Abstract
This research report entitled “Nurses and the Health Service System at Primary Care level” aimed at conducting a process to develop concepts, design and a management system at primary care level in a socio - cultural context and the health system reform. Emphasis was placed on proposing nursing as a major tool for the development of a health services system at primary care level. The study was conducted collaboratively by nursing faculties and a nursing department of 6 universities and the Thai Nursing Council. Universities were Khon Khan, Chiang Mai, Mahidol, Burapa, Prince of Songkhla and Walailuk .The study was a participatory action research design employing epidemiological study and a qualitative descriptive approach, focused on stakeholder’s participation. The target sample were health care consumers especially community leaders, members of local authority organizations and health service providers who were nurses and other health personnel. The key informants reflected the current situation of health services for the community. Models of health service delivery systems at primary care level from different settings were critically analysed and synthesized including to roles and functions of nurses in providing health care in communities, especially for the strengthening of the self care capacity of individuals and the self-reliance of communities. Nurses roles and functions included collaboration with local authority organizations in developing health policy and appropriate strategic plans for local health care. Knowledge generated from the findings of the study provides descriptions of health service delivery systems at primary care level which includes health care demands, type of health services needed, type of health personnel required and its management structure. The findings are as follows. The desired primary care service should be a service that should be as a bridge between people and the local health service system. It should be easily accessible, cover all age groups, all dimensions of health, integrated and continuous of care including collaboration with other health services and appropriate referral systems. The service should focus on empowering individuals and families in self-care, the use of local wisdom, and encourage community participation. The structure of the primary care service management could be best designed by considering the potentiality of each setting. The underlying principles for structural design include : health service strategies, health care activities, characteristics and competencies of health service providers, financial management, availability of human resources, health units, quality of service and primary care networks. Conditions contributing to the quality of the primary care service system Government policy should be stated clearly regarding service management that covers all characteristics of the desired primary care services including the establishment of mechanisms for administration, financial systems and human resource development. To achieve the goals of health care at a primary care level, adequate numbers of health professionals should be provided in designated areas. The ideal ratio of health care providers to population should be 1 : 3,000 .Health service providers who are professional must be legally protected by professional legitimization of their practice. There must be standards or guidelines of practice in health care and service, and quality must be ensured. To encourage effective care, the services must collaborate with others institute and organizations in a networking atmosphere. Recommendations for involving authorities. Government must have clear policy and measures on health care finance, resources allocation, laws and regulations, workforce production and development, decentralization and participation in health care. Professional councils mustlegitimize the practice of health care providers. Develop standards and practice guidelines for primary care and develop systems and mechanisms for quality control, audit and assessment including promoting and sharing understanding of concepts and professional roles and functions among its members. Under the current situations of the country health care system, it is proposed that the professional nurse is the most likely person to generate quality of health services at primary care level. There are two strategic approaches to the designs of the system management structure.1). using the existing structure and modifying roles and functions of professional nurses through capacity building.2). creating new structures to implement the appropriate ratio of health service providers and population in designated areas. These two approaches must be pursued under the contracting system for networking services. Collaborative efforts with educational institutes must be made for human resource planning and development of new and existing nursing personnel to be able to provide effective services at primary care level. Health institutions and primary care units should have clear policies and plans for financial management, collaboration with educational institutes and other supporting systems. Professional organizations at all levels must work collaboratively in developing shared visions, concepts and understanding among its members, standards and guidelines for practice, quality management and the enhancing of a network of professional entrepreneurship in community health care.
