Study on Support for

Persons

with Disabilities

Project Director

Professor P antyp Ramasoota

Research Members

Assist. Prof. Boonyong Keiwknrnka

Ms. Somjai Pramanpol

Mr. SomsskWongsawass
Ms. D o un gs amorn Chinchotikas em

M* Bang-onThepthien

ASEAN

Instltute for llealth DeveloPment
Mahldol LlntversltY
March 2OOO

ffi

Japan Internatlonal Cooperatlon Agency Thailand

Study on Support for
Persons with Disabilities

Project Director

Professor

P

antyp Ramasoota

Research Members

Assist. Prof. Boonyong Keiwkarnka

Ms, Somjai Pramanpol

Mr. SomsakWongsawass
Ms. D o un gs amo r n Chin chotikas em Ms. Bang-onThepthien

ASDAN

Institute for flealth Development
Itlahidol Universlty
March 2OOO

Japan International Cooperatlon Agency Thailand

Study on Support for Persons with Disabilities

By

Pantyp Ramasoota, Boonyong Keiwkarnka, Somjai Pramanpol, Somsak Wongsawass, Doun gsamorn Chinchotikasem, Bang-on Thepthien

ISBN: 974-663-795-9

First Edition 2000 Printed Printing Division ASEAN Institute for Health Development Mahidol University, Salaya Nakompathom 731 T0,Thailand

by:

Pantyp Ramasoota Study on Support for Persons with Disabilities / pantyp ... [et al.]

1. Disability
W8320 P19s 2000 ISBN: 974-663-795-9

Evaluation L Title

Acknowledgement
The research team would like to express their acknowledgements to
the following persons and organizations for their kind cooperation, valuable
guidance, and technical, emotional and financial support provided throughout

the study.

First and foremost, thanks are due to Ms. Naoko lTO, Mr. Mitsuhiko
KAZOE and JICA for the opportunity offered to conduct this study, along with

the supplement of information, advise and references to facilitate the study, Appreciation also goes to Prof.Dr.Somarch Wongkhomthong, director

of AIHD, for his generosity in administrative and motivational support of the
study.

We are especially gratefulto Dr. Kriangsak Akepongse, director of SBR Hospital, and his staff for unconditional assistance and hearty support during
the field operation and beyond.

Last but not least, we are indebted to PWDs and their families,
guardeans of PWDs and key informants in the community for providing us
valuable data for the study.

Pantyp Ramasoota
and Research Team

I

Executive Summary
The comparative descriptive study for the support of PWDs in Nong Bua Lumpoo (NBL) Province was conducted from 8 February - 23 March 2000. Sriboonruang (SBR) District, where the CBR Program had been used for ten years, was the study site, and Naklang District was the control area.
The objectives of the study were to compare the characteristics of the PWDs in both districts in terms of socio-demographic, epidemiologic, problem needs,

assistance received, quality of life as a measure of the impact and contribution of the CBR Program, and lastly, to investigate feasible and
effective projects to support PWDs.

The study methods included qualitative and quantitative approaches; i.e., documentation review, focus group discussions, indepth interviews, observation of activities, and surveys using structured questionnaires. The

study subjects included guardeans

of

PWDs, key informants

in

the
:

communities PWDs and their relatives. The results of the study showed that

1. From the quantitative study, the findings revealed that NBL Province

was ranked

14th

for

the

prevalence rate of disabled, of the whole kingdom.

There were more male PWDs than females. The working age group was suffering more than other age groups; SBR District had the highest number of

PWDs. Other characteristics were similar in both district. Physical and mobility impairment was the most common, the second was intellectual and learning ability impairment, and the least was mental and behavioral
impairment. The main cause of disability was illness.

The majority of PWD were single, however almost all of them were living with their families. They were generally unemployed, low education, and poor. Most of them did not have special equipments or received any
assistance. Their main source of assistance was their family. The assistance
needs were for work to earn money and medical care.

For the quality of life, PWDs, in general, perceived their health status and living conditions as tolerable. They were satisfied with public health
services, and assistance received, except for welfare for equipment.

ilt

2. From the qualitative study, the findings showed that there were
several activities organized for PWDs in SBR District but none in Naklang, District. The projects were generally initiated and supported by government organizations with involvement and participation of local people to a certain

degree. Activities and contributions of the project were found to be active at
the district level and had little effect in the peripheral areas.

3. Although the government was strongly committed and supported CBR action, the implementation made only a small achievement, due to
several factors. They were
:

-

Knowledge and technology for the CBR Program were imported
and

and not appropriate for local and rural application. Research

Development should be encouraged to systematically collect the local body of knowledge and indigenous technology and adapt it to suit the needs and ways of life of PWDs in the Thai cultural context.

-

Shortage of personnel to work in the CBR Program both in quantity

and quality. Personnel development was recommended to provide and upgrade skills and knowledge of the CBR Program for personnel who are now
working as well as those newly recruited.

-

Family and community were lacking capability to deal with their

PWDs. They had little concerned for PWDs. The priority of PWDs was ranked
below other health problems since the impact of the disabilities to society is

not visibly obvious. The poor and disadvantaged rural people were more
concerned with their living conditions than health problems. The family,

society as well as PWDs themselves possessed fatalistic attitudes and
prejudices toward disabilities. The comprehensive approach integrating all

aspects

of the CBR Program for the disabled (medical, educational,

vocational and social) was recommended at the family and community levels.

4. The coordination probtems between involved organizations for the
CBR Program, such as; referral system management, classification criteria for registration and inadequate medical specialists, were suggested to be solved

by the appointment of working group and liaison officers to work on the
problematic issues and to facilitate the coordination.

IV

5.

The lack of intersectoral coordination among those involved in the

Rehabilitation Action resulted in the problems of practical management. In

coping with the problem,
networking

it was

recommended

to

develop an informal

to build a good sense of

understanding among collaborating

sectors through a liaison officers in each organization.

6. In NBL Province, the lack of decentralized authority and
responsibility resulted in limiting the contributions of CBR activities, which were active only at the district level. There was no evidence of any spill-over effect to PWDs at peripheral rural

areas.

In addition to centralization, the

reactive nature of services, as well as the lack of public relations and public education, were also limiting factors. The proactive strategies of the CBR Program in the villages were recommended including, developing

a

mobile

team to mobilize the activities in the community; setting-up the CBR unit in the

community with regular supervision from mobile team; providing public
education to correct negative social attitudes and improve knowledge and

understanding

in regard to PWDs; and mobilize community

participation

through TOA and people organization.

7, The feasible and effective projects to support PWDs through the
technical cooperation
scheme

of JICA was proposed under the JICA assistance of "experts dispatch, "JOCV', trainee acceptance" and "community

empowerment program". The projects included: Training

of Leaders of
Community

PWDs; Vocational Training for PWDs; Capacity Strengthening for Personnel

Working with PWDs; Disability Resource Team; and
Empowerment through PAR.

V

List of Abbreviations
ARI
BM

Acute Respiratory Infection
Bangkok Metropolitan Bangkok Metropolitan Administration

BMA CPHCC

Community Primary Health Care
Center

CBR
FGD

Community Based Rehabilitation Focus Group Discussion Government Organ ization Ministry of Education Ministry of Public Health National Statistics Office Non-government Organization Naklang District Nong Bua Lamphu Province Office of Social Security Participatory Action Research Person with disabilities Sriboonruang District Tambon Administrative Organization

GO MOE MOPH
NSO NGO

NK NBL OSS PAR PWD SBR TAO

VHV

Village Health Volunteer

VI

Table of Contents
Page

Acknowledgement Executive Summary

i

ii
V

List of Abbreviations
Table of Contents

vi

List of Tables List of Figures List of Charts
Chapter

viii
ix
ix

1

Methodology

1.1 Specific Objectives 1.2 Approach 1.3 Methodology 1.4 Study Population 1.5 Research Instruments 1.6 Data Collection
Ghapter

1
1

2 2
6 6

2

Background Information

2.1

Disability Statistics at the National Level

I
9

2.1.1 2.1.2 2.1.3 2.1.4 2.1.5

Epidemiology of Disabilities Registration Status Government Health and Welfare

I
11

Assistance Need from the Government
Organizations Involved in Rehabilitation For PWDs

'14

16

2.2 2.3
Chapter

Disability Statistics of the Northeastern Region Nong Bua Lamphu Provincial Information

18
21

3

Research Findings

3.1

Quantitative Study

26 26 29 34

3.1.1 Socio-demographic Characteristics 3.1.2 Epidemiology of Disabilities 3.1.3 Needs and Resources for PWDs

vii

3.1.4 Knowledge about Rehabilitation
Disabled Persons Act

of

36

3.1.5 Attitudes of the Family and

Community

36

toward PWDs and Disability

3.1.6 Quality of Life of PWDs

38
41

3.2

Qualitative

Study: Project

Community Activities for People with Disabilities

3.2.1 Sriboonruang: a Model District 3.2.2 The Club for PWDs

41

42

42 3.2.3 The Sriboonruang Foundation 3.2.4 The Tambon Administrative Organization 43 (rAo) 43 3.2.5 Sriboonruang Hospital 3.2.6 School with lntegration (Mainstreaming) 44 Program

3.2.7 LocalWisdom of Poo-Pri
Chapter

45

4

Discussion and Recommendations

4.1

Rehabilitation Program for

PWD Province

47

Responsible Factors for Minimal Progress of CBR Action

4.2

Situation of CBR in Nong Bua Lamphu

51

Recommended Proactive Strategies for CBR in the village

4.3

Future Technical Cooperation with

JICA

52 59

Bibliography - Number of Organizations which Provide Services Annex |
to PWDs, Thailand

Annex Annex

Directory of Non-Government Organizations who Provide services to PWDs, North-Eastern Region Directory of Government Organizations who Provide services to PWDs, North-Eastern Region

ll lll

-

List of ln-depth Interviewees List of Participants of Focus Group Discussion

Questionnaire

vill

List of Tables

Table

Page

1. 2. 3. 4. 5. 6. 7. 8. 9.

Number and percentage of samples in study and comparison area Reported disabled population by age, sex and area
in the northeastern region

2

19

Reported disabled population by age and type of

20

disability in the northeastern region
Registered PWDs in NBL by sex, age and type of impairment Number of registered disabled persons in Nong Bua Lamphu by district Registered PWDs in NBL by district and types of impairment Socio-demographic characteristics of relative respondents Socio-demographic characteristics of PWDs Epidemiology, etiology and management of the disabilities 25 27 28
31

23 24

10. Assistance needs and resources for PWDs 11, Knowledge and information on rehabilitation in the Disabled Acts 12. Perceptions of PWDs on the attitudes of family and community
toward their disabilities

35

36 37

13. 14.

Attitudes toward disabilities Number and percentage of PWD satisfaction toward facilities and quality of life

38 40

ix

List of Figures
Figure
Page

1.

Percentage of type of disability by sex for the whole kingdom

10

2.
3.

Percentage of PWDs receiving health insurance by sex for the whole kingdom Percentage of disabled persons by type of disability and kind of government assistance need for the whole kingdom

12

13

List of Ghart
Ghart

1. Rights and Benefits for PWDs by Programs
Legislative Act

and

CHAPTER

I

Methodology

This descriptive study compares the situation

of

Persons with Disabilities

(PWDs)

in Sriboonruang District of Nong Bua Lamphu Province, where the

Community-Based Rehabilitation (CBR) Program has been launched since 1990, with Naklang District of the same province.

1.1 The specific objectives include:
1. to study the disability
statistics in the two districts.

2.
3.

to study the social and epidemiological characteristics of the disabilities
in the two districts.

to study the activities of

governmental organizations, international

organizations and non-government organizations (NGOs) including
community self-help organizations for PWDs in the two districts. 4. to identify the problems and needs of PWDs and their families in terms of medical, educational, financial, legal and socialwelfare.

to determine the quality of life of the PWDs in terms of their
satisfaction, welfare and aid received.

life

to compare the situation of PWDs in the two districts as a measure of
the impact and contributions to the CBR Program.
7. to investigate feasible and effective projects to support PWDs based on

their problems, needs and availability of governmental and social
structures.

1.2 Approach
The approach used three research channels: 1. A documentation review of relevant data on the PWDs in Thailand and

the North-Eastern region in general, with an emphasis on Nong Bua Lamphu
Province in particular.

2. In-depth interviews and focus group discussions on the information of
disabilities with the authorities and key informants at local, provincial and national
levels.

3. A survey using structured questionnaires to identify the individual
problems, needs and life satisfaction of PWDs with individual PWDs in the two
districts.

4. Observation of activities provided for PWDs by existing organizations
(govemment, non-govemment, private, community and family) in the two districts.

1.3 Methodology
Design : descriptive Population

:

1. PWDs in Nong Bua Lamphu Province (NBL)

2. Authorities for PWDs

1.4 Study population

:

The PWDs in NBL Province, aged 20 years and over were included.
Sriboonruang District (SBR), where the CBR Program has been operating for 10 years was purposely selected as a study area; Naklang District was chosen to be
a comparison study site, based on the comparable prevalence rate of disabilities.

Trained interuiewers made a survey using a structured questionnaire with every PWD in two randomly sampled tambons of each district. In case PWDs were not
able to communicate, the relatives were interviewed instead.

Table

I

Number and percentage of samples in study and comparison areas

Study Area

Number
181

Percentage
64.4
64.1

Sriboonruang District

- Tambon Nakorg - Tambon Muangmai
Naklang District

116

65 100 38 62

3s.9 35.6 38.0 62.0

- Tambon Noen Muang - Tambon Naklang

Map of Thailand

3

Map of Northeastern Region Showing Provincial Boundaries

4

Nong Bua Lumphu Map

N

+

Udon Thani Province

Muang

Udon Thani Province

o

Khon Kaen Province

5

1.5 Research lnstruments
Research instruments for the proiect included:

1. A precoded structured suruey with closed and opened
regarding socio-demographic characteristics of PWDs

questions

2. 3.

Epidemiological characteristics of PWDs Problems and needs of PWDs

Quality of life of PWDs, including life satisfaction, welfare and
assistance received.

Check lists for observation of activities provided for PWDs

Unstructured questions
discussions.

for

in-depth interuiews and focus group

1.6 Data collection
The data collection comprised four methods including:

1.

In-depth interviews with 13 authorities for PWDs at national and local
levels concerning topics of policy plans, budget and conslraints related

to health services and programs on education, welfare, as well
social, political and legal issues of PWDs.

as

2,

Focus group discussions on the awareness and management of PWDs

with four groups of 10-12key informants in each of at the villages in
four tambons.

3. 4.

Surveys by trained interviewers using structured questionnaires.

Observations of activities in the Center for PWDs, the SBR Hospital,

Muangmai Vitaya School,

the

Disabled Club,

and Sirindhorn

Rehabilitation Center for PWDs.

6

Focus Group Discussion

In-depth Interview

7

;*$ilir

t!'

l*'

fft

-+ #

Household survey of PWD and Relatives

8

CHAPTER II

Background Information

2.1. Disability Statistics at the National Level
2.1.1. Epidemiology of Disabilities
The Thailand Institute for Health System Research, MOPH, has made a survey of the health status of the Thai population aged five years and over, by

means of physical examination. The study revealed that the total number of
PWDs was approximately 4,825,681 or 8,1 percent of the total population (57.1
million). They were classified as follows: Seeing impairment Hearing and communication impairment Physical and mobility impairment Mental or behavioral impairment Intellectual or learning ability impairment Others 955,485

or or or or or or

19.8Y"

299,192 2,745,813
226,807 477,742

6.2% 56.9%
4.7o/o 9.9o/o 2.SYo

120,642

Epidemiological data showed an apparent increasing trend of the numbers

of PWDs. A survey by The National Statistical Office (NSO) reported

that

between 1986 and 1991 the prevalence of disabilities increased 2.5 times and
remained stable until 1996. The distribution was higher among males, the elderly

and working age groups. The highest number was physical and locomotive impairment, followed by seeing and hearing impairment, and mental and
intellectual impairment was the lowest group. Data from the Otfice of Social Security (OSS) revealed that although the rate of occupational hazards was
increasing every year, the disability rate was decreasing.

2.1.2. Registration Status Recent records on the registration status of PWDs by the Department of Social Welfare, Ministry of Labor and Social Welfare revealed that in 1g96, only

231,2ffi PU\lDs uere regisbred under the Rehabilitation of Disabled Persone Ast
BE 2534, distribubd by rcgion as:

(BM) Cental Region (excluding BM)
Bangkok Mefopolitan

10,663

49,849 57,910 85,864 26,920

Northem Region
Northeastem Region

Southem Region

Flgurc

I

Percentage

of

type of disability by sex for tfie whole kingdom

oE
OE

FE PE

otr rE

ss EE

Esfi

Typcf

s

frdity

Source: Natiotd Suvey on Hedth ardWblfare: 19S, NSO, Offico dthe Prirne Midsier

10

2.1.3.Government Health and Welfare
More than half of PWDs, 52.5 percent, receive welfare and health seruices

from the government through some kind of insurance. PWDs who hold assistance cards of all kinds, including a low income welfare card, elderly card
and veteran card, are the major recipients of welfare and health seruices from the

government, 55.5 percent, 29.6 percent receive services through health cards,

and 8.9 percent comprised the group of government official welfare/pensioners
and state enterprises. A small proportion receive assistance from social security,

Workman's Compensation Fund, 3.8 percent, and personal private health
insurance accounts tor 2.2 percent.

11

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2.1.4. Assistance Need from the Government

A survey by the NSO 1996, revealed that 66 percent of PWDs for the
whole kingdom expressed needs for assistance from the government. The assistance needs were specified as follow:
medical care, surgery and physiotherapy instruments for disabilities
30.2o/o

7.4o/"
5.9Yo

skilltraining jobs
loans for earning and living lodging special education others

5.7o/"
5.4o/o

4.30/"

4.0%
3.3"/o

Male and female PWDs varied in assistance needs from the government according to the type of disability. Both sexes needed medical services, surgery

and physiotherapy as well as equipment for disabilities. Among PWDs with physical and mobility impairments, for males, the assistance needs were in
providing jobs and opportunity to work, while for females, the assistance needs

were providing loans for earning and living. Males with mental or behavioral impairments and intellectual and learning disabilities needed assistance for
lodging, but females of the same disability type needed assistance for special education.

For the multiple disabilities group, females needed assistance for skill
training but males needed special education. Govemment policy for PWDs incorporates the concept that "PWD5 are socially disadvantaged and are entitled to receive medical services and health

free security" and emphasizes " the rehabilitation of patients receiving medical services rather than the rehabilitation of the disabled after treatment,,.

14

Chart

1

Rights and Benefits for PWDs by Program and Legislative Act.

Programs/

Responsible Organization
Ministry of Labor and SocialWelfare, Ministry of Public Health

Financial Sources
Government budget

Rights & Benefits For Disability
Rehabilitation services

Service Unit
Public and Private Health Facilities

Act

1.

Rehabilitation

Act. BE 2534

2. Compensation Act. BE 2517

Ministry of Labor And SocialWelfare

-

Employer Government

-

Compensation

Public and Private Health Facilities

-60% of salary, 10 yrs for loss of body parts
15 yrs. for disabled

3. SocialSecurity Act. BE 2537

Ministry of Labor And SocialWelfare

Employer Employee Government

-

Medicalfees not over
2000 BahUmonth 50% of salary compensation for life

Public and Private Health Facilities

4. Car-accident lnsurance

Ministry of Commerce

Car owners

- Medicalcare - Compensation
for death
Fees for

Public and Private Health Facilities

Act. BE 2535
5. Welfare for

Ministry of Finance

Government budget

-

OPD Patient

government officials, pensioners, and state enterprises

- rehabilitation - specialequipment
prosthesis/orthesis

(public facilities)

-

IPD & OPD

Patients (private & public facilities)

6. Private Health
lnsurance

Insurance company

lnsured persons

-

compensation for prosthesis/orthesis compensation for loss of income

Public & Private Health facilities

7. MedicalWelfare for the helpless and needy

Ministry of Public Health

Government budget

Free rehabilitation Medical equipment

-

Public Health facilities

The new paradigm that views "PWDs as

a

national resource and

rehabilitation of the disabled as an investment in human resources to enable them to live productively with dignity in the society" has been recently adopted
after the democratic movement for the rights of PWDs.

There were several acts and programs developed for PWDs of which the
rights and benefits are summarized in Chart
1.

15

2.1.5. Organizations involved In Rehabilitation for PWDs
There are governmental organizations distributed among the six ministries

and 68 non-governmental organizations involved in rehabilitation activities for
PWDs as presented in the followings:

Ministry of Labor and Social Welfare

1. Department 2. Department

of Social Welfare Office of Rehabilitation for PWDs

of Labor Protection

3. 4.
5.

Rehabilitation Center for Workers, Bangpoon Department of Labor Skill Development Office of Social Security (OSS)

Ministry of Defense

1.

Pra Mongkut Klao Medical College

2.
3. 4.

Department of Military Medicine, Army, Navy, Armed Force, Bhumipor
Hospital, Pra Pin Klao Hospital, Military Hospital in several provinces Veteran Organization Sai Jai Thai Foundation

Ministry of Interior

1.

Police Hospital

Bangkok Metropolitan Administration

1.

Otfice of Medical Service

2. Office of Health Seruice 3, Vachira Hospital, Taksin Hospitat, Klang Hospital
Ministry of Public Health

1.

Office of Permanent Secretary

- Hospitals under the Office

2.

Department of Medical Service

- Sirindhom National Medical Rehabilitation Center - Four Hospitals under the Department

16

Department of Mental Health
- Two Hospitals under the Department 4. Department of Health - Occupational Health Division

Ministry of University Affairs

-

Faculties of Medicine under the Ministry Office of Policy and Planning

Non-Government Organizations
Seruices for seeing impairment Services 4 7 24
5 5

for hearing impairment

Services for physical impairment Services for intellectual impairment Seruices for multiple impairments

Ministry of Education
School with Integration (Mainstreaming) Programs

Bangkok Areas

-

Preschool Primary school Secondary school

2
10 5

Outside Bangkok A,rea
Northern Region Northeastern Region Southeastern Region Gentral Region 4
12

3
2

Bangkok Metropolitan Administration
Primary School for Slow Learners Private School for Autistic
13

2

17

2.2 Disability Statistics of the Northeastern Region
The prevalence rate of PWDs is the highest in the noftheastem region of
Thailand, the rate is 386.8 per 1,000 population. There were more males than females in all age groups except in the old age group (age 60 years and over)

where females outnumbered males (a9:33). However, the highest rate is found among the older age group,60 years and over, (82.1 per 1,000 population).
Most of them were scattered throughout non-municipal areas which was 20 times more than municipal areas (368.5 and 18.3 per 1,000 population). Of all the types

of disability, physical and mobility impairment (128.2 per 1,000 population) has the highest prevalence followed by hearing impairment, mental retardation and

seeing impairment, 74.5, 67.0 and 46.9 per 1,ooo population, respectively
(Tables 2 and 3)

18

o E
.c

o o

c (U

F
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2.3. Nong Bua Lamphu Provincial Information
Nong Bua Lamphu (NBL) Province is the 73'd province of Thailand,
situated in the northeastern region. lt has been separated from neighboring Udornthani Province since 1993. The province is 608 km from Bangkok. lt is adjacent to Udornthani Province in the north and east, to Khonkaen Province

on the south, and to Loei Province in the west. The total area is 3,859,626
square km, covering six districts, 58 subdistricts (tambons) and 623 villages.

The administrative areas consist of 1 municipality, 29 communities and

11

sanitation units. There are 1A2,082 households and the total population is 507,130, most of them, 55 percent, belong to the working age group and
elderly people constitute 6.6 percent.

Geographical and geological characteristics

The landscape of NBL Province is a plain plateau area of fields and
forests. A majority of the land is dry, mountainous and the soil structure is
sandy and rocky. The climate is hot and humid in summer and cold in winter. The economic status is ranked 9fr among the 16 provinces of the northeastern region with a per capita income of 19,186 bahVyear.

Health statistics

Public health facilities consist of one Provincial Hospital (120 beds),

four District Hospitals (two 60 beds and two 30 beds), and 81 Health Centers.
The health statistics are as follows:
- Crude Birth Rate
- Crude Death Rate 13.70

- lnfant Mortality Rate
- National Growth Rate

/ 1,000 population 4.76 | 1,000population 2.59 | 1,000population
0.89/1,000population

Morbidity and mortality data reflect the life styles and living standards
of the people. The statistics demonstrate that heart disease of all kinds is the

first leading cause of death (102.4

/

10O,0OO population)

followed by cancer of

21

all kinds (85.38

/

100,000 population) accident, injuries, suicide, and homicide

is ranked eighth (9.66

/

100,000 population.) and the 10h leading cause of

death is from AIDS (7.88 / 100,000 population)

Human Health Resources of Nong Bua Lamphu Province
Data on 30 September 1990 revealed that there were 13 physicians, 4 dentists, 46 professional nurses, 66 technical nurses, 5 pharmacists, and 38
paramedics, working in public health facilities of Nong Bua Lamphu Province
.

The leading cause of morbidity, from OPD records of all hospitals in
NBL District, is ARI with a total number of 42,904.97 patients per 100,000
population. The second order is gastrointestinal diseases with a morbidity rate

of 28,425.65 per 100,000 pop. The distribution of morbidity of in-patients
follows the same pattern.

Epidemiology of Disabilities in Nong Bua Lamphu Province The number of PWDs of NBL Province as determined by registration
status, which is at the rate of 34 per1100,000 population, was ranked at the
14m order of the whole kingdom. There were more male disabled persons

than female. The working-age group population is suffering more than other age groups. (Table 4) Sriboonruang (SBR) District had the highest number of
PWDs probably due to the positive impact of the CBR Program in the area which increased awareness of the PWDs and their families and alerted them to come for registration. (Table 5)

Physical and mobility impairments is the most common among the PWDs in NBL Province, the second is intellectual and learning abllity impairment, which is less than half of the first and the least is mentality and
behavioral impairment. (Table 6)

22

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Table

5

Number of registered PWDs in Nong Bua Lamphu by district

Total
Muang Naklang (NK) Sriboonruang (SBR) Non-Sang Sawan Kuha
Na Wang

252
241 287 175

158
119

410 360 454

167
139

314
335 125
1,ggg

206
75

129 50
761

1,234

Source:

Provincial Health office of Nong Bua Lamphu province, 1gg9 MopH

24

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CHAPTER III
Research Findings
3.1. Quantitative study
3.1.1 Socio-demographic characteristics

Study subjects comprised 281 PWDs; two-third of them were from
Sriboonruang District. Respondents were 66 percent PWDs and 34 percent

relatives. The proportion of PWD/relative distribution showed the same trends
in both districts. (Table 1)

The majority (78 percent) of relative respondents were females of a
high age group (45 and above). Most of them were parents and siblings of PWDs (67 percent). Only nine percent were spouses. The PWD families
were generally poor, 78 percent of them had a monthly income of less than

2000 baht. Families averaged five members. Their main occupations were farmers (70 percent) and laborers (20 percent). They were permanent members

of the village with an

average

of 38 years

tenancy. The
the

characteristics were comparable in the study in almost every aspect. Only the

economic status and duration

of tenancy were slightly greater in

comparison area than in the study area. (Table 7)

The majority of PWDs, 45 percent were single and 17 percent were divorced or separated. However, almost all of them were living with their
families including parents (42 percent) spouse 33 percent children 52 percent and siblings 31 percent, There were only 2.5 percent that were living alone.

Only 23 percent of PWDs had jobs and earned on their own. Such work
included: rice farming, weaving, basket-making, and common

labor. Half of

them were unemployed, while 25 percent worked for their families with no pay. Two-third of the PWDs had schooling and a majority had completed
primary education. Only 13 percent attained a higher education than primary

level. PWDs in SBR District were generally less educated than thqse in NK District. Almost all in-school PWDs attended regular school, only 2.1 percent
were educated in schools with special education programs for the disabled. For the blind and deaf, 32 percent never had schooling, the main obstacle
was due to their disabitities. (Table 8)

zo

During the daytime, nearly 90 percent of PWDs stayed at home, of

which two-thirds lived unproductive lives. They did nothing or watched TV
most of the

time. Only 10 percent worked at home to earn money, and 21

percent helped with household chores without wages.

Relationships between PWDs and their neighbors were positive. The
neighbors were helpful and friendly to PWDs, When PWDs were in need they received help from their families, friends and neighbors. The most resourceful people for PWDs were their parents (40 percent) followed by spouse, children and siblings 30 percent,22 percent and 20 percent, respectively.

Table

7

Socio-demographic characteristics of relative respondents
Characteristics Sriboonruanq
N (48)
o/o

N (48) o/o 48 52 9 39
1

Naklanq

Total
N (96) 96 185
21

Interviewees

-

Family/relative Disabled Male Female 14-24

48
133 12

26.5 73.5 25.0 75.0
6.3 20.8
29.2

48.0 52.0
18.8 81.2
2.1

34.2

65.8
21.9 78.1

Sex

-

36
3 10 14
21

75
4

Age (years)
4.2
25.O

25-44
45-59 60 and over llliterate Primary Secondary

43.8
10.4

14 18 15 5 36 6
1

29.2

37.5 31.3
10.4

24 32 36
10

33.3 37.5
10.4
BO.2

Education
5
41
1

85.4
2.1 2.1

75.0
12.5
2.1

77
7 2

7.3
2.',|

Vocationaland higher Marital Status

1

-

Married Single Divorced/separated/widowed

30
2 16 7 34 6
1

62.5
4.2

30
4
14

62.5 8.3
29.2 18.8 67.7 12.5
2.1

60
6

62.5 6.3
31.2 16.7 68.7 12.5
2.1

33.3
14.6

30
16

Occupation
Unemployed Agriculture Labor Government sector Relationship with PWDs Spouse Parent Grandparent Child/grandchild Brother/sister

-

I
32 6
1

70.8
12.5
2.1

66
12 2

-

2 27 1 10
3 5

4.2 56.3
2.1

10.4
20.8

- Relative

6.3

7 14.6 18 37.5 12.1 11 22.9 I 18.8 2 4.2

I
45
2 16 19

9.4 46.9

2.6
16.7 19.8

5

5.2

27

Table

I

Socio-demographic characteristics of PWDs

Characteristics

Sriboonruang
N

Naklang
N (100) o/o N

Total

(181)
76
73 32

o/o

(281)

o/o

Maritalstatus of PWDs

- Married - Single
Widowed/divorced/ separated

42.0

51

51.0 33.0
16.0

40.3
17.7

33
16

127 106 48 118 93 146 86 1 10 9 7 147 64 70 3 189 89 109 96 65 60 28 10
203 189 67 108 81 58 45

45.2

37.7
17.1

Living with (multiple response)

- Parent - Spouse - Child/grandchild - Brother/sister - Friend - Grandparent - Relative - Living by oneself
Occupation

77
61

42.5

41

41.0
32.O

42.0
33.1
52.O

33.7 55.8 32.0 0.6 3.3
1.7

32 45 28

101

45.0
28.O

58
1

30.6

0.4 3.6
3.2 2.5

6 3

4 6 3

4.O

6,0
3.0

4

2.2

- Unemployed - Self-employed
Work without pay

89 43
49

49.2

58
21 21

58.0 21.0
21.O

52.3 22.8 24.9

23.8
27.1

Education

- Current enrolment - Past enrolment - Never
Daify activity (multiple response)

2

1.1

1

1.0

1.1

122
57

67.4

67
32

67.0
32.O

67.3 31.7

31.5

- Resting/ do nothing - Assisting housework
- Watching TV, reading,etc. - Working with pay

70 70 42
41

38.7 38.7
23.2

39 26 23
19 8 7

39.0
26.O 23.O

38.8 34.2
23.1

22.7
11.0 1.7

19.0 8.0 7.0

21.4 10.0 3.6

- Handicraft, gem cutting - Playing with friends
Relationship with neighbors (multiple response)

20
3

- Greeting
Talking/Chatting

137

75.7 70.8 27.6 47.0 32.6
23.2

66
61

66.0 61.0
17.O

72.2 67.3 23.8 38.4 28.8 20.6 16.0

128 50 85 59
42

- Playing together - Eating together - Participation Social Activity - Being helped/take care by neighbors - Helping disabled when they need
taking care

17

23 22
16

23.0
22.O

16.0 8.0

37

20.4

I

28

3.1.2. Epidemiology of the disabilities
There were more number of PWD males than females. The age
group of 60 and above comprised 27 percent, followed by age group 20-29 and 30-39 at similar proportions,24 percent. Nearly half of them, 45 percent
became disabled after 20 years of age. One-fourth were born disabled. Those

with disabilities developed during preschool age, 1-5 years old, comprised 15
percent.

Only one-third of PWDs had registered for diagnosis of impairment

status and were issued the official document confirming their impairment

condition. Non-registration was mainly due to a lack of knowledge and
information about the Rehabilitation for Disabled Persons Act, BE. 2543.

Regarding the type

of disability, physical or mobility

impairment

comprised the majority, 43 percent. lmpairment in terms of seeing, hearing or

communicating, and intellectual or learning ability followed, 26 percent, 18

percent and 12 percent, respectively. Multiple impairments comprised 12 percent. The least impaired among study subjects were in terms of mentality
or behavior 10 percent.

The characteristics of impairments among studied PWDs included
stammering, dumbness, blindness in one or two eyes, hearing impairment or total deafness, amputated legs, arms, fingers and toes and disabilities of the

limbs, harelips and cleft palate, paralysis, paresis, kyphosis (humpback),
psychosis and mental retardation.

The etiology of disabilities among PWDs, based on respondents' perceptions, revealed that illness accounted for 39 percent, whereas 3
percent claimed that medical malpractice was the responsible factor, accident

and congenital defects were of equal proportion, 22 percent and unknown
cause was 8 percent.

Most of the disabilities caused by accidents occurred outside the
home. Road and working accidents were of the same proportion, 24 percent. Others included drowning, falls and injuries.

A majority of PWDs, 74 percent in both districts did not have
facilities and equipment needed for their disabilities, such as, prosthesis, orthosis, hearing aids, canes and crutches. Nevertheless, two-third of them

29

were able

to go out by themselves.

Difficulties and inconveniences
physical

encountered

by PWDs when going out were from their own

handicaps as well as deficiencies in infrastructure such as ramp ways, street

footpaths, and public transportation, and inadequacies
mentioned.

of

facilitating

equipment. In addition, feelings of shamefulness and inferiority were reasons Of the PWDs, 21 percent had other

fami! members who were

also
41

disabled. Most of the disabilities were first noticed by family members,

percent, 36 percent were recognized by health personnel, physicians, nurses

and public health workers and 29 percent were identified by

PWDs

themselves. The immediate management of the family for PWDs was seeking

treatment. The rest, 31 percent, took no action. There were several choices

of treatment sought for PWDs, varying from modern treatment from public
hospitafs and health center, 84 percent, folk magic treatment, 22 percent, folk

medicine, 15 percent, traditional medicine, 10 percent, to self-treatment, 4 percent. However, at present, only 15 percent of PWDs were under treatment. The reasons given for not being treated included: 67 percent not necessary because impairments were not treatable, 27 percent not able to atford the
cost of their treatment and time factor 6.3 percent.

The present conditions of impairment compared to its initial stages were 41 percent stable, 31 percent deteriorating, and 27 percent improved. PWDs were generally healthy, half of them never reported being sick, 31 percent had minor ailments and received treatment at the hospital and/or
health center. Their health behaviors were considered fair. as one-fourth of them smoked and drank.

Of the PWDs 60 percent perceived that their impairments were irreversible. Although two-thirds of them had attended training courses for
rehabilitation, they rarely practiced it, (table g)

30

Table

9

Epidemiology, etiology and management of the disabilities

Characteristics
N

Sriboonruang

Naklang
N

Total
N (281)

(181)
90
91

o/o

(100)
61

o/o

Sex of PWDs

- Male - Female
Age of PWDs (years)

49.7

61.0 39.0

151

53.7 46.3

50.3

39

130

- 20 -29 - 30 -39 - 40-49 - 50 -59 - more than 59
Age that dlsability developed

44
41

24.3 22.7
12.2 11.0

26 27
13
12

26.0 27.0
13.0 12.0

70 68 35
32

24.9
24.2 12.5 11.4

22

20
54

29.8

22

22.0

76

27.0

-

At birth
years years

41

22.7
17.7

30
11

30.0
11.0

71

25.3
15.3

- 1-5

32
12

43
18

- 6-10

6.6 7.7 45.3

6 10

6.0
10.0

6.4 8.5
44.5

- 11 - 20 years - more than 20 years
Registration status

14 82

24

43

43.0

125

-

Yes

72 107 2

39.8
59.1
1.1

34 65
1

34.0 65.0
1.0

106 172 3

37.7
61.2
1.1

-No

-

Unsure

Type of impairments (Multiple response)

- Hearing - Seeing - Locomotion - Mental/behavioral - Intellectual - Multiple impairment

29
51

16.0 28.2 44.2

21

?1.0 22.0
42.0 12.0 18.0 13.0

50
73 122

17.8

22

26.0
43.4

80
15

42
12 18 13

8.3
15.5 11.0

27 46
33

9.6
16.4 11.7

28 20

31

Characteristlcs
N

Srlboonruang

Naklang
N

Total
N

(181)
4
46

oh

(100)
4
16

o/o

(281) I
62

7o

Gause of dlsability

- Genetics
Accident

2.2
25.4

4.0
16.0 45.0 25.0
1.0

2.9
22.1

- lllness - Congenital - Drug addiction - Malpractice - Stress - Unknown
Type of accident

64
38
1

35.4 21.0 0.6 3.3 2.2 9.9

45 25
1

109

38.8 22.4 o.7

63
2 9

6
4 18

3
1

3.0
1.0

3.2
1.8

5 23

5

5.0

8.2

- In house setting - Occupational
- Traffic - Others
Speclal equipment received

11

23.9
26.1
2',1.7

1

6.3
18.8 31.3 43.8

12 15 15 2A

19.4 24.2 24.2 32.3

12

3

10 13

5 7

28.3

-

Yes

42 135 4

23.2 74.6 2.2

26 74

26.0
74.O

68 209 4

24.2 74.4

-No

- None needed
Self-help ability

't.4

Dlff

Yes

't21

66.9
33.1

63 37

63.0 37.0

184
97

65.s
34.5

-No
lcultlesl lnconven lences
(Multiple response)
Own physicalhandicaps
Def iciency

60

134
58 34

74.O

71

71.O

205 83 56

73.0 29.5 19.9

of

inf

rastructure

32.0
18.8

25 22

25.0
22.O

Feeling shamefulness

Having relatives who were dlsabled Initial detection by
(Multiple response)
44

65.9

16

16.0

60

21.4

-

Doctors/f,,lurses/PH

59

32.6

42

42.O

101

35.9

Otficer

- Family - Oneself - Friends/neighbors
Others

70 62 6
1

38.7 34.3 3.3 0.6

45
19
1

45.0
19.0

115
81

40.9 28.8

7

2.5 0.4

':o

1

32

Characteristics
N

Sriboonruang

Naklang
N

Total
N (281)

(181)
63
1

o/o

(100)
23

o/o

lmmedlate Management

- None - Unsure
Treated

34.8 0.6 64.6

23.0

86
1

30.6 0.4 69.0

117

77

77.0

194

Treatment received
(multiple response)

- Modern medicine - Magic /folk medicine
Traditionalmedicine
Self-treatment

100 17
11

85.5
14.5

62
12 9 3

80.5
15.6

162
29 20
7
41

83.5
14.9 10.3

9.4
3.1

9.0 7.0

-

4

3.6 14.6

Current treatment
( Multiple response)

32

17.7

I
7
1
1

9.0

- Modern medicine - Magic/ Folk treatment
Traditional/herbal medicine

30
1

93.8
3.1

77.8
11.1 11.1

37
2 4

90.2 4.9 4.9

3

9.3

Not treating currently Reason for not treating

149

82.3

91

91.0

240

85.4

- lmprovemenVself-care - Not treatable - Costly treatment
Time constraints

28 95

18.8

14

15.2

42
154

't7.5
64.2 26.7 21.3

63.8 27.5
24.2

59
23 15

64.8
25.3 16.5

4'l
36

64
51

Disablllty status compared

to initial stage

- lmproved - Deteriorating - Stable
Rehabilitatlon training
Hospitalstaff
Foundation staff VHVs and others

49 62

27.1

28 26 46

28.0 26.0 46.0

77 88
116

27.4 31.3
41.3

34.3 38.7

70

16 6 2

66.7
25.O

5

83.3

21

70.0 20.o
10.0

6
1

8.3

16.7

3

33

3.1.3 Needs and resources for PWDs Family members are the main source of assistance for PWDs. Of the PWDs 43 percent were assisted by their children, 39 percent by parents, 26 percent by siblings and only 16 percent by spouses. The greatest needs of PWDs from their families were care and assistance in time of sickness, in
daily living activities as well as financial support for necessary equipment.

Most PWDs, 88 percent, had varieties of assistance needs such as

the need to work and earn money, 69 percent, to receive medical care, 65
percent, to receive education, 10 percent, and to have legal assistance, only 2 percent.

Among the people and groups in the community, the most important

persons that PWDs perceived as having significant roles in providing help were the Tambon Chief, Village Headman and VHVs, 47 percent, neighbors

and the Tambon Administrative Organization (TAO) were also seen as
important, 33 percent and 14 percent, respectively. (Table 10)

34

Table 10 Assistance needs and Resource for PWD

Assistance need

Sriboonruang
%

Naklang
7o

Total
Yo

Helping persons (multiple response)

- Spouse - Child/grandchild - Parents - Brothers/sisters - Grandparent - Relatives - Friends/neighborhood - Noone
Assistance needs from Government (multiple response)

14

15.1

10
1

16.7

45 32 27
1

48.4

35.0 45.0
21.7

34.4 29.0
1.1

7
13

2 3

3.3 5.0 5.0
1.7

9
9

9.7 9.7 2.2

3
1

2

24 66 59 40 3 12 12 3 162 172 24 4 86 24 19 69 86 19 12 67 93 65 39 28 11

15.7
43.1

38.6
26.'1

2.0 7.8 7.8 2.0

-

Medicalservices
income

103 116 15

65.2

59 56
9
1

65.5
62.2

65.3 69.4 9.7
1.6

- Work and

73.4 9.5
1.9

- Education - Legalassistance
Assistance needs from family
(multiple response)

10.0
1.1

3

- No need - Medical care/treatment - Providing aid/equipment - Home care - Financial support - Moralsupport - Income generation
Help from lndividual/ group in

57 20
17

31.5
11.0

29 4
2

29.0

30.6 8.5 6.8 24.6 30.6 6.8 4.3

4.0 2.0
27.O

9.4 23.2 27.6 4.4 5.5

42 50
8 10

27 36
11

36.0
11.0

2

2.0

community (multiple response)

- Village headman

39 65 43
21 21

21.5

28
28 22
18 7

28.0 28.0 22.0
18.0

23.8
33.1 23.1

- Friend/neighbor - Village Health Volunteer . TAO
- Teacher/monk - Club or group

35.9 23.8
11.6 11,6

13.9 10.0

7.0 5.0

6

0.6

5

3.9

35

3.1.4. Knowledge about the Rehabilitation of Disabled Persons Act

Only 18 percent of PWDs knew about the Rehabilitation of Disabled Persons Act, (BE 2534). Half of them learned from mass-media including TV,
radio and newspaper. They also received information from hospital staff and from the Tambon Chief / Village Headman, 28 percent and 20 percent, respectively. Most, 86 percent, knew that once registered to be diagnosed and officially documented they were entitled to receive free medical care and
1

1 percent knew that they could receive monthly allowances. (Table

1

1)

Table 11 Knowledge and Information on
Persons Acts

The Rehabilitation of

Disabled

Information
Source of information

Sriboonruang
33 18.2

Naklang

Total
17.O

17 17.0 17
9

about the Rehabilitation of Disabled Persons Acts - Television, Radio

14

42.4
6.1

52.9
17.6

23
2 10 14
1

46.0 4.0
'17.6

- Printed materials - Neighbors - Hospital statf - Family member
Benefits of registration

2

7

21.2

3 5

I
1

27.3 3.0 17.7 87.5
'12.5

29.4 12.0 83.3 8.3
16.7

29.4

2.0
15.7

32 28
4

12
10
1

44
38 5 6

- Free medical care - Monthly allowances - Other socialwelfare

86.4
11.4

4

12.5

2

13.7

3.1.5. Attitudes of the family and community toward pwDs and

disability
Regarding altitudes toward PWDs, 88 percent of pwDs had positive perceptions on the attitudes of their families toward themselves. Generally, most of them perceived that their families cared for and treated them as a person who deserved consideration and understanding due to their unique need. Further, they were able to be someone that the family could be proud

36

of. However, there were some negative perceptions that humiliated PWDs
such as being a burden and bringing shame to the family. Moreover, they felt fatalistic attitudes by family members toward their disabilities.

PWDs expressed similar perceptions on the attitudes of the community toward themselves as toward the family, but to a less positive
degree. (Table 12)

Table 12 Perceptions

of PWDs on the attitudes of family and community
Family

toward their disabilities

Perception

Community

o a a a o

ls a burden on the family ls shameful for the family ls a result of sin and bad conduct ls a person to be understood ls a useful person ls a person that needs to be cared for ls a person that the family can be proud of ls a person that needs special consideration

180 121

64.1
43.1

105

37.4 32.7 64.8 78.3 60.5 71.5 53.7

92

225 244 213
241

80.1

182 220
170 201
151

86.8 75.8 85.8
62.6

a
o

176

240

85.4 207
61.6 83.6
151

73.7

a a

ls a person with talents ls a person that should receive

173

53.7 71.2

235

200

exceptional privilege
ls a person that should be treat like any other
105

37.4

188

66.9

Regarding attitude toward disabilities, apparently thg PWDs and the

communities possessed fatalistic attitudes toward disabilities. Sin and bad conduct of PWDs themselves, as well as of their parents, in either a previous
or the present life, were factors claimed to be responsible for their disabilities at the highest proportion, 68 percent. Consistently, 60 percent perceived that

the disabilities were not preventable. Among the objective perceptions, 47

37

percent of PWDs perceived that their disabilities resulted from illness; 25
percent from accident and carelessness; 9 percent from medical malpractice

of including health/medical personnel; 6 percent from work conditions and
lastly 5 percent from heredity. (Table 13)

Table

13

Attitudes toward disabilities

Aftitudes
Causes (multiple response)

Sriboonruang

Naklang

Total
Vo

- Sin of PWD - Sin of parents - Bad conduct - lllness - Old age
- Trauma during pregnancy - Accident - Carelessness

94 23 6 79
3

51.9
12.7

54
13

54.0

148
36

52.7
12.8

3.3 43.6
1.7

2 38
0

13.0 2.0
38.0

7
117

2.5 41.6
1.1

I
47
1

5.0
26.O

2
2A

0.6
6.1

0
5

- Work conditions
Prevention of disability

11

03 2.O 20.0 01 5.0
45.0 52.0

11

3.9
23.8

67

o.4
16

5.7

-

Preventable Unpreventable Unsure

68
98
15

37.6
54.1

45
52
3

113
150 18

40.2

53.4
6.4

8.3

3.0

3.1.6. Quality of Life of PWDs

The quality of life for PWDs, was assessed based upon their self estimation of their health status, life satisfaction in terms of availability of
needed equipment and facilities, accessibility to services and information, and

welfare and supports from public and private agencies. The findings revealed

that although PWDs in SBR District seemed to enjoy the availability of a variety of services, from both public and private agencies, the satisfaction for their present health status and living conditions were noticeably lower than PWDs in Naklang District. Satisfaction of public services for education,
occupation, and legal aspects, except for health, were recognized as better, in

38

SBR District as well as the availability of private services. However, PWDs in

Naklang District were more satisfied with facilitating infrastructure, such as public transports, recreation areas, and public toilets, as well as personal
equipment (wheel chairs, hearing aids) than PWDs in SBR District.

In general, half of PWDs perceived their health status and living
conditions as tolerable. Two-third was satisfied with public health services,

and more than half perceived that the existing road system was convenient. The least satisfaction, only 18 percent, was about welfare for equipment.
Interesting enough, it was found that PWDs of Naklang District appreciated

their health and living conditions more than in those of SBR District. (Table
14)

39

Table

14

Number and percentage of PWD satisfaction toward facilities and Quality of Life

Satisfaction about

Sriboonruang

Naklang
n

Total
o/o

Infrastructure for PWDs

-

Road

110

60.8 38.7
19.3

49
39 37 34 49 24

- Transportation - Park/recreation - Telephone
- Toilet
Supportive aids or equipment
Health status

70
35
61

33.7 38.7
15.5

70 28

49.0 159 39.0 109 37.0 72 34.0 95 49.0 119 24.0 52
62.0 151 55.0 149 74.O 198

56.6 38.8 25.6 33.8
42.3
18.5

89 94

49.2

62 55

53.7 53.0

Living condition
Government eenrices

51.9

- Medical - Educational - Social - Consultation/ legal rights
Non-Government services

124
66

68.5 36.5 25.4
19.9

74
31

70.5

46 36

15
13

31.0 97 15.0 61 13.0 49
3.0 2.0 4.0
13

34.5
2'.1.7

17.4

- Foundations - Funds - SocialWelfare

10

5.5 3.3 8.3

3 2

4.6 2.8
6.8

6

I
19

Groups

15

4

40

3.2 Qualitative Study
In-depth interviews with authorities

for PWDs and focus

group

discussions with four groups of local key informants in SBR and Naklang Districts revealed that disability is prioritized at the fourth or fifth rank among public health problems of SBR District, since problems such as communicable diseases and drug addiction have a greater impact on society. Besides, the magnitude of disabilities that appears to be a major problem in SBR District, compared to other places, may not represent the true picture. Since SBR
District had conducted a survey of PWDs and other places had not; therefore,

the rate of disabilities in sBR District is higher, but actually, would be
approximately the same as other places.

Community Activities for PWDs
The activities of the community organized for PWDs were concentrated mostly in SBR District. The project was generally initiated and supported by government organizations with involvement and participation of local people to a certain degree. Activities and contributions of the project were found to be active at central levels and had little effect at the peripheral areas; e.g., the
majority of PWDs in the village never heard about any organization for PWDs. The following are the projects for PWDs in SBR District. 3.2,1. Sriboonruang : a Model District Project

A project for PWDs was established under the initiation of the director
of Sriboonruang District Hospital. The project was chaired by the District Chief

Officer, and a committee consisting of the chief of every government sector, the temple abbot, merchants, local politicians and well-to-do people in sBR District. The secretary of the project was the Sriboonruang Hospital Director,

who was very enthusiastic towards problems of PWDs. The hospital staff
were also active committee members. The project is famous because it was developed by the government sector. The people, as well as local authorities,

such as the Village Headman, TAo, VHVs and school teachers were all involved in the project. The Village Headman, Village Health Volunteers and

41

school teachers cooperated in conducting a survey of PWDs in their areas

and sending them for registration. They also provided them with knowledge about the rights of PWDs under the Rehabilitation Act. The project activities

included: physical rehabilitation services, occupational training, special
education programs and fund-raising. Each activity was responsible by its unit committee. In addition, the project provides a loan with interest for PWDs to use as seed money in their business or occupation. The project was able to

raise large amounts of funding through the participation and involvement of
SBR District residents.

3.2.2. The Club for PWDs

In 1998, PWDs, through the guidance and facilitation of Sriboonruang
District Hospital, organized a club of PWDs in SBR District. The club has 50

members and

a committee with a

chairman and secretary. The office is

situated

in

Sriboonruang Rehabilitation Center within

the compound of

Sriboonruang Hospital. Since it is still a growing organization, the activities are

limited. However, they were able to get funds from the Department of Social
Welfare and the Ministry of Labor and Social Welfare to run the club activities in the amount of 200,000 baht. The activities of the club included occupational

training, physical rehabilitation and meetings among club members to plan
work opportunities for PWDs. They had planned to recruit more members and

to have a PWD representative from each of the 12 Tambons (subdistricts) to
sit as a committee member so that they could share problems and exchange
experience. They also planned to set up a life insurance scheme for PWDs.

3.2.3. The Sriboonruang Foundation

The Sriboonruang Foundation is an organization established for the
purpose of helping relieve the financial problems of SBR District,

a

model

district project. This foundation has its specific functions to mobilize funds to:

1.

support the activities of Sriboonruang; a model district project and the club for PWDs.

2.

act as a consultative body for the Sriboonruang Project.

42

3. work as a coordinating body among the Sriboonruang Project, the Club for PWDs and the community. The
committee of the Sriboonruang Foundation is separated from

the Sriboonruang Project so that it will be independent in decision-making and management. lt will also relieve the
workload of the Sriboonruang Project staff. The committee of

the

foundation consists of representation from the government, NGOs, private sectors and the people of

lt is chaired by the director of Sriboonruang Hospital, through the nomination of its
Sriboonruang District.
members.

3.2.4. The Tambon Administrative Organization (TAO)
Public consciousness and movements in Sriboonruang have increased awareness of the TAO in every tambon of the problems of PWDs in their own

responsible area. They were encouraged to allocate

a budget for specific

to suppoft PWDs in various forms. They provided financial assistance to PWDs to individuals as well as groups; e.9., providing
purposes
transportation for PWDs to participate in social activities organized for PWDs

on National PWDs Day. Some TAOs had planned to allocate funds for the
construction of infrastructure and public facilities necessary for PWDs such as
street footpaths, ramps, toilets and drinking water and recreation facilities.

3.2.5. Sriboonruang Hospital

is an extraordinary district hospital, for the director, Dr. Kriengsak Akepongse, is highly motivated. He is strongly
Sriboonruang Hospital
committed to the problems of PWDs. Efforts were made to renew activities of

the CBR Center and revitalize the spirit of the staff which had been steadily
declining since the Foundation for PWDs was withdrawn. A special hospital team was set up for PWD activities. A social worker was assigned to take full

time responsibility, specifically for CBR, and to be an active secretary of the
team.

43

The seruices provided by Sriboonruang Hospital for PWDs include:
medical rehabilitation and treatment services (diagnostic service, laboratory inspection and other types of special examination), hospital nursing care, home visiting service, counseling service and referal for special treatment
services.

3.2.6. Pilot School with lntegration (Mainstreaming) Programs

There were three pilot schools in SBR District that integrated special
education children into regular programs; they were Muangmai Vitaya School,
Baan Don Por School and Baan Sriboonruang School.

Obseruation of activities and an in-depth interuiew with a teacher was conducted in Muangmai Vitaya School. The finding revealed that at present the school accommodates 40 disabled children who study together with a total
of 700 students. The teacher, Ms. Sarapee Naambundit, had been personally

interest in teaching the children with disabilities even before the integrated program was announced. She had tried to develop teaching techniques as well as modify the teaching methods for these children by her own initiative and many years later she was sent for training on communication with PWDs.
She said integrated education program had many problems to be solved such
AS:

1.

Relationships between disabled children with disabilities and normal children are not natural

2. Although the children with disabilities may have average learning

abilities compared to their non-disabled class-mates, but in general,

they are slower learners with short spans of concentration due to

their handicaps. Thus, the rate of learning slowed. Cooperation among the families is needed to prepare the children with
disabilities appropriately before sending them to school.
3.

A deficiency of qualified and devoted teachers for these children exists due to a shortage of teacher human resources in general;
therefore, an integrated educational program is extra work for the
teacher.

44

9.2.7. The Local Wisdom of Poo-Prai

Poo Prai (Grandpa "Prai") is a 71-year-old man of sBR District whose only grandson "suriya" had been a crippled child since he was born. Suriya
had cerebral palsy from an abnormal delivery. Grandpa Prai was the only one

in the family that had hope for Suriya. He took Suriya to see the doctor at every appointment and performed physical rehabilitation for him regularly as instructed by the physician. Most striking, Poo Prai improvised equipment from household materials to be used as rehabilitative tools for Suriya, such as walking ramps, crutches, canes, and wheel chairs. His indigenous wisdom became famous not only in the village and SBR District, but all over the
country. He is now a resource person for every PWD center. Poo Prai said his inspiration came from the encouragement of the staff of the Foundation for PWDs who gave him constant emotional and technical support. His grandson

is now 16 years old and is studying in the senior class of his secondary
school. His physical handicaps, although much improved, are still prominent but he has the skills to manage his life etficiently,

45

lmprovised Equipment for Disability Rehabilitation

'"il

*\
t,r,i,rf..r

Local wisdom and Indigenous technology "from grandpa to grandson with love"

CHAPTER IV

Discussion and Recommendations

The study of support for PWDs was conducted through several methods of data collection, including surueys of pWDs and relatives, FGD with key community informants in-depth interviews with authorities,
observation of activities, and a review of documents. The findings provided knowledge on the situation of disability and CBR, and its related compound
problems.

4.1 Rehabilitation Program for pWDs
The Rehabilitation of Disabled persons Act, BE 2sg4 (1991), presented policies to provide equity between disabled and non-disabled persons in

society. For example, it allows disabled persons to become senators, to work
in government positions and to have the right to be employed, The law ent1les

PWDs, who have registered under the Rehabilitation Act,
rehabilitation services including:

to receive

a. medical

rehabilitation service, medical treatment costs, aids and

equipment

for

rehabilitating physical, mental/psychological

conditions or improving capabilities.

b.

providing all levels of education as appropriate either in ordinary schools or special schools. their physical condition and potentialto work.

c. giving advice, consultation and occupational training appropriate to
d.
entitling them to participate in social activities and access to various facilities and essential services.

e. providing government lawsuit seruices and contact
governmental organ izations.

with

47

The main policy of the CBR is to promote community members, including state and private agencies in the city and rural areas, family
members

of PWDs, local organizations at nationwide, provincial,

district,

subdistrict and village levels to work together in using community resources

and local knowledge to contribute to the rehabilitation of PWDs to their
highest potential. Thus, the family and community will participate in caring for and providing rehabilitation efforts for the PWDs in the community. This will
result in maintaining a happy life for the PWD.

In conclusion, the CBR consists of four components; i.e.,

medical

educational, occupational/vocational, and social/psychological rehabilitation.

Responsible factors for minimal proqress of CBR action

Although governmental policy was clearly laid out and
commitment was demonstrated through the support

a

strong

of large amounts of

governmental funds for CBR action, the implementation had made only
minimal progress. The responsible factors ranged from ideological, technical
and managerial to cultural components.

1. First and foremost, the knowledge and technology for the CBR were

imported and were not appropriate

for local and rural application.

For

example, to wheelthe imponed wheel chair on the dusty unpaved village road

and to construct street footpaths or ramp ways in public toilet in the village,

were all absurd ideas which would be impossible in the rural community setting today. Therefore, the local body of knowledge and indigenous

technology existing

in the community should be encouraged and

systematically collected, through research and development, and adapted to
suit the needs and way of life for PWDs in the Thai cultural context.

2. The shortage of personnel to work in cBR programs in terms of quantity and qualityi i.e,, lacking of skills, knowledge, and understanding of
CBR concepts and practices at the urban and rural levels and the curriculum in university and college limited development.

Recommendations

for the development of personnel working

with

PWDs include:

-

Increasing the availability of personnel training and upgrading
Requiring all personnel working with PWDs, (health, education)

the skills of untrained personnelwho are now working with PWDs.

to complete a specific number of hours of " upgraded skills training" each year
with evaluative reports tied to salary increases.

Providing regular workshops

for staff to learn adaptive

technology available for servicing PWDs.

3. The capabilities of the family and community to deal with PWDs were lacking. FGDs with key informants revealed that the community had
little concern for PWDs. The community leaders had little or no knowledge at

all about the problems of PWDs in their village. The health priority of PWDs
ranked low due to the fact that the impact of disability to society is not visibly

obvious. The communities did not think of PWDs as a burden because the
family takes care of PWDs themselves. The belief that disability results from

sin or misconduct was widespread. In addition, rural people, due to their
poverty and economic disadvantage, were more concerned with their living
conditions and finances more than health and social problem.

The attitudes of some key informants expressed toward PWD reflected

the prejudice of the community against disability and PWDs in general. There
were families that felt ashamed of having a disabled child and tried to hide them from the public. The school teacher admitted that integrating disabled

children into regular classroom is impossible because they disrupted and
slowed down the class.

It is recommended that a comprehensive approach at the family and
community levels should be strengthened by integrating all essential aspects

into PWD services. Social and economic problems of PWDs and families
should be addressed as much as their impairments and health problems.

49

4. Almost all health/medical

care facilities concentrate their seruices on

corrective treatment of the impairments rather than functional rehabilitation; therefore, the facilities and equipment necessary for rehabilitation services are inadequate. lt is recommended that the dissemination rehabilitation concepts

and skill training to carry out PWD activities should be strengthened among
medical staff and authorities.

5.

The coordination between involved organizations for the CBR was

also a problem, including: referral system management, classification criteria

for registration, i.e., the MOPH has five levels of impairment while the MOE has nine levels and inadequate medical specialists to issue certificates of
registration. There were needs to develop a practical standard for use that

would be accepted by all partners

-

through the appointment of a working

group on the problematic issues. Another recommendation is to have a liaison

officer at each institution that would be able to make recommendations on
needs which can be given to allthe various organizations.

6. Since there are several sectors involved in the Rehabilitation Act, such as the MOPH, Ministry of Labor and Social Welfare, Ministry of Education, Ministry of University, BMA, Budget Bureau and also nongovernment organizations; therefore, the intersectoral coordination problem
was inevitable and resulted in problems of practical management. The Office

of Rehabilitation Authority can only give recommendations and suggestions but has no power to reinforce. Unless the authority came from the Prime Minister with united enforcement the problem of intersectoral coordination
could not be solved. However, it is necessary to distribute functions and roles

for CBR services among various organizations, since one organization can
not provide the full range of rehabilitation seruices needed by PWDs. 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, it is recommended to develop an informal network and build a good sense of understanding among collaborating sectors so each organization

50

knows its role in coordination with others through liaison officers in each
organization.

7. The ministerial regulations issued under the

Rehabilitation of

Disabled Persons Act was a law intended to facilitate assistance and support in society with no compulsory status. The measures were rather in the form

of

motivations and incentives, such dS,

the company or industry

that

employed the PWD will be entitled to tax exemptions. But for the working place that did not want to hire PWDs, there was no negative consequence.

Therefore,

the

vocational/occupational rehabilitation

as well as

social

rehabilitation were not very successful. lt might be workable if the law had

attached the negative incentives such
employment of PWD.

as

increasing taxation

for

non-

4.2 The Situation of the CBR in NBL
As it was revealed by the qualitative study, the activities of the CBR for
PWDs in NBL District were quite impressive. There was a strong commitment

for the CBR program among government officials at provincial and district
levels. Collaboration among various organizations, including, district offices, district hospitals, local parliament and schools, as well as unofficial leaders,

i.e., abbots, and Poo Prai were efficient and effective. The team was
regarded nationwide as a professional rolemodel for the CBR.

long period of withdrawal by the Foundation for Handicapped Children, the activities of the cBR were continued and sustained. The physical facilities and funds were available with good After
management. However, those activities were only active and recognized at

a

the district level. There were no, or only very little spill-over effects in the community, either at Tambon or village levels. Little was known or discussed about the Sriboonruang Project, PWD Club, Sriboonruang Foundation,
lntegrated Education School or the wisdom of "poo prai" The factors contributing to the situation were due to the nature of the functions and roles of the government organization that concentrated and

51

confined the work within their settings. The strategy was also reactive rather

than proactive. The lack of public relations and public education were also
contributing factors.

Recommended Proactive Strateoies for CBR in the Villaqe

It is recommended to use the proactive strategy for the CBR in the
village and to: 1. Develop a mobile team statf who will serve as a catalyst to mobilize the activities in the community and to coordinate between the community and
involved organizations for needed assistance.

2. Set up the CBR unit in the communityi i.e., CPHCC, in which simple

and routine activities can be handled by local people or VHVs themselves
under the supervision of specially trained health center statf and periodic
supervision by medical teams from district hospitals.

3. Provide knowledge and understanding in regard to the disabled to
the community people in order to correct negative social attitudes, in the form

of group education, individual dialogues at home visits, and public relations
through the means of the public address system in the village.

4. Encourage the participation and involvement of the community
specific activities, and giving recognition to promote motivation.

in

any activity for PWDs, including the assignment of responsibility in handling

5. Use Pafticipatory Action Research as a tool to
form of a civil society.

mobilize civic

consciousness for PWDs, and effect collective decisions and actions in the

4.3

Project on Future Technical Cooperation with JICA for PWDs in Thailand
Justification

The study on support for PWDs in Thailand revealed that the prevalence of PWDs is the highest in the northeastern. There were more
males than females in all age groups except in the old age group aged 60 years and over. However, the highest rate is found among the older age

physical and mobility impairment had the highest prevalence, 128.2 per 1,000

population, followed by hearing impairment, mental and seeing impairment,
respectively (74.5,67.0 and 46.9 per 1,000 population).

Although the government had provided assistance to PWDs, in terms

of

medical, educational, occupational, and social services, through the

that 5 percent of the total estimated PWDs were registered under the Act, despite 66 percent of them had
Rehabilitation Acts, BE 2534, the fact expressed their need for assistance from the government, which included all services specified in the Act. The reasons were mainly due to the limitations on the PWDs part. Most of them are poor, living in rural non-municipal areas and physical handicapped. Poor understanding of family and community and

a lack of facilities and equipment for commutation were also barriers. The government and community also had limitations in terms of a shortage of
skilled and qualified personnel, including medical specialists, public health nurses, physiotherapists, social workers and teachers. In addition, the institutional based non-proactive type of service was unable to cover the
majority of PWDs.

With reference to the philosophy of the CBR that aimed at providing an equity between the disabled and non-disabled in society, and the CBR policy of promoting the community members, including state and private agencies to
work together to contribute to the health and welfare of PWDs, therefore, it is

necessary to strengthen the capacities of all sectors involved, in terms of
improving their knowledge, understanding, skills and expeftise to perform their

tasks in providing services to PWDs. These include the family and community

members, health personnel, school teachers,
themselves. The examples of activities are:

as well as the PWDs

53

1. Training PWD Leaders

Under the JICA assistance scheme of "trainee acceptance" and "expert

dispatch," training will be organized for PWDs who show capabilities and interest to devote themselves to the health and welfare of all PWDs. The training will be either a domestic course for Thai PWDs or an international course for PWDs from neighboring countries, i.e., Laos, Cambodia, Vietnam and Myanmar.

Objective:

1.

to

provide PWDs information and knowledge regarding other

PWDs leading to a deeper understanding of PWD problem.
2. to provide opportunities for PWDs to share problems and exchange

experience in problem management.
3.

to enable PWDs to serve as leaders in the promotion of welfare
measures for PWDs at local and regional levels.

Method and Content
The training will consist of lectures, study tours and practice on:

-

analysing the current situation
PWDs

to understand the needs

of

promoting organized activities for PWDs

improve public relations programs regarding the rights and
needs of PWDs organizing social activities for PWDs

Training Srtes

-

The domestic training will be organized in the Noftheastern
region, where the Rehabilitation Center for the Disabled is
located; e.9., Udornthani or Khonkaen Province.

54

-

The international training will be conducted either in Thailand
or in Japan.

2. VocationalTraining for PWDs

Under The JICA assistance scheme of "JOCV," a vocational training is proposed for poor, unemployed PWDs who need assistance to work and earn

money. The vocational training will be designed

to suit the types of

impairments of trainees and will be organized in the community to fit the local

context. Community resources, including, human resources, materials,
technology and local knowledge will be mobilized to support training.

Objective:

1. to provide knowledge and skills for PWDs to conduct
appropriate for their impairments

works

2. to provide the opportunity for PWDs to find employment and to access the chance for successful employment and business
opportunities

3. to alleviate the low economic status of PWDs and family 4. to equip PWDs with dignity and self-reliance 5. to mobilize community resources to contribute to the improvement
of the quality of life of PWDs.

Method and Content

The JOCV teams, consisting of all kinds of professional experts, will be

the trainers of the training. The content of training will vary according to the
conditions and needs. Home industry training may include: mushroom raising mat and basket weaving, artificial flower making and, garment manufacturing.

Training in the institution may include computer training, printing, electronics, metal working, accounting and management.

55

Training Site
The home industry training should be conducted in the community at household sites. The institutional training should be conducted vocational

colleges (technological colleges) or teacher colleges (Rajapat Institutes)
which are scattered over almost every province in Thailand.

3. Gapacity Strengthening for PersonnelWorking with PWDs.
Findings revealed that the greatest felt needs of PWDs was for medical

seruices and special equipment and that there was a shortage of qualified

personnel working with

PWDs. The total number of doctors who

had

received medical rehabilitation certification, to date, was only 41 persons all

over the country. The other types of personnel; i.e., public health nurses, social workers, and medical technicians, were lacking knowledge and skills such as home nursing, counseling, rehabilitation prosthesis, production and repairing, orthosis and other equipment operation. Knowledge and skill
training regarding rehabilitation seruices for PWDs; therefore, is proposed to

be conducted under the JICA assistance scheme of "expeft dispatch" or "JOCV team program". The training will be a "training for trainers".
Training Site

The training will be conducted in Institutes such as Khonkaen University within the Faculty of Medicine, Faculty of Medical Technology, Equipment and Physiotherapy, Faculty of Nursing and School of Social
Wod<ers.

Objective:

1. to strengthen the capability of the health personnel working with PWDs, in terms of knowledge and skills regarding rehabilitation
seruices

56

2.

to familiarize health personnel working with pwDs to
concepts, strategies and technologies appropriate for pWDs

modern

3.

to prepare health personnel to be the trainers for the training of
other health staff

4.

to

provide the necessary facilities and equipment for training institution, and training activities

Method and Content
The training method will include lectures, demonstrations, and practice. The content will vary according to professionaljobs and responsibilities:

-

Medical assessment, diagnosis and rehabilitation
doctors

for

medical

Home nursing care, family-based care and community-based
rehabilitation for public health nurse

Nursing assessment and nursing diagnosis of PWDs for hospital nurses counseling and case management of pwDs for social workers. Production and repair of prosthesis, orthosis, hearing aids, and other equipment for technicians

Similar training should be also applied to other types of personnel working for PWDs, outside the health sphere, such as, school teachers,
school administrators, as well as educators and education administrators. The topics for training will include, special education and integration education for PWDs and improvement of accessibility to mainstream vocational training.

4. Disability Resource Team

technical cooperation with JICA and existing international organizations like the ILO or FAO could be organized to develop a Disabil1y Resource Team to complement rehabilitation programs and provide an
integrated training environment for PWDs and non-PWDs. The team will not

A

57

its services limit its focus to iust training or the rehabilitation center, but extend will to reach out to PWDs in remote areas. The composition of team members

be

multidisciplinary, including health personnel, teachers, vocational in the instructors and business assistants. Health centers or the oPHCC for community could be used to set up a community office or unit with rehabilitation. The Disability Resource Team will coordinate their work
assistant coordinators in each district. These coordinators will actively locate and identify PWDs who need rehabilitative services, or who have no current training and are interested in gaining employment or starting a small

skill

business. 5. Community Empowerment through Participatory Action Research

To mobilize community consciousness and empower PWDs,

their

familiesrand the communitYrto be self-reliant in the management of their own health and social problem. The process of PAR will enable the community people to identify their own problems and needs, to decide the means and methods to handle and manage their problems with their own resources.

Finally, they will be able

to utilize the knowledge learned from the PAR

process to transform their social realities, through collective action. The CBR units can be established in the community with the assistance and suppott of the TAO and VHVs and as a result of PAR. This activity can be supported by JICA under the CEP scheme.

58

Bibliography

1. Department

of Medicine, Ministry of Public Health, "Community Based

Rehabilitation for Persons with Disabilities ", 1991.

2. 3.

Foundation for Handicapped Children, "Manual of disability prevention: Disability is Preventable", Foundation for Handicapped Children, "Dohsa-Hou for Disability Children
in Japan", 1998.

4.
5.
6.

Foundation for Handicapped Children, "Prai Grandpa's Toy", second print,
1997.

Institute of Population and Social Research, Mahidol University, "National Survey on Pre-school and School Disabled Children", 1998. Kanitha Thewindhorpakdi "Rehabilitation for the Disabled: Way to Success

of people with disability'', Department of Social Welfare, Ministry of
Labor and SocialWelfare, 1996.

7.
8.

National Statistics Office, "The Status of Thai Disabled Persons", Otfice of Prime Minister, 1999. Otfice of Rehabilitation for Disabled Person Committee, Department of

SocialWelfare, Ministry of Labor and Social Welfare, "Directory of GOs and NGOs Working with Disabilities".

9.

Office of Rehabilitation for Disabled Person Committee, Department of

SocialWelfare, Ministry of Labor and Social Welfare, "National Plan of
Rehabilitation for the Disabled 1997-2001".

10. Office of Rehabilitation for Disabled Person Committee, Department of SocialWelfare, Ministry of Labor and Social Welfare, "Annual Report
1ggg".

11. Otfice of Rehabilitation for Disabled Person Committee, Department of

SocialWelfare, Ministry of Labor and Social Welfare, "Manualfor
Persons with Disabilities".

12. Otfice of Rehabilitation for Disabled Person Committee, Department of SocialWelfare, Ministry of Labor and Social Welfare, "Rehabilitation for
Persons with Disabilities Acts 1991'.

13.

Pantyp Ramasoota, Suchada Thawesit and Somjai Pramanpol.
Evaluation Report "Rehabilitation Project, Sriboonruang District,
Udonthani Province.' ASEAN Institute for Health Development,

Mahidol University, March, 1994.
14. Pantyp Ramasoota, Suchada Thawesit and Somjai Pramanpol. "The Community Self-Help for the Disabled: Sriboonruang District, Udonthani Province.' ASEAN Institute for Health Development,

Mahidol University, June, 1994.

15. Prapont Praethanond (translator) , "Outdoor Life in spite of Disabilities"
Rainbow Bridge Fund, Foundation for Handicapped Children, 1996.
16.

,

Sriboonruang Rehabilitation and Prevention for Persons with Disability
Committee "Sriboonruang: Role Model for Rehabilitation and Prevention" Nong Bua Lamphu,1996.

lT.Sirindhom National Medical Rehabilitation Center, Department of
Medicine, Ministry of Public Health, Bulletin of Medical Rehabilitation,

vol.8 (2), May-August, 1999.

18. Sirindhorn National Medical Rehabilitation Center, Department of
Medicine, Ministry of Public Health, Bulletin of Medical Rehabilitation, vol.8(3), September-December,
1

999.

19. Sirindhom National Medical Rehabilitation Center, Department of
Medicine, Ministry of Public Health, "Executive Summary for supporting Community Based Rehabilitation under National Health Development Plan 8", 1999.

20. Sirindhorn National Medical Rehabilitation Center, Department of
Medicine, Ministry of Public Health, "Medical Rehabilitation Standard Development", 1995.

21. Sirindhom National Medical Rehabilitation Center, Depaftment of
Medicine, Ministry of Public Health, "Annual Repod", 1998.

22. Sirindhom National Medical Rehabilitation Center, Department of
Medicine, Ministry of Public Health, "Future of Community Based Rehabifitation Program", National Conference, Feb 27- March 1, 1995.

60

23. Som-arch Wongkhomthong, Chongkoknce Chutimatavin, *Research on
the Needs of Community Based Rehabilitation (CBR) for Disabled
Persons in Thailand", ASEAN Institute for Health Development,

Mahidol University, 1 998.

24. Somsri Ruksasri (translator), "Precious to God", Rainbow Bridge Fund,
Foundation for Handicapped Children, 1999.

61

Annex

I

Number of organizations which provide services to Services Government Oroanizations

pwDs, Thailand
Number

1.

Medical care and rehabilitation Education

2

2.

5
1

3

3.

SocialWelfare and Occupation
4 2

Non Government Orqanizations

1.

Seruice for the Blind

16 9 13
1

2. Seruice for persons with hearing impairment 3. Seruice for persons with locomotive impairment 4. Service for persons with mental impairment 5. Service for persons with intellectual impairment 6. General service for persons with disabilities
Source

6
15

:

Directory of GO and NGO working with PWDs, Department of Social Welfare. Ministry of Labor and Social Welfare

Directory of Non-Government organizations who provide seruices to pwDs, North-Eastern Region

NAME

Address

Seeing Thailand Association for the Blind Nofth-Eastern Region

633/3 Mahachaidamri, Talard
Subdistrict, Muang District, Mahasarakham 44000 Tel : (043) 722-029 Maharat-Nakhon ratchasima

Suranaree Eye Foundation

Hospital, 49 Changpuerg Road, Muang District, Nakhoratchasima
30000 Tel : (044) 341310-39 ext 1209 Fax:(044) 246389

Chaiyaphum Eye Foundation

Chaiyapoom Hospital, Muang
District, Chaiyaphum Tel: (044) 811444

Christian Foundation for the Blind in Thailand

HQ 214 Moo 6, Prachatiruk, Bann Ped, Muang, Khonkaen
As above

A) Educational Development
Center for the Blind at Khonkaen

B) Educational Development
Center for the Blind at Nakhonratchasima Roi-et Education and Rehabilitation for the Blind Center

149 Moo 6, Mukmontri Road, Muang, Nakhonratchasima
49 Moo 10, Ratchadamneon, Muang, Roi-et 45000 Tel: (043) 512289 Fax: (043) 512989

Hearina or communication

The Deaf Association of Thailand

A) Deaf group of NorthEastern Region

63711-5 Ratuthit Road, Muang, Nakhonphanom 48000 Tel: (042) 513005 511074 Fax : (042) 51 1653

NAME

Address

Phltsical or Locomotion Siriwatana Chestchier Foundation A) Bann lttirat Roi-et Chestchier

lntellectual or learninq abilitll

109 Moo 12, Pattamanond Road, Robmuang, Muang, Roi-et 45000 Tel: (043) 526641

Support for mental retardation Foundation of Thailand A) Social Welfare Center for Udorn-Khonkaen Road, Noensoong, the Mentally Retarded; Muang, Udonthani North-Eastern Region Tel: (042) 295252 Daughter of Charity Foundation
(Th ida-Metadham Foundation)

A) Saint Gerald Social
Welfare Center for Disabled Children in Khonkaen B) Community Based Rehabilitation Project for Disabled Persons in Loei C) Community Based Rehabilitation Project for Disabled Persons in Udonthani

164 Moo 16, Mariwan Road, Naimuang, Muang, Khonkaen

Directory of Government organizations who provide services to pwDs, Nodh Eastern Region Name Ministry of Public Health Mental Health Department

Address

A) Nakhonratchasima
Mentality Hospital

86 Changpeurg Road, Naimuang,
Muang, Nakhonratchasima 30000 Tel : (044) 271667-9 Fax : 259187

B) Nakhonphanom Mentality
Hospital

210 Nakhonphanom-Tha Uthain Road, Arch-samard, Muang, Nakhonphanom 48000 Tel : (042) 512272 512512 Fax : 51 3262
Sri-mahaphot Mentality Hospital, Muang, Ubonratchathani 34000 Tel: (0a5) 312550 Fax:312542 Khonkaen Mentality Hospital, Muang, Khomkaen 40000 Tel : (043) 227422 Fax: 224-722

C) Sri-mahaphot Mentality
Hospita.

D) Khonkaen Mentality
Hospital Medical Seruice Department

A) Chaiyaphum general
hospital

Muang, Chaiyaphm 36000 Tel : (044) 81 100s Muang, Nakhonphanom 48000 Tel : (042) 511424 Muang, Buriram 31000 Tel : (044) 612082 Muang, Yasothon 35000 Tel : (045) 71 1580 Muang, Roi-et 45000 Tel : (043) s13001 Muang, Srisaket 33000 Tel : (045) 61 1503 Muang, Loei 42000 Tel : (042) 81 1679 Muang, Sakonnakhon 47000 Tet : (042) 71 1636

B) Nakhonphanom general
hospital

C) Burirum general hospital
D) Yasothon general hospital

E) Roi-et general hospital

F) Srisaket general hospital
G) Loei general hospital

H) Sakonnakhon general

hospitat

Name

Address Muang, Surin 32000 Tel : (044) 514127-8

l)

Surin general hospital

Ministry of University Affair

A) Khonkaen University

Sri-nakarinHospital, Mitrtaparp Road, Muang, Khonkaen 40000 Tel : (043) 241331-44 ert 1696

Ministry of Education

A) Education Region 9
Muang, Khonkaen 40000 Tel : (043) 221-751 Fax222962 Muang, Udonthani 41000 Tel : (042) 323682 Fax 232683 Muang, Khonkaen 40000 Tel : (043) 246-493

Udonthani

Khonkaen

B) Education Region
retard)

10

Muang, Ubonratchathani 34000 Tel: (045) 3127641 Muang, Mukdahan 49000 Tel : (042) 612237 Muang, Kalasin 46120 Tel : (043) 891080 Muang, Roi-et 45170 Tel : (043) 569278

(deaf/hearing loss)

C) Education Region

11

Muang, Surin 32140 Tel : (044) 551793 Muang, Nakhonratchasima 30000 Nakhonratchasima

Tel: (044) 214983
Muang, Chaiyaphum 36000 Tel : (044) 812307 Muang, Khonkaen 40000 Tel : (043) 221751,239055 Fax 239073

Chaiyaphum Special Education Center Region 9

Name Special Education Center Region Special program (Blind + normal) Primary School Education

Address

10 Muan@
Tel : (045) 312764 Fax 281308

Muang, Khonkaen, (043) 236506 Muang, Khonkaen, (043) 236579 Muang, khonkaen, (043) 2377O2 bumrung Muang, Khonkaen, (043) 221829 Muang, Khonkaen, (043) 236978 Muang, Khonkaen, (043) 22225a Normal Education Department Muang, Khonkaen, (043) 221511 Muang, Khonkaen, (043) 2217A9 Muang, Khonkaen, (043) 2G1154 Muang, Nakhonratchasima, (044) 214557 Fax21444O Muang, Nakhonratchasima, (044) 213398 Muang, Nakhon ratchasima,

(044) 257667
M

uang, Nakhon ratchasima,

Tel : (04a) 371301-2
Ministry of Labor and SocialWetfare (Ban Thongphumpowpanus)
16 Srinarong Road, Naimuang, Muang, Ubonratchathani 34000 Tel: (045) 254092
1

Khonkaen

76 Moo 9, Khongsoong, Ubonrat Khonkaen 40250 Tel : (043) 246080
Klungarwut Road, Kamyai Muang, Ubonratchathani 34000 Tel : (045) 28s469

North-Eastern Region

Annex ll

List of in-depth interviewees

Name

Praku Wanroph

Yarnnawaro

WatTunry
Khonkaen. District Chief Officer Sriboonruang, t\long Bua Lamphu

Mr. Prachil Nilkhet

Dr.Kriengsak

Akepongse

Director of sriboonruang community Hospital, Nong Bua Lamphu

Iel : (042) 353443-5, 351063
Fax: 351214
Dr. Sarawut

Santinantaruk

physician of Sriboonruang Community Hospital, Nong Bua Lamphu l'el : (042) 353443-5, 351063

Fax:351214
Mr. Samart Ratanapatheepporn President of Provincial Administrative Organization, Nong Bua Lamphu Mr. Prai Somlela Grandfather of a PWD

34 Moo 7,Ban Saimoon, Saithong,
Sriboonruang, Mr. Suriya Nong Bua Lamphu 39190 pWD

Somlela

34 Moo T,Ban Saimoon, Saithong,
Sriboonruang, Nong Bua Lamphu 39190 Mr. Pongsawat

Tumwong

chairman of Disabled club
Sriboonruang Community Hospital Nong Bua Lamphu

Ms.Sarapee

Nambandhit

Teacher
Muang Mai School Nong Bua Lamphu

Name Ms.Surapee

Vasinonffi
Office of the on Committee Rehabilitation for Disabled persons, Oepartment of Social Welfare, lvlinistry of Labor and SocialWelfare

fel:2822853,
Mr.

O2B3O19

Wisit

Sanamchuad

Lawyer Otfice of the Committee on Rehabilitation for Disabled persons, Oepartment of Social Wetfare, Ministry of Labor and Social Welfare.

Dr. Pattariya

Jaruttat

Tel : 2922953 Fax : 2921422
Director

Sirindhorn National Medical
Rehabilitation Centre, Ministry of Public Health,

Tel:5914242
Mr. Teera Jantrarat Director Education for PWD Division, Ministry of Education

Tel:2807045-6
Fax:2807045

List of pafticipants of Focus Group Discussion

Name

Tambon Nakoro. Sriboonruano

1. Abbot Pisarn Wimonkit

Abbot

2. 3. 4. 5. 6. 7. 8. 9.

Mr.Thongka Thikaban

Village headman assistant
Member of TAO School Teacher Village health volunteer Village health volunteer Village heath volunteer

Mr.Porn Haoheng
Ms.Suwisa Rongjumnong Ms.Junhorm Sriraksa

Mr.Sa-nga Prommin Mr.Somkuan Noikhun
Mr.Boonchu Phicanitr Mr.Sombat Thatthong

Village heath volunteer Village health volunteer
Member of TAO

10. Mr.Suphe Phaikhet

Tambon Naklano, Naklang

1. Adul

Ung-kavaro

Monk

2. 3. 4. 5. 6. 7. 8, 9.
10.

Mr.Srita Porsaket Mr.Chantra Poontawee Mr.Sathit Nasayond
Mr.Kampoon Thup-arsa
Ms.Arunee Boonsrima

Village headman assistant Village headman assistant
School principal Subdistrict chief off icer Housewife Village health volunteer Member of TAO Village headman assistant Subdistrict chief officer

Mr.Charus Thavorn

Mr.Nicoom Malee
Mr.Kamsaen Champakaew

Mr.Chalerm Sacha

Annex lll

Study on Support for Persons with Disabilities

"Study on Support for Persons with Disabilities"
ASEAN lnstitute for Health Development

Mahidol University

lnterviewer

:

Mr./Mrs./Miss

lnterviewee : Mr./Mrs./Miss

Address:......

Village:..

..Sub-district...

District

,....Province:

@

Date of Interuiew : ...... ......lFebruary/ 2000

1. Sex

) 2. Age
(

Male

(

)

Female

......,.years

3. Education
(
(

(

llliterate Secondary Bachelor

o

() ()

Primary Vocation Other (specify).

4. Marital status
( ) Single O Married ( ) Widowed/SeParated/Divorced

5. Occupation

O UnemPloYed o o O Labor () Business O
6. Household status
( ( (

Agriculture Government employee Other (specify).

) Head of household ) Parent ) Dependent

o o o o o o

Spouse Children/Grand children Other (specify).

7. Relationship with disabled person
( ) SPouse ( ) Grandparent ( ) Brother/Sister

Parent Children/G rand children Relative (specify).

ASEAN lnstitute for Health Development, Mahidol University

Study on Support for Persons with Disabilities

1. Main occupation

of family ( ) Labor ( ) other (specify).

( ) Agriculture/farming O Own business ( ) Government employee

O Self-employment

2. 3.

Family

income
O Saving

.. BahVmonth
( ) Enough ( ) Not enough

Balance of income and expenses

4. Period of settlement: .. 5. Family members 6. Number of siblings

. years........ months

persons person

7. Number of disabled person in family. 8. Birth order of disabled persons

.. persons

1.

Sex

O
3.

Male

2. Duration of disability

.....

O
... years ...... years

Female

Age.

4. Marital status

O Single O Married ( ) Widowed /divorced/separated
5. PWD living with
(

(

O O ()

Parents Children/grand children Friends Relatives Other specify

() () () ()

Spouse Brother/Sister Grandparent Living alone

ASEAN /nstltute for Health Development, Mahidol tJniversifu

Study on Support for Persons with Disabilities

6.

Education

O Current

)

)

()

Past ) )

Class .... Type otrinooi O Normal Education School O Special Education School ( ) Informal Education School
Level of highest education Type ofschool Normal Education School O Special Education School ( Informal Education School Reason for not studying. Reason for never attending school

(

t ) Never )
)

O )

7.

Occupation
( Unemptoyed ( ) Earning income for their own (Specify job) Helping family (e.9. agriculture, business etc.) without pay O

)

Information of daily activity of pWDs

8.

Does PWD have aids or special equipment for disability?

O

Yes

O No
outside by themselves?

O not appticabte

9. Can PWD going

O Yes O No (specify

reason).
( ) g-5 day/week ( 1-2 day/month

.......)

10. How often do PWD go out (for study, work, travel)?
( 1-2 ( ) Never () ( ( () () () ()

O Everyday

)

day/week

)

11. What are the inconveniences when going outside?

) )

No helper Road condition Ditficulty in getting on/otf Bus/Mass Transit Expensive transportation fare Afraid Embarrassing /feel shame Others (specify)

ASEAN lnstitute for Heatth Development, Mahidot lJniversitv

Study on Support for Persons with Disabilities

12. Normally, where do PWDs stay during daytime?

) )

)

Otfice

Institute/Foundation/Hospital

Other (specify).

O School O Home

13. What does the PWD do in leisure time?

1....

2..... 3.,...
1

4. Interpersonal retationship (multiple response)
O O Tatking/Chatting ( )Playing ( ) Eating together ( ) Participating social activity ( ) Being helped/ taken care by neighbors ( )Helping disabled when they need care ( ) Other (specify).

Greeting together

15. When PWD have problem

with, whom do they consult

?

3.

1.

Did you register for your disability? ()

O

Yes

No
I

(why ?)

Type of d isabi ity/characte ristics of disability

O

Hearing or Communication
( ) Stammering

) Dumbness ( ) Hearing impairment
(

O O

Total deafness

Seeing
( ) One-eyed blindness

O

Two-eyed blindness

ASEAN lnstitute for Health Development, Mahidol university

Study on Support for Persons with Disabilities

O Body or Movement
( ) Amputation/part of arm ( ) Amputation/part of leg

) Amputation/part of finger ( ) Amputation/part of toe ( ) Cleft lip or palate
(

( ) Paralysis or paresis ( ) Disability of limbs ( ) Scoliosis or kyphosis

@ Mental or behavior
( ) Psychosis

O lntellectual disability
( ) Mental retardation
@

Muftipfe disabilities (specify)

3. Cause of disability

O Heredity ( ) Accident (specity)

I

o o o o

Home (specify) Work place (specify) Traffic (specify) Others (specify)

o o o o

lllness Congenital abnormality Behavior (drug addict,alcoholism)

Other (specify)

4. Number of disabled ONo

relatives

( ) Yes (number) ......(specify type of disabitity)

ASEAN lnstitute for Health Devetopment, Mahidol tJniversitv

Study on Support for Persons with Disabilities

1. Initial detection

of disability of PWD by

( ) Health personnel ( ) Family

O Self-detection
( ) Friend/neighbor ( ) Colleagues/teacher/monl</village headman ( ) Other specify.

2.

What was the first management for disability?
( ) Nothing ( ) Consulted with villager/neighbor ( ) Treated at government hosPital

O Treated at health center O Consulted with village health volunteers ( ) Treated by fraud ( ) Treated by traditional healers ( ) Treated by spiritual healers ( ) Treated by masseuse/masseur O Treated by monks
( ) Other (specify).

3.

At present , do PWDs receive treatment?

O Yes by9
( ) Modern practitioner (e.9. doctor, nurse, etc.) ( ) Fraud ( ) Spiritual practitioner ( ) Traditional practitioner ( ) Other (specify). ()

No

reason for not receiving treatment
( ) The condition is better ( ) lt's

I

not treatable/ it's incurable

( ) Cannot afford/ costly
( ) PWDs refused treatment

ASEAN lnstitute for Health Development, Mahidol University

Study on Support for Persons with Disabilities

( ) Family is too busy ( ) Difficult to go out for treatment ( ) Don't know the place for treatment ( ) Provide treatment themselves ( ) Other (specify).

4. Are PWDs able to do these activities

by themselves?

( ) Need help or assistance from someone

O Partially independence 9 specify
( ) Bathing/ toothbrush / wearing clothes

O Eating
( ) Urinating/defecating ( ) Traveling/moving ( ) Doing house work

O Communicating

O Reading
( ) Writing ( ) Independence / perform regular tasks

9

specify
( ) Working to earn income (self financial support) ( ) Working to earn income for their own families

5. Who provides

care and assistance it PWDs unable to help themselves?

( ) Spouse ) Children/grandchildren ( ) Parent ) Brother/sister ( ) Grandparent ) Relative ( ) Friend/neighbor ( ) Nobodyhelps ( ) Other specify

6.

What assistance do PWDs need from family?
1

2 3

7.

Can the family provide assistance needs ?

O Yes
( ) No (specify the reason) ( ) Depend

ASEAN lnstitute for Health Development, Mahidol University

Study on Support for Persons with Disabilities

Current health and disability status at present ?
1. Disabilities status when compared with initial stage ( ) lmproved
( ) Deteriorating

( ) Stable

2. Health status from January

- February 2O0O

O Have been sick
( ) Sick and unable to perform task ( ) Sick but able to perform task ( ) Never been sick

O Treatment received
( ) Modern medicalcare
( ) Self treatment /or traditional medicine

( ) No treatment

O Ever had any accidenUinjury
( ) Had (specify) ( ) Never
@ Have been admitted to the hospital

( ) Yes (specify)

ONo
O Smoking

O Yes

ONo
O Drinking alcohol O Yes

ONo

ASEAN lnstitute for Health Development, Mahidot tJniversity

Study on Support for Persons with Disabilities

1. Do PWDs think that the disability can be treated ?
O Yes

ONo

( ) Not sure

2. Have PWDs ever been trained or attended rehabiritation courses?

( ) No (skip to Question no. 4) ( )Yes9 specify ( ) Care /rehabilitation (where)...... ( ) Education (where). ( ) Occupation (where).....
3. Are PWDs satisfied with rehabilitation courses?

O Yes O No (specify).
4. Have PWDs ever had rehabilitation ?

O Yes ONo
5. lf yes, from whom?
(

( (
(

Health personnel Foundation staff Villagers (specify). Other (specify).

6.

Do PWD practice rehabilitation at home?

) Regularly
) Once in a while ) Never

7.

What following assistance do PWDs need?
( ) Medical care/Rehabilitation assistance ( specify) ( ) Occupational rehabilitation assistance (specify) ( ) Legal/ law suit assistance (specify). ( ) Education assistance(specify)....... ( ) Other (specify).

8. Have PWDs ever heard about

the Rehabilitation of the Disabled Person Act

()

Yes (How).
the benefits about being registered as pWDs
?

ONo
9. Did PWDs know

( ) Yes (specify).

ONo

ASEAN lnstitute for Health Development, Mahidol tJniversitv

Study on Support for Persons with Disabilities

10. Have PWDs ever been assisted or helped by the following persons/group in the community ?

Persons/group
- Village headman - Teacher - Monk - Neighbor - Volunteer - Group/club specify - Tamboon Administration - Other

les (specify)

No

1

' How do PWD perceive the attitudes of family and community towards their
disabilities
?

Family /Community thinks that pWD yes

Family no

Community yes
no

- ls a burden on the family - ls shameful for the family - ls a result of sin and bad conduct - ls a person to be understood - ls a useful person - ls a person that needs to be cared for - ls a person that the family can be

proud of - ls a person that needs special consideration - ls a person with talents

- ls a person that should receive exceptional privilege ls a person that should be treated like qny other
2. Do you think that disability can be prevented ?

OYes

ONo
10

ASEAN /nstllute for Health Development, Mahidol UniversiV

Study on Support for Persons with Disabilitres

3.

What factor do you think is the cause of the disability?

Perception of cause of disability - lllness
- Accident - Occupation risk - Trauma during pregnancy - Malpractice of practitioners - Sin of the disabled - Treated malpracticing doctor - Sin of parent - Congenital anomaly - Bad conduct - Othe(specifu)...................................................

Yes

No

.........

.......

4.

Are PWD satisfied with facilities and quality of life ?

Satisfaction Facilities - Road/ pathway
- Transportation/ mass transit

Yes

No

- ParW recreation place
- Telecomm - Toilet
un

ication/telephon e

Special equipment (e.g., wheelchairs, hearing aids, etc.) Health status

Living conditions
Government services
- Medical carel rehabilitation services - Education
- Occupation/ job opportunity

- Legal/ law consultation

Services of Non government organization and private - Foundations
- Village funds

- Social welfare groups

ASEAN lnstitute for Health Devetopment, Mahidot lJniverstv

11

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2.1.4. Assistance Need from the Government

A survey by the NSO 1996, revealed that 66 percent of PWDs for the
whole kingdom expressed needs for assistance from the government. The assistance needs were specified as follow:
medical care, surgery and physiotherapy instruments for disabilities
30.2o/o

7.4o/"
5.9Yo

skilltraining jobs
loans for earning and living lodging special education others

5.7o/"
5.4o/o

4.30/"

4.0%
3.3"/o

Male and female PWDs varied in assistance needs from the government according to the type of disability. Both sexes needed medical services, surgery

and physiotherapy as well as equipment for disabilities. Among PWDs with physical and mobility impairments, for males, the assistance needs were in
providing jobs and opportunity to work, while for females, the assistance needs

were providing loans for earning and living. Males with mental or behavioral impairments and intellectual and learning disabilities needed assistance for
lodging, but females of the same disability type needed assistance for special education.

For the multiple disabilities group, females needed assistance for skill
training but males needed special education. Govemment policy for PWDs incorporates the concept that "PWD5 are socially disadvantaged and are entitled to receive medical services and health

free security" and emphasizes " the rehabilitation of patients receiving medical services rather than the rehabilitation of the disabled after treatment,,.

14

Chart

1

Rights and Benefits for PWDs by Program and Legislative Act.

Programs/

Responsible Organization
Ministry of Labor and SocialWelfare, Ministry of Public Health

Financial Sources
Government budget

Rights & Benefits For Disability
Rehabilitation services

Service Unit
Public and Private Health Facilities

Act

1.

Rehabilitation

Act. BE 2534

2. Compensation Act. BE 2517

Ministry of Labor And SocialWelfare

-

Employer Government

-

Compensation

Public and Private Health Facilities

-60% of salary, 10 yrs for loss of body parts
15 yrs. for disabled

3. SocialSecurity Act. BE 2537

Ministry of Labor And SocialWelfare

Employer Employee Government

-

Medicalfees not over
2000 BahUmonth 50% of salary compensation for life

Public and Private Health Facilities

4. Car-accident lnsurance

Ministry of Commerce

Car owners

- Medicalcare - Compensation
for death
Fees for

Public and Private Health Facilities

Act. BE 2535
5. Welfare for

Ministry of Finance

Government budget

-

OPD Patient

government officials, pensioners, and state enterprises

- rehabilitation - specialequipment
prosthesis/orthesis

(public facilities)

-

IPD & OPD

Patients (private & public facilities)

6. Private Health
lnsurance

Insurance company

lnsured persons

-

compensation for prosthesis/orthesis compensation for loss of income

Public & Private Health facilities

7. MedicalWelfare for the helpless and needy

Ministry of Public Health

Government budget

Free rehabilitation Medical equipment

-

Public Health facilities

The new paradigm that views "PWDs as

a

national resource and

rehabilitation of the disabled as an investment in human resources to enable them to live productively with dignity in the society" has been recently adopted
after the democratic movement for the rights of PWDs.

There were several acts and programs developed for PWDs of which the
rights and benefits are summarized in Chart
1.

15

2.1.5. Organizations involved In Rehabilitation for PWDs
There are governmental organizations distributed among the six ministries

and 68 non-governmental organizations involved in rehabilitation activities for
PWDs as presented in the followings:

Ministry of Labor and Social Welfare

1. Department 2. Department

of Social Welfare Office of Rehabilitation for PWDs

of Labor Protection

3. 4.
5.

Rehabilitation Center for Workers, Bangpoon Department of Labor Skill Development Office of Social Security (OSS)

Ministry of Defense

1.

Pra Mongkut Klao Medical College

2.
3. 4.

Department of Military Medicine, Army, Navy, Armed Force, Bhumipor
Hospital, Pra Pin Klao Hospital, Military Hospital in several provinces Veteran Organization Sai Jai Thai Foundation

Ministry of Interior

1.

Police Hospital

Bangkok Metropolitan Administration

1.

Otfice of Medical Service

2. Office of Health Seruice 3, Vachira Hospital, Taksin Hospitat, Klang Hospital
Ministry of Public Health

1.

Office of Permanent Secretary

- Hospitals under the Office

2.

Department of Medical Service

- Sirindhom National Medical Rehabilitation Center - Four Hospitals under the Department

16

Department of Mental Health
- Two Hospitals under the Department 4. Department of Health - Occupational Health Division

Ministry of University Affairs

-

Faculties of Medicine under the Ministry Office of Policy and Planning

Non-Government Organizations
Seruices for seeing impairment Services 4 7 24
5 5

for hearing impairment

Services for physical impairment Services for intellectual impairment Seruices for multiple impairments

Ministry of Education
School with Integration (Mainstreaming) Programs

Bangkok Areas

-

Preschool Primary school Secondary school

2
10 5

Outside Bangkok A,rea
Northern Region Northeastern Region Southeastern Region Gentral Region 4
12

3
2

Bangkok Metropolitan Administration
Primary School for Slow Learners Private School for Autistic
13

2

17

2.2 Disability Statistics of the Northeastern Region
The prevalence rate of PWDs is the highest in the noftheastem region of
Thailand, the rate is 386.8 per 1,000 population. There were more males than females in all age groups except in the old age group (age 60 years and over)

where females outnumbered males (a9:33). However, the highest rate is found among the older age group,60 years and over, (82.1 per 1,000 population).
Most of them were scattered throughout non-municipal areas which was 20 times more than municipal areas (368.5 and 18.3 per 1,000 population). Of all the types

of disability, physical and mobility impairment (128.2 per 1,000 population) has the highest prevalence followed by hearing impairment, mental retardation and

seeing impairment, 74.5, 67.0 and 46.9 per 1,ooo population, respectively
(Tables 2 and 3)

18

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2.3. Nong Bua Lamphu Provincial Information
Nong Bua Lamphu (NBL) Province is the 73'd province of Thailand,
situated in the northeastern region. lt has been separated from neighboring Udornthani Province since 1993. The province is 608 km from Bangkok. lt is adjacent to Udornthani Province in the north and east, to Khonkaen Province

on the south, and to Loei Province in the west. The total area is 3,859,626
square km, covering six districts, 58 subdistricts (tambons) and 623 villages.

The administrative areas consist of 1 municipality, 29 communities and

11

sanitation units. There are 1A2,082 households and the total population is 507,130, most of them, 55 percent, belong to the working age group and
elderly people constitute 6.6 percent.

Geographical and geological characteristics

The landscape of NBL Province is a plain plateau area of fields and
forests. A majority of the land is dry, mountainous and the soil structure is
sandy and rocky. The climate is hot and humid in summer and cold in winter. The economic status is ranked 9fr among the 16 provinces of the northeastern region with a per capita income of 19,186 bahVyear.

Health statistics

Public health facilities consist of one Provincial Hospital (120 beds),

four District Hospitals (two 60 beds and two 30 beds), and 81 Health Centers.
The health statistics are as follows:
- Crude Birth Rate
- Crude Death Rate 13.70

- lnfant Mortality Rate
- National Growth Rate

/ 1,000 population 4.76 | 1,000population 2.59 | 1,000population
0.89/1,000population

Morbidity and mortality data reflect the life styles and living standards
of the people. The statistics demonstrate that heart disease of all kinds is the

first leading cause of death (102.4

/

10O,0OO population)

followed by cancer of

21

all kinds (85.38

/

100,000 population) accident, injuries, suicide, and homicide

is ranked eighth (9.66

/

100,000 population.) and the 10h leading cause of

death is from AIDS (7.88 / 100,000 population)

Human Health Resources of Nong Bua Lamphu Province
Data on 30 September 1990 revealed that there were 13 physicians, 4 dentists, 46 professional nurses, 66 technical nurses, 5 pharmacists, and 38
paramedics, working in public health facilities of Nong Bua Lamphu Province
.

The leading cause of morbidity, from OPD records of all hospitals in
NBL District, is ARI with a total number of 42,904.97 patients per 100,000
population. The second order is gastrointestinal diseases with a morbidity rate

of 28,425.65 per 100,000 pop. The distribution of morbidity of in-patients
follows the same pattern.

Epidemiology of Disabilities in Nong Bua Lamphu Province The number of PWDs of NBL Province as determined by registration
status, which is at the rate of 34 per1100,000 population, was ranked at the
14m order of the whole kingdom. There were more male disabled persons

than female. The working-age group population is suffering more than other age groups. (Table 4) Sriboonruang (SBR) District had the highest number of
PWDs probably due to the positive impact of the CBR Program in the area which increased awareness of the PWDs and their families and alerted them to come for registration. (Table 5)

Physical and mobility impairments is the most common among the PWDs in NBL Province, the second is intellectual and learning abllity impairment, which is less than half of the first and the least is mentality and
behavioral impairment. (Table 6)

22

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Table

5

Number of registered PWDs in Nong Bua Lamphu by district

Total
Muang Naklang (NK) Sriboonruang (SBR) Non-Sang Sawan Kuha
Na Wang

252
241 287 175

158
119

410 360 454

167
139

314
335 125
1,ggg

206
75

129 50
761

1,234

Source:

Provincial Health office of Nong Bua Lamphu province, 1gg9 MopH

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CHAPTER III
Research Findings
3.1. Quantitative study
3.1.1 Socio-demographic characteristics

Study subjects comprised 281 PWDs; two-third of them were from
Sriboonruang District. Respondents were 66 percent PWDs and 34 percent

relatives. The proportion of PWD/relative distribution showed the same trends
in both districts. (Table 1)

The majority (78 percent) of relative respondents were females of a
high age group (45 and above). Most of them were parents and siblings of PWDs (67 percent). Only nine percent were spouses. The PWD families
were generally poor, 78 percent of them had a monthly income of less than

2000 baht. Families averaged five members. Their main occupations were farmers (70 percent) and laborers (20 percent). They were permanent members

of the village with an

average

of 38 years

tenancy. The
the

characteristics were comparable in the study in almost every aspect. Only the

economic status and duration

of tenancy were slightly greater in

comparison area than in the study area. (Table 7)

The majority of PWDs, 45 percent were single and 17 percent were divorced or separated. However, almost all of them were living with their
families including parents (42 percent) spouse 33 percent children 52 percent and siblings 31 percent, There were only 2.5 percent that were living alone.

Only 23 percent of PWDs had jobs and earned on their own. Such work
included: rice farming, weaving, basket-making, and common

labor. Half of

them were unemployed, while 25 percent worked for their families with no pay. Two-third of the PWDs had schooling and a majority had completed
primary education. Only 13 percent attained a higher education than primary

level. PWDs in SBR District were generally less educated than thqse in NK District. Almost all in-school PWDs attended regular school, only 2.1 percent
were educated in schools with special education programs for the disabled. For the blind and deaf, 32 percent never had schooling, the main obstacle
was due to their disabitities. (Table 8)

zo

During the daytime, nearly 90 percent of PWDs stayed at home, of

which two-thirds lived unproductive lives. They did nothing or watched TV
most of the

time. Only 10 percent worked at home to earn money, and 21

percent helped with household chores without wages.

Relationships between PWDs and their neighbors were positive. The
neighbors were helpful and friendly to PWDs, When PWDs were in need they received help from their families, friends and neighbors. The most resourceful people for PWDs were their parents (40 percent) followed by spouse, children and siblings 30 percent,22 percent and 20 percent, respectively.

Table

7

Socio-demographic characteristics of relative respondents
Characteristics Sriboonruanq
N (48)
o/o

N (48) o/o 48 52 9 39
1

Naklanq

Total
N (96) 96 185
21

Interviewees

-

Family/relative Disabled Male Female 14-24

48
133 12

26.5 73.5 25.0 75.0
6.3 20.8
29.2

48.0 52.0
18.8 81.2
2.1

34.2

65.8
21.9 78.1

Sex

-

36
3 10 14
21

75
4

Age (years)
4.2
25.O

25-44
45-59 60 and over llliterate Primary Secondary

43.8
10.4

14 18 15 5 36 6
1

29.2

37.5 31.3
10.4

24 32 36
10

33.3 37.5
10.4
BO.2

Education
5
41
1

85.4
2.1 2.1

75.0
12.5
2.1

77
7 2

7.3
2.',|

Vocationaland higher Marital Status

1

-

Married Single Divorced/separated/widowed

30
2 16 7 34 6
1

62.5
4.2

30
4
14

62.5 8.3
29.2 18.8 67.7 12.5
2.1

60
6

62.5 6.3
31.2 16.7 68.7 12.5
2.1

33.3
14.6

30
16

Occupation
Unemployed Agriculture Labor Government sector Relationship with PWDs Spouse Parent Grandparent Child/grandchild Brother/sister

-

I
32 6
1

70.8
12.5
2.1

66
12 2

-

2 27 1 10
3 5

4.2 56.3
2.1

10.4
20.8

- Relative

6.3

7 14.6 18 37.5 12.1 11 22.9 I 18.8 2 4.2

I
45
2 16 19

9.4 46.9

2.6
16.7 19.8

5

5.2

27

Table

I

Socio-demographic characteristics of PWDs

Characteristics

Sriboonruang
N

Naklang
N (100) o/o N

Total

(181)
76
73 32

o/o

(281)

o/o

Maritalstatus of PWDs

- Married - Single
Widowed/divorced/ separated

42.0

51

51.0 33.0
16.0

40.3
17.7

33
16

127 106 48 118 93 146 86 1 10 9 7 147 64 70 3 189 89 109 96 65 60 28 10
203 189 67 108 81 58 45

45.2

37.7
17.1

Living with (multiple response)

- Parent - Spouse - Child/grandchild - Brother/sister - Friend - Grandparent - Relative - Living by oneself
Occupation

77
61

42.5

41

41.0
32.O

42.0
33.1
52.O

33.7 55.8 32.0 0.6 3.3
1.7

32 45 28

101

45.0
28.O

58
1

30.6

0.4 3.6
3.2 2.5

6 3

4 6 3

4.O

6,0
3.0

4

2.2

- Unemployed - Self-employed
Work without pay

89 43
49

49.2

58
21 21

58.0 21.0
21.O

52.3 22.8 24.9

23.8
27.1

Education

- Current enrolment - Past enrolment - Never
Daify activity (multiple response)

2

1.1

1

1.0

1.1

122
57

67.4

67
32

67.0
32.O

67.3 31.7

31.5

- Resting/ do nothing - Assisting housework
- Watching TV, reading,etc. - Working with pay

70 70 42
41

38.7 38.7
23.2

39 26 23
19 8 7

39.0
26.O 23.O

38.8 34.2
23.1

22.7
11.0 1.7

19.0 8.0 7.0

21.4 10.0 3.6

- Handicraft, gem cutting - Playing with friends
Relationship with neighbors (multiple response)

20
3

- Greeting
Talking/Chatting

137

75.7 70.8 27.6 47.0 32.6
23.2

66
61

66.0 61.0
17.O

72.2 67.3 23.8 38.4 28.8 20.6 16.0

128 50 85 59
42

- Playing together - Eating together - Participation Social Activity - Being helped/take care by neighbors - Helping disabled when they need
taking care

17

23 22
16

23.0
22.O

16.0 8.0

37

20.4

I

28

3.1.2. Epidemiology of the disabilities
There were more number of PWD males than females. The age
group of 60 and above comprised 27 percent, followed by age group 20-29 and 30-39 at similar proportions,24 percent. Nearly half of them, 45 percent
became disabled after 20 years of age. One-fourth were born disabled. Those

with disabilities developed during preschool age, 1-5 years old, comprised 15
percent.

Only one-third of PWDs had registered for diagnosis of impairment

status and were issued the official document confirming their impairment

condition. Non-registration was mainly due to a lack of knowledge and
information about the Rehabilitation for Disabled Persons Act, BE. 2543.

Regarding the type

of disability, physical or mobility

impairment

comprised the majority, 43 percent. lmpairment in terms of seeing, hearing or

communicating, and intellectual or learning ability followed, 26 percent, 18

percent and 12 percent, respectively. Multiple impairments comprised 12 percent. The least impaired among study subjects were in terms of mentality
or behavior 10 percent.

The characteristics of impairments among studied PWDs included
stammering, dumbness, blindness in one or two eyes, hearing impairment or total deafness, amputated legs, arms, fingers and toes and disabilities of the

limbs, harelips and cleft palate, paralysis, paresis, kyphosis (humpback),
psychosis and mental retardation.

The etiology of disabilities among PWDs, based on respondents' perceptions, revealed that illness accounted for 39 percent, whereas 3
percent claimed that medical malpractice was the responsible factor, accident

and congenital defects were of equal proportion, 22 percent and unknown
cause was 8 percent.

Most of the disabilities caused by accidents occurred outside the
home. Road and working accidents were of the same proportion, 24 percent. Others included drowning, falls and injuries.

A majority of PWDs, 74 percent in both districts did not have
facilities and equipment needed for their disabilities, such as, prosthesis, orthosis, hearing aids, canes and crutches. Nevertheless, two-third of them

29

were able

to go out by themselves.

Difficulties and inconveniences
physical

encountered

by PWDs when going out were from their own

handicaps as well as deficiencies in infrastructure such as ramp ways, street

footpaths, and public transportation, and inadequacies
mentioned.

of

facilitating

equipment. In addition, feelings of shamefulness and inferiority were reasons Of the PWDs, 21 percent had other

fami! members who were

also
41

disabled. Most of the disabilities were first noticed by family members,

percent, 36 percent were recognized by health personnel, physicians, nurses

and public health workers and 29 percent were identified by

PWDs

themselves. The immediate management of the family for PWDs was seeking

treatment. The rest, 31 percent, took no action. There were several choices

of treatment sought for PWDs, varying from modern treatment from public
hospitafs and health center, 84 percent, folk magic treatment, 22 percent, folk

medicine, 15 percent, traditional medicine, 10 percent, to self-treatment, 4 percent. However, at present, only 15 percent of PWDs were under treatment. The reasons given for not being treated included: 67 percent not necessary because impairments were not treatable, 27 percent not able to atford the
cost of their treatment and time factor 6.3 percent.

The present conditions of impairment compared to its initial stages were 41 percent stable, 31 percent deteriorating, and 27 percent improved. PWDs were generally healthy, half of them never reported being sick, 31 percent had minor ailments and received treatment at the hospital and/or
health center. Their health behaviors were considered fair. as one-fourth of them smoked and drank.

Of the PWDs 60 percent perceived that their impairments were irreversible. Although two-thirds of them had attended training courses for
rehabilitation, they rarely practiced it, (table g)

30

Table

9

Epidemiology, etiology and management of the disabilities

Characteristics
N

Sriboonruang

Naklang
N

Total
N (281)

(181)
90
91

o/o

(100)
61

o/o

Sex of PWDs

- Male - Female
Age of PWDs (years)

49.7

61.0 39.0

151

53.7 46.3

50.3

39

130

- 20 -29 - 30 -39 - 40-49 - 50 -59 - more than 59
Age that dlsability developed

44
41

24.3 22.7
12.2 11.0

26 27
13
12

26.0 27.0
13.0 12.0

70 68 35
32

24.9
24.2 12.5 11.4

22

20
54

29.8

22

22.0

76

27.0

-

At birth
years years

41

22.7
17.7

30
11

30.0
11.0

71

25.3
15.3

- 1-5

32
12

43
18

- 6-10

6.6 7.7 45.3

6 10

6.0
10.0

6.4 8.5
44.5

- 11 - 20 years - more than 20 years
Registration status

14 82

24

43

43.0

125

-

Yes

72 107 2

39.8
59.1
1.1

34 65
1

34.0 65.0
1.0

106 172 3

37.7
61.2
1.1

-No

-

Unsure

Type of impairments (Multiple response)

- Hearing - Seeing - Locomotion - Mental/behavioral - Intellectual - Multiple impairment

29
51

16.0 28.2 44.2

21

?1.0 22.0
42.0 12.0 18.0 13.0

50
73 122

17.8

22

26.0
43.4

80
15

42
12 18 13

8.3
15.5 11.0

27 46
33

9.6
16.4 11.7

28 20

31

Characteristlcs
N

Srlboonruang

Naklang
N

Total
N

(181)
4
46

oh

(100)
4
16

o/o

(281) I
62

7o

Gause of dlsability

- Genetics
Accident

2.2
25.4

4.0
16.0 45.0 25.0
1.0

2.9
22.1

- lllness - Congenital - Drug addiction - Malpractice - Stress - Unknown
Type of accident

64
38
1

35.4 21.0 0.6 3.3 2.2 9.9

45 25
1

109

38.8 22.4 o.7

63
2 9

6
4 18

3
1

3.0
1.0

3.2
1.8

5 23

5

5.0

8.2

- In house setting - Occupational
- Traffic - Others
Speclal equipment received

11

23.9
26.1
2',1.7

1

6.3
18.8 31.3 43.8

12 15 15 2A

19.4 24.2 24.2 32.3

12

3

10 13

5 7

28.3

-

Yes

42 135 4

23.2 74.6 2.2

26 74

26.0
74.O

68 209 4

24.2 74.4

-No

- None needed
Self-help ability

't.4

Dlff

Yes

't21

66.9
33.1

63 37

63.0 37.0

184
97

65.s
34.5

-No
lcultlesl lnconven lences
(Multiple response)
Own physicalhandicaps
Def iciency

60

134
58 34

74.O

71

71.O

205 83 56

73.0 29.5 19.9

of

inf

rastructure

32.0
18.8

25 22

25.0
22.O

Feeling shamefulness

Having relatives who were dlsabled Initial detection by
(Multiple response)
44

65.9

16

16.0

60

21.4

-

Doctors/f,,lurses/PH

59

32.6

42

42.O

101

35.9

Otficer

- Family - Oneself - Friends/neighbors
Others

70 62 6
1

38.7 34.3 3.3 0.6

45
19
1

45.0
19.0

115
81

40.9 28.8

7

2.5 0.4

':o

1

32

Characteristics
N

Sriboonruang

Naklang
N

Total
N (281)

(181)
63
1

o/o

(100)
23

o/o

lmmedlate Management

- None - Unsure
Treated

34.8 0.6 64.6

23.0

86
1

30.6 0.4 69.0

117

77

77.0

194

Treatment received
(multiple response)

- Modern medicine - Magic /folk medicine
Traditionalmedicine
Self-treatment

100 17
11

85.5
14.5

62
12 9 3

80.5
15.6

162
29 20
7
41

83.5
14.9 10.3

9.4
3.1

9.0 7.0

-

4

3.6 14.6

Current treatment
( Multiple response)

32

17.7

I
7
1
1

9.0

- Modern medicine - Magic/ Folk treatment
Traditional/herbal medicine

30
1

93.8
3.1

77.8
11.1 11.1

37
2 4

90.2 4.9 4.9

3

9.3

Not treating currently Reason for not treating

149

82.3

91

91.0

240

85.4

- lmprovemenVself-care - Not treatable - Costly treatment
Time constraints

28 95

18.8

14

15.2

42
154

't7.5
64.2 26.7 21.3

63.8 27.5
24.2

59
23 15

64.8
25.3 16.5

4'l
36

64
51

Disablllty status compared

to initial stage

- lmproved - Deteriorating - Stable
Rehabilitatlon training
Hospitalstaff
Foundation staff VHVs and others

49 62

27.1

28 26 46

28.0 26.0 46.0

77 88
116

27.4 31.3
41.3

34.3 38.7

70

16 6 2

66.7
25.O

5

83.3

21

70.0 20.o
10.0

6
1

8.3

16.7

3

33

3.1.3 Needs and resources for PWDs Family members are the main source of assistance for PWDs. Of the PWDs 43 percent were assisted by their children, 39 percent by parents, 26 percent by siblings and only 16 percent by spouses. The greatest needs of PWDs from their families were care and assistance in time of sickness, in
daily living activities as well as financial support for necessary equipment.

Most PWDs, 88 percent, had varieties of assistance needs such as

the need to work and earn money, 69 percent, to receive medical care, 65
percent, to receive education, 10 percent, and to have legal assistance, only 2 percent.

Among the people and groups in the community, the most important

persons that PWDs perceived as having significant roles in providing help were the Tambon Chief, Village Headman and VHVs, 47 percent, neighbors

and the Tambon Administrative Organization (TAO) were also seen as
important, 33 percent and 14 percent, respectively. (Table 10)

34

Table 10 Assistance needs and Resource for PWD

Assistance need

Sriboonruang
%

Naklang
7o

Total
Yo

Helping persons (multiple response)

- Spouse - Child/grandchild - Parents - Brothers/sisters - Grandparent - Relatives - Friends/neighborhood - Noone
Assistance needs from Government (multiple response)

14

15.1

10
1

16.7

45 32 27
1

48.4

35.0 45.0
21.7

34.4 29.0
1.1

7
13

2 3

3.3 5.0 5.0
1.7

9
9

9.7 9.7 2.2

3
1

2

24 66 59 40 3 12 12 3 162 172 24 4 86 24 19 69 86 19 12 67 93 65 39 28 11

15.7
43.1

38.6
26.'1

2.0 7.8 7.8 2.0

-

Medicalservices
income

103 116 15

65.2

59 56
9
1

65.5
62.2

65.3 69.4 9.7
1.6

- Work and

73.4 9.5
1.9

- Education - Legalassistance
Assistance needs from family
(multiple response)

10.0
1.1

3

- No need - Medical care/treatment - Providing aid/equipment - Home care - Financial support - Moralsupport - Income generation
Help from lndividual/ group in

57 20
17

31.5
11.0

29 4
2

29.0

30.6 8.5 6.8 24.6 30.6 6.8 4.3

4.0 2.0
27.O

9.4 23.2 27.6 4.4 5.5

42 50
8 10

27 36
11

36.0
11.0

2

2.0

community (multiple response)

- Village headman

39 65 43
21 21

21.5

28
28 22
18 7

28.0 28.0 22.0
18.0

23.8
33.1 23.1

- Friend/neighbor - Village Health Volunteer . TAO
- Teacher/monk - Club or group

35.9 23.8
11.6 11,6

13.9 10.0

7.0 5.0

6

0.6

5

3.9

35

3.1.4. Knowledge about the Rehabilitation of Disabled Persons Act

Only 18 percent of PWDs knew about the Rehabilitation of Disabled Persons Act, (BE 2534). Half of them learned from mass-media including TV,
radio and newspaper. They also received information from hospital staff and from the Tambon Chief / Village Headman, 28 percent and 20 percent, respectively. Most, 86 percent, knew that once registered to be diagnosed and officially documented they were entitled to receive free medical care and
1

1 percent knew that they could receive monthly allowances. (Table

1

1)

Table 11 Knowledge and Information on
Persons Acts

The Rehabilitation of

Disabled

Information
Source of information

Sriboonruang
33 18.2

Naklang

Total
17.O

17 17.0 17
9

about the Rehabilitation of Disabled Persons Acts - Television, Radio

14

42.4
6.1

52.9
17.6

23
2 10 14
1

46.0 4.0
'17.6

- Printed materials - Neighbors - Hospital statf - Family member
Benefits of registration

2

7

21.2

3 5

I
1

27.3 3.0 17.7 87.5
'12.5

29.4 12.0 83.3 8.3
16.7

29.4

2.0
15.7

32 28
4

12
10
1

44
38 5 6

- Free medical care - Monthly allowances - Other socialwelfare

86.4
11.4

4

12.5

2

13.7

3.1.5. Attitudes of the family and community toward pwDs and

disability
Regarding altitudes toward PWDs, 88 percent of pwDs had positive perceptions on the attitudes of their families toward themselves. Generally, most of them perceived that their families cared for and treated them as a person who deserved consideration and understanding due to their unique need. Further, they were able to be someone that the family could be proud

36

of. However, there were some negative perceptions that humiliated PWDs
such as being a burden and bringing shame to the family. Moreover, they felt fatalistic attitudes by family members toward their disabilities.

PWDs expressed similar perceptions on the attitudes of the community toward themselves as toward the family, but to a less positive
degree. (Table 12)

Table 12 Perceptions

of PWDs on the attitudes of family and community
Family

toward their disabilities

Perception

Community

o a a a o

ls a burden on the family ls shameful for the family ls a result of sin and bad conduct ls a person to be understood ls a useful person ls a person that needs to be cared for ls a person that the family can be proud of ls a person that needs special consideration

180 121

64.1
43.1

105

37.4 32.7 64.8 78.3 60.5 71.5 53.7

92

225 244 213
241

80.1

182 220
170 201
151

86.8 75.8 85.8
62.6

a
o

176

240

85.4 207
61.6 83.6
151

73.7

a a

ls a person with talents ls a person that should receive

173

53.7 71.2

235

200

exceptional privilege
ls a person that should be treat like any other
105

37.4

188

66.9

Regarding attitude toward disabilities, apparently thg PWDs and the

communities possessed fatalistic attitudes toward disabilities. Sin and bad conduct of PWDs themselves, as well as of their parents, in either a previous
or the present life, were factors claimed to be responsible for their disabilities at the highest proportion, 68 percent. Consistently, 60 percent perceived that

the disabilities were not preventable. Among the objective perceptions, 47

37

percent of PWDs perceived that their disabilities resulted from illness; 25
percent from accident and carelessness; 9 percent from medical malpractice

of including health/medical personnel; 6 percent from work conditions and
lastly 5 percent from heredity. (Table 13)

Table

13

Attitudes toward disabilities

Aftitudes
Causes (multiple response)

Sriboonruang

Naklang

Total
Vo

- Sin of PWD - Sin of parents - Bad conduct - lllness - Old age
- Trauma during pregnancy - Accident - Carelessness

94 23 6 79
3

51.9
12.7

54
13

54.0

148
36

52.7
12.8

3.3 43.6
1.7

2 38
0

13.0 2.0
38.0

7
117

2.5 41.6
1.1

I
47
1

5.0
26.O

2
2A

0.6
6.1

0
5

- Work conditions
Prevention of disability

11

03 2.O 20.0 01 5.0
45.0 52.0

11

3.9
23.8

67

o.4
16

5.7

-

Preventable Unpreventable Unsure

68
98
15

37.6
54.1

45
52
3

113
150 18

40.2

53.4
6.4

8.3

3.0

3.1.6. Quality of Life of PWDs

The quality of life for PWDs, was assessed based upon their self estimation of their health status, life satisfaction in terms of availability of
needed equipment and facilities, accessibility to services and information, and

welfare and supports from public and private agencies. The findings revealed

that although PWDs in SBR District seemed to enjoy the availability of a variety of services, from both public and private agencies, the satisfaction for their present health status and living conditions were noticeably lower than PWDs in Naklang District. Satisfaction of public services for education,
occupation, and legal aspects, except for health, were recognized as better, in

38

SBR District as well as the availability of private services. However, PWDs in

Naklang District were more satisfied with facilitating infrastructure, such as public transports, recreation areas, and public toilets, as well as personal
equipment (wheel chairs, hearing aids) than PWDs in SBR District.

In general, half of PWDs perceived their health status and living
conditions as tolerable. Two-third was satisfied with public health services,

and more than half perceived that the existing road system was convenient. The least satisfaction, only 18 percent, was about welfare for equipment.
Interesting enough, it was found that PWDs of Naklang District appreciated

their health and living conditions more than in those of SBR District. (Table
14)

39

Table

14

Number and percentage of PWD satisfaction toward facilities and Quality of Life

Satisfaction about

Sriboonruang

Naklang
n

Total
o/o

Infrastructure for PWDs

-

Road

110

60.8 38.7
19.3

49
39 37 34 49 24

- Transportation - Park/recreation - Telephone
- Toilet
Supportive aids or equipment
Health status

70
35
61

33.7 38.7
15.5

70 28

49.0 159 39.0 109 37.0 72 34.0 95 49.0 119 24.0 52
62.0 151 55.0 149 74.O 198

56.6 38.8 25.6 33.8
42.3
18.5

89 94

49.2

62 55

53.7 53.0

Living condition
Government eenrices

51.9

- Medical - Educational - Social - Consultation/ legal rights
Non-Government services

124
66

68.5 36.5 25.4
19.9

74
31

70.5

46 36

15
13

31.0 97 15.0 61 13.0 49
3.0 2.0 4.0
13

34.5
2'.1.7

17.4

- Foundations - Funds - SocialWelfare

10

5.5 3.3 8.3

3 2

4.6 2.8
6.8

6

I
19

Groups

15

4

40

3.2 Qualitative Study
In-depth interviews with authorities

for PWDs and focus

group

discussions with four groups of local key informants in SBR and Naklang Districts revealed that disability is prioritized at the fourth or fifth rank among public health problems of SBR District, since problems such as communicable diseases and drug addiction have a greater impact on society. Besides, the magnitude of disabilities that appears to be a major problem in SBR District, compared to other places, may not represent the true picture. Since SBR
District had conducted a survey of PWDs and other places had not; therefore,

the rate of disabilities in sBR District is higher, but actually, would be
approximately the same as other places.

Community Activities for PWDs
The activities of the community organized for PWDs were concentrated mostly in SBR District. The project was generally initiated and supported by government organizations with involvement and participation of local people to a certain degree. Activities and contributions of the project were found to be active at central levels and had little effect at the peripheral areas; e.g., the
majority of PWDs in the village never heard about any organization for PWDs. The following are the projects for PWDs in SBR District. 3.2,1. Sriboonruang : a Model District Project

A project for PWDs was established under the initiation of the director
of Sriboonruang District Hospital. The project was chaired by the District Chief

Officer, and a committee consisting of the chief of every government sector, the temple abbot, merchants, local politicians and well-to-do people in sBR District. The secretary of the project was the Sriboonruang Hospital Director,

who was very enthusiastic towards problems of PWDs. The hospital staff
were also active committee members. The project is famous because it was developed by the government sector. The people, as well as local authorities,

such as the Village Headman, TAo, VHVs and school teachers were all involved in the project. The Village Headman, Village Health Volunteers and

41

school teachers cooperated in conducting a survey of PWDs in their areas

and sending them for registration. They also provided them with knowledge about the rights of PWDs under the Rehabilitation Act. The project activities

included: physical rehabilitation services, occupational training, special
education programs and fund-raising. Each activity was responsible by its unit committee. In addition, the project provides a loan with interest for PWDs to use as seed money in their business or occupation. The project was able to

raise large amounts of funding through the participation and involvement of
SBR District residents.

3.2.2. The Club for PWDs

In 1998, PWDs, through the guidance and facilitation of Sriboonruang
District Hospital, organized a club of PWDs in SBR District. The club has 50

members and

a committee with a

chairman and secretary. The office is

situated

in

Sriboonruang Rehabilitation Center within

the compound of

Sriboonruang Hospital. Since it is still a growing organization, the activities are

limited. However, they were able to get funds from the Department of Social
Welfare and the Ministry of Labor and Social Welfare to run the club activities in the amount of 200,000 baht. The activities of the club included occupational

training, physical rehabilitation and meetings among club members to plan
work opportunities for PWDs. They had planned to recruit more members and

to have a PWD representative from each of the 12 Tambons (subdistricts) to
sit as a committee member so that they could share problems and exchange
experience. They also planned to set up a life insurance scheme for PWDs.

3.2.3. The Sriboonruang Foundation

The Sriboonruang Foundation is an organization established for the
purpose of helping relieve the financial problems of SBR District,

a

model

district project. This foundation has its specific functions to mobilize funds to:

1.

support the activities of Sriboonruang; a model district project and the club for PWDs.

2.

act as a consultative body for the Sriboonruang Project.

42

3. work as a coordinating body among the Sriboonruang Project, the Club for PWDs and the community. The
committee of the Sriboonruang Foundation is separated from

the Sriboonruang Project so that it will be independent in decision-making and management. lt will also relieve the
workload of the Sriboonruang Project staff. The committee of

the

foundation consists of representation from the government, NGOs, private sectors and the people of

lt is chaired by the director of Sriboonruang Hospital, through the nomination of its
Sriboonruang District.
members.

3.2.4. The Tambon Administrative Organization (TAO)
Public consciousness and movements in Sriboonruang have increased awareness of the TAO in every tambon of the problems of PWDs in their own

responsible area. They were encouraged to allocate

a budget for specific

to suppoft PWDs in various forms. They provided financial assistance to PWDs to individuals as well as groups; e.9., providing
purposes
transportation for PWDs to participate in social activities organized for PWDs

on National PWDs Day. Some TAOs had planned to allocate funds for the
construction of infrastructure and public facilities necessary for PWDs such as
street footpaths, ramps, toilets and drinking water and recreation facilities.

3.2.5. Sriboonruang Hospital

is an extraordinary district hospital, for the director, Dr. Kriengsak Akepongse, is highly motivated. He is strongly
Sriboonruang Hospital
committed to the problems of PWDs. Efforts were made to renew activities of

the CBR Center and revitalize the spirit of the staff which had been steadily
declining since the Foundation for PWDs was withdrawn. A special hospital team was set up for PWD activities. A social worker was assigned to take full

time responsibility, specifically for CBR, and to be an active secretary of the
team.

43

The seruices provided by Sriboonruang Hospital for PWDs include:
medical rehabilitation and treatment services (diagnostic service, laboratory inspection and other types of special examination), hospital nursing care, home visiting service, counseling service and referal for special treatment
services.

3.2.6. Pilot School with lntegration (Mainstreaming) Programs

There were three pilot schools in SBR District that integrated special
education children into regular programs; they were Muangmai Vitaya School,
Baan Don Por School and Baan Sriboonruang School.

Obseruation of activities and an in-depth interuiew with a teacher was conducted in Muangmai Vitaya School. The finding revealed that at present the school accommodates 40 disabled children who study together with a total
of 700 students. The teacher, Ms. Sarapee Naambundit, had been personally

interest in teaching the children with disabilities even before the integrated program was announced. She had tried to develop teaching techniques as well as modify the teaching methods for these children by her own initiative and many years later she was sent for training on communication with PWDs.
She said integrated education program had many problems to be solved such
AS:

1.

Relationships between disabled children with disabilities and normal children are not natural

2. Although the children with disabilities may have average learning

abilities compared to their non-disabled class-mates, but in general,

they are slower learners with short spans of concentration due to

their handicaps. Thus, the rate of learning slowed. Cooperation among the families is needed to prepare the children with
disabilities appropriately before sending them to school.
3.

A deficiency of qualified and devoted teachers for these children exists due to a shortage of teacher human resources in general;
therefore, an integrated educational program is extra work for the
teacher.

44

9.2.7. The Local Wisdom of Poo-Prai

Poo Prai (Grandpa "Prai") is a 71-year-old man of sBR District whose only grandson "suriya" had been a crippled child since he was born. Suriya
had cerebral palsy from an abnormal delivery. Grandpa Prai was the only one

in the family that had hope for Suriya. He took Suriya to see the doctor at every appointment and performed physical rehabilitation for him regularly as instructed by the physician. Most striking, Poo Prai improvised equipment from household materials to be used as rehabilitative tools for Suriya, such as walking ramps, crutches, canes, and wheel chairs. His indigenous wisdom became famous not only in the village and SBR District, but all over the
country. He is now a resource person for every PWD center. Poo Prai said his inspiration came from the encouragement of the staff of the Foundation for PWDs who gave him constant emotional and technical support. His grandson

is now 16 years old and is studying in the senior class of his secondary
school. His physical handicaps, although much improved, are still prominent but he has the skills to manage his life etficiently,

45

lmprovised Equipment for Disability Rehabilitation

'"il

*\
t,r,i,rf..r

Local wisdom and Indigenous technology "from grandpa to grandson with love"

CHAPTER IV

Discussion and Recommendations

The study of support for PWDs was conducted through several methods of data collection, including surueys of pWDs and relatives, FGD with key community informants in-depth interviews with authorities,
observation of activities, and a review of documents. The findings provided knowledge on the situation of disability and CBR, and its related compound
problems.

4.1 Rehabilitation Program for pWDs
The Rehabilitation of Disabled persons Act, BE 2sg4 (1991), presented policies to provide equity between disabled and non-disabled persons in

society. For example, it allows disabled persons to become senators, to work
in government positions and to have the right to be employed, The law ent1les

PWDs, who have registered under the Rehabilitation Act,
rehabilitation services including:

to receive

a. medical

rehabilitation service, medical treatment costs, aids and

equipment

for

rehabilitating physical, mental/psychological

conditions or improving capabilities.

b.

providing all levels of education as appropriate either in ordinary schools or special schools. their physical condition and potentialto work.

c. giving advice, consultation and occupational training appropriate to
d.
entitling them to participate in social activities and access to various facilities and essential services.

e. providing government lawsuit seruices and contact
governmental organ izations.

with

47

The main policy of the CBR is to promote community members, including state and private agencies in the city and rural areas, family
members

of PWDs, local organizations at nationwide, provincial,

district,

subdistrict and village levels to work together in using community resources

and local knowledge to contribute to the rehabilitation of PWDs to their
highest potential. Thus, the family and community will participate in caring for and providing rehabilitation efforts for the PWDs in the community. This will
result in maintaining a happy life for the PWD.

In conclusion, the CBR consists of four components; i.e.,

medical

educational, occupational/vocational, and social/psychological rehabilitation.

Responsible factors for minimal proqress of CBR action

Although governmental policy was clearly laid out and
commitment was demonstrated through the support

a

strong

of large amounts of

governmental funds for CBR action, the implementation had made only
minimal progress. The responsible factors ranged from ideological, technical
and managerial to cultural components.

1. First and foremost, the knowledge and technology for the CBR were

imported and were not appropriate

for local and rural application.

For

example, to wheelthe imponed wheel chair on the dusty unpaved village road

and to construct street footpaths or ramp ways in public toilet in the village,

were all absurd ideas which would be impossible in the rural community setting today. Therefore, the local body of knowledge and indigenous

technology existing

in the community should be encouraged and

systematically collected, through research and development, and adapted to
suit the needs and way of life for PWDs in the Thai cultural context.

2. The shortage of personnel to work in cBR programs in terms of quantity and qualityi i.e,, lacking of skills, knowledge, and understanding of
CBR concepts and practices at the urban and rural levels and the curriculum in university and college limited development.

Recommendations

for the development of personnel working

with

PWDs include:

-

Increasing the availability of personnel training and upgrading
Requiring all personnel working with PWDs, (health, education)

the skills of untrained personnelwho are now working with PWDs.

to complete a specific number of hours of " upgraded skills training" each year
with evaluative reports tied to salary increases.

Providing regular workshops

for staff to learn adaptive

technology available for servicing PWDs.

3. The capabilities of the family and community to deal with PWDs were lacking. FGDs with key informants revealed that the community had
little concern for PWDs. The community leaders had little or no knowledge at

all about the problems of PWDs in their village. The health priority of PWDs
ranked low due to the fact that the impact of disability to society is not visibly

obvious. The communities did not think of PWDs as a burden because the
family takes care of PWDs themselves. The belief that disability results from

sin or misconduct was widespread. In addition, rural people, due to their
poverty and economic disadvantage, were more concerned with their living
conditions and finances more than health and social problem.

The attitudes of some key informants expressed toward PWD reflected

the prejudice of the community against disability and PWDs in general. There
were families that felt ashamed of having a disabled child and tried to hide them from the public. The school teacher admitted that integrating disabled

children into regular classroom is impossible because they disrupted and
slowed down the class.

It is recommended that a comprehensive approach at the family and
community levels should be strengthened by integrating all essential aspects

into PWD services. Social and economic problems of PWDs and families
should be addressed as much as their impairments and health problems.

49

4. Almost all health/medical

care facilities concentrate their seruices on

corrective treatment of the impairments rather than functional rehabilitation; therefore, the facilities and equipment necessary for rehabilitation services are inadequate. lt is recommended that the dissemination rehabilitation concepts

and skill training to carry out PWD activities should be strengthened among
medical staff and authorities.

5.

The coordination between involved organizations for the CBR was

also a problem, including: referral system management, classification criteria

for registration, i.e., the MOPH has five levels of impairment while the MOE has nine levels and inadequate medical specialists to issue certificates of
registration. There were needs to develop a practical standard for use that

would be accepted by all partners

-

through the appointment of a working

group on the problematic issues. Another recommendation is to have a liaison

officer at each institution that would be able to make recommendations on
needs which can be given to allthe various organizations.

6. Since there are several sectors involved in the Rehabilitation Act, such as the MOPH, Ministry of Labor and Social Welfare, Ministry of Education, Ministry of University, BMA, Budget Bureau and also nongovernment organizations; therefore, the intersectoral coordination problem
was inevitable and resulted in problems of practical management. The Office

of Rehabilitation Authority can only give recommendations and suggestions but has no power to reinforce. Unless the authority came from the Prime Minister with united enforcement the problem of intersectoral coordination
could not be solved. However, it is necessary to distribute functions and roles

for CBR services among various organizations, since one organization can
not provide the full range of rehabilitation seruices needed by PWDs. 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, it is recommended to develop an informal network and build a good sense of understanding among collaborating sectors so each organization

50

knows its role in coordination with others through liaison officers in each
organization.

7. The ministerial regulations issued under the

Rehabilitation of

Disabled Persons Act was a law intended to facilitate assistance and support in society with no compulsory status. The measures were rather in the form

of

motivations and incentives, such dS,

the company or industry

that

employed the PWD will be entitled to tax exemptions. But for the working place that did not want to hire PWDs, there was no negative consequence.

Therefore,

the

vocational/occupational rehabilitation

as well as

social

rehabilitation were not very successful. lt might be workable if the law had

attached the negative incentives such
employment of PWD.

as

increasing taxation

for

non-

4.2 The Situation of the CBR in NBL
As it was revealed by the qualitative study, the activities of the CBR for
PWDs in NBL District were quite impressive. There was a strong commitment

for the CBR program among government officials at provincial and district
levels. Collaboration among various organizations, including, district offices, district hospitals, local parliament and schools, as well as unofficial leaders,

i.e., abbots, and Poo Prai were efficient and effective. The team was
regarded nationwide as a professional rolemodel for the CBR.

long period of withdrawal by the Foundation for Handicapped Children, the activities of the cBR were continued and sustained. The physical facilities and funds were available with good After
management. However, those activities were only active and recognized at

a

the district level. There were no, or only very little spill-over effects in the community, either at Tambon or village levels. Little was known or discussed about the Sriboonruang Project, PWD Club, Sriboonruang Foundation,
lntegrated Education School or the wisdom of "poo prai" The factors contributing to the situation were due to the nature of the functions and roles of the government organization that concentrated and

51

confined the work within their settings. The strategy was also reactive rather

than proactive. The lack of public relations and public education were also
contributing factors.

Recommended Proactive Strateoies for CBR in the Villaqe

It is recommended to use the proactive strategy for the CBR in the
village and to: 1. Develop a mobile team statf who will serve as a catalyst to mobilize the activities in the community and to coordinate between the community and
involved organizations for needed assistance.

2. Set up the CBR unit in the communityi i.e., CPHCC, in which simple

and routine activities can be handled by local people or VHVs themselves
under the supervision of specially trained health center statf and periodic
supervision by medical teams from district hospitals.

3. Provide knowledge and understanding in regard to the disabled to
the community people in order to correct negative social attitudes, in the form

of group education, individual dialogues at home visits, and public relations
through the means of the public address system in the village.

4. Encourage the participation and involvement of the community
specific activities, and giving recognition to promote motivation.

in

any activity for PWDs, including the assignment of responsibility in handling

5. Use Pafticipatory Action Research as a tool to
form of a civil society.

mobilize civic

consciousness for PWDs, and effect collective decisions and actions in the

4.3

Project on Future Technical Cooperation with JICA for PWDs in Thailand
Justification

The study on support for PWDs in Thailand revealed that the prevalence of PWDs is the highest in the northeastern. There were more
males than females in all age groups except in the old age group aged 60 years and over. However, the highest rate is found among the older age

physical and mobility impairment had the highest prevalence, 128.2 per 1,000

population, followed by hearing impairment, mental and seeing impairment,
respectively (74.5,67.0 and 46.9 per 1,000 population).

Although the government had provided assistance to PWDs, in terms

of

medical, educational, occupational, and social services, through the

that 5 percent of the total estimated PWDs were registered under the Act, despite 66 percent of them had
Rehabilitation Acts, BE 2534, the fact expressed their need for assistance from the government, which included all services specified in the Act. The reasons were mainly due to the limitations on the PWDs part. Most of them are poor, living in rural non-municipal areas and physical handicapped. Poor understanding of family and community and

a lack of facilities and equipment for commutation were also barriers. The government and community also had limitations in terms of a shortage of
skilled and qualified personnel, including medical specialists, public health nurses, physiotherapists, social workers and teachers. In addition, the institutional based non-proactive type of service was unable to cover the
majority of PWDs.

With reference to the philosophy of the CBR that aimed at providing an equity between the disabled and non-disabled in society, and the CBR policy of promoting the community members, including state and private agencies to
work together to contribute to the health and welfare of PWDs, therefore, it is

necessary to strengthen the capacities of all sectors involved, in terms of
improving their knowledge, understanding, skills and expeftise to perform their

tasks in providing services to PWDs. These include the family and community

members, health personnel, school teachers,
themselves. The examples of activities are:

as well as the PWDs

53

1. Training PWD Leaders

Under the JICA assistance scheme of "trainee acceptance" and "expert

dispatch," training will be organized for PWDs who show capabilities and interest to devote themselves to the health and welfare of all PWDs. The training will be either a domestic course for Thai PWDs or an international course for PWDs from neighboring countries, i.e., Laos, Cambodia, Vietnam and Myanmar.

Objective:

1.

to

provide PWDs information and knowledge regarding other

PWDs leading to a deeper understanding of PWD problem.
2. to provide opportunities for PWDs to share problems and exchange

experience in problem management.
3.

to enable PWDs to serve as leaders in the promotion of welfare
measures for PWDs at local and regional levels.

Method and Content
The training will consist of lectures, study tours and practice on:

-

analysing the current situation
PWDs

to understand the needs

of

promoting organized activities for PWDs

improve public relations programs regarding the rights and
needs of PWDs organizing social activities for PWDs

Training Srtes

-

The domestic training will be organized in the Noftheastern
region, where the Rehabilitation Center for the Disabled is
located; e.9., Udornthani or Khonkaen Province.

54

-

The international training will be conducted either in Thailand
or in Japan.

2. VocationalTraining for PWDs

Under The JICA assistance scheme of "JOCV," a vocational training is proposed for poor, unemployed PWDs who need assistance to work and earn

money. The vocational training will be designed

to suit the types of

impairments of trainees and will be organized in the community to fit the local

context. Community resources, including, human resources, materials,
technology and local knowledge will be mobilized to support training.

Objective:

1. to provide knowledge and skills for PWDs to conduct
appropriate for their impairments

works

2. to provide the opportunity for PWDs to find employment and to access the chance for successful employment and business
opportunities

3. to alleviate the low economic status of PWDs and family 4. to equip PWDs with dignity and self-reliance 5. to mobilize community resources to contribute to the improvement
of the quality of life of PWDs.

Method and Content

The JOCV teams, consisting of all kinds of professional experts, will be

the trainers of the training. The content of training will vary according to the
conditions and needs. Home industry training may include: mushroom raising mat and basket weaving, artificial flower making and, garment manufacturing.

Training in the institution may include computer training, printing, electronics, metal working, accounting and management.

55

Training Site
The home industry training should be conducted in the community at household sites. The institutional training should be conducted vocational

colleges (technological colleges) or teacher colleges (Rajapat Institutes)
which are scattered over almost every province in Thailand.

3. Gapacity Strengthening for PersonnelWorking with PWDs.
Findings revealed that the greatest felt needs of PWDs was for medical

seruices and special equipment and that there was a shortage of qualified

personnel working with

PWDs. The total number of doctors who

had

received medical rehabilitation certification, to date, was only 41 persons all

over the country. The other types of personnel; i.e., public health nurses, social workers, and medical technicians, were lacking knowledge and skills such as home nursing, counseling, rehabilitation prosthesis, production and repairing, orthosis and other equipment operation. Knowledge and skill
training regarding rehabilitation seruices for PWDs; therefore, is proposed to

be conducted under the JICA assistance scheme of "expeft dispatch" or "JOCV team program". The training will be a "training for trainers".
Training Site

The training will be conducted in Institutes such as Khonkaen University within the Faculty of Medicine, Faculty of Medical Technology, Equipment and Physiotherapy, Faculty of Nursing and School of Social
Wod<ers.

Objective:

1. to strengthen the capability of the health personnel working with PWDs, in terms of knowledge and skills regarding rehabilitation
seruices

56

2.

to familiarize health personnel working with pwDs to
concepts, strategies and technologies appropriate for pWDs

modern

3.

to prepare health personnel to be the trainers for the training of
other health staff

4.

to

provide the necessary facilities and equipment for training institution, and training activities

Method and Content
The training method will include lectures, demonstrations, and practice. The content will vary according to professionaljobs and responsibilities:

-

Medical assessment, diagnosis and rehabilitation
doctors

for

medical

Home nursing care, family-based care and community-based
rehabilitation for public health nurse

Nursing assessment and nursing diagnosis of PWDs for hospital nurses counseling and case management of pwDs for social workers. Production and repair of prosthesis, orthosis, hearing aids, and other equipment for technicians

Similar training should be also applied to other types of personnel working for PWDs, outside the health sphere, such as, school teachers,
school administrators, as well as educators and education administrators. The topics for training will include, special education and integration education for PWDs and improvement of accessibility to mainstream vocational training.

4. Disability Resource Team

technical cooperation with JICA and existing international organizations like the ILO or FAO could be organized to develop a Disabil1y Resource Team to complement rehabilitation programs and provide an
integrated training environment for PWDs and non-PWDs. The team will not

A

57

its services limit its focus to iust training or the rehabilitation center, but extend will to reach out to PWDs in remote areas. The composition of team members

be

multidisciplinary, including health personnel, teachers, vocational in the instructors and business assistants. Health centers or the oPHCC for community could be used to set up a community office or unit with rehabilitation. The Disability Resource Team will coordinate their work
assistant coordinators in each district. These coordinators will actively locate and identify PWDs who need rehabilitative services, or who have no current training and are interested in gaining employment or starting a small

skill

business. 5. Community Empowerment through Participatory Action Research

To mobilize community consciousness and empower PWDs,

their

familiesrand the communitYrto be self-reliant in the management of their own health and social problem. The process of PAR will enable the community people to identify their own problems and needs, to decide the means and methods to handle and manage their problems with their own resources.

Finally, they will be able

to utilize the knowledge learned from the PAR

process to transform their social realities, through collective action. The CBR units can be established in the community with the assistance and suppott of the TAO and VHVs and as a result of PAR. This activity can be supported by JICA under the CEP scheme.

58

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of Medicine, Ministry of Public Health, "Community Based

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6.

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Medicine, Ministry of Public Health, "Annual Repod", 1998.

22. Sirindhom National Medical Rehabilitation Center, Department of
Medicine, Ministry of Public Health, "Future of Community Based Rehabifitation Program", National Conference, Feb 27- March 1, 1995.

60

23. Som-arch Wongkhomthong, Chongkoknce Chutimatavin, *Research on
the Needs of Community Based Rehabilitation (CBR) for Disabled
Persons in Thailand", ASEAN Institute for Health Development,

Mahidol University, 1 998.

24. Somsri Ruksasri (translator), "Precious to God", Rainbow Bridge Fund,
Foundation for Handicapped Children, 1999.

61

Annex

I

Number of organizations which provide services to Services Government Oroanizations

pwDs, Thailand
Number

1.

Medical care and rehabilitation Education

2

2.

5
1

3

3.

SocialWelfare and Occupation
4 2

Non Government Orqanizations

1.

Seruice for the Blind

16 9 13
1

2. Seruice for persons with hearing impairment 3. Seruice for persons with locomotive impairment 4. Service for persons with mental impairment 5. Service for persons with intellectual impairment 6. General service for persons with disabilities
Source

6
15

:

Directory of GO and NGO working with PWDs, Department of Social Welfare. Ministry of Labor and Social Welfare

Directory of Non-Government organizations who provide seruices to pwDs, North-Eastern Region

NAME

Address

Seeing Thailand Association for the Blind Nofth-Eastern Region

633/3 Mahachaidamri, Talard
Subdistrict, Muang District, Mahasarakham 44000 Tel : (043) 722-029 Maharat-Nakhon ratchasima

Suranaree Eye Foundation

Hospital, 49 Changpuerg Road, Muang District, Nakhoratchasima
30000 Tel : (044) 341310-39 ext 1209 Fax:(044) 246389

Chaiyaphum Eye Foundation

Chaiyapoom Hospital, Muang
District, Chaiyaphum Tel: (044) 811444

Christian Foundation for the Blind in Thailand

HQ 214 Moo 6, Prachatiruk, Bann Ped, Muang, Khonkaen
As above

A) Educational Development
Center for the Blind at Khonkaen

B) Educational Development
Center for the Blind at Nakhonratchasima Roi-et Education and Rehabilitation for the Blind Center

149 Moo 6, Mukmontri Road, Muang, Nakhonratchasima
49 Moo 10, Ratchadamneon, Muang, Roi-et 45000 Tel: (043) 512289 Fax: (043) 512989

Hearina or communication

The Deaf Association of Thailand

A) Deaf group of NorthEastern Region

63711-5 Ratuthit Road, Muang, Nakhonphanom 48000 Tel: (042) 513005 511074 Fax : (042) 51 1653

NAME

Address

Phltsical or Locomotion Siriwatana Chestchier Foundation A) Bann lttirat Roi-et Chestchier

lntellectual or learninq abilitll

109 Moo 12, Pattamanond Road, Robmuang, Muang, Roi-et 45000 Tel: (043) 526641

Support for mental retardation Foundation of Thailand A) Social Welfare Center for Udorn-Khonkaen Road, Noensoong, the Mentally Retarded; Muang, Udonthani North-Eastern Region Tel: (042) 295252 Daughter of Charity Foundation
(Th ida-Metadham Foundation)

A) Saint Gerald Social
Welfare Center for Disabled Children in Khonkaen B) Community Based Rehabilitation Project for Disabled Persons in Loei C) Community Based Rehabilitation Project for Disabled Persons in Udonthani

164 Moo 16, Mariwan Road, Naimuang, Muang, Khonkaen

Directory of Government organizations who provide services to pwDs, Nodh Eastern Region Name Ministry of Public Health Mental Health Department

Address

A) Nakhonratchasima
Mentality Hospital

86 Changpeurg Road, Naimuang,
Muang, Nakhonratchasima 30000 Tel : (044) 271667-9 Fax : 259187

B) Nakhonphanom Mentality
Hospital

210 Nakhonphanom-Tha Uthain Road, Arch-samard, Muang, Nakhonphanom 48000 Tel : (042) 512272 512512 Fax : 51 3262
Sri-mahaphot Mentality Hospital, Muang, Ubonratchathani 34000 Tel: (0a5) 312550 Fax:312542 Khonkaen Mentality Hospital, Muang, Khomkaen 40000 Tel : (043) 227422 Fax: 224-722

C) Sri-mahaphot Mentality
Hospita.

D) Khonkaen Mentality
Hospital Medical Seruice Department

A) Chaiyaphum general
hospital

Muang, Chaiyaphm 36000 Tel : (044) 81 100s Muang, Nakhonphanom 48000 Tel : (042) 511424 Muang, Buriram 31000 Tel : (044) 612082 Muang, Yasothon 35000 Tel : (045) 71 1580 Muang, Roi-et 45000 Tel : (043) s13001 Muang, Srisaket 33000 Tel : (045) 61 1503 Muang, Loei 42000 Tel : (042) 81 1679 Muang, Sakonnakhon 47000 Tet : (042) 71 1636

B) Nakhonphanom general
hospital

C) Burirum general hospital
D) Yasothon general hospital

E) Roi-et general hospital

F) Srisaket general hospital
G) Loei general hospital

H) Sakonnakhon general

hospitat

Name

Address Muang, Surin 32000 Tel : (044) 514127-8

l)

Surin general hospital

Ministry of University Affair

A) Khonkaen University

Sri-nakarinHospital, Mitrtaparp Road, Muang, Khonkaen 40000 Tel : (043) 241331-44 ert 1696

Ministry of Education

A) Education Region 9
Muang, Khonkaen 40000 Tel : (043) 221-751 Fax222962 Muang, Udonthani 41000 Tel : (042) 323682 Fax 232683 Muang, Khonkaen 40000 Tel : (043) 246-493

Udonthani

Khonkaen

B) Education Region
retard)

10

Muang, Ubonratchathani 34000 Tel: (045) 3127641 Muang, Mukdahan 49000 Tel : (042) 612237 Muang, Kalasin 46120 Tel : (043) 891080 Muang, Roi-et 45170 Tel : (043) 569278

(deaf/hearing loss)

C) Education Region

11

Muang, Surin 32140 Tel : (044) 551793 Muang, Nakhonratchasima 30000 Nakhonratchasima

Tel: (044) 214983
Muang, Chaiyaphum 36000 Tel : (044) 812307 Muang, Khonkaen 40000 Tel : (043) 221751,239055 Fax 239073

Chaiyaphum Special Education Center Region 9

Name Special Education Center Region Special program (Blind + normal) Primary School Education

Address

10 Muan@
Tel : (045) 312764 Fax 281308

Muang, Khonkaen, (043) 236506 Muang, Khonkaen, (043) 236579 Muang, khonkaen, (043) 2377O2 bumrung Muang, Khonkaen, (043) 221829 Muang, Khonkaen, (043) 236978 Muang, Khonkaen, (043) 22225a Normal Education Department Muang, Khonkaen, (043) 221511 Muang, Khonkaen, (043) 2217A9 Muang, Khonkaen, (043) 2G1154 Muang, Nakhonratchasima, (044) 214557 Fax21444O Muang, Nakhonratchasima, (044) 213398 Muang, Nakhon ratchasima,

(044) 257667
M

uang, Nakhon ratchasima,

Tel : (04a) 371301-2
Ministry of Labor and SocialWetfare (Ban Thongphumpowpanus)
16 Srinarong Road, Naimuang, Muang, Ubonratchathani 34000 Tel: (045) 254092
1

Khonkaen

76 Moo 9, Khongsoong, Ubonrat Khonkaen 40250 Tel : (043) 246080
Klungarwut Road, Kamyai Muang, Ubonratchathani 34000 Tel : (045) 28s469

North-Eastern Region

Annex ll

List of in-depth interviewees

Name

Praku Wanroph

Yarnnawaro

WatTunry
Khonkaen. District Chief Officer Sriboonruang, t\long Bua Lamphu

Mr. Prachil Nilkhet

Dr.Kriengsak

Akepongse

Director of sriboonruang community Hospital, Nong Bua Lamphu

Iel : (042) 353443-5, 351063
Fax: 351214
Dr. Sarawut

Santinantaruk

physician of Sriboonruang Community Hospital, Nong Bua Lamphu l'el : (042) 353443-5, 351063

Fax:351214
Mr. Samart Ratanapatheepporn President of Provincial Administrative Organization, Nong Bua Lamphu Mr. Prai Somlela Grandfather of a PWD

34 Moo 7,Ban Saimoon, Saithong,
Sriboonruang, Mr. Suriya Nong Bua Lamphu 39190 pWD

Somlela

34 Moo T,Ban Saimoon, Saithong,
Sriboonruang, Nong Bua Lamphu 39190 Mr. Pongsawat

Tumwong

chairman of Disabled club
Sriboonruang Community Hospital Nong Bua Lamphu

Ms.Sarapee

Nambandhit

Teacher
Muang Mai School Nong Bua Lamphu

Name Ms.Surapee

Vasinonffi
Office of the on Committee Rehabilitation for Disabled persons, Oepartment of Social Welfare, lvlinistry of Labor and SocialWelfare

fel:2822853,
Mr.

O2B3O19

Wisit

Sanamchuad

Lawyer Otfice of the Committee on Rehabilitation for Disabled persons, Oepartment of Social Wetfare, Ministry of Labor and Social Welfare.

Dr. Pattariya

Jaruttat

Tel : 2922953 Fax : 2921422
Director

Sirindhorn National Medical
Rehabilitation Centre, Ministry of Public Health,

Tel:5914242
Mr. Teera Jantrarat Director Education for PWD Division, Ministry of Education

Tel:2807045-6
Fax:2807045

List of pafticipants of Focus Group Discussion

Name

Tambon Nakoro. Sriboonruano

1. Abbot Pisarn Wimonkit

Abbot

2. 3. 4. 5. 6. 7. 8. 9.

Mr.Thongka Thikaban

Village headman assistant
Member of TAO School Teacher Village health volunteer Village health volunteer Village heath volunteer

Mr.Porn Haoheng
Ms.Suwisa Rongjumnong Ms.Junhorm Sriraksa

Mr.Sa-nga Prommin Mr.Somkuan Noikhun
Mr.Boonchu Phicanitr Mr.Sombat Thatthong

Village heath volunteer Village health volunteer
Member of TAO

10. Mr.Suphe Phaikhet

Tambon Naklano, Naklang

1. Adul

Ung-kavaro

Monk

2. 3. 4. 5. 6. 7. 8, 9.
10.

Mr.Srita Porsaket Mr.Chantra Poontawee Mr.Sathit Nasayond
Mr.Kampoon Thup-arsa
Ms.Arunee Boonsrima

Village headman assistant Village headman assistant
School principal Subdistrict chief off icer Housewife Village health volunteer Member of TAO Village headman assistant Subdistrict chief officer

Mr.Charus Thavorn

Mr.Nicoom Malee
Mr.Kamsaen Champakaew

Mr.Chalerm Sacha

Annex lll

Study on Support for Persons with Disabilities

"Study on Support for Persons with Disabilities"
ASEAN lnstitute for Health Development

Mahidol University

lnterviewer

:

Mr./Mrs./Miss

lnterviewee : Mr./Mrs./Miss

Address:......

Village:..

..Sub-district...

District

,....Province:

@

Date of Interuiew : ...... ......lFebruary/ 2000

1. Sex

) 2. Age
(

Male

(

)

Female

......,.years

3. Education
(
(

(

llliterate Secondary Bachelor

o

() ()

Primary Vocation Other (specify).

4. Marital status
( ) Single O Married ( ) Widowed/SeParated/Divorced

5. Occupation

O UnemPloYed o o O Labor () Business O
6. Household status
( ( (

Agriculture Government employee Other (specify).

) Head of household ) Parent ) Dependent

o o o o o o

Spouse Children/Grand children Other (specify).

7. Relationship with disabled person
( ) SPouse ( ) Grandparent ( ) Brother/Sister

Parent Children/G rand children Relative (specify).

ASEAN lnstitute for Health Development, Mahidol University

Study on Support for Persons with Disabilities

1. Main occupation

of family ( ) Labor ( ) other (specify).

( ) Agriculture/farming O Own business ( ) Government employee

O Self-employment

2. 3.

Family

income
O Saving

.. BahVmonth
( ) Enough ( ) Not enough

Balance of income and expenses

4. Period of settlement: .. 5. Family members 6. Number of siblings

. years........ months

persons person

7. Number of disabled person in family. 8. Birth order of disabled persons

.. persons

1.

Sex

O
3.

Male

2. Duration of disability

.....

O
... years ...... years

Female

Age.

4. Marital status

O Single O Married ( ) Widowed /divorced/separated
5. PWD living with
(

(

O O ()

Parents Children/grand children Friends Relatives Other specify

() () () ()

Spouse Brother/Sister Grandparent Living alone

ASEAN /nstltute for Health Development, Mahidol tJniversifu

Study on Support for Persons with Disabilities

6.

Education

O Current

)

)

()

Past ) )

Class .... Type otrinooi O Normal Education School O Special Education School ( ) Informal Education School
Level of highest education Type ofschool Normal Education School O Special Education School ( Informal Education School Reason for not studying. Reason for never attending school

(

t ) Never )
)

O )

7.

Occupation
( Unemptoyed ( ) Earning income for their own (Specify job) Helping family (e.9. agriculture, business etc.) without pay O

)

Information of daily activity of pWDs

8.

Does PWD have aids or special equipment for disability?

O

Yes

O No
outside by themselves?

O not appticabte

9. Can PWD going

O Yes O No (specify

reason).
( ) g-5 day/week ( 1-2 day/month

.......)

10. How often do PWD go out (for study, work, travel)?
( 1-2 ( ) Never () ( ( () () () ()

O Everyday

)

day/week

)

11. What are the inconveniences when going outside?

) )

No helper Road condition Ditficulty in getting on/otf Bus/Mass Transit Expensive transportation fare Afraid Embarrassing /feel shame Others (specify)

ASEAN lnstitute for Heatth Development, Mahidot lJniversitv

Study on Support for Persons with Disabilities

12. Normally, where do PWDs stay during daytime?

) )

)

Otfice

Institute/Foundation/Hospital

Other (specify).

O School O Home

13. What does the PWD do in leisure time?

1....

2..... 3.,...
1

4. Interpersonal retationship (multiple response)
O O Tatking/Chatting ( )Playing ( ) Eating together ( ) Participating social activity ( ) Being helped/ taken care by neighbors ( )Helping disabled when they need care ( ) Other (specify).

Greeting together

15. When PWD have problem

with, whom do they consult

?

3.

1.

Did you register for your disability? ()

O

Yes

No
I

(why ?)

Type of d isabi ity/characte ristics of disability

O

Hearing or Communication
( ) Stammering

) Dumbness ( ) Hearing impairment
(

O O

Total deafness

Seeing
( ) One-eyed blindness

O

Two-eyed blindness

ASEAN lnstitute for Health Development, Mahidol university

Study on Support for Persons with Disabilities

O Body or Movement
( ) Amputation/part of arm ( ) Amputation/part of leg

) Amputation/part of finger ( ) Amputation/part of toe ( ) Cleft lip or palate
(

( ) Paralysis or paresis ( ) Disability of limbs ( ) Scoliosis or kyphosis

@ Mental or behavior
( ) Psychosis

O lntellectual disability
( ) Mental retardation
@

Muftipfe disabilities (specify)

3. Cause of disability

O Heredity ( ) Accident (specity)

I

o o o o

Home (specify) Work place (specify) Traffic (specify) Others (specify)

o o o o

lllness Congenital abnormality Behavior (drug addict,alcoholism)

Other (specify)

4. Number of disabled ONo

relatives

( ) Yes (number) ......(specify type of disabitity)

ASEAN lnstitute for Health Devetopment, Mahidol tJniversitv

Study on Support for Persons with Disabilities

1. Initial detection

of disability of PWD by

( ) Health personnel ( ) Family

O Self-detection
( ) Friend/neighbor ( ) Colleagues/teacher/monl</village headman ( ) Other specify.

2.

What was the first management for disability?
( ) Nothing ( ) Consulted with villager/neighbor ( ) Treated at government hosPital

O Treated at health center O Consulted with village health volunteers ( ) Treated by fraud ( ) Treated by traditional healers ( ) Treated by spiritual healers ( ) Treated by masseuse/masseur O Treated by monks
( ) Other (specify).

3.

At present , do PWDs receive treatment?

O Yes by9
( ) Modern practitioner (e.9. doctor, nurse, etc.) ( ) Fraud ( ) Spiritual practitioner ( ) Traditional practitioner ( ) Other (specify). ()

No

reason for not receiving treatment
( ) The condition is better ( ) lt's

I

not treatable/ it's incurable

( ) Cannot afford/ costly
( ) PWDs refused treatment

ASEAN lnstitute for Health Development, Mahidol University

Study on Support for Persons with Disabilities

( ) Family is too busy ( ) Difficult to go out for treatment ( ) Don't know the place for treatment ( ) Provide treatment themselves ( ) Other (specify).

4. Are PWDs able to do these activities

by themselves?

( ) Need help or assistance from someone

O Partially independence 9 specify
( ) Bathing/ toothbrush / wearing clothes

O Eating
( ) Urinating/defecating ( ) Traveling/moving ( ) Doing house work

O Communicating

O Reading
( ) Writing ( ) Independence / perform regular tasks

9

specify
( ) Working to earn income (self financial support) ( ) Working to earn income for their own families

5. Who provides

care and assistance it PWDs unable to help themselves?

( ) Spouse ) Children/grandchildren ( ) Parent ) Brother/sister ( ) Grandparent ) Relative ( ) Friend/neighbor ( ) Nobodyhelps ( ) Other specify

6.

What assistance do PWDs need from family?
1

2 3

7.

Can the family provide assistance needs ?

O Yes
( ) No (specify the reason) ( ) Depend

ASEAN lnstitute for Health Development, Mahidol University

Study on Support for Persons with Disabilities

Current health and disability status at present ?
1. Disabilities status when compared with initial stage ( ) lmproved
( ) Deteriorating

( ) Stable

2. Health status from January

- February 2O0O

O Have been sick
( ) Sick and unable to perform task ( ) Sick but able to perform task ( ) Never been sick

O Treatment received
( ) Modern medicalcare
( ) Self treatment /or traditional medicine

( ) No treatment

O Ever had any accidenUinjury
( ) Had (specify) ( ) Never
@ Have been admitted to the hospital

( ) Yes (specify)

ONo
O Smoking

O Yes

ONo
O Drinking alcohol O Yes

ONo

ASEAN lnstitute for Health Development, Mahidot tJniversity

Study on Support for Persons with Disabilities

1. Do PWDs think that the disability can be treated ?
O Yes

ONo

( ) Not sure

2. Have PWDs ever been trained or attended rehabiritation courses?

( ) No (skip to Question no. 4) ( )Yes9 specify ( ) Care /rehabilitation (where)...... ( ) Education (where). ( ) Occupation (where).....
3. Are PWDs satisfied with rehabilitation courses?

O Yes O No (specify).
4. Have PWDs ever had rehabilitation ?

O Yes ONo
5. lf yes, from whom?
(

( (
(

Health personnel Foundation staff Villagers (specify). Other (specify).

6.

Do PWD practice rehabilitation at home?

) Regularly
) Once in a while ) Never

7.

What following assistance do PWDs need?
( ) Medical care/Rehabilitation assistance ( specify) ( ) Occupational rehabilitation assistance (specify) ( ) Legal/ law suit assistance (specify). ( ) Education assistance(specify)....... ( ) Other (specify).

8. Have PWDs ever heard about

the Rehabilitation of the Disabled Person Act

()

Yes (How).
the benefits about being registered as pWDs
?

ONo
9. Did PWDs know

( ) Yes (specify).

ONo

ASEAN lnstitute for Health Development, Mahidol tJniversitv

Study on Support for Persons with Disabilities

10. Have PWDs ever been assisted or helped by the following persons/group in the community ?

Persons/group
- Village headman - Teacher - Monk - Neighbor - Volunteer - Group/club specify - Tamboon Administration - Other

les (specify)

No

1

' How do PWD perceive the attitudes of family and community towards their
disabilities
?

Family /Community thinks that pWD yes

Family no

Community yes
no

- ls a burden on the family - ls shameful for the family - ls a result of sin and bad conduct - ls a person to be understood - ls a useful person - ls a person that needs to be cared for - ls a person that the family can be

proud of - ls a person that needs special consideration - ls a person with talents

- ls a person that should receive exceptional privilege ls a person that should be treated like qny other
2. Do you think that disability can be prevented ?

OYes

ONo
10

ASEAN /nstllute for Health Development, Mahidol UniversiV

Study on Support for Persons with Disabilitres

3.

What factor do you think is the cause of the disability?

Perception of cause of disability - lllness
- Accident - Occupation risk - Trauma during pregnancy - Malpractice of practitioners - Sin of the disabled - Treated malpracticing doctor - Sin of parent - Congenital anomaly - Bad conduct - Othe(specifu)...................................................

Yes

No

.........

.......

4.

Are PWD satisfied with facilities and quality of life ?

Satisfaction Facilities - Road/ pathway
- Transportation/ mass transit

Yes

No

- ParW recreation place
- Telecomm - Toilet
un

ication/telephon e

Special equipment (e.g., wheelchairs, hearing aids, etc.) Health status

Living conditions
Government services
- Medical carel rehabilitation services - Education
- Occupation/ job opportunity

- Legal/ law consultation

Services of Non government organization and private - Foundations
- Village funds

- Social welfare groups

ASEAN lnstitute for Health Devetopment, Mahidot lJniverstv

11

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