MPH/HSMP 2007-2008 : Central assignment: my problem statement

The problem that I submited to coach for analising and making the solution before being coaching by coach.

                 Health problem: High turn-over rate and insufficiency of doctors and health care workers in Tak province

                 Background           

                  There are 19 regional health areas in Thailand now, Each area has 4-10 provinces. Ministry of Public Health (MOPH) is responsibility to authorize all of areas and Provincial Health Office is responsibility to authorize all public health services.           

                 Tak province is in 2^nd regional health area. It has the second largest area in Northern of Thailand. There are hills, mountains and a longest Thai-Myanmar boarder for 560 kms in length. There are 500,000 Thai people with a lot of hill-tribe people. There are 200,000 migrants, both legal and illegal. There are 3 temporary shelters for 100,000 displaced persons. Tak is divided to 2 different areas by geographical features, 4 districts in East, 5 districts in West along to Thai-Myanmar border.            

                    Health care services, There are 2 general hospitals, 310 beds with 26 doctors in Muang district, 320 beds with 34 doctors in Maesot district and 6 community hospitals, 2 sixty beds hospitals with 5 doctors in each hospital , 4 thirty beds hospitals with 4,4,55 doctors in each hospital. In Sub-district level, There are 9 District Health Offices authorizing 115 health centers. NHSO provides budget by Universal program per capita especially registered population.            

                      There are a lot of health problems, both in Thai and Non-Thai people. There are insufficiency of doctor in community hospital with high workload that make them high turn-over rate. There are scarce of some specialists in regional hospital such as surgeon, anesthetist, medical physician.  There are 1-5 health care workers in health center, and no health care worker in some health center. Length of service of doctors in community hospital is usually 1-3 years.

Causes:

1.    Remote and rural area, Thai-Myanmar boarder

2.    Motivation: salary, personal growth, career path

3.    High workload with difficult in working, culture, language, insufficient resources

4.    Low modernization of city, low economic area for private clinic

Approach to management:

A.   Quantitative : Increase Number of doctors & Health care worker

1.    Recruitment : University & MOPH hospital & School & Community college collaboration

2.    Retain by motivation : salary, career path, training, social welfare

3.    Post-graduate training: On the job training, Rural Medicine training

4.    Public-private mix health service: doctors in private clinics & hospital collaboration in services, NHSO’s budgeting support

B.   Qualitative : Increase capability of Health care worker

1.    Increase capability of health care worker to be gate keeping & primary care in Health center by implement Family Medicine concepts

2.    Increase potentiality of Health center to be gate keeper3.    Setting appropriate referral system between Health center & Hospital.

4.    Setting collaboration for Outpatient care between private clinics & public hospital with appropriately, effective, efficient budgeting system.

C.   Decrease workload in Curative care that suffering doctors & Health care worker

1.    Improve capability of Village health volunteer to Primary health care.

2.    Increase responsibility & competency of population to take care of themselves.

3.    Balancing between accessibility & patient responsibility to improve their health by Co-payment system.