Evolution of primary health care in Thailand: what policies worked?

Thailand has a long history of primary health care (PHC) developmentwhich started before the Declaration of Alma Ata in 1978. TheNational PHC programme was implemented nation-wide as part ofthe Fourth National Health Development Plan (1977–1981)focusing on the training of ‘grass-root’ PHC workersconsisting of village health communicators and village healthvolunteers. Since then PHC has evolved through many innovativehealth activities: community organization, community self-financingand management, the restructuring of the health system and multisectoralco-ordination. Many of the essential elements of PHC have beenachieved. Improvements in the nutritional status of childrenunder five households accessiblity to clean water, immunizationcoverage, and the availablity of essential drugs have been observed.PHC has been successful in Thailand because of community involvementin health, collaboration between govermment and non-govermmentorganizations, the integration of the PHC programme, the decentralizationof planning and management, intersectors collaboration at operationallevels, resource allocation in favour of PHC, the managementand continuous supervision of the PHC programme from the nationaldown to the district level, and the horizontal teaining of villagersto villagers.