ECI

1. Enhancing Care Initiative ECI Thai Team Ultimate Goal Quality of life among PWHAs and affected people

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

3. Community Empowerment Methodology: People Research and Development (PR&D) Purposes: 1. Sustainable development of community …to promote supportive environment for PWHAs and their affected families 2. Improvement of health & well-being for individuals, family, and community

4. Management Learning Development Framework of Community Empowerment MAN Community potential KNOWLEDGE & WISDOM NATURALRESOURCES

5. 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

6. 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, wisdom, man & 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

7. Areas of development initiated and implemented by communities

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

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

10. 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.

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

12. 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.

13. 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.

14. Care Of the Dying 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 of COD 4. Try-out the guidelines by PWHAs and caregivers 5. Publication and distribution of the guidelines 6. Putting the COD into the national plan of AIDS care (2002-2007)

15. 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.

16. 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.

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

18. Solidarity Self-confidence New way of thinking Self-reliance Network & friends PR&D Active Learning Knowing self Holistic health

19. Basic Components of Community Health Care Government Hospital Traditional Care Community Healthy Work/ environment Healthy Food

20. They have learned through PR&D that HIV/AIDS could not be separated from other issues in the community. People living with HIV are not problems, but parts of solution for their community. Community empowerment is the mean to achieve quality of life - where one lives with sufficient basic needs and dignity. The vicious cycle of debt without any solution is obstacle for community to care for PWHAs.

21. Right to health and well-being Right to human development Right to dignity and non-discrimination Human Rights Enhanced by ECI 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.

22. 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 work with team organizations How to encourage learning process How to change ways of thinking

23. On going activities initiated & implemented by community 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

24. Network of community-based care Impacts Sub-district Administration Organization (SAO) Health personnel Groups of PWHAs Community leaders Community healers Network of natural agriculture Bank for Agriculture and agricultural cooperatives ECI team

25. 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

26. Future Plans of ECI Thailand 1. Organize National forum to share results and lesson learned 2. Submit executive summary of the result and lesson learned 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

27. Thank You