THE WORLD REPORT ON DISABILITY: IMPLICATIONS FOR ASIA AND THE PACIFIC
5-7 December 2011
Sydney, Australia
Orientation and Mobility Training Service for the Blind under the Universal Health Coverage Program in Thailand
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Praew Eiamnoi, Kaewta Wissavabamrungchai, Wachara Riewpaiboon
ABSTRACT 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.
Introduction
Objective
The national blind & low vision survey in 2006-7 of Thailand showed 0.59% with bilateral blindness. The
This study aims at monitoring and providing
main condition was correctable cataract, 51.64% followed by glaucoma, degenerative and diabetic retina
feedback
diseases. The context-based orientation and mobility (O&M) training service was considered essential for
development.
resuming independent social living but rather limited availability in healthcare system.
for
further
O&M
service
system
Methods & Materials
In 2002, the Universal Coverage (UC) health insurance
scheme was established for 2/3 of Thai population. In 2003,
The data were collected quantitatively through
rehabilitation budget was certainly allocated 4 Bath/UC capita
structured questionnaire during June-August
while O&M training for the blind was unavailable, only white
2011
cane was provided. The pilot O&M training service development
instructors whereas 712 blind who were service
was conducted in 2006-2007 by the collaboration among the
recipients during October 2010 - March 2011
Health Promotion Program for People with Disability, The Blind
were face-to-face interviewed by 30 trained
Association and the National Health Security Office. The
eye-nurses.
Rachasuda College, Mahidol University was responsible for O&M
functioning information was included. The focus
instructor training.
group discussions and in-depth interviews were
During 2008-2009, O&M service was added in rehabilitation
by
mailing
The
approach
ICF
for
concept
113
for
O&M
personal
done for qualitative data.
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
Figure 1 : Target of 6-yr strategic
implementation plan of
O&M service
and started in 2010 aimed at providing appropriate O&M
service to accumulated 70,000 blind in the communities.
Results
Discussions & Conclusions
The study showed achievement by objectives of
The O&M service units were established at 23 Eye Departments in 22 provincial hospitals and 1 district
the strategic plan.
hospital throughout 12 national health security management regions. 113 O&M instructors were trained
service management model having flexibility and
through three batches of 200-hour curriculum. O&M service were delivered to 748 blind.
potential for holistic care management. Referral
PROCESS
INPUT
 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
which
model
education
shared
collaborative
special
centers/schools
personnel
to
be
across sectors to enhance social participation
OUTCOME
Fifty-eight
outcomes seemed practical. Co-financing and
trained
45% of blind client aged >60 yrs, 55%
provided
was in range of 15-59 yrs. The functioning
O&M services to 748
information after received O&M services was
blind were different in
revealed. More than 90% of blind clients had
background; health and
no difficulty in performing daily activities and
education-related
household ambulation. There still were some
professions
including
difficulties in doing instrumental or domestic
physical
therapist,
activities e.g. cooking, gardening, shopping
occupational
therapist,
which age was statistical different factor.
instructors
nurse, special education
teacher
and
general
ability
to
perform
ADL
and
increasing
service
Employment security of
health with more mobility in everyday life but
these O&M
least satisfied in increasing opportunity in
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
hospital model
referring
then
O&M
services were provided by
any others center
was also varied.
improvement
should
self-confidence,
feeling
good
Manpower development and management needed
to be more addressed in order to be good
platform for quality improvement process and
sustainability
of
care
system.
in
education and vocational life areas.
temporally
employed. The services
were mostly arranged in
ratio
of
instructor:
blind of 1:5 or 2:10.
service
it more responsive to the need of blind clients.
the hospitals while the
group with the average
O&M
package needed for more differentiation to make
were permanent staff of
were
considered.
client empowerment dimension of health service.
Only 13 instructors
rest
be
Participation of the DPO was the strength for
ambulation,
knowledge background.
instructors
quality
Most satisfying issues included improving
trained and provided O&M
 3 sites were operated by
There were alternatives in
Collaborative organizations :