1. 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

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

3. 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?

4. 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’

5. 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

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

7. 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

8. 5-year strategic plan 2005-2009 procedure (done in 2004)
Background
5-year strategic plan 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)

9. 3-year rolling plan 2007-2009 procedure (done in 2006)
Background
3-year rolling plan 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)

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

11. 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

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

13. 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)

14. 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)

15. 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)

16. 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

17. 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

18. 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
Toxic goiter
Total 180
Source: Bueng Nium health center, 2007

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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 ( ), currently done by the Bueng Nium SAO during April-July 2007

26. 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

27. Thank You for Your Attention