Conditions’ Constraints, and Strategies for Increased 条件的约束，和策略，增加.docVIP

Conditions, Constraints, and Strategies for Increased Contribution of General Practitioners to the Health System in Thailand Supattra Srivanichakorn (1) and Monique Van Dormael (2) (1) Ayutthaya Provincial Health Office, Thailand. (2) Institute of Tropical Medicine, Antwerp, Belgium. Abstract Huge efforts were made in the past decades in Thailand to establish a strong country-wide network of health facilities serving the community. But acceptability of existing first line services remains low. The rapid growth of specialization and parallel decline of general practice in medicine contribute to a health care system marked increasingly with hospital-and technology-oriented values. However, general practitioners are likely to be one of the key elements to promote and improve first line care, if adequate conditions are created. This paper analyzes the present situation of general practitioners in the Thai health care system and the conditions under which their contribution could be strengthened. Definition of general practitioners functions requires adaptation to the Thai context. The rural district general practitioners role (presently hospital-based care, competing with rather than complementing health centers) needs reorientation towards responsibility for the functioning of the district health system as a whole, including support and supervision of first line care providers and clinical practice concentrating on secondary care. In urban areas, where the demand for medical doctors increases, health centers with general practitioners providing first line care themselves should be introduced gradually. This requires a sufficient number of general practitioners, whose functions are defined as complementary to those of specialists, whose training is adequate to their function, whose working conditions and career perspectives are reasonably motivating, and whose tasks are facilitated by adequate health service organization and policy. Key words :- gen