The promotion of community responses to HIV/AIDS in Phayao Province, Northern Thailand

Summarised from the report The Promotion of Community Responses to HIV/AIDS: Experiences from Phayao Province, Northern Thailand, by Dr Aree Tanbanjong, Assistant to Provincial Chief Medical Officer, Phayao Province.

For further information, contact:Dr Petchsri Sirinirund, Provincial Chief Medical Officer, or Dr Aree Tanbanjong, Assistant to Provincial Chief Medical Officer, Phayao Provincial Health Office, Phayao Province, Thailand. Tel: 66 054 431129, 482264

The Phayao Provincial Health Office has collaborated with UNAIDS and JICA(Japan International Cooperation Agency) in implementing activities aimed at community involvement in responding to HIV/AIDS.

In April 1998, the Phayao AIDS Action Centre produced a report entitled HIV and Health Care Reform in Phayao. The significant messages were: “ the battle against AIDS is in the community” and “ it might be necessary to change the roles and functions of health staff at health centre level to become facilitators rather than activity implementers.” Therefore, capacity development should be done at the levels of individual, family and community. The essential capacities at family level are awareness in self value, life skills, communication skills in building up a better relationship in the family, and the ability to assess their own vulnerabilities and risks including behaviour adaptation.

Implementation has focused on developing leaders of various groups, including young people, community leaders and members of the Tambon Administrative Organization (the tambon is the sub-district). It was found that the situation assessment by the community was only implemented temporarily since it had been initiated or requested by governmental sectors, and the community itself had not adopted it as part of the community’s life. Consequently, these processes could not continue in the community. It is therefore important to make further studies on how to support communities because the awareness and the competence of people in response to AIDS is the only way to put a stop to AIDS problems.

Objectives

To acknowledge effective models and strategies in developing community capacity.

Study procedures

1. Study the implementation of community capacity development that has been implemented throughout the province from 1997 to the present.

2. Develop an AIDS-competent tambon, implemented in one pilot area and facilitated by health staff at tambon level.

3. Study the process of community responses to AIDS which have been intiated and supported by community and private organisations in various parts of five upper northern provinces.

Results of the study

1. An assessment of the implementation of community capacity development in response to community problems. Problems encountered included:

· The project identified implementation steps by the health sector without discussing them or planning with other sectors, even though each step in the plan concerned identified the need for the collaboration of the working team.

· During the process of staff preparation, despite the training of trainers from one level to another, there were no other activities arranged to enhance the understanding among team members about the roles and functions of their regular work, which might be affected by the impact of HIV/AIDS.

· There was no assessment during each step of the training.

· During the planning process at village level representatives of various social groups were identified to share information, opinions and plans. However, there was no preparation for these group representatives to understand the purpose and ways of discussion at the village level. Therefore, only certain groups were involved in the planning process and the discussion was mostly on presenting problems and plans for each individual group in order to receive supporting funding. As a consequence, the process of overall assessment and planning did not come about.

· Throughout the process, health staff were found to be the key actors who run the business, though the provincial team as well as district and sub-district teams required the collaboration of various sectors. Some sectors did not come for training. In some areas, many sectors came for training at the beginning but did not continue. As a result, the most important step in assessing problems and planning for the activities focussed only on health and medical problems since most facilitators were health staff and health volunteers.

2. An assessment of activities implemented in Tambon Loe, Chun District, under the project of the Development of an AIDS-Competent Tambon.

1. The implementation of the development of an AIDS competent tambon identified key steps in developing community capacity:

· Personnel preparation

· Skills building for the community on the basis of ‘Learning by Acting’ cycle: vision building, situation assessment, planning, implementation, and evaluation

· Institutionalising the society

1. The initial activities implemented in 1999 included: a) personnel preparation which had two aspects: the importance of community capacity development as the key mechanism to success in preventing and controlling AIDS; and identifying the goal of creating an AIDS Competent Tambon (community);

b) Process management on various social group discussions.

2. Regarding the discussion among people in the village, certain important issues should be taken into consideration, such as:

· People felt uncomfortable discussing the issues of sex in front of a Buddha image.

· In deciding to have a mixed group, we were expecting each group member to represent and reflect problems of their own social group, hence enhancing information exchange among them. However, community leaders dominated the group discussion. Young people were unable to discuss certain specific issues in front of adults. Wives did not dare to express certain opinions in front of their husbands.

· The identification of five steps towards vision building; situation assessment; planning; implementation; and evaluation.

Learning experiences

Lessons learned from the assessment of the implementation on community capacity development and the initial activities implemented for the development of AIDS Competent Tambon in Tambon Loe, Chun District.

1. Identify explicitly the roles of people in supporting the development of community capacity, which:

· allow chances for representatives of social groups, and the personnel of governmental, non governmental and local administrative organizations to discuss and exchange information.

· provide additional information regarding the collection and analysis system of each sector, provide related knowledge to enhance situation assessment, facilitate the discussion and reflect the real situation.

· Facilitate the planning steps with reference to the actual situation.

· Create people-centred attitudes around planning and allocating the budget so as to solve problems beneficially for people overall rather than benefiting only certain specific groups.

· Enhance management skills along with other important skills for implementing the planned activities in the village.

· Facilitate the evaluation and continually review the plans.

1. Improve knowledge and skills corresponding to the skills of personnel in facilitating group discussions appropriately. Assess whether the group members should be mixed or homogeneous. We found that the characteristics of the group influenced group discussion. Skills in activating the discussion and allowing everyone to discuss issues freely.

2. Evaluate the work by staff trained in skills improvement, tools development, and the management of activities on developing community capacity in the pilot areas.