Abstract
This research aimed to comprehend the concepts, practices and judgment on mechanisms of health system reform movement and impacts of the past and present health system reform mechanisms by studying perception and expectation of people concerning the reform process, the outcomes, participation and role of people. The study also intended to determine the development trend and formation of various groups and agencies involving in health system reform process. The qualitative research method was employed. Study population included people attending health assembly forums and people who lived in Phayao, Nan and Chiang Mai provinces in the North of Thailand during October 2003 – March 2004. The main findings of this study are as follows: 1. Most people still held on the biomedical model of health that emphasized on physical health mainly illnesses and diseases. Few people gave other health concepts that linked to other dimensions such as occupation and socio-economic aspects. Even among health personnel, they seemed to have no clear concepts and judgment on health in the new paradigm of “holistic health”. The so-called holistic health was just a discourse commonly used among people without obvious explanation. 2. People’s concepts and judgment of health still affixed to physical and mental health and absence of disease. This reflected the practices on health promotion and medical care that also concerned mainly physical health. People continued to perceive that health promotion was an approach to prevent themselves from getting diseases and was responsible solely by doctor or health personnel. It was evident that health care and health promotion activities depended on activities of health personnel. 3. The symbol of health was still the “hospital or doctor”. Health care was a matter of explanation in relation to the conventional structure of health service system such as hospitals and health centers. People or even health personnel still could not elucidate how school, temple or other organizations in a community could help build the health and how people can promote their health. 4. There was a disparity of perception among samples with different education levels. Most of subjects who took part in health assembly forums could explain the reform process better than other groups. Subjects who did not directly participate in the forum mostly did not know or were not aware of the reform process. Although some subjects mentioned that they had heard about the process, but they could not describe its definition or meaning. Most people noticed the ongoing changes through the development of health care facilities in the community in forms of building extension, sophisticated equipment, and presence of specialized doctors. 5. Activities and formation of groups, besides actions taken by health personnel, for example, livelihood, income and well-beings, were perceived as matters not related to health. Health personnel mostly initiated health campaigns during health system reform movement. These included groups or clubs connected to health centers like an exercise group, an herb group, and an elderly group whom people could not interpret as health or holistic health issues and as results of health system reform. 6. Health system reform process or movement in community level did not sufficiently stress on learning process. Exercise groups, which were set up almost everywhere, were promoted as activities without the promotion of learning process. This did not stimulate people to modify their thoughts on health care satisfactorily. The promotion of various job clusters was not linked to learning process in health as well. 7. People partially involved in health system process particularly in cooperation, policy acknowledgement and implementation. The involvements in lesser extent were participation in thinking, initiating, and making decision by people themselves. Concepts and beliefs of most people still stuck to conventional thoughts that those who were skillful of health care were exclusively health personnel whom people placed their trust on and ready to follow suit. It was perceived that the major role of health movement propulsion belonged to health personnel and health volunteers. Community leaders or tambon administration organization committees also regarded health as a separated issue from other modes of development. In performing the health system reform policy implementation, the learning process must be integrated to the developmental activities. The lessons learned will thus be the analytic thinking exercise. Health promotion needs the new paradigm of health that connects all dimensions of health particularly the spiritual aspect. Shifting of health paradigm among health personnel is needed in the development of understanding in health system reform process among villagers, groups, local agencies including health personnel itself. The research should also focus on the learning process of civic sector.
