Questions/Answers

The Department of Health Service Support Ministry of Public Health of Thailand has introduced “Integrated Tambon Health Management” or “ITHM” since 2010. The objectives of the initiative are to develop an innovative social movement tools and to ensure that integrated approaches are employed at both central and local levels. The guiding principles are area-based, people-centered, and sustainable health system. “Area-based” means implementation organized at and within Tambon or sub-district which is the smallest local administrative body in Thailand. In fact, Tambon is close to the people; and activities regarding health promotion, prevention, and protection take place here. “People-centered” means to mobilize all stakeholders to put people at the center of development. “Sustainable health system” means official supports from both central and local mechanisms. Participation at all levels and ‘health in all policies’ are parts of ITHM. Target groups include those vulnerable and marginal individuals such as aged people, families with low income index and people with disabilities, without consideration of race, ethnicity, religion, or any discrimination. Aims of the initiative are to deliver inclusive and equitable health services to eliminate the multisectoral determinants of health – social, commercial, and political, and to leave no one behind.

ITHM Initiative introduces and operates institutional frameworks that integrate and harmonize policies, strategies and programmes for implementation of the 2030 Agenda by fostering collective leadership, human resource capabilities and a collaborative organizational culture. The Initiative aims to support and facilitates social inclusiveness and collaboration among government agencies and citizens such as Tambon Administration Organization and Village Health Volunteers. The Initiative helps enhancing organizational performance by integrating vital government services across different agencies such as Ministry of Public Health, Ministry of Education, and Ministry of Interior and encourages use of network systems.

“ITHM” is an innovative value-based community health management for new social movement that ensures integrated approaches in the public-sector institutions from central to local partners that fairly and transparently involves all strategic partners to find solutions for health problem and to fully improve people quality of life by effective and sustainable ways. Aligned with HM King Bhumibol’s Principles of Sufficiency Economy and Agenda 2030 (Goals 3 and 17), the innovative emphasizes partnerships toward the Goals ‘Leave No One Behind.’

The Integrated Tambon Health Management Initiative has positive impacts to several groups of population, especially those vulnerable ones. For example, nearly 6.4 million elderly people all over Thailand has been registered to ITHM database. 1.3 million People of whom were categorized as house-ridden and bedridden. The initiative has been run using innovative value-based community health management and has changed the mindset of stakeholders and engage participants and delegates from all sectors. Some innovative models has been created with role transformation such as ‘upgrade nurse to be a skilled practitioner and to empower village health volunteer to be a community nurse, making a house functioned as hospital’ with an ultimate goal of self-care and liberated access to basic healthcare services. The principle of primary health care is a significant foundation promoting public participation, which is consistent to the policies of the Ministry of Public Health. To raise health awareness of the Thais, they need to change their lifestyle according to the Sufficient Economy of the late King. The Ministry of Public Health of Thailand has continuously sustained ITHM as an essential strategy of the reformation of health system.

ITHM is a policy and strategy innovation for a new social movement that helps to create and engage partners from all public and societal sectors to realize the importance of ‘Health For All and All For Health’ and ‘Health in All Policies’. The idea is to create a positive working space; to pursuit community innovations; and to create learning centers especially for dealing with social determinants of health. The ITHM has also an idea to make sure that integrated approaches for community health management be employed and sustained with alignment of the Late King Bhumibol’s philosophy of sufficient economy.

The Department of Health Service Support, Ministry of Public Health of Thailand, has developed and propose ITHM as an extension of the original 4-decade-long Primary Health Care Initiative with a distinctively new approach and unique policy implemented in order to meet the SDGs and solve problem of public concern with no one left behind. The ITHM’s innovative tools – UCARE and TPAR - has engaged all stakeholders from public and societal sectors, central and sectoral, to envisage social determinants of health and to align with Agenda 2030 especially for those vulnerable groups in remote and rural areas.

ITHM is very adaptable to many contexts (e.g., cities, countries or regions). ITHM of Thailand has been shown and shared with many health regions across the country. From 2012 to 2017 ITHM has been scaled up from 878 to 7255 tambons (more than 70% of all tambons in Thailand). The ITHM was likewise shared with several countries globally. Thailand was welcoming many countries such as Indonesia, Bangladesh, Sri Lanka, South Africa, Maldives, Bhutan and the USA to have study visits for ITHM. The ITHM has also been shared among the ASEAN under “One Health Project.”

The ITHM was partly supported by per capitation from the National Health Security Office (NHSO) under the Tambon Health Security Fund. The Tambon Administration Organizations (TAO) topped up the budget as a rule or contract of political commitment with the NHSO. These funds can be allocated for capacity building and services provision activities. Village health volunteers (VHV) are community members who committed with the principles of VHV – Volunteer, Unity, and Discipline. A Care giver (CG) is an example of the upgrade version of VHV who is trained to specialize in providing care for elderly and people with disabilities.

The Four-Decade Development of Primary Health Care (PHC) in Thailand has been time-proven as evidence of evolution and sustainability. The ITHM Initiative is the extension version of PHC with integrated approaches under the principle of UCARE (U = unity team, C = community-based, A = appreciation, R = resource sharing, E = essential cares) and apply monitoring system using 4 components of TPAR (T = team, P = plan, A = activities, R = results). The Primary Health Care Division, Department of Health Service Support, Ministry of Public Health, by implication of its name, is the example of official organization for the sustainability and passion of the Government of Thailand for this issue. The ITHM has been running with 4 fundamental principles including 1) equitable distribution of health care, 2) community participation, 3) use of appropriate technology, and 4) multisectoral approach. Evolution of the Triangle Theory, comprising 1) Committee, which were community representatives, 2) Fund which was managed by community committee, and 3) Manpower which were community members who handled PHC mission within their community.

Yes

External evaluation was systematically implement by the Office of the Public Sector Development Commission (OPDC) and won the National Excellent Award for Participatory Management of Public Sectors Years 2015 and 2016. The OPDC deployed evaluators and sub-committee to evaluate both central and local implementation. These processes also help catalyze the ITHM to strive for high quality and make more progresses of integrated approaches for every group of people.

ITHM tools, TPAR, have been used to systematically evaluate outcomes and impacts. T stands for team approach and working style. P is for participatory planning begin with data collection, situation analysis, and community action planning. A is for activity which based on life course approach. R is results. Stakeholders work together to evaluate impact on their people within the community. For example, health literacy, appropriate health behaviors, and proportion of elderly and people with disabilities who receive basic health cares are assessed.

The outcomes from the assessment were used as inputs for analysis, knowledge management, and process enhancement. It was shared as a brain bank through www.thaiphc.net. An award for the best tambons at provincial, regional and sub-national levels was granted as motivation and inspiration for expansion at the national scale. Strategic partners have been increasing with passion and in pursuit of sustainable development. Nearly 20,000 care givers were trained and providing cares for elderly across the country. ITHM can help decongest services within hospitals and can contribute to life expectancies of the Thai people.

ITHM engaged all stakeholders, within and outside MOPH, from central to local sectors, to work hand-in-hand for achievement of Agenda 2030. Participants and delegates joined and worked together from beginning with leadership commitment. The DHSS-MOPH made ITHM a clear priority for Thailand and drove accountability and provide the necessary resources and environment to create positive working conditions. Stakeholders at every level of Thailand MOPH participated and help plan and carry out efforts to promote ITHM. Thailand National Policies, programs, and practices focused on positive working conditions. The initiative ran with comprehensive and collaborative strategies. Staff from across the Ministry and from outside worked together to develop comprehensive health and social initiatives. These include the DHSS, Regional, Provincial, and District Health Offices, Health Promoting Hospitals, Village Health Volunteers, Community and Village Leaders, etc. Adherence to central and provincial regulations, as well as ethical norms, advanced people and community health and well-being with data-driven change. ITHM also engages stakeholders to monitor progress to quickly adapt and find new solutions, if necessary. Monitoring also has implications for ITHM Team long-term success and enhance visibility. All participants and leaderships recognized the important changes which can build support and sustain the progress.

Many lessons have been learned from individual champions to community innovations which were shared and learned together. They expanded and scaled up to improve quality of life for people around the country. Collaboration and coordination have been proved to be a vital working principle for future seamless system. Collective leadership with good governance and vision and adaptability to global and local health management with passion for ‘People-Centered Health Management, Self-Reliance, Liberated Access to Essential Health Services is sustainable, ensuring healthy lives and promoting well-being for all ages and leave no one behind.