4. In which ways is the initiative creative and innovative?
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DMSc by the 8thRMSC, Udon Thani has applied the concept of Community Medical Sciences (Com Med. Sciences) to solve the health problem of the villagers from benighted using the traditional medicines containing steroids. This initiative focused on participation of people in communities. The first pilot model was developed at Na-Muang Subdistrict, Udon Thani. Then the success model has been extended to cover broader areas. The initiatives to support the achievement of this project were as follows:
1) Development of test kit for screening steroids in traditional medicine samples that can be used easily in the rural area by the trained district volunteers without any need of scientific equipment;
2) The appropriate community system for surveillance and risk management of traditional medicines containing steroids established and implemented by the community under auspices of DMSc and local governments ;
3) Development of “Single Window: Unsafe Product Alert” application (http://www.tumdee.org/alert/) which can be accessed via the Internet and mobile phones by all levels of health officers including the district health volunteers for sharing and accessing information in order to perform further action to solve the community’s problem precisely and in time.
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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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DMSc was a main player of this project and responsible for the following activities:
1) Support and providing knowledge to the community leaders, villagers , and all levels of relevant government organizations by direct communication and training to initiate Community Medical Scientist Volunteers and Unsafe Product Alert System of the villages;
2) Development, production and supply of the test kit to the community for surveillance of steroids in traditional medicines;
3) Development of the “Single Window: Unsafe Product Alert” application for free access via internet or mobile phone to all levels of health officers and volunteers to the information of test for steroids in traditional medicines a s well as in other consumer products;
4) Conducting laboratory testing for confirmation of steroids detected in the samples of traditional medicines, food and beverages by test kit;
5) Development of training materials and providing training to strengthen the capacity of Medical Scientist Volunteers of the villages to be able to use the test kit and send the positive samples for laboratory confirmation correctly. In addition, providing training to the health officers in all levels to be able to use the “Single Window: Unsafe Product Alert” application efficiently.
The outcome of this project conducted during 2011 to 2015 have affected to all 14 villages in Na-Muang Subdistrict. Every village has established its own surveillance and risk management system which has been being implemented continuously by the community in each village. Therefore, risk of using traditional medicines containing steroids inappropriately which could cause health problem in about 10,683 populations has been reduced. Moreover, in 2016 the concept of Na-Muang model has been applied to 90 more Public Health Centers and it was planned to extend this model across the country in 2017.
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6. How was the strategy implemented and what resources were mobilized?
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During 2007- 2010, DMSc by the 8th RMSC, had conducted surveillance of steroids containing in traditional medicines distributed in the areas under its responsibilities and found 17.9 % of traditional medicines containing steroids illegally.
In March 2011, the 8th RMSC started the integrated project with the relevant organizations including local governments, SHPHs, and District Health System (DHS) on community empowerment for surveillance and risk management of consuming steroids containing in traditional medicines distributed in rural areas.
The first strategy was adjustment of attitude and belief of villagers on using the traditional medicines and raising their awareness on hazardous steroids containing in those medicines. The first target group was the community leaders. The assigned coordinator from DMSc had provided them the problem of steroids in traditional medicines detected by DMSc, causes of problem, and seriousness of steroids chronic diseases occurred from consuming these medicines. Then, the community leaders called for meetings with the villagers to convey them those information and convinced them to participate in establishment of system for social awareness and control of these products in their community.
The second strategy focused on networking between DMSc and the relevant organizations to solve this steroids problem in the villages. Agreement on sharing responsibilities and fundraising by different partners was made.
In 2012, public health centers started working with the community to select 2 to 3 health volunteers in each village to be trained and certified by DMSc on health deleterious effect of steroids and using DMSc’s test kit for screening steroids containing in traditional medicine samples. These trained and certified volunteers were assigned as the Community Medical Sciences Volunteers responsible for surveillance of steroids in traditional medicines, providing unsafe product alerts to their community and sending the suspected samples to DMSc for laboratory confirmation.
DMSc had used its own budget and human resource for capacity building of the volunteers and communities, test kit development, and laboratory confirmation. The communities had used budget from Subdistrict Health Fund for procuring test kit, sending samples for laboratory confirmation and compensation for the Community Medical Sciences Volunteers. In 2016, in order to extend results of “Na-Muang Model” to the other 90 Health Centers, Health Consumer Protection Program, Chulalongkorn University supported 1.2 million Baht for procuring DMSc test kit for these Health Centers and 1.7 million Baht in 2017 for supporting capacity building program for the Community Medical Sciences Volunteers.
The third strategy focused in solving problem of the steroids chronic patients in the communities. Since 2011 the Community Medical Sciences Volunteers had worked with family care team and SHPHs in searching for the chronic steroids patients, provide them treatment and knowledge, and follow up to make sure that those patients had completely recovered and would not use traditional medicines containing steroids again. Moreover, in 2014, the initiative for treatment of these patients using traditional medical services was developed including pain reliever made from local medicinal plants, five parts of Senna siamea formulation, and the Thai Hermit Exercise for rehabilitation. The budget used for the patient treatment and follow up as well as development of traditional medical services was from the Subdistrict Health Fund.
The fourth strategy was enhancing the communication channel. From 2011 to 2013, the risk communication and unsafe product alert were conducted through village broadcast towers. In 2014, DMSc had worked with Health Consumer Protection Program to develop “Single Window: Unsafe Product Alert” application via mobile phone and internet. Moreover, the Unsafe Products Alert Center in each village was established. These centers have been controlled by SHPH and their quality was ensured by DMSc.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The stakeholders involved in this project and their responsibilities are as follows:
1) DMSc was responsible for project design, development , production and supply of test kit, transferring knowledge and technology to the community and health volunteers through several training courses, support the technical information, development of the “Single Window: Unsafe Product Alert” system and announce the unsafe product alert via this system;
2) 60th Anniversary Chaloem Phra Kiat Navamintarachinee Health Center, Na-Muang, was acting as the Subdistrict manager working in collaboration with the community in establishment of the Unsafe Product Alert Center and selection of Community Medical Sciences volunteers who would be responsible for surveillance of steroids in traditional medicines;
3) Chief Executive of the Subdistrict Administrative Organization (SAO), Na-Muang and community leaders including Village Headman, Subdistrict Headman and the Community Medical Sciences Volunteers were responsible for communication with villagers in order to adjust their attitudes in using traditional medicines inappropriately and receiving complaints about the steroids detected in the testing samples;
4) The Community Medical Sciences Volunteers had worked with family care team and SHPHs in searching for the chronic steroids patients, provide treatment and knowledge for them and follow up to make sure that those patients had completely recovered and would not use those medicines containing steroids again;
5) Health Consumer Protection Program, Chulalongkorn University had supported budget, provided technical information and worked in collaboration with DMSc in development of database of the “Single Window Product Alert” as well as supported the budget for training of Community Medical Sciences Volunteers;
6) Queen Sirikit Health Center Foundation had announced its policy to extend results of Na-Muang Model to all 90 Health Centers under the Foundation across the country.
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8. What were the most successful outputs and why was the initiative effective?
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The important outputs of this project were:
1) Community leaders and villagers living in Subdistrict Na-Muang including vulnerable citizens have received the information and knowledge and were well aware of the health hazard of steroids containing in traditional medicines. The communities were empowered under auspices of DMSc and local government in surveillance and risk management of traditional medicines containing steroids. Moreover, the community had declared their public policy for all local merchant to stop selling these high risk products and investigated all peddlers coming in their community.
2) “Na-Muang Model” as the community empowerment model in solving problems of the communities by using the concept of community participation under this system could be modified accordingly to type of problem, life style and attitude of the population in each area. The community could follow this model by using its own budget, human resource, and mechanism of social control appropriately and efficiently. Fourteen Unsafe Product Alert Centers were established. Three Community Medical Sciences Volunteers from each of 14 villages were trained and have worked on surveillance and screening of steroids in consumer products in their community.
3) “Na-Muang Model” had been applied in other rural areas. Ninety Health Centers had established the system following “Na-Muang Model”. Besides extending results of “Na-Muang Model” to broader area, they were also extended to the surveillance and risk management of other health hazardous agents such as antifungal in fermented vegetables, formalin in seafood, ammoniated mercury in cosmetics, etc.
4) The people and relevant organizations could access to the information of unsafe product alert via many communication channels including appropriate public media established by the community, “Single Window: Unsafe Product Alert” application via mobile phone and internet. Database was established. Trend analysis using the database was used in planning of future surveillance and solving problem in time. Moreover, the regulator had used the information from “Single Window: Unsafe Product Alert” in investigation and arrest of the person who produced traditional medicines illegally in many provinces such as Khon Kaen, Kalasin, Maha Sarakham, Nonthaburi, etc.
5) Sixty six out of 67 patients (98.5%) on chronic steroids found in Subdistrict Na-Muang had recovered and no new patient was found. Alternative traditional medical services in order to replace use of traditional medicines containing steroids were developed. These included pain reliever using five parts of Senna siamea formulation and rehabilitation of the patients by Thai Hermit Exercise.
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9. What were the main obstacles encountered and how were they overcome?
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The main obstacles encountered and the performances to overcome them were:
1) Attitude adjustment of community leaders and villagers to stop using traditional medicines containing steroids required appropriate communication skill. The communication in the area of medical sciences technology to the villagers who had no background knowledge in this area was very difficult. Therefore, the person knowledgeable in the local culture was assigned to communicate with community leaders. Then, the community leaders convinced the villagers to participate in design of their own system suitable for solving problems in their community.
2) At the beginning, establishment of networking moved very slowly because all stakeholders did not understand the importance of this project and did not provide any support. The scientists from the 8th RMSC had to provide them periodically with the actual evidences from laboratory surveillance and explained them about importance and benefit of this project. Negotiation and agreement on sharing responsibilities and budget appropriately to work together efficiently was also done.
3) Although the technique in using DMSc test kit for screening steroids containing in traditional medicines was very simple, most of Community Medical Sciences Volunteers had no basic scientific knowledge. Therefore, the community had no confidence in their results of the steroid screening. The training course and competency testing for these volunteers had been established and implemented by DMSc to increase confidence of the volunteers and to build the community trust.
4) The villagers did not want to stop using traditional medicines containing steroids because these medicines could relief their pain quickly and they were not aware of their deleterious effect. Therefore, in order to provide the villagers the other affordable and effective treatment options, DMSc and Na-Muang SHPH had developed the other pain relief methodology using local medicinal plants and Thai Hermit Exercise.
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