An Evaluation of Awareness and Preparedness on Infectious and Emerging Diseases at the Cross Border Areas; Thailand – Myanmar – Cambodia – Lao PDR Project in the Fiscal year 2015–2017

Abstract

Background: As the north of Thailand is bordered to Myanmar and Laos, and the east to Laos and Cambodia, the high migration of populations between border areas leading to a high risk of an outbreak of contagious diseases and emerging diseases due to people’s migration. The surveillance system of disease control and prevention at border areas did not entirely cover and reach the standard in five systems as well as lacking information in all five dimensions. In order to improve surveillance system of disease control and prevention at border areas, Thailand International Cooperation Agency (TICA) launched a pilot project in five provinces from 2015 to 2018 to build up awareness and preparedness for better border health. Objectives: To evaluate outcomes of the project and lesson learnt from work systems in the study areas. The results will be used to make a decision for budget support in the second phase and to investigate the factors related to the processes for successful project. Methods: This study was an evaluation research design by using both quantitative and qualitative methods consisting of questionnaire, focus group and group discussion. The study tools were developed to cover the CIPP model. The data were obtained from purposive sampling in five groups of people covering board of directors, public health staff, Thai public health volunteers, non-Thai health volunteers (border countries), stakeholders and immigrant workers in the six parallel border areas. The data were analyzed by using percentage, mean, standard deviation (descriptive study) and by content analysis and triangulation (qualitative study). Results: The quantitative study showed that Tak province had the highest overall knowledge scores at 16.07, followed by Vientiane, Nong Khai, and Chiang Rai, respectively. For the knowledge of health volunteers, the village health volunteers showed the highest knowledge scores (the first rank) while the home health volunteers, border community health workers and lay people after training in the surveil­lance and disease control and prevention were ranked in the second, third, fourth, respectively. The results by CIPP model revealed that the outcomes from the project were completely processed from context and policy and received a great support from Thai - Laos - Cambodia border areas. For the input factors, all personnel demonstrated an effective working and operation from all border areas, however the lack of budget and equipment was still the weak process in the three border areas. Product part, all borders developed the processes for surveillance system of disease control and prevention at both provincial and district levels based on the context of each area. Conclusion: The outcomes of the op­eration in three border areas varied upon the context and extent of experiences exchanges among volunteers, health workers and health providers in both provincial and district levels through co-learning and sharing as well as integrating their work with other organizations. Good cooperation between com­munities at parallel border areas was strong at Nong Khai province; health strategy was prominent in both border areas in Tak province; patient referral systems were established in Chiang Rai and Ubon Ratchathani provinces between two borders; and strategic personnel development was formed at Sa Kaeo province. In order to improve border health care system in a sustainable way, the crucial key components include intensive support and policy from the executive committee at ministry and local areas to effectively guiding the working in a timely manner on the strategy of emerging diseases and surveillance system of disease control and prevention at cross border areas.