in Samut Phra Kaen province, Thailand. This is my first time speaking at a broad conference outside Asia, so for up to one hour. And I am not native English speakers. So please forgive my lack of English language skill, and please be kind to me. For introduction, to see an overview of Thai health care system. Yeah. Since the publication of World Health Organization declaration of Alma-Ata in 1978, it has been the beginning of global focus on primary health care, emphasis on good health for all. One of the important tasks of the primary health system is village health volunteers or community health workers whose roles and responsibilities are providing health information to families and communities. Visit home and communities to provide information on right and public health welfare. Visit and follow up with people who do not have access to public health service. Distribute equipment for prevention and treatment of local disease. Access and follow up to support public health for underprivileged people with training under the supervision and advice from public health officers. In Thailand, the Ministry of Public Health has continuously issued strategic plans for the primary care system that are related to village health volunteers. The village health volunteer system includes selection, training, and knowledge review. Are you all familiar with Thailand? Yeah. Thank you. Benefits for village health volunteers in Thailand and their families able to reimburse travel expense for work, some health insurance, and money paid. It is systematic and continuous. Currently, there are more than one million registered as village health volunteers in Thailand. And more than 80,000 are regular workers. I would like to provide an overview of the health care system in Thailand. If you have any insight or suggestion that could help me address related challenge, please feel free to share. OK. In Thailand, Thailand health care welfare system encompass three main types, government officer benefits, social security schemes, and universal coverage. Most individuals receive free hospital treatment based on their entitlements. Yet, there are still options to utilize private insurance or pay out-of-pocket for service in any hospital. In community health care, there is typically one village health volunteer for every 50 to 200 residents. This role is lifelong. So subject to current system constraints and limitations, village health volunteers are required to submit monthly reports at the health office to receive compensation monthly. Regarding compensation salaries for these, positions start at 1,000 Thai baht. It's about three days of minimum wage. This role can either serve as one's primary occupation or as a supplementary one. In Thailand, OK, we'll pass it. For back to the village health volunteer program, the World Health Organization's operating guidelines for the village health volunteer system are currently in place. It is recommended that the selection of village health volunteers is an important activity for village health volunteers to make their work more efficient, sustainable, and better. People who become village health volunteers should be selected appropriately. One of the factors affecting the performance of village health volunteers is the level of social capital. Social capital has many definitions. World Health Organization and World Bank reports, it has been defined as the characteristic of organizations in society, such as trust, norms, and networks that can help improve social efficiency by helping each other. Social capital can be divided into several dimensions. The division of social capital as defined in health-related research consists of, one, structural social capital. It refers to relationships in society that can be seen, including the number of networks in society, helping each other within the group or between individuals, and citizenship activities or civic duty. And two, cognitive social capital refers to interpersonal feelings that cannot be seen or touched, such as trust and norms of feeling each other. Samut Prakhan province is located in the central region of Thailand. There is local government of all size. There are local administrative organizations consisting of metro municipalities, city municipalities, sub-district municipalities, and rural administrative organizations. There are approximately 1.3 million people in the household registration. Furthermore, for an overview, in Thailand, the local government's structure comprises two main branches. Firstly, there is the central government system akin to federal set up in the USA, which is elected by parliament. This branch holds the authority to designate provincial governors and district chiefs who, in turn, have the power to appoint civil servants, including those in significant institutions like center hospitals, police departments, and high school. Secondly, there is the local government system where leaders are chosen by the residents of area. The mayor elected through this system is responsible for various aspects, such as education, sanitation, community health centers, and temples, to excluding police duties. In Samut Prakhan, there are 7,600 village health volunteers registered with the Samut Prakhan Provincial Public Health Office distributed among 87 community health centers. Research objective, firstly, to study the level of social capital of village health volunteers in Samut Prakhan province. Secondly, to study the relationship between factors related to the level of social capital of village health volunteers in Samut Prakhan province. And thirdly, to study the relationship between the level of social capital and the work performance of village health volunteers in Samut Prakhan province. This research determined that the primary variables from the literature review consist of, one, personal factors, two, work factors, three, evaluating the performance of village health volunteers to find a relationship with the dependent variable social capital consisting of three dimensions of social capital. One, structural social capital, two, citizenship activities, and three, cognitive social capital, as shown in diagram one. This research is cross-sectional descriptive study. The population is 7,600 village health volunteers who are registered and working in Samut Prakhan province in 2022. The sample group was village health volunteers who were selected from a random sampling method and multi-stage cluster sampling. The research towards the social capital The research towards the social capital form and general information consisting of three parts. Part one, personal factors and work factors, totaling 13 items. Part two, work assessment form for village health volunteers. Part three, social capital assessment form, Thai version adapt from the SASCAT, the short adapt social capital assessment tool. This is SASCAT tool. Translate follow W-H-O-D-A-S, version two guideline for translation into Thai and adapt with cultural aspect. We do a validity test, which index of objective congruence, each item more than 2.67 to one. And then we do reliability test, which convert alpha more than 2.7. The result from randomly dividing village health volunteers into 10 groups, a total sample of 979 people was obtained, consisting of two groups of metro or city municipalities, two subdistrict municipalities with dense population, two subdistrict municipality with sparsely population, and four groups of outside the municipal area. We received 778 questionnaires back, representing a response rate of 79.5%. Table one, personal factors. The sample had an average age of 61 years and mean period of time living in the current community of 39 years. Most of them were female. 36% had primary education or less. 47% did not work other than village health volunteers and got 1,000 baht per month. Their economic status has sufficient income but no saving. 56% had comorbidities diagnosed by doctors. Table two, work factors. The sample group had an average period of time they had been working as village health volunteers of 13 years. Village health volunteers, 30% received, advised, or had work meetings with public health officers three to five times per year. Performance of village health volunteers. Data on the performance of village health volunteers when combining the performance scores of individual village health volunteers in all four areas. It was found that sample group had a median performance value for village health volunteers equal to 15 points and classified into groups with performance score 15 points or more was at high level, found that there were 56%. And performance score less than 15 points called a low level. They are representing 43%. Information on the level of social capital of village health volunteers are related factors. The level of social capital consisting of three dimensions, structural social capital, citizenship activities, and cognitive social capital. Relationship between structural social capital and factors with multiple logistic regression analysis. When controlling and confounding valuable factors found to be related to the level of structural social capital were residence area, economic status, age, frequency of meeting with public health officers, and time to become village health volunteers. Table four, association between citizenship activities and factors with multiple logistic regression analysis. When controlling for confounding valuables, factors found to be related to citizenship activity levels include residence area, education level, and time living in community. Table five, the dependent variable factor three, association between cognitive social capital and factors with multiple logistic regression analysis. When controlling for confounding valuable factors that were related to the level of cognitive social capital. Factors that are related, consist of two factors, include residence area, economic status, include residence area and economic status. Analysis of the relationship between the work performance of village health volunteers and all three dimensions of social capital. In comparison with those with a low level of work performance, it was found that those with a high level of work performance related to high level of social capital. For summary, considering all three dimensions of social capital consisting of structural social capital, citizenship activities, and cognitive social capital. Overall, this study found that factors related to the level of social capital include all of these. In this study, it was found that good work performance is associated with a greater level of social capital, including structural social capital, citizenship activity level, and cognitive social capital levels. This is consistent with reports from the World Health Organization and previous studies, which found that people with more social capital may be assumed to be more accepted by their family, have close tie with the community. Therefore, the level of social capital, it should be used as a part of consideration in selecting people to become village health volunteer. So we implement this research to the Ministry of Public Health in Thailand to use this selection criteria for whole country. We have some of the opposite results obtained regarding the level of citizenship activity. It was found that people living outside of municipality and living longer in community have lower level of citizenship activity than urban areas or shorter living in current communities. This can be explained by the dimension of bonding social capital. When the group is too tightly packed together, it is the reason to exclude outsiders. Less strict personal freedom feel inconsiderate too much to each other and have negative impact on citizenship activity in light of gangster. And social capital increase the credibility of village health volunteers themselves, especially by setting to know people in higher positions. Yes, it's therefore the level of social capital it should be used as a part of consideration in selecting people to become village health volunteers. And strength of this study. This study is the first to assess social capital at the individual level in Thailand. It is the first time in Thailand that a relationship has been found between social capital and the work performance of village health volunteers to be used as one of the World Health Organization recommend criteria for selecting village health volunteers. The limitation of this study include the design of this study was a cross-sectional descriptive study which can tell the association and the size of the problem but still cannot tell the reason of various factors. Social preference bias and the CSCAT tool does not have clear criteria for interpreting results. Suggestion for further study. Social capital can be used as one factor in selecting village health volunteers. Factors related to the work of village health volunteers such as social capital, education and the necessity of income from village health volunteers' work can be used to consider to selection of village health volunteers. Promoting these factors which positively associated with high level of work performance will help increase the level of work of village health volunteers. And the last one, further study. A cohort study may be conducted to be able to determine cause and effect. Study more with the CSCAT tool can help develop criteria for interpreting results as a result it can be more useful and easier. And this CSCAT tool is suitable for use in developing countries like Thailand who must rely on each other informally. And if the city develops more or change the context of area this tool may not be your first choice. Thank you. And if you have any question, please feel free to ask me. Thank you. Could I got my English support penalty back? Okay, thank you. Can you go back to the WHO criteria for social capital? Okay, sure. This is a, I'm not sure is in U.S. they have community health workers or not, but in. I have not met them yet. I have not met them yet. Wow. So you had a slide. Oh. Um, this mean like a connection, yeah, but connection with we can, we can touch and interpret in the objective data. Okay. Yeah. So with all of their jobs, some of them have to pay out of the budget? Pay for their education? It's what is their education level, what is their income, are they doing anything? Okay, I already understand your question. Yeah, thank you so much. You did fine. You did fine. I'm just new at this. Okay. Thank you. First of all, the volunteer system in Thailand is quite a little bit not good, you know. We have one million people registered and got money paid. However, we have only regular workers, only 80,000 people from one million people. So I would like to do the selecting criteria for got the village health volunteer system better. So we start to study WHO guidelines because we cannot use CDC guidelines or developed countries guidelines because it's a different situation and different cultural aspect. So we search and we think WHO guidelines is a match with our situation. The WHO guidelines suggest that to got the village health volunteer system have in many countries like China, India, or in Africa. And some countries is a collapse and some countries can do good in some situation. Like in COVID-19 era in Thailand, it can be controlled very well due to village health volunteers because we have a lot. And I would like to develop a village health volunteer system to be better. So we search how to become a better version of system. So WHO guidelines suggest ours to one of the key criteria to got it better is selecting village health volunteers at better in the first. So one of the criteria in village health volunteer guideline in selecting village health volunteer is social capital. This is one of the criteria that suggest by WHO. And village health volunteer is I see in the guidelines is called community health workers in the U.S., but I don't know is it available today. And in Thailand, there are many underprivileged people, like they're not there to go to hospital or not there to meet a doctor. So village health volunteer is a center, is a messenger to communicate between health officers and other people. Yep. Did you say that appointment or that selection is for the life, that's for their entire life as a village health care worker? Yeah. To get appointed for the duration of their life? Ah, normally, normally, you can do lifelong, but you can't exit. However, the limitation of this system is when they got monthly paid 1,000 baht without doing any work, so it's the constraint of system that village health volunteers in system mostly, not mostly, about 70% did not function. Yep. But if they are too sick to send a report to officers, they will exit from village health volunteer. It's not a regular work. You can do just one or two days in a month. You can receive money from government. Yep. Have any question? You can ask me about high health care system and you can suggest me to develop this system because I work in a ministry of public health and I would like to gather knowledge to improve our systems. Yep. You work in the ministry of public health? Yep. And preventive medicine, public health, occupational medicine? I am an occupational medicine in the ministry of public health in the province. Is there a separation between occupational health and personal health, or is it combined? Is occupational health separate from personal health? Yes. Ah, okay, I understand. I am not doing public health service system in the central ministry of public health, but I am in the regional ministry of public health in one province. He helped me understand. This is new to me, but I'm still young. Yeah, it's also new to me. Agreed. Yeah. Okay, do you have any suggestions? Do I have any suggestions? Yes, I suggest you lecture more often. What did he say? He wants you to speak more often. Okay, I'm not sure. In fact, you know, I think public health is normally in Thailand, the high-income people or middle to high-income people will go to a private hospital or meet the doctor directly. But normally public health is for underprivileged people or low-income people or some lower to middle-income people. You know, in Thailand, there are universal coverage. All is free. Everybody can go to a hospital and meet a doctor for free. So it's pros and cons. The bad way is OEM in Thailand is quite difficult to work because you are a free healthcare system. You have free insurance. So why do we have to do occupational and environmental medicine or public health? Because it's free. So it's a constraint of the system. Yeah. And... First of all, thank you very much. I enjoyed your talk immensely. And so it sounds like the focus that you're suggesting to do back at home to make this better is then to do better selection of the village health workers from the beginning so that then you'll have more successful village health workers and ultimately probably better health outcomes. So, yeah, I think it's awesome. Thank you. Okay. Do you have any share about Thai culture? Yes, thank you. So if anything done, we go to coffee break. But you can ask anything to me about Thailand. Thank you. How does the incidence or prevalence of chronic disease, like heart disease, cancer, obesity, how does that contrast, say, with what we have in the U.S.? Okay. I ever search and research about this. This is lower. Lower in Thailand? Yeah, in Thailand, lower than the U.S. Sure. In any chronic disease. Yeah. I don't have a table. You know, in this subject, population in this research is over 60 years, so it's an aging worker, right? And that's only about 50% have comorbidities like chronic disease. Because I think I ever search and it's a lower level compared with U.S. Sure. I'm sorry I was late. And maybe you've already discussed this, but what are some of the more primary occupations that you're seeing in these areas? Okay. Thank you for the question. From this research, table one, most of them do only this job because, you know, in Asia, I think in Asia, when you are older, you can become less respectful from your communities more than younger. So for the work like this, if you are aging, it's easy to you to send a message or tell anybody. So when they retire from their main job, they will become village volunteers. But the population that they're working with, what are their primary occupations? Oh, okay. People that village volunteers work with, right, all of everybody, yeah, but normally it depends on the areas. Like if you work in metro or city area, normally village volunteer will work with underprivileged people. And mostly it's like labor. However, if you are outside city in the rural areas, most of them are farmers or agriculture. And village volunteer will work with there. It depends on area. And in this research and from the data, the village volunteers in the rural area is more high income because normally they are like a boss in their area. But in city or in metro, there is a kind of boss of labor. And in city or metro and rural area have many difference of incomes, maybe five or ten times compared with city or rural areas. Okay. Done. Thank you so much.

Thai healthcare system

village health volunteers

community health workers

primary care system

social capital

Samut Prakhan province

healthcare delivery