Questions/Answers

Thailand already entered the full-fledge aging society; this leads to an increase in health problems among the elderly in Thailand, particularly musculoskeletal disorders affecting their movement and daily routines. The disorders also make them feel physical-impaired and depressed and imply themselves as a family burden. This is considered a great challenge for authorities to solve the problem; therefore, Banbung Municipality Office discovered a “Hydrotherapy” approach, the use of water to relieve and recover musculoskeletal problems and blood circulation system, with the objective to help office workers and impoverished people with disability along with the elderly to recover from such illnesses. A founding of public health center in the municipality and “Hydrotherapy Center” is an integration of government sector and its associates to respond to the aging society and allow impoverished people with disability to gain necessary knowledge from healthcare experts and accessibility to effective, equal, and immediate healthcare services. The initiative expected to relieve the burden of healthcare costs and achieve better well-being of the people in the community with health-promoting activities that everyone can attend.

The initiative “Hydrotherapy Center” aligns with Category 1: Comprehensive and equal service without leaving anyone behind” as its services cover all ranges of people including the people with a small amount of service fees. The initiative does not only allow a convenient and inclusive service along with the quality standards to all, but also helps clients to reduce their travel time instead of travelling to a hospital.

The initiative fully supports Sustainable Development Goals (SGDs) stated in Article 3 and Article 10. Apart from the hydrotherapy, having a healthy lifestyle and good well-being promote an opportunity for patients to recover and enhance both body and mind condition. The initiative also tightens health disparities among children, people with disabilities, and the elderly, allowing them to access the medical services by the government sectors equally. After recovering from the illness, these people would not feel as a burden of the family and be able to stay healthy and happy in their society. This initiative responds to difficulties for the disadvantaged to access the quality services with the small amount of service fees and highlights all ranges of people to stay healthy.

Social terms: The initiative forms a participatory approach by establishing a health-promotion network to support the treatment procedures, leading to the generous and courtesy society. Economic terms: The service fee of the treatment is affordable (50 THB/time). Therefore, the impoverished people and the elderly can afford to get the service. Once they regained their movements, they can earn their living, like a normal person. Environmental terms: The quality of water used in the treatment is strictly controlled in a closed system. The wastewater from the initiative will be reused in other purposes.

According to Chonburi and its community’s sustainability plan, public services are considered as fundamental rights that all people in the are shall receive even those people are children, impoverished people, or the elderly. The “Hydrotherapy Center” is the initiative that responds to the challenge of inequal access to healthcare services by granting the disadvantaged to receive the quality and standard care. Moreover, it established a collaborative network between government and private sectors to develop the elderly’s life quality to be sustainable through the hydrotherapy approach. The initiative was launched in 2018 with 5 network organizations: (1) BanBung Hospital, (2) Nuchwarin Physical Therapy Clinic (Public sector) (3) Village Health Volunteers (4) Woman Development Group of BanBung Municipal (5) Civil Defense Volunteers

The initiative responds to the gender inequality by minimizing not only the gaps between genders, but also connect all people regardless of age and physical conditions of the people. That is, the initiative facilitates everyone to access and obtain this public service equally.

Banbung Municipal has the population of 19,593 (2019); therefore the target group that this initiative aims at is 2,694 elderly people, consisting of 13.74% of the overall population in the municipal. Banbung Municipal Office addressed problems that may occur with the elderly. The Office then organized several health promotion activities, interactive health knowledge classes, and home visits by physicians. Moreover, a water-based therapy initiative, “Hydrotherapy Center”, was exclusively devised for the elderly to rehabilitate and relieve their aging diseases (i.e. musculoskeletal disorders, blood circulation, and paralysis). The initiative aims to improve the elderly people’s health by 90%.

Banbung Municipal Office has one of its key responsibilities to provide healthcare services along with health-promotion, disease prevention, and rehabilitation measures to people of all age groups. Therefore, the Office accumulated the information to conduct the assessment by using the following indicators: (1) Medical records: the record is used to record results from the patient’s physical examination as well as treatment programs and progression notes. (2) Significant qualitative aspect: This will refer to the physical therapy assessment and other international assessments to track the patient’s symptom(s). (3) Quantitative aspect: the report of a number of patients with remarkable progress of treatment according to (2). (4) Classification of diseases and level of urgency while the patient is having the hydrotherapy. This will indicate the progress of the provided treatment. (5) Comments and suggestions from the clients: these comments are retrieved from surveys and used as a crucial source of information to develop the initiative in the future. Launched in 2018, the initiative received the collaboration from every single sector with the mutual objectives to aid the elderly and the disadvantaged in health problems and promote the hydrotherapy to be a sustainable healthcare service that can be accessible and affordable to everyone with the small amount

Below were the obstacles found during the operation: (1) Insufficient physical therapists: Resolved by opening vacancies and seeking more cooperative networks to find professional physical therapists to perform duties at the center. (2) Insufficient equipment: Fixed by the community cooperation, such as donations from the community, to procure useful equipment. (3) Difficulty within clients: Some clients sometimes found that the working hours of the center did not match their arrival; therefore, the extension of working hours in weekends and holidays is a solution. (4) Lack of public relations: Solved by increasing the communication channels to reach the interested people.

This initiative is considered as a healthcare knowledge center model by using the hydrotherapy approach to relieve musculoskeletal pain as well as reduce the use of NSAIDs antibiotics in the patients. These help the patients recover and return to their normal lives. The initiative also established a health promotion network by professional physical therapists as a lecturer and a demonstrator through activities and lectures. The innovation was transmitted to other local municipal offices, government sectors, and public sectors who are interested to come and study this

Mr. Surasit Kangwonkit, Mayor of Banbung Municipal, did his detailed research and observational study at Somdet Phra Sangharaj Geriatric Hospital, Chonburi, and found that the “Hydrotherapy” is an innovative method by using water as the medium to rehabilitate and recover patient’s pain and illness. Furthermore, he analyzed several aspects to establish the center such as obstacles, needs, financial status together with personnel availability and benefits that the clients would gain. The initiative would draw attention and collaboration from organizational networks to expand to other areas and adapt its operations to other target groups.

The development of the initiative leads other municipal offices, government agencies, and public sectors who are interested in the Hydrotherapy Center to visit and do observation study regularly as well as exchange thoughts and knowledge in operating the center since the center was open on the first day. The initiative does not only impart the healthcare management to promote good health to the people in communities but establish health-promotion participatory networks. The center is capable of providing expert personnel as a lecturer and demonstrator to teach how to use devices available in the center. Currently, this initiative was publicized through several social network channels to allow other people to gain healthcare knowledge and acknowledge the present activities. Recently, Chumporn Municipal Office, Chumporn province, and Don Kaew Local Government Organization Committee, Chiang Mai province, visited and did the observational study so that they could adapt and establish their hydrotherapy centers.

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The training was organized to provide expertise and knowledge to system administrators and physical therapists who were working with the hydrotherapy. Key personnel: (1) Physical therapists (2) Personnel/Officers from the Ministry of Public Health (3) All sections of municipal office (4) Physicians and nurses from hospitals (5) Collaborative networks (Village Health Volunteers and Woman Development Group) (6) Nuchwarin Physical Therapy Clinic (Public sector) This includes materials and equipment for physical therapy, pamphlets, screening equipment (i.e. blood pressure meter, thermometer, and weighing machine). The annual budget to operate this initiative is 290,000 THB.

The initiative remains sustainable as it is a model to be learned by other municipal offices and every section who desire to increase the accessibility to healthcare services to the people at all ages. The initiative derives from the collaboration among government and public sectors and educational institutions. The curriculum “How to take care of the aging people” was open for enrollment in universities by the signing of MOU. The research was conducted to reveal the worthiness of the initiative while the ease of use and accessibility to the initiative have the assessment center to broaden the personnel knowledge and networks effectively.

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Using the Local Performance Assessment (LPA) of 80% as the criteria, the evaluation of the initiative was conducted in the category of “Local Government Organization Committee with Good Governance” and “Local Initiative Project”. Once the initiative passed with 80% or more score in LPA; it was processed to the second stage where educational institutions determined whether it passed. The last stage was assessed by the committee appointed by ODLOC.

ODLOC is responsible for selecting the “Local Government Organization Committee with Good Governance” by using the following criteria: transparency, public participation and networks, facilities, and satisfactory surveys.

The initiative was assessed by ODLOC and awarded in general category with the 3rd prize in “Local Government Organization with Good Governance” as the services execute health-promotion, disease prevention, and rehabilitation procedures; therefore, the Office accumulated the information to conduct the assessment by using the following indicators: (1) Medical records: the record is used to record results from the patient’s physical examination as well as treatment programs and progression notes. (2) Significant qualitative aspect: This will refer to the physical therapy assessment and other international assessments to track the patient’s symptom(s). (3) Quantitative aspect: the report of a number of patients with remarkable progress of treatment. (4) Classification of diseases and level of urgency while the patient is having the hydrotherapy. This will indicate the progress of the treatment. (5) Comments and suggestions from the clients: these comments are retrieved from surveys and used them to develop the personnel and the venue in the future.

In according with the initiative development, the Hydrotherapy Center becomes the healthcare educational center for an internship from Faculty of Allied Health Science, Burapha University. Besides, 5 network organizations below agreed to cooperate with Hydrotherapy Center in 2018: (1) Banbung Hospital: Provides medical teams to track and assess the clients. (2) Nuchwarin Physical Therapy Clinic (Public sector): exchanges and provides healthcare assistance according to the needs of the Hydrotherapy Center. (3) Village Health Volunteers: take care and aid in the necessary physical therapy process. (4) Woman Development Group of Banbung Municipal: coordinates with the service assessment. (5) Civil Defense Volunteers: join in several general meetings to assess an overall operation of the initiative.

All operations were conducted by the collaboration of relevant sectors and public participation through the processes below: Planning: (1) The management and personnel of the municipal determine the operational policies. (2) Operations of this initiative are derived from Somdet Phra Sangharaj Geriatric Hospital’s operating model. (3) The locals participate in voting the local development plan. (4) Banbung Hospital support the relevant information. (5) Chonburi Provincial Administrative Organization provides financial support. (6) S.S.Suan (Bangkok) Co., Ltd. provides a consultation in facility construction. Implementation: (1) Physical therapists are responsible for an assessment and screening along with physical therapy treatment and fitness consultation to the patients. (2) The Hydrotherapy Center is open to all people, including the elderly and people with disability. (3) The networks in Section 4A support the operations while the office exchanges knowledge and provides further assistance, if needed. Follow-up and assessment: (1) Hydrotherapy service users. (2) The committee of the Health Security funds. (3) Community leaders who publicize the initiative. (4) Physical therapists assessing the progress of the patient’s recovery. (5) Banbung Community Healthcare Center arranging teams of doctor to track and assess the satisfactory of the clients. (6) The management and personnel of the network municipals.

The initiative results in a success in rehabilitation and recovery in the elderly with musculoskeletal disorders as they were able to regain their movements and live in the society without a feeling of a family burden. The lesson learned from this initiative is that health-promotion campaigns along with medical treatment shall require the participation from every sector, especially the locals who ought to perform as both a decision-maker and practitioner. With these participation processes, we strongly suggest organizing health promotion funds or allocating regular budget to healthcare sections in the communities, which can further promote and develop the public health affairs. Not only the budget support, the awareness of the people toward importance of healthcare shall be considered and raised by organizing the committee elected from every relevant section. It is claimed that public participation is more significant than the allocated budget when conducting the healthcare-promotion campaigns. The better the management in health-promotion activities are, the healthier the people in the community will be.