| 4. In which ways is the initiative creative and innovative?
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Prevention and control of dengue project was conducted in 2 phases as follows;
Phase I in 2009, Fort ThepsatriSrisunthon hospital collected morbidity data dengue found an infection rate of 113.33 per 100000, which is expected to outbreak in 2010. The hospital with women community volunteers started the campaign to prevention and control disease during the rainy season in May and reactive monitor infected rate, container index, house index. As a result in 2010, the team found an infection rate was 106.66 per 100000 and did not achieve project goals.
Phase II in 2011, Fort ThepsatriSrisunthon hospital with women community volunteers analysed community context and culture from environmental community survey. They found that there are breeding site indoors and outdoors with a basin and forest degradation. Housing is a consecutive row surrounding with basin .Children need to study in schools 20km away from the city which has a chance to bring dengue fever to the community. The population education level was mostly lower secondary schools, so they usually lack of access to information and health awareness. Behavioural aspects, there is waste management, but it does not cover the area and is not discrete. The disposal method piled together in a particular area, makes it conducive to mosquito breeding sources. Elimination of breeding sites was not performed consistently during the campaign of health agencies only. Therefore proactive action by Fort ThepsatriSrisunthon hospital along with other networks occurred.
The team decided to start the Awareness Campaign since February 2011onwards with the support of local government budget. Waste management activities in the office are organized every Wednesday by Fort ThepsatriSrisunthon hospital and military leaders.
At first, waste recycling units are established which are open every Wednesday but there are the amount of waste at pool areas which do not have waste separation.
In 2012, collaborated with agencies in the community and proactive monitoring monthly. Fort ThepsatriSrisunthon, military leaders and army wives community volunteer expand the environmental management from office to the community. There is a commitment to environmental management, waste separation, recycle waste to household income, wet waste was fertilized to be used in vegetable demonstration of bio-based units, applied effective microorganism (EM) to be a general purpose cleaner such as dish washing, liquid bathroom used in hospitals and offices for reduced rates of using chemicals. Waste from composting bio to build a fertilizer, residues of fermented mixed with other organic materials such as rice husk, grass, leaves, coir, soil to make soil organic and used in households, economic forests or bags to sell. Improve the basin to crops and vegetables. Divide the space of military units of arable areas to take advantage of space for those who earn less as sufficiency farmers.
In 2013, nontoxic vegetable consumption culture occurs in the community. A learning centre was established to provide an environmental management model for young people. As a result of local administrative organization, high school and graduate students visited to study environmental management.
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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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The Thai military is responsibility for the Fort ThepsatriSrisunthon area, which has Fort ThepsatriSrisunthon hospital as the health care agency responsible for soldiers, their families, and the public in the area according to the ministry of defence and ministry of public health policy. In this area, local government supports policies and budgets. The implementation of the initiatives main goal is holistic health care of the military community at Fort ThepsatriSrisunthon to meet the community requirements of health promotion and treatment is the final stage of health care caused the cooperation of all sectors. First, Fort ThepsatriSrisunthon hospital launched an initiative in a meeting of the camp. Educated women community volunteers, heads of household, troops and practices in destroy breeding sites, self-care prevention. Fort ThepsatriSrisunthon hospital, military leaders and army wives club called “Three-Team Coordination”collaborated to complete environmental management to establish a recycling bank, waste separation from households. Furthermore, hospitals collaborated with a network of public health and local government targets in disease control at the district level, the district level campaign plan, community leaders monitored community disease surveillance, women community volunteers proactive monitoring breeding sites, house index and container index monthly and reflected data back to the community to adjust their operations.
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| 6. How was the strategy implemented and what resources were mobilized?
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To complete the initiative we asked for collaborative in the area both inside and outside the army, in terms of budget and personnel, with the goal to reduce dengue infection and community well-being.
In the budget, local administration support for mosquito pesticide (1%Temephos sand granule). Fort ThepsatriSrisunthon hospital distributed to the community. The Army Medical Department supports oil and smog spraying chemicals, Fort ThepsatriSrisunthon hospital fogging the infected reported area with a radius of 100 meters. The campaign activity is supported by the National Health Security Office (NHSO). Media support is provided by the provincial public health Office in Nakhon Sithammarat.
Fort ThepsatriSrisunthon hospital supports surveillance teams, patient care teams, health promoting teams in the area. Military leaders support environmental committees and troops to develop degraded forest and basin areas. Woman community volunteers monitor indicators. The network public health disease control targeting at level district and SRRT team support if necessary. Local governments plan to campaign at local level.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Phase I, The result of prevention and control of dengue in 2009 - 2010are infected rate 113.33 and 106.66 per 100000 which exceed the target of not more than 50 per 100000.
Phase II, Change reactive to proactive operation by the networks, in cooperation with the hospital officers result to indicator decreased. Fort ThepsatriSrisunthon meets the community health management criteria by health agencies from HI, CI and infected rate not exceed the target. In 2011-2013, hospital data query satisfaction rates of soldiers and their families are increased by 80.05%, 83.33% and 83.89%, respectively. There is the cooperation of three units in the network; Fort ThepsatriSrisunthon hospital, military units and army wives called "Three-Team Coordination".The output from the activity in this phase is reducing the cost of the treatment, reducing the cost of oil and chemicals from the Army Medical Department to 183,134 baht per year, a good environmental management model of the organization so as to reduce the burden of waste disposal.
In 2014, the hospital along with woman community volunteers monitor the infected rate of 6.67 per 100000, not exceed goals (50 per 100000) larvae index (HI 18.6, CI 7.1) does not exceed goals ( HI <50, CI <10).Dengue infection rate less when compared with adjacent area infection rate are 6.67, 145, 76 and 77 per 100000 in Fort ThepsatriSrisunthon, Kangpla district, Kapang district and Klongtook district respectively. Not secondary infections were found, no dengue related deaths were noted in the area.
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| 8. What were the most successful outputs and why was the initiative effective?
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Phase I, in 2009-2010 Fort ThepsatriSrisunthon hospital reactive monitoring infected rates from patient access and women community volunteers monitored larvae indices monthly but cannot control the epidemic of Dengue because of inaccurate time of control.
Phase II, in 2011, monitor areas at risk. Women community volunteers proactive monitored larvae indices monthly. Hospital officer was data analysed areas at risk of dengue monthly and audit every 3 months, monitoring infected rate, number of fogging and monitor compliance with the principles of prevention found that principles were not continuous. Military leaders established a recycling bank for waste management which opened weekly and monitored the deposit of recycled waste by an environmental committee but still has waste retention in the house to solve it by collecting recycled waste at home. In 2012, monitor progress of waste management. Environmental committee monitored the points and the progress of economic vegetable beds weekly. In 2013, monitor the knowledge and practice of DHF. Fort ThepsatriSrisunthon hospital with women community volunteers educated and monitored the knowledge and practice of the community. The score of knowledge and practice in DHF protection were high, as detail: The knowledge about symptoms of dengue is high fever, headache, bored with food and red spots on the arms, legs and torso, which is 98.5% correct answered. Operating on dengue, 100%sleeping under mosquito nets or bed in a room every day, practice the principle of prevention is 83.33%. The suggestions are environmental management in basin and degraded forest. Fort ThepsatriSrisunthon hospital with women community volunteers monitored infective rates, larvae indices compared to the standard of the Ministry of Health and reported back in network meetings formally and informally monthly. Random checking of breeding sites every three months in working units. Report data to public health district, The Army Medical Department, and medical commander of the 4th army area to use as a comparison, in the district and national levels. Hospital officer monitored the use of resources supported by other agencies, including personnel, budget, chemical and fogging and sent a summary report to the army medical department to investigate the results.
The system records the data using computer networks in the hospital. Sent patient information by documents, phone, and email through the district health office daily and the information were forwarded to the Office of Public Health and Center for Disease Control to analyse patient data reported in different areas.
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| 9. What were the main obstacles encountered and how were they overcome?
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Firstly, the implementation of prevention and control dengue in Phase I failed to achieve its goals because reactive management, communities do not have participation in planning and implementation and agencies work split.
Secondly, there are not have a person mainly taking care of space and residential areas between consecutive rows of houses. Indeed, army wives whose husband works outside not have knowledge of environmental management. This may result from the Fort ThepsatriSrisunthon hospital requested cooperation of military leaders to manage that area instead of the householders.
Thirdly, inaccessibility of surrounding area of Fort ThepsatriSrisunthon where are an area of deep degraded forest and basins. To overcome this problem, we just only educated communities how to prevent mosquito bites during the pandemic and sleep in closed rooms or under mosquito nets via cable TV and broadcasting cars.
Fourthly, some groups did not cooperate with the project implementation. The solution to improve environmental management gradually persuaded by neighbours, divided into zones setting committees from the residents of the same row, residents in each row and the committee from area outside the camp to participate in a contest rating of environmental scores compared to the different area before and after the development and continuous improvement results.
Finally, the physical structure of incorrect slope drainage behind houses is a source basin, an inactive large water tank waiting for approved destruction.
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