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4 Thesis Name Degree Title The Development of Prinary Health Care Based on the brperiences of Conmunity Primary Health Care Center : A Case Study of a Village Central Region of Thailand Prasert Leksansern Master of Arts (Medical and Health Social Sciences) Thesis Supervisory Connittee Prasit Leerapan, M.Ed. Preecha Upayokin, Ph.D. Date of Graduation Luckana Thernsirikunchai, M.A. 28 May B.E (1996) ABSTRACT The purpose of this research was threefold. First, was to study the operations of prinary health care in a village environnent before the institution of a community primary health care center. Second, was to compare and contrast the activities of the center in relation to other pre-existing centers. Third was to observe and gauge the effectiveness of the activities of the primary health care center in developing primary health care. A lrilt"g" in central region of Thailand yas selected as a " pilot village " for the four mnth intensive study. The study employed four different date collection methods in assessiry the village's situation. The mettpds included in-depth interviews, participant observation and the review of docurents. The study revealed that prinary health care activities were generally introduced by sub-district health officers prior to the

5 {t establishnent of the center. As a result, the tlpes and patterns of primary health care operations did not arise from within the village via a comnunity-based joint developnent, but rather from an outside source, the health officers. The activities that proved nost successful were ones gernane to the village's specific problems and henceforth required comnunity involvement. This process tended toword the process of original problen solving. After a connunity primary health care center was established, there was no distinctive variation in the primary health care activities. Activities originally introduced by health officers, such as grouping, mobilization and administration, were undertaken by volunteers of the community prinary health care center. Because these activities were initiated, planned, inplemented, controlled and evaluated by health officers, there was no evidence of connunity participation in the health care activities, even while under the adninistration of the center. This study serves to denonstrate that present prinary health c&re nodel is not conducive to effectively developing prinary health care across all villages and communities. Different villages have different characteristic primary health care problems that nust be considered in developnent of a primary health care progran. The Ministry of Rrblic Health should consider inproving its primary health care mdel by oaking it rrcre responsive to the needs of a particular community and less stringently bureaucratic. Operations should be sensitive and flexible and not operate under strict guidelines and pre-ordained conditions. Growledge of this need-based nethodologt should be disseminated to sub-district health officers.