RSC-BPP School
Border Patrol Police Bureau

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Thailand’s borders are adjacent to 4 neighboring countries and are known for their specific remoteness, wilderness, difficult transportation and high-risk security issues. They have a total length of 5,656 kilometers: 2,401 km. with Myanmar, 1,810 km. with Laos, 647 km. with Malaysia and 798 km. with Cambodia. Local people in these areas are Thai, mountaineers, labor immigrants and people living along the borders of those neighboring countries. These groups of people usually face problems of accessibility to public welfare services provided by the government such as electricity, water supply, transportation, health services etc. The quality of their lives, especially in terms of health, is relatively poor. People in these areas are faced with a high neonatal mortality rate, high maternal mortality rate, iodine deficiency and child malnutrition. Though the public health services are provided by the government in all sub-districts, there are plenty of remote villages which are only accessible to services in some seasons. It can be claimed that the weather condition is another hindrance of the accessibility to health services. Moreover, the problems mentioned above also exist in areas of high security, namely, the three southern border provinces of Thailand where people lack of the opportunity to gain the health services from the government because of poverty and fear. Although Thailand has attempted to expand the coverage of public health services to all provinces, the unfairness of accessibility to the services still existed. Apart from the problems mentioned above, the other interesting reasons are: 1. Insufficient number of health personnel and staff, particularly doctors, dentists, pharmacists, nurses and other professional staff needed to accommodate the increasing number of health problems. 2. Inequitable distribution of health personnel, including the distribution of tertiary hospitals compared with a high concentration areas such as Bangkok or urban areas, while some rural areas do not have access to public health services. 3. Low or limited potential of health personal and staff is another issue as they cannot deal with the rapid change in health problems. It is such a complex issue which requires the cooperation from other sectors and local communities. In addition, the three reasons mentioned above also lead to issues of inequality and social justice to the public services. As well as the remote area people may not access to knowledge and basic information to build up the understanding of disease prevention and treatment which causes health issues. For children, lacking of basic knowledge of hygiene may relate to being unwell physically and brain growth, while adults might face both communicable and non-communicable diseases and pregnant women cannot access ANC or delivery from disruptive and area-limited treatment or might gain unequal quality services as in the city. Furthermore, the inequality of health services may affect the nation’s economic and social long-term development.

B. Strategic Approach

 2. What was the solution?
To be a public health service place that not only provides basic health care services but also provides integrated health services. They are beneficial to children, women, border people and people in neighboring and high-risk areas. These people can access health services more conveniently and thoroughly 24 hours a day.

 3. How did the initiative solve the problem and improve people’s lives?
From the above issues, the Border Patrol Police Bureau (BPP) has established the Border Patrol Police School (BPP School) to teach Thai to these border people to ease their communication and understanding. We found that these people are at a disadvantage and are remote from welfare, the Bureau then began to take part in assisting their health and sanitation in the part not covered by the government’s services by giving physical checkup services to students and sick people in the area of the Schools by using the school’s nursing room as a service point and by coordinating with local public health officers. From her visits to remote and wild areas, Her Royal Highness Princess Maha Chakri Sirindhorn has recognized the problems of public health accessibility of border people. She has passed her idea of adjusting nursing rooms in BPP Schools to become the Royal Suksala clinics of Border Patrol Police School (hereafter, RSC-BPP School) with her determination to enable the poor to have access to primary health care service with quality, high standards and equality without exception so that they can have a better quality of life. From the above determination, government units, namely, the Office of HRH Princess Maha Chakri Sirindhorn's Projects, the Border Patrol Police Bureau, the Royal Thai Police and the Department of Health Service Support, Ministry of Public Health, the Department of Alternative Energy Development and Efficiency cooperating with the private sector, namely, students of Batch no. 46 from Thailand’s National Defense College and TOT Public Company Limited, have all taken her ideas as an operating guideline for establishing the RSC-BPP School by improving nursing rooms of BPP School, prescribing medicine and medical supplies to cover and cure the sicknesses of students and local people and by developing competency of nurse teachers, border patrol police officers who perform their duties in the RSC-BPP School to have knowledge and skills on primary nursing, health promotion, disease surveillance, prevention and control including health communicating and learning management so that the RSC-BPP School can gain the status of a health care service unit linked to local health service networks and primary health care centers. The main reasons why the people in the remote border areas are unable to reach the health service are two-fold. One is related to the physical distance. For example, hospitals are too far away; traveling to the medical clinics is not convenient; or the medical equipment and medicines available necessary for taking care of the patients in the local areas are not sufficient. Another problem is a financial one, which prevents the patients accessing medical services because the cost of a health checkup is too expensive. Particularly for the people in the border areas and remote villages, or dangerous areas, these physical and financial problems are far serious. In this respect, the RSC-BPP School has become a place where the most remote villagers can receive proper medical treatment. As a result, the clinic has encountered problems like a shortage of the number of physicians to accommodate this growing need from the people in the remote border areas. The target of the service provision of “The RSC-BPP School” is to enable students and people who lack the opportunity to access public health services to reach primary health care services both in both regular checks and in emergency cases. In addition, this enables students and people to obtain correct, suitable and updated news and information of their health in order that they can take care of themselves, their families and their community.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Since 2006, the BPP has launched the RSC-BPP School in three ways. The clinics shall be located in a permanent, separate building that concurrently accommodates the training facilities such as libraries and cooperatives. At present, there are total seventeen (17) RSC-BPP School compound. These RSC-BPP School have successfully demonstrated the following: - The RSC-BPP School has setup and developed the health service system as well as the medical treatment network through radio communication by equipping the necessary medicine and medical supplies, and this process has so far met a satisfactory level of achievement. - The RSC-BPP School has contributed to developing the human resources including the BPP teachers and therapeutics. - The RSC-BPP School provides the basic first aid, emergency service, transportation of the patients, continuous treatment of the patients and rehabilitation services, health-keeping service, hygiene of the mother and children, and disease control. - The RSC-BPP School has contributed to the development of learning centers and communications related to health conditions by utilizing various instruments and audiovisual aids. - The RSC-BPP School has developed the basic public health curricular that allows people to augment necessary knowledge and ability to take care of their own health.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The RSC-BPP School can gain the status of a health care service unit linked to local health service networks and primary health care centers by: 1) Government units, namely, the Office of HRH Princess Maha Chakri Sirindhorn, the Border Patrol Police Bureau, the Ministry of Public Health, the Department of Alternative Energy Development and Efficiency. 2) Private sector, namely, students of Batch no. 46 from Thailand’s National Defense College and TOT Public Company Limited, have all taken her idea as an operating guideline for establishing the RSC-BPP School. The RSC-BPP School facilitates these people to access to the health care services easily and thoroughly. The patients can arrange themselves for flexible services 24 hours. In the normal cases, the patients are treated and provided essential and sufficient medical supplies. In the emergency cases, the patients are treated with the system of emergency medical service as well as the referral process to the health center or hospital. The RSC-BPP School also provides a vehicle with rescue equipment and communications devices or other related technologies appropriately, along with fostering BPP teacher skills to be able to treat emergency patients. For health promotion and hygiene knowledge, BPP teachers usually take the role to communicate and convey the useful health care information to the community. Now there are 17 the RSC-BPP Schools which will be expanded toin 9 provinces. There were not less than 10,000-15,000 patients walking in medical treatment each year. Most were villagers and people of neighboring countries. The minor illness patients kept in the clinic to observe symptoms. If they are in serious condition, the health staff will contact a police officer to refer them to a regional hospital.
 6. How was the strategy implemented and what resources were mobilized?
The RSC-BPP School has the strategies in terms of establishment and development as follows: Strategy 1: To provide or improve buildings in border patrol police schools to be suitable for applying as the RSC-BPP School Strategy 2: To develop the management of health service systems to meet the expected standard and quality by procuring necessary and sufficient medicine and medical supplies for routine hospital visits and emergency cases. To develop nursing, treatment and referral network systems including telemedicine systems. Strategy 3 To develop competency of nurse teachers of BPP schools by updating knowledge refresher courses, short-term training courses and to promote them to join suitable courses and to promote them to be able to correctly practice according to the law and medical personnel licenses. Strategy 4 To manage and develop health learning and communication centers in the schools so that it can provide knowledge and news to communities. Strategy 5 To promote and support people, communities, and all parties to participate in developing and supporting activities of the RSC-BPP School by managing students and people to reach necessary news and information on health by organizing learning activities according to or additional to education courses, developing a database in order to develop health behavior, monitoring health behavior, channels for health knowledge communication, The resources used for providing services in the RSC-BPP Schools were: 1. Appropriate places or Suksala clinic buildings: the operations were carried out by improving existing nursing rooms in Border Patrol Police Schools. 2. Human resource: in the Suksala clinics, there were nurse teachers, who were border patrol police providing nursing services and primary health knowledge, health promotion and disease prevention to students and people who came to use the services; associate escorts delivered by provincial public health offices help to take care of services and knowledge and held training with local people so that they can do primary nursing and the health volunteers who assist nurse teachers on primary nursing as well as promote and support local people and communities to participate in the Suksala clinics by establishing the Suksala clinic Committee comprised of religious leaders, community leaders and local people to support the operations of the Suksala clinics. 3. Government units: In emergency cases which the local health station or Suksala could not handle, the next process runs through the coordination with several parties, namely, The BPP which was the supervising unit of The BPP School, Local Administrative Organizations and Health Volunteers. The Provincial Health Office and District Health Office had the role of supporting the development of places and buildings and coordinated to ask for support from officers from hospitals and health stations in the area to join operations assisting nurse teachers on medicine, medical supplies and vehicles for patient referral. 4. Budget: The BPP provide the financial support for buying medical supplies and medicine on an annual basis but the budget is inadequate so it requires the coordination and seeks for cooperation from the local administrative organizations and Provincial Health Offices and District Health Offices to support the medicine and medical supplies to be a match with problems or sicknesses of students and local people. 5. Technology: A Referral system was developed for referring patients from the Suksala clinics to the Health Service Unit of the Ministry of Public Health. Also, a telemedicine system network was developed to enable and receive visual and audio treatment suggestions and health knowledge teaching to local people. 6. Power source (Solar cells) Due to its remoteness, electricity is unavailable in many areas. Services and operations in the Suksala clinics mostly rely on electricity for necessary medical appliances.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Those who played an important role in providing the services were nurse BPP teachers who provided treatment, health knowledge, health promotion and disease prevention to students and people in the area of their responsibility and associate escorts provided by the Public Health Office to give support on both services and knowledge such as support on good service systems, medicine and medical supplies systems, infection control and prevention system, consultation systems, referral systems, skill refreshing training and health volunteers (local people) development in order that they could participate in providing services including having a role in giving orientation, monitoring and assessment. Provincial Health Offices and District Health Offices would take part in supporting the management, medicine and medical supplies by making the RSC-BPP School a part of the public health service network; holding training and rehabilitating knowledge for nurse teachers, public health volunteers, traditional midwives, community health officers and volunteers; and monitoring and giving orientation to local administrative organizations; building linkage of joint operations with the community both in the building structure, community leader networks, medicine and medical supplies acquisition, personnel development, making of media suitable to local conditions, provision of vehicles for patient referral and remuneration for operators. The Department of Alternative Energy Development and Efficiency advocated the development of solar energy use in the RSC-BPP School where no electricity was provided. In the private sector, students of Batch no. 46 from Thailand’s National Defense College contributed budget for building, necessary instruments and computers. TOT Public Company Limited expanded the frequency of satellite signals in the area of the RSC-BPP School and installed receivers to improve and develop communication between the RSC-BPP School and district hospitals, especially telemedicine for both video and audio channels.

 8. What were the most successful outputs and why was the initiative effective?
From 2008-2016, 131,590 people who live along the borders and in remote or risky areas have received health services at 17 Royal Suksala clinics per year. It was also found that most clients came for treating diseases of the respiratory system, followed by those of the digestive system and muscle system, dressings, skin diseases, malaria, and eye, nose and throat diseases respectively. One of the Suksala clinics which were located on high land and was difficult to access was the Suksala services of Maejunta. This Suksala had the most referral records because it was very far and difficult to reach. According to the data collection for the Suksala clinic operations from 2010 to 2016, up to 500 patients were referred, 5,912 people receiving family planning, 451 female patients came for pre-natal care and 88 patients gave birth there. In providing the disease prevention services, apart from giving medical treatment, a health learning and communication center was established by providing necessary tools and audio visual aids as well as settled as a source of health news and information which supported health learning or hygiene activities. Also, a primary health care system was developed so that people become knowledgeable and take care of themselves individually. Moreover, this promoting participation of the community and locality to have sustainable and self-reliance service on health matters. Improvement guidelines in the future: The period of developing the Suksala clinics can be divided into the following phases: Phase 1: 2006-2007, operations were for building, places, tools and instruments and teacher’s potential. Phase 2: 2008-2011, strategies for project operations and policy implementation were set. Currently, strategies for the Suksala clinics have been determined. Phase 3: 2013-2017. The RSC-BPP School will be developed to be the primary health service shelter for students and the community in remote areas thoroughly and equally. Operations of joint working units will be integrated by focusing on seeking cooperation from local working units and communities. The key factors of success were co-operation of related agencies in making the RSC-BPP School become a shelter of primary health service for students and people in remote areas thoroughly and equally, a systematic integration of network members (joint working units), management of common resources for management in the RSC-BPP School, and awareness raising of service providers to fully assist students and marginalized people on health services.

 9. What were the main obstacles encountered and how were they overcome?
Many obstacles were encountered since the operating areas are along the borders, highlands and remote areas where are far from transportation. The roads themselves are also problematic as for some areas. In the rainy season, patient referral to hospital was very difficult due to rough roads or roads destroyed by flooding. Some areas were very far away to reach and it was quite difficult to travel in order to provide the health services. There was also no suitable vehicle for referral. In the rainy season, farm trucks might be used for referral in some areas. Computers were not regularly used because users did not have enough knowledge to use or maintain them. In some areas, there were no electricity and solar energy to use which also affects computer devices and if they are broken, it will take long time to fix. To solve these problems, Telemedicine systems and telecommunications via satellite were developed and installed to enable communication so that the treatment can be provided from hospitals or the public health stations. The medical communications via satellite are beneficial for both treatment and health education to people in the marginalized areas. The project coordination center was established to support the RSC-BPP School Project in order to seek for both of the public and private networks to support service provisions of the Suksala in procuring durable articles for health services and management on health knowledge. Knowledge is delivered to computer users through the supporting electricity systems, budget, vehicles and medical equipment as well as seeking the cooperation from local people to encourage self-reliance, or even to be the health volunteers in order to support vehicles for referral, to participate in the community and local activities so that they can set their own sustainable and self-reliance on health service matters.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
According to the result of the RSC operation, it shows that the health services can be delivered not only by the main agencies such as Ministry of Health, but also by supporting from the local people as well as the community along with BPP schools. Due to the cooperation, RSC shifts itself to be the basic health service center for the local people and community totally and equally. In addition, the integration between each agency such as office of HRH Princess and BPP can foster the effectiveness and efficiency of the health service with a well-organized system. The locals tend to manage with the available resources in their areas in order to deliver the health service along with raising awareness among the service providers to run the RSC as effective as they can. This cooperation will help to decrease the gaps of inequality social welfare especially for the marginalized people to get the better life quality. There are other key factors which will enable the success of the RSC as follows; 1) Building the mutual understanding and participation among the related agencies; both of the public and private sectors, the local administrative organization and the community in order to support the RSC-BPP school. 2) Supporting the medical appliances as well as the health learning and communication center is required. The appliances, devices and durable articles are still low quality according to the setting standards. Moreover, the emergency kits, computer devices, telemedicine devices, other essential medicine should be supplied in order to match with the demand of the customers. The need analysis can be implemented to survey the basic needs in each areas in order to plan and provide appropriate facilities. 3) The development of radio communication and telemedicine for health service should be done align with the cooperation from locals which might do the survey and design operational planning to facilitate RSC to communicate or even seek for necessary assistance. The training on health service radio communication should be also provided. 4) Supporting the electricity sources. RSC still needs the electricity source and necessary devices. However, the electricity source should be considered carefully on the constraint budget as well as settle the support center to maintain the devices or train the staff sustainably. 5) In order to make the service sustainable, locals should take an important role and supported by the BPP offices and the Ministry of Health. The supportive offices can provide the locals some training or conference to build the mutual understanding of the RSC operation. 6) Training and recovering the previous knowledge and practice the manual operation process for the nurse teachers such as medicine and prescription, emergency treatment, delivery service, and support them to run the health learning and hygiene activities for schools and communities. 7) Supervise the integration of RSC development and operation from the center government and among the nurse teachers in each area themselves in order to run the services more appropriately and effectively.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Since its launch in 2006, the RSC-BPP School project is now equipped with a clearly defined framework, missions statements, areas of responsibilities, medical supplies and other resources required to undertake the project. Specified strategies to establish and develop the RSC-BPP Schools; management techniques to procure the necessary supplies and maintain health control in the villages; an educational team to setup the curricular for health learning and communication equipment to support medics are all in accordance with the RSC-BPP School’s main objectives. In addition, the project has clearly set the role of its BPP participants (schoolmasters, school medics and public health officials in nearby hospitals or public health department branches of the local administrations, medical volunteers in the villages) in order to effectively coordinate the project implementations in the RSC-BPP Schools. In the RSC-BPP Schools, there were nurse teachers, who were border patrol police providing nursing services and primary health knowledge, health promotion and disease prevention to students and people who came to take the services; associate escorts delivered by provincial public health offices helped to take care of services and knowledge and held training with local people so that they could do primary nursing and health volunteers (OrSorMor) who assisted nurse teachers on primary nursing and promoted and supported people and communities to participate in the Sanatorium by establishing the Sanatorium Committee comprised of religious leaders, community leaders and local people to support the operations of the RSC-BPP School. In emergency cases which could not be handled, coordination was done with several parties, namely, The BPP which was the supervising unit of The BPP School, Local Administrative Organizations and Health Volunteers. The Provincial Health Office and District Health Office had the role of supporting the development of places and buildings and coordinated to ask for support from officers from hospitals and health stations in the area to join operations assisting nurse teachers on medicine, medical supplies and vehicles for patient referral. These performance have made health services to cover the remote areas in which the agency of the Ministry of Public Health unable to access services. It can create fairness in access to health services in Thailand.

 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 main reasons why the people in the remote border areas are unable to reach the health service are two-fold. One is related to the physical distance. Another problem is a financial one, which prevents the patients accessing to the medical services because the payment for the health checkup is too expensive. Especially pregnant women and childbirth are lack of care that causing a high risk of death. The RSC-BPP school has become a place where the most remote villagers can receive a proper medical treatment. This has encountered the problems like the shortage of the number of physicians to accommodate this growing need from these people. This service has been coordinated with the local public health stations and the BPP teachers. The BPP has been providing medical services to the villagers who are deprived of a proper medical treatment as well as the accessibility due to the remoteness and underdevelopment of their community. Of course, most pregnant women have received more care and pre-natal care. According to the data collection for the RSC-BPP school operations from 2010 to 2016, 5,912 people receiving family planning, 451 female patients came for pre-natal care and 88 patients gave birth there.

Contact Information

Institution Name:   Border Patrol Police Bureau
Institution Type:   Government Department  
Contact Person:   Ladawan Chatthai
Title:   Police Lieutenant Colonel  
Telephone/ Fax:   +(66) 2 279 2154
Institution's / Project's Website:  
E-mail:   cladawan@hotmail.com  
Address:   1279 Phaholyothin Road, Samsannai
Postal Code:   10400
City:   Phayathai
State/Province:   Bangkok
Country:  

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