Thailand : attainable targets / by Sawat Ramaboot

Primary Health Care Thailand: attainable targets D n Thailand diarrhoea! diseases are the leading cause of sick-ness and death. The problem is especially severe in children aged under five, who account for about 40 per cent of all cases and about 50 per cent of all deaths due to diarrhoea. Thailand's national control of diar- rhoea! disease programme began in October 1980. lt had as its targets a substantial reduction in mortality from acute diarrhoea! diseases through ORT by way of the primary health care approach, and reduced morbidity by promoting better nutritional and ma- ternal and child health practices and safer water supply and sanitation. The government's Pharmaceutical Organization produces 750-millilitre packets of ORS to W HO formula specifications. These are purchased by the Department of Communic- able Diseases and distributed to all W oRLD HEALTH, April 1986 by Sawat Ramaboot health facilities and to village health volunteers through the provincial health offices . Some villages have their own drug cooperatives run by village committees or by volunteers. where people can also buy ORS and other essential drugs. Two years ago, the health authorities began promoting early treatment with locally available fluids mixed at home. W HO and UNI CEF are helping to supply training materials in the Thai language for health staff at all levels, to familiarise them with clinical and programme management. The vol- unteers themselves receive training as providers of ORS and as dis- seminators of health information. Village drug cooperatives in Thailand stock and sell ORS packets. Photos WHO/S. Ramaboot Since 1983, more and more mes- sages reach the public through the mass media, especially television and radio. Most hospitals are able to screen slide sets and video cas- settes about ORT and diarrhoea prevention while the mothers sit in the waiting rooms . Between 1981 and 1984, the proportion of the population under five years of age with access to ORT has risen from 12 per cent to about 60 per cent . In areas where the programme is fully developed, the use rate of ORS in the same group has gone up from 12 per cent to 30 per cent. Throughout Thailand as a whole, the use rate in children under five suffering from diarrhoea is about 18 per cent. According to the Division of Epidemiology in Bangkok, the mor- tality rate from diarrhoea in these young children between 1981 and 1983 fell from 4.97 per 100,000 to 2.35 - a reduction of 53 per cent. Surprisingly, in 1984 the mortality rate increased from the previous year while the morbidity rate de- creased. One reason may be that most non-severe cases can be self- managed by ORT, while more sev- ere cases are detected and referred by the village health volunteers and other health workers, and this re- sults in a higher number of deaths being reported at the health facilities. Some problems still exist. particu- larly as regards health education of the public and professional resist- ance to the new concepts of diar- rhoea management. But given the continuing good cooperation with concerned institutions. the targets of reduced mortality and morbidity are expected to be achieved within the next five years . • 23