| 4. In which ways is the initiative creative and innovative?
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The National Health Security Office set aside an O&M fundin 2012 according to the urgent need of increasing training centres of O&M for blind people nationwide. The main purpose was to train a large scale of blind people for independent living annually. The Ratchasuda College, Mahidol University, was an institution to perform training for trainers. The director of TakBai Hospital, Narathiwat Province, was interested in thisprogramme and forming a team to take part in this course. The standard duration for training blind people is 20 days. Five skilled trainers prepared the course at the hospital as a training centre. The first year of this new provincial centre, 4 batches of learners (50) were trained. All blind scholars had to travel on their own to the hospital daily. At the end of the courses, most learners complained the difficulty of traveling and many topics could not meet their actual needs. The recommendations were partially served as an important input for the following year.
The curriculum of the following year was reviewed to meet scholar needs. The training place was moved into the community on the decision-making of multi-stakeholders. Scholars could participate in deciding which situations they wanted to practice. Eventually, as the training centre was moved into the community, the total duration was shortened to only 10 days with the similar achievement as the standard course.
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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 director of TakBai Hospital expressed his concern upon the quality of life of disabled in the unsettled areas. The accessibility to health care of these people seemed not to be conveniently reachable. Due to insecure circumstances, many of them are left at home unless they got seriously sick. It is quite obvious that the quality of life of disabled group is rather poorer than ordinary people. When an announcement of O&M centre establishment project was addressed in early 2012, the director did not hesitate to apply for. He was convinced that blind people could have a great opportunity to practice in the workshop that has been as good as those at the centre. An O&M team was then set up. Four nurses and a village health volunteer got trained atthe Ratchasuda College, Mahidol University, ancentre of excellence for disabled rehabilitation. The advanced course took place for one month. The National Health Security Office, Region 12 Songkhla, additionally supported an amount of budget at 9,000 baht per one blind person for providing a training course at the hospital. The duration of the course was 20 days. Due to the inconvenience of daily traveling during the course and the place for practicing was not met their actual needs. Since 2013, the outreached training course has been undertaken at the community level. The duration was shortened to 10 days, nevertheless the overall objectives are still accomplished. It is highly expected that the rotation of courses would take place to all districts of the province. Each batch, the local authorities; district health officers; head of communities together with the instructors will make decision on the appropriate place as a centre for training. Moreover, the people-centred approach is still applied for other places in the community that they would like to practice. Apart from the centre of training in the community, they could have a chance to practice at the rubber tree plantation; orchards; riversides; local roads; going up and down stairs; and attending religious activities either at temple or mosque. This community approach is very favour able to all participants. From 2012 to 2016, the total number of participants is 351 covering 10 districts of Narathiwat Province. In the present year, the last two districts will be covered.
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| 6. How was the strategy implemented and what resources were mobilized?
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The multi-disciplinary cooperation among stakeholders in the community is a key strategy of this project. The people-centred approach is another issue to be raised in order to meet their real needs. Outreached training programme has, thus, be implemented.
Human resources play a pivot role of this project. Without the cooperation of local authorities and health workers, it would be rather difficult to search for blind people in villages. Community leaders and religious leaders also play as a key role to convince and ensure blind people and their relatives and families about the advantages of the training course.
Financial support mainly came from the National Health Security Office. It covers all the expenses throughout the course i.e. training materials; white cane; travel expenses of participants and their care givers; and all other operational costs.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Narathiwat Provincial Social Development and Human Security Office takes charge of the official disabled registration. The list of blind people with addresses has been supported. Health care staff of TakBai Hospital play a key role in this project. The National Health Security Office, Region 12 Songkhla, is the coordinator function of financing support. Teamwork from all district health offices and health centresare key players at local levels in line with community leaders to search for blind people. Last but not least, religious leaders facilitate the acceptance of the training course in the community.
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| 8. What were the most successful outputs and why was the initiative effective?
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The quality of life of blind people is the primary goal of this project. Even if the coverage of this project within 5 years is not high (351 out of 2,179 (16%)), the distribution of service provision to other districts is apparently accomplished. The whole province is expected to be covered within this year. Upon the following-up after 2 weeks; one month; 3 months; and 6 months, respectively, many of them stated that they could live independently and have a much better quality of life. All of them were satisfied with this training course. Using white cane effectively, they are confident to walk outside and have less accident. Almost 90% of respondents replied that they are able to participate community and religious activities; andto perform daily life activities. More than half of respondents could be able to work again such as gardening, cooking, and household work. Cheerfulness becomes apparent. Members of families got several positive effects. First, they have more time to go to work. Second, in some families that hire care giver to look after a blind person, they save a lot of money. From the political point of view, this project plays a fundamental role of mutual understanding between local residents and government officers. Trust could be developed and very obvious. Eventually, peace is the prime benefit of this project as well
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| 9. What were the main obstacles encountered and how were they overcome?
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During the first batch of the course, the learning centre was at the hospital. All details of the curriculum conformed what the Ratchasuda College designed. Along 20 days of the entire course, all participants had to travel from home to the hospital. Generally, they were not familiar with traveling as mostly they were kept inside their home. It was not very convenient to get on public transport especially in remote area. In addition, the sessions all were designed by experts in Bangkok. This standard curriculum was absolutely not appropriate for people in countryside. As a result, several participants could not attend everyday. In addition, most of the topics and practical sessions were developed upon the urban situation. No recreation activity during the day was intervened. Many of participants complained that the course was not interesting. After the first evaluation, restructuring the details of sessions was immediately conducted. The outreached approach was applied. The community centre was replaced. The duration was shortened down from 20 days to only 10 days. However, all objectives were still in place. All participants of each batch must be in the same district for travel convenience. Need assessment was done in advance. Recreation activities were intervened in order to keep participants’attentionand to gain student participation in the class. Places for white cane training in local community could be listed according to their needs. It is interesting to note that Muslim language was preparedin particular for the ones who cannot understand Thai language.
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