Questions/Answers

Disabled and elderly people with mobility problems who live in the countryside of Kalasin Province in Thailand face great barriers in accessing health services. Centers for home-based health services have been established to deal with the problems presented by relatively low incomes, inadequate public transportation, and the lack of other rehabilitation services in the community. The Centers provide the disabled and elderly who have mobility problems with equal and continuing access to comprehensive rehabilitation services. When the community addresses the needs of its members in a manner in keeping with community contexts, it enhances the dignity and quality of life of the population. Disabled people, the elderly, family members, members of the community, and organizations both inside and outside the community participate in promoting social mobilization for the development of a system of rehabilitation services. This helps solve the problems of accessibility to public services, lack of community awareness and participation, lack of budget, lack of healthcare providers, and issues of regarding cooperation among the stakeholders.

Delivering inclusive and equitable services that leave no one behind and applying “Community Based Rehabilitation: CBR” enhance continuing access to services, facilitate procedures, and reduce the cost of rehabilitation services. This service system provides care coverage for the target groups, including health, education, social well-being, and capacity empowerment by compassionate integration and participation of all relevant network parties in the operation of the system.

The operation of the Home Suk Centers is based on cooperation within the community network. Volunteers care for disabled people and older people with mobility problems, and their families, to help them live happily. This project encourages the community to solve other problems by itself to promote health and well-being, and enhance the quality of life for patients and their families. This innovation focuses on addressing the targets’ needs according to the community context. It is related to the United Nations' Sustainable Development Agenda 2030, goal number 3: to ensure people’s health and well-being at all ages.

There are 14,564 disabled and older people with mobility problems who need continuous care in Kalasin Province, of whom 65.70% are unable to receive it. They face problems arising from the fact that it is the third poorest province in Thailand, with an average income of 128 baht (3.88 USD) / person / day. In comparison, the average expense for going to hospital is 330 baht (10 USD) / person / visit. Moreover, there are long waiting times; as a result, patients and family members often lose one day or more of income. People are also affected by the limited number of physical therapists, with rehabilitation workloads of up to seven times the standard threshold. They are affected as well by the fact that many in society regard disability as a stigma and have negative attitudes; these include regarding the disabled as less valuable or less acceptable than others. These attitudes affect both the disabled/elderly and their families, producing a sense of decreased worthiness, of being a burden, of reduced human dignity, and reduced human happiness. To provide a happy home is the goal of organizing rehabilitation services in the community so these problems can be effectively reduced.

Rehabilitation services normally focus on hospital services, with government employees providing specialized physical care. These do not cover all aspects of the needed services and the cost is high. However, the innovation "Home Suk Centers" addresses these problems using volunteers and the strength of the Northeastern Thai community, kindness and loving compassion --leaving no one behind, to provide continuous community based rehabilitation services. By coincidence, the English word "home" pronounced in the Northeastern Thai dialect Isaan means “getting together”; in the case of Home Suk Centers, it means collaborating and getting together to use community resources to maximize benefits.

Home Suk Centers Kalasin, are an innovation applying the Community Based Rehabilitation (CBR) concept of the World Health Organization 2010 to develop a rehabilitation service system. The development process uses participation of all sectors to learn about the community and identify opportunities and obstacles, in order to address the needs of service recipients. The Centers have 5 factors for success: 1) volunteers working in the Center; 2) a convenient location for accessibility; 3) sufficient budget and equipment; 4) creation of a service-oriented and proactive model to provide services; 5) sufficient support resources and stakeholder participation in the utilization of volunteers

Home Suk Centers can be easily adapted to other areas at low cost. The Kalasin Centers have expanded coverage with an increase from 40 to 55 Centers in 2016-2018. Results are outstanding, a model for long-term care and intermediate care policy-making. Kalasin Centers provide practice opportunities for 54 physiotherapy students from 5 Thai universities. Center workers have participated as speakers in 18 lecture programs and national seminars. Many national and international groups have visited to study and apply the model to their areas. Maha Sarakham Province applied the model to care for the elderly as a "Home Hug Center”.

There are 550 community volunteers and 935 administrative committee members representing all sectors. Ten government organizations provide support; the number increases every year. The average annual operating budget is 120,000 baht / year (3,636 USD), furnished by Kalasin Province. 20,070 elderly and disabled people received services each year; the number of visits reached 97,080 visits / year. There are 9 categories of equipment which includes 16 devices applied (modified) from local materials. Equipment is used in the centers and also lent for use at home. The centers provide transportation to and from the centers and a car for home visits.

The Home Suk Centers, Kalasin, are a sustainable operation because empowerment comes from within. The Centers are operated by volunteers and stakeholders from all sectors participating in every step of the process, giving them a sense of ownership. Resources support continuous operation, addressing the needs of the target groups in the community; this maximizes the benefits to the people. Regarding the social dimensions, there is a showing of generosity, that people in society care for each other, empowerment of disabled people and the elderly. There are learning group processes, and increased income for disabled people who are employed in government agencies. Family members do not lose income because of time they would otherwise spend to care for the disabled and the elderly. This can reduce daily family living expenses and expenses for hospital visits, reduce duplication of services, and reduce the use of government resources. With the help of all sectors, home environments can be improved for the disabled and the elderly in a manner appropriate for physical rehabilitation. As a result, vulnerable groups can have improved access to services and to better quality of life.

Yes

The Centers received internal assessment from Kalasin Provincial Public Health Office. The evaluation is based on the standards Home Suk Center in each district. Regarding external agency evaluation, the centers were evaluated by representatives from Kalasin Provincial Social Development and Human Security Office; Kalasin Provincial Administrative Organization; and Disabled People's Club of Kalasin. The National Health Security Office, Region 7, Khon Kaen, evaluated the rehabilitation fund of the Home Suk Centers; the fund won first prize. The Sirinthorn Institute for Rehabilitation, Ministry of Public Health, evaluated Home Suk Centers operations which won first place in the CBR FORUMS Thailand.

The following are indicators for evaluation of the process and its outcome: 1. Every district to establish a Home Suk Center and operate with 100% coverage. 2. Home Suk Centers to meet seven operational standards for utilizing rehabilitation funds for the disabled; they are set forth under the acronym “HOME SUK”, using the initials of the English language words. 3.The target groups to be able to access continuous rehabilitation services in the community in order to improve their quality of life by at least 70%. 4. Expenses to be reduced for transportation to government rehabilitation services.

All provincial districts established Home Suk Centers and have standardized operations costing about 120,000 baht per year each to help disabled/elderly people reach and receive continuous rehabilitation services. Accessibility increased every year, from 34.30% to 77.31%, . 91.43% of the elderly with mobility problems had access to services. The project saved up to 32,036,400 baht (US $970,741) in transportation expenses. The Centers provided approximately 3,300 mobility assistance devices per year. There were 205 home and environmental modifications at a cost of 4,100,000 baht (US $124,234). Employment for 245 disabled people was found, generating total income of 2,235,625 baht (US $67,742).

Home Suk Center work is a combination of the roles and responsibilities of stakeholders. Stakeholders participate in the process of recognition, thinking, designing, implementation and evaluation. Stakeholder engagement consists of an Owner Team, a Supporter Team, and an Alliance Team. The Owner Team is composed of volunteers, the executive committee, and local government organizations. These stakeholders play a role in identifying the needs of the disabled people and elderly who need continuous care. They forward information to the relevant organizations and solve problems together. Their knowledge, skills, and material are supported by Supporter Teams. The Supporter Team consists of government agencies and organizations both inside and outside the community. Their mission is to address the needs for services and to participate in designing, implementing, and evaluating the service system in the community. Moreover, they implement the learning process and enhance volunteer spirit to promote kind and humane care for the people in the community. The Alliance Team is responsible for academic support, positive reinforcement, and recognition of good work. The teams, including universities, co-produce and apply medical devices made from local materials. All teams work together seamlessly, to go in the same direction to create a sustainable service system.

Home Suk Centers operate in the rural province of Kalasin. For success: first, volunteers in the Centers, government officials, and stakeholders must feel an ownership interest in the program to provide humane care for the disabled and elderly. This can be created with knowledge management and public recognition of work well done. Second, healthcare providers and social workers must cooperate to meet the needs of the people. Last, knowledge should be transferred to volunteers and community members to change their perspectives in looking at and solving problems, particularly access to services. Through operation of the Centers, accessibly increased 2.25 times.