Abstract
This qualitative study aimed to identify people's concepts, values, perceptions, practices, expectations on health, health system reform process and its effects on people. It also focused on the formation of people involvement and participatory mechanism in health system reform process in the Northeast of Thailand. There were 2 phases of data collection, First, was during the Northeast People Health Assembly on Breaking the Impasse!, from Chemical Agriculture towards Alternative Agriculture of the Northeast, organized in Sakolnakorn. Second phase focused on people health assembly networks and general population in Sakolnakorn, Mahasarakham and Nongboulumpu. Key informants were, people organizations, people, people assembly regional coordinators, governments officers and NGOs. Document reviews, in-depth interviews, focus group discussion and observation were applied for data collection. The Information from various sources was undergone content analysis.The results revealed that, people had different concepts on health. People who did not or seldom participated in any people health assembly viewed health as an absent of disease, physically fit and could continue their work. Those who involved in people health assembly defined health in a wider aspect as, the state of well being not only physical but also psychological, conscious, spiritual as well as environment and life style which is similar with those identified by coordinators and NGos. People who did not involve in the process thought health is individual responsibility, whereas those who involved suggested that it should be a share responsibility of individual, community as well as government and other sectors. It was found that people health assembly had effects on people perception on health, however it was limited within those who continuously involved in the process. People attentions were on alternative (organic) agriculture, organic fertilizer, people rights protection, environmental development, traditional life style, and herbs. They linked the issues with the Health Bill, which hoped to be the main mechanism in creating a system, which would facilitate good health of the people. People were not familiar and understand some terms used in the health assembly and health system reform process, since they were new and rather academic. The common terms used were health, spiritual, holistic health, health system reform, health assembly, Health Bill, vision, health strategy, focusing on health promotion not curative and quality care at hand. People involved in health assembly in various meetings of groups, organizations, and networks. Agendas in the meetings were based on community problems. They shared information, brain stormed for appropriate strategies in problem solving in the assembly especially on alternative agriculture, environment, local wisdom, traditional medicines and supports for the Health Bill. Most of the groups and networks were formed before the initiation of the health system reform process such as the forest protection groups, herbal groups. After joining the health assembly they could relate their activities with health and develop activities on health. They strengthen their groups by leading and participation of members, identifying problems and strategies in solving them, as well as requested for outside financial supports. Groups and networks, which formed after the health system reform process, were mostly exercise and consumer groups. There were loosely integrated, they just joined activities but not involved in identifying problems or strategies. Some of them join the process from being directly told or invitation letters by coordinators or organizers. People who continuously joined or followed the process had similar concepts with the health system reform and had insight on holistic health. Those who never or seldom joined the process had different perceptions. They could not relate health determinants, some perceived that exercise was the only method of health promotion. People main concern was how to make health, health assembly and health system reform widely known to the public.
