Traditional Medicine Box Model for Self-reliance on Primary Health Care in Thailand in the Rural Communities
At the WHO Congress on Traditional Medicine held in Beijing, China during 6-9 November 2008, Dr. Margaret Chan, Director General of WHO, addressed the significance of “Primary Health Care” especially in the developing countries and the role that traditional medicine can play in PHC because of its availability, easy access, and affordability for most people. During the congress, Mr. Yohei Sasakawa, Chairman of the Nippon Foundation (TNF), introduced congress participants the result of the application and modification of Japanese “Haichi model” to promote the use of traditional medicine kit in Mongolia where tribal people live in remote areas far from health service facilities. The success of traditional medicine kit project in Mongolia led TNF to expand the project in other countries including ASEAN with appropriate modification to suit the health care system and cultural context of each country.
For Thailand, after studying and reviewing the traditional medicine kit project in Mongolia and Haichi model in Toyama prefecture, the Department of Health Service Support (DHSS) and Department for Development of Thai Traditional and Alternative Medicine (DTAM), Ministry of Public Health agreed that traditional medicine kit is another useful model to increase the utilization of traditional/herbal medicines at the grass-root level. Therefore, in 2008, with the financial support of USD 576,200 from the Nippon Foundation, DHSS and DTAM launched the project “Model Development of Promotion of Rational use of Traditional Medicine in Thailand” to promote the use of herbal medicines in the household in 4 provinces; namely, Chiang Rai in the north, Si Sa Ket in the northeast, Surat Thani in the south, and Suphan Buri in the central region. Village health volunteers (VHV), instead of company salesman were trained to educate people in the community on the 19 items of selected herbal medicines in the box, replenish the medicines, collect the money for the medicines used, and follow-up on the effectiveness of the medicines and the satisfaction of the participants.
The results of the quasi-experimental study conducted to evaluate this two-year Phase1 project (June 2008 – May 2010) showed that almost all of the participants in the implemented community appreciated the types and forms of herbal medicines in the box for the treatment of common minor illnesses in the household and would like the project to be further maintained. As a result, in the three-year Phase 2 project, DHSS planned to expand the target areas and increase the role of local governing body to manage the project. However, it was found that in the first year of Phase 2 (2011), the situation of the availability of traditional/herbal medicines in the rural areas in Thailand has significantly changed from the period when phase 1 study was conducted. Lately, due to the clear government policy to support the integration of TTM in the health care system and the use of traditional/herbal medicines in all levels of health service facilities, nowadays most items of herbal medicines selected into the box are in the National List of Essential Medicines and are also available for free (covered by Health Security System) at the Tambon (sub-district) Health Promotion Hospitals (the lowest level of health service facilities, equivalent to “health centers” in most countries). Therefore, the use of traditional medicine in the medicine box is reduced in all 4 provinces. In addition, as the project was expanded, there was also a problem of collecting money from the people for the medicines used in this phase and some medicine boxes are not used in some areas.
In the second year of Phase 2 of the project, lesson learned analysis was conducted of the past activities and the current situation in order to develop research questions and appropriate model of the traditional medicine kit project, and test the model in newly selected target areas, as well as strengthen the potential of people in the original target areas in order to fully gain benefit from traditional medicine kit project. The researcher from the Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, is responsible for conducting the research. It is expected that the model developed and the results of the study will help improve the management system and sustainability of the project so that it will be well-recognized not only by people in Thailand but also in other ASEAN Member States as well.
In order to introduce medicine box model as one of the models that can be applied in ASEAN Member states to promote the use of traditional and herbal medicines for primary health care, Department of Thai Traditional and Alternative Medicine organized “the Study Visit of ASEAN Member States on Traditional Medicine Box Model in Thailand” in March 2012. Suphan Buri Provincial Health Office and U-Thong Hospital in Suphan Buri Province presented the progress report, administrative system, and benefits of the medicine box project, and problems encountered during the implementation of the project in Suphan Buri Province to the delegates of ASEAN Member States. Delegates also got a chance to visit a household in the Tambon where the project was implemented and discussed with the family’s members and the village health volunteers about their comments and attitudes towards the project.
Institute of Thai Traditional Medicine, Department for Development of Thai Traditional and Alternative Medicine. Ministry of Public Health. Traditional Medicine Box Model for Self-reliance on Primary Health Care in Thailand in the Rural Communities, 2012.