BackgroundIn Thailand, the inequitable distribution of doctors between rural and urban areas has a major impact on access to care for those living in rural communities. The rural medical education programme ‘Collaborative Project to Increase Rural Doctors (CPIRD)’ was implemented in 1994 with the aim of attracting and retaining rural doctors. This study examined the impact of CPIRD in relation to doctor retention in rural areas and public health service.MethodsBaseline data consisting of age, sex and date of entry to the Ministry of Health (MoH) service was collected from 7,157 doctors graduating between 2000 and 2007. There were 1,093 graduates from the CPIRD track and 6,064 that graduated through normal channels. Follow-up data, consisting of workplace, number of years spent in rural districts and years within the MoH service, were retrieved from June 2000 to July 2011. The Kaplan-Meier method of survival analysis and Cox proportional hazards ratios were used to interpret the data.ResultsFemale subjects slightly outnumbered their male counterparts. Almost half of the normal track (48%) and 33% of the CPIRD doctors eventually left the MoH. The retention rate at rural hospitals was 29% for the CPIRD doctors compared to 18% for those from the normal track. Survival curves indicated a dramatic drop rate after 3 years in service for both groups, but normal track individuals decreased at a faster rate. Multivariate Cox proportional hazards modelling revealed that the normal track doctors had a significantly higher risk of leaving rural areas at about 1.3 times the CPIRD doctors. The predicted median survival time in rural hospitals was 4.2 years for the CPIRD group and 3.4 years for the normal track. The normal track doctors had a significantly higher risk of leaving public service at about 1.5 times the CPIRD doctors.ConclusionsThe project evaluation results showed a positive impact in that CPIRD doctors were more likely to stay longer in rural areas and in public service than their counterparts. However, turnover has been increasing in recent years for both groups. There is a need for the MoH to review and improve upon the project implementation.

Despite Thailand having had universal health coverage (UHC) with comprehensive benefit packages since 2002, services are neither listed nor budget earmarked for COVID-19 responses. Policy decisions were made immediately after the first outbreak in 2020 to fully fund a comprehensive benefit package for COVID-19. The Cabinet approved significant additional budget to respond to the unfolding pandemic. The comprehensive benefit package includes laboratory tests, contact tracing, active case findings, 14-day quarantine measures (including tests, food and lodging), field hospitals, ambulance services for referral, clinical services both at hospitals and in home and community isolation, vaccines and vaccination cost, all without copayment by users. No-fault compensation for adverse events or deaths following vaccination is also provided. Services were purchased from qualified public and private providers using the same rate, terms and conditions. The benefit package applies to everyone living in Thailand including Thai citizens and migrant workers. A standardised and comprehensive COVID-19 benefit package for Thai and non-Thai population without copayment facilitates universal and equitable access to care irrespective of capacity to pay and social status and nationality, all while aiming to supporting pandemic containment. Making essential services available, notably laboratory tests, through the engagement of qualified both public and private sectors boost supply side capacity. These policies and implementations in this paper are useful lessons for other low-income and middle-income countries on how UHC reinforces pandemic containment.