Department of Health, Ministry of Public Health, 88/22 Tiwanon Rd, Amphoe Mueang, Nonthaburi, 11000, Thailand.
International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.
Health Res Policy Syst. 2021 Nov 27;19(1):139. doi: 10.1186/s12961-021-00791-1.
In response to an increased health burden from non-communicable diseases (NCDs), primary health care (PHC) is effective platform to support NCDs prevention and control. This study aims to assess Thailand's PHC capacity in providing NCDs services, identify enabling factors and challenges and provide policy recommendations for improvement.
This cross-sectional mixed-method study was conducted between October 2019 and May 2020. Two provinces, one rich and one poor, were randomly selected and then a city and rural district from each province were randomly selected. From these 4 sites in the 2 provinces, all 56 PHC centres responded to a self-administrative questionnaire survey on their capacities and practices related to NCDs. A total of 79 participants from Provincial and District Health Offices, provincial and district hospitals, and PHC centres who are involved with NCDs participated in focus group discussions or in-depth interviews.
Strong health infrastructure, competent staff (however not with increased workload), essential medicines and secured budget boost PHC capacity to address NCDs prevention, control, case management, referral and rehabilitation. Community engagement through village health volunteers improves NCDs awareness, supports enrolment in screening and raises adherence to interventions. Village health volunteers, the crucial link between the health system and the community, are key in supporting health promotion and NCDs prevention and control. Collaboration between provincial and district hospitals in providing resources and technical support enhance the capacity of PHC centres to provide NCDs services. However, inconsistent national policy directions and uncertainty related to key performance indicators hamper progress in NCDs management at the operational level. The dynamic of urbanization and socialization, especially living in obesogenic environments, is one of the greatest challenges for dealing with NCDs.
PHC centres play a vital role in NCDs prevention and control. Adequate human and financial resources and policy guidance are required to improve PHC performance in managing NCDs. Implementing best buy measures at national level provides synergies for NCDS control at PHC level.
为应对非传染性疾病（NCDs）带来的日益加重的健康负担，初级卫生保健（PHC）是支持 NCD 预防和控制的有效平台。本研究旨在评估泰国提供 NCD 服务的 PHC 能力，确定促进因素和挑战，并提出改善的政策建议。
本横断面混合方法研究于 2019 年 10 月至 2020 年 5 月进行。随机选择两个省，一个富裕，一个贫穷，然后从每个省随机选择一个城市和一个农村地区。在这两个省的 4 个地点，所有 56 个 PHC 中心都对与 NCD 相关的能力和实践情况进行了自我管理问卷调查。来自省和地区卫生办公室、省和地区医院以及参与 NCD 工作的 PHC 中心的 79 名参与者参加了焦点小组讨论或深入访谈。
强大的卫生基础设施、有能力的工作人员（尽管工作量没有增加）、基本药物和有保障的预算提高了 PHC 预防、控制、病例管理、转诊和康复的能力。通过乡村卫生志愿者进行社区参与提高了 NCD 意识，支持参加筛查，并提高了对干预措施的依从性。乡村卫生志愿者是连接卫生系统和社区的关键环节，是支持健康促进和 NCD 预防和控制的关键。省和地区医院之间在提供资源和技术支持方面的合作提高了 PHC 中心提供 NCD 服务的能力。然而，国家政策方向不一致以及关键绩效指标的不确定性，阻碍了 NCD 管理在业务层面的进展。城市化和社会化的动态，特别是生活在致肥胖环境中，是应对 NCD 的最大挑战之一。
PHC 中心在 NCD 预防和控制中发挥着重要作用。需要足够的人力和财力资源以及政策指导，以提高 PHC 在管理 NCD 方面的绩效。在国家层面实施最佳购买措施为 PHC 层面的 NCD 控制提供协同作用。
