ANEXO C: GUÍA DE USUARIO – APLICATIVO BPM

1.8.1 Geography and socio-demography

Thailand is a fertile land located in Southeast Asia, covering an area of 514,000 square kilometres (200,000 square miles). The country shares boundaries with the Lao People’s Democratic Republic in the north and northeast, Cambodia and the Gulf of Thailand in the east, Myanmar in the north and west, the Andaman Sea in the west and Malaysia in the south (see Figure 1.1). Thailand is divided into four regions: Central, Northern, Southern and North-eastern (United Nations, 2009). According to the 2010 national census, the population of Thailand was 65,958,158, consisting of around 97% Thai, 2% Burmese and 1% others. Of the total population, 9.27 million people live in Bangkok, the capital city (Central Intelligence Agency 2015; National Statistical Office Thailand, 2010). The main religion in Thailand is Buddhism, practised by more than 92% of all Thais. Islam and Christianity are the next most common religious faiths. The official and national language of the country is Thai (Central Intelligence Agency, 2015).

1.8.2 Buddhism and Thai culture

In Thailand, 95% of people identify their religion as Theravada Buddhism. The Thai cultural background and lifestyle has been deeply influenced by Buddhism for many centuries. The main beliefs of Buddhism are to be free from suffering and to live in the spirit of Metta (kindness) and Karuna (compassion) (Klunklin & Greenwood, 2006). The law of karma and the associated concept of merit accumulation are the moral principles of Thai Buddhism (Tantiwiramanond, 1997). The law of karma states that all livings beings have their own actions (karma) and that all actions have consequences which will affect the doer. The right actions will have good consequences and wrong actions will lead to bad consequences (Reichenbach, 1988).

Gender differentiation due to Buddhism in Thailand can be obviously seen. Men have authority to perform all religious activities at the temple. Only men can be ordained as monks and women are not allowed to become monks (Tantiwiramanond & Pandey, 1987). Buddhists believe that becoming a Buddhist monk brings honour and power to the family. This ordination of the son is believed to bring his parents to heaven in the next life. On the other hand, in a religious or spiritual way, women cannot pay back their parents. The tradition of repayment of the parents’ goodness is perceived as a value for everyone. This value is generally taught to children right from the early years of their life, and is later passed on to the next generation. For this reason, women are generally considered inferior to men (Klunklin & Greenwood, 2006). Because most Thai people consider themselves to be Buddhists, and Buddhism plays an important role in Thai culture and society and has had its greatest impact over the Thai way of life, thoughts and behaviours,

this helps to explain the gender differences observed within Thai communities (Limanonda, 1995; Choowattanapakorn, 1999). Furthermore, gender inequality in Thailand is also historically deep-rooted and is caused by the culture and based in the family unit. Historically, Thai sons and daughters are treated and taught differently (Praparpun, 2009). Most boys are usually given more freedom and no or fewer household responsibilities than girls. They are also treated with more significant consideration because parents expect them to pay them back by becoming a monk, whilst girls are not treated in the same manner as their male counterparts. Most Thai girls have to do household chores and they are expected to give lifelong service to their parents as a means of paying them back. In terms of their sexual life, Thai women have been expected by society to be modest and passive in their relationships, and to accept having less power and less sexual desire in comparison to men. Young women are not allowed to talk about sex in public and are taught to keep their virginity until after marriage (Sridawruang, Crozier and Pfeil, 2010). For Thai women, remaining a virgin until marriage is the social norm to be a ‘good lady’ (Ounjit, 2011). Having a sexual relationship before getting married is unacceptable among women. In contrast, Thai men are widely perceived as having superior status to women, especially regarding the value placed on sex in society. They have the privilege of sexual freedom; they can have sex before marriage, they can have more sexual partners, or can have a sexual relationship outside marriage (Knodel, 1997; Ounjit, 2011). These beliefs have been entirely different for women, who are expected to display faithfulness and endurance, to maintain married life and to ensure the welfare of their offspring (Thaweesit, 2004).

Some Thai proverbs reflect the inequality between Thai women and men. For example, a traditional Thai proverb is ‘Chai Kao-Pluenk, Ying Kao-sarn’, which

means men are rice paddy and women are rice. The rice paddy (a plot of land) is valuable and can continue to grow rice, whereas rice itself is less valuable and cannot increase any more in value because the rice itself is the final product (Praparpun, 2009). As a consequence of all these beliefs and cultural norms, Thailand has long been a male-dominated country and the social system operates as a patriarchal structure.

The transition of Thailand over the last forty years from a low-income country to an upper-middle income one, and from an agricultural to an industrial economy has brought several challenges and changes, including new technology which has greatly influenced everyday Thai life. These changes have affected the way people think, their beliefs, behaviour, conduct, manners and values as well as the value attributed to females. Thai women’s social, educational, political and economic opportunities have improved significantly. Sexual expression, intimate relationships and social norms about sex among Thai people are also affected by these changes. People are more open- minded about premarital sex than ever before (Ounjit, 2011; Srijaiwong et al., 2017). For example, cohabitation is an increasingly common trend in Thai society and can be found across society from students to working age people (Ounjit, 2011). However, the previously entrenched Thai beliefs and cultural traditions are still followed today in many families, especially in rural areas (Praparpun, 2009; Ounjit, 2011).

1.8.3 The healthcare system in Thailand

Health care in Thailand is organised and provided by a variety of organisations in the public, private and civil society sectors. All public health hospitals in Thailand are under the administration of the Ministry of Public Health (MOPH), which is the principal agency responsible for formulating, implementing, monitoring and

evaluating health policy. The MOPH has held both a service delivery role and a financial management role which operate on two levels, central and provincial. The central administration includes the Office of the Permanent Secretary and three clusters of technical departments: the Cluster of Medical Service Development, the Cluster of Public Health Development, and the Cluster of Public Health Service Support. The provincial administration is the responsibility of the Provincial Health Office (PHO), which oversees the regional hospitals, district hospitals and district health offices within each province.

Public hospitals in Thailand are categorised by the MOPH into four levels. The first level are regional hospitals which are located in the large provincial cities and serve as referral centres in the region. These hospitals provide tertiary care and can provide complex care. Some of these hospitals have been upgraded to centres of excellence for particular services and have a considerable range of physical facilities, medical equipment and a workplace which specialises in the treatment of numerous diseases. The second level is the general hospitals which are located in the provincial capitals and have a capacity of between 90 and 500 beds. The third level are community or district hospitals which are located in districts and have a capacity of between 30 and 120 beds. These hospitals are able to refer complex cases to general and regional hospitals within the MOPH system. The fourth level is health centres in sub-district (Tambon) areas which are mainly concerned with primary care and are staffed by nurses, technical nurses or public health officers. The service provides curative, preventive and promotive care, especially for maternity and child healthcare requirements (Jongudomsuk et al., 2015; Ministry of Public Health, 2016).

health-care facilities covering all districts, and there were 94 regional and general hospitals (excluding Bangkok Metropolitan) serving as tertiary hospitals located in large provincial cities throughout the country (Jongudomsuk et al., 2015).

In the Thai healthcare system, the distribution of healthcare professionals, especially doctors, has been a big problem. The distribution is different between Bangkok, urban and rural areas; there are more doctors in Bangkok. By 2009, the doctor to population ratio was 1:3,427 for the whole country, 1:793 for Bangkok and 1:5,161 for other provinces (Jongudomsuk et al., 2015; Sakunphanit, 2015).