Palliative Care Scaling-up in Thailand

This research investigates a central health systems challenge in Thailand, why progress in palliative care availability does not automatically translate into effective coverage. The thesis argues that existing global and national assessments often describe palliative care development through structural indicators such as policies, services, and training, but do not adequately explain why certain models scale successfully while others do not. To address this gap, the study examines palliative care service models across public and private sectors and across institutional- and community-based delivery arrangements. It uses a two-phase realist evaluation design consisting of documentary review and qualitative fieldwork to identify and refine Context-Mechanism-Outcome (CMO) configurations. Fieldwork spans Chiang Mai, Khon Kaen, Bangkok, and Songkhla, with stakeholders including policymakers, purchasers, regulators, and provider organizations. The study ultimately aims to produce explanatory insights, a cross-model understanding of scaling barriers, and practical managerial and policy recommendations to improve effective coverage of palliative care in Thailand.