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Enhancing Care Initiative

Enhancing Care Initiative. For People Infected with and affected by HIV/AIDS In Upper Northern Thailand. The XIV International AIDS Conference Barcelona, Spain. July 7-12, 2002. Presented by Associate Professor Wilawan Senaratana RN., MPH. Faculty of Nursing, Chiang Mai University Thailand.

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Enhancing Care Initiative

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  1. Enhancing Care Initiative For People Infected with and affected by HIV/AIDS In Upper Northern Thailand The XIV International AIDS Conference Barcelona, Spain July 7-12, 2002 Presented by Associate Professor Wilawan Senaratana RN., MPH.Faculty of Nursing, Chiang Mai University Thailand

  2. ECI-Thai Team Six collaborative organizations : The Faculty of Nursing, Chiang Mai University The Office of Communicable Disease Control 10 AIDS Network Development Foundation Chiang Mai Provincial Public Health Office The Church of Christ in Thailand AIDS Ministry (CAM) The Upper Northern People Living with HIV/AIDS Network

  3. Project purpose To improve Quality of life through comprehensive and holistic care for people infected with and affected by HIV/AIDS in northern Thailand

  4. ECI Target Areas : 6 sites Sub-district Sub-district Sub-district ECI Team Sub-district Sub-district Sub-district Total = 68 villages 13-15 villages / sub-district

  5. Enhancing Care Initiative ECI Thai Team Areas of Implementation Improving Institutional Health Care Care of the Dying Home-based Care Empowering the Groups of PWHAs Community Empowerment Human right is a cross-cutting theme.

  6. Improving Institutional Health Care 1. Developing the Protocol of ‘Opportunistic Infection Treatment and Care’ 2. Developing the guideline of UP for Training and monitoring UP practice 3. Improving quality of care among health personnel 4. Improving practice concerning ‘patient rights’ 5. Establishing the ‘community health committee’ comprising of health personnel, PWHAs, community leaders, and health volunteers.

  7. End of Life Care 1. Learning forum on ‘preparing for terminal life’ and ‘care of the dying’ 2. Training program on ‘counseling for the dying’ 3. Developing the guidelines for end of life care (ELC) 4. Try-out the guidelines by PWHAs and caregivers 5. Publication and distribution of the guidelines 6. Putting the ELC into the national plan of AIDS care (2002-2007)

  8. Improving Home-based Care 1. Synthesis body of knowledge and lesson learned 2. Training ‘community volunteers’ for home-based care 3. Home visit for the sick (not only AIDS) 4. Home visit for people who firstly receive ARV 5. Establish home care model by the collaborative team comprising of community health volunteers, health personnel, and PWHAs.

  9. Empowering the Groups of PWHAs 1. Training for OI treatment and care 2. Training for ARV 3. Training for home-based care and counseling 4. Learning forum on ‘human rights’ 5. Participating in counseling and care provided for PWHAs at AIDS clinic of the hospital.

  10. Community Empowerment Methodology People Research and Development (PR&D)

  11. Process of PR&D 1. Finding ‘community research coordinators’ Select 3-5 volunteers for each village (by village participants) 2. Training the‘community research coordinators’ 3. Collecting community data (history, local wisdom, natural resources) 4. Learning from the ‘best practice’ of other communities 5. Analyzing community potential and identifying options 6. Develop the development master plan for each sub-district 7. Implementing the plan

  12. 0n going process of learning & implementingby communities

  13. Natural agriculture - organic farming Purposes Bio-fertilizer Production Safety food & Safety environment Community health Reducing cost

  14. Back to the Nature Bio-fertilizer Project • More simple way of life • Using local herbal instead of • chemical substance. Healthy food & environment for all

  15. More than 50 villages in 6 sub-districts have implemented the ‘bio-fertilizer project’ supportedby ECI team. Basing on the lesson learned from ECI project,the implementation of the bio-fertilizer project has been expanded to other villages and sub-districts. It has been accepted and supported bySub-district Administration Organization. The 13 community leaders trained by ECI have become to be important resource in the region. The well-trained leaders have been invited to share knowledge via the local radio programevery month. Supported by Sub-district Administration Organization, one sub-district has publicly declared that within the year 2005 their sub-district must be a “chemical - free farming” zone.

  16. Community Health Care TraditionalThai Massage Herbal Medicine Community Health Volunteers

  17. The 11- day training program was provided as requested by the communities. ECI paid for the trainer, the trainees took care of their own expenses (food and travel). Twenty one women in 3 sub-districts were trained in Thai Massage. They use their skill with their family members and neighbors. Eight of them have become the trainers and expanded the training to other sub-districts. Learning forums on herbal medicine, healthy food, and care for the sick have been conducted in 6 sub-districts. PR&D was applied and the content of process is about health and illness, including HIV/AIDS.

  18. Right to health and well-being Right to human development Right to dignity and non-discrimination Right to a standard of living adequate for the health and well-being of oneself and family, including food, clothing, housing, medical care, and social services. Human Rights Enhanced by ECI

  19. Enhancing Care Initiative ECI Thai Team Lesson Learned as Reported by ECI Participants June 28-29, 2002

  20. Basic Components of Community Health Care as learned by ECI participants Government Hospital Traditional Care Community Healthy Work & environment Healthy Food

  21. Enhancing Care Initiative ECI Thai Team Roles of ECI Facilitators Community forums Encourage thinking & learning Supporters Experts & Trainers Financial support at the beginning Learners How to work with community How to encourage learning process How to change ways of thinking Team building & partnership development

  22. Summary Results Before ECI Project Health service activities were based on budget & focused on health problems AIDS is responsibility of infected person and his family No freedom to think HIV/AIDS is not a problem of the community No creativity in work AIDS project is focused on seeking support from external resources Separate activities of services ARV is not accessible for all PWHAs in the target areas

  23. Summary Results After ECI Project Gain learning process Initiate new way of thinking & working together More flexible, happy and confidence to work Budget is not the main focus for problem solving Active participation of PWHAs in enhancing care in community and hospital Expand the training on counseling for the dying to Mae-Hongson province

  24. Summary Results After ECI Project This is the way to overcome health problem and economic crisis of community Human right is respected, fulfilled, and protected Initiate new economic system - ‘subsistence economy’ Proud to work with ECI project HIV/AIDS is everyone responsiblity

  25. Summary Results After ECI Project ARV is available for PWHAs in the target areas 83 international participants from 13 countries have been trained and learned from ECI A group of 6 Indonesian requested to come for 2-week training program from ECI Six target sub-districts have become learning communities for people to learn from

  26. Health care system Impacts Counseling - preparing for the end of life Well-trained health personnel Care for the dying patients Improved quality of care Nursing Care OI ARV Human rights UP

  27. Impacts on Community development Impacts Community Health Care Team healthy food, healthy environment, healthy work, herbal medicine, and traditional care Bio-fertilizer project & animal feeding factorials with financial support of the government via the policy of Sub-district Administration Organization Set up rice mill in the village Groups of Thai massagers Community leaders - human resource development

  28. Network of community-based care Impacts Sub-district Administration Organization (SAO) Health personnel Groups of PWHAs Community leaders Community healers Network of natural agriculture Thai Farmer Bank ECI team

  29. Limitations 1. Project progress is very slow at the beginning due to rethink, redone, and revised of the conceptual framework and strategies. 2. Multisectoral and multidisciplinary research team need more effort to coordinate. 3. Burden to research team members due to additional heavy workload.

  30. Future Plans 1. Organize National forum to share results and lesson learned 2. Executive summary of the result and lesson learned will be submitted to policy maker 3. Expand the ECI model to other provinces or countries 4. Propose to funding agency to be a research training center for HIV/AIDS and community health 5. Register to be a foundation for community health

  31. Thank You

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