Language:
Search
 
Somjai Luevisadpaibul
The Public Health Office Ubonratchathani
Thailand

The Problem

Rehabilitation services for disabled persons in Thailand urgently needed to be improved. A national survey of disability in 2002 by The National Statistical Office found that 1.7% of 63.3 million people suffered from a disability, which gradually increased to 2.9% in 2007. Most disabled persons were settled in the rural areas of the North-Eastern of Thailand and the main area of problem was physical disability. In Ubonratchathani province, there were 10,040 disabled persons in 2002, which then increased to 18,821 persons in 2007 (approximately 1.8-fold increase in the number of disabled persons within five years). These disabled persons required support including continuing rehabilitation services. However, most of them had immobility problems, leading to difficulty in transportation and therefore inaccessibility to rehabilitation services in hospitals. Since there was no solid protocol of rehabilitation services in the community at that time, those immobilized disabled persons had no chance to receive that benefit.
A similar situation had occurred with patients who were prone to disability states i.e., ischemic stroke patients. During the acute period, those patients were admitted in the hospital to receive the standard treatment and also rehabilitation services until being discharge as sub-acute patients. Ideally, sub-acute patients should be rehabilitated during the golden period (the first six months after acute onset) due to higher chances of recovery. However, those patients had a low possibility to access rehabilitation services after being discharge from hospitals because of immobility problems (similar to that of disabled persons). In addition, there was no registration and referral system that supported continuing rehabilitation programs for this group of patients. Previous studies on rehabilitation services conducted at Sunpasittiprasong central hospital in 2007 showed that patients with cerebrovascular disease who lived in rural areas frequently progressed to be disabled persons. Approximately 73% of patients received rehabilitation services only 1-2 times during the golden period. These results suggested that sub-acute patients did not receive appropriate rehabilitation.
There were several problems and serious consequences following the absence of a solid rehabilitation system in Thailand. Ideally, disabled persons and sub-acute patients should receive rehabilitation services until daily living activity was restored. However, most of them did not achieve that goal and also had no knowledge of how to take care of themselves. Finally, sub-acute patients may become disabled persons and they may be totally dependent on caregivers, which in turn lead to socioeconomic problems due to loss of workers and income for those families. Many disabled persons were neglected, leading to depression and suicide attempts. All these multi-level problems and complications were expanded according to the increasing number of disabled persons and should be concerned as a national problem that urgently needs to be solved.
In conclusion, main problem of the disabled persons and sub-acute patients in Ubonratchathani was “inaccessibility to rehabilitation services in hospitals” due to several difficulties, particularly immobility. Another discovered problem was “no registration and referral system for sub-acute patients”. Thus, those patients had been unexpectedly neglected until they developed a disability and had registered as disabled.

Solution and Key Benefits

 What is the initiative about? (the solution)
This initiative established a “community rehabilitation program” for all disabled persons in Ubonratchathani province. This active rehabilitation project aimed to rehabilitate disabled persons within their communities by multidisciplinary, physical therapy (PT) teams and a collaborative network of rehabilitation (i.e., community health care volunteers, community leaders, leaders of disabled persons, Provincial Administrative Organization, Sub-district Administrative Organization, Department of Social Development and Human Security, Institute of Skill Development and Special Education centers) instead of waiting for the immobilized persons to come to hospitals.
For sub-acute patients with a high risk of disability, the initiative developed a registration and referral system based on the novel computer software “PTSendRefer”. Therefore, sub-acute patients would receive the community rehabilitation program (by the same mechanisms as those of the disabled persons) within their golden period to prevent permanent disability and improve their quality of life. Both developments played a key role in the improvement of solid rehabilitation services in Thailand.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
In rehabilitation conference 2005 arranged by Public Health Office of Ubonratchathani and Sunpasittiprasong central hospital, Ms. Somjai Luevisadpaibul, the head and a senior physical therapist of the PT team of Sunpasittiprasong central hospital, raised a critical problem in rehabilitating services for disabled persons. After discussion by the four main participants including the chair of Public Health Office of Ubonratchathani, the PT team of Sunpasittiprasong central hospital and community leaders and the representative of the disabled persons, this initiative was designed in order to improve the rehabilitation system in Ubonratchathani.
The collaborative network consisted of Ubonratchathani Health Office, Provincial Administrative Organization, multidisciplinary team and the Information Technology (IT) team of Sunpasittiprasong central hospital, the PT teams of community hospitals, community health care volunteers and community disabled societies were responsible for implementing the strategy into action. The Public Health Office of Ubonratchathani was responsible for setting this initiative as an urgent provincial health policy and managing the budget. The Provincial Administrative Organization provided the transportation and was responsible for orthotic repair. The multidisciplinary team also played a role in the initiative administration in order to coordinate with other public organizations and the private sector for further collaborations. The multidisciplinary team of central hospital and the PT teams of community hospitals were jointly responsible for implementing the community rehabilitation program, including going out to communities, physical examinations, assessment of disabilities, designing the appropriated rehabilitation program, occupational training, and teaching/training the basic rehabilitation procedure to caregivers and volunteers. The IT team was responsible for developing computer programs and the data management system of the initiative. Community health care volunteers were responsible for continuously rehabilitating disabled persons within the community. Community disabled societies played a role as a consultant and supporter for new disabled persons in that community.
The stakeholders were presented as followed; 1) 22,012 disabled persons and 1,200 sub-acute patients who required rehabilitation services in the communities, 2) community leaders and disabled societies, 3) disabled families and relatives, 4) people in communities, 5) rehabilitation teams from the Ministry of Health, 6) community health care volunteers, 7) Provincial Administration and local organizations, 7) Department of Social Development and Human Security, 8) Institute of Skill Development Disabilities and 9) Special Education centers.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
Practical strategies were applied to establish a solid rehabilitation system in Ubonratchathani including establishing a collaborative network of rehabilitation, launching the community rehabilitation program, developing a data management and referral system, and strengthening the community for sustainable rehabilitation.
A collaborative network of rehabilitation was established by cooperation among Public Health Office of Ubonratchathani, a multidisciplinary team of Sunpasittiprasong central hospital and PT teams of community hospitals. The initiative has also coordinated with several government organizations and public/private sectors to provide rehabilitation services and multi-dimensional support simultaneously. These include Provincial Social Development and Human Security Office, Provincial Administrative Organization, Sub-district Administrative Organization, Department of Skill Development, Thong Phun-Pao Manat Vocational Rehabilitation Center, Special Education Center and Non-Formal Education Center of Ubonratchathani, and The Rotary Club in Thailand. Community health care volunteers, care givers, community leaders and established disabled societies have joined into the collaborative network. Multidisciplinary team functions as the hub of this collaboration.
A community rehabilitation program was implemented by multidisciplinary team of Sunpasittiprasong central hospital and PT teams of community hospitals to provide active rehabilitation service within the community instead of waiting for immobilized persons at the hospital. Multidisciplinary team including physiatrists, nurses, physical therapists and occupational therapists was responsible for providing rehabilitation services in the community once a week. The PT team including general practitioners, nurses and physical therapists was responsible for providing services in the community 3-4 times a week.
To organize this initiative smoothly and systemically, two newly developed software programs “PTSoft” and “PTSendRefer” were used as the data management and referral system for rehabilitation services in Ubonratchathani. PTSoft was applied to record the information of disabled persons including demographic data, disabled registration status, information related to caregiver, information related to disability (i.e., type and cause of disability, current status and problems, past medical history and treatment, complications of the disability, the needs for orthosis and other supports) and the received rehabilitation service. The data extracted from PTSoft could be used to organize a schedule and plan for community rehabilitation programs, and assess progressions and weak points that need to be improved. PTSendRefer was developed to apply for registration and recording the data of sub-acute patients after discharge from the hospital. The software then “sent” the patient information as the “referred” duty of continuous rehabilitation to community hospitals. According to this system, sub-acute patients could receive an appropriated rehabilitation program during the golden period.
Strengthening the community for sustainable rehabilitation was implemented by several methods. Education and training community health care volunteers and caregivers for basic rehabilitation procedures by multidisciplinary and PT teams were the main activities. Since it was not possible to send the PT team to the same community everyday, trained volunteers and caregivers have taken the duty of daily rehabilitation for disabled person in that community. On the other hand, the initiative empowered and supported the disabled persons to form their own society. Increasing the community strength to take care of their disabled persons was one of the top priorities of this initiative.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
During 2005-2007, Public Health Office of Ubonratchathani and Sunpasittiprasong central hospital arranged rehabilitation conferences and workshops for the multidisciplinary team of Sunpasittiprasong central hospital, PT teams of community hospitals, members from collaborative networks and all volunteers in order to build the common goal, promote understanding of the strategy, and develop capabilities of the responsible tasks.
During 2007-2008, a preliminary project of community rehabilitation program was initiated in the urban area of Ubonratchathani. This aimed to check the readiness of the established system. Assessment plans and project activities were revised and adjusted in this period to meet both standardization and practicality. The PTSoft program was successfully developed and used as a data management system for this initiative. The success of this preliminary project provided confidence to run the full project.
From 2008-present, the full project of the community rehabilitation program has been launched which covers all disabled persons in Ubonratchathani including those settled in rural areas. The multidisciplinary team from Sunpasittiprasong central hospital and the PT teams from community hospitals were sent to rehabilitate disabled persons in the community. At the same time, a collaborative network including an education and occupation training team also provided their services. Workshops for community health care volunteers and caregivers were initiated to practice basic rehabilitation procedures for daily rehabilitation.
From 2010-present, the initiative was extended to cover sub-acute patients with a high risk of disability in Ubonratchathani. A registration and referral system for sub-acute patients was then established. The PTSendRefer program was successfully developed and has been used as the core of the registration and referral system for sub-acute patients. According to this system, the PT team could intentionally visit high-risk patients in order to provide community rehabilitation programs within the golden period.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
The main obstacles encountered during implementing the initiative included unregistered disabled persons, lack of budget to provide sufficient orthosis, lack of manpower during expansion of the initiative and problems with data management.
During the launch of the initiative, the team discovered several disabled persons that were missing from the database of the Thailand Ministry of Social Development and Human Security. Therefore this group of disabled persons would not receive benefits according to the rights of the disabled such as disability allowance, medical treatment, disability support and also rehabilitation services. This problem was overcome in collaboration with The Department of Social Development and Human Security. The department would send representatives to the communities to register those disabled persons.
The next two problems encountered during expansion of the initiative were lack of budget to provide sufficient orthosis and lack of manpower. These problems were due to underestimating the real number of disabled persons. In addition, an extension of the project to cover sub-acute patients (who were certainly unregistered as disabled persons) also aggravated the strain on resources. To overcome this problem, physical therapists in combination with community health care volunteers, were responsible to provide local made orthotics. Some broken orthotics were fixed and reused. Hiring additional physical therapists and training more community health care volunteers and caregivers solved the lack of manpower.
The last main obstacle was data management. This initiative used PTSoft to manage the information of the disabled person. However, an increase in the number and the requirement for additional data resulted in the need to update PTSoft. This was responsible by the IT team of Sunpasittiprasong central hospital. The PTSoft system was updated a total of ten times.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
The main human resource consisted of a multidisciplinary team (physiatrists, nurses, physical therapists and occupational therapist) from Sunpasittiprasong central hospital and PT teams (general practitioner, nurses and physical therapists) from community hospitals. In addition, 2,017 health care volunteers and 100 caregivers were trained in basic rehabilitation methods in order to provide primary care for disabled persons in the community. Members of the disabled societies participated in the initiative as the community consultants for newly developed disabled persons. These groups of people were accounted as the sustainable human resource of the initiative.
Computer programs “PTSoft” and “PTSendRefer” were established and maintained by Dr.Virat Luevisadpaibul and the IT team of Sunpasittiprasong central hospital.
The budget to operate this initiative was taken from the annual statement of expenditure approved by The National Health Security Office (NHSO), approximately 9 million baht (300,000 US dollars) per year. The Provincial Board of Rehabilitation was responsible to allocate this budget to support every sector related to rehabilitation services in Ubonratchathani.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
One mission of this initiative was to establish sustainable rehabilitation services in communities. This goal could only be achieved by strengthening the capability of communities to take care of disabled persons. The initiative then taught basic rehabilitation methods to community health care volunteers and caregivers. In addition, disabled persons were empowered and supported to form their own societies within the community. These parts of community actions were surprisingly effective. We found that disabled persons have received rehabilitation services within their communities regularly and thoroughly, and disabled persons have developed mechanisms to help and support each other. New persons with disabilities were rapidly detected by disabled societies and urged to get state benefits. These community mechanisms, together with the initiative implementations, made us feel more confident that the rehabilitation system in Ubonratchathani is sustainable.
The success of this initiative in Ubonratchathani was recognized in several National congresses and received several awards from government organizations. The “Ubon model” was selected by The Ministry of Public Health in order to adopt the concept for development of the solid rehabilitation system in Thailand. Since then, trends of active rehabilitation have been built in every province. Nowadays, the PTSoft program is widely used by PT teams all over the country to record information related to rehabilitation services of disabled persons. Concepts, strategies and data management systems used in this initiative were adopted by several provinces i.e., Mahasarakham, Burirum, Mukdahan, Udonthani, Sakon Nakhon, Nakon Phanom, Nong Khai, Nong Bua Lum Phu, Loei, Bungkan. All these examples demonstrate the transferability of this initiative.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
The key elements that made this initiative successful are presented as followed:
- Understanding the exact problem of disabled persons and sub-acute patients in the community. The key element was the inaccessibility of rehabilitation services in the hospital due to immobility problems and sub-acute patients had no registration and referral system for continuing rehabilitation programs.
- Solving the problem at the critical point. The solution for immobilized disabled persons was to provide rehabilitation services in the community by multidisciplinary and PT teams sent from hospitals. For sub-acute patients, the registration and referral system was established to provide early rehabilitation within the golden period.
- Well design, practical, flexible and transferable strategy. All steps in this strategy were well designed by the multidisciplinary team, which was subsequently revised and criticized by every involved organization and collaborative network before advancing the strategy into action. The limitations including human resources and budget were also considered. In addition, flexibility is one of the characteristics of this initiative. This allows adapting the plans and actions to meet the needs of disabled persons in various contexts, while it still maintains the primary goal of the initiative. In addition, this initiative was adopted by several provinces in Thailand to set their own community rehabilitation system.
- Good cooperation among the initiative, public organizations, private sectors and community societies. A highly collaborative network that covered all areas of Ubonratchathani province and had multi-dimensional support for disabled persons was critical to the success of this initiative.
- Empowerment for sustainability rehabilitation in the community. Training health care volunteers/caregivers to practice basic rehabilitation methods and support disabled persons to form their own societies increased their strength to take care of themselves and act as the key to achieve sustainable rehabilitation activity in the community.
- Several honors and awards have confirmed the success of the initiative:
1. Thailand Public Service Award 2012
From: Office of The Public Sector Development Commission Thailand
Title: Development of rehabilitation and referral system for disabled persons and patients in community
2. Best Academic Award 2011
From: Annual Academic Conference of The Ministry of Public Health 2011
Title: Development of rehabilitation service systems for disabled persons within the communities of Ubonratchathani
3. Outstanding Model of Rehabilitation Service 2011
From: The Ministry of Public Health
4. Invited speaker
- National Physical Therapy Conference 2012 on the title of “Innovation of Community Rehabilitation for Disabled Persons”
- 13th Hospital Accreditation National Forum 2012 on the title of “Disabled Persons, Life and Work”
- 12th Hospital Accreditation National Forum 2011 on the title of “Continuing Rehabilitation in Ubonrachathani Province”

Contact Information

Institution Name:   The Public Health Office Ubonratchathani
Institution Type:   Government Agency  
Contact Person:   Suraporn Loiha
Title:   Chief of The Public Health Office Ubonratchath  
Telephone/ Fax:   +(66) 8 1660 2732
Institution's / Project's Website:   www.sunpasit.go.th
E-mail:   viratlue@gmail.com  
Address:   112,114 Pichitrangsang Road
Postal Code:   34000
City:   Muang
State/Province:   Ubonratchathani
Country:   Thailand

          Go Back
Print friendly Page