Questions/Answers

Mobility impairment is the incapacity of individuals to use their extremities or to be independent, and if this group of people isn’t provided with rehabilitation, they will soon be bedridden, the condition that becomes family burden and brings about agony as a result of fatal complications. Unfortunately, this circumstance has occurred to many physically disabled people living in Tha Khantho Sub-District Municipality because they are unable to go to rehabilitation service in hospitals thanks to their immobility and financial problem. Therefore, what they can do is to wait for the field healthcare team that is also limited in the number. For standard rehabilitation materials allocated by the government, they are not sufficient and rare: the restriction causes deprivation and disadvantage. To increase these people’s ability to access rehabilitation service, we have devised the innovation, ‘The Bank of Innovative Physiotherapy Equipments for Individuals with Mobility Impairments’. The notion behind this project is to create participation amongst government, private sectors and community working cooperatively on helping them restore their mobility at homes according to medical standard. The ultimate goals are for them to be able to be self-dependent which could improve their life quality and to resolve health service inequality.

The teamwork contributed by Tha Khantho Sub-District Municipality and networks in establishing the innovation reflects the achievement in destroying the barrier of the inequality in rehabilitation service within unsupervised, underprivileged disabilities by supplying them with near-home service and adequate quality rehabilitation materials. This project is fueled by the collaboration of multi sectors coming together to learn the problems and brainstorm how to render the service effective, comfortable and accessible. Our subjects can manifest their information and needs; this could encourage citizens to help make a decision. At last, the rehabilitation is successful and comprehensive; moreover, everyone’s needs are equally met.

For producing 11 physiotherapy equipments, the bank employed the system of exchanging, donating and purchasing raw materials which were common and low-priced. Disabled people borrowed the equipments with knowledge of self-rehabilitation to practice at home without charge; then they could exchange the borrowed equipments needed for each rehabilitation phase without waiting like the past. During their at-home-rehabilitation period, the volunteers went to them for helping with equipment use, assessing safety and improvement and managing environment. Our system initiated the success in restoring our subjects’ mobility within suitable time period, making them be self-dependent. In succession, vigorousness, happiness and well-being came.

In 2015, Tha Khantho Sub-District Municipality has 159 disabled people, but only 27.04% of them met physical therapists for rehabilitation session; the rest of them, 72.95%, hasn’t received appropriate rehabilitation practice. Due to long distance from our village to main hospitals and lack of public transportation, 159 disabled people and their families had to rent cars, making up $3,466.17 annually. The families also had to break from work, which made them lose about $17329.70 annually. Rehabilitation equipments in local hospital are deficient and cannot be supplied to meet the needs; moreover, the equipments are prohibitively expensive for the families. In trying to send the rehabilitation team to their home, we have only 4 therapists who couldn’t handle 159 disabled people effectively, but these people needed rehabilitation session in the appropriate period of time in order to be prevented from permanent disabled condition that could expand to other organs. If that happened, they, subsequently, would face with complications because of immobility, and then they would become bedridden and die with terribly pain.

The innovation contains 3 essential elements for people with movement problems to perform rehabilitation at home: 1) economical rehabilitation materials but highly efficient, 2) rehabilitation that is precise in theories and consistent with their ways of living and 3) monitor and follow-up system. These solve the previous inaccessibility to rehabilitation service thanks to long distance, understaffing, restrictive materials as well as the insufficient knowledge. The application of the innovation leads to a reduction in the health care cost both in the system and in our subjects’ families, effective and always-available rehabilitation session at disabled people’s own homes.

This innovation is a continued project of the care for disabled people and people with mobility problems in the same area which was unable to fully provide rehabilitation session at these people’s home. The innovative physiotherapy equipment bank applies ‘supply chain management’ to the system; this effective management is involved with the flow of equipments and services from Health Care Service System to the disabled. The bank is the centre of 3 internal supply chains: 1) Purchasing prevailing, cheap raw materials as well as rehabilitation knowledge; 2) Production of 11 safe, quality rehabilitation equipments; 3) Distribution, exchange through borrow-return system.

The innovative physiotherapy bank provides rehabilitation equipments including knowledge of mobility recovery. The bank has developed 2 manuals: the manual of equipment use and the manual of the production process of the 11 innovative physiotherapy equipments made from raw materials. Also, the bank has the system of rehabilitation knowledge transition to 60 volunteers in 13 communities. Our bank has become the learning source for 22 government sectors, and become the leader in knowledge exchange in the Innovation Expo by Kalasin Provincial Public Health Office, Regional Health Promotion Center 7 Khonkaen and National Health Security Office 7 Khonkaen.

The bank had financial support from Tha Khantho Sub-District Municipality Health Security Office Fund and Kalasin Provincial Administrative Organization Fund in order to purchase production materials which were examined and designed to suit for each body’s part by hospital therapists, the nurses with volunteers who were responsible for screening and following up disabilities. Engineers and mechanics helped control the equipments’ production process for safety. There are bank staff whose tasks are to withdraw, to pay, to analyse the need of the equipments via information from users, volunteers and interdisciplinary, and to assess the equipments’ quality.

The integration of collaboration from various related sectors drives the bank operation leading to sustainable rehabilitation and care in the physical disabilities. What maintained this operation is 1) the collaboration between party networks and the disabilities in working and learning to transfer the rehabilitation service to everyone in every area, 2) there are manuals of rehabilitation material use and production for general people to be able to produce by themselves using prevailing, cheap raw materials and 3) the instruction of disability care, rehabilitation material production and their use whereby community learning, which could also construct learning habits in the community. This sustainability helped disabilities recover themselves at home systematically by way of the bank system. Finally, disabilities’ health and condition were effectively restored within familiar environment, and a sense of being burden disappeared. Their families could fully work for living for better financial background. The community had a chance to participate in every steps of the work.

Yes

This innovation has received evaluation from external organisations by these followings: 1. Kalasin Provincial Public Health Office: The evaluation of long-term care in dependent elderly and disabilities 2. Sukhothai Thammathirat Open University: The evaluation of accessibility to rehabilitation service in people with physical problems, namely elderly, disabilities and patients in rehabilitation stage 3. Kalasin Provincial Administrative Organization: The evaluation of rehabilitation fund with excellent management in disability care 4. National Health Security Office Area 7: The evaluation of the area that practiced fund management for long-term public health care for dependent elderly.

The evaluation of the innovation was carried out by both external and internal organisations in the means of quantity and quality in 4 areas: system management; service and accessibility management; evaluation and monitor; and local cooperation. The criteria were from the selection of good local management in the fiscal 2018. Besides, the evaluation of service and accessibility was based from the criteria of the evaluation of the operation potential in disability care from Provincial Administrative Organisation. The evaluation of fund management for long-term dependent elderly’s public health care was by National Health Security Office.

Based on the criteria used to measure Local Admirations with good management, the result of the Innovation is distinction in the year 2018. All 4 areas are considered excellence. According to the evaluation of the operation potential in disability care from Provincial Administrative Organisation of the year 2018 and the evaluation of fund management for long-term dependent elderly’s public health care, both awarded our work excellence. This proves that 100% of our subjects could access to the physiotherapy equipments. ADL is better in 75.59%. 88.26% reflects our success in the rehabilitation innovation leading to the presence of total services.

Tha Khantho Sub-District Municipality: The organisation has established the Bank of Innovative Physiotherapy Equipments including operation and management. More importantly, it has created the network of self-care in the community expanding to other networks in the area for the most effective rehabilitation in people with mobility problems, and it has also laid the sustainable foundation in disability care. Tha Khantho Hospital: It has a role in screening problems and is prepared to serve health services including supplying quality rehabilitation equipments and providing rehabilitation knowledge. Community leaders/Volunteers: They worked with the local in search of problems in physically disabilities and disabilities. They provided information for people who wanted to participate and went to the target location to take care of health, encouragement and environment. They also helped evaluate operation’s quality and produced the equipments for the bank. Physically disabilities and families: They worked together on planning self-care strategy and solved the problems. They had also given back their rehabilitation knowledge and experiences to the bank system, and the bank transferred this useful to other target groups. Private sector: Thai Wah Public Company Limited sponsored raw materials for innovative physiotherapy equipment production.

The collaboration contributed by state and private members, disabilities and their families in every steps of rehabilitation service in the area resulted in not only more effective rehabilitation but also the spirit and self-reliance in disabilities, their families and community. This has formed truly sustainable development in the community. Other areas could employ the equipments from the bank for their local disabilities’ advantages. The establishment of the bank with thorough system management has generated the opportunity of utter accessibility to health service.