Abstract
Objective: To synthesize lessons learned from the existing community-based health interventions
for vulnerable populations in Thai contexts in order to create policy recommendations for further health
systems development and response to health needs of vulnerable populations. Methods: This study utilized
qualitative study design to investigate and compare community-based health interventions for vulnerable
populations in eight district health systems (DHS) of Thailand, including Umphang, Ubolratana,
Dan Sai, Khon Buri, Kuchinarai, Lam Sonthi, Kong Rha, and Khlong Khlung. Qualitative data were collected
from the local practitioners by semi-structured interviews, focus-group interviews, and non-participant
observations, and were synthesized by thematic content analysis. Results: Content analysis reveals
four emerging themes. First, sense-making of the vulnerable population concept was challenging
for practitioners in Thai contexts. Second, effective community interventions for vulnerable populations
were initiated by local practitioners, not from policy and planning at the national level. Third, effectiveness
of community interventions for vulnerable populations depends on services design being customized
to the nature of vulnerability. Lastly, traits of local leadership, not authority, are necessary for creating
and implementing sustainable community-based health interventions for vulnerable populations.
Discussions: Despite no mutual understanding of the vulnerable population concept in Thai contexts,
we found strong evidence of innovative community-based health interventions in Thailand. To
scale up such programs, policymakers should create criteria to help practitioners identify vulnerable populations
in their contexts, allow for contextualizing health needs of different vulnerable populations, and
put more emphasis on developing information systems at both the national and the local level, so there
will be more systematic monitoring and evaluation of community-based health interventions for vulnerable
populations in Thailand.
