Making a contribution of just Bt5 a month, or Bt60 a year, to a community fund to bring better health benefits might seem simple enough. But it did take a while for the villagers of Thasom sub-district to appreciate this new step in the prevention of disease and promotion of health.

It was primarily through the efforts of Phra Subin Paneeto, better known as Phra Ajaan Subin of Wat Phai Lom, the spiritual leader of the sub-district, that this admired initiative took off.

Initially, not many of the 4,800 people who make up the five villages of Thasom sub-district thought the matter of health was their business.

"If you asked them who was responsible for their health, many would simply answer 'doctors'," Phra Subin said.

"All right, so doctors are trained to treat you. But do they share the same illness or the pain you have when you are ill? No," said the revered monk, who was prepared to speak bluntly and candidly about health problems in the sub-district. Over time he gradually changed the attitudes of the locals about health and got them to believe that the best course for everyone was prevention first and foremost.

"They didn't realise what they spent when something bad happened to their health from things like smoking cigarettes, or the cost of travelling to hospital when ill. It's much more than Bt60 per year," he said.

The idea to set up a sub-district fund dedicated to community health promotion and prevention was strongly resisted at first by many of the villagers, recalls Kunya Saengrungrueng, a 44-year-old health volunteer.

But because of the reverence people have for Phra Ajaan Subin, the Thasom health fund was eventually set up this year with about 62 per cent of the people joining initially.

Although it is pretty much a pittance, many people complained about why they should have to pay more for their healthcare since the Bt30 scheme was in place and covered treatment for them.

Before the Thasom health fund came into existence, anyone wanting an annual check-up would have to pay about Bt160 for some tests not covered by the Bt30 scheme. As well, they had to travel to the state-run Trat Hospital, which was pretty much over-crowded most of the time.

Under the Thasom health fund, the annual check-up is quite elaborate, covering a list of potential health threats including various cancers such as breast, cervical and prostate. To make it more attractive, the cancer checks are carried out in Thasom by the National Institute of Cancer from Bangkok, with the other check-ups given by a private hospital.

When they realised just how beneficial the health fund was, more villagers decided to jump on the bandwagon and today less than 20 per cent of the population of the sub-district has not joined up.

Apart from the provision of annual health check-ups, the Thasom fund has three other major goals - physical exercise promotion; garbage management and reduction; and food safety.

For exercise, the fund supports a range of activities based on the interests of people according to gender and age, such as aerobics for housewives and soccer for male school students.

For the food-safety campaigns, health volunteers check and certify stores in the markets around the five villages on a monthly basis as well as continually providing person-to-person food-safety education in home visits.

The results have been superb, says Vien Suamsheap, 44, a health volunteer. The data now shows the incidence of common diarrhoea in Thasom has dropped dramatically.

On top of the contribution from the villagers, the Thasom health fund also receives funds from the Thasom Tambon Administration and Trat Provincial Health Office. The fund now has more than Bt1 million.

Under another fund in Thasom sub-district, known to the villagers as Thasom Sajja (truthfulness) Co-operative Savings, members are given financial assistance for the cost of travel to and from the hospital when ill, plus some pocket money for being away from work.

The Sajja fund has accumulated about Bt4 million for the welfare of the members. Both Sajja and the Thasom health fund came from the ideas of Phra Ajaan Subin.

"Getting the villagers to pay Bt60 a year is simply a tactic to build up their sense of belonging to get them involved actively with health promotion and prevention activities," the monk explains.

Getting people to take good care of themselves to prevent illnesses is an uphill battle, concedes the monk, although that does not mean it is "impossible" to win.

Dr Sa-gnuan Nitayarumphong, the head of the National Health Security Office, calls the Thasom health fund a role-model initiative in health promotion and prevention. It works very well because it combines the talents and efforts of villagers, local administration and the government.

Arthit Khwankhom

The Nation

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