The Royal Suksala clinics of Border Patrol Police School
Border Patrol Police Bureau

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Thailand’s borders are adjacent to 4 neighboring countries and are known by their specific remoteness, wilderness, and difficult transportation, high- risked security issues. They have a total length of 5,656 kilometers: 2,401 km. with Myanmar, 1,810 km. with Laos, 647 km. with Malaysia and 798 km. with Cambodia. Local people in these areas are Thai, mountaineers, labor immigrants and people living along the borders of those neighboring countries. These groups of people usually face problems of accessibility to public welfare services provided by the government such as electricity, water supply, transportation, health services etc. The quality of their lives, especially in terms of health, is relatively poor. People in those areas particularly face with high neonatal mortality rate, high maternal mortality rate, iodine deficiency and child malnutrition. Though the public health services are provided by the government in all sub-districts, there are plenty of remote villages which are only accessible to the services in some seasons. It can be claimed that the weather condition is another hindrance of the accessibility to health services. Moreover, the problems mentioned above also exist in areas of high security, namely, the three southern border provinces of Thailand where people lack of the opportunity to gain the health services from the government because of poverty and fear. Although Thailand has attempted to expand the coverage of public health services to all provinces, the unfairness of accessibility to the services still existed. Apart from the problems mentioned above, the other interesting reasons are: 1. Insufficient number of health personnel and staffs, particularly doctors, dentists, pharmacists, nurses and other professional staff needed to accommodate with the increasing number of health problems. 2. Inequitable distribution of health personnel, including the distribution of tertiary hospital comparing with a high concentration areas such as Bangkok or urban areas, while some rural areas do not have the public health services. 3. Low or limited potential of health personal and staffs is another issue as they cannot deal with the rapid change in health problems. It is such a complex issue which requires the cooperation from other sectors and local communities. In addition, the three reasons mentioned above also lead to the issues of inequality and social justice to the public services. As well as the remote-area people may not access to knowledge and basic information to build up the understanding of disease prevention and treatment which cause eventually unhealthiness. For children, lacking of basic knowledge of hygiene may relate to the unwell physical and brain growth, while adults might face both of the communicable and non-communicable diseases from disruptive and area-limited treatment or might gain unequal quality services as the urbanites do. Furthermore, the unwell and inequality of health services may affect the nation’s economic and social development in long-term.

B. Strategic Approach

 2. What was the solution?
According to the diversity of local people around border areas, the Border Patrol Police Bureau has established Border Patrol Police Schools to teach Thai language to these border people to ease their communication and understanding. We found that these people are at disadvantage and are remote from social welfare, particularly in health services. The Bureau then began to take part in providing those people health and sanitation which not covered by the government’s services; for example, physical checkup services to students and sick people in the area of the BPP Schools by using the school’s nursing room as a service point as well as coordinating with local public health officers. From her visits to the remote areas nationwide, Her Royal Highness Princess Maha Chakri Sirindhorn has realised the problems relating to the accessibility to public health services among the border people. Her initiative is to adjust the nursing rooms in Border Patrol Police Schools to become the Royal Suksala clinics of Border Patrol Police School (RSC.BPP.School) with her determination to enable the marginalized people access to the primary health care service with quality, high standards and equality without any exceptions so that they can have a better quality of life. From the above determination, government units, namely, the Office of HRH Princess Maha Chakri Sirindhorn's Projects, the Border Patrol Police Bureau and the Department of Health Service Support, Ministry of Public Health, the Department of Alternative Energy Development and Efficiency cooperating with the private sector, namely, students of Batch no. 46 from Thailand’s National Defense College and TOT Public Company Limited, have all taken her ideas as an operating guideline for establishing The RSC.BPP.School by improving nursing rooms of Border Patrol Police School, prescribing medicine and medical supplies to cover and cure the sicknesses of students and local people and by fostering along with building the competency of nurse teachers. As well as training the border patrol police officers who perform their duties in the RSC.BPP.School to be knowledgeable and skillful on the primary nursing, health promotion, disease surveillance, prevention and control including the management for health communication and learning centre so that the RSC.BPP.School can shift the status as a health care service unit linked to other local health service networks and primary health care centers. The RSC.BPP.School facilitates these people to access to the health care services easily and thoroughly. The patients can arrange themselves for flexible services 24 hours. In the normal cases, the patients are treated and provided essential and sufficient medical supplies. In the emergency cases, the patients are treated with the system of emergency medical service as well as the referral process to the health center or hospital. The RSC.BPP.School also provides a vehicle with the rescue equipment and communication devices or other related technologies appropriately, along with fostering BPP teacher skills to be able to treat emergency patients. For health promotion and hygiene knowledge, BPP teachers usually take the role to communicate and convey the useful health care information to the community. In summary, the output from the operation of “The Royal Suksala clinics of Border Patrol Police School” is to enable students and marginalized people who face the inaccessibility to the public health services to reach primary health care services in both regular checks and emergency cases. In addition, this service enables students and people to obtain correct, suitable and updated news and information of their health in order that they can take care of themselves, their families and their community.

 3. How did the initiative solve the problem and improve people’s lives?
Although in the old days, the marginalized people may receive the health service from Suksala service, the accessibility of this welfare is still a challenge in case of an inadequate number of doctors and health care personnel. Therefore, the Border Patrol Police get involves in facilitating and developing health care service for public. The RSC.BPP.School have been established as the timeframe since 2006 provided hereby; - The RSC.BPP.School provide many services; both primary health care service and emergency cases, referral process, patient following-up, recovery process, health promotion. The health service system management and development as well as the radio communication for health services have been set up along with providing the essential and adequate medicine, medical appliances, and the durable articles for clinics by considering on the locational appropriateness. Moreover, the system also covers the emergency cases and the referral process to the other health care station or hospital. - Developing the basic health care service system in order to support the local people knowledge and information to be able to take care themselves and promoting the participation of communities and local organization to become self-reliance and sustainability of health care service.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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.
 6. How was the strategy implemented and what resources were mobilized?
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.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.

 8. What were the most successful outputs and why was the initiative effective?
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.

 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
According to the result of the RSC operation, it shows that the health services can be delivered not only by the main agencies such as Ministry of Health, but also by supporting from the local people as well as the community along with BPP schools. Due to the cooperation, RSC shifts itself to be the basic health service center for the local people and community totally and equally. In addition, the integration between each agency such as office of HRH Princess and BPP can foster the effectiveness and efficiency of the health service with the well-organized system. The locals tend to manage with the available resources in their areas in order to deliver the health service along with raising awareness among the service providers to run the RSC as effective as they can. This cooperation will help to decrease the gaps of inequality social welfare especially for the marginalized people to get the better life quality. There are other key factors which will enable the success of the RSC as follows; 1)Building the mutual understanding and participation among the related agencies; both of the public and private sectors, the local administrative organization and the community in order to support the RSC project. 2)Supporting the medical appliances as well as the health learning and communication center is required. The appliances, devices and durable articles are still low quality according to the setting standards. Moreover, the emergency kits, computer devices, telemedicine devices, other essential medicine should be supplied in order to match with the demand of the customers. The need analysis can be implemented to survey the basic needs in each areas in order to plan and provide appropriate facilities. 3)The development of radio communication and telemedicine for health service should be done align with the cooperation from locals which might do the survey and design operational planning to facilitate RSC to communicate or even seek for necessary assistance. The training on health service radio communication should be also provided. 4)Supporting the electricity sources. RSC still needs the electricity source and necessary devices. However, the electricity source should be considered carefully on the constraint budget as well as settle the support center to maintain the devices or train the staffs sustainably. 5)In order to make the service sustainable, locals should take an important role and supported by the BPP offices and the Ministry of Health. The supportive offices can provide the locals some training or conference to build the mutual understanding of the RSC operation. 6)Setting the standards for operation and the manuals for RSC operation in order to be used as the roadmap to reach the expected goals. 7)Providing the learning materials, management and the application of the health learning and communication center as well as setting the health learning and communication process for the schools and communities. 8)Training and recovering the previous knowledge and practice the manual operation process for the nurse teachers such as medicine and prescription, emergency treatment, delivery service, and support them to run the health learning and hygiene activities for schools and communities. 9)Provide the training for the health service volunteers to serve the locals more effectively. 10)Manage the system for health information bank as a resource for the teachers. 11)Study visit and exchange the operational experience from each area. 12)Supervise the integration of SRC development and operation from the center government and among the nurse teachers in each area themselves in order to run the services more appropriately and effectively. 13)Research the diversity of RSC operational patterns to see which pattern will work most particularly in health service, health learning and communication service as well as the radio communication for health service. 14)Evaluate the operational results, and report should be concise and include the operational staffs’ opinion or review.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The RSC.BPP.School is a public health service place that not only provides basic health care services but also provide integrated health services. The RSC.BPP.School are beneficial to students, border people and people in neighboring and risky areas. These people can access to the health services more conveniently and thoroughly 24 hours a day, 365 days a year. It is also a source of health learning and communication as well as the community’s health development center. The RSC.BPP.School act as a “nursing unit” providing primary treatment services, first aid and disease monitoring and prevention and as a “Health learning and communication” for school’s health learning activities and for news and information center of community. Moreover, the RSC.BPP.School can bridge the coordination among the village’s health volunteers, the community leaders and the local administrative organization to manage health care service for students and local people by providing technology, lifesaving appliances, vehicles, communication devices and other necessary technologies for patients’ nursing and treatment suitably and within an immediate time (Emergency kits). Computer devices, electronic media, press media and audio visual aids are also applied and utilized for distributing news, information and knowledge to communities. In addition, they can share their ideas on developing the Suksala. Past outcomes show the continuity of operations and response to services in various aspects as follows: Efficiency of service provision: Previous performance reflected the continuity of operations. Operating processes and time allocated for primary nursing including patient referral were reduced and this resulted in a decrease in the death rate of children and people who lived along borders and in remote areas. This provided more opportunities to access public health services. Indicators also showed the efficiency of service provision at 90%. Quality of service: In terms of clients’ satisfaction, over 80% of students and people who were clients were satisfied with the services. Over 80% of stakeholders/other units that took part in the operations or services were satisfied with the services. No claim or unsatisfying clients were found. Worthiness: Patient expenses spent on accessing services were reduced because the services were free of charge so costs/productivity of services of the working unit reduced because the output was beyond the set target. Overall worthiness in terms of the economy, society and the community was that students and people could access health services more conveniently and more quickly and they felt they could be relieved of their suffering and concern without payment. Output in conclusion: Output from the operations was that people along borders or in remote and risky areas far from transportation could access primary health services equally and totally, they could receive health news and information to take care of their own, their families’ and the community’s health. Outcome: The final outcome of the Suksala was that people along the border, in remote and risky areas far from transportation were physically and mentally healthy. Death rates from preventable diseases were reduced.

 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)
Public health service provision needs not to rely on the main responsible working units, but can be supported from the demand to conquer remoteness, wilderness, poverty or risk with the co-operation of related parties who wish to make the sanatoria become shelters for primary health services of students and border people who live in remote and risky areas without exception and equally. Operations were systematically integrated as a network (both governmental and private sectors). Resource management was applied to manage the sanatoria. Awareness of service providers to fully assist students and people on primary health services can not only reduce gaps and unfairness, but also increase the quality of life for these poor people. The starting point of service provisions came from the demand to solve security problems and develop the quality of life of border patrol police by using existing materials of field nurses or nurse teachers, using medicine and medical supplies allocated each year to assist students and local people. Moreover, elements of success of the efficient and potential sanatorium operations were achieved through the collective understanding, participation and support of the sanatoria with organizations from all sectors, namely, governmental, private, local administrative and community sectors Sustainability and expansion of the development of the RSC.BPP.School were in response to the determination of HRH Maha Chakri Sirindhorn who wishes to see that the vulnerable people living in remote, distant and risky areas can receive higher quality of health care service and have a better quality of life. Moreover, the project could help to relieve troubles caused by expenses for traveling to visit public health centers and government units (money and time saving) since they are poor and live faraway. The main objective of service provision improvement is to set the Border Patrol Police School to be a center of public health service in the area where service is difficultly accessed with cooperation from all sectors in the society that willingly give support and are determined to expand the project all areas in need. The key factors of success were co-operation of related agencies in making the RSC.BPP.School become a shelter of primary health service for students and people in remote areas thoroughly and equally, a systematic integration of network members (joint working units), management of common resources for management in the RSC.BPP.School, and awareness raising of service providers to fully assist students and marginalized people on health services.

Contact Information

Institution Name:   Border Patrol Police Bureau
Institution Type:   Government Agency  
Contact Person:   Ladawan Chatthai
Title:   Pol.Lt.Col.  
Telephone/ Fax:   +(66)814413732
Institution's / Project's Website:
Address:   1279 Phaholyothin Road, Phayathai
Postal Code:   10400
City:   Samsainnai District
State/Province:   Bangkok

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