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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For People Infected with and affected by HIV/AIDS In Upper Northern Thailand
The XIV International AIDS Conference
July 7-12, 2002
Presented by Associate Professor Wilawan Senaratana RN., MPH.Faculty of Nursing, Chiang Mai University Thailand
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
To improve Quality of life through comprehensive and holistic care for people infected with and affected by HIV/AIDS in northern Thailand
Total = 68 villages
13-15 villages / sub-district
Areas of Implementation
Improving Institutional Health Care
Care of the Dying
Empowering the Groups of PWHAs
Human right is a cross-cutting theme.
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.
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)
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.
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
People Research and Development (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
Safety food & Safety environment
Healthy food & environment for all
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.
Community Health Volunteers
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.
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
as Reported by ECI Participants
June 28-29, 2002
as learned by ECI participants
Healthy Work & environment
Roles of ECI
Encourage thinking & learning
Experts & Trainers
Financial support at the beginning
How to work with community
How to encourage learning process
How to change ways of thinking
Team building & partnership development
Before ECI Project
Health service activities were
based on budget & focused on
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
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
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
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
Counseling - preparing for the end of life
Well-trained health personnel
Care for the dying patients
Improved quality of care
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
Sub-district Administration Organization (SAO)
Groups of PWHAs
Network of natural agriculture
Thai Farmer Bank
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.
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