applying participatory health impact assessment

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Applying Participatory Health Impact Assessment Applying Participatory Health Impact Assessment for Advocating Development of for Advocating Development of

Healthy Public Policy in Thai Local Government Healthy Public Policy in Thai Local Government Planning ProcessesPlanning Processes

Uraiwan InmuongUraiwan InmuongLertchai CharerntanyarakLertchai CharerntanyarakFaculty of Public Health, Khon Kaen University, Faculty of Public Health, Khon Kaen University, ThailandThailand

Peter FuruPeter FuruDBL- Centre for Health Research and DevelopmentDBL- Centre for Health Research and DevelopmentFaculty of Life Sciences, University of Faculty of Life Sciences, University of Copenhagen, DenmarkCopenhagen, Denmark

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Overview of presentation

1 Background

Objectives of the studyObjectives of the study

MethodsMethods

Study resultsStudy results

Discussion and conclusionDiscussion and conclusion

2

3

4

5

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Thailand decentralization Thailand decentralization countrywide 1999.countrywide 1999.

The local governments (LG) The local governments (LG) have legitimate role in have legitimate role in city/town/village policy city/town/village policy development and planningdevelopment and planning

Question: Question: HOW can HIA be HOW can HIA be capable of advocating HPP capable of advocating HPP within the LG policy& within the LG policy& planning framework?planning framework?

Background

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Thailand LG structureThailand LG structure

75 Provincial Administrative 75 Provincial Administrative OrganizationsOrganizations

1,129 Municipalities1,129 Municipalities 6,744 Sub-district Administrative 6,744 Sub-district Administrative

Organizations (SAOs)Organizations (SAOs) The lowest and closer to people is the The lowest and closer to people is the

‘SAO‘SAO’’

Background

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Study siteStudy siteA small LG at

Khon Kaen Province Northeast Thailand (400 km from Bangkok)

Bueng Nium LGBueng Nium LGwith 12 Villages with 12 Villages and 8,000 Populationand 8,000 Population

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Bueng Nium SAO governing structureBueng Nium SAO governing structure

Office of LG Administration (29-Officers)Office of LG Administration (29-Officers)(Head : LG Permanent Secretary)(Head : LG Permanent Secretary)

Finance DivFinance Div Civil Work DivCivil Work Div Education DivEducation Div Planning DivPlanning Div

24-LG Council 24-LG Council Members Members (elected 2 (elected 2 members per members per village)village)

1-President 1-President with 2-Vice with 2-Vice Presidents Presidents (elected)(elected)

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Bueng Nium SAO planning frameworkBueng Nium SAO planning framework

National Guideline by Ministry of

Interior

5-year Strategic Plan(approved by LG Council)

3-year Rolling Plan(approved by LG Council)

Annual Action Plan(approved by LG Council)

• Sectoral oriented

Village/Community

SAO Planning Committees

SAO Implementing Divisions/Sections

Background

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5-year strategic plan 2005-2009 procedure 5-year strategic plan 2005-2009 procedure (done in 2004)(done in 2004)

ProcedureProcedure StakeholdersStakeholders

1. Collections of problems and needs of community

2. Formulating draft strategic plan

3. Approval of draft strategic plan

1. Local development committee, community leaders and villagers

2. Local development supporting committee

3. Local development committee

4. Adoption strategic plan toSAO Council

4. SAO council members(Decision-makers)

Background

99

ProcedureProcedure StakeholdersStakeholders

1. Collections of problems and needs of community

2. Formulating draft 3-year plan

3. Approval of draft 3-year plan

1. Local development committee, community leaders and villagers

2. Local development supporting committee

3. Local development committee

4. Adoption 3-year plan toSAO Council

4. SAO council members(Decision-makers)

3-year rolling plan 2007-2009 procedure3-year rolling plan 2007-2009 procedure(done in 2006)(done in 2006)

Background

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Components of the 3-year Bueng Nium rolling plan (2007-2009)

7 plans:7 plans:

1.1. Poverty reduction planPoverty reduction plan2.2. City and healthy community development City and healthy community development

planplan3.3. Human resources and quality society Human resources and quality society

development plandevelopment plan4.4. Grass root economy, trade and investment Grass root economy, trade and investment

development plandevelopment plan5.5. Tourism development plan Tourism development plan6.6. Natural resources and environmental Natural resources and environmental

management planmanagement plan7.7. Good governance development planGood governance development plan

1-6 were later 1-6 were later selected to selected to be assessed be assessed health health impactimpact

Background

1111

Objectives

1. To apply participatory HIA tool for assessing an existing 3-year SAO rolling development plan

2. To create participatory recommendationsfor building healthy public policy and planning frameworks for future SAO development plan

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1. Screening

2. Scoping

3. Full scale HIA

4. Appraisal of draft HIA report

Applying HIA procedure in planning processes

5. Decision-making

6. Evaluation of HIA outcome

SAO 3-year development plan(2007-2009) (done in 2006)

SAO 3-year development plan(2008-2010)

(being done in May-July 2007)

Methods (1)

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Research activities:Research activities:(June 2006 – September 2007)(June 2006 – September 2007)

HIA processHIA process Method/TimeMethod/Time1. Screening1. Screening Participatory Participatory

HIA screening HIA screening workshopworkshop (14 Sep 06)(14 Sep 06)

2. Scoping2. Scoping Steering Steering Committee HIA Committee HIA scoping scoping workshop workshop (20 Oct 06)(20 Oct 06)

Methods (2)

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HIA processHIA process Method/TimeMethod/Time3. Full scale3. Full scale HIAHIA

- Focus group - Focus group discussion with discussion with key informants key informants and key and key stakeholders stakeholders ( ( Nov 06)Nov 06)

-Full scale HIA -Full scale HIA workshop workshop (15 Dec 06)(15 Dec 06)

Methods (3)

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Methods (4)

HIA processHIA process Method/TimeMethod/Time4. Appraisal of HIA report4. Appraisal of HIA report - Steering Committee and key stakeholders meeting - Steering Committee and key stakeholders meeting

(14 Feb 07)(14 Feb 07)

5. Decision-making 5. Decision-making

6. Evaluation of HIA 6. Evaluation of HIA outcomeoutcome

- Proposed a set of recommendations for future- Proposed a set of recommendations for future improvement of the next 3-year planimprovement of the next 3-year plan- Submitted the final HIA report to the Bueng Nium SAO- Submitted the final HIA report to the Bueng Nium SAO (Apr 07)(Apr 07)

- Participatory observations on the SAO planning activities - Participatory observations on the SAO planning activities - In-depth interviews and focus group discussion with- In-depth interviews and focus group discussion with key stakeholders key stakeholders (May – Aug 07)(May – Aug 07)

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Population health statusPopulation health statusfrom health authority recordsfrom health authority records

Indicators (2006)Indicators (2006)– Birth rate Birth rate : 10.05/1000: 10.05/1000– Mortality rate : 0.75/1000Mortality rate : 0.75/1000– Population increasing rate : 9.30/1000Population increasing rate : 9.30/1000

Key health problems (2006)Key health problems (2006)– DiarrhoeaDiarrhoea– Diabetes mellitus /HypertensionDiabetes mellitus /Hypertension

Vulnerable groups (2007)Vulnerable groups (2007)– 117 Elderly117 Elderly– 28 Handicaps28 Handicaps– 5 AIDs patients5 AIDs patients

Study results (1)

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Number of communicable disease cases (Jan-Dec 06)Number of communicable disease cases (Jan-Dec 06)

050100150200250

Diarrhoea

Conjuncti

vitis

Food poin

soningPneu

monia PUO

Chicken p

ox

Tuberculo

sis

Dengue fe

ver

DiarrhoeaConjunctivitisFood poinsoningPneumoniaPUOChicken poxTuberculosisDengue fever

Source: Khon Kaen hospital, Bueng Nium health center, 2007

PUO = Pyrexia of unknown origin

Study results (2)

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Number of chronic non-communicable disease casesNumber of chronic non-communicable disease cases(April 2007)(April 2007)

Source: Bueng Nium health center, 2007

NumberNumber Diabetes mellitus (DM)Diabetes mellitus (DM) 134134 Hypertension (Ht)Hypertension (Ht) 27 27 DM and HtDM and Ht 18 18 Toxic goiterToxic goiter 1 1

TotalTotal 180180

Study results (3)

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Health hazards Health hazards perceived by local villagersperceived by local villagers

Health hazardsHealth hazards– Intestinal pathogenIntestinal pathogen– Influenza virusInfluenza virus– Dengue virusDengue virus– Pesticide poisonsPesticide poisons– Particulate matters from Particulate matters from

rice mill factoryrice mill factory– Traffic Traffic

Study results (5)

2020

Health determinants viewed by local villagersHealth determinants viewed by local villagers

Individual & family determinantsIndividual & family determinants– age/gender/genetic/education/eating behavior/alcohol age/gender/genetic/education/eating behavior/alcohol

consumption/exercise/occupation/family structureconsumption/exercise/occupation/family structure

Environmental determinantsEnvironmental determinants

Physical & Chemical environmentPhysical & Chemical environment– floodingflooding/food hygiene/water quantity and quality/air quality/soil /food hygiene/water quantity and quality/air quality/soil

quality/recreation area/housing/communityquality/recreation area/housing/communitysanitation/infrastructure/industrial pollutionsanitation/infrastructure/industrial pollution

Biological environmentBiological environment- plant insects attack/plant disease/ disease vector breeding place - plant insects attack/plant disease/ disease vector breeding place

Study results (6)

2

1

2121

Social environmentSocial environment– religion/believe/local cultures/ traditions/community development activities/localreligion/believe/local cultures/ traditions/community development activities/local

regulations/community agreements/social cohesion/lottery buying / individual/family andregulations/community agreements/social cohesion/lottery buying / individual/family andcommunity security/burglary/crime/drug abusecommunity security/burglary/crime/drug abuse

Economical environmentEconomical environment– income/debt/agricultural production priceincome/debt/agricultural production price

Institutional determinantsInstitutional determinants – Sub-district health center services/health volunteer services/community development Sub-district health center services/health volunteer services/community development

volunteer service/police servicevolunteer service/police service– SAO services:SAO services:

solid waste collectionsolid waste collection emergency responseemergency response community security services community security services

Health determinants viewed by local villagersHealth determinants viewed by local villagers

Study results (7)

3

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Assessing health impacts from development plansAssessing health impacts from development plans

PlanPlan Changes in health Changes in health outcomesoutcomes

Poverty reduction planPoverty reduction plan All positives All positives exceptexcept disease vector disease vector breeding placebreeding place (organic composting)(organic composting)

City and healthy community City and healthy community development plandevelopment plan

All positivesAll positives

Human resources and quality society Human resources and quality society development plandevelopment plan


Study results (8)

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Assessing health impacts from development plansAssessing health impacts from development plans

PlanPlan Changes in health Changes in health outcomesoutcomes

Grass root economy, trade and investment Grass root economy, trade and investment development plandevelopment plan


Tourism development planTourism development plan Most positives,Most positives, but negatives to insect but negatives to insect breeding place/community breeding place/community sanitation /environmental pollutionsanitation /environmental pollution

Natural resources and environmental Natural resources and environmental management planmanagement plan


Study results (9)

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Benefits of HIA found:Benefits of HIA found:

Stakeholders responded of gaining knowledge and experiences Stakeholders responded of gaining knowledge and experiences on policy & planning development processon policy & planning development process

HIA well supported and fixed community participation problem HIA well supported and fixed community participation problem in the planning development processin the planning development process

HIA fostered social cohesion between decision-makers, HIA fostered social cohesion between decision-makers, community leaders, local officers and villagerscommunity leaders, local officers and villagers

HIA made the local stakeholders know more about health HIA made the local stakeholders know more about health hazard/risk/safeguard as well as how to do HPPhazard/risk/safeguard as well as how to do HPP

Discussion and conclusion

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HIA report was submitted to the SAO, some HIA report was submitted to the SAO, some changes were recently observed:changes were recently observed:

Some recommendations were used for Some recommendations were used for improvement of the SAO action plan 2007improvement of the SAO action plan 2007

A set of recommendations based on HIA report A set of recommendations based on HIA report were brought at stake and used for planning were brought at stake and used for planning development process of the LG 3-year plan development process of the LG 3-year plan (2008-2010), currently done by the Bueng (2008-2010), currently done by the Bueng Nium SAO during April-July 2007Nium SAO during April-July 2007

Discussion and conclusion

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AcknowledgementsAcknowledgements Higher Education Commission, Ministry of Education, ThailandHigher Education Commission, Ministry of Education, Thailand The Graduate School, Khon Kaen University, ThailandThe Graduate School, Khon Kaen University, Thailand DBL- Centre for Health Research and DevelopmentDBL- Centre for Health Research and Development

Faculty of Life Sciences, University of Copenhagen, DenmarkFaculty of Life Sciences, University of Copenhagen, Denmark IAIA and Swedish International Development Cooperation IAIA and Swedish International Development Cooperation

AgencyAgency Bueng Nium SAO administrators, SAO council members, Bueng Nium SAO administrators, SAO council members,

community leaders, SAO officers, health volunteers, community leaders, SAO officers, health volunteers,

community development volunteers, sub-district health community development volunteers, sub-district health center officers, and local people center officers, and local people

applying participatory health impact assessment

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