Relevant changes
Improvements in health infrastructure
Investment in health infrastructure resulted in substantial expansion of public health facilities to rural areas, where full geographical coverage with such facilities was reached well before UHC was achieved. In 2010 there were 9758 health centres in the 7255 subdistricts; 731 district hospitals in the 801 districts; and 68 provincial and 25 regional hospitals in the 76 provinces outside Bangkok. Some provincial hospitals were located in large districts.
Infrastructural improvement was followed by securement of a larger health workforce. The number of physicians increased from 8000 in 1985 to 35 000 in 2009 – a fourfold increase in 24 years. A 3.3-fold increase in nurses was noted during the same period.
Medical schools outside Bangkok have increased their production capacity over the last decade.
In addition, nursing schools have increased in number from 39 in 1976 to 80 in 2009. Notably, private nursing colleges increased from 3 to 21 over this period and all of them were accredited by the Thai Nursing and Midwifery Council.
15,16
In addition to an increase in thenumber of graduates, there has alsobeen improvement in worker distribution. In 1979 there was one doctor foevery 1210 residents of Bangkok, whilein the north-eastern part of Thailandthere was one doctor for every 25 713residents. This 21-fold difference wareduced to a 5-fold difference in 2009.Over the same period, the gap in thenumber of nurses between Bangkok andthe north-eastern part of the countrywas reduced from 18-fold to 3-fold.
According to survey data, graduaterecruited through special tracks (theCPIRD and the ODOD programme)had 10 to 15% higher chances of complying with their three-year mandatoryservice than those recruited throughthe normal track.
They also showedlonger retention in rural district hospitals. It was noted that 80% and 16%of CPIRD graduates were still servingin such hospitals after three and