• 
• 

Published on October 22, 2007

 Thanks to the courage and efforts of Kaysorn Wongmanee, the 200,000 people in 31 tambon can now get primary medical care from health centres in their community without having to travel for hours to the state hospital in Phetchabun's Lom Sak district.

Like the chiefs of other district health offices, Kaysorn works with a limited annual budget and human resources allocated by the Public Health Ministry.

Unlike other chiefs, though, Kaysorn has been able to improve all 31 health centres under her supervision.

Visit any health centre in Lom Sak district and you'll probably be surprised by how new everything looks. This is just the first sign of a spreading professionalism. The ground floor, which used to be under-utilised, is now an emergency unit equipped with basic medical and life-saving equipment. Some health centres even have their own dental department and physical therapy unit.

In creating her new kind of health centre, Kaysorn has had to push the boundaries of conventional practice set by the Health Ministry.

"To upgrade healthcare services for people in remote areas, we can't allow ourselves to get tied up in the ministry's red tape," she says.

Instead of waiting for a budget from the ministry, Kaysorn introduced the so-called "Bt2 contribution project". Since 2002 - just a year after Kaysorn took up her position - each person in Lom Sak has contributed Bt2 a month, the money has been spent on upgrading the capacity of each health centre so that they're now the equivalent of small, self-sufficient hospitals. She's also succeeded in convincing all 31 Tambon Administration Organisations in Lom Sak district to contribute their budget to the health centres.

"We can't only rely on the money from the ministry as there's never enough to make improvements to health centres," she says.

Due to a budget allocation system that was calculated on a per-capita basis in the area, each health centre had been allocated less than Bt300,000 a year. But to upgrade the capacity and to build trust in their services among local people, each subdistrict health centre needed about Bt700,000.

After more than two decades working as head of the nursing division of Lom Sak Hospital, Kaysorn had seen firsthand how the lack of basic medical facilities in their own locales meant hundreds of people flooded the hospital every day, many of them with minor ailments. In her other role, in charge of the hospital's outreach team, Kaysorn's eyes were opened to the problems at the subdistrict level.

She saw that insufficient budgets were just one of a host of obstacles to increasing the efficiency of the health centres.

"Health centres came up short on all resources - budget, manpower, medical equipment and morale of health officials," she says.

Thus it was that the centres became Kaysorn's first priority on taking up her post in Lom Sak six years ago.

Renaming upgraded health centres "tambon hospitals" put Kaysorn in hot water with high-ranking officials in the Public Health Ministry - under the structure of the ministry, there were only district hospitals. With no doctors or nurses stationed at the local health centres (they are staffed by health officials with public-health science degrees), they couldn't qualify as hospitals.

"Though we don't have doctors, the services we provide are no different from the services that small hospitals offer," says Kaysorn.

Instead of paying heed to the pressures, Kaysorn and her team focused on bringing her vision for tambon hospitals to fruition. Success has been easy to measure: Lom Sak hospital treated around 700 people a day a few years ago, that figure's now down to 300. The Health Ministry's ultimate goal - to ease the burden of district hospitals with better local facilities - has been met.

With no quota of doctors assigned to health centres, Kaysorn decided to improve the skills of health officials through courses and training. This allowed more complicated ailments such as diabetes and respiratory diseases to be taken care of by health officials in all 31 centres.

In 2003 Kaysorn received recognition for her efforts when the Health Security Office awarded her the Health Innovation of the Year for her Bt2 contribution project.

Kaysorn has long-term plans for dealing with the lack of skilled medical workers. A fund to finance local schoolchildren to study fields including nursing and dental care management has been set up as part of the Bt2 contribution project. In return for the funding, the students sign a contract to work in a health centre in their own community once they are qualified.

As a result of the scheme, two health centres now have their own dental assistants providing basic dental care and some have their own nurse.

Kaysorn hopes eventually to have professional practitioners at all 31 health centres in her district. Though that dream has yet to come true, Kaysorn is justifiably proud of what she's done for the people in her care and encourages others in positions like hers to follow her example.

"My advice is, don't surrender, whatever the obstacles you face."

Pennapa Hongthong

 The Nation

PHETCHABUN