Publication

Community Engagement for Stakeholder and Community Trust in Healthcare: Short-term Evaluation Findings from a Nationwide Initiative in Lao PDR

Abstract

Background

Trust remains a critical concept in healthcare provision, but little is known about the ability of health policy and interventions to stimulate more trusting relationships between communities and the health system. The CONNECT (Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust) Initiative in Lao PDR provided an opportunity to assess the community-level impact of a trust-building community engagement approach.

Methods

A mixed-method process evaluation was implemented from 10/2022–12/2023 among 14 diverse case study communities in four provinces across Lao PDR. Data collection involved two rounds of census surveys (3161 observations incl. panel data from 618 individuals) including an 8-item trust scale, 50 semi-structured interviews with villagers, and 50 contextualizing key informant interviews. The two data collection rounds were implemented before and three months after village-based CONNECT activities and helped discern impacts among activity participants, indirectly exposed villagers, and unexposed villagers in a difference-in-difference analysis.

Results

Stakeholders attested strong support for the CONNECT Initiative although community-level retention of trust-related themes from the activities was limited. Quantitative data nevertheless showed that, at endline, the 8-item trust index (from [–8 to +8]) increased by 0.95 points from 4.44 to 5.39 and all trust indicators were universally higher. Difference-in-difference analysis showed that villagers exposed to the CONNECT activities had a 1.02-index-point higher trust index compared to unexposed villagers. Trust impacts improved gradually over time and were relatively more pronounced among men and ethnic minority groups.

Conclusions

The CONNECT Initiative had considerable direct and systemic effects on community members’ trust in their local health centers in the short term, which arose from strong stakeholder mobilization and gradual institutional learning. Relational community engagement approaches have the potential to create important synergies in health policy and broader cross-sectorial strategies, but also require contextual grounding to identify locally relevant dimensions of trust.

การสร้างความทรงจำผ่านอาหาร: การศึกษาความทรงจำ, พื้นที่และผัสสะ

บทคัดย่่อ

บทความนี้้นำเสนอแนวทางการศึกษาที่่ใช้อาหารเป็นวัตถุุทางวัฒนธรรมในการสร้้างความทรงจำทั้้งปัจเจกบุุคคลและความทรงจำร่วมในสังคม จุุดประสงค์หลักคือ การทบทวนแนวคิด ทฤษฎี และกรณีศึกษาเพื่่อนำไปใช้ทำความเข้้าใจกระบวนการสร้้างความทรงจำที่่สามารถปรับเปลี่่ยนหรืือถููกกระตุ้นด้วยอาหาร บทความนี้้นำความทรงจำมาเป็นจุุดเริ่มต้นของการประกอบสร้างความหมายของอาหารโดยเฉพาะมุมมองที่่นำอาหารมาเป็นศููนย์กลางในการศึกษาเพื่่ออธิบายโครงสร้างทางสังคมและวัฒนธรรม ซึ่่งเป็นการอธิบายความสัมพันธ์ระหว่างอาหาร และความทรงจำที่่

สัมพันธ์์กับแนวคิดมานุุษยวิทยาอาหารซึ่่งนำเสนอพัฒนาการการศึกษาอาหารจากช่วงเวลาต่าง ๆ จากนั้นทบทวนกระบวนการสร้างความทรงจำผ่านการรับรู้อาหารผ่านผัสสะ ได้แก่ รสชาติและกลิ่นซึ่งเป็นแง่มุมสำคัญในการศึกษาอาหาร หัวข้อสุุดท้ายพยายามเชื่อมโยงกับความสำคัญของ

พื้้นที่่ที่่ก่อให้เกิดความทรงจำที่่เชื่่อมกับอาหาร ความทรงจำและพื้นที่่เฉพาะ ดัังนั้้นบทความนี้้นำเสนอที่่มาที่่ไปของการสร้างความทรงจำผ่านอาหารและนำเสนอวิธีการศึกษาอีกวิธีหนึ่งในการทำความเข้าใจและสำรวจพื้นที่่การศึกษาอาหารใหม่ๆ ที่่ยังไม่ได้รับความสนใจเท่่าที่่ควร

Multiplicities and Contingency: Rethinking 'Popular Buddhism', Religious Practices and Ontologies in Thailand

This paper reconsiders explanations of ‘popular’ Buddhism in Thailand initiated in midtwentieth century anthropological definitions of vernacular articulations of religiosity in village settings. Buddhist localism, in its various manifestations, is seen to contrast with a doctrinal or literate ‘great’ monastic tradition. In this persisting ethnographic argument, an actor may draw randomly on various syncretic elements of their religiosity according to circumstances (an historical complexity which is sourced in a mix of Sinhalese-sourced Buddhism, animism including magic, and folk Brahmanism). It is therefore not wholly or consistently one, but substantively divided into several strands. This long-standing position is problematic as the paper shows. There are multiple coextensive Buddhism/s (plural) within the Greater Theravada tradition, which emerge from an identification of the actors themselves with the one, not the many, as one-unitary-Buddhists. I theorise using a general framework of Meillassoux’s discussion on contingency and, by way of contrast, taking Deleuzian ideas on multiplicity. It is grounded on an understanding of popular or organic lived religion sourced in the early counter-enlightenment or radical enlightenment thinking of Giambattista Vico. Here, it is argued that in Thailand villagers would identify cosmologically as the one, not as the many (in a sense as in the assemblages or varieties of religious practices detached from the totality of the cosmological unitary one). Understanding

the creative processes behind cosmological multiplicities is a starting point, with the notion that within specific cultural forms we are faced with a multiplicity of definitions and things to observe, as in an understanding of the varieties of lived Buddhism. The essay is based on an ethnographic assessment from over three decades of field research among ethnic Thai Buddhists at various modalities and settings, and in framing these vernacular religious practices and their ontologies. My gratitude to two anonymous reviewers for their constructive comments. The essay does not deal directly with specific ethnographic case studies; instead, it is intended as retheorising representations of ‘Popular Buddhism’ in Thailand as based on early scholarship since the 1960s (where Buddhism is constituted as three or more distinctive but intertwined religious strands).

Biopolitics in Rebel- Controlled Myanmar: Exploring Why the United League of Arakan Supports the Kyaukphyu Special Economic Zone

In this article, we explore why the Myanmar-based insurgency organisation known as the United League of Arakan (ULA) supports the Kyaukphyu Special Economic Zone (KSEZ): a controversial Belt and Road Initiative (BRI) project. We argue that the

ULA’s support for the KSEZ is rooted in a biopolitics that benefits the ULA by attractively showcasing its insurgent aims and by effectively boosting its local authority. The ULA’s pro-KSEZ policy partially explains why the KSEZ, unlike other BRI projects in

junta-led Myanmar, has enjoyed moderate success. Despite its biopolitical benefits, the ULA’s pro-KSEZ policy has marginalised certain anti-KSEZ actors in the rebel organisation’s sphere of control. The resulting fragmentation may both destabilise the ULA’s hard-fought social order and undermine the prospects of the KSEZ. Our examination of the ULA–KSEZ relationship empirically contributes to BRI-in-Myanmar research, which has heretofore paid little attention to rebel-controlled societies’ significant influence on foreign-led domestic development projects.

Trust in healthcare: methodological and conceptual insights from mixed-method research in Lao People’s Democratic Republic

Background

Global health foregrounds trust as a key requirement for the achievement of international health initiatives, but it remains an elusive concept that is often mobilised without consideration of its dimensions, drivers and downstream behavioural consequences. This paper aims to contribute to the conceptual development and measurement of ‘patient trust in primary healthcare’ from the lower middle-income country perspective of rural Lao PDR.

Methods

A two-phase mixed-method research design was implemented between January 2021 and April 2023. Phase 1 involved exploratory qualitative research to understand the local expressions and dimensions of patient trust in primary healthcare, with 25 semistructured interviews and 17 focus group discussions (120 participants) in eight villages in Bokeo Province. Phase 2 involved explanatory research to assess patterns of trust systematically at scale in 14 villages across four provinces, wherein 26 cognitive interviews, 17 expert interviews and non-participant community observations informed a community census survey with 1838 participants. We analysed qualitative data through content-oriented thematic analysis and developed an 8-item trust scale on that basis. Quantitative data analysis used descriptive statistical and regression analysis.

Results

We found that trust in primary healthcare is readily understood and intrinsically valuable in rural Lao PDR. Key dimensions included communication, respectful care, relationship, fairness, integrity, reputation, assurance of treatment and competence. The survey highlighted that reputation, competence, integrity and respectful care had the lowest trust scores. Health centre operations predicted the local expressions of trust. The behavioural consequences of trust were limited to a positive statistical association with antenatal care uptake among pregnant women but outweighed by alternative measures that also captured the availability of healthcare facilities. Conclusions Overall, the development of our quantitative trust scale offers a process model for future researchers. We conclude that interpersonal, institutional and service-related trust require more explicit recognition in health system development and integration into health policy.

The impact of conservation and land use transitions on the livelihoods of indigenous peoples: A narrative review of the northern Thai highlands

Ecosystem conservation has moved to the centre of global development agendas in light of an unprecedented acceleration of environmental degradation, species extinction, and catastrophic weather events. Global and national conservation policies with seemingly laudable aspirations, however, have been widely instrumentalised and distorted – leading researchers to argue that the very tools to safeguard natural spaces feed consistently into a market-oriented agricultural production and modernisation agenda. Indigenous peoples who continue to inhabit protected spaces as their ancestral lands have systematically suffered in this process. We conducted a place-based narrative literature review to formulate a consistent agenda for the next generation of conservation research and policy to help overcome this persistent challenge, drawing on the extensive and interdisciplinary research literature of the northern Thai highlands published until 2021.

The place-based narrative review traced gradual contextual change, inconsistent policy directions, and perverse incentives that have created a systemic challenge to ecosystem conservation. Key research gaps are the under-appreciated symbolic and affective dimensions of evolving tropical landscapes at the interface of Indigeneity, conservation, and development. Our proposed research agenda involves the synergistic combination of tools of human security, everyday environmental heritage, activity spaces, and behavioural design to understand these experiential dimensions of conservation from the perspective of Indigenous peoples, their active role as security contributors, pathways to impact, and new models of policy making. Suggested policy responses revolve around comprehensive domains of action (instead of isolated interventions) to overcome the systemic and contextual challenges affecting Indigenous livelihoods.

Review of the Research on the Belt and Road Initiative in Myanmar

The Belt and Road Initiative (BRI) is among the largest transnational development initiatives globally. In this article, we review the research on the BRI in Myanmar, a developing country that is of considerable geopolitical importance. To date, the BRI literature has made three central contributions: it has captured much of the complexity of BRI projects, filled a notable research gap in BRI studies, and raised awareness of local voices. In addition, two analytically meaningful topics are worth exploring, namely the contested relations (1) between China’s Ministry of Foreign Affairs and prospective Chinese BRI investors and (2) between the Myanmar government and local anti-BRI groups. Responding to the current focus of the literature and to advance future research, we recommend that scholars consider the analytical framework of state transformation to disaggregate statehood, account for diverse actors, and explain their contested relations. Because it challenges state-centric frameworks (e.g., realism and Westphalian national sovereignty), the state-transformation model can yield theoretically and empirically stimulating findings.

Online publication: https://brill.com/view/journals/ejea/22/3/article-p229_2.xml

date: 14 Dec 2023

Chinese Investor Networks and the Politics of Infrastructure Projects in the Eastern Economic Corridor in Thailand

This research examines Chinese investment and the impact of infrastructure projects on the Eastern Economic Corridor project (EEC), a special economic zone linking Thailand with Cambodia, Laos, Myanmar, Vietnam, and China, which aligns with the Belt and Road Initiative (BRI). Drawing on Actor Network Theory (ANT), this study analyzes emerging Chinese investor networks and the resulting negotiations between various actors such as the Thai state, Chinese and Thai investors, and local farmers. Many Chinese investors have moved their production bases to avoid the tax barriers raised by the United States or Europe, as well as to expand their markets in Southeast Asia. The Thai state offers tax benefits to foreign investors, allowing them to import raw materials and machinery from China, making their production costs lower than those of Thai investors. The findings reveal that the neoliberal state facilitates foreign investors through deregulation: enacting city planning laws that permit the establishment of industrial estates in agricultural zones, thus dispossessing farmers of their land. These factories can release toxic waste, thus impacting the local environment and livelihoods of nearby farmers. Thai business-people are often unable to compete with Chinese investors to match their bids. In order to maintain their positions in these economic networks, they build affective relations with Chinese investors. In addition, these affective relations attract resistance and indignation from locals dispossessed of land and resources.



Carnivalesque communities: Thai TV dramas and the Chinese censorship

This paper explores how Thai television dramas, which have been a staple of the nation’s TV landscape for many decades, have made new inroads in mainland China. Despite intense censorship by the Chinese state, China’s extremely large market enticed the Thai media industry. Control over what citizens can see on websites has also created an obstacle for which fan communities must find ways to bypass. The paper outlines both the historical process of Thai TV dramas’ inroads into the Chinese market and the different tactics Thai media companies and Chinese fan communities employ to circumvent Chinese state censorship. Based on interviews with various actors, including Thai TV media personnel, Chinese fansub groups, and fan communities, the paper argues that Chinese fan culture surrounding Thai TV series is a mixture of a subversive community that rebels against state control, as well as a constantly negotiating subculture that adopts various practices to break out from state censorship. Chinese youth today show that consumption is a site of contestation, rather than a site of control and manipulation.

Heterosexual Reading vs. Queering Thai Boys' Love Dramas among Chinese and Filipino Audiences

Over the past decade, Thai boys' love (BL) series,[1] which typically portray two young men as the focus of a love interest, have been a phenomenon throughout Asia. Originating from Japanese yaoi manga translated into Thai in the 1990s, the Thai BL genre has expanded from manga to novels, fan fictions, films and live action TV series. This paper focuses on Thai BL series whose stories depict homoromantic or homoerotic relationships between young male couples, which have become popular throughout Asia.Since its inception in 2014, enthusiastic fans in many different linguistic communities have worked to provide subtitles to BL content and helped to popularise Thai BL series. Thai BL actors have gained a large following among mostly heterosexual women, not only in Thailand but also in China, Japan, Vietnam, Malaysia, Indonesia, the Philippines, Taiwan and even Latin America.

Turbaned Northern Thai-ness: selective transnationalism, situational ethnicity and local cultural intimacy among Chiang Mai Punjabis

Chiang Mai is home to approximately 400 diasporic Punjabis, some of whom are sixth-generation residents of Thailand. While their transnational orientation, distinct sartorial choices and cultural practices might present them as outsiders to essential Thainess, Northern Thai Punjabis transgress the national image of Thainess and subjectively consider themselves to be Northern (Lanna) Thais. At the same time, these Thai citizens avail themselves of Overseas Citizenship of India (OCI) status for privileged access to economic, cultural and educational resources in India. Based on 51 in-depth interviews and 17 focus group studies among resident Hindu, Sikh and Namdhari Sikh communities in Northern Thailand, this research explores family histories, selective transnationalism, and regional Lanna identities among these overseas Punjabis. As this article will argue, while Punjabi Thais maintain their networks and cultural connections with an historic ancestral homeland, they also cultivate forms of local cultural intimacy in ways which leapfrog the linguistic and cultural hegemony of Thai national identity.

Shan Female Sex Workers’ Vulnerabilities and Coping Strategies in Response to COVID-19 in Chiang Mai, Thailand

The Thailand government has marginalized, criminalized, and discriminated against migrant sex workers for decades and the COVID-19 pandemic has only increased the vulnerability of sex workers to hardship. Using a mixed research methodology including interviews, this article outlines the risks Shan sex workers in northern Thailand faced during the COVID-19 pandemic that began in 2020, their vulnerability contexts, and their coping strategies, including how institutional aid and existing assets impacted their livelihoods. Our findings reveal that Shan sex workers in Thailand have suffered primarily from oppressive laws and social stigma. They were excluded from government COVID-19 mitigation measures such as health services, compensation, and economic support. Identifying vulnerability factors highlights the difficulties of both systemic and individual-level responses, leading to suggestions for policymaking to improve the quality of sex workers’ lives. This study reveals that Shan sex workers are still being left behind and discriminated against in Thailand, but they have persevered to speak their minds and struggle to live through the COVID-19 crisis. There is an urgent need for Thailand authorities to decriminalize sex work and restructure the social security system so that it is inclusive for migrants.

Explaining Challenges That Beset Transdisciplinary Projects in the Global South: The Shift from Methodological Perspectives to a Political- Economic Dynamic Analysis

In this paper, I argue that rigorous attempts to grasp the challenges unique to transdisciplinary projects in the Global South (TPGSs) require an understanding of the target state’s politicaleconomic dynamics, which can undermine TPGSs. In this regard, I harness social-conflict theory to examine how and why Cambodia’s political-economic dynamics affected my own transdisciplinary project, which addressed dam-induced problems in the northeast of the country from 2018 to 2021. The present paper’s findings clarify the relationships among various nonacademic TPGS stakeholders—a topic that has attracted little attention from transdisciplinarians but that can significantly shape TPGS

outcomes.

ทบทวนอคติทางชาติพันธุ์ในปริมณฑลรัฐไทย

มุกดาวรรณ ศักดิ์บุญ. 2565. "ทบทวนอคติทางชาติพันธุ์ในปริมณฑลรัฐไทย" ในหนังสือ "ส่องอคติทางชาติพันธุ์." กรุงเทพฯ: ศูนย์มานุษยวิทยาสิรินธร. หน้า 104-125. 

หนังสือ ส่องอคติทางชาติพันธ์ุ 1 นี้ ได้รวบรวมบทความของนักวิชาการหลายท่านที่เสนอวิธีคิด การตรวจสอบ และแนวทางการวิเคราะห์ปัญหาอคติทางวัฒนธรรมในมิติต่าง ๆ อย่างกว้างขวาง ทั้งอคติที่สัมพันธ์กับความเป็นชาติ ศาสนา เชื้อชาติ ชาติพันธุ์ แรงงานข้ามชาติ อคติต่อคนไร้ที่อยู่อาศัย คนต่างรุ่นต่างวัย คนหลากหลายทางเพศ การกลั่นแกล้งกันในโรงเรียน อคติในยุทธศาสตร์และนโยบายของรัฐ การลำเอียงของสื่อมวลชน และการนำเสนอชีวิตของคนอีสานและเพศทางเลือกในภาพยนตร์ไทย คนเหล่านี้ล้วนเผชิญกับการดูหมิ่นเหยียดหยามด้วยคำพูด การล้อเลียนเสียดสีด้วยกิริยาท่าทาง การตีตราว่าร้าย และการประณามทางสังคม ที่เป็นการลดคุณค่าและศักดิ์ศรีของควมเป็นมนุษย์..."

The Role of Civil Society Networks in Promoting Organic Food as A Path to Food Security in Chiang Mai, Thailand

Food security is an important topic involving people’s everyday lives. In recent decades, organic food consumption has been touted as a path to food security. As such, civil society networks in Chiang Mai have been working to support the movement toward organic food. Organic food networks linking producers and consumers are critical to building food security. This research article aims to understand civil society networks' roles and working styles on organic food issues in Chiang Mai province, Thailand. The working styles and outcomes of the civil society network (CSN) are analyzed as the intermediary between food producers to urban consumers in the food system. Four CSNs in Chiang Mai were selected as the case studies and compared with Chiang Mai’s Young Farmer Group. This study, based on observation techniques and in-depth interviews with key informants, investigates the working styles of CSNs and networks of food producers. The questionnaires were distributed to consumers to study consumer knowledge and perceptions of food security issues. The focus group meetings were organized to obtain feedback from food producers, consumers, and CSN’s staff. The authors found that each CSN linked with food producer networks according to the working styles of the CSN’s staff and that the key actors in each CSN knew each other personally. CSNs can introduce organic farming to local communities. However, many CSNs are struggling to connect with urban consumers.

Regional Seminar of Water Politics and Water Governance in the Mekong Countries

SUMMARY

The Regional Seminar on Water Politics and Water Governance in the Mekong Countries was hosted by the Center for Ethnic Studies and Development (CESD), in collaboration with the Regional Center for Social Science and Sustainable Development (RCSD), Faculty of Social Sciences, Chiang Mai University from November 22nd to November 24th, 2023 at the Bisirimaya Hotel in Chiang Mai, Thailand.

During the first two days of the seminar, participants engaged panel discussions and paper presentations covering a wide range of topics. Key themes revolved around water management politics and governance of countries situated along the Mekong and Salween Rivers, along with in-depth exploration of hydro-sociology concepts. The discussions also covered the role of the MRC, considerations of environmental justice in the context of large-scale development projects, the interplay of local knowledge with food security, the participation of women and

ethnic groups in water governance, business and human rights in cross-border water management, and the impact of sedimentation and its accumulation on lifestyle. On the final day of the seminar, insightful presentations and exchanges on cross-border social networks were held, along with discussions on scientific research methods aimed at strengthening local initiatives in water management. The inclusion of a photo exhibition and film screenings added to the overall value of the event.

The seminar featured 71 participants, including 35 presenters comprising senior and junior scholars, and practitioners with experience in studying and researching the transformation of the Mekong and Salween Rivers, as well as the role of international organizations in water management. Presenters, participants and observers from Cambodia, Vietnam, Lao People’s Democratic Republic, the Philippines, Myanmar, Australia, the USA, France, Singapore, and Thailand actively joined and contributed their findings and perspectives to the seminar. The event was supported by International Rivers, and the Mekong Culture Well, Henry Luce Foundation.

This report covers the summary of the presentations, debates, and analyses shared during the two and a half-day meeting. The concept note and seminar agenda can be found in the ANNEX.