Stakeholders’ Perspectives on Child Healthcare Services under Rural Health Reform in Thailand: A Qualitative Study

Authors

1 Department of Child and Adolescent Nursing, School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand;

2 Nursing Innovation Research and Resource Group, School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand;

3 Department of Maternity Nursing and Midwifery, School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand

Abstract

Background: Children under 5 years old are a global health priority; however, healthcare services for this age group remain limited, especially in rural areas of Thailand. This study explores the perspectives of stakeholders responsible for child healthcare delivery in resource-constrained rural communities.
Methods: This study is a qualitative research using thematic framework analysis. Participants (N=45) including twenty parents, ten healthcare providers, five village health volunteers, five teachers, and five community leaders were recruited using purposive sampling. In-depth interviews and focus group discussions, lasting between 40 and 70 minutes, were performed to explore the participants’ perspectives. Data were collected from February to November 2021. All interviews were transcribed and analyzed using NVivo software version 21.
Results: The research identified two themes, each with two sub-themes: 1) Structural limitations: disparity in the distribution of service and healthcare provider training and challenges in policy implementation, and 2) Opportunities to optimize childcare: fostering community ownership and multidisciplinary collaboration and strengthening family engagement.
Conclusions: This study revealed significant challenges and opportunities in delivering healthcare services to children in rural Thailand. The findings underscore the importance of coordinated interventions that enhance community involvement and strengthen family engagement.

Highlights

Katemanee Moonpanane (Google Scholar) (PubMed)

Keywords

References


1.    Chonnapasatid W, Viwattanatipa N, Manopatanakul S, Jaruratanasirikul S. Thai Universal Health Care Coverage scheme promotes the accessibility to cleft lip/palate treatment: the result of cleft care provision assessment using modified Geographic Information System. BMC Health Services Research. 2022; 22:416. 
2.    Paek SC, Meemon N, Wan TT. Thailand’s universal coverage scheme and its impact on health-seeking behavior. Springerplus. 2016; 5:1952. 
3.    Darling JC, Bamidis PD, Burberry J, Rudolf MCJ. The First Thousand Days: early, integrated and evidence-based approaches to improving child health: coming to a population near you? Archives of Disease in Childhood. 2020; 105:837-41.
4.    Benedict L, Hong SA, Winichagoon P, et al. Double burden of malnutrition and its association with infant and young child feeding practices among children under-five in Thailand. Public Health Nutrition. 2021; 24:3058-65.
5.    Coll-Seck A, Clark H, Bahl R, et al. Framing an agenda for children thriving in the SDG era: a WHO-UNICEF-Lancet Commission on Child Health and Wellbeing. Lancet. 2019; 393:109-12. 
6.    Topothai T, Suphanchaimat R, Topothai C, et al. Thailand achievement of SDG indicator 4.2.1 on early child development: An analysis of the 2019 multiple indicator cluster survey. International Journal of Environmental Research and Public Health. 2022; 19:7599.
7.    Chamchan C, Apipornchaisakul K. Health insurance status of cross-border migrant children and the associated factors: a study in a Thai-Myanmar border area. BMC Health Services Research. 2022; 22:1276.
8.    McGovern ME, Krishna A, Aguayo VM, Subramanian SV. A review of the evidence linking child stunting to economic outcomes. International Journal of Epidemiology. 2017; 46:1171-91.
9.    Mukuku O, Mutombo AM, Kamona LK, et al. Predictive Model for the Risk of Severe Acute Malnutrition in Children. Journal of Nutrition and Metabolism. 2019; 2019:4740825.
10.    Pongcharoen T, Rojroongwasinkul N, Tuntipopipat S, et al. Triple burden of malnutrition among Thai children aged 6 months to 12 years. Public Health Nutrition. 2024; 27:e152.
11.    Lu C, Cuartas J, Fink G, et al. Inequalities in early childhood care and development in low/middle-income countries: 2010-2018. BMJ Global Health. 2020; 5:e002314.
12.    Veginadu P, Masood M, Gussy M, Calache H. Patterns and predictors of public dental service utilisation among refugees in Victoria, Australia: a latent profile and multilevel analysis. BMC Oral Health. 2023; 23:201.
13.    Sitthisettapong T, Tasanarong P, Phantumvanit P. Strategic management of early childhood caries in Thailand: A Critical Overview. Frontiers in Public Health. 2021; 9:664541.
14.    Srichan P, Thohinung U, Kodyee S, Apidechkul T. Vaccine serocoverage under the expanded program on immunization among hill tribe children in Thailand: A cross-sectional study. Vaccine. 2021; 39:6477-84. 
15.    Kitreerawutiwong N, Jordan S, Hughes D. Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand. PLoS One. 2017; 12:e0174055.
16.    Jongudomsuk P, Srisasalux J. A decade of health-care decentralization in Thailand: What lessons can be drawn? WHO South East Asia Journal of Public Health. 2012; 1:347-56.
17.    Tangcharoensathien V, Patcharanarumol W, Kulthanmanusorn A, et al. The Political Economy of UHC Reform in Thailand: Lessons for Low- and Middle-Income Countries. Health Systems and Reform. 2019; 5:195-208.
18.    Songserm N, Woradet S, Bureelerd O, et al. Effectiveness of leader village health volunteers training program on preventing cholangiocarcinoma in Thailand: advantages for high-risk area with limited public health personnel. Journal of Cancer Education. 2021; 36:1306-15.
19.    Lester P, Mogil C, Milburn N, et al. A public partnership to support well-being: Population health implementation of trauma and resilience informed care across child and family ecosystems. Child and Adolescent Psychiatric Clinics of North America. 2021; 30:737-50.
20.    Moonpanane K, Pitchalard K, Thepsaw J, et al. Healthcare service utilization of hill tribe children in underserved communities in Thailand: Barriers to access. BMC Health Services Research. 2022; 22:1114.
21.    Harrington RA, Califf RM, Balamurugan A, et al. Call to action: Rural health: A presidential advisory from the American heart association and American stroke association. Circulation. 2020; 141:e615-44.
22.    Brennan E, Abimbola S. The impact of decentralisation on health systems in fragile and post-conflict countries: a narrative synthesis of six case studies in the Indo-Pacific. Conflict and Health. 2023; 17:31.
23.    Treleaven E, Whidden C, Cole F, et al. Relationship between symptoms, barriers to care and healthcare utilisation among children under five in rural Mali. Tropical Medicine & International Health. 2021; 26:943-52.
24.    Guba EG, Lincoln YS. Competing paradigms in qualitative research. In: Denzin NK, Lincoln YS, editors. Handbook of Qualitative Research. US: Sage Publications; 1994. p.105-17.
25.    Roberts R. A rural health governance model that is fit for purpose-It’s not them and us: It’s ‘we’. Australian Journal of Rural Health. 2021; 29:816-20. 
26.    Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, et al. Health systems development in Thailand: A solid platform for successful implementation of universal health coverage. Lancet. 2018; 391:1205-23. 
27.    Probst JC, Barker JC, Enders A, Gardiner P. Current State of Child Health in Rural America: How Context Shapes Children’s Health. Journal of Rural Health. 2018;34:s3-12.
28.    Robinson LR, Holbrook JR, Bitsko RH, et al. Differences in health care, family, and community factors associated with mental, behavioral, and developmental disorders among children aged 2-8 years in rural and urban areas - United States, 2011-2012. Morbidity and Mortality Weekly Report. 2017; 66:1-11.
29.    Thet MM, Khaing MNT, Zin SS, et al. Choice of health providers and health-seeking behaviour among forest goer population in Myanmar: findings from a cross-sectional household survey. Malaria Journal. 2022; 21:382.
30.    DeHaven MJ, Gimpel NA, Gutierrez D, et al. Designing health care: A community health science solution for reducing health disparities by integrating social determinants and the effects of place. Journal of Evaluation in Clinical Practice. 2020; 26:1564-72.
31.    Gale J. Exploring options to strengthen rural health care: comparing the United States of America and United Kingdom. Rural and Remote Health. 2023; 23:8145.
32.    Lungu EA, Darker C, Biesma R. Determinants of healthcare seeking for childhood illnesses among caregivers of under-five children in urban slums in Malawi: a population-based cross-sectional study. BMC Pediatrics. 2020; 20:20.
33.    Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet. 2017; 389:1431-41.
34.    George M. The fragmentation and weakening of institutions of primary healthcare a prescription for their revival. Economic and Political Weekly. 2020; 55:58-64. 
35.    Bitton A, Ratcliffe HL, Veillard JH, et al. Primary health care as a foundation for strengthening health systems in low- and middle- income countries. Journal of General Internal Medicine. 2017; 32:566-71.
36.    Viegas da Silva E, Hartwig FP, Barros F, Murray J. Effectiveness of a large-scale home visiting programme (PIM) on early child development in Brazil: quasi- experimental study nested in a birth cohort. BMJ Global Health. 2022; 7:e007116.
37.    Emmers D, Jiang Q, Xue H, et al. Early childhood development and parental training interventions in rural China: a systematic review and meta-analysis. BMJ Global Health. 2021; 6:e005578.
38.    Pagaiya N, Noree T, Hongthong P, et al. From village health volunteers to paid care givers: the optimal mix for a multidisciplinary home health care workforce in rural Thailand. Human Resources for Health. 2021; 19:2.
39.    Li R, Rose N, Zheng YM, et al. Early Childhood Reading in Rural China and Obstacles to Caregiver Investment in Young Children: A Mixed-Methods Analysis. International Journal of Environmental Research and Public Health. 2021; 18:1457.
40.    Luo R, Emmers D, Warrinnier N, et al. Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial. Social Science and Medicine. 2019; 239:112545.
41.    Zhang L, Ssewanyana D, Martin MC, et al. Supporting child development through parenting interventions in low- to middle- income countries: An Updated Systematic Review. Frontiers in Public Health. 2021; 9:671988.
42.    Munns A, Toye C, Hegney D, et al. Aboriginal parent support: A partnership approach. Journal of Clinical Nursing. 2018; 27:e437-50.

Files

Share

How to cite

Statistics