Ultimate Goal Quality of life among PWHAs and affected people

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

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

Comm unity potent ial NATURA L RESOUR CES MAN Manage ment Lear ning Develop ment Framework of Community Empowerment KNOWLE DGE & WISDOM

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

Process of PR&D 2. Training the ‘community research coordinators’ 1. Finding ‘community research coordinators’ Select 3-5 volunteers for each village (by village participants) 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

Areas of development initiated and implemented by communities

Natural agriculture - organic farming Safety food & Safety environment Community health Reducing cost Bio-fertilizer Production Purp oses

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

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. More than 50 villages in 6 sub- districts have implemented the ‘bio-fertilizer project’ supported by 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 by Sub- 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 program every month.

Community Health Care Traditional Thai Massage Herbal Medicine Community Health Volunteers

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. 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).

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.

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 ( )

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.

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.

Lesson Learned as Reported by ECI Participants June 28-29, 2002

PR& D Know ing self Active Learni ng Self- relianc e Self- confiden ce Solida rity Netwo rk & friend s New way of thinkin g Holist ic healt h

Basic Components of Community Health Care Healthy Food Healthy Work/ environme nt Traditiona l Care Hosp ital Commu nity Govern ment

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.

Human Rights E nhanced by ECI 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. Right to health and well- being

Facilita tors Lear ners Suppo rters Communit y forums Encourage thinking & learning Experts & Trainers Financial support at the beginning How to work with community How to work with team organizations How to encourage learning process How to change ways of thinking Roles of ECI

Impac ts Community Health Care Team On going activities initiated & implemented by community Community leaders - human resource development 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 healthy food, healthy environment, healthy work, herbal medicine, and traditional care Groups of Thai massagers

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

Impac ts Health care system Care for the dying patients Counsel ing - prepari ng for the end of life Improved quality of care UP ARV OI Human rights Well-trained health personnel Nursing Care

1. Organize National forum to share results and lesson learned Future Plans of ECI Thailand 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

Thank You