Questions/Answers

From the national disease surveillance system pertaining to health effects of haze in northern Thailand, there were 826,247 haze affected patients (14,533.03 per 100,000 population). The highest health effects of haze found were coronary and heart diseases (8,291.62 per 100,000 population), respiratory diseases (5,218.89 per 100,000 population), dermatitis (521.05 per 100,000 population) and conjunctivitis (501.47) respectively. The main factors causing this haze came from human’s behavior and topography surrounded by mountains. When there is an occurring of haze situation under this kind of topography, the air pollution will be confined in the area surrounded by mountain and float into the community nearby affecting the health of people. The high risk people for the haze situation are the elderly, people with chronic diseases such as asthma, pulmonary problems, coronary heart disease, young children and pregnant women. To decrease the morbidity rate of Cardiovascular disease, Respiratory Disorders, Dermatitis, Conjunctivitis and to build the multispectral engagement and collaboration for taking care of the health of people living in haze- affected areas, we have initiated and implemented this project for the better health of our people, especially the ones residing in haze- affected areas.

This project aligned with Selected Category named Ensuring integrated approaches in the public-sector institutions. It has been implemented by the concept “HCG”. This is to say that we integrate “H” which stands for Health team, “C” for Community and “G” for Government organization together in order to jointly implement the project for alleviating health effects of haze. The main objective of the concept “HCG” is to build the network, strengthen multi collaboration, encourage people - centered approaches and enhance the efficiency of government’s implementation where people can trust.

The objective of this project aligns with SDG target 3 : Good health and well being since it aims to encourage the better health of people living in haze- affected areas with the effort to decrease the morbidity rate of Cardiovascular disease, Respiratory , Dermatitis, Conjunctivitis. 3 crucial activities implemented in the community; 1. Risk communication 2. Diseases prevention and control 3. Social measure encouraging people not to act any practices causing the haze such as slash-and-burn. Then, people can adapt the knowledge from these activities to practice in daily life for their better health and quality of life.

The aim of this project was to resolve of health haze problem in Northern of Thailand. It was designed for public health service access of haze problem and provided for all target groups, particularly those with high risk being affected by the haze (50 cases). The people-centered approach was applied in this project to meet each person’s needs including public participation in local government and related organizations. The project's outcome after implementation was showed as follows; 1. Health outcomes: the reduction of health impact of haze 2. Hotspots: active fire hotspot was not found in the implemented area, which means that there is no deforestation and waste burning in the forest. 3. Satisfaction surveys results: it was indicated that 96.2 percent were satisfied with the project as it contributed to a strong community by the community participation. Moreover, the results also found a declining of respiratory tract disorders prevalence decreased from 189 cases to 170 cases (10 percent) of the number of patients receiving treatment in Ban Hong Hospital during 2017 - 2018. It was estimated that the hospital costs have decreased by 44 percent.

The project was created as innovation process. The haze problem persisted for long time due to loss of awareness among people in haze .Therefore, Office of Disease Prevention and Control Region 1, Chiangmai has reported the data of haze affected patients and implemented people - centered approach. Active surveillance was adopted by using PM10. Community leader provides information and warn people about haze situation for follow up risky patients at home by knocking on the patients' door. The results have been extended to better the quality of people's life and lead to community self management.

This project was original concept and initiated by community collaboration. The effective and sustainable preventive health measure must be addressed by all relevant government agencies and regional communities. The community engagement was an essential element of sustainable development, as it contributes to knowledge sharing in applying to implement among their communities and result extension to other areas. There are several benefits provided by this project including reduced incidence rate of cardiovascular diseases, respiratory tract disease, skin disorders and allergic conjunctivitis.

This project was piloted at Ban Hong village having 1,400 populations and was extended to another 61 villages covering a total of 39054 populations. Office of Disease Prevention and Control 1, Chiangmai will provide a technical support, be a coach for implementation and disseminate the success of implementation through the following activities, 1. JOIN INTERNATIONAL TROPICAL MEDICINE MEETING 2017 (JITMM 2017) 2. 9th International Conference on Public Health among Greater Mekong Sub-Regional Countries at YANGON, MYANMAR 3. The annual MOPH symposium 2018

The project entitled funded by the Department of Disease Control, and supporting staffs are DDC staffs for providing disease prevention and control knowledge, soldiers, hospital personnel for patient screening, community leaders, volunteers and Chiang Mai University’s staffs. After project implementation, numbers of haze risk patients were decreased and stronger community health collaboration in a sustainable way had been established. As stronger community awareness on haze prevention and control, Ban Hong Municipality had put a Haze Management plan into its 4-year development plan (2018-2021).

Economic dimension, active case detection of haze risk patients can save time for health service access, patients can access to treatment promptly after haze risk detected from vital signs and reduce disease severity, save patient’ travel expense, and reduce service costs. In, 2018-2019, data has showed that Haze risk patients in Ban Hong Hospital had been reduced from 189 cases to 170 cases calculated as 10%. Haze risk patients visit hospital decreased from 323 times to 288 times (11%). Ban Hong Hospital had saved 44 % of its expenses for haze risk cases. Finally, quality of people’s life at the project area is getting better. Social dimension, people are proud to participate in the network for addressing the local haze problem and a strong health network had established and supported by a strong partnership collaboration that can be developed into a real community collaboration in the future. People in the network also had an opportunity for capacity building, learning together to address a haze problem. Environmental dimension, this community had launched a Ban Hong Environmental project that aimed to improve people’s quality of life, keep the air clean, pollution free and nature conservation in the area.

Yes

Success of the program can be evaluated from 1) the outcome. Progress reports and full research paper were submitted to the funder in a form of summative evaluation that reported all goals achieved of this program.2) satisfactory evaluation 3) lesson learnt of project efficiency evaluation found that haze risk patients at Ban Hong hospital decreased and numbers of Hotspot also reduced. Later, post-implementation evaluation conducted. After comparing of the output, outcome and impact, 3 benefits from this project are useful data for policy makers, upgrading project quality, reducing the risk of work.

Indicators for this project are health outcomes which are 1) reducing the rate of 4 diseases and illnesses: heart, vulnerary vascular, respiratory diseases, eye-related and skin illnesses from haze from last year 2) reduce Hotspot in the project area 3) project satisfaction rate at 96.2 %. There are 3 outcomes from the project implementation: health outcome which showed haze risk decreased, Hotspot outcome which was no Hotspot in the implementing area resulting of no incineration or forest burning.

For evaluation, outcome of this project is Hotspot did not occurred at the project area, haze risk patients reduced including those with heart and Cardiovascular diseases, respiratory disorders, Dermatitis and Conjunctivitis. After project implementation during January 2015 - April 2017, these 4 haze-related diseases and patients were reduced continually with a good signal of lower occurrence. Finally, people in the project area have better quality of life, community self-reliance, stronger community participation on health problem and lower haze risk patients.

Under this project, there are 10 main stakeholders which jointly implement the following activities; 1. Office of Disease Prevention and Control 1, Chiangmai provides stakeholders the integrated proactive disease for implementation of action engaging stakeholders to work together . 2. Ban Hong Hospital takes care of the haze affected patients, provide a database about servant, recipient and risky patient. 3. Community leader provides information and warn people about haze situation to Village Health Volunteer. 4. Village Health Volunteer follow up risky patients at home by knocking on the patients' door. 5. Local administrative organizations supports technical staff, budget, materials, equipment and law enforcement a haze coordinating center (work 24 hour/day) to provide information. 6. Military cooperates with other sectors by supporting public relations campaign to reduce haze problem. 7. Department of Forestry provides the knowledge of environmental protection. 8. Ban Hong District Office take strict measures to prevent haze and operate a hotline for haze. 9. Ban Hong District Health Office give face masks and brochure to promote haze prevention, operate house visit and support mobile health units. 10. Chaing Mai University invents a portable air-monitoring device to monitor the haze situation.

This project has 4 successful factors as follows, 1. Building a strong community leader who is willing to sacrifice and be a role model. 2. Stimulating people to realize the important of community and environmental protection. 3. Promoting sustainable stakeholders’ engagement 4. The continuing support from local organization Moreover, this project should cooperate with neighboring village to avoid haze problems from other communities. Local agencies should play a role as facilitators, leader and key actors to drive and develop the implementation based on a participatory basis between the government and other stakeholders.