English Newsletter No.111: Strengthening community health system responding to COVID-19

Mr. Preeda Taearak, ILDC 1988, Mr. Techid Chawbangpom, ILDC 2012,
Ms. Khanitta Saeiew, ILDC 2019, Ms. Nanoot Mathurapote,
National Health Commission Office (NHCO), Thailand

Situation of slum area in Bangkok, Thailand

Thailand was the first country outside China to report the COVID-19 case in January 2020. Last year, Thailand efficiently managed COVID-19 prevention and control. The government provided screening, treatment and quarantine sites for Thai and non-Thai people, while people complied with government measures. The whole of society supported the government to fight against COVID-19, for example, organizing home visit by health volunteers to explain correct information on COVID-19 prevention and awareness, producing fabric face masks and alcohol gels by themselves and sharing to people in need, setting up community kitchens and distributing food to affected people and etc. In September 2020, it marked the first 100 days that Thailand had no new confirmed cases from local transmission.

Until the end of 2020, the COVID-19 situation has altered. The second wave of COVID-19 started at the shrimp central market in Samut Sakhon province near Bangkok, followed by the third wave in April 2021 starting at an entertaining venue in Bangkok. From there, the virus transmission has spread to slum area nearby and further to construction worker sites. Since then, the number of confirmed cases has risen. As of July 13, 2021, the cumulative total of COVID-19 patients in Bangkok was 101,575 people, while number of patients in Thailand was 353,712.

The COVID-19 transmission in slum areas has sparked a high concern to all responsible organizations such as NGO networks, academic institution and Government. It is difficult to control the transmission of the virus in such densely populated areas. The poor living condition in slum areas make the situation deteriorated. In Patana Mai Community of Klong Toei sub-district, 13 people live together with one toilet. In another slum area, Supot Uthit community of Sala Thammasop Sub-district in Thawiwatthana district, 38 people or 19% of total population were infected COVID-19.

On top of COVID-19 rapid spread, the number of complete vaccinations in Thailand is still limited. As of July 12, 2021, only 4.83% of population received two doses of vaccines and 14.28% received one dose. The situation is then worrying that the health care system might be collapsed sooner or later.

Community response to COVID-19

National Health Commission Office (NHCO), which is a government organization, established in 2007 with an objective of developing healthy public policies through collaboration and synergy from various sectors and stakeholders particularly civil societies and communities. Health charter has been promoted for each community to discuss and get involved in the solving the problems.

In 2020, NHCO encouraged communities throughout the country including Bangkok to discuss among themselves on how to handle COVID-19 in their communities. The output of the discussion is the development of the social measures against COVID-19 initiated by community members. It aims to supplement the government measures, which are too generic or hard to comply with such as a lockdown measure. NHCO organized training on developing community health charter and invited local leaders. Then local leaders facilitate a community health charter process in their area with a support of NHCO. Various community members, such as village headman, community committee members and village health volunteers participated in discussion of the development process. They had experiences of coping with social issues such as air pollution and housing in the slum area.

They discussed on the roles and functions of each stakeholder in response to COVID-19, for example;
– Community leader/ president / a village headman: provide a special infectious waste disposal site for the community, collect information of people who traveling to another province, provide prevention COVID-19 information and encourage community members to clean their house especially doorknobs and sink.
– Police station: provide necessary equipment to prevent COVID-19 for community volunteer such as a disposal mask, alcohol gel.
– Public health office: provide necessary information on prevent COVID-19 to community leader.
– Temple/mosque: provide alcohol gel or soap for people, give a sermon on preventing COVID-19 and emotional and mental care.
– a community health volunteer: collect information of vulnerable group such as elderly people, bed ridden and children.

The development of the health charter gives an opportunity for both community members and local government to discuss on how to handle with the outbreak. That leads to understanding the expectation of both sides and trust-based collaboration.

Responding to the dramatic change of situation due to COVID-19 from 2020-2021, NHCO has focused on engaging communities to set up a community iso-lation system for COVID-19 prevention and control.
Many organizations such as Thawiwatthana District Office under Bangkok Metropolitan Administration (BMA) covering Supot Uthit community slum area, and Health and Society Institute, which has a research area in a Klongtoei slum area, contacted NHCO for advice and collaboration with its wider network. These organizations supported communities to set up a community isolation system in a slum area.

A Community Isolation System

The system can be categorized as listed below.

1) Bubble and seal
This system applies for a small community. It closes the community and requests community members to quarantine or stay within a community for 14 days, except patients to go to hospitals. Food, vaccines, medical supplies and survival packages are provided at the community. The community opens again when everyone in the community tests COVID-19 negative.
2) Community control
This system is for bigger community and sets up 3 centers, namely, a waiting center for patients to go to hospitals, a quarantine center for high-risk contact person, and a rehabilitation center for recovered patients to stay 14 days before returning home. All centers are located in the community. A government hall or a temple can be used for these centers.
3) Data and communication
This system applies to both big and small communities for collecting data on health and negative impacts from COVID-19 such as job loss. The data is used for providing assistance and sharing information. Doctors and health volunteers use this data to follow up symptoms or find hospitals for patients. NGOs or volunteers can know who are in need for food and survival package in time.

NHCO has developed a guideline on the community isolation system for any communities to be able to apply and set up the system by themselves. Communities which adopted this system has a good relationship among local government, community and external partner. When community needs help from those partners they will directly contact them. We also found some community leaders try to share their experiences on coping with this crisis to others communities and try to set up their micro system when third wave of COVID-19 coming. Community sense of ownership and sustainability is more ensured.

Lessons learned

As working on COVID-19 response for almost two years, NHCO draws the following lessons.
Community strength with a good leader helps communities to ensure safety from COVID-19 or at least mitigate the negative impacts from COVID-19. During the time of emergency, the government has to prioritize their assistance to vulnerable communities. If a community is strong, it helps community members assist one another and even helps other communities.

Problem solving in a systematic manner is vital. When NHCO together with the networks designed the community isolation system, a working mechanism, resources, manpower (government officers and volunteers), data and communication system should be designed in a right way.Long term investment in building trust-based collaboration with multi-sectors and stakeholders is valuable. This investment blossoms when crisis happens. Without long term investment in this matter, collaboration during crisis hardly occur and may be worse leading to conflict. NHCO builds trust-based collaboration through provide a neutral platform such as health assembly or health charter where various sectors and stakeholders come to discuss problems, find solutions and take actions together for more than a decade.

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