Village health workers exchange views at a meeting in Mae Sa Reang. Photo credit and case study credit: UNFPA

Tida Charoenjitnirun, from Mae La Noi district, belongs to the Karen ethnic minority. She lives in an area that has one of Thailand’s highest maternal mortality ratios. Like other Karen mothers in her community, she did not bother coming down the mountain to seek health advice and services during her first pregnancy. “I used to think that when a mother or a baby dies, it is a tragedy but also a fact of life,” she recalls.

“Two months ago, I gave birth to my second child. It was early morning in the rainy season. We needed more than 10 men to help pull the car so I could get to the hospital safely,” recounts Tida Charoenjitnirun, 23, noting that the un-paved road was slippery and treacherous, so the men helped guide the car. ”Usually the trip takes only half an hour, but on that wet day we left before 3 a.m. and arrived around 5. I gave birth 10 minutes after arriving—it was lucky I did not give birth on the way.”

Her views changed after the Department of Health and UNFPA, began training village health workers to educate their neighbours on maternal and child health. “In my second pregnancy we learned that I should get antenatal care, and my husband drove me to see the doctor every month,” she says. Today Tida is herself a volunteer health worker, offering lifesaving advice to other pregnant women.

“Our first child, now almost 4, gets sick easily,” says Tida’s husband Uthai. He hopes the new baby will be healthier.

“Tida learned about many things after she became a village health worker,” Uthai says proudly. “When we go to church on Sunday, she shares her knowledge with other church members. The tasks she does may be simple,” he adds, “but they help pregnant women stay healthy and are good for the health of the children. “We used to accept the deaths of mothers and chidren as a law of nature. But now we’ve learned how to reduce risks and prevent unnecessary deaths.”

Neonatal mortality rate  (per 1,000 live births) (2011) 8
Under-five mortality rate (per 1,000 live births) (2011) 12
Maternal mortality ratio (per 100,000 live births) (2010) 48
Number of doctors, nurses and midwives per 10,000 people (2010) 18.2
Births attended by skilled personnel (2009) 99.4%
Total expenditure on health as a percentage of gross domestic product (2011) 4.1%
General government expenditure on health as a percentage of total expenditure on health (2011) 75.5%

In Thailand, social health insurance mechanisms, the largest of which is the Universal Coverage Scheme, cover about 98% of the population. The benefits package includes inpatient, outpatient, curative and preventive care. Non-communicable diseases are the greatest causes of mortality, with the exception of HIV/AIDS, which is the number one cause of mortality and morbidity.

Of the dimensions of availability, accessibility, acceptability and quality of the workforce, accessibility is perhaps in greatest need of attention, as disparities are observed in the geographic distribution of health workers. Availability of skilled health professionals is below the thresholds but with a good chance of scaling up before 2035; and there is evidence of good mechanisms in place for accreditation, regulation and licensing of the health workforce. The HRH Strategic Plan (2007-2016) includes a focus on addressing the inequitable distribution, as well as other measures for scaling-up and improving quality and performance.

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