Community participation to improve the accessibility to medical services of persons with disabilities: a case study of Nong Bon Sub-district, Kosum Phisai District, Maha Sarakham Province

Abstract

Most of persons with disabilities (PWDs) in Thailand are living in rural areas and facing a problem of accessibility to medical services, especially home health care and assistive devices. An action research based on the participation concept of community-based rehabilitation was conducted to improve the accessibility to home health care and assistive devices of the PWDs in a community. This article reveals the findings of the first part of the research. The objectives of this part were 1) to explore the current situation of the accessibility to home health care and assistive devices of the PWDs, and 2) to develop action plans to improve the accessibility to the services of the PWDs. The research was operated at Nong Bon Sub-district, Kosum Phisai District, Maha Sarakham Province during October 2009 and July 2010. To obtain the first objective, 99 PWDs (42 women and 57 men, average age 55.4 ± 18.7 years) were interviewed using a structured interview form designed by the investigators. For the second objective, a group meeting was organized for 20 persons including representatives of the PWDs, caregivers, village health volunteers, community leaders, Nong Bon sub-district administrative organization, and relevant health personnel of primary care unit and Kosum Phisai Hospital. It was shown that, during the past 6 months, only 34.3 % of the PWDs received a monthly home health care which was mostly short visits by village health volunteers, whereas 41.4 % did not obtained appropriate assistive devices. The main strategy to improve the accessibility to medical services of the PWDs was to promote the village health volunteers’ competency in providing home health care and assistive devices to the PWDs. A set of action plans was established including 1) development of practical guidelines and an instruction manual for village health volunteers, 2) organization of training courses for village health volunteers, and 3) implementation of the services by village health volunteers. In conclusion, a development of action plans to improve the accessibility to medical services of the PWDs via the community participation concept could be possible. Physical therapists should then have a wide range of skills of community mobilization to promote community participation in the PWDs’ issues.