The Development of improving the participation of network parties in order to prevent road accident
Khon Kaen Hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Road accidents around the world is causing enormous loss both life and property at 1.2 million people each year and economic loss over US$100 billion. Data from Ministry of Public Health, Thailand (2010) indicated there were an average of 13,000 deaths per year or 33 deaths per day with 1,000,000 injured and accumulated 100,000 disabled people. Thus, this led to economic loss of THB254,935 millions or accounted for 2.6% of GDP. Most deaths were among working age which is an important principle in the development of the nation. The age range 25-29 had the highest loss at 4,534 deaths and followed by the age range 30-44 at 3,621 deaths. These were accounted for 32.93 and 26.30 percent of all deaths respectively. Eighty percent (80%) of deaths were from riding motorcycle without helmets. More importantly, death ones were the head of the family which would result in family breakdown. Each year, Khon Kaen Hospital is responsible for injuries and medical burden from road accidents, especially with serious brain surgery from the motorcycle with an average of 430 annually. Serious injuries admitted in a hospital for treatment in a long period is accounted for 4,044 cases annually. Therefore, the hospital encountered economic burden of heavy medical expenses and economic loss. Khon Kaen is the center for education and business partnership of the Northeast with a population of 1.7 million people. There is an increase in numbers of road users from statistics data, Police Department, Khon Kaen Province. In 2011, there were 319 deaths or rate of 17.3 people per one hundred thousand populations per year. This was equivalent to one death and 200 injured per day. Eighty percent (80%) of accidents was from working age group and youth who ride motorcycle without helmets. This affected the loss of life and property in the family, society and the nation particularly. From the analysis of the road accident prevention in Khon Kaen province, a structural problem in public sector existed. There is a lack of integration of participation. Laws and regulations are not strictly enforced as well as lack of good publicity to bring awareness to people who drive cars. In addition, there is a lack of awareness on the prevention of road accidents. Data system is not properly collected and stored. Data is not properly applied for good use in order to prevent and resolve the problems. Aiding the emergency injured and delivering them to the hospital are not properly reflected. Thus, this resulted in a higher number of injury and disability. As a result, Khon Kaen Hospital has presented this information to the provincial governor of Khon Kaen and the governor has appointed a committee to prevent road accidents in 1991. The committee includes the governor who serves as the president and Khon Kaen Hospital that serves as the secretary. Besides, other public sectors, private sectors, local government, civil society serve as members of the Board and a meeting is held monthly to solve the problems together.

B. Strategic Approach

 2. What was the solution?
Khon Kaen Hospital has coordinated in conjunction with its network party that consists of public sector, local communities, civil society and private sectors to seek methods to prevent and resolve the problems according to its target audiences of 3 levels. Khon Kaen Hospital and Community Level which aims to have personnel in the hospital, people that use the services in the hospital, people in the community have safe driving habits. Provincial Level which aims to provide network party an involvement in planning and problem solving on road accidents create road safety to the people in Khon Kaen province. National Level to create a network of cooperation with relevant parties to boost road safety policy to people in the nation by using strategic driven under the concept of Safe Community (Karolinska Institutet, WHO collaborating center for safe community). This concept contains Information (develop and manage information for good use and effective) Priority (select critical problems with high risk to be carried out first) Multidisciplinary (support multidisciplinary co-operation to prevent and resolve problems in a concrete matter) Cost effective (choose cost effective measures that are possible to carry out. Community participation (allow community to participate and to play a major role in all processes to deal with problems). This will be operated into two (2) phases. Phase 1: It was driven in the area within Khon Kaen hospital and has expanded its work into provincial level by the Board of Committee in the province. In addition, it solved the problems in community school by the community-working team brainstorming, planning and implementing. Phase 2: It was an expansion of the operation to prevent road accidents by using the original modal of Khon Kaen Province to expand throughout the nation by the Board of Committee of Multidisciplinary Task that consisted of 6 elements (E). It is as follows: Law Enforcement-focused on the strict enforced of laws and regulations consistently. Engineering-focused on planning, designing and improvement of factors related to environment that can cause frequent road accidents. Education-focused on educating, building understanding and conscious awareness of driving safely. Empowerment-focused on encouraging participation, strength, and encouragement for people who involve in the operational system to achieve target goals successfully. Emergency Medical Service System-focused on giving priority in treating people who were injured from the accidents fast and accurate while delivering them to the hospitals. Evaluation-focused on reports and evaluation according to different strategies.

 3. How did the initiative solve the problem and improve people’s lives?
Education in youth group was originally formed in classroom through theory. Now it is done by providing integrated knowledge with theory and learning from actual victims. From random telephone interviews with guardians, behavior of youth group improved. Working with community: Presently, the participation of community involved in all processes from analysis and seeking plans to solve problems. Methods of presenting data that leads to solution: With the new process of presenting data both quantitative and qualitative along with photo of victims, it is visible to see the impact such as loss of family and society. Publicity through mass media: The original pattern is to raise public awareness of violence via presenting news. Currently, networking party is built between journalists in a form of in-depth analysis of structure and culture of Thai people which is the root cause of accidents. Operation of the network party along with multidisciplinary: There are formal and informal conferences every month. Data was analyzed to solve common problems and to track the problems. Elements in the control and prevention of injuries and deaths from road accidents: 6Es from Haddon Matrix are as follows: Law Enforcement Engineering Education Empowerment Emergency Medical Service System and Evaluation.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The target is to reduce deaths at the rate of 5 percent per year. Objectives: 1. To integrate work and engage with network parties 2. To promote public knowledge, understanding and awareness 3. To support and develop a strong network parties 4. To drive the policy proposal in the provincial levels and regional levels There are two (2) phases under the operation. Phase 1: The Executive Committee of the Khon Kaen hospital began a campaign of wearing helmets for officers in the hospital and this campaign is still in-use until now. This created organizational measures to wear a helmet and seat belt 100 percent. This campaign has expanded to every governmental unit. The Committee for preventing road accidents in Khon Kaen province is established in 1991. There is a follow-up meeting held every month. It also proposed the necessity of the law in the enforcement of the helmet to the Minister of Public Health on 5 November 1993. As a result, the legislation of wearing helmets for both drivers and passengers is being enforced. In addition, it covers all areas in Thailand since 1 January 1996 till the present. Khon Kaen Hospital Emergency Medical Services has been established as the first province of Thailand since 1994 with the purpose of aiding injured people as quickly as possible. In 1997, Khon Kaen Hospital and the College of Public Health have organized course of pilot rescue staffs until this course is approved and certified. Currently, the hospital offers course for rescue team in colleges across the nation. In 2004, the hospital has developed emergency medical services system at district level for the first time in Thailand and it became a policy of the National Institute of Emergency Medical Services. It requested that all provinces organize emergency medical services at district level 100 percent with emergency call center at 1669. Presently, this model has been extended to the entire country. The Medical Emergency Act has been declared in 2008 and is active till now. The Mapping has begun in 1996 by using data from patients who have been hospitalized in Khon Kaen Hospital. There is an analysis of data from the map to use in planning to resolve the common accidents in every hospital in the province and several other provinces. As a result, the number of accidents decreased. Phase 2 will expand its operations in the underlying processes of the province as follows. In 2003, Khon Kaen Hospital and its network party organized the seminar in collaboration with national accident about prevention and control of the road accident. This is the forum to exchange knowledge at national level by learning from Khon Kaen model in 2009. Then it presented the impact caused by road accidents to the Cabinet of Ministers. The Cabinet agreed and approved that year 2011-2020 is the Decade of Road Safety. It also has been declared that road accident was a national agenda to enact nationwide. The Government has announced a policy statement 4.5.6 entitled "Reduce traffic accidents and loss from traffic accidents to a minimum number.” It promotes the learning and the use of safe transport by maintaining the principle about traffic solution into practice. From 2005 to the present, Khon Kaen has cooperated with multidisciplinary party in each region to drive the project of management in the prevention of road accidents by using the model of Khon Kaen province and extending to cover all provinces. It has been supported by Thai Health Promotion Foundation.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Khon Kaen Hospital has a working committee to prevent and resolve road accidents. It consists of relevant agencies with a role in the preparation of accident data. Then it will propose to the Board of Directors of the hospital to set the measures to prevent, solve and follow-up the performance with the progress in operation every month. At provincial level, there is a committee to prevent road accidents. There is a provincial governor serves as the president and Khon Kaen hospital serves as a secretary. The head of public and private sectors, media and shopping malls serve as the committee. They have roles in analyzing and planning in accordance with the policy of the province and the country. They hold meetings formal and informal every month to trace progress and solve problems together. At national level, there is an executive committee to support the prevention of traffic accidents in the province. The Executive Committee of Khon Kaen Hospital serves as management of the program. The committee includes public and private sectors and the media. The management is divided into Node of 5 regions. They play major role in driving operational support and policy at the provincial level. They hold meetings monthly to follow up and support the Committee's direction in preventing traffic accidents. This committee came from related units such as the Police, Public Health, and the media to monitor and evaluate both 5 regions. There is a technical support team that came from multidisciplinary and professional sources. Important mechanism that causes cooperation at all levels is meeting forum that was held by analyzing data, planning and defining strategies to continuously solve the problems together. Thus, it results in joint operations, exchanging, and mutual learning. Strong leadership will bring changes and goodwill will result in more efficient operation.
 6. How was the strategy implemented and what resources were mobilized?
The budget is mainly obtained from government agencies such as Bangkok Fire and Rescue Department, Transport Department, and Police Department. This is accounted for 75 percent and is used in organizing meeting to exchange knowledge and experiences, academic conferences, other activities in actual risky areas, campaigning and others. Budget from other independent organizations is accounted for 10 percent such as Thai Health Promotion Foundation. A fund from private sector is accounted for 5 percent such as Road Accident Victims Protection Company Limited, Department stores, and entrepreneurs. Funds from international organizations are accounted for 5 percent such as WHO Japan International Cooperation Agency (JICA), Global Road Safety Partnership (GRSP). Funds from local agencies are accounted for 5 percent such as local and provincial administrations and local government organization. Human resources – there is a working committee on an individual level which have been ongoing meetings and brought outcomes from the conference into actual practice to support and solve problems together. It consists of a working Committee to promote prevention and solution to road accidents in hospitals. There are also accident prevention committees and the executive committee to work in support of traffic accident prevention plans in the national level. Resources for building/ facilities/ tools/ equipments include - Helmets for children and adults: these were supported continuously from Honda GRSP and Hess corporations. There are community activities to raise funds such as helmet funds. Other activities include police will not accept the fine but drivers must buy helmets instead as a reward for good people. There are quiz helmet, speed detector, and alcohol detector which are supported from the government and independent funds. - The set knowledge of road safety media campaign has been supported by Toyota Thailand, motorcycle companies and Road Accident Victims Protection Company Limited. Publicity signs: Stop speeding, Stop deaths on Mittraphab Road are supported by Kosa Hotel, and Automotive Dealers Association in the province. Outreach programs through media are supported by local cable television companies such as KTV and 3, 5, 7, 9 (MCOT), 11 (NBT) and TV Thailand (Thai PBS). Building and other facilities for meetings and activities are supported by Central Plaza, Khon Kaen, Kosa Hotel in Khon Kaen that provided snack bar and meeting rooms free every month.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
There is driving behavior surveillance of people who arrive in the hospital. In 1992, there were less wearing helmet at 20 percent and safety belt at 10 percent. However, after the measure has been carried out consistently, the rate increase to 98 percent and 95 percent respectively. In Khon Kaen Municipality, prior to utilize the measure in 2001, there were 9 deaths at risk area. However, after performing a change according to traffic engineering, there was no death in 2012. The data in 2000 indicated that there were drink and drive of 43 percent and the time during 22:00-02:00 o’clock caused the high number of accidents. Network parties have jointly set the region extraction point to check motorists who drink alcohol in Khon Kaen Municipality day and night every day. Prior to 2000, the death toll from road accidents with alcohol drinking was equivalent to 43 cases. However, after setting up checkpoints, there were no deaths in 2012. An integrated network of provincial-level party is existed. A successful activity is a campaign of wearing helmet to honor HM the King on 26 December, 2011. This created a stream of consciousness to people who use roads. Several sectors participated in this event. There was 70 percent wearing helmets. However, after the event, wearing helmet rate increased to 85 percent. A set of knowledge in the youth groups is existed. Media is disabled victims to share experiences, warn, and encourage them to see who was from the motorcycle accident. The set of knowledge has improved the behavior. After assessment of post-training, there were several parents thanked. The children wear helmet and force family members to wear at all times Measures in the community have changed their views of solving the problems by themselves. There is an integration of community network such as Model Community Baan Toom. During 7-day danger Songkran and New Year festive, the community has set up checkpoint of no drunken extracted out of the house. There were 5 deaths in 2002 and the number was down by 1 in 2012. Media network participated in the presentation of news and in-depth analysis of structure and culture which are the root cause of the problems in order to remind the public in terms of preventing more accidents.

 8. What were the most successful outputs and why was the initiative effective?
Evaluation is divided into three levels. Monitoring model in Khon Kaen Hospital: There is a working group meeting monthly to track the progress. Security officer will take photos of personnel who do not follow the measures and will submit the photographs to supervisor for a warning signal. If warning signal is granted for the second time, it will affect the merits. Evaluation at hospital level: It conducts a random inspection about wearing helmets and seat belts behavior of motorcycle riders and passengers as well as drivers and passengers who sit in the front row respectively. These are conducted twice a year. - Collects statistics on deaths and injuries of hospital’s personnel who have been in road accidents. - Inspect risk spots which have been resolved or have not been resolved. The committee will analyze and seek ways to resolve the problems. Evaluation pattern at Community level: Compliance with the rules of the community means to conduct 100%. There will be a random survey about wearing helmet and seat belts’ behavior to people in the community before and after the operation. Monitoring Model at the provincial level is conducted by the meeting of the Committee every month. Data will be analyzed for cause, environment and risk behavior of riders and drivers and find ways to prevent actions by delegating these tasks to relevant agencies. Evaluation Pattern at provincial level There will be a random survey of using helmets, seat belts in the driver and front passenger car twice a year. - Inspect risk spots in the area and see how much improvement is needed. - Collect statistical data of accidents and deaths at the risk spots and compare before and after situation after modification. Monitoring Model at National Level There will be a meeting of the executive board every month. This is to track the progress of the scheme placed in each province in order to analyze and seek guidelines together. -There is a meeting with the Committee Board every 2 months. This is to provide feedback on the work as well as the planning. -Organizing learning exchange forum to submit a portfolio of all provinces. Then each province can share and exchange knowledge to other provinces. Evaluation Pattern at national level Thai Roads Foundation will evaluate, reflect the problems, provide statistics of accidents, injuries, deaths, severity indicator from road accidents and compared to a nation as a whole.

 9. What were the main obstacles encountered and how were they overcome?
Obstacles are as follows: 1) There is an unclear direction of the Ministry-level policies. There is no cooperation at operational level. The objective has not been achieved. There will be guidelines for using the process to create a stream (Advocacy) and submit a proposal to the Prime Minister (through the Minister's Secretary), review the task framework in accordance with the situation where there is violence of deaths from road accidents then set the format to work both at the global and regional indicators as defined. 2) There is a lack of public awareness on the prevention of road accidents and some other risk behavior. Disseminating information to the public is not covered by comprehensive solution. Solution is to create a party network of media partners to join, share and disseminate information to the wider public through social Media. 3) Data storage system for injuries and deaths from road accidents of police departments and public do not match. Therefore, users are confused and data seems unreliable. Solution is to have a working group to develop a national database of public transport consisting of the police, insurance companies, so that the database will be the most reliable road accident in an international standard. 4) Law enforcement is not strict enough. There is strict in some areas in the city, county, and municipality. However, in rural areas, the level of law enforcement is still far from the level. Solution is to have organizational measures to protect the community's road accidents of people in the community. 5) There are budget deficits. Solution is to have project supported from independent agencies like the Office of the Thai Health Promotion Foundation, and other private sectors.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The benefit from the operation, the project is divided into 3 levels. Hospital Level: includes staff and service users which consist of patients, relatives and visitors at Khon Kaen Hospital. The hospital's organizational measures required them to wear helmets and seat belts 100 percent. This is to encourage greater awareness to the public consciousness. From random survey of behavior in wearing helmet, motorcycle riders coming into hospital prior to operation in 2004 rates are capped at 50 percent after the operation in 2012 to a 98 percent. The rate of wearing seat belt on the driver and passenger were first performed in 2004 to 47 percent after the operation in 2012 the rate increased to 95 percent. Therefore, it indicated that the number of injuries and deaths decreased. From the data, there were 225 injured in 2010 and down to 120 in 2012 and there were 4 deaths in 2010 and the number reduced to 1 death in 2012. This measure extends the results to 1 general Hospital, 20 Hospitals and other hospitals in the network area health service 7 Number 3. After monitoring, there were 24 hospitals implemented the measures. This caused in better driving behavior and safety of road accidents. All injuries and deaths decline. At the community level: Community could benefit from attending a planned joint ownership of solutions to prevent road accidents which have been taken seriously as planned. For example, the village community is a community of mutual agreement. Yet, the regulation of the village, if you are not wearing a helmet, you will be fined THB10 to helmet fund in the village. This can adapt the behavior of the people driving in the community. People wear a helmet prior to 2001 was 40% and increased to 75% in 2007. This resulted in a decrease of the deaths of 31%-no deaths Provincial-level party group network is a work from multidisciplinary group. This resulted in a more efficient way. There were 100 in 2003 and increased to 330 people in 2012 with the cooperation from private sector, local and public sector. From a random survey of wearing a helmet in Khon Kaen province, the number increased from 57 percent in 2002 to 85 percent in 2012. Likewise, the survey of wearing the safety belt presented that there were only 47 percent in (2002) and increased to 85 percent in 2012. Injuries and deaths of people are reduced by the rate of deaths in 2010, 2011 and 2012 as 16.95, 16.88 and 16.85 per one thousand populations respectively. According to the number of spots in areas at risk and hazard point, Khon Kaen province were resolved from the risk points are corrected in 2011 at 24 spots to 30 spots in 2012. The benefits gained from the area with less people injured from road accidents. National network party level- it is a multidisciplinary work that increased in numbers of people from 60 people in 2005 to 200 people in 2012. There is a support team driven to prevent road accidents at provincial level. There is Thai National Status Report on Road Safety 2011 prepared and published throughout the country: in Thai language 2000 copies and translated into English and published throughout SERO groups and other groups that have studied and researched in the planning to the problems of road accidents in each area. From the evaluation, the rates of injured and deaths from road accidents is declining. The death rates in 2007, 2008, 2009, 2010, 2011 and 2012 were at 19.82, 17.77, 17.39, 16.82, 15.87 and 15.08 per one hundred thousand populations respectively. (Data from Police Department Office) In addition, it reduces economic loss. There were 12,492 deaths in 2007 or equivalent to THB56,214 in economic loss (one death is equaled to THB4.5 millions). The number went down to 9,719 deaths from road accidents or equivalent to TBH 43,736 millions in economic loss. This showed the decrease of THB 12,478 millions or 22.19 percent.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Operating Prevention and road accidents has extended to other areas as follows. • Hospital space level: Khon Kaen Hospital started a campaign to wear a helmet in 1992. Then it expanded the coverage to all government agencies in Khon Kaen to push legislation to enact a helmet throughout the nation on January 1, 1996. In 2004, Khon Kaen hospital started a measure of wearing helmets and seat belts 100% to all personnel in the hospital and people who run into the hospital. • Provincial level network in Khon Kaen province that have used network model of Baan Tuum Community. In 2008, it expanded the program of wearing helmet in 3 pilot districts: Amphur Bhupamaan, Wang Yai and Baan Phai. The method allowed people to participate in all process from data analysis, learning and tracking the progress of the operation every month. This resulted in better driving behavior. • Initiated an informal meeting of the management committee of Khon Kaen province to prevent accidents. Sub-committee on information systems, Sub-committee on risk solutions spots and Sub-committee on the media that have well-defined roles. Initiated to organize a meeting of the emergency medical services at every level every month to monitor the progress of the problems that occur together. National level: A model has been extended to the entire country from 2005. It covered 76 provinces which has a clear management structure with the executive committee of Khon Kaen Hospital. International level – the work plan can extend results to international level. Khon Kaen Hospital has been appointed by the World Health Organization as a WHO Collaborating Center for Injury Prevention and Safety Promotion, which is the only place in Thailand and the second in Asia since 2003 until now. It received Technical support from Japan International Cooperation Agency (JICA) for 3 Phases (Phase 1-1992 to 1997, Phase 2-2000 to 2006, and Phase 3-2007-2009). This is the key factor that makes it possible to transform the operation of Thailand through a network at all levels to participate in a road accidents prevention. Performance has been extended as follows. • Serves as International training center of WHO in Traffic Injury Prevention, Pre hospital care, Injury surveillance to personnel and officers in the countries under WHO-SEARO. • President of the project (Witthaya Chatbanchachai, MD) has been appointed from WHO to serve as WHO Expert Advisory Panel for Injury Prevention and Control. He is an expert in the conduct situation analysis and development of national strategy for prevention of road accidents in Timor Leste, 12-22/1/2004. - Expert in Inter country consultation on strengthening of injury prevention and control in medical and using education program in countries in SEA Region Haryana India 5-7/5/2004 - Technical exchange training program between Thailand and Laos on traffic injury and emergency medical service, 14-17/3/47, Cambodia 8-12/8/2004, Vietnam 12-16/9/2004. Whenever he has the opportunity to be a guest speaker in several countries, he will bring the country’s Thai model to broadcast to other countries so they can put into practice in their countries.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Executive at provincial level the governor of Khon Kaen province pays special interest in solving road accidents. He focuses in serious practice in the areas covered by the policy agenda of the province. All units carried out the agenda seriously and continuously. For example, the governor of Khon Kaen province serves as a presenter in driving a motorcycle with helmet campaign all the time. He visits the drunken driving checkpoint in the municipal area consistently. He visits the district during Song Kran and New Year festival. He directs to all government agencies about organization measures. This leads to a strong operation. All agencies have systematically driven and have a team of Khon Kaen Hospital acts as a secretary. This enables a strong team that can interface with the network platform to meet and coordinate with other major agencies that have joined forces for the same goal of reducing road accidents. Executives at national level: With the approval and acceptance of the proposal of the executive board of committee of Khon Kaen province, it has pushed policy proposal, law enforcement practices throughout the nation, which is extremely proud. For example, Helmet legislation declared in 1996 and the act of medical emergency system declared in 2008. The government has announced a policy on road accidents in 2010 Clause 4.5.6 titled “Reduce accidents and 4.5.6 of “reduce accidents and loss from traffic accidents to a minimum as possible.” This practice has shared across the 7 –day danger during Songkran New Year festival. Power multidisciplinary networks have come together to work on all levels. They share mutual benefit to help reduce injuries from road accidents. For example, the meetings that have been very effective lessons are informal meetings. “Taan Kao Lao Rueng” during evening time. Network party seems happy and friendly every time they get together. They will share good suggestions which are very useful and can lead to useful practical results in teamwork with powerful strength. An important lesson from the past revealed that driving to create awareness to the public is not yet thoroughly covered. Therefore, it has a network connection to the media 2 years ago and found out that it got media’s attention. The news presented about road accidents. There are some causes analysis linked to the prevention as well as it result in more public awareness. If we linked to mass media faster, this would help prevent road accidents more. Law enforcement is not strong enough because police officers have few methods to solve the problems. Setting measures in different units, communities and organizations are other ways help police officers. Let the community participate and solve the problems themselves. This will create more sustainable outcomes. If we first used organization measures, it would reduce the number of road accidents. More importantly, networks that work together as a team, based on the principle of merit, there will be no health benefit to the greatest human friends to rescue them.

Contact Information

Institution Name:   Khon Kaen Hospital
Institution Type:   Government Agency  
Contact Person:   Dr.Wittaya Chadbunchachai
Title:   Director -TCC  
Telephone/ Fax:   +(66)43 337 525
Institution's / Project's Website:  
Address:   56 Srichan Rd. Tambon Nai Muang
Postal Code:   40000
City:   Amphur Muang
State/Province:   Khon Kaen

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