Health Promotion for the Marginalized Thai People in the North

8/14/2019 Health Promotion for the Marginalized Thai People in the North

http://slidepdf.com/reader/full/health-promotion-for-the-marginalized-thai-people-in-the-north 1/81

Chiang Mai

Health Promotion

Project 2544-2545

Uthaiwan KanchanakamolDDS,CDPH,MPH

Chiang MaiUniversity,THAILAND



Increasing Community Capacity

and

Empowering Community Members

to

Improve the Health and Well-Being

of

Chiang Mai Hill-Tribes

and

Low-income Groups

in



Participatory

Action

Research

Type of Research





1.To determine how to improve

implementation and effectiveness

in promoting

the integral development

of youth, seniors and women

in Hilltribes

Overall Goal



And….. low income communities

while increasing community cohesion

and collaboration through cultural,

political, social and artistic activities



2.

To determine how toimprove implementation

and effectiveness in

promoting development of

skills among sub-district

administration/organization

and municipality personnel

in the area of community development.

Overall Goal

STRIVING>COPING





3

To determine how to

improve implementation

and effectiveness in

promoting creation of

community partnerships

by local actors

for health promotion

Overall goal

STRIVING>COPIN



Project Significanceand

ealth Issues Involved



The local area health-care has beenplanned.

The programs were

implementedunder the authority of provincialboard

consisting of representatives

from the local government,communities,

and the Ministry of Health.



This is especially crucial for disadvantagedgroups like the Chiang Mai Hill-Tribesandother low-income communities.





Consensus vs Conflict

Community Social ActioDevelopment (Alinsky Mod

Collaboration

Community Building Empowerment-Oriented

& Capacity Building Social Action(“power with”) (challenging “power over”)

Community Competence

Leadership Development

Critical Awareness

StrategiesGrassroots Oganizing

Professionally Driven Oganizing

Coalitions

Lay Health Workers

Building Community Identity

Political/Legisletive Action

Culturally Relevant Practice

Advocacy

nity Organizing & Community Building Ty

Strength

sBased

NeedsBased

1 2





• Specifically, it is proposed that proven,

effective

participatory action techniques are utilizedto

educate, empower, and involve members of these





sParticipatory planning

sNeeds assessmentmethods

(with emphasis on

“asset-based"methods )

sParticipatory programevaluation techniques

s Increasing CommunityCapacity

includes





These included:

s Appreciative Inquiry

s Asset Based Community Development

s Training in the use of focus groupss Delphi methods

s Participatory rural appraisal (PRA)

s Community Walking Mapping

Community Empowerment



Comm nit



CommunityEmpowerment startsfrom….

realizing the benefits of projectsrealizing the benefits of projects

thatthat

result in improved livingresult in improved livingconditionsconditions



C it



CommunityEmpowerment starts from….

crystalizing their owncrystalizing their ownideasideas

Community



CommunityEmpowerment startsfrom….

building communities from thebuilding communities from the

inside outinside out



The amazingtool inpositively,approachingmarginalizedpeople in

health

articipatoryural

ppraisal,PRA)



uture search conferenc

the youth network



Future search conferencein community leaders





Focus Group Discussionin an old age group



Local-local dialogue



Future search conferencein the youth



Community Mind Mapping











through community actionparticularly through groupsorganized by women&youth



through community action

particularly through groupsorganized by women&youth



Participatory evaluation on empowermentParticipatory evaluation on empowerment







BY STRENGTHENING COMMUNITY ACTIONBY STRENGTHENING COMMUNITY ACTION

AND CREATING SUPPORTIVE ENVIRONMENTAND CREATING SUPPORTIVE ENVIRONMENT

CIVICAWARENESS

BUILDINGBUILDING

CBO NETWORK CBO NETWORK ESTABLISHINGESTABLISHING

C B OC B O



The New Role in Health Promotion Teamwork

• THE HP-CATALYSTTHE HP-CATALYST• THE HP-FACILITATORTHE HP-FACILITATOR• THE HP-PROMOTERTHE HP-PROMOTER• THE HP-DEVELOPMENT ENABLERTHE HP-DEVELOPMENT ENABLER• THE HP-MEDIATORTHE HP-MEDIATOR

• THE HP- ADVOCATETHE HP- ADVOCATEinin

The Healthy Community ProgramThe Healthy Community ProgramThe Caries Free Village ProgramThe Caries Free Village ProgramThe Vital , Creative HealthThe Vital , Creative Health

Promotion Program, etc .Promotion Program, etc .

The

NewRoleOf HealthProfessionalsinthe21 stCentury



Kanchanakamol

U.,1998Dev. from Ottawa

Optimal HealthOptimal Health

Quality of LifeQuality of LifeCivil SocietyCivil Society

A D V O

C A C Y

A D V O

C A C Y

M E D

I A T

E

M E D

I A T

E

ENABLEENABLE



Community OrganizationsCommunity Organizations

Area hospitals, NGOs, Local governmentalArea hospitals, NGOs, Local governmental

groupsgroups

were enlisted as collaborators in this learningwere enlisted as collaborators in this learningrocess.rocess.



• Their involvements have the additional Their involvements have the additionaladvantagesadvantages

of identifying issues early-on for discussion andof identifying issues early-on for discussion and

resolution, enabling coalition-building andresolution, enabling coalition-building and

increasing trust between the three partnerincreasing trust between the three partner

groups.groups.



Local - Local Dialogue

Helps Local Actors Create Partnerships

LocalLocalAuthoritiesAuthorities

CBOsCBOsNGOsNGOs

CentralCentral

GovernmenGovernmen

tt

PrivatePrivate

SectorSector

Donor



NCCCBO

ICECCLA

PASED

NGO

Autonomous Network

Local AdministrationOrganizations

Community Based

Organizations

Healthy Community

Good Governance

CentralGovernment

Sectors

Funders

&

Private Sectors

CBO21

MUNICIPALITY2

CBO1

LAO5Coordinated Actions

by

Multiple Actors/Sectors



Concerned communitieshold the key to successfuladvocacy for healthypublic policy.

Without communityinvolvement,a truly public policy

cannot evolve.

Therefore …Advocacy for communitysupport should arousepublic interest andcommunity action that willgenerate pressure for



Poverty andilliteracy do

not preventpeople

from

recognizingtheir needsand calling for

action



Type of Research



Type of Research




Type of Research



Type of Research




Type of Research








Type of Research



Type of Research



Type of Research



Type of Research



Poverty and illiteracy do notprevent people from

recognizing their needs andcalling for action

C it



CommunityEmpowerment

Starts From….

s Building people’s capacity to formulate

and implement local developmentinitiatives

s analyzing & choose

amongalternative

approaches

Wh i b i



Who is beingempowered ?

See them in ...

s ..........community participation

process

1. Local initiative



communication,art,media Though drama,song,community dialogue,musictherapy,internet

6. LOCAL WISDOM 2. HEALTHY CONSUMER Traditional healing, herbal medicine Macro-

biotic,vegetarian,etc.

5. PHYSICAL EXERCISE 3. RELIGION AND

HEALTH

Aerobic,Yoka,cycling, jocking HEALTH Meditationnetwork Tichi,Traditional exercise PROMOTION

Interreligious activities Northern Thai boxing dance

INITIATIVES Tribal culture

4 LIBERATED LIFE STYLE

Holistic self-care, alternative medicine, self body massage HEALTHY COMMUNITHEALTHY CITYEALTHY CITY







he Evolution of Oral Health Care Teamwork





The achievement of local autonomy throughthe development and use of life skills

Community Empowerment

Local Decision Making is the Key

TheCitizen



TheLadder of

CitizenParticipatio

nin

CommunityHealth

Program

DegreesDegrees

of of

citizencitizenpowerpower

DegreesDegrees

of of

tokenismtokenism

Non -Non -

participationparticipationKanchanakamol, UKanchanakamol, U

20002000

developed fromdeveloped from

Arnstein,1971:70Arnstein,1971:70

control

Delegatedpower

Partnership

Placation

Consultation

Informing

Therapy

Manipulation



Death/ Deformity/Disability/Symptom/SignGrowth & Social Self Self

Development/acceptance/esteem / fulfilm

Negative Health PositiveHealth

discernablepoint

Holistic Health

Rehabilitation /Early Diagnosis/ Eradicating/ Raising Individual / EffectiveRehabilitation /Early Diagnosis/ Eradicating/ Raising Individual / EffectiveEnduringEnduring

& Prompt Rx Health Risks QOL Social Change& Prompt Rx Health Risks QOL Social Change

1 3o 2o

o

Disease Prevention

1o 2o

3o

Health Promotion



• Developing one’s creativity &potentiality

• Making maximum use of one’sability

• Self-esteem Esteem of others

•Love Belonging

Closeness

Safety Security

Food Air ShelterWater

Rest Exercise Sex

M a s l o

w ’ s

H i e

r c h

y o f

N e e d

s

OPTIMAL



Early DiagnosisPrompt Rx

Rehabilitation

Eradicating

HealthRisks1 o Disease

Prevention2 o Disease

Prevention3 o Disease

Prevention

Disease-oriented(Bio-medical

model

MINIMALDISEASE

Kanchanakamol U.

Dev. from Brown V., 1985

3 o Health

Promotion2 o Health Promotion

1 o Health Promotion

Health - oriented

(health model)

HEALTH

EffectiveEffectiveenduringenduring

Social changeSocial change

Raising individualRaising individualQOLQOL





Community

Empowerment…



Born men are we all but oneBorn men are we all but one

Brown black by the sun CulturedBrown black by the sun Cultured

Knowledge can be ones alikeKnowledge can be ones alikeOnly the heart differs from man to manOnly the heart differs from man to man

Thai-old sayingThai-old saying

GO TO THE PEOPLE



GO TO THE PEOPLE

LIVE WITH THEM

PLAN WITH THEM

WORK WITH THEM

LEARN FROM THEM

BUILD FROM WHAT THEY HAVE

START FROM WHAT THEY KNOW



PEOPLE DON’T CARE

HOW MUCH YOU KNOW

UNTIL THEY KNOW

HOW MUCH YOU CARE



Sawaddee(Goodbye)

Documents

Health Promotion for the Marginalized Thai People in the North