[Primary health care in Thailand with community participation special reference to Japanese assistance]

The international health cooperation of Japan for developing countries has been mostly concentrated on matters such as improvement of hygienic environment, prevention of tropical infectious diseases, establishment of hospitals with modern medical instruments and devices, and dispatch of medical experts. PHC (Primary Health Care) activities based on voluntary participation of local inhabitants in developing countries have been largely neglected. In the field of health and medical care, sufficient effect may not be achieved unless the local health activity is based on voluntary participation of the inhabitants. The introduction of highly advanced modern medical techniques may be beneficial to some of the inhabitants, while most of the local inhabitants may not have the chance to receive such benefits, and additionally it is difficult to propagate modern medical care and technique widely to rural areas in Thailand. In Thailand, PHC activity based on community participation was started in 1985, with the following three items as main themes: (1) Training of Village Health Volunteers (VHV) and Village Health Communicators (VHC), and development of their activities. (2) Establishment and operation of Health Centers. (3) Establishment and operation of Drug Cooperative System (DC). Earlier, as one of PHC activities developed by Japan, "Thailand Local Health Activity Improvement Project" based on the program of Thailand-Japan Partnership was initiated in 1976 in rural areas of Chanthaburi Prefecture. From 1982, third country training programs have been carried out by Japan International Cooperation Agency (JICA). Since 10 years have elapsed the initiation of PHC activity in rural areas in Thailand under the cooperation of the Governments of Thailand and Japan, it seems to be time to reconsider and study again how PHC activity should be developed in future based on candid evaluation of achievements and results.