1. Strengthening and Evaluating
Health Promotion and Chronic
Disease Prevention at the
Community Level in Thailand:
A Comparative Analysis of
Various System Approaches
Ms.Sudarat Lijutipoom
Dr Piya Hanvoravongchai
Faculty of Medicine, Chulalongkorn
University, Thailand

2. Background and Rationale
• Many national programs for chronic
disease prevention at community
level
• No study to evaluate these
programs comparatively
• Objective : To investigate and
compare health promotion and
chronic disease prevention
approaches from four

3. Four major organizationsOrganizat
ion
Program What they do
Department of
Disease
Control
Strong disease-
control district
program (SDD)
Strengthen communities to reduce the
risks and diseases (CD,NCD) based on
community context to ensure
sustainability
Department of
Health Service
Support
Village Health
Management
program (VHM)
Support community to integrate local
resources (people, knowledge and
finance) to solve local health problems
appropriately and sustainably
Department of
Health
Community with
No Belly (CNB)
Promote healthy behavior among risk
groups in the community in three areas
of life style modification i.e. diet,
exercise, and emotional management.
National Health
Security office
Local Health
Security Funds
(LHSF)
Co-invest with local administrative unit
to support community initiated health
and primary care programs

4. Methods
• Literature and document review
to identify their goals,
objectives, operation guidelines,
and evaluation frames
• Additional interviews with key
informants in each organization
• Comparative analysis from the
WHO’s conceptual framework on
health system strengthening

5. Building blocks
Framework of Health System and
its ComponentsLeadership/
stewardship
Human
Resources
Technology
Information
Health Care
Financing
Health
Services

6. RESULTS

7. Program characteristics
SDD VHM CNB CHSF
Year started 2010 1996 1995 1996
Responsible
Organization
MOPH/DDC MOPH/DHSS MOPH/DOH NHSO/Local
Governments
Setting Community
(any level)
Village Organization Sub-district
(Tambon)
Areas
implemented
10 provinces
in XXX
districts

8. Department of
Disease Control
community based
intervention
Department of
Health Service
Support Ministry
of Public Health
Village
Department of
Health
Organization or
community
project.
National Health
Security office
(NHSO)
Municipalities /
Sub-district
Administration
Organization
participating.
SDD
CHM
CNB
LHSF

9. NHSO contributes 40 Baht per
head to the fund. Local
government contributes another
40 Baht per head. Additional
contribution from the community
also possible.
Relying on funding from other
government projects depending
on target group
No funding
support, only
technical
guidance
SDD
CHM
CNB
LHSF

10. Human
resource
Department of
Disease Control
Health
personal in
the area
Key
informants
in
community
Department of
Health Service
Support Ministry
of Public Health
Health
personal in
the area
Key
informants
in
community
Department of
Health
Organizatio
ns /
community
Risk gr. for
lifestyle
modification
National Health
Security office
(NHSO)
Municipaliti
es SAO
Key
informants
in
community

11. Informati
on
Department of
Disease Control
Based on
health care
office
Department of
Health Service
Support Ministry of
Public Health
Planned
community.
Department of
Health
Hospital
base
Surveillance
data from
organization
National Health
Security office
(NHSO)
Planned
community.

12. Technolog
y
Department of
Disease Control
Context of
the
community
Focus on
good results
Department of
Health Service
Support Ministry of
Public Health
Context of
the
community
The
innovative
new solutions
Department of
Health
Intervention
by risk group
F / U
National Health
Security office
(NHSO)
By the
problems
By budget

13. Health
service
delivery
DDC
committee
Health problem
identification
Community
planning
Follow by
planning
Participatory M
& E
DHSS
Situation
analysis
A learning
platform in the
village
Community
planning by
SRM
Follow by
planning
M & E
DOH
committee
Policy from
partnership
Physical and
social planning
Concept of diet
, exercise and
emotional
Continuous F /U
NHSO
Local fund
committee
Co-payment :
NHSO. ,
Municipalities /
SAO and
community
4 D of planning
: promotion ,
prevention.
Treatment and
rehabilitation
Online data
M & E

14. Discussion
• Community health promotion
(Blake D et.al 2000, KAREN GLANZ
et.al. 2005 )
– Social planning : 3 levels ( individual
interpersonal and community)
– Social Action : community
development , community problem
identification, community solving
,community monitoring and evaluation)

15. Discussion 2
• Difference in regard to above
- All projects have the same of
concept and objective but different
from setting and process of
activities.
- Most of programs are interesting in
social action not social planning

16. Discussion 3
• Activities can be integrated
together for reduce redundancy
and depending on the problems
of the community
• Each project should enhance the
social planning activities in order
to increase the capacity of
community members at all levels
to solve problems together more

17. Discussion
• Thus it is important to understand the community
to make a suitable plan to adjust and implement
in the context of each community.
• All programs have evaluation components and all
except one organization relies on existing
information system for monitoring and evaluation.
• In the evaluation requirements, most
organizations only monitor inputs and process of
the projects plus some indicators on the level of
outputs.
• Evaluation of outcome is only used in one
program that focuses on short term outcome

18. Conclusion
• every organization uses a community
approach, instead of programmatic
approach
• All organizations rely on existing
workforce in the community, mostly
volunteers and health staff, to carry out
their work.
• Only one organization provides
supplementary financial resources in the
form of matching contribution while the

19. Thank you