Summary final report of the Lampang health development project

The project"s major strategy - the use of health manpower from village resources and the provincial health care system - succeeded in achieving a high level of health manpower coverage at peripheral levels (village, district, and subdistrict) where there formerly was a manpower gap. The use of health services has substantially increased, primarily as the result of the contributions of community health volunteers (CHV"s), community health paraphysicians or wechakorn (mid-level MOPH personnel linking local areas to the government health system), and the mobile clinic of the Provincial Hospital"s Community Health Department. Besides the increase in overall service volume, there has been a shift in the use of services from the Provincial Hospital to local levels. This trend implies the need to strengthen health system logistics at the rural periphery and, consequently, for greater emphasis on supplying rural health centers, supervising health center personnel, and improving health service management and information systems. As a result of greater public demand and the consequent priorities adopted in the training programs and in the supervision of new health workers, major improvements wrought by the project were in curative care and family planning services rather than in health promotion or disease prevention. Nonetheless, the credibility established by the project and the health manpower now available have the potential to generate substantial improvements in the latter two areas; most needed are improvements in nutrition, water supply, and sanitation. CHV"s should take major roles in these activities. Although the unit costs of services decreased as a result of CHV contributions, overall budgetary requirements for greatly expanding service coverage could become excessive. Careful monitoring of costs and perhaps local financing schemes are needed.