Abstract
Thailand’s Historical Development of TBs Control by DOTs(Directly Observed Therapy, Short-course)The DOTS (Directly Observed Treatment, Short-course is one of the alternatives considered most efficient and supported by most international health organisations including WHO. The DOTs are composed of processes of patient identification, diagnosis, short-course medication, directly observed treatment, management for drug sufficiency, quality control in lab, training and supervision, situation adjustment and public commitment for TB control. DOT is one of these potentially performed by health officials, health volunteers, community leaders and family members. Training for the DOT was started since 1996 in Thailand. In the end of 1998, 299 districts (34.1%) had the DOT program which was problematic in quality due to a number of people performing the program without being trained. The most observers were family members (47.6% - 100%). The supervision by provincial and district tuberculosis coordinators was irregular resulting in poor evaluation which was likely to assess quantity preferable to quality of the program. The patients who were registered between October 1995 and January 1998 were randomly sampled for sputum testing in every 4 months showing negative result in percentage of 79.65, 80.1%, 80.0%, 73.4% and 77.6% respectively. Problems of running the DOTs program in Thailand were lack of concern in people at policy administrative level, lack of interests in people who were potential to be effective observers leading to low number of people attending training course, shortage of coordination and supervision at all levels to support the DOTs, and lack of effective information system. This paper recommends establishment of research network to increase positive impact on policy direction and to develop models suitable for particular areas.
