Checking your own health: Helping Thais to take better personal care
Non-communicable diseases have become the major cause of death in Thailand, and casualties are on the increase. These diseases, such as diabetes and high blood pressure, are mainly caused by behavioural risk factors, such as eating highly seasoned food, lack of sleep and exercise, and stress.
Mindful of the need to raise awareness among members of the public about monitoring personal health, the National Science and Technology Development Agency (NSTDA), the National Health Security Office (NHSO) and the Bank for Agriculture and Agricultural Cooperatives (BAAC) have jointly developed a pilot project called Health CheckUp Kiosk. It is an automatic device that provides basic health checkups and provides general results so that people can be aware of the condition of their health and take better care of themselves.
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The NHSO currently takes care of 48 million Thais who are eligible for the National Health Security Program, and the agency’s Deputy Secretary-General, Dr Atthaporn Limpanyalert, says that this involves about eight-million in-patient visits and another 180-million out-patient visits, every year.
“During the first years [of the National Health Security Program], there were 120-million out-patient visits. Now the number has increased to 180-million. You may notice that the number of service users keeps increasing,” he says.
With new medicines and medical tools, as well as more advanced technologies, the health-related costs keep increasing. That means a larger financial burden for Thailand that could grow beyond the country’s capacity to pay. Among the regular patients are people with non-communicable diseases such as diabetes and blood pressure disorders, which are caused by unhealthy behaviour, so the NHSO came up with a plan to curb the sickness rate while making people aware of their health conditions. The plan focused on awakening a determination in people to act to prevent health issues, and that led to the development of a device or system capable of warning them when health readings become problematic, and telling them what to do.
Basic readings that can indicate health problems include blood pressure, weight and height, says Songphon Dumnin, a senior assistant researcher on biomedical signal processing at the NSTDA’s Assistive Technology and Medical Devices Research Center (A-MED). A medical-grade device for measuring blood pressure and a modified weight scale were the basic elements of the Health CheckUp Kiosk when the agency began its development.
“We then thought of ensuring easy access, so that people didn’t need to go to hospital,” he says. “We had to develop a machine that could be installed easily anywhere, such as a bank or in a community. Also, the machine had to include all the basic components.”
The Health CheckUp Kiosk has automatic instructions for easy usage. Users start with identity verification with their ID card or ID number. Then, their weight and blood pressure are measured and they are asked to specifying their height.
The system then analyses the data and notifies the user whether their blood pressure and body mass index (BMI) are within the standard range.
For those who use the machine regularly for several months, the machine can provide a record of previous readings so users can see whether their health is improving or getting worse.
Unlike other similar devices, the Health CheckUp Kiosk can collect data through the NHSO’s cloud-based system and display records through an application.
“We are currently developing the machine with NHSO,” Songphon says. “If it is used by other agencies in the future, we can connect with their databases.”
Distributing Health CheckUp Kiosks throughout the country
Following its successful development, the NHSO began experimental usage of Health CheckUp Kiosk among its own employees, while the BAAC made the devices available for customers at its branches all over the country.
“We first placed a machine at the Government Office Complex and asked passers-by to try it,” Atthaporn says. “We observed their behaviour and discovered that the number of users was on the increase, and there were regular users.”
He points out that the NHSO and BAAC have been long-time allies who share the same group of customers, so they agree that their customers’ good health is beneficial to both of them.
“You get a bank book when you visit a bank. Now, you may also get a ‘health book’ that keeps records of the state of your health, and you can review it at any time,” he says.
BAAC Assistant Manager Nicha Auypornrungrat says her bank is expecting its customers to benefit from the Health CheckUp Kiosk because they are able to get readings of their vital signs, blood pressure and BMI. By using the machine, they are able to take care of their health and have a qualify life.
Nicha says that at present, Health CheckUp Kiosk machines are installed at 85 BAAC branches all over the country. “Our goal is to improve the quality of life for farmers and rural residents. Good health brings a good quality of life.” she says.
Satisfactory results
After almost a year since the first Health CheckUp Kiosk machines were installed, the NHSO and BAAC are now able to scrutinize records of usage and response.
According to Atthaporn, the NHSO had three important questions about the project: whether the machines could be left unattended; whether there were users, and whether the readings could actually benefit the users.
When the machines were first installed, they needed attendants. But after the system was seen to be working normally, this was no longer required. Data collected over the past year showed that as many as 6,000 people used the machines. As for the benefits, the health data collected by the machines resulted in warnings when health problems started to take shape and, in many cases, users were advised to see a doctor.
“We discovered that as many as a third of the users developed health issues that required advice from medical professionals. That means that our three original questions were answered,” Atthaporn says.
He believes that the real benefit of the system is its ability to inform users with health issues that they should see a doctor. Simply seeking medical advice does not necessarily mean they a person is ill; in many cases they just require early treatment to prevent expensive chronic disorders. For instance, people who develop chronic kidney failure need to undergo hemodialysis every two days at a cost of Bt3,000 for each visit. This translates into a monthly expenditure of about Bt45,000 baht, and the monthly cost could reach Bt100,000 if the patient requires medicines.
“If we can warn those people beforehand, they will not be in such a situation. If we can expand the project and make it more flexible, it will bring massive benefits to Thailand’s public health sector,” Atthaporn says.
According to Nicha, a survey by the BAAC found that 78 per cent of respondents said they were satisfied with the Health CheckUp Kiosk. She says that customers suggested some improvements, such as giving the machines the ability to print-out checkup results (instead of having to capture the screen or access the results through a QR code); the ability to measure a user’s height; and more stability when transferring data to the cloud.
Plan for continuous development
Atthaporn says the Health CheckUp Kiosk has one major weakness: its large size. Therefore, the next stage of development will involve making the device smaller and wearable.
A wearable device can collect data constantly and warn the user immediately in case of unusual readings. If a user needs to see a doctor, he or she can inform their local hospital or a village health volunteer, as the NHSO already has their records.
Atthaporn confirms that the NHSO aims to implement these features in the future.
Meanwhile, the BAAC aims to take its customers’ health data into account when approving loans, Nicha says. In the past, the bank never collected data involving the health of its clients. who are mainly farmers.
“Farmers work hard and fail to take a good care of their health,” she says. “The cloud-based data will allow us to see the big picture of their health history.”
The BAAC expects to see greater use of the Health CheckUp Kiosks in the future, and believes the ability of its customers to care of their health will benefit the agricultural sector as a whole. She says that customers with good health have the potential to improve their farmland or business, and while health records may be taken into account when the bank considers loan applications, it accepts that such records are only one factor to be considered; they may not be directly linked to business and there may be other problems. The BAAC’s mission involves providing not only capital, but also knowledge and care over different matters to ensure a good quality of life for its customers, Nicha said.
“We have about four million loan customers,” she says. “Regarding the ‘health accounts’ concept, at present we have not linked health to business. We have the simple and general expectation that people should have good health by taking basic care of themselves.”
Meanwhile, the NSTDA’s A-MED center plans further improvements to the Health CheckUp Kiosk’s capabilities. Songphon says its sensors may be enhanced to acquire more data, such as body temperature, body-fat percentage and muscle mass, to improve the system’s data processing. Another upgrade may involve the kiosk’s ability to provide more personalized instructions. At present, users get similar recommendations because of its standard guidelines for evaluation.
“If we have data from each region, we will be able to set some plan or policy that makes people aware of their health and take better care of themselves,” Songphon says.
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All of the agencies involved in the project have a joint goal of bringing a good quality of life to the people, Nicha says.
“The agencies work together and each of them focuses on their strengths to support the project in taking good care of the health of people in this country. On the BAAC’s part, we have the duty to promote a better quality of life for farmers and general people. We are pleased to be a part of this project and make use of the device for maximum benefits to our country,” she says.
Expressing the NHSO’s point of view, Attaporn says the agencies involved aim to ensure that, in the near future, everyone in Thailand has access to quality health services, to reduce the sickness rate of Thai people.
“We will try every means to make Thais aware of their health conditions. We believe that the days of ‘old-style’ public health are over. The future lies with patients having self-awareness that they must take care of themselves. Health services will be easy to manage and better designed for target groups, bringing better health for Thais, and this is the goal shared by the NHSO and researchers,” he says.
Songphon reiterates the philosophy guiding A-MED’s development of the Health CheckUp Kiosks: non-communicable diseases are caused by risky behaviour and lifestyles, so it is best to prevent them now than seek treatment later.
“If this research project makes people aware of the need for self-improvement to bring better health, it means we have achieved our intended goal,” he concludes.
