| 4. In which ways is the initiative creative and innovative?
The problem was one of scale. The number of patients greatly exceeded the numbers the well-trained medical staff and well-equipped hospital
s could deal with. Long waiting times, lack of continuity of treatment and a distrust of modern medicine for some of the rural elderly saw that the system was failing the most vulnerable. Working within the financial constraints of the situation, the PPAO devised an innovative approach in the following ways.
• Harnessing the private, public and local resources to empower communities to self-manage their health needs.
• Making the care free and available in their homes and villages by providing local care and mobile medical units.
• Strengthening community networks and building trust in modern medicine at the local level.
• Training and using volunteers to connect with individual patients and bring harmony between local wisdom and modern medicine.
• Educating the local community about health and emphasizing the importance of public service to the population.
• The cost per day of treating a person in hospital is US$80 and with an annual budget of US$164 the program has not only been a success by supporting the health of its citizens and their communities but has also been financial and sustainable success.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The project began planning in 2007 and was implemented in 2009 by the Phuket Provincial Administrative Organization. It continues to be administered by the PPAO in consultation with its local partners. Such is the success of the project there has been an increasing number of participants each year. Currently there are about 1,465 people participating and as a result, the most vulnerable people of Phuket can receive adequate health services and an improved quality of life within their community.
| 6. How was the strategy implemented and what resources were mobilized?
After identifying the issue and evaluating the available resources - economic, physical and human; the PPAO adopted the following strategy to improve the health and lives of its most vulnerable citizens.
1. Established a Division of Health Promotion and Disease Control. This is the primary agency for supporting the medical staff and provides technical specialist advice.
2. Analyzed the health problems of elderly, poor, chronically ill and disabled in the community.
3. Design an action plan to tackle the health of the community to achieve sustainability within the community. The Phuket Provincial Administration Organization conducted joint planning sessions with the Phuket Provincial Health Office.
4. Local governments in the region were consulted to facilitate the establishment of the local networks to build acceptance of and sustainability of the project within the community.
5. A joint operation between the Ministry of Health in Phuket and the PPAO to identify, recruit and train community volunteers.
6. Advertising and promoting the project to the people. This was done via newspapers, local newsletters, The Journal News, local TV, radio and through community networks.
7. Continual monitoring and evaluation of the project has taken place with external Universities engaged to conduct research projects.
The volunteers are the heart of the project. Thai people believe in a holistic approach to health with spiritual well-being essential. Being well does not only mean an absence of disease. The mental health of the patient is equally important. Modern medicine, especially in an overcrowded system where there is no opportunity to build a relationship between the patient and medical professional, can be seen as cold and mechanical, lacking a human heart. The volunteers provide the link between the professional health services and an understanding of the local people. At the initial training session there were 239 volunteers and many more have come forward during the project. Currently there are 214 fully trained, active volunteers.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The project was initiated in 2007 by the Phuket Provincial Administrative Organization and Phuket Provincial Health Office. This was a response to a Community forum with patients and relatives. The forum highlighted the lack of access for the vulnerable and the feeling that the government did not care. Some of the disadvantaged ethnic groups and fishing villages felt their unique cultures were being abandoned and they we being left at home alone without care. After consultation with other Government agencies including Social Development and Human Security, local government and community leaders research was undertaken and the project was implemented in 2009. The number of program participants increase every year with The Institute of Child Develoment Rajanagarindra National Health Security Office (NHSO) and the Rotary Club of Sino Phuket provides material, equipment and medical supplies.
The Phuket Provincial Administration Organization was responsible for:
• The initial identification of the need.
• Supplying the mobile medical teams. Cooperated with local Government and external bodies such as Rotary to fund the materials and ambulance service.
• Developing the Primary Health Inspection Service to provide advice and knowledge about health.
• Created a display at their 3 monthly exhibitions to advertise the project to people.
• Coordinating local governments to facilitate the transport of patients
• Support the travelling medical teams
• Assess patients and provide care
The Phuket Provincial Health Office was responsible for:
• Arranging the meeting to clarify the guidelines
• Run workshops for volunteers
• Run activities for the most vulnerable
• Provide volunteers to advise and support patients
| 8. What were the most successful outputs and why was the initiative effective?
The implementation of the project has resulted resulting in Phuket’s most vulnerable people having equal access to public health services. No longer does your health care depend upon your income, sex, religion or education standard and this contributes to a strong community that is self-reliant.
The following examples showcase some of the achievements and strategies.
• Relatives do the daily care, ensuring healthy eating and basic exercises.
• Local volunteers visit the vulnerable for health checks keeping a record of vital signs and basic hygiene and advise relatives on how to care for the patient. The volunteer will provide basic care such as massage, cleaning and dressing wounds, where necessary they liaise with the local health center or district hospital for further treatment.
• The volunteers arrange for ongoing records on each patient to be maintained.
• Since the volunteers are local there is respect for traditional medicine and the use of medicinal plants.
• Local government provides ambulances to transport patients where necessary.
• The district hospital admits patients for emergency care or rehabilitation that cannot be done in the local settings.
In addition there have been other very important but less measurable outcomes.
• Increased awareness and education in local areas about health matters.
• An increase in the acceptance of the role of modern medicine in good health.
• With currently 214 trained volunteers the idea of community service has been reinforced and valued.
The blueprint for this project has been used to reproduce this program in three other provinces in Thailand. This testifies both to the success of the project and the high regard it is held in by the Thai people.
The project has been successful because it utilizes volunteers as the primary health givers. This is cost effective but also has a number of benefits beyond economic.
• Building knowledge of health issues in the community
• Providing a human element to the modern medical process
• Allowing patients to be more self-sufficient and allowing them to spend more time in their community and not become disconnected from it.
| 9. What were the main obstacles encountered and how were they overcome?
The main obstacles faced by the project were not enough trained medical staff, insufficient beds at the hospitals and the resultant overwhelming pressure on the system. The Phuket Care Program reduced the reliance on the hospital for primary medical care whilst at the same time empowering local communities and increasing the awareness of health issues at the local level.
For patients unable to attend the hospital, even in emergency situations, a mobile team was established to go to the patient.
Some of the practical issues to overcome were:
• The initial training of the volunteers. With 239 volunteers at the beginning of the program they were given only a basic training but this is updated and extended every six months. Volunteers are required to provide a written report on every visit and this helps with maintaining quality control over service delivery.
• Some families were resistant to taking on the care of their family members as they felt this may be too difficult for them. The volunteers worked closely with these families to demonstrate the level of support they would receive.
• The provision of specialized equipment and consumables such as pulleys, bandages, and beds.
• The administration of the program was undertaken by PPAO and its experience with administrative procedures was invaluable as new processes needed to be created for this project.