Equity of access to and utilization of reproductive health services in Thailand: national Reproductive Health Survey data, 2006 and 2009.

This study assessed trends in equity of access to reproductive health services and service utilization in terms of coverage of family planning, antenatal care and skilled birth attendance in Thailand. Two health indicators were measured: the prevalence of low birthweight and exclusive breastfeeding. Equity was measured against the combined urban-rural areas and geographic regions, women's education level and quintiles of household assets index. The study used data from two nationally representative household surveys, the 2006 and 2009 Reproductive Health Surveys. Very high coverage of family planning (79.6%), universal antenatal care (98.9%) and skilled birth attendance (99.7%), with very small socioeconomic and geographic disparities, were observed. The public sector played a dominant role in maternity care (90.9% of all deliveries in 2009). The private sector also had a role among the higher educated, wealthier women living in urban areas. Public sector facilities, followed by drug stores, were a major supplier of contraception, which had a high use rate. High coverage and low inequity were the result of extensive investment in the health system by successive governments, in particular primary health care at district and sub-district levels, reaching universality by 2002. While maintaining these achievements, methodological improvements in measuring low birthweight and exclusive breastfeeding for future reproductive health surveys are recommended.

Economic analysis of the diabetes and hypertension screening collaboration between community pharmacies and a Thai government primary care unit.

AIMS: To evaluate models for collaboration between community pharmacies and a government primary care unit (PCU) in carrying out a screening program for diabetes and hypertension. METHODS: An action research was undertaken and a screening and referring protocol developed. Study sites were two community pharmacies (Model 1) and footpaths/streets and seven communities (Model 2) under supervision of PCU in the city of Maha Sarakham Province, Thailand. The Combined Model consisted of Models 1 and 2. Those eligible were aged 40 years and over, not known to have diabetes or hypertension. Activity based costing of three models was analyzed from the provider perspective. RESULTS: The study involved 456 people during July-September 2007; 11 out of 51 attending pharmacies (21.6%) and 27 out of 405 attending the communities (6.6%) met criteria for referral to PCU for confirmatory diagnosis. Only six attended the PCU. Two of 456 (0.4%) were confirmed the diagnosis having hypertension, one was referred from a pharmacy (2%, 1/51) the other from a community (0.2%, 1/405). Model unit costs were US$ 11.2, 4.3 and 5.1 per screened person, respectively. CONCLUSIONS: The results indicate a working model can identify people in the community requiring treatment of hypertension or diabetes. Pharmacy-based screening was more costly, but the success rate for referral was higher compared with a community-based service. More effort is needed to ensure referred patients attend the PCU.