Doctors' roles in primary health care.

Doctors in developing countries where the majority of the population live in rural areas are facing difficult adjustments of their roles to attain health for all of the rural population. In Thailand, doctors directing remote district hospitals act as the focal points of other health care facilities serving the entire population of the districts. To supplement the existing governmental health service network and in accordance with principles of primary health care, community primary health care volunteers are being developed to expand service coverage to rural communities. These lead to changes in doctors' roles. Doctors are required to be not only competent clinicians but also good managers of health promotive and preventive programmes, effective hospital administrators, competent trainers and qualified researchers. They must not only work within the hospital but also support the health personnel and activities of the entire district, and in particular the community primary health care workers. However, as it is now, they are graduates of traditional medical schools, whose educational programmes do not equip them adequately for their emerging new roles in rural hospitals. Reorientation of the existing health system, including its health personnel, is needed. The critical factor in such a process is the development of appropriate attitudes at all levels of health services. This is a difficult but challenging task, as it involves long established medical institutions which hold firmly to old traditions and values.