Questions/Answers

Thailand has been transitioning from agricultural to industrial society that machines are involved in manufacturing. Workers, however, are unaware of the threats associated with machines, as well as of occupational safety, resulting in work-related injuries and diseases. Once the workers become disabled, they are unable to work and finally quit from work. This causes a shortage of income that eventually affects their behaviour, psychology, and emotion. Moreover, it may also lead to a broken family, having an inferiority complex or become disadvantaged persons. The Social Security Office of Thailand (SSO) realises the importance of this matter, hence the SSO has established the Industrial Rehabilitation Centre (IRC) which is under the Social Security Office, the Ministry of Labour. The IRC has a responsibility to provide comprehensive rehabilitation services for the disabled workers who suffer work-related injuries and the disabled insured persons under the social insurance scheme. Ultimately, the rehabilitated workers are expected to regain opportunity of their life and employment, to be independent and able to take care of themselves and their families and to live proudly in society. As such, the rehabilitation is considered a vital factor for disabled workers to contribute to the development of the nation again. In Thailand, the IRC is the only governmental agency responsible for comprehensive industrial rehabilitation including medical, vocational, and psychosocial rehabilitation. The services are collaborated by the multidisciplinary team and in coordination with other involved agencies and experts, for the disabled workers to be ready to return to work or be self-employed. This will support them to earn income for their own living and family, and live in a society with confidence and not being a burden to society.

Comprehensive rehabilitation is the rehabilitation program covering medical, vocational, and psychosocial services. The program focuses on the client-centred approach in collaboration with a multidisciplinary team with the aim to help the rehabilitants regain their work capability and become independent to earn income for themselves and their family, and live with dignity and hope again. It is relevant to the 1st category on “Delivering inclusive and equitable services to leave no one behind”.

Sustainable Development Goals # 8 promotes continuous, inclusive, and sustainable economic growth, full and productive employment and decent work for all. The comprehensive rehabilitation provides rehabilitation services to help the workers who suffered from the work-related injury, loss of work capability, or disability to have a better life. “Increase revenues–decrease expenditures” is considered as the main strategy. “Increase revenues” aims to enable the disabled workers to live in society independently, earn income for themselves and their family which results in reducing social problems. Another complementary strategy, “decrease expenditures”, aims to reduce the cost of transportation, medical services, and rehabilitation services. This also includes reducing unemployment rates and reducing expenses and number of personnel in providing services to strengthen social and economic competitiveness as well as national security.

Social: The rehabilitants are fostered with self-value, confidence, and self-reliance. They can act as a role model to share their experience, overcome disability and reintegrate into society. Economic: The comprehensive rehabilitation provides the disabled workers with skill training suitable for their conditions so that they regain self-confidence to return to work and earn income for themselves and their family that they can live in a society with dignity. Environment: The IRC performs home visit follow-up for rehabilitants and provides consultations to enterprises, employers, colleagues, and family to encourage positive attitudes of living together with the disabled.

In the past, the disabled workers had to contact several government agencies to claim benefits because the database-sharing among agencies was not effective. Moreover, rehabilitation service was not inclusive, hard to access and very complicated. Therefore, the IRC developed a comprehensive rehabilitation process to assist the disabled and was complimented by a more efficient referral system and data linkage to reduce workflow process and less complicated. In taking care of both Thai and foreign disabled workers, the comprehensive rehabilitation also strengthens public service management through integration and collaborations in the national and regional level. The services include medical treatment, rehabilitation and after rehabilitation follow-up so that they can return to work and live in a society with more confidence.

Rehabilitants are equally treated regardless of gender, nationality and age. Rehabilitation is planned and designed upon individual interests and suitable for their physical conditions. Gender does not obstruct training capability. Female or male participants can join vocational training upon their aptitude, such as crafting, cooking, bead-work, welding, fixing, dressmaking, and etc.. Those who complete the training can re-enter work, earn income and reintegrate into society with human dignity.

The target groups are workers who suffer from work-related injury, loss of organs, or disability, and lost their working capability thus become the disadvantaged group that cannot be self-reliant. In the past, if the injured workers needed physical rehabilitation service after completing medical treatment, they had to go to the hospital. If they needed vocational training, they had to contact the Department of Skill Development or other related governmental units. As a result, the workers experienced slow and complicated access to services and needed to bear for the service costs. In dealing with these difficulties, the IRC was established in Thailand as the only agency with special function to provide comprehensive rehabilitation services including physical, vocational and psychosocial rehabilitation. Besides, prostheses and orthotics for rehabilitants are also provided together with vocational counselling and training. The disabled workers who complete rehabilitation services will feel confident to return to work and earn income without being a burden to family and society. Furthermore, with these reduced service procedures and costs, as a consequence of becoming one comprehensive agency, the clients can access to rehabilitation services faster and more convenient.

The Industrial Rehabilitation Centre Region 1 (Pathum Thani) was the first rehabilitation centre for workers. The government later recognised the importance of the workers’ rehabilitation. Consequently, another 4 industrial rehabilitation centres were established to extend rehabilitation service coverage in each region of the country. Until now, the IRCs can provide the rehabilitation services for 9,000 persons. The rehabilitation services include: 1. Psychosocial rehabilitation. It is provided by psychologists and social workers. The professionals conduct capability assessment and individual counselling for disabled workers. Besides, the case conference with the multidisciplinary team also takes an important role in the process. It is under the supervision of the rehabilitation subcommittee consisting of various medical specialists with the main responsibility to set the client-centred individual rehabilitation plan. 2. Medical rehabilitation. The multidisciplinary team works together in the planning and monitoring for medical treatment. The treatment includes physical therapy, activity therapy, and making prostheses and orthotics. This is to help rehabilitants recovered and prevent for more severe disability to prepare their physicals ready to work. 3. Vocational rehabilitation. Training for working capability and skills of rehabilitants will be designed for the rehabilitants upon their interests, aptitudes, and physical conditions. The requirements of employees and employers are also considered. In addition, rehabilitants are provided with assistive tools for vocational training and preparation for the National Skill Standard test. The expected outcomes are to help rehabilitants prepared for re-enter work and earn income. Importantly, the IRC conducts follow-up visits after the rehabilitation, in the coordination with other local agencies such as municipality or district officers, for further service improvement.

Most employers do not fully understand and have a lack of knowledge on how to employ people with disabilities. Considering these difficulties, the IRC conducts enterprise visits to create understanding on how to live and work with disabled employees. Creating a positive attitude on the acceptance of their capabilities is also encouraged through certification of skills to increase employer’s confidence and find suitable positions for the disabled employees. If wishing to be self-employed, the IRC provides rehabilitants with the training on small businesses management and internship courses for them to gain experiences.

The comprehensive rehabilitation treats workers/insured persons attentively on an individual basis. The process starts from reception, medical and rehabilitation planning. The rehabilitation is later provided to solve problems regarding physical and social, work/income, and family. Vocational consultation also takes an important part in re-entering work, either with the former or new employers or becoming self-employed. Apart from this, the follow-up visit after rehabilitation, in coordination with the rehabilitation network, plays crucial roles in the comprehensive rehabilitation process.

The comprehensive rehabilitation is the innovation developed from conventional support, in which the Social Security Office pays the compensation from the Workmen’s Compensation Fund directly to the disabled workers. They, however, cannot resume normal living condition. Besides, the disabled workers experience difficulties in contacting many agencies for physical, mental, vocational rehabilitation services, as well as prostheses and orthotics. The comprehensive rehabilitation process has been innovated to solve those difficulties and assist disabled workers to regain their normal living, having job and income.

The Industrial Rehabilitation Center Region 1 (Pathum Thani) is the first rehabilitation centre in Thailand with a comprehensive system of rehabilitation. It acts as the model for other Industrial Rehabilitation Centers covering all regions of Thailand: the Industrial Rehabilitation Centre Region 2 (Rayong), the Industrial Rehabilitation Centre Region 3 (Chiang Mai), the Industrial Rehabilitation Centre Region 4 (Khon Kaen) and the Industrial Rehabilitation Centre Region 5 (Songkhla). Moreover, the IRC is a learning centre on knowledge exchange, study visit, and training for other related agencies both locally and abroad that they can apply to their context. For examples, the IRC provides education to set up the local organisations as the training centre for students and specialists such as the rehabilitation medicine, therapists, psychologists, and social workers, at all levels. In addition, knowledge can be applied to manage the caring service for disabilities in the community. Regionally, the training on Comprehensive Rehabilitation for Workers with Physical Disabilities among the member countries of the ASEAN Social Security Association (ASSA) is also organized.

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The administration expenses of the IRC are allocated from the investment return of the Workmen’s Compensation Fund, which comes from the contributions of employers as prescribed by laws. The expenses cover the rehabilitation expenses for the workers who suffer a work-related injury and the Khunakorn Foundation under the Royal Patronage of HRH Princess Maha Chakri Sirindhorn, The Princess Debaratanarajasuda, The Princess Royal of Thailand. The personnel of the IRC consists of doctors, nurses, physiotherapists, occupational therapists, orthotists, psychologists, social workers, labour specialists, skill development technical officers, and skill trainers.

The IRC’s activities are the integration of multidisciplinary team that assists the workers who suffer work-related injury and later become disabled so that they can return to work with confidence, self-esteem, and dignity. It is regarded as the returning of human resource to society. The services cover the whole process of rehabilitation that receive acceptance and participation from family, employers, and other related stakeholders. The budget to run the rehabilitation program is from the investment return of the Workmen’s Compensation Fund which, by law, employers are liable to pay the contributions into the Fund.

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There is an external evaluation by the Revolving Fund Management Policy Board and advisor of the Comptroller General’s Department. The performance indicators have been set based on criteria of the evaluation of revolving fund performance (Workmen’s Compensation Fund). The main indication is the percentage of rehabilitants who get a job after completion of the rehabilitation, compared to the total number of rehabilitants. The indicator reflects its objective that the disabled workers can get a job and earn income. In this evaluation, the follow-up and report are done quarterly.

In 2018, the percentage of rehabilitants who get a job after completion of the rehabilitation was set as a KPI to evaluate achievement of the rehabilitation. The maximum score was 5 points meaning that 100 percent of the total rehabilitants can return to work. The reports of the follow-up results and visiting the rehabilitants who complete rehabilitation were conducted. Additionally, the summary of critical success factors, problems and obstacles, and solution measures were also analysed as a guideline to improve rehabilitation service.

The rehabilitants, who complete the rehabilitation, can return to work and regain their decent living. The social and economic problems are alleviated. The rehabilitants’ home and enterprise visits were arranged to accommodate their re-integration into society. Also, individual challenges and needs were noted for the improvement of the rehabilitation program, for example, adjustment of their home environment, installation of handrails, ramps, and other improvements.

The Industrious Rehabilitation Centre has created participation mechanisms among the private sector, public sector, and community. The mechanisms strengthen teamwork in preparation for any problems the rehabilitants may face. For example, physicians from various hospitals join the Rehabilitation Subcommittee to formulate rehabilitation plan, the Sirindhorn National Medical Rehabilitation Institute receives some disabled workers from the IRC for specific types of rehabilitation, the Department of Skill Development gives advice in drafting vocational training courses, organises skill standard tests, and supports the disabled workers in participation of the vocational skill competitions for the disabled at all levels, the Department of Employment provides the lists of employers who want to employ workers with disability, the enterprises employ the rehabilitants from the IRC, the Ministry of Social Development and Human Security facilitates the registration of the disabled and provides allowances as prescribed by law, the Sports Authority of Thailand supports Pathum Thani Provincial Sport Association in nomination of the rehabilitants to compete in Thailand Para National Games at all levels.

The IRC has designed the rehabilitation program based on problem analysis and clients’ needs, as well as the consideration of multidisciplinary team. The crucial factor is the active role of the public sector, private sector, and the clients. The IRC has established collaborations with many diverse entities: - Pathum Thani Office of Social Development and Human Security, to provide the guidelines to issue the ID card for people with disability to help access to their rights prescribed by law. (There are approximately 50-60 clients per year.) - The Rajamangala University of Technology, Department of General Education, and the Office of the National Primary Education Commission, to produce assistive equipment and instrument for people with disabilities. - Pathumthani Office of the Non-Formal and Informal Education, to support rehabilitants to get higher education degrees, creating more employment opportunities. - Maheyoung Temple, to provide meditation for mind training. - Enterprises, to organise awareness-raising activities and knowledge-sharing concerning workplace safety mainly through simulations of their real experiences. - Rehabilitation Subcommittee, to monitor and evaluate outcomes of the IRC services to ensure that rehabilitants would not face any obstacles alone until they gain decent living in society.

- Active participation of all parties in conducting analysis is essential for the rehabilitants’ acceptance and individuality, as it would encourage the rehabilitants to have a stronger desire to succeed. - The connections with the related organisations and the stakeholders encourage seamless and effective cooperations. - The processes after the completion of the rehabilitation itself are required to ensure smooth re-entry into society and workforce for the rehabilitants, for examples: the preparation process before the re-entry and the follow-ups and house/enterprise visits to adjust the environment for better accommodation of the rehabilitants, which can benefit also the human resource management as a whole. - The client-centred approach and the belief to recognise the potentials of all equally are the cornerstones of the Comprehensive Rehabilitation System. The concept breeds the value of creative cooperation among the personnel in the IRC, resulting in the dedication to develop the procedure until it matures into the professional and comprehensive service it is in the present. The fruition of the development is the accumulation of specialized knowledge, resulting in the establishment of the IRC as the learning centre for industrial rehabilitation work to educate the people both in the country, ASEAN region, and international stage.