Elaine Smith

It has taken more than a village – it has required an entire country – to reduce the rate of prenatal mother-to-child transmission (MTCT) of HIV in Thailand, as student researchers from the Reach Project confirmed during their visit in June.

The team of four students – Simran Dhunna, Aylin Manduric, Joy Dawkins and Andrea Macikunas – spent the 2016-17 academic year researching the amazing success Thailand has had in cutting down the national MTCT rate to less than two per cent over the past 17 years. The trip to Thailand, led by the Reach Project’s Principal Investigator, Professor Joseph Wong, helped the researchers – most of them undergraduates – answer their remaining questions.

Ensuring that development initiatives have the intended impact on their target populations is the goal of the Reach Project, supported by a partnership between the Munk School of Global Affairs and the MasterCard Center for Inclusive Growth. The Thailand team’s work added to a growing body of Reach Project research that documents successes in disseminating services in the world’s poorest countries to those who are often hardest to reach geographically or those who are marginalized by the societies in which they live.

“Our research is valuable because it allows us to identify the key players and components of social policies that reach the hardest to reach,” said Dhunna, a Munk One alumna who recently graduated with a BSc in molecular genetics and evolutionary biology. “We hope others will be able to use these insights in crafting programs for those who are often left behind.”

The Reach Project team spent a week conducting interviews in Thailand, travelling to Bangkok, Phrao and Chiang Mai to talk to the various players instrumental in reducing the prenatal MTCT rate so drastically.

“Our work documented how much work went into first introducing universal health coverage for Thai citizens and, later, in adding coverage for anti-retroviral drugs to under this plan,” said Manduric, who graduated from U of T in June with a double major in international relations and peace, conflict and justice studies.

While in Thailand, the students conducted face-to-face interviews with a variety of people who had a hand in in making the reduction of prenatal MCTC a reality in order to round out their understanding of the government’s success: government officials, frontline service providers and members of civil society organizations and officials of non-governmental organizations, such as UNICEF.

“Change began to occur in the early 2000s when the government overhauled the healthcare system to provide no-cost care,” said Dhunna. “Local AIDS activists, with support from the global movement, pressured the government to provide the drug regimen necessary to prevent MTCT.

“We also discovered that Thailand’s effective monitoring and surveillance system is one of the primary reasons why the MTCT policy was so swiftly and effectively implemented.”

Interviews on the ground also highlighted problems that the Reach Project team hadn’t considered in detail: the need to monitor teen pregnancies and the thorny issue of stigma and discrimination.

“We got the sense that a stronger concerted education effort needs to take place on a national level, particularly to ensure the new generation of young people are aware of the risks of unsafe sex,” said Dhunna.

After their trip to Thailand, the students can’t overstate the value of fieldwork.

“Fieldwork has been one of the most enriching and challenging experiences for our team,” said Dhunna. “After all, the words we read on paper are limited in their capacity to translate the human experience.”

The team’s final report is in the works and they hope to disseminate the findings to organizations and policy-makers in other countries who can take these lessons and adapt and apply them to their own situations.

July 14, 2017