Research paper presented at The Silver Jubilee International Conference on New Frontier in Health Se

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Research paper presented at The Silver Jubilee
InternationalConference on New Frontier in
Health Service Management
Organized by Christian University of Thailand

• September 8, 2008
• By Asst. Prof. Dr. Janjira Wongkhomthong

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Title Paper The Efficiency of the Implementation
of Strategic Plan for Prevention of Avian
Influenza in Lopburi Province

• Authors Asst. Prof. Dr. Janjira Wongkhomthong,
  Assoc. Prof. Penchan S. Monayapong,
  Col. Dr. Nongpimol Nimit-arnum, Dr.
  Supatana Chomson, and Miss Sasithorn Roojanavech.
• Affiliation Graduate school, Christian
  University of Thailand

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• Avian Influenza (Bird Flu) is considered serious
  health problem in Thailand.
• Lopburi province is one of ten provinces in the
  central part of Thailand where report about
  patients and deceases from Avian Influenza
  occurred.
• Lopburi is also the gathering site for enormous
  numbers of field ducks and natural birds that
  immigrate to find food in this area.

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• The strategic plan and guideline were established
  for preventing the epidemic in every step.
• pre-epidemic
• infection period
• out-break period
• post-epidemic
• The responsibilities of involved sectors and
  officers were also specified in order to be well
  prepared to efficiently respond to the impending
  epidemic.

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• The overall results of the implementation of the
  previous strategic plan for a short period were
  satisfied. The Bird Flu watch report from the
  latest report on the Epidemiology Office,
  Ministry of Public Health on August 23, 2549
  revealed that there was no new case of Bird flu
  report in Lopburi Province.

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• Research Questions
• How was the efficiency of the implementation of
  the strategic plan for prevention of Avian
  Influenza in Lopburi?
• How was the effectiveness the implementation of
  the strategic plan for prevention of Avian
  Influenza in Lopburi?

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• Objectives of the Study
• To evaluate the efficiency of the implementation
  of strategic plan for prevention of Avian
  Influenza in Lopburi.
• To evaluate the effectiveness of the
  implementation of the strategic plan for
  prevention of Avian Influenza in Lopburi.
• To attain the suggestions from all involved in
  altering such strategic plan.

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• Research Methodology
• This study was the evaluative research using CIPP
  Model
• Both qualitative and quantitative analysis were
  applied to evaluate such strategic plan
• The populations of this study were the
  administrators of the province and district in
  Lopburi province
• Community leaders, health officers, volunteers,
  individuals from various sectors and delegates
  from industrial sectors

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• The tools of this study was developed by
  researchers through reviewing related literatures
  such tools were questionnaire, semi-structure
  interview, open end questions and group
  interview.
• The tools were evaluated for content validity by
  experts and reliability test was done with strict
  protection of patients right.
• The individual and group interview, observation,
  related literature review questionnaire were used
  to collect the data from 312 volunteers (public
  health and livestock) and 400 individuals.
• Multi-stage sampling technique were used in 8
  villages of 4 districts.

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• The Study Findings
• The result of qualitative analysis revealed that
  this strategic plan was established in the
  awareness that Avian Influenza (Bird Flu) is the
  national disaster. This plan was established on
  the problem-based approach by using the strict
  enforcement of laws, rules, and regulations in
  reordering the society for readiness in
  responding to the possible out-break epidemic.

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• The implementation of this strategic plan well
  responded in controlling quick spread of epidemic
  for a period of time in order for the sustainable
  results, it is necessary to decrease the
  conflicts among locals especially farmers who
  felt powerless in negotiation.
• And felt that their traditional way of life being
  threatened by provincial regulations.
• Lopburi governor was a strong leader to support
  the establishment of the integrated strategic
  plan by opening to the contribution of all
  provincial sectors in establishing, implementing
  and evaluating the plan.
• The consultations in all levels led to creating
  network and multidisciplinary team work.

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• The local officers had opportunity to contribute
  to the establishment of the action plan
• And felt the sense of ownership of the plan,
  therefore, they were committed to accomplish
  their missions in successfully controlling and
  prevention of Avian Influenza.
• Volunteers were a significant key in propelling
  such plan in sub-district level and this also led
  to the combination of networking groups of Avian
  Influenza Watch in the communities that were
  very strong and energetic.
• The local leaders also were very strong in
  communities (such as head of sub-districts, head
  of villages and volunteers) contributing to build
  Avian Influenza free community.

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• The result of the survey among 312 public health
  volunteers were as follows
• The activities they did mostly were surveying of
  poultry census.
• And giving advice and keeping samples of poultry
  excretion.
• The appliances that they mostly used were masks
  and gloves, but 51.9 of populations complained
  that there was inadequate of such appliances.
• The contents that they mostly advised were
• surveillance in poultry.
• Informing the incident.

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• Surveillance in human and personal hygiene
  respectively.
• The most frequent method to be suggested was
  giving verbal advice, and people accepted and
  complied with such advice well.
• The public health volunteers were well prepared
  to work and confident in working
• and were highly proud of their work.
• 80.1 of them wanted some payment for the expense
  of gasoline for their motorcycle.
• The correlational analysis of various factors
  found that the preparation for a readiness to
  work was positive related significantly to the
  confidence and proundness in working and the
  acceptance and cooperation from people.

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• The results of the survey study on knowledge and
  opinions in preventing of Avian Influenza in the
  400 people revealed that
• Most subjects of this study received information
  about this epidemic on television.
• 66.7 of them had good knowledge about this
  disease.
• 91.8 of the subjects thought people were willing
  to cooperate in preventing Avian Influenza.
• Held highly trust in preventive measures and the
  outcomes of implementations of the preventive
  measures of Avian Influenza.
• The correlational analysis also showed that the
  opinions about the prevention of Avian Influenza
  were positive and significantly related to the
  knowledge about such disease.

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• Research Discussion
• The results of both qualitative and quantitative
  analysis were explained as follows
• 1. The integrated strategic plan leading to
  successful management
• The most one significant factor that lead to
  successful management was leaders vision.
• The Lopburi province governor had far-sighted
  view about the mass impact of Avian Influenza.
• He was assured that all sectors in society could
  synergize their energy.

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• As a leader, he supported all involved sectors in
  participating the formation of the plan and
  rehearsal the plan, and implementing according to
  the action plan.
• Lopburi province started to establish the public
  health action plan in 5 dimensions.
• All involved parties mutually accepted the major
  plan through meeting on a regular basis
  circulate official letters together empowerment
  strategy to all sectors to establish their own
  sub-action plans to design their own practical
  guidelines.

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• The strategic plan rehearsal for prevention of
  Avian Influenza both on table exercise and
  fieldwork trial.
• periodically rehearsal also activated a readiness
  of all involved in each sector and creates a
  close liaison, exchanging and sharing of
  resources economically.
• Various leaders gave high priority to this
  disease and projected that if the epidemic of
  Avian Influenza reoccurred a mobilization of all
  sectors needed in order to prevent and control
  such epidemic.

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• When individuals or people perceived the
  intensity of such epidemic, they then emphasized
  on the preventive measure by watching such
  serious disease.
• induced a preventive behavior in various ways
  according to their roles, responsibilities and
  social status.
• Thai government, placed an emphasis on
  campaigning the epidemic by heavily spreading the
  news but, this sometimes frightens people.
• This study revealed that through television and
  giving verbal advice from home to home on foot by
  public health volunteer were the most popular
  media.

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• 2. The effectiveness of strategic plan decreasing
  the incidents in both humans and animals
• There were 59 cases who were under surveillance
  for Bird Flu, but there was no Bird Flu infection
  identified.
• This could be deduced that this strategic plan
  could effectively decrease the incidents in both
  humans and animals.
• there was no report of sickness or decease of all
  poultry pen.
• the overall assessment of this strategic plan was
  considered effective and it could efficiently
  decrease the epidemic incident of Bird Flu in
  Lopburi province.

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• 3. The adapted risk behavior
• People and farmers received information regarding
  Bird Flu from various media, enabling their
  understanding of risk factors, severity, and
  advantage of prevention of Bird Flu which lead
  to better adapted preventive behavior
• The behavior of contacting poultry or poultry
  products such as decreasing empty-handed contact
  of deceased poultry or decreasing in using dead
  poultry for cooking.
• People mostly receive such information from
  television (92.5)
• The next channel was from officers or volunteers

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• The third one was from the village news
  disseminating tower.
• Leaflets and posters were less popular channels
• With regard to giving advice about Bird Flu by
  public health volunteers The most popular one
  was giving advice (78.8)
• Next was leaflets (55.8)
• posters was the third popular method used (45.2)
• The next popular method was the village news
  disseminating tower and wired-dispersing by
  reading short, simple, and understandable
  message.

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• The topics that those volunteers mostly gave
  advice were surveillance of abnormal symptoms in
  poultries.
• reporting on poultry sickness and death.
• surveillance of abnormal symptoms in humans.
• taking care of health and sanitation.

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• 4. Public health volunteers power as village
  protective armour
• Public health volunteers were the critical
  propelling engines in implementing the strategic
  plan in the area of surveillance in villages.
• Those leaders and volunteers were regarded as
  high sacrificers.
• but they were quite exhausted from multiple
  responsibilities.
• In this study, 92.3 were both public health and
  livestock volunteers. Some of them were at the
  same time volunteers of narcotic drug protection,
  or disaster relief and protection.
• These volunteers requested small allowance and
  gasoline expense for their motorcycle while
  working in field.
• The government should find ways to recruit and
  persuade large member of young people to work as
  volunteer.

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• The study revealed that there were the
  establishments of Bird Flu Watch Center,
  information networking, cautionary informing
  system, evaluation and summary of the
  establishment of Bird Flu Watch system.
• There were health network alliance in
  sub-district level.
• Researchers also found that 66.0 of public
  health volunteers perceived that they were
  prepared to prevent Bird Flu with high rating
  score which built their confident and pride of
  their work, and drew people attention and
  participation.

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• 5. Network building for improving the learning
  community
• Lopburi province provided opportunity to all
  sectors to participate including government
  sector, private sector and individual.
• These involved integrating system, coordinating
  all involved through conference and
• consultation at all levels both administrators
  and operators, to create network and
  multi-disciplinary team working.

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• The efficiency of the implementation of such
  model depended on the leadership of
  administrators and scholars
• the budget
• the evaluation and continual control
• the establishment of standard of working system
  under a strong team work building
• Provincial officers should function as supporter,
  consultant, and being a coach to district and
  sub-district staff
• To provide more services instead of just command
• All involved should participate in integrative
  implementation.

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• 6. The adjustment of work paradigm emphasizing on
  community power
• Avian Flu problem became the national agenda, the
  problem-based approach was applied to drive such
  measures to control the possible epidemic, in
  conjunction with strict enforcement of laws,
  rules, and regulations of society.
• Researchers suggested that adjusting work
  paradigm of all involved in identifying measures
  or guidelines that emphasized the people
  development, build a strong community, and lived
  harmoniously in the civil society. The
  establishment of people stage people to
  acknowledge should be able to freely present
  their opinions. Some people who lost their
  advantages should be given chances to solve
  problems and eradicate obstacles.

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• Suggestions
• The researchers suggested to improve the
  implementation of strategic plan for Avian
  Influenza in Lopburi province as follows
• The government and local administrative sectors
  should consider promoting the volunteers who have
  volunteerism -hearts and the sub-district leaders
  who held the concept sustainable human resource
  development in order to become disaster armour
  of village.

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• 2. The government officers should have good
  attitude for a cock-fight game. They should
  regard it as a local game for entertainment.
• 3. The raising of disease-free fighting-cocks
  should be supported.
• 4. Government officers should support in
  organizing the local poultry farm to be able to
  raise poultry in local ways.
• 5. The alteration of the structure of
  administration and increasing numbers of
  livestock officers should be exercised.

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• 6. The tacit knowledge occurred during group
  learning, the opportunity should be provided for
  volunteers in each area to exchange knowledge and
  experience and wisdom leading to the explicit
  knowledge. Public health practice guidelines,
  which integrate the knowledge of all health
  involved sectors and community. The continual
  learning community and the community of best
  practice would be good model for other community.
• 7. The community empowerment should be emphasized
  in order to strengthening the community to be
  by people and for people and peacefully living
  .

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