Thailand - Stop TB Partnership

curricula, 125 and by doing more to ensure in-service training and continuing education for
doctors and nurses on the latest developments in TB care. In a recent example of policy-oriented
research, researchers from the TB Cluster assessed curricula from 71 nursing schools
and found that an average of just 15 minutes was devoted to TB. 126 Spurred by these findings,
a new curriculum and teaching guidelines were developed and are being disseminated. TB
Cluster staff believe that this research has sparked greater interest in the importance of
increasing the level of training and teaching on TB at other institutions as well; for example,
a TB component has been added to Mahidol University’s annual HIV/AIDS training for
nurses. 127 The government should consider urgent measures to improve the incentive package
for TB workers to attract new staff, ensure high-quality TB services through appropriate
and ongoing training, decrease high levels of staff turnover, and enhance the prestige of
TB work.
Budgeting and expenditures
Health reforms have made it more difficult to obtain an accurate and comprehensive picture
of annual government spending on TB care.
The universal coverage system places a priority on preventive care rather than
treatment of illnesses. As a result, TB treatment is now included in the “essential package
of care.” Provincial and district hospitals receive funding from the MoPH to cover the costs
of providing the essential package of care, but without any specification as to how much
funding is required to ensure TB control. According to some officials, this situation has
resulted in a lack of transparency and consistency in decision making on health budgets
and in the underfunding of TB in some areas since “it’s a struggle to get TB prioritized.” 128
This has had a particularly serious impact on budgets for training, monitoring, and supervision
since these activities are funded at the discretion of provincial medical officers, who
are under pressure to cut costs.
Funding for the NTP is provided from the MoPH budget. Between 1991 and
1998, despite a severe financial crisis in 1997, 129 per capita NTP expenditure on TB control
remained roughly constant in absolute dollar terms. 130 More recently, the NTP budget has
been reduced significantly, from $6.1 million (231 million baht) in 2002 to $4.7 million
(178 million baht) in 2005, compared to the total estimated cost of $10 million per year
(378 million baht). 131
However, the NTP budget figure reported to the WHO for 2005 only reflects
the budget managed by the TB Cluster, and not total spending on TB control. The apparent
reduction in NTP funding does not reflect the amounts allocated to TB control at the
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