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Ms sudarat 24 sep


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Ms sudarat 24 sep

  1. 1. Strengthening and Evaluating Health Promotion and Chronic Disease Prevention at the Community Level in Thailand: A Comparative Analysis of Various System Approaches Ms.Sudarat Lijutipoom Dr Piya Hanvoravongchai Faculty of Medicine, Chulalongkorn University, Thailand
  2. 2. Background and Rationale • Many national programs for chronic disease prevention at community level • No study to evaluate these programs comparatively • Objective : To investigate and compare health promotion and chronic disease prevention approaches from four
  3. 3. Four major organizationsOrganizat ion Program What they do Department of Disease Control Strong disease- control district program (SDD) Strengthen communities to reduce the risks and diseases (CD,NCD) based on community context to ensure sustainability Department of Health Service Support Village Health Management program (VHM) Support community to integrate local resources (people, knowledge and finance) to solve local health problems appropriately and sustainably Department of Health Community with No Belly (CNB) Promote healthy behavior among risk groups in the community in three areas of life style modification i.e. diet, exercise, and emotional management. National Health Security office Local Health Security Funds (LHSF) Co-invest with local administrative unit to support community initiated health and primary care programs
  4. 4. Methods • Literature and document review to identify their goals, objectives, operation guidelines, and evaluation frames • Additional interviews with key informants in each organization • Comparative analysis from the WHO’s conceptual framework on health system strengthening
  5. 5. Building blocks Framework of Health System and its ComponentsLeadership/ stewardship Human Resources Technology Information Health Care Financing Health Services
  6. 6. RESULTS
  7. 7. Program characteristics SDD VHM CNB CHSF Year started 2010 1996 1995 1996 Responsible Organization MOPH/DDC MOPH/DHSS MOPH/DOH NHSO/Local Governments Setting Community (any level) Village Organization Sub-district (Tambon) Areas implemented 10 provinces in XXX districts
  8. 8. Department of Disease Control community based intervention Department of Health Service Support Ministry of Public Health Village Department of Health Organization or community project. National Health Security office (NHSO) Municipalities / Sub-district Administration Organization participating. SDD CHM CNB LHSF
  9. 9. NHSO contributes 40 Baht per head to the fund. Local government contributes another 40 Baht per head. Additional contribution from the community also possible. Relying on funding from other government projects depending on target group No funding support, only technical guidance SDD CHM CNB LHSF
  10. 10. Human resource Department of Disease Control Health personal in the area Key informants in community Department of Health Service Support Ministry of Public Health Health personal in the area Key informants in community Department of Health Organizatio ns / community Risk gr. for lifestyle modification National Health Security office (NHSO) Municipaliti es SAO Key informants in community
  11. 11. Informati on Department of Disease Control Based on health care office Department of Health Service Support Ministry of Public Health Planned community. Department of Health Hospital base Surveillance data from organization National Health Security office (NHSO) Planned community.
  12. 12. Technolog y Department of Disease Control Context of the community Focus on good results Department of Health Service Support Ministry of Public Health Context of the community The innovative new solutions Department of Health Intervention by risk group F / U National Health Security office (NHSO) By the problems By budget
  13. 13. Health service delivery DDC committee Health problem identification Community planning Follow by planning Participatory M & E DHSS Situation analysis A learning platform in the village Community planning by SRM Follow by planning M & E DOH committee Policy from partnership Physical and social planning Concept of diet , exercise and emotional Continuous F /U NHSO Local fund committee Co-payment : NHSO. , Municipalities / SAO and community 4 D of planning : promotion , prevention. Treatment and rehabilitation Online data M & E
  14. 14. Discussion • Community health promotion (Blake D 2000, KAREN GLANZ 2005 ) – Social planning : 3 levels ( individual interpersonal and community) – Social Action : community development , community problem identification, community solving ,community monitoring and evaluation)
  15. 15. Discussion 2 • Difference in regard to above - All projects have the same of concept and objective but different from setting and process of activities. - Most of programs are interesting in social action not social planning
  16. 16. Discussion 3 • Activities can be integrated together for reduce redundancy and depending on the problems of the community • Each project should enhance the social planning activities in order to increase the capacity of community members at all levels to solve problems together more
  17. 17. Discussion • Thus it is important to understand the community to make a suitable plan to adjust and implement in the context of each community. • All programs have evaluation components and all except one organization relies on existing information system for monitoring and evaluation. • In the evaluation requirements, most organizations only monitor inputs and process of the projects plus some indicators on the level of outputs. • Evaluation of outcome is only used in one program that focuses on short term outcome
  18. 18. Conclusion • every organization uses a community approach, instead of programmatic approach • All organizations rely on existing workforce in the community, mostly volunteers and health staff, to carry out their work. • Only one organization provides supplementary financial resources in the form of matching contribution while the
  19. 19. Thank you