| 4. In which ways is the initiative creative and innovative?
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The Royal Suksala clinics have started since 2006 by setting the framework, missions, necessary medicine and durable articles at the clinics. Along with determining the strategies in term of establishment and development for Suksala clinic, the project have prepared the appliances which require to provide the health care service and the health service information centre. The radio communication system and the health service system management were set up. The staffs and personnel work under the responsibility framework. They also co-work with the BPP school principals, nurse teachers (staffs from the health station or hospital), the local administrative organization, and the health service volunteers to promote the health care service for their community.
There are three phases of the development of the RSC.BPP.School.
The first phase (2006- 2007): Supporting the infrastructures such as buildings, medical appliances, instrument and training BPP teachers.
The second phase (2008- 2011): Setting the operational strategies and implementing the policy to practical. Nowadays the RSC.BPP.School’s strategies are provided.
The third phase (2013-present): Drawing the roadmap of the RSC.BPP.School in order to be the agency providing the basic health care services for students and remote area people totally and equally with the integrated system to response HRH Princess Sirindhorn’s initiative and remarks as well as seeking the cooperation from related agencies and community.
Strategic operations can be divided as follows:
Strategy 1: To provide or improve buildings in border patrol police schools to be suitable for applying as the RSC.BPP.School
Strategy 2: To develop the management of health service systems to meet the expected standard and quality by procuring necessary and sufficient medicine and medical supplies for routine hospital visits and emergency cases. To develop nursing, treatment and referral network systems including telemedicine systems.
Strategy 3 To develop competency of nurse teachers of border patrol police schools by updating knowledge refreshing courses, short-term training courses and to promote them to join suitable courses and to promote them to be able to correctly practice cures according to the law and medical personnel license.
Strategy 4 To manage and develop health learning and communication centers in the schools so that it can provide knowledge and news to communities.
Strategy 5 To promote and support people, communities, and all parties to participate in developing and supporting activities of the RSC.BPP.School by managing students and people to reach necessary news and information on health by organizing learning activities according to or additional to education courses, developing a database in order to develop health behavior, monitoring health behavior, channels for health knowledge communication, community services through media and news on health in communities, establishing towers for health news, holding monthly parent meetings and providing knowledge on nutrition to groups of housewives.
The strengths of the RSC.BPP.School are:
1. The RSC.BPP.School is a public demand and a good cooperation. The services are one stop service.
2. There are BPP. Teachers and the local people working as the service staffs in the RSC.BPP.School. Those Staffs understand the local language that make the communication with patients and cooperation more easily.
3. A Referral system was developed for referring patients from the RSC.BPP.School to the Health Service Unit of the Ministry of Public Health. There is variety referral ways, such as motorcycle, truck, helicopter etc.
4. The RSC.BPP.School use Technology: a telemedicine system network was developed to enable and receive visual and audio treatment suggestions and health knowledge to educate the local people.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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1) Government units, namely, the Office of HRH Princess Maha Chakri Sirindhorn's Projects, the Border Patrol Police Bureau, the Ministry of Public Health, the Department of Alternative Energy Development and Efficiency.
2) Private sector, namely, students of Batch no. 46 from Thailand’s National Defense College and TOT Public Company Limited, have all taken her idea as an operating guideline for establishing the RSC.BPP.School.
Those who played an important role to provide the services were the nurse teachers providing treatment, health care knowledge, health promotion and disease prevention to students and people in the area of their responsibility. Provincial Health Offices and District Health Offices would take part in supporting the management, medicine and medical supplies by promoting the RSC.BPP.School become a part of the public health service network; providing training and rehabilitating knowledge for nurse teachers, community health officers and volunteers; as well as monitoring and giving orientation to the local administrative organizations; building linkage of joint operations with the community both in the building structure, community leader networks, medicine and medical supplies acquisition, personnel development, making of press media suitably to local conditions, preparing the vehicles for patient referral and remuneration for operators. The Department of Alternative Energy Development and Efficiency advocated the development of solar energy use in the RSC.BPP.School where electricity wasn’t provided. In the private sector, students of Batch no. 46 from Thailand’s National Defense College contributed budget for infrastructures such as building, necessary instruments and computers. TOT Public Company Limited expanded the frequency of satellite signals in the area of RSC.BPP.School and installed receivers to improve and develop communication between RSC.BPP.School and district hospitals, especially telemedicine for both video and audio channels.
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| 6. How was the strategy implemented and what resources were mobilized?
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The resources used for providing services in the Suksala clinics were:
1. Appropriate places or Suksala clinic buildings: the operations were carried out by improving existing the nursing rooms in Border Patrol Police Schools to be the Suksala clinic or by constructing the clinic according to standardized construction rules supported from private sector budgets.
2. Human resource: in the Suksala clinics, there were nurse teachers, who were border patrol police providing nursing services and primary health knowledge, health promotion and disease prevention to students and people who came to use the services; associate escorts delivered by provincial public health offices help to take care of services and knowledge and held training with local people so that they can do primary nursing and the health volunteers (OrSorMor) who assist nurse teachers on primary nursing as well as promote and support local people and communities to participate in the Suksala clinics by establishing the Suksala clinic Committee comprised of religious leaders, community leaders and local people to support the operations of the Suksala clinics.
3. Government units: In emergency cases which the local health station or Suksala could not handle, the next process runs through the coordination with several parties, namely, The Border Patrol Police Bureau which was the supervising unit of The Border Patrol Police School, Local Administrative Organizations and Health Volunteers. The Provincial Health Office and District Health Office had the role of supporting the development of places and buildings and coordinated to ask for support from officers from hospitals and health stations in the area to join operations assisting nurse teachers on medicine, medical supplies and vehicles for patient referral.
4. Budget: The Border Patrol Police Bureau provide the financial support for buying medical supplies and medicine on an annual basis but the budget is inadequate so it requires the coordination and seeks for cooperation from the local administrative organizations and Provincial Health Offices and District Health Offices to support the medicine and medical supplies to be match with problems or sickness of students and local people; and gain support from the private sector on supplying medically durable instruments, communication instruments and vehicles for use in the Suksala clinics.
5. Technology: A Referral system was developed for referring patients from the Suksala clinics to the Health Service Unit of the Ministry of Public Health. Also, a telemedicine system network was developed to enable and receive visual and audio treatment suggestions and health knowledge teaching to local people.
6. Power source (Solar cells) Due to its remoteness, electricity is unavailable in many areas. Services and operations in the Suksala clinics mostly rely on electricity for necessary medical appliances. Consequently, power should be provided at a minimum cost to be affordable particularly in local and remote area people.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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From 2008-2013, there have been up to 71,823 people or approximately 12,000 people who live along the borders and in remote or risky areas have received health services at nine Royal Suksala clinics per year. It was also found that most clients came for treating diseases from the respiratory system, followed by those of the digestive system and muscle system, dressings, skin diseases, malaria, and eye, nose and throat diseases respectively. One of the Suksala clinics which were located on the highest land and to difficultly access was the Suksala services of Letongkhu. This Suksala had the most referral records because it was very far and difficult to reach. According to the data collection for the Suksala clinic operations from 2010 to 2012, up to 95 patients were referred, 2,054 people receiving family planning, 81 female patients came for pre-natal care and 27 female patients gave birth there.
In providing the disease prevention services, apart from giving medical treatment, a health learning and communication center was established by providing necessary tools and audio visual aids as well as settled as a source of health news and information which supported health learning or hygiene activities. Also, a primary health care system was developed so that people become knowledgeable and take care of themselves individually. Moreover, this promoting participation of the community and locality to have sustainable and self-reliance service on health matters.
Improvement guidelines in the future: The period of developing the Suksala clinics can be divided into the following phases:
Phase 1: 2006-2007, operations were for building, places, tools and instruments and teacher’s potential.
Phase 2: 2008-2011, strategies for project operations and policy implementation were set. Currently, strategies for the Suksala clinics have been determined.
Phase 3: 2013-2017. The RSC.BPP.School will be developed to be the primary health service shelter for students and the community in remote areas thoroughly and equally. Operations of joint working units will be integrated by focusing on seeking cooperation from local working units and communities. The next plan is to expand more 60 Suksala clinics in the next three years (2013-2015) to cope with and support the ASEAN Economic Community (AEC in 2015) and to provide services for more border people.
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| 8. What were the most successful outputs and why was the initiative effective?
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The follow-up and operational machinery of the RSC.BPP.School are as follows;
The supervision process
1. Follow-up and supervise at the local area for administrative level at least twice a year and for operational level once a month.
2. Conduct the local area survey to seek the possibility for developing the technology information system of the RSC.BPP.School especially the areas with severe problems.
3. Hold the operational meeting for exchanging the information and reviewing the strategies for developing Royal Suksala clinics. At the present the RSC.BPP.School strategies 2013-2017 have been implemented.
4. Hold the semi-conference for the advisory on the operation of the RSC.BPP.School and the meeting for the administrative committee of the RSC.BPP.School.
5. Promote and support the training to foster the capabilities of nurse teachers, health service volunteers, students and local people through the Telemedicine service from the voluntary doctors of the Faculty of Medicine, as well as to educate the useful information on health care and hygiene (held every Wednesday) by using the audiovisual aids.
Evaluation Process
The machinery for evaluating the operation of the RSC.BPP.School are as follows;
1. Report the operational result of the RSC.BPP.School annually. However, the location is still the obstruct for travelling and communication. Thus, it is required to set the result reporting process from the operational staffs of the Ministry of Health to facilitate.
2. Survey the satisfactory level of the RSC.BPP.School’s customers annually by the evaluation team from the Department of Health, Ministry of Health. The team designed the questionnaire and conduct the survey in local area yearly. The result of satisfactory level of the RSC customers in 2012 are as follows;
The satisfactory level for the overall evaluation was 4.31 average point. It can be divided into each field: 1) the customers voted to the staffs most (4.47 average point), 2) the satisfactory to the quality of service and 3) the satisfactory for the process of service were 4.31 and 4.13 average points respectively.
For the reliability of RSC service, it was found that the customers’ reliability to the overall service was 3.73 average point. When considering on each particular field, they voted for the achievement of the public service most (4.46 average point), the reliability of social justice and the effectiveness and efficiency of the public service were 4.32 and 2.39 average point respectively.
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| 9. What were the main obstacles encountered and how were they overcome?
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Many obstacles were encountered since the operating areas are along the borders, highlands and remote areas where are far from transportation. The roads themselves are also problematic as for some areas. In the rainy season, patient referral to hospital was very difficult due to rough roads or roads destroyed by flooding. Some areas were very far away to reach and it was quite difficult to travel in order to provide the health services. There was also no suitable vehicle for referral. In the rainy season, farm trucks might be used for referral in some areas.
Computers were not regularly used because users did not have enough knowledge to use or maintain them. In some areas, there were no electricity and solar energy to use which also affects to the computer devices and if they are broken, it will take long time to fix.
To solve the problems above, Telemedicine systems and telecommunication via satellite were developed and installed to enable communication so that the treatment can be provided from hospitals or the public health stations. The medical communications via satellite are beneficial for both treatment and health education to people in the marginalized areas.
The project coordination center was established to support the RSC.BPP.School Project in order to seek for both of the public and private networks to support service provisions of the Suksala in procuring durable articles for health services and management on health knowledge. Knowledge is delivered to computer users through the supporting electricity systems, budget, vehicles and medical equipment as well as seeking the cooperation from local people to encourage self-reliance, or even to be the health volunteers in order to support vehicles for referral, to participate in the community and local activities so that they can set their own sustainable and self-reliance on health service matters.
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