Integrating Network and Community Participation for Effective Malaria Management in Tha Song Yang Di
Department of Disease Control, Ministry of Public Health

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Malaria is a global health concern involving morbidity, mortality and anti-malaria drug resistance, found mainly in tropical countries. It is seen in large parts of Africa and Asia. In 2010, according to the World Health Organization, there were 216 million cases of malaria and 655,000 deaths worldwide. Approximately 86 percent were children. From 2008 to 2010, there were approximately 73,000 reported cases of malaria in Thailand, of which 90 percent occurred along the international borders of the Mekong region. In this region, the incidence rate of malaria in Tak Province was 2-3 times higher than the rest of Thailand. Tha Song Yang, a district in Tak Province, near to the Thai-Myanmar border in the Mekong region, reported a disproportionately high rate of malaria, accounting for 44 percent of Tak Province. This area also has a high level of transmission. The most vulnerable groups being young children, who have not yet developed immunity to malaria, and pregnant women, whose immunity is compromised by pregnancy. Additionally, it is the extremely poor areas that are surrounded by high hills and deep forests, promoting a climate of mosquito transmission, in addition to the weak infrastructure and transportation, lack of electricity and other basic utilities. The distance from a pocket border village to the nearest malaria service unit is approximately 50 km, requiring a walk up to 7 hours long. The situation is only worse in the rainy season- the malaria peak season. Inevitably, Tha Song Yang experiences the largest impact of malaria with poor accessibility to health care services that predominantly impact children, pregnant women and the elderly. Furthermore, ethnic minorities and refugees fleeing along border areas, seeking better jobs and higher wages, deal with malaria infection and drug resistance. In addition to geographic and infrastructure difficulties, economic insecurities and social instability, ethnic diversity, language differences, and cultural beliefs also prove to be a challenge to malaria management. There were approximately 30% Thai nationality and 70% ethnic minorities in Tha Song Yang. Annual income for a typical border resident is USD 1,170 or about 23% of a Thai national average of USD 4,650. Deeply-rooted traditions, such as beliefs in the spiritual and supernatural, prohibit the acceptance of modern medical diagnoses and treatments. Such concrete mindsets pose another major challenge to local healthcare workers, complicating the delivery of urgently needed treatment, often resulting in unnecessary deaths. This lack of access and communication results in under-detection, under-reporting, increased-morbidity, mortality and drug resistance to malaria and poor control. The treatment of P. falciparum, a resistant strain of malaria, has significantly increased (from 6 Baht [0.2 USD] to 217 Baht [6.7 USD]) making the achievement of a parasitological cure problematic. These have challenged for healthcare providers to deal with them so far (see annex 1).

B. Strategic Approach

 2. What was the solution?
The Head and staff of The Vector Borne Disease Control Unit Number 9.3.5 (VBDU9.3.5) initiated the conceptualization and implementation of the Integrated Capacity Development/Capability Improvement Model (ICD/CIM) for malaria care. The director of the Office of Disease Prevention and Control #9 Phitsanulok (ODPC9) fully supported the initiatives by determining ODPC9’s strategy and allocating a budget. The Head and staff of The Vector Borne Disease Center 9.3 Mae Sod (VBDC9.3) supported technical staff and provincial data (see annex 2). This initiative came from citizens during the meeting that included the village chief, malaria patients and relatives and health volunteers. The meeting served as a forum to discuss malaria in terms of delayed diagnosis, treatments, anti-malaria drug resistance and unnecessary deaths, as well as to solve these problems by sharing perspectives and a strategic plan of action. Moreover, the VBDU 9.3.5 continually collected public opinions from the meeting and during subsequent field trips. The initiative’s objectives were: 1) to increase participative policy making amongst stakeholders in order to create a proactive malaria care plan, as well as coordinate a collaboration to utilize the resources available and harness the efforts from all parties involved 2) to be effective malaria health care by enhancing equity among citizens in the challenging area and provide optimal health care results, and 3) to maintain networks through building human capacity and community trust. The initiative of ICD/CIM consists of four pillars namely: 1) Leveraging partnership to drive policy change 2) Serving proactively on-site and at the source 3) Enlisting key advocates and human capability building, and 4) Maintaining community trust, acceptance and involvement (see annex 3). The first pillar proposed to foster the collaborating network and community through public policy and commitment. As mentioned previously, the solution from organization and community’s meeting needed the cooperation, integration and service improvement. Most importantly, the alliances have actively promoted quality of life improvements in affected areas and have gained the trust and equity of any residents in Tha Song Yang as a commitment. Therefore, the sub-district health committee was established, important data were considered together, and strategy and action plan were developed including networks’ activities were determined, monitored and evaluated. The second pillar involved improving the delivery of malaria health services which on site malaria service was main networks’ activity. It provided early case detection, diagnosis, treatment, follow up malaria case and education by outreach team. This can reduce patient’s transportation time, overall cost, allowing for mass screening and early detection of the disease. Timely diagnosis and treatment at the initial stage and tacking case could increase rates of treatment, decrease the number of severe malaria and unnecessary deaths. Particularly, drug resistance caused by self-medication will be greatly reduced and containment of malaria, spreading by vector control can be done immediately. For the third pillar, key community members, such as village chiefs or shamans served as advocators and role models by publically accepting and integrating the modern medical treatments in traditional beliefs. Therefore, spiritual treatments were conducted in addition to, rather than instead of the modern treatment alone. As a result, affected people with supernatural beliefs could be more cured and acceptable. Importantly, key community leaders and influencers needed to be trained appropriately for effective advocates, networks and community support. The final pillar was to maintain networks by building trust, acceptance and involvement. This based on win-win situation concept and work together sincerely. Achieving key advocates, participating traditional and cultural activity in community, health education and integrating key activities among stakeholders such as committee meeting, on-site malaria service, monitoring and evaluation were approached continually.

 3. How did the initiative solve the problem and improve people’s lives?
There were three main ways to develop this initiative (ICD/CIM): 1) Data feedback and SWOT analysis, 2) Strengthening networks and public involvement, and 3) Determining the framework of ICD/CIM. The first method was the data collection and analysis, together with the application of a SWOT analysis to determine a strategic action plan. In the second method, VBDU9.3.5 set the meeting for agencies and the community to disseminate data, to discuss the situation and context, to achieve the solution, a mutual agreement, an implementation plan and a procedural process of participatory malaria management. To effective communication, the utilization of radio waves was conducted for contacting and maintaining communication with remote rural areas. Moreover, VBDU officers sometimes stayed in the village and participated in traditional culture or work activity in community to recognize people’s attitudes and behaviors. They found that trust and acceptance were also important for community participation. The final way, the framework of four pillars was intentionally created by brainstorm of VBDU 9.3.5 officers which it was called as the Integrated Capacity Development/Capability Improvement Model (ICD/CI Model) for malaria management. This was initiative and creative for high affected area of malaria in Tha Song Yang.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The first strategy of ‘leveraging partnership through policy driving’ involves: 1) initiating three networks, 2) expanding to six networks 3) establishing Tha Song Yang committee for malaria management, 4) meeting, monitoring and evaluation. In 2010, ODPC 9, in coordination with VBDU 9.3.5, identified relevant stakeholder presently providing health care (SHPC, DHO and Tha Song Yang community hospital) and NGOs and invited them to join the initiative. Ad-hoc and regular meetings, such as district health board monthly meetings, were held to identify and discuss present roles played by each involved member and their available resources. After deliberation of all issues, challenges were identified through SWOT and gap analysis of health care services at each stage and contact points within health care delivery chain. It was found that malaria in childhood was also a significant emerging including the scarcity of the resource which these needed more assistance. Therefore, the BPPU, local or Tambon administrative Organizations and community were involved for collaboration to manage the challenges in 2011. With a purpose to reducing malaria case and increasing quality of life in an affected area as a commitment, sub-district Tha Son Yang committee for malaria management was developed and ensured all objectives and strategies were represented. Additionally, communication channels were set up to ensure those involved were constantly updated on the developments of the project such as telephone contact list, email address and radio wave for remote area. Furthermore, formal and informal meeting, monthly monitoring and fiscal evaluation were key activities which has influenced to decision-making process amongst six stakeholders. This serves as the mechanism for maintaining participation and involvement throughout the implementation of the ICD/CIM initiative. The second stage set into action of service on site and prevention activities which were agreed upon by the team discussed above in 2011. Main activities were active malaria care in the village by integrating team, campaigning and surveillance .For more efficient work, an instruction manual was developed, proposing the organization’s role and responsibility, job descriptions such as the screening, blood testing, prescribing, and follow-up of patients. For example, it provided case identification by the community health volunteers, blood examination, diagnoses, giving medication by VBDU officers and education for malaria prevention by outreach team. Moreover, the BPPU has played a significant role to tracking and promoting student case for treatment and disease surveillance. Concurrently, the selection for health volunteers in community and training could be done for achieving community health advocates and building capacity of health volunteers of the third strategy. During 2010-2012, one day course training has been arranged for village health volunteers and community leaders for malaria prevention and education which this trains 100 persons per year. There was intensive program for healthcare providers such as hospital staff, VBDU officers and health center officers for laboratory technique, diagnosis and treatment in 2011. Furthermore, VBDU 9.3.5 has applied the workshop training or focus group training for one day which this course has selected the key community influencers such as shamans, village chiefs and teachers to be health representatives and advocates since 2012. All trainees will be listed in the record and provided jobs in cluster of community for coordinating team when visits, identifying case, tracking and educating. Moreover, they are a member of the committee which can be developing the policy. These activities can be served the achievement and sustainability of this initiative due to increasing community networks, trusts and acceptance, public involvement and health education in the fourth strategy. Therefore, to maintain networks, it needs to develop key health advocates, health education, meeting, and having participation with community in traditional culture. (see annex 4)

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Stakeholders and their responsibilities in the ICD/CIM initiative were as follows: 1) VBDU 9.3.5 and VBDC 9.3 served as the coordination and communication organizations, assisting all partnering organizations’ implementation activities, along with acted as secretary of the committee. At the same time, they also delivered the primary service of malaria care (eg. detecting, treatment under supervision, follow up, education). 2) Public Health Agency and Health Care Providers in the area included the Sub-district Health Promotion Center (SHPC), the District Health Office (DHO), and Tha Song Yang community hospital. These provides health volunteers, administered health care services (diagnosis, treatment, transfer, follow up), educated and communicated with community leaders, as well as shared data on epidemiology and shared materials, medication and vehicles. 3) Local Administrative Organization in Tha Song Yang provided on-site identification of key community leaders, solicited their assistance with the initiative, and also supported budget, materials, vehicles and gasoline 4) The Border Patrol Police Units (BPPU) acted in accordance with the Royal Program initiated by HRH Princess Sirindhorn in the eradication of childhood malaria in the region. The BPP teachers educated parents and children serving as mentors in malaria prevention. Furthermore, The BPP teacher assisted healthcare providers to follow up student who affected malaria and recorded data for the report and surveillance. 5) Non-government Organization (NGO) such as International Organization for Migration (IOM) and Project Local Empowerment (PLE) coordinated and educated migrants and refugees for malaria prevention. 6) Community by key community leaders such as village chief, community head, teacher and ex malaria person. They were volunteers assisted in preparing community when team visited and identifying risky people, disseminating malaria information, monitoring medicine administration, tracking treatment, and keeping records’ affected patients. Their fluency in various local dialects bridged the communication gap, obtaining the vital voices of patients and community members.
 6. How was the strategy implemented and what resources were mobilized?
The initiative was intended to minimize resource use, as well as to leverage and combine all available resources amongst the stakeholders. The budget of this initiative has been funded approximately 90,000 Baht (2,790 USD) each year by the Department of Disease Control, allocated through ODPC9. The funding was primarily intended for materials, supplies and fuel to control and treat the disease. External funding support came from the Global Fund project approximately 500,000 Baht (15,500 USD) in 2012, but this funding was not integrated with the projects of the original allocations. Conversely, the other budgets, including that from the Vector-borne Disease Control Center, Tha Song Yang District and Tak Province, serve primarily to implement the action plan of the network members including the Border Patrol. For all units involved, the total budget includes resources would be allocated for network activity in specific periods, target areas, and participants in order to implement aggressive antimalarial practices. It was less probably to share the budget amongst stakeholders, but human resources, technology resources, materials, vehicles and technical supports could be sharing. In terms of human resources and technical supports, main staff were taken from relevant agencies, that is, 4 persons from the VBDU 9.3.5, 6 persons from Tha Song Yang community hospital, Sub-district health promotion center and health center office, 1-2 persons from TAO, 2 persons from BPPU, 4 persons from NGOs and 4 persons from community. The staffs were responsible for managing the meeting, administering their resource, practicing the pro-active service on site following a guidance and action plan. Four staff from the VBDC 9.3 and ODPC9 had a role of supervision and evaluation. Furthermore, about four hundred community health leaders and advocates volunteered for malaria prevention and participation. Within ethnic minority, Tha Song Yang team assigned 7 – 9 such volunteers in the fiscal year 2010 – 2012 and NGO team communicated through the translators also provided access to information on disease prevention, control and monitoring the patients’ drug usage. Other resources such as non-pharmaceutical supplies, equipment, mosquito nets, vehicles and gasoline presented inadequate. It could be transfer materials and any supplies between organizations. In cases where extra vehicles were required, they were provided by the hospital, or in the case of routes that are difficult to traverse, military vehicles were provided. Each collaborating member must commit to reduce the number of people affected by malaria and ensure the continued efforts to provide comprehensive public service. Therefore, resources management: all resources were blended to create an approach to reach the initiative’s goals. The principal approaches involved: 1) encourage participation from allied public agencies at every level from districts to province, 2) incorporate data, information technologies, and knowledge management to provide a database for malaria management in high transmission areas, 3) introduce the ICD/CI Model to conduct the initiative, and 4) take full responsibilities by relevant public officers and volunteers.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
First, to networks, the initiative has changed organizational administration and transformation amongst six organizations so that organizational culture changed and administrative reforms occurred. Six parties developed the same purpose and a commitment, policy feedback, the collaborative efforts to deserve the malaria management and resource management. The sub-district administration facilitated all activities in the area and pushed health policy into the committee at district and provincial level. Moreover, the participation of volunteers enhanced connection and communication between the organizations and their communities. In addition, the network’s outputs were creative malaria activities and a guidance of work instruction for network collaboration on-site service. Second, to malaria service, VBDU 9.3.5 has changed an approach of malaria care from passive service at malaria clinic to pro-active service in the village by collaborating team (annex 5). More than the malaria treatment, new approach could detect asymptomatic cases, outreach the high risk area, high risk groups such as children, pregnant and immigrants, as well as trace the patients and educate people. Furthermore, it reduced time and cost of travelling to health facilities and also built the community trusts. People satisfaction increased from 80% to 95% after the pro-active service approached and an average time consuming of service including travelling time dramatically decreased from 10 hours to 15 minutes per person (Mass screening is about 50-60 person per visit). Third, to individuals and providers, the achievements included the reduction of malaria morbidity and mortality rate, the prevention of disease transmission by early case detection and treatment, an increased disease prevention reaction rate and the use of vector control, and an increase the outcomes despite a reduced budget. Number of infected malaria in Tha Song Yang was reduced from 6,096 cases in 2010 to 5,453 and 3,208 cases in 2011 and 2012. From the data in Tha Song Yang community hospital, the severity of malaria cases also reduced as demonstrated by the decreasing of average admission period to two day during 2010-2012. The budget for anti-Malarial drugs was decreased from 462,654 baths (14,457 USD) in 2010 to 260,735 baths (8,148 USD) in 2012, and blood transfusion was reduced from 217 to 194 to 160 packs in 2010, 2011, and 2012 respectively. Forth, to human capability and community, there have been the different courses for training the health volunteers and community leaders since 2010 which were about 400 volunteers in community.

 8. What were the most successful outputs and why was the initiative effective?
The program of integrated service provision to control malaria in high-risk areas was operated from 2010 to 2012. It was monitored monthly by the operational plan and by comparing the data with the standard of the MoPH for Malaria control. The information included service data and disease control data. Service data included information on the number of visitors, including risk group patients, screening, type of infection, treatment, outcome, follow up and number of deaths. Disease control data included information on the number of households receiving the mosquito nets and vector control by chemical spray. In the past, the data were compiled according to the epidemiological report system of the MoPH. The information system was established using a geographic information system, located in Bangkok. Both the Bureau of Vector Borne Disease Control and the Department of Disease Control collaborated to conduct the system with faculty of Tropical Medicine, Mahidol University. This management information system collected real time data of malaria activity. The National Malaria Program and health facilities were able to enter, retrieve and analyze the data in their area directly. Additionally, there were network meetings in the area to discuss, problems and obstacles of the implementation in order to develop solutions that incorporated all involved parties and practices. The process consisted of performance monitoring and evaluation based upon the guidelines and usage of the resources such as personnel, budget, vehicle, disease control materials, and customer satisfaction. The monitoring program focused on the number of services received, population screenings, patient treatments, numbers of treated patients who needed a follow up, numbers of families receiving the insecticide- mosquito nets and the activity of chemical substances controlling the disease carrying mosquitoes. The reports for the ODPC 9 included performance reports of each health unit and summarized reports with data analysis. Additionally, higher unit supervision and monitoring (VBDC9.3 and ODPC9) served as technical support for both standard and high quality services. During the monthly operation higher-level inspectors Vector Borne Disease Center 9.3, the Office of Disease Prevention and Control 9, Phitsanulok Province inspected the accuracy of the implementation. Ultimately, the formal assemblies included monthly meetings of health units, district health committee meetings, monthly village meetings and yearly refresher courses for health volunteer and community leaders. Moreover, the informal cooperation and participation by all networks and stakeholders from government, local administration and citizen sectors were seen through meetings and discussions.

 9. What were the main obstacles encountered and how were they overcome?
Three main obstacles were encountered during the implementation of the initiative. First, people with deeply-rooted belief in spiritual and supernatural refused and dissatisfied with medicine procedures and treatment, so they were habitual talking and persuading the others to deny. All respective providers were implemented to solicit their trust and cooperation with ‘Openness, Understanding, Communicating, Educating and Trust other’. Healthcare providers initially participated with people any traditional activities and cultures, often consulted for amenable practices to patients and relatives and encourage other community members, educated and communicated on the causes and effects of malaria, on malaria immunity and the ways in which modern medicine might save their lives. This was applied continuous, gradual pressure in order to modify the behavior of community members to one of vigilance, subsequently allowing them to embrace the modern medicine without compromising their ancestral beliefs. Also this initiative invited and trained shamans could be enhanced through the success of the combination of spiritual and medical treatments. Second, population movement and diversity as well as the language difference were complexity. Community volunteers and NGOs could help for interpreters and educate the refugee and immigrant patients. Furthermore, the IEC materials, including VCDs, posters and leaflets, were available in Thai, Karen and Burmese and other language. Third, the staff, healthcare officers, integrating teams and volunteers were changed their jobs, positions, retired or dead. This led to discontinuing of practice when visited and serviced. A guidance and work instruction for integrating team on-site service was developed and applied for all. Within this, it clarified each organization’s role and responsibility, flowchart of work process and job description. Additionally, on the job training, lay knowledge, exchange knowledge forum and regular meeting can transfer knowledge and help each other. The AAR was used to facilitate learning and improvement.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
In the local area and region, 5 main benefits were 1) integrating and administering six organizations to health reforms through participation 2) improving health services in several area of high transmission and increasing patient and community satisfaction 3) Overall cost and time savings 4) increasing Capacity of Trained Workers and health education. Synergistic benefit processes and results from integrating networks were found such as resource management, communication and relationship among people, civic society and government organizations. Moreover, public involvement could share their needs and develop bottom-up health policy applied through key strategies and activities and driving the public policy to district and provincial level. Moreover, the participation all administration may develop a sense of ownership and trust between the organizations. This initiative can change pattern of malaria service for more effectiveness. The most profound benefit resulting from the ICD/CIM initiative was the ability in providing ‘equitable’ malaria health care services to ‘hard to reach’ and ‘at risk’ groups such as the nine indigenous race/ethnic minorities, migrant workers from Myanmar, and Thais living in the high-risk area (57,052 residents living in 12,866 households became immediate beneficiaries). Numbers of malaria patients reduced from 2010 to 2012 as follows: Thai malaria patients reduced from 2,800 to 1,391 cases, the foreign malaria patients reduced from 3,296 to 1,817 cases in Tha Song Yang. The numbers of people who received the service were 20,267 and 5,028 people also received other health care such as surveillance and prevention of Elephantiasis, Dengue fever, worm infection surveillance and 13 people received other kinds of medical service and transferred to received advanced medical treatment in time. People were satisfied with the integrated proactive service delivery for malaria control in the high-risk areas with the higher satisfaction rate. Overall time and cost savings such as transportation cost, material cost and medication cost and also waiting time and travelling time. For example, in 2010, the CD/CIM initiative conducted 545,361 malaria blood tests on-site with 30,578 positive cases found. If each of these positive cases had to travel to the nearest malaria center, it would cost the residents US$1,009,074 (US$ 33/trip X 30,578 trips) in travelling expenses and 214,046 travelling hours (7 hours/trip X 30,578 trips) - equivalent to 26,755 working days wasted. Most important of all, more than 30,000 human lives were saved. Increasing capacity of trained workers and health education, people participated in solving the problem of malaria and other health problems in their community as 400 health care volunteers were trained to advocate and to surveillance the vector borne disease prevention and control. Distribution of insecticide-coated mosquito nets and insecticide residual spray was done for 250 families. These trained volunteers help to coordinate between the government staff and community population and worked as change agent in their community to make people adopt in malaria prevention. Concurrently, Heath education media was integrated between the medical knowledge and lay knowledge of the people in order to fit with the ways of life, society, and culture. Tools for prevention which are proper for their lifestyle and culture were provided such as insecticide impregnated mosquito nets, hammock covering nets for the local people who lived by collecting non-timber forest products, and hunting at night time. At the national and global level, an annual incidence rate per 1,000 was decreased from 0.28 in 2010, 0.17 in 2011 and 0.10 in 2012 respectively in Thailand. The numbers of deaths from malaria was also decreased from 80 persons in 2010 to 43 and 37 persons in 2011 and 2012. Early detecting and preventing limit drug resistance and pro-active services decrease of health disparity between Thais and non-Thais. Furthermore, financial burden for malaria patients has been reduced due to quick diagnosis and treatment. Economic loss due to misdiagnosis that may be incurred by the patients and their families is substantially reduced. In the case of a misdiagnosis in a patient with severe symptoms, he/she must be admitted to a hospital. The cost of medical care at a hospital is approximately 6,500 Baht (202 USD). Therefore, these patients received the appropriate treatment from the healthcare providers with the less cost of medical care compared to at a hospital.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The characteristics of the integrated proactive service delivery for malaria control in high-risk areas had fruitful concrete results such as standard service, accessibility to the service, reduction of disease, and reduction of expenditure. All had the same final aim that was the health of people. Holistic care with true understanding of differences in social, economic, cultures, belief, and the living styles that affected to the illness, which would be better, solved with participation and opinion from the community and affected population. For sustainability of the initiative, this involves: 1) Better networking management through promoting the participatory among the partners and expand network to cover all service area. Mutual interest and benefits for each organization were managed equally and fairly. That is ‘win-win situation’ and ‘Trust together’ 2). Creating the change agents continuously to cover more service areas. The local volunteers and their network help in coordination, communicate for people’s acceptance of the service more easily since they were locally from the communities. They are our public relations staff, peer educator, and sometimes handing the services to the people in community. If there are continuations, improvement of coverage of service areas, the program could be carried on. 3) Improving of the supportive mechanism and resource allocation with the principle of transparency, fairness, accountability and empowerment. The program allowed the people and related partners to take part in all implementation steps from planning, implementing which allowed the people and partners to know and learn the results as well as opened up for their opinions and suggestions to adjust the implementation. With this way, people would be empowered to do the self-care for themselves, learn basic health care, and share this knowledge with other people for better self-protection. The people‘s behavior would reflect in sustainable healthy practices that could help in reducing expenditure on health, by disease prevention. 4) Managing of related knowledge through encouraging knowledge exchange. Providing knowledge for personnel in the organization and in the network, they would be enabled to use the knowledge in the implementation and transferring of knowledge from one generation to another with non-stop. So the program would have been equipped with the knowledge staff to continue working sustainably. This initiative can be transferable: The VBDU 9.3.5 presents this initiative to the other ODPC (ODPC1-12) under DDC. It is an excellent center of integrating malaria service of DDC. There are a number of international organizations visit such as USAIDS, Global Fund Malaria including University in Thailand. It is also the training of post-graduate students from Mahidol University. Scaled up of this initiative to national level is attainable with minimum cost in equipment and training. The model can be applied in areas that were encountering similar problems. It promotes horizontal integration and coordination to provide holistic service to citizens by personnel from different organizations, different cultures and different styles but with the same vision to serve people.

 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)
The lessons learned from the program operation are: 1. The participatory action of organizations in the same local district were coordinated horizontally, the integration of works give the services to people that fit their true needs and produced highly effective and efficient jobs for the government. 2. The solutions for health problem and quality of life of people should be relied on the local context. The solutions must be based on the understanding of people’s lives, different living styles under different cultures. The success of public health and health care services started from trust and acceptance from the people in the community. 3. Using the actual facts and information of the implemented areas, so it would lead to the right decision making at the right point. 4. Transferring the knowledge about malaria disease treatment, prevention and control not only to the people in village in the program area, but also the other government organization personnel, so that they could hand on the knowledge and practices concerning malaria to the others very well. The lessons learned from the people are: 1. The participatory from family, community in health care management made people understand better about basic self-care, such as how to prevent malaria when they were in high-risk areas. 2. The integrated proactive service delivery for malaria control in the high risk areas was the working approach that encouraged people to reach the malaria prevention and control services widely and covered all target groups, as well as people would get the other basic health care services at the same time. 3. The integrated proactive service delivery for malaria control in the high-risk areas could create a way to exchange and mix health care with medical knowledge and lay knowledge perfectly. In future development, 1. Establish ownership of the malaria control project within the community by including the public in civil projects. Involvement by the public in such operations is increasing. As these services develop, access to health care services by the public has increased. These efforts will ultimately act as agents of change for the malaria problems in these communities. 2. Teamwork efforts have allowed for the free exchange of knowledge in real time. This results in an increase in knowledge by personnel in strategic agencies or locations where the malaria problem is particularly bad. Furthermore, it allows information to exchange both ways: from agency personnel to the community and from the community to personnel. This partnership increases the quality of service. 3. ASEAN countries are increasing supporting cross-community integration, meaning the population movement and mixing will increase. Our experiences with networking and teamwork, and sharing limited resources, can therefore be applied to many different settings and are ultimately relevant for a broad range of problems or issues.

Contact Information

Institution Name:   Department of Disease Control, Ministry of Public Health
Institution Type:   Government Agency  
Contact Person:   Dr. Sakchai Chaiyamahapurk
Title:   Director of ODPC#9 Phitsanulok  
Telephone/ Fax:   +(66) 5521 4615-7 /+(66) 5532 1238
Institution's / Project's Website:  
Address:   306 M.5 Phitsanulok-wat bot Road, Muang District, Phitsanlok Province, Thailand
Postal Code:   65000
City:   Muang
State/Province:   Phitsanulok

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