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A learning experience from the Graduate Health Volunteers and the Graduates Return Home Projects.

Krasae Chanawongse

Som-arch Wongkhomthong
Rosa Corazon F. Cosico
Bangkok, Thailand : FebruarV 6, 1989

This book is dedicated to the University Graduates of Thailand in honour of their selfless endeavour in the pursuit of health and social development.

We would like to invite the attention of the reader to the fact that this book is a sequel to Publication No. 8 Research for PHC Model Development, Chanthaburi hovince, entitled "Primary Health Care -

A Continuing Challenge" published by the Mahidol University's then ASEAN Training Cenhe for


Health Care Development (ATCIPHC) now ASEAT{ Inslitute for Healttr Development (AIHD),

on the 1$ of May, 1987 in Bangkok, Thailand. The book is an excerpt to the emotionally - laden experiences of the university graduates of Thailand. While it reveal elusive dreams it nevertheless proved an awakening of Thai university graduates to their roles and responsibilities as catalysts and leaders in health and social progress. A combined effort from the "Triumvirate Authors" armed with analytical dissectiveness, devotion and drive, literary and scientific prowress; the book has been a by - product of a persevering distillation process of the dual projects, "The Graduate Health Volunteers Project" and "The Graduates

Return Home Project".

We have subdivided the book into three chapters in the hope of providing assistance to the
reader through the pages ahead, Basic findings were highlighted at the end of. every Chapter if only

to leave a more tangible imprint on the reader's mind.

It may come as a pleasant revelation to the reader that Thailand's university graduates have limitless potentials waiting for an awakening, anxious to be recognized, raring to be utilized as the

country fights its perilous battle in the maximization of health and social development.

The Authors

The operations staff of the Graduate Health Volunteers and the Graduates Retum Home Projects wish to acknowledge the invaluable cooperation and assistance rendered to them by the following :

Prof. Dr. Natth Bhamarapravati; Rector of Mahidol University and the founding father of the Graduate Health Volunteers Project. Prof. Dr. Natth has conceptualized and operationalized the
utilization of the university graduates in health and social development and has provided unrelenting stimuli to the project operqtions staff through all the phases of the project implementation. Prof. Dr. Masami Hashimoto of Japan, the former Japanese National Team l.eader on ASEAT{ Training Cente for himary Health Care Development (ATC/PHC) Proiect who has closely collaborated

hof. Dr. Natth in the formulation of effedive strategies for the mobilization of university graduates in the community.
with Iwamura of Japan, former Team Leader based at ATC/PHC for the inspiration, the encouragement and the support he has given to the graduate health volunteers (GHVs) and

hof. Dr. Noboru

community leaders of Thailand.

Mr. Somphong Pantsuwan and his staff; Governor, Chantaburi Province and concurrently the Chairman of the Graduates Retum Home (GRH) hoiect for his stuong political will in the achievement of a successful project delivery. Dr. Kosin Rangsayapan and his staff; Rector Rambai Bami College and Honorary Adviser of the GRH Project for sharing his precious time and energy throughout the entire project life.
The 3 batches of GHVs and the first batch of the GRH for unhesitatingly spending a year of their youth as human resoluce vehicles in the achievement of integrated heafth and social development in the villages of Thailand.

lvb. Chc$oerce ChdLnderft, the prcFd seclfuy ftr nnlrrrg dr olhenrrise gaar en&arctn a gratifuing experience. Ms. Chongkolnee has provided the necessary morale booster to the project viahlfty fuough her chum and devotion,


and dlplomacll oeafrrg much needed hcnrony throWh-

out the entire proirct duration and, last but not the least to;
The Japan krternatlrnd Cooperdon Agency for ttr much - needed and equally apereclded

financial assistance and technical support.

For the past decade, the long-term goal of WHO's Health for All by the Year 2000 has reoriented the national health care systems of virtually every country of the world. One of the main reasons that this

goal, and its inherent primary health care movement, came about was due to the previous lack of success in extending the benefits of new medical and health services to the majority of populations in disadvantaged and remote rural areas. A common observation was (and is) that those resources
needed to raise the standard of living are usually insufficient or oftentimes not properly managed in rural sector, as opposed to its urban counterpart. The result is a common set of synergistic problems: lack of education, poverty and ill-health. The limited resources involved are not necessarily monetary in nature, but include especially
a lack of information and the manpower needed to guide community members in becoming self-reliant.

Government's, be they in Thailand or elsewhere, cannot and should not take sole responsibility for the health and development of each rural community. Rather, community members must be given the guidance, information and leadership skills to recognize and identify strategies for solving their own health and development problems, to provide for their own means, and to manage their own resources and development. This remains the true social and political challenge of Thailand's primary health care and quality of life movements. In this light, manpower development has become even more essential and important at the present time if we are to support the long-term goal of WHO's Health for All by the Year 2000. Moreover, "people development" in this case centers not only on
health personnel, but an inter/inha-sectoral partnership between officials and personnel at all organiza-

tional levels on down to the community members themselves.

In many developing nations, health and community development workers are implemented to provide information and assistance as well as the promotion of community participation. The types of workers involved vary by country and community according to the needs and resources available


for satisfying them. Thus, they may include in different societies people with limited education who
have been given elementary training in health care and community development. In Thailand, though, university graduates are one extremely viable target group who has been under-utilized and under-

mobilized for health and development purposes, even though many have difficulty finding jobs after graduation.

On its part, the ASEAN Institute for Health Development at Mahidol University has aimed itself towards designing innovative strategies to mobilize university graduates as a skilled communitybased manpower force. Initially begun as a component to the Project on Primary Health Care Model Development, the concept of Graduate Health Volunteers (GHVs) has embarked on polishing the
Ieadership skills for health and development of volunteer graduated youths. These youths, who through the third batch totalled forty{wo persons, operated within the shuctured primary health care delivery srvice of Chantaburi province. Their purpose was to promote community participation through sound

leadership and thereby assist community members in remote rural Chantaburi villages in improving their health status and community development. To date, these youths and their enthusiasm have in one way provided a low cost solution to the problems of health manpower shortage even under a restricted financial climate. Throughout the project's duration, continuous brain-storming sessions were held by project staff in an effort to identify even more effective alternative shategies for project implementation. One
such strategy is that rather than providing service to villages other than their own, GHVs should be encouraged to return and contribute their efforts in the development of their home villages. Such an alternative would reduce the feeling of "outsiderness" or "alienation" which in some cases brought

about feelings of resentment both on the part of the GHVs and the existing community health staff . It is likewise strongly felt that the provision of monetary remuneration might adversely affect project sustainability and nation-wide replicability. Based on lessons leamed from the original GHV prolect,
an altemative model was conceptualized and implemented, that isthe "Graduates Retum Home hoject". This new shategy is based firmly on theprinciples of self-reliance and personal commitment for both

the university graduate as he/she works to improve the standard of living in his/her natal community. This new project also emphasi?ps even more a search for excellence in leadership. Communityr participation and self-reliance, once initiated, can be a powerful force for change. But this cannot come about if people are not encouraged to stand up and take action. For this purpose, informed leaders who are willing to work with community members and are a part of the community are esser,tial if the delivery of integrated health and social services is to become a concrete and sustained reality. Excellence in leadership, in this case, rests on the knowledge, skills and sensitivity of university graduates as they return home to apply their abilities for the lives and livelihoods of their fellow community members.

Krasae Chanawongse, M.D., Dr.P.H.


ASEAN Institute for Health Development

Mahidol University at Salaya
6 February 1989

Preface lll

Acknowledgements Prologue
The ASEAN Instltute for Health Development (AIHD)

iv vi

xii xiii

The Japan International Cooperation Agency (JICA)



Problems to Cope with in Real - llfe Situation

1. Problem Analysis 2. Problem Categories,/hoblem Remedies

1 1

Chapter 2 The Graduate Health Volunteer (GHVs) Project

2.L 2.2 2.3 2.4 2.5 2.6 2.7


ProjectOverview ProjectObjectives
Project Site

8 8 8 9

ProjectActivities Projed.Evaluation Results

Concluding Remarks Return Home Project

49 53

3 The Graduates

3.1 Projecl Overview 3.2 ProjedObjectives 3.3 Project Site 3.4 Project Activities 3.5 Concluding Remark

55 55 56 56 56




Epllogue Annexee:



Annex Annex

Publications on Research for PHC Model Development,

Chanthaburi hovince




75 79


ProjectTime Plan for Operaflon

Annex 4 Annex 5 Annex 6 fuinex 7 TheAuthors

hoject Mllestones Summary of Mini-Projects Undertaken by the Third Batch of GHVs

List of Graduate Health Volunteers List of Parttcipants in the Graduates Retum Home ProJect

83 85 87 88


(formerly the ASEAN Training Centre for Primary Health Care Development


The ASEAN Training Centre for Primary Health Care Development (ATC/PHC) was established in Octobr, 7982 as a part of the ASEAN Human Resources Development Project under the technical cooperation of the Government of Japan. A collaborative project between the Mahidol University and the Minishy of Public Health, the ATC/PHC is supported by the Royal Thai Government (RTG) and collaborating agencies. The ATC/PHC is working closely with the ASEAN Secretariat to the
Committee in Social Development, Expert Committee in Health and Nutrition, the Japan Intemational Cooperation Agency (JICA), the South East Asia Medical Information Centre (SEAMIC), the World Health Organization (WHO), other United Nations (UN) health related agencies and concemed non-

government organizations NGOs)

The ATC/PHC functions

as an international institution for human resources development

with the ultimate goal of serving as a fulcrum for exchange of knowledge acquired and experiences gained in the field of primary health care and social development among member countries of the

ASEAN. The Centre concentrates on a manifold of specific objectives: training of all categories of
health workers (from policy makers and policy makers to-be, down to the primary health care cadres)

enhancing their managerial potentials and functions; research and model development for primary health care in the different levels of the health care delivery system; strengthening of infrastructure support to meet the training needs of the target population both locally and internationally among the
neighboring ASEAN counties; and, the establishment of local and intemational networls of information

exchange on primary health care and related activities. Adminisbatively, the Cente operates under the Mahidol University, the forerunner of medical and public health education in Thailand. The Mahidol University has been named in honour of the pioneering activities of H.R.H. Prince Mahidolof Songkhla the father of His Majesty, The Great King, Bhumibol Adulyadej the present King of Thailand. The Centre's policy is guided by the Executive


Board whose membership comprised of the Minishy of Public Health, the Mahidol University and the

Director of ATC/PHC amongst others, serving as members of the Board. The ATC/PHC was established along side with four RegionalTraining Centres (RTC) at the request of the Ministry of Public Health. These four RTCs are located in Khon Kaen, Chonburi, Nakornsawan and Nakorn Srithammarat provinces. Over the short span of its five-year operation, the Centre has proved as the ever-dynamic training institution, it has envisaged to be; in the development of PHC cadres and of potential PHC
development managers and policy makers both locally and in the neighboring Asean countries. Likewise, the Centre has fulfilled its commitment on functioning as a springboard for resource mobilization

and in the strengthening of regional cooperation and integration. It has also prided itself with its role as a facilitator on technical cooperation and technological transfer at intracountry and inter-country

In time, the scope of the Centre's effort has expanded considerably with participation from other countries in the Middle Eastern South Asian and the Asia-Pacific regions. Accordingly, the Centre fias evolved approaches to PHC development that are in keeping with national policies and responding to the results of an extensive research and development process undertaken in this country. Thailand has adopted its approaches to achieving the goals of PHC which
has been relenedto as the Quality of Life Improvement Campaign based on Basic Minimum Needs. This programme has made considerable progress in achieving intersectoral cooperation between the

main development agencies in the country as well as providing greater autonomy and self-reliance
at the periphery of the health care delivery system and in the communities. With these developments came a realization that ATC/PHC must also evolve and redefine its policies and approaches in accor-

dance with national trends. In 1986, Ivlahidol's Universig Council chaired by former Minister of Public Health, Prof . Dr. Sem Pringpoungkaew, submited a proposal to upgrade the Cente to a firll institution under Mahidol University with an expanded scope of operation. The proposal went through the Ministry of University Affairs to the Cabinet which approved the measure in August 1988 and then refened in to H.M. the Great King whose Royal Decree officially established the new Institute.

AIHD has been conferred

a full institute. status with an even broader mandate. The thrust

of the Institute's operations will be on policy related issue for health development to include a more comprehensive approach over and beyond that of primary health care. This broader mandate enables

the Institute to develop'collaborative approaches with other local government agencies.


The Govemment of Japan through the Japan Intemational Cooperation Agency (JICA) has committed itself to a dual channelled flow of support to the AIHD formerely ATCIPHC; grant-in-aid and technical
assistance. The grant-in-aid was mainly in the form of capital costs at the initial construction and setting

of phase of the AIHD. The technical cooperation, on the other hand, is concentrated on all necessary technical support in the operationalization of various project activities conducted by the centre. This includes costs in the conduct of training programmes and seminars, research, model development,

equipment, fellowship and the assignment of experts. The JICA's technical assistance on model development for the PHC activities has ushered the formulation of the "Project on Research for Primary Health Care Model Development-Chanthaburi Province", in January 1985. The JICA has likewise provided a considerable amount of technical advisory back-stopping towards the implementation of the "Graduate Health Volunteers" and the "Graduates Return Home" project; launched in January, 1985 and January, 1988; respectively.

Health service has always been an elusive commodity to the developing world. The concept of integrated

health and social development is all the more unattainable if not totally incomprehensible to the less priveledge brothers of the western civilization. The absence of a well-oiled machinery for the delivery
of health services has been to a certain extent further handicapped by futile attempts twoards an integrated

health and social development approach. Much as Thailand has earned the positive reputation of creeping quietly into the shadow of progress, still a lot of energy has to generated to achieve an enviable health and social milieu. Despite
the current upsurge in farm produce, the monumental hike in local and foreign investment, the tourist boom, housing programes; unemployment problems have continuously hamper social groMh. The problem of unemployment is a constraint both the educated and the non-educated Thai

youths have to cope with.

University graduates end up in a dilemma as to what to do with their diplomas. Parents are as equally in a quandary having mortgaged family properties to educate their children. There simply are no jobs. And if there are, the jobs do not parallel the expectations of both the graduates and their
parents. Most of the graduates' orientation of a university degee is for an ultimate enty into the govemment

service. This aspiration has come as a result of medieval educational concept of preparing university graduates as future public servants. Other graduates are more attuned to being "salary-men" that is, one with a fix income to rely on at the end of every month. Still others are opting for the big cities

where job competetions are thrice more stifling.

The situation has become so dismal that it rarely comes as a shock to find that the friendly
saleslady has a bachelor of science in social work. Neither is it surprising that a waiter tending to a half

sober customer is a political scientist. The overproduction and consequent underutilization of university graduates hs appended


to a highly complex problem - that of the vicious cycle of unemploymen!, poverty, ignorance and

It has become imperative f6r the concemed government agencies to take note at precisely u,hich cplical point they should mediate; at which clrclical point can etfer,trve interr.rention be intoduced, which altematives would be feasible and which of the feasible alternatives would be acceptable to all concemed.
What is obvious

that an interdisciplinary approach is mandated, implementing a multsectoral

pool of intervention strategies.



The problem is complex and has long beleaguered government systems of the developing world. Solutions pre-require a combined approach; both scientific and behavioural. It will take a long time before any occurring event is labelled as productive, and the reasons are obvious; the growing
social decadence, change in values and the glamour of modemization that had to be overcome. However; while the problem is multi-pronged, it is not completely unfathomable. What is required for is an honest assessment of the facts on hand and the sifting of fanciful dreams from the raw realities.

1.1 The Fanciful Dream

During the ancient era, the universities are required to direct student goals towards govemment

service. Thus, every student's dream is to find oneself in the government employ at whichever field one has graduated from. This orientation has brought forth a great amount of delusion to the university graduates; many of whom find it impossible to enter the government service. While it is most noble to be of service to the nation as government officials, students have to be awakened to the fact that it is not only by serving in govemment's offtces that they can be of value to the counhy. While it is not wrong for the graduates to aspire for a civil service position, it must also be realhedthat currently there
are not enough govemment posts to wanant accomodation of the majority of the university graduates.

Another unfulfflled dream is that of being a "salary-man". The attactiveness of a lixed monthly wage may well be rooted from the sense of security it brings forth. A fixed amount of income always
carries along the advantage of a well-managed, well-budgeted finances. The present-day financial drain

has reverberated into a brain drain. University graduates would rather be employed on a fixed-time salary scale than utilize their intellectual capabilities in health and social development. There seemed to

be no interest at all generated by small-time business indushies for them. They are happy and contented

enough to be fix-salaried employees instead of shiving as employers themselves. Their sense of values have not been primed to the enhancement of social development. The call of Bangkok and the rest of the big cities is far too loud to be ignored by the country's university graduates. The prospect of work in an air-conditioned offtce, sitting in an executive swivel chair wearing an immaculate white shirt has tong been a secretly nurtured dream. The tendency of graduates to tum their backs away from their home village is almost always expected and is more the rule rather than the exception. Parents of the graduates are themselves a partner to their children's dream of a big city employment. The goal has somehow always been to leave an imprint in the big with a resultant concept that success achieved elsewhere is less of a success. Bright, optimistic dreams of bright, optimistic university graduates, determined at finding their place in the sun. And yet, most of these dreams were bound to remain as dreams.

1.2 The Facts:

There are an approximate total number of 72 universitites in Thailand. Rough estimates show 'that there are about 100,000 university students graduating per year. Statistical projections revealed that of the 100,000 university graduates; only a maximum of from 30% - 4Q% (30,000 - 40,000) will be opportuned enough to land at jobs specific to their field of expertise. About 50% (50,000) will not be as fortunate and may therefore end up taking menial jobs or joining the unskilled labour work force; worse, some of these graduates may succumb into the lucrative
but hideous business of drug and flesh'tade. The re$ of the 10% graduates. (10,000) are the unaccounted for. Some may just be wandering around aimlessly in the areas where their alma mater is situated; living

on whatever left-over money they have; temporarily rooming-in with more fortunately - employed friends. A few may have contributed to a nationwide brain drain by imigration to other countries. A handful, out of having nothing better to do, may decide to tie the knots and leave the problem of jobhunting to their spouse. And still fewer may have packed their bags and gone home, quietly nursing

the wound of broken dreams. The fact is that underneath the problematic processes, there lies the common denominator of civic inertia that necessitates an unrelenting retinue of stimuli.


As an adage to the problem solving process, an attempt has been made to group the problems

under three broad categories


Acadaemia vis a vis the real Thailand

2.2 Values and social norms of the university graduates 2.3 Health and inter-related problems'
furd thus began a rigorous exercise of problem solving. ldentifying vialbe models, formulating
theoretical concepts, basking on old experiences - this has ushered forth the nativity of the "Graduate

Health Volunteers" shortly followed by the "Graduates Retum Home Project"

2.1 Academia Vis a Vis the Real Thailand

Since frme immemorial, developing counMes have always looked

rp to their developed brothers

as a showcase of what education and culture should be. From the English alphabets to the ultasonic

sound waves, from the electronically devised toys to potato chips, the feeling is that "West is Best". Thailand is no exception. fu a result of an almost idolatrous worship of everything that is west, a Thai
student is willing to forgo a haditional, Thai lunch of rice and cumy ended by a cup of khanoml in favow

of a sandwich, some french fries and a bottle of carbonated beverage, the nam keng sai na* chu2 has been left behind to oblivion. Likely, Thai children holds close to their hearts mobile robot warriors in lieu of the previous sheer delights they enioy from kite-flying and kite-fights.
This constant immersion to modem hends also affect the elite members of the academic societv. Confined to the four walls of their classrooms, they are hardly afforded a glimpse of the real life situation in the Thai villages. A great majority of them have risen from the rank as a freshly-graduated university student to the distinguished rank of a university professor which would entail some three decades of life spent within the protective environs of the university campus. Without as much experience of the rural and rustic side of Thailand, one finds it difficult to put the blame on the professors for their ascrip-

tion to modern theoretical and scientific concepts far beyond the grasp of the Thai rural civilization. Just as difficult to disassociate is the ideological thrust of their stewardship inculcating the prestige, nobility and dignity of govemment service. Stongly upheld during the early pedod of academic existence,
such an ideology is highly improbable if not an almost impossible feat to implement in the current situa-

tion. Consider the number of university graduates per academic year as compared to the recently
existing vacant post in the civil service does not make it dfficult to appreciate the overwhelming disparity

between the two.

The thrust of the present educational qntem on research development is praiser,r,orthy. Howwer, scientific researches will be of lesser applicability in a developing county like Thailand. Instead of pushing forward to innovative technologies with its consequent prohibitive costs, what would be of bettr applica-

tion are researches directed towards adequate utilization of appropriate technology. The enhancement and maximum utilization of the counby's existing resource necessitates the undivided attention of the
academic staff. The academic cuniculum has its share of westem inclination. The Thai university students have been suffocated with westem tenets that hardly left them with a b,reathing gellfrom all that which
is far-advanced, and far-fetched. This situation has predisposed university students to self-criticism

and to blame ones own count$, baclnvardness. Aware of the limitations of a developing country technology and yet unknowing of how to formulate remedeal measures over counby's ails and miseries. Students

therefore were only equipped with the academic wisdom to criticize but not to criticize constuuctively. The analyticalprocess has been handicapped by the lack of sufficient background informations over that which actuatly hanspire in the country's villages. The academic cuniculum has been structured to focus on elechonic marvets. The crippling effed.ofmodem technology does not stop with financial handicaps over the technology's procurement rather it has also left the question of its maintainance unanswered. Granted that generous benefactors come to the counby's rescue, still the county's situational limitations for adequate hardware maintainance is a factor to be considered. The academic contenb adhere to a theoretical base. Informative lecture on existing social values of an average Thai family are

ndeded. The student's role as an 4ent of change

in the bettsrnent of healtfi and social do.relopment


Khuno- is a term used for any type of Thai dessert

na- k"ng

sai nam cha is a mixture of tea hghly dlluted in water and comes free of charge with a tlrpical Thal meal

has been way laid. Take the predominant social malady of erroneous prioritization in budgetary expenditures. Most Thai families have still favoured wearing of fashionable clothes over that of eating a well-balanc-

ed diet. Wrong priority-setting of buying a coloured television over that of spending for construction of a private latrine, bringing only sick or dying children over the preventive wisdom of a well-baby consulta-

tion; these are only a few of the existing values where adequately informed university students may well intervence with. The university has conpletely neglected the enormous wealth of human resources that is virtually their captive audience for about ten to sixteen years. There is little doubt that the university campus is a very fertile gound for sowing either habed or compassion, vice or virtue, decadence or aspiration. Peer-infulence, change in lifetyles have always been primed within the campus'cloistered womb. The iountry's exsiting health and social development problems; from cigarette smoking to alcoholic and drug abuse to the sexually transmitted diseases (STD) may well be traced over what are initially
friendly and innocent campus'interactions. The university campus has therefore become an important

venue in instituting positive approaches to health and social development. Inorder to bridge the presently existing academic gaps, the Thai system of education is in need of a re-orientation and re-direction. The academic staff should get as much an exposure as academically feasible to the village social structure. Nothing could better equip them to import existing
values and social norms to their students than a first hand exposure to taditional village life. A system may be developed to incorporate field practice in all categories of social sciences to enable prospective graduates to merge into haditional social networks. The academic should reconcile itself to the fact that the acqeuisition of knowledge has to be in parallelto its several limitatons to application; that the urgency is in the ability of the students to implement knowledge availed of within the existing developing

counby situation of Thailand. It should be bome in mind that much as scientific advances and concepts
are hghly commendable components of any educational module, the over all goal should stlll be directed

to that whichever would effect a developmental progress.

The thrust is to enable the present academic pattem to take positive steps towards "adaption"

and not merely "adoption" of the leaming processes. It calls for a painstaking analysis for re-direction of leaming materials to that which is applicable, attainable and cost-beneficial in the achievement of the county's socio-economic goals. Perhaps unknowingly, the highly noble objectives of the academe
has advanced way beyond the country's own move to advancement. The time has come for the academe

to produce graduates who will be able to provide expertise tailored-cut to existing constraints. The
time has come for a move towards the simplification of the present highly scientifically-based educational

module to suit the developing country-needs.

2.2 Values and Social Norms of the University Graduates

Thailand's university graduates are comprised of youth barely out of their adolesence who as a resuh of westem-pattemed educational modules are held in awe by scientific marvels. They bubble with hopes and aspirations, fearless, sblf confident, proud and righteous. These same graduates have been, through no fault of their own, sheltered from the hard realities of life. Self-contained in the ambience of the university campus where they spend an average of sixteen years in academic pursuit; they get to visit their native villages once, at most twice in an academic year. During this brief visit to

their homes, they are teated as guessts, protected from unforfituous events like a failed crop, a

"takatan"3 infested farm, an overflow of the prawn farm due to flood, or any unsavory tales. Instead, they get seVeral requests from families and neighbours to recount their experiences from the big city. The narratives held the audience in admiration often with a silent sigh of "why can't it be me?" or "why can't it be o'ur son?" During all these days, the visiting student may hardly ever miss the family waterbuffalo that has been sold as a result of his latest letter asking for an increase in pocket-money. In the
case of other students who reside within university commuting distance, the scenario is not at all too

different. The student is priveledge enough to be exempted from even ordinary household chores.
For, what mother would have the heart to call on a sibling busy preparing for a forthcoming examination

to attend to the laundry or for that matter even set the family dinner table?
Detached from reality, students rarely find the home condition as athactive. Inhoduction into a new culture and the sorption of everything novel has led into the formulation of new values.

The call of the big city has always been much too difficult to resist. Just like the proverbial lamp that has athacted moths to swarm around its flame just to get bumed, university graduates crowd the city just to suffer the burning ache of rejection. True, there are a number of success stories about a graduated villager earning his mark in the big city but successes are documented, failures are not.

The process of equating self worth with self-accomplishment in one's own birthplace
should be fed into the students at all stages of academic pursuit. Parents'attitude towards the allure of govemment posting needs alteration. Pride and dignity should spring from the extent of productiveness over and above material gains. Job satisfaction may not come only from job areas where a student
has undergone baining and specialization. A political science graduate need not indulge in day-dreams

of becoming his province's governor. He need not aspire for recognition by way of a political seat in the government. Respect, recognition and human dignity may just as well be achieved while raising hogs and cattles right at ones'own backyard or polishing gems by a sidewalk shop. In much the same way, a graduate in commercial science need not be frustrated if he does not end up as a "salary man" While financial status is indeed an ego booster, it certainly takes more than an ego-boost to be happy. Values of selflessness, love for ones'own birthplace, humility, patience and perseverance had to be rekindled in the mind of the students. The ability to take pride over ones'conhibution no matter how minute in his village's stride to progress is worth re-strengthening.

It is not enough to preach on values. Without necessary reinforcments the value structure bound to collapse. Reinforcement comes by way of inhoduction to the use of appropriate technology. It may be impossible for an auxiliary village health worker to heat a case of dehydration in the absence of oral rehydration salt (ORS) . However; given the knowledge of how to prepare ORS at home over

a glass of water with a lump of sugar and a pinch of salt will spell the difference between cure and death

from elecholyte imbalance.

The present trend of giving recognition awards has produced a negative reinforcement effect to most of the university graduates. It has been a widely accepted social practice to present recognition awards to the graduates who has made best in their respective areas of expertise. They are praised be-medalled and toasted to. This goes without saying that those who did not make good in their own
careers are failures. No man would savour being branded as a failure. A reorientation of recognition

T"k",pn is a variety of locust which feast on ripening rice grains

6 awards wlll help create positive reinforcement effed.. Awards given to the graduates who have contibuted

most to his birthplace's progress in health and social development irrespective o{ their field of study will definetely mobilize university gradates to return home and put forth the most treasured energy of their youth at their village populace's disposal. Such awards will erase the stigma of failure associated

to inability to be employed along the field one has graduated from.

A restucturing of social acceptance is another form of positive reinforcement for the university graduates to consider returning to their villages. Returning graduates most often than not, find
themselves in isolation from the village sbucture. They are either considered far too leamed that village folks just avoid any form of interaction with them or they are laughed-at from behind as having retumed unaccomplished after several years of absence and several hundred thousands baht expense. It becomes

imperative that the social structure be prepared to welcome the graduates back into the village, as assets to the village's developmental pursuits. The graduates may be integrated into the youth clubs
where they can act as role models for youths who may be preparing for university studies. The graduates'

wealth of experience will provide background resource for any group endeavour. The elder villager may enjoin them into their work force as consultants and/or administrators. ln the case of the affluent
graduates they may be encouraged to join their family business enterprise or venture into the establishment

of their own small-scale industrv.

2.3 Health and Inter-related Problems

As known and accepted by health policy and decision-makers, disease is a major component

factor of the vicious cycle of unemployment, poverty and ignorance. And as health has been defined by the World Heahh Organization as "the complete state of mental, physical and social well-being and not only the absence of infirmity and/or disease", it is therefore just as clearly understood that the
achievement of health goes far beyond the elimination of diseases. Physical, mental and social well-being are all so closely intertwined making it difficult to achieve one in the absence of the other two. Thus, the means to achieve health is obviously not an isolated process rather it is a multicorporate approach

tempered with dedication and determination. Easier discussed than implemented the complexities of an integrated approach is multifadorial. Stategies deemed to be a pool of efforts from all concemed sectors and agencies, both government and non-govemmental. Over and above, there is a necessity

for concerned individual involvement to begin from the early planning stages of any health and
social development plan. In the formulation of a youth development programme, the youth should themselves be consulted over what their felt needs are. There should be participatory effort from the basic structure of society which is the family, and a positive community endoresment and support. Hence, commitment to endeavours should be generated throughout the hierarchy of the social stuatum.

An in-depth study of the health situation and trends in Thailand reveals the classic problem
of inadequacy of bained health manpower & health service delivery outlets, the subminimal budgetary allocation for health and the plaque of govemment inertia hidden under the cloak of a more sophisticated terminology "bureaucracy". The inadequate supply of trained health manpower personnel is reflected by the following health statistics4. The ratio of medical doctors to population is 1 : 5564, nurse to population is 1 : 1286 This is further compounded by the shortage in the country's health service

So,rr"" : Division of Health Statistics, Minishy of Public Health, Thailand, 1986.

delivery outlets. The ratio of hospital bed to patientis 7 : 774 health cente to population is 1 : 6395. Added to this is the inadequacy of logistics from medical equipment and supplies including essential drugs.

A multicorporate approach to the solution of problems in health and social development has
long been undertaken by the Thai govemment. Seminars, working groups, meetings among the multi-

tiered government ministries have been carried out with encouraging results. Relations previously percieved as strained both intersectoral and inter-minishies had relaxed and has been considerably cordial as a result of the periodic interaction between policy-makers and policy implementors. This situation may be creditted as a giant leap to the mechanics of problem solving. Integration of social services into health programme has been both acceptable and applicable to the consumer community
at large. The current level of impetus should however; be sustained, lest the contagion of government

inertia re-surface. Sufficiently documented are multisectoral approaches directed towards the common

goal of the achievement of an optimum quality of life for the citizenry of the country. Cooperation and collaboration between the health, education, agriculture and community development sectors are evidence of positive political will towards a team context of endeavour. However; the university graduates'role in this team-approach has remained unsolicited until a bold step has been undertaken towards the initiation of the graduates as volunteer workers in health services with the advent of the two projects focussing on the roles of university graduates in health and social development; "The

Graduate Health Volunteers" and the "Graduates Return Home" Projects.

What has been percieved as most ironical is the fact that while the village suffer from the dearth of health personnel, thousands of university graduates remained unemployed. Graduated youths who if only were provided for with enough impetus could have been the support system of their village's progress to health and social development. What could be percieved as most ironical is the fact that the government system is unable to absorb these graduated youths and even worse, is unable to mobilize them into the villages were there
services are highly called for.

What would have been percieved as most ironical is to be witnesses to bright intelligent youths waste in frustration. The academe has the greatest burden to bear in the identification of potentials in the graduated students. The academe is best in position to formulate strategies towards their mobilization. It is this seriously felt responsibility that has led the then ASEAN Training Cente for PHC Development (ATC/ PHC) now the ASEAN Institute for Health Development (AIHD) through the benevolence of the Mahidol University Rector, Prof . Dr. Natth Bhamarapravati and the magnanimity of the Japan Intemational Cooperation Agency (JICA) to conceptualize the projects on Graduate Health Volunteers and Graduates Return Home.




The project on "The Graduate Health Volunteer" (GHVs) was spearheaded by the project on -"Research on.Primary Health Care Model Development - Chanthabwi Province" and has been launched

concomitantly in January 1985 through the collaborative auspices of the AIHD (formerely ATC/PHC), the concemed offfclals of the Ministuy of Public Health (MOPH) and the provincial authories of Chantha-


of : creation of communications channel between the universityr and thB communityr; education, exposure and mobilization of university graduates to the challenge of
Based on a four-fold objective health problems; awareness stimulation of the village and its officials and the utilization of health services as an approach to integrated solving-process mechanism : the project has for its over-all goal the utiliza-

tion of university graduates in health care as ultimate providers, facilitators and leaders in health and
related activities. The project has four major project activities; recruitment and selection of GHVs, placement and fteld experience reports.

taining; field


2.2.L Tocreate a channel of communication betveen the academic world and the community. 2.2.2 To educate, expose and mobilize university graduates to challenge existing health

problems in the community.

2.2.3 To stimulate awareness of villagers and local officials in problems related to health. 2.2.4 To utilize heahh service delivery as an enty point to an integrated approach to problem



The province of Chanthaburi can rightfully claim itself as the fruit basket of Thailand. Noted for its vast orchards of rambutan, durian, mangosteen, pineapple, a visitor is always welcome to eat into his head's content these topical fruits without payment, right within the backyard of any orchard

owner. However; it will not do justice to the province to highlight only on its fruit-bearing capability,
for over and above its fruit produce, Chanthaburi also abounds in colored gems; precious rubies, sparlding

topaz, midnight-blue sapphires and lush-green emeralds that athact both tourists and haders alike. Adding to its economic potential are the rubber plantation that abounds the province. Chanthaburi may therefore well be described as properous. The hovince has a total estimated population of 374,56O and an estimated land area of 6,000
sq.kilometer. It receives approdmately eight months of rainfallper year. Geographically, the population are scattered amidst fruit orchards and gem-pits rendering communication and access to health services,

difficult. People have always been hade-oriented leaving no time for commercial-type of activities. Livelihoods take people away from home during the entire waking hours, hence the lack of stamina and disinterest for congregation and community-oriented projects. ln addition, there is a high migration
rate as a result of existing job opportunities. The migrants being not only economically disadvantaged

but also ignorant as to accessibility of health care facilities are therefore indifferent to any participatory movement in their new communitie5.



Provincial Public Health Office

Provincial Chil Mcdicd Officer

Provinclal Hospital Drector

Technical and Health

Services Promotion Offlce



Line of admlnbbation Line

ol coordtnofron and/or superulslon


hovincial Public Health






Planning and Evaluation




Technical and Health

Servlces Romotion Office

Health Promotion

Health Education and Training


Medical SeMces

Sanitation and Environment


Supportive Seciion

Communicable Dseases

Conkol Section


&xuolly Transmltted




Cenhd Health lnlormadon Center

Provincial Statisdcd Office other provincial office unit

hovlnclal Heafth


lnformaflon Center



- Prlvate Hospftal - Provircial Hocpital - Dstrict Hospftal - Medical & Heafth

Services Center

- Dsbict

- Municipalities - Sanitary Dsbict

Sub-dtstict hedth
lnformatlon Center Heahh C,enter


- ViilaS Headman



- Traditional


Traditional Healer Tambon Doctor


Mntsty of Public Heahh

Proolnctal Public Heakh Offlce Dtsfficr Publtc Heakh Vlllage Health




llloge Heolth Communlcators

Demographic Data Population by Age Group and Sex (1986). Total Population 398,937
Male Female






5-9 10-14 L5-24

4.57 5.32 5.36

10.19 13.55

5.15 5.68
10.93 L3.92

9.01 10.48

21.L2 27.47 14.22



6.99 3.27

7.23 3.39





The above table indicates that population belonging age group 25-44 compises the highest percentage and those belonging 60 and above comprises the smallest percentage.


Health resources and health manpower











1 1

Ta-mai Lam-singh Klung Pong-Num-Ron Ma-Kam

29 6
L2 13 13





Muang Ta-mal


9 9

65 65
22 27 36



Klung Pong-Nam-Ron Ma-Kam





1:356 l:9,36i1 l:3,358 l:5,485 l:3,O2 t:4,%3



1:1,878 1:1,184

'Pubkc health otffers lnclude son,tortoru and mldwloes.


Village Heahh Communicator (VHC) and Mllage Heahh Volunteer (VHV) Coverage by


Muang Ta-mai

19 7 10



Klung Pong-NamRon Ma-Kam

83 68


78ffi 188 38 83 67



247 545


38 83



9 8



of totd sub-dtstuicts and 92.91% of total villages VHV coverage %.77% of total sub-dtsfrlcts and 90.84% of total vtllages Average numbr of VHC/vilage 8.3 Average numb of VHV/village 1.0


coverage 96.77%



Health Care Facilities

Public Health Center Heahh Center Community Hospital Regonal Hospital

6 83 5

is inadequate coverage with tetanus vaccination and poor nubition information which have negative effects to both mother and

hegnant women seldom avail of existing ante-natal facilities hence there

child. This lack of utilization of existing heahh facilities may be atEibuted eitherto lack of adequate informa-

tion on the part of the mothers or on apparent inaccessibility of the health facilities.

Nutitional Status of Children Age 0-5 Years

lst degree malnourished

2nd degee malnourished
3rd degree malnourished Narmal


20.9 1.9 0.1




The present nutritional status of children under 5 years of age leaves much to be desired. Although there are statistically insignificant number of cases suffering from 2nd degree and 3rd degree malnutrition, 2O% of these children are within the 1st degree malnourished bracket.


Morbidity'and Mortality" of the General Popula{on by Eilology


2 3





unknonrn fuver Qlcentertl





245.6 22.7



rvtal conjuncdvtds
Pneumonla lnfluenza




Rrlmonu!, Tuberculods
Food polsonlng Hemonhaglc ferrr Sexually
Dlreases lnsecdclde polsonlng

8 9


100.3 112.5



t0 l1 t2



78.9 54.1




113 109

Chkken pox
Crerman measles

42.5 30.5



27.6 16.3 8.9 8.9

Mumpe !,!enlngms Pedusds

60 3:|



t9 t9

.o2 4 2


3.2 2.7 2.2




I-cptocplroCs Cronococcal meningltis



4 ,2





.5 .@2

'Per 7(N,ilfi Populadon



7,000 Populofron Basc





1985-1988 Research areas

in Chantaburl Rovince O fueas wtth GHVs O fueas without GHVs

ALHD 1989

The Prouincial Gouernor Office.

Rambhoi Barni College.

The Provincial Public Health Office.

The first meeting towards GHV project implementation.

A GHV giuing nutrition education

A GHV leauing the village


at'ter one year


A GHV receiuing his certificate lrom the Mahidol

Uniuersity President.

The first batch of GRH project participants

Attending lectures ot the Rambhai Barni College.

A lecture on uillaqe suruiual.

spiritual session with a Buddhist monk.

Welcome home!

A political scientist learning how to raise tiger


A lawyer's return to the uillage.

Tending to uegetable garden.

--fixing the motor boat engine


from the project operations stoff

--a show of ualue change

The beginning of a continuing challenge

Promotion ol u illoge


elopment actiuities "'

Str e ngth e n ing w o m en's gro up p articip otion


Stimulating cultursl octiuities among the youth-----

Towords an improved quo@ ol lile in the uilloges.




2.4.1 Recruitment and selection of Graduate Health Volunteers

The recruitment of GHVs started in May 1985 by newspaper advertisements and university bulletin announcements. It must be mentioned at the outset that preference for GHVs setection is given to those, who are not graduated in health or health-related field. This may be an innovative approach to the usual standard criteria for health volunteer workers. This completely new approach is based on the concept of the preparation of leaders in health. Tapping the group of young and educated volunteers
who have completed their Bachelor's dqren,, at the height of their stamina and the prime of their ideology; will produce a muftiplier e{fect on the number of potential health leaders imbued with first hand knowledge about health, health services and ultimately health service delivery.

During the process of selection, the project implementors were constantly aware that these volunteers will have to commit themselves over a year to serve a community whose population they do not know, whose needs they are not familiar with and whose health problems they uue even more
shangers to, hence; it becomes imperative that exheme care and a highly circumspect attitude be excer-

cised throughout the selection process and that as the project is implemented a constant monitoring

is of priority requisite.


A GHV inorder to quahfy for selection should have a Elachelor's degree on any of the following fields-political science, education, English, Geography, Communication, Sociology, etc., in addition to an e><pressed desire and interest on health and development activities. Atotal number of 675 applicants responded in 1985, L,024 applicants in 1985 and 7,260 applicants in 1987. A written examination on the understanding of health and community development activities, the importance of health to the population at large, civic involvement, communications ability and strength of leadership is given to the candidates, reducing the number of candidates of 58 , 153 and 157. Individual interviews were then conducted inorder to assess leadership potential, maturity and extent of commitment among the candidates, from which 15 candidates and 25 altemates were finally chosen to undergo the first three
week tuaining course.

2.4.2 The Training Programme

The taining programme may be categorically suMivided into: theoretical and praciical componenb

over a total duration of eight weeks.

The initial three weeks is devoted to the theoretical aspect of primary health care and healthrelated activities including community development. The objectives of the project were discussed in great detail to enable the GHVs to self-assess their extent of interest and their degree of commitment. The fourth week of the theoretical component of the haining process is spent on a study-tour of several provinces located in the eastern part of the country where the GHVs had a first-hand experience of how community-oriented activities are canied out. They were specifically b,rought to witress places with successful achievement on community-oriented activities.
The practical component of the taining programme is held in Chanthaburi province. Following
a formal intoduction to the area, the GHVs received two weels of insbuctions on matemal and child

20 health care and one week of training on emergency interventions at the Community Hospital. This one week of training also incorporates knowledge on primary health care activities and proper refenal channels. Their fourth and final week is spent in their site of assignment. Each GHV is given a monthly subsidy of three thousand baht (E 3,000) equivalent to an approximate one hundred fourty five dollars (US.$ 145.00) to cover living expenses. Likewise a motorcycle is provided to facilitate out reach to the scattered household. It is envisaged that through the varieg of educational experience the GFIVs have been exposed to during their academic years; an interplay of social science, formal taining in political science, geography and topography and their interaction with researchers and the community; an innovative model for PHC activities will be realizedboth creative and practical and tailored-cut to meet the felt and unfelt needs of the people at the grass-roots level. The GHVs will be given a chance to evaluate there own orientation under an aura of complete independence in the hope of developing their decision-making
capabilities, identfuing their own stengths and weaknesses and ultimately re-inforcing their self-confidence

while developing full leadership potential in health and in their respectively chosen field of endeavours. Progress of GHV activities will be closely monitored by the research team in collaboration with the Project Manager.

The different parameters for measurement of the effectiveness of the GHVs are

1. 2. 3.

perception of his/her leadership role by the community final written report his/her productivlty as perceived through process indicators by the village committee,

village health communicators, village health volunteers and ongoing health development activities in

his/her village of assignation; and through health indicators (birth weight, infant mortality, maternal mortality, malnutition cases) . However; not all favorable perceived results may be solely attributed to the GHVs, hence the limitation of measurement by health indicators.

Theoretical Training at ATC/PHC now AIHD (May 7-23, Lg86l

(Example of GHVs Batch II haining program)

Hrs. Lecturer(s)



Problemc of Developlng Countrlec





Mahidol University and the GHV training

Problems in developing nations and the roles


The Rector of M.U.


ATC staff

of GHV's
Socials (getting to know each other)
The national health policy in the VI National

ATC staff
Health Planning

Economic and Social Development Plan

Social Development Plan Concepts and principles in the integrated
rural development and concemed Oganizations

Dvision, MOPH


Hrs. Lecturer(s)

Nat'l economic problems and the necessity of


NESDB Social Science Dept.

rural development. Social problems and rural developments 9.

10. 11.

Educational problems and the nessity of rural developments. Group activities Summary of the module 1. 3

3 l% 3 3 3 3 3 3 3 3 3
3 3


ATC staff


Concepts and principles of PHC Office of PHC, MOPH Office of PHC, MOPH
Representative from


PHC snategies PHC & QOL movement


QOL committee,

Health education in PHC

Faculty of PH Faculty of PH
Representative from


Health Card Fund Expanded Immunization in PHC Environmental sanitation in PHC
The provision oI essential drugs in the com-

HCF committee, MOPH

L9. 20.

CDC, MOPH Faculty of PH

Govemment Phamaceutical Bureau Folk Doctor Magazine Dental Public Health Division, MOPH Mental Hospital, MOPH

munity Treatment oI common diseases Dental Health in PHC Mental Health Nutrition in PHC
Sef-Manased PHC village and Mni Thailand Project

22. 23.



Dvision of Nuhition

25. 26.

Summary oI Module 2.

ll/z ATC



Rural Development
The utilization of BMN 1, 2, 3 forms for community survey
Community preparation



3 3

ATC staff ATC staff ATC staff

The Center for Continuing Education,



Community diagnosis and planning in the

community Leadership in rural development Human relations for rural development Summary of Module 3. Closing ceremony for the training


31. 32.

3 3

MU ATC staff ATC staff

The programme consist of one day study{our to various places with successful PHC service delivery. The objectives of the tour are to expose the GHVs to actual implementation of PHC and rural development programme, learn various PHC strategies and be able to device their own strategies in accordance to the needs of the population in their community of assignment.

2.4.3 Field Placement of the GHVs

This consist of a one month programme of activity divided as follows:

Two weeks haining on health center activities, including; MCH and EMC, teatnent, prevention and control of common diseases, refenal system and the mechanics of rural development.

One week training at the community hospital One week training at the health centre

During the process of field placement, the graduates were given a free choice of where they would like to stay. A great majority of them opted to stay at the health centre and to work with health centre staff. The longest and most important part of GHVs'haining is the actual field operation. This lasts for nine months during which the GHVs put allof his theoretical knowledge into practice. The GHVs are expected to learn and apply the mechanics of good public relations and maintain colaborative working relationship with the villagers, the village committees, the research teams and with the health and other concemed govemment agency personnel. They will have to face and cope with day-to-day
constraints in the implementation of their activities. Moreover: they are envisaged to formulate solutions to constraints and recommendations to the next batch of GHVs for a more successful programme


An application fee of for by every applicant.

10 (US$ 0.37) and examination fee of B 30 (US$


11) has to

be paid

The contractual agreement stipulates that a GHV has to reimburse the amount of the baining cost should he/she fails to comply with the one year contract duration. The ATC/PHC is responsible for the entire taining expenditure in addition to a monthly allowance of 82,5A0 (US$ 92.59) for each candidate qualifying for the post of GHV. In the second year of project operation, inorder to a support and in response to requests for transportation, the project provided for a motorcycle and a gasoline (US$ 8.00) per month to each GHV. In the third year oI the project, the GHVs propct funds to initiate community activities and the project has provided the amount have requested for of E 5,000 (US$ 200) to some GHVs (Please refer to Annex 5) as seed money to mini-projects to be




carried out in the,community.

2.4.4 Field ExPerience RePort

In April 1985 : 675 young Bachelor of Science degree holder had responded to the advertisement of ATC/PHC Mahidol University for volunteer health work in the province of Chanthaburi. After a rigid screening process which consisted of both theoretical examination and personnel interviews, 15 were selected for the post of GHV and 25 as alternate, to undergo an 8 weeks training programme.


part of their theoretical taining, the GI-IVs were guided in the presentation of their reports to

include the following salient aspects; geography, main occupation, problems in primary health care development, perceived role of the GHV in primary health care community development activities,

23 accomplishments in their community of assignment, constraints encountered during the period of assignment, suggestions,/recommendations.

The GHVs were provided with a notebook which serves as their diary wherein they keep note of their activities. The report submitted by the GHVs will be an indicator of their performance in addition to their intetaction with the researchers, the village population and the health cente staff. An evaluation of the GHV performance will be conducted at the end of their assignment. Any GHV found to be highly competetive, totally dedicated and willingly committed to his community of assignment has a chance to compete for the post of senior GHV. The senior GHV will exercise supervisory functions over the second batch of GHVs. A senior GHV will receive a monthly subsidy of Baht three thousand five hundred (E 3,500) which is equivalent to US$ 129.62.
The following report has been the result of a cumulative experience during the eight months
assignation of a group of 1nung, educated and hard working GHV in their respective vilages of assignment.

The views and opinions expressed were strictly of the GHVs and not of the project personnel. It is obvious that the topographical location of houses in Chanthaburi has greatly disadvantaged the healih service delivery system. This has even been compounded by an inherent lack of interest in health and community participatory activities brought about by ignorance, high migration rate and the villagers' total absorption in their jobs. Another great handicap is the insufficiency of water supply causing health problems to remain unabated.
It is noteworthy that the report incorporated experiences that varied from lack of identity, with

the consequent feeling of insecurities and inadequacies at one exteme ; and a total command of the community, from problem identification to problem solution ; at another. There has been a general
request for a vehicle for greater outeach and requests for a decrease in the number of assigned villages

to ensure a more complete coverage. Likewise, there has been an expressed resentment for being duty-stationed in the health centre, the lack of authority for decision-making, the poor rapport with
health cente officials and the poor perception of their roles as GHVs by the heafth staff, by the community and by the GHVs themselves. Despite resentments, solutions proposed by the group were all positive

and highly constructive. This included the request for a revision of the taining curriculum towards a
greater emphasis on the practical component of the taining programme and a GHV working manual as a guide for day to day activities. The projert operations $aff has benefited a great deal from the report, egecially in the re-oriention of the haining programme and the provision of working guidelines. The project operations staff has also conducted a dialogue with health centre officials in an effort to bridge the gap between the GHVs

and the health centre officials.

The following are the reports of the first batch of GHVs

Tambon Sam Pee Nong. Ta Mat Dlstrict. Chanthaburl
Surasak Jamchalern

Problems in PHC development

1. 2.

Ignorance on basic health care as a result of lack of information

Poor communications due to sparse distribution of households and poor roads



High rate of migration rendering follow-up activities on health care difficult if not altogether Poverty

Poor community participation by community leaders Inadequate number of health manpo\uer Lack of coordination among four major ministries involved in PHC/CD (Ministry of Agriculture, Transportation, Education and Health)

4. 5. 6. 7.

Perceived role of GHV in PHC and CD

as facilitators

of meetings among public health officials in the study and analyses of identified


as a liaison officer between health officials and other government sector as an entry point in the preparation of the community for planned health activities by public as a catalyst to the implementation of existing health activities as an evaluator by submission of periodic assessment reports as an adviser on the organization

health personnel

& management of community development fund


as an assistant in the strengthening of health center information system as a disseminator of health information to as a supervisor to

VHCs/VHVs performance as a motivator to community participation in health and health-related activities as a participant to meetings, and other community development activities

GHV's Accomplishment in the community of assignment

- Participated in road and bridge repairs - Promote supplementary food preparation by demonstration and nuMtion education - Reviewed the neglected drug fund project - Conducted health education lecture both in the community and in school - Facilitated communications between villagers and health centre officials - Home visitation - Conducted special immunization campaign in highly remote village (tetanus toxoid to pregnant women and immunization against common childhood diseases to children under five years of

Supervised VHCs/VHVs activities

Suggestions /recommendations
Shengthening of leadership role of village leaders Improvement of collaborative activities among commupity leaders, health authorities and various government officials. - Repair'of roads and bridges - Recruitment of an agricultural consultant to improve technology and produce


Tambon Koa-Perd. Lamsingha District. Chanthaburi

Mlss Usa Khlew-rod

Problems in PHC development 1. High rate of migration causing difficulties in

disease control

2. High incidence of venereal diseases due to the presence of massage parlours,/bars 3. High incidence of haemorrhagic fever. Insufficient water supply forces the village to store
rain water in container jars which are good breeding places for dengue-causing mosquitoes 4. Poor swage disposal 5. Poor roads 6. Poor community participation 7 . Poor organization of health center staff/health centre activities 8. Inefficient supervision of health centre staff by their superior officers

Perceived role of GHV in PHC and CD 1.

as coordinators between the community and the health authorities

2. as motivators in community development 3. as supervisors of VHCs and VHVs


Constraints encountered 1. The GHV is perceived as a fault-finder by health centre personnel 2. The GHV owing to his frequent questioning and consulting is made to feel to be more of
a liability than an asset by the health personnel as GHV tends to interfere with their daily activities

has led

The villagers regard them as medical doctors, inability of the GHV to meet these expectation

to frustration and distrust of GHV by the community

GHV's Accomplishments in the community of assignment


Participated in solving managerial problems related to community funds Encouraged community leaders in strengthening their roles on health and development Surveyed and collected health statistics for use as baseline data in planning health activities Liased with other health organizations in the conduct of health and health-related activities

Suggestions / recommendations

- Orientation of community leaders on their role on leadership for health - homotion of the concept of team work to shengthen cooperation and collaboration among
GHV and health cenhe staff - Dissemination of information on the health significance of community organizations
Improvement of the existing supervisory methodology favouring unannounced supervisory visit perceieved as more effective than the present planned visit - Promotion of secondary occupation during off-planting/harvesting-seasons for income

generation and as a detenent to frequenting bars,/massage parlours

GHVs should be based in the villages and not in the health centes so as to avoid unaccessary expectations from the villagers leading to frustoation and dishust. Living with the villagers will allow a greater interaction between the GHV and the community


Tambon Koa-Perd. Lamslngha Distrtct. Chanthaburl

Mr. Somsak Srlwatanatakul

Problems in PHC development 1.


2. Poor communications 3. Crimes and assault mostly due to land dispute 4. Illiteracy
Perceived role of GHV in PHC and CD


as a coordinator between the community and the government sector as a source of knowledge and information regarding health and communig development

- as a social agent of change among the villagers and the village leaders - as a model of good health and high morale to the members of the community
Constraints encountered 1. Lack of public interest on health 2. Inability to perceieve GHVs role by community,/govemment
coordinating activities for them

officials hence the difficulty of


Communication gap due to the parsely distibuted household and fre presenae of hill/hillocks

4. Lack of means of tranportation 5. Weak performances of VHCs/VHVs 6. Lack of community participation by the community leaders themselve, 7. Frequency of migration and high mobility compounding the problems of communications
and follow-up

GHVs Accomplishments in the community of assignment

- Gave health education lecture on MCH/FP and PHC - Advised on proper waste and sewage disposal
Exemplified benefiS derived from communig participatory activites and community develop-

ment funds
Liased between the village and concerned govemment officials on matters of health and health-related activites

Participated in meetings with the 4 major ministries

Suggestions / recommendations 1. Need for a working manual for GHVs

2. Need for a vehicle for access to remote areas 3. Need for additional information on communities that are highly inaccessible


Tambon Sanamchai. Tamai District. Chanthaburi

Miss Nareerat Samrongrat

Problems in PHC development

1. Lack of adequate prenatal, delivery and postnatal care including family planning 2. Maternal and child malnutrition due to lack.of nutrition education 3. I-ack of knowledge on the nutitional values of breast feeding, appropriate kind of weaning
foodlbreast milk substitutes

4, Poverty compounded by poor communication facilities 5. Lack of community participation 6. Poor coordination of health centre activities giving rise to frustrations and dishusts among
health center clients 7. Lack of full comprehension by VHCs/VHVs on their role in health service delivery

Perceived role of GHV in PHC and CD

- as a participant to problem-identification and analyses - as a coordinator between health officials and the members of the community - as a coordinator for village health activities - as a support system ior a more effective perfomance by health officials - as a supervisor and evaluator in the management of community fund - as a supervisor and evaluator of VHCs and VHCs performance - as a participant to meetings of health officials - as a stimulant to community irarticipation - as a disseminator of health information - as a participant to community development activities
Constraints encountered 1. Lack of decision-making

authority, decision making is being relegated to health centre

2. Lack of vehicle 3. Lack of constant contact with inaccessible communities for fear of safety 4. Lack of community participation 5. Poor perception of the GHV's roles by VHCs/VHVs

GHtfs Accomplishments in the community of assignment - Gave health education lectures - Lectured on environmental sanitation - Lectured on benefits derived from community funds - Acted as coordinator between the community and government officials - Acted as trainer in training courses held in the Tambons - Participated in meetings among the four major ministries


Suggestions /recommendations

1. Need for a vehicle 2. Training on curative services for GHVs

3. Decision-making authority not to be a sole prerogative of health centre officials 4. Provision of a GHV working manual Tambon Nong Ta Kong. Pong Nam Ron Distrlct. chantaburi
Mtss PanPls ToPrakone

Perceived role of GHV in PHC and CD

- as a liason officer between villagers and government officials - as.a leader and promoter of youth group activities - as a representative of government officials during community meetings - as a health educator to school children and the villagers - as a friend and advisor to VHCs and VHVs - as an informer about the extent and limitations of a GHV's role which do not include


- as a communitY develoPer - as a motivator of MCH/FP activities - as an aide during home visitation and in the follow-up of cases
GH\i's Accomplishment in the community of assignment


Home visitation Attended community development, Mllage Committee and the Tambon Council meetings Relocated villagers living near the frontier of Cambodia because of the dangerous border Trained VHCs/VHVs on MCH/FP and in the use of the'MCH/FP survey form performed the duties of a health educator both in the health centre and in the villages

Constraints encountered 1. Lack of knowledge on PHC activities and existing health problems in the community 2. Wrong perception of GHV role by health centre officials 3. Inadequacy of GHV's knowledge and exposure to PHC activities giving rise to feelings of

Suggdstions /recommendations
Dminish the area of responsibility to allow GHV a more complete coverage of health and community development activities - Station the GHV in the village to altow better rapport and understanding with the villagers

and the village committee - Increase the number of GHV working per Tambon - Increase supervision of GHV by the research team

Provision should be made for observations of other GHVs at work


Tambon Ta Kien Tong. Makam District. Chanthaburt

Miss Chamai-Porn Srlkanok

Problems in PHC development 1.

Sparse dishibution of household

2. Poor agricultural technique 3. Poverty and poor health status 4. Lack of knowledge on the importance of community development 5. Conflict between villagers and health officials responsible in the area 6. Problems between the migrants and the local residents 7. llliteracy 8. Lack of participation from government officials
Perceived role of GHV in PHC and CD
To explain the GHV role to the villagers for better understanding of his/her presence in the community - To make the people realize the importance of knowing their health problems and to help them analyze and solve those problems - To participate in community development activities

To coordinate health and health-related activities among different categories of govemment

official assigned in the locality

GHV's Accomplishments in the community of assignment

- Participated in Tambon council and village committee meetings - Supervised VHCs and VHVs and the drug funds - Coordinated with the mobile medical unit of the provincial health office - Demonstrated supplementary food preparation with agricultural officers - Home-visitation - Conducted school health care service - Conducted haining programme on MCH/FP EMC for VHCs/VHVs - Improved the physical set-up of the health center and its sunoundings
Constraints encountered
Misunderstanding betrveen GI-IV and health cente staff due to poor delineation of role

activities of GHVs

2. lack of means of transport for GHV 3. Lack of interest among villagers on community development 4. Lack of understanding of GHV role by the community 5. Irresponsible performances of VHCs/VHVs 6. Poverty


Suggestions /recommendations

lncrease the responsibilities of govemment officials on communi$ development by target

setting on important community activities - Increase the knowledge and under*anding of the community on the importance of community

development activities

Improve knowledge of

VHG/VHVs on their role and responsihlities in heahh and community



Provide GHVs with operation plan to assist them in the performance of their daily activities GHV should consult health centre staff if problems arise during their performance Researchers should explain in detail their research activities to the health staff Researchers should invite participation among GHVs and health staff during fieir meetings
Researchers should give support to GHVs in the performance of their research activities

Tambon Chang-Kham. Ta Mat Dtstrict. Chanthaburi

Mlse Ploenelrl Slrleempan

Problems in PHC development 1. Lack of communication between the villagers and the health centre staff 2. Non-participation of health official with VHCS/VHVs activites

3. Lack of knowledge on the importance of adequate pre-natal care 4. Poor understanding of GHV role in the community
Perceived role of GHV in PHC and CD

To join the health officials in the identification, analyses and problem-solving of community

health problems and in the preparation of the community - To coordinate between government and NGOs on health and health-related activities - To coordinate PHC activities among the communrty and the health officers in PHC activities

- To encourage health officials in the use of innovative approaches in health service delivery - To motivate community participation in PHC activities - To submit periodic performance report - To disseminate knowledge on PHC to VHCs/VHVs and evaluate their performance - To participate in community development activities - To participate in follow-up and evaluation of fund management activities - To strengthen health centre management information system - To act as health educator to the villagers - To go on home visitations - To keep the health centre clean
GHV's Accomplishments in the community of assignment

- fusisted the auxilliary health midwife in MCH/PHC - Assisted in the baseline survey



- Acted as a health educator - Participated in religious ceremonies - Participated in supplementary food preparation
Constraints encountered 1. Health centue charged

and other nutrition-related activities

fees for consultation as a result of which people are discouraged seek medical advise unless in extreme cases of emergency

2. Lack of means of transportation 3. Poor perception of GHV role by the health centre staff
Suggestions /recommendations

- More frequent home visitation for better coverage - Provision of an outline as a guide to daily activities - Greater emphasis on the practical aspect of the training program - Meeting time and dates should be fixed in advance
The format of meeting should be based on participatory discussion and not just presentation Need for a sphygmomanometer to enable GHV to take blood presure readings

Need to function as a VHC to motivate VHC in the performance of their activities

Tambon Wan-yao. Klung Dtstrict. Chanthaburi

Miss Somruedee Sarapirom

Problems in PHC development

1. Lack of interest in health and hygiene due to lack of knowledge 2. False beliefs/traditions on matters related to health practices 3. Weak community leadership and poor community participation 4. Lack of trust on health official 5. Insufficient water supply 6. Poor family planning acceptance due to lack of interest
Perceived Role of GHV in PHC and CD


as a health educator and informer-to correct false belie.'s and superstitions about health

- as a supervisor to VHCs/VHVs - as an advisor in the construction of tanks for water storage - as a family planning motivator - as a liason between health official and villagers to re-instore the trust of the villagers on their
health officers - to assist in the selection of potential replacement to the present village head man who has shown little interest in his community


GH\i's Accomplishments in the community of assignment

- Assisted in MCH data collection - Supervised VHCs/VHVs - Home visitations - School health education - FP motivations
Constraints encountered 1. Lack of hansportation facilities 2. Lack of interest among the affluent member of the community on GHV activities 3. Disrruption of GHV activities due to frequent absence of health cente staff
Suggestions /recommendations

- Better explanation of GHV role to health officers - Participation of GHV in all health centre activities - Better understanding by GHV of community development


Ban Ta Moon Health Centre. Tambon Sai Kao. Pong Nam Ron
Mles Afma Jlnwala

Problems in PHC development 1. Poverty giving rise to malnutrition, disease and inability to participate in health card project fund 2. Lack of information and communications due to poor media facilities 3. Poor Community participation as majority of the population are migrants 4. Poor environmental sanitation

GHV's Accomplishments in the communip of assignment

- Explained the importance of membership to the health card fund project - Participated in MCH/nutition and other health cenhe activities - Supevised VHCs/VHVs - Strengthened health centre management information system
Constraints encountered
1. Poor understanding of his own role resulting into confusion
with the villagers

to his activites and relationship

2. Oppression by health centre staff 3. Poor understanding of GHV role by health cente


4. Area is too wide and households


are very sparsely dishibuted Lack of self-confidence and lack of creativeness on the part of the GHV

Suggestions /recommendations

A need for working guideline emphasizing on GHV's duties on the villagers and not on the
Freedom for GHV to choose the place he/she prefers to reside (in the health centre or in

health centre staff

the village)

Tambon Zueng. Klung District. Chanthaburi

Mlss Kannlka Promsao

Perceived role of GHV in PHC and.CD


To produce health information materials for dissemination of PHC knowledge To coordinate with four major ministries To participate in community development activities
To learn from the villagers, need-based strategies in developing appropriate community

To attend Tambon council meetings

Constraints encountered 1. Villagers lacked appropriate information on health card funds 2. Disagreement by GHV on the health card fund concept; feeling that its system

does not

work the way it should as regards to the "green channel" aspect, and because of the inability of the villagers to select their own doctors and hospital. The health card fund has provision for only one doctor
leaving the holder no other choice.

Suggestions /recommendations
It is better for GHV not to be involved in health card fund as they are viewed upon more as a liability than as an asset by the health card fund organizers - GHV should concern himself/herself with the group of depressed migrants who cannot immuniafford to buy the health card and cannot avail themselves of basic heahh services services such as


GHV should have greater awareness of the village situation inorder to be able to supervise VHCs/VHVS more effectively

Tambon Takad'ngao. Ta Mai District. Chanthaburi

Miss Supts Puhin

Problems in PHC development 1. Poverty as a result of poor industrial land agricultural technique 2. Public health problems such as ; poor environmental sanitation, high incidence
and inefficiency of VHCs/VHVs
of malnutition


Perceived role of the GHV in PHC and CD

- To disseminate public health information - To motivate people on proper sewage disposal - To suggest people to conshuct concrete water tank for water storage - To give nutrition education - To join the Tambon council in the demonstration of income-generating activities
GHVs Accomplishments in the community of assignment

- Home visitation and follow-up immunization - Conducted family health survey - Assisted in health card fund management - Supervised VHVs - Child weighing - Child weighing
Participated in community meetings

Assisted the health centre officers in their daily activities in the health centre Disseminated pubtic health informations activities

Constraints encountbred

- Lack of community awareness on the value of health card - Inability to purchase the health card due to poverty - Lack of means of tansportation - Poor understanding by the GHV of his role - Poor community perception of who and what is a GHV - Lack of decision making authority on the part of the GHV
Suggestions /recommendations

GHV need a working outline GHV has to be given authority for decision-making The role of the GHV should be more elaborately explained to the health centre officials

Tambon Salang. Mueng Dtstrict. Chanthaburl

Mlcc Chanalla lertprapuert

Problems in PHC dwelopment 1. Lack of knowledge on medicinal drugs

2. Poor understanding of the health card fund project 3. lnefficient VHCs/VHVs 4. Inability of the villager to generate community activities 5. Poor environmental sanitation (sewage disposal)


Perceived Role of the GHV in PHC and CD

- To disseminate public health information - To participate in meeting among the four major ministries - To participate in community development activities
GHVs Accomplishments in the community of assignment

- Disseminated public health iriformation - Participated ine village committee and Tambon council meetings - Supervised VHCs/VHVs
Assisted health centre officials in school health activities Assisted health centre officials in their daily health centre activities

Constraints Encountered
L. Lack of self - confidence in associating with health centre

2. Poor leadership role by health centre officials 3. Training course was mainly theoretical and the practical aspect is insufficient 4. Lack of adequate supervision of GHV
Suggestions /Recommendations


Boost self - confidence of GHV by allowing him/her to give suggestions to health centre

2. Health officers should be made aware of their leadership for health role 3. Revision in the haining cuniculum to give more gmphasis on the practical aspect 4. Better supervision of GHV

Reports of the Second and Third Batch of GHVs

Just like the first batch of GHVs the second and the third batch were requested a specific reporting format which includes; geographical data, roles and status of community organization, salient

community problems on health, socio-economic and traditional beliefs. However; the herewith reports focussed only on the health aspects of their community participatory activities. In the case of the third batch of GHVs, some of them have additional reports about their mini-projects in which they have assisted in identifying and implementing. (Pleas e refer to Annex 5) The second and the third batch of GHV's detailed reports were submitted and published in Thai. It may be noted that three of the third batch of GHVs have been fielded in a neighboring province, Chonburi. This is because of an anticipated urbanization-related problem upsurge in the aforecited
province. The Royal Thai Govemment is presently implementing the "Eastem Seaboard Development Roject" which is envisaged to gve rise to air and noise pollution, taffic accidents and problems associated to industrialization and migration. The project operations staff therefore, have decided to assign three GHVs in an attempt of conceptualize a viable strategy to solve these constraints.

The following are the abstracted reports of the second and third batch of GHVs


Report of the Second Batch GHVs (1986



Tambon Taklenthong, Makham District, Chanthaburt Provlnce.

Ms.Lakkhana SwangPrak (MCH/FP)

Problems in PHC development 1. Lack of public health knowledge : e.g. MCH.

2. Poor community participation due to too far distance from village to health center. 3. People are used to easy living with low priority for sanitation 4. Povery 5. Rapid urbanization, so people attempt to own electrical equipment much more than give
attention to public health and environmental development

Guidelines to implement PHC 1. Provision of MCH

& CD

care education

2. Promotion of drug cooperatives 3. Identification and maximum utilization of existing village manpower resource 4. Environmental development 5. Coordination with other related officials in the area, including community organization.
GHV's Accomplishments in the community of assignment
Provided follow-up care to malnourished children Cooperated with village organizations in the conduct of meetings

Tambon Chang Kham, Tarmal District, Chanthaburi ProvlnceMs.Wanna Pongthtnthong-ngam (MCH/FP)

Problems in PHC development 1. Village leaders

are not aware of importance of public health activities

2. Public heahh leaders are not effective enough 3. Mllagers ignore their own health 4. Most villagers lack knowledge in health and still believe
Guidelines to implement PHC

in old beliefs

& CD
age and other target population

1. Health Education Campaign about MCH 2. Health Education dissemination emphasizing on school
(Grade-VI students of primary school'(s))

Drug cooperative improvement to promote cheap sales of powder milk in order to change attitude in the use of condensed milk (in case of mothers who are not able to breast feed)



GHV"s Accomplishments in the community of assignment

- Health Education about MCH - School health education for grade-Vl students in primary school - Drug cooperative improvement to promote powder milk sales at cheap price - Campaign for healthy mothers to breast feed their babies - Mobile clinic
Tambon Sanamchai, Tamai Distrlct, Chanthaburl Province.
Ms.Anchalee Pannark (MCH/FP)

Problems in PHC development

1. Lack of awareness about epidemic disease 2. Poor transportation 3. Incoordination among village organizations and members 4. Poor understanding of people, village organizations' member and volunteers of their role. 5. People give low priority to their health needs. 6. Poverty 7. Malaria problem due to many forests. 8. Old beliefs related to nutrition, MCH
Guidelines to implement PHC

& CD.

1. 2. 3. 4. 5.

Coordinate the union among villagers and related persons Identify problems and find solutions Stimulate people to solve their problem by themselves Community cooperation Development of feasible and flexible PHC strat egies

GHV's Accomplishments in the community of assignment.

- Coordinated various offices and village organizations - Provided stimuli for people to be aware of development - Established the roundlatrine fund
Tambon Nongtakong, Pong-Nam-Ron Dlstrict, Chanthaburi Province.
Ms.Slrlporn Ua-sllamonskol (MCH/FP)

Problems in PHC develoPment

1. 2. 3. 4. 5.

Lack of unity among various village organizations to develop public health activities People are not familiar with initiating new activities in health development People do not understand the advantage of development Poor understanding of people about community participation Unhealthy traditional behavior and beliefs


Guidelines to implement PHC

& CD.

1.. Adaptation of community organizations to make them shong, able to unite and aware

of the value self-development 2. People participation : stimulate them to unite and make them feelthey are facing with public health problems which they themselves must solve 3. For MCH/EMC, assign VHVs/VHCs to disseminate public health matters in villages and to arrange public health service in villages, whenever possible

GHV's Accomplishments in the community of assignment

Community study, home visits Training of community leaders of Tambon Nongtakong

Tambon Wanyao, Khung Dlstrlct, Chanthaburl hovlnce

Ms.Patinan Thlprat (MCH/FP)

Problems in PHC development 1.

Most people lack interest in group organizations

2. Poverty 3. Heads of village organizations are not stuong enough to initiate heafth development activities 4. Most people do not rely on VHVs/VHCs
Guidelines to implement PHC/CD
Stimulate VHVs/VHCs to be enthusiatic to work and to understand about their village development activities


2. Manpower development 3. Good personal relations with villagers to generate their love and respect 4. Cooperate with VHVs/VHCs to disseminate to target population MCH knowledge and
nutrition information 5. Develop coordination in the entire village

GHV's Accomplishments in the community of assignment

Prenatal and post-natal home visitation

VHVs/VHCs taining in cooperation with research team ald health center officers on nutiCoordinated the project on "The Solution of Malnutition hoblem with Fund Development

tion and dental health

"and" Study on Tooth Decay Among Pre-schoolers"


Tambon Talan, Muang District, Chanthaburl Province

Mr.Ekkapong Wannapong (UPHC) Ms.WutAi Nakiapo (UPHC)

Problems in PHC development 1. VHVs do not understand their role.

2. P oor environmental sanitation-few latrines 3. Lack of safe drinking water, especially in summer 4. Malnutrition problem due to poverty 5. Strange beliefs about care of pregnant and post-partal women
Guidelines to implement PHC/CD in urban area 1. PHC implementation to focus on the group with percievel problems

2. Need to study and understand the community 3. VHVs must participate in problem solving


GHV's Accomplishments in the community of assignment.

Taught illiterate people in community Published pamphlets about fund dissemination Informed concerned officials on community development concepts

Tambon Bangsakao, Lamsing Distrlct, Chanthaburl Province.

Mr.Krtengkrai Swaltsuthtstrtkul (HCF)

Problems in PHC development 1. VHVs/VHCs are not accepted

for their real role

by people due to their young ag'e and some does not care


Only 50% of the population recieve curative and preventive care

Guidelines to implement PHC/CD 1.

People's participation in the solution of public health problems

2. Mobilization of limited community resource 3. Close coordination among village officials 4. Support of health-related activities
GHV's Accomplishments in the community of assignment

- Organized 23 funds to be Tambon Development fund - Surveyed primary data of community and people's attude to health card project - Trained sub-group leaders for spreading out knowledge on health card to the community


Tambon Tagrad-ngao, Tamal District, chanthaburi province.

Mr.Adul Noogpakdee (HCF)

Problems in PHC development 1. Poverty

2. Poor environmental sanitation 3. Poor community participation especially as regards 4. Poor cooperation from VHCs and VHVs
Guidelines to implement PHC/CD 1. VHV
members refresher haining courses

to drug cooperatives

2. Promotion

of PHC concept among village leaders and other distinguished community

3. Frequent dissemination of health education materials 4. Support of drug coopeiative by village officials 5. Arrangement of observation tours to development village 6. Promotion of health card fund by concerned community officials
GHV's Accomplishments in the community of assignment

- Campaigned for latine construction - Cooperated with health officers in survey and suggested covers for drinking-water jars - Assisted in household survey and village map making - Assisted in health checking f& primary school students - Suggested fund management by VHVs/VHCs - Disseminated public health education : e.g. Malaria and cholera clean water project to be
dedicated to the Great King's Birthday (5 December)

Tambon Ko-Perd, Lamslng Dlsttlct, Chanthaburl hovlnce

Mr.Pornthep Lerdpattanapong (PHC/CD)

Problems in PHC development 1.


1.1 Lahine-only 11% have latrines 1.2 Rain water tank, must adapt the

base to be firm enough with the water & concrete

2. Lack of community
Poor leadership

understanding of public health problems

Guidelines to implement PHC/CD 1.

2. Lack of community 3. Poor leadership

Study various community problems clearly to know causes and obstacles of development understanding of public health problems


Guidelines to implement PHC/CD 1. 2.

Study various community problems clearly to know causes and obstacles of development Realize that community development is a long process not like any concrete conshuction

which can be time-fixed 3. Encourage community leaders toward continuous health and development activities

GHV's Accomplishment in the community of assignment

Assisted the health officer on basic data survey home visits, coordination of village committee,

VHVs and VHCs

Assisted in problem identification and need analysis

Tambon Gang Hang Maew, Tamai District, Chanthaburl Province

Mr.Praiuab Wongwal (PHCICD)

Problems in PHC development

1. Too many assignments in health
center, so officers have less time to visit people; this affects

PHC implementation in the village 2. Most people do not understand public health problems 3. Officers do not get cooperation of people because they do not have much free time

Guidelines to implement PHC/CD

1. Increase in the number of health personnel 2. Generate awareness to respective roles and responsibilities

among village and health offi-

3. Generate the awareness of VHVs and VHCs on the quality of their performances 4. Stimulate community self-help activities 5. Initiate attempts to change attitude and old beliefs and utilize acceptable new technologies 6. Encourage people and community leaders to participate with public health problems-solution and village development

GHVs Accomplishments in the community of assignment

Surveyed villages'public health problems, analysed problems with VHVs/VHCs, village committees and health officers and planned for problem solution - Collaborated and assisted health officers to perform school health activiites - Collaborated with related officials to train village committees, VHVs and VHCs to perform and survey 1o, 2nd and 3'd step of BMN.


Tambon Sampeenong, Tamal District, Chanthaburt Provlnce

Mr. Yuttana Suktalodgngkun (PHC/CD)

Problems in PHC development 1. Lack of knowledge and understanding of disease prevention

2. Lack of interest among community leaders 3. Poor performances of VHVs and VHCs 4. Overloaded activities of health centre staff
Guidelines to implement PHC/CD 1. Suggest people participation in the identification of public health problems 2. Attempt to develop communip leaders to be initiators of PHC development and self-reliance

3. Encourage VHVs and VHCs to perform 4. Increase in the number of health staff

their duties according to the haining's objectives

GHVs Accomplishments in the community of assignment

Lahine construction campaign with public health staffs Health education dissemination both public and individual Extended service of essential drug supply in search for appropriate model and its trends inorder to promote correct drug use

Tambon Plap-pla, Muang District, Chanthaburi Provlnce

Ms. Thtppatee Maruetusatorn (PHCICD)

Problems in PHC development 1. Migration in order to find new job or new settlement 2. People worry over material gains instead of their health problems

3. Lack of participation from community leaders 4. VHVs/VHCs are not dedicated enough; moreover, they do not understand their roles 5. Lack of collaboration among officials to develop PHC 6. Problem finding by officials is not along the same line as the community's 7 . People prefer to see doctors at private clinics, as they think they can get better treatment
(must improve government health service system)

Guidelines to implement PHC/CD 1. Additional manpower training 2. Stimulate and motivate VHVs/VHCs,
performance of public health activities village committees and community leaders in the


GHVs Accomplishments in the community of assignment - Re-divided responsible cluster for VHVs/VHCs to avoid confusion
of responsibilities

and overlap in areas


Coordinated for development group to upgrade various health activities

Assisted in model village preparation as study area for visitors : e.g. foreigners, students,

Developed the awareness of the community about research for "Model Family of PHC"

Tambon Sa-kao, Pon-Nam-Ron District, Chanthaburi Province.

Mr. Prayong Pomnark (PHCICD)

Problems in PHC development 1. The distance between households 2. Poverty since their income depends
most of them are in debt is quite far on product price (agriculture) which is changeable, so


Due to households far distance from health center (about 6-7 kms) officials do not visit the

place which affect VHVs/VHCs performance

Guidelines to implement PHC/CD

Assist VHVs/VHCs to understand better their roles and functions including their participation

on problem solution in the villages


Good coordination between health center staffs and VHVs/VHCs & village committee for

a more eff.ective health problem identification and solution.

GHVs Accomplishments in the community of assignment

- Acted as advisor for public health activities - According to research assignment, identified new model of PHC supervision, study results
of supervision through systematic performance and the satisfaction of VHVs/VHCs with systematic supervision

Reports of GHV

III Batch

Tambon Tungbencha, Tamai District

Mr. Thamrong Tuntlwlpawln

Problems in PHC development 1. Lack of sanitary

latrines and safe water supply

2. Overloading of health centre responsibilities 3. The concept of top-down PHC ideology (from the government to the people)


Recommendations/guidelines for PHC development 1. Strengthening community organizations 2. Improving dissemination of information among the villagers 3. Creating incentives for communal work and healthy life style 4. Promotion of self-care appropritate to villager's beliefs and tradition

GHVs Accomplishment in the community of assignment

Promotional campaign on environmental sanitation Pilot study on promotion of village-sub-unit leaders.

Tambon Changkam, Tamai District

Ms. Natthaya Chuymungphan

Problems in PHC development 1. Lack of sanitary


2. Superstitious beliefs and practices on pregnancy, 3. Unsuccessful operation of Health Card Project

family planning and child rearing

Recommendations/guidelines for PHC development 1. Refresher courses for VHVs/VHCs 2. PHC education for the last year primary school students 3. Health education campaign on MCH, prevention of mosquito breeding and setting up the
village drug cooperatives

GHV's Accomplishment in the community of assignment

- Pre-natal health education - Campaigned for regular health check up of women in the reproductive age - Assisted health centre staff on school health programs, information management, health
education and other health-related activities

Assisted the MCH research team on mobile clinics, improvement of

malnuffion and campaign

on dental public health.

Tambon Takadngao
Mr. Pichlt Sophonwasu

Problems in PHC development 1. Lack of sanitary

latrines and clean water supply

2. Consumption of uncooked food and dangerous drugs use 3. Problems on Health Card Fund hoject implementation 4. Inactive community leaders and VHVs/VHCs


Recommendations/guidelines for PHC development 1. Strengthening the activities of VHVs/VHCs and the health centre staff 2. Campaigning for annual Village Contest on health activities 3. Shengthening coordination among the responsible govemment officers for PHC
munity development

and com-

GHV's Accomphishments in the community of assignment

- Campaigning for the construction of sanitary latrines - Strengthening the community organizations and the village volunteers - Giving health education and surveying Basic Minimum Needs of the people - Setting up the village development fund
Tambon Sanamchai, Tamai District
Ms. Nanthaporn Vrutnak

Problems in PHC development 1. Lack of sanitary


2. 3. 4.

Consumption of uncooked and contaminated food Lack of health consciousness on disease prevention Lack of MCH education, ie., family planning, pregnancy, child rearing etc.

Recommendations/ guidelines for PHC development 1. Strengthening of people's capabilities on self-help activities 2. Promotion of community participation for solving individual

and community problems

GHV's Accomplishment in the community of assignment 1.

Assisting health cenhe staff on MCH education, nutirtional surveillance, campaigning for Assisting the MCH research team on community study, data collection and promotion of

vaccination and other health-related activities


MCH services

Tambon Kaopred, Lamsing District

Ms. Rampeng Hongwaha

Problems in PHC development 1. Lack of sanitary


2. Malnutrition 3. Use of cloth dyeing agents in Kapi (Shrimp paste) production


Recommendations/guidelines for PHC development

1. 2.
Human resource development for every category of manpower resource Development of physical facilities for tansportation, communications and healthly life style

CHV's Accomplishments in the communigl of assignment 1. Community


2. Strengthening community organization 3. Setting the youth group 4. Health education during home visit 5. Campaigning for the special project on the village sanitation fund. Tambon Bangsakao, Klung District
Mr. Chakri Strlrak

Problems in PHC development 1. Malnutrition

2. lnability of VHV's and VHC's to understand their indidual roles and responsibilities 3. Infrequent home visitation of villagers by health centre staff 4. Lack of interest on a healthy life style
Recommendations/guidelines for PHC development 1. Strengthening VHV's/VHC's activities 2. Reduction of health centre staff load 3. Improvement of public education on health
GHV's Accomplishment in the community of assignment 1. Community

2. Campaign for "The Land of Morality, the Land of Prosperity" project 3. Promotion of Health Card Project 4. Set up the village information centre 5. fusist health center staff on medical treatment and health education Tambon Nongtakong, Pongnamron District
Ms. Parlchat Thep-rath

Problems in PHC development 1. Malnuhition

2. Problemsprovement of VHVs/VHCs capabilities 2. lmprovement of health cente services, especially the promotion of "mobile health cente" 3. Promotion of communal self-help activities 4. Coordination with the frontier police and frontier military for health promotion


GH\i"s Accomplishment in the community of assignment 1. Community


2. Promotion of MCH services and knowledge 3. Promotion and surveillance of nutritional status 4. Stengthening VHVs/VHCs capabilities 5. Assisting MCH research team on various research


Tambon Plubpla, Muang Dtstrict

Mc. Saslma Mungntmlt

Problems in PHC development 1. Sanitation problems (water, latine)

2. Over use of insecticides and herbicides 3. Problems on Health Card Fund project


Recommendations /guidelines for PHC development 1. Promotion of communal spirit (work for community spirit, and communal activities) 2. Promotion of heahh education for heahh improvement and other agects of development

GHVs Accomplishments in the community of assignment 1. Promotion of appropriate drug use and provision of essential drugs for the family 2. Assist the PHC research team in

2.1 Encouraging VHVs/VHCs on their work 2.2 Developing systematic PHC data collection 2.3 Refresher courses for VHVs/VHCs

Tombon Taklentong, Pongnumron Dlstrlct

Ms. Jarana Joolapo

Problems in PHC development


Nutitional problems

2. Not enough vaccination coverage 3. Sanitation problems 4. Overuse of drug, especially analgesics
Recommendations /guidelines for PHC development 1. Human resource development through communal activities

2. Coordination

and collaboration among officers from various sectors


GHV's Accomplishments in the community of assignment 1.

Promotion of MCH services, such as campaigning for ante-natal care, post-partum care,
Assist health cente staff on school health, health education, cataract teatment campaign,

EPI, nutrition and family planning


dental health campaign and health information management

Tambon Banralnung, Chonburi Prvince

Ms. Slrtporn Palsarnslrlrath

Problems in PHC development 1. Traffic accident and work accident 2. Noise pollution due to motorcycles and heavy trucks

3. Foul smell from animal farms 4. Problems of factory workers due to inegular eating habits Recommendations/guidelines for PHC development

and not enough rest

1. Training of student leaders on healthly habits 2. Refresher courses for VHVs/VHCs, especially on the knowledge of enironmental pollution 3. Health campaign for fpctory workers 4. Training for local officers and community leaders on environmental hazards 5. Campaign for sanitary food shops GHl/"s Accomplishments in the community of assignment 1. Set up village information centre 2. Village survey on rurla and health problems, and nutritional status. 3. Assist community members on village planning and physical construction

Tambon Banglamung, Chonburi Province

Ms. Slrlwan lym-ted

Mr. Thitiyed Tlnnam

Problems in PHC development 1.

People have no basic health knowledge on disease prevention and common treatment.

2. Indiscriminate use of medications 3. Water pollution due to the presence of many fatories Recommendations/guidelines for PHC development
1. Strengthening activities of VHV's/VHC's
especially on environmental problems

2. Strengthening capabilities of health centre staff in working with the community GHt/s Accomplishments in the community of assignment
1. Set up the
village reading centre


Although a member of evaluations had been conducted on the project "Primary Health Care Model Development - Chanthaburi hovince" of which the GHV project was originally a major project component, results of these evaluations cannot isolate GHV's activities. Hence, three evaluations were conducted specifically on impact assessment of the project on GHVs' acquired skills and on

the GHVs'perceived impact of the project on themselves.

2.5.1 Perspectives and Potentials of GHVs on the Expanded Programme

on Immunization (EPI)
The abovecited evaluation was conducted by a Master on Primary Heahh Care Management

(MPHM) student from India,.Dr.Damodar Bachani as his dissertation. He selected EPI as the best
indicator of GHVs'potential in health snice delivery because EPI is a well-stuctured henlth programme in the province of Chanthaburi and the GHVs have completed a comprehensive taining programme

on the health implications of a complete immunization coverage.

The following are the mechanics and the result of the evaluation as reported by Dr.Bachani

Perspecftrc and Potesrfals of G.H.V. tn Erpanded nognmme on lmmunlzatlon

Ih.Dammodar Bachanl
May 1988

Brief Summary of Preliminary Analysis

(1) K.A.P. of G.H.V.'s and Health workers of Health Centres :(Regarding EPI).

Total Score : Maximum 50

Total GH.V.



SD 2.97 4.24 3.95



Present GHV.


Health Worker





9 24


32.43 + 35.85 x, YA6 + 36.06 t 35.22 r 35.75 *,



- 4A6


1.40 P


0.05 Not Stgnificant

50 This suggests that graduate health volunteets has compuable I(AP of EPI wtth health workers. The difference was not dgnfficant, inspite of thls fact that had only one lrear oposure to health cae qlstem. (except 2 Senior GHV who had 2 years expertence). Heafth rryorkem had mean expedence of about

5 years 14.79l..

BCG wlth ln 12 months DPT. wrlhrn 12

OPV. wtthln 12
Measles Measles withln 12

T.T. (one) T.T. (Tuo de)

ft was found that mean coverage

% (for 1985, 1986, 1987) for all vacdnes was hlgher in those

centes where GHVs were coordinating. Even the proportlon of children getdng immunlzailon with in 12 months werc htgher in o<pedmental group (Centers wilh GHV.) GFIVs har,ae not been rvorhng for EPI alone but for PHC & MCH ln integrated nnnner. Inspite of this, an indhec{ impct on uflltzaflon of preventive health services, like lmmunlzation services is evident.
Rise in coverage (1985

to 1987) after GHV. scheme was inboduced, ls being analysed.


Omoorneof Optddt of OreTrahcrr &I{dh'Wor|rerraandof the GHVrThenrdrrcctr Se.lectng Health Scrvlcee ln whlch the can be Ueefrrl:-

1. Itft'6y66n


1. Modvaton ofparenb



vulnes to bables


non-aecpfiors of


2. Arangng 3. 4. 5.


2. 3. 4.

Ananglng groups health talks

2. 3. 4,

Motlvailon of drop-outs

Health edncaUon Cooperaffng wtth VHV andl Modvatlon of non-acceptors Cooperafing urlfr VHV/VHC


& moilvaton of

Modvatlon of drop-outs

Moilvaffon of parents/drop-outs

Moffvailon of drop-outs

5. Tahng

uretgtrt of batles

5. Fdow-p cf Immunffir Savle

ln general they preferred, that GHV



Though thcy llked to be tnvolved ln

should nork at the graseroot level to boost lmmunlzadon overage, ln

close contact wlth

recdve less prlorlty. They also llkcd to have help of GHV tn

asdrdng under 5 cllnh (eg. by



pacrG udh VHVNHC

they also wlsh to be Involved ln


tahng wt. of bables.)


ac{udly vacdnaflng a mother/ TtA qr hcree thel ugefuhes

and credlblllty ln the communlty

Evaluation of Usefulness of Graduate Health Volunteers in Immunization Acdvites ffotal Scores


Organidng lmmunlzatlon Cllnlc Regislratlon of Babtes

3.75 3.55 3.8 3.0 2.9 3.5 3.5 2.8 4.3 4.5 4.15

4.5 4.4


4.L 4.7 3.5 3.7

Tahng Welght of Bables

Storage ol Vacclnes

hocurement of Vacc,lnes
Recordlng Data of Vacc{natons Repordng Data to Hlghr Lval Giving Vacclnes to Babies lvlotlvatlon of Parents Ananglng Group Talks ln Vlllages Arranging Extended Camps Cooperating Wlth VHV/VHC Follow-up of lmmunlzadon Cases Motivadon of Drop-outs

3.7 3.3 3.7 4.5 3.9 4.0

3.5 3.6

& Mothers

4.7 3.8 4.5 4.5 4.7 4.7 3.7

3.8 4.3 4.5 3.8

4.5 4.6



Modvaton of Non-Acceptors
Evaluadon Suruey of lmmunlzafion


tury Other Speclfy

2.5.2 lmpact Assessment of the ProJect on GHVs

Another evaluailon was conducted by the project officers and some community volunteerb consisting of 17 persons on March 1987 on proiect's irnpact on the GHVs. Evatuation results revealed that the prlnctpal skllls devbloped were good human retations, environmentat adJustment and flexibility in dealing udth colleagues. The next sldlls were the abilfty to initate group partlCpatory acdvites, implement local technology and local resouraes for deveilopment, abilfty to constuuct quesdonnahes and conduct evaluaton. The least developed of sldll urcre the abtltty to coordinate wtth provincial government offlclals, ablllty to conduct quantttailve problem analysis, statistical analyses and preparation of reports.

2;5.3 GHVs Percelved Impact of the Project on Themselves

A thtrd evaluafron was done by the second batch of GHVs on themselves whlch consists of 14 GFNs on March 1987.


Evaluation results revealed that the best skills they have developed were the ability to live with others, cope with existing environmental pressures, improve human relations and conduct of health education. The least developed skills were the application of local technology, adminishation of research and development activities and coorilination with government officials. As regards to the GHVs'attitude on the project, a great majority considered the project as
a good venue for applying their gained a<pertise in health and developnfent. However; they perceived

that the financial remuneration is essential even to volunteers.

2.6.L Positive Yield
The evaluation results have documented the multifaceted benefits society could derive from the Graduate Health Volunteer hoject. Having been provided with an exceptionally good field
demonsration venue, the project has foster concern, involvement and an unsurmountable drive among the universitgl graduates to seek their roles in the village mechanism for health service delivery. The project has undoubtedly polished these group of intellectuals through an exercise of theory application within existing socio-economic limitations.
Endowed with youth and vitality, unaffected and unbiased, the GHVs have proven themselves
as an effective tool to problem identification. Their natural warmth, curiousity and creativity likewise

made them excel at proposing solution to perceived conshaints.

A very good learning eeqlerierrce in the contad of the presently exir$ing gap between the academe the community, GHVs may be viewed as a human bridge to close the gap. Universities may and
take on this project as an initial step towards re-direction and re-orientation of the academic curriculum. Field practice could well be incorporated into social sciences cunicula with a dual benefit of answering

the problem of acute manpower shortage in the villages and transformation of social values of the university graduates as regards to the dignity of working in the rural areas.

2.6.2 Negative Yields

While the three evaluations conducted have revealed very encouraging results, still several negative yields were palpable during the interaction between the GHVs and the project operations staff. The following are some of the field observations:

In the mini-protrcts implemented by the third batch of GHVs the result of the

proirt implementa-

tion did not create the desired impact on the community. (Please see annex 5 for detailed report
on the mini-projects). This could be attributed to the very short duration of project implementation (6-9 months). It has well pointed out that projects of short duration could hardly leave any room for

impact assessment.

As what obvious on the report of the GHVs, there is a palpable gap bordering on total resent-

ments on the part of some health staffs. Quite understandably, the GHVs were perceived as shangers

tying to assert their roles in areas beyond their expertise. The health staff could not be totally faulted for their undisguised paranoia. The fact remains that GHVs are outsiders.


Another evident observation


the reality of the complexities in the social structure of the

communityr. Just as complex and interrelated are the problems that exist therein. It has therefore become an impossible expectation that virtual outsiders be solicited to effect a mechanism for problem-solving.

Voluntary efforts will not suffice to answer the multifaceted constaints on health and social development in a community. Not even the services generated by both govemment and nongovemment organizations (NGO) members of whom mostly stay in the villages only during their working hours will produce the desired progress in community development activities. It has been well-perceived by the project operations staff that the long struggle towards the achievement of an optimum quality of life will
best be remedied by an attempt to restore the intellectual drain in the community.

Even more obvious is the financial implication of the project on any prospective implementing

body, which render its replication highly improbable if not altogether impossible.
Lastly, is the fact that the project has to deal with a group of young, vulnerable graduates deprived of practical experiences, inadequately equipped with technical skill for the task that they
were made to cam/ out, wanting in tact and diplomacy and worst they were made to function at paralled

with clever, hardened adults who have withstood the hials and tribulations of life. It has become clear why the sorption of the GHVs into the community social structure was far from being fluid.


There are several lessons learned from the Graduate Health Volunteer Proiect. However: the concluding remarks will center on three crucial issues: First, that university graduates have demonstrated maximum potential in the identification and in propoSing solutions to health and social problems; Secon4 that the graduate health volunteers

while full of youthful energy are lacking in maturity, practical and technical skills, and; Third but not the least, that no amount of sustainable development may be aspired from outsiders whose
bound to a communit5l is limited by a contactual agreement based on a substantial financial remuneration. Hence, the project operations staff have come up with a viable stuategy that has taken into consideration the lessons leamed from the GHV project. This has ushered forth the conceptualization of the "Graduates

Return Home Project".

Based on the concept of the promotion of a homeward-bound attitude among university graduates

both young and old, the project envisages to effect sustained developmental activities by fielding native village people who have successfully pursued their university degree programme. This shategy will solve the constraint of a limited stay on a conhactual basis by volunteer "strangers". Instead,
the village will be able to restore its own people with their life-time commitment to their village development. The complex, inter-related problems typical to a closely-knit community social structure will therefore be alleviated through the utilization of inherently existing community manpower resource who have been fortified with academic capabilities. The GRH project offers an ultimate solution to the nationwide

problem of an over-production and an under-utilization of university graduates with concomitant acute shortage of skilled human resource in the villages. The GRH project has likewise attempted to solve the problem of project replicability arising
from financial limitations by abolishing the provision of monetary remumerations to the project participants. In lieu of contactual agreements, the project generated life-time commibnent and life-time endeav-

our from the returning graduates.



The "Graduate Return Home Project" was conceptualized after a series of brain - storming
session among the project operation staff'and the concerned local officials of the Govemor, Chantha-

buri Provice on January 1988. The project has for its goal the provision of an ultimate solution to the problem of rural brain drain and urban unemployment. The thrust of the project is on the promotion of the return of the university graduates to their own native communities through the stimulation of their ability towards job-creation, self sufficiency and self-help, and the re-direction of their social values from urban to rural settlement. It is envisaged
that the return of the graduates will lead to an eventful sustained social and economic progress which

the rural communities have long been deprived of.

In close collaboration and continuous cooperation with the Govemor, Chanthaburi Rovince; his staff and the following institutions

The The The The The The The

Rambhai Barni College

Chanthaburi Chanthaburi Chanthaburi Chanthaburi Chanthaburi Chanthaburi

Office for Community Development

Office for Agriculture Office for Industry. Office for Fisheries

Office for Education

Office for Public Health. and

The ASEAN Institute for Health and Development of the Mahidol University, the Graduates Return Home Project was formally launched on May 1988.



3.2.1 To encourage graduates to retum home and spend their lives in their own communities 3.2.2 To hain graduates to create their own means of livelihood in their communities 3.2.3 To cooperate with the provincial office in setting a support mechanism for the retuming


To provide much needed continuity of project results and to enable unbiased comparative studies, it was agreed upon that project site remains the same, the province of Chanthaburi.


3.4.1 Recruitment and Selection of Universip Graduates for the Graduates Return Home Project.
With no holds baned on sex and age, the graduates need not be freshly graduated from universities.

Anyone who has a universig degree on social or related rience with an evidently fiong commitment to return to his/her home village or to settle in village communities even not necessarily that of his/her birth origin is qualifies to join the project. There is no monetary remunerations and even during some phases of the taining programme the participants are expected to take care of their own meats, and this fact has been made clear at the outset during the recruitment process. Just as in the GHV Project, recruitment has been carried

out throug newspaper advertisements. However; unlike in the GHV Project, there were absolutely no examinations of any kind, oral or written. Of the 40 university graduates who have applied, 22 reported for orientation and 14 decided to stay. Of the 14; hveweref{males, six were freshly-graduated from the university, eight were below the age of 25 and four were orignially from Chanthaburi. The ten non-Chanthaburians have an age-range of 23 to 39 years.

3.4.2 Training Programme

The graudates underwent a fourteen - week period of training. The first two weeks were mainly theoretical in nature and was held at the AIHD. The next two weeks consisted of an orientation programme to Chanthabud kovince and theories on technique of pb - creation and communrty development which were held at the Rambhai Barni College in Chanthaburi. During these four weeks formal education; tuition fee, board and lodging were provided for hee - of - charge. From the Rambhai Barni College, the graduates proceeded for a one-week study tour to the northeastern provinces and to Chachoengsao province. The graduates were given free accommodation nevertheless, they
have to take responsibility over their food bills. The graduates retumed to spend five weeks in the rural

community in Chanthaburi province. During this tiem, they were required to carry out an indepth
situational analysis of the community and at the same time finalized their selection of a means of livehhood. They have formulated their own occupation and community development plans in close collabora-

tion with their colleagues and in consultation with the project committee.

57 The graduates went back to the Rambhai Barni College for an interaction seminar, during which they presented to their colleagues and to the project committee their five year occupation and community development plans. The graduates then returned to the rural communities for an on-the-job haining period of another four weeks. There, they worked closely with villagers engaged in the same occupaffons the graduates have chosen to embark in. This gave them the opportunity to gather first hand informations and valuable experiences along the occuption they have chosen to
camT out. After the total of 14 week taining programme, the graduates were then prepared to retum to their communities of choice to implement their five year occupation and development plans. Throughout these ftve years, the members of the project committee will dl be available for technical

advisory back-stopping to the graduates. Seminars wlll be held 7 times over the frst two years of projert

operation and once ayear for the succeeding three years. Project evaluation will be undertaken by the project committee yearly during the ftrst three experimental years.

TheoreticalTraining at the AIHD

Module I

hobleme ln Derelopfng Countrler

Orientafion Director of AIHD


lnboduction of AIHD staff

What is your life objective? l-abour market bend in govemment and private sctors Impact ol unemployment among the university


5 6

AIHD staff T.U stdf

3 2 3
3 2

How to solve the graduates' unemployment

problems What are the dftematives of a unlverslty

AIHD stdf

8 9

hoblems of urban congesilon Problems of drug abuse Open forum



hoblemr fn 6e Runl Arear

hoblems in rural Thalland (poverty,
education, otganlzaflon) RRAFA staff MOPH starl.

13 L4 15

hoblems ls rural Thaland, condnuafion (quality of llfe, envhonmental savltatlon etc.)

Problems of chemlcals and lnsecticlde

K.U staff 3

toxicity in agricuhure
Necesslty of agricultural cooperatves

Role of GRH In rural problems

Religious doctlne and counhy development


AIHD stdf BMA Governor


L7 18 L9


hecent and Future Trendc ln Rural

The National Economic and Social Develment (NESD) Plan Re-direction in developing rural area, BMN, PHC and QOL Shategies and community parficipation in rural development
Obstacles in community development

NESDB staff

AIHD staff
3 TIRD staff


22 23 24

GRH response to feaslbillties in communlty carrer development



DCD staff

Altematives for development

Necessity oI nature conservation and


ADSP staff

C.U. staff

environmental sanitation for acheivement of an OQL 25 26 27 The role GRH In development Rehabllltadon of communlty culture, ad and wlsdom 2

AIHD staff
TIRD staff

GRH: a new hope to Thai society

AIHD staff

Theoretical Training Held at Rambai Bami College, Chanthaburi Province

llodule lV
28 29 30 31 32 33

lntroducllon to Cbmtf,aburl hovlnce

Experiences ln development

lVz Ir/z

Chanthaburl hovince

Altematives ln job creatton ln Chanthaburl province Open forum The role of Chanthaburl provlnclal offlce Admlnlshaflon, plannlng and management

G.O staff

to suppod Job creadon Dhectlons toward job cradon

Module V


Slratcgla to &b.creallon
Alternatlves In ceatng pb f,or oneseff My professlonal eryrlence Budness men
successful gr"du.tes $rho went back to


How do we slart our llfe Reld btp

2 9@

A farmer
AIHD Proiect stdf


38 39

hesentation of haining programme fo the

following week GRH suggestions on the haining programme Msit to the Thai Chamber of Commere Chanthaburi province

3 5

Rambhai Bami staff




45 46 47

It is not difficult to be a millionaire Observation tour to frult orchard How to raise shrimps in floating baskets Observation tour to gem pits, lapidiary,
gem markets at Na-Wong Chanthaburi Msit to shrimp farm ln Rayong province Visit to the Man Creation Foundation in Rayong province Attend the Seminar at Eastern Hotel on Counselling Service in Managerial lnvestment

3 3 2

3 3 6

50 51 52

Summary and general observatlons Summary of altematives in lile Appropriate models among community



H6w to formulate a proJeci proposal and

how to evaluate GRH selection of places for professional training.


GRH Field Study Programme

29 August

. 2 September, 1988



t *tq
Religious doctrines

Nonmuang Temple Tambon Nonmuang Kham Sakal - Saeng

Abbot of Nonmuang Temple

for development
Experiences in

Dshict, Nakorn
Ratchasima provinc 2

developing Nonmuang
Self reliance philosophy of Buddha

Ban - Talat Tambon Kan - loeng Waeng-Noy District Khon Kaen province

Agriculture style


The villagers

"to earn enough

to make a living"
Self-reliance in cultural dimensions Self-reliance based on experience of private enterprise Dscussion with private enterpris
Self-reliance Forest agriculture 10

Center for Cutltural and Development/ Northeast Ban Huay-Hin


CCD staff

The village headman


Life experiences on production Conclusion/synthesis of contents of field study





ASEAN Institute for Health Development Thammasat University Rural Reconstruction Alumni and Friends Association Ministry of Public Health Kasetsart University Bangkok Mehopolitan Adminishation National Economic and Social Development Board Thai Institute for Rural Development Department of Community Development, Ministry of Interior Alternative Devlopment Studies Pro-gramme Chulalongkorn University Governor Office Center for Cultural and Development/Northeast


Personal Data and Field Placement of the 14 GRH



Name Age Place of Birth Education

Mr. Jongrak Banjongkit


36 Moo.6 Tambon Gongdin, Klang District, Rayong Province. Rambhai Barni College B.A. (Community Development), 7987

2. Training
First period from 3 September, 1988 to 2 October, 1988.

Content : Integrated agriculture at his own land. Second period from 8 October; 1988 to 30 October. 1988. Content : Integrated agriculture at his own land.

3. Five-year

plan after achievement GRH training.

(1 November, 1988 to 31 October, 1993)

36 Moo. 6 Tambon Gongdin Klang District, Rayong Province : Better crop yield through integrated agriculture and gardening technique Goal and fish culture in his wells. Community development plan To participate with every community development activity, attempt to
change neighbours attitude and beliefs to retum to work in their own villages.


Study the community and utilize experiences to improve, apply, adjust

His motto

and solve village's problems in consultation with village committee. "Overcome obstacles no matter how difficult they may be"

GROUP 2 1. Background
Name Age Place of Birth Education

Mr. Sanit Han-Namthieng

11 Moo. 4 Tambon Tagard-ngao Tarmai District, Chanthaburi Province Chachoengsao Teacher College B.Ed. (lndustrial Arts), 1986

2. Training
First period from 3 September, 1988 to 2 October, 1988.


Tiger prawn raising at Moo. 4 Tambol Tagard-ngao Tamai District, Chanthaburi Province

62 Second period from 8 October, 1988 to 30 October, 1988. Content : Well-preparation to raise tiger prawn at Moo.7 Ban Tanonmakork, Tambol Tagard-

ngao Chanthaburi Province. Five-year plan after achievement GRH training. (1 November, 1988 to 31 October, 1993)
Khun Nid Tiger hawn Well, Moo. 7 Tambon Tagard-ngao, Tarmai Dsbict

Chanthaburi Province.
Goal To raise tiger prawn at first in an 8,000 square meters (1 well) and expand

later if successful Commnity development plan To persuade nearby groups raising tiger prawn to form a cooperative.
The expected location of cooperative will be at tambol development cenbe

His motto

which is in Moo. 4 Tambol Tagard-ngao, Chanthaburi Province. "Knowledge application to develop oneself and society".

GROUP 3 1. Background
Name Age Place of Birth Education

Mr. Saney Sungsakun


40 Moo.3 Tambon Praneed

Kao Saming District, Trad Province Ramkhamhaeng University

B.A. (Political
2. Training


First period from 3 September, 1988 to 2 October, 1988.


Mllage youth combination and self-study appropriate occupation at his own land.

Second period from 8 October, 1988 to 30 October, 1988.


Fruit garden and gem business in his hometown.

3. Five-year plan after achievement GRH training. (1 November, 1988 to 31 October, 1993)



Praneed Village, 40 Moo.3

Tambon Praneed, Kao Saming District Trad Province. to improve fruit garden 13 Rais (20,800 square meters) and then proceed to gem business.

Community development plan : To motivate village to utilize the youth in community development. : "Attempt to implement successfully anything planned" His motto




Operational & experimentat group at Thung-grang Village, Pong Namorn District.

The first person :-


Name Age Place of Birth


Mr. Samrit Kaew-pipop Moo. 2 Tambon Nonprodaeng

Phu Kradueng District

: :


Loi Province Loi Teacher College B.Ed. (Agriculture), 1986

2. Training
First period from 3 September, 1988 to 2 October, 1988.

Agricultural technologies at Mr. Jarouy Pongcheep's gardens, Klung District Chanthaburi Province. Second period from 8 October, 1988 to 30 October, 1988. Content : Integrated Agricultural Activities at Ban Thung Grang Mllage, Pong Namron District. Chanthaburi Province "Mutual Discussion during work achieve the best results" His motto


The second person 1. Background

Name Age Place of Brith Education

Ms. Narumon Srangsuanphon


/2 Moo. 5 Tambon Ang-Kiri Makham District. Chanthaburi Provice


Rambhai Bami College

B.Ed. (lndustrial Arts), 1987

2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Agricultural technologies at Mr. Jarouy Pongcheep's gardens. Second period from 8 October, 1988 to 30 October, 1988.

Her motto

Integrated Agricultural Activities as Ban Thung Grang Mllgage, Moo. 4 Tambol Tabsai, Pong Namron District, Chanthaburi Province

"Self improvement for better use to her community"

The third person :-


Name Age Place of Brith

Ms. Jamnien Phumsopa


Moo. 8, Tambon Yeelin

Wisaitchaichan Diskict

Ang-thong Province.



Ramkhamhaeng University B.A. (Political Sciences), 1980

2. Training
First period from 3 September, 1988 to 2 October, 1988.

Content : Marketing Business at Chanthaburi Chamber of Commerce. Second period form 8 October, 1988 to 30 October, 1988. Content : Integrated Agricultural Activities at Ban Thung Grang Mllage, Moo. 4 Tambon
Tabsai, Pong-Nam-Ron District Chanthaburi Province,

Her motto


Self adjustment to village life always in support of the villagers"

The fourth person 1. Background

Name Age Place of Birth Education

Ms. Jutiporn Duang-Dej 24 Moo. 1 Tambon Wangtago, Muang District,

Petchburi Province Petchaburi Teacher College B.A. (Community Development)

2. Training
Frist period from 3 September, 1988 to 2 October, 1988. Content : Gardening and Integrated Agriculture at Phanason Farm of Mr. Sonthi Inchan,

Pong Namron District, Chantaburi Province. Period from 8 October, 198 to 30 October, 1988. Second Content : Integrated Agricultural Activities at Ban Thung Grand Village, Moo. 4 Tambol Tabsai, Pong Namron District Chanthaburi Province : "Help herself to help her community". Her motto

The fifth person 1. Background

Name Age Place of Birth Education

:26 : 2 Moo. 2 Tambon Ponesung, Pathumrat Dstrict

Roi-Ed Province RamkhamhaengUniversity B.A. (Political Sciences), 1986

Mr. Pinith Khammasorn

2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising at Ban Namdaeng Mllage Klung District, Chanthaburi Province Second period from 8 October, 1988 to 30 October, 1988. Content : Integrated Agricultural Activities at Tambol Tabsai, Pongnamron District,

Chanthaburi Province


These 5 members of Thung Grang have five-year plan after completion of GRH training (1

November, 1988 to 31 October, 1993). Plac..e : Ban Thung Grang Village, Moo. 4 Tambon Tabsai Pong Namron District Chanthaburi Province. Goal : To grow vegetables then proceed to integrated agriculture and commerce to help sell agriculture products at fair price, at the same time, assist in development and foster community leadership. Comrnunity development plan
To coordinate with village committee, union youth gloup to promote envi-

ronmental sanitation morever, assist agricultural producers (vegetables and fruits, etc.) to achieve better harvest.

GROUP 5 The first person :1. Background

Name Age Place of Birth Education

Mr. Sanon Thien-Thong


Moo. 1 Tambon Chokenue

Lamduan District, Surin Province Ramkhamhaeng University

L.LB., 1985

2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising and being assistant teacher in frontier police school, Ban Namdaeng Village Moo. 6 Tambol Bangchan, Klung Dishict, Chanthaburi Province. Second period from 8 October, 1988 to 30 October, 1988. Content : Tiger prawn raising and being assistant teacher in frontier police school, Ban Namdaeng Village Moo. 6 Tambol Bangchan, Klung District, Chanthaburi Province.

The second person 1. Background

Name Age Place of Brith Education

Mr. Theerayuth Phengphajorn


Moo. 1 Tambol Natuamtai

Muang District, Trang Province Phuket Teacher College B.Ed. (lndustrial Arts), 1986

2. Training
First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising and being assistant teacher in frontier police school, Ban Namdaeng Mllage Moo. 6 Tambol Bangchan, Klung Dstrict, Chanthaburi Province.

66 Second period from 8 October, 1988 to 30 October, 1988. Content : Tiger prawn raising'and being assistant teacher in frontier police school, Ban Namdaeng Mllage Moo. 6 Tambol Bangchan, Klung Dstrict, Chanthaburi Province.


Five-year plan after achievement GRH taining. (1 November, 1988 to 31 October, 1993) Place : Frontier Police School, Namdaeng Village, Moo. 6 Tambol Bangchan, Klung District, Chanthaburi Province. Goal : To work as volunteer assistant teacher and to find way to earn for daily living. First, they will teach students in school and at the same time, they will encourage students to catch seafood on holidays to sell. They want
to emphasize self-help to those students. Then, they will raise tiger prawn.

Community development plan Try to decrease gambling in the village by forming youth group and then
involving the village committee in campaigns about the bad effects of gambl-

ing. He expects to motivate the youths to perform other useful village


GROUP 6 1. Background
Name Age Place of Birth Education

Ms. Suwiman Treerat 24 54/7 Moo. 1 Tamban Thung Kanan Soi Dow District, Chanthaburi Province Chombueng Teacher College

B.Ed. (Thai), L987

2. Training First period from 3 September, 1988 to 2 October, 1988. Content : Gardening and Integrated Agriculture at Phanason Farm of lvlr. Sonthi Inchan and Ban Thung Grang Mllage, Pong Namron District, Chanthaburi Province. Second period from 8 October, 1988 to 30 October, 1988.


Integrated Agricultural Activities at Ban Thung Grang Village, Pong Namron District, Chanthaburi Province.

Five-year plan ater achievement GRH tralning. (1 November, 1988 to 31 October, L9931 Place : Thung Kanan Mllage 54/lMoo.2 Tambon Thung Kanan Soi Dow Dstrict, Chanthaburi Province

To change farm crops into fruit and rubber gardens. To dig wells for raising

fish, and watering plants in dry season. During the wait for the produce
of longJife fruit and rubber hees, she will grow other crops to save money and enable her to proceed to her future plans.


Community development plan

To be a good model to the community so people will accept and believe in her.

Her motto

"Aim towards self and'community development".

GROUP 7 1. Background
Name Age Place of Birth Education

Mr. Khanae Khamphee


1111 Moo. 3 Tambon Sathon Pong Namron District, Chanthaburi Province Ramhamhaeng University

B.BA. (GeneralAdmin.)

2. Training
First Period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn cultivation and water-dwelling system to raise the prawn at Khung Kabain Bay, Tarmai District, Chanthaburi Province. Second period from 8 October, 1988 to 30 October, 1988.


Tiger prawn raising in floating basket at Ethep Village, Tambon Bangchan, Klung District, Chanthaburi Province.

3. Five-year

plan ater achievement GRH training.

(1 November, 1988 to 31 October, 1993)

Place Goal

: :

Demonsbation Project of Tiger Prawn Raising in floating basket at Tambon

Bangchan, Klung District, Chanthaburi Province.

To raise tiger prawn in floating basket, and to study work trends

Community development plan To promote cooperative's union of tiger prawn raisers, utilize income
from raising it to support GRH project, and coordinate with the cooperative

group (raisers) to form the cooperative in Klung District and Tarmai


His motto

"Self and social development"



Name Age Place of Birth Education

Ms. Kannikar Arch-rith


Tambon Ammarut, Paakhai District Ayuddhaya province. Ramkhamhaeng University

L.LB., L987

68 2. Tralnlng Fust period from 3 September, 1988 to 2 October, 1988.

Content Content

: :

Marketing business at Chanthaburi Provincial Chamber of Commerce. Performed sale business at her own house 703/L Soi Suksan, Bangkok-Nonthaburi Road. Bangsue, Dusit DsMd, Bangkok

Second period from 8 October, 1988 to 30 October, 1988.

3. Five-year plan after achievement GRH training (1 November, 1988 to 31 October, 1993)

: :

Her own house,


Tambol Bangsue, Dusit Dshict Bangkok.

To promote commerce at her place and coordinate with GRHs at Thung Kanan Mllage, Pong Namron Dstrict, Chanthaburi, by contacting buyers directly (not to pass) through middle merchants.

Community development plan To work with Crowded Community Development Project (Urban fuea Development) in Bangkok. Responsible office is NIDA. "To achieve something, proceed with seriousness" Her motto

GROUP 9 1. Background
Name Age Place of Birth Education

Mr. Wisithsak Saitree


Tambon Phu - Nguen, Selaphoom District, Loi - Ed Provincg. Ramkhamhaeng University B.A. (Political Sciences), 1986

First period from 3 September, 1988 to 2 October, 1988. Content : Tiger prawn raising at the farm of lvlr. Chandom, Phangrad Mllage,

Rayong Province. Second period from 8 October, 1988 to 30 October, 1988.


Tested himself to be company's driver in Muang DsMct Rayong Province to save

money for his future plan. 3. Five-year plan after achievement GRH training. (1 November, 1988 to 31 October, 1988) : Not specified Place


: :

Not specified

Community development plan

Not specified Reports on Field Experiences were presented during the GRH Seminar. The Group

following are the reports of the 14 GRH.


GRH Seminar Report held on 26 - 27 December, 1988 at Kitchakoot National Park, Chanthaburi Province : Problems on Project Operation and Project Progress Report Seminar Participants - consist of representatives from the following : - Cooperating government institutions - Rambhai Barni College staff - Mahidol University staff, and - 14 GRH

1. To enable the GRH to present their project

progress report including their conshaints on

project implementation to the project committee and member of concemed institutions and to formulate

feasible solutions to identified constraints. 2. To opn a venue for aftee exchange of ideas in determining aftemative taining,/implementa-

tion,/supervision,/evaluation modules in preparation for the next GRH project.

Ban Nam Daeng Groups, I(hlung District


Mr.Theerayuth Phen-Phachorn The GRH volunteered to teach students (free of charge) in the piimary school spending their holidays catching crabs/shrimps for food. Problems ldentifted : The preponderance of gambling activities and the poor environmental sanitation.



GRH project participants should be better prepared in planning their own job from the practical and realistic point of view, - GRH proiect participants should be able to start their new jobs with none or very little investments,


GRH project participants should exercise caution in dealing with local people.

Project support for a smallfishing boat to help them earn their livelihood.

Ban Thung Krang, Pong Nam Ron District


- Mr.Samrit Kaew-phipop - Ms.Narumon Srangsuanphon - Ms.Jutiphorn Duang-Dej - Ms.Jamnien Phumsopha

This group earn their livelihood through selling sweets and desserts and planting vegetables.


Problems ldentifted : - Lack of money to buy water motor pump - Unstable income from crop - production


- GRH project participants should lind themselves a regular buyer of their produce, - GRH project participants should have better public exponsure to improve public relations,
and that the

GRH project participants should identify an appropriate technology to take the place of water pump.

Mr.Sanit Han-Namthieng, Tamai District

He is doing a pilot shrimp farm project on 5 Rai of pond wfth 100,000 stuimp seedling. He intends to set up a cooperative organization among the various shrimp farm ou'ners.

Probleins ldentlfted : - The water salinity is not conducive to shrimp growth - Middlemen pullthe prices down


GRH proiect participants should be in close consultation wtfi the bcal chamber of commerce.

Mr.Saney Sungsakun
He is at present still undecided as to what occupation he intends to embark in.


He should be given more time to enable himself to adjust and face the challenge of home
village development and eventually take pride on his participation in village developmental activtfles.

Mr.Khanae Khamphee, Tamai District

He plans to raise shrimp in floating baskets, however; he has not started yet.


He should be gven more encouragement to start his sfuimp raising in natural condition rather than in floating basket. Or, he could identify other means of livelihood and start immedeatly.

Flnal Recommendatlons : 1. To set up GRH revolving fund for those who lack money,
To publish a GRH newsletter to disseminate informaflon on the various stage of project implementation by the different participants and to serve as inspiration to others who ae dill nndedded


over what to do, and


To study project feasibility in other communities with the ulfimate goal of upgrading



The GRH project could be the answer to the perennial problem of b,rain-&ain in the rural



Initial project results have revealed three major points for consideration

Flrst, economic shuggle. Without any means of financial remunerations, the graduates survival. The knowledge of the urgency to find a source of livelihood had stimulated a number of unpolished creative ideas. Though not
were practically left alone to deviie their own mechanics for
all of them were at the prime of their youth, their enthusiam was contagious and their vitality enviable. All have a unilateral goal and that is; to ffnd a place for oneself in the rural communities of Chanthaburi Province. Some have in the process gone through the extent of selling treasured belongings while others unhesitatingly carried out unskilled jobs and yet majority are determined to seek the fulfillment of contributing to community progress.

Second, social adaptation. Since not all of the project participants were Chanthaburians, only four of them were native of the province; they have to undergo a gradual process of adaptation

preliminary to their merger into the existing community social network. Even those who were originally from Chanthaburi, in view of their long absence while in pursuit of their academic studies

adaptation. It is admirable how the 14 parti@ants were able to do so. Probably it is due to their individual flexibilities, their strength of character, their pre-determined goal, or;
have to undergo social

half of the credit could be given to the villagers who have given the graduates a room in the village and a room in their hearts.

Thlrd, self-development. This could well be the most productive aspect of the project on the part of the participants. The project has tansformed a group of undecided youths into matured responsible human resource that will speed up their nation's creep into progress.

The Graduates Retum Home (GRH) Project is a giant leap towards the restoration of rural intellectual resource. The project has painstakingly identified the root cause of rural brain drain as emanating from a change in a graduated students's goal orientation. Whether the newly-acquired urban-oriented goal has been iatrogenically triggered by the academic environment or whether the change in value

What is obvious is the fact that university graduates from the rural areas have expressed very little desire to return home.
While the project has demonstated its ability to re-direct goals and re-orient social values, it may nevertheless raise a certain degree of scepticism as to its extent, limitations and viablility among some of our readers. Questions may be put forward such as; the difficuhy of reconciling a long-winding intellectual shuggle of an education graduate to a five-year plan of self dedication as a village assistant teacher, or that of a political scientist's decision to raise tiger prawns. Questions may be asked as regard; parental reactions after having spent hard-earned baht over their siblings' decision to tend to vegetable gardens, fruit orchards, prawns. Questions as to how many of Thailand's university graduates and how many of Thai parents will embrace the promise therein in small scale industries,

system has come as an aftermath to a long period of urban exposure is beside the


the wisdom of achievements outside and beyond one's academic orientation, the ultimate nobility of being a co-partner to one's own village development. We beg our readers for "TIME" to answer these questions. Behaviour modification and value change is indeed a gargantuan mandate, hourever;
in our own small way the GRH Project has documented that such a mandate is feasible. The GRH hoject does not limit its challenge to the university graduates and their parents alone, rather the project
is an attempt to a call for an academic upheaval towards an over-all adaptation of existing curricula

along the context of the Thai social btructure. The project is an attempt towards an awakening of support mechanisms for the tens of thousands of Thailand's university graduates as they tread unto

the pathway back home.

Dr.Rosa Corazon F. Cosico M.D., M.P.H.

Expatriate Short-Term Consultant to the AIHD, Mahidol University
6 February, 1989.


Publication on Research for PHC Model Development, Chanthaburi Province

1. GHV Monthly Newsletter (in Thai)

2. Intoduction

to the Research for Primary Health Care Model Development hoject (in Thai and

3. A Manual for the Training of GHVs (in Thai) 4. A Manualfor the Training of GHVs in MCH and EMC (in Thai) 5. Situation Analysis and Community Assesssment on Primary Health Care, Maternal and Child Health, Family Ptanning, Essential Medical Care and Community Development in Chanthaburi Province (in Thai and English) 6. The Re,ports of GHVs (19851986) : Problems Obstacles and Recommendations for PHC, MCH and Community Development in Chanthaburi Province (in Thai)
7. The Study on the Interest of Thai University Graduates in PHC and Community Development

(in Thai)


Progress Report (January 1985 - December 1986) : Research for Primary Health Care Model

Development, Chanthaburi Province (in English) 9. The GHVs Short Stories (in Thai) 10. The Report of GHVs (1986 - L987) : Problems, Obstacles and Recommendations for PHC, MCH and Community Development in Chant{raburi Province (in Thai) 11. A Manual for the Training of GHVs in Primary Health Care (in Thai) 72. ATC/PHC Research and Development Monthly Newsletter (in Thai) 13. Primary Health Care - A Continuing Challenge (English) 14. The Reports of GHVs (1987 - 1988) : Problems, Obstacles and Recommendations for PHC, MCH and Community Development in Chanthaburi hovince (in Thai)




ASEAN lnstitute for Health Developmeqt Association of South-East Asian Nations ASEAN Training Cenbe for Rimary Health Care Development
Basic Mnimum Needs

Community Development
Communicable Disease Control District Public Health Office Expanded Programme on lmmunization Family Planning Graduate Health Volunteer Graduates Return Home Health Card Fund lnformation, Education, Communication Japan Intemational Cooperation Agency Knowledge, Attitude, hactice Matemal and Chlld Health Mnisby of Public Health Master in Primary Health Care Managment Non-Government Organization Oral Rehydration Salt Provincial Public Health Office Primary Health Care Quality of Life Regional Training Centre Royal Thai Government Southeast fuia Medical Information Cente Sexually Transmitted Disease Traditional Birth Attendant Technical Cooperation among Developing Mllages United Village Village Village












Committee Health Communicator Health Volunteer World Health Organization



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January 1985 7

Project Milestones
Field visit by ATC staff to Chanthaburi Field visit bv ATC staff and researchers to Chanthaburi The first.orirultutlon meeting at ATC/PHC among ATC staff, Chanthaburi provincial health officers, Phra-Pok-Klao Regional Hospital medical doctors. members of MOPH. member of RTC Chonburi and other researchers




GHVs First Batch


(tutay 1985 - March 1986)



Application and Selection of the First Batch of Graduate Health Volunteers GHV application (585 person applied) GHV written examination (50 persons passed) GHV oral examination (15 persons passed)

Preparation of the GHV training program and training materials GHV training & preparation for data collection GHV theoreticalhaining at ATC/PHC GHV field study at Nakornrajsima and Khonkaen provinces Continuation of the GHV fteld training at Chanthaburi and pre-test of questionnaires GHV haining at Chanthaburi




Start of field work and data collection GHVs begin work in the field
Data collection by researchers and GHVs

October 9 -11

Data analysis and conference on work plans by researchers, GHVs, health centre staff and others at RTC Chonburi


Conference on community leaders, ATCIPHC. participated by GHV and community leaders form Chanthaburi province

Preparation and printing of the reports on : The Manual for Training of Guaduate Health Volunteers
Seminar in the field among GHV's and the researchers at Ban-Som-Dej Hospital, Chonburi Province


January 1986


GHV's monthly meeting


February 24

27 -28

Consultative meeting on the selection of GHVs batch 2, ATC/PHC GHV's monthly meeting at Chanthaburi
Semhar in the fteld arnong GI-Ms and the reseamchers at Kitchakoot Natural Forest, Chanthaburi Province Acceptance of applicaton for the second the batch of GHVs at ATC/PHC



GHVs Second Batch (April 1986 - March


April 1 2l - 25 29 - 30 May 2 - 30 7-8 23 26 June 2 - 22

17 -

Selectlon of GHVs
Orientation training for the applicants and written examination Oral examination Monthly GHVs meeting at Chanthaburi

Tralning of new GHVs Training of new GHVs at ATC/PHC

fuinual Conference on the Reseach for PHC Model Development Chanthaburi province at ATC/PHC GHVs batch 2 finished theoretical training 15 Motor bicfrcles were tangorted to Chanthaburi for GHV fteld operation

GHV Field Training tn Chanthaburt

GHVs confrnuous taining at the hovincial Public Heahh Office, Phra-PokKlao Regional Hospital, and communities hospitals Japanese experts surveyed the research areas

20 27

26 -

30 July 9
29 -

GHVs began to work in the field Seminar among GHVs, health centre staff, and local researchers at The Provincial Public Health Office GHV's batch 1 graduation day


GHVs field operatlon and lnterventlon In PHC and MCH and MCH acffvltles Presentation of the project activiites to Dr.H.Mahler, Director.General WHO at ATC/PHC Monthly GHV's meeting, Chanthaburi province
Submission for first report on situation analysis and plan of acfivities, by





The ftrst annual conference of heahh center staff, GHVs, research teams

and community leaders at RTC Chonburi

October 6-9

Regular supervislon of GHV by ATC staff

November 30 December

Submisiion of GHV second reports

Training programme for VHV/VHC and local officers at Ban-Plang sub-


district, Pong-Nam-Ron district, Chanthaburi Province Presentation of the project activiites to Prof . Natth Bhamarapravati, the Rector of Mahidol University at ATC/PHC
Evaluation on the project activiites by Prof. N,Iasami Hashimoto, the chairman

17 -L9 January 1987

of Japanese National Committee on ATC/PHC Proiect, ATC/PHC


Seminar for the second mid-year project appraisal and preparation for

the annual conference, Krating Natwal Forest, Chanthaburi Approximate participants 80, from ATC/PHC, Chanthaburi provincialhealth office, the GHVs and the Research Team


t7 -22

Study tour to the northeast by the local research teams and GHVs to observe

successful PHC activities


Data collection in the model villages by the GHVs and the research teams


Data analysis at the ATC computer facility Selection of senior GHVs Acceptance of applications for new GHVs

GHVs Third Batch (March 1987 - March



GHV application (1,960 applied)



GHV written examination GHV oral examination (13 passed)

GHV theoretical training at ATC/PHC GHV field study at Khon-Kaen, Makasarakham and Nakornrajsima provinces



GHV field training at Chanthaburi

Start of GHV field research



Field supervision




Seminar among GHV, health centre staff and local researchers at RTC



Field supervision


Field supervisiogt
Meeting at Chanthaburi with representatives of research team for the mo-

GRH First Batch
January 1988

dification of GHVs training module (January 1988 - March 1989)

Brainstorming session

L7 Meeting at Chanthaburi province with representatives of concemed Ins{itutes

3 23

Drafting of project proposal Review of the project proposal Meeting at Chanthaburi provincial hall for the inhoduction of the GRH project by the Governor, Chanthaburi province attend by the Rector of Mahidol University, hof.Dr.Natth Bhamarapravati and the Director of

April 4

AIHD, Dr.Krasae Chanawongse Project site visitation by Prof.Dr.Natth and Dr.Krasae

GRH application Continuation of GRH application Orientation for applicants at Chanthaburi province GRH recruitment (14 persons) individual registation of GRH Theoretical taining at AIHD
C.ontinuation of baining at Rambhai Bami Co[ege in Chanthaburi province



July 4
10 31



29 September

GRHs fteld study at Khon-Kaen and Chachoengsao province



GRH field supervision Community study and development of occupational plan



10-30 27-23

GRH plan submission GRH occupational training Field supervision kesentation of taining certificates to GRH by the Govemor, Chanthaburi



Field supervision

January 1989

First seminar among GRH, representatives from cooperating institutions, staff of the Mahidol University
Meeting at Rambhai Bami College for reformulation of evaluation question-


naires to be used on the GRH project evaluation

Open forum with GRH and the Governor, Chanthaburi province held
at the provincial hall

Project I Title : Promotion of Environmental
hoject site : Tung
Sanitation Through Health Education

Bencha Village, Tamai District

Project objectives : 1. to promote environmental health and uplift the quality of life in the village, and 2. to campaign for the construction of low-cost latrines
Responsible persons : Mllage committee, community leaders, Tamai district health officers, health centre staff and GHVs

Project duration Project activities


1 October - 31 December, 7987

1. community


2. demonshation of construction of low - cost latrines 3. establishment of community sanitation fund

Project budget
Baht 5,000 from ATC/PHC Baht 7,000 village counterpart contributioh TotalBaht 12,000 (US $ 480.00)


Project 2

Promotion of Family Drug Box



Plub-Pla Mllage, Muang District


Project objectives

1. to ensure that every household will have a ready access to essential

of common illnesses, and 2. to promote correct attitude to drug use
Responsible persons Project duration

drugs for the teatrnent

Health centre staff and GHVs


September 1987 - March 1988

Project activities

1. educational campaign on essential drug use, 2. community assessment for essential medicine needs, and 3. sale of family drug box containing essential drugs to the villagers
Project budget

Baht 4,500 (US$ 180) from ATC/PHC

Project 3

The Establishment of Vllage Information Center



Kao Wongkot Mllage, Tamai Dstict


Project objectlves
village visitors, and

1. to disseminate community informations to the villagers, to govemment offtcials and to

2. to promote
Responsible persons

the activiites of community organizations

Mllage committee, health cenhe staff and GHVs

Project activities


8 September - SNovemberl, 1987


basic village data survey,

2. 3.

identification of the village information centre site, and data posting at the centre

Project budget

Baht 1,000 from ATC/PHC

Baht 472 village counterpart contribution Total Baht 1,472 (US$ 59.00)

Project 4

The Promotion of Village Sanitation Fund



Kao Pred Mllage, Lam Sing District

Project objectives : 1. to promote environmental sanitation education on safe water supply and latrines, and 2. to strengthen village capbility towards self sufficiency


Responsible persons

community leaders, health centre staff, VHVs, VHCs and GHVs.

Project duration


1 June, 1987 - 30 March 1988

Project operation

1. community preparation,

2. solicitation of funds from the villager, and 3. purchase of water containers form the neighboring province
Approximate budget

Baht 5,000 from ATC/PHC Baht 3,000 from MOPH Baht 2,000 from village contributions Total Baht 10,000 (US$ 400)

Project 5

The Promotion of Village Development Fund

Project site

Takadngao Village, Tamai Dishict

Project objectives : 1. to promote village communal activities, 2. to facilitate the purchase of low-cost good quality commodities, and 3. to set-up a hade centre for village handicraft
Responsible persons

offcials from the fow cooperating ministuies, village development fund committee,

village committee and the GHV

Project duration Project activities



December, 1987 - March 1988

2. 3. 4.

information dissemination, solicitation of fund, observation tours to other villages (TCDV), and the establishment and management of the development fund by the villagers themselves

Project budget


Baht 5,000 from ATC/PHC Baht 900 village contribution Baht 5,900 (US$ 236)



List of Graduate Health Volunteers


The ftrst batch 1. Miss Kannikar 2. Miss Kanjana 3. Miss Chanalai

Prepree Lertpraplut


4. Miss Chamaiporn 5. Miss Nareerat 6. Miss Panpit 7. Miss Plernsiri 8. Miss Rungnapa 9. Miss Somruedee
10. 11. 12. 13. 14. 15.
tvtr. Surasak

Srikanok Samrongrak Toprakone

Sirisampan Srisad Sarapirom Jamcharoen Sriwatanatakul

Mr. Somsak Mr. Suchat

Miss Supis Miss Ajma Miss Usa

Titayanpong Puhin Jinwala Khiew-rod

The second batch 1. Ms. Lakkhana 2. Ms. Wanna 3. Ms. Anchalee 4. Ms. Siripom 5. Ms. Patinan 6. Mr. Ekkapong 7. Ms. Wuthi 8. Ivtr. Krienglaai 9. l"tr. Adul
10. 11. L2. 13. 14.
l/tr. Pornthep Mr. Projuab


Pannark Uasilamongkol

Thiprat Wannapong Nakjapo


W, Yutthana
Ms. Thippatee


Nuypakdee Lerdpattanapong Wongwai Suktalodyingkun Maruethusathorn Pomnark

The third batch 1. Miss Siriporn


2. Miss Siriwan 3. Mr. Thitiyod 4. Ms. Natthaya 5. Ms. Parichat 6. Ms. Nanthaporn 7. Mr. Phichit 8. l/tr. Changkri 9. Mr. Sanit
10. 11. 12. 13.
Mr. Thamrong
Ms. Sasima Ms. Rampeng Ms. Jarana

Tinnam Chuymungphan Thep-rath Krutnak
Sophonwasu Sirirak inthasara

Tuntiwipawin Mungnimit Hongwaha Joollapo




List of Pardcipants in the Graduates Return Home hoject

Banjongkit Han-Namthieng


2. I'lr. Sanit 3. Mr. Saney 4. ttlr. Samrit 5. lvG. Narumon 6. Ms. Jutipom 7. Mr. Rnlth 8. Mr. Sanon g. Itlr. Teerayuth
10. 11. 12. 13. 14.
lv|s. Suwimon

Srangsuanphon Duang-Dej

Khammasom Thien-Thong Phengphapm

Khamphee Arch-rith

Mr. Klranae
lrG. Kannikar

Mr. Wisithsak
lv|s. Jamnien


Dr.Krasae Chanawongse
Dr.lkasae has dedicated himself in the pursuit of public health goals for the under-privileged

majority. It may well be deduced that the empathy has flourished from the fact that he once belonged to the less advantaged population subgroup in his birthplace Muang Phon, Khon Kaen, which is located about 365 km. Northeast of Thailand.
if only to prove that poverty is not a deterring factor to any form of intellectual

fumed with dedication and perseverance he has worked his way through the medical school pursuit. In 1960 he

was awarded his medical degtee by.the Faculty of Medicine, Siriraj Hospital, University of Medical

Sciences (now, the Mahidol University) , in Bangkok. Immediately after graduation, he went back to his native dis[ict tuming a deaf ear to the lucrative life that the capital city has to offer to promising young physicians. Instead, Dr.l&asae concentated on the application of his newly-acquired expertise to expand and stuengthen the existing health service facility in Muang Phon, through community participation. In 1968, Dr.Krasae received a Colombo Plan grant to pursue a course at the London School of Hygiene and Tropical Medicine. On completion of his post-graduate studies, again he returned to Muang Phon to resume his public health career. A recipient of a number of awards both locally and intemationally; among them the prestigious Ramon Magsaysay Foundation Award from the Philippines in 1973; Dr.Krasae was appointed Deputy Minister of Health by the Royal Thai Government in recognition of his pioneering effort on health and

community development activities from 1975 to 1977. In 1980 Dr.lGasae received his Doctoral Degree in Public Health (Dr.P.H.) from the Columbia University, New York. USA. At present, Dr.lftasae is the Director of the ASEAN Institute for Health Development. Despite his hectic schedule both as an adminishator and as a resource person for the Center, he never fails
to go home every weekend to visit his beloved Muang Phon, listen to his people's tale of woe and offer alternative solutions to existing health problems.
Dr.Krasae is the hoject Drector of the Research on himary Health Care Model Development, Chantaburi

hovince, The Graduate Health Volunteers and The Graduates. Return Home Project. Dr.Krasae is married with two children.


Dr.Som-arch Wongkhomthong
Dr.Som-arch has left Thailand at the tender age of 18 after qualifoing for a Japanese C:overnment

scholarship. Hereceivedhismedical degeefromtheUniversityof Tokyoin 1975. Hethenpursued his training in Clinical Surgery. In 1980, Dr.Som-arch received his Master Degree in Public Health from Harvard University in Boston, Massachusetts. Then, he went back to Japan to pursue a Doctoral Degree in Health Sciences. ln 1982, the University of Tokyo awarded Dr.Som-arch his second doctoral degree.
to be of

In 1984, after 16 years of absenen,Dr. Som-arch was homeward bound in an eager anticipation to his own people. He irined the Mahidol Univercity Facuh of Public Health as a lecturer

in the Department of Health Services Adminishation. Simultaneously, he joined the ASEAN Institute

for Heahh Development as a lecturer to the Master in Primary Health Care Management course and as the fusistant Director to the Center.
Whenever he is asked if he should ever leave his counby again, Dr.Som-arch's answer with his characteristic disarming smile is - NEVER.
Dr.Som-arch is the R,ojert lvlanagr of the Research on himary Heafih Ctre Model Development, Chantaburi Province, The Graduate Health Volurteers and the Graduates Retum Home Project.

Dr.Rosa Corazon F. Cosico

Dr. Cosico received her degree on Doctor of Medicine from the University of St. Thomas Manila, Philippines, in 1966.
She started her public health career as a volunteer Puericuhure Center physician in her native

town of Pulo Bulacan (now, Valenzuela, Meho Manila) She later jreined the Manila Heahh Department and was awarded the South-East Asean Minister of Education Organization (SEAMEO) Fellowship Grant on Master Degree in Public Health at the Mahidol University in Bangkok, Thailand, In 1978, she received her degree ranking as First, in the MPH International Course from Mahidol University. Shortly after her return her Government has awarded Dr. Cosico a second scholarship on

Development. She was unable to complete the course as fate destined her for an even greater challenge by way of a WHO recruitment as a short term consultant in MCH/FP with duty station in Thailand, in 1980 and later on as Medical Officer in Family Health at the WHO Regional Office for South East fuia in New
Master Degree in Government Management, major in Human Resources

Delhi, India. In November, 1986; on completion of her WHO assignment; Dr.Cosico set foot on what she claims as her second country-Thailand, to join Mahidol University as a Msiting Professor to the Faculty of Social Sciences & Humanities, until May, 1987. Dr.Cosico is the short-term consultant to the project on Research on Primary Health Care Model Development, Chantaburi Province, The Graduate Health Volunteers and The Graduates Return Home Projects. She is also consultant to The Intensive Development the Quality of Life Association of Thailand. In March, 1989; she will assume duties as the WHO National Consultant to the Royal Thai Govemment, Ministry of Public Health. Dr.Cosico is married with three children.


At :


Thammasat Unftrerslty hcec, Bangkok 102(X), Thalland. Tel. 2%13fi Arunee Indrasuksrl, 19t9