Mobilizing University Graduated For Health and Socail Development
Mobilizing University Graduated For Health and Socail Development
Mobilizing University Graduated For Health and Socail Development
SOCIAL DEVELOPMENT
A learning experience from the Graduate Health Volunteers and the Graduates Return Home Projects.
Krasae Chanawongse
Som-arch Wongkhomthong
Rosa Corazon F. Cosico
Bangkok, Thailand : FebruarV 6, 1989
This book is dedicated to the University Graduates of Thailand in honour of their selfless endeavour in the pursuit of health and social development.
PREFACE
We would like to invite the attention of the reader to the fact that this book is a sequel to Publication No. 8 Research for PHC Model Development, Chanthaburi hovince, entitled "Primary Health Care -
A Continuing Challenge" published by the Mahidol University's then ASEAN Training Cenhe for
ki-*y
Health Care Development (ATCIPHC) now ASEAT{ Inslitute for Healttr Development (AIHD),
on the 1$ of May, 1987 in Bangkok, Thailand. The book is an excerpt to the emotionally - laden experiences of the university graduates of Thailand. While it reveal elusive dreams it nevertheless proved an awakening of Thai university graduates to their roles and responsibilities as catalysts and leaders in health and social progress. A combined effort from the "Triumvirate Authors" armed with analytical dissectiveness, devotion and drive, literary and scientific prowress; the book has been a by - product of a persevering distillation process of the dual projects, "The Graduate Health Volunteers Project" and "The Graduates
country fights its perilous battle in the maximization of health and social development.
The Authors
ACKNOWLEDGEMENTS
F
The operations staff of the Graduate Health Volunteers and the Graduates Retum Home Projects wish to acknowledge the invaluable cooperation and assistance rendered to them by the following :
Prof. Dr. Natth Bhamarapravati; Rector of Mahidol University and the founding father of the Graduate Health Volunteers Project. Prof. Dr. Natth has conceptualized and operationalized the
utilization of the university graduates in health and social development and has provided unrelenting stimuli to the project operqtions staff through all the phases of the project implementation. Prof. Dr. Masami Hashimoto of Japan, the former Japanese National Team l.eader on ASEAT{ Training Cente for himary Health Care Development (ATC/PHC) Proiect who has closely collaborated
hof. Dr. Natth in the formulation of effedive strategies for the mobilization of university graduates in the community.
with Iwamura of Japan, former Team Leader based at ATC/PHC for the inspiration, the encouragement and the support he has given to the graduate health volunteers (GHVs) and
Mr. Somphong Pantsuwan and his staff; Governor, Chantaburi Province and concurrently the Chairman of the Graduates Retum Home (GRH) hoiect for his stuong political will in the achievement of a successful project delivery. Dr. Kosin Rangsayapan and his staff; Rector Rambai Bami College and Honorary Adviser of the GRH Project for sharing his precious time and energy throughout the entire project life.
The 3 batches of GHVs and the first batch of the GRH for unhesitatingly spending a year of their youth as human resoluce vehicles in the achievement of integrated heafth and social development in the villages of Thailand.
lvb. Chc$oerce ChdLnderft, the prcFd seclfuy ftr nnlrrrg dr olhenrrise gaar en&arctn a gratifuing experience. Ms. Chongkolnee has provided the necessary morale booster to the project viahlfty fuough her chum and devotion,
tct
out the entire proirct duration and, last but not the least to;
The Japan krternatlrnd Cooperdon Agency for ttr much - needed and equally apereclded
PROLOGUE
For the past decade, the long-term goal of WHO's Health for All by the Year 2000 has reoriented the national health care systems of virtually every country of the world. One of the main reasons that this
goal, and its inherent primary health care movement, came about was due to the previous lack of success in extending the benefits of new medical and health services to the majority of populations in disadvantaged and remote rural areas. A common observation was (and is) that those resources
needed to raise the standard of living are usually insufficient or oftentimes not properly managed in rural sector, as opposed to its urban counterpart. The result is a common set of synergistic problems: lack of education, poverty and ill-health. The limited resources involved are not necessarily monetary in nature, but include especially
a lack of information and the manpower needed to guide community members in becoming self-reliant.
Government's, be they in Thailand or elsewhere, cannot and should not take sole responsibility for the health and development of each rural community. Rather, community members must be given the guidance, information and leadership skills to recognize and identify strategies for solving their own health and development problems, to provide for their own means, and to manage their own resources and development. This remains the true social and political challenge of Thailand's primary health care and quality of life movements. In this light, manpower development has become even more essential and important at the present time if we are to support the long-term goal of WHO's Health for All by the Year 2000. Moreover, "people development" in this case centers not only on
health personnel, but an inter/inha-sectoral partnership between officials and personnel at all organiza-
vii
for satisfying them. Thus, they may include in different societies people with limited education who
have been given elementary training in health care and community development. In Thailand, though, university graduates are one extremely viable target group who has been under-utilized and under-
mobilized for health and development purposes, even though many have difficulty finding jobs after graduation.
On its part, the ASEAN Institute for Health Development at Mahidol University has aimed itself towards designing innovative strategies to mobilize university graduates as a skilled communitybased manpower force. Initially begun as a component to the Project on Primary Health Care Model Development, the concept of Graduate Health Volunteers (GHVs) has embarked on polishing the
Ieadership skills for health and development of volunteer graduated youths. These youths, who through the third batch totalled forty{wo persons, operated within the shuctured primary health care delivery srvice of Chantaburi province. Their purpose was to promote community participation through sound
leadership and thereby assist community members in remote rural Chantaburi villages in improving their health status and community development. To date, these youths and their enthusiasm have in one way provided a low cost solution to the problems of health manpower shortage even under a restricted financial climate. Throughout the project's duration, continuous brain-storming sessions were held by project staff in an effort to identify even more effective alternative shategies for project implementation. One
such strategy is that rather than providing service to villages other than their own, GHVs should be encouraged to return and contribute their efforts in the development of their home villages. Such an alternative would reduce the feeling of "outsiderness" or "alienation" which in some cases brought
about feelings of resentment both on the part of the GHVs and the existing community health staff . It is likewise strongly felt that the provision of monetary remuneration might adversely affect project sustainability and nation-wide replicability. Based on lessons leamed from the original GHV prolect,
an altemative model was conceptualized and implemented, that isthe "Graduates Retum Home hoject". This new shategy is based firmly on theprinciples of self-reliance and personal commitment for both
the university graduate as he/she works to improve the standard of living in his/her natal community. This new project also emphasi?ps even more a search for excellence in leadership. Communityr participation and self-reliance, once initiated, can be a powerful force for change. But this cannot come about if people are not encouraged to stand up and take action. For this purpose, informed leaders who are willing to work with community members and are a part of the community are esser,tial if the delivery of integrated health and social services is to become a concrete and sustained reality. Excellence in leadership, in this case, rests on the knowledge, skills and sensitivity of university graduates as they return home to apply their abilities for the lives and livelihoods of their fellow community members.
TABLE OF CONTENTS
PAGE
Preface lll
Acknowledgements Prologue
The ASEAN Instltute for Health Development (AIHD)
iv vi
x
xii xiii
Introduction
Chapter
1 1
ProjectOverview ProjectObjectives
Project Site
8 8 8 9
19
Velds
Concluding Remarks Return Home Project
49 53
3 The Graduates
3.1 Projecl Overview 3.2 ProjedObjectives 3.3 Project Site 3.4 Project Activities 3.5 Concluding Remark
55 55 56 56 56
7l
lx
PAGE
Epllogue Annexee:
72
73
Annex
Annex Annex
Chanthaburi hovince
73
2.:
Glossary
74
75 79
3:
83 85 87 88
ATC/PHC)
The ASEAN Training Centre for Primary Health Care Development (ATC/PHC) was established in Octobr, 7982 as a part of the ASEAN Human Resources Development Project under the technical cooperation of the Government of Japan. A collaborative project between the Mahidol University and the Minishy of Public Health, the ATC/PHC is supported by the Royal Thai Government (RTG) and collaborating agencies. The ATC/PHC is working closely with the ASEAN Secretariat to the
Committee in Social Development, Expert Committee in Health and Nutrition, the Japan Intemational Cooperation Agency (JICA), the South East Asia Medical Information Centre (SEAMIC), the World Health Organization (WHO), other United Nations (UN) health related agencies and concemed non-
with the ultimate goal of serving as a fulcrum for exchange of knowledge acquired and experiences gained in the field of primary health care and social development among member countries of the
ASEAN. The Centre concentrates on a manifold of specific objectives: training of all categories of
health workers (from policy makers and policy makers to-be, down to the primary health care cadres)
,
enhancing their managerial potentials and functions; research and model development for primary health care in the different levels of the health care delivery system; strengthening of infrastructure support to meet the training needs of the target population both locally and internationally among the
neighboring ASEAN counties; and, the establishment of local and intemational networls of information
exchange on primary health care and related activities. Adminisbatively, the Cente operates under the Mahidol University, the forerunner of medical and public health education in Thailand. The Mahidol University has been named in honour of the pioneering activities of H.R.H. Prince Mahidolof Songkhla the father of His Majesty, The Great King, Bhumibol Adulyadej the present King of Thailand. The Centre's policy is guided by the Executive
X1
Board whose membership comprised of the Minishy of Public Health, the Mahidol University and the
Director of ATC/PHC amongst others, serving as members of the Board. The ATC/PHC was established along side with four RegionalTraining Centres (RTC) at the request of the Ministry of Public Health. These four RTCs are located in Khon Kaen, Chonburi, Nakornsawan and Nakorn Srithammarat provinces. Over the short span of its five-year operation, the Centre has proved as the ever-dynamic training institution, it has envisaged to be; in the development of PHC cadres and of potential PHC
development managers and policy makers both locally and in the neighboring Asean countries. Likewise, the Centre has fulfilled its commitment on functioning as a springboard for resource mobilization
and in the strengthening of regional cooperation and integration. It has also prided itself with its role as a facilitator on technical cooperation and technological transfer at intracountry and inter-country
levels.
In time, the scope of the Centre's effort has expanded considerably with participation from other countries in the Middle Eastern South Asian and the Asia-Pacific regions. Accordingly, the Centre fias evolved approaches to PHC development that are in keeping with national policies and responding to the results of an extensive research and development process undertaken in this country. Thailand has adopted its approaches to achieving the goals of PHC which
has been relenedto as the Quality of Life Improvement Campaign based on Basic Minimum Needs. This programme has made considerable progress in achieving intersectoral cooperation between the
main development agencies in the country as well as providing greater autonomy and self-reliance
at the periphery of the health care delivery system and in the communities. With these developments came a realization that ATC/PHC must also evolve and redefine its policies and approaches in accor-
dance with national trends. In 1986, Ivlahidol's Universig Council chaired by former Minister of Public Health, Prof . Dr. Sem Pringpoungkaew, submited a proposal to upgrade the Cente to a firll institution under Mahidol University with an expanded scope of operation. The proposal went through the Ministry of University Affairs to the Cabinet which approved the measure in August 1988 and then refened in to H.M. the Great King whose Royal Decree officially established the new Institute.
of the Institute's operations will be on policy related issue for health development to include a more comprehensive approach over and beyond that of primary health care. This broader mandate enables
of phase of the AIHD. The technical cooperation, on the other hand, is concentrated on all necessary technical support in the operationalization of various project activities conducted by the centre. This includes costs in the conduct of training programmes and seminars, research, model development,
equipment, fellowship and the assignment of experts. The JICA's technical assistance on model development for the PHC activities has ushered the formulation of the "Project on Research for Primary Health Care Model Development-Chanthaburi Province", in January 1985. The JICA has likewise provided a considerable amount of technical advisory back-stopping towards the implementation of the "Graduate Health Volunteers" and the "Graduates Return Home" project; launched in January, 1985 and January, 1988; respectively.
INTRODUCTION
Health service has always been an elusive commodity to the developing world. The concept of integrated
health and social development is all the more unattainable if not totally incomprehensible to the less priveledge brothers of the western civilization. The absence of a well-oiled machinery for the delivery
of health services has been to a certain extent further handicapped by futile attempts twoards an integrated
health and social development approach. Much as Thailand has earned the positive reputation of creeping quietly into the shadow of progress, still a lot of energy has to generated to achieve an enviable health and social milieu. Despite
the current upsurge in farm produce, the monumental hike in local and foreign investment, the tourist boom, housing programes; unemployment problems have continuously hamper social groMh. The problem of unemployment is a constraint both the educated and the non-educated Thai
service. This aspiration has come as a result of medieval educational concept of preparing university graduates as future public servants. Other graduates are more attuned to being "salary-men" that is, one with a fix income to rely on at the end of every month. Still others are opting for the big cities
The situation has become so dismal that it rarely comes as a shock to find that the friendly
saleslady has a bachelor of science in social work. Neither is it surprising that a waiter tending to a half
sober customer is a political scientist. The overproduction and consequent underutilization of university graduates hs appended
tvx
to a highly complex problem - that of the vicious cycle of unemploymen!, poverty, ignorance and
disease.
It has become imperative f6r the concemed government agencies to take note at precisely u,hich cplical point they should mediate; at which clrclical point can etfer,trve interr.rention be intoduced, which altematives would be feasible and which of the feasible alternatives would be acceptable to all concemed.
What is obvious
is
CHAPTER
service. Thus, every student's dream is to find oneself in the government employ at whichever field one has graduated from. This orientation has brought forth a great amount of delusion to the university graduates; many of whom find it impossible to enter the government service. While it is most noble to be of service to the nation as government officials, students have to be awakened to the fact that it is not only by serving in govemment's offtces that they can be of value to the counhy. While it is not wrong for the graduates to aspire for a civil service position, it must also be realhedthat currently there
are not enough govemment posts to wanant accomodation of the majority of the university graduates.
Another unfulfflled dream is that of being a "salary-man". The attactiveness of a lixed monthly wage may well be rooted from the sense of security it brings forth. A fixed amount of income always
carries along the advantage of a well-managed, well-budgeted finances. The present-day financial drain
has reverberated into a brain drain. University graduates would rather be employed on a fixed-time salary scale than utilize their intellectual capabilities in health and social development. There seemed to
be no interest at all generated by small-time business indushies for them. They are happy and contented
enough to be fix-salaried employees instead of shiving as employers themselves. Their sense of values have not been primed to the enhancement of social development. The call of Bangkok and the rest of the big cities is far too loud to be ignored by the country's university graduates. The prospect of work in an air-conditioned offtce, sitting in an executive swivel chair wearing an immaculate white shirt has tong been a secretly nurtured dream. The tendency of graduates to tum their backs away from their home village is almost always expected and is more the rule rather than the exception. Parents of the graduates are themselves a partner to their children's dream of a big city employment. The goal has somehow always been to leave an imprint in the big with a resultant concept that success achieved elsewhere is less of a success. Bright, optimistic dreams of bright, optimistic university graduates, determined at finding their place in the sun. And yet, most of these dreams were bound to remain as dreams.
on whatever left-over money they have; temporarily rooming-in with more fortunately - employed friends. A few may have contributed to a nationwide brain drain by imigration to other countries. A handful, out of having nothing better to do, may decide to tie the knots and leave the problem of jobhunting to their spouse. And still fewer may have packed their bags and gone home, quietly nursing
the wound of broken dreams. The fact is that underneath the problematic processes, there lies the common denominator of civic inertia that necessitates an unrelenting retinue of stimuli.
2.1
2.2 Values and social norms of the university graduates 2.3 Health and inter-related problems'
furd thus began a rigorous exercise of problem solving. ldentifying vialbe models, formulating
theoretical concepts, basking on old experiences - this has ushered forth the nativity of the "Graduate
as a showcase of what education and culture should be. From the English alphabets to the ultasonic
sound waves, from the electronically devised toys to potato chips, the feeling is that "West is Best". Thailand is no exception. fu a result of an almost idolatrous worship of everything that is west, a Thai
student is willing to forgo a haditional, Thai lunch of rice and cumy ended by a cup of khanoml in favow
of a sandwich, some french fries and a bottle of carbonated beverage, the nam keng sai na* chu2 has been left behind to oblivion. Likely, Thai children holds close to their hearts mobile robot warriors in lieu of the previous sheer delights they enioy from kite-flying and kite-fights.
This constant immersion to modem hends also affect the elite members of the academic societv. Confined to the four walls of their classrooms, they are hardly afforded a glimpse of the real life situation in the Thai villages. A great majority of them have risen from the rank as a freshly-graduated university student to the distinguished rank of a university professor which would entail some three decades of life spent within the protective environs of the university campus. Without as much experience of the rural and rustic side of Thailand, one finds it difficult to put the blame on the professors for their ascrip-
tion to modern theoretical and scientific concepts far beyond the grasp of the Thai rural civilization. Just as difficult to disassociate is the ideological thrust of their stewardship inculcating the prestige, nobility and dignity of govemment service. Stongly upheld during the early pedod of academic existence,
such an ideology is highly improbable if not an almost impossible feat to implement in the current situa-
tion. Consider the number of university graduates per academic year as compared to the recently
existing vacant post in the civil service does not make it dfficult to appreciate the overwhelming disparity
tion are researches directed towards adequate utilization of appropriate technology. The enhancement and maximum utilization of the counby's existing resource necessitates the undivided attention of the
academic staff. The academic cuniculum has its share of westem inclination. The Thai university students have been suffocated with westem tenets that hardly left them with a b,reathing gellfrom all that which
is far-advanced, and far-fetched. This situation has predisposed university students to self-criticism
and to blame ones own count$, baclnvardness. Aware of the limitations of a developing country technology and yet unknowing of how to formulate remedeal measures over counby's ails and miseries. Students
therefore were only equipped with the academic wisdom to criticize but not to criticize constuuctively. The analyticalprocess has been handicapped by the lack of sufficient background informations over that which actuatly hanspire in the country's villages. The academic cuniculum has been structured to focus on elechonic marvets. The crippling effed.ofmodem technology does not stop with financial handicaps over the technology's procurement rather it has also left the question of its maintainance unanswered. Granted that generous benefactors come to the counby's rescue, still the county's situational limitations for adequate hardware maintainance is a factor to be considered. The academic contenb adhere to a theoretical base. Informative lecture on existing social values of an average Thai family are
often
I
2
na- k"ng
sai nam cha is a mixture of tea hghly dlluted in water and comes free of charge with a tlrpical Thal meal
has been way laid. Take the predominant social malady of erroneous prioritization in budgetary expenditures. Most Thai families have still favoured wearing of fashionable clothes over that of eating a well-balanc-
ed diet. Wrong priority-setting of buying a coloured television over that of spending for construction of a private latrine, bringing only sick or dying children over the preventive wisdom of a well-baby consulta-
tion; these are only a few of the existing values where adequately informed university students may well intervence with. The university has conpletely neglected the enormous wealth of human resources that is virtually their captive audience for about ten to sixteen years. There is little doubt that the university campus is a very fertile gound for sowing either habed or compassion, vice or virtue, decadence or aspiration. Peer-infulence, change in lifetyles have always been primed within the campus'cloistered womb. The iountry's exsiting health and social development problems; from cigarette smoking to alcoholic and drug abuse to the sexually transmitted diseases (STD) may well be traced over what are initially
friendly and innocent campus'interactions. The university campus has therefore become an important
venue in instituting positive approaches to health and social development. Inorder to bridge the presently existing academic gaps, the Thai system of education is in need of a re-orientation and re-direction. The academic staff should get as much an exposure as academically feasible to the village social structure. Nothing could better equip them to import existing
values and social norms to their students than a first hand exposure to taditional village life. A system may be developed to incorporate field practice in all categories of social sciences to enable prospective graduates to merge into haditional social networks. The academic should reconcile itself to the fact that the acqeuisition of knowledge has to be in parallelto its several limitatons to application; that the urgency is in the ability of the students to implement knowledge availed of within the existing developing
counby situation of Thailand. It should be bome in mind that much as scientific advances and concepts
are hghly commendable components of any educational module, the over all goal should stlll be directed
and not merely "adoption" of the leaming processes. It calls for a painstaking analysis for re-direction of leaming materials to that which is applicable, attainable and cost-beneficial in the achievement of the county's socio-economic goals. Perhaps unknowingly, the highly noble objectives of the academe
has advanced way beyond the country's own move to advancement. The time has come for the academe
to produce graduates who will be able to provide expertise tailored-cut to existing constraints. The
time has come for a move towards the simplification of the present highly scientifically-based educational
their homes, they are teated as guessts, protected from unforfituous events like a failed crop, a
)
"takatan"3 infested farm, an overflow of the prawn farm due to flood, or any unsavory tales. Instead, they get seVeral requests from families and neighbours to recount their experiences from the big city. The narratives held the audience in admiration often with a silent sigh of "why can't it be me?" or "why can't it be o'ur son?" During all these days, the visiting student may hardly ever miss the family waterbuffalo that has been sold as a result of his latest letter asking for an increase in pocket-money. In the
case of other students who reside within university commuting distance, the scenario is not at all too
different. The student is priveledge enough to be exempted from even ordinary household chores.
For, what mother would have the heart to call on a sibling busy preparing for a forthcoming examination
to attend to the laundry or for that matter even set the family dinner table?
Detached from reality, students rarely find the home condition as athactive. Inhoduction into a new culture and the sorption of everything novel has led into the formulation of new values.
The call of the big city has always been much too difficult to resist. Just like the proverbial lamp that has athacted moths to swarm around its flame just to get bumed, university graduates crowd the city just to suffer the burning ache of rejection. True, there are a number of success stories about a graduated villager earning his mark in the big city but successes are documented, failures are not.
The process of equating self worth with self-accomplishment in one's own birthplace
should be fed into the students at all stages of academic pursuit. Parents'attitude towards the allure of govemment posting needs alteration. Pride and dignity should spring from the extent of productiveness over and above material gains. Job satisfaction may not come only from job areas where a student
has undergone baining and specialization. A political science graduate need not indulge in day-dreams
of becoming his province's governor. He need not aspire for recognition by way of a political seat in the government. Respect, recognition and human dignity may just as well be achieved while raising hogs and cattles right at ones'own backyard or polishing gems by a sidewalk shop. In much the same way, a graduate in commercial science need not be frustrated if he does not end up as a "salary man" While financial status is indeed an ego booster, it certainly takes more than an ego-boost to be happy. Values of selflessness, love for ones'own birthplace, humility, patience and perseverance had to be rekindled in the mind of the students. The ability to take pride over ones'conhibution no matter how minute in his village's stride to progress is worth re-strengthening.
It is not enough to preach on values. Without necessary reinforcments the value structure bound to collapse. Reinforcement comes by way of inhoduction to the use of appropriate technology. It may be impossible for an auxiliary village health worker to heat a case of dehydration in the absence of oral rehydration salt (ORS) . However; given the knowledge of how to prepare ORS at home over
is
a glass of water with a lump of sugar and a pinch of salt will spell the difference between cure and death
6 awards wlll help create positive reinforcement effed.. Awards given to the graduates who have contibuted
most to his birthplace's progress in health and social development irrespective o{ their field of study will definetely mobilize university gradates to return home and put forth the most treasured energy of their youth at their village populace's disposal. Such awards will erase the stigma of failure associated
imperative that the social structure be prepared to welcome the graduates back into the village, as assets to the village's developmental pursuits. The graduates may be integrated into the youth clubs
where they can act as role models for youths who may be preparing for university studies. The graduates'
wealth of experience will provide background resource for any group endeavour. The elder villager may enjoin them into their work force as consultants and/or administrators. ln the case of the affluent
graduates they may be encouraged to join their family business enterprise or venture into the establishment
factor of the vicious cycle of unemployment, poverty and ignorance. And as health has been defined by the World Heahh Organization as "the complete state of mental, physical and social well-being and not only the absence of infirmity and/or disease", it is therefore just as clearly understood that the
achievement of health goes far beyond the elimination of diseases. Physical, mental and social well-being are all so closely intertwined making it difficult to achieve one in the absence of the other two. Thus, the means to achieve health is obviously not an isolated process rather it is a multicorporate approach
tempered with dedication and determination. Easier discussed than implemented the complexities of an integrated approach is multifadorial. Stategies deemed to be a pool of efforts from all concemed sectors and agencies, both government and non-govemmental. Over and above, there is a necessity
for concerned individual involvement to begin from the early planning stages of any health and
social development plan. In the formulation of a youth development programme, the youth should themselves be consulted over what their felt needs are. There should be participatory effort from the basic structure of society which is the family, and a positive community endoresment and support. Hence, commitment to endeavours should be generated throughout the hierarchy of the social stuatum.
An in-depth study of the health situation and trends in Thailand reveals the classic problem
of inadequacy of bained health manpower & health service delivery outlets, the subminimal budgetary allocation for health and the plaque of govemment inertia hidden under the cloak of a more sophisticated terminology "bureaucracy". The inadequate supply of trained health manpower personnel is reflected by the following health statistics4. The ratio of medical doctors to population is 1 : 5564, nurse to population is 1 : 1286 This is further compounded by the shortage in the country's health service
delivery outlets. The ratio of hospital bed to patientis 7 : 774 health cente to population is 1 : 6395. Added to this is the inadequacy of logistics from medical equipment and supplies including essential drugs.
A multicorporate approach to the solution of problems in health and social development has
long been undertaken by the Thai govemment. Seminars, working groups, meetings among the multi-
tiered government ministries have been carried out with encouraging results. Relations previously percieved as strained both intersectoral and inter-minishies had relaxed and has been considerably cordial as a result of the periodic interaction between policy-makers and policy implementors. This situation may be creditted as a giant leap to the mechanics of problem solving. Integration of social services into health programme has been both acceptable and applicable to the consumer community
at large. The current level of impetus should however; be sustained, lest the contagion of government
inertia re-surface. Sufficiently documented are multisectoral approaches directed towards the common
goal of the achievement of an optimum quality of life for the citizenry of the country. Cooperation and collaboration between the health, education, agriculture and community development sectors are evidence of positive political will towards a team context of endeavour. However; the university graduates'role in this team-approach has remained unsolicited until a bold step has been undertaken towards the initiation of the graduates as volunteer workers in health services with the advent of the two projects focussing on the roles of university graduates in health and social development; "The
What would have been percieved as most ironical is to be witnesses to bright intelligent youths waste in frustration. The academe has the greatest burden to bear in the identification of potentials in the graduated students. The academe is best in position to formulate strategies towards their mobilization. It is this seriously felt responsibility that has led the then ASEAN Training Cente for PHC Development (ATC/ PHC) now the ASEAN Institute for Health Development (AIHD) through the benevolence of the Mahidol University Rector, Prof . Dr. Natth Bhamarapravati and the magnanimity of the Japan Intemational Cooperation Agency (JICA) to conceptualize the projects on Graduate Health Volunteers and Graduates Return Home.
CHAPTER
The project on "The Graduate Health Volunteer" (GHVs) was spearheaded by the project on -"Research on.Primary Health Care Model Development - Chanthabwi Province" and has been launched
concomitantly in January 1985 through the collaborative auspices of the AIHD (formerely ATC/PHC), the concemed offfclals of the Ministuy of Public Health (MOPH) and the provincial authories of Chantha-
buri.
of : creation of communications channel between the universityr and thB communityr; education, exposure and mobilization of university graduates to the challenge of
Based on a four-fold objective health problems; awareness stimulation of the village and its officials and the utilization of health services as an approach to integrated solving-process mechanism : the project has for its over-all goal the utiliza-
tion of university graduates in health care as ultimate providers, facilitators and leaders in health and
related activities. The project has four major project activities; recruitment and selection of GHVs, placement and fteld experience reports.
taining; field
2.2
PROJECT OBJECTIVES
2.2.L Tocreate a channel of communication betveen the academic world and the community. 2.2.2 To educate, expose and mobilize university graduates to challenge existing health
2.2.3 To stimulate awareness of villagers and local officials in problems related to health. 2.2.4 To utilize heahh service delivery as an enty point to an integrated approach to problem
solving.
2.3
ANALYSIS
The province of Chanthaburi can rightfully claim itself as the fruit basket of Thailand. Noted for its vast orchards of rambutan, durian, mangosteen, pineapple, a visitor is always welcome to eat into his head's content these topical fruits without payment, right within the backyard of any orchard
owner. However; it will not do justice to the province to highlight only on its fruit-bearing capability,
for over and above its fruit produce, Chanthaburi also abounds in colored gems; precious rubies, sparlding
topaz, midnight-blue sapphires and lush-green emeralds that athact both tourists and haders alike. Adding to its economic potential are the rubber plantation that abounds the province. Chanthaburi may therefore well be described as properous. The hovince has a total estimated population of 374,56O and an estimated land area of 6,000
sq.kilometer. It receives approdmately eight months of rainfallper year. Geographically, the population are scattered amidst fruit orchards and gem-pits rendering communication and access to health services,
difficult. People have always been hade-oriented leaving no time for commercial-type of activities. Livelihoods take people away from home during the entire waking hours, hence the lack of stamina and disinterest for congregation and community-oriented projects. ln addition, there is a high migration
rate as a result of existing job opportunities. The migrants being not only economically disadvantaged
but also ignorant as to accessibility of health care facilities are therefore indifferent to any participatory movement in their new communitie5.
t0
I
I I
L____
il
ORGANOGRAM OF THE PROVTNCIAL HEALTH OFFICE
General
Food
&
Drugs
Adminishation
Section
Section
Health Promotion
Section
Medical SeMces
Supportive Seciion
Communicable Dseases
Conkol Section
STD'
&xuolly Transmltted
Diseoses
12
hovlnclal Heafth
lI-
lnformaflon Center
PPHO
-{
L
- Dsbict
Office
Sub-dtstict hedth
lnformatlon Center Heahh C,enter
Kum-nun
- ViilaS Headman
/vHc
other:
- Traditional
Attendants
Bidh
VHV
vHc
Ollre
olunteerc
t3
Demographic Data Population by Age Group and Sex (1986). Total Population 398,937
Male Female
202,799
196,138
Ase
Male(%)
Fematc(%)
Tota(%)
G4
5-9 10-14 L5-24
4.M
5.15 5.68
10.93 L3.92
9.01 10.48
11.M
21.L2 27.47 14.22
25-M
45-59
<60
Total
6.99 3.27
7.23 3.39
6.66
49.25%
il.75%
r00.00%
The above table indicates that population belonging age group 25-44 compises the highest percentage and those belonging 60 and above comprises the smallest percentage.
Healttl
Becourcee
Reglonal
Dhtrlct
Hocpttal
Medlcal
Center
Health
Center
Communlty
Publtc
Dlstrtct
tloopltal
Heahh
Ofice
Muang
I
13
1 1
1
29 6
L2 13 13
I
1
Total
86
'14
Muang Ta-mal
65
2
a2
t2
9 9
65 65
22 27 36
1:1,458
l:!t6,D7
lam-dngh
Klung Pong-Nam-Ron Ma-Kam
I I
1
l:T,t2,
l:49,36
:13,9)2
10
l:42,539
1:1,t158
t:1,7D
1:1,373
t:1,7O2
1:1,878 1:1,184
DisMA/Tambon/Village
Muang Ta-mai
9
19 7 10
92
188
8
19
tamlngtt
Klung Pong-NamRon Ma-Kam
&
83 68
6
10
78ffi 188 38 83 67
78
188
78
193
t,452
247 545
l9
6
10
38 83
57
38
932
9 8
63
&t
of totd sub-dtstuicts and 92.91% of total villages VHV coverage %.77% of total sub-dtsfrlcts and 90.84% of total vtllages Average numbr of VHC/vilage 8.3 Average numb of VHV/village 1.0
VHC
coverage 96.77%
t5
6 83 5
1
is inadequate coverage with tetanus vaccination and poor nubition information which have negative effects to both mother and
child. This lack of utilization of existing heahh facilities may be atEibuted eitherto lack of adequate informa-
tion on the part of the mothers or on apparent inaccessibility of the health facilities.
4,691
4%
10
L7,219
77.r
The present nutritional status of children under 5 years of age leaves much to be desired. Although there are statistically insignificant number of cases suffering from 2nd degree and 3rd degree malnutrition, 2O% of these children are within the 1st degree malnourished bracket.
Mahda
I
2 3
2,377.8
6,4t6.7
1,747.0
1,483.1
4l
.1
Dhfica
unknonrn fuver Qlcentertl
6,ffi
5,484
1,516
l4
.03
4
5
w.9
245.6 22.7
184.9
1'1i1.6
I I
1t
.u2
.@2
.03
rvtal conjuncdvtds
Pneumonla lnfluenza
It{eaCes
9G
742
6
7
6g
531
Rrlmonu!, Tuberculods
Food polsonlng Hemonhaglc ferrr Sexually
Dlreases lnsecdclde polsonlng
8 9
45
416
100.3 112.5
18,
2.005
Tnngnlted
t0 l1 t2
13
D2
m
158
78.9 54.1
42.7
.005
Hepaffis
t4
15
r57
113 109
Chkken pox
Crerman measles
42.5 30.5
.w2
l6
t7
18
D.5
27.6 16.3 8.9 8.9
Trphold
Mumpe !,!enlngms Pedusds
to2
60 3:|
3r3
Enccphaltl3
n
2t
22
t9 t9
.o2 4 2
.01
14
3.8
3.2 2.7 2.2
1.1
Dbtherh
Tetanus
t2
10
.005
Tphus
R$ls
Clrolera
I-cptocplroCs Cronococcal meningltis
23
u
25
4 ,2
'4
I I
.oo2
.01
*j
.5 .@2
Bw
"Per
17
pRorfivqr,
P'eunt
,sS
ALHD 1989
of
Welcome home!
uisif
Promotion ol u illoge
deu
----
l9
2.4 PROJECT
ACTIVITIES
During the process of selection, the project implementors were constantly aware that these volunteers will have to commit themselves over a year to serve a community whose population they do not know, whose needs they are not familiar with and whose health problems they uue even more
shangers to, hence; it becomes imperative that exheme care and a highly circumspect attitude be excer-
cised throughout the selection process and that as the project is implemented a constant monitoring
is of priority requisite.
20 health care and one week of training on emergency interventions at the Community Hospital. This one week of training also incorporates knowledge on primary health care activities and proper refenal channels. Their fourth and final week is spent in their site of assignment. Each GHV is given a monthly subsidy of three thousand baht (E 3,000) equivalent to an approximate one hundred fourty five dollars (US.$ 145.00) to cover living expenses. Likewise a motorcycle is provided to facilitate out reach to the scattered household. It is envisaged that through the varieg of educational experience the GFIVs have been exposed to during their academic years; an interplay of social science, formal taining in political science, geography and topography and their interaction with researchers and the community; an innovative model for PHC activities will be realizedboth creative and practical and tailored-cut to meet the felt and unfelt needs of the people at the grass-roots level. The GHVs will be given a chance to evaluate there own orientation under an aura of complete independence in the hope of developing their decision-making
capabilities, identfuing their own stengths and weaknesses and ultimately re-inforcing their self-confidence
while developing full leadership potential in health and in their respectively chosen field of endeavours. Progress of GHV activities will be closely monitored by the research team in collaboration with the Project Manager.
The different parameters for measurement of the effectiveness of the GHVs are
1. 2. 3.
perception of his/her leadership role by the community final written report his/her productivlty as perceived through process indicators by the village committee,
village health communicators, village health volunteers and ongoing health development activities in
his/her village of assignation; and through health indicators (birth weight, infant mortality, maternal mortality, malnutition cases) . However; not all favorable perceived results may be solely attributed to the GHVs, hence the limitation of measurement by health indicators.
Hrs. Lecturer(s)
Module
1.
l.
LUz ATC
staff
2.
lr/z
3.
ATC staff
3
3
of GHV's
Socials (getting to know each other)
The national health policy in the VI National
ATC staff
Health Planning
Dvision, MOPH
NESDB
ll
Hrs. Lecturer(s)
3
3
M.U.
Educational problems and the nessity of rural developments. Group activities Summary of the module 1. 3
3 l% 3 3 3 3 3 3 3 3 3
3 3
NESDB
ATC staff
Module
PHC
Concepts and principles of PHC Office of PHC, MOPH Office of PHC, MOPH
Representative from
t2.
13.
14.
QOL committee,
NESDB
15.
Faculty of PH Faculty of PH
Representative from
\6.
t7.
8.
18.
MCH iN PHC
Health Card Fund Expanded Immunization in PHC Environmental sanitation in PHC
The provision oI essential drugs in the com-
L9. 20.
2L.
10.
munity Treatment oI common diseases Dental Health in PHC Mental Health Nutrition in PHC
Sef-Manased PHC village and Mni Thailand Project
22. 23.
11.
24.
Dvision of Nuhition
MOPH MOPH
25. 26.
Summary oI Module 2.
ll/z ATC
staff
Module
Rural Development
The utilization of BMN 1, 2, 3 forms for community survey
Community preparation
t2.
27.
3
3 3
28.
13
D.
30.
14.
31. 32.
3 3
The programme consist of one day study{our to various places with successful PHC service delivery. The objectives of the tour are to expose the GHVs to actual implementation of PHC and rural development programme, learn various PHC strategies and be able to device their own strategies in accordance to the needs of the population in their community of assignment.
Two weeks haining on health center activities, including; MCH and EMC, teatnent, prevention and control of common diseases, refenal system and the mechanics of rural development.
One week training at the community hospital One week training at the health centre
During the process of field placement, the graduates were given a free choice of where they would like to stay. A great majority of them opted to stay at the health centre and to work with health centre staff. The longest and most important part of GHVs'haining is the actual field operation. This lasts for nine months during which the GHVs put allof his theoretical knowledge into practice. The GHVs are expected to learn and apply the mechanics of good public relations and maintain colaborative working relationship with the villagers, the village committees, the research teams and with the health and other concemed govemment agency personnel. They will have to face and cope with day-to-day
constraints in the implementation of their activities. Moreover: they are envisaged to formulate solutions to constraints and recommendations to the next batch of GHVs for a more successful programme
delivery.
1.
11) has to
be paid
The contractual agreement stipulates that a GHV has to reimburse the amount of the baining cost should he/she fails to comply with the one year contract duration. The ATC/PHC is responsible for the entire taining expenditure in addition to a monthly allowance of 82,5A0 (US$ 92.59) for each candidate qualifying for the post of GHV. In the second year of project operation, inorder to a support and in response to requests for transportation, the project provided for a motorcycle and a gasoline (US$ 8.00) per month to each GHV. In the third year oI the project, the GHVs propct funds to initiate community activities and the project has provided the amount have requested for of E 5,000 (US$ 200) to some GHVs (Please refer to Annex 5) as seed money to mini-projects to be
allowance
ot6
2OO
fu
part of their theoretical taining, the GI-IVs were guided in the presentation of their reports to
include the following salient aspects; geography, main occupation, problems in primary health care development, perceived role of the GHV in primary health care community development activities,
23 accomplishments in their community of assignment, constraints encountered during the period of assignment, suggestions,/recommendations.
The GHVs were provided with a notebook which serves as their diary wherein they keep note of their activities. The report submitted by the GHVs will be an indicator of their performance in addition to their intetaction with the researchers, the village population and the health cente staff. An evaluation of the GHV performance will be conducted at the end of their assignment. Any GHV found to be highly competetive, totally dedicated and willingly committed to his community of assignment has a chance to compete for the post of senior GHV. The senior GHV will exercise supervisory functions over the second batch of GHVs. A senior GHV will receive a monthly subsidy of Baht three thousand five hundred (E 3,500) which is equivalent to US$ 129.62.
The following report has been the result of a cumulative experience during the eight months
assignation of a group of 1nung, educated and hard working GHV in their respective vilages of assignment.
The views and opinions expressed were strictly of the GHVs and not of the project personnel. It is obvious that the topographical location of houses in Chanthaburi has greatly disadvantaged the healih service delivery system. This has even been compounded by an inherent lack of interest in health and community participatory activities brought about by ignorance, high migration rate and the villagers' total absorption in their jobs. Another great handicap is the insufficiency of water supply causing health problems to remain unabated.
It is noteworthy that the report incorporated experiences that varied from lack of identity, with
the consequent feeling of insecurities and inadequacies at one exteme ; and a total command of the community, from problem identification to problem solution ; at another. There has been a general
request for a vehicle for greater outeach and requests for a decrease in the number of assigned villages
to ensure a more complete coverage. Likewise, there has been an expressed resentment for being duty-stationed in the health centre, the lack of authority for decision-making, the poor rapport with
health cente officials and the poor perception of their roles as GHVs by the heafth staff, by the community and by the GHVs themselves. Despite resentments, solutions proposed by the group were all positive
and highly constructive. This included the request for a revision of the taining curriculum towards a
greater emphasis on the practical component of the taining programme and a GHV working manual as a guide for day to day activities. The projert operations $aff has benefited a great deal from the report, egecially in the re-oriention of the haining programme and the provision of working guidelines. The project operations staff has also conducted a dialogue with health centre officials in an effort to bridge the gap between the GHVs
1. 2.
2A
3.
impossible
High rate of migration rendering follow-up activities on health care difficult if not altogether Poverty
Poor community participation by community leaders Inadequate number of health manpo\uer Lack of coordination among four major ministries involved in PHC/CD (Ministry of Agriculture, Transportation, Education and Health)
4. 5. 6. 7.
of meetings among public health officials in the study and analyses of identified
problems
as a liaison officer between health officials and other government sector as an entry point in the preparation of the community for planned health activities by public as a catalyst to the implementation of existing health activities as an evaluator by submission of periodic assessment reports as an adviser on the organization
health personnel
as an assistant in the strengthening of health center information system as a disseminator of health information to as a supervisor to
VHCs/VHVs performance as a motivator to community participation in health and health-related activities as a participant to meetings, and other community development activities
- Participated in road and bridge repairs - Promote supplementary food preparation by demonstration and nuMtion education - Reviewed the neglected drug fund project - Conducted health education lecture both in the community and in school - Facilitated communications between villagers and health centre officials - Home visitation - Conducted special immunization campaign in highly remote village (tetanus toxoid to pregnant women and immunization against common childhood diseases to children under five years of
age)
Suggestions /recommendations
Shengthening of leadership role of village leaders Improvement of collaborative activities among commupity leaders, health authorities and various government officials. - Repair'of roads and bridges - Recruitment of an agricultural consultant to improve technology and produce
25
disease control
2. High incidence of venereal diseases due to the presence of massage parlours,/bars 3. High incidence of haemorrhagic fever. Insufficient water supply forces the village to store
rain water in container jars which are good breeding places for dengue-causing mosquitoes 4. Poor swage disposal 5. Poor roads 6. Poor community participation 7 . Poor organization of health center staff/health centre activities 8. Inefficient supervision of health centre staff by their superior officers
activities
Constraints encountered 1. The GHV is perceived as a fault-finder by health centre personnel 2. The GHV owing to his frequent questioning and consulting is made to feel to be more of
a liability than an asset by the health personnel as GHV tends to interfere with their daily activities
3.
has led
The villagers regard them as medical doctors, inability of the GHV to meet these expectation
activities
Participated in solving managerial problems related to community funds Encouraged community leaders in strengthening their roles on health and development Surveyed and collected health statistics for use as baseline data in planning health activities Liased with other health organizations in the conduct of health and health-related activities
Suggestions / recommendations
- Orientation of community leaders on their role on leadership for health - homotion of the concept of team work to shengthen cooperation and collaboration among
GHV and health cenhe staff - Dissemination of information on the health significance of community organizations
Improvement of the existing supervisory methodology favouring unannounced supervisory visit perceieved as more effective than the present planned visit - Promotion of secondary occupation during off-planting/harvesting-seasons for income
26
2. Poor communications 3. Crimes and assault mostly due to land dispute 4. Illiteracy
Perceived role of GHV in PHC and CD
activities
as a coordinator between the community and the government sector as a source of knowledge and information regarding health and communig development
- as a social agent of change among the villagers and the village leaders - as a model of good health and high morale to the members of the community
Constraints encountered 1. Lack of public interest on health 2. Inability to perceieve GHVs role by community,/govemment
coordinating activities for them
3.
Communication gap due to the parsely distibuted household and fre presenae of hill/hillocks
4. Lack of means of tranportation 5. Weak performances of VHCs/VHVs 6. Lack of community participation by the community leaders themselve, 7. Frequency of migration and high mobility compounding the problems of communications
and follow-up
- Gave health education lecture on MCH/FP and PHC - Advised on proper waste and sewage disposal
Exemplified benefiS derived from communig participatory activites and community develop-
ment funds
Liased between the village and concerned govemment officials on matters of health and health-related activites
2. Need for a vehicle for access to remote areas 3. Need for additional information on communities that are highly inaccessible
27
1. Lack of adequate prenatal, delivery and postnatal care including family planning 2. Maternal and child malnutrition due to lack.of nutrition education 3. I-ack of knowledge on the nutitional values of breast feeding, appropriate kind of weaning
foodlbreast milk substitutes
4, Poverty compounded by poor communication facilities 5. Lack of community participation 6. Poor coordination of health centre activities giving rise to frustrations and dishusts among
health center clients 7. Lack of full comprehension by VHCs/VHVs on their role in health service delivery
- as a participant to problem-identification and analyses - as a coordinator between health officials and the members of the community - as a coordinator for village health activities - as a support system ior a more effective perfomance by health officials - as a supervisor and evaluator in the management of community fund - as a supervisor and evaluator of VHCs and VHCs performance - as a participant to meetings of health officials - as a stimulant to community irarticipation - as a disseminator of health information - as a participant to community development activities
Constraints encountered 1. Lack of decision-making
personnel
2. Lack of vehicle 3. Lack of constant contact with inaccessible communities for fear of safety 4. Lack of community participation 5. Poor perception of the GHV's roles by VHCs/VHVs
GHtfs Accomplishments in the community of assignment - Gave health education lectures - Lectured on environmental sanitation - Lectured on benefits derived from community funds - Acted as coordinator between the community and government officials - Acted as trainer in training courses held in the Tambons - Participated in meetings among the four major ministries
28
Suggestions /recommendations
3. Decision-making authority not to be a sole prerogative of health centre officials 4. Provision of a GHV working manual Tambon Nong Ta Kong. Pong Nam Ron Distrlct. chantaburi
Mtss PanPls ToPrakone
- as a liason officer between villagers and government officials - as.a leader and promoter of youth group activities - as a representative of government officials during community meetings - as a health educator to school children and the villagers - as a friend and advisor to VHCs and VHVs - as an informer about the extent and limitations of a GHV's role which do not include
aspects
curative
- as a communitY develoPer - as a motivator of MCH/FP activities - as an aide during home visitation and in the follow-up of cases
GH\i's Accomplishment in the community of assignment
situation
Home visitation Attended community development, Mllage Committee and the Tambon Council meetings Relocated villagers living near the frontier of Cambodia because of the dangerous border Trained VHCs/VHVs on MCH/FP and in the use of the'MCH/FP survey form performed the duties of a health educator both in the health centre and in the villages
Constraints encountered 1. Lack of knowledge on PHC activities and existing health problems in the community 2. Wrong perception of GHV role by health centre officials 3. Inadequacy of GHV's knowledge and exposure to PHC activities giving rise to feelings of
insecurity
Suggdstions /recommendations
Dminish the area of responsibility to allow GHV a more complete coverage of health and community development activities - Station the GHV in the village to altow better rapport and understanding with the villagers
and the village committee - Increase the number of GHV working per Tambon - Increase supervision of GHV by the research team
IY
2. Poor agricultural technique 3. Poverty and poor health status 4. Lack of knowledge on the importance of community development 5. Conflict between villagers and health officials responsible in the area 6. Problems between the migrants and the local residents 7. llliteracy 8. Lack of participation from government officials
Perceived role of GHV in PHC and CD
To explain the GHV role to the villagers for better understanding of his/her presence in the community - To make the people realize the importance of knowing their health problems and to help them analyze and solve those problems - To participate in community development activities
- Participated in Tambon council and village committee meetings - Supervised VHCs and VHVs and the drug funds - Coordinated with the mobile medical unit of the provincial health office - Demonstrated supplementary food preparation with agricultural officers - Home-visitation - Conducted school health care service - Conducted haining programme on MCH/FP EMC for VHCs/VHVs - Improved the physical set-up of the health center and its sunoundings
Constraints encountered
1.
Misunderstanding betrveen GI-IV and health cente staff due to poor delineation of role
activities of GHVs
2. lack of means of transport for GHV 3. Lack of interest among villagers on community development 4. Lack of understanding of GHV role by the community 5. Irresponsible performances of VHCs/VHVs 6. Poverty
30
Suggestions /recommendations
setting on important community activities - Increase the knowledge and under*anding of the community on the importance of community
development activities
Improve knowledge of
'
development
Provide GHVs with operation plan to assist them in the performance of their daily activities GHV should consult health centre staff if problems arise during their performance Researchers should explain in detail their research activities to the health staff Researchers should invite participation among GHVs and health staff during fieir meetings
Researchers should give support to GHVs in the performance of their research activities
Problems in PHC development 1. Lack of communication between the villagers and the health centre staff 2. Non-participation of health official with VHCS/VHVs activites
3. Lack of knowledge on the importance of adequate pre-natal care 4. Poor understanding of GHV role in the community
Perceived role of GHV in PHC and CD
To join the health officials in the identification, analyses and problem-solving of community
health problems and in the preparation of the community - To coordinate between government and NGOs on health and health-related activities - To coordinate PHC activities among the communrty and the health officers in PHC activities
- To encourage health officials in the use of innovative approaches in health service delivery - To motivate community participation in PHC activities - To submit periodic performance report - To disseminate knowledge on PHC to VHCs/VHVs and evaluate their performance - To participate in community development activities - To participate in follow-up and evaluation of fund management activities - To strengthen health centre management information system - To act as health educator to the villagers - To go on home visitations - To keep the health centre clean
GHV's Accomplishments in the community of assignment
- fusisted the auxilliary health midwife in MCH/PHC - Assisted in the baseline survey
activities
3t
- Acted as a health educator - Participated in religious ceremonies - Participated in supplementary food preparation
Constraints encountered 1. Health centue charged
fees for consultation as a result of which people are discouraged seek medical advise unless in extreme cases of emergency
2. Lack of means of transportation 3. Poor perception of GHV role by the health centre staff
Suggestions /recommendations
- More frequent home visitation for better coverage - Provision of an outline as a guide to daily activities - Greater emphasis on the practical aspect of the training program - Meeting time and dates should be fixed in advance
The format of meeting should be based on participatory discussion and not just presentation Need for a sphygmomanometer to enable GHV to take blood presure readings
1. Lack of interest in health and hygiene due to lack of knowledge 2. False beliefs/traditions on matters related to health practices 3. Weak community leadership and poor community participation 4. Lack of trust on health official 5. Insufficient water supply 6. Poor family planning acceptance due to lack of interest
Perceived Role of GHV in PHC and CD
problem
as a health educator and informer-to correct false belie.'s and superstitions about health
- as a supervisor to VHCs/VHVs - as an advisor in the construction of tanks for water storage - as a family planning motivator - as a liason between health official and villagers to re-instore the trust of the villagers on their
health officers - to assist in the selection of potential replacement to the present village head man who has shown little interest in his community
JI
- Assisted in MCH data collection - Supervised VHCs/VHVs - Home visitations - School health education - FP motivations
Constraints encountered 1. Lack of hansportation facilities 2. Lack of interest among the affluent member of the community on GHV activities 3. Disrruption of GHV activities due to frequent absence of health cente staff
Suggestions /recommendations
- Better explanation of GHV role to health officers - Participation of GHV in all health centre activities - Better understanding by GHV of community development
funds
Ban Ta Moon Health Centre. Tambon Sai Kao. Pong Nam Ron
Mles Afma Jlnwala
Problems in PHC development 1. Poverty giving rise to malnutrition, disease and inability to participate in health card project fund 2. Lack of information and communications due to poor media facilities 3. Poor Community participation as majority of the population are migrants 4. Poor environmental sanitation
- Explained the importance of membership to the health card fund project - Participated in MCH/nutition and other health cenhe activities - Supevised VHCs/VHVs - Strengthened health centre management information system
Constraints encountered
1. Poor understanding of his own role resulting into confusion
with the villagers
as
2. Oppression by health centre staff 3. Poor understanding of GHV role by health cente
staff
are very sparsely dishibuted Lack of self-confidence and lack of creativeness on the part of the GHV
Suggestions /recommendations
A need for working guideline emphasizing on GHV's duties on the villagers and not on the
Freedom for GHV to choose the place he/she prefers to reside (in the health centre or in
the village)
activities
To produce health information materials for dissemination of PHC knowledge To coordinate with four major ministries To participate in community development activities
To learn from the villagers, need-based strategies in developing appropriate community
Constraints encountered 1. Villagers lacked appropriate information on health card funds 2. Disagreement by GHV on the health card fund concept; feeling that its system
does not
work the way it should as regards to the "green channel" aspect, and because of the inability of the villagers to select their own doctors and hospital. The health card fund has provision for only one doctor
leaving the holder no other choice.
Suggestions /recommendations
It is better for GHV not to be involved in health card fund as they are viewed upon more as a liability than as an asset by the health card fund organizers - GHV should concern himself/herself with the group of depressed migrants who cannot immuniafford to buy the health card and cannot avail themselves of basic heahh services services such as
zation
GHV should have greater awareness of the village situation inorder to be able to supervise VHCs/VHVS more effectively
Problems in PHC development 1. Poverty as a result of poor industrial land agricultural technique 2. Public health problems such as ; poor environmental sanitation, high incidence
and inefficiency of VHCs/VHVs
of malnutition
34
- To disseminate public health information - To motivate people on proper sewage disposal - To suggest people to conshuct concrete water tank for water storage - To give nutrition education - To join the Tambon council in the demonstration of income-generating activities
GHVs Accomplishments in the community of assignment
- Home visitation and follow-up immunization - Conducted family health survey - Assisted in health card fund management - Supervised VHVs - Child weighing - Child weighing
Participated in community meetings
Assisted the health centre officers in their daily activities in the health centre Disseminated pubtic health informations activities
Constraints encountbred
- Lack of community awareness on the value of health card - Inability to purchase the health card due to poverty - Lack of means of tansportation - Poor understanding by the GHV of his role - Poor community perception of who and what is a GHV - Lack of decision making authority on the part of the GHV
Suggestions /recommendations
GHV need a working outline GHV has to be given authority for decision-making The role of the GHV should be more elaborately explained to the health centre officials
2. Poor understanding of the health card fund project 3. lnefficient VHCs/VHVs 4. Inability of the villager to generate community activities 5. Poor environmental sanitation (sewage disposal)
Jf
- To disseminate public health information - To participate in meeting among the four major ministries - To participate in community development activities
GHVs Accomplishments in the community of assignment
- Disseminated public health iriformation - Participated ine village committee and Tambon council meetings - Supervised VHCs/VHVs
Assisted health centre officials in school health activities Assisted health centre officials in their daily health centre activities
Constraints Encountered
L. Lack of self - confidence in associating with health centre
staff
2. Poor leadership role by health centre officials 3. Training course was mainly theoretical and the practical aspect is insufficient 4. Lack of adequate supervision of GHV
Suggestions /Recommendations
1.
staff
Boost self - confidence of GHV by allowing him/her to give suggestions to health centre
2. Health officers should be made aware of their leadership for health role 3. Revision in the haining cuniculum to give more gmphasis on the practical aspect 4. Better supervision of GHV
community problems on health, socio-economic and traditional beliefs. However; the herewith reports focussed only on the health aspects of their community participatory activities. In the case of the third batch of GHVs, some of them have additional reports about their mini-projects in which they have assisted in identifying and implementing. (Pleas e refer to Annex 5) The second and the third batch of GHV's detailed reports were submitted and published in Thai. It may be noted that three of the third batch of GHVs have been fielded in a neighboring province, Chonburi. This is because of an anticipated urbanization-related problem upsurge in the aforecited
province. The Royal Thai Govemment is presently implementing the "Eastem Seaboard Development Roject" which is envisaged to gve rise to air and noise pollution, taffic accidents and problems associated to industrialization and migration. The project operations staff therefore, have decided to assign three GHVs in an attempt of conceptualize a viable strategy to solve these constraints.
The following are the abstracted reports of the second and third batch of GHVs
36
'
1987)
2. Poor community participation due to too far distance from village to health center. 3. People are used to easy living with low priority for sanitation 4. Povery 5. Rapid urbanization, so people attempt to own electrical equipment much more than give
attention to public health and environmental development
& CD
care education
2. Promotion of drug cooperatives 3. Identification and maximum utilization of existing village manpower resource 4. Environmental development 5. Coordination with other related officials in the area, including community organization.
GHV's Accomplishments in the community of assignment
Provided follow-up care to malnourished children Cooperated with village organizations in the conduct of meetings
2. Public heahh leaders are not effective enough 3. Mllagers ignore their own health 4. Most villagers lack knowledge in health and still believe
Guidelines to implement PHC
in old beliefs
& CD
age and other target population
1. Health Education Campaign about MCH 2. Health Education dissemination emphasizing on school
(Grade-VI students of primary school'(s))
Drug cooperative improvement to promote cheap sales of powder milk in order to change attitude in the use of condensed milk (in case of mothers who are not able to breast feed)
3.
37
- Health Education about MCH - School health education for grade-Vl students in primary school - Drug cooperative improvement to promote powder milk sales at cheap price - Campaign for healthy mothers to breast feed their babies - Mobile clinic
Tambon Sanamchai, Tamai Distrlct, Chanthaburl Province.
Ms.Anchalee Pannark (MCH/FP)
1. Lack of awareness about epidemic disease 2. Poor transportation 3. Incoordination among village organizations and members 4. Poor understanding of people, village organizations' member and volunteers of their role. 5. People give low priority to their health needs. 6. Poverty 7. Malaria problem due to many forests. 8. Old beliefs related to nutrition, MCH
Guidelines to implement PHC
& CD.
1. 2. 3. 4. 5.
Coordinate the union among villagers and related persons Identify problems and find solutions Stimulate people to solve their problem by themselves Community cooperation Development of feasible and flexible PHC strat egies
- Coordinated various offices and village organizations - Provided stimuli for people to be aware of development - Established the roundlatrine fund
Tambon Nongtakong, Pong-Nam-Ron Dlstrict, Chanthaburi Province.
Ms.Slrlporn Ua-sllamonskol (MCH/FP)
1. 2. 3. 4. 5.
Lack of unity among various village organizations to develop public health activities People are not familiar with initiating new activities in health development People do not understand the advantage of development Poor understanding of people about community participation Unhealthy traditional behavior and beliefs
'lA
& CD.
1.. Adaptation of community organizations to make them shong, able to unite and aware
of the value self-development 2. People participation : stimulate them to unite and make them feelthey are facing with public health problems which they themselves must solve 3. For MCH/EMC, assign VHVs/VHCs to disseminate public health matters in villages and to arrange public health service in villages, whenever possible
2. Poverty 3. Heads of village organizations are not stuong enough to initiate heafth development activities 4. Most people do not rely on VHVs/VHCs
Guidelines to implement PHC/CD
Stimulate VHVs/VHCs to be enthusiatic to work and to understand about their village development activities
1.
2. Manpower development 3. Good personal relations with villagers to generate their love and respect 4. Cooperate with VHVs/VHCs to disseminate to target population MCH knowledge and
nutrition information 5. Develop coordination in the entire village
VHVs/VHCs taining in cooperation with research team ald health center officers on nutiCoordinated the project on "The Solution of Malnutition hoblem with Fund Development
39
2. P oor environmental sanitation-few latrines 3. Lack of safe drinking water, especially in summer 4. Malnutrition problem due to poverty 5. Strange beliefs about care of pregnant and post-partal women
Guidelines to implement PHC/CD in urban area 1. PHC implementation to focus on the group with percievel problems
2. Need to study and understand the community 3. VHVs must participate in problem solving
situation
Taught illiterate people in community Published pamphlets about fund dissemination Informed concerned officials on community development concepts
by people due to their young ag'e and some does not care
2.
2. Mobilization of limited community resource 3. Close coordination among village officials 4. Support of health-related activities
GHV's Accomplishments in the community of assignment
- Organized 23 funds to be Tambon Development fund - Surveyed primary data of community and people's attude to health card project - Trained sub-group leaders for spreading out knowledge on health card to the community
40
2. Poor environmental sanitation 3. Poor community participation especially as regards 4. Poor cooperation from VHCs and VHVs
Guidelines to implement PHC/CD 1. VHV
members refresher haining courses
to drug cooperatives
2. Promotion
3. Frequent dissemination of health education materials 4. Support of drug coopeiative by village officials 5. Arrangement of observation tours to development village 6. Promotion of health card fund by concerned community officials
GHV's Accomplishments in the community of assignment
- Campaigned for latine construction - Cooperated with health officers in survey and suggested covers for drinking-water jars - Assisted in household survey and village map making - Assisted in health checking f& primary school students - Suggested fund management by VHVs/VHCs - Disseminated public health education : e.g. Malaria and cholera clean water project to be
dedicated to the Great King's Birthday (5 December)
1.1 Lahine-only 11% have latrines 1.2 Rain water tank, must adapt the
tank
2. Lack of community
Poor leadership
Study various community problems clearly to know causes and obstacles of development understanding of public health problems
41
which can be time-fixed 3. Encourage community leaders toward continuous health and development activities
Assisted the health officer on basic data survey home visits, coordination of village committee,
PHC implementation in the village 2. Most people do not understand public health problems 3. Officers do not get cooperation of people because they do not have much free time
1. Increase in the number of health personnel 2. Generate awareness to respective roles and responsibilities
cials
3. Generate the awareness of VHVs and VHCs on the quality of their performances 4. Stimulate community self-help activities 5. Initiate attempts to change attitude and old beliefs and utilize acceptable new technologies 6. Encourage people and community leaders to participate with public health problems-solution and village development
A2
2. Lack of interest among community leaders 3. Poor performances of VHVs and VHCs 4. Overloaded activities of health centre staff
Guidelines to implement PHC/CD 1. Suggest people participation in the identification of public health problems 2. Attempt to develop communip leaders to be initiators of PHC development and self-reliance
3. Encourage VHVs and VHCs to perform 4. Increase in the number of health staff
Problems in PHC development 1. Migration in order to find new job or new settlement 2. People worry over material gains instead of their health problems
3. Lack of participation from community leaders 4. VHVs/VHCs are not dedicated enough; moreover, they do not understand their roles 5. Lack of collaboration among officials to develop PHC 6. Problem finding by officials is not along the same line as the community's 7 . People prefer to see doctors at private clinics, as they think they can get better treatment
(must improve government health service system)
Guidelines to implement PHC/CD 1. Additional manpower training 2. Stimulate and motivate VHVs/VHCs,
performance of public health activities village committees and community leaders in the
43
GHVs Accomplishments in the community of assignment - Re-divided responsible cluster for VHVs/VHCs to avoid confusion
of responsibilities
etc.
Developed the awareness of the community about research for "Model Family of PHC"
Problems in PHC development 1. The distance between households 2. Poverty since their income depends
most of them are in debt is quite far on product price (agriculture) which is changeable, so
3.
Due to households far distance from health center (about 6-7 kms) officials do not visit the
2.
Good coordination between health center staffs and VHVs/VHCs & village committee for
- Acted as advisor for public health activities - According to research assignment, identified new model of PHC supervision, study results
of supervision through systematic performance and the satisfaction of VHVs/VHCs with systematic supervision
Reports of GHV
III Batch
2. Overloading of health centre responsibilities 3. The concept of top-down PHC ideology (from the government to the people)
AA
Recommendations/guidelines for PHC development 1. Strengthening community organizations 2. Improving dissemination of information among the villagers 3. Creating incentives for communal work and healthy life style 4. Promotion of self-care appropritate to villager's beliefs and tradition
2. Superstitious beliefs and practices on pregnancy, 3. Unsuccessful operation of Health Card Project
Recommendations/guidelines for PHC development 1. Refresher courses for VHVs/VHCs 2. PHC education for the last year primary school students 3. Health education campaign on MCH, prevention of mosquito breeding and setting up the
village drug cooperatives
- Pre-natal health education - Campaigned for regular health check up of women in the reproductive age - Assisted health centre staff on school health programs, information management, health
education and other health-related activities
Tambon Takadngao
Mr. Pichlt Sophonwasu
2. Consumption of uncooked food and dangerous drugs use 3. Problems on Health Card Fund hoject implementation 4. Inactive community leaders and VHVs/VHCs
45
Recommendations/guidelines for PHC development 1. Strengthening the activities of VHVs/VHCs and the health centre staff 2. Campaigning for annual Village Contest on health activities 3. Shengthening coordination among the responsible govemment officers for PHC
munity development
and com-
- Campaigning for the construction of sanitary latrines - Strengthening the community organizations and the village volunteers - Giving health education and surveying Basic Minimum Needs of the people - Setting up the village development fund
Tambon Sanamchai, Tamai District
Ms. Nanthaporn Vrutnak
2. 3. 4.
Consumption of uncooked and contaminated food Lack of health consciousness on disease prevention Lack of MCH education, ie., family planning, pregnancy, child rearing etc.
Recommendations/ guidelines for PHC development 1. Strengthening of people's capabilities on self-help activities 2. Promotion of community participation for solving individual
2.
MCH services
46
2. Strengthening community organization 3. Setting the youth group 4. Health education during home visit 5. Campaigning for the special project on the village sanitation fund. Tambon Bangsakao, Klung District
Mr. Chakri Strlrak
2. lnability of VHV's and VHC's to understand their indidual roles and responsibilities 3. Infrequent home visitation of villagers by health centre staff 4. Lack of interest on a healthy life style
Recommendations/guidelines for PHC development 1. Strengthening VHV's/VHC's activities 2. Reduction of health centre staff load 3. Improvement of public education on health
GHV's Accomplishment in the community of assignment 1. Community
study
2. Campaign for "The Land of Morality, the Land of Prosperity" project 3. Promotion of Health Card Project 4. Set up the village information centre 5. fusist health center staff on medical treatment and health education Tambon Nongtakong, Pongnamron District
Ms. Parlchat Thep-rath
2. Problemsprovement of VHVs/VHCs capabilities 2. lmprovement of health cente services, especially the promotion of "mobile health cente" 3. Promotion of communal self-help activities 4. Coordination with the frontier police and frontier military for health promotion
47
2. Promotion of MCH services and knowledge 3. Promotion and surveillance of nutritional status 4. Stengthening VHVs/VHCs capabilities 5. Assisting MCH research team on various research
activities
2. Over use of insecticides and herbicides 3. Problems on Health Card Fund project
implementation
Recommendations /guidelines for PHC development 1. Promotion of communal spirit (work for community spirit, and communal activities) 2. Promotion of heahh education for heahh improvement and other agects of development
GHVs Accomplishments in the community of assignment 1. Promotion of appropriate drug use and provision of essential drugs for the family 2. Assist the PHC research team in
:
2.1 Encouraging VHVs/VHCs on their work 2.2 Developing systematic PHC data collection 2.3 Refresher courses for VHVs/VHCs
l.
Nutitional problems
2. Not enough vaccination coverage 3. Sanitation problems 4. Overuse of drug, especially analgesics
Recommendations /guidelines for PHC development 1. Human resource development through communal activities
2. Coordination
A8
2.
Problems in PHC development 1. Traffic accident and work accident 2. Noise pollution due to motorcycles and heavy trucks
3. Foul smell from animal farms 4. Problems of factory workers due to inegular eating habits Recommendations/guidelines for PHC development
1. Training of student leaders on healthly habits 2. Refresher courses for VHVs/VHCs, especially on the knowledge of enironmental pollution 3. Health campaign for fpctory workers 4. Training for local officers and community leaders on environmental hazards 5. Campaign for sanitary food shops GHl/"s Accomplishments in the community of assignment 1. Set up village information centre 2. Village survey on rurla and health problems, and nutritional status. 3. Assist community members on village planning and physical construction
2. Indiscriminate use of medications 3. Water pollution due to the presence of many fatories Recommendations/guidelines for PHC development
1. Strengthening activities of VHV's/VHC's
especially on environmental problems
2. Strengthening capabilities of health centre staff in working with the community GHt/s Accomplishments in the community of assignment
1. Set up the
village reading centre
(MPHM) student from India,.Dr.Damodar Bachani as his dissertation. He selected EPI as the best
indicator of GHVs'potential in health snice delivery because EPI is a well-stuctured henlth programme in the province of Chanthaburi and the GHVs have completed a comprehensive taining programme
Mean
Score
26
Present GHV.
t2
L4
OId AII
Health Worker
GHV. GHV.
26
15
24
Midwives/nurse
Sanitarian
9 24
AII HW
3.59
2.4L
35.75
- 4A6
I'D
0.91
1.40 P
>
50 This suggests that graduate health volunteets has compuable I(AP of EPI wtth health workers. The difference was not dgnfficant, inspite of thls fact that had only one lrear oposure to health cae qlstem. (except 2 Senior GHV who had 2 years expertence). Heafth rryorkem had mean expedence of about
5 years 14.79l..
B.C.G.
BCG wlth ln 12 months DPT. wrlhrn 12
oPv.
OPV. wtthln 12
Measles Measles withln 12
% (for 1985, 1986, 1987) for all vacdnes was hlgher in those
centes where GHVs were coordinating. Even the proportlon of children getdng immunlzailon with in 12 months werc htgher in o<pedmental group (Centers wilh GHV.) GFIVs har,ae not been rvorhng for EPI alone but for PHC & MCH ln integrated nnnner. Inspite of this, an indhec{ impct on uflltzaflon of preventive health services, like lmmunlzation services is evident.
Rise in coverage (1985
51
Omoorneof Optddt of OreTrahcrr &I{dh'Wor|rerraandof the GHVrThenrdrrcctr Se.lectng Health Scrvlcee ln whlch the can be Ueefrrl:-
1. Itft'6y66n
vacc,lnaflon
o1
1. Modvaton ofparenb
1.
Glvlng
vulnes to bables
and
non-aecpfiors of
mothers
2. Arangng 3. 4. 5.
group
2. 3. 4.
2. 3. 4,
Motlvailon of drop-outs
Health edncaUon Cooperaffng wtth VHV andl Modvatlon of non-acceptors Cooperafing urlfr VHV/VHC
vHc
lnformadon
parents
& moilvaton of
Modvatlon of drop-outs
Moilvaffon of parents/drop-outs
Moffvailon of drop-outs
5. Tahng
uretgtrt of batles
C,omments
ln general they preferred, that GHV
C.oopcrailng'r,ilh
WIC/VFIV
rndvdon
of
VHV/JFIC
d&.
52
Evaluation of Usefulness of Graduate Health Volunteers in Immunization Acdvites ffotal Scores
5)
3.75 3.55 3.8 3.0 2.9 3.5 3.5 2.8 4.3 4.5 4.15
4.0
4.5 4.4
4.O
4.O
hocurement of Vacc,lnes
Recordlng Data of Vacc{natons Repordng Data to Hlghr Lval Giving Vacclnes to Babies lvlotlvatlon of Parents Ananglng Group Talks ln Vlllages Arranging Extended Camps Cooperating Wlth VHV/VHC Follow-up of lmmunlzadon Cases Motivadon of Drop-outs
4.t
3.7 3.3 3.7 4.5 3.9 4.0
3.6
3.5 3.6
& Mothers
4.8
4.7 3.8 4.5 4.5 4.7 4.7 3.7
4.4
3.8 4.3 4.5 3.8
4.5
4.5 4.6
llllll
Dose
Modvaton of Non-Acceptors
Evaluadon Suruey of lmmunlzafion
4.5
4.2
51
Evaluation results revealed that the best skills they have developed were the ability to live with others, cope with existing environmental pressures, improve human relations and conduct of health education. The least developed skills were the application of local technology, adminishation of research and development activities and coorilination with government officials. As regards to the GHVs'attitude on the project, a great majority considered the project as
a good venue for applying their gained a<pertise in health and developnfent. However; they perceived
2.6 YIELDS
2.6.L Positive Yield
The evaluation results have documented the multifaceted benefits society could derive from the Graduate Health Volunteer hoject. Having been provided with an exceptionally good field
demonsration venue, the project has foster concern, involvement and an unsurmountable drive among the universitgl graduates to seek their roles in the village mechanism for health service delivery. The project has undoubtedly polished these group of intellectuals through an exercise of theory application within existing socio-economic limitations.
Endowed with youth and vitality, unaffected and unbiased, the GHVs have proven themselves
as an effective tool to problem identification. Their natural warmth, curiousity and creativity likewise
A very good learning eeqlerierrce in the contad of the presently exir$ing gap between the academe the community, GHVs may be viewed as a human bridge to close the gap. Universities may and
take on this project as an initial step towards re-direction and re-orientation of the academic curriculum. Field practice could well be incorporated into social sciences cunicula with a dual benefit of answering
the problem of acute manpower shortage in the villages and transformation of social values of the university graduates as regards to the dignity of working in the rural areas.
In the mini-protrcts implemented by the third batch of GHVs the result of the
proirt implementa-
tion did not create the desired impact on the community. (Please see annex 5 for detailed report
on the mini-projects). This could be attributed to the very short duration of project implementation (6-9 months). It has well pointed out that projects of short duration could hardly leave any room for
impact assessment.
As what obvious on the report of the GHVs, there is a palpable gap bordering on total resent-
ments on the part of some health staffs. Quite understandably, the GHVs were perceived as shangers
tying to assert their roles in areas beyond their expertise. The health staff could not be totally faulted for their undisguised paranoia. The fact remains that GHVs are outsiders.
54
is
communityr. Just as complex and interrelated are the problems that exist therein. It has therefore become an impossible expectation that virtual outsiders be solicited to effect a mechanism for problem-solving.
Voluntary efforts will not suffice to answer the multifaceted constaints on health and social development in a community. Not even the services generated by both govemment and nongovemment organizations (NGO) members of whom mostly stay in the villages only during their working hours will produce the desired progress in community development activities. It has been well-perceived by the project operations staff that the long struggle towards the achievement of an optimum quality of life will
best be remedied by an attempt to restore the intellectual drain in the community.
Even more obvious is the financial implication of the project on any prospective implementing
body, which render its replication highly improbable if not altogether impossible.
Lastly, is the fact that the project has to deal with a group of young, vulnerable graduates deprived of practical experiences, inadequately equipped with technical skill for the task that they
were made to cam/ out, wanting in tact and diplomacy and worst they were made to function at paralled
with clever, hardened adults who have withstood the hials and tribulations of life. It has become clear why the sorption of the GHVs into the community social structure was far from being fluid.
while full of youthful energy are lacking in maturity, practical and technical skills, and; Third but not the least, that no amount of sustainable development may be aspired from outsiders whose
bound to a communit5l is limited by a contactual agreement based on a substantial financial remuneration. Hence, the project operations staff have come up with a viable stuategy that has taken into consideration the lessons leamed from the GHV project. This has ushered forth the conceptualization of the "Graduates
both young and old, the project envisages to effect sustained developmental activities by fielding native village people who have successfully pursued their university degree programme. This shategy will solve the constraint of a limited stay on a conhactual basis by volunteer "strangers". Instead,
the village will be able to restore its own people with their life-time commitment to their village development. The complex, inter-related problems typical to a closely-knit community social structure will therefore be alleviated through the utilization of inherently existing community manpower resource who have been fortified with academic capabilities. The GRH project offers an ultimate solution to the nationwide
problem of an over-production and an under-utilization of university graduates with concomitant acute shortage of skilled human resource in the villages. The GRH project has likewise attempted to solve the problem of project replicability arising
from financial limitations by abolishing the provision of monetary remumerations to the project participants. In lieu of contactual agreements, the project generated life-time commibnent and life-time endeav-
CHAPTE-
buri Provice on January 1988. The project has for its goal the provision of an ultimate solution to the problem of rural brain drain and urban unemployment. The thrust of the project is on the promotion of the return of the university graduates to their own native communities through the stimulation of their ability towards job-creation, self sufficiency and self-help, and the re-direction of their social values from urban to rural settlement. It is envisaged
that the return of the graduates will lead to an eventful sustained social and economic progress which
The ASEAN Institute for Health and Development of the Mahidol University, the Graduates Return Home Project was formally launched on May 1988.
56
Anyone who has a universig degree on social or related rience with an evidently fiong commitment to return to his/her home village or to settle in village communities even not necessarily that of his/her birth origin is qualifies to join the project. There is no monetary remunerations and even during some phases of the taining programme the participants are expected to take care of their own meats, and this fact has been made clear at the outset during the recruitment process. Just as in the GHV Project, recruitment has been carried
out throug newspaper advertisements. However; unlike in the GHV Project, there were absolutely no examinations of any kind, oral or written. Of the 40 university graduates who have applied, 22 reported for orientation and 14 decided to stay. Of the 14; hveweref{males, six were freshly-graduated from the university, eight were below the age of 25 and four were orignially from Chanthaburi. The ten non-Chanthaburians have an age-range of 23 to 39 years.
community in Chanthaburi province. During this tiem, they were required to carry out an indepth
situational analysis of the community and at the same time finalized their selection of a means of livehhood. They have formulated their own occupation and community development plans in close collabora-
tion with their colleagues and in consultation with the project committee.
57 The graduates went back to the Rambhai Barni College for an interaction seminar, during which they presented to their colleagues and to the project committee their five year occupation and community development plans. The graduates then returned to the rural communities for an on-the-job haining period of another four weeks. There, they worked closely with villagers engaged in the same occupaffons the graduates have chosen to embark in. This gave them the opportunity to gather first hand informations and valuable experiences along the occuption they have chosen to
camT out. After the total of 14 week taining programme, the graduates were then prepared to retum to their communities of choice to implement their five year occupation and development plans. Throughout these ftve years, the members of the project committee will dl be available for technical
advisory back-stopping to the graduates. Seminars wlll be held 7 times over the frst two years of projert
operation and once ayear for the succeeding three years. Project evaluation will be undertaken by the project committee yearly during the ftrst three experimental years.
TRAINING MODULE
TheoreticalTraining at the AIHD
Module I
I
2
3
Wz
4
5 6
7
It/z
3 2 3
3 2
AIHD stdf
8 9
10
llodule
11
ll
t2
13 L4 15
K.U staff 3
2
toxicity in agricuhure
Necesslty of agricultural cooperatves
16
58
llodule
L7 18 L9
lll
NESDB staff
AIHD staff
3 TIRD staff
20
2l
22 23 24
3
2
DCD staff
3
3
ADSP staff
C.U. staff
environmental sanitation for acheivement of an OQL 25 26 27 The role GRH In development Rehabllltadon of communlty culture, ad and wlsdom 2
AIHD staff
TIRD staff
AIHD staff
llodule lV
28 29 30 31 32 33
lVz Ir/z
Govemor
Chanthaburl hovince
Altematives ln job creatton ln Chanthaburl province Open forum The role of Chanthaburl provlnclal offlce Admlnlshaflon, plannlng and management
G.O staff
Module V
v
35
Slratcgla to &b.creallon
Alternatlves In ceatng pb f,or oneseff My professlonal eryrlence Budness men
successful gr"du.tes $rho went back to
Chanthaburl
2 9@
A farmer
AIHD Proiect stdf
59
38 39
3 5
9r/z
l6
t7
N
4l
42
43
l8
19
44
45 46 47
It is not difficult to be a millionaire Observation tour to frult orchard How to raise shrimps in floating baskets Observation tour to gem pits, lapidiary,
gem markets at Na-Wong Chanthaburi Msit to shrimp farm ln Rayong province Visit to the Man Creation Foundation in Rayong province Attend the Seminar at Eastern Hotel on Counselling Service in Managerial lnvestment
Project
3 3 2
9L/z
3 3 6
I
49
50 51 52
Summary and general observatlons Summary of altematives in lile Appropriate models among community
graduates
2
1
I I
3
60
. 2 September, 1988
Dag
Placer
t *tq
Religious doctrines
10
for development
Experiences in
Dshict, Nakorn
Ratchasima provinc 2
developing Nonmuang
Self reliance philosophy of Buddha
Ban - Talat Tambon Kan - loeng Waeng-Noy District Khon Kaen province
Agriculture style
10
The villagers
CCD staff
province
Abbreviation
AIHD T.U.
RRAFA MOPH K.U.
BMA
NESDB TIRD DCD ADSP
c.u.
G.O.
ccD
ASEAN Institute for Health Development Thammasat University Rural Reconstruction Alumni and Friends Association Ministry of Public Health Kasetsart University Bangkok Mehopolitan Adminishation National Economic and Social Development Board Thai Institute for Rural Development Department of Community Development, Ministry of Interior Alternative Devlopment Studies Pro-gramme Chulalongkorn University Governor Office Center for Cultural and Development/Northeast
6t
l.
Background
Name Age Place of Birth Education
36 Moo.6 Tambon Gongdin, Klang District, Rayong Province. Rambhai Barni College B.A. (Community Development), 7987
2. Training
First period from 3 September, 1988 to 2 October, 1988.
Content : Integrated agriculture at his own land. Second period from 8 October; 1988 to 30 October. 1988. Content : Integrated agriculture at his own land.
3. Five-year
36 Moo. 6 Tambon Gongdin Klang District, Rayong Province : Better crop yield through integrated agriculture and gardening technique Goal and fish culture in his wells. Community development plan To participate with every community development activity, attempt to
change neighbours attitude and beliefs to retum to work in their own villages.
Place
His motto
and solve village's problems in consultation with village committee. "Overcome obstacles no matter how difficult they may be"
GROUP 2 1. Background
Name Age Place of Birth Education
2. Training
First period from 3 September, 1988 to 2 October, 1988.
Content
Tiger prawn raising at Moo. 4 Tambol Tagard-ngao Tamai District, Chanthaburi Province
62 Second period from 8 October, 1988 to 30 October, 1988. Content : Well-preparation to raise tiger prawn at Moo.7 Ban Tanonmakork, Tambol Tagard-
ngao Chanthaburi Province. Five-year plan after achievement GRH training. (1 November, 1988 to 31 October, 1993)
Khun Nid Tiger hawn Well, Moo. 7 Tambon Tagard-ngao, Tarmai Dsbict
Chanthaburi Province.
Goal To raise tiger prawn at first in an 8,000 square meters (1 well) and expand
later if successful Commnity development plan To persuade nearby groups raising tiger prawn to form a cooperative.
The expected location of cooperative will be at tambol development cenbe
His motto
which is in Moo. 4 Tambol Tagard-ngao, Chanthaburi Province. "Knowledge application to develop oneself and society".
GROUP 3 1. Background
Name Age Place of Birth Education
B.A. (Political
2. Training
Sciences)
Content
Mllage youth combination and self-study appropriate occupation at his own land.
Content
3. Five-year plan after achievement GRH training. (1 November, 1988 to 31 October, 1993)
Place
Goal
:
:
Tambon Praneed, Kao Saming District Trad Province. to improve fruit garden 13 Rais (20,800 square meters) and then proceed to gem business.
Community development plan : To motivate village to utilize the youth in community development. : "Attempt to implement successfully anything planned" His motto
63
GROUP
4:
l.
Background
Name Age Place of Birth
:
26
: :
Education
2. Training
First period from 3 September, 1988 to 2 October, 1988.
Agricultural technologies at Mr. Jarouy Pongcheep's gardens, Klung District Chanthaburi Province. Second period from 8 October, 1988 to 30 October, 1988. Content : Integrated Agricultural Activities at Ban Thung Grang Mllage, Pong Namron District. Chanthaburi Province "Mutual Discussion during work achieve the best results" His motto
Content
2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Agricultural technologies at Mr. Jarouy Pongcheep's gardens. Second period from 8 October, 1988 to 30 October, 1988.
Content
Her motto
Integrated Agricultural Activities as Ban Thung Grang Mllgage, Moo. 4 Tambol Tabsai, Pong Namron District, Chanthaburi Province
l.
Background
Name Age Place of Brith
Ang-thong Province.
6A
Education
2. Training
First period from 3 September, 1988 to 2 October, 1988.
Content : Marketing Business at Chanthaburi Chamber of Commerce. Second period form 8 October, 1988 to 30 October, 1988. Content : Integrated Agricultural Activities at Ban Thung Grang Mllage, Moo. 4 Tambon
Tabsai, Pong-Nam-Ron District Chanthaburi Province,
Her motto
:
:
2. Training
Frist period from 3 September, 1988 to 2 October, 1988. Content : Gardening and Integrated Agriculture at Phanason Farm of Mr. Sonthi Inchan,
Pong Namron District, Chantaburi Province. Period from 8 October, 198 to 30 October, 1988. Second Content : Integrated Agricultural Activities at Ban Thung Grand Village, Moo. 4 Tambol Tabsai, Pong Namron District Chanthaburi Province : "Help herself to help her community". Her motto
2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising at Ban Namdaeng Mllage Klung District, Chanthaburi Province Second period from 8 October, 1988 to 30 October, 1988. Content : Integrated Agricultural Activities at Tambol Tabsai, Pongnamron District,
Chanthaburi Province
A5
These 5 members of Thung Grang have five-year plan after completion of GRH training (1
November, 1988 to 31 October, 1993). Plac..e : Ban Thung Grang Village, Moo. 4 Tambon Tabsai Pong Namron District Chanthaburi Province. Goal : To grow vegetables then proceed to integrated agriculture and commerce to help sell agriculture products at fair price, at the same time, assist in development and foster community leadership. Comrnunity development plan
To coordinate with village committee, union youth gloup to promote envi-
ronmental sanitation morever, assist agricultural producers (vegetables and fruits, etc.) to achieve better harvest.
L.LB., 1985
2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising and being assistant teacher in frontier police school, Ban Namdaeng Village Moo. 6 Tambol Bangchan, Klung Dishict, Chanthaburi Province. Second period from 8 October, 1988 to 30 October, 1988. Content : Tiger prawn raising and being assistant teacher in frontier police school, Ban Namdaeng Village Moo. 6 Tambol Bangchan, Klung District, Chanthaburi Province.
2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising and being assistant teacher in frontier police school, Ban Namdaeng Mllage Moo. 6 Tambol Bangchan, Klung Dstrict, Chanthaburi Province.
66 Second period from 8 October, 1988 to 30 October, 1988. Content : Tiger prawn raising'and being assistant teacher in frontier police school, Ban Namdaeng Mllage Moo. 6 Tambol Bangchan, Klung Dstrict, Chanthaburi Province.
3.
Five-year plan after achievement GRH taining. (1 November, 1988 to 31 October, 1993) Place : Frontier Police School, Namdaeng Village, Moo. 6 Tambol Bangchan, Klung District, Chanthaburi Province. Goal : To work as volunteer assistant teacher and to find way to earn for daily living. First, they will teach students in school and at the same time, they will encourage students to catch seafood on holidays to sell. They want
to emphasize self-help to those students. Then, they will raise tiger prawn.
Community development plan Try to decrease gambling in the village by forming youth group and then
involving the village committee in campaigns about the bad effects of gambl-
GROUP 6 1. Background
Name Age Place of Birth Education
Ms. Suwiman Treerat 24 54/7 Moo. 1 Tamban Thung Kanan Soi Dow District, Chanthaburi Province Chombueng Teacher College
Content
Integrated Agricultural Activities at Ban Thung Grang Village, Pong Namron District, Chanthaburi Province.
Five-year plan ater achievement GRH tralning. (1 November, 1988 to 31 October, L9931 Place : Thung Kanan Mllage 54/lMoo.2 Tambon Thung Kanan Soi Dow Dstrict, Chanthaburi Province
Goal
To change farm crops into fruit and rubber gardens. To dig wells for raising
fish, and watering plants in dry season. During the wait for the produce
of longJife fruit and rubber hees, she will grow other crops to save money and enable her to proceed to her future plans.
A'l
Her motto
GROUP 7 1. Background
Name Age Place of Birth Education
1111 Moo. 3 Tambon Sathon Pong Namron District, Chanthaburi Province Ramhamhaeng University
B.BA. (GeneralAdmin.)
2. Training
First Period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn cultivation and water-dwelling system to raise the prawn at Khung Kabain Bay, Tarmai District, Chanthaburi Province. Second period from 8 October, 1988 to 30 October, 1988.
Content
Tiger prawn raising in floating basket at Ethep Village, Tambon Bangchan, Klung District, Chanthaburi Province.
3. Five-year
Place Goal
: :
Community development plan To promote cooperative's union of tiger prawn raisers, utilize income
from raising it to support GRH project, and coordinate with the cooperative
His motto
GROUP 8
l.
Background
Name Age Place of Birth Education
L.LB., L987
Content Content
: :
Marketing business at Chanthaburi Provincial Chamber of Commerce. Performed sale business at her own house 703/L Soi Suksan, Bangkok-Nonthaburi Road. Bangsue, Dusit DsMd, Bangkok
3. Five-year plan after achievement GRH training (1 November, 1988 to 31 October, 1993)
Place
: :
703/l
Goal
To promote commerce at her place and coordinate with GRHs at Thung Kanan Mllage, Pong Namron Dstrict, Chanthaburi, by contacting buyers directly (not to pass) through middle merchants.
Community development plan To work with Crowded Community Development Project (Urban fuea Development) in Bangkok. Responsible office is NIDA. "To achieve something, proceed with seriousness" Her motto
GROUP 9 1. Background
Name Age Place of Birth Education
Tambon Phu - Nguen, Selaphoom District, Loi - Ed Provincg. Ramkhamhaeng University B.A. (Political Sciences), 1986
Training
First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising at the farm of lvlr. Chandom, Phangrad Mllage,
Content
money for his future plan. 3. Five-year plan after achievement GRH training. (1 November, 1988 to 31 October, 1988) : Not specified Place
Goal
3.4.4
: :
Not specified
Not specified Reports on Field Experiences were presented during the GRH Seminar. The Group
69
GRH Seminar Report held on 26 - 27 December, 1988 at Kitchakoot National Park, Chanthaburi Province : Problems on Project Operation and Project Progress Report Seminar Participants - consist of representatives from the following : - Cooperating government institutions - Rambhai Barni College staff - Mahidol University staff, and - 14 GRH
Subject
Objectives
:
project implementation to the project committee and member of concemed institutions and to formulate
feasible solutions to identified constraints. 2. To opn a venue for aftee exchange of ideas in determining aftemative taining,/implementa-
Mr.Theerayuth Phen-Phachorn The GRH volunteered to teach students (free of charge) in the piimary school spending their holidays catching crabs/shrimps for food. Problems ldentifted : The preponderance of gambling activities and the poor environmental sanitation.
Mr.SanonThien-Thong
Suggestions
GRH project participants should be better prepared in planning their own job from the practical and realistic point of view, - GRH proiect participants should be able to start their new jobs with none or very little investments,
Request
GRH project participants should exercise caution in dealing with local people.
Project support for a smallfishing boat to help them earn their livelihood.
This group earn their livelihood through selling sweets and desserts and planting vegetables.
70
Problems ldentifted : - Lack of money to buy water motor pump - Unstable income from crop - production
Suggestions
- GRH project participants should lind themselves a regular buyer of their produce, - GRH project participants should have better public exponsure to improve public relations,
and that the
GRH project participants should identify an appropriate technology to take the place of water pump.
Probleins ldentlfted : - The water salinity is not conducive to shrimp growth - Middlemen pullthe prices down
Suggestions
GRH proiect participants should be in close consultation wtfi the bcal chamber of commerce.
Mr.Saney Sungsakun
He is at present still undecided as to what occupation he intends to embark in.
Suggestlons
He should be given more time to enable himself to adjust and face the challenge of home
village development and eventually take pride on his participation in village developmental activtfles.
Suggestions
He should be gven more encouragement to start his sfuimp raising in natural condition rather than in floating basket. Or, he could identify other means of livelihood and start immedeatly.
Flnal Recommendatlons : 1. To set up GRH revolving fund for those who lack money,
To publish a GRH newsletter to disseminate informaflon on the various stage of project implementation by the different participants and to serve as inspiration to others who ae dill nndedded
2.
3.
life.
To study project feasibility in other communities with the ulfimate goal of upgrading
riral
Concluslon
communities.
The GRH project could be the answer to the perennial problem of b,rain-&ain in the rural
71
Flrst, economic shuggle. Without any means of financial remunerations, the graduates survival. The knowledge of the urgency to find a source of livelihood had stimulated a number of unpolished creative ideas. Though not
were practically left alone to deviie their own mechanics for
all of them were at the prime of their youth, their enthusiam was contagious and their vitality enviable. All have a unilateral goal and that is; to ffnd a place for oneself in the rural communities of Chanthaburi Province. Some have in the process gone through the extent of selling treasured belongings while others unhesitatingly carried out unskilled jobs and yet majority are determined to seek the fulfillment of contributing to community progress.
Second, social adaptation. Since not all of the project participants were Chanthaburians, only four of them were native of the province; they have to undergo a gradual process of adaptation
preliminary to their merger into the existing community social network. Even those who were originally from Chanthaburi, in view of their long absence while in pursuit of their academic studies
adaptation. It is admirable how the 14 parti@ants were able to do so. Probably it is due to their individual flexibilities, their strength of character, their pre-determined goal, or;
have to undergo social
half of the credit could be given to the villagers who have given the graduates a room in the village and a room in their hearts.
Thlrd, self-development. This could well be the most productive aspect of the project on the part of the participants. The project has tansformed a group of undecided youths into matured responsible human resource that will speed up their nation's creep into progress.
EPILOGUE
The Graduates Retum Home (GRH) Project is a giant leap towards the restoration of rural intellectual resource. The project has painstakingly identified the root cause of rural brain drain as emanating from a change in a graduated students's goal orientation. Whether the newly-acquired urban-oriented goal has been iatrogenically triggered by the academic environment or whether the change in value
What is obvious is the fact that university graduates from the rural areas have expressed very little desire to return home.
While the project has demonstated its ability to re-direct goals and re-orient social values, it may nevertheless raise a certain degree of scepticism as to its extent, limitations and viablility among some of our readers. Questions may be put forward such as; the difficuhy of reconciling a long-winding intellectual shuggle of an education graduate to a five-year plan of self dedication as a village assistant teacher, or that of a political scientist's decision to raise tiger prawns. Questions may be asked as regard; parental reactions after having spent hard-earned baht over their siblings' decision to tend to vegetable gardens, fruit orchards, prawns. Questions as to how many of Thailand's university graduates and how many of Thai parents will embrace the promise therein in small scale industries,
system has come as an aftermath to a long period of urban exposure is beside the
point.
the wisdom of achievements outside and beyond one's academic orientation, the ultimate nobility of being a co-partner to one's own village development. We beg our readers for "TIME" to answer these questions. Behaviour modification and value change is indeed a gargantuan mandate, hourever;
in our own small way the GRH Project has documented that such a mandate is feasible. The GRH hoject does not limit its challenge to the university graduates and their parents alone, rather the project
is an attempt to a call for an academic upheaval towards an over-all adaptation of existing curricula
along the context of the Thai social btructure. The project is an attempt towards an awakening of support mechanisms for the tens of thousands of Thailand's university graduates as they tread unto
ANNEXES
ANND(
1
2. Intoduction
English)
to the Research for Primary Health Care Model Development hoject (in Thai and
3. A Manual for the Training of GHVs (in Thai) 4. A Manualfor the Training of GHVs in MCH and EMC (in Thai) 5. Situation Analysis and Community Assesssment on Primary Health Care, Maternal and Child Health, Family Ptanning, Essential Medical Care and Community Development in Chanthaburi Province (in Thai and English) 6. The Re,ports of GHVs (19851986) : Problems Obstacles and Recommendations for PHC, MCH and Community Development in Chanthaburi Province (in Thai)
7. The Study on the Interest of Thai University Graduates in PHC and Community Development
(in Thai)
8.
Progress Report (January 1985 - December 1986) : Research for Primary Health Care Model
Development, Chanthaburi Province (in English) 9. The GHVs Short Stories (in Thai) 10. The Report of GHVs (1986 - L987) : Problems, Obstacles and Recommendations for PHC, MCH and Community Development in Chant{raburi Province (in Thai) 11. A Manual for the Training of GHVs in Primary Health Care (in Thai) 72. ATC/PHC Research and Development Monthly Newsletter (in Thai) 13. Primary Health Care - A Continuing Challenge (English) 14. The Reports of GHVs (1987 - 1988) : Problems, Obstacles and Recommendations for PHC, MCH and Community Development in Chanthaburi hovince (in Thai)
7A
ANNEK 2
Glossary
AIHD
ASEAN
ATC/PHC
BMN CD
ASEAN lnstitute for Health Developmeqt Association of South-East Asian Nations ASEAN Training Cenbe for Rimary Health Care Development
Basic Mnimum Needs
Community Development
Communicable Disease Control District Public Health Office Expanded Programme on lmmunization Family Planning Graduate Health Volunteer Graduates Return Home Health Card Fund lnformation, Education, Communication Japan Intemational Cooperation Agency Knowledge, Attitude, hactice Matemal and Chlld Health Mnisby of Public Health Master in Primary Health Care Managment Non-Government Organization Oral Rehydration Salt Provincial Public Health Office Primary Health Care Quality of Life Regional Training Centre Royal Thai Government Southeast fuia Medical Information Cente Sexually Transmitted Disease Traditional Birth Attendant Technical Cooperation among Developing Mllages United Village Village Village
Nations
cDc
DPHO
EPI FP
GHV
GRH HCF
IEC
JICA
KAP
MCH
MOPH MPHM NGO
ORS
PPHO PHC
QotRTC
RTG
SEAMIC
STD
TBA TCDV
UN
VC VHC
VHV
wHo
75
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79
ANNEX 4
January 1985 7
Project Milestones
Field visit by ATC staff to Chanthaburi Field visit bv ATC staff and researchers to Chanthaburi The first.orirultutlon meeting at ATC/PHC among ATC staff, Chanthaburi provincial health officers, Phra-Pok-Klao Regional Hospital medical doctors. members of MOPH. member of RTC Chonburi and other researchers
-8
February
14-t6
26-27
5-15
20
30-31
June
Application and Selection of the First Batch of Graduate Health Volunteers GHV application (585 person applied) GHV written examination (50 persons passed) GHV oral examination (15 persons passed)
Preparation of the GHV training program and training materials GHV training & preparation for data collection GHV theoreticalhaining at ATC/PHC GHV field study at Nakornrajsima and Khonkaen provinces Continuation of the GHV fteld training at Chanthaburi and pre-test of questionnaires GHV haining at Chanthaburi
July
r-22
23-26
August
1-30
September
1
Start of field work and data collection GHVs begin work in the field
Data collection by researchers and GHVs
2-30
October 9 -11
Data analysis and conference on work plans by researchers, GHVs, health centre staff and others at RTC Chonburi
20-26
November
Conference on community leaders, ATCIPHC. participated by GHV and community leaders form Chanthaburi province
Preparation and printing of the reports on : The Manual for Training of Guaduate Health Volunteers
Seminar in the field among GHV's and the researchers at Ban-Som-Dej Hospital, Chonburi Province
December
26-27
January 1986
30-31
80
February 24
27 -28
March
Consultative meeting on the selection of GHVs batch 2, ATC/PHC GHV's monthly meeting at Chanthaburi
Semhar in the fteld arnong GI-Ms and the reseamchers at Kitchakoot Natural Forest, Chanthaburi Province Acceptance of applicaton for the second the batch of GHVs at ATC/PHC
3-5
17
-28
1987)
Selectlon of GHVs
Orientation training for the applicants and written examination Oral examination Monthly GHVs meeting at Chanthaburi
20 27
3
26 -
30 July 9
29 -
GHVs began to work in the field Seminar among GHVs, health centre staff, and local researchers at The Provincial Public Health Office GHV's batch 1 graduation day
30
GHVs field operatlon and lnterventlon In PHC and MCH and MCH acffvltles Presentation of the project activiites to Dr.H.Mahler, Director.General WHO at ATC/PHC Monthly GHV's meeting, Chanthaburi province
Submission for first report on situation analysis and plan of acfivities, by
August
30
September
LS
GHVs
L7
The ftrst annual conference of heahh center staff, GHVs, research teams
October 6-9
8t
November 30 December
8-L2
9
district, Pong-Nam-Ron district, Chanthaburi Province Presentation of the project activiites to Prof . Natth Bhamarapravati, the Rector of Mahidol University at ATC/PHC
Evaluation on the project activiites by Prof. N,Iasami Hashimoto, the chairman
L8-2L
Seminar for the second mid-year project appraisal and preparation for
the annual conference, Krating Natwal Forest, Chanthaburi Approximate participants 80, from ATC/PHC, Chanthaburi provincialhealth office, the GHVs and the Research Team
February
t7 -22
March
Study tour to the northeast by the local research teams and GHVs to observe
2-24
March
Data collection in the model villages by the GHVs and the research teams
3-20
Data analysis at the ATC computer facility Selection of senior GHVs Acceptance of applications for new GHVs
1988)
April
8
20-24
May
4-29
June
1-4
8-30
July
1
August
24-28
Field supervision
82
October
11-13
December
Seminar among GHV, health centre staff and local researchers at RTC
Chanthaburi
9-t2
February
Field supervision
15-19
March
Field supervisiogt
Meeting at Chanthaburi with representatives of research team for the mo-
3-5
GRH First Batch
January 1988
11
Brainstorming session
February
L7 Meeting at Chanthaburi province with representatives of concemed Ins{itutes
March
3 23
Drafting of project proposal Review of the project proposal Meeting at Chanthaburi provincial hall for the inhoduction of the GRH project by the Governor, Chanthaburi province attend by the Rector of Mahidol University, hof.Dr.Natth Bhamarapravati and the Director of
April 4
May
15-31
June
1-30
July 4
10 31
August
1-11
t5-26
29 September
22-25
3-30
83
October
3
10-30 27-23
31
GRH plan submission GRH occupational training Field supervision kesentation of taining certificates to GRH by the Govemor, Chanthaburi
Province
November
26-28
December
Field supervision
26-29
January 1989
First seminar among GRH, representatives from cooperating institutions, staff of the Mahidol University
Meeting at Rambhai Bami College for reformulation of evaluation question-
8-11
10
Open forum with GRH and the Governor, Chanthaburi province held
at the provincial hall
ANNEX 5
SUMMARY OF MINI.PROJECTS UNDERTAKEN BY THE THIRD BATCH OF GHVs
Project I Title : Promotion of Environmental
hoject site : Tung
Sanitation Through Health Education
Project objectives : 1. to promote environmental health and uplift the quality of life in the village, and 2. to campaign for the construction of low-cost latrines
Responsible persons : Mllage committee, community leaders, Tamai district health officers, health centre staff and GHVs
:
:
1. community
preparation
8A
Project 2
Title
Project
sit
Project objectives
:
:
Project activities
1. educational campaign on essential drug use, 2. community assessment for essential medicine needs, and 3. sale of family drug box containing essential drugs to the villagers
Project budget
Project 3
Title
Project
site
Project objectlves
village visitors, and
2. to promote
Responsible persons
Projectdurafion
Project activities
:
:
1.
2. 3.
identification of the village information centre site, and data posting at the centre
Project budget
Baht 472 village counterpart contribution Total Baht 1,472 (US$ 59.00)
Project 4
Title
Project
site
Project objectives : 1. to promote environmental sanitation education on safe water supply and latrines, and 2. to strengthen village capbility towards self sufficiency
85
Responsible persons
Project duration
:
:
Project operation
1. community preparation,
2. solicitation of funds from the villager, and 3. purchase of water containers form the neighboring province
Approximate budget
:
Baht 5,000 from ATC/PHC Baht 3,000 from MOPH Baht 2,000 from village contributions Total Baht 10,000 (US$ 400)
Project 5
Title
Project site
Project objectives : 1. to promote village communal activities, 2. to facilitate the purchase of low-cost good quality commodities, and 3. to set-up a hade centre for village handicraft
Responsible persons
offcials from the fow cooperating ministuies, village development fund committee,
:
:
2. 3. 4.
information dissemination, solicitation of fund, observation tours to other villages (TCDV), and the establishment and management of the development fund by the villagers themselves
:
Project budget
Total
Baht 5,000 from ATC/PHC Baht 900 village contribution Baht 5,900 (US$ 236)
ANNEX
6:
Prepree Lertpraplut
86
4. Miss Chamaiporn 5. Miss Nareerat 6. Miss Panpit 7. Miss Plernsiri 8. Miss Rungnapa 9. Miss Somruedee
10. 11. 12. 13. 14. 15.
tvtr. Surasak
The second batch 1. Ms. Lakkhana 2. Ms. Wanna 3. Ms. Anchalee 4. Ms. Siripom 5. Ms. Patinan 6. Mr. Ekkapong 7. Ms. Wuthi 8. Ivtr. Krienglaai 9. l"tr. Adul
10. 11. L2. 13. 14.
l/tr. Pornthep Mr. Projuab
Swangprak
Pongthinthong-Ngam
Pannark Uasilamongkol
W, Yutthana
Ms. Thippatee
I\,tr.
kayong
Paisarnsirirath
2. Miss Siriwan 3. Mr. Thitiyod 4. Ms. Natthaya 5. Ms. Parichat 6. Ms. Nanthaporn 7. Mr. Phichit 8. l/tr. Changkri 9. Mr. Sanit
10. 11. 12. 13.
Mr. Thamrong
Ms. Sasima Ms. Rampeng Ms. Jarana
lym{ed
Tinnam Chuymungphan Thep-rath Krutnak
Sophonwasu Sirirak inthasara
87
ANNEK
1.
7:
I\,1r.
Jongrak
2. I'lr. Sanit 3. Mr. Saney 4. ttlr. Samrit 5. lvG. Narumon 6. Ms. Jutipom 7. Mr. Rnlth 8. Mr. Sanon g. Itlr. Teerayuth
10. 11. 12. 13. 14.
lv|s. Suwimon
Kaew-ptpop
Srangsuanphon Duang-Dej
Trcqat
Khamphee Arch-rith
Mr. Klranae
lrG. Kannikar
Mr. Wisithsak
lv|s. Jamnien
Saltee
Phumsopa
THE AUTHORS
Dr.Krasae Chanawongse
Dr.lkasae has dedicated himself in the pursuit of public health goals for the under-privileged
majority. It may well be deduced that the empathy has flourished from the fact that he once belonged to the less advantaged population subgroup in his birthplace Muang Phon, Khon Kaen, which is located about 365 km. Northeast of Thailand.
if only to prove that poverty is not a deterring factor to any form of intellectual
fumed with dedication and perseverance he has worked his way through the medical school pursuit. In 1960 he
was awarded his medical degtee by.the Faculty of Medicine, Siriraj Hospital, University of Medical
Sciences (now, the Mahidol University) , in Bangkok. Immediately after graduation, he went back to his native dis[ict tuming a deaf ear to the lucrative life that the capital city has to offer to promising young physicians. Instead, Dr.l&asae concentated on the application of his newly-acquired expertise to expand and stuengthen the existing health service facility in Muang Phon, through community participation. In 1968, Dr.Krasae received a Colombo Plan grant to pursue a course at the London School of Hygiene and Tropical Medicine. On completion of his post-graduate studies, again he returned to Muang Phon to resume his public health career. A recipient of a number of awards both locally and intemationally; among them the prestigious Ramon Magsaysay Foundation Award from the Philippines in 1973; Dr.Krasae was appointed Deputy Minister of Health by the Royal Thai Government in recognition of his pioneering effort on health and
community development activities from 1975 to 1977. In 1980 Dr.lGasae received his Doctoral Degree in Public Health (Dr.P.H.) from the Columbia University, New York. USA. At present, Dr.lftasae is the Director of the ASEAN Institute for Health Development. Despite his hectic schedule both as an adminishator and as a resource person for the Center, he never fails
to go home every weekend to visit his beloved Muang Phon, listen to his people's tale of woe and offer alternative solutions to existing health problems.
Dr.Krasae is the hoject Drector of the Research on himary Health Care Model Development, Chantaburi
hovince, The Graduate Health Volunteers and The Graduates. Return Home Project. Dr.Krasae is married with two children.
89
Dr.Som-arch Wongkhomthong
Dr.Som-arch has left Thailand at the tender age of 18 after qualifoing for a Japanese C:overnment
scholarship. Hereceivedhismedical degeefromtheUniversityof Tokyoin 1975. Hethenpursued his training in Clinical Surgery. In 1980, Dr.Som-arch received his Master Degree in Public Health from Harvard University in Boston, Massachusetts. Then, he went back to Japan to pursue a Doctoral Degree in Health Sciences. ln 1982, the University of Tokyo awarded Dr.Som-arch his second doctoral degree.
to be of
serruice
In 1984, after 16 years of absenen,Dr. Som-arch was homeward bound in an eager anticipation to his own people. He irined the Mahidol Univercity Facuh of Public Health as a lecturer
in the Department of Health Services Adminishation. Simultaneously, he joined the ASEAN Institute
for Heahh Development as a lecturer to the Master in Primary Health Care Management course and as the fusistant Director to the Center.
Whenever he is asked if he should ever leave his counby again, Dr.Som-arch's answer with his characteristic disarming smile is - NEVER.
Dr.Som-arch is the R,ojert lvlanagr of the Research on himary Heafih Ctre Model Development, Chantaburi Province, The Graduate Health Volurteers and the Graduates Retum Home Project.
town of Pulo Bulacan (now, Valenzuela, Meho Manila) She later jreined the Manila Heahh Department and was awarded the South-East Asean Minister of Education Organization (SEAMEO) Fellowship Grant on Master Degree in Public Health at the Mahidol University in Bangkok, Thailand, In 1978, she received her degree ranking as First, in the MPH International Course from Mahidol University. Shortly after her return her Government has awarded Dr. Cosico a second scholarship on
Development. She was unable to complete the course as fate destined her for an even greater challenge by way of a WHO recruitment as a short term consultant in MCH/FP with duty station in Thailand, in 1980 and later on as Medical Officer in Family Health at the WHO Regional Office for South East fuia in New
Master Degree in Government Management, major in Human Resources
Delhi, India. In November, 1986; on completion of her WHO assignment; Dr.Cosico set foot on what she claims as her second country-Thailand, to join Mahidol University as a Msiting Professor to the Faculty of Social Sciences & Humanities, until May, 1987. Dr.Cosico is the short-term consultant to the project on Research on Primary Health Care Model Development, Chantaburi Province, The Graduate Health Volunteers and The Graduates Return Home Projects. She is also consultant to The Intensive Development the Quality of Life Association of Thailand. In March, 1989; she will assume duties as the WHO National Consultant to the Royal Thai Govemment, Ministry of Public Health. Dr.Cosico is married with three children.
Printed
At :
Publlsher
Thammasat Unftrerslty hcec, Bangkok 102(X), Thalland. Tel. 2%13fi Arunee Indrasuksrl, 19t9