Country Report Thailand

The 6th ASEAN & Japan High Level Officials Meeting on Caring Societies:

“Healthy Next Generation”

under the Tight Collaboration between Health and of Social

Welfare

Tokyo, Japan

8-11 September 2008

Ministry of Public Health

And

Ministry of Social Development and Human Security

Thailand

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1. Country demographic profile implications for maternal and child health

Location

Thailand is situated in the center of the Indo-Chinese Peninsula, and covers an area of about 514,000 square kilometers. It is the third largest country among the Southeast Asian nations, compared to Indonesia and Myanmar. It is bordered by the Lao People’s Democratic Republic on the north, Kingdom of Cambodia on the east, Malaysia and Gulf of Thailand on the south, and Myanmar on the west and northwest. Geographically, Thailand is divided into four regions: Central, North, Northeast and South and is administratively divided into 76 provinces, one of which is the Bangkok Metropolis. Each province is further subdivided into districts/minor-districts (amphoe and king-amphoe), sub-districts (tambon) and villages (muban). There are 926 districts / minor districts, 7,426 sub-districts and 74,944 villages. Some areas are also designated as municipalities, including all provincial capitals.

General Information

According to the Institute of Population and Social Research, Mahidol University, as of 1 July 2008 the population of Thailand was 63.1 million, 31.1 million of which were male and 31.99 million were female, making the male to female proportion of 97.2:100. When considering the age group, it was found that the young population (aged 0-14) accounted for 13.635 million or 21.6 % of the total population. The working-age group (aged 15-59) accounted for 42.44 million, or 67.24 %, and the elderly group (aged 60 or more) accounted for 7.04 million or 11.16%.

The literacy rate among Thai people aged 15 and over increased from 78.6 per cent in 1970 to 93.5 per cent in 2005 which is much higher than the average rate (67.0%) for developing countries.

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General Information Data year

1.GNI per capita (US $) 2990 2006

2.Poverty rate 9.6 2006

3.Adult literacy rate

male 96 2006

female 90.6 2006

4.1 Ratio of girls to boys in primary education(%) 97 2004

5.Net Primary School attendance (by sex) 98 2006

6.Access to safe water % 97.4 2006

Vital Statistics

Over two decades of the 1970s and 1980s, great achievements have been reached in population and family planning. The fertility rate has slowed down while the crude birth rate fell from 35.6 per 1,000 population in 1974-1976 to 12.5 per 1,000 population in 2008 and the crude death rate was 8 per 1,000 population. The total fertility rate (TFR) dropped from 6.3 in 1964-65 to 1.5 in 2008.

For life expectancy at birth, in 2008 life expectancy at birth was 76.9 years for female population and 70.2 years for the male counterparts.

Vital statistics 2008

1. Total Population 63,121,000

1.1 Population by Sex

Male 31,125,000

Female 31,996,000

1.2.1. Population in Urban Areas 22,799,000

1.2.2. Population in Rural Areas 40,322,000

1.3. Population by Region

Bangkok Metropolis 6,663,000

Central (excluding Bkk Metropolis) 15,107,000

Northern 11,734,000

Northeastern 21,245,000

Southern 8,372,000

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Vital statistics 2008

1.4. Population by Age Group

Children (under 15) 13,635,000

Labor force (15-59) 42,444,000

Elderly (60 and over) 7,042,000

School ages (6-21) 15,438,000

Women in RH ages (15-44) 17,842,000

2. Crude Death Rate (per 1,000 pop) 8.0

3. Crude Birth Rate (per 1,000 pop) 12.5

4. Infant Mortality Rate (per 1,000 lbs) 15.2

5. U5MR (per 1,000 live births) 19.7

6.Maternal Mortality Ratio (per 100,000 lbs) 18.1*

7. Life Expectancy at Birth (years)

Male 70.2

Female 76.9

8. Total Fertility Rate (per women) 1.5

Source: Mahidol population gazette 2008 * Bureau of Health Promotion, Department of health 2006 Life Expectancy at Birth

In 2004, the life expectancy at birth of Thai people was 70.3 years. Though higher than that of the people in other developing countries and of the world population, life expectancy of Thai people is still lower than that for several other ASEAN countries . However, during 1964-2006, Thais’ life expectancy at birth substantially increased from 55.9 years to 69.9 years for males and 62.0 years to 77.6 years for females. In 2025, it is expected that the life expectancy of Thai citizens will reach 74.8 years for males and 80.3 years for females

Year Males Females Females-Males difference

1964-1965 55.9 62.0 6.1

1974-1976 58.0 63.8 5.8

1985-1986 63.8 68.9 5.1

1989 65.6 70.9 5.3

1991 67.7 72.4 4.7

1995-1996 69.9 74.9 5.0

2005-2006 69.9 77.6 7.7

2005-2010 69.6 76.2 6.6

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Year Males Females Females-Males difference

2010-2015 71.3 77.5 6.3

2015-2020 73.1 78.9 5.8

2020-2025 74.8 80.3 5.5

Source: Thailand Health Profile 2001-2004

Maternal Mortality

The maternal mortality ratio (MMR) in Thailand has declined from 374.3 per 100,000 live births in 1962 to 18.1 per 100,000 live births in 2006). However, MMR estimates from several surveys are higher than the reporting system. For example, the 1995-1996 RAMOS survey on mortality among women of reproductive age revealed a MMR of 44.1, while the Safe Motherhood Project

reported the MMR at 16.3 and the 2003 study of Yongjuea Laosirithavorn

reported a MMR of 52.2 for the same period. Infant Mortality In Thailand, the infant mortality rate (IMR, per 1,000 live births) rapidly declined from 84.3 in 1964 to 40.7 in 1984 and to 16.7 in 2006. However, although IMR for Thailand is lower than the global average (54 per 1000 live births in 2004), it is still higher than that for some other countries in the same region such as Singapore and Malaysia

Child Mortality The child mortality rate (among children aged less than 5 years per 1,000 live births) has significantly changed from 58 in 1980 to 20.6 in 2006. However, even though the Thailand CMR is lower that the global average (79 per 1000 live births in 2004), it is still higher than that for other countries in this region such as Singapore and Malaysia. It is also noted that the rate of reported by the civil registration office tends to be lower than reality, whereas the rate of 15.7 was derived from the 2006 population change survey. Causes of Death

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A study on the causes of death among Thai people

1. 5 leading causes of Maternal deaths (2006) a. Antepartum and postpartum hemorrhage b. Toxemia of Pregnancy c. Amniotic embolism d. Indirect causes e. Direct causes

2. 5 leading causes of infant deaths (2004) a. Death during labour b. Prematurity c. Birth asphyxia d. Congenital anomaly e. Infection

3. 5 leading causes of under5 deaths (2000-2003) a. Neonatal causes b. Diarrhea c. Pneumonia d. HIV/AIDS e. injuries

Conditions related to maternal and child health and welfare

Conditions related to MCH and welfare

data year

1.Malnutrition 7.45% 2007

2. Under weight births 8.7% 2006

3. Child abuse and neglect (N) 719 2007

4. Child labor 10,044 2007

Pregnancy and delivery data year

1. Average age at first marriage 23.5 yrs 2003

2. skill birth attendant 97.9% 2001

3. place of delivery

Government hospitals 92.4% 2006

Private hospitals 6.2% 2006

Home 1.3% 2006

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2. Legislation & Institutional framework for Maternal and Child Health and Welfare

Globalization and the world capitalist system have led Thailand to develop in a direction that lacks balance and good governance in the past decade. The administration and management of the country which lopsidedly stressed material development had caused fierce competition with everyone striving for advantage over the other. The family, children, the elderly, the disabled, the weak and the poor, are all neglected. The environment and natural resources are exploited and destroyed, creating pollution in the process. Because of this, here is the detail of changes in Thailand

2.1 Community and Family Support for Mothers and

Children

2.1.1 Legal Aspect Legal rights of the people under several laws, which are

consistent with the basic human rights as stated in the Constitution of the Kingdom of Thailand B.E. 2550 (2007), contribute to the support given by the general public and families to disadvantaged mothers and children as follows:

(1) The Constitution of the Kingdom of Thailand B.E. 2550 (2007): From Sections 75 to 87 of Chapter 5 which is concerning with the Directive Principles of Fundamental State Policies, several roles that the State has to play have been specified. These cover the roles played by the State itself which include protecting and upholding the institution of kingship, its independence, sovereignty and security of the State and the people, patronizing and protecting Buddhism, promoting friendly relations with other countries, maintaining and protecting the rights and freedom of the people, promoting law enforcement and justice, people participation in State affairs and decentralization. The State also plays a supporting role to facilitate the works which are carried out, not by government agencies but by others such as those involving with urban development, the conservation of natural resources and environment, the provision of services relating to education and training, welfare and development for the disadvantaged and the poor. Such Directive Principles of

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Fundamental State Policies as stated in the Constitution ensure the rights of the people to enjoy good quality services made available by the State which they are entitled to. Not only the rights according to the Constitution but the people themselves also demand for effective services in all aspects in order to guarantee that they will be provided with quality and standard services that proceed rapidly, transparently and thoroughly. (2) The Decentralization Act of B.E. 2542 (1999): Under Chapter 2, Section 16 indicates that Pattaya Municipality and local administration organizations have the duties and responsibilities to develop the system of rendering public services to benefit people under their service coverage. As for Section 17, it is concerning with social welfare and improving the quality of life of children, women, older persons and disadvantaged people. (3) The Child Protection Act of B.E. 2546 (2003): Under the law, procedures and proper treatment for children have been specified to ensure that they are brought up, educated and develop a healthy growth that will further strengthen family institution. The law also protects children from being abused, commercially exploited or discriminated and promotes cooperation between public and private sector in proper child protection. (4) The Child Adoption Act of B.E. 2522 (1979) and the Child Adoption Act Amendment (No.2) B.E. 2533 (1989): According to the law, prospective parents are required to observe and follow rules and regulations concerning child adoption. The aim is to provide welfare protection for adopted children taking into consideration their best interest and the prevention of children from being commercially exploited by means of child adoption. The law also aims to protect the interest of both the natural parents and the adoptive parents.

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Laws Relating to Protection, Promotion and Development of Women and Family Members: (5) The National Child and Youth Development Promotion B.E. 2551 (2008): The law indicates guidelines and improves methods of how to promote proper child and youth development that is consistent with the current situation. According to the law, district child and youth centers and child and youth councils shall be set up to ensure more effective child and youth development. In addition to that, non-governmental organizations and local administrative organizations are encouraged to be involved in child and youth development. (6) The Domestic Violence Victim Protection Act B.E. 2550 (2007): The law underlines the key principles of gender equality and non-discrimination on the ground of the difference in sex.

(7) The UN Convention on the Rights of the Child: The principles with regard to the rights of children in 4 main areas are outlined, namely the right to survival, the right to be protected, the right to participate and the right to be developed on an equal basis bearing in mind the best interest of children. As party to the Convention on the Rights of the Child, Thailand fully adheres to basic rights and principles for the best interests of the child. The National Economic and Social Development Plan has given priority to human development, including child protection and participation. Indicators such as Social Indicators (Basic Minimum Needs), Indicators on Child and Youth Development and Indicators on Child Rights were introduced as guidelines for the effective protection of children’s right. Furthermore, Thailand attaches great importance to the outcome of

the 27th Special Session on Children. Accordingly, Thailand’s draft

“National Strategy and Plan of Action for a World Fit for Children”

for the year 2005-2015 has been formulated on the basis of the

framework of the final document adopted by the 27th Special Session,

with the addition of certain aspects which are pertinent to the situation in the Thai society. Public hearing processes on the draft National Strategy and Plan of Action have been completed and it is

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expected that the revised draft would be ready for submission to the

Cabinet of Ministers for approval in early 2005.

(8) The Memorandum of Understanding (MOU) between the Ministry of Social Development and Human Security and the Ministry of Public Health on Improving the Quality of life of Abandoned Children: The MOU was signed on September 9, 2005 based on the UN Convention on the Rights of the Child which clearly states the right of children to survival. The role of the State is to provide protection to ensure that they will be able to survive and to be developed in order to be well-prepared to live in society. The Constitution of the Kingdom of Thailand B.E. 2540 (1997) also specifies that the State has the duty to provide care for children such that they will enjoy a good quality of life and become self-reliant.

2.1.2 The Mechanism

The Public Administration Act (No. 7) B.E. 2550 (2007) recognizes provincial authority and groups of provincial authority as being government agencies in line with the law relating to budgeting. Under the law, such provincial authority and groups of provincial authority can formulate plans and subsequently submit them directly to the Budget Bureau. In addition, they have been assigned with the duty to provide protection, promotion and assistance for disadvantaged people and communities on an equal basis whether socially or economically such that they can make a living on the principles of sufficiency economy. The law also states that quality public services shall be provided for the people equally and rapidly. Local administrative organizations shall also be promoted, encouraged and supported so that they can perform duties assigned or transferred to them by line ministries or departments. In the process of preparing plans, consensus from various government agencies, the civil society and the private sector shall be sought to promote participation by all stakeholders in jointly determining the direction for future development within provinces and groups of provinces. Local administrative organizations are encouraged to allocate budget to support activities in the following areas:

- Welfare assistance for the low-income families

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- Welfare assistance for children infected with or affected by HIV/AIDS - Foster care in communities (both long term and short term) - The establishment of community child development centers

2.2 The roles of Government Officials at Community

Level Working with communities is a key policy that will enable all sectors within society to join hands and work together in order to develop the common community agenda and increase community awareness with regard to active community involvement in problem solving. These sectors should become more aware of how important communities are and be involved in integrated community development. Action must be taken seriously in dealing with community problems with prime consideration being on the actual needs of communities and people participation should be the key strategy. The main mechanism should include a community-based planning process and a participatory learning process through existing community learning centers. These centers can play a significant role in enhancing the strengths of communities in order to become learning communities as far as self-reliance is concerned. 2.2.1 Social Workers and Community Work Social workers are persons responsible for providing assistance for families and communities in problem solving, counseling, advisory and welfare services for various groups of people. To be more specific, the roles of social workers are as follows:

(1) Provide counseling service for families and communities facing social and other problems;

(2) Maintain contact and coordination with communities for the implementation of various community development activities based on the key concept of community-based participation;

(3) Research into current situation of communities to be further used for prevention and solving of community problems;

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(4) Provide development and rehabilitation services for families and communities;

(5) Develop the working system that involves the organizing of recreation activities, employment placement services in community centers, summer camps or workshops.

2.2.2 Volunteers and Community Work

Volunteers are persons who offer their services free of charge to help other people in the society in an attempt to prevent and solve problems that emerge and to promote social development subsequently.

Volunteer work is considered to be beneficial to the society at large. Persons who devote themselves to volunteer work are, therefore, praiseworthy.

Life in the present Thai society has changed quite significantly. Social problems are increasing and working out solutions requires sensitivity, in-depth information about the actual problems and a determined and unfailing effort to deal with the problems. Involvement by all sectors within society is required. Despite the need for more effort and resources in problem solving, the number of personnel in the public sector is decreasing due to a reform in 2003. Consequently, volunteer work should be very useful and ease the problems the country is now facing.

The Ministry of Social Development and Human Security has social development and human security volunteers who, in fact, are those volunteers already work in communities and are interested in being involved in various aspects of social development work.

2.2.3 The Roles of Social Development and Human Security Volunteers

Their roles are as follows: (1) The role of identifying targets and maintaining surveillance: This involves presenting data/information relating to the target groups facing problems and current community problems that will further lead to the implementation of preventing or problem solving activities. The main mission according to this role is survey and data collecting. (2) The role of strengthening both the existing networks and new networks: Their role is to maintain coordination with networks of government and non-government agencies both within

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and outside communities for the promotion of activities relating to social development and human security. The role is in line with the concept of village volunteer work which is aimed towards developing a mechanism that will foster linkages between agencies in the public sector and local organizations. The main mission according to this role is coordinating. (3) The role of promoting participatory community planning: Community planning is an important instrument that will further put the task relating to the promotion of social development and human security into actual implementation resulting in concrete outcomes. The role of a social development and human security volunteer is, therefore, to encourage community members to work together in order to develop a simple community plan that will serve as a guideline for implementing activities relating to social development and human security. 3. Management of Systematic Care Procedures Based on the restructuring of organizations in the public sector, the principles relating to improving efficiency, increasing the potential of agencies in the public sector in providing services that are responsive to the needs of clients, downsizing of central administration, decentralization and the transfer of responsibilities to local organizations in the future are underlined. Such principles are consistent with the objectives of the reform in the public sector and the will of the Constitution of the Kingdom of Thailand with regard to the 3 core functions the public sector is expected to carry out: policy formulation, regulation and promotion. In view of the expected functions, the Ministry of Social Development and Human Security has to play a leading role in the process of social development. Working with the civil society and community networks is emphasized in order to produce effective outcomes when it concerns promoting social welfare service providing, solving social problems and building strong social immunization. The Ministry should serve as the main organization that will integrate the overall social welfare service providing. With the roles and functions as earlier mentioned, it is necessary for the Ministry to improve its functions and duties in order to become “a high performance organization”. The role of being “a strategic state” is particularly

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underlined. That is the state has the duty to develop strategic planning and ensure that its commitments with various groups are fulfilled. The Ministry will be responsible for some duties that are deemed necessary and priority shall be given mainly to strategic development. The administration which is based on the concept of distributed governance is promoted with duties and responsibilities being transferred to other sectors within society. The Ministry shall play the roles of being the regulator and authorize other non-governmental organizations to act on its behalf. Support shall be given to individuals and the people to encourage them to play a greater role, promote decentralization such that local administrative organizations can increase their potential and the ability to perform the duties of providing services to people under coverage more effectively. This also proceeds consistently with the principles of democracy which people at grassroots level are entitled to the rights and responsibility to make decision and to bear the results or outcomes brought about by their own decision; and the implementation of activities that respond directly to the needs of local people themselves. In the long run, organizations in the private sector are encouraged to be gradually involved which will enable them to become stronger and play a greater role in development of the country and society. These are guidelines which, on the whole, will contribute to the strengthening of the country’s overall economic system and sustainable development. Contribution by working groups at various levels from local to national levels should be considered and emphasized. There should be community plans and a mechanism to implement the plans at both individual and local administrative organization levels. In conclusion, the management of systematic care procedures in response to the expectations that the society has towards the Ministry of Social Development and Human Security is as follows: 1. The Ministry should serve as a focal point that links all sectors within society especially communities in social development. This might be done in the form of a committee bearing in mind the need to be able to control situation/ solve problems of their own with more involvement by other development partner’s especially local authorities through the promotion of “Partnership” approach. All partners are treated equally and work together in a way that allows them to think and make decision deliberately along the line they find suitable. Local administration should be considered as being important

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for the 2 roles it can play: (1) To be the linkage that will help strengthening coordination leading to the unity as far as the formulation of national policies and strategic plans are concerned and (2) To be the mechanism of the public sector that extends services into communities. 2. Focus should be on the management system that involves cooperation network between agencies in public and private sectors under the strategy-based or issue-based structure regardless of the vertical line of command. In each of the two types of structure, there is a central body which can be compared to central nerve of a human body which links the organizations at various levels from national-level government, ministries, departments, districts to local administrative organizations. It links communication, reinforces work, strengthens the structure and process of working, promote proper adjustment, dynamism and equilibrium bearing in mind the best interest of people in communities 3. A mechanism to move the work at community level: 3.1 There is unity in the public sector as far as the expectation for common targets and outcomes are concerned. These are promote by maintaining strategic linkages between the policies of government / the Ministry and the needs of local areas and people, strategic alternatives, community plans to be further implemented in order to produce concrete outcomes with coordination and transfer of work proceeding consistently towards the same direction. More effort should be made by the Ministry to minimize the role of being an implementing agency or a direct service provider and to promote the devolution of power and involvement by local administrative organizations in service providing and more support by networks of other concerned organizations. 3.2 Community-based government agencies will play only 2 roles: - The role of being a coordinator or an advisor for technical matters/issues, the formulation of strategic policies or research and supervision for the provision of public services by various sectors to comply with or meet the minimum standard requirements and for support and control of local administrative organizations; - The role of being an operating unit that offers direct services to the people focusing on those which the central government has to provide in order to ensure efficiency or

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consider to be more efficiency if implementing by the government agencies themselves than transferring them to regional or local authorities or services that cannot be provided by local authorities.

4. Good Practices of the Activities related to support from community and the family, the role of professionals, or the administrative system enabling the continuum care.

To improvement Health services, social welfare and social work services in communities, the Department of Health, Ministry of Public Health and Department of Social Development and Welfare, Ministry of Social Development and Human Security organizes activities under various projects as follows:

4.1 Sai Yai Rak Hang Krobkrua Project HRH Princess Srirasmi, consort of the Crown Prince of Thailand has considered a high priority of family institution. She had an ambition to raise her child by herself and gave breastfeeding to her child as long as possible. Soon after the first birth of her child, Price Teepungkorn Rassameechoti, on 9th December 2005, the Sai Yai Rak Hang Krobkrua project was initiated. It aims to build a happy society which includes good families taking care of children since in uteri, newborn until adolescent in a proper way to build up resources and future of the country. This is under the belief that family bonding is a perfect environment, builds strong mental health and protects children from any harm when they grow up. The project also promotes child development under sufficient economy scheme. The princess tried to be a model for her staff, mothers in cities and urban areas. She promotes the project in various settings such as in work places, hospital, factories and communities. The Ministry of Public Health has conveyed HRH’s ambition through various stakeholders in promoting breastfeeding, maternal and child health and development of family institution by integration of work with other ministries, such as:

1. Family Love bonding Hospitals to develop standard antenatal care, intrapartum and postpartum for maternal and newborn care. Promote standard well child services in hospitals. Community participation by mother support group on encourages breastfeeding and good practices for child rearing.

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2. Caravan Sai Yai Rak Hang Krobkrua “IQ EQ capital to 76 provinces” to campaign on breast feeding and child development.

3. Breastfeeding promotion and development of child development center in 4 pilot provinces: Bangkok Nakornratchasima, Nakornsrithammaraj and Chiangmai, to be models of other provinces as appropriate to their culture and economy.

4. Cooperate with Ministry of Agriculture and Co-operations to set mobile clinics to support Sai Yai Rak Hang Krobkrua project. Those clinics are agricultural clinic to promote growing vegetable and safety food for mother and child; breastfeeding promotion clinic to acknowledge pregnant women and post-partum mothers on breast feeding, nutrition and self health care; medical clinic for treatment, examine child development.

HRH Princess Srirasmi is a leader on breast feeding promotion and child development in Thailand nowadays. She tries to demonstrate to all Thai mothers on possibility to breast feed the babies in various settings for the future of Thai children and the country.

4.2 MCH handbook Maternal and Child Health Handbook (MCH handbook) is a handbook that the Bureau of Health Promotion, Department of Health, Ministry of Public Health produces to be as a tool in provide information, monitoring, and follow-up maternal and child program. The MCH Handbook is distributed to every pregnant woman who attends the antenatal care at government and private health facilities all over the country for free of charge. The purpose of MCH Handbook is to be used as a home based maternal record from pregnancy, delivery, until postpartum period and for child care from newborn to five years of age. In addition, it can be used for birth registration and for health record of a child until entering kindergarten school. The MCH handbook started to be used since 1985 with 4 pages of A4 size. The contents and the designs have been revised every 3 to 5 years to update the knowledge and the appearance in order to appreciate the health providers and the consumer. Now there are

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many details for taking care during pregnancy and child rearing practices, after last revision the MCH handbook contains 60 pages.

4.3 Prevention and Control Program for Thalassemia

and hemoglobinopathies in antenatal care Thailand has 800,000 births per year. Thalassemia and abnormal hemoglobins (Hb) are high prevalence in Thailand. Approximately 30-40% of the populations are carriers of thalassemia and abnormal hemoglobins. The most common abnormal genes are alpha thalassemia, beta-thalassemia, Hemoglobin E and Hemoglobin Constant Spring (CS). For prevention new cases of Thalassemia, the Ministry of Public Health started the control program for thalassemia since 1994. The services in Antenatal clinic composed of

o All pregnant women receive genetic counseling for thalassemia o All pregnant women get voluntary blood screening for

thalassemia carrier o If her test is positive, then do voluntary testing her husband

after pre test thalassemia counseling. o If both are positive, then do hemoglobin typing for confirmation.

o In case that result from hemoglobin typing show there are

severe thalassemia, then prenatal diagnosis is suggested for final diagnosis.

4.4 Prevention Mother-to-Child HIV Transmission and

Enhancing Care and Treatment for HIV-infected new mothers and their families

Nowadays HIV/AIDS has been more affecting to reproductive-aged women particularly on housewives. For Thailand, there are about 12,000-13,000 cases of HIV-infected pregnant women in each year. If there were no any intervention on prevention mother-to-child HIV transmission, about 3,000-4,000 infants born to those women would be infected, also caused nations socio-economic.

Thailand implemented a prevention mother-to-child HIV transmission by having policies of voluntary counseling and testing (VCT) for pregnant women in every governmental health facility since 1995. Later in 1997, there was a research study on providing anti-retroviral drug for pregnant women during pregnancy and intra partum, also providing AZT syrup for infants at the Public Health Region 10 that was a high prevalence of HIV/AIDS infection among

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pregnant women. Afterwards, another implementation was occurred in Public Health Region 7 that was a low prevalence of HIV/AIDS infection among pregnant women. It showed the reduction of mother-to-child HIV transmission from 25.5% to 8-9%. Thus, the Ministry of Public Health initiated a national policy for providing ARVs for HIV-infected pregnant women all over the country in every public health facility in the year 2000.

The report of the year 2007 from Perinatal HIV Intervention Monitoring System remarked that more than 90% of HIV-infected pregnant women received ARVs and 95% of infants born to HIV-infected mothers received AZT syrup to reduce mother-to-child HIV transmission. Also, the HIV transmission rate was reduced to be 5.6%. Furthermore, another program of enhancing care and treatment for HIV-infected new mothers and their families including husbands and infants born to those HIV-infected women was initiated in the same year of 2002. The goal of this program is to reduce a number of orphans at their first 5 years, related to the quality of Thai human resource in the future. A main objective of the program is to relay the morbidity and mortality of those HIV-infected pregnant women and their families, also preventing for HIV horizontal transmission to their couples or others. Each public health facility has to arrange continuum counseling, providing care for health promotion and opportunistic infection treatment, psycho-social support and providing ARVs at the proper time for keeping good health among those mothers and fathers as well as their quality of life as long as possible in order to feed up their own children with love, care, also receiving proper life development stimulating to create future qualified citizen of the nation.

4.5 Bookstart Project In 2004, the Department of Health cooperated with Book for Children Foundation launched the Bookstart Project, which encourages parents to get their children involved with reading since they are infants. About 2,526 families with babies, aged six to nine moths, participated in this project. The method is simple and easy. Parents only spend five to 15 minutes a day reading books to their babies. This is not only induces the children’s attachment to books, but also increases the bond between parents and babies. The result shows that there is change in family 83.5%, parents and children come closed together 69.1%, relatives closed to children 62.9%,

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children growing up faster and smarter 79.4%, family members spend more time together 54.2%. This year we expand the project to be provincial scale and need more community participation.

4.6 Project on Child Development Caravan To promote a holistic approach to child development whether in the formal or non-formal education system, all concerned aspects and dimensions must be taken into consideration with children being regarded as the future’s valuable human resources. The project is implemented based on the concept of child and youth development. Under the concept, the importance of family and community dimensions is underlined as follows:

- Families and communities should be aware and be involved in child care by giving support to various forms of community-based child care These include child development communication media/ material/ equipment, preparation of families for various stages of child development, training for parents and careers and counseling

- Communities play an important role in creating an environment contributing to children’s learning so that they can develop a healthy growth and be able to adjust themselves properly to the present economic and social changes. Communities should have knowledge and understanding about child development and support activities that aim towards promoting child development.

4.7 A Bond of Family Love Project

Her Royal Highness Princess Srirasmi put the principles given by His Royal Highness Crown Price Maha Vajiralongkorn with regard to family and community child care into actual implementation. Primarily, focus is on breastfeeding. Her Royal Highness Princess Srirasmi herself acts as a role model by making necessary preparations whether they concern promoting strong physical health or nutritionally balanced food consumption starting from early pregnancy. Subsequently, a determined effort was made by Her Royal Highness Princess Srirasmi to breastfeed as long as possible with the aim to develop a warm and caring family where members are strongly attached by the bond of love.

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The objectives of the project are to: - Create awareness regarding the importance of families

and their involvement in child and youth care; - Develop a prototype for further expansion; - Promote an integrated approach which work of all

concerned sectors within society is included.

4.8 Project on the Establishment of 3-generation Centers to Strengthen a Bond of Family Love

The Ministry of Social Development and Human Security has proceeded with the establishment of the 3-generation Centers to Strengthen a Bond of Family Love. Focus is on the 3 generations of children, parents and older persons. The centers serve as focal points where the quality of life of family members are developed within a cycle which each stage proceeds continuously and links to others and in the manner that will enable members whether in a family, a community or a society to live together in loving and caring environment. Family institution is, therefore, strengthened and forms a solid base for security as far as the 3 main institutions are concerned: the nation, the religion and the monarchy.

4.9 Project on Creating a New Life for Rural Women It is a project that aims to organize various vocational training courses for women at risk or women in communities i.e. the course on dress making. After the training, support is also given to the ex-trainees for the formulation of vocational groups to carry out income-generating activities in their own community.

4.10 The Establishment of Reception Homes, Residential Homes, Development and Rehabilitation Centers and Welfare Protection Centers The aim is to provide shelters for children, women and all types of the disadvantaged.

4.11 The Center for the protection of Children’s rights Foundation

It is a Thai NGO which is concerned primarily with preventing and confronting the physical and sexual abuse, exploitation and neglect of children in Thailand, was established in 1981. The objectives are 1.to advocate for the promotion and protection of

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children’s rights in agreement with the United Nations Convention on the Rights of the Child 2. To provide protection and assistance to children and young people whose rights have been violated, in accordance with the Convention on the Rights of the Child 3.To examine the issues concerning children and young people then seek and propose methods which give greater protection of children’s rights, in accordance with the Convention on the Rights of the Child 4.To foster greater cooperation amongst organizations concerned with children’s right, both government and non government, In the promotion and protection of children’s rights 5. Challenges and actions for the collaboration between health care and social welfare services for mothers and children

5.1 Low Birth weight babies Low birth weight is a major determinant of mortality, morbidity

and disability in infancy and childhood and also has a long-term impact on health outcomes in adult life. The consequences of poor nutritional status and inadequate nutritional intake for women during pregnancy not only directly affects women’s health status, but may also have a negative impact on birth weight and early development. Low birth weight also results in substantial costs to the health sector and imposes a significant burden on society as a whole. The prevalence of Low birth weight is still high so it is one of our major public health challenges.

5.2 Child rearing practices

In our Asian cultures, many parents believe that very small children are too young to understand, their early years are probably the most important opportunity for parents to start them in the right direction. Once good patterns are established, they will be easy to maintain. Once bad patterns are established, they will be difficult to change. Parental school will help the family in taking care how to deal their children from pregnancy period until them growing up to school. An understanding of these key issues is critical in creating sensitive and timely services that in turn are important in promoting personal well-being and social progress.

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5.3 Teenage pregnancy

The major consequences of teenage pregnancy, relate firstly to the social and economic impact of teenage pregnancy and secondly upon the incidence of medical complications within the pregnancy itself. There are many studies suggests that teenage pregnancy is associated with disruption of schooling, social disadvantage and an ongoing cycle of poverty, with many teenage mothers having themselves been the child of a teenage mother. The children of teen mothers are more likely to be born prematurely or low birth weight babies and we know that Low birth weight raises the probabilities of infant death, blindness, deafness, chronic respiratory problems, mental retardation, mental illness, and cerebral palsy. There will be the chance that a child will later be diagnosed as having dyslexia, hyperactivity, or another disability. In Thailand we have mothers who have first baby less than 20 year old 12-13% so this are the major challenge for us how to reduce this problem.

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