Orientation and Mobility Training Service for the Blind under the Universal Health Coverage Program in Thailand

5-7 December 2011Sydney, Australia

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THE WORLD REPORT ON DISABILITY: IMPLICATIONS FOR ASIA AND THE PACIFIC

Praew Eiamnoi, Kaewta Wissavabamrungchai, Wachara Riewpaiboon

PURPOSES: The study aims to monitor and provide feedback on the implementation of a six-year strategic plan (2010-2015) of the development of orientation and mobility (O&M) training services under the universal health coverage (UC) program in Thailand. METHODS: An ICF-based questionnaire was developed for face-to-face functional outcome survey by trained ophthalmological nurses while O&M instructors were interviewed by mailing questionnaire. The O&M service performance was assessed through reports and focus-group discussion. RESULTS: 23 collaborative O&M training centers were established in 12 health regions. 113 O&M instructors were trained. Instructors’ background was physiotherapist, occupational therapist, social worker, nurse, teacher and others. Services were delivered to about 700 blind clients within the first year. 517 blind clients were interviewed. The gender ratio was 1:1, 54% aged 15-59 years, 45% over 60. 47% had acquired blindness, 35% were progressive low vision, and 15% were congenital blindness. 80% of them lived with their families, 60% were unemployed, 20% were temporary general employee, and 10% had agricultural job. The post-service functional profile revealed more than 90% were independent in basic activities of daily living and household mobility whereas the proportion of domestic activities ranged from 50%-90% correlated to age. The most improvements were on increased self-confidence, more independent in self-care and ambulation, sense of well-being, opportunity to make friends and social participation but very little on job opportunities, access further education and receiving eye health examination. CONCLUSIONS: Although the program’s effectiveness was demonstrated, improvement both in service distribution and in outcome quality particularly on social participation is needed. The more differentiated training modules for elderly, active adults in different life styles and children are important. Effective collaboration is required for achieving the social participation goal.

ABSTRACT

Introduction

Methods & Materials

Discussions & Conclusions

The study showed achievement by objectives of

the strategic plan. There were alternatives in

service management model having flexibility and

potential for holistic care management. Referral

across sectors to enhance social participation

outcomes seemed practical. Co-financing and

quality improvement should be considered.

Participation of the DPO was the strength for

client empowerment dimension of health service.

Manpower development and management

needed to be more addressed in order to be good

platform for quality improvement process and

sustainability of care system. O&M service

package needed for more differentiation to make

it more responsive to the need of blind clients.

The national blind & low vision survey in 2006-7 of Thailand showed 0.59% with bilateral blindness. The

main condition was correctable cataract, 51.64% followed by glaucoma, degenerative and diabetic retina

diseases. The context-based orientation and mobility (O&M) training service was considered essential for

resuming independent social living but rather limited availability in healthcare system.

In 2002, the Universal Coverage (UC) health insurance

scheme was established for 2/3 of Thai population. In 2003,

rehabilitation budget was certainly allocated 4 Bath/UC capita

while O&M training for the blind was unavailable, only white

cane was provided. The pilot O&M training service development

was conducted in 2006-2007 by the collaboration among the

Health Promotion Program for People with Disability, The Blind

Association and the National Health Security Office. The

Rachasuda College, Mahidol University was responsible for O&M

instructor training.

During 2008-2009, O&M service was added in rehabilitation

benefit package of UC health insurance scheme and

sporadically implemented through project-based approach. The

provincial blind associations were service contractor units. This

showed uneven distribution and un-sustainability. Therefore the

6-year strategic implementation plan of O&M service was

developed and started in 2010 aimed at providing appropriate

O&M service to accumulated 70,000 blind in the

communities.

Objective

This study aims at monitoring and providing

feedback for further O&M service system

development.

The data were collected quantitatively through

structured questionnaire during June-August

2011 by mailing approach for 113 O&M

instructors whereas 712 blind who were service

recipients during October 2010 - March 2011

were face-to-face interviewed by 30 trained

eye-nurses. The ICF concept for personal

functioning information was included. The focus

group discussions and in-depth interviews were

done for qualitative data.

Results

Figure 1 : Target of 6-yr strategic implementation plan of O&M service

16 sites were operated by

conventional health service

model which a hospital

allocates personnel to be

trained and provided O&M

service

3 sites were operated by

educational collaborative

model which special

education centers/schools

shared personnel to be

trained and provided O&M

service

3 sites were operated by

Disable People Organization

(DPO) collaborative model

which DPO shared personnel

to be trained and provided

O&M service

1 site was operated by only

screening and referring

hospital model then O&M

services were provided by

any others center

Fifty-eight trained

instructors provided

O&M services to 748

blind were different in

background; health and

education-related

professions including

physical therapist,

occupational therapist,

nurse, special education

teacher and general

knowledge background.

Employment security of

these O&M instructors

was also varied.

Only 13 instructors

were permanent staff of

the hospitals while the

rest were temporally

employed. The services

were mostly arranged in

group with the average

ratio of instructor:

blind of 1:5 or 2:10.

OUTCOMEINPUTPROCESS

The O&M service units were established at 23 Eye Departments in 22 provincial hospitals and 1 district

hospital throughout 12 national health security management regions. 113 O&M instructors were trained

through three batches of 200-hour curriculum. O&M service were delivered to 748 blind.

Collaborative organizations :

45% of blind client aged >60 yrs, 55%

was in range of 15-59 yrs. The functioning

information after received O&M services was

revealed. More than 90% of blind clients had no

difficulty in performing daily activities and

household ambulation. There still were some

difficulties in doing instrumental or domestic

activities e.g. cooking, gardening, shopping

which age was statistical different factor.

Most satisfying issues included improving

ability to perform ADL and ambulation,

increasing self-confidence, feeling good in

health with more mobility in everyday life but

least satisfied in increasing opportunity in

education and vocational life areas.