City Report and Action Plan

Khon Kaen

Ms. Wallapa Prangthawat
Public Health Technical Officer
Khon Kaen Provincial Health Office
Thailand

CITY REPORT

Khon Kaen is situated 450 km from Bangkok in Thailand's northeast region and is the capital of the province that bears the same name. The city has a population of 125,000 and serves as the regional center for education, business and government. Khon Kaen province has a population of 1.77 million and agriculture is the main source of income. Continual growth in various industrial sectors is playing a significant role in the development of the province.

The municipality of Khon Kaen has a directly elected municipal council and an executive board. The 24-member council serves as the legislative body the duties of which include approval of budgets and passing of municipal ordinances. The executive comprises a president, a mayor and three deputy mayors, who are elected by the council. It functions to administer municipal functions.

Reproductive Health

Public Health in Khon Kaen falls under the jurisdiction of the Bureau of Public Health and Environment. Programs and services for reproductive health in the city include (1) family planning counseling and related information, education, communication services, (2) mother/child education and services for pre- and post-natal care and safe delivery, (3) prevention of unsafe abortions (4) information, education and treatment for reproductive tract infection, (5) counseling and services for adolescents, (6) education on sex, sexuality and responsible parenting, and (7) prevention of HIV/AIDS and STDs.

HIV/AIDS

As of May 2005, there have been 5,599 confirmed cases of HIV/AIDS in Kohn Kaen province. There were 410 cases in 2002, 505 in 2003 and 529 in 2004. The 20-39 age group accounted for the largest proportion of those infected at 70%, and the 25-34 age group alone accounted for as much as 57% of all cases. As for means of transmission, 84.1% was heterosexual, 2.4% was intravenous needles, 5.2% was from mother to child and 8.4% was unidentified. HIV prevalence has been significantly reduced among some high-risk groups, such as commercial sex workers (from 27% in 1996 to 7% in 2004) and military conscripts (from 28% in 1996 to less than 5% in 2004).

Khon Kaen province is actively fighting HIV/AIDS through condom promotion, an antiretroviral drug program for people living with AIDS, and collaboration among government, NGOs and people living with AIDS. Promotion of condoms has been quite successful, particularly among sex workers and their clients. There are now 447 condom vending machines in Khon Kaen, which help provide easy access to condoms. Efforts to raise awareness about HIV/AIDS have been carried simultaneously with condom promotion.

The antiretroviral drug program has 24 participating hospitals and has provided care for 1,864 cases of HIV/AIDS. The program emphasizes the psychological needs of people living with AIDS together with their requirements for physical care.

Partnership among government, NGOs and people living with AIDS has fostered and strengthened HIV/AIDS programs and activities. Various NGOs focused on HIV/AIDS are active in Khon Kaen, and national budgets are provided to support NGOs and people living with AIDS. HIV/AIDS committees comprising the above groups help manage response and formulate action plans for public agencies. Furthermore, an AIDS center is located in each of the province's 25 districts.

ACTION PLAN

In Thailand, the love for king, country and religion are paramount forces. If an idea is proposed as doing something for the king, everyone will want to join the campaign. Most of the population is Buddhist. Even among counselors there are Buddhist monks.

No.1 Goal: To decrease the rate of HIV infection among adolescents.
Factors leading to this rise in the infection rate are premature sexual behavior, sex without condoms (especially among close friends), lack of skill to use a condom properly when they are used, and lack of good access to condoms. We are striving to have 100 percent use of condoms, and to supply adolescents with the knowledge of how to properly use the condoms.

This requires a great deal of training, organizing, coordinating and enrollment of support from many parts of the community, including schools, businesses, NGO's, and individuals.

Activities for the first two years of the program include forming an AIDS committee, recruiting members and volunteers from different parts of the community, training the trainers who in turn train other volunteers who will serve as counselors, production of brochures, leaflets, etc., to publicize the programs, and supply condoms.

Activities in the subsequent years include continuing the training, expanding the program throughout the community, and measuring and evaluating the success of the programs. The target population for these programs can be found in schools, workplaces, and throughout the community.

No.2 Goal: To decrease unwanted pregnancies among adolescents.
Significant factors in this problem include lack of contraceptive skills, an inability to safely resolve unwanted pregnancies, and illegal abortions. Activities to improve the situation include establishing a "Friends Corner Club" where resources are available to adolescents, establishing counseling clinics to provide advice and knowledge, and to make information available via a web site for easy and anonymous access. Target populations to recruit resources for these positions include health personnel, school teachers, NGOs, and workplaces.

No.3 Goal: To decrease both maternal and infant mortality rates.
Factors involved in these problems include substandard levels of service from Public Health staff, complications in pregnancy that are not identified and treated in a timely manner, and the lack of a prenatal care system. Activities to address these problems include increasing the training of Public Health staff, especially in the areas of prenatal care, pregnancy care, and both delivery and emergency delivery care; and producing a manual in those areas of care for health care to staff to use. The targeted place for this activity is the 24 hospitals in the area.

No.4 Goal: To decrease health problems in vulnerable groups.
In particular, this refers to prison inmates, where there is a high rate of HIV infection. Overcrowding in prisons, and lack of means to control sexual behavior in prisons, are contributing factors of this. Activities to work to control this problem include assessing the risk behaviors and environment that inmates are subject to, seeking means to change those behaviors and the environment, and developing adequate medical equipment and health personnel for prisons.