Questions/Answers

As a result of congestion in the hospital, inadequate numbers of patient beds, topographical characteristics of the island (a total area of 252 square kilometers), more than 300,000 non-registered population (Thai and foreigners), insufficient public health services (one of 120 beds government hospital and four of private hospitals) for increasing rate of chronic diseases, travel inconvenience to receive medical treatment at some remote hospitals, high cost of treatment at private hospitals, insufficient treatment and difficult access to public health services; therefore, the executives of Koh Samui Municipality and relevant agencies have collaboratively established goals and visions for proactive medical services by focusing on building human values and strengthening community health under the name of "Ten Thousand Beds Hospital Project" (the Project), and integrating collaboration between the government and civil society sectors and village health volunteers. Three main responsible agencies include Koh Samui Municipality, Koh Samui Hospital and 9 sub-district health promotion hospitals (sub-agencies of Koh Samui District Public Health Office). The Project has collaboratively and effectively utilized available resources to provide medical treatments and services at home for disadvantaged people, particularly chronic patients, incapable to do self-care patients, and capable to do basic self-care patients. Residents in the area are visited by medical and multidisciplinary teams to provide consultation and knowledge regarding health care practices. Therefore, healthier life and better physical health of residents in the area have been obtained. In addition, congestion at hospital and insufficient public health personnel, and expenses for medical treatments have been reduced. Furthermore, standardized and equal health care services have been accessed by residents in the area.

Category 2: Competency Enhancement of Government Agency for Achievement of Sustainable Development Goals The Project is implemented under the SDGs to solve health problems. The policies on proactive health services are established and the level of well-being is raised. The collaboration approach of government agencies is employed for health care. Data management technology of various government agencies on a government platform is utilized as a searching and consultation tools in the pattern of a health network. The mechanisms for participation in planning, preparing and evaluating the performance of the Project is also established for the greatest benefits.

Goal of Sustainable Development Agenda No. 3: Good Health and Well-being; Ensuring healthy lives and promoting well-being for all at all ages by supporting healthy lives and well-being for all persons at all ages (Indicator 3.4) by 2030 as well as providing proactive public health services to residents of all households. Goal of Sustainable Development Agenda No. 5: Achieving gender equality and empowering all women and girls (Indicator 5.6); Providing proactive medical services, knowledge regarding health care and proper health care of patient at home and ensuring all target groups (male and female) receive equal medical services. Goal of Sustainable Development Agenda No. 17: Strengthen the means of implementation and revitalize the global partnership for sustainable development (Indicator 17.17); Integrating resources, governmental public health agencies in the area, public health networks, private sector and civil society.

Implementation guidelines to achieve sustainable outcomes Social Dimension - Establish an engagement mechanism by establishing MOU; - Promote knowledge management for personnel and health networks; - Develop a health security fund by supporting civil society organizations to conduct public health activities; - Build a strong family institution by organizing activities to provide education and understanding among family members; - Build strong networks of community organizations for awareness of “belonging”. Economic Dimension - Raise fund resources from governmental agencies; - Empower people to be independent. Environment Dimension - Promote knowledge on environmental impact management in accordance with the patient's home context.

The outcomes of the Project have collaboratively established policies and visions as “Building Human Values and Strengthening Community Health”, promoted leadership of personnel with visions, values and culture on collaboration, participatory governance, and good governance principles. It also focus on development of efficiency and good governance of government agencies with clear procedures, processes and methods of work to allow follow up for decreasing of problems regarding regulation, administration, or services of government sector. The Memorandum of Understanding (MOU) has been established between municipality, hospital, public health district office and public health networks to create system on health care for patient with chronic diseases, people with disabilities, the poor, disadvantaged people, and socially vulnerable groups. Patient homes are used as major base and mechanism to promote equality, equal and inclusive access to public health services where all people, genders, and ages have equal access to services. In addition, the implementation also enhances knowledge, understanding, and awareness regarding participation of communities, families and patients which creates networks of social care support system.

The Project is aimed at providing proactive health services, raising the level of well-being. It is intended to provide medical services at home, promote knowledge and understanding regarding overall health care and health care for specific diseases. Health care for each type of patient is properly conducted without any limitation or discouragement. Everyone can equally and thoroughly access to the services to achieve the goal of “Building Human Values and Strengthening Community Health”.

Target groups: It include elderly groups, people with disabilities, psychiatric patients, and disadvantaged people of all ages. Patients are classified into 3 categories; category A (incapable to do self-care), category B (capable to do basic self-care), and category C (capable to do self-care). These patients are visited by physician, nurse and multidisciplinary teams. They are advised, provided with right knowledge, supported with equipment required for health care, monitored and prevented complications from illness, received proper physical and mental rehabilitation continuously which resulted in security, anxiety relief, better physical health and well-being of the patients. Impact on families: Decreasing of travel expenses, time for regular occupation, and decreasing of impacts on economy household. Positive impact on government service agencies: Reduction of patient congestion at hospital and expense of government sector. Positive impact on communities and societies: Disadvantaged patients can be capable to do self-care and live happily with communities. They are not considered as dependent groups. Families and communities collaboratively provide health care and no one will be left behind.

Implementation Methodology 1) Survey target groups in the area conducted by health networks (sub-district health promotion hospitals, village health volunteers, and community leaders). 2) Conduct public relation for registration of target groups. 3) Target groups are divided into 3 categories 3.1) Category A: Bed-bound patients that incapable to do self-care. 3.2) Category B: Bed-bound patients that capable to do basic self-care. 3.3) Category C: Chronic patients that capable to do self-care. 4) Management Methodology 4.1) Management of normal target groups using proactive medical services conducted by physicians and multidisciplinary teams on a regular basis at home as planned schedule for visiting, monitoring and evaluating in comply with the implementation procedures and processes. 4.2) Management of minor risk groups in comply with the treatment guidelines for each type of patient. 4.3) Management of severe abnormality (emergency) groups conducted by transferring to the hospital in the area 24 hrs a day. 5) Monitoring and Evaluation 5.1) Survey on service satisfaction of patients, relatives, and relevant parties found that the average level of satisfaction is high. 5.2) Meeting between service teams for improvement and development of work. 5.3) Koh Samui Municipality entered a contest for selection of good governance of local government organization on the fiscal year 2020 for large municipality (general category) by submitting outcomes to the Office of the Permanent Secretary (Office of the Prime Minister), the Office of the Decentralization to the Local Government Organization Committee. Koh Samui Municipality is awarded 1st prize with 4 million THB and trophy for honor and praise announcement for achievement of public administration. It brings pride and encourages personnel and networks for the future sustainable works.

Insufficient medical personnel, lack of knowledge and expertise of health personnel solved by collaboration between Koh Samui Municipality, Koh Samui Hospital and Koh Samui District Public Health Office. - Koh Samui Hospital is responsible for supporting of multidisciplinary and physician teams. - Koh Samui Municipality is responsible for remuneration payment for attending of physicians and arrangement of vehicles with drivers for teams of site visit. - Koh Samui District Public Health Office is responsible for supporting of public health personnel and networks, participating in the site visit and supporting technical issues regarding knowledge management for personnel of the Project.

It is an innovation of health care at home for the target group of patients with stable condition by integrated collaboration of public health agencies in the area to increase the efficiency of access to public health services. Medical and multidisciplinary teams have visited, treated, promoted, prevented disease complications, as well as rehabilitated physical and mental health for socially disadvantaged patients. It also helps to reduce congestion at hospital. Hospital can provide timely service to patients with critical condition reducing mortality and provide more access to public health system.

It is inspired by the concept of successful of the operation of the National Health Security Office (NHSO) which is the innovation of health system of Thailand in promotion of public participation in health care from various sectors in the society. Local government organizations are main mechanism to collaborate with agencies and local health networks in finding problems and needs of people, participating in planning, promoting self-care of people with the support of the agencies of the Ministry of Public Health regarding knowledge and technical issues on public health.

Data on general history, visit history, treatment history, coordinates of type and location of patient of the Project are recorded on website platform at the data center of Koh Samui Municipality. Personnel of the Project and health care units as well as interested parties can access using unique login account to save, search and use for further planning of public health management in the area.

Koh Samui Municipality participated in the organizing exhibition of “Ten Thousand Hospital Beds Project” at the award ceremony for excellent performance of local administration organization (fiscal year 2020) on 23rd September 2020 at Miracle Grand Convention Hotel, Bangkok to disseminate outcomes to other local administration organizations, interested parties, and mass media. The exhibition booth got attention with large of number of visitors. Office of the Decentralization to the Local Government Organization Committee conducted live broadcast of exhibition on online media for interested parties in the country and international parties. Local administration organizations in Thailand who have policy on public health and development of quality of life of people in the area can employ this innovation to create sustainable development. Koh Samui Municipality has disseminated the project on social media of municipality (website, YouTube, and Facebook). In addition, Chiang Mai Municipality took 70 personnel of Chiang Mai Hospital to visit for discussion and learning regarding the operation of knowledge management of the Project on 19st September 2020.

Koh Samui Municipality can transfer or apply knowledge in the operations with other contexts as follows. 1. Knowledge transfer regarding operation system of the Project 1.1 At local, regional and national meetings. 1.2 Participate in arranging local, regional and national exhibition with other agencies as well as provide assistance and recommendation to interested parties as role model in their operation. 2. Model and concept of operation system of the Project are applied for other operations; waste management in the community; with consultation of networks in the community to determine role in the operation. Koh Samui Municipality is responsible for establishment of system, support of personnel and equipment, as well as establishment of health security fund which is main innovation of local health system with people from various sectors of the society. Koh Samui Municipality is an important mechanism for collaboration with various groups, agencies, organizations particularly public sector to support the budget for the operation of the Project, health promotion, illness prevention, primary treatment and rehabilitation of the people.

Annual average budget of 1,000,000 THB is used for purchasing budget for medical supplies and equipment (bed, air bed, and wheelchair) for better living of patients, remuneration budget for physicians and personnel after hours of patient visit, and potential development (training and study visit). Human resources consist of 2 physicians, 2 Thai traditional physicians, 2 nurses, 2 physical therapists, 9 personnel, 900 village health volunteers, and 118 community leaders.

Policy of Organization Dimensions: The executives have established policies based on needs of people. The project has been driven since 2009 to present with participation principle in preparation of MOU. Leadership with visions, values and cultures of collaboration of personnel has been built. Clear procedures, processes, and method of operation have been employed to allow monitoring and evaluation resulted in reduction of problems regarding regulation, public administration or services. Economic Dimensions: Use of government resources can minimize expense with maximum efficiency and effectiveness.

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External evaluation by Office of the Permanent Secretary, Office of the Prime Minister to evaluate whether the outcomes are innovative with development, improvement and transformation of procedures, processes, and methods used in public administration for public health. Resources of various government agencies have been collaboratively utilized for administration and integrated cooperation to allow access and receipt health services at home. It increases efficiency of performance, cost-effective work, and build health system for benefits of people resulted in sustainable development of quality of local people life. Internal evaluation using survey and interview method to evaluate the satisfaction of users.

External evaluation conducted by using evaluation criteria for selection of good governance of local government organization. Qualified outcomes shall meet the flowing evaluation criteria. 1. Good governance (60%) based on proportion of integrity and transparency (ITA) and efficiency (LPA) and public administration (minimum indicator and target value of the standards for public administration) 2. Project evaluation (40%) Internal evaluation consists of the following indicators 1) Proactive health services delivered to everyone's home 2) Reduction of expense of patients and relatives 3) High level of satisfaction 4) Reduction of congestion at hospital

The utilization of resources of various government agencies for administration and integrated cooperation with signing MOU on provision of health care services increase efficiency of work and build sustainable public health system. The evaluation and recommendation from the committee resulted in improvement, development of administration, and better public services. As a result of 1 prize award, the Project is widely known. People in Koh Samui are interested to be a member of the Project. In addition, project personal and networks are proud and encouraged for better work and project development. Koh Samui Municipality plans to utilize 4,000,000 THB award for project extension and development (e.g. purchasing vehicle to transport patients) to be facilitated and adequate for the project operation. In addition, the outcomes will be extended by disseminating the model of innovation to interested parties and extensively used as guidelines for provision of health care services which will deliver better development of quality of life of people.

Involvement of relevant sectors 1. Government Agencies - Koh Samui Municipality is responsible for project management, budget supporting, purchasing medical equipment, facilitating arrangement of vehicle and personal for site visit. - - Koh Samui Hospital is responsible for supporting of medical personal and multidisciplinary teams for treatment, consultation during site visit. - Koh Samui District Public Health Office is responsible for supporting of public health personnel and academics, technical support, and knowledge management on public health. - Nine Sub-district Health Promotion Hospitals is responsible for supporting of nurses and public health officer to participate in site visit. 2. Private Sectors - Private hospitals, establishments, hotels participated by supporting of health services, educating and donation of equipment. 3. Public Sectors - Thirty-nine village health volunteers is responsible for site navigation and participating in site visit as well as act as caregiver in the area. - Ten senior citizen clubs is responsible for site navigation and participating in health care provision in the communities. - Local people are responsible for conducting public relations on project operation and donation of equipment.

Koh Samui Municipality has established policies on development of quality of life of people in compliance with strategic framework for health development as specified in the National Health Development Plan to achieve goals of the 2030 Agenda for Sustainable Development. Three main agencies; Koh Samui Municipality, Koh Samui Hospital, and 9 sub-district health promotion hospitals are collaborated under the vison of “building human values and strengthening community health”. Meetings are conducted to plan for problem solving, state the work process, monitor and evaluate, drive the project for better well-being and physical health of people in the area. It also reduces congestion and use of bed in hospital, insufficient health personnel, and treatment expense. People can equally access to the standardized health care services. In addition, it promotes the participation process of community (e.g. community leaders and village health volunteers) in the site survey resulted in extensively access to correct target groups to provide assistance, follow-up, advise for work development and service satisfaction.

Lessons learned is involvement of people in the community for the survey of target groups, contact, navigation for site visit resulted in access the area and problem solving thoroughly and meet the needs of patients. Proactive health care services provided by patient visit teams can find illness caused by environment conditions, context, and real life of patient. Thus, problem analysis, recommendation, assistance provision can be comprehensively conducted. In addition, volunteer care for assisting and monitoring can provide continuous assessment of health status. Integrated collaboration applied for work promotes learning and potential development of personnel. Exchange and sharing of problems, obstacles, and experiences both inside and outside the area, consultation, recommendation on work and proposed rectification between colleagues are conducted. In case of patients want to consult with physicians regarding specific health issues and physicians are not at site. Phone call is used for consultation between patients and physicians. If personnel encounter problems at site and problems are solved, sharing of experience to colleagues is conducted and can be used as work guideline.