Chapter I

1. Walt, G., Community Health Workers: Policy and Practice in National Programmes. A review with selected annotations. London 1988. pp. 1-2.

2. Brudon, P., Global Action Towards Rational Drug Use, In: Arundel, A. et al. (edit), Primary Health Care and Drugs: Global Action Towards Rational Use. Proceedings of a conference held in Bielefeld, Germany, September 21-23 1990. BUKO/HAI. Bielefeld 1990. pg 101.

3. Walt, G 1988; 8-9.

4. Jamroon, M. (edit), Report on The Evaluation of The First Decade Of Primary Health Care in Thailand (1978-1987). Office of The Primary Health Care Committee, Ministry of Public Health. Bangkok 1991. pp 23,25.

5. Office of the Primary Health Care Committee (OPHCC). Village Drug Fund in The Primary Health Care Programme. Ministry of Public Health. Bangkok 1989. pg 47.

6. Office of the Primary Health Care Committee (OPHCC). The Evaluation of Village Drug Funds Project. Ministry of Public Health. Bangkok 1993. pg 3.

7. See, for example, Thavitong H. et al., Alternative to Primary Health Care Volunteers in Thailand. Center for Health Policy Studies, Mahidol University. Nakornprathom. 1988.; Panittha, P., A report on Village Drug Fund Evaluation. Khonkan University Khonkan 1988.; and Luechai S., Community Participation in Village Drug Fund: A Survey Study. Unpublished M.A. Thesis. Mahidol University. Bangkok 1987.

8. Suvit V., Drug System in Thailand, unpublished report. Food and Drug Administration. Ministry of Public Health. Bangkok 1994. pp 5-6.

9. Suvit 1994: 10.

Chapter II

1. Jamroon 1991:23,25

2. Jamroon 1991: 22.

3. Jamroon 1991: 86,89; The Ministry of Public Health, Guidelines of Health Development Towards Health For All. Bangkok 1992. pp 23-27.

4. Heggenhougen, K. et al., Community Health Workers: the Tanzanian experience. Oxford University Press. New York 1987. pg 154.

5. Jamroon 1991: 52.

6. Jamroon 1991: 16.

7. Jamroon 1991; 71-72.

8. Jamroon 1991: 71.

9. Jamroon 1991:71.

10. This model has been implemented nation-wide since the beginning of the national PHC programme. Yet it was later gradually changed when the problem of high drop-out rate and inactiveness of the majority of VHCs became apparent. The changes seemed to begin at the implementation level in the training of new VHVs and VHCs in some provinces. In those cases, the number of VHC to be recruited were reduced to a level that implies that a certain number of active VHCs can be assured at all times. In some areas, Only VHVs were trained, no more VHCs were recruited. In the present 7th National Health Plan, under the programme “The Promotion of Community Center for Primary Health Care” (CCPHC), about five VHVs or VHCs are suggested by the MoPH to be involved in the CCPHC in each village.

11. The MoPH considered it the most appropriate method to recruit the VHCs. Yet, in reality, it was rarely practiced. The important reason was that it took time and could not guarantee that the villager who was chosen through, this technique would be the right person or a suitable health communicator. Furthermore, many villagers were not willing to be the VHC after being chosen. It, therefore, was quite usual that the tambon health officials or, sometimes, the community leaders themselves recruited the VHV or VHCs without any participation from the villagers. Also see Thavitong 1988: 62

12. Jamroon 1991: 73.

13. The Primary Health Care Committee Office, The Manual for VHV/VHC Training. Bangkok. ND.

14. Jamroon 1991: 73-74.

15. Tantisirintr et al 1986; Sudsukh 1984; Nutrition Division 1987, cited in Thavitong 1988: 45.

16. Thavitong 1988: 52.

17. Thavitong 1988: 68.

18. Thavitong 1988: 51.

19. Thavitong 1988: 76-80.

20. The MoPH 1992: 27-28.

21. The Primary Health Care Committee Office, Village Drug Fund in The Primary Health Care Programme. Bangkok 1989, p 47.

22. The Primary Health Care Committee Office, 1989: 28

23. “Household drugs” are a group of drugs that the MoPH classifies as common drugs and can be sold over the counter. The former MoPH’s list of household drugs contained 63 drugs but has been presently reduced to 42 drugs (see Annex 2), Almost all these drugs are produced by the Government Pharmaceutical Organization (GPO), Household drugs are also promoted as drugs for primary health care by the MoPH, The Primary Health Care. Committee Office. The Consumer’s Right Protection in PHC Programme: Problems and Solutions. Bangkok 1992, pp 166-170.

24. The MoPH will supply drugs only once per VDF during the setting up period.

25. MoPH 1992: 27-28.

26. The Primary Health Care Committee Office 1989: 32

27. Sec Panittha 1988; Luechai 1987.

28. The operational definition of functioning VDF used by the MoPH is quite loose i.e. a functional VDF is one that has at least five household drugs; has sale volume 100-200 Bahts/month; and has a continuous drugs supply. See MoPH 1992: 42.

29. Note that a functional VDF was operationally defined in this survey simply as on-going drug dispensing and replenishing activities. Yet about 10% of these functional VDFs did not dispense or sell any drugs within the last four weeks (about two-third or 21 VDFs in Chumporn and Songkla). If this had been taken into account, the effective retention rate would have been lower. On the whole it could be said that with the exception of Chumporn and Songkla, the VDF retention rates from the two different sources of data are quite comparable. It could be concluded that only approximately 43% of the Village Drug Funds ever set up in the whole country was still functional in 1992. The MoPH figure of 78% was apparently too high.

30. An example of such policy is the VDF, once being set up, it could not collapse. It has to exist because it belonged to the government. This kind of perception was found among the VHVs, village leaders and the tambon health officers in some areas which, then, forced them to try to keep the VDFs functioning, no matter how.

31. The other community-based PHC funds promoted by the MoPH are: 1) Nutrition Fund; 2) Sanitation Fund; and 3) Health Card Fund. Besides, there are also village funds promoted by other ministries i.e. ministry of Interior, These funds are normally set up separately and have often difficulty in surviving.

32. The MoPH 1992: 27-28; The Primary Health Care Committee Office, The PHC Policy in The 7th National Health Development Plan (1992-1996). Bangkok 1992, pp 15-18.

Chapter III

1. The total number of drug items (drug range) in each individual village was drawn from the number of drugs of the grocery with the largest number of drugs (measured by counting brand names or/and registration numbers) in that village. This range was assumed to cover all brand names of drugs available in that village. Drugs with the same formulation are supposed to have the same brand name. Yet, in practice, it was quite usual to come across drugs with different formulations having the same brand name. In this case, drugs with the same brand name but under different formulations (which can be checked by their registration code) were counted as different ones.

2. Drugs items here are the total, aggregated number of brand names of drugs found in all villages.

3. Prescription drugs are classified according to the MoPH categorization.

4. Over the Counter Drugs (OTC Drugs) here comprise household drugs which are mostly produced by the Government Pharmaceutical Organisation and other common drugs classified by the MoPH as non-prescription drugs or as ready-packed drugs.

5. Analgesics & antipyretics 29.4%, antibiotics 1.3%, anticough & cold 20.5%, antacid & anti-ulcer 13.9%, antidiarrhoeals 0.3%, vitamin 3.7%, other common drugs 30.8%.

6. Analgesics & antipyretics 5.2%, anti-inflammatory 11.3%, antibiotics 54.9%, antidiarrhoeals 11.1%, vitamin 2.3%, “Ya-Chud” 9.7%, other 5.4%.

Chapter IV

1. Pain killers or “Ya-Song” are also perceived as having a universal effect so they can be used for many reasons. During the FGDs it was quite usual to hear stories about how or why pain killers were used. People in the villages use pain killers in many ways for many purposes ranging from getting relief from headache, body pain and fatigue, toothache, diarrhoea, reducing side effect of drunkenness, reducing irritable temper, to helping to be able to work around the clock. Some villagers use the paper from the pain killers packets to roll a cigarette as they believed that it will make it stronger. In fact, pain killers have become an essential and integral part of the daily life of many villagers, also sec Luechai S. et al., Socio-Cultural Aspects of Pain Killers Use: A case study of Thailand. Paper presented at the First International Conference on Social and Cultural aspects of Pharmaceutical, Woudchoten, Zeist, The Netherlands. 17-21 October 1991.