Abstract
Development of Pharmacy Vision for Health System ReformObjectives: The major objectives of the project are:To brainstorm from pharmacy-related group, their thoughts and to synthesize as vision of the new national health system;To synthesize the new role of pharmacist that can drive the new national health system; and To show an initiative of a new drug system for national health system reform.MethodologySample and sampling technique Both pharmacists and non-pharmacists from several sectors are invited to participate in the meetings. They are opinion leader and are stakeholders in the system, and (for non-pharmacists) have been interacted with pharmacists before. They are drug store owners, non-governmental organizations (NGOs), physicians, nurses, journalists, community leaders, as well as the general public. Samples are selected by judgemental sampling by the investigators. Representatives are from all four regions, the north, northeast, south, and central. Altogether, the ratio of pharmacists to non-pharmacists is 2.17 to 1 (152 to 70, with a ratio of 36:7 (5.14:1), 29:12 (2.42:1), 20:11 (1.82:1), 28:23 (1.22:1), and 39:17 (2.29:1) for the central, north, northeast, south, and combined 4-region, respectively.Data collection Five meetings of brainstorming are held, each in the central, north, northeast, south, and the last one, the combined 4-region, during 28 April and July 8, 2000. The places are Nakorn Pathom, Chiang Mai, Udorn Thani, Songkhla, and Kanchanaburi Province respectively. Future Search Conference (FSC) technique, a participatory method for mutual learning, is used as a means to get information from the participants. Except for the meeting at Udorn Thani for the northeast region, where the Appreciation, Influence, Control (AIC) technique is used.Health System SummaryThinking process and health problemsThe general publicAre dependent on physicians'services and drugs, not self-sufficient,Are influenced by western way of life which impacted upon all aspects of Thai society, economics, politics, social, as well as cultural. Evidences are the changing health behavior such as eating fast food and not taking good care of personal health.Are not aware of consumer’s right. An example is being passive when consulting with physicians.Health personnel such as physician, pharmacistFocus on treating a disease, not the person who is sick.Lack a holistic approach in treating patients, as well as lack of a team approach.Emphasize treatment rather than prevention and health promotion,Health becomes a business enterprise,Based on western thinking process, local wisdom on health and drug are neglected,Lack of professional ethics.Management systemInefficiency, particularly the centralized government bureaucracy.Under political influence.Inaccessibility to services among the population.Lack of health insurance for the general public as well as inequity to services.Pharmacy Vision for the New Thai Health SystemFour different aspects of vision will be discussed: policy, services, personnel and management system.Policy. Priorities are: change in paradigm of all parties involved, health participation among the general public, decentralization of power, self-reliance by going back to community wisdom and heritage, and promote consumer’s right.Services. Included are: quality assurance for consumer protection and improve quality of life, health promotion and prevention rather than treatment, optimization of health information among the population, community involvement is services provision, and a network of health services to all the people.Personnel. Characteristics of health personnel are: public service, patient-focused care, holistic approach with bio-psychosocial and spiritual dimension, quality service, team-work, equitable distribution of personnel throughout the country, and professional ethics.Management system. The new system should: have universal health coverage with equity and efficiency, be an efficient drug system with a strong research and development foundations on community wisdom, be accountable, and with strong community development approach.Strategies for pharmacy toward health system reformProfessional organization. A multidisciplinary professional organization should be established with the obligations to: policy development, promote multidisciplinary research of health service, promote the multidisciplinary health approach to the population, and serve as a center for public grievance.Pharmacy personnel. Future pharmacists should possess the following characteristics: have value system based on eastern culture, be a knowledgeable pharmacist with professional ethics, competent in practice skills, and act as a team of primary care provider in community health services.A community health insurance fund. This is a community insurance scheme, funded by and for community with the goal to health provision to members. Participation from the community in setting up the policy as well as operation decision is essential. Primary missions are health promotion and prevention. Services for the members are purchased from health providers such as drug stores, traditional medicine, etc.Drug system. The new system should: be an integrated system among eastern and western philosophy, focus on research and development for self-reliance (such as herbal medicine), have standard quality assurance. Also needed is an effective and accountable drug distribution system, promotion of rational and cost-effective drug utilization, a health information network accessible by the public,, and promotion of pharmacist as primary care provider.
