Thailand has partnered with Japan to implement new programs and policies targeting the gap in LTC facilities and services across the country.
The focus: In low- and middle-income countries without established LTC offerings, implementing programs at the community level and working up to the acute care level offers a compelling model for national transformation. Evolving in three distinct phases, this work builds on the phase before it by targeting new needs with every step.
How it works: Thailand’s multi-phased program offers services that target different aspects of LTC provision. The Japan International Cooperation Agency (JICA) began the C-TOP (Community Health Care and Social Welfare Services Model for Thai Older Persons) in Thailand in 2007, to improve the community health volunteer co-ordination and provision of health and social care for older adults. These volunteers receive a government stipend and serve as community-based health and social co-ordinators, offering the first line of care to older people while referring those with additional needs to other care providers. The second phase of the work, L-TOP (Long-term Care Service Development for the Frail Elderly and Other Vulnerable People), ran from 2013 to 2017 because C-TOP revealed many older adults in need of LTC due to a loss of independence or mobility. L-TOP focused on identification and case management of at-risk older adults across Thailand. The latest iteration of this program (running from 2017 to 2022), S-TOP (Project on Seamless Health and Social Services Provision for Elderly Persons), aims to improve care co-ordination after an older adult is discharged from a hospital. Each of these phases relies on the national health volunteers who receive a stipend from the Thai government to carry out these programs. Select volunteers and nurses travel to Japan to receive training in care and co-ordination for older adults and, on returning to Thailand, train other volunteers and nurses.
Enabling environment: The policy environment was crucial in establishing these three programs. The Thai government recognized their existing policy gaps, particularly in light of the anticipated increase of older adults, and utilized Japan’s expertise in this area to recommend policies and programs. In the initial stages of this program, the strong partnership between JICA and the Thai Ministry of Public Health and Ministry of Social Development and Human Security was key in establishing new services and trainings. At the start of the program, none of the stakeholders knew what C-TOP would become and allowed the needs they saw on the ground determine the next phases of the project. Rather than being prescriptive about implementation, these stakeholders collaborated to meet the most urgent needs of older adults by volunteers who respect older adults as part of the sociocultural norms of the country. Recently, Thailand launched the “Health in All Policies'' framework, which requires the national government to ensure healthy policies, underscoring the government’s critical role in securing services for adults as they age.
Impact: The primary indicator of success in these programs has been improvements in activities of daily living. Over two-thirds of participants have reported improvements, and qualitative surveys are under way to determine further benefits of the programs. The Thai government has also dedicated funding to continue training nurses and health volunteers on co-ordination and care for older adults. The program is in the process of being expanded to other countries, including Chile, Mexico and Sri Lanka.