Professional Documents
Culture Documents
REPORT NRCT
Authors
Dr.Bang-on Thepthien
Ms. Piyachatr Tragoolvongse
Ms. Parinda Tasee
73170
02-4419870, 02-4419040 3 45, 54
02-4419044 www.aihd.mahidol.ac.th
1 /
2554
2551
2554
2
1.
2. (Community participation)
/
3.
4.
5. (Decentralization)
1
1
10
11
11
11
12
12
12
15
15
20
27
28
31
35
37
40
44
45
46
52
2 ()
6.
(.)
(.)
7.
3
4 :
1. 1
55
55
56
56
56
64
66
66
70
81
81
82
82
82
84
84
86
87
87
87
89
89
89
90
90
91
4 :
()
2. 4
3.
4.
5.
6.
7.
5 : 1 4
(Key informant persons) 1
(Key informant persons) 4
(Community participation)
6 :
1.
/
2.
91
91
93
93
93
93
94
94
94
94
94
98
99
100
101
107
107
161
213
217
218
219
221
223
223
225
227
6 : ()
3.
4.
:
:
7
()
228
242
242
245
248
251
252
255
256
257
259
260
262
264
265
266
269
269
273
274
276
278
280
282
282
286
287
1
1.1
1.2
20 2554
2 /2550 25 2550
2
8
2
2.1
2.2
65
68
4
4.1
95
5
5.1
5.2
5.3
5.4
5.5
1 ()
1 ()
4 ()
4 ()
/
6
6.1
6.2
108
157
162
209
222
229
240
4
4.1
4.2
4.3
4.4
4.5
4.6
5
5.1
5.2
5.3
215
216
220
272
274
275
277
7
7.1
7.2
7.3
7.4
88
89
90
92
93
97
.
.
.
.
.
.
.
CUP
=
=
=
=
=
=
=
=
()
()
1 () 4
()
.. 2550
()
Abstract
The research for Models of Health Service Rendered by Local Administrative
Organization after the Transfer of Health Centers to the Local Authorities The objective of this
research are to study on The Good Governance Management of the local authorities on health
service and challenges after health center was transferred from Ministry of Public Health. This
qualitative research used 1) formal interview with health personnels, executive board and
member of sub-district administration organization at BaanProk district, Samutsongkram
Province, villagers, at Moo1 (Baan-lad-juan) and Moo 4 (Baan-suan-pa) 2) Non-participatory
observation, 3) Community mapping and 4) Field note. All the research methods are for
answer all research question.
In 2550, the BaanProk Sub-district health center was transferred to BaanProk Tambon
Administration Organization. In term of health service there have strengths such as the health
personals work citizen center and work more closely to the villagers, the better accessibilities
of the villagers to health service, health service management by the local Administration
Organization is more flexible and freedom in term of Policy making, Human resource and
Financing.
From the improvement of the proactive management of Baanprok health centre which
is effect to increase the number of accessibility to health service in the community. The most
common of techniques have been used such as home health care, chronic disease screening
ageing care etc. From the study found beginning of self reliance and health service
satisfaction are showed. Also it show less expectation from the medical doctor service as they
know it is the limitation of the health centre. The people in the Baanprok area realize that the
health decentralization is very important. If the heath center can function for primary care
under the support of the government by people centered very effectively. The clear picture for
self reliance in the community will be reflected.
The most important challenge that found in this study is the limitation of the community
participation. Most of the local people engage their own health service activities only in
practically such as to be the health volunteers, community meeting and to be the committee in
village funds. For well being and sustainability development of community health, the
government should consider to establish mechanisms for increase public participation and
health advocacy in planning and decision making process that effect health in the community.
In the other hand the considering for local administration readiness in good governance and
political condition that relate to health service are also very important. Both of their capacity,
local people and local administration are very important for impact of health decentralization.
After transferring the health center, the health personnel have to play in the different
role of health service management by follow to Ministry of Interior role, example of financing,
budget planning, people participation, to be the committee on project presenting, purchasing.
It will be their responsibility to contribute key elements of good governance undertaken of
local government. So the decentralization and mission transfer greatly affect the livelihood and
future of health personnel. Thus, the operation in this aspect has to be carried out carefully
and clearly to ensure that, after the transfer, their rights and dignity will not diminish.
According to the health center transferring to the local government is aimed to empower the
villagers for self reliance and participate in term of policy making, management and financing.
Also the health personnel have to highly level of responsibility and accountability.
1 :
(INTRODUCTION)
2
(Decentralize)
7,853
(: www.thailocaladmin.go.th / 20 2554)
5 (
) (.) (.)
1.1
20 2554
76
2,010
27
145
1,838
5,765
2
: 2554
... ..2542
4 (..2544-2547)
4 10
(..2544-2553)
...
..2544
20 ..2549
35 12
..2543 4
.. 2544-2547
4 10 (..2547-2553)
3
l
10 (..2554 )
3
3 1) 2)
3)
27 2549
(.) (.)
( )
(.)
(Autonomous Public Organization)
.
4
4 1. 2.
3.
4.
( , 2551) ( 1
)
5
l
2543
()
(Responsibility)
15 2549
(.) 30 23
7
l
1.2
2 /2550 25 2550
1.
4 . / 8 . /
10 .
1.1 . .
1.2 .
.
2.
2.1 . .
3.
3.1 . .
3.2 . .
3.3 . .
3.4 . .
4.
4.1 . .
1.
1.1 . .
2.
2.1 .
4 . / 4 . /
.
5 .
3.
3.1 . .
4.
4.1 . .
1.
1.1 . .
11 . /14
2.
2.1 . .
. / 15 . 3.
3.1 . .
4.
4.1 . .
5. 5.1 . .
6.
6.1 . .
7.
7.1 . .
7.2 . .
8.
8.1 . .
8
. /
.
. /
.
.
.
.
.
.
.
.
. /
.
.
.
.
.
.
.
.
.
.
..
.
4 . /4 . /
5 .
4 . / 4 .
/
5 .
9.
9.1 . .
9.2 . .
10.
10.1 .
.
10.2 . .
11.1 . .
1.1 . .
11.
1.
2.
3.
4.
2.1 .
.
3.1 . .
4.1 . .
.
./
.
.
.
.
.
.
.
.
.
./ 22 16
()
9
l
11
3
3
1
1
70
(.)
.
2542 (.)
1.
(
) (
)
10
( . )
2.
(.)
3. 1
1.
2.
3.
1
/ 1
11
l
1.
/
2.
(/)
3.
1.
/
2.
3.
/
5
12
( .. 2550)
8
.. 2545
( .. 2550)
(
.. 2550)
(...
..2542)
13
l
(Decentralization)
(Deconcentration)
(
.. 2542,
2 ..2549
(good governance)
4
14
2 :
1.
2. (Community participation)
3.
4.
5.
6.
7.
1.
1. -
2. -
3. - ()
4. -
1.
2.
3.
4.
5.
1. -
-
/
/
/
16
()
-
(determinism)
(/)
2. -
(prevention)
17
l
3. -
18
4. -
HIV/AIDS
(Pierret, J,
Radley, A,.(ed). 1993 ,2547 :41 - 56)
19
l
(medical sociology)
(Parsonian)
. 1970
Berkanovic (1972) Gallapher (1976), Gerson (1976) Gerhardt (1978) A lonzo
(1984) (
,2547 :33) (deviance)
()
( ,2547 :33)
(actors)
(- )
(medicocentic)
(allopathic medical
treatment)
(Pierret, J, Radley, A,.(ed). World Of illeness. 1993, Routledge New York. : 9)
..1970
(ordinary people)
20
(Chrisman 1977 ; Helman 1978 ;
Pill Stott 1982 ;Blaxter 1983 ; DHoutaud Field 1984, Radley ed.,1993)
(Herzlich1973)
(social representations of health and illness)
- (Blaxtes
Paterson 1982 ; Williams 1981, 1983 1990 ; Cornwell 1984 ; Crawford 1984 ; Calnan
1987, Redly ed., :10)
(Backett
1990)
(Edinburgh)
(new health consciousness) (Crawford 1980,
Radley, ed., 1993) (health behavior)
(health promotion) life style
21
l
(preventive behaviors) (behaviors for health)
(Anderson et.al., 1988)
( ,2547 :34)
/ Black Report
(Townsend Davidson 1982, Blaxter Peterson 1982 ; Cornwell 1984, Calnan
Johnson 1985, Calnan 1987) (Macintyre 1986 : 393)
social patterning
(correlate)
(occupational class)
The Health and Life-Style Survey
9,003 ..1984 1985
(multidimensional)
(objective) (subjective)
22
3. /
4.
( Cornwell
(1984) Williams (1990) ( ,2547 : 36)
(interpretive approach) Calnan
(1987)
(Calnan 1987 : 8, , 2547 : 36)
(illness) (health)
23
l
Auge (1984)
(Eventful)
()
(Pierret,
Adley (ed) 1993 : 12)
24
( , 2547 : 36)
() (value)
(new health and fitness consciousness)
(healthiest) (duty to be healthy) (Zola 1977,
Crawford 1977 1980 ; Renoud 1981 ; Herzlich Pieret 1987,
, 2547 : 36) (bodyism) (selfdevelopment) (pleasure) (hedonism)
Crawford (1984)
(American health consumerism)
()
()
()
(internalized) (Crawfor 1984 : 97, , 2547 : 38)
(
)
Auge event
( , 2547 : 38)
25
l
Herzlich (1984)
(social representations)
(social
representation) ()
()
( )
(Herzlich, 1984 ; 77)
Calnan (1985)
(Calnan 1985 : 90)
(elements)
Fitzpatrick (1984)
(Fitzpatrick 1984: 19,
, 2547 : 38)
26
(reservoir of signs)
Herzlick
(terms)
(signifies)
(Herzlick 1984 a, , 2547 : 39) Pierret
( Constructing discourses about health and their social determinant)
(survey)
(
WHO ; Stacey 1976 Anderson 1984)
( , 2547 : 40)
2. (Community participation)
27
l
. .
8 - 10
..2540
(Community)
1.
28
2.
3. (Risk group)
(Epidemiology)
(participation) (World
Health Organization-WHO) 3 (World Health Organization, 1991)
- (participation as contribution)
(labour) (cash) (material)
- (participation as organization)
-
(participation
as
empowerment)
Oakley P. Marsden D. ( Oakley P. and Marsden D., 1983)
3
1. Participation must be active:
participation involvement
2. Participation involves choices:
3. Choice must have the possibility of being effective:
29
l
4
5
1 2 passive
passive active
involvement
active involvement
passive ( 1 2)
(Non-government organization- NGOs)
active
30
(empower people)
(sustainable
development)
active ( 3-5)
( , 2541)
/
(Cohen, M.J. and Uphoff, N.T., 1977)
4
1. (decision making)
2. (implementation)
3. (benefits)
4. (evaluation)
(working definition) /
(partnership)
(local self-reliance)
31
l
1.
(sponsored or induced participation)
WHO Community Participation, Health and
Development: The Primary Health Care Approach. (United Nation, 1983)
3
1.1 (spontaneous-participation)
(self-sustaining)
1.2
(sponsored or induced participation)
1.3 (compulsory participation)
2.
2
32
2.1
2.2
- (community assessment)
- (definition of problem)
- (setting priorities)
- (making decision)
- (planning)
- (implementation)
- (monitoring and
evaluation)
5
1. /
passive participation
2. /
active
participation
3. /
33
l
4. /
5.
1.
2. (knowledge)
3.
34
4.
5.
1. /
2.
3. /
4. / (felt need)
(real need)
( / )
(Cost effectiveness)
(Demand)
35
l
2
1.
(.)
(.)
. .
600
()
( , 2541) Walt (Walt G., 1988)
(authoritarian structure)
36
( , 2541)
2.
2
2.1
2.2
1
3.
Attitude
(2531: 125-127)
37
l
(2535: 215)
2537: 198-199 ;
, 2524)
1. (Cognitive component)
(attitude object)
3. (Action tendency component)
3
2)
3)
1. (Interview)
39
l
2. (Questionnaire)
3. (Indirect Techniques)
(
2537: 198-199; 2524 .)
4.
40
2
(Social change)
(Cultural change)
(Norms)
(Social
relations)
41
l
1.
2.
(Transitions)
(Transitions)
4
(Franz Boas)
(Sherry B. Ortner, 1977 , 2549)
(Allan Pred and M.J. Watts, 1991
, 2549)
(James C. Scott, 1991 , 2549)
Asian
Medical Systems: A Comparative Study) (Charles Leslie, 1976)
.. 1976
..
42
1980
( , 2549)
(system centered approach) (actor
centered approach) (Symbol)
(Senses and Sensory experience)
(object of inquiry)
(Reflexivity)
(reflexivity)
(George E. Marcus and Michael M.J., ,
2549)
(Ethnographic representation)
43
l
(James Clifford and George E. Marcus, 1986 , 2549)
5. (Decentralization)
(Decentralization)
1.
2.
3.
4.
1.
2.
3.
44
1.
2.
3.
(Decentralization)
2
(2535 : 60-61)
(Decentralization)
45
l
2
5
1.
2.
3.
4.
5.
2540
5 78
46
284 2540
.. 2542
4 (..2544-2547)
4 10 (..2544-2553)
12 ... ..
2543 3
1.
2540
.. 2542
2.
3.
3
47
l
1. 3
1.1
/
1.2
1.3
2.
3.
.. 2545 .
/
/
/ / /
48
.
.
.
2
1. 1 1-4 (..2544-2547)
4 30 (1)
.. 2542
2. 2 1-10 (.. 2544-2553)
10
30(2)
.. 2542
2.1 1-5 (.. 2544-2547)
4
30(2)
2.2 4-10 (.. 2544-2553)
5
30(2)
49
l
1.
2.
3. /
4.
5.
6.
(.)
(.) 2552
104,099.79
57,233.60
46,717.44 .
148.75
.
1.
2.
50
3.
4.
5.
2552 104,099.79
.. 2542
51
l
4 30
.. 2544
..
2549
" .. 2549
. 35"
.. 2544
52
(.)
..
2544
2 .
.. 2545
30 2544
.. 2545
18 2545 .
53
l
()
HA ISO
(Excellent Center)
...
47
.
2549 2,680
.. 2550
(.)
... .. 2550
54
(.)
(.)
6.
.. 2540 2
1. (Upper Level)
2. (Lower Level)
(.)
.. 2540
1
55
l
10,000
50,000
(..2543) 20
(.)
..2537 (
3) .. 2543 (.)
. 3 . . .
1.
2.
3.
4.
5.
56
1959-1971
borough
5 boroughs borough
57
l
5
3
4
5
5 maximum feasible
community participation
1
( )
1
1972-1975
58
the day
of the districts has arrived
,
1)
2)
1973
38 6
6
1975
59
l
The Local
Government Code (LGC)
5
62% 42%
93% 78 65 1,543 41,924
60
4
50%
25% 25%
The Local Government Assistance and Monitoring
Services (LGAMS)
61
l
The Local Health Board (LHB)
Comprehensive Health Care Agreement (CHCA)
62
CHCA The Health Development Fund
(HDF)
CHCA
9
Medicare Program II
60% 15% 25%
(meanstest) The Philippine Health
Insurance Corporation (PhilHealth)
PhilHealth 1 3
4 6 10%
63
l
2
1. 2
(County)
2.
15
64
2.1
C, M
M
M
C
M
C
C
C
Central
C, M
M
M
C
M
C
C
C
Central
C, M
C
M
M
M
C
C
C
C
M
M
M
M
M
M
M
M
Central
Central
M
M
Central
Central
Central
Central
Central
Central
Central
Central
C
C
C
C
C
Central
C
C
C
C
C
C, M
Central, M
Central
M
M
Central, M
Central
Central
None
: C = , M = , Central =
: Hakkinen, Gudfinnsdottir and Unde 1995; Hjortsberg and Ghatnekar 2001; Lingren 1995;
Hakansson and Nordling 1997; Hakkinen 1995; Rissanen and Hakkinen 1999; Koivusalo 1999;
Gudfinndottir and Gunnarsson 1995. (2544)
65
l
2
(province) (state) (district)
1 (.. 25012504)
66
1 7
(.)
8 (..2540-2544)
2540 8
(.)
.
.
67
l
43
2
1. ()
()
2. (
)
2.2
()
/
()
*
*
*
*
*
*
*
-
-
*
*
*
()
*
*
68
*
*
/
/.
*
*
*
*
*
()
2.2
()
()
/
/.
*
()
*
*
*
*
*
*
()
*
(/)
*
*
*
2548
1. 7
1.1 1
1.2 6
- 2544 2545
- ()
-
-
-
-
2. 27 ( ...
... )
.. 2545 2545
69
l
7.
, , , (2551)
25422550
.. 2542 / /
- 2550
.
.1
.
(
.)
CEO
70
(2542)
11
(2544)
:
3
7
30
2543 2
.. 2542
.. 2542
71
l
2 1) .
2) .
(2543)
.
(
.)
72
(2545)
:
(in-dept interview)
14 14 14
,
(2545)
:
3 , ,
73
l
36
, , 36
44 116 3
1 31 2546
/
(2545)
232
207
74
4 1
2
3
4
3
(2545)
306
174
75
l
(2547)
()
()
43
2546 2547
2547
(2548)
1
76
1
.
. 1
(Cross-sectional Design)
(Secondary data)
1 (2544-2546)
1 . 3
2 1
. 1 303 (909 ) 2544 2545
.
. .
3
(2551)
255
(Frequency) (Percentage) (mean )
77
l
(Standard
Deviation)
t-test One-way ANOVA
..2542
3
2
(2551)
(In-depth interview)
(Key Informants) 6
.
(.. .) .
.
.
.
.
. . .
78
.
. .
2547
16
1 2 3
11 20 ..
2541-2546 (1) 14
( )
(2)
6
7
2 66
4,755-16,288
5 6
(2551)
79
l
2550 2551
80
3 :
(Qualitative
Research)
1 1 () 4
()
()
()
Internet
2
1
1 () 4 ()
71
(Key Informants) 3
1 () 4 () 1
23 46 ( 2
1 )
2
20
3 /
5
1
4 2
(Observation)
(Non-Participant Observation)
82
(Formal Interview)
//
1 4
/
(Informal Interview)
(Mapping Technique)
(Kinship Diagrams)
(Field Note)
83
l
2552
(
)
84
( )
( )
8 2552
2-3
.. 2552
20 80
2
(
) 30 2-3
(3-4 )
85
l
()
-
( )
1
2
86
4
:
( 1) ( 4)
3
1.
2.
3.
1
(
)
5 6
.
4 2 .
10 .
4.1
(Participatory mapping)
50 10
() ( 4.3) 1 2
2
88
1,074
528 546 338
( 4.1)
4
4.2
89
4.3
90
4
40
-
5 . .
1 .
91
10 .
4.4
(Participatory mapping)
2
92
2
3
660 323
377 161
10
3
30 40
4.5
80
93
8
11
94
2
11
8,100 3,872 4,228
14 % 1,354 / 2,490
5.98 3,739
4.1
() ()
1
2
3
4
5
6
528
80
193
323
257
432
546
86
234
337
285
470
()
1,074
166
427
660
542
902
338
39
97
161
119
325
95
4.1 ()
() ()
7
8
9
10
11
299
256
606
540
358
3,872
315
276
655
588
436
4,228
()
614
532
1,261
1,128
794
8,100
180
143
486
359
241
2,488
* : ( 30 2552)
6
/
6
3 4
2
1
5
3
96
1 5
6 11
89
87 1 1
6 7 - 8 11
4.6
97
(..)
3
4 .. () 18
.. 2549 -2551
42
11
7
5 12 .
7
4 /
15 19 4
98
2552 (
29 2552)
2551
2552
()
869,997.12
1,203,154.03
12,531,957.69
11,423,647.18
4,152,167
9,177,412.41
NA
12,979,818.14
17,554,121.81
34,784,031.76
.
-
1-5 3,492
5
1. 2
2. 2
3. 1
5
5
99
417 461,000
3 36 284
-
23
300
11 87
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
100
101
102
103
104
105
5
:
1 4
(Key Infromances persons) 1
1 () 23
4 19
() 41-74 60
10 1
1
2 2
1 ()
1
4
1
1
6
1
80
2
5.1 1 ()
44
50
52
52
52
52
53
55
55
10
57
11
59
12
62
13
63
14
64
15
67
16
70
108
.4
.4
.4
.4
.4
.6
.2
.7
.4
..1
. 4
.4
.4
.4
:
1 4
5.1 1 () ()
17
70
18
73
19
74
20
41
21
52
22
60
23
74
.4
.2
.6
.6
.4
.4
1 1
44 4
200-300
4
()
10
3
2 6 1
3 14
109
5
17.00-18.00 .
() 1
U
U =c
= z 44
ego
U= c
-
( 40 ) 2-3
120,000
(
)
110
:
1 4
2 1
50
30,000
( )
6 ( ) 2
2 52
2-3
2 8.00 .
17.00 .
2
-
111
() 1
U =
U= c
z 50
ego
c
2-3
1
/
3 1
52 4
80-100
112
:
1 4
500
5
2
13 1
30 3
()
3
120
11
4-5
17.00 18.00 .
113
() 1
U =
z 52
ego
U= c
U= c= c
U= c
U= c
U U
c c
c c
( 2-3 )
( 10 )
30
3
2
2
114
:
1 4
-
( )
()
4 1
55 4
500
3-4 ()
() 6
5
5
()
1
( 5)
115
2-3
() 1
U = z 52
ego
U= c
c
U = c
U= c
() 5-6
500
( 5 )
116
:
1 4
1
2
1
5 1
52 7
()
200
4
10.00 .
10
3
2 3
-
-
117
() 1
U = z 52
ego
U =c
U
U
c U
5
-
118
:
1 4
6 1
52
4
3,000 3
20,000 7,000
3
3
3
119
9.00-10.00 .
() 1
U = z 52
ego
U
120
:
1 4
7 1
() 1
U = z 53
ego
c
4 2
4-5
1
( 2552)
-
2
/
3
121
2 2
/
()
(
)
/
2-3
30 ()
100
122
:
1 4
.3
1
1 1,000
400-500
1520
60
()
2
2
2-3
123
2
8 1
55 2
65 6,000
3
2 10
3
-
() 2-3
10
1 -
2
124
:
1 4
() 1
U = z 55
ego
Uc
U= c
Uc
()
2
( 179)
()
2
3-4
()
125
2
-
9 1
() 1
U = z 55
ego
c
58 3
.. 2519
( 2) ..
2516 Early Retine .. 2543
15
126
:
1 4
()
(/.)
()
Vote
( 500 ) 2
127
()
280 ( .. 2552)
()
(
)
128
:
1 4
4 8
(
)
129
10 1
57
100-150 7
-
-
-
-
() 1
U =c
U= 6
z 57
ego
c
U c c U
130
:
1 4
1
-
()
11 1
() 1
U = z 59
ego
c
131
: 3
5,000 4
4
:
:
:
:
132
:
1 4
12 1
() 1
U = z 62
ego
U
62 1
5 3
( )
()
( ) 5 ()
6
() (
133
11 )
134
:
1 4
100% -
20 ( )
135
13 1
() 1
6 = z 63
ego
U =c
U=c
U= c
U
c
: 12
3 2 1
.
.
1,000
5
:
:
:
136
:
1 4
:
14 1
64
15 70-100
3 10
3
()
1
6.00 .
()
8.00 . 3
137
10
() 1
6 = z 64
eg
U= c
U
U= c
c
U=c
U=c
U= 6= c
c U
( : 1 1
) 2
138
:
1 4
() (
) 1
2
15 1
() 1
ego
z 67
()
U= c
c
67
35 1 ()
CP
() ( 60 )
139
( 4-5 )
200-500
5
7-8
2
/
()
140
:
1 4
4-5
141
16 1
() 1
6 = z 70
ego
U =c
U= c
U U
Uc c
U =c
U= c
U c U
U
:
5 2 3
:
:
:
142
:
1 4
:
17 1
() 1
6 = z 70
ego
U= c
c
U =c
U
U=c
U= c
UU c
U =c
U= c
UU c
c c
U= c
UU c
U= c
c
U =c
U =c
U
:
14
143
:
:
:
:
()
.. 2550-2551
:
18 1
73
144
:
1 4
9 2
3
6 4
7 3 4
() 1
73 S = c
eg
6
U= c
U =c
U=c
U= c c U = c U=c
c
U c U
U U c
cU
145
1
Check
()
19 1
() 1
U z74
ego
U =c
U =c
U =c
U = c
c U
U U
c c
: 3
1
250 3,000 4
2 2
146
:
1 4
:
100
:
3
:
147
20 1
41 6
250
4 2
12 6 2 11
72
5-6
(
-
10,000 2
5
-
10
10
2
20
148
:
1 4
5 40
() 1
6 = c
41 S c
ego
U
/
()
-
2
149
2
21 1
52 6
20,000
40,000
3
2 15
2
2 (.2-3) 2
7.30 .
17.00 18.00 . 2
3
150
:
1 4
() 1
52 S c
ego
c
151
22 1
() 1
60 S = c
ego
U = c
c
U= c
U
U=c
6
5-6
06.00 17.00 . 1
( )
2 05.30 .
60
()
152
:
1 4
60
60
2-3
-
(
) ()
100 ( 2 ) ()
7
( )
153
23 1
() 1
74 S = c
ego
c
U= c
U=c
74
20 10 (2529) 2
4 71
49
3 2 ( 2-3)
2-3
154
:
1 4
-
6 7 11
155
,
(DM+HT)
-
156
:
1 4
157
158
:
1 4
159
160
:
1 4
3
1
1 1
() 2
4
4
4
161
5.3 4 ()
26
37
41
42
42
44
46
46
46
10
48
11
48
12
50
13
54
14
55
15
58
16
65
17
42
18
19
20
162
42
43
45
/.
.6
.3
.6
.4
.3
.6
.3
.4
.6
.7
.4
.4
.4
.4
.4
.3
.6
.6
:
1 4
5.3 4 ()
21
61
22
80
23
80
.4
.4
.4
1 4
( )
26 200
() -
2-3
3
1 3
- 6
1 (14 )
() 1 1 3
8 - 1
() (
)
163
() 1
8.00-17.00 .
100 200 /
15.00-17.00 .
() 4
U = c
U
U = 6 = z226
ego
U
U U
8
3 2 3
3
6
() (
) 3
164
:
1 4
2 4
2
2
6 74 72 37
. 3 5-6 44 .6
2 2
BBP -
10 2
( 4 )
20-30 64
2
165
4
13
-
8
5-6
() 4
U = c
U= c
U = z 37
ego
c c
U U
-
500
166
:
1 4
- ( )
3 4
41
7 6 210
51
20
3 2
3 ()
6.00-17.00 .
167
3
5-8
() 4
U = z 41
ego
8-9
-
/
()
-
168
:
1 4
4 4
42
4
300 (.)
3
(12 ) 13
100,000
2-3 6 ( 1 )
()
20
(
)
7.00 . ()
() 4
U = z 42
ego
U= c
169
1
10
6
1
( )
( )
170
:
1 4
5 4
() 4
U = z 42
ego
U
3 2
()
2-3
1
() (
5 3 )
2
2
4-5
171
2 ()
172
:
1 4
6 4
() 4
U = z 44
eg
U
()
4 2 3
10
AIA 8.00-20.00 .
2 (/) 15,000
2-3
200,000
3 10
24
173
10
- OT
OT
(45 )
17-18
( 3 )
1
174
:
1 4
7 4
46
3
10 2
5
2 10
()
- 12 -
()
Bakery
5.3019.30 .
(9.30-12.00) 2
-
175
() 4
46 z
ego
4
6
(
)
176
:
1 4
8 4
46
3
8
2
2
( )
7.00 .
9.00 . 10.00 .
15.00-16.00 .
-
177
() 4
U = z 46
ego
U= c
U
5 5 1
10
-
178
:
1 4
9 4
46 7
200
5 order
8.00-12.00 .
() 3
7
3 1 1
1
2 5 4 1
6
500 300
3
179
() 4
U = z 46
ego
U = c
U= c
c
U
2
4 1
( )
20
180
:
1 4
10 4
48
2 ( 5,000 )
3 (
)
1 SLE
1
SLE
-
8.00 . 12.00-14.00 .
3
3
5
()
()
3
() 4
U = z 48
ego
c
U=c
181
() 1
2
-
3-4
182
:
1 4
11 4
() 4
U = z 48
ego
U = c
U= c
43 2
7
1
183
()
( 1 )
1 ( 17 )
(10-15 )
184
:
1 4
12 4
() 4
U = z 50
ego
U= c
U c
U
c c
:
9
:
: .
185
: 3
8
:
2 ()
:
3 1
13 4
() 4
U = z 54
ego
c
54
2 2
2
7-8
186
:
1 4
31
1
(4 )
600
600
600
1,804
600 600
/
20 ( 4 )
()
187
() ()
(
) ()
3 ()
1
30 ()
5
()
10
( 1 5)
14 4
55
order 100
188
:
1 4
(2 )
2
3 () 2 (
)
10 2
6 - 2
-
() 2
2 ()
75
() 4
U
U= c
U
= z 55
ego
U =c
U
189
3
()
3-4
2
( ) ( 1 )
10 3-4
() 4
2
( )
190
:
1 4
15 4
58
4 9 2 (
) 5-6
57 10 30
3 21
Order
( 6 )
2
191
() 4
U = z 58
ego
U
10
-
192
:
1 4
16 4
() 4
U = z 65
ego
c
U= c
c
U=c
U=c
U U
U U
: 10
5 2 3
:
:
30 1 5 2
2
193
:
()
:
17 4
42 ()
6,800
() 6,700 1 3
2
700,000
()
5
()
3
- ( 800,000
) ()
194
:
1 4
-
() 4
42 S = c
ego
U
7-8
2-3
()
()
195
18 4
42 6
2 50-60 3
8.30-12.00 . 3 ( )
3 10
( 3 )
250
15.00-18.00 .
1 ( 6-7 1213 ) 2
)
37 4
(20.00-21.00 .)
3
196
:
1 4
2 2
30
20
(1 10 ) 9
5 1
(
) EM
() 4
42 S = c
ego
c
U
2 3
197
6
-
5
2
(
)
198
:
1 4
() 30
10 ( 1 = 3 )
4
19 4
43 6
1 43 .2
17 7 ()
20
20,000
()
199
2 6
8.00-13.00 .
17.00-20.00 .
21.00 .
() 4
U = z 43
ego
U =c
U
(
)
( )
2-3 ()
200
:
1 4
(
)
()
20 4
() 4
U
c
c
45
S = c
ego
c
45
36,000 7 36
() 3 2 1
51 91
4-5 10
45
201
(
)
6.00 .
(
)
Paracetamol
202
:
1 4
60-70 %
-
203
21 4
() 4
61 S = c
ego
c
U= c
c U
Uc
c
30 3
1 2 2
3 2
2
(-)
() 1 3
2,000
500
()
100
204
:
1 4
1
3
22 4
() 4
80 S = c
ego
c
U =c
c
205
30
3 2 1
2
1
2
(, )
206
:
1 4
30
()
23 4
() 4
80 S = c
ego
c
c
U
c
U
80
207
6 2 3
9 10
:
:
: 3
:
2-3
:
208
:
1 4
209
210
:
1 4
211
212
:
1 4
1 4
()
()
()
1 4
() -
213
5 4
200 1 300-500
6
7
8
9
10
( )
/ (Fast Track)
()
214
:
1 4
1 4
8 ( )
5.1
()
215
1
5.2
()
/
216
:
1 4
() -
()
1 1 4
(
)
1 4
(
)
(
)
217
1 4
(
)
(
)
(.)//
218
:
1 4
(Community participation)
..
2550
(Special section)
3
(
)
/
219
5.3
()
()
()
(/)
1 4
1.
220
:
1 4
2. 1 4
3
3.
(
)
()
1 4
221
5.5 /
1
4
/
3
3
1.
2.
(health need)
3
3. /
4. ( )
5.
6.
3
3
7.
8.
222
6
:
I.
II.
III.
IV.
V.
VI.
-
- -
I. -
II.
III.
224
/
-
/
- -
225
226
/
/
3
()
.. 2540 5
227
1
2
3
4
5
()
528
80
193
323
257
()
546
86
234
337
285
()
1,074
166
427
660
542
338
39
97
161
119
2,869 35
800
.
10 (. 59 )
(Formal Interview)
(Key Information)
228
6.1
1
2
3
4
5
6
7
8
9
10
38
38
38
43
43
46
48
49
50
52
.
.4
.6
.6
.3
.7
.6
10
8 2
38-52
229
()
28 S
ego
U = c
U U U
c= c
c c
7 ()
31 2552
3
16 2
2
2 1
()
U = c
U= c
S 38
ego
c cU
230
6
2 2
(gender) -
(
)
()
4
2
115 16
.
()
38 S c
ego =
U U
4
2
2-3 (10 )
231
4 1 3
-
232
()
43 S = c
ego
U
3 1
1
3
3 2551 143
()
U= c
S43
ego
233
-
3 1 2
5
--
( )
5 10%
( 80 ) 60%
2
234
()
6 = c
46
ego S = c
3
- 7 4 3
4 2
81
4 4
4
235
()
6 = c
48 S = c
ego
4
- 5 4 1
(-)
20
()
2
236
()
49 S = c
ego
U= c
U
U= c U
c
U= c
U
2
4 4
3 4
4
/
237
()
U = c
U U
50
z c c c
ego
6 2
4 3
10
238
4
()
U = z 52
ego
c
4 2
2
10
239
240
241
//
242
(
)
243
244
2551 2 3
2551
1.
25.49
2.
17.65
3.
15.68
4.
13.73
5.
7.85
6.
13.72
7.
1.96
8.
3.92
: 3
64.06
11.79
11.45
9.23
1.31
1.08
0.60
0.48
2538 - 2544
80
( , 2550)
-
245
1 (
)
246
2 3
1.
2.
/
3.
247
1
(
)
(1)
3,500,000 ( 1,000,000
2,500,000 )
248
(2)
(
)
249
(
)
250
251
252
1.
2.
3.
4.
5.
6.
7.
1.
253
2.
3.
( .)
1. .. 2550
2.
3.
4.
5.
254
255
++++
/ +++++
passive participation
+++
+++
/
active participation
256
++++
++
++
4-5
(Change Agent)
(Change Agent)
257
4
/
/
(
.)
/
IT
258
3 (.. 2551 .. 2553)
16 1 45 35
5 3 2
259
2
2
2 24 100
5
260
261
(.)
2
3 (.. .2551-2553)
262
--
2 ()
5
263
5
1.
2.
3.
4.
5.
6.
264
7.
. 20
19 , . 13 7-8
()
100%
8.
9. 1
10.
11.
12.
265
Routine
.
/
266
267
1- 5 6 - 11
268
7
2540
4 (.. 25442547)
1)
2)
3)
1
(1)
(Health Need)
/ (customer focus)
.
.
/
()
270
,
2
2
271
7.1
(//)
272
1.
)
) (/)
) / ()
2.
)
)
)
)
3.
) (Health Need)
) (/)
( )
) (people center)
4.
) ( & )
) ( & )
)
(Self Reliance)
(Specializational)
)
(/)
(Home Care)
(2)
2
1.
600
600
273
2.
/
(Self-Reliance)
()
7.2
(Community participation)
(3) ()
274
7.3
.
/
Networking
1-5
275
(4)
1) 3
(One Stop Service)
2)
4
3) 4 6
-
4)
5)
6)
276
7)
Unit
8) /
7.4
(leadership)
/
(Good Government)
(Relationship)
(Community Participation)
( )
277
(5)
254
278
279
(6)
11 2
( )
1-5
6
11
.. 2537 (
3 .. 2543)
280
(Decentralization)
-
()
- (
)
- (
)
- -
-
-
-
-
281
(7)
3 4
(Unit )
(8)
(.)
(.)
2550 80(2)
282
281 - 290
2540
.. 2550
283
(Flexibility)
(Responsiveness) (Participation)
(.)
. 3 (1.) .
. accountability
.
(2.) . accountability
social capital
(3.) . Political
accountability
. respond
()
14,21
(CUP)
()
284
()
/ (
, 2551)
285
(9)
(
) /
3 4 structure design
zero based
mind set
privatize
privatize
286
. (2545).
: .
. (2550). 10
() .
: .
. (2544).
. (2544). 16, 3 (..-.. 2544):
; 38-46
. (2540). (.)
. ;
30-37)
, . 2545.
. : (.)
_______. 2535. . :
. . .
. (2550). 2549
. .
.
. (2550) .
. :
.
.
...... [cited 2007 Sep 15]. Available from: URL;http://
www.nccc.go.th/constitution/Document/constitution_draft.pdf
.(2548).
. : .
. (2543).
. ; .
(2537). 2 :
. (2547). . :
.
. (2543). . :
.
. (2545). :
. : .
. (2545). :
. : .
288
. . (2547).
. : .
. (2542). - : ?, :
(.).
. (2543). . :.
. 2545. :
. : (.)
. (2541). :
. :
.
. . . . .(2544).
10(2544-2553). :
.
. (2548).
1.
. (2545). :
.
. (2547).
.
6 2547.
. . :
2 . : .
. 2524. . : .
.(2550). !
23 2550
13.00 16.00 2 2 .
289
. 2545. :
. : (.)
. (2547).
. . 25482550.
. (2551).
.: .
. (2545). ..
2540. : .
. (2547).
() .
. .
. (2544).
: ; 2544. 95-98.
. (2543). .
20 . 2543 .
; 2543 18-21
. . . . (2547).
. : .
. (2539).
. ; 2539. 4-14
. (2540). : .
: .
. (2548)
: . .
: .
290
. (2544).
: . :
.
. (2547).
: . :
.
. (2550).
2542 2550.
, , . . (2545).
..(.)
. (2545). ( 30
). : ;
.(2553). .
,
. (2541). :
. : .
. (2544). :
:
. 2544.
(2)
..2549 124 2 8
2550
. (2544). . :
.
. (2545).
.
291
.(2540). (.)
(.). :.
. (2545).
.
: .
. (2541).
(.). :
.
.(2546). . 9. :
.
. (2540). . .
: .
, . (2543). .
. : .
. (2550). .
.
.(2553).
. ,
. (2544).
: . :
. .
. (2544).
: .
. (2543).
.
292
. (2543).
. (2543).
: .
. . . (2543).
. : .
. . [cited 2007 Sep 15]. Available from:
URL;http://www.trf.or.th/tips/x.asp?Art_ID=93
. (2548). . :
.
. (2553). :
. ,
. (2551).
.
. . (2543).
.
; 2543. 15-25.
., . 2543. . :
.
, , . (2553).
. ,
.(2553).
. ,
. (2549). : . :
.
293
. (2540).
. :
.
. (2546).
. 4.
: .
. 2546. :
.
. (2551).
. :
.
. (2539). (.)
(.) .
: .
.. (2550). ()
.
23 2550 13.00 16.00 2 2
.
. (2545).
. :
.
.
()
. http://www.local.moi.go.th/webst/menu52a.htm
(). (2545).
. 24 2545. .
294
. (2545). 1
: 10 . : .
. (2550). 2550.
.;.
. (2540).
. 2540; 65-85.
. (2545).
. .
. (2540). (.)
.
().
.
. (2542)
.
. (2545).
.
. . .. 2547 [cited 2007 Sep 17]
Available from: RLhttp://www.nidambe11.net/ekonomiz/2004q4/article2004nov10p6.htm.
. 2546. . :
(.)
Beck, U. 1992. Risk Society. London : Sage.
Cunniingham, A. and Andrews, B. 1997. Western Medicine As Contested Knowledge.
Manchester and New York : Manchester University.
Good, B. 1994. Medicine, Rationality and Experience : An Anthropological Perspectives.
Cambridge : Cambridge University.
Lindenbaum, S. and Lock, M., eds. 1993. Knowledge, Power and Practice : The Anthropology
of Medicine and Everyday Life. Berkley : University of California.
Radley, A., ed. 1993. World of Illness. New York : Routledge.
295
RESEARCHER
RESEARCHER
AIHD
MAHIDOL UNIVERSITY