What has Thailand done to improve health?
The analysis of how Thailand achieved good maternal and child health
outcomes sought to link the improvements to a range of specific interventions
that have been undertaken over the years. Table 7.3 lists 25 interventions that
are effective in addressing nine major causes of under-5 mortalitya and are generally
viewed as critical for child survival32, as well as desirable for the survival of
mothers. Table 7.3 presents an assessment of current coverage levels based on
interviews with a maternal and child health programme expert (a clinician in a
teaching hospital). Most interventions have high coverage, except for exclusive
breastfeeding at six months, which was 5.3% in 2006, and antenatal steroids to
prevent premature labour, which is in the scaling-up phase. There were no policies
regarding the use of zinc to prevent diarrhoea, or antibiotics for premature
rupture of membranes.
All interventions were fully integrated into primary health care networks and
were implemented through district health systems. A typical district health
system consists of 10–12 health centres, each covering 5000 people, and a
district hospital covering 50 000 people. District health systems integrate maternal
health, covering antenatal care, pregnancy, childbirth and early neonatal care,
and family planning; and child health programmes, including immunization
and well-baby clinics37.
Nurses and public health workers are the backbone of rural health systems; they
are multipurpose and are well trained to serve the community in particular
public health functions, such as health promotion services, preventive services,
and other community-based health services such as school health and home
visits. Some professional nurses have one-year post-service training as anaesthetic
nurses and conduct local and general anaesthesia in district hospitals, including
for caesarean sections and other obstetric emergencies.
Nurses in district hospitals also provide the first antenatal care visit, which
requires laboratory screening with consultation backup by general doctors (not
obstetricians) for high-risk pregnancies, such as women with diabetes, a history
of preterm labour and hypertension. Subsequent antenatal care visits are mostly
managed by health centres. Nurses in district hospitals are also trained to provide
counselling for HIV/AIDS in pregnancy, offering advice about prevention of
mother-to-child transmission. Nurses are responsible for normal uncomplicated
deliveries, while complicated cases are referred to general doctors in district
hospitals or to provincial hospitals where obstetricians are available.