2021 HAPI Grand Prize Winner
Thailand is projected to become to an “aged society” (over 14 percent of the population aged 65 or over) within the next five years. In Bangkok, this demographic shift has put pressure on the Bangkok Metropolitan Administration (BMA), as they have had to increase spending to provide medical services to older people suffering from noncommunicable diseases such as degenerative joint disease, osteoarthritis, sarcopenia, and dementia, while also contending with the fact that the number of working-age people available to support the increasingly older population is in decline.
In response to this challenge, in 2017 the BMA launched a community-based program that aims to use a Preventative Long-Term Care (PLC) model to promote the physical and mental well-being of older people. The PLC activities combine locomotion training, which focuses on balance training for fall prevention, and “cognicise” activities—a concept that originated in Japan and combines physical activities with cognitive tasks, such as word games, to help improve cognitive health (learn more). Since its launch, this program has expanded rapidly and now has 630 instructors, who operate across 69 communities, with plans to expand to 345 communities by 2022.
In addition to training instructors to carry out PLC activities, the project includes a community element, through which instructors also train community volunteers to become community trainers. As of March 2020, there were 345 of these community trainers. There have even been instances where older people transition from participating in PLC activities to volunteering as community trainers themselves. This community aspect is itself an important part of the program’s success.
The above-mentioned core activities are supplemented by recreational ones, designed for the residents to enjoy, such as seasonal events or ice-breaking activities. This provides participants with opportunities to leave home and have positive interactions with their communities, helping them to avoid social isolation.
The initial pilot phase of the model was conducted in cooperation with Fukuoka Prefecture, Japan, sponsored by the Japan International Cooperation Agency (JICA). During this initial two-year period, BMA developed materials, equipment, and documentation, which have played a critical role in the program’s success. These materials include a guide for instructors and a trainer’s manual for community trainers, as well as the various equipment to be used in PLC activities, all of which can be manufactured locally in Thailand. By creating this robust foundation for their program, BMA was quickly able to scale their work in 2020 when the pilot ended, and they began to expand the project.
BMA built in an evaluation stage, which took place in 2019 (the third year of the project). They monitor outcomes on a biannual basis and found that there have been a total of 5,822 participants since February 2018. They also found strong improvements in the physical and social wellbeing of participants across the project’s sites, with no incidences of falls during program activities. The program also appears to have reduced the burden on caregivers in some cases. For example, one participant was a 70-year-old woman who lived with her son. As her health was in decline her son was considering placing her in a long-term care facility, and she was spending most of her time at home while he had to travel for work. However, after joining the PLC activities, she connected with a neighbor who can take care of her and is now able to go out to the market by herself.
While the initial pilot project was funded with support from JICA, when BMA was ready to begin expanding the project, the Health Department requested a budget of 1.6 million baht (slightly over $50,000) to produce the materials they had developed to carry out the project activities. In addition, in order to ensure project sustainability, they encouraged public sector involvement, asking individual public agencies or communities and their residents to request funding from the Bangkok Health Security Fund to support their activities at the district level.
The municipal government is strongly supportive of the program, including it in the BMA Annual Action Plan as well as the Quality of Life Development Plan of the Elderly BMA, in which it was designated as the flagship project. The goal is to expand the program from 69 communities to 345 communities in 2022, and eventually to cover more than 2,000 organized communities.
KEYS TO SUCCESS
- Developing a robust set of training and program materials during the pilot phase of the project allowed the program to be scaled up quickly once it had demonstrated positive results.
- Strong commitment from the municipal government, combined with district-level public sector and community involvement and the ability of communities to request funding themselves to carry out preventative long-term care activities ensures the sustainability of the project.
- Cooperation with international partners (JICA) brought in new ideas, such as implementing “cognicise,” which had originated overseas.
- Leveraging community volunteers to act as “community trainers” creates a sense of community involvement in the activities and helps to provide opportunities for older people to engage with the community themselves.