Questions/Answers

“Suksala” - Cooperative Mechanisms for Increasing Accessibility to Primary Health Care or The Suksala Project - is an innovation focused on enhancing capabilities of first aid rooms of border patrol police schools, childcare centers, and non-formal and informal education centers, and developing them to become primary health care stations. Each station is called a “Suksala”. It is a medical and public health service that is not under the Ministry of Public Health and aims to increase accessibility to public health services for all people in the areas. Suksalas help all tribal people, stateless people, vulnerable people, underprivileged people, and people in various areas such as special areas with security issues, along the borders, in backcountry areas, and from neighboring countries to have access to quality basic medical services and primary health care. Suksalas aim to reduce inequality and create stability and sustainability of health and society, to provide telemedicine system for medical treatment, patient referral, and health communication, and to apply local wisdom and traditional medicine for health promotion and disease prevention for all people and communities. Moreover, the collaboration from the organizational network helps Suksalas create health and community security and sustainability which are fundamental factors of the country’s development.

The Suksala Project is an innovation aimed to increase accessibility to quality primary health care for all individuals, including underprivileged groups, vulnerable groups in remote areas, backcountry areas, border areas, and special areas with security issues to be able to access standardized health services by developing personnel’s skills and capabilities of medical treatment, health promotion, and with resource integration from organizational networks, such as personnel, budget, location, knowledge and management systems, results in technology utilization which enhances the quality of medical services.

- SDG 3 : Suksalas provide family planning services, health promotion for mothers and infants, child development and nutrition promotion for children aged 0-5 years, local diseases prevention, and health literacy for students and community. - SDG 10 : 83.3% of Suksalas are located in backcountry or border areas. 16.7% are located in special areas having insecurity concerns. Therefore, the establishment of Suksalas increase more accessibility to health services, reduce social and health care inequality by providing services for people of every age, gender, religion, and nationality. - SDG 2 : Suksalas prevent malnutrition in children and community by teaching methods on how to grow vegetables, raise farm animals, bring their meat to cook food, and put an emphasize on food with high protein to reduce malnutrition in children, families, and communities. - SDG 6 : Toilets are built in every family, and proper, hygienic usage is taught to prevent feces from contaminating water sources. - SDG 1 : Every health services provided at Suksala is free, reducing health expenses and other related expenses on travel, accommodation, food, and reducing wasted vocational time and opportunities.

Social Term: The personnel are encouraged to receive training in primary health care. Village health volunteers help provide public health services, local administrative organizations and the private sector are responsible for the budgets and resources. Economic Term: They earn extra income and reduce food costs by growing vegetables and raising animals. With medical services provided in Suksalas, they can reduce travel expenses and living expenses outside the communities. Environmental Term: Most Suksalas use sunlight as a source of electricity. Water sources for consumption are managed, and waste is separated and disposed of properly.

Suksalas provide health services that are universal, inclusive, and equal to every individual without any discrimination on races, religions and ethnicities in backcountry areas, border areas and special areas with security issues by providing and developing primary health care with health service standard. Suksalas improve the quality of many medical aspects such as public health services, health promotion, disease prevention, rehabilitation, and consumer protection. Information technology is utilized to enhance the efficiency of medical services, such as telemedicine, communication via social media platforms, and medical and health records in electronic medical records. The Suksala Project develops the governance and administration systems, develop the consultant and mentor system which takes care of various medical and public health services management and provision. For instance, district hospitals are responsible for directing, monitoring, and mentoring on medical treatment, patient referrals, and personnel capability development. Subdistrict health promoting hospitals and the medical division of the Border Patrol Police are responsible for supervising, monitoring, evaluating and serving as mentors on health promotion and environmental management in each area. Local administrative organizations and the private sector support budgets and other resources.

For service recipients, Suksalas provide primary health care services to people of all genders, all age groups, both inside and outside the places. They focus on maternal and child health promotion especially the care of women after childbirth and newborns, which can reduce maternal and infant mortality and low birth weight. They provide home health care for the elderly, handicapped, vulnerable and disadvantaged in the community. For personnel, Suksalas provide opportunities for all genders with the required qualifications to apply for various positions such as nurses, Suksala health workers, village health volunteers, etc.

The service recipient group: Since 2008-2021, they had provided medical treatment for patients and other health care services 294,378 cases, which the average of 21,027 cases per year. In addition to primary health care, the services provided were: - Patient referrals 1,952 cases. - Family planning 9,778 cases. - Maternal and child health promotion 1,945 cases, deliveries 244 cases. - Measuring and promoting growth and development of children. – Health checkup for students twice a year – Promoting and demonstrating vegetable cultivation and animal husbandry for students and community. - Campaigning for health promotion, disease prevention and environment management in the community. The service providers and network groups. - All local administrative organizations have supported the budget and resources for patient referrals and health promotion and disease prevention. - Village health volunteers, student’s health leaders and community leaders are responsible for health service provision, jointly establish health learning centers and transfer knowledge to the communities, and be role models for having good health.

Guidelines and procedures: 1. Prepare and develop policies and strategies 2. Prepare and develop the standard of public primary health care services in Suksala which covers primary health care service, community health and resource management. 3. Develop the capabilities of personnel and co-workers by providing training courses to restore knowledge and practice on medical treatment and community health management, and encourage them to studying in health science courses such as nursing assistants or public health. 4. Encourage and support partners for co-providing services and management. For example, village health volunteers and student’s health leaders do primary health screening for service recipients and housewives cook food for students. 5. Follow and evaluate the performance in order to provide quality and standardized health care services to people. 6.Monitoring and evaluation by: - Subdistrict health promoting hospitals: Monthly evaluation of primary health care services, administration of drugs and other supplies. - District hospitals and their networks: Quarterly monitoring and evaluation on the resource management, personnel development, customer satisfaction and network participation. - Health Service Quality Assessment Committee: Certifying the performance once a year. - Administrative Committees: monitoring and evaluation twice a year for policies impact and the quality of life of service providers and recipients. 7. Arrange knowledge management to allow personnel from each Suksala to share their experiences and to make their knowledge and experiences benefit other personnel.

- Obstacles about belief and communication are solved by selecting staff who live in the area, develop students to become health leaders and encouraging village health volunteers to engage in daily health service provision. - For cases that patients cannot be referred by ambulance, the district hospitals will arrange the referral by a helicopter. - For patients with symptoms that exceed the capacity of personnel, they will consult a doctor through telemedicine system. - For lack of communication signal and electric power, the organizational network will support the satellite communication system and electricity from solar energy.

“Suksala” is a collaborative innovation between organizations to develop the potential for first aid rooms of border patrol police schools to provide medical treatments and manage community’s health by standards, as well as providing health care services to students and local people and being a healthcare learning centers in the communities. The Border Patrol Police manages areas and personnel, while the Department of Health Service Support allocates budget and manages the health system, and the other organizations support communication systems and solar energy electricity equipment.

The project was inspired by the concerns about the development of children and youths in the backcountry areas of Thailand, and about fulfilling the duty of the teachers who provide health care services and first aid care to students at the first aid rooms in border patrol police schools in the backcountry areas, and concerns about maternal and child health and local communicable diseases. Therefore, it became the idea of developing the potential of nursing teachers, providing adequate medicine, medical supplies, materials and instruments, and creating health systems and coordination.

- Telemedicine is used for consultation about treatments that are beyond nursing teachers and the personel’s capabilities, for patient referrals, for health learning and for coordinating. - There is online medical recording, drug and medical supplies administration through web sites. - Solar cells are used for generating electric power from sunlight.

The target areas of “Suksala” are backcountry, border and special areas with security issues. Currently, there are 24 Suksalas. In 2006: there were 9 established in border patrol police schools (6 in the western border and 3 in special areas with security issues of the southern region of Thailand). In 2014, 7 more Suksalas were established (4 in remote areas of the northern border and 2 in the western border and 1 in the southern region). In 2017 - 2021, 8 more Suksalas were established (5 in remote areas of the northern border, 3 in the western Border). There were 2 Suksalas established in 2018 that were not in border patrol police schools; each in a child development center under Nan’s local administrative organization, and in Mae Fah Luang non-formal and informal education center. In addition, the Suksala model was adopted to establish 4 foreign Suksalas to provide health services to neighboring population along the border in Umphang District, Tak Province.

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- The Border Patrol Police is responsible for budgets for personnel’s salary and compensation, construction and maintenance of buildings, equipment, drugs and medical supplies. - Local administrative organizations are responsible for budget for health promotion and disease prevention. - Department of Health Service Support is responsible for budget for health services improvement, monitoring, evaluation, and knowledge management. - National Telecom Public Company Limited (NT) is responsible for information technology system. - Department of Alternative Energy Development and Efficiency is responsible for electric power system. - The private sector supports other budgets and equipment.

-To raise funds and gather resources continuously and perform duties systematically and provide more chances to people and organizations to participate in the project. - Personnel and stakeholders are local people who are willing to engage in the development of their families and communities for better quality of life. They are also supported for study in health sciences. - Medical Treatment and Health Service Standard of Suksala is used as a tool for development of health services until the results of the performance occur concretely. -Telemedicine is used as a tool for communication and consultation on treatment, referral.

Yes

1. Evaluate the quality of health services of Suksala by the following processes 1) Each Suksala conducts a self-evaluation. 2) The site visit committee visits and analyzes the area and presents the result to the service quality assurance committee. 3) The service quality assurance committee considers and reports the result. 2. Evaluate the satisfaction of Suksala’s service recipients by distributing questionnaires, analyzing and summarizing information. 3. Evaluate the performance annually by the Department of Health Service Support and partners by analyzing and summarizing information in a term of service categories.

There is "Medical Treatment and Health Service Standard of Suksala” to evaluate the implementation of Suksalas, which is divided into 6 categories: 1 Organization’s Objectives and Structure 2 Human Resources Management and Personnel Development 3 Implementation Processes and Procedures 4 Medicines, Medical Supplies, Materials, Equipment, Tools, Buildings, and Environment 5 Medical Treatment Processes, Patient Care, and Health Service Provision. 6 Health Promotion Processes with Community’s Participation. and other evaluation instruments, such as a self-assessment report form, an on-site visit evaluation report form, and a quality evaluation report forms.

1. People put more trust in Suksala’s services. It is found that the number of service recipients has increased with the average of 10 percent each year. As a result, there are more donation from the private sector to establish new Suksalas, the organizational network has supported resources adequately and continuously, as well as health volunteers and community leaders have assisted to provide health services voluntarily. 2. Children and students have grown proportionally and developed suitably. Protein deficiency and dental problems have decreased, as well as more children have received medical checkup and development promotion. 3. Communicable diseases including malaria, helminthiasis and diarrhea have decreased. 4. The death rate of mothers and infants, and low birth weight have decreased. Challenges include: 1. Conservation of local traditional medicine to apply in health services provision. 2. Developing community infrastructure with technology and innovations in electric power system, digital communication and environmental management. The solution is using results and challenges on sustainability to formulating the 5-year performance policy and strategy that organizations and stakeholders are able to participate in.

- Border Patrol Police: providing health services, arranging and developing personnel, administrating service areas, materials, instruments and environment, monitoring and evaluation - Department of Health Service Support: formulating policies and strategies, developing the quality of health service provision, supporting academic works and budget, developing information technology systems and providing knowledge - Local hospitals and their network: developing personnel’s potential in medical treatments and public health, being a medical consultant and providing telemedicine, referring patients, managing medicine, medical supplies and infectious waste and developing health service provision procedure - National Telecom Public Company Limited: arranging computer equipment and developing communication system, telemedicine and information technology personnel - Department of Alternative Energy Development and Efficiency: providing solar-powered electric power system. - Local administrative organizations: providing personnel and allocating budget for patient referral and public health works - The private sector: allocating the budget for building establishment and medical equipment.

1. Stakeholder engagement: The Border Patrol Police has to maintain peace and security of the country. There are also border patrol police officers who act as nursing teachers in Suksalas, By witnessing local people have easy and convenient access to primary health care, the nursing teachers and personnel are willing to continuously participate for work and development of Suksalas. 2. Resource management for maximum benefit and worthwhileness: Public health offices and local administrative organizations are responsible for health service provision, but there is the lack of personnel and service providing spaces. As a result, they coordinate with the Border Patrol Police that has nursing teachers and first aid rooms to provide the health services. 3. People as the center of development: All local people need quality and security of life, but living in the backcountry and insecure areas make those needs hard to achieve. Therefore, the organizational network provides resources and health service provision systems for those people. People especially students, community leaders and health volunteers can engage in providing health services, being a health model and passing on the knowledge to the new generations.

1. Personnel or students in the areas will be encouraged to study health science programs, such as nursing assistants, which local administrative organizations, Ministry of Public Health, and other sectors will support the scholarships. 2. A plan for teachers and personnel short course training in basic medical care, emergency care and primary health care will be implemented. There will also be a personnel replacement plan and backup plan for emergency cases. 3. The personnel will be trained continually to improve their capabilities of primary health care provision and community health management. 4. Health learning and communication center will be developed, by training village health volunteers and local healers to be community health leaders. They will be health broadcasters, health communicators and health behavior change leaders. 5. The environment will be kept conducive to good health by various means, such as the clean water for consumption, disposing of waste according to sanitary methods, and promoting organic farming without pesticides . 6. The communication system, telemedicine, and electric power sources will be improved for more efficiency and stability. 7. There will be a development in network coordination system for continuous cooperation.