Planning to make the health services suitable to the way of the life of the poor, and to have such services available widely:

Developing a ‘caring society’ so that attention may be given to ensure that there is mutual concern for the needs among the members of the communities facing different kinds of challenges;

Adapting state management systems to enhance the creation of opportunities for the poor;

Promoting participation by the people in each locality in determining the priorities and services needing to be provided, or challenges attended to, according to the experience and perspectives of those who after all are the key stake-holders to secure the needed solutions.

Extending, in view of all the fore-going, the efficient health insurance coverage and making it accessible to, all members of different localities on an equitable basis.

(b) Concepts and policies for public health care and services as held by health service providers (doctors, nurses and public health officials) at various levels:
It can be assumed that the concepts and policies for health care and public health services of doctors, nurses and public health officials in the province are much influenced by the leaders and policy-makers at the national levels. The growth in the number of health service providers partly reflects the quality and increased availability of the services being provided. Of course, the growth of population in the province also leads to the necessity of increase in health clinic (159 in 1981 to 250in 1997) and the number of service providers (1926 persons in the year 1981 to 2994 persons in the year 1997). Though the figures include both private and public sectors, facilities and personnel related to the latter predominate.

The rate of infant as well as maternal mortality in the province is low in comparison with, or in terms of, the standards of other developing countries. We may conclude that generally speaking the concepts and policies of the health service providers at various levels were progressive and in line with national goals (esp. those of the Ninth National Economic and Social development Plan). We may also deduce that there implementation of the concepts and policies have been commendable in producing the improved results.

(c) Perception and satisfaction levels of users or consumers of the health services:
Again, on the basis of data collected and the visible results, it is not unreasonable to conclude that the users or consumers of the health services have a positive perception and acceptable level of satisfaction concerning the health care they received.

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Particularly in the matter of reproductive health the fact that there is increased practice of family planning indicates that the rate of its acceptance by the user of health care services is high. Information about marriage, sex and family planning belong culturally to sensitive and very private sharing practice.

Khon Kaen Province’s record of progress in the health of mother and child, in family planning and dissemination of sex education implies that those at the receiving end of public health care services find them satisfactory and desirable.

Referring to the conclusions reached by Dr. Chuanchom in her research work of reproductive health in Thailand the situation of health care and services in the province can be understood as providing a positive level of satisfaction by the users or consumers. We can say that the scope of the work concerning reproductive health begins at birth and continue till death. The quality of pre-natal care for safe birth, and post-natal care for e healthy growth a child are important. So also is sex education, marriage counseling and information on family planning. In all these matter those in Khon Kean Province both in terms of policy makers, the providers of health care services, as well as the consumers or users of the services, all seem to be doing well as we look at the available data and the responses to questionnaire distributed to the relevant members of the urban community.

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III. Research Methodology

3.1 Study design

This study was a descriptive research, conducted to study the reproductive health status and primary health care in urban setting by surveying the opinions of 346 people who live in Khon Kean Municipality areas. This included interviewing 18 health care providers and administrators in Khon Kean Municipality Health Services Center (MHSC). A total of 364 respondents questionnaire was collected for quantitative and qualitative data during February to March of the year 2002.

3.2 Study population

The target population included people who lived in the community of Khon Kaen Municipality, health service providers and administrators oh Khon Kean Municipality.

3.3 Sample description

Regarding sample selection, it used purposive sampling with a total of 364 cases. The sample selection was performed as follows:

3.3.1 Selecting who have received health care service from a municipality health center. There were 202 respondents from khon Kaen Municipality Health Center, Noonchai Health Center, Noontan Health Center and Mitthaparb Health Center.

3.3.2 Selecting 144 people who have received health care services from a community Primary Health Care Center under the responsibility of the Municipality Health center in 3.3.1.

3.3.3 selecting 12 health service providers working in the Municipality Health Center in 3.3.1. They consisted of physicians, pharmacist and professional nurses.

3.3.4 Selecting 6 administrators of Khon Kean Municipality. They included the Secretary of the Municipality, Deputy Secretary of the Municipality, Chairman of the Municipality Council, Vice Chairman of the Municipality council and Municipal Counselor of the Financial Office.

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3.4 Research instrument

The research instrument in this study consisted of three components as follows:

3.4.1 The health opinion survey of people in urban setting was composed of 4 major parts:

Part 1 General characteristics of the respondents included gender, age, religion, education level, occupation, married status and family income per month.

Part 2 Reproductive health behavior of married respondents living with spouse and aged 15-49 years old.

Part 3 The opinion of the respondents is using the government health center in urban settings.

Part 4 The opinions about types of health system management and health service needs of respondents.

3.4.2 Interview of health service providers about health opinions of people in urban settings. There were five opened ended questions.

3.4.3 Interview of administrators about health opinions of people in urban settings. There were seven opened ended questions.

3.5 Test for the quality of research instrument

Regarding the research instruments of the three components mentioned above, the questionnaires were piloted on a similar study population. Then it was revised and some questions were improved for validity and appropriate questions.

3.6 Data collection

1. Preparing the community by informing health officers, community leaders and Village Health Volunteers.
2. Assistant researchers such as lectures and nursing student of Khon Kean Nursing College were trained and practiced using the survey before data collecting. This was supervised by lecturer as an assistant researcher. For the interview of health service providers and administrators, the lecture would be the interviewer.

3.7 Data analysis

3.7.1 General Characteristics of respondents including age, gender, education level, occupation, married status and family income per month were analyzed and presented in percentage.

3.7.2 Reproductive health behavior, the opinions of the respondents in using public health center in urban settings and the opinions about types of health system management and health service needs of the respondents were analyzed and presented in percentage.

3.7.3 For the qualitative data, the health opinions of health service providers in urban settings and municipality administrators were analyzed according to Suphang Chanatawanich (1993), the details are described as follows:

A. The health opinion framework was constructed.

B. Tested validity by interviewing to be sure of identical data.

C. Basic data analyzed for quality and competition every time after receiving information for the further data collection.

D. Summarized temporary data as brief concepts and related data basic.

E. Summarized data by collecting temporary data that had been tested and confirmed for correction by the health opinion framework of health service providers and municipality administrators. It included problems and health situation in urban settings, medical and health service management, primary health care management, and the agreement of primary health care elements in implementation with the current situation. The necessity of health volunteers, problems of environment and quality of life in urban settings, reproductive health problems, the necessity of reproductive health services and satisfaction level of health service providers.

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IV. Results

This research studied Reproductive Health Status and Primary HealthCare in urban settings by surveying the opinions of health service users and providers, and health status opinions of the Khon Kean Municipality Administrators. After data collection and analysis, the results were organized as follows:

4.1 General characteristics of the respondents

4.2 Reproductive health behavior of married respondents living with spouse and aged 15-49 years who used health services at the Municipality Health Services Center (MHSC) and Community Primary Health Care Center (CPHCC)

4.3 The opinions of the health service users in urban settings at the Municipality health Services Center and Community Primary Health Care Center

4.4 The Opinions of health system management and health service needs of the users at the Municipality Health Services Center and Community Primary health Care Center

4.5 The health opinions of health service providers in urban settings.

4.6 The health opinions of Khon Kaen Municipality Administrators.

4.1 The general characteristics of the respondents

The respondents totaled 346 people and were divided into two groups. There were 202 health service users at the MHSC and 144 health service users at the CPHCC in the catchment areas of MHSC.

The respondents were mostly female and Buddhists. Their educational level was primary school level, the age group of the respondents who used health services at the MHSC was 45-49 years (23.9%) and the age group of the respondents who used health services at the CPHCC was 30-34 years (24.3%). Both of them were close; 36 and 35 years of average age (Table1).

The MHSC users were mostly housewives (30.2%), but the CPHCC users were business owners and traders (36.1%). Both groups were married women and had income less than 5,000 baht, but the average income was nearly 7,000 and 6,642 baht (Table 1)

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Table 1 General characteristics of the respondent

4.2 reproductive health behavior of married respondents living with spouse and aged 15-49 years who used health services at the municipality health services center and community primary health care center.

The number of married respondents living with their spouse and aged 15-49 years, using health services at the MHSC was 183 at the CPHCC it was 128. The reproductive health behaviors were as follows:

The first age at marriage groups of the users at the MHSC and the CPHCC was mostly 20-24 years (44.8% and 46.1%). Both groups never had an abortion (76.0% and 72.6%), but for abortion only one time, both groups found that the number of cases were nearly the same (20.2% and 20.3%), in Table 2.

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The MHSC users practicing the contraceptive method were 66.1%, it was less than the CPHCC users, which was 73.4%. The most common contraceptive method was sterilization (60.3% and 47.9%) and they used this kind of service at the government hospital (71.1% and 64.9%), in Table 2.

Regarding gestation within the past 3 years, it was found that 25.1% of the MHSC users and 30.5% of the CPHCC users, used mostly Ante-Natal Care services (91.3% and 94.9%). However, the second group it was more than the number of ANC service users in the CPHCC group, which was only 1-3 times (Table 2)

The MHSC users comprised 91.3% while the CPHCC users comprised 100%. They used the delivery service at the government hospital. The main reason for delivery service use was convenience (80.4% and 72.9%). The short distance between their houses and the hospital were 56.5% and 59.5%, while safety was 56.5% and 54.1%. For Post-Natal Care Service, the MHSC users (58.7%) received this kind of service less than the CPHCC users (73.0%), in Table 2.

The Papanicolaou Test in women over 35 years, it was found that the MHSC users (66.1%) and CPHCC users (62.0%), both received this kind of test, and they had never contracted AIDS or Sexual Transmitted Diseases (STDs).

The birth weight of the children in the MHSC users was mostly 3,000-5,500 grams (45.7%), and in the CPHCC it was 2,500-3,000 grams (62.2%). Both of the mother groups used only breast-feeding, but the MHSC group was less than the CPHCC group (54.4% and 67.6%).

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Table 2 Reproductive health behavior of married respondents living with spouse and aged 15-49 years who used health services at the municipality health services center and community primary health care center

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For immunization of children under 1 year in the municipality health centers, it was found that there were 14 children less than 1 year who had completely received vaccination. They were for BCG, Diphtheria, Pertussis, Tetanus, OPV and Rubella, almost all were vaccinated (92.9% and 90.0%). For the Rubella vaccine 4 children should have received this vaccine, but only 3 children had received it (75.0%), in Table 3. The Community Primary Health Care Center found that there were 16 children under 1 year had completely received the BCG vaccine, 81.3% received the Hepatitis B vaccine, DPT and OPV were received by 75%. The Rubella vaccine was received by only 50.0% (Table 4).

Table 3 The immunization of children under 1 year in the municipality health service center

Table 4 The immunization of children under 1 year in the community primary health care center

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Regarding the immunization in children 1-6 years, it was found that the most of them, 91 children in the municipality health service center had been completely vaccinated for BCG, DPT, OPV, Hepatitis B and Rubella. The Encephalitis vaccine was received by only 78.0% (Table 5).

The immunization in children 1-4 years in the primary health care center showed that 68 children had completely received BCG and Hepatitis B vaccines. The DPT and OPV vaccines were received by 94.1%. Rubella vaccine and Encephalitis vaccine were received by 88.2% and 76.5%, respectively (Table 6).

Table 5 The immunization of children 1-6 years in the municipality health service center

Table 6 The immunization of children 1-6 years in the community primary health care center

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The health facility, to which the parents brought their children to receive immunization, was examined in the MHSC and the CPHCC. The health service behaviors of the users were quite similar. Most of the parents brought their children to the MHSC (59.3%) and CPHCC (54.4%) to receive vaccination. The second place was government hospital, 38.5% and 44.1%. Also there were a few cases that went to private clinic, 2.2% and 1.5% (table 7).

The reason why the parents brought their children to receive immunization at the MHSC and CPHCC was similar; the main reason was convenience (92.3% and 85.3%), the second reason was only 16.5% and 20.6% thinking about the modern equipment (Table 8).

Table 7 The health facility used by parents to bring their children for immunization

Table 8 The reason for using the health facility for immunization

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4.3 The opinions of the health service users in urban settings at the municipality health services center and community primary health care center

4.3.1 Examining the opinions of the health service users in the urban settings at the MHSC from 202 people, it was seen that most of them thought that it was very convenient for traveling to use the provided services, appropriate service period, enough services and inexpensive cost for treatment, 81.2% up to 95.5% (Table 9).

For the Health personnel’s skill, most of them thought that the health personnel had good services; it was 71.8% up to 79.2%. These kinds of services included diagnosis, physical check up, treatment, health education and information, disease control and prevention, community activities (village development, fund administration) and consultant. The referral system, consumer protection, AIDS control and home visit activities was 40.9% up to 63.4% and laboratory practice was only 53.5% (Table 9).

Their opinions about equipment and medical supplies in the MHSC were that the quality of that equipment was good, the quantity was enough and modern for used. Most of their opinions were 60.4% up to 62.9% (Table 9).

Regarding inside and outside condition areas of the MHSC were good (84.7% and 87.1%), and the numbers of health personnel were enough (69.3%). The health personnel had a good relationship and skill (82.2% and 75.7%), in Table 9.

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Table 9 The opinions of the health service users in urban settings at the municipality health service center (n= 202)

4.3.2 Regarding the opinions of the health service users in urban settings at the CPHCC, from 144 people, most of their opinions were that it was very convenient for traveling to use the provided services (82.6%), service period was appropriate (72.9%), but there was only 51.4% for sufficient services (Table 10).

For the village health volunteer’s skill at the CPHCC, it was found that the first performance was conduction meetings for villagers (66.0%), the second was village development (58.0% up to 63.9%) such as garbage disposal, local disease surveillance (mosquito breeding place destruction, stool collection for examination, and bacteria checking in the water) and nutrition. For the other activities such as physical check up (measure blood pressure, check fever, examine urine for diabetes), treatment, first aid, referral system, health education and information, and AIDS control (condom distribution and health education), the performance of village health volunteer in these activities was rated quite low (43.1% up to 54.2%), in Table 10.

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The opinions about equipment and medical supplies at the CPHCC were that they were inadequate (19.4%). The equipment condition was modern and viewed by only 20.8% and 18.1% (Table10).

Opinions on the inside and outside condition areas of the CPHCC were quite good (63.2% and 62.5%). The village health volunteer performance had good relationship (70.1%), the number of village health volunteer was adequate (56.3%) and their skills were good (39.6%), in Table 10.

Table 10 The opinions of the health service users in urban settings at the community primary health care center (n= 144)

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4.4 The opinions of health system management and health service needs of the users at the municipality health services center and community primary health care center

4.4.1 Regarding the opinions of health system management and health service needs of the users at the municipality health center from 202 people, most of them thought that the management of government health services in many levels gave equal opportunity for treatment and convenient services (84.2% and 86.1%). Health facilities had enough services, covered population needs and had a good quality of services (74.3%, 73.8% and 74.3%). Ongoing services such as referral system, resources management for services such as health manpower, equipment, supply and efficient health problem solving in the community were rated (64.4%, 66.8% and 69.3%), in Table 11

Table 11 The opinions of the health system management of users at the municipality health services center and hospital (n=202)

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The health service needs in the community at the MHSC perceived that there were many diseases, there were AIDS, nutrition, safe water, maternal and child health, health education, disease control and prevention, essential drugs and immunization (80.2% up to 94.6%). Ratings of accident prevention, mental health, dental health, family planning, drug addiction and services for the elderly were 73.8% up to 79.2% and services for people with disability and consumer protection were rated low (68.3% and 66.8%), in Table 12.

Most of them thought that every provided health services in the community was a necessary services (99.0% up to 99.5%), the quality of services were rated 80.2% up to 93.1%, including disease control and prevention, family planning, basic essential drugs and maternal and child health and immunization. Drug addiction, dental health, AIDS, services for the elderly, nutrition, environmental health, safe water and health education were rated 71.8% up to 78.7% while consumer protection, services for people with disability, accident prevention and mental health were rated quite low (58.5% up to 67.7%), in Table 12.

Table 12 The health service needs in the community of users at the municipality health service center and hospital (n= 202)

Service	Community percent	Quality percent	Need percent
Family planning Maternal and child health Immunization Health education Safe water Essential drugs Disease control and prevent Mental health Dental health Consumer protection Nutrition Accident prevention Drug addiction AIDS Services for the elderly Services for people with disability Environment health	78.2 83.7 94.6 84.2 83.7 89.1 84.1 73.8 77.2 66.8 81.2 73.8 78.7 80.2 79.2 68.3 82.7	80.2 82.2 93.1 78.7 77.7 80.7 80.2 67.7 72.6 58.5 76.7 67.3 71.8 72.8 74.8 61.4 76.2	99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.5 99.0 99.0

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4.4.2 Regarding the opinions of health system management and health service needs of the users at the CPHCC from 144 people, it was found that the government health service management was provided at the village level. This was the CPHCC managed by the village health volunteer. Their opinions were that they had a chance for equal treatment (74.3%), good coverage of population needs (81.9%), and adequate services, convenient services and effectiveness of solving problem in community were rated 59.0% up to 63.2%. The quality of services, ongoing services such as health manpower, equipment and medical supply were rated quite low (32.2% up to 47.9%), in table 13.

Table 13 The opinions of the health system management of users at the community primary health care center (n= 144)

Regarding the health services needs of the users at the CPHCC, it was found that 81.3% up to 84.0 was rated for AIDS, health education and immunization. Environmental health, safe water, service for elderly and drug addict were rated 72.2% up to 79.2%. Consumer protection, family planning, maternal and child health, dental health, services for people with disability, disease control and prevention, accident prevention, nutrition, essential drugs and mental health were rated 43.8% up to 69.4%.

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Rating were that all provided health services were necessary (97.2% up to 98.6%), quality of services were rated 64.6% up to 67.4%, including drug addiction, AIDS, immunization and health education. Essential drugs, accident prevention, environmental health, nutrition, mental health, safe water and services for the elderly were rated 50.0% up to 59.0%. Consumer protection, services for people with disability, family planning, maternal and child health, dental health and disease control and prevention were quite low (33.3% up to 47.9%), in Table 14.

Table 14 The health service needs in the community of users at the community primary health care center (n= 144)

4.5 The opinions of the health status of health service providers in urban settings

The opinions of the health status of health service providers in urban settings were taken from 12 people, the physician, pharmacist, and professional nurse by interviewing and using open-ended questions. The interview questions concerned health service coverage, reproductive health, and satisfaction of service provider with health services, problems, barriers and the other needs for practice. The results were as follows:

4.5.1 Their opinions about medical problems and people’s health in urban setting included:

Congested community and pollution such as air, water, garbage and waste, causing respiratory and digestive system diseases

Accident and traffic problems, high competition, causing stress, mental problems, drug addiction and high mortality.

Chronic diseases and heredopathia such as diabetes, hypertension, arthritis.

Influencing behavior such as eating behavior, taking care of themselves, lack of health promotion and consumer protection.

Malnutrition

The important problems in reproductive health was a lack of knowledge, consultants and sex education in the reproductive age, having sex at on early age, unsafe sex, unwanted pregnancy and child, illegal abortion and STD contraction. It should have cooperation from many organizations.

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4.5.2 The opinions about current medical services and health and efficient problem solving according to the policy included:

Current medical service and health could solve some problems

It was a passive practice, problem solving did not hit the point, and many people received illness from their behaviors. The most important was the people should have self-care and health promotion to prevent these problems.

The health services for people still had discrimination and quality of services were not different.

The ratio between the users and providers was very different, especially the small health service center, where health promotion could not be practiced.

4.5.3 The opinions of current medical service and health in urban settings included:

Use active practice and manage the ratio between the users and providers Emphasize practice in community.

Have good coordination with many organizations.

Improve the health service system such as convenient accessibility, good services, good relation between the users and providers, reduction of unnecessary processes and efficiency.

4.5.4 The opinions of reproductive health services included:

Stipulate that for solving problems and promoting reproductive health by involved persons such as from education, society, economics and health sectors, there should be reproductive health curriculum for the pupils in their school or university.

Control teenage behavior.

Parents should take care of their children.

Provide more information about reproductive health at all ages in their schools and communities.

4.5.5 The opinions of satisfaction with current practice, needs, problems and barriers in their jobs included:

The regulation did not match with practice or the real situation.

The development did not last long, budget and manpower did not match with the real situation.

The staff practice did not match with the real situation.

No incentive for staff.

Providers needs included:

Manipulate the ratio of the users and providers.

Improve management, regulations and rules.

Create incentives.

Have good attitude.

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4.6 Health status opinion of the Khon Kaen Municipality Administrator

The opinions of health status by Khon kaen Municipality Administrator included 6 people; they were the Secretary of the Municipality, Deputy Secretary of the Municipality, Chairman and Vice Chairman of the Municipality Council and the Municipal Counselor.
The interview questions concerned health service coverage such as health problems in urban settings, medical service and health management in urban settings, current primary health care activities, village health volunteer in urban settings, environmental problems in urban settings and quality of people in urban setting indicators.

4.6.1 The opinions of health problems in urban settings and target included:
The current problems were drug addiction, pollution such as air, water, garbage, toxins, and chemicals. People could not access basic health services. Treatment was more than health promotion.

4.6.2 The opinions of current medical service and health agreed with the real situation and included:

Emphasize health promotion prevention rehabilitation more than treatment

Cooperate with involved organization

Decentralize

Develop of treatment and new knowledge

Improve referral system improvement

Coordinate

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4.6.3 The opinions of primary health care management in urban settings included:

Capitation

Planning consideration system

Cooperation and coordination

4.6.4 The opinions of primary health care elements in urban settings in the current situation were in terms of agreeable elements and its necessity. Municipality administrators thought that all elements were necessary and agreed with the current situation. It should be completed and followed-up continuously.

4.6.5 The opinions of village health volunteer in urban setting and performance included:
It was necessary to have village health volunteers because they were the people in the community. They could know, understand and cooperate with the staff. We should have training for them to improve their knowledge and skill.

4.6.6 The opinions of environmental health in urban settings included:
The environmental problems were pollution from garbage, water, traffic and smoke. The weak law could not punish the violators. We should encourage the people to improve their environment.

4.6.7 The opinions of quality of people in urban settings included:
The quality of people should be happy with healthy and good mental condition. The good conditions of people were happy family and community, good health and education, sufficient income and equality in their society.

V. Conclusion

5.1 Conclusion

This study was a descriptive research aimed investigating reproductive health status and urban primary health care in Khon Kaen Municipality from February- March 2002.

The largest population was 202 clients at the municipality Health services Center (MHSC), 144 clients at the Community Primary health Care Center (CPHCC), 12 health providers at MHSC and 6 administrators of the Khon Kaen Municipality, the total target population was 364 persons.

The data wee colleted both by quantitative and qualitative methods by using structured questionnaires consisting of survey forms on health opinions of people in urban settings for clients at the MHSC and CPHCC and interview forms on health opinions of people in urban settings for health providers and municipality administrators. Percentages have been used to analyze quantitative data and the analysis guideline of Chantawanich (1993) has been used for qualitative data.

Research results were as follows:

5.1.1 Reproductive health behavior

The target population who used health care services at the MHSC and CPHCC found that the first marriage was at 20-24 years. Mostly there were no abortion and among people who have, mostly it was only once. Most of the respondents practiced contraceptive methods, the popular method was sterilization at a government hospital (Table2).

Regarding pregnancy within the past three years, clients who visited the services at the MHSC and CPHCC had similar pregnancy rates at 25.1% and 30.5% accordingly. Almost all pregnant women visited an Ante-natal care unit; however, the number of visits of clients at the NHSC was 10-12 times, while the clients at the CPHCC was 1-3 times. Both groups preferred to deliver at the hospital for the reason of convenience, nearness to house and safety. Post-natal care of clients at the MHSC and CPHCC was 58.7% and 73.0% respectively and women 35 years and higher were tested for cancer and female genitalia. It was found that the number was similar, 66.7% of clients at the MHSC and 62.0% of clients at the CPHCC. Almost all family member of both groups had never contracted a sexually transmitted disease (Table 2).

The weight of newborn babies at the MHSC was over 3,000 to 3,500 grams, much more than at the CPHCC, which was only 2,500 to 3,000 grams. Breast feeding of clients at the MHSC was less than the CPHCC (Table 2).

All children under 1 year of both groups received BCG vaccination; however, vaccinations for Diphtheria, Pertussis, Tetanus, Poliomyelitis, Hepatitis and Rubella for children at the MHSC were received much more than children at the CPHCC (Table 5). Almost children 1-6 years at the MHSC received BCG, Diphtheria, Pertussis, Tetanus, Poliomyelitis, Hepatitis and Rubella vaccines much more than children at the CPHCC. Regarding Encephalitis vaccinations, they were both alike, 78.0% and 76.5% (Tables 5 and 6). Both groups preferred to go to the MHSC for child immunization because it is near the house and convenient (Tables 7 and 8).

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Opinions toward government health care services of both groups were similar regarding convenience and appropriate service times. The types of health care service at the CPHCC were less than the MHSC (Table 9 and 10).

The abilities of health providers at the MHSC were rated good in terms of diagnosis, physical check-up, treatment, suggestion, information distribution, disease control and prevention, conducting community activity and counseling. The capabilities of laboratory rooms at the MHSC was rated only fair at 53.5% (Table 9). The performance of Village Health Volunteers (VHVs) at the CPHCC work quite well in terms of calling for village meetings. The other tasks, which wee rated only fair were basic check-up (blood pressure, fever measurement, urine test) treatment, first aid, referring, counseling, health education and AIDS control (Table 10).

Regarding the adequacy of equipment, medical supplies and condition of equipment at the MHSC, almost all respondents stated that they were good at 60.4-62.9%. however, 18.1-20.8% of respondents at the CPHCC thought that they were good (Tables 9 and 10). The condition of both inside and outside areas at the MHSC were rated better than th CPHCC, human relation and ability of health provider at the MHSC also were rated better than the CPHCC, and 69.3% thought that there were enough of health personnel (Table 9 and 10).

5.1.2 Opinions towards health care services system

The health care service system at the MHSC was rated good in terms of equal treatment, convenient services, full coverage of services, coverage of population and quality of services. However, the continuous services such as referral system, resource allocation on health services in terms of staff, equipment and medical supplies including effectiveness of health problem-solving were rated less than the other aspects (Table 11). While health care services system at the CPHCC were rated good, only equal treatment and coverage of population, and other aspects such as coverage of health services, convenient services, effectiveness of health problem solving, services quality, continuous service and resource allocation on heath care were rated less (tables 12 and 13).

5.1.3 The needs of community health care services

According to perception of community health care services, the respondents at the MHSC knew that there were community health care services with good quality and it is a requirement of community, while the respondents at the CPHCC were less accepting of community health care services. At the MHSC 80.2-94.6% of respondents knew about AIDS, nutrition, clean water, mother and child health, health education, disease control and prevention, basic essential drugs and immunization. In addition, 73.7-79.2% of respondents knew about accident prevention, mental health, dental health, family planning, drug addiction and elderly services. The least known health care services were handicapped services and consumer protection. The above-mentioned health care services could be set up in order of best quality rated from 80.2%- 93.1% and were as follows: disease control and prevention, family planning, basic essential drugs, mother and child health and immunization. The second best quality, rated from 71.8%-78.7% were drug addiction, dental health, AIDS problem and services for the elderly. The lowest quality, rated from 58.5%-67.7% included consumer protection, handicapped services, accident prevention and mental health (Table 12).

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The highest perception by respondents at the CPHCC in the proportion, 87.3% to 84.0%, included AIDS, health education and immunization. The second, in the proportion of 72.7% to 79.2% were pollution prevention, having clean water, elderly services and drug addiction. The least known, 43.88% to 69.4%, were consumer protection, family planning, mother and child health, dental health, handicapped service, disease control and prevention, accident prevention, nutrition, basic essential drugs and mental health. The best quality of service were drug addiction and AIDS in the proportion of 64.4% to 67.4%.

Immunization and health education were the second best, 50.0% to 59.0%, which included only a few such as basic essential drugs, accident prevention, pollution prevention, nutrition, mental health, having clean water and elderly service. Consumer protection, handicapped services. Family planning, mother and child health, mental health and disease control and prevention were rated 33.3% to 47.9%.

The health care services mentioned above were perceived to be essential to both groups.

5.1.4 Health opinions of health providers in urban settings

The opinions of health providers towards the important health problem in urban settings were follows:

Congestion problems, pollution, accident and traffic, narcotics, stress, psychosis, malnutrition, chronic disease and genetic disease such as diabetes mellitus, hypertension and disease of the bones and joints.

Behavioral problems such as eating behavior and lack of consumer protection.

Reproductive health problems such as a lack of knowledge, counseling on sex education, adolescence do not know about pregnancy prevention causing unwanted pregnancy, illegal abortion and sexually transmitted diseases. At present, reproductive health services still do not cover the problem. Also, the cooperation between inside and outside authorized organizations to solve problems was not clear.

The providers thought that they were satisfied with their tasks because they used their knowledge and worked closely with the people. However, they still had some obstacles with the tasks such as the bureaucratic system that depends on the regulation more than production and task effectiveness. The regulation did not go along with the performance, it only emphasized working quickly, not the rationale. Also, human resource development and funding did not agree with the real situation and had no sustainable development. Moreover, the health personnel did not adjust their way of working for harmony with the real situation including motivation for working, and did not agree with policies and improved performance. Thus, the need for health providers to put the right man to the right job, improving the smooth management, promoting attitudes towards advanced performance and strengthening people’s self-reliance and encouraging staff to work in the community.

Current medical care services and health care services were able to solve some problems due to defending performance, inequity of services, different proportion of clients and providers, especially at small health care services center. Medical services and urban public health should be changed to agree with the policy and the current situation. There should be clear coordination at high policy levels for mutual understanding among the staff and easy coordination at the implementing level, putting the right person to the right job, including encouraging staff to work in the community. Furthermore, improving the service system has to agree with health care insurance policy in terms of equity, accessibility, sincere services, quality service, accountability and decrease procedure for task effectiveness.

Reproductive health services are very essential to take care of people’s health throughout their lives. Current services do not cover or suit the problems. It was only a single solution not a holistic solution. The important thing to improve is policy identification on solution and promotion of holistic reproductive health by mobilizing all human resources such as educational, social, economic and public health for mutual coordination at all levels. Regarding society, regulations have to be re-arranged to control adolescent behavior.

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5.1.5 The health opinions of the Khon Kaen Municipality Administrators included:

They have been implementing health care services and have had success in some aspects, the lack of success was because it was a passive task only and emphasized treatment more than health promotion and prevention. The important health problems are pollution, such as air pollution, water and toxic substances. People lack health care insurance, and have less self-reliance and more inequity.

Current medical care and health care services have to be adjusted to agree with health care reform policy by adjusting work procedures in the active performance aspect and strengthening the potential of family and community to be self-reliant. The roles of health personnel need intersectoral coordination between organization and in the community to work closely together. The implementation should go along with research study and bring the research result to develop the task continuously. The roles of health personnel at the Provincial Public health Office should be central link between policy and local staff, also working at the policy level. Local staff have to transfer tasks to authorized sections and have equal decentralization both in urban and rural settings. The referral system needs to be improved at health care service centers for continuous care.

Cooperation and coordination among responsible units for urban primary health care was felt to be less. The 30-baht policy caused information systems to change all the time and increase the workload for staff. The hospital was still centralized and the municipality had a less active plan. However, if there is a reengineering for new organizational structures and new roles would mainly be based on the quality of life of the people.

Urban primary health care management should allocated funding per head, emphasizing the people. All plans should be proposed by responsible organizations and considered by the Provincial Committee.

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The current implementation of primary health care elements are essential and agreeable with the real situation nowadays; however, it should complete all elements and follow-up continuously. The urban village health volunteers are still needed because they act as the coordinators among health personnel and the community and speed up implementation. There should be an increased number of village health volunteers to cover the entire area. The training course should be continuously offered emphasizing knowledge and ability and giving the chance to learn and practice skills at health services centers to develop potential and be more accepted by the community. The characteristics of village health volunteers include good human relations, willingness, good intention and community acceptance.

Important problems on social environment in urban settings include pollution from garbage, waste water, air pollution and traffic jam. Policy for environmental problems-solving need mutual responsibility from all units to set up an educational system and create awareness in adolescence for environmental conservation. Law has to be seriously enforced.

At present, the quality of life of people in urban settings is better than rural people due to the chance to receive information and easy accessibility. The indicators to measure the quality of life of people in urban settings are the happiness of the individual, family and the community, good hygiene, education, adequate, income, safety and sufficient properties, receiving social services equally and being good citizens.

We have enjoyed the cooperative effort directed towards mutual benefit between us and the Asian Urban Information Center of Kobe. It is our hope that the finding and our interpretation will be not only of academic interest but that it will also contribute practically towards the uplifting of health of those people in the sectors of populations suffering poverty and malnutrition. As mentioned earlier their sickness, and the number of those who died under these conditions had not been seen as part of the health problem. We hope this study can be one suggestion to such indifferences or insufficient evaluations of the past, and that it will provide a needed perspective for policy makers and relevant leaders to take the kind of necessary initiatives to promote the health of the needy sectors of our national population.

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VI. References

ICPD. Programme of Action of the United Nations International Conference
On Population and Development; 1994

Chanawongse, Krasae. Et al. Khon Kaen: Heart of the Northeast. In:Gayl D. Ness and Michael M. Low, (eds.). Five Cities Modeling Asian Urban Population- Environment Dynamics. Singopore: Oxford University Press; 2000

Sakondhavat, Chuanchom. Reasearch Study on Services and Development in Reproductive Health and Primary Health Care. Khon Kaen: Faculty of Medicine; 2001.

Chantawanich, Supang. Data Analysis on Qualitative Research. Text book Project of Faculty of Political Science, Chulanlongkorn University; 1993.

Kaewhawongse, theeraphong. Model Development of Cooperation among Gos, NGOs and people Organization to Implement Primary Health Care policy in Khon Kaen Province: Klung-nana Wittaya Press; 1999 Supradit, Pornthip. Et al. Current Situation Report and Trend of Primary Health Care in Thailand. Bangkok: Express Transportation Organization of Thailand Press; 2000.

Wirakul, Wanida, Muenkham, Kwanchai and Hassaroke, Jirawan. A Study onSituation and Development Trends of Primary Health Care in Northeastern, Khon Laen: Klung-nana Wittaya Press; 1998.

Wirakul, Wanida. A Study on Evolution, Success and Development Trends Of Primary Health Care, Khon Kaen: Klung-nana Wittaya Press; 2002.

Wongkhomthong, Som-arch and Pramanpol, Somjai. Evolution of Primary Health Care in Thailand. Bangkok: P.A. Living Co. Ltd; 1997.

VII. Appendex

Research Instruments

- survey form on health opinions of people in urban settings (clients at the Municipality Health Services Center)

survey form on health opinions of people in urban settings (clients at the Community Primary Health Care Center)

interview form to health providers on health opinions of people in urban settings

interview form to administrators on health opinions of people in urban settings

Survey Form
Health opinions of people in urban settings
(Clients at the Municipality Health Care Services Center)

Date of interview…………………..month…………….year
Name of interviewer……………………………………………..
Name of field supervisor…………………………………….
Address…………………Sub district………………………….Muang District. Khon Kaen

Part 1 Demographic data

1. Gender

1. Male 2. Female

2. Age………….fully year.

3. Religion

1. Buddhism 2. Muslim
3. Christian 4. Others specify………………….

4. Educational level

1. No schooling
2. Primary school (Grade 4)
3. Primary school (Grade 7)
4. Junior secondary
5. High school
6. Junior college
7. Diploma
8. Bachelor Degree
9. Higher than Bachelor
10. Other, specify………………

5. Occupation

1. Government services
2. Agriculturist
3. Business/commerce
4. Housewife
5. Laborer
6. Student
7. Firm/Factory employee
8. Other, specify……………….

6. Marital status

1. Single
2. Married
3. Divorce/Separated

7. Family income per month…………………….bath

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Part 2 Reproductive health behavior (delivery, contraception, child rearing)

(Question 1-9 only married people aged between 15-49 years)

1. How old were you and your wife when first married?………………Years

2. How many times have you had an abortion……………….times
Male…………….. Female…………………

3. Do you practice contraceptive methods now?

Yes

During pregnant (skip to Q. 10)

No

4. What methods of contraception do you practice now (choose more than one)

Sterilization

Oral pill

Injection

IUD

Condom

Norplant

Other, specify…………………..

5. Where is the place you get contraceptive service?

Government hospital

Municipality health Service Center

Private hospital

Private clinic

Drug store

Other, specify……………….

6. Are you satisfied with the service?

Yes

No, because…………….

Don’t know/never practiced contraceptive

7. During the past 3 years, have there been any pregnant woman in your family?

Yes, …………….person

No (skip to Q. 13)

8. Did the pregnant woman go to visit ANC? (In case there are many pregnant women, give the details of the latest pregnancy)

Yes, number of ANC visits……………….times

No

9. Where did you deliver?

Hospital

Municipality Health Service Center

Private Health Center

Other, specify…………………….

Weight of newborn baby………………….grams

10. Why did you go to that palace for delivery?

Convenience

Near house

Cheap/Free

Safety

Modern equipment

Other, specify…………………….

11. After delivery, did you ever receive post natal care (both mother and child) or receive
a home visit by health personnel?

Yes,…………………..times

No

12. Did you give breast-feeding to your children after birth?

No

Yes

Breast feeding and formula powdered milk

13. Do you have children under 1 year in your family?

Yes, age………………month

No (skip to Q. 16)

14. Did your children get complete immunization as mentioned below?

14.1 Diptheria / Pertussis /Tetanus
1. Complete
2. Not completed, because……………..

14.2 BCG
1. Complete 2. Not completed, because……………..

14.3 Poliomyelitis 1. Complete
2. Not completed, because……………..

14.4 Hepatitis
1. Complete 2. Not completed, because……………..

14.5 Rubella
1. Complete 2. Not completed, because……………..

15. Do you have children 1-6 years?

Yes,……………….person

No (skip to Q. 19)

16. Did your children get complete immunization as mentioned below? (if there are many children, report only the youngest one)

14.1 Diptheria / Pertussis /Tetanus
1. Complete 2. Not completed, because……………..

14.2 BCG
1. Complete 2. Not completed, because……………..

14.3 Poliomyelitis
1. Complete 2. Not completed, because……………..

14.4 Hepatitis
1. Complete 2. Not completed, because……………..

14.5 Rubella
1. Complete 2. Not completed, because……………..

14.6 Encephalitis
1. Complete 2. Not completed, because……………..

17. Where did you go to get immunization as mentioned above?

Hospital

Health Service Center

Private Health Services

Other, specify………………….

18. Why did you go that place? (choose more than one)

Convenience

2. Near house

Cheap/Free

Safety

Modern equipment 6. Other, specify

19. Do you have people whose age is over 35 years old?

Yes,………………person

No (skip to Q. 21)

20. Do the people mentioned-above go to check for cancer of the genital system?

Yes

Some had checked

No

21. Have you family members contracted any sexually transmitted disease (AIDS and Venereal Diseases)?

Yes, specify disease………………..

No

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Part 3 Opinions towards urban health services provided

Do you have a Municipality Health Care services Center?
No, because there is a hospital in the sub district
Yes, namely……………………………….located at……………………………….

Part 4 Opinions towards health system management and essential health service

4.1 What do you think of the health system management and health services which also have a CPHCC, MHSC and hospital in the same area: