The history of medical institutions in Thailand starts with the establishment of the Department of Public Health under the Ministry of the Interior in 1918. The responsibilities of the Department expanded and in 1942 the Ministry of Public Health was formed. The control of many infectious diseases in Thailand was enabled by several subsequent factors: the advent of more advanced medical knowledge about the causes of diseases, the principles of epidemiology and the acknowledgement of the importance of sanitation combined with new medical technology and the geographic expansion of health facilities.

Reflecting the changes in disease pattern and new priorities, the new Village Health and Sanitation Project was implemented in 1960. This project targeted maladies such as dysentery, typhoid, gastroenteritis and parasite infections.

Today the emphasis in Thai public health care is on prevention rather than cure. The concept of Primary Health Care Services now includes programmes for maternal and child welfare, school health service, nutrition promotion, environmental sanitation, mental health and lately also the prevention and control of HIV-infection.

The public health services in the rural areas are structured as shown on the organizational chart below:

(World Health Organization, 1988, DAP/88.5)

Available information on human resources for health is incomplete. The table below summarizes what is known:

Source: Ministry of Public Health, Thailand, 1990.

(World Health Organization 1993: 189)

In 1977 a new and expanded primary health care programme was initiated in Thailand. This programme included the training of village health workers to provide first aid, treat common diseases and manage a village health fund which provides essential drugs such as paracetamol, oral rehydration salts and chloroquine in areas with malaria. According to Nitayarumphong (quoted in Le Grand et al. 1989), 98.4% of all villages were covered by village health workers (Le Grand et al. 1993: 1024). There was one government health centre for every 10 villages and 1 hospital for every 100 villages (ibid: 1024). But only 27.1% of the public health expenditures were in 1989 spent on primary health care (World Health Organization 1993: 189). In 1983 the health expenditure was 4.6% of the Gross National Product (GNP) and the 1985 per capita expenditure on health was US$ 38 of which US$ 26 were paid directly by the consumer and US$ 12 were financed through taxes etc. (World Health Organization 1988: 35). In 1988 the health expenditure was 5.7% of the Gross National Product (World Health Organization 1993: 184).

In 1991 the second evaluation of the global strategy for health for all by the year 2000 indicated that the per capita GNP had grown to US$ 1,065.8 (equivalent of 26,645 baht). The maternal mortality was down to 0.2/1000 births. Safe water was accessible to 78.3% of the rural population and 73.7% had some form of sanitation. Immunization rates overall were:

(World Health Organization 1993: 184)

As mentioned before the number of health care facilities have expanded significantly. A report based on data from 1981 indicated that there were a total of 4,728 health centres in Thailand (Pejaranonda and Santipaporn 1991); while another report based on data from 1993 states that there are now 7,880 health centres in the country. Furthermore, there are 604 community hospitals (10-90 beds) at the district level and 72 general hospitals. In addition, there are 15 regional hospitals at the provincial level (World Health Organization 1993: 187). In spite of this, the overall population coverage in terms of local health services (defined as access to essential drugs⁶ is only 59% (ibid: 184)).

⁶ Defined as availability of affordable and safe drugs within one hour of walking.