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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

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


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


Project purpose

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


ECI Target Areas : 6 sites




ECI Team




Total = 68 villages

13-15 villages / sub-district


Enhancing Care Initiative


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.


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.


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)


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.


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.


Community Empowerment


People Research and Development (PR&D)


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

natural agriculture organic farming

Natural agriculture - organic farming


Bio-fertilizer Production

Safety food & Safety environment

Community health

Reducing cost


Back to the Nature

Bio-fertilizer Project

  • More simple way of life
  • Using local herbal instead of
  • chemical substance.

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 care

Community Health Care

TraditionalThai Massage

Herbal Medicine

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.

human rights e nhanced by eci

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


Enhancing Care Initiative


Thai Team

Lesson Learned

as Reported by ECI Participants

June 28-29, 2002


Basic Components of Community Health Care

as learned by ECI participants



Traditional Care


Healthy Work & environment

Healthy Food


Enhancing Care Initiative


Thai Team

Roles of ECI


Community forums

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


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


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


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


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


Health care system


Counseling - preparing for the end of life

Well-trained health personnel

Care for the dying patients

Improved quality of care

Nursing Care



Human rights



Impacts on Community development


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


Network of community-based care


Sub-district Administration Organization (SAO)

Health personnel

Groups of PWHAs

Community leaders

Community healers

Network of natural agriculture

Thai Farmer Bank

ECI team



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.


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