a small proportion of dentists
worked in the South region. Pharmacist and nurse proportions were higher in
the Central and the Northeast regions. However, the proportion figure merely

18
represented the distribution but could not illustrate the inequitably in
distribution of health workforce.

Table 3.5 Regional/District/province distribution of workers

Sub- Total Bangkok Central North South North-East

Number (%) (%) (%) (%) (%)
category

Doctors 26,162 9,082 (34.7) 5,832(22.3) 3,848(14.7) 2,809 (10.7) 4,591 (17.5)
Dentists* 9,926 4,886 (49.2) 1,760(17.7) 1,194(12.0) 869 (8.8) 1,217 (12.3)
Pharmacists 8,134 1,555 (19.1) 2,069(25.4) 1,523(18.7) 1,160 (14.3) 1827 (22.5)
Nurses 138,710 22,725(16.4) 35,564(25.6) 25,847(18.6) 19,403 (14.0) 35,171(25.4)
Sources: MoPH, 2010
* Dental council, 2009

Table 3.6 clearly illustrates the disparity of health workforce distribution.

The health workforce per 1,000 population ratio showed that health workforce
was distributed around the capital, Bangkok. On the contrary, the Northeast
region - the poorest region- has less health workforce compared to the other
regions. Especially for doctors and dentists, the density of doctors and dentists
working at Bangkok were 7 times and 15 times higher than those in the
Northeast region. However, the distribution situation has been better for the
case of nurses - where the nurse per 1,000 population in the Northeast region
was close to those of other regions and just only 2 times less than that of
Bangkok.

Table 3.6 Health workforce per 1,000 population by regions

Sub-category Total Bangkok Central North South North-East

Number
Doctors 26,162 1.59 0.37 0.33 0.32 0.21
Dentists* 9,926 0.86 0.11 0.10 0.09 0.06
Pharmacists 8,134 0.27 0.13 0.13 0.13 0.08
Nurses 138,710 3.99 2.26 2.20 2.20 1.64
Sources: MoPH, 2010
* Dental council, 2009

3.2.4 Urban/rural distribution by occupation/cadre

Due to the socio-economic development in the past, the country

infrastructures, technology and transportation have improved. Thailand's urban
areas have expanded. To date, approximately 54% of the population lives in
19
rural areas. However, accessibility to the health workforce was inequitable
between the people residing in urban and rural areas. Table 3.7 illustrates that
only 18% and 20% of doctors and dentists served the rural areas, making the
density of urban areas approximately 5 times higher than that of the rural areas.
In the case of nurses, the density of nurses in urban areas was almost two times
that of the rural areas. Though Table 3.7 does not show much different between
urban and rural areas for pharmacists, the fact that this database did not cover
drug stores located at urban areas should be of note. Therefore, several
pharmacists working at drug stores were not captured. Interestingly, public
health generalists are the only health workforce were dominant in rural health
facilities.

Table 3.7 Urban/Rural distribution of workforce

Sub-category Total % % HW/ HW/
Number Urban Rural 1000 P 1000 Pop
op in in rural
urban
Doctors 26,244 21,539 4,705 0.74 0.14
(82.1) (17.9)
Dentists 9,926 7,991 1,935 0.27 0.06
(80.5) (19.5)
Pharmacists 8,700 5,401 3,299 0.18 0.11
(62.1) (37.9)
Nurses 136,447 82,871 53,576 2.83 1.56
(60.7) (39.3)
Public health 22,158 969 21,189 0.03 0.62
generalists (4.4) (95.6)
Note: Urban health workforce = All health workers working in cities,
municipalities, and district centres/head offices (including those health
workers in other sectors outside health ministry).
Rural health workforce = All health workers working outside cities,
municipalities, and district centres/head offices (including those health
workers in other sectors outside health ministry).
Sources: MoPH, 2010
* Dental council, 2009

3.2.5 Distribution by occupation/cadre

Of the health workforce, dentists working in the private sector were

approximately half of those who worked in the public sectors. On the contrary,
all dental nurses - dental health auxiliaries- worked in the public sector
particularly under the MoPH’s facilities. In the case of other professionals, only
18% of doctors, 18% of pharmacists and 10% of nurses worked in the private
sector. However,due to the limitation of drug store data, the number of
pharmacists working in the private sector was underestimated.

20
Table 3.8 Public/Private organization distribution of health workers

Sub-category Total Number Public sector Private sector

Number (%) Number (%)
Doctors 26,244 21,550 (82.1) 4,694 (17.9)
Dentists* 9,926 4,725 (47.4) 5,221 (52.6)
Dental nurses* 4,313 4,313 (100) -
Pharmacists 8,700 7,173 (82.4) 1,527 (17.6)
Nurses 136,447 122,460 (89.7) 13,987 (10.3)
Public sector: Includes all government owned/funded health facilities under health ministry
and other related ministries.
Sources: MoPH, 2010
* Dental council, 2009

21
4. HRH Production

4.1 Pre-service education

The production of the 4-year graduates of university education including

post-graduate degree is under the responsibility of the Ministry of Education
(MoE). However, MoPH has also been responsible for the production of nurses
and health auxiliaries- those who are trained for 2 years, i.e., primary health
workers, pharmacy assistants, dental nurses, medical technology assistants,
physiotherapist assistants, etc. There are 19 medical schools, and only one is a
private school. The production of dentists has relied on 10 dentistry schools,
whereas only 2 are private schools. There are 74 nursing schools, 29 schools are
under MoPH, 27 are other public nursing schools and 18 private nursing
schools. To produce public health generalists, there are 7 schools under MoPH,
36 other public schools and 8 private schools. However, the 7 public health
schools under MoPH also trained health auxiliaries, namely, primary care
workers, pharmacy technicians, dental nurses, medical technologist assistants,
etc.

The production of medical technologists, physiotherapists and medical

radiology technicians are all under MoE, where there are 13 schools, 15 schools
and 3 schools, respectively.

The production of doctors is linked to the requirement of MoPH, as

MoPH has requested the additional production of approximately 700-1,000
doctors, and was implemented in 2003. In this regard, an ad-hoc mechanism
was set up for this link. The production plan of schools under MoPH to produce
nurses and auxiliaries was related to MoPH’s needs. However, the production of
other cadres is mainly related to the capacity of each school rather than the
needs of the health system.

22
Table 4.1 Number of Training Institutions by type of ownership

Type of ownership Total

Type of training institution Public/ Public/ FBO Private
MoPH MoU for
Profit
Doctors 1 18 1 19
Dentists 8 2 10
Pharmacists 13 5 18
Nurses 29 27 18 74
Public health generalist 7 36 8 51
Medical technologists 10 3 13
Physiotherapists 11 4 15
Medical Radiologist 3 3
TOTAL 37 124 0 42 202
FBO = Faith Based Organization
Public = All government owned/funded training institutes under health, education and other
related ministries.
Source: HRDO (2011)

Before 2004, the production of doctors was at about 1,300 doctors per
year, which was less than the health system required. The collaboration between
MoPH and medical schools to increase the production of doctors has been put in
effect for 2004, in addition to the 300 rural doctors per year trained under the
collaborative project to increase the production of rural doctors initiated in
1993, and the outputs appeared in 2000. The increase of dentist and nurse
production was also implemented during 2004-2005 in order to meet with the
health system requirements. In addition, in 2008, the policy to produce 3,000
more nurses to serve the southernmost provinces in Thailand was put in effect.

The production of other cadres was not quite linked with the needs of the
health system. For example, the production of public health generalists was
increased and this relied mainly on the increase of the public health schools.
The production of pharmacists, however, has quite steady. For medical
technologists and physiotherapists, the production slightly increased each year,
but the outputs were still low. There is no mechanism to link the production of
such cadres and the health service system.

As for health auxiliary production, dental nurses, pharmacy assistants,

primary care workers have declined. Although they are produced at schools
under MoPH, the small numbers of the outputs were due to the capacity of the
production institutes and the opposition from professional councils. Therefore,
the production of such health auxiliaries tends to decline.

23
 Table 4.2 Number of entrants and graduates during 2007-2010

Professionals Number of entrants Number of graduates

Total Total
input output
2007 2008 2009 2010 2007 2008 2009 2010
Doctors 2,112 2,245 2,357 2,485 9,199 1,514 1,457 1,319 1,690 5,980
Dentists 679 801 777 848 3,105 431 403 431 475 1,740
Dental nurses 300 350 350 350 1,350 262 290 288 345 1,185
Pharmacists 2,272 2,323 2,266 2,107 8,968 1,386 1,429 1,591 1,731 6,137
Pharmacy 300 300 300 300 1,200 321 294 299 308 1,222
technicians
Nurses 7,714 10,974 7,985 7,933 34,606 4,398 4,060 5,676 5,966 20,100
Public Health 5,961 6,282 6,553 6,668 25,464 1,670 2,123 2,917 4,363 11,073
Generalists
Primary care 750 750 750 750 3,000 708 609 644 744 2,705
workers
Medical 1,051 1,125 1,329 1,281 4,786 754 727 852 845 3,178
technologists
Physiotherapists 786 892 1,138 1,175 3,991 413 472 514 513 1,912

Radiology 175 181 176 177 709 151 127 130 167 575
technicians
Source: HRDO (2011)

In addition to curriculum are reviewed every 3- 5 years, there are some

accreditation mechanisms for educational accreditation in place at all process,
curriculum development, curriculum implementations, and educational
outcomes. Generally, before curriculum implementation, each curriculum is
approved by university councils and professional councils based on the set
criteria. During the learning and teaching process, the process is approved
regularly by the Office for National Education Standard and Quality
Assessment – an independent body. The graduates are assessed on their quality
by the license examination. For those who do not need the license, for example
health auxiliaries,their practice will be covered by their associated
professionals.

24
 4.2 In-service and continuing education

Annually, each organization puts together a health workforce

development plan, including planning for in-service training and continuing
education. The in-service and continuing education discussed here has been
divided into 3 parts- in-service training at work place, short course training and
continuing education.

The in-service training conducted at work place has mainly aimed to

provide capacity building to improve the knowledge, attitude and skills of
health workforce to be in line with local health services. This type of in-service
training is conducted at the work place, ranging from 1-2 days to 3 months.

The short course training, range from 1-2 days to 6 months, is mainly
conducted by the training institutes, both public and private sectors. The health
workforce can attend the course provided that is in line with the organisation
needs and has been approved by the head of each organisation.

Continuing education has been planned for each organisation. MoE has
provided the continuing education ranging from bachelor degrees to post-
doctoral degrees. The health workforce is allowed to attend continuing
education in line with the organisational needs.

As the continuing education curriculum is under the educational

accreditation system of MoE, professional councils play important roles in
approving the continuing education curriculum. A mechanism to accredit the
training curriculum of most of the health workforce has not been in place,
except nursing professional. The fact that nurses are relicensed every 5 years
and that they required to accumulate 50 nursing continuing education credits
over 5 years for the eligibility for relicensing. What is more, nursing council has
actively involved in nursing training by accrediting the training curricula.

4.3 Health workforce requirements

In 2008, the National Human Resources for Health Commission

(NHRHC) set up a sub-committee to work on the health workforce projection
and supply of the whole country for the next 10 years (2019). The working
group to project health workforce supply for each cadre was set up. For each
cadre, the working group comprised of academia from academic institutes,
representatives from professional councils, and representatives from health
service systems.

25
 The doctor requirement projection was based on the population ratio
where 1: 1,400 population is required in the next 10 years (Sirikanokwilai et al
1998). It is projected that 50,072 doctors will be required in 2019 compared to
the existing doctors in 2009, when 23,828 additional doctors were needed. The
production should be about 2,400 doctors a year. The existing doctor production
is likely to meet with the future demand.

The dentist requirement, based on health need methods, projected that

17,999 dentists and 8,298 dental nurses are required in 2019. Compared to the
existing number, it thus needs 8,073 dentists and 3,985 dental nurses. Therefore,
the existing production plan is likely to meet the requirements.

Pharmacist projection group used the staffing standard-where each level

of health facility is analyzed for the requirement of pharmacist and pharmacy
assistants. The projection was for mainly the requirement of health facilities
both at public and private sectors. It is projected that 15,238 pharmacists and
15,090 pharmacy assistants are required in 2019. Though the production plan of
the pharmacists tends to be in surplus, but the pharmacist assistant production
needs to increase at about three times.

Nurse production seems to be in line with requirements. The population

ratio (1:400) approach requires 180,435 nurses in 2019, therefore it requires an
additional 43,988 nurses. The production of about 7,900 nurses per year is
likely to be able to sufficiently produce nurses.

For public health generalists and primary health workers, the projection
requires 31,114 public health generalists and 30,566 primary care workers. The
existing production plan of public health generalists tends to be in surplus, but
the primary health worker production is likely to meet the requirement.

The projection of physiotherapists based on staffing standard – setting a

number of physiotherapists per health facility- requires an additional 4,034-
5,895 physiotherapists. The existing production plan is likely to meet the
requirement.

26
Table 4.3 Projections for health workforce requirements for the next 10 years
(2019)

Sub-category Existing health Requirement Methods

workforce 2019
(2009/ 2010)
Doctors 26,244 50,072 Pop ratio 1:1400
Dentists 9,926 17,999 Health needs
Dental nurses 4,313 8,298 Health needs
Pharmacists 8,700 15,238 Staffing standard, health
facilities only
Pharmacy assistants 3,441 15,090 Staffing standard, health
facilities only
Nurses 136,447 180,435 Pop ratio 1:400
Public Health 15,090 31,114 Workload
Generalists
Primary Health Workers 22,513 30,566 Workload
Physiotherapists 524 4,561-6,419 Staffing standard
Source: National Human Resources for Health Commission (2010)

27
5. HRH Utilization

5.1 Recruitment

Before 2001, all health workforces were hired as civil servant positions
where recruitment was made centrally, by the Civil Service Commission (CSC).
The employment rule and regulations were applied at all public health facilities.
Health workforce were hired with the civil servant benefit packages, i.e.,
permanent contract, civil servant medical benefit package, career advancement,
opportunity for continuing education, and other fringe benefits. However, the
downsizing policy, implemented in 2001, put a limitation on recruitment of new
staffs as civil servants at all health facilities.

Since 2001 onward, the health workforce is recruited locally by each

health facility and employed as temporary employees. The salary scale has been
developed by the central MoPH, however, it has provided some room for local
discretion. Temporary staff is hired by each facility, and there is no such benefit
packages such as those of civil servants. Therefore, without attractive incentives
like those of civil servants, the turnover rate for temporary staff is very high.

5.2 Deployment and distribution mechanisms

In 2003, MoPH developed a master plan for health workforce,

particularly for facilities under MoPH. A modified population ratio at each
geographical area was used. The population ratio for each professional; doctors,
dentists, dental nurses, pharmacists, nurses, public health generalists,
physiotherapists have been set up by professional groups. Following the
universal coverage scheme implemented in 2001, health workforce distribution
according to population ratio was implemented as such. However, due to the
limitations of the health workforce in the labour market and the public sector
failure to attract and retain the health workforce, the shortage problem
continues to persistent.

5.3 The work environment

The main health workforce problem severely affecting the Thai health
system is the maldistribution of the health workforce. More health workforces
work in urban areas than in rural areas, although the majority of Thais reside in
rural areas. This indicates the inequitable distribution of the health workforce in
relation to geography.

28
Measures to improve work environmental

Ranges of measures that have been implemented to improve the work

environment in order to attract and retain health workforce are summarized
below.

(1) The development of a rural health infrastructure

The development of a rural health infrastructure to support the
functioning of rural health services has been implemented to help distribute and
retain health workers in rural areas. The result has been an increase in rural
health facilities such as health centers and district hospitals. Along with this,
logistic support such as housing, drugs and equipment, transportation and
communication have been provided.

(2) Educational strategies

Increase production: The classic approach to solving the problem of a
shortage of health workers is to increase the production of workers. This
approach has often been used by the government to increase the number of
doctors, nurses and other health workforce as well as to improve the distribution
of such workers. In particular, the approach of rural recruitment, local
training and hometown placement has been used. This strategy was initially
implemented with nurses and primary health workers. Local students are
recruited through their hometown provincial communities and trained at
regional colleges with government scholarship provisions. They are required to
sign a contract to return services for double of the time they spent in the
schools.
Curricula reform: The health workforce production process can
contribute to the attitudes of health workers toward working in rural areas.
Since primary health workers and public health generalists mainly serve rural
areas, their curriculum has been rurally-oriented. Doctor and nursing curricula
have also been developed to include primary health care approaches as well as
serving rural areas.

(3) Compulsory service strategies

All primary health workers and nurses trained by colleges under the
MoPH are required to obtain a government scholarship and to sign a contract
for compulsory public service for 4- 8 years after graduation. Due to a
downsizing policy, this approach was terminated in 2001. In the case of
doctors, this approach was initiated to address a critical shortage of doctors in
rural areas. Since 1972, all doctors have been compelled to serve in rural public
hospitals for 3 years. If they breach their contract, they are required to pay a fine
of 120,000 Baht or USD 3,000 (1997 price). This fine was increased to 200,000

29
Baht or USD 8,000 and 400,000 Baht or USD16,000 in 1971 and 1977,
respectively.

(4) Financial motivation

The difference in pay between the public and private sectors is considered an
important factor for drawing health workers from the public/rural sector to the
private sector, especially for doctors. To cope with internal brain-drain, the
government has used financial incentives to retain doctors and other cadres in
rural areas by increasing the rural hardship allowance for them. The salary of
doctors posted in rural areas increased through the implementations of various
incentives such as the hardship allowance (introduced in 1965), non-private
practice allowance (1995), professional allowance (1997) and pay for overtime
duty (2005). Due to the situations of political conflicts in the 3 south most
provinces resulting in shortages of health workforce in the 3 provinces, ever
since 2005 government has implemented the hardship allowance for health
workforce working there. The high turn over of health workforce from rural
areas during 2005-2007, particular doctors, has prompted the government to
increase financial incentives to all health workforce working in rural in 2008,
the amount of incentive depended on the hardship areas and years in services.

(5) Non-financial motivation

Career Development: To make working in rural areas more attractive to
health workers, career advancement for those who work in such areas has been
introduced for all cadres. For example, district doctors start their career at PC
level 4 and they are promoted to PC level 7 after approximately 8 years of
service and could be at PC level 8 after 12 years of service. All other cadres
working in rural areas have career advancement opportunities as well, although
they are not as high as that of doctors.

Specialist Training/continuing education: There has been an attempt to

provide specialist training as an incentive for doctors working in rural areas as
well as for district hospital development. Experience in rural services is a
prerequisite for residency training programs. A minimum of one year of service
in a rural area is required for most training. Rural doctors fall under a special
quota for specialty training on the condition that they return to a district hospital
afterwards. Though further education opportunities are offered to other cadres,
the opportunities are no different from those provided to those working in urban
areas.
Job substitution: An alternative approach to addressing doctor shortages
is to shift tasks from doctors to other professionals such as nurses and primary
health workers, as long as it does not diminish quality of care. Such job
substitution is seen at the early stages of health system development among
30
doctors, nurses and primary health workers. Appropriate training and technical
supervision is needed with this approach.

(6) Supervision
The supervision mechanisms have been in place, particularly under
MoPH facilities. At sub-district and district level, a district network among
secondary care- community hospital and primary care – health centers, has been
set up at each district. The district health board has been established to oversee
the district health system. Community hospitals, under the district health board,
provide support in relation to financial, health workforce, technical issues, and
medical supplies to health centers. At a higher level, the provincial hospitals
have also served as referral hospitals and provided technical support to
community hospitals.

Staff turnover
Though some mechanisms have been implemented to facilitate the health
workforce distribution, i.e., financial regulation to hire staff, staffing standard
setting for each health facilities; minor changes of the health workforce
distribution have been observed. In general, though some health facilities are
able to hire more staff with their own revenue, lack of attractive benefit
packages to hire temporary employees have resulted in high turnover rate of
temporary employees from the public sector both in urban and rural areas. This
has left many large health facilities struggling with staff shortages.

Rural health facilities were affected most, particularly from doctor

turnover. Although new graduated doctors were posted at rural hospitals each
year, the doctors turning over from community hospitals have added to the
existing shortage problem. The turnover rate trend increased sharply from 2000
to 2003, however, the trend was quite stable after 2004 (Table 5.1).
Interestingly, the turnover rate slightly declined from 11% in 2008 to 9.2% in
2009. One possible explanation was that the MoPH increased financial
incentives for doctors and other health workforce working at rural health
facilities in 2008-9. However, the trend bounced back in 2010, as the financial
increase was not stable due to the shortages of facility revenue.

31
Table 5.1 Turn over from community hospitals of physicians in relation to
physicians working at community hospitals, during 2000-2009

Year Number of Turn over

doctors number %
2000 2,291 114 4.9
2002 2,732 305 11.1
2003 2,885 602 20.9
2004 3,050 242 7.6
2005 3,229 391 12.1
2006 3,523 393 11.1
2007 3,583 376 10.5
2008 3,977 436 11.0
2009 4,439 412 9.2
2010 4,263 544 11.8
Source: MoPH (2010)

5.4 Employment of health workers in the private sector

In general, private sector is more flexible in employment system. The

recruitment system and the benefit packages offered to the health workforce
could be designed at each health facility. Compared to public health facility
employment, private health facility employment is more attractive in terms of
being located in urban areas, offer higher salary, provide better working
conditions. Therefore, the expansion of private facilities unavoidably would
drain health workforce from public, particularly rural areas. Before the
implementation of downsizing policy, in 2001, the civil servant positions
offered to health workforce were attractive and would be able to prevent the
brain drain from public to private sector to some certain degree, particular for
nurses. Hiring as temporary employees is at risk to push the health workforce
out to the private sector.

32
6. Governance for HRH

6.1 HRH policies and plans

Over the past 10 years, some HRH plan and interventions have been put
into actions in order to solve the health workforce problems. It was not only the
MoPH who developed and implemented the interventions/plan; some
interventions were implemented by other partners as follows.

(1) Financial inclusive measure

Before 2000, government budget allocation to health facilities was based
on supply side, where budget was allocated according to the health facility
sizes, types and their resources. The universal coverage scheme implementation
in 2001 has reformed the budget system, with the new budget system allocated
based on the demand side budget system. The new financial system was
allocated on the capitation basis to district and provincial health system where
health workforce salary was included. This approach aims to facilitate the health
workforce distribution and allow the system to decide financial incentives to
attract and retain health workforce, so that equitable distribution of health
workforce would be achieved.

(2) Health workforce master plan and production.

It was not until 2003 that the initiative to develop a health workforce
master plan was put in place. The key measures implemented in the master plan
were that the health workforce requirements have been forecasted, and the
measures to increase the production of doctors, dentists and nurses were
implemented in 2004. To cope with the political conflicts in the 3 southernmost
provinces as well as to solve nursing shortages in the South, the government has
increased the production of an additional 3,000 nurses in 2007 (MoPH 2003).

(3) Alleviation of Financial régulation barriers

The downsizing policy, implemented in 2001, put an effect on the

limitation of the recruitment of new staffs as civil servants. Therefore, health
facilities have to use their own budget to hire new health workforce. To
alleviate financial restrictions, the MoPH has approved the new financial
regulation that provides authority to health facilities to hire new health
workforce. However, the salary scale has been centralized by central
government (MoPH 2001).

33
 (4) National HRH Strategic Plan
HRH requirements are dynamic and greatly depend on the context
changes affecting individual and community health needs. With the health
system becoming more complex and dynamic, the existing HRH policy and
plan, thus, could not fully address the HRH problems. Moreover, lacking of the
national mechanism to guide and direct the HRH policy and strategies and to
collaborate with all stakeholders in order to plan, develop and use the HRH
effectively has made the problem become worse. The solutions for these
complex problems need the involvement from all stakeholders under the explicit
national HRH strategic plan. To achieve these objectives, the national human
resource for health strategic plan was developed to guide the HRH development
over the next 10 years, 2007 – 2016, five strategies have been developed as the
following.

Strategy 1 Establish and develop the mechanism to set up the national human
resources for health policy and strategic plan responsive to the
country health system.
Strategy 2 Reorient the human resources for health production and
development system to produce and develop adequate in number
and skills of HRH who could provide services responsive to people
health needs, health service system and other health-related system
in order to achieve the equity access to services of the people.
Strategy 3 Reorient the HRH management system in order to equitably
distribute, retain, and encourage human resources for health to
work effectively and satisfactory in the organization
Strategy 4 Generate and manage knowledge and link evidence-based
information to HRH policy development, strategic plan,
implementation, monitoring and evaluation.
Strategy 5 Strengthen and empower the roles of Thai indigenous healer,
community health workforce and civil society in order to
strengthen healthy communities.

The HRH strategic plan has been endorsed by the Cabinet-council on

April, 24th, 2007, and a multi-stakeholder, the “National Human Resource for
Health Strategic Plan Commission”, has been set up to guide, mobilise and
monitor the strategic plan. The Plan is the principle strategies in order to
develop the country HRH.

(5) Implement of financial incentive to attract and retain health workforce

in rural areas
Due to the high turnover rate of doctors from rural areas, in 2008, the
MoPH implemented the financial measure to increase monthly allowance to
34
health workforce working in rural areas, particularly doctors. Resulting from
this policy, doctors working in rural areas get monthly incomes at about 29-
62% higher than those who work in urban areas. The allowance has been paid
according to hardship areas and years in service. However, this measure put
large burdens on hospital revenue. In 2011, the measure has been under
revision.

(6) The project of the development of Tambol (sub-district) health

promotion hospitals
Realising the important role of health centres- the primary care health
facilities-, the MoPH has developed and implemented the project on the
development of Tambol Health Promotion Hospitals. This project aims to
strengthen primary care facilities in relation to infrastructure, equipments and
health workforce. Resulting from the policy, the increase of nurses working at
health centres is evident. Other health workforce, such as doctors, dental
nurses, physiotherapists, Thai traditional healers, has also gradually increased in
health centres as part time and full time staff.

6.2 Policy development, planning and managing for HRH

Within MoPH, there are 3 units/organisations working on HRH policy

development and implementations. However, their roles and functions are
fragmented. One small section of the Bureau of Health Policy and Strategy is
responsible for development of the HRH policy and plan. In addition, the
Workforce Development Institute, under MoPH, is responsible for production
of health workforce, whilst the Personnel Division has looked after the
recruitment, resignation and database of HRH. These 3 organizations work
independently. In relation to the plan implementation, these 3 organizations
have put the plan into practice thru regional and local authorities, i.e., provincial
health office, regional training institutes, etc. The Bureau of Health Policy and
Strategy has monitored the HRH situations.

In 2006, in order to solve the HRH problems in such an integrated and

sustainable approach, the MoPH set up a “National Human Resource for Health
Strategic Plan Committee”. The committee members comprise of ranges of
stakeholders: representatives from MoPH, MoU, other Ministries, private
sector, professional councils, and other health-related organizations. To develop
the HRH strategic plan, the full participation from ranges of stakeholders was
assured by several approaches. The HRH strategic plan was endorsed by the
Cabinet-council on April, 24th, 2007. The National strategic plan will serve to
guide the implement direction for the next 10 years, 2007 – 2016, and the multi-
35
stakeholders commission,“National Human Resources for Health Commission”
has been set up as the main mechanism to put forward the HRH strategic plan to
its full implementations.

6.3 Professional Regulation

Each of health workforce cadres in Thailand gather and form

associations, but only professional councils play their role on professional
regulation. There are 6 professional councils: medical, dentist, pharmacist,
nursing, medical technologist, and Physiotherapy councils. As the radiology
technician is not able to established the council, therefore the radiology
technician professional association has performed this function. The councils
play active roles on regulate the quality of care provided by the professionals
thru several mechanism, i.e., registration, licensing and relicensing, approval of
the professional curriculums, support on training and continuing education,
promoting ethical practices, recommendation on health workforce policy, etc.
The licensing approaches for all professions, except nursing councils, are life-
long registration. To obtain licenses, one has to be qualified to test the license
examination and the license would be granted after passing the license
examination. For nursing, the re-licensing takes place every 5 years.

6.4 HRH information

HRH information system is considered as one important aspect of HRH.

It has been mentioned under the strategy “Generate and manage knowledge and
link evidence-based information to HRH policy development, strategic
plan, implementation, monitoring” of the National HRH Strategic Plan (2007-
2016).

However, the existing information system is fragmented. There are

ranges of sources of HRH information. The HRH database of MoPH, for
instance, has been collected by 9 departments of MoPH and 7 professional
councils, and data set is not consistent. Realizing the need to have accurate
HRH information for monitoring, decision making and planning, MoPH, by the
Bureau of Health Policy and Strategies, conducted the facility census annually
where all health facilities are surveyed, and the data then complied, analyzed
and also reported annually. The annual survey does not only consist of HRH
data but all other health resources: number of beds, health equipments,
population, workload, as well.

36
 Moreover, the computerized HRH information system is made available
at the Personnel Department, Office of the Permanent Secretary as well as at
each health facility, supported by the Human Resources for Health Research
and Development Office. In this HRH system, individual data of HRH working
at all MoPH facilities: 9,768 sub-district health centres, 734 community
hospitals, 69 general hospitals and 25 regional hospitals under the Office of the
Permanent Secretary are covered. By this system, the data will be updated
promptly when the individual record changes have made.

The other main source of private facilities is under the Department of

Health Service Support, MoPH- where private health facilities register. The data
comprising health workforce, bed, other health resources are available.

Annually, data from three sources of HRH information: Bureau of Health

Policy and Strategy, Personnel Department and Department of Health Service
Support, are triangulated, and then annual report is made.

6.5 HRH research

The Health System Research Institute and the International Health Policy
Program has jointly established “the Human Resources for Health Research and
Development Office (HRDO). The program started as a pilot project since 2006
and then further developed into a full program in 2009. The sin tax based Thai
Health Promotion Foundation has provided funding support. The goal of the
HRDO is to ensure sustainable capacity that supports “knowledge-based HRH
policies formulation and implementation as well as adequate and timely HRH
information to monitor the HRH situations”

To achieve the goal, the framework for actions of the HRDO was
developed from the stakeholder consultation. Three strategies have been planed,
i.e., evidence-based information to advocate policy, HRH information systems
and HRH capacity building. These strategies were aimed to support the
implementation of the National HRH strategic Plan (2007- 2016), which was
formulated through multi-stakeholders consultations and approved by the
cabinet. The work of HRDO is guided by a steering committee, comprising
HRH experts, policy makers, and representatives from health professions,
chaired by the former Minister of Health. The HRDO provides the main
technical support to the National HRH Development Commission established
by the National Health Commission, chaired by the Prime Minister. So the
evidence generated from this HRDO can be channelled directly to the supreme
political decision.

37
 Its research strategy aims to generate a body of knowledge in line with
HRH challenges at the national as well as sub-national levels. The extensive
stakeholder consultations helped to shape up the policies relevant research
questions. This strategy consisted of 5 themes of researches:

(1) Research on factors affecting HRH

- Impacts of aging care on health workforce. The results showed a
rapid increasing trend in elderly in Thailand, which requires more institutional
and home care. This project also estimates the increasing requirement of health
workforce with appropriate new elderly care skills.
- The impacts of universal coverage on health workforce. This project
analyses the increase in service utilization after the Universal Health Coverage
Scheme in Thailand since 2002, and its effect on the requirement of HRH. It
also assesses several effective measures, which have been implemented in
response to increasing requirement of health workers.
- The changing patient-providers relationship. Changing socio-
economic environment and the increasing out of pocket payment to the private
health facilities have altered the consumer demand for quality health care. The
patient-providers relationship started to move from the more vertical ‘patron-
client’ to the more horizontal and ‘contractual’ type. This change created a
wider gap of the formerly trust-based relationship. However, there are several
success stories in building more ‘trust-based’ communitarian relationship. The
lesson learnt from success case stories were systematically documented and
shared.
- Impact of international trade on HRH. There are more than 2
million foreign patients per year in Thailand. These ‘medical tourists’ have
created an increasing demand for HRH and compete with the increasing
demand from the Universal Health Coverage policy. The competition is serious
among some super-specialists, like neurologists, cardiologists, chemotherapists,
and plastic surgeons. This project reviewed the situation, trend and implications
on HRH. The results served as an essential input to formulate resolution on the
‘medical hub policy’ at the 3rd National Health Assembly in December 2010.

(2) Supply side study.

- The evaluation of the innovative policy on ‘rural (provincial)
recruitment, local training and hometown placement’ under the ‘Collaboration
Project to Increase the Production of Rural Doctors (CPIRD). This aims to
prove the effectiveness of the approach. The results have been successfully used
to develop the policy recommendation to extend the CPIRD program.
- The documentation of the success stories on the collaboration between
health service systems and the education institutes. Some successful cases on
the collaboration between the health service systems and the academic institutes

38
to produce community nurses and public health auxiliaries for the local health
system, supported by the local government, have been documented and shared.

(3) Rural retention

- The cohort study using Discrete Choice Experiment (DCE) to elicit job
preference of doctors and nurses towards rural jobs and to following up to
access the real choice. The results showed that combinations between financial
incentives and non-financial motivations could be effective to attract doctors
and nurses to rural areas.
- The survey of job choice of new graduated doctors and dentists also
confirmed that financial incentives as well as non-financial motivation are of
importance for their choices of jobs.
- The study on new tract of employment to replace civil servant positions
has been carried out. The public sector reform introduced in 2001 resulted in
fewer civil service position and reduction of health workforce entering public
and rural hospitals. A new type of ‘employees’ to the hospitals was established,
using both financial and non-financial incentives. The results showed that
combination of financial and non-financial incentives could help increase new
enrolees to replace civil servant positions. The results have been used to support
policy recommendations to develop attractive employment packages for
temporary employees.

(4) Supportive and management system

- A qualitative study on effective management system. The study has
documented the lessons learnt from cases that successfully retain staff and
increase their job satisfaction. Success cases include those in the private
hospitals, a few public hospitals and one autonomous hospital.

- A cohort study to assess quality of life at workplace and the mobility of

nurses. This study is a long-term work in collaboration with the Nursing
Council. It aims at following up 20,000 nurses, age ranging from 22-70 years
old.

(5) Primary health care and community workforce

- The study on health workforce requirement for primary health care
services. The results have been used for the formulation of requirements and
recommendations to produce, develop and manage primary health care
workforce has been developed.
- The review of the evolution and development of community health
workforce was conducted, and presented at the consultative forum.
Recommendations have been refined.
39
6.6 Stakeholders in HRH

HRH concerns several stakeholders, MoPH and other ministries, private

facilities, professional councils, MoE, consumers and others. Each sector plays
different role concerning health workforce. MoPH has play the roles in health
workforce planning, recruitment, management, as well as production. Other
ministries, such as MoE, Ministry of Interior (MoI), Ministry of Defence and
local administration organizations own health facilities too. MoE, at the same
time, are major sources of health workforce productions, while professional
councils involve in regulating professional practices as well as ensuring
qualified services delivered. Private sector plays prominent roles on both health
care providers and health workforce productions. The roles and relationship of
these stakeholders evolved over time. The following will illustrate the role and
functions of HRH stakeholders.

The Era of solidarity (1940s -1959)

Since early 1940s, in its early phase of development of modern medicine

and HRH, all HRH education institutes were within the Ministry of Public
Health (MoPH). Most graduates were employed into the public health systems.
The Medical University was a ‘Technical Department’ within the MoPH. Thus
the policies for the development of health care infrastructure and HRH planning
and production went hands in hands under the same umbrella.

The Era of independence of HRH educations and professions (1960s

– 1990s)

In 1959, the professional level HRH education institutes were shifted

from the Ministry of Public Health to the Higher Education Ministry. Only
those that produced lower than bachelor degrees and were to be employed by
the MoPH, were still under the MoPH until now. Since then the close
connection between the health professional schools and the health systems
development started to reduce. Furthermore, in 1964, the Medical Profession,
which was under the Medical Registration Act enforced by the MoPH, became
independent under the self-governed ‘Medical Council’ based on the Medical
Profession Act. Later on the independent Nursing Council (1988), the Dental
Council (1993), the Pharmacy Council (1994), the Medical Technology Council
(1999), and the Physiotherapy Council (2002), were established. The MoPH
thus has less and less control or oversight on the HRH education and practice of
the health professionals.

40
 The PHC era: Successful multi-sectoral collaboration during
Primary health care (PHC) (early 1980s – mid 1990s)

During the PHC era in early 1980s, with the strong government policy
towards extensive establishment of rural health infrastructures, including the
rural health centres and the rural district hospitals, there was a huge increase in
HRH requirement. The policy to extensively produce more health professionals
and community health workers necessitated a close collaboration between the
MoPH and the Higher Education Ministry, as well as the National Economic
and Social Development Board (NESDB) and the Civil Service Commission
(CSC). A multi-stakeholder “Medical and Public Health Co-operation
Committee” was set up in 1982 to co-operate between educational sectors and
health sectors with strong secretariat team working at “The Centre for Medical
and Public Health Co-operation”. The Permanent Secretary of the MoPH and
the Higher Education Ministry chaired the committee based on a yearly
alternation. The committee members were from the two sectors together with
the NESDB, the CSC, the Budget Bureau, and the medical and nursing
professional councils. This centre recruited a new generation of leaders,
building up their capacity in HRH planning and management, to serve the
demand from the committee. This mechanism has proved to be very effective
and succeeded in formulation and implementation of a ‘Costed National HRH
Plan’. The plan aimed at massive increase in the production of medical doctors
to the rural areas as well as community health workers to the rural health centers
and district hospitals. At the 4th National Medical Education Conference in
1982, all medical schools committed to produce medical graduates to serve the
rural district hospitals with 4 main characteristics, i.e., to be a good clinician, a
good teacher, a good manager, and finally a good PHC supporter. Massive
increase in rural doctors and community health workers production as well as
recruitment and training of village health volunteers were carried out
successfully, with little opposition from the professional councils. The rural
doctor group was successfully elected into the Medical Council Committee to
ensure that the council would support the PHC movement. All health
professionals and community health worker graduates had to sign a contract to
work for the public sector for a certain period of time, for example three years
in the case of medical doctors. Most of them started their career in the rural
areas with strong public spirits. This collaboration helped successfully
implement the Costed HRH Plan. This success resulted in all rural district
hospital being manned with at least one medical doctor. In 1988, the then Prime
Minister announced that there would be no rural district hospital that has only
one doctor within the next 5 years. The different in the doctor density between
the capital, Bangkok, and the poorest Northeastern region was reduced from
more than 20 times in late 1970s to 8 times in late 1980s.

41
 The Era of rapid economic and private sector growth with
disintegration of HRH education and increasing inequitable distribution
(early 1990s till now).

The rapid economic development (double digits growth in late 1980s to

mid 1990s), and mushrooming of the private medical services, had resulted in
movement of doctors into the urban cities and private sectors. In mid 1990s, 20
rural district hospitals went on without a single medical doctor. The ratio of
doctor density between Bangkok and the Northeastern region increased from 8
times in late the 1980s to 14 times in the mid 1990s.

Due to political reasons, the Committee for Medical and Public Health
Co-operation and the Centre were abolished in 1993. The Medical Council
started to be under the influence of the medical specialists and the private
medical doctors, with more focus on ‘professional interests’.

During 1995-1996, the Health System Research Institute (HSRI) together

with the Health Workforce Development Institute and the Bureau of Health
Policy and Plan, MoPH jointly developed the health workforce researcher
networks and conducted research on health workforce planning and projection
in all health professionals. In 1997, an international HRH Development Journal
(HRDJ) was started in Thailand and after 5 years became the electronic journal
managed by WHO/HQ until now. A local HRH journal was also initiated. These
journals, together with many training workshops aim at building capacity on
HRH research in the MoPH. It has been partially successful at building
individual capacity in the MoPH and some universities.

However, the 1997 economic crisis with strong Public Sector Reform
measures, the influx of foreign patients from the medical tourism policies, the
emergence of the Universal Health Coverage policy in 2002, have shifted the
focus of the health policy leaders towards health economic and health care
financing. Interests in HRH planning and management have been reduced since
then. Meanwhile, some sporadic HRH development proposals to further
increase the production of medical doctors, while upgrading the nursing
education to Bachelor degree only, together with higher financial incentives for
health professionals in the rural areas, have been formulated without any multi-
stakeholders participation.

The current era of renewal of multi-sectoral collaboration under the

2007 National Health Act
In 2005, the Health Systems Research Institutes (HRSI) set up the “HRH
research and development office (HRDO)” funded by the sin-taxed based Thai
Health Promotion Foundation. The HRDO worked closely with stakeholders to
42
develop the ten-year National HRH strategic plan, 2007-2016, and the plan was
approved by the Cabinet in 2007. Under the National HRH strategic plan, the
National HRH Development Committee was set up by the National Health
Commission. It was mandated to guide and steer the implementation of the
National HRH Strategic Plan. The National Health Commission was established
under the new National Health Act 2007, chaired by the Prime Minister. There
are 39 members of the National Health Commission, one-third from the political
sector including ministers of relevant ministries, local governments and also
independent public agencies, one third from the academia and health
professional bodies, and one third from the civil society organizations. Only the
Minister of Public Health represents the MoPH in this National Health
Commission. Thus the National HRH Development Committee can report and
recommend directly to the National Health Commission, chaired by the Prime
Minister and to the cabinet. The members of the National HRH Development
Commission are from the MoPH, the MoE, professional councils, private health
facilities, local administrative organizations, as well as consumers. It is chaired
by the former minister of public health (Dr Mongkol NaSongkla). This
commission plays its role in monitoring and guiding the National HRH
Strategic Plan as well as serving as a forum for full participation from all
stakeholders to develop the plan, monitoring and evaluation in order to develop
HRH system continuously and in line with the country health needs.

Realizing from past experience, a secretariat team comprising HSRI,

M0PH, National Health Commission and HRDO has been set up to support the
evidence-based input as well as facilitate the function of National HRH
Commission. The National HRH Development Committee meets regularly
under the support of the secretariat team. However, due to the rapid increase in
demand of health policy and health systems researchers to cope with the
massive increase in demand from the Universal Health Coverage Scheme, there
was a severe shortage of the capacity to generate adequate evidence on HRH.
Thus the National HRH Development Committee is facing serious information
shortage and capacity to manage. A new program to build up the capacity on
HRH researches and management was started again in 2008. However, it will
take some time to materialize. Thailand also takes the lead to establish a
regional networks of HRH leaders in Asia Pacific, supported by the two
regional offices of WHO (SEARO and WPRO), the Rockefeller Foundation, the
China Medical Board and the World Bank. This Asia Pacific Action Alliance on
HRH (AAAH) has so far convened 6 annual conferences to share their
experiences together with some joint activities like workshop on HRH planning
and workshop. It has also created a website to collect all essential HRH
information in the Asia Pacific region as well as the collection of case stories.

43
 This case tells the story of previous successes, failures and current
challenges on the HRH Development in Thailand in the past 4 decades. The
initial successes in the era of PHC with the massive expansion of rural health
infrastructures and training of health professionals and community health
workers to man these facilities are due to the close collaboration between the
MoPH, MoE, NESDB, CSC, and Budget Bureau as well as professional
councils, under a collaborative mechanism of the ‘Committee for Medical and
Public Health Co-operation’. The committee received strong technical support
from the ‘Center for Medical and Public Health Co-operation’ with strong
capacity for HRH planning, management and researches. Due to rapid economic
growth and mushrooming of the private sector and market driven health
services, the attempt at formulating a costed HRH Plan was considered outdated
and the Committee was abolished together with the Center and the loss of the
capacity. Not until the enactment of the National Health Act in 2007, with the
establishment of the National Health Commission, chaired by the Prime
Minister and the formulation of the National HRH Development Committee,
chaired by the former public health minister, was the HRH Strategic Plan
revitalized. However, the implementation is still a big challenge due to the
inadequate capacity on HRH researches, management and leadership. The
program to rebuild the capacity has just been started and will take some years to
achieve what is targeted. The story provides us the lesson that we do need a
sustainable capacity, individual, institutional, and networks to ensure
sustainable success on the HRH development plan.

44
References

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8. MoPH (2001) Regulation of revenue of health facilities under Ministry of
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15. Nursing and Midwifery Council. (2011). Nursing and Midwifery
Database. The Nursing and Midwifery Council.
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17. Physiotherapy Council. (2011). Physiotherapy Database. The
Physiotherapy Council.
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18. Pongpirul K and Sriratana S (2005) Computerized information system in
hospitals in Thailand: a national survey. Journal of Health Science. 2005;
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46
Annex 1: Classification of health workforce of the WHO South-East Asia
Region

The health workforce of the WHO South-East Asia Region is grouped

into the following 10 categories:

1. Medical practitioners
Includes general practitioners, medical specialists and medical assistants.

2. Dental practitioners
Includes dentists, dental specialists and dental technicians (e.g. dental
assistants, dental hygienists, dental nurses).

3. Pharmacy practitioners
Includes pharmacists, pharmaceutical technicians/assistants (e.g. pharmacy
assistants, pharmaceutical technicians).

4. Nursing and midwifery practitioners

Includes nursing professionals, midwifery professionals, nursing-midwifery
professionals, nursing specialists, midwifery specialists, nursing associate
professionals (e.g. public health midwives, community midwives, assistant
midwives, community-based skilled birth attendants), and nursing-
midwifery associate professionals (e.g. auxiliary nurse-midwives).

5. Non-medical public health practitioners

Includes public health generalists, public health, specialists, food and
nutrition professionals (e.g. nutritionists, food science specialist, dieticians),
environmental and occupational health professions (e.g. environmental
health officer, sanitarians, occupational health officers), environmental and
occupational health inspectors and associates (e.g. public health inspectors,
food inspectors), community health workers (e.g. basic health workers,
family welfare assistants, family welfare visitors, health assistants, lady
health visitors), and community health volunteers.

6. Medical technologists
Includes medical imaging technicians (e.g. radiographers, mammographers),
medical technologists (e.g. medical laboratory technicians, blood bank
technicians), laboratory assistants (e.g. medical laboratory assistants,
assistant radiographers, assistant blood bank technician), and biomedical
technologists (e.g. medical equipment technicians, medical equipment
engineers, biomedical technologist, biomedical engineers).

47
7. Traditional medicine practitioners
Includes traditional medicine practitioners (e.g. Ayurvedic Practitioner,
Homeopath, Koryo Medicine Practitioners, Unani Practitioners.

8. Veterinarian practitioners (working for human health aspects)

Includes veterinary public health specialists, and veterinary technicians.

9. Other health workers

Includes a large number of health workers such as optometrists,
physiotherapists, physiotherapy assistants, occupational therapists,
occupational therapy assistant, and other health professional and health
associate professionals not elsewhere classified.

10. Health management and support staff

Includes a large number of non-health professional workers such as health
service managers, medical records technicians, health statisticians, clerical,
accounting and other general support staff (e.g. ward clerks, medical
secretary, medical store keepers).

48
 Annex 2: Health workforce classification mapping of the WHO South-East Asia Region
(Note: Code for each sub-category as per International Standard Classification of Occupations’ code)
Category Sub-category Definition based on
(Code) educational qualification
Medical General Professionals with
Practitioners Practitioner minimum of 4 years of
(2211) university education in the
field of medicine with
minimum of 1 year
internship.
Medical Medical doctors with
Specialists minimum of 1 year of
(2212) postgraduate education/
training.
They are recognized as
specialists by a national
regulatory body (such as
medical council).
Scope of work Examples of designations
Preventing, diagnosing, caring for and treating illness, General Medical Practitioners,
disease and injury in humans and the maintenance of Medical Doctors, Physicians.
general health.
They do not limit their practice to certain disease
categories or methods of treatment, and may assume
responsibility for the provision of continuing and
comprehensive medical care.
They may supervise the implementation of care and
treatment plans by other health care providers, and
conduct medical education and research activities.
Preventing, diagnosing, caring for and treating illness, Anesthesiologists,
disease and injury in humans using specialised testing, Cardiologists, Community
diagnostic, medical, surgical, physical and medicine specialists, Critical
psychological techniques. care medicine specialists,
They specialise in certain disease categories, types of Dermatologists, Emergency
patient or methods of treatment, and may conduct medicine specialists,
medical education and research activities in their Endocrinologists, Family
chosen areas of specialisation. medicine physicians/
specialists,
They may supervise the implementation of care and
Gastroenterologists, Geriatric
treatment plans by other health care providers.
medicine specialists,
Haematologists, Hepatologists,
Infectious disease specialists,
Medical examiners, Medical
49
 Category Sub-category Definition based on Scope of work Examples of designations
(Code) educational qualification
oncologists, Neonatologists,
Nephrologists, Neurologists,
Nuclear medicine specialists,
Obstetric-Gynecologists,
Occupational medicine
specialists, Orthopedic
surgeons, Otolaryngologists
(ear, nose, and throat
specialists), Pathologist,
Pediatrician, Perinatologist,
Preventive and social
medicine/Public health
specialists, Psychiatrists,
Radiation oncologists,
Radiologists, Rheumatologists,
Sports medicine specialists,
Surgeons, Urologists.
Medical Assistants to the medical Perform basic clinical and administrative tasks to Medical Assistants.
Assistants doctors with minimum of 3 support patient care under the direct supervision of, or
(3256) years of accredited as per plan, practices and procedures established by a
education/training in medical practitioner or other health professional.
medical assistant.
Dental Dentists Professionals with Diagnosing, treating and preventing diseases, injuries Dentists.
Practitioners (2261) minimum of 4 years of and abnormalities of the teeth, mouth, jaws and
accredited university associated tissues to promote and restore oral health.
education leading to a
dentistry degree.

50
 Category Sub-category Definition based on
(Code) educational qualification
Dental Dentist with accredited
Specialists post-graduate degree in
(2261) dental specialty.
They are recognized as
specialists by a national
regulatory body (such as
dental council).
Dental Assistants to dentists with
Technicians minimum of 1 year of
(3251) training in dental skills.
Pharmacy Pharmacists Professionals with
practitioners (2262) minimum of 4 years
university education in
pharmacy and internship.
Pharmaceutical Assistants to pharmacists
technicians/ with minimum of 1 year of
assistants accredited education in
(3213) pharmacy assistant or
technician.
Nursing and Nursing Professionals with
Midwifery professionals minimum of 3 years of
Scope of work Examples of designations
Diagnosing, treating and preventing diseases, injuries Endodontists, Oral and
and abnormalities of the teeth, mouth, jaws and maxillo-facial surgeons,
associated tissues where the complexity of a condition Orthodontists, Paedodontists,
requires specialised diagnostic, surgical and other Periodontists, Prosthodontists.
techniques to promote and restore oral health.
They usually practise in their specialized field only.
Provide basic dental care services for the prevention Dental Assistants, Dental
and treatment of diseases and disorders of the teeth and Hygienists, Dental Nurses.
mouth, as per care plans and procedures established by
a dentist or other oral health professional.
Store, preserve, compound, test and dispense medicinal Pharmacists.
products.
They counsel on the proper use and adverse effects of
drugs and medicines following prescriptions issued by
medical doctors and other health professionals.
They contribute to researching, preparing, prescribing
and monitoring medicinal therapies for optimising
human health.
Perform routine tasks associated with preparing and Pharmacy Assistants,
dispensing medicinal products under the supervision of Pharmaceutical Technicians
a pharmacist or other health professional.
Plan, manage, provide and evaluate nursing care Professional Nurses, Staff
services for persons in need of such care due to effects Nurses, Public Health Nurses,
51
 Category Sub-category Definition based on
(Code) educational qualification
practitioners (2221) accredited education in the
field of nursing.
Midwifery Professionals with
Professionals minimum of 3 years of
(2222) accredited education in the
field of midwifery.
Nursing- Professionals with
Midwifery minimum of 3 years of
Professionals accredited education in the
(2221 & field of nursing and
2222) midwifery or nursing
professionals having 6
months - 1 year of
accredited post-basic
education in the field of
midwifery.
Scope of work Examples of designations
of illness, injury, or other physical or mental Community Health Nurses.
impairment, or potential risks for health.
They work autonomously or in teams with medical
doctors and other health workers.
They may supervise the implementation of nursing care
plans, and conduct nursing education activities.
Plan, manage, provide and evaluate midwifery care Professional Midwives.
services before, during and after pregnancy and
childbirth and newborn care.
They provide normal delivery care for reducing health
risks to women and newborns, working autonomously
or in teams with other health care providers.
They may supervise the implementation of midwifery
care plans, and conduct midwifery education activities.
Plan, manage, provide and evaluate (1) nursing care General Nurse-Midwives,
services for persons in need of such care due to effects Professional Nurse-Midwives.
of illness, injury, or other physical or mental
impairment, or potential risks for health and (2)
midwifery care services before, during and after
pregnancy and childbirth, including normal delivery,
and newborn care.
They work autonomously or in teams with medical
doctors and other health workers.
They may supervise the implementation of nursing-
midwifery care plans, and conduct nursing-midwifery
education activities.
52
Category Sub-category Definition based on
(Code) educational qualification
Nursing Nursing Professionals with
Specialists minimum of 1 year of
(2221) accredited post-basic
training/education in any
specialty in nursing (e.g.
pediatric, neonatal, cardiac
nursing, etc).
They are recognized as
specialists by a national
regulatory body (such as
nursing council).
Midwifery Midwifery Professionals
Specialists with minimum of 1 year of
(2222) accredited post-basic
training/education in
advanced midwifery.
They are recognized as
specialists by a national
regulatory body (such as
midwifery council or
nursing and midwifery
council).
Nursing Practitioners with
Associate minimum of 18 months of
professionals accredited education in the
Scope of work Examples of designations
Plan, manage, provide and evaluate specialized nursing Clinical Nurse Specialists,
care services for persons in need of such care due to Advanced Practice Nurses,
effects of illness, injury, or other physical or mental Nurse Practitioners.
impairment, or potential risks for health.
They specialise in certain nursing specialty and may
conduct nursing education and research activities in
their chosen areas of specialisation.
They work autonomously or in teams with medical
doctors and other health workers.
They may conduct midwifery education activities and
provide consultation to other nursing practitioners.
Plan, manage, provide and evaluate midwifery care Advanced Practice Midwives,
services before, during and after pregnancy and Midwife Practitioners.
childbirth and newborn care where complexity of
conditions/situations required advanced knowledge and
skills in midwifery.
They provide normal delivery care as well as perform
selected life-saving interventions for reducing health
risks to women and newborns, working autonomously
or in teams with other health care providers.
They may conduct education and research activities in
midwifery and provide consultation to other midwifery
practitioners.
Provide basic nursing care for people who are in need Practical Nurses.
of such care due to effects of illness, injury, or other
physical or mental impairment.
53
Category Sub-category Definition based on
(Code) educational qualification
(3221) field of nursing.
Practitioners with 6 months
- 1 year of
education/training in the
field of nursing.
Midwifery Practitioners with 18
Associate months – 2 years of
professionals accredited education in the
(3222) field of midwifery.
Practitioners with 6 months
of accredited midwifery
education.
Nursing- Practitioners with
Midwifery minimum of 18 months of
Associate accredited education in the
professionals field of nursing and
Scope of work Examples of designations
They implement care and referral plans as per plans,
practice and procedures established by nursing and
other health professionals.
Assist in providing routine patient care services as per Assistant Nurses, Nurse Aids.
care plans, practices and procedures established by
nursing and other health professionals.
Provide basic midwifery care and advise before, during Public Health Midwives,
and after pregnancy and childbirth and newborn care. Community Midwives.
They implement care and referral plans, including
normal delivery, to reduce health risks to women and
newborns as per plans, practice and procedures
established by midwifery and other health
professionals.
Assist in providing basic midwifery care and advise Assistant Midwives,
before, during and after pregnancy and childbirth and Community-based Skilled
newborn care. Birth Attendants.
They implement care and referral plans, including
assisting in normal delivery, to reduce health risks to
women and newborns as per plans, practice and
procedures established by midwifery and other health
professionals.
Provide basic nursing care for people who are in need Auxiliary Nurse-Midwives.
of such care due to effects of illness, injury, or other
physical or mental impairment as well as provide basic
midwifery care and advise before, during and after
pregnancy and childbirth, including normal delivery,
54
 Category Sub-category Definition based on Scope of work Examples of designations
(Code) educational qualification
(3221 & 3222) midwifery. and newborn care.
They implement care and referral plans as per plans,
practice and procedures established by nursing,
midwifery and other health professionals.
Non-Medical Public Health Non-medical professionals Plan, manage, provide and evaluate basic public health Public Health Officer, Public
Public Health Generalists with university education services for disease prevention and promotion of Health Technical Officer.
Practitioners (2263) in public health bachelor’s population health.
degree. They manage environments to reduce health risks of the
community.
Public Health Non-medical public health Plan, manage, provide and evaluate specialized public Epidemiologists, Health
Specialists professionals with post- health interventions in their area of specialization for Educators, Health Promotion
(2263) graduate degree in public disease prevention, promotion of population health, and Officer/specialists,
health specialties (e.g. minimize health risks of the community. Biostatisticians.
epidemiology, entomology,
health economics, health
statistics, health education
etc).
Food and Professionals with Plan, manage, provide and evaluate various dietary Nutritionists, Food Science
Nutrition minimum of 3 years of interventions, clinical and/or public health nutrition specialists, Dieticians.
Professionals university education in programmes, food safety, food technology or food
(2265) nutrition/dietetics. toxicology programmes.
Environmental Professionals with Plan, assess and investigate the implementation of Environmental Health Officer,
and minimum of 3 years of programs and regulations to monitor and control Sanitarians, Occupational
Occupational university education in environmental factors that can potentially affect human Health officer.
Health environmental and/or health, to ensure safe and healthy working conditions,
Professionals occupational health. and to ensure the safety of processes for the production

55
 Category Sub-category Definition based on Scope of work Examples of designations
(Code) educational qualification
(2263) of goods and services.

Environment Practitioners with Plan, assess and investigate the implementation of Public Health Inspectors, Food
and minimum of 2 years programmes and regulations to monitor and control inspectors.
occupational training in public health or environmental factors that can potentially affect water,
health related fields. sanitation, food hygiene, food safety; and carry out
inspectors and disease investigation and prevention.
associates
(3257)
Community Practitioners, not elsewhere Provide health education, referral and follow-up, case Family Welfare Assistants,
Health workers classified, work at the management, and basic preventive health care and Family Welfare Visitors, Lady
(3253) district level and below in home visiting services to specific communities. Health Visitors, Health
the health system with They provide support and assistance to individuals and Assistants, Basic Health
formal education of 6-18 families in navigating the health and social services Workers,
months. system.
Community People chosen by the Provide health education and assist individuals, Community health volunteers,
Health community and trained to families in the communities accessing health care Public Health Communicators,
Volunteers deal with health problems services. Public Health Volunteers,
(3253) of individuals and the Village Health Volunteers.
community.
Medical Medical Practitioners with Test and operate radiographic, ultrasound and other Radiographers,
Technologists Imaging minimum of 2 years of medical imaging equipment to produce images of body Mammographers.
Technicians education in medical structures for the diagnosis and treatment of injury,
(3211) technology, radiology or a disease and other impairments.
related field.

56
 Category Sub-category Definition based on
(Code) educational qualification
Medical Practitioners with
Technicians minimum of 2 years of
(3212) accredited
education/training in
medical technology or
related field.
Laboratory Assistants to medical
Assistants technicians with minimum
(3212) of 1 year of accredited
training in any health
technicians’ course. (e.g.
laboratory, radiology, etc.).
Biomedical Practitioners with
technologists minimum of 2 years of
(3211) education in the field of
bio-medical engineering or
a related field.
Traditional Traditional Practitioners recognized in
Medicine Medicine indigenous system of
Practitioner Practitioners medicine (Homeopathic/
(2230) Oriental Medicine
/Complementary Medicine)
with minimum of 4 years
education leading to a
degree + 1 year internship
Scope of work Examples of designations
Perform tests on environmental and human specimens Medical Laboratory
of body fluids and tissues in order to get information Technicians, Blood Bank
about the disease epidemiology and / or health of a Technicians.
patient or cause of disease/death.
Assist in non-invasive diagnostic/screening procedures Medical Laboratory Assistants,
(radiographic, ultrasound, other imaging procedures) or Assistant Radiographers,
perform/assist in conduct of tests on environmental and Assistant Blood Bank
human specimens of body fluids and tissues in order to Technician
get information about the disease epidemiology and / or
health of a patient or cause of disease/death as per plan,
practices and procedures established by medical
technology and other health professionals.
Service, maintain and repair radiographic, ultrasound, Medical Equipment
laboratory and other medical equipment. Technicians, Medical
Equipment Engineers,
Biomedical technologist,
Biomedical Engineers.
Apply procedures and practices based on the theories, Ayurvedic Practitioners, Unani
beliefs and experiences indigenous to different cultures, Practitioners, Homeopath,
used in the maintenance of health and in the prevention Koryo medicine practitioners.
or treatment of physical and mental illnesses.
57
 Category Sub-category Definition based on Scope of work Examples of designations
(Code) educational qualification
Veterinary Veterinary Veterinary doctors Preventing, diagnosing and controlling zoonoses, food Veterinary Public Health
practitioners Public Health (professionals with at least borne illnesses and intoxications. Specialists, Veterinary
(working for Specialists 4.5 years of university Providing expert opinion as a team member in outbreak Epidemiologists.
human health (2250) education in the field of investigation of emerging diseases/zoonoses at the
aspects) veterinary medicine + human animal interface.
internship) with minimum They may assume responsibility for food safety.
1 year of post-graduate
education on epidemiology/
veterinary public health.
Veterinary Assistants to veterinarians Assist in performing basic veterinary tasks to support Veterinary Technicians,
technicians with minimum 1 year of laboratory animal management and zoonoses control Veterinary Assistants
and assistants education in animal under the direct supervision of, or as per plan, practices
(3240) science. and procedures established by a veterinary doctor or
other health professional.
Other Health Optometrists Practitioners with Provide primary eye health and vision care services. Optometrists, Ophthalmic
Workers (2267) minimum of 2 years They provide diagnosis management and treatment Technicians.
education in the field of services for disorders of the eyes and visual system.
optometry Dispensing opticians design, fit and dispense optical
lenses for the correction of reduced visual acuity.
Physiotherapist Practitioners with Provide physical therapeutic treatments to patients in Physiotherapists, Physical
s minimum of 2 years of circumstances where functional movement is Therapists.
(2264) education in physiotherapy. threatened by injury, disease or impairment.
They may apply movement, ultrasound, heating, laser
and other techniques.
Physiotherapy Assistants to Provide basic physical therapeutic treatments to Physiotherapy Assistants.
Assistants physiotherapists with patients as per plan, practices and procedures

58
Category Sub-category Definition based on Scope of work Examples of designations
(Code) educational qualification
(3255) minimum of 1 year of established by physiotherapy and other health
education in physiotherapy. professionals
Occupational Practitioners with Provide occupational therapeutic treatments to patients Occupational Therapists.
Therapists minimum of 2 years of to improve their ability to perform tasks in their daily
(2269) education in occupational living and working environments.
therapy. They work with individuals who have conditions that
are mentally, physically, developmentally, socially or
emotionally disabling.
They also help them to develop, recover, or maintain
daily living and work skills.
Occupational Assistants to occupational Provide basic occupational therapeutic treatments to Occupational Therapy
Therapy therapists with minimum of patients as per plan, practices and procedures Assistant.
Assistant 1 year of education in established by occupational therapy and other health
(2269) occupational therapy. professionals.
Other health To be defined by countries To be defined by countries as per country context. To be defined by countries as
professionals as per country context. per country context.
not elsewhere
classified
(2269)
Other health To be defined by countries To be defined by countries as per country context. To be defined by countries as
associate as per country context. per country context.
professionals
not elsewhere
classified
(3259)

59
 Category Sub-category Definition based on Scope of work Examples of designations
(Code) educational qualification
Health Health Service Non-medical professionals Plan, coordinate and supervise the provision of clinical, District Health Officer.
management Manager with minimum of 2 years personal care and community health care services.
and support (1342) education in health service
staff management.
Medical Practitioners with Assess, manage and implement health records Medical Records Technicians,
Records minimum of 1 year of processing, storage and retrieval systems in medical Health Statisticians.
Technicians education in health facilities and other health care settings to meet the
(3252) information and/or medical legal, professional, ethical and administrative records-
records. keeping requirements of health services delivery.
Support staff Clerical, accounting, and This category may include a wide range of occupations Ward Clerks, Medical
other support staff. connected with health service provision. Secretary, Medical Store
Keeper.

60
 Annex 3: Health workforce classification mapping of Thailand
Category Definition based on
educational qualification
Doctors Professionals with 6 years
of university education in
the field of medicine with 1
year internship.
Dentists Professionals 6 years of
accredited university
education leading to a
dentistry degree.
Dental nurses Assistants to dentists with 2 Provide basic dental care services for the prevention
year of training in dental
skills.
Pharmacists Professionals with 5-6
years university education
Scope of work Examples of
designations
Preventing, diagnosing, caring for and treating illness, Physicians, doctors
disease and injury in humans and the maintenance of
general health.
They do not limit their practice to certain disease
categories or methods of treatment, and may assume
responsibility for the provision of continuing and
comprehensive medical care.
They may supervise the implementation of care and
treatment plans by other health care providers, and
conduct medical education and research activities.
Diagnosing, treating and preventing diseases, injuries Dentists.
and abnormalities of the teeth, mouth, jaws and
associated tissues to promote and restore oral health.
Dental Nurses.
and treatment of diseases and disorders of the teeth
and mouth, as per care plans and procedures
established by a dentist or other oral health
professional.
Store, preserve, compound, test and dispense Pharmacists
medicinal products.
61
 Category Definition based on Scope of work Examples of
educational qualification designations
in pharmacy and internship. They counsel on the proper use and adverse effects of
drugs and medicines following prescriptions issued by
medical doctors and other health professionals.
They contribute to researching, preparing, prescribing
and monitoring medicinal therapies for optimising
human health.
Pharmacy Assistants to pharmacists Perform routine tasks associated with preparing and Pharmacy Assistants,
Technicians with 2 year of accredited dispensing medicinal products under the supervision Pharmacy Technicians
education in pharmacy of a pharmacist or other health professional.
assistant or technician.
Registered nurses Professionals 4 years of Plan, manage, provide and evaluate nursing care Registered Nurses, Staff
accredited education in the services for persons in need of such care due to Nurses
field of nursing. effects of illness, injury, or other physical or mental
impairment, or potential risks for health.
They work autonomously or in teams with medical
doctors and other health workers.
They may supervise the implementation of nursing
care plans, and conduct nursing education activities.
Public Health Non-medical professionals Plan, manage, provide and evaluate basic public Public Health
Generalists with 4 years of university health services for disease prevention and promotion generalists, Public
(2263) education in public health of population health. Health Technical
bachelor’s degree. They manage environments to reduce health risks of Officer.

62
 Category Definition based on
educational qualification
Primary health Non-medical professionals
workers with 2 years training in
(3257) public health or related
fields.
Medical Professionals with 4 of
technologists university education in
medical technology or
related field.
Medical Assistants to medical
technologist technologists with 2 year of
Assistants accredited training in
laboratory
Physiotherapists Professionals with 4 years
of university education in
physiotherapy.
Scope of work Examples of
designations
the community.
Plan, assess and investigate the implementation of Primary health workers,
programmes and regulations to monitor and control community health
environmental factors that can potentially affect workers.
water, sanitation, food hygiene, food safety; and carry
out disease investigation and prevention. They could
be able to provide basic treatment.
Perform tests on environmental and human specimens Medical technologists
of body fluids and tissues in order to get information
about the disease epidemiology and / or health of a
patient or cause of disease/death.
Assist in non-invasive diagnostic/screening Medical technologist
procedures or perform/assist in conduct of tests on Assistants
environmental and human specimens of body fluids
and tissues in order to get information about the
disease epidemiology and / or health of a patient or
cause of disease/death as per plan, practices and
procedures established by medical technology and
other health professionals.
Provide physical therapeutic treatments to patients in Physiotherapists
circumstances where functional movement is
threatened by injury, disease or impairment.
They may apply movement, ultrasound, heating, laser
63
 Category Definition based on Scope of work Examples of
educational qualification designations
and other techniques.
Physiotherapy Assistants to Provide basic physical therapeutic treatments to Physiotherapy
Assistants physiotherapists with 2 patients as per plan, practices and procedures Assistants.
year of education in established by physiotherapy and other health
physiotherapy. professionals
Radiology Professionals with 4years Test and operate radiographic, ultrasound and others Radiology Technicians
Technicians of university education in to produce images of body structures for the diagnosis
radiology or a related field. and treatment of injury, disease and other
impairments.
Radiology Assistants to medical Assist in non-invasive diagnostic/screening Radiology Technician
Technician radiologist with 2 year of procedures (radiographic) or perform/assist in Assistants
Assistants accredited training in conduct of radiographic in order to get information
Radiology about the disease epidemiology and / or health of a
patient or cause of disease/death as per plan, practices
and procedures established by medical technology
and other health professionals

64
Annex 4: Health workforce by cadres and population ratios at national level

Category 2009 2010

Number HW/1000 Number HW/1000
population population
Doctors 21,569 0.33 26,244 0.41
Dentists 9,926 0.16 11,847 0.19
Dental nurses 4,250 0.06 5,375 0.08
Pharmacists 8,390 0.13 8,700 0.13
Registered nurses 109,797 1.7 138,710 2.15
Public Health Officers 27,372 0.43 37,774 0.59
Medical Technologists 2,859 0.04 2,696 0.04
Medical technologist assistants 3,121 0.04 2,717 0.04
Physiotherapist 1,248 0.01 1,499 0.02
Physiotherapist Assistants 385 0.006 337 0.005

65
Annex 5: Health workforce status

% % % % %
Cadre Total women Urban Rural Public Private
Doctors 26,244 41 82.1 17.9 82.1 17.9
Dentists 9,926 67 80.5 19.5 47.4 52.6
Pharmacists 8,700 66 62.1 37.9 82.4 17.6
Nurses 136,447 NA 60.7 39.3 89.7 10.3
Medical technologists 11,751 70 NA NA NA NA
Physiotherapists 524 81 NA NA NA NA
Public Health Generalists 22,158 NA 4.4 95.6 NA NA
Note:
NA = Not available

Urban health workforce = All health workers working in cities, municipalities, and district centres/head
offices (including those health workers in other sectors outside health ministries).
Rural health workforce = All health workers working outside cities, municipalities, and district centres/head offices
(including those health workers in other sectors outside health ministries).

66
ANNEX 6: Members of the taskforce

Name Position/title Organization Contact address

Dr. Nonglak Pagaiya Manager Human Resources for International Health Policy
Health Research and Program, Minstry of Public
Development Office Health, Tiwanond Rd,
Muang , Nonthaburi 11000
Dr. Phusit prakongsai Director International Health International Health Policy
Policy Program, Program, Minstry of Public
Health, Tiwanond Rd,
Muang , Nonthaburi 11000
Ms. Nichakorn Head of Human Bureau of Health Minstry of Public Health,
Sirikanokwilai Resources for Health Policy and Strategy Tiwanond Rd, Muang ,
Section Nonthaburi 11000
Dr. Krisada Researcher International Health International Health Policy
Sawaengdee Policy Program, Program, Minstry of Public
Health, Tiwanond Rd,
Muang , Nonthaburi 11000
Dr. Tipicha Researcher Office of the National Office of the National
Posayajinda Health Commission Health Commission,
Tiwanond Rd, Muang ,
Nonthaburi 11000
Ms. Sanya Sriratana Research Co- Human Resources for International Health Policy
ordinator Health Research and Program, Minstry of Public
Development Office Health, Tiwanond Rd,
Muang , Nonthaburi 11000
Mr. Krisada Research Assistant Human Resources for International Health Policy
Wongwinyu Health Research and Program, Minstry of Public
Development Office Health, Tiwanond Rd,
Muang , Nonthaburi 11000

67