Applying Participatory Health Impact Assessment for Advocating Development of Healthy Public Policy in Thai Local Government Planning Processes Uraiwan Inmuong Lertchai Charerntanyarak Faculty of Public Health, Khon Kaen University, Thailand Peter Furu DBL- Centre for Health Research and Development Faculty of Life Sciences, University of Copenhagen, Denmark

Overview of presentation Background Objectives of the study Methods Study results Discussion and conclusion 1 2 3 4 5

Background Thailand decentralization countrywide 1999. The local governments (LG) have legitimate role in city/town/village policy development and planning Question: HOW can HIA be capable of advocating HPP within the LG policy& planning framework?

Thailand LG structure Background 75 Provincial Administrative Organizations 1,129 Municipalities 6,744 Sub-district Administrative Organizations (SAOs) The lowest and closer to people is the ‘SAO’

Study site A small LG at Khon Kaen Province Northeast Thailand (400 km from Bangkok) Bueng Nium LG with 12 Villages and 8,000 Population

Bueng Nium SAO governing structure 24-LG Council Members (elected 2 members per village) 1-President with 2-Vice Presidents (elected)

Bueng Nium SAO planning framework Background Bueng Nium SAO planning framework National Guideline by Ministry of Interior 5-year Strategic Plan (approved by LG Council) SAO Planning Committees 3-year Rolling Plan (approved by LG Council) Annual Action Plan (approved by LG Council) Sectoral oriented SAO Implementing Divisions/ Sections Village/Community

5-year strategic plan 2005-2009 procedure (done in 2004) Background 5-year strategic plan 2005-2009 procedure (done in 2004) Procedure Stakeholders 1. Local development committee, community leaders and villagers 1. Collections of problems and needs of community 2. Formulating draft strategic plan 2. Local development supporting committee 3. Approval of draft strategic plan 3. Local development committee 4. Adoption strategic plan to SAO Council 4. SAO council members (Decision-makers)

3-year rolling plan 2007-2009 procedure (done in 2006) Background 3-year rolling plan 2007-2009 procedure (done in 2006) Procedure Stakeholders 1. Local development committee, community leaders and villagers 1. Collections of problems and needs of community 2. Formulating draft 3-year plan 2. Local development supporting committee 3. Approval of draft 3-year plan 3. Local development committee 4. Adoption 3-year plan to SAO Council 4. SAO council members (Decision-makers)

Components of the 3-year Bueng Nium rolling plan (2007-2009) Background Components of the 3-year Bueng Nium rolling plan (2007-2009) 7 plans: 1. Poverty reduction plan 2. City and healthy community development plan 3. Human resources and quality society development plan 4. Grass root economy, trade and investment development plan 5. Tourism development plan 6. Natural resources and environmental management plan 7. Good governance development plan 1-6 were later selected to be assessed health impact

Objectives To apply participatory HIA tool for assessing an existing 3-year SAO rolling development plan To create participatory recommendations for building healthy public policy and planning frameworks for future SAO development plan

Applying HIA procedure in planning processes Methods (1) Applying HIA procedure in planning processes 1. Screening SAO 3-year development plan (2007-2009) (done in 2006) 2. Scoping 3. Full scale HIA 4. Appraisal of draft HIA report SAO 3-year development plan (2008-2010) (being done in May-July 2007) 5. Decision-making 6. Evaluation of HIA outcome

Research activities: (June 2006 – September 2007) Methods (2) Research activities: (June 2006 – September 2007) HIA process Method/Time 1. Screening Participatory HIA screening workshop (14 Sep 06) 2. Scoping Steering Committee HIA scoping workshop (20 Oct 06)

Research activities: (June 2006 – September 2007) Methods (3) Research activities: (June 2006 – September 2007) HIA process Method/Time 3. Full scale HIA - Focus group discussion with key informants and key stakeholders ( Nov 06) -Full scale HIA workshop (15 Dec 06)

Research activities: (June 2006 – September 2007) Methods (4) Research activities: (June 2006 – September 2007) HIA process Method/Time 4. Appraisal of HIA report - Steering Committee and key stakeholders meeting (14 Feb 07) 5. Decision-making 6. Evaluation of HIA outcome - Proposed a set of recommendations for future improvement of the next 3-year plan - Submitted the final HIA report to the Bueng Nium SAO (Apr 07) - Participatory observations on the SAO planning activities - In-depth interviews and focus group discussion with key stakeholders (May – Aug 07)

Population health status from health authority records Study results (1) Population health status from health authority records Indicators (2006) Birth rate : 10.05/1000 Mortality rate : 0.75/1000 Population increasing rate : 9.30/1000 Key health problems (2006) Diarrhoea Diabetes mellitus /Hypertension Vulnerable groups (2007) 117 Elderly 28 Handicaps 5 AIDs patients

Number of communicable disease cases (Jan-Dec 06) Study results (2) Number of communicable disease cases (Jan-Dec 06) PUO = Pyrexia of unknown origin Source: Khon Kaen hospital, Bueng Nium health center, 2007

Number of chronic non-communicable disease cases (April 2007) Study results (3) Number of chronic non-communicable disease cases (April 2007) Number Diabetes mellitus (DM) 134 Hypertension (Ht) 27 DM and Ht 18 Toxic goiter 1 Total 180 Source: Bueng Nium health center, 2007

Health hazards perceived by local villagers Study results (5) Health hazards perceived by local villagers Health hazards Intestinal pathogen Influenza virus Dengue virus Pesticide poisons Particulate matters from rice mill factory Traffic

Health determinants viewed by local villagers Study results (6) Health determinants viewed by local villagers 1 Individual & family determinants age/gender/genetic/education/eating behavior/alcohol consumption/exercise/occupation/family structure Environmental determinants Physical & Chemical environment flooding/food hygiene/water quantity and quality/air quality/soil quality/recreation area/housing/community sanitation/infrastructure/industrial pollution Biological environment - plant insects attack/plant disease/ disease vector breeding place 2

Health determinants viewed by local villagers Study results (7) Health determinants viewed by local villagers Social environment religion/believe/local cultures/ traditions/community development activities/local regulations/community agreements/social cohesion/lottery buying / individual/family and community security/burglary/crime/drug abuse Economical environment income/debt/agricultural production price Institutional determinants Sub-district health center services/health volunteer services/community development volunteer service/police service SAO services: solid waste collection emergency response community security services 3

Assessing health impacts from development plans Study results (8) Assessing health impacts from development plans Plan Changes in health outcomes Poverty reduction plan All positives except disease vector breeding place (organic composting) City and healthy community development plan All positives Human resources and quality society development plan

Assessing health impacts from development plans Study results (9) Assessing health impacts from development plans Plan Changes in health outcomes Grass root economy, trade and investment development plan All positives Tourism development plan Most positives, but negatives to insect breeding place/community sanitation /environmental pollution Natural resources and environmental management plan

Benefits of HIA found: Discussion and conclusion Stakeholders responded of gaining knowledge and experiences on policy & planning development process HIA well supported and fixed community participation problem in the planning development process HIA fostered social cohesion between decision-makers, community leaders, local officers and villagers HIA made the local stakeholders know more about health hazard/risk/safeguard as well as how to do HPP

Discussion and conclusion HIA report was submitted to the SAO, some changes were recently observed: Some recommendations were used for improvement of the SAO action plan 2007 A set of recommendations based on HIA report were brought at stake and used for planning development process of the LG 3-year plan (2008-2010), currently done by the Bueng Nium SAO during April-July 2007

Acknowledgements Higher Education Commission, Ministry of Education, Thailand The Graduate School, Khon Kaen University, Thailand DBL- Centre for Health Research and Development Faculty of Life Sciences, University of Copenhagen, Denmark IAIA and Swedish International Development Cooperation Agency Bueng Nium SAO administrators, SAO council members, community leaders, SAO officers, health volunteers, community development volunteers, sub-district health center officers, and local people

Thank You for Your Attention