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Key words:

crisis, health sys- tem, southern pro- vinces

Abstract Health System during Crisis in Restive Southern Provinces of Thailand Pongthep Sutheravut*, Amorn Rodklai^†, Suwat Wiriyapongsukit^‡, Supat Hasuwannakit^§

*South-Health Systems Research Institute, ^†South Branch of National Health Security Office, ^‡Thepha Hospital, Songkhla Province, ^§Chana Hospital, Songkhla Province

The violence in the Southern provinces in Thailand took a toll on physi- cal, psycho-social and spiritual health. Data collection began from March 2004 to March 2007 using questionnaires, face to face interview including group semi- nars and brainstorming sessions. It was found that the frequency of chaotic events occured 5,460 times during January 2003 to August 2006. About 1,730 have been killed and 2,513 injured. These victims included 22 health workers and 31 health volunteers.

In the prime of the violence, every single hospital has prepared itself to be ready to cope with those crises. Health workers, for example, suddenly changed their behaviors substantially such as adjusting their work schedules, not wearing uniform, taking more precautions, decreasing or avoiding their proac- tive roles in field works, particularly health promotion and health prevention.

These were remarkable changes in health care roles which would have long term serious effects on the communitiy health. In addition, security in hospitals has been tightened while stocks of food became critically necessary. Some local health offices rearranged their teams by having village health volunteers working closely with their health officers. These actions could boost their morale and ensure their safety. Community faith in them and being natives inspired health workers to remain in their posts.

It was interesting that the number of cases of out-patient and in-patient departments had not changed much but the number of patients visiting local health offices clearly decreased. Nevertheless, the number of patients in labor departments increased and the chronic disease cases increased as well. Besides, the number of cases with psychosis or having mental problems sharply increased.

Eventhough, the turn over and replacement of health workers became even but the lack of medical specialists in some areas remained. Number of registered nurses would become the major concern in the near future if the violence is not restrained.

The crisis dictates requirements on short-term measures to focus on secu- rity, life protection, creating the supporting systems about counseling, referring, transferring and maintaining the systems. In the long run, measures include peace restoration, then, create health participatory system of people in commu- nities, self-care system and enhance effectiveness of health system. It should be concerned about the opportunity to build Muslim medical curriculum and agenda. Having a specific team work to monitor the situation closely, connect- ing and communicating with the government and developing the participatory management of data system and solving the problem may gradually decrease the violence. In addition, research and development on the consequences of the health system of the restive southern provinces are required in order to cope with the drastic change.

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2546 35 36 0 71

2547 869 435 44 1,348

2548 1,087 893 23 2,003

2549 1,114 689 42 1,845

2550 69 25 0 94

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∑—πµ·æ∑¬å 23 2 1 20

‡¿ —™°√ 51 1 2 48

欓∫“≈«‘™“™’æ 786 5 30 751

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ᾷŒ 80 13 8 59

∑—πµ·æ∑¬å 16 › 5 11

‡¿ —™°√ 42 1 5 36

欓∫“≈«‘™“™’æ 737 737

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ᾷŒ 101 16 1 84

∑—πµ·æ∑¬å 41 › › 41

‡¿ —™°√ 67 2 2 63

欓∫“≈«‘™“™’æ 243 3 1 239

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2.2 ¡’·æ∑¬å¢Õ‚Õπ‰ªªØ‘∫—µ‘√“™°“√Àπ૬Õ◊Ëπ 2 √“¬ „π®—ßÀ«—¥π√“∏‘«“ ‡∑à“π—Èπ

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❍ °“√√—°…“∫ÿ§≈“°√„Àâ§ßÕ¬Ÿà ‚¥¬¡’¢âÕ‡ πÕ®“°æ◊Èπ∑’Ë¥—ßπ’È

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π‚¬∫“¬ ·≈–¡“µ√°“√¥â“π°”≈—ߧπ„π™π∫∑„Àâ™—¥‡®π·≈– Õ¥§≈âÕß°—∫∫√‘∫∑¢Õßæ◊Èπ∑’Ë ∑—Èß°“√§—¥‡≈◊Õ°§π (recruitment) ·≈–°“√°”Àπ¥°”≈—ߧπ∑’ˉ¡à„™â‡°≥±å∑“ß¿Ÿ¡‘»“ µ√å (GIS) ‡∑à“π—Èπ

■ °“√ √â“ß·√ß®Ÿß„®„Àâ°—∫∫ÿ§≈“°√∑ÿ°°≈ÿࡥ⫬§«“¡‡À¡“– ¡ ‡ªìπ∏√√¡ ‚¥¬¡’¡“µ√°“√®Ÿß„®

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- ¡“µ√°“√∑“ß°“√‡ß‘π °“√°√–®“¬/®—¥ √√ß∫ª√–¡“≥‰ª™π∫∑¡“°¢÷Èπ ·√ß®Ÿß„®¥â“π°“√

‡ß‘π∑’ˇªìπ∏√√¡ ´÷ËßµâÕß·µ°µà“ß®“°æ◊Èπ∑’Ë°—π¥“√Õ◊Ëπ ·≈–§«√»÷°…“µ—«‡≈¢∑’ˇÀ¡“– ¡µàÕ∑ÿ°«‘™“™’æ‚¥¬‡©æ“–

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π—°»÷°…“™π∫∑

- ¡“µ√°“√¥â“π —ߧ¡ „À⧫“¡°â“«Àπâ“ ¡’‡°’¬√µ‘ √≥√ߧå √â“ߧ«“¡¬Õ¡√—∫ °“√¡Õ∫

√“ß«—≈„π°“√ªØ‘∫—µ‘Àπâ“∑’Ë

- ¡“µ√°“√¥â“π°“√∫√‘À“√®—¥°“√ ‡™àπ °“√ª√—∫ª√ÿ߇°≥±å°“√ª√–‡¡‘πº≈ °“√∫√√®ÿ π—°‡√’¬π∑ÿπ°√–∑√«ß “∏“√≥ ÿ¢‡ªìπ¢â“√“™°“√

¡“µ√°“√√–¬–¬“«

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❍ °“√ √â“ß√–∫∫°“√¥Ÿ·≈µπ‡ÕߢÕß™ÿ¡™π

❍ °“√ √â“ßÀ≈—° Ÿµ√°“√·æ∑¬å„π«‘∂’¡ÿ ≈‘¡

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❍ °“√‡æ‘Ë¡ª√– ‘∑∏‘¿“æ„π√–∫∫∫√‘°“√ ÿ¢¿“æ

❍ °“√®—¥°“√¥â“π∫ÿ§≈“°√

■ ‡ªî¥‚Õ°“ „Àâ§π„πæ◊Èπ∑’Ë‚¥¬‡©æ“–„π™π∫∑ ¡’°“√»÷°…“∑“ߥâ“π°“√·æ∑¬å·≈– “∏“√≥ ÿ¢

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■  π—∫ πÿπ°“√»÷°…“µàÕ‡π◊ËÕߢÕß∫ÿ§≈“°√„πªí®®ÿ∫—π

■ ®—¥√–∫∫§à“µÕ∫·∑π·≈– «— ¥‘°“√∑’ˇÀ¡“– ¡

■ ‡ªî¥‚Õ°“ „Àâ∫ÿ§≈“°√∑“ß°“√·æ∑¬å„πæ◊Èπ∑’Ë∑’Ë®∫®“°µà“ߪ√–‡∑»‡¢â“ Ÿà√–∫∫∫√‘°“√ “∏“√≥ ÿ¢

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5. ¢âÕ‡ πÕ°≈‰°°“√∑”ß“π‡æ◊ËÕ°“√·°âªí≠À“√–∫∫ “∏“√≥ ÿ¢Õ—π‡π◊ËÕß®“°«‘°ƒµ§«“¡

√ÿπ·√ß

● µâÕß¡’‚§√ß √â“ß∑’¡∑”ß“π‡©æ“– ∑’ˇ°“–µ‘¥ ∂“π°“√≥å ∑”Àπâ“∑’ˇªìπ Head & Brain & Body

‚¥¬¡’Õߧåª√–°Õ∫À≈—°‡ªìπ§π„πæ◊Èπ∑’Ë·≈–®“° à«π°≈“ß

●  √â“ß™àÕß∑“ß°“√‡™◊ËÕ¡µàÕ °“√ ◊ËÕ “√°—∫ºŸâ∫√‘À“√ ºŸâ°”Àπ¥π‚¬∫“¬

● °“√æ—≤π“ Crisis Forum ‡ªìπ‡«∑’√à«¡§‘¥ ·≈°‡ª≈’ˬπ¢âÕ¡Ÿ≈¢à“« “√ °“√µ‘¥µ“¡°“√·°âªí≠À“ ‡æ◊ËÕ

„À≥â¢âÕ¡Ÿ≈∑’Ë∂Ÿ°µâÕß

● ∑”°“√»÷°…“«‘®—¬·≈–æ—≤π“√–∫∫∑’Ë Õ¥§≈âÕß°—∫ ∂“π°“√≥姫“¡√ÿπ·√ß

«‘®“√≥å·≈–¢âÕ‡ πÕ·π–

º≈°“√»÷°…“· ¥ß„Àâ‡ÀÁπ«à“  ∂“π°“√≥å¡’·π«‚πâ¡∑’Ë®–√ÿπ·√ß¡“°¢÷Èπ·≈– àߺ≈°√–∑∫µàÕ√–∫∫ ÿ¢¿“æ

‚¥¬√«¡ ¢≥–∑’Ë∑”°“√»÷°…“«‘®—¬  ∂“π°“√≥å¡’°“√‡ª≈’ˬπ·ª≈ßµ≈Õ¥‡«≈“·≈–√«¥‡√Á« ∑—Èß ∂“π°“√≥å„π æ◊Èπ∑’Ë·≈–π‚¬∫“¬°“√·°âªí≠À“¢Õß√—∞ ºŸâ«‘®—¬®÷ß®”‡ªìπµâÕß„™â¢âÕ¡Ÿ≈∑—Èß®“°°“√‡°Á∫¢âÕ¡Ÿ≈‡Õß·≈–®“°·À≈àß

¢âÕ¡Ÿ≈µà“ß Ê ¡“ª√–°Õ∫°“√«‘‡§√“–Àåº≈°“√»÷°…“ ´÷Ëß∑”„Àâ∑√“∫«à“√–∫∫°“√®—¥°“√¢âÕ¡Ÿ≈¢à“« “√°“√·°â ªí≠À“«‘°ƒµ§«“¡√ÿπ·√ߢÕßÀπ૬ߓπ„πæ◊Èπ∑’Ë ¬—ß¡’ªí≠À“Õ¬Ÿà¡“° ∑—Èß°“√¢“¥°“√√«∫√«¡¢âÕ¡Ÿ≈ ¢“¥·À≈àߢâÕ¡Ÿ≈

§«“¡πà“‡™◊ËÕ∂◊Õ¢ÕߢâÕ¡Ÿ≈ ·≈–°“√π”¢âÕ¡Ÿ≈‰ª„™â

πÕ°®“°π’È ·π«§‘¥„π°“√·°âªí≠À“∑—È߇√◊ËÕß ∂“π°“√≥姫“¡√ÿπ·√ß·≈–°“√∫√‘°“√ “∏“√≥ ÿ¢ ¡—°

‡ªìπ·π«§‘¥À√◊Õ‡ªìππ‚¬∫“¬®“° à«π°≈“ß ‰¡à‰¥â„À⧫“¡ ”§—≠°—∫°“√¡’ à«π√à«¡¢Õß∫ÿ§≈“°√„πæ◊Èπ∑’Ë∑’Ë¡’

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1. »√’ ¡¿æ ®‘µ√å¿‘√¡¬å»√’. 32 ‡¥◊Õπ·Ààߧ«“¡√ÿπ·√ß®—ßÀ«—¥™“¬·¥π¿“§„µâ. ªíµµ“π’: »Ÿπ¬å‡ΩÑ“√–«—߇™‘ßÕߧ姫“¡√Ÿâ ∂“π°“√≥å

¿“§„µâ; 2549.

2. ‡¡µµ“ °Ÿπ‘ß. √“¬ß“π ∂“π°“√≥姫“¡™à«¬‡À≈◊ÕºŸâ‰¥â√—∫º≈°√–∑∫®“°‡Àµÿ°“√≥姫“¡‰¡à ß∫„π®—ßÀ«—¥™“¬·¥π¿“§„µâ. ªíµµ“π’:

»Ÿπ¬åª√– “πß“π«‘™“°“√„À⧫“¡™à«¬‡À≈◊ÕºŸâ‰¥â√—∫º≈°√–∑∫®“°‡Àµÿ°“√≥姫“¡‰¡à ß∫„π®—ßÀ«—¥™“¬·¥π¿“§„µâ; 2550.

3.  ÿ«—≤πå «‘√‘¬æß»å ÿ°‘®. √“¬ß“π ∂“π°“√≥å‡Àµÿ°“√≥姫“¡‰¡à ß∫„π®—ßÀ«—¥™“¬·¥π¿“§„µâ: ‡Õ° “√ª√–°Õ∫°“√ª√–™ÿ¡

§≥–∑”ß“π·ºπß“π√–∫∫ ÿ¢¿“æ„πæ◊Èπ∑’ËæÀÿ«—≤π∏√√¡. 30 惻®‘°“¬π 2549 ≥  ∂“∫—π«‘®—¬√–∫∫ ÿ¢¿“æ¿“§„µâ

¡À“«‘∑¬“≈—¬ ß¢≈“π§√‘π∑√å.  ß¢≈“:  ∂“∫—π«‘®—¬√–∫∫ ÿ¢¿“æ¿“§„µâ ¡À“«‘∑¬“≈—¬ ß¢≈“π§√‘π∑√å; 2549.

4. Õ¡√ √Õ¥§≈⓬,  ÿ¿—∑√ Œ“ ÿ«√√≥°‘®,  ÿ«—≤πå «‘√‘¬æß»å ÿ°‘®. °“√®—¥°“√√–∫∫∫√‘°“√ ÿ¢¿“æ„π¿“«– «‘°ƒµ‘ 3 ®—ßÀ«—¥

™“¬·¥π¿“§„µâ.  ß¢≈“:  ∂“∫—π«‘®—¬√–∫∫ ÿ¢¿“æ¿“§„µâ ¡À“«‘∑¬“≈—¬ ß¢≈“π§√‘π∑√å; 2548.

5.  ÿ«—≤πå «‘√‘¬æß»å ÿ°‘®. √“¬ß“π ∂“π°“√≥å∫ÿ§≈“°√ “∏“√≥ ÿ¢„π®—ßÀ«—¥™“¬·¥π¿“§„µâ : ‡Õ° “√ª√–°Õ∫°“√ª√–™ÿ¡§≥–

°√√¡°“√ π—∫ πÿπ°“√¥”‡π‘πß“πµ“¡π‚¬∫“¬ ÿ¢¿“æ§≥–∑’Ë 2 §√—Èß∑’Ë 2/2550 11 ¡°√“§¡ 2550; ≥  ”π—°ß“π “∏“√≥ ÿ¢

®—ßÀ«—¥ ß¢≈“.  ß¢≈“:  ”π—°ß“π “∏“√≥ ÿ¢®—ßÀ«—¥ ß¢≈“; 2550.

6. æߧå‡∑æ  ÿ∏’√«ÿ≤‘. √–∫∫ “∏“√≥ ÿ¢„π¿“«–«‘°ƒµ 3 ®—ßÀ«—¥™“¬·¥π¿“§„µâ.  ß¢≈“:  ∂“∫—π«‘®—¬√–∫∫ ÿ¢¿“æ¿“§„µâ

¡À“«‘∑¬“≈—¬ ß¢≈“π§√‘π∑√å; 2549.