Purpose
In most of the countries, lack off an explicit health workforce planning results in unbalance in the health care delivery hindering the attainment of the objectives. This had provided rationale towards the prospect of developing the health care delivery system that are more responsive towards the requirements and the expectations of the public by providing a systematic method to the health planners for managing the human resources in the health care sector (Al-Sawai & Al-Shishtawy, 2015). The study emphasizes on the national workforce planning of Australia by comparing its merits and demerits with another country in Who Western Pacific Region. The current assignment focuses on the health workforce planning of the Kingdom of Thailand while comparing it with Australian healthcare workforce practices and policies.
Rationale for choosing this country
According to Al-Sawai & Al-Shishtawy (2015) large crowd and long queues are very common in most of the Thai hospitals. It has been found that the rural hospitals are suffering from severe shortage of doctors and most importantly most of the hospitals are falling short of funds. According to Thailand Medical council, there are only 50,000 doctors present in the country out of which most of them are present in Bangkok (World health organization, 2015). Due to the absence of the medical practitioners, the rural hospitals are always crowded by a long queue of clients with a handful of doctors, which proves that there is an urgent need of the health work force planning for addressing the need of the people. As per the standard ratio of one doctor per population, one doctor should be held responsible for 1,500 people and lack of doctor in the rural areas have turned to be as high as 7000 . The Thai public hospitals generally struggle with the doctors leaving to join the private sectors for high salaried jobs (O’Brien-Pallas et al., 2011). On the other hand as a country of WHO Western Pacific Region Better benefits, higher salary, less strain, less workload and shorter working hours are enough for persuading the new generation doctors to work in the private clinics and hospitals of Australia. At the same time, because of the ever-present poor integrity in ground level collaboration within government and nongovernment organisation, the health care conditions of rural area is not well enough.
National health workforce condition and work structure
Thailand is a developing country and its goal is to reach the highest quality of life for the population but as discussed earlier, the health care condition of the rest of Thailand other than Bangkok is poor. The main reason identified is the lack of human resource (Al-Sawai & Al-Shishtawy, 2015). The state subsidized health care was an important political issue for various Thai governments. As per the military government in Thailand, the new family doctor scheme would run a long way in addressing the demand of the public for such services. The infant mortality death in Thailand has been found to be 12/1000 live births. The life expectancy at birth of woman/man is 77/77 years (World health organization, 2015). Thailand has been found to be one of the 22 countries with high burden of tuberculosis as stated by WHO (Centre for Disease Control and Prevention, 2013). The transmission of the infectious disease among the immigrants in Thailand is also a raising concern.
The condition of health workforce in Australia indicates that it is difficult to achieve expected outcome for the nation. The main reason is the lack of stable human resource in the heath sector especially in rural areas. The country is suffering from shortage of incentive mechanism, remuneration, training, education and health workers (Dussault & Franceschini, 2016). The human resource issue have received poor attention in the nation. The budget and poor investment fail to achieve expected outcomes of the Health Workforce of Australia (HWA). Apart from that the rural clinics or health camps do not receive well collaboration and cooperation from the nearest urban Hospitals. In spite of repeated workshops and awareness programs arranged by the Australian Institute of Health and Welfare (AIHW) the distributed workforce in rural area receives de-motivation from their operational environment as well as the payroll structure. The current situation of decreasing nurses and shortage of registered medical professionals are resulted because of low salary structure of Government controlled healthcare organisations. This type of dilemma can be noticed in healthcare system for Aboriginal people, Turret Strait Islanders, which has become the burden for the health workforce of Australia.
International Intervention in health workforce
Health workforce is a primary constituent of health system. It is imperative to provide proper consideration to the sector in order to recover the health status of the nation. Countries as Thailand experience countless challenges in the health workforce sector thus facing crisis regarding the healthcare condition of the inhabitants (Wiwanitkit, 2011). The global health agenda thus determined to provide effective interventions in order to improve the poor condition of health workforce sector. In order to preserve the connection with the neighbouring country, countries have provided grants to Thailand for development in the healthcare subdivision. In order to recover the capacity of the nation, the United States has supported by grants amounting $190 million to Thailand (Wilson et al., 2009). The purpose behind the involvement was to present skilled, aggravated and sympathetic health worker in the nation as per the requirement. To assist the nation in this situation, the Global Forum on Human Resources for Health has provided economic support to Thailand.
Vision
The plan
Activities that can be undertaken
Capital Investment budget and percentage of total health budget of Thailand:
The following table and graphical representation refer to the national and international capital investment in Thailand in Table 1 and Graph 1 and the percentage of total health budget in table from the year 2002 to 2010.
Table 1:
|
Year |
MoPH and NHSO |
NHSO alone |
|
2002 |
6500 |
4000 |
|
2003 |
4000 |
2000 |
|
2004 |
7000 |
5000 |
|
2005 |
6500 |
4000 |
|
2006 |
9000 |
7000 |
|
2007 |
9500 |
7500 |
|
2008 |
10300 |
7400 |
|
2009 |
12000 |
7600 |
|
2010 |
8500 |
800 |
(Source: Chaiwarith et al., 2013
The Table 3 and the Graph 3 represent the total number of medical doctors and the number of medical doctors per 1000 population from 1986 to 2010 in thiland. Table 3b and Graph 3b represent the total number of medical doctors and the number of medical doctors per 1000 population in Australia.
Table 3a
|
Year |
Doctors |
Per 1000 population |
|
1986 |
8496 |
0.16 |
|
1992 |
12803 |
0.23 |
|
1998 |
16596 |
0.27 |
|
2001 |
25039 |
0.29 |
|
2004 |
22465 |
0.29 |
|
2007 |
19663 |
0.31 |
|
2010 |
23909 |
0.37 |
Table 3b: employed Doctors per 1000 population in Australia
|
Year |
Doctors |
Per 1000 population |
|
2005 |
23834 |
2 |
|
2006 |
24272 |
2.1 |
|
2007 |
24903 |
2.2 |
|
2008 |
25726 |
2.8 |
|
2009 |
26613 |
2.9 |
|
2010 |
27639 |
3.1 |
|
2011 |
29011 |
3. |
The Table 4 and the Graph 4 represent the total number of Pharmacists and the number of medical Pharmacists per 1000 population from 1986 to 2010.
Table 4:
|
Year |
Pharmacists |
Per 1000 population |
|
1986 |
3307 |
0.06 |
|
1992 |
4436 |
0.08 |
|
1998 |
5927 |
0.10 |
|
2001 |
6793 |
0.10 |
|
2004 |
7754 |
0.11 |
|
2007 |
8813 |
0.13 |
|
2010 |
10108 |
0.38 |
The Table 5a and the Graph 5a represent the total number of registered trained nurse and the number of nurses per 1000 population from 1986 to 2010 in Thailand. The Table 5b and the Graph 5b represent the total number of registered trained nurse and the number of nurses per 1000 population from in Australia
Table 5a:
|
Year |
Nurses |
Per 1000 population |
|
1986 |
26019 |
0.50 |
|
1992 |
40685 |
0.80 |
|
1998 |
56366 |
0.93 |
|
2001 |
70978 |
1.15 |
|
2004 |
91615 |
1.46 |
|
2007 |
101797 |
1.63 |
|
2010 |
109797 |
1.90 |
Table 5b:
|
Year |
Nurses |
Per 1000 population |
|
2006 |
240256 |
6.5 |
|
2007 |
245491 |
7.2 |
|
2008 |
253685 |
8 |
|
2009 |
260121 |
8.5 |
|
2010 |
264212 |
8.8 |
|
2011 |
268883 |
9 |
The government of Australia has integrated the three years rural service as well as the urban upon graduation, which was in line with the NIHW Declaration of health for all, which promoted the rapid development of the health infrastructure. This resulted a significant increase in the number of the rural doctors (Fritzen, 2007). The government’s active policy in the year 2010, for promoting Thailand as a medical hub for attracting the International patients, which has had a positive impact on the GDP of Thailand (Bruckner et al., 2011). According to the reports, Australia has neither adopted the policies for the foreign health care professionals to practice in their indigenous policies for the internal health care professionals to practice. This medical hub policy has created opportunity for the health care professionals to practice abroad, which had led to brain drain from Thailand (Fritzen, 2007). Hard work and lower pay in the public pay has been the driving factor for this brain drain for the professional nurses. The private hospitals are offering higher salaries, overseas trainings and better infrastructure. The drowsiness of the public sector are compelling the young nurses to become contractual workers. All these are making the turnover rate of the employees to be high. In Australia, about 48 % of the nurses are leaving the public sectors and are shifting to the private sectors (World health organization, 2015). Access to the basic public health care services such as immunisation, prevention services and family planning is high in the Indigenous population. As per the third and the fourth national health survey, improvement has been found in the screening for the chronic diseases such as diabetes, hypertension (Bruckner et al., 2011). It has been found that cancer, accidents, heart diseases, suicides in rural are the leading causes of death among the rural and the semi rural population of Australia. Vehicle accidents, strokes, and acute myocardial infections had topped in the five leading causes of death due to inappropriate distribution of workforce. Incidents of injuries due to accidents have been found to be 110.8-151.7 cases per 100000 persons (World health organization, 2015). This poor level of emergency care triggered the need of the triage trained nurses. It can be said that the hospital emergency services need serious investment towards the improvement of the infrastructure, in terms of communication technologies, equipment and human resources in terms of quality and quantity the day care services have not developed systematically (Bruckner et al., 2011). The current system of payment does not provide any financial incentive to the hospital to shift inpatient care to the day care. Due to the efforts of the Thai government for promoting Thailand as the medical hub, only a few private hospitals target the foreign patients. This exacerbated the shortage of the medical staffs. One of the major challenges related to health care have come from the increased needs of rehabilitation care for the aged population in Thailand. The current health care system has very little scope for the subacute labour intensive rehabilitation facility that requires more time. The palliative care facilities and the mental health care facilities also requires improvement.
The National Healthcare Council of Thailand as well as the Australia has made initial recommendations for national level medical practice and pharmaceutical operation. These recommendations improvise the interconnection among various government, non-government and NGOs to enhance the current condition of rural as well as sub urban healthcare system (Nash et al., 2008). However, there are some other recommendations that can be very beneficial in order to enhance the healthcare condition of the Thailand.
In order to develop the healthcare system initially, the most essential factor is basic capital and the regulatory investment of that capital in the healthcare system. The increasing investment in healthcare operation in both rural and urban area can enhance the current human resource management system of both government and non-government organisation (Thoresen & Fielding, 2011). It also will increase the remuneration structure to the satisfactory level that can increase the workforce satisfaction level. In order to invest the capital for this purpose the government of Thailand should procure their existing investment plan.
Monitoring is another effective operation that can improve the functionality of any small to large level operation. The national level healthcare management system of Thailand poses multilevel operation structure with complex cardinality and operational integrity. Therefore, in this vast management system monitoring on the various functional units irrespective of their position and connectivity should be monitored with the help of strong and efficient direct and alternative monitoring and feedback collection system (Ahuja, Chucherd & Pootrakool, 2006). Through this strategy, the keyholes and flaws of the existing system can be identified and changed.
The pricing strategy of the healthcare can also influence the current healthcare management system as well as the operation workforce functionality. Not only its pharmaceutical implementation, the pricing strategy can also improvise the investment of consumers for healthcare sectors (Pagaiya & Noree, 2009). These investments collectively can increase the total capital of the healthcare government as well as non-government organisation.
The NHSO and MoPH should work together to for the promotion of the TTM and CAM In Thailand. The effective implementation of healthcare workforce related policies can improve the overall condition of healthcare system through Australian Commission on Safety and Quality on Healthcare (ACSQH). At the same time the government should also procure their healthcare camp development plan with more strategic and effective distribution. The strategic and effective distribution of the healthcare camps and the small rural clinics can also improve the integrity while reducing the time complexity.
The establishment of EM units should be considered on the basis of diverse economic scale and care quality. It can also increase the competitive environment within the workforce structure that would improve the overall performance level and the collective functionality. At the same time, the transportation system should also be improved in order to decries the overall time complexity of the healthcare workforce distribution and resource allocation in Astralia.
The EMIT should work collaboratively with relevant private and public organisation in order to increase the functionality of the existing healthcare system (Somboonwit & Sahachaisaeree, 2012). The effective leadership cycle and the plan-do-check-act can inspire the operating healthcare workforce irrespective of their designation and role.
Conclusion
This assignment focuses on the health workforce planning of the Kingdom of Thailand while comparing it with the existing and past healthcare workforce condition of Australia. According to Thailand Medical council, there is considerably low number of doctors present in the country out of which most of them are present in Bangkok. The Thai public hospitals generally struggle with the doctors leaving to join the private sectors for high salaried jobs. The premature death, child diseases, accidental death, vulnerability of patients condition due to lack of healthcare services and workforce influence the overall healthcare functionality of the national level healthcare operation. From the above analysis, it can be said that the low pay of the Thai public health care settings, high pay of the private clinical settings and lack of governmental financial support can be one of the cause of the deteriorating health condition of Thailand. The drowsiness of the public sector are compelling the young nurses to become contractual workers. On the other hand, hard work and lower pay in the public pay has been the driving factor for the brain drain. At the same time, the district hospitals and the health centres are not covering sufficiently all the districts and the sub districts throughout the country. Due to the efforts of the Australian government for promoting Aboriginal healthcare as the medical hub, only a few private hospitals exacerbate the shortage of the medical staffs. The National Healthcare Council of Thailand has made initial recommendations for national level medical practice and pharmaceutical operation that improvise the interconnection among various government, non government and NGOs to enhance the current condition of rural as well as sub urban healthcare system.
References
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