Abstract
From the context of the COVID-19 virus pandemic that occurred in 2019, Health Region 10, with the involvement of the Health Region Committee for the local population, in collaboration with the Health Coalition Networks across all five provinces, including Ubon Ratchathani, Sisaket, Yasothon, Amnat Charoen, and Mukdahan, has developed and initiated the implementation of a region-specific Health Constitution at the district level, focusing on addressing the challenges posed by the COVID-19 pandemic. This initiative was launched in August 2021, emphasizing coordinating cooperation within provincial networks to promote a mutual understanding of the constitution-making process. Mechanisms were established at the provincial and district levels to support and monitor the progress of the Health Constitution's implementation in the fight against COVID-19. This research aims to evaluate the effectiveness of implementing the Health Constitution and monitoring the spread of the COVID-19 virus in Health Region 10. The study utilizes a mixed-method research approach and applies the Community Coalition Action Theory (CCAT) by Butterfoss & Kegler. It is divided into two phases: Phase 1 involves quantitative data collection with 2,451 key members of the Health Constitution teams at various administrative levels, including district, provincial, and sub-district, to assess progress in activities, awareness, participation, and success in implementing the Health Constitution and monitoring the spread of COVID-19 using questionnaires. Phase 2 includes qualitative data collection from 406 key members of the Health Constitution teams through in-depth interviews and focus group discussions. Data analysis involves statistical analysis, calculating percentages, averages, standard deviations, content analysis, and summarizing the findings. The research was conducted from October 2021 to October 2022. The research results can be divided into four main parts: 1. Evaluation of the effectiveness of developing and implementing the Health Constitution at the local level for monitoring the spread of COVID-19. Those involved in the process have a high level of awareness regarding the importance of driving the Health Constitution. The highest-scoring statement in this category is recognizing that the COVID-19 pandemic is a problem everyone must collaborate to address (Mean=4.37, SD=0.69). The level of participation in promoting health is also very high, with almost all statements scoring high, with the highest being involvement in community gatherings to analyze issues, listen to the public's thoughts and needs, and inspire vigilance against the spread of COVID-19 in the area (Mean=3.93, SD=0.85). In terms of the output of the Health Constitution implementation, all items score high, and the highest-scoring statement is ensuring that people with COVID-19 receive timely medical care in state healthcare facilities (Mean=4.21, SD=0.76). 3. The overall level of success in driving the Health Constitution averages at 8.34 out of a total score of 10. 2. The mechanism for implementing the Health Constitution and monitoring the spread of COVID-19 involves using the Health Constitution mechanism at the local level. It begins with creating an understanding among the local population about the meaning, benefits, and process of the Health Constitution. Community members are invited to participate in its development, and a leading team is established to drive this effort. This leading team comprises the management team, the Constitution drafting team, the community team, and the monitoring and evaluation team. Clear roles and responsibilities are defined for each team. Subsequently, the constitution is drafted to specify the guidelines and regulations the public should follow once the constitution is drafted and brought to the community for public feedback. If approved, it is enacted, but if there are still issues, it goes back for further adjustments and re-engagement with the community. Once the constitution is enacted, it is enforced at the community level using a grassroots visitation approach to assess issues with the implementation and make any necessary corrections. 3. To address problems and enhance the effectiveness of the Health Constitution in monitoring the spread of COVID-19, it is recommended to motivate the application of the constitution in the local context and integrate it into the work plans of local authorities. Developing educational programs related to using the Health Constitution is essential, as is expanding channels for community engagement and providing information through websites or official government pages. It is crucial to simplify processes to make them more efficient during crises, such as budget allocation. While the Health Constitution is voluntary, there should be a clear and enforceable accountability system. 4. The recommendation is that the Health Constitution for COVID-19 should be considered a shared public policy involving local residents in decision-making processes within their communities. However, the existing system is inadequate, so it is recommended to promote local governance by developing a curriculum for local Health Constitution officers and strengthening the role of local teams more than individual responsibilities to address issues related to changing positions or workplaces. The Ministry of Education should focus on increasing education at the youth level through school programs, and an important role is to drive the efficient use of the Health Constitution at the sub-district level to promote well-being in all areas of life, not just health. In summary, the COVID-19 Health Constitution is a tool that can effectively address the spread of the COVID-19 virus. It strengthens communities and fosters sustained participation, connecting both vertical and horizontal aspects of government operations. This reflects that the Health Constitution mechanism can enhance cooperation and coordination among government agencies, local authorities, and the public. It is an efficient approach that can be further applied in managing public health emergencies, particularly during severe outbreaks of new infectious diseases that are similar in severity to coronavirus disease 2019.
