Macro situation of dental care delivery services at district level of Thailand during 1997-1998.

Abstract

The objectives of this study was to analyse the present situation of dental health care delivery services at district level of Thailand which include oral care coverage, types of oral care delivered, service utilization, and the service-linkages between district hospital and subdistrict health center. Quantitative data were collected through mailing questionnaire to all district hospitals during August 1998. Qualitative data including in-depth interview of 17 dentists and dental nurses from 4 selected provinces were collected, and analyzed 1-year workload of dental personnel. The returned rate of questionnaire was 93.5 %. The result showed that 1) District hospitals were the main providing institute in rural area. There were private clinic, dental clinic under other ministries and sub-district health center covered at 32.9 %, 8.7%and 28.0 % respectively. 2) 88.5% of district hospitals had both dentists and dental nurses. 3) Dental services provided in district hospitals were met service standard. However, the quantity or service load was quite different among hospitals after adjusted by number of dental personnel.The qualitative data from 4 specific study hospitals showed that both dentists and dental nurses provided almost the same types of basic dental care. It was recommended that 1) district hospitals and the connection to sub-district health centers are the core structure for delivering oral health care services to rural people . 2) To support this model of service delivery, dentists and dental nurses at the district hospitals should be trained to acquired epidemiological and managerial skill for a better community dental health problem solving. Dental health personnel at this level should also received further training to handle complicated conditions referred from the sub-district level. 3) A set of performance indicators should be developed for regular evaluation and improvement of dental care services at this level. 4)The policy of public sector reform, which may lead to terminate 3-year compulsary dentist program and decrease dental nurse production, may effect the distribution of dental personnel in rural area.