Integrating NCD into Primary Health Care in Thailand: a Mix Method Study

Abstract BackgroundIn response to an increased burden from non-communicable diseases (NCDs), primary health care (PHC) is advocated as an effective platform to support NCD prevention and control. This study aims to assess Thailand’s PHC capacity in providing NCD services, identify enabling factors and challenges and provide policy recommendations for improvement.MethodsThis cross-sectional mixed-method study was conducted between October 2019 and May 2020. Two provinces, one rich and one poor were randomly selected and then a city and rural district from each province were randomly selected. From these four sites in the two provinces, 56 officers from PHC centres were sampled purposively for a self-administrative questionnaire survey on their capacities and practices related to NCD.A total of 79 participants from Provincial and District Health Offices, provincial and district hospitals, and PHC centres who involved with NCD participated in focus group discussions or in-depth interviews.ResultsStrong health infrastructure, competent staff, though not matched with increased workload, and secured budget boost PHC capacity to address NCD prevention, control, case management, referral and rehabilitation. Community engagement through village health volunteers improves NCD awareness, enrols in screening and improves adherence to interventions. Collaborations between provincial and district hospitals in providing resources and technical support improve NCD capacity of PHC centres. In addition, village health volunteer, a crucial link between health sector and community, is key in supporting NCD control. Additionally, inconsistent national policy directions and uncertainty related to key performance indicators hamper progress in NCD management at the operational level.ConclusionPHC centres play a vital role in managing NCDs prevention and control. However, adequate human and financial resources and policy guidance are required to improve PHC performance in managing NCDs. Implementing best buy measures at national level provides synergies for NCD control at PHC level.