Research On The Needs of Community Based Rehabilitation (CBR) For Disabled Persons in Thailand

Research on the Needs of Communlty Based
Rehabilitation (CBR) for Disabled Persons in Thailand
Som-arch Wongkhomthong, M.D Chongkolnee Chutimatavin, IVIA
ASEANI
Institute for Health Development Mahidol UniversitY

1998
Funded by Natlonal Rehabllltatton Center for Dlsabled Persons JaPart
Research on the Needs of Community Based
Rehabilitation (CBR) for Disabled Persons in Thailand
Som-arch Wongkhomthong, M.D Chongkolnee Chutimatavin, MA
ASEAI{ Institute for Health Development
Mahidol University
1998
Funded by National Rehabilitation Center for Disabled Persons Japan
'ffit-
The Needs of Community Based Rehabilitation (CBR) for Disabled Persons in Thailand
By Som-arch Wongkhomthong, Chonkolnee Chutimatavin ISBN: 974-661-593-9
First Edition 1998 Printed by Printing Division ASEAN Institute for Health Development Mahidol University, Salaya Nakornpathom 7 3170, Thailand
Som-arch Wongkhomthong Research on the needs of community based rehabilitation (CBR) for disabled persons in Thailand /Som-arch Wongkhomthong, Chongkolnee Chutimatavin l.Rehabilitation-Thail and. 2. Handicapped. 3. Research. Chongkolnee Chutimatavin. II. Title. w8320. JT3 5693 1998 ISBN :974-661-593-9
I.
Acknowledgements
In regards to the success of this research project, I would like to thank
and acknowledge the kind assistance and cooperation of people
and
organization concerned. Many thanks to the Director of Sirindhron National
Medical Rehabilitation Centre of Department of Medical Service, MOPH and
her team, The Director of Office of the Committee on Rehabilitation for

Disabled Persons of the Department of Public Welfare and his team. Also
thanks to the Provincial Chief Medical Officer, Kanchanaburi Province, Head Department
of
Personnel Development and Primary Health Care and the
Heads of the Health Center.
our special thanks to Assoc. Prof. Dr. Boongium Tragoolvongse
for
providing information and his helpful opinions, Mr. Kevin Anthony Noble for his assistance in language editing. Last but not least, our thanks to those whose
names we have not mentioned, for their kind cooperation during the
interviewing, and data collecting processes.
Som-arch Won gkhomthong

Chon g kol nee Chutimatavi n
August 3, 1998.
Executive Summary
A cross-sectional descriptive study to identify the situation and needs of
community-based rehabilitation (CBR) for disabled persons in Thialand was
carried out during June 29 - August 3, 1998. The research study has three
specific objectives: identifying the general situation
of
disabilities and
impairments, the situation and needs for community-based rehabilitation and possible areas for international cooperation for CBR in Thailand. The research
methodologies consist of three methods;
a literature survey from published
and non-published documents from organizations working in this field, visits to nine institutions in Thailand as well as personal interviews of twenty-four Thai authorities, using unstructured questionnaires. The research results were summarized under six topics: basic statisties, CBR services, the needs of
CBR, foreign assistance for CBR and the potential uses and limitations of CBR
model in Thailand. In summary, the research results show that: 1. Basic Statistics: there were approximately
'1
p24,12O (1-7
Yo
of total
population) disabled persons of all ages. Some sources of information cited higher figures, 4,825,682 persons (8.08 %) of the total population as being
disabled. Most of the disabled were scattered in rural areas. The majority of disabled persons were in the Northeast, followed by the North and Central
regions respectively. The South had the least compared to all regions. The
caurses of disability are mostly due to congenital anomalies, accidents and

unidentified causes.
2. CBR Services: In 1991, the government has issued six decrees

The Rehabilitation of Disabled Person Act which consist
in
of policies to provide
equity between disabled persons and non-disabled person
in
society,
Furthermore, the law entitles and encourages disabled person who have
ill
registered under the "Rehabilitation Act" to receive rehabilitation services free
of charge, providing all levels of education as considered appropriate. The

handicapped also received vocational training with no charge. The problem
are: (a) the total registration of disabled persons in only 3.49 - 16.40% of all
the disabled, and (b) there are no prosthetist nor orthotists in Thailand. This
results in low production standards of artificial body parts.
3. Needs of CBR: Since the CBR concept has earned exceptance and
is considered as essential for disabled person who want to live happily in their
own communities, the Medical Service Department (MDS) has begun by

translating
a rehabilitation manual. Now the MDS is in the process of pilot-
testing a model of "lndependent Living Unit". CBR by the Public Welfare

Department were established by selecting 10 provincial pilot projects and will
be expanded to 15 provinces in 1997. There are some problems in creating
jobs for disabled persons so that they are economically independentindependent living
in
community-such
as the educational limitations that
prevent them from enrolling in the vocational training program once they enter
as well as the ability to complete the vocational training program, The training
tools is insufficiency, the information being taught is not keeping up with

modern technology and there is
a severe shortage of "workshop
trainers".
Moreover, CBR is often inadequately supported by the referral system.
4. The Potential use and Limitation of the CBR Model: The potential of
CBR the model for Thailand is that
it will be utilized by Village
Health
Volunteers (VHV) who will have the role of giving information and the provision
of basic medical services. VHVs will detect disabling symptoms and report
them to the Health Center in order to give training to the handicapped people.
This model has the best potential
for
success for CBR. At present, there is a
pilot test of the model in some provinces. There are also some limitations of
IV
CBR model, i.e, shortage of staff, and health centers do not have a prominent role in rehabilitating the disabled. The key to success is to have clear policies
with a sufficient budget for providing training. Also, the success will depend
upon the efficiency of each individual health center.
5. Request for International Co-operation: This research has found that

the disabled have obvious problems in all aspects of rehabilitation. The most
urgent needs concern

rehabilitation. These point
the inadequacy of
vocational and medical
are: (a) people working with the disabled need a
special school for prosthetists and orthotists which would not only benefit
Thailand but also neighbouring countries, (b) provide scholarships to P&O Technicians for advance training, (c) need updated equipment vocational training, and (d) specialists are needed
trainers. CBR concepts have already taken hold among GOs, NGOs, and Self -
to
improve
to help train vocational
Help Groups, as well
as the disabled people
themselves. These efforts have
lead to programs for research and development, brainstorming seminars and collective effort on drawing a master plan for CBR in Thailand.
The next stage on CBR in Thailand has now been undertaken by

various pilot projects. This is a sigificent stage. lf the model from the pilot projects is expanded on a large scale, it will need good collaboration among
the networking parties and sufficient financial support to accommodate its implementation. The goal of CBR will then be attained, leading to the
assistance to disabled people in Thailand in sustainable ways.
Table of Contents
Page
Acknowledgement Executive Summary
ii-iv v-vi vii

1
Table of Contents
List of Tables
l.
ll.
I
Introduction Research Objectives
1-2
2
2
ll. Research Methodologies
lV. Research Period
V. Research
Results
5.1 Basic Statistic 5.1.1. lndicators of health and population

5.1.2. Competent authorities on health services 5.1.3. Health policies and planning 5.1.4. The present conditions of people with disability 5.1.5. Summary of the latest survey
5.1 .6. Networking among administrative organizations 5.1 .7 . Specialist in the rehabilitation field
3-5 6
6-7
7-10
11
14
14-15
15
5.1.8. Main organization of CBR
5.2 CBR Services

5.2.1. The policies for people with disabilities 5.2.2. The actual condition of medical rehabilitation 14-28
29
5.2.3 The education for handicapped 5.2.4 fhe condition of employment and vocational training
5.2.5. The present condition of supply of prosthesis and orthosis 5.3 The Needs of CBR 5.3.1. Training for staff and specialist
29-45 44-49
50-52
53-55
vi
5.3.2. Distribution of primary health care in the district

5.3.3. Vocational training for economicue independence
55-56
56-61
61
5.3.4. Information network system 5.3.5. Seminar and meeting for specialist 5.3.6. Present condition of CDR implementation Foreign Assistance for CBR
61-66 66
1. 2.
International organizations providing education support Operating agencies for people with physical disability
67
6B-69
5.4 The Possibility and Limitation of CBR Model 5.4.1. Model A : Support team by handicapped people (Mexico 5.4.2. Model B : Mobile rehabilitation unit (lndonesia
case)
70 70
71
case) 5.4.3. Model C : Community volunteer system (Philippines case) 5.4.4. CBR Model for Thailand 5.5 Request for International Gooperation Annex 1: List of References Annex 2: List of Institutional Visits Annex 3: List of Interviewees
72-74 74-75 76
77
78-82
vii
List of Tables
Page
reported) 2. Livebirths and Deaths 3. First 10 leading cause group of death

1,
Total population (Latest
4
5
4.
area 5. Population reported disabled by type of disability 6. Population reported disabled when the impairment occured 7. Total of disabled person and ratio of registration 8. Causes of disabilities: data from thesis 9. Causes and type of disabilities: NSO survey 10. Government budget plan for special education 11. Government sponsored school for special education l2.Teachers in special education program 13. School and classrooms for children with disability 14. School with integration program of Bangkok area 15. School with integration program outside Bangkok l6.Teacher college with special education program 17. Short course teacher training in special education 18. Opinions of handicapped on vocational training 19. Knowledge acquired from vocational training
Population reported disabled by age, sex and
I
10
11
12 13
23 30
31
34
38 39 43 45 56 57 57 58 58
20. Reason on why the knowledge acquired from training was not
enough
disabled 22. Assistance needs in self-employed business

21. Occupational choice of the 23. Total handicapped enrolled and completed training
program
60
The Needs of Community -Based Rehabilitation (CBR)

in Thailand
l. Introduction
Thailand, similar
to other countries in
South-east Asia,
is in the
transition period from an agricultural society to
newly industrialized
country. During this transition period, it is expected that Thailand will face a
lot of problems, ie, traffic and other kinds of accidents, occupational disease
and others, which will lead to disabilities and impairments. Those disabilities
and impairments also caused by other factors such as

abnormalities, other types
congenital
of communicable and non
- communicable
diseases, mental illness, chronic alcoholism and drug addiction, malnutrition
and disability from environment factors,( ie, taken a wrong drug, being
exposed to loud noise). In previous research, researchers have identified
the magnitude of the problems as well as organizations that deal with

disabilities and impairments in Thailand, In this report, the researchers will
examine in
- depth the situation and the needs of community -
based
rehabilitation (CBR) programs in Thailand. The result of the study will help
policy makers as well as national and international organizations dealing

with disabilities and impairments to set up appropriate measures to improve
the situation of CBR programs in Thailand.
ll. Research Objectives

General objective: To identify the situation and needs of community - based
rehabilitation (CBR) programs in Thailand.
Specific objectives:
1. To identify the general situation of disabilities and impairments.
2. To identify the situation and needs for community rehabilitation (CBR).
based
3. To identify possible areas for international cooperation for CBR.
lll. Research Methodologies.

The research methodologies consist of the following methods.
1. Literature survey from published and non-published,
ie,
internal,
documents of related organizations, both in Thai and in English ( see Annex

|
- List of References).
2. Institutional visits to observe certain activities as well as to gather

some unpublished information ( see Annex ll - List of lnstitutional Visits).
3.
Personal Interviews:
individually
A total of 24 persons were interviewed by using unstructured questionnaires ( see Annex lll - List of
lnterviewees). The twenty four interviewees were purposively selected

according to their direct involvement in rehabilitation.
lV. Research Period
: June 29 - August 3, 1998.
V. Research Results
The results were summarized under the following six topics:
1. Basic statistics
2. CBR services
3. The needs of CBR
4. Foreign assistance for CBR

5. The possibility and limitation of CBR model
6.
Request
for International cooperation to National
Rehabilitation
Center for the Disabled in Japan
5.1 Basic Statistics
1. Indicators of health and population
Table 1: Total Population ( latest reported, January 1998)
No.
1.
Population Total population Total population classified by sex
Total Number
60,763,000
2.
- Male
- Female
3.
30,363,000 30,400,000 19,127,000 41,636,000
Total population in urban area Total population in fural area Total population classified by region
4.
5.
- North - Northeast
- South - Central (not included BKK) - Bangkok
6.
11,363,000 20,72A,000 8,021,000 13,550,000 7,109,000
Total oopulation classified bv oroup of aoe

- Under 1 5
16,375,000 39,282,000 5.106.000
- 15-59
- 60 and above
Source
Institute of Population and Social Research
Table 2 : Live births and Deaths by Sex, Number and Rate per 1,000
Population
(1
982-1 994)
rate per 1,000

Year
Total
1982 1983 1984 1985 1986
1,075,632 1,055,802 956,680 973,624 945,827
Live births
Male
548,643 535,074 489,114
498,001
Live birth
Female
526,989 520,728 467,566 475,623 462,855
Deaths Total
247,402
525,552
Death Female
103,336 107,776 94,433
96,1'r1
Rate
22.2 21.3
19,0 18.8 18.0
Male
144,066 144,816 130,849 128,977 125,086
Rate
5.1
c.
225,282 225,088
218,025
4,5 4.4
4.1
482,972
92,939
1987 1988
1
884,043 873,842 905,837 956,237 960,556
452,508 447,750 465,515

49't ,010
431,535 426,092
440,322
'16.5
232,968
231,227 246,570
133,179
133,721 143,'156
99,789 97,506 103,414 104,625 109,152
4.3 4.2 4.4 4.5 4.7
16.0 16.3 17.0

17.O
989
1990
1991
465,227 466,803
zcz,c tz
264,350
147,887 155,198
493,753
1992 1993 1994
964,557 957,832 960,248
493,900 491,243 494,485
470,657
16.8 16.5 16.3
275,313
285,731 305,526
162,546 170,747 184,480
112,767 114,984 121,046
4.8 4,9
5.2
466,589 465,763
Table 3 : First 10 Leading Cause Groups of Death by Rate Per

100,000 Population According to ICD Mortality Tabulation List,1, 1Oth Revision 1994
Cause Group
Order
Total
Number
Rate
Male
Number
Rate 109.2
Female
Number
19,857 Rate
l.Diseases of the
circulatory system 2.Other accidents, including
sequelael 3.Neoplasms
51,936
88.5
32,079
67.6
36,155
61.6
28,833
98.1
7,322
25.0
28,741
48.9
17,216
58.6
11,525
39.3
4.Diseases of the respiratory system

S.Certain infections and
20,772
35.4
14,102
48.0
6,670
22.7
'15,961
27.2
10,609
JO.
5,352
18.2
parasitic diseases
6.Diseases of the digestive
system T.Diseases of the genitourinary system S.Diseases of the nervous system 6,338
10.8
o
10,618
18.1
7,381
25.1
3,237
11.0
3,467
'1'1.8
2,871
9.8
I
o
6,334
10.8
4,156
14.1
2,178
7.4
9.Endocrine, nutritional and

metabolic diseases
4,520
7.7
1,892
6.4
2,628
9.0
l0.Axsault
10
4,161
'7 I tl
3,481
'1
1.9
680
2.3
2. Competent authorities on health services: principle organizations

Ministry of Public Health -Provincial Hospital Division
( under the Office of The Permanent Secretary)
-Rural Health Division

( under the Office of The Permanent Secretary)
-Department of Medical Services
Bangkok Metropolitan Administration

-Department of Medical Services Ministry of University Affairs -University Hospitals
Collaboration among organizations
All organizations have a defined common goal that is to serve people in the country including disabled persons; despite some organizations that
may have varied ideas and action plans, all still maintain the goal of
achieving benefits for the people. However, although they have had good collaboration at the policy level, to some extent on the operational level, they still need to cooperate
more efficiency.
3. Health policies and planning: the present policies by central and local
governments.
According to the 8th National Development Plan (1997-2001) there

are four main policies in public health development as summarized belows
:
a) HUMAN RESORCE DEVELOPMENT: To develop human resources

in the field of health at all levels - ministry, provincial, district, sub-district and
village - especially in reaching down to the family level in order to develop
competencies in taking care of oneself and one's family members. This is the main objective of health administration.
b) EOUITY: To manage the health service system to ensure equity of

health services to the people,
c)
HEALTH CARE REFORM: To reform
the
health care system by
introducing new models in health services. For example, the "Family Doctor" which will link the hospital to the community, etc.
d) HEALTH INSURANCE: To emphasis health insurance service for

people, to ensure the establishment of a public system so that people will
have assurance of medical care whenever they become sick.
4. The present conditions of people with disabilities (Statistic survey)
A study from the National Statistics Office found that in 1995 there
were approximately 1,024,120 disabled person of all ages. Most of disabled
persons were scattered in rural areas (in both municipal areas and non-
municipal areas). The majority of disabled person were in the Northeast,

followed by the North and Central respectively, and that the South had the least compared to all the regions. The figures
for
people with disabilities
will be presented by using the most recent survey data (1996). The detailed
data is shown in the following tables.(Table 4,5,6 respectively)
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44 ll
Summary of the Latest Survey Regarding the Disabled' s Circumstances

In the most recent survey (1996), Thailand had a disabled population
totaling al 1 ,024,120 or 1 .7% of the total population (report form the National
Statistics Office). The National Health Foundation reported 4,825,682

persons or 8.08% of the total population as being disabled.
The disabled who are eligible to register as disabled persons

according to the Rehabilitation Act totals 716,884
(70o/o),
- 3,377,g78 persons
but the actual total registration is only 117,728 persons or 3.49 of all the disabled (Table 7)
16.40
%o
Table 7
: Total of Disabled Persons and Ratio of Registration

From NSO Survey
(1996)
From NHF Survey

% of the Total
Characteristics
Total Registration
Total
Total of
Totalof
disabled
who are eligible to register
(70o/o)
% of the
of disabilig
Number
disabled who are eligible

to
disabled
who have registered
number
disabled
who have registered
register
(70%) Mobility
14,994
10,300
77,210
tv.lz
955,344
668,741
z.z1
lmpairment Hearing and

Communication
14,864
208,033
145,623
10.21
298,545
208,982
'7 44
lmpairment
Physical and Mobility 59,122 431,991
302,394
19.55
2,746,614
1,922,630
3.08
lmpairment
Psychosis
2,322
16,290
58,1 96
40,737
5.70 15.57
229,283 476,478
160,498
1.45
Mentally
Retardation Others
149,445
104,612
333,534
4.88
10,136
66,1 55
46,308
21.88
119,418
83,593
12.12
Source : lnstitute of Health System Research
12
Characteristics and causes of disabilities:
From the thesis on "Employment Opportunity
for
Handicapped
Persons " done by Wasana Tapaopong from Thammasart University (1994),
( sample size is 60 persons), it was found that the causes of disability are
mostly from sickness (63.40%) and from accidents (18.30%) as shown in the following table:
Table 8: Causes of disability (data from thesis)
Causes Accident
Blind
Deaf
4
Physic. Disabi.
2
Total
11
(25.0)
(20.0)
13
(10.0)
15
(18.3) 38 (63.4)
11
Result from Sickness unknown
10
(50.0)
5
(65.0)
3
(75.0)
3
(25.0)
(15.0) 20
(15.0) 20
(18.3) 60 (100.0)
Total
20 (100.0)
(100.0)
(100.0)
From statistic suryey of National Statistic Office, latest survey in 1996,

it was found that the causes of disability are mostly from
congenital anomaly
( 358.6) , secondly from accidents (264) as details in table 9:
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14
5. Networking among administrative organizations in the rehabilitation

services
To resolve and alleviate the problems of disabled persons,

pooling of various resources from different fields are needed.
the
Presently, no one organization provides the full range of rehabilitation service for disabled people, covering all aspect of rehabilitation, ie, medical,
education, vocational and social issues. Doing so is a huge investment with
too many specialties and detailed functions; it is too big a job for any
individual organization to handle. Therefore, in coping with the problem, and in order
to serve the
disabled most effectively and efficiently, a network among administrative
organizations was developed to coordinate the various services and

resources from the different agencies so that the services appropriately
serve the disabled persons according to their needs.
6. Specialists in the rehabilitation field (medical,education,vocation,social)

In Thailand, there are 16 different kinds of specialists working in the
rehabilitation field listed as follows:

1. Physician ( physicatrist, surgeon
)
2. Nurse 3. Physiotherapist
4. Occupational therapist
5. Speech theraphist
6. Social working expert 7. Psychiatrist
8. Psychologist
9. Nutritionist
1
0. Vocational training officer
15
11. Interpreter 12. Note taker (for deaf student)

13. Tutor (for deaf student) 14. Vocational guidance officer
15. Low vision specialist

16. Optometrist
All of the above mentioned specialists have a significant role

helping to rehabilitate disabled persons and assist their families as well.
in
In
addition, together they plan to help disabled people to return to their highest
level of normal functioning as well as to strengthen them to be able to help themselves as much as possible.
7. Main Organizations of CBR

- Ministry of Labour and Social Welfare
(Department of Social and Welfare)
- Ministry of Health
(Department of Medical Services)
- Ministry of Education
(Department of General Education & Non-Formal Education)
5.2 C.B.R. Services
1. The policies for people with disabilities
At present, the government has issued six decrees in The

Rehabilitation of Disabled Person Act (1991), which consists of policies to
provide equity between disabled persons and non-disabled persons
in
society, For example, it allows disabled persons to become senators, to
16
work in government positions, and to have the right to be employed in the

private sector. Furthermore, the law entitles and encourages disabled people who have registered under the "Rehabilitation of Disabled Person Act" to receive the following rehabilitation services:
(a) Medical rehabilitation service, medical treatment costs, aids and

equipment for rehabilitating physical, mental or psychological conditions or for improving capacities as follows:
- Diagnostic service, laboratory inspection and other type of special

examination.
- Counseling
- Medicine
- Surgery
- Medical rehabilitation and nursing care - Physicaltherapy

- Occupational therapy
- Behavioral therapy - Physiotherapy

- Social service and therapy - Speech therapy - Audio therapy, hearing and therapy
- Use of equipment or supporting machine for disabled persons
(b) Providing all levels of education as considered appropriate, ie,

primary, secondary, high school and vocational school, including college
level under the National Education Plan. Such education can be provided in
special schools for disabled persons or by ordinary schools as a dual

program.
17
(c) Giving advice and
consultation regarding occupation and
providing, free of charge, vocational training appropriate to their physical condition and their potential to work. (d) They are entitled to participation in social activities and access to
various facilities and services essential to them ie, toilets, telephone booths, lifts, ramps, water coolers, etc.
(e) Government lawsuit services and contact with

organizations.
governmental
The policies of communitfbased rehabilitation
The main policy of community-based rehabilitation is to promote

community members, including state and private agencies both in the city and rural areas, family members of disabled persons, local organizations at every level nationwide
- province, district, sub-district, and village, to work
together in using community resources and local knowledge to contribute to
the rehabilitation of disabled persons to their highest potential. Thus, the

family and community will participate in the caring for and the providing of rehabilitation efforts for the disabled in the community. This will result
maintaining a happy life for the disabled.
in
Areas of insufficiency: material aspect. personal aspect

Material Aspects (facilities & equipment)
a) Disabled persons feel transportation is inconvenient (ie, getting on

& off the public bus)
b) Ramp ways for disabled persons are inadequate.
c)
Public services for the disabled are very scarce (ie, public
telephones, public toilets, clubs, sport centers, recreation facilities)
18
d) Street footpaths are a problem for the disabled (ie, no covers on

drainage holes on the footpath)
e) Inadequacies of tools, equipment and educational materials for

disables persons.
Prosthesis and orthosis are not enough and often not suitable to
their particular needs. Personal aspects:
a) Lack of skilled training
personnel who have knowledge and
understand the problems of disabled persons. b) The deaf lack language interpreters.
c) There is a great need for interpreters, note takers and tutors for the
deaf student.
d) Lack of professional personnel in rehabilitation
- Lack of physicatrists to assess physical capacities.
- Lack of physical therapists for body conditioning and instructing

and orienting disabled people with adaptive tools.
- Lack of vocational guidance counselors to consel as appropriate to

the disabled's needs.
- Lack of social workers to help solving personal problem, including

general referrals and coordination of services.
- Lack of vocational trainers to provide knowledge and strengthen the

skills in various occupations.
e) Training centers for the disabled are still not well-equiped,
ie,
buildings, facilities. They are inadequate in updated technology, still having outdated training equipment which is not competitive to the real world of the
labour market demands.
19
Networking between the central organization and the peripheral branches Each social welfare and health organization has their headquarters in Bangkok and a branch offices in allthe provinces.
The nature of collaboration partly follows the line of command and
partly is dependent on the individual who coordinates with the various

related agencies. Sometime coordinating on the personal level works well
for conducting business in the health development field. At village level, the two small organizations at local level in the village
that the help coordinate services are the Community Welfare Center and
Community Primary Health Care Center.
Policies and networking between public and private sectors
The networking between public and private sectors has shown a good collaboration in which each organization knows well the role of the
other. Thus, once a particular cases is presented, they can refer cases to specific responsible agency accordingly.
Government and private agencies work in collaboration to study the
operational conditions, to research and develop models for services, to develop information systems, and to give clear direction to rehabilitation services in certain areas. The principle coordinating organization is the
Office of the Committee on Rehabilitation (OCR).
A good example of collaboration was the effort in preparing
the
"master plan" - Rehabilitation for disabled persons (1997-2001). There was
joint seminar which included various government agencies, NGO's and

organizations of disabled persons. The objective was to brainstorm ideas and service needs. After the seminar, OCR incorporated the information in
the responsible agencies: in the Ministry of Public Health for planning
20
purposes on medical rehabilitation, the Ministry of Education for planning purposes on educational rehabilitation, and the Social Welfare Department
for planning purposes on vocational & social issues.
After that, a workshop revised the master plan one more time, before
submitting it to the cabinet to be approved and inclusives within the

National Economics and Social Development Plan.
Bth
Registration systems for people with disabilities
Disabled persons are able to apply for registration with the central
registrar at head office of rehabilitation for disabled persons in Bangkok or submit an application form to the provincial registrar at the provincial Office
of Labour and Social Welfare in the particular province where the disabled
persons have residency. The procedure of registration is outlined as follows:
a) Submit Form: to register and classify the disabilities by type, class

and characteristics of disabi lity.
b) Interviewing: disabled persons will be asked about their
history
and their needs will be assessed relating to their families, education, and in
other relevant aspects.
c) Assistance Plan: to bring relief to the immediate or

problems which are followed with long-term assistance,
urgent
d) Follow-Up: to check the outcomes following referrals to the various

service agencies.
The future scheme for rehabilitation system a) Future Scheme for Medical Rehabilitation
- lmproving the structure and service system by having a clear

responsible unit
- Developing service standards
21
- Promote research and development of technology appropriate to

the disabled
lncrease training for personnel
in fields where their are labor
shortages
- Set up information systems for information exchange concerning

operations
- Developing the efficiency of personnel on a continuous basis - Educating people in preventing disability
Establish
a priority in assessing the development of 0-6 years old
children in the hope of preventing disability
Establish
priority
to deal with dangerous toxins and
harmful
environmental factors
- Promote medical rehabilitation

disability symptoms are identified
from the beginning as soon as
b) Future Scheme for Educational Rehabilitation
Develop a survey form and methodology
in
cooperation with the

more
Statistical Office and the Ministry
of
Education
to collect data to
accurately estimate of the number of special education eligible children in
regards to disability and their region of residency. The survey needs to

particularly target areas in which no information is available or appears to be very unreliable.
Develop a "standard" measure of minimal competencies, such as

in
the national exams that are given to all students in regular education
Thailand. These exams can be designed to measure

acheivement, without emphasizing disabilities,
academic
if
done thoughtfully. (For
example, written exam material for the exams can be made available in
22
Braille for the blind. However, the content of the material would remain at the same level as expected of regular students)
Increase cooperation between the NGOs and the government by
clearly defining needs and budget requirements that would allow the
government to more effectively make financial contributions to the various
program.
Develop (and fund) a liaison position at each institution that would
be able to make recommendations on needs which can be given to all the

various organizations, either public or private, that provide assistance to the school.
Increase government efficiency by eliminating unnecessary paper

most
work. Allow more autonomv at the local or individual site level for
tasks.
Increase the availability of teacher training and upgrading of skills

more
of inadequately trained teachers who are now working. Provide
special education teacher training programs at Teacher Colleges throughout the country. Require all teachers to complete a specific number of hours of "up-graded skills training" each year with reports to be made on this training
and to be tied to their salary increases.
Establish
National Committee
to
develop an appropriate
curriculum for the disabled. Include special education professors as well as outstanding staff that are working in the institutions at this time. Attempt to
develop
a curriculum that is feasible and
effective and maintains high
standard of accomplishment for the students and teachers.
Provide regular workshops for staff
to learn about the adaptive
technology available for teaching the disabled. ln addition, encourage the

various institutions to work with the Ministry of Public Health in using funding
23
available through the Rehabilitation Act that could buy equipment for the use
of students.
Tabfe 10
Government Budget Plan for Special Education(1995 - 2001)
Planning
Urgent or lmmediate 1995
I th National Plan
1997 - 2001
1,083.000
- 1996
Expanding Services Administration Development
487.870 260.970 68.630
1,248.640 78.940
Academic Development
Total Budget
886.100
2,410.580
*Number reoorted in million Baht
C) Future Scheme for Vocational Rehabilitation
- Building a good sense of understanding about disabled persons.
Adjust tools, equipments and training facilities
to be more
appropriate to each type of disabled persons.

- Eliminate those law which limit the right of disabled persons to work.
Government agencies provide more appropriate positions to
disabled government officers who return to work instead of dismissing them.
- Set up a research unit focusing on adaptive

disabled persons working as normal people.
tools so to keep
- Promote special facilities for

workplace.
disabled persons within
the
Speed up to the obtaining of more adaptive equipment for the
disabled on commuting or traveling services.
24
- Promote more training of "guidance counselors on employment" for

disabled persons.
- Promote "business management"
training to disabled persons
in
order to help them learn more skills in doing business.
- Provide a source of funds for them to be entrepreneurs in addition to

making loans.
Support private institutions relating
to vocational training and

funding,
employment placement
personnel and instruments.
for disabled persons by providing
Cooperate taxes should be exempted for those companies that
employ 50-80% of disabled persons in the work force.
Speed up support for competent networking, especially
in rural
areas, in regards
to provide
information about vocational training and
employment prospects.
- Government
needs to stress vocational training for the disabled,
especially those disabled persons in rural areas.
d) Future Scheme for Social Rehabilitation
- Extension of social welfare to those disabled according to the needs
of the specific type of disability. Thus, by providing the disabled
with
assistance, welfare service protection, re-conditioning, rehabilitation, guidance, the development of problem-solving skills, self-reliance, the
development of quality of life (QOL), and the ability to participate in social
activities.
- The promotion of knowledge, understanding and good attitude
in
regards to the disabled to society, the communities, the rural area and to
25
individuals through public relations and cooperation from all concerned

sector, ie, government, NGO and private individuals.
- Developing a system of information and personal in the universities

to assist in the operation of social rehabilitation.
Laws, regulations, and rules, including the process
of
its
implementation, have to be clearer in order to help protect the human right

of the disabled. - The promotion in all levels of organizations, government and private,
of participating in social rehabilitation more than before. Furthermore, to

establish more effective networks within the system.
- The development of models for community-based rehabilitation for
the disabled more appropriate to the problem situation and the needs of
each type of disability.
e)Future Guideline for mass media implementation
- Publicize an emphasis on prevention and causes of the total range

of disabilities to all group, especially the less privileged - people in rural communities and in slum areas.
- Correcting negative
social attitudes toward the disabled, so that
society understands, accepts, and gives opportunities to the disabled as

they are also members of society,
- Having an intensive campaign through all forms of mass media that
is in close collaboration with organization for the disabled focusing on

reducing the numbers of disabled persons in the future and promoting QOL
of the disabled so that they may have more opportunities to enjoy a happy, successful life, just as other people do.
26
- Having a central role in encouraging the various governmental

agencies to quickly assume responsibility in improving the extension of
services to the disabled as well as pressing for the reform of laws and rules
which constrain and abuse the rights of disabled persons.
fl Future Roles of Religions lnstitutions in Helping theDisabled
- Taking on the role as a development center to provide special

education as well as a rehabilitation center for both disabled children and adults, under the supervision
of
specialists and involving village volunteers.
This will enable them

community
to participate
more fully
in activities such as
- based rehabilitation.
The temple area is to be a venue for
activities ie, vocational training.
For the monks, when preaching
to the people, should
include
supplementary information, ie, an example
of an outstanding
disabled
person, as well as educating the community in order to mould positive
attitudes toward the disabled so that they will earn acceptance and
opportunities within society like other people.
- Providing opportunities to the disabled to participate in making merit

or religious charity according to their economic status.
g) Future Guidelines for Peoole and Communities to Assist the Disabled
- People should have more understanding of the disabled and
treat
them as fellow human beings who have feeling and needs like other people. No insults or discrimination.
- Encourage the disabled to show their potential and ability and give
them opportunities to take on self-assistance and self-reliance as much as possible.
27
- More knowledge to prevent people from becoming disabled and thus reduces the number of disabled.
Those in the working place, ie, factories, should provide work
opportunities to the disabled according to their abilities. ln particular, private
enterprises should seriously follow the "Ministerial Regulations" regarding
the hiring of the disabled to work in their factories like other people so that
they are able maintain a livelihood.
h) Future Guideline for Operational Functions of Disabled Organizations and Self-helo Groups.
- To be a resource center responsible for maintaining, coordinating

and disseminating information to organizations of disabled persons.
Promoting self-help groups among the disabled and building
networks from central to rural areas, ie, from Bangkok to province - district community - village. Thus, members will be able to get information about the rights and opportunities to access services.
Promoting effective self-development among members
in
the
organizations through exchanging experiences, shared problem-solving and
suggesting ideas which will guide them toward a quality life'
- Protect the right of the disabled and spread information to promote

understanding thus creating a more positive attitude toward the disabled. In addition, advisers should be available to members who have problems, etc.
- Coordinating with state & private agencies which work with disabled
persons to build mutual understanding so as to have a cooperative effort and constructive way to problem-solve.
The Referral System
Chart 1: Referral System for Disabled Persons to Receive the Services.
Interview
for history and problem
Checking information on agencies which provide services

& assistance
Assisting operation
Giving
guidance
to the
disabled
and fam
The Follow - up System
When the disabled person had been referred to particular agency,

the sending agency will send a follow-up letter or inquire by telephone to
find out how the case transpired. Also, a separate follow-up letter will be
sent to the disabled person directly. From time to time, the follow - up letter
will be sent along with a newsletter or PR publication to keep informed of
29
various issues concerning rehabilitation development. This
useful
information will also be stored in a computer at the central office in Bangkok.
The follow - up system will go together with the referral system in order to
have the organization become more concerned with effective coordination.
2. The actual condition of medical rehabilitation
At present, all institutions concerning CBR have served wide range of

problems but problems still exist in some areas: a) Inadequate services in medical rehabilitation, especially the lack of coverage to all rural communities.
b)
People
in rural areas are lacking knowledge
concerning
disabilities; therefore, they are not interested in bringing disabled persons

for treatment and rehabilitation services.
c)
Personnel with skill and expertise in rehabilitation are too few to
cover all the areas.
d) Coordination and transferring systems for patients are inefficient.
3. The education for handicapped (Pre school - university)
The Thai government and Thai non-profit groups work together
in
many special education programs that have received funding. ln the past,
the funding has been assigned to specific local programs, such

providing funds for
as
school building, or providing food for boarding
students in a special education facility. However,
it is mostly small
local
infrastructure projects that are funded, rather than educational program. The following is the information excerpted from a sectoral survey on
special education for the disabled (3-24 years old) investigated by Dr.
Poolpit Amattayakul and his team:
30
Table 11 :Government Sponsored School of Special Education

Year
1992 1993
Province
Nakorn Sawan Pitsanulok Nakon Ratchasima
Region
North Central
North
N.E. N.E N.E. N.E,
SP/Ed.Pop
Qssf+M.R. Deaf+M.R,
Remark
Dual Program Dual Program Dual Program
pssf+M,R. Blind+Deaf+M.R
Deaf+M.R. Deaf+M.R. Deaf
M,R, M.R. M.R, M.R. M.R.
Ubon Rachathani
Surin
Mixecl Program
Dual Program Dual Program
Mookdaharn Prachuab Kirikhan Chumporn Songkla

1994
South South South
Lopburi Rayong Phuket
Central
East South
1995
Nakorn Pathom Suphanburi Karllasin

Roi-Et
Central Central
N,E.
N.E.
Deaf
M.R.
M.R.
Blind
M.R M.R M.R M.R
1996
Chaing Rai
Prae
North North North North North
7h Natioanl Plan
Pichit
Nan
Petchaboon Chachaengsao Prajeenburi Kanchanaburi Petch-buri Chaiyapoom Khon Kaen
Deaf
M.R.
Central Central Central Central

N.E. N.E.
Deaf Deaf
M.R.
Deaf Physically Disabled
Source: lnformation from Division of Special Education
31
Overview of schools and teachers in special education
An overview of the number of schools and their current staffing ratio is
given in Table 12 below. These programs are grouped by both disability and geographic location. Both the estimated need and the number of programs
available can be determined by comparing the figures in this table with

those of the Government Census figures to get an estimate of under-served students in each region of the country.
Table 12: Teachers is Special Education Program
Program & School
Site of School
Province Region
Number of Teacher in Sp.Ed.Program.
Total
49 45
36 38
10
I
1
tn.o.
lu".t",
2
leacnetorlcertiticate
School for the Deaf Setsatian Thong Mahamek Sote Nontaburi

Sote Cholburi Sote Theparat
Bangkok Bangkok Nontaburi Cholburi Prachuab Kirikhan
Central Central Central Central Central
45
41
4
1
35 35
3
I
I
1
Sote Nakon Pathom Sote Pattana Pratamnak

Sote Tak
Nakon Pathom Cholburi Bangkok

Tak
Central Central Central

North North N.E. South South
8
7 2
4
5
45
?1
4
I
45
Anusarn Sunthorn Sote Khon Kean

Sote Songkla Sote Thungsong
Khon Kaen Khon Kaen Songkla

Nakon
28 47
35
14
2
3 3
1
51
1 4
I
39
17
Sritammarat
32
Table 12 (Continued)
Program & School

School for Blind Bangkok School School of the Blind Ed.Ctr.of Blind Redemptis Sch Blind
South sch. of Blind
Site of School
Province Region
Totat
en.o. luaster laacnetorlcertincat"
Bangkok
Central
North N.E.
41
31
7
1
Chaing Mai
Khon Kaen Chonburi Suratthani Korat
Roiet
22 4
18 17
19 3
Central
South N.E. N.E.
6
7
11
Ed.Ctr,of Blind Ed.Ctr.of Blind
8
7
I
7
School for the Physically Disabled
SriSangwan
Redemptorist Sch.of Physical Dis. School for Mentally Retardation
Panya Wootthikorn
Nonthaburi
Central
33
24
Cholburi
Central
17
10
Bangkok Bangkok Lopburi Suphanburi Chaing Mai Udon Thani

Phuket
Central Central Central Central

North N.E. South South South
14
2 2
1
10 21 7
2
I
I
Rachanukul Suksapiset Lopburi Suksapiset Suphan

Kawila Anukul
24
8
4
2
41
1
44
3
B
Suksapiset Udon Suksapiset Phuket Chumporn Panyanukul Songkla Patana Panya
Chumporns Songkla
12 14
z
4
I
I
10
Classroom for Mentally Retardation Prapakarn Panya Bangkok Central

13
I
33
Program & School
Site of School
Province Region
Totat
en.o. lMaster leacnetorlcertincate

4
I
School for Dual Prog.fams (Deaf+M.R.) Suksapiset Suksapiset Suksapiset Suksapiset Suksapiset Suksapiset (Blind+M.R.+Deaf) Suksapiet Ubol Nakorn Sawan
Rayong
Central Central
North
N.E,
11
10
6 6 12 6
11
Pitsanulok Ratchasima Mookdaharn

Surin
6 12
N.E. N.E.
11
Ubol Ratchathani
N,E.
24
23
Classrooms for Children with Brain Damage & Behavioral Disorders Saeng Sawang Inst. Yuwaprasart Hosp. Samut Prakarn Samut Prakarn Central Central
55
I lz 1,.
tospital Classroom
1
loo
Classrooms for Children with Multiple Prachabodee Home of Children with Multiple Disorders Total
disorders (not registered as school)

Central Central
10
Nonthaburi Bangkok
I
6 10
to
844
49
678
116
34
Table 13 : School / Classrooms for Children with Disabilities
Type & School

Province
Area
Regions
Stu.ffeacher Class R
Ratio
Remarks
School for Deaf Setsatian

Sote Tungmahamek
Bangkok Bangkok Nonthaburi Prachaub Cholburi Bangkok
Central Central Central Central Central Central.

North North
N,E.
357t46 327t46
351134
7014
34 34
Ministry of Education Ministry of Education
Sote Nonthaburi
Sote Theparat
37
6 5 7
Sote Pattana Kinder

Pra Tamnak Suankularb Sote Anusarnsoontorn Sote Tak
45t8
62t7
NGO+Church Local Government

Ministry of Education
Chiang Mai
Tak
324t33
433144 375137
32 JZ 30
Sote Khon Kaen

Sote Songkla
Khon Kaen Songkla Tungsong
South South
345t42
190t14
30
12
Sote Nakorn Sritammarat School for Blind

Bangkok School of the Blind Northern School of the Blind
Khon Kean Ed.Ctr. of Blind
Bangkok
Central
North
N,E
211t41 133t22
4014
20
16
Foundation of the Blind Ministry of Foundation
Chaing Mai
Khon Kaen Cholburi Suratthani
Nakonratsima
4
10
11
Christian Foundation Catholic Church.NGO

Ministry of Education
Redemptoris School of Blind
East South
N.E.
90t20
116t17
South School of Blinc
Korat Ed.Ctr.of the Blind

Roiet Ed.Ctr.of the Blind
Lampang Ed.Ctr.of the Blind
120t8
37t7
12 7
Christian Foundation Christian Foundation Christian Foundation
Roiet
N,E.
Lampang
North
School for Mental Retardation

Panya Wootthikorn
Bangkok Bangkok Lopburi
Central Central Central

North
148t14
14 19 3
Private School Ministry of Health Ministry of Education Ministry of Education
Rachanukul Suksapiset Lopburi

Kawila Anukul
350t24
1513
Chaing Mai
412t42
36
35
Type & School

Province
Area
Regions
Stu.ffeacher Class R
Ratio
Remarks
Suksapiset Phuket Chumporn Panyanukul Songkla Patana Panya
Phuket
South South South

N.E.
6418
5l
12 15
Ministry of Education Ministry of Education Ministry of Education
Chumporn Songkla Udon
120t15
172114
Udon Panyanukul
10017
No report M inistry of Education
Classroom for Mentally Retardation Prapakan Panya Bangkok Central
70t13
10
Private Foundation
School of Dual Programs(Deaf+M.R.) Suksapiset NakornSawan Suksapiset Rayong Suksapiset Pitsanulok Suksapiset Ratchasima Suksapiset Mookdaharn Suksapiset Surin
Central (Deaf 0/ M.R.40)

Central
North
N.E. N.E, N.E.
80/9 28t4 40t3 154t12 40t3
I
3
Ministry of Education Ministry of Education Ministry of Education Ministry of Education Ministry of Education Ministry of Education Ministry of Education
4
9
4
o
1
Deaf
109/8
1211
School of Mixed Program (Blind+Deaf+M.R.)
Ubon Panya Nukul
N.E.
Blind Deaf
M.R.
35t4
22t4
Ministry of Education Ministry of Education Ministry of Education
J
15
237t15
School of Physically Disabled
SriSangwarn,
Redem ptorist Vocational
Nonthaburi
Pattaya
East of Central
Central Cholburi
257133 145t17
22
11
NGO+Government NGO-Church
Schoolfor the Disabled
Classroorns for Children with Multiple Disorders (not registered as a school) Sathabun Saeng Sawang Yuwaprasart Hospital
Samut Prakarn Samut Prakarn
Central Central
Nurses
roorss
250t
15
11
NGO Foundation Ministry of Health
36
Type &
School
Area
StudenUTeacher Class Ratio
Remarks
Classrooms for Children with Multiple Disorders (not registered as a school)
Pak Kred Nonthaburi Province:-Prachabodi School of Multiole Disorders Mixed -Ban Nonthapoom,Home of Multiple Disorder Mixed -Ban Fuang Fa,Home of Disabled Children -Ban Rachawadi,Home of Brain Damage & M.R. Prathumthani Province:-Ban Kung ViTee Children (Mental) -Ban Kung ViTee Children (Mental)
304 304 467
92t16
593
Schoolfor 3 Homes Below

Dept. of Public Welfare
935
Home for boys with mental diso Home for girls with mental diso
Integration-Mainstreaming Program of Special Education Children
lnformal integration has occurred with small numbers of children for

a number of years. In 1957 a formal program was established with the slowlearning children in the Bangkok area; in the last 10 years there has been
more formal approach to developing quality integration program.
The Christian Foundation of the Blind in the Northeast of Thailand has
developed outstanding integration programs for the
blind. The program
consists of a preparatory segment which can run for one to two years in which the child lives in a residential setting. This program trains the blind
child in daily living skills, effective learning skills and the use of various
adaptive equipment needed by the blind to function competitively in the
regular school environment.
37
The foundation also open Educational Centers in additional areas of
the North and Northeast and train various officials in the techniques of
successful integration.
The integration of the deaf is part of a longterm project started at the
Suan Dusit College of Teacher in Bangkok, This first group of integrated deaf children were of preschool age and consisted of a mix of half non-deaf and half deaf children in the classroom. Some of the teachers were trained
in early intervention programs abroad, at the John Tracy Clinic in
Los
Angeles and in a deaf program at Tel Aviv. Later, some of the children from Suan Dusit were integrated at the Phayathai School (grade 1-6, started in
1973) in Bangkok.
The Prathamnak Suan Kulurb School was established in 1981 by

HRH Princess Sirindhorn who has a long-term interest in the disabled. This school started with 16 children in two classrooms and 2 teachers who had a B.A. degree in special education (deaf program). Today, there are 7 rooms with 62 children andT trained teachers, 5 with B.A. in Special Education and 2 with MA in Special Education all with majors in deaf education. Students from this school continue their studies in two main systems, the oral system
at other primary school such as the Payathai school or the Bangkok School
for the Deaf which used sign language.
Ratcha-vinit Primary School was the next integration site with a similar program to the one at Phayathai school, followed by Pibul-prachasan which
is a secondary school of mixed programs where young deaf, blind,

physically disabled can attend at the secondary level. The government is
making an attempt to start programs of integration of the deaf in areas which
already have a school for the deaf and to offer support services to local
schools interested in integrating deaf students into their regular classes.
38
Table 14 :School with Integration (Mainstreaming) Programs of

Bangkok Area (Up date December 1995)
Area & School

Bangkok Area
Program
Student
Teacher
Remark
School Under supervision of Ministry of Education

Rachapat Suan Dusit
Pra Tamnak Suan Kularb Phayathai
Deaf- Blind - M.R.
98 62
17 7
Pre School Pre School
Deaf Deaf Deaf Deaf Deaf Deaf Blind Blind Blind

M.R. M.R.
99
16
I
2
1
Primary Primary Primary Primary
Samsen Ratchavinit Wat Chawmon Piboon Prachacsan Chinoros Thep Lee La

Santirat Wittayalai
25
6 127
13
13
Secondary Secondary Secondary Secondary

Primary Primary Primary Primary Primary Primary
2
1
3
7
Ban Bang Kapi Wichutit

Wat Way Tawan
No Report No Report
70
Slow Learner Slow Learner Slow Learner Slow Learner Slow Learner
5
.1
Wat Chana Songkram Wat Hnang Darakam Piboon Prachasan
20
65
2 2
11
27
103
Secondary
School Under Supervision of the Bangkok Metropolitan Area (Local Government)

Wat Tasanaroon Suntari
Slow Learner Slow Learner Slow Learner Slow Learner Slow Learner Slow Learner Slow Learner
43
60
19
B1
2
6
Primary Primary Primary Primary Primary Primary Primary
Prathom Bang Kae Way Hongj RatanaRam Prathom Non Zee Wat Maha Boot Wat Don Yannawa Wat Suwannaram
2 3 2
4
I
34
8 12
39
Area & School

Soon Puam Nam Jai Samsen Nok Wat Lard Prao
Programme
Slow Learner Slow Learner Slow Learner Slow Learner Slow Learner Slow Learner
Student
B
Teacher
1
Remark
Primary Primary Primary Primary Primary Primary
41 15
1
I
RitthiWittaya
Wat Nimman Noradee
Wat Jang Ron
72
21
I
I
66
Private School
Jantayanond Kindergarten
Supawan Primary School
Autistics Autistics
30
3
12
Primary Primary
Table 15 :School with Integration (Mainstreaming ) Programs Outside

Bangkok Area (1995)
Area & School

North Thailand
Chit Aree, Lampang
Program
Student
Teacher
Remark
Deaf Blind Blind

M.R.
34
3 o
1B
3 3
Primary Primary Secondary
Ho Pra, Chaing Mai Wattano Thai Payap

Nan Welfare School
Primary
North East Thailand Sakol Nakorn Welfare Sanam Bin Khon Kean Kindergarten Thesaban Suam Sanook Ban Kham Hi Thesaban Sri Than Deaf Blind Blind Blind Blind Blind
11
Primary Primary
I
6
9 9
Pre School
Primary
1
Primary
40
Area & School

Ratchasima Wittaualai Kaen Nakorn Wittayalai Kalayanawat
Program
Blind Blind Blind
M,R. M.R. M.R,
Student
6
2
Teacher
Note
Secondary
Secondary Secondary
3 50
3
LeoiWelfare School
Panom Tuan Welfare Non Somboon Welfare
Primary Primary Primary
48 80
I
5
No Report
Central Thailand
Panom Tuan, Kanchanaburi
M.R.
48 No Report
Primary Primary
Prachabodi, Nonthaburi
South Thailand
Wat Thalay
Mult. Handi
Sorn SuratthaniWelfare
I I
Blind
II
Secondary
t*
391
Primary 25
Primary+
Integrated Program for Chronically and Hospitalized Children 6 Hospitals in Bangkok and 5 out of Bangkok Area
Secondary
Physically disabled children who are more severely impaired are
often given bed-side instruction until they are capable of living in a less
restrictive setting. After these children are released from the hospital they
often are given training in
residential setting where there are few
opportunities for full integration, The few children who are able
to be
integrated are these who are not wheel-chair bound, but can ambulate independently. There is no school for the physically disabled in Bangkok.
The only school available for this group of children is named "Sri Sangwan"
and is located outside of Bangkok. This is a boarding school with relatively good access for wheel chair students, however it only provides instruction to
Grade 9 at this time.
41
The mentally impaired enrolled in the Rachanukul program have been
integrated into some of the regular education programs in the area (see the next table). They are usually integrated until they are of secondary school
age and then they are transferred into vocational programs. At this point
there are two programs for the integration of the mentally impaired,
Chiang Mai in the North of Thailand.
in
Brain-damaged and autistic children usually are not able
to
be
integrated because of the severity of their disability, Some of them are able
to be controlled with medication, but the most successful program
for
autistic children is at the Satit Kaset School run by the Faculty of Education
of the Kasetsart University in the Bangkok arca. This has been a successful
programme, but is considered as a rather expensive alternative as the staff

used in this setting are all Masters Degree teachers. Post-secondary mainstream programmes for students with disabilities in Thailand are still in their infancy. Today only a few of the btind students
taking the National Exams (1-3 students per year) were able to pass the
National College Entrance examination to public universities, In the past 2
years there were 2 or 3 blind students who finished a B.A. degree in Law,
Education and Computer Technology, while only one deaf students got his
B.A. in Applied
Arts. Another two deaf students received degrees Home
Economics. At the open universities, the Ramkhamhaeng and the Sukhothai

Thammatirat as well as in the Teacher Colleges, some physically disabled
(wheel-chair user) students were reported
to
have finished their B.A.
degrees in Education, Social Sciences and Humanities. Srinakarin Wirote Prasanmitr
in Bangkok is the only University in
Thailand that grants a Master's degree in Special Education (Deaf, Mental Retardation and Gifted Child Programs) and also
a Master's Degree
in
42
Related Programs in which teachers can study and return to work in schools as specialists in various fields of intervention.
There are programs in special education in Speech Pathology,

Speech Therapy and Audiology through Mahidol University at the Faculty of Medicine and Ramathobodi Hospital in Bangkok.
In
1996 Ratchasuda College (Disabled Program)
of Mahidol
University started
a masters degree programme in rehabilitation service
development for people with disabilities. This masters degree programme
will meet the nation's need for training special education teachers in such
fields as in Access Technology, Rahabilitation Counseling Services, and

Rahabilitation Service Administration. In addition, it will sponsor short and
long-term courses for teachers wishing to improve their skills in adaptive technology for the disabled. lt plans to offer another in Research and finally a Masters in Media Production for Special Education. There are 6 out of 53 Teacher Colleges that offer training in special
Education courses. The following Teacher Colleges offer Bachelor Degrees
in areas of Special Education:
43
Table 16
Teacher Colleges with Special Education Programs
Area of the Kingdom and
Age of Program Year

26
Areas of Specialty
School (Programme Major)

Bangkok-Ratchapat Suan Dusit
Special Education Blind Major Deaf Major

M.R, Major
4
26
?
South-Rachapat Songkla
z
1
GeneralSpecial Ed.
M.R. Major
North-Rachapat-Chiang Mai
2 2
GeneralSpecial Ed.
Deaf Major
M.R. Major
Planning Blind Major in '1996

North-Phiboonson gkram Col lege of Teacher, Pitsanaulok
2
1
GeneralSpecial Ed.
M.R. Major
Northeast-Ratchapat-Korat
z
1
General Special Ed. Bling Major
Northeast-Ratchaoat Mahasaraka m
Generalspecial Ed.
Blind Major
Planning M.R.and Deaf in 1997
In addition, a separate university in Bangkok, Srinakarin Wirot, offers
special day and evening programs in Special Education. Through this

program, graduate students can earn a Masters Degree in Education of the Deaf and Education of the Mentally lmpaired. This University has offered
programs for teachers of the deaf for almost 10 years and majors for education of those with mental disabilities for the last 3-5
years.
This
programs usually serves 74 graduate students, with 169 completing their

Masters Degree since its inception 10 years
ago.
In addition, the university
provides short-course training for bachelor level teachers who need more
information about the education of the special needs
child. lt has trained
210 teachers in this short-course summer program since its inception.
44
Short Course Teacher Training in Special Education

Short course training in special education for teachers has been done
in Thailand for several decades by individual schools of special education.
It started even before the
government had established the Teacher's
College programs in Special Education over 30 years
ago. Back in those
days all teachers in schools of special education were graduated first from
the regular education programs of the Teacher Colleges (since there were
no formal training programs in special education.) Later, short course

training was offered in this specialty area which might consist of 2 weeks of lectures and demonstration. As an incentive to special education teachers,
about 30 years ago the Ministry of Education provided teachers who had
passed this training an extra 300 Baht per month.
Today this kind of short course training is still being done, but
in
larger groups with targeted teachers who are willing to work with the
disabled students in both schools of special education programs and with
integrated programs. Training is being sponsored officially by the Ministry of
Education (Department of General Education and /or the department of the
National Primary Education Commission) and
by the Srinakarin
Wirote
University (which also offers
a masters degree program in Special
Education). After the training (which consists of a 200 hour training often
given during 4-6 weeks during summer) all teachers would receive the
addition of 1,200-2,000 Baht per month to their regular salary (depending on
their current rank). Table 17 shows the number of teachers completing short course training in the past 9 years.
.
45
Table 17 :Short Course Teacher Training in Special Education

1986-1995
Training Venue
Srinakarin Wirote University Srinakarin
Wi
Year
1
Number of Teachers Trained

68 27 25 25 166 39 39
rt cl
986 990
rote
niversity
N.P.E.C. Min. of Education*
1992 1992
1
Sdnakarin Wirote
niversity
Dept. of Gen. Ed., Min. of Education

Srinakari n Wi rote
U
993
niversity
1994
1
N.P.E.C. Min. of Education*
994 995 995
Srinakarin Wirote University Dept. of Gen. Ed., Min. of Education
84
Total
Teachers
9 Years
578
N.P.E.D,= National Primary Education Commission Department
4. The condition of employment and vocational training for handicapped
Vocational Training for handicapped
The handicapped receive vocational training from governmental or
private organizations with no charge.

services are listed as follows
:
A variety of vocational
training
For vocational training with non-handicapped people,

organization offer training
:
two
O Multiple skills Training School (Under the Vocational Education

Department, Ministry of Education)
46
Skills training on the following topics
-Automation mechanics
-Metallic lathing
-Electric wiring -Electric fan repair -Radio - TV repair -Women's dress making -Beauty services
-Advertising design
-Photography -Computer prog ram
m
ing.
O Institute for Skills Development (under the Ministry of Labor and

SocialWelfare)
This institute focuses on upgrading skills in

provide training nationwide Training Topics:
:
8 different fields
and
- Electronics
- Computer education
- Automobile - electric wiring
- Industrial sewing machine

- Building painting
- Material-ware painting
- Construction carpentry
-
Air & cooling conditioner machanics
- Industrial - tooling machanics

- Motor - bike repair
47
- Radio - TV. repair

- Telecommunication machanics
- Automobile machanics
- Metallic lathering
- Aluminium structure setting - Agreecultural machine machanics
- Auto - engine repair
OTwelve NGO's Provide Vocational Training (Throughout Thailand).

Training Topics
- Radio & TV repair - Leather cutery

- Glass sculpturing & cutting
- Program design
- Office computer course (6 months)
- Traditional massage - Weaving
- Artificial flower making
- Cooking
- Astrology - Carpentry
- Painting
- Drawing
- Telephone operator
- Lottery selling
- Musical performance
- Dessert - baking
48
- Waste - materials handicrafting
For vocational training in clothing and hair styling that require
higher level of skill, after completing the course, the disabled will have
further training and practice at the Vocational Development Center before work placement.
Emoloyment for the handicaoped
ln accordance with employment and occupational placement for the

handicapped, the Social Welfare Department has set guidelines as per B.E 2537(1994) Ministerial Regulations providing
a description of the work
in
which the handicapped are capable of engaging in. These guidelines list
the criteria for employment appropriate to the knowledge, capability and

physical condition of disabilities to the job. Consequently, according to Ministerial Regulations, it's required that
private establishments, ie, factories, companies,

workforce
or enterprises with a
of at least 200 employees must to employ at least one (1)
handicapped person, lf any particular workplace does not have a suitable

position for the handicapped, then it is required to remit money annually to
the Rehabilitation Fund for the handicapped, at a rate of remittance of half of
the annual minimum wage multiplied by 365 and matching the ratio of the
number of handicapped persons that would have been in the workforce. Employers who employ the handicapped will have the right to claim
twice the amount of salary paid to the handicapped as company expenses
in regards to revenue tax. In addition, facilities expenses (ramps ,toilets,

etc.) allocated for handicap accommodation can be included as a tax
deduction.
In reality, according to the research on Employment Opportunity of
Handicapped Persons (1994)
by Wasana Tapaopong of
Thammasat
University, most employers do not want to employ the handicapped, which proves that even though the employer may have very good attitude towards
the handicapped and the Rehabilitation for Disabled Act is in place,
in
practicality this Act has not worked and it seems difficult to employers to
employ the handicapped.
From the OCRDP survey, it had found that there are 5,000 workplaces
(employing more than 200 persons) which are required to hire the disabled. However, only 2,000 workplaces have complied with the "Rehabilitation
Act"; 1,200 workplaces have hired the disabled and another 600 workplaces
have chosen to submit funding into the "Rehabilitation Fund". The rest of the
3,000 workplaces have not followed the Act.
However, the "Rehabilitation Act" has no penalty for wrongdoers. Therefore, no enforcement can be done, In practical terms, the Ministry of
Labour Protection and Social Welfare tries to use positive reinforcement

perks of various types,
ie, tax deductions as previously
mentioned, giving
"recognition awards" for those workplaces which hire disabled persons, and
by constantly publicizing the performance of the disabled in the workplace. Presently, employers' attitudes have begun to change. This is due to
the good performance of the disabled, In the future, it appears that

occupational placement will improve.
On August 21, 1998, principle organizations working with

disabled in entering the labour market.
Parliament Assembly.
the
disabled will have a forum to consider the various problems facing the
The forum will be held at the
50
Employment Problems after Vocational Training
In addition to the previously cited data, results of the
research
conducted by Orapin Phitakmahaket from the Institute of Population and
Social Research, Mahidol University on the topic "Problems Facing the

Disabled who were Trained in Rehabilitation Centers", found the following
noteworthy nformation
i
1. More than half of the disabled did not have employment matching
their training,
2. Radio and television repair employment did match their previous

training and resulted in a secured job, while those in leather cutting and
cloth-making had a significant problem to do the same.
3. Among the problems facing the disabled in entering the labour

force that were reported in the research were: the job being too hard, the job
not being suitable to physical needs, the majority earning income less than
minimum wage, and insufficiency of housing and/or facilities, ie, ramp and toilets to accommodate the disabled. (Note from researchm Concerning the
facilities
to accommodate the disabled in the workplace, they are now
becoming supported and enforced by the latest Act declared on March 10,
1ee8.)
4. The principle factor impacting on the disabled' s enterance into the workforce was "earned little income"
5. The present condition of the supply of prosthesis and orthosis
Upon interviewing the Director of Sirindthron National Medical

Rehabilitation Centre (Dr, Phatriya Jaruthat) Praphan Phongkhanitanont (also
and Deputy Director,
Dr.
a Division Chief of Medical Treatment
&
Rehabilitation), information was given which is summarized below:
51
1) In Thailand, after the law (Rehabilitation Act.) related to artificial

body-parts had come into effect in 1995, good budgetary support from the government resulted in obtaining enough of the required artificial units.
2) Currently, Thailand is unable to produce those artificial body-part

locally. They need to be imported from the USA, England and Germany.
The only item that can be produced locally is the artificial foot-sole, but it is
not of a good enough quality compared to imported items due to the low production technique.
3) There are no prosthetists nor orthotists. Thailand only has P&O

Technicians. This results in low production standards, ie, artificial foot-soles do not correctly fit the foot of the disabled person.
4) There is an inadequate supply of P&O Technicians on duty at

provincial hospitals in the country. There is only one P & O Technician per provincial hospital on average and about 10 % out of 96 hospitals have no
P&O Technicians at all.
5) Currently, the Artificial Leg Foundation (private agency) and the

King MongKut Institute of Technology have jointly undertaken research
order to build artificial knee - joints.
in
6) Sirindthron Centre has the responsibility to act as the P&O Center
and distribute artificial body
- parts to provincial hospitals nationwide
according to their individual requests.
52
Procurement for Prosthesis, Orthosis, Gait Aids, etc.
National Budgetary Bureau
lt II
ll
ll
Sirind hron Rehabilitation Centre
Health Service Unit
ll tl
tl
Note : - lf the provincial hospital or regional hospital wants to have their own
budget for purchasing their own needs, those hospitals are able to do so
through the Sirindthorn Centre, The Sirindthorn Centre will aggregate the
budget then allot to individual hospital their share respectively.
5.3 The Needs of CB
ln the past, it has been the traditional understanding that real success
in rehabilitating the disabled meant to bring them to receive treatment at a

residential compound, ie, hospital, school, etc.
At present, it is realized that the disabled who are capable of making
living have no real need to stay in a treatment compound but should stay
with their family. The CBR concept is accepted and deemed essential because its help sustaining the development on rehabilitation
of
the
disabled. lt uses resources from community services and agencies as well
as cooperating with members of the community to provide support to the
disabled, according
to their specific
disability and according
to
the
suitability of the particular community, so that the disabled can be self-reliant
living in their own community. CBR in Thailand were established by the Public Welfare Department
in 1994 by selecting 10 provincial pilot projects, which succeeded in only 2 provinces, on education in Kanchanaburi Province and on occupational
aspects in Chiang-Mai Province. The plan will be expanded to an additional
5 provinces in the year 1999. CBR activities by the Medical Service Department, MOPH have been
done before Public Welfare Department, has begun with the translation of rehabilitation manual for people who work with the disabled. Now the
Medical Service Department's are in the process of pilot testing the model of
the
" Independent Living Unit" that is modified from the Japanese model
in
order to be more appropriate to Thais.
l.Training for Staff and Specialists

Special courses in the rehabilitation field in higher education
At present, Ratchasuda College is a newly opened school
that
provides graduate study in the field of rehabilitation services for persons with disability. However, there is only one course in the graduate curriculum
that deals with community
based rehabilitation. This master degree
program will be started in 1999.
Ratchsuda College is under the umbrella of Mahidol University and under patronage of H.R.H Princess Sirindhron. Prior to starting this master
degree program, an orientation session will be conducted for faculty and
staff by experts from Australia and the USA in order to become well
prepared before launching the program.
54
In addition, Ratchasuda College is now providing
-Teacher training
in special education in
techniques, counseling,
research, and educational media production.
-Training
of
teacher skills
Orientation
& Mobility, adaptive
technology, and teaching of sign language/Braille.
Methods of providino information services for patients after discharge.
Personnel from Sub-District Health Center, ie Health Technical

Officers, Health Community Officers or Nursing Officers, work as the point person in providing information services on the village level. The central agency provides manuals (4 manuals) to the Health Center dealing with the
care of the disabled persons' rehabilitation, ie, blind, deaf, physical disability
and mentally retarded.

These 4 manuals will be used in educating and helping the disabled
and their family. The Health Officers provide information not only at the
Health Office but also through home visits and advise them on useful topics,
ie, ways of sitting so as to avoid further injuries or educating the family of brain-damaged or mentally retardation about their nutrition needs, so that
they are able to help themselves In some villages, the Village Health
Volunteer will be of help in this manner depending on their capability.
Activities of Village Health Volunteers.

In the past, there were two kinds of volunteers working in the village,
Village Health Communicators (VHC) and Village Health Volunteers (VHV).

Presently, VHC's have merged with VHV's.
55
The number of VHV's are based on the density of households in the

area; usually one VHV will serve 15 - 20 households. VHV;s receive no salary
but receive incentives, such as free medical treatment, covering their entire
family. VHV's also earn the "respect of cognition" from their community.
Roles and Activities of VHV's are as follows
1. ln charge of running the Community Primary Health Care Center which have been set up to deal with the community's primary health care
problems in village. For example, if villagers became sick, the VHV would
do simple treatment or if villagers have some other problems, they would

consult the VHV as well.
2. VHV's are responsible for the early detection of disease,

conducting surveys to gather information as needed.
ie
diabetes, high blood pressure, etc. as well as assisting the Health Center in
3. Providing necessary heath information (14 elements of PHC)

villagers in their respective areas.
to
4. Weighing pre-school children and distribution of supplementary

food for malnourished children.
2. Distribution of primary health care in the district

Primary health care centers are spread throughout the provinces nationwide and are under the responsibility of the Provincial Health Office
(The Department of Personal Development
and Primary Health Care) which
is directed by the Provincial Chief Medical Officer who has authority within
their province under the same central policy guideline.
At district level, Health District Offices oversee primary health care

service within their district. For sub-districts, the Health Center is responsible for PHC services at the sub-district level.
56
From the Sub-District level down to the village level, there are small
units of primary health care services called "Community Primary Health Care
Centers".
3.Vocational training for economical independence (independent living in

the community)
From research conducted by Wasana Taphophong regarding

vocational training for handicapped persons, it was found that the majority of the disabled are satisfied with their training, especially regarding the training evaluation, the venue and the trainer.
Table 18
Opinions of the handicapped on the learning system during vocational training
Opinions
satisfy
Blind
unsatisfactory 4
(20.0)
1
Deaf
satisfy
'18
Physical Disability
satisfu
16
Unsatisfactory
2
unsatisfactory 4 (20,0)
Curriculum & learning
16
- teaching process
Teacher, trainer
(80.0)
(eo.o)
16
(10.0) 4 (20.0)
I
(80.0)
20
(e5.0)
(5.0) 7
(80.0)
'19
(100.0)
16
Teaching & Training materials Training venue
13
4 (20.0)
2
(65.0) 20
(35.0)
(e5,0)
20
(5.0)
(80.0) 't8 (eo.o) 20 (100.0)
(100.0)
(100.0) zu
(100.0) 2
(10.0)
Training evaluation
20
(100.0)
Rules and regulations
18
to
(80.0)
4 (20.0)
17
(eo.o)
(10.0)
(85.0)
(15.0)
57
Table 19: Knowledge acquired from vocational Training
Knowledge Acquired
Blind
Deaf
Physical Disability
Total
Number
Number
12 8
Number
Number
37
19
o/o
Enough
16 4
80.0 20.4
ou.u 40,0
I
7 4
45.0 35.0 20.0

100.
0
61.7 31.7 6.6 100.0
Not - enough
Uncertain
Total
20
100,0
20
100.0
20
60
Table 20 : Reason on why the knowledge acquired from training was not
enough
Reasons
Blind
Deaf
Physical Disability
Total
Number
Want more
experience
3
% 75.0
Number
Yo
Number
4
%
57.1
Number
7
% 36.8
Too liille
knowledge acquired Not enough on occupational practice
25.0
25.0
71
14.3
21.1
50.0
4-
21.1
58
Table 21 : Occupational choice of the disabled.
Occupational Desired
Blind
Deaf
Physical Disability
Total
Self - employed
I
(45.0)
11
I
(45.0)
10
26 (43.3) 28 (46.7)
6
(40.0) Work in company or fac'tory

7
(35.0) Study at a higher level

6
(55.0)
(50.0)
1
(25.0)
(5.01
(10.0) 60 (100.0)
Total
20
20
20 (100.0)
(100.0)
(100.0)
Table 22 : Assistance Needs in Self - employed business
Type of assistance needs Financial capital
Blind N=8
8
Deaf
N=9
5
Physical Dis.
N=9 9
Total N=26
22
(100.0)
(55.5)
5
(100.0)
5
(84.6)
13
Market outlet
(37.5)
(55.5)
(55.5)
7
(50.0) 22
Additional
I
(100.0)
guidance on
occupation Place to work
(75.0)
(77.8)
(84.6)
(12.5)
(3.8)
1
Publicize the service
(12.5)
(3.8)
59
Upon interviewing with Mr. Somporn Ampavasriri, the Director of the
Office of the Committee on Rehabilitation for Disabled Persons (OCRDP)
and his team, and studied the present situation of vocational training for
disabled persons living in the community. The results are summarized as
follows: 1. The number of centers for vocational rehabilitation is sufficient to
accommodate those handicapped who live in the community, ie, OCRDP

has 7 centers
in provinces outside Bangkok.
In addition, The Department of
Skills Development has a Center for Skills Development (CSD) in each of the
76 provinces that are able to accommodate the handicapped to be trained
alongside non-handicapped people. Moreover, approximately 10 NGO's
also provide training for the handicapped. However, the number of

handicapped receiving training are still unsatisfactory since there are some
limitations that impede the handicapped from enrolling, such as education limitations (they have to complete grade 9 before enrolling at SDC) and the
ability to complete the vocational training. Table 23 will show the total
number of handicapped who have enrolled and completed the training
program at vocational training centers for the handicapped of OCRDP.
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61
2. The vocational training tools and equipmentare insufficiency and

are an obstacle to effective training because they are inadequate and out of
date, ie, black & white televisions are still being used in training.
3. The information being taught is not keeping up with

technology.
modern
4. There is a severe shortage of "workshop trainers" in over 7 different
provincial centers. Trainers must be solicited from local radio
- TV repair
shops; however the centers rarely find trainers due to the very low official
rate of pay which is BIBO per hour. Potential trainers said they are able to
make more per hour working at the shop.
4. Information network system
The majority of agencies, ie, Sirindthron National Medical

Rehabilitation Center, etc. which are governmental,
do not have a good

funcb.
system
of
organizing information due
to inadequate operating
lnformation gathering is based onthe particular agency's policies.
5. Seminars and meetings for Specialists

Recent seminars and meetings for specialisb are listed as follows:
a) National Seminar on Thailand's Future Arrangement for Special

Education
Arranged by : The Ministry of Education, 7-B July 1993
Participants
250 persons attended this seminar for
special
educators, medical doctors, psychologists, audiologist, speech

pathologists, speech instructors, persons with disabilities and their parents.
&rertsjnlhig
semlnar
- Education integration
]
62
- Teacher training
- Computer access for education
- Report on early intervention

- Thai deaf culture
- Problems in special education
b) Seminar on Future Professional Studies for Post Secondary

Education for Persons with Disabilities
Arranged by
February, 1995. Participants
Ratchasuda College Disabled Program
27
28
150 disabled, 30 teachers, educatos from the Ministry
of Education, the Minister of University Affairs, the Department of Public

Welfare, the press, TV workers, and parent of the disabled.
Objective
: to gather base-line data on attitudes of persons
with
disability concerning their needs in education and occupation placement

and post secondary education and training.
Contents of the Seminar - Common concerns of disabled persons needs
- Video presentation about higher education and access inthe USA,

Japan, the Philippines and France.
c) Seminar Evaluation of Special Education in the year of 1994. Arranged by : The Division of Special Education 10 - 14 July, 1994 at
Songkla province
Particioants
Directors and representatives from
educational
organizations and teacher of special education.
Objective
- to evaluate resulb of the work in special education - to deliver policy and strategystatements
63
- to share experiences, problems andobstacles.
d) Seminar on the Thai Brailles Grade
II
Arranged by : Ratchsuda College February 1995. Particioants : Blind educators, teachers of the blind, representatives
from the Blind Association of Thailand and Braille expcts.
Obiective : To consider of principles and rules on the Thai Braille Grade
II
in the contraction methodology for Ester writing, reading and
abbreviation coding,
e) Workshop in Orientation & Mobility of the Blind Arranged by : Ratchsuda College, 13 - 14 November 1995.
Participant: O & M specialistfromthe USA, O & M teachersfrom

schools throughout Thailand, blind educator representation from the blind association, students from teachels college. Objective
-to develop a curriculum in O & M
-to demonstrate a oracticum in O & M
f) Seminar workshop in Thai sign language

Arranged by: Ratchsuda College
This Seminar Workshop is part of a "Continuing Programs" series

given three times per year. lt started in 1994 and three more meetings were
done in 1995. with three more scheduledin 1996 Participants: - Deaf Teachers and Thai Sign Language Experts
- Teachers from Schools of the Deaf
- Representatives from the Thailand Association of the Deaf - Deaf Students
64
- Special Ed. Educators from the Ministry of Education.
Targets Activities : Areas of Work in Thai Sign Language:
June 1994 1st. Seminar: Medical & Health Related Fields. 2nd Seminar Daily Life Skills. June 1995 3rd. Seminar: Educational Field Aug. 1995 4th. Seminar; Sochl Field
Nov. 1995. Sth. Seminar: Occupational Field
1996, 6th Seminar Plan : Thai Sign Language in the Globalization

Period, signs of communication, computes, etc.
Results
-Over 2140 Thai words and 4139 signs from all 5 seminars were
collected by Video Camera
- Editing of Sign Language Vocabularies will be made in CDROM
- Distribution for experimental uses in the Deaf Communities

- Availability of Official Thai Sign language video
g)Seminar on developing standardization
in medical
rehabilitation,
November 29 - 30, 1995. At Rama Garden, Bangkok.
Arranged by
Sirindhron National Medical Rehabilitation
Centre and Provincial Hospital Division Participants : 295 people from

:
1)
Representatives from
the Sub-Committee of
Medical
Treatment for the disabled
2) Medical Directors, Deputy Directors, Academic Heads of

Regional Hospitals and hospitals from Bangkok 3) Group ieaders for medical rehabilitation
4) Representatives relating to medical rehabilitation
65
5) Representatives from the Association for the Disabled Objectives:

1) Standardizing policy and information relatingto the service
system for medical rehabilitation in order to attain a common understanding among all of those involved
2)
Exchanging information and viewpoinb
to
encourage
participation. 3) Setting standard criteria and overall direction in developng
a rehabilitation service system for the disabled nationwide

order to maintain themselves in the community.
in
h) National conference on the direction for CBR operation, February

27 -March 1, 1995 atPetchaburi Province Arranged by : The Organization for Helping Children Fund (United Kingdom) Thailand and Sirindhorn National Medical Rehabilitation
Centre
Participants : 260 representatives from the Ministry of Public Health, representatives from the Ministry of Labor, Protection
and Social Welfare, representatives fromvarious organizations for

the disabled Objective : 1) To exchange work experiences in operating CBR.
4 f o develop
a direction for implementation of a common
direction forthe 3 principle government organization (MOPH, MOLPSW,

MOE) and NGO's that are involved with the disabled
3) To improve efficiency in collaboration among

participating organization
Topics of panel discussions
1. Empowerment for equalization of opportunities
66
2. Global view of communitybased Rehabilitation

3. Rehabilitation for Disabled Persons in Thailand
4. Direction for CBR lmplementation
Topics of Presentations
1. CBR projects operated by private organizatiors
2. CBR projects operated by government agencies 3. CBR projects operated by Provincial Health Offices 4. CBR projects operated by the agency's from Head Office
6. Present condition of CBR implementation
1. The policy of CBR is multi-sectoral in approach; health, education,
social and vocational. These four sectors try to engage in more cooperation and interrogation, however, the present work of CBR is still so diverse, some
of the activities of 4 agencies seem to be overlapping.
2. Most of community leaden, community health offices, community
workers and other personnel who work

knowledge of CBR
in
community have limibd
3. The condition of CBR implementation has now passed through its
first phase (disseminating the concept and ideas, work method

personnel motivation). Presently, the CBR
and
is in the second phase which
entails the promotion and strengthening of the referral system.
4. We have found that CBR is often inadequately supported by he referral system. This is due to the fact that the majority
Hospitals have almost noservices in rehabilitation.
of
Community
67
Foreign Assistance for CBR
Some of the foreign organizations that provide support to CBR are

listed as follow
:
1. Intemational organizations providing education support.

a. Christoffel Blindenmission (CBM) Supports Education for the Blind in Thailand since 1984. Bangkok Office Tel.278 - 0040, Fax.271 - 2457
- Supports Integrated Education Tor the Blind - Community-Based Rehabilitation Programs for All Disabilities
b. Hilton Perkins International Program
American foundation, started working in Thailand
in
1987
Office at School for the Blind, Bangkok, Tel 246 - 0070 Fax.
248
- 1369
Provides and Produces Braille Books, Talking Books for the Blind, Provides Educational Equipment & Tools for School for the Blind c. Save the Children Foundation of the United Kingdom.
Address: Sukhumvi Soi 4, Bangkok 10110
d. Christian Outreach
Office
123188 M.River Home Chaengwattana Road,
Nonthaburi P.O. Box 47 Pak Kred Post Office, Nonthaburi

11120
Home for Handicapped Babies, 7919 Tivannond Road Tel.

583-3392
68
2. Operating agencies for people with physical disability

Name: Handicap lnternational Contact: B7l2 Sukhumvit 15, Pra - kanong
Bangkok 101 10
Tel. 255 - 7871 ,252 - 3676, Fax 255 - 1718
Objective : To acquire prosthesis and orthosis to help accommodate disabled persons in the country whle emphasizing the use of local materials and utilities to economize costs.
Activities/Service
:
1) Helping the disabled by providing prosthesis,orthosis, gait aids, etc. with no charge. 2) Rehabilitation services to those with physical disabilities and conducting Orientation & Mobility Training for the disabled
3) Providing training to local people, mostly disabled persons,
for making artificial legs and such by using local materials along
instruction for maintenance and repair so that they can be self-sustained.
with
Additional remarks from the interview
From additional information acquired from interview, ongoing

cooperation and support from international organizatiors are described as
follows:
1. Christoffel Blindedmission (CBM) is going to support the Office of

the Committee on Rehabilitation for Disabled Person by sending experts,
specialists and equipment to OCRDP in the coming year.
2. The Japanese lnternational Cooperation Agency (JICA) is also

plans to send specialists to the Department of Social Welfare
to
help
develop vocational training. Morover, JICA has alloted funds to build an in-
door stadium for disabled persons at Sirindhorn National

Rehabilitation Centre, Department of Medical Seryices, MOPH
Medical
3. The Handicapped
International Organization, Francq had
provided some support to the Sirindhorn National Medical Rehabilitation

Center (SNMRC) by sending prosthetisb and othotists to help train P&O technician.
4.
World Health Organization sometimes provides funding to support
SNMRC in conducting seminas/meetings on CBR.
70
5.4 The Possibility and Limitations of the CBR Model
1.CBR model case in three countries (Mexico, Indonesia and Philippines)
Model A: Support team by handicapped people (Project PROJOMO, Mexico)
Rehabilitation team Main roles by handicapped people
(supported by rehabilitation specialists)

treatment, training, manufacturing equipment
Village Rehabilitation Center (VRC)
Supporting lives
Mutual aid such as nurturing, The activities of community development
71
Model B: Mobile rehabilitation unit (Supplementation of C.B.R. Indonesia)
Community rehabilitation center at

Every districts
3 months services
Supplementation of the community rehabilitation cente Out - reach services by MRU specialist team
(doctors, physiotherapists)
activities of volunteer, community worket

home visiting, vocational training
Independence of the handicapped lncludino economical independence
Model C
: Community volunteer
system
(Local supervisor system, the Philippines)
Local supervisor (LS
Instruction, management, psychological support
Families
Specialists give one-week training to the local supervisors who are chosen
by the village people.
72
2. CBR model for Thailand.
Volunteer systems with health care centers. Thailand VillageHealth Volunteer with roles of giving information and provision of basic medical service.
VHV
Early detection and in
to the disability
handicapped
families
VHV will detect disabling symptoms and report to the health center.
The health center will train handicapped people, their family and volunteers
based on the gathered information. VHV's are chosen among the village
people.
Suggestions & Recommendations
As
earlier mentioned, the Village Health Communicator (VHC)
ha
merged with the Village Health Volunteer. Thus there are only VHV's in the
Thailand CBR Model.
73
According to the above model, joint analysis has been conducted among the various agencies working on CBR, including academics and health service personnel from the Health Centers, in order to clarify the model's possibility
and
limitations. They have concluded that the above
model has the best potential for a successful CBR project because the
Health Center
is a
competent governmental unit
in the community.
medical
in
Concerning this, some health officers have complained somewhat about the limitation
of personnel at the Health Center since there are no
doctors on duty (as done in other countries such as Indonesia). However,
the case of medical rehabilitation, the particular agencies (the hospitals
in
the respective provinces) are ready to deal with this need through a "referral
system" to refer the disabled to obtain medical rehabilitation, lf the Health
Center cannot handle it, they may refer to the community hospital, the provincial hospital or the regional hospital. For vocational and education
rehabilitation, it could be handled by requesting collaboration with the public welfare office and the education office in the respective areas.
At present, there is a pilot test on CBR in some provinces that use the Health Center as the center of CBR, ie, in Phayao Province in the northern
part
, Chumphon Province in the southern part and Nakhon Phanom

Although, CBR in pilot test area as aboved
Province in the Northeast of Thailand. lt has been done well.
mentioned have been
performed well, but for more information, from in-depth interview
of
Dr.
Pantyp Ramasoota and team on "Evaluation Disabled Children Project"

Province, had found
of the
Rehabilitation for
Udornthanee
at Sri Boonroung District ,
that
health centers do not have enough standing-out
role in rehabilitating the disabled ,ie, role as information disseminator and

role on referral case for the disabled to have medical treatment.
74
ln regard to the aboved, the key to success is to have a clear policy

with an sufficient budget for the operation, especially for providing training to the Health Center staff and Village Health Volunteers. However, the PCMO (Provincial Chief Medical Officer) seems to be
an important factor in the success of the model. lf the PCMO seriously

undertakes the
job,
his subordinate will do so as well.
Finally, the success of CBR implementation will depends not only on
setting up
a good model but will depends on the efficiency of each
individual Health Center (with the support system) as well as the capabilities
of the VHV's and the readiness of the community.
5.5 Request for International Cooperation to the National Rehabilitation Center for the Disabled
Tokorozawa, Japan.
This research has found that the disabled have obvious problems in
all aspects of
rehabilitation, ie, educational rehabilitation regarding the
shortage of schools and teachers, problems related to social rehabilitation.

However, the most urgent needs for the disabled concern is the inadequacy
of vocational and medical rehabilitation. These points are discussed in detail as follows:
l.Thailand lacks of Prosthetists and Orthotists, only having P&O

Technicians. This problem has caused low quality in the production of
prosthesis and orthosis. Currently, Thailand is not able to set up schools in the areas of Prosthetics & Orthotics. Most artificial items of good quality must
be imported from overseas. Therefore, people working with the disabled
75
need a specialized school for the instruction of P&O. This can be done by
setting up as regional institute which would not only benefit Thailand but
also neighboring countries.
2. There is a need to provide scholarships to P&O Technicians for
overseas advance training. This will allow them
to gain new ideas,
innovations and technology in order to improve their work.
3. As
mentioned earlier, vocational training still experiences
problems, especially outdate equipment and tools, including electronic

equipment, televisiors, radios, computers, and so on. Updated equipment
can give support to improving vocational training for disabled persons and
improve their competence and skillsto enter the workforce more effectively,
subsequently leading to their success in sustaining a livelihood.
4. Vocational trainers working with the disabled also haw limited

knowledge and have fallen behind
in using new technology.
Therefore,
specialists are needed to come to Thailand to help train vocational traines.
76
ANNEX 1: List of References
1. Department of Public Welfare, The Rehabilitation of Disabled person Act

(1 991
), 25 pages.(Thai)
2. Poonpit Amattayakul, et al., Sectoral Survey on Special Education in Thailand , reported
of December 1995, 129 pages. (English)
3. Khanitha Thevinphakti, The Rehabilitation for Disabled persons , published by Office of the Committee on Rehabilitation for disabled persons, 1996, 86 pages.(Thai) 4. Orapin Mahaket, Employment Problem After Vocational Training , lnstitution of Population and Social Research, 1994,77 pages.(Thai)
5. Wasana Tapaophong , Employment Opportunity of Disabled Persons.
Faculty of Social and Welfare, Thammasart University,1994,179 pages.(Thai) 6. Ministry of Public Health, Public Health Statistics , Division of Health Statistics Bureau Health Policy and Plan, 1994,168 pages. (Thai&English)
7. Sirindhron National Medical Rehabilitation Centre, Direction for CBR
lmplementation , Community Based Rehabilitation Division, 1995,157
pages. (Thai)
B. Department of Medical Services,
Rehabilitation, 1 995, 70 pages.( Thai) 9. Pantyp Ramasoota, et al., Evaluation on Rehabilitation Project for Children. Sriboonroung District, Udornthanee Province, 1 995,79 pages.(Thai) lO.National Statistical Office, Report of the Health and Welfare Survey 1996. (Thai&English)
l l.Sugunya Sriprachry-anant, Rehabilitation Information,Yol.2 No.1, January June 1995, Sirindhorn Medical Rehabilitation Centre, 38 pages, (Thai)
77
ANNEX 2 : List
of Institutional Visits
1. Office of the Committee on Rehabilitation for Disabled Persons, Ministry of Labour and Social Welfare.
2. Sirindhorn National Medical Rehabilitation Centre, Ministry of Public Health.
3. Rachasuda Collage, Mahidol University.
4. Provincial Health Office, Kanchanaburi Province.

5. Phahon Pol Phayahasena, General Hospital of Kanchanaburi Province. 6. Community Hospital, Phannom Thuan District. 7. Lum Hin Health Center, Phaunom Tuan District, Kanchanaburi Province. 8. Boo Ra - Haeng Health Center, Phanom Tuan District, Kanchanaburi
Province.
9. The Industrial Rehabilitation Centre, Social Security office, Ministry of

Labour and Social Welfare
78
ANNEX 3: List of Interviewees
1. Name
Mr. Somporn Ampavasrini
: Address :
Position
Director Office of the Committee for Rehabilitation of Disabled Persons, Department of Public Welfare, Ministry of Labour and Social Welfare Tel :282 - 1472,282 - 3853
2. Name
: :
Mrs. Sunee Saisaphatphol
Position
Chief Division, Vocational Rehabilitation and Employment Placement for the Disabled
Address: Office
of the Committee for Rehabilitation of Disabled
Persons, Department of Public Welfare, Ministry of Labour and Social Welfare
3.
Name:
Position
Chanchai Yaem - yoo
: Social Worker, Division of Welfare for the Disabled Address : Office of the Committee for Rehabilitation of Disabled
Persons, Department of Public Welfare,
Ministry of Labour and Social Welfare
4. Name
: :
Dr. Phatriya Jaruthat Director,
Position
Address
: Sirindhorn National Medical Rehabilitation Centre,

Department of Medical Services, Ministry of Public Health
Nonthaburi Province
Tel . 591 - 4242,591 - 5455
79
5. Name
: :
Dr. Praphan Pongkhanitanont Deputy Director and Head of Medical Treatment &Rehabilitation,
Position
Address

Nonthaburi Province
Tel : 591-4242
6.
Name:
Position
Mrs.
Srijit Hungsasoota
Chief, CBR Unit,
Address

Nonthaburi Province
7. Name
Mr. Aphichart Trammulsiri
: Lectuer for the Blind, Address : Ratchasuda Collage, Mahidol University

Position Salaya Campus, Phuthamonthon 4 Nakhon Prathom Province
Tel.889-5312
8. Name
Mrs. Sooksiri Pananyawas
: Head, Training Division and Education Service Address : Ratchasuda Collage, Mahidol University
Position Salaya Campus, Phuthamonthon 4 Nakhon Pathom Province
Tel. 889 - 5315
80
9. Name: Position
:
Dr. Boongium Tragoolvongse
Deputy Director,
Address: ASEAN Institute for Health Development

2515 Phuthamonthon 4, Salaya
Nakhorn Pathom Province 73170
TeL441-9040-3
10, Name
Dr. Suraphong Tantanasrikul
Position : Provincial Chief Medical Officer,
Address : Provinical Health Office, Muang District

Kanchanaburi Provinice.
11. Name
Mrs. Penphimol Siripachoti
Position : Head, PHC and Personnel Development,
Address : Provincial Health Office

Kanchanaburi Provinice
12. Name
Mr. Vichai Sampavnoi
Position : Community Health Officer,
Address : Provincial Health Office

Kanchanabu ri Provinice
13.
Name:
Mrs. Chusri Sornprasert
Position : Head, Health Center
Address : Boo Ra - haeng Health Center

Tambon Pung
Tru,
Phanom Tuan District
81
14. Name: Position
Mr. Suraphon Dap-kaeo
Head, Health Center
Address : Lum Hin Health Center

Tambon Tuam district
Kanchanabu ri Provi nice
15. Name:
Position
Mr.
Sirirat Ketprathum
Information Officer,
Address : Department of Non - formal Education,

Ministry of Education Ratchadamnoen RD, Bangkok
16. Name: Position
Dr. Kasem Vetsuthanont
Director, Phanom Tuan Community Hospital
Address Phanom Tuan District,

17. Name: Position
Mrs. Ruangrong Dephadoog Director, The Industrial Rehabilitation Centre
Address :97 Moo 3 Bangpoon, Muang District

Phathum Thani Province 12000
18. Name
Mr. Chom
Position : Chaiman, Community PHC Center
Address : Boo - Rahaeng, Pang Tru Sub-district

Phanom Tuan District,
82
19. Name
Mr. Vithaya Rabil
Position : Village Health Volunteer,
Address :8712 Moo 1 Ta - muang District

20.
Name: Akaboon
Fakfaiphauk
Position: Health Specialist, Address: Provincial Health Office Chathaburi Province

Tel. 039 - 31 1 - 166 Ext. 105
21-22. Two disabled persons at The Industrial Rehabilitation Centre
23. A staff in charge Rehabilitation Section at Phahon Pol Phayuhasena,
Provincial Hospital of Kanchanaburi Province
24.Name:
Mrs. Thasanee Srisawang
Position: Teacher, Preparatory School for the Blind Address: The Christian Foundation for the Blind in Thailand under The
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Research On The Needs of Community Based Rehabilitation (CBR) For Disabled Persons in Thailand

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Research On The Needs of Community Based Rehabilitation (CBR) For Disabled Persons in Thailand

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Research on the Needs of Communlty Based

Rehabilitation (CBR) for Disabled Persons in Thailand

Som-arch Wongkhomthong, M.D Chongkolnee Chutimatavin, IVIA

Institute for Health Development Mahidol UniversitY

Funded by Natlonal Rehabllltatton Center for Dlsabled Persons JaPart

Research on the Needs of Community Based

Rehabilitation (CBR) for Disabled Persons in Thailand

Som-arch Wongkhomthong, M.D Chongkolnee Chutimatavin, MA

ASEAI{ Institute for Health Development

Funded by National Rehabilitation Center for Disabled Persons Japan

By Som-arch Wongkhomthong, Chonkolnee Chutimatavin ISBN: 974-661-593-9

In regards to the success of this research project, I would like to thank

and acknowledge the kind assistance and cooperation of people

organization concerned. Many thanks to the Director of Sirindhron National

Medical Rehabilitation Centre of Department of Medical Service, MOPH and

her team, The Director of Office of the Committee on Rehabilitation for

Personnel Development and Primary Health Care and the

Heads of the Health Center.

our special thanks to Assoc. Prof. Dr. Boongium Tragoolvongse

Som-arch Won gkhomthong

A cross-sectional descriptive study to identify the situation and needs of

community-based rehabilitation (CBR) for disabled persons in Thialand was

specific objectives: identifying the general situation

methodologies consist of three methods;

a literature survey from published

caurses of disability are mostly due to congenital anomalies, accidents and

2. CBR Services: In 1991, the government has issued six decrees

equity between disabled persons and non-disabled person

registered under the "Rehabilitation Act" to receive rehabilitation services free

of charge, providing all levels of education as considered appropriate. The

own communities, the Medical Service Department (MDS) has begun by

a rehabilitation manual. Now the MDS is in the process of pilot-

testing a model of "lndependent Living Unit". CBR by the Public Welfare

be expanded to 15 provinces in 1997. There are some problems in creating

as the educational limitations that

tools is insufficiency, the information being taught is not keeping up with

a severe shortage of "workshop

Moreover, CBR is often inadequately supported by the referral system.

CBR the model for Thailand is that

it will be utilized by Village

This model has the best potential

success for CBR. At present, there is a

5. Request for International Co-operation: This research has found that

urgent needs concern

vocational and medical

are: (a) people working with the disabled need a

to help train vocational

Help Groups, as well

as the disabled people

themselves. These efforts have

The next stage on CBR in Thailand has now been undertaken by

Acknowledgement Executive Summary

ii-iv v-vi vii

Introduction Research Objectives

ll. Research Methodologies

lV. Research Period

5.1 Basic Statistic 5.1.1. lndicators of health and population

5.1.8. Main organization of CBR

5.2 CBR Services

5.3.2. Distribution of primary health care in the district

reported) 2. Livebirths and Deaths 3. First 10 leading cause group of death

disabled 22. Assistance needs in self-employed business