May 11, 2015 — Now in its 14th year, Thailand’s universal health care system provides coverage to 99.9% of the population, but as it grows the system is facing challenges caused by a shortage of doctors and nurses, especially in rural areas. Rajata Rajatanavin, Thailand’s Minister of Public Health, addressed these challenges when he delivered the Dean’s Distinguished Lecture on April 28 at the Joseph B. Martin Conference Center.
Since its inception in 2001, Thailand has provided health care through a tiered system of public providers: large regional hospitals with a comprehensive set of specialists, smaller hospitals with capacities ranging from 200 to 250 beds, and community health centers focused on providing primary care in more rural areas. The country has a large network of dozens of public universities that teach and train thousands of doctors and nurses per year and physicians from public universities must spend three years working at a state-run hospital in a rural area upon graduation. Despite the government’s efforts, however, there are simply not enough doctors and nurses practicing in rural areas to meet the health care demand.
“Education has failed to serve the needs of our patients and population,” Rajatanavin said. He highlighted the disparities between major cities and rural areas: In Bangkok there is one doctor for every 850 people, while in the country’s rural northeast provinces there is just one doctor for every 5,308 people. He estimates Thailand needs about 9,000 more doctors and 43,000 more nurses to address rural shortages.
“Another problem we are facing is the lack of family physicians,” said Rajatanavin, estimating that only about 5% of young doctors are choosing to become primary care doctors after finishing their three-year service in rural areas. Instead, they are leaving for jobs in the private sector, or are pursuing financially lucrative specialties such as cardiology, he said, adding that for doctors who are interested in family medicine, “There are no role models for them to follow.”
Thailand is working to address this gap through a series of health care education reforms. A major part of this is using a homegrown approach to train future doctors by seeking out high performing students already living in rural areas and offering them scholarships.
Rajatanavin said this is a model the Thai government has already successfully used to train nurses. The Community Nursing Initiative involved partnering with Khon Kaen University to identify students in the province, offer them scholarships, and then train them using a special curriculum. “We think that this is a good model to increase the nurse population working in rural communities and we hope to expand this model throughout the country.”
In addition to addressing the doctor and nursing shortage in Thailand, Rajatanavin spoke of other public health challenges facing the country. One of the major current focuses is reducing non-communicable diseases—particularly motor vehicle deaths. According to the World Health Organization (WHO), Thailand has the fourth-highest traffic fatality death rate in the world.
photo: Emily Cuccarese