Questions/Answers

Chronic diseases are not only the leading cause of death and disability, but it is also increasing demand for health care and driving up costs. The number of people with chronic diseases in Tambon Tha Kha has been increasing every year. In 2017, chronic disease patient ratio was 174.4 per 1,000 population. In fact, 2.57 % of those patients were no longer perform the daily routines and only waited for care from health professionals, while the number of health professionals was limited. As a result, the patient mortality rate was 2.58 per 1000 population. In Tambon Tha kha context, a flea market is the place to buy consumables as well as a community assembly point. Therefore, the proactive outreach at the flea market was implemented by engaging community at all levels (community, household, and individuals level) and targeting 3 groups of population (normal group, risk group and illness group). Additionally, the proactive implementation applied 3 measures: health literacy, motivation,and Behavior modification to (1) reduce the risk of chronic disease; (2) reduce chronic disease patients; (3) provide coverage healthcare services for chronic-disease patients; and (4) minimize the mortality among population.

This proactive outreach at a flea market is linked to Category 1 (delivering inclusive and equitable services to leave on one behind). This initiative was developed and implemented according to Tambon Tha Kha context. Health professionals provided the proactive outreach and educated people at the flea market. Moreover, a public participation strategy was used as a key strategy to grow a healthcare network to take care of patients in every households. More importantly, a nearby-home clinic was established to provide equitable health care and reduce death of chronic disease patients.

The proactive outreach at a flea market is aligned with sustainable development goal No.3 (good health and well-being). This initiative engaged and empowered the community to develop the health promotion and chronic disease prevention. This initiative provided proactive outreach to increase healthcare-service accessibility of population and brought clinic to home to reduce deaths in chronic disease patients. This proactive model was not only improving the quality of life of the population, but it was also building community’s capacity for self-reliance and sustainability.

The proactive outreach at a flea market increased healthcare service accessibility according to Tambon Tha Kha context. This initiative was implemented between 2015 and 2018. The study found that the healthcare service accessibility of population covered 96.68 percent; none of new chronic-disease patients and none of patient’s death without receiving care from health professional were found. Fortunately, there was a considerable decrease in risk of chronic disease patients. For instance, the risk group for high blood sugar reduced from 10.70% to 7.20%; risk group for hypertension decreased from 42.63 % to 10.98%; the waist circumference over standard group reduced from 66.34% to 39.25%; and the body mass index (BMI) when compared to a standard group decreased from 57.78% to 37.44%. In a comparison to other patent groups, the healthcare expenditure of chronic disease declined continuously in every year, the decline percentage of health expenditure between 2015 and 2018 were 10.71, 9.90, 9.78 and 9.78, respectively. The initiative was successful and received a great response and support from community. Moreover, the local government contributed yearly budget to support this intervention and this can ensure the sustainability of the initiative.

The proactive outreach at a flea market was a systematic innovation to prevent local population in Tambon Tha Kha from chronic diseases. Nowadays, health behavior has been changed over time and the flea market played important role in daily life and became as an assembly point of the community. Therefore, the flea market was selected to be the place to provide healthcare services as well as health education. This involved religious beliefs to motivate family in a change of health behavior. This would lead to healthcare policy-driven in community at all levels.

This initiative was innovative process covering all levels. Firstly, community level, namely “flea market for good health” which aimed to increase the access of health information and health service by using community participation. Secondly, family level, namely “disease-free family” which involved religious beliefs to motivate family to adjust their behavior. Lastly, individual level namely, “bring clinic to home” was a medical multidisciplinary team providing care at home towards chronic disease patients. This was not only providing holistic healthcare accessibility, but it was also building the capacity of medical multidisciplinary team.

The information of this initiative was continuously collected throughout 4 years of implementation (2015-2018). The study conclusion was presented as “Routine to Research (R2R)” and disseminated to 50 Tambon health promotion hospitals in Samut Songkhram province, 3 provinces nearby and relevant stakeholders. In 2018, this initiative was awarded from The Ministry of Public Health as the best practice in chronic-disease area and received the Public Sector Excellence award, Public Sector Service, Service Development, outstanding level. Additionally, the report was published in several journals.

The committee were appointed to ensure the initiative sustainability which consists of family representatives, health volunteers, representatives from both government sector and private sector. The resource was basically contributed from the community. The development model was introduced in both short-term and long-term budget plan of Tambon Tha Kha’s national health security local fund. To ensure the quality and sustainability of services, significant activities were carried out as follows: reviewing proactive outreach monthly to improve services, following up patients by using individuals’ health report and systematic support medical multidisciplinary team to provide holistic health care.

The initiative was developed and covered 5 elements: quantity of work, quality of work, period and workforce, satisfactions and community economic. This development model was implemented as a prototype research and development project of a chronic disease surveillance system, health behavior changes, increasing effectiveness and sustainability of the measure. This development model adopted several crucial concepts which were Knowledge Management (KM), Sustainable Community Development and Public-Private-Partnership (PPP). The Sufficient Economic Philosophy was applied to minimize expenditure in both public sector and household. Additionally, community was engaged to take care of community and create social measures to ensure appropriate environment for patients in a family.

Yes

The proactive outreach served key performance indicators regarding coverage chronic disease screening. Therefore, this initiative was officially assessed by the local government annually as a funding organization. In addition, this initiative was also officially assessed by The Office of the Public Sector Development Commission (OPDC); and it was awarded with public sector excellence award in 2016.

Health screening coverage rate was 96.68%; none of new chronic disease patients were found. The results also found the decrease of risk group in 4 chronic diseases: 3.57% high blood sugar; 31.65% hypertension; 20.34% body mass index over standard; and 27.09 % waist circumference over standard group. Of all population, 49% had good health literacy. The accessibility of healthcare rate was 88.20%. 68% of population, as a consequence, decided to behave according to health promotion recommendation. The overall of health literacy was 56.60%, health behavior according health promotion recommendation was 56.40%. Additionally, percentage of household-free of chronic disease was 47.80%.

The impact of the proactive outreach provided the coverage healthcare services and equitable healthcare accessibility. The population was encouraged to change health behavior for better health status. There was no new chronic disease patient and the death rate of chronic disease patient decreased. The quality of life of chronic disease patient was on a rise while the healthcare expenditure was in a fall.

The proactive outreach implemented collaboratively with relevant stakeholders. The different stakeholders played different roles in order to achieve the initiative’s goal. First, health professional provided health education. Second, the local government funded the program. Third, the venders in the flea market were engaged to establish social measures for taking care of population. Fourth, health volunteers were a crucial network in community providing care covering 1,232 households. Fifth, a temple likewise played an important role in bringing religious beliefs into family by using disease-free household as a symbolic to motivate people. Finally, the population in Tambon Tha Kha, who participated in every process until decreasing the risk of chronic disease eventually, were the key stakeholders. The collaboration of all stakeholders in community created innovation and sustainability.

The proactive outreach at flea market was the health promotion model. This initiative was developed to serve population needs according to the community context. The community participation was the main strategy to build community network, develop intervention, gather budget and resources and implement throughout the whole process to achieve the goals. This created healthcare service innovation covering at all levels (community, household and individuals). The significant concepts of this initiative were to improve equitable healthcare accessibility, develop the good health promotion system, health prevention and improve the quality of life of population.