Assessing health volunteers’ success in Thailand’s COVID-19 response

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By Professor Vikas Kumar, Director of Research and Professor of Operations and Supply Chain Management

Thailand is one of the countries that has successfully managed COVID-19 outbreak control – the number of new infections is on the decrease and related deaths are limited. Playing a huge role in this success has been the country’s 800,000 active Village Health Volunteers (VHVs).

Each volunteer acts as a messenger and goes into the community to relay the latest news about  public health, as well as providing primary healthcare and planning for and monitoring of health issues. Their dedication strengthens the primary healthcare system and helps tackle the healthcare crisis, which now includes COVID-19. Each province contains approximately 104,000 VHVs, many of whom were active during SARS in 2002 and Avian influenza in 2004.

Having received a Newton Fund Institutional Links Grant, we are working with Mahasarakham University in Thailand and will initially assess how effectively VHVs are performing their role in COVID-19 limitation across Thailand, whether in suburban or more remote rural areas.

I will be leading an interdisciplinary team of researchers in Thailand (Dr Kittipol Wisaeng, Dr Amporn Kai, Dr Petcharat Lovichakorntikul, Ms Aim-on Tarakam, Ms Somsri Sungkharom and Dr Worawat Sa-ngaimvibool) who will be working closely with a range of local stakeholders (VHVs, Local medical practitioners like doctors and nurses, local government, councils, etc.). Also included in the team are researchers from the Innovation Operations Management and Supply (IOMS) research group (jointly led by Prof. Wendy Phillips and myself) at the Bristol Business School.

We will then look at ways in which VHVs might perform more effectively in COVID-19 control in the future as their ability to social distance, help implement curfews etc. is hindered by extraneous factors such as climate change. We will also outline operational and logistical challenges they face while executing their role in remote areas. These could include short- and long-term changes in mobility, landscapes, other emergencies (e.g. epidemics).

In line with these potential challenges, we will look at the associated developmental needs and ultimately our work will look at how we can re-conceptualize the role, forms, and management of VHVs in preparation for impacts of COVID-19 and other emergent epidemics.

Baed on our conclusions, we will put produce effective strategies and a toolkit to help VHV perform better in COVID-19 control in changing contexts.

All these additional innovations to the VHV scheme and lessons learned will better facilitate contributions to other countries in COVID-19 control as well as the control of other emergent epidemics.

By achieving the objectives, this project hopes to contribute significantly to existing literature and community practices in Thailand. The developmental strategies will help local government/authorities to increase the potentials of the volunteers for COVID-19 and similar outbreak control in the future. There is also an opportunity for other countries to learn from this project who are struggling to manage this pandemic.

Apart but not Alone? Neighbour support during lockdown

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By Amy Beardmore, Research Associate in Public Health and Community Development

As the UK went into lockdown on 23 March in response to the Covid-19 pandemic, communities across the country sprang into action and initiated a rapid process of self-organisation, the likes of which had never been seen before. Help for people within communities was quickly coordinated using online platforms such as Facebook, WhatsApp and the hyperlocal social network Nextdoor, alongside more traditional forms of communication such as phoning neighbours or dropping notes through letterboxes. The pace at which this unprecedented community response to the crisis was organised appeared to overtake the implementation of more formalised voluntary and statutory sector support in the area. The result was a complex network of street, neighbourhood and community level help, support and resources.

Rapid research

It quickly became apparent to researchers in the Centre for Public Health and Wellbeing that a unique opportunity was emerging to document the extent of this sudden surge in ground level support and how it might be affected by levels of social deprivation. Enlisting the help of colleagues from within the centre and external partner organisations, as well as a number of community researchers and public contributors, the team designed a piece of research consisting of three distinct phases. This work began just four days after lockdown on 27 March under the heading Apart but not Alone, starting with an online cross-sectional survey.

Survey One

Launched on 2 April and promoted largely through online channels, email and text messages, the first survey asked respondents about who and how they were helping, and their wider experiences of personal involvement in neighbourhood life. Of the 862 people who responded to the survey, a total of 539 responses from the Bristol built-up area were eligible for analysis.

Complex picture in areas of higher deprivation

The results showed that help and support unsurprisingly tended to be aimed at the most vulnerable in communities – specifically the over 70s and those self-isolating. Interestingly, the data also indicated that respondents from more deprived areas of the city and surrounding areas tended to be disproportionately supporting those with disabilities and mobility issues, those with no access to outdoor space and those experiencing financial difficulties. These areas of higher deprivation were also less likely to strongly agree that neighbours were supporting each other well.

Women shouldering majority of the burden?

It is notable that 80.9% of survey respondents were female. There could be a number of reasons for this, including the possibility that women are more actively engaged in social and community networks – both on and offline – and men’s helping behaviours therefore exist but are simply less visible. It may also be that women are shouldering the burden of caring for their community as well as immediate family members, with many also trying to work from home, often with children present.

Low BAME response rate

Bristol has a BAME population of around 14% (although this figure is much lower for South Gloucestershire and North Somerset), so a survey response rate of 5.3% does not appear to be representative of the local population. This may well be due to the restrictive nature of an online survey promoted largely via social media, although the sample did specifically include BAME organisations. It is hoped that the experiences of the BAME population will be explored in more detail through the qualitative element of the project.

In-depth interviews reveal lived experience

The second phase of the project consists of in-depth qualitative interviews with some of the survey participants in order to get a better understanding of how social capital – the resources and connections that people have access to that can influence their ability to navigate systems or to generally do well in life – influences individual and community experiences of lockdown. Eighteen interviews have been conducted so far as part of a unique piece of research in which the researchers themselves are living through the same experience as their interviewees.

“Two of my neighbour’s cousins have died because of Covid-19…and it’s difficult for her because they can’t get together as a family to mourn…”

Research participant

Follow-up survey on community spirit

Participants from the original survey who expressed an interest in taking part in further research were also invited to take part in Phase Three – a follow up survey, published on 27 May. This survey asked about positive and negative experiences in communities since the easing of lockdown on 10 May, and early analysis suggests that whilst many reported a continuation of positive activity (such as increased communication, street level events and volunteering), participants also identified a number of emerging concerns. These tended to indicate that tensions were starting to creep in, particularly associated with confusion over the rules and social distancing as well as more general concerns about previous negative behaviours being exhibited by some members of the community. Of particular note were a number of negative comments about the behaviour of young people and teenagers, indicating potential generational conflict.

What next?

Results from Survey One were recently published in Emerald Open Research, and it is hoped that a second article will be published in the next few weeks summarising the findings of Survey Two, which is currently undergoing analysis. The qualitative element remains ongoing as we continue to explore the participant links to social capital and the impact it has had on their experiences of lockdown. For regular project updates, please follow us on Twitter @ApartAlone.