Abstract
This qualitative study aims to develop the policy recommendation in order to support reform of roles of village health volunteers and Bangkok health volunteers for sustainable development goal. Specific objectives are defined as follows: a) to determine the alternative choices of roles reform, b) analyze and synthesize the policy recommendations about these criteria or guidelines, c) assess potential choices to support this roles reform in order to achieve the sustainable goals, and d) to propose development strategies for administrative authorities in supporting this reform process and implementation. Documentation reviews, case studies investigation, participatory action research and future search are deployed, in-depth interviewing and focus group discussion of all stakeholders and health volunteers were purposively recruited and actively participating in the data collection process. Their ideas or opinions are shared and coded into themes. Participants are village health volunteers and Bangkok health volunteers, community leaders, local authorities who support health volunteer work as well as others stakeholder in community health care system. A total of 800 participants were selected from 7 provinces; Nakhon Ratchasima, Chanthaburi, Kanchanaburi, Chiangmai, Roi-et, Pattani, Surathani and Bangkok Metropolitan Administration. The findings illustrated that present role of village/ community health volunteers align and reaffirm with Astana declaration 2018. Responsibilities are defined as follows; a) providing the service and integrate to essential primary health care, b) empowering of various sectors in driving policies and activities for good health, and c) empowering people and communities to take care of their own health. In presence, roles of being primary health care providers and public health work are predominated than other two roles which are influenced by policy from ministry of public health and need for community acceptance of village health volunteers themselves. However, the future roles could be shifted or up-skilled as community health care managers who can support and promote self-care in their community and perform as caregivers. In order to create behavioral change and improve quality of life as a whole by means of community participation and work collaboratively with local administrative authority. Acting as a leader in community health care teams, working together with family doctors and healthcare networks. Nevertheless, barriers and challenges that volunteers facing are listed as follows; lack of supportive medical devices, age of volunteers, accessibility to training courses for their competency development. In urban setting like Bangkok, district health volunteers have troubles in reaching their people due to acceptance. An important challenge is Thailand become an aging society, which creates a high demand for services such as long-term care from village health volunteer, and this factor is driving the change roles, operations and management. The results of the synthesis of alternative approaches to support the role of village health volunteers and Bangkok health volunteers in order to achieve sustainable development goals offer four approaches; 1) using same approach as Ministry of Public Health implementing (no change), 2) no change but add up or enhancing village health volunteers and Bangkok health volunteers’ power and competencies, 3) relocate village health volunteers and Bangkok health volunteers to work under local administration organizations, and 4) relocate to work under the management of the Prime Minister's Office with the Act to support the work of the village health volunteers and Bangkok health volunteers. The results of the alternative assessment revealed that the current model does not respond effectively to challenging problems. The ideal model is to change to work under the management of the Prime Minister's Office so that village health volunteers and Bangkok health volunteers can manage themselves. However, there is still a lack of law to support the operation. This research concludes that the implementation of the current guidelines with improvements to enhance the potential of the village health volunteers and Bangkok health volunteers Club of Thailand and village health volunteers and Bangkok health volunteers Club/VHV club at the local level for effective self-management could be an appropriate approach that will lead to self-management of village health volunteers and Bangkok health volunteers in the future. This research presents criteria for considering 7 alternative issues, namely; 1) government policy, 2) policy of the Department of Health Service Support, 3) having sufficient budget, 4) the competency of the village health volunteers and Bangkok health volunteers; 5) efficiency of the health care management of VHVs, 6) strengthening of the village health volunteers and Bangkok health volunteers club, and 7) promoting public acceptance. This research offers a preliminary approach to development to support reform of the role of health volunteers towards achieving sustainable development goals, consisted of; 1) accelerate self-assessment report and set up effective database of village health volunteer registration system, 2) strengthening village health volunteer clubs in all level coordinate as networking, 3) Supporting authorities such as department of health service support, ministry of public health and health department of Bangkok Metropolitan Administration should implement these operational strategies as follows: 3.1) support human capacity building for village health volunteers and Bangkok health volunteers by development plan with timeframe and coverage, 3.2) establish mentoring system for village health volunteers and Bangkok health volunteers via creating networking system, and 3.3) proactive public relations acknowledging health volunteers’ services in order to motivate and improve the roles’ of health volunteers, and lastly 4) local government administrations including provincial administration organization contribute budgets and support capacity building in order to improve their competencies and work more effectively to achieve the better quality of life of people in their communities.
