8.2. PoE en ventanas de señal y ruido
8.2.2. PoE en ventanas con el filtrado de Prony por mínimos cuadrados
The subdistrict health centre, commonly called by the locals and the informants as
Anamai, is a substructure of the Provincial Administration. Health centres are classified as the primary care level or first-line public healthcare providers in the Thai public health services. Health centres, according to the Thai Ministry of Public Health (MoPH), are expected to provide integrated health services to the residents of their designated subdistricts, called Tumbon. The size of population covered by a health centre could range from 1,000 to 5,000 (Bureau of Policy and Strategy, 2005). Generally, the health centres of Thailand receive technical support and resources from Contracted Units of Primary Care (CUP), which are provincial and community hospitals. However, health centres are not under the line of command of the MoPH. They instead are part of District Health offices which are under the line of command of provincial administrationled by a provincial governor who acts as Chief Executive Officer (CEO).
Fig ure 1 Structure of the Provincial Health Administraton
Ministry of Public Health Permanent Secretary Ministry of Interior Permanent Secretary Technical Departments Director-Generals Office of the Permanent Secretary Regional Centres
Provincial Public Health Offices
Provincial Chief Medical officers (75)
Regional & General Hospitals Directors (95) Community Hospitals Directors (725) Districts District Chiefs
District/Subdistrict Health Officers D/SD Health officers
(795/81)
Health Centres Chiefs (9,765)
Community Primary Health Care Centres (69,331)
Village Health Volunteers:
Or-Sor-Mor
Community Health Posts (331) Community Health Workers Line of command Line of technical support Province Governor
Figure 7-1 Structure of provincial health administration (Bureau of Policy and Strategy, 2005)
A health centre has an obligation to provide health services following the standard operational procedures initiated by the MoPH. According to the MoPH’s proposal, each health centre is responsible for providing health services including health promotion, disease prevention and curative care (Lorga, 2003). Ideally, the staff of a health centre includes a health worker, a midwife and a technical nurse. In the future, the MoPH wishes to allocate more health staff, including a dental nurse, a professional nurse and a health specialist, to work at each large health centre. Besides, there are village health volunteers, called Or-Sor-Mor, working as extra hands under the supervision of the health workers of health centres. They, theoretically, run the community primary health care centres in their villages (if there is one).The health volunteers are trained to provide some basic health services to villagers in their designated area, and to facilitate the work of health centres. One health volunteer covers 10-15 households (Fieldnote, 2005).
The health centre of the subdistrict where the study took place at the time of fieldwork, dealt with 1,315 households (population of 6,446) of six villages (Moo- Ban) under the administrative system of one subdistrict, with three health staff and two support staff (Subdistrict Health Centre, 2005a). The health staff included a public health administrator, who was the head of the health centre, a midwife, and a public health specialist (Fieldnote, 2005). The support staff included a computer and information support person and a maid. Furthermore, one morning per week, a nurse of the health centre’s CUP was assigned to visit the health centre to assist with providing treatment and health consultation. There were about 107 village health volunteers under the supervision of the subdistrict health centre.
As directed by the MoPH, the health services that are covered by the health centre are curative care, family planning, maternal and child care, nutrition, health promotion and disease prevention. Each health worker is responsible for specific services. The curative care is shared among the three health staff members, based on task rotation. Health promotion, family planning, maternal and child care are under the responsibility of the midwife, whereas, the public health specialist is responsible for disease prevention. The head of the health centre, apart from the administrative responsibility, takes care of some activities concerning health promotion and disease
prevention. Details of the designated job description for each position are shown in the following table.
Table 7-1 Health Centre Staff's Job Descriptions (Subdistrict Health Centre, 2005b)
Position Job description
Head of the health centre
-Public Health administrator -Education:
- Midwifery certificate
- Technical nurse (2 years’ training) - Bachelor degree in Public Health
1. Developing administrative plan 2. Summarising and evaluating outcomes
3. Administering equipment and medication storage 4. Administering office files/archives
5. Preventing and controlling non-communicable diseases
6. Mobile health service 7. School health 8. Healthy Thailand 9. Inventories/stationery
10. Health educating, training projects
11. Developing the action plan for providing health services
12. Health promotion: population 13. Health promotion: elderly 14. Organising public brain storming 15. Establishing health promotion club
16. Updating demographic information, and health statistic
17. Improving health centre physical appearance 18. Dealing with public complaints on health services 19. Cooperating with related agencies
20. Financial report (with CUP)
21. Urgent assignments/requests directed by the government
22. Supervising/and monitoring health services 23. Health education and public relations 24. Cooperating for community development 25. Monthly report
26. Staff roster
27. Others, as assigned by higher authorities
Midwife
-Education : Midwifery certificate
1. Maternal and child care 2. Family planning 3. Health promotion 4. Nutrition
5. Health promotion: focusing on disable population 6. Mental health
7. Health education/public relations 8. Child development (0-6 years old)
9. Preventing and monitoring cervical cancer and breast cancer in women aged 35 years old and over
10. Health promotion: Menopause population both males and females
11. Supervising community primary health care centres
Public Health Specialist -education:
- Public health certificate
- Public health specialist certificate
1. Planning/developing project in health education 2. Immunization
3. Food safety
4. Preventing and monitoring communicable diseases 5. Epidemiology
6. Environmental hygiene and health 7. curative care
8. Food hygiene 9. Drug abuse
10. Supervising community primary health care 11. Protection of consumer rights
12. Medical supplies
13. Coordinating/public relations 14. Social security report 15. Monthly report
16. Thai traditional treatment
17. Others as assigned by higher authorities