Questions/Answers

As the COVID-19 outbreak in Thailand continues to spread widely, the number of infected people across the country is rising steadily to more than ten thousand per day causing severe shortages of hospital beds. Overflowing patients lined outside the hospital buildings. As reported by the Prachachart News in July 2021, at least 21 patients died at home waiting for hospital beds while more than 6,000 frustrating patients desperately need help in a day. Elderly people, women, children, and migrant workers are most vulnerable during the crisis. Chulalongkorn University had conducted a survey and came up with an idea to help COVID-19 patients handle this crisis by providing them with a “Survival kit” complete with essential items for their needs and the WHO guidance of home care for patients with suspected or confirmed COVID-19 and management of their contact. The important part is the Digital Platform Initiative for communication with medical personnel and volunteer while waiting for their beds. This Platform consists of 4 parts: 1) “Virtual ward” to provide online medical care for monitoring patient wellbeing, and medical reconciliation, 2) LINE-OA application for psychosocial support to the patients, stop the misinformation, and enable the community to survive the crisis together, 3) The e-learning providing video clips of knowledge sharing for better recovery. 4) The referral system & data management connected with local healthcare authorities for Emergency Medical Services. So that the transparency, accountability, and two-way communication that digital technology makes possible can help government works on behalf of citizens in ways that are responsive, efficient, fair and help restore trust in public institutions. The objective of this prototype is to suppress transmission, reduce exposure, reduce death and illness, counter misinformation, protect the vulnerable, accelerate equitable access to new diagnostics & therapeutics, and ensure that no one will be left behind.

Category 4: Institutional resilience and innovative responses to the COVID-19 pandemic. Chulalongkorn University proactively support the public in this crisis. During the first wave of pandemic through 2020, we support the Medical Center by providing innovations such as CU-Respirator, Covid strip test and Vaccine, AI, and CU-Robotics. For the second wave in Jan 2021, we provide the prototype of the Express Analysis Mobile Units to reach the underprivileged patients for active surveillance. In May 2021, the third wave outbreak rapidly spread to many provinces. Severe hospitals beds shortage made us came up with the idea of Home Isolation Initiative Platform.

The Home Isolation Platform Initiative directly contributes to the SDG3 goals and targets. By using digital platform and engagement of volunteers, the death case of Home Isolation could be avoided (target 3.3). Everyone gets universal health coverage (target 3.8), coverage of essential health services >95% (indicator 3.8.1). This program supports universal access to affordable medicine (target 3.b). The essential medicines available and affordable on a sustainable basis 100% (indicator 3.b.3). Increase health financing and support health workforce (target 3.c) by reducing unnecessary admission and workload by 83.3%, saving budget 909-1,202 US$/patient, and reduce workload 7man-hour/patient. The local volunteer home-support food and sanitation also links to SDG 1;1.3 (social protection systems and measures for all), SDG 2;2.1 (end hunger and ensure access by all people, the poor and people in vulnerable), SDG 5; 5.4 (value unpaid care and domestic work through public services), SDG 6;6.1 (drinking water), 6.2 (sanitation), SDG 9;9.1 (support human well-being, with affordable and equitable access), 9.c (access to information and communications technology), SDG 10; 10.3 (equal opportunity and reduce inequalities of outcome), SDG 11;11.5 (reduce the number of deaths and the decrease the direct economic losses), SDG 17;17.16 (multi-stakeholder partnerships that mobilize and share knowledge, expertise).

Chulalongkorn University together with volunteers collaborated with the Institute for Urban Disease Control and Prevention (IUDC), and the private sector, such as The Engine Life and The Sharpener, for strategic consultant, policy advocacy, raising fund, and technology transfer. We empower stakeholders and citizens to co-develop, with government, new initiatives, programs and services that respond to their needs. We adopted the concept of SDGs by encouraging social engagement. Women, children, migrant workers have the equal opportunity to get the best care and access to information technology. Multi-stakeholder partnerships allowing people to share opinions and decisions and join the implementation and evaluation.

COVID-19 is a crisis. The Home Isolation Platform Initiative can break down the wall of Silo Organization in Healthcare bureaucratic system by using an online approach. We empowering people, sharing information, opinion and crossover resources. Guidelines and recommendations for case management are discussed. The online applications LINE-OA, ZOOM, ClubHouse, were frequently used by our stake holders for education, monitoring and evaluation. The transparency of two ways communication can create trust, fairness, timely response. Laboratory report could be available online within 3 hours. Transfer of severe cases could be done within an hour. Consultation and Medical chart review could be done online. By using these networking, we can ensure timely response, safer home isolation, equitable access across the platform. Human resources crisis in the health sector have continued to be a major challenged during COVID-19 outbreak. Our Platform could help to reduce unnecessary admission 83.3%. Work load of medical personnel could be reduced by 7 Man hours per patient. Data management system is another problem with the crisis. By enrolling into our Platform, the Medical Record will be collected and generate report to the authority for budget allocation and resource planning without the necessity of doing paper work again.

There are more women and children in our program. This may be due to the fact that more men in the village were working in Business or Industrial Estates and mostly receive the health insurance from the company. The company will support a Community Isolation or Bubble & Sealed Policy for their employee. Women especially mother with young children are suffering, not having the same opportunity. Before we implement the program, many women were waiting in their homes risking infecting family members which may eventually lead to death. With our Initiative, women have equitable access to new diagnostics & therapeutics.

The target groups are those who have tested positive in the proactive screening for COVID-19. This “green” group has no or mild symptom. It is an important mission to bring patients into the system and make it easier to track their symptoms and prevent spread. The elderly, women and children account for 70% of our program due to socioeconomic and working lifestyle. No patient died at home despite the increasing number of infected patients. Unmet need for hospitalization for those who developed severe clinical condition at home is 0%. No more migrant workers were left untreated in our surveillance. The Six Strategic Objectives of WHO COVID-19 Strategic Preparedness and Response Plan (SPRP2021), to suppress transmission, reduce exposure, counter misinformation, reduce death, protect the vulnerable, accelerate equitable access to new diagnostics and therapeutics, were all met with more than 95% achievement. In the evaluation from Baan Rai village. There were 11% positive rate (563 from 5100 villagers) of COVID-19. Reduction of unnecessary admission by 83.3%. The reported death case at home was reduced from 5 patients to zero within one month. The budget for the treatment of this group in the small village could be save approximately US$ 563,000.

Despite the initial lack of information available on this outbreak, the flexibility and adaptability of Chulalongkorn University enabled it to innovatively responses to rapidly changing situation. Jan13,2020; Thailand was the first country outside China to report a COVID-19 case. Mar2020; We formed a volunteer group to support the Medical Center with innovations such as CU-Respirator, Strip test and Vaccine, AI and CU-Robotics. Jan2021; The second outbreak spread to many provinces. Initial policy was based on active surveillance and contact tracing. We create the Express Analysis Mobile Unit to reach the underprivileged. Apr2021; Thailand has been experiencing an uncontrolled resurgent outbreak for the third time. The “Food for Fighters” program established to support food and water. We conducted a survey to find out the need of the patients and the most used online platform. May2021; We came up with an idea of the Home Isolation Platform Initiative under the code name “Klong Rod Tai” which is the prototype of Digital Support Home Isolation. The naming of the kit is straight forward, literally translated as a “Survival kit” in Thai. On the Box has a QR Code of “Scan for survival”, LINE-OA that will connect the patients with volunteer groups who will keep them informed of useful information and follow up on their symptoms. The Survival kit contains the necessary supply adequate for 14 days. The list of items came from the survey of patient real need and the Department of Disease Control, are: thermometer, pulse oximeter, Acetaminophen, Thai herbal medicine, face mask, and alcohol gel. But actually, the most importance part is the Digital Supporting. Volunteer team will continuously monitor the patient for 14 days or until they get hospital beds. To date (Nov1,2021), there are 83,205 patients registered to our system. It is the biggest Home Isolation Platform in Thailand.

The elderly patients may not familiar with online connection. Many poor families cannot afford a mobile phone and online connection. We solve this by setting up a team of volunteers who will go to their home and help them with the connection. Some family has only one phone for 4-5 people sharing together, we adapted our mobile application to accept more than one account from a single phone. The problem of delayed Laboratory report was solved by creating an online connection with Lab/Home isolation/Local Hospital. This can also help the hospital to generate and analyzed daily report information for monitoring.

As treating patients at home is new to Thai Society, it is important to collaborate with community to educate people about the necessity and benefit of a home isolation and ensure safety. This new concept is implemented for the first time in Thailand. The online Platform includes: “Virtual Ward” to help monitoring the cases similar to hospital ward. The “LINE-OA” application help replacing telephone line with 2way online communication. The “e-learning” will educate patient by using video clip replacing the paper document. The “Data management & Referral system” will ensure timely response with transparency and fairness to all.

We had previously launched a very successful “Food for Fighters” program for supporting medical personnel and patient at home and the Community Isolation. More than 500,000 food boxes and drinking water were delivered to those who needed. Chulalongkorn University Alumni Association works as a linking pin to establish a networking connection with Public-Private Organization and formed a volunteer group. During this time, we put a QR code on the box to survey for the most popular online platform and the patient needs. More than 90% of patients are familiar with LINE-OA application and use it to chat with friends.

We use several online platforms of communication. The “Virtual Ward” will monitor the patients allocated into small group of 50 each, assign to a team of volunteers using video call and chat with medical personnel. The “LINE-OA” to chat with volunteers for psychosocial support, stop the misinformation, and medical reconciliation. E-learning with video clips showing how to use Oximeter and Digital thermometer. Application “Zoom” for volunteer group meeting and evaluation. Application “Clubhouse” for experience sharing. All Medical records, Laboratory results and patient statistic reports were made online and connected to local hospital for government data analysis, resources planning and allocation.

The Home Isolation Platform Initiative has been transferred to many parts of the country and now being integrated into government policy. The concept of setting up a volunteer team of local people together with Digital platform to fight COVID-19 is very well accepted. The example of a successful program such as Baan Rai district, Ratchburi Province. Rapidly increasing number of patients, mostly elderly, women and children made the hospital beds shortage and medical team exhausted. A very strong engagement from local people working together with Village Administrative Officer and Subdistrict Health Promotion Hospital help to create a safer Home Isolation with our platform. Many of the patients who recovered from the disease came back as a volunteer to help others. This proved that they are very satisfy with our program. The story at Baan Chang district, Rayong Province is a bit difference. There are many migrant workers in the industrial estate. With small adjustment of the recruitment process, we could ensure that no one will be left behind. The National Television Channel3, Channel7, Thai PBS, PPTV36 broadcasting our activities as a documentary. Private sectors help to raise fund by showing our initiative on 41 Bill-Boards in business centers in Bangkok.

Apart from the above transferred for fighting COVID-19 in Thailand, we plan to adapt this initiative for other crisis such as environmental disasters and new emerging diseases as part of Preparedness and Response plan. The community engagement, coordination and planning with the expert team from University and Private sector translate knowledge into practice as in Baan Rai model. The volunteer team with real-time, rapid response capacity strengthening and supporting the system by using a simple user-friendly technology. The digital platform used for surveillance, contact tracing, together with risk communication and management of information can create trust, fairness, and make the implementation effective. The multi-stakeholder commitment will make the program sustainable for every challenge. This approach could be easily adapted and transferred to other part of the world.

Chulalongkorn University Alumni Association has a strong collaboration with Public-Private sectors. More than 200 volunteers are actively supporting the human resources. These are University student, alumni, and citizen who are willing to contribute by devoting their time and money. Fund raising from alumni and Private sector and Society during the initial phase is approximately US$ 150,000 for creation of 10,000 set. The cost of one “Klong Rod Tai” survival box is approximately US$15.15. Private enterprise such as the PTT support budget for the procurement of medical supplies. The online technology was supported by The Engine Life and The Sharpener.

The commitment of the stake holders will ensure the sustainability of the program. Social understanding and engagement also very important. Collaboration with Private enterprise could continuously support the budget for medical supplies procurement and technology transfer. The use of online platform with 2 ways communication could create trust and equitability for every generation, women and children. The safety of Home Isolation must be ensured all the time. Online platform used must be user friendly. Policy advocacy and strong support from every level of government administration is crucial. The initiative needs to be adjusted frequently according to the situation change.

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Internal assessment done by group meeting and data analysis in accordance with the indicators by the project monitoring committee. The supervisor team will monitor the quality of care daily with immediate feedback. There was also an external assessment by outside organization. The program was evaluated by Subdistrict Municipality of Ratchburi for patients and volunteer satisfaction and outcome of medical services. Our Strategic Advisor, the Sharpener, evaluate the targets and indicators related to the SDGs and the alignment with the 6 objectives of WHO Strategic Preparedness and Response Plan (SPRP2021). Data analysis, medical records review, and In-depth interviews were used.

The questionnaires were sent online to the patient and volunteer. Medical records were analyzed. The indicators were patient & volunteer satisfaction, the adequacy of medical supply, the clearness of information, the timely response, the seamless of transferring, and how they met with their expectation. Data analysis from the Health Promotion Hospital and District Hospital. The indicators were death rate of Home Isolation patient, percentage of universal health coverage, budget allocation and management, work-load reduction. The WHO SPRP2021 objectives are; to suppress transmission, reduce exposure, reduce death and illness, counter misinformation, protect the vulnerable, equitable access to new diagnostics and therapeutics.

The outcome of the evaluation shows more than 96% patient satisfaction, 90% volunteer satisfaction. The coverage is 92%. The adequacy of supply 85%. The information provided is clear. The timely response is excellent. No unmet need for transfer to the hospital. From data analysis shows no case death at home (before the program, 5 patients died at home in this village). The medical team is very satisfied with less problem of hospital bed shortage and lessen time used answering the call from the patients. Reduce unnecessary admission 83.3%. Hospital budget could be saved by approximately 1,000 US$ per patient, and reduce workload by 7 Man hours per patient. For the evaluation according to the WHO Strategic Preparedness and Response Plan (SPRP2021) shows that all six objectives; suppress transmission, reduce exposure, reduce death and illness, counter misinformation, protect the vulnerable, accelerate equitable access to new diagnostics & therapeutics, were met with more than 95% achievement. The information was shared and being used to adjust the plan for more collaboration, coverage, increase supplies, budget planning and allocation. The successful of the program also being used for policy advocacy and implementation of Home Isolation by the government.

Chulalongkorn University Alumni Association has a strong networking of Alumni who are willing to support the social activity of Chulalongkorn University together with the Institute for Urban Disease Control and Prevention (IUDC), the Department of Disease Control and the Private sectors such as The Engine Life and The Sharpener group. The University-IUDC-the Sharpener formed a formal networking linked by Alumni Association, co-develop and co-create this new initiative together with support from people in the community. The organization of the Home Isolation Platform Initiative divided into 2 parts; The Central Office at Chulalongkorn Alumni Association and The Local area Healthcare and volunteer team. The Central Office divided into 4 teams; A) Production team (procurement of medical supplies and put them into the box), B) Communication team (content creator, e-learning, advisor for volunteer), C) System support team (application support, LINE-OA administration, database management), D) Virtual Ward team (volunteer and medical personnel). The local area Healthcare facilities and IUDC will prepare for referral system support, emergency medical response, and consultation. The volunteer team from local people take care of logistics and psycho-social support. The Subdistrict Municipality support policy advocacy and other necessary items such as food, clean water, and sanitation.

Stakeholders consist of representatives from various sectors within the governance network which can jointly identify policy issues in various dimensions. By enabling stakeholders to participate in designing, implementing, recognizing diversity and seeking equality, the qualifications are identified and stakeholders are selected according to their competencies, interests and backgrounds. The volunteers of Home Isolation Platform Initiative came from every generation. Medical Science students and alumni could help with medical advice, medical reconciliation and patient monitoring. Other field of study could help with psychosocial support, online content creator, and communication with others team. The IUDC team help with transferring and referral system. The Engine Life and The Sharpener group help with online technology application, system support and evaluation. Local healthcare team could be medical personnel from district hospital and Health Promotion Hospital or IUDC team. Local volunteer came from villagers will help supporting the logistics for the team. Some of them were the recovered patients from COVID-19. Food, water, and sanitation were brought to the patients who needed by Subdistrict Administrative team. The PTT public company help with the budget for procurement of Medical supplies for production team. They are planning and working together as multi-stakeholder team for sustainable development.

A major challenge is inequality in Thai society, which has led to the establishment of a hierarchical control mechanism by the government in COVID-19 situation. The Home Isolation Platform Initiative demonstrated that Teamwork and an open forum for opinions is a Key Success factors to fight the crisis. A unicentric system of public administration where the government has the power to regulate, control and organize various social and economic systems, which this initiative has narrowed the gap. The lessons learned are 1. Promote dialogue and exchange of resources and knowledge, working together to solve problems by building consensus among all parties. 2. Policy advocacy from local administration could create confident and support of the people. 3. Technology must be user friendly, preferable the one that they are already used. 4. Multi-stakeholder partnership, strong collaboration of Public-Private helps. 5. Continuous training and development will provide the personnel a vision to solve the problem, able to work beyond potential tasks, that organizational culture in the aspect of teamwork. 6. The integration of SDGs concept could result in maximum organizational performance achievement and sustainability. 7. This prototype could be adapted for preparedness and response of other crisis and disaster in the future.