Questions/Answers
Question 1
Please provide a brief summary of the initiative including the problems/challenges it addressed and the solutions that the initiative introduced (300 words maximum)
As Thailand is experience the growth of aging society, the occurrence of degenerative disease such as Degenerative Joint Disease (DJD) inevitably becomes more prevalent in the population. Despite age being the most natural common cause of the disease, poor lifestyle choice and overuse over the years also can exacerbate the onset of the disease at a younger age. Currently in the population surround our facility there are many elderly suffering from DJD with many severe cases causing immobility. Normally DJD is a chronic disease causing suffering for years and decades which without proper intervention and continuous treatment often worsen over a lifetime leading to joints deformation, stiffness and eventually incapacitation of the joint. It is one of the most disruptive diseases to a person’s quality of life; even if proper surgical intervention such as joint replacement is available the cost of surgery is for most people in rural areas far from affordable.
Fort Krit Siwara Hospital realizing this upward trend of DJD in general population and have set up an intervention program to educate the municipal area about DJD. This is done by collaboration between the hospital and local government to disperse information pamphlets about DJD early treatment and knee joint strengthening exercise program alongside clinics to teach exercise that elderly can perform at home to strength and keep their joints mobilized throughout the day. The intervention program also has follow up phases to check and reaffirm behavioural changes of elderly to promote more active and healthy lifestyle choices. From this intervention we hope to see decreases in prescription medication, less hospital visits and debilitation of this elderly population.
a. What are the overall objectives of the initiative?
Please describe the overall objectives of the initiative (200 words maximum)
1.1 For elderly population to have knowledge to take proper care of themselves and reduce risk of being debilitated from DJD
1.2 For DJD diagnosed people in the community to be able to live more independently and reduce expenses of assisted acre service.
1.3 To increase accessibility to elderly group in community
b. How does the initiative fit within the selected category?
Please describe how the initiative is linked to the criteria of the category (200 words maximum)
1.1 With the intervention program the elderly population and those having difficulties from DJD can have better accessibility through service from Fort Krit Siwara Hospital program staff.
1.2 The program will hope to provide equality in health care service and collaborative effort in rehabilitating the community from DJD from local government hospital network and local community themselves regardless of gender, religion age and race.
1.3 Local volunteer will also help communicate with the DJD elderly to bring the entire community closer to promote better well beings for DJD people through continuous care and support.
Question 2
The initiative should improve people’s lives, notably by enhancing the contribution of public services to the implementation of the 2030 Agenda for Sustainable Development and the realization of the SDGs
a. Please explain how the initiative improves the delivery of public services (200 words maximum)
For equality of service with the least limitation and maximum accessibility for people with DJD we established an collaboration between the community and local government to issue information pamphlet with information about DJD care and preventative measures to increase awareness of the disease in the community which will hopefully bring DJD patients and their community closer for better support and care throughout their life. For this project the process of community development and education starts will follow these steps we set up;
1. Start pilot study in the community before development project commence.
2. Hold gathering for community development ideas and form local collaboration.
3. Commence development and education program that suits the community.
4. Recruit volunteers to follow up on program development and awareness 2-3 times per month and evaluation by physiotherapist every 3 months for 1 year then with follow up every 6 months after
Question 3
The initiative must impact positively a group or groups of the population (i.e. children, women, elderly, people with disability, etc) and address a significant issue of public service delivery within the context of a given country or region.
a. Please explain how the initiative has addressed a significant issue related to the delivery of public services (200 words maximum)
This project was started in hope to alleviate problem of limited access to health care facility especially for those patients with DJD, which often finds great difficulty in traveling to hospitals therefore inevitably lacks proper health care and treatments. The lack of proper care and awareness symptoms of DJD in many patients can result in faster deterioration of joints and surrounding tissues which eventually can lead to immobility and impairment. It is also worth recognizing that once impaired DJD patients are also affected psychologically with great amount of stress by not being able to live actively and move.
Therefore, this project is designed to be more progressive and directed towards really delivering the care and awareness to where it’s needed rather than have the care centralized in hospitals. This project will develop all aspect of care needed for DJD patients from family, community, local authority and is done with equality which promotes sustainability of development over long period of time.
b. Please explain how the initiative has impacted positively a group or groups of the population within the context of your country or region (200 words maximum)
The program we created have created more equality for those less opportune population with DJD to have better access to health care knowledge and services. As community comes together to support their member with DJD there is a more consistent care and support for the betterment of DJD patient life quality.
Question 4
The initiative must present an innovative idea, a distinctively new approach, or a unique policy or approach implemented in order to realize the SDGs in the context of a given country or region.
a. Please explain in which way the initiative is innovative in the context of your country or region (200 words maximum)
This project is innovative in the way we transformed standard health care procedure in community to be more decentralized from hospital but achieved better, lasting and more patient oriented care for DJD patients. The project also aims to educate the general population to increase awareness about DJD and as a result giving people other than DJD patients knowledge about the disease well before they get DJD. This allows them to have much earlier intervention such as proper exercise and nutrition before the symptom appears later in life. Therefore, the program helps both DJD stricken population and also normal population that can be affected by the disease in the future acting as both remedial and preventative measures to DJD in the community.
Question 4b
b. Please describe if the innovation is original or if it is an adaptation from other contexts (If it is known)? (200 words maximum)
This project is developed in consideration of existing physiotherapy knowledge for DJD. The programs serves as a communication and educational platform so that these knowledge to treat, alleviate ad prevent DJD symptoms are made aware to the general population other than healthcare professionals. The program is also aimed towards changing people’s lifestyle so that they are at lower risks of having DJD later in life through education of proper exercise and nutrition program. Therefore, this is a novel approach to disease prevention in a community being much more proactive and decentralized from hospital.
Question 4c
c. What resources (i.e. financial, human , material or other resources, etc) were used to implement the initiative? (200 words maximum)
1. Human Resources:
1). DJD elderly patients whom we can work with and educate to treat and better their own symptom of DJD
2). Community leaders and volunteers to help disperse information and knowledge about DJD and also provide support for DJD stricken population
3). Heath care professionals to lead and hold classes for local authority and volunteers
2. Supplies and capital:
1). Krit Srivara Hospital local development budget
2). Local government meeting room and public areas
3). Community supports from local governing bodies
4). Local family and elderly adoption of the program
Question 5
The initiative should be adaptable to other contexts (e.g. other cities, countries or regions). There may already be evidence that it has inspired similar innovations in other public-sector institutions within a given country, region or at the global level.
a. Has the initiative been transferred to other contexts?
Yes
Currently out program is now awarded from the Sakon Nakhon city municipality and is adopted by many other community areas in Sakon Nakhon province. We have lectured this program to many other hospitals which results in great support and adoption rate. Currently the program has be adopted and modified to suit other local communities and hospitals such as Fort Suranari Hospital, Pon Nakaew Hospital, Ajaran Funn Ajaro Hospital, Fort Prachaksinlapakom Hospital, Fort Sripatcharin Hospital and Fort Ingkhayutthaborihan Hospital all being government or military hospital with high community involvement.
Question 6
The initiative should be able to be sustained over a significant period of time.
a. Please describe whether and how the initiative is sustainable (covering the social, economic and environmental aspects) (300 words maximum)
By decentralizing the care for DJD patients to local community members the cost of treating and exercising DJD patients reduces significantly. With community support and better understanding of the general population the knowledge of helping DJD patients and prevention will stay with the local community therefore increasing the sustainability of the program. Over time with continuous support and successful example from local hospitals that runs the program to other hospitals it is foreseeable that the program can be spread out throughout the country bringing community close and increasing awareness and care given to DJD disease. This will definitely bring the treatment cost of care and medication paid by the government for DJD patients boosting the program popularity.
b. Please describe whether and how the initiative is sustainable in terms of durability in time (300 words maximum)
The program can be run to maintain its sustainability by constant check and support from local health care professional and volunteer. The volunteer will make sure the program is being run smoothly and is well supported and have meeting and checks 2-3 times per month. Knowledge and other new technique that proves effective in one community will also be shared to other community whether its health care based of management based. The programs will also be visited by physiotherapist or other responsible healthcare professional every 3 months for 1 year and once every 6 months after one year unless more visits is needed.
Question 7
The initiative should have gone through a formal evaluation, showing some evidence of impact on improving people’s lives.
a. Has the initiative been formally evaluated?
Yes
If yes, please describe how the initiative was evaluated? (200 words maximum)
This program was evaluated and recognized by Thailand Public Service Awards 2017 committee. The program participant reports 86.64% satisfaction rating resulting in 91.25% of the family affected very satisfied with the program this percentage is surveyed by licensed physiotherapist after 3 months consecutive monitoring periods over 1 year.
b. Please describe the outcome of the evaluation of the impact of the initiative (200 words maximum)
The program was evaluated to be a valuable program which is worth implementing to alleviate DJD patients and elderly at risk of DJD throughout Thailand, and have improves the quality of life for many elderly participants. This program also helped reduce dependency to travel pain killers and drugs intake and reduced risk of being debilitated.
c. Please describe the indicators that were used (200 words maximum)
Success of the program is evaluated by physiotherapy standards such as:
1. Wong-Baker Face Pain Rating Scale
2. Oxford knee score
3. Activity of daily living
4. Interview and satisfactory survey from the affected population and local community
The result from the program showed that out of the 120 patients that is in the program 73.42% reported reduced pain, symptom severity reduced by 59.98%, activity evaluation also showed 75% increase in ability to perform daily tasks, 20 from 45 patients showed less dependency on others in daily life. The program stake holders reports great satisfaction in the program. This program will hope to form a collaboration between many government authority and local hospitals to form a more sustainable well-being promotion program is each area.
Question 8
The initiative must demonstrate that it has engaged various actors such as from other institutions, civil society, or the private sector, when possible.
a. The 2030 Development Agenda puts emphasis on collaboration, engagement, coordination, partnerships, and inclusion. Please describe what stakeholders were engaged in designing, implementing and evaluating the initiative. Please also highlight their roles and contributions (300 words maximum)
1. Elderly – Through the program they are able to understand their body condition more and were able to adopt a new life style which either helps to alleviate symptoms of DJD or lowering the risk to having DJD.
2. Family and locals – Family and community are now able to support DJD patients with the correct mentality technique and care closing the gap between DJD patients and their family.
3. Community Leaders – they are now able to lead and evaluate to see improvement in the quality of life of the elderly in their community.
4. Physiotherapist – The physiotherapists in the program are now able to disperse their knowledge in treating DJD to the community. They also do not have to wait for patients to arrive at the hospital or clinic to start treating them.
5. Local government – The local governing body are now part of the driving force to form good network to other and within their community to allow program operating smoothly and cohesively
Question 9
a. Please describe the key lessons learned, and any view you have on how to further improve the initiative (200 words maximum)
1. There is much better motivation from both the patients affected by DJD and their community when there are properly educated about the disease and were able to adopt a healthier lifestyle faster with support from each other.
2. By educating the elderly and community about DJD care and rehabilitation process that can be done easily in their home there is a significant decrease in healthcare bill for DJD, while the patients can experience same increase in comfort being treated and rehabilitated at home.
3. Having local government networks working together can builds great momentum to support a public health movement such as this program which will make it more sustainable and widespread.
4. In the future with the aid of mobile app and online media development we hope to reach more communities to educate and provide better care service.