การถ่ายโอนโรงพยาบาลส่งเสริมสุขภาพตำบลให้แก่องค์กรปกครองส่วนท้องถิ่นของประเทศไทย: ความก้าวหน้าและความท้าทาย

Sonvanee Uansri; Kamolphat Markchang; Somtanuek Chotchoungchatchai; Sasivimol Ontong; Nitjanan Panapong; Thanin Pattanasiri

Authors

Sonvanee Uansri International Health Policy Program Foundation
Kamolphat Markchang International Health Policy Program Foundation; Doctor of Philosophy Program in Political Science, Faculty of Political Science, Thammasat University
Somtanuek Chotchoungchatchai International Health Policy Program Foundation
Sasivimol Ontong International Health Policy Program Foundation
Nitjanan Panapong International Health Policy Program Foundation
Thanin Pattanasiri International Health Policy Program Foundation

Keywords:

health facility transfer, sub-district health promoting hospitals, Chaloem Phra Kiat 60 Years Nawamintrachini Health Center, decentralization, local government organization

Abstract

This qualitative research reviewed documents to investigate the progress of health facility decentralization according to sequential plans, decrees following revisions of the Decentralization Plan Act. Specifically, this research examined the criteria and procedures of transferring the Chaloem Phra Kiat 60 Years Nawamintrachini Health Centers and sub-district health promoting hospitals to local government organizations in 2021. The results reveal continuous improvements in the clarity and flexibility of the transfer criteria and conditions. Notably, the transfer criteria have been segmented into stages to evaluate the readiness and potential of local government organizations for the expected responsibilities. However, significant challenges persist, particularly regarding the laws and regulations governing the operations of medical and health professionals, including all other categories of human resources, and budgetary management by the National Health Security Office related to primary health care function of the transferred facilities. These challenges were compounded by a lack of continuity in decentralization and operational plans, budgetary constraints, legal issues encountered in the transfer of human resources, and an unclear division of duties between related units. The study offers policy proposals as follows: 1) review and amend the Ministry of Interior’s regulations regarding the operations of transferred health facilities to enhance efficient management and service delivery. 2) Amend regulations to increase workforce flexibility of transferred health facilities to local government organizations taking account of local contexts, issues, and limitations within the personnel budget framework. 3) Allocate budgets according to the responsibilities of transferred health facilities to ensure stable income to attain self-managed revenues for effective health service delivery.

References

Singhaniyom S, Singhakachen W. Decentralization of health for the strength of local people. Quality of Life and Law Journal. 2006;2:54-70. (in Thai)

Determining Plans and Process of Decentralization to Local Government Organization Act, B.E. 2542 (1999). Office of the Decentralization to the Local Government Organization Committee. The Government Gazette Volume 134. (in Thai)

Office of the Decentralization Commission for Local Administrative Organizations. Information on revenue allocation to local administrative organizations during the fiscal year 2009-2013. Bangkok: Office of the Permanent Secretary, Office of the Prime Minister. Government House; 2013. (in Thai)

Announcement of the Committee on Decentralization to Local Administrative Organizations on the Action Plan to Determine the Procedures for Decentralization to Local Administrative Organizations [internet]. The Government Gazette Volume 119. (Mar 13, 2002). [cited 2024 May 29]. Available from: http://www.oic.go.th/FILEWEB/CABINFOCENTER20/DRAWER059/GENERAL/DATA0000/00000042.PDF. (in Thai)

The Committee Determines Mechanisms, Criteria, and Methods for Evaluating the Readiness of Local Government Organizations to Support the Transfer of Public Health Center. Guidelines for transferring public health to local administrative organizations. Nonthaburi: Office of the Permanent Secretary, Ministry of Public Health; 2007. (in Thai)

Wangrat C. Decentralization of public health: background, situation, and future trends. Public Health System Research Substance. 2011;5(4):530-8. (in Thai)

Office of the Decentralization Commission for Local Administrative Organizations. Manual for operating according to the plan for decentralization to local government organizations (2nd ed.) 2008 and the action plan specifying the steps for decentralization to local government organizations (2nd ed.) in the area of promoting quality of life. Transferring public health missions to local government organizations. Bangkok: Office of the Decentralization Commission for Local Administrative Organizations; 2010. (in Thai)

Jongudomsuk P, Srithamrongsawat S, Patcharanarumol W, Limwattananon S, Pannarunothai S, Vapatanavong P, et al. The Kingdom of Thailand Health System Reivew. Tangcharoensathien V, editor. Geneva: World Health Organization; 2015.

Announcement of the Committee on Decentralization to Local Government Organizations regarding the enforcement of the decentralization plan for local government organizations (No. 2) B.E. 2551 (2008) and the action plan specifying the steps for decentralization to local administrative organizations (No. 2) B.E. 2551 (2008). (in Thai)

Ministry of Public Health. Facts on 10 important issues regarding the transfer of health center missions to local government organizations (Local Administrative Organizations) and health decentralization guidelines. Nonthaburi: Ministry of Public Health; 2007. (in Thai)

Srisasalux J, Vichathai C, Kaewvichian R. Experience with public health decentralization: the health center transfer model. Journal of Health Systems Research. 2009;3(1):16-34. (in Thai)

Center for Information and Investigative News for Civil Rights. Until 2016, the transfer of ‘Subdistrict Health Promoting Hospitals’ (Subdistrict Health Promoting Hospitals) to local administration was only 51 out of a total of 9,787 [internet]. 2017 [cited 2024 May 29]. Available from: https://www.tcijthai.com/news/2017/9 /scoop/7326. (in Thai)

Announcement of the Committee on Decentralization to Local Administrative Organizations on the criteria and procedures for transferring the missions of the Chaloem Phrakiat 60th Anniversary Nawaminthrachini Health Station and Sub-district Health Promoting Hospital to the Provincial Administrative Organization, (2021). (in Thai)

Office of the Decentralization to the Local Government Organization Committee. Mission information transferred according to the action plan specifying the process of decentralizing power to local administrative organizations, Issues 1 and 2: Health station information [internet]. 2022 [cited 2024 May 29]. Available from: http://bit.ly/3XatLQE. (in Thai)

Sudhipongpracha T, Chotsetakij W, Phuripongthanawat P, Kittayasophon U, Satthatham N, Onphothong Y. Policy analysis and policy design for the transfer of subdistrict health promotion hospitals to provincial administrative organizations (PAOs). Bangkok: Thammasat University, College of Interdisciplinary Studies; 2021. (in Thai)

Kulthanmanusorn A, Saengruang N, Wanwong Y, Kosiyaporn H, Witthayapipopsakul W, Srisasalux J, et al. Evaluation of the devolved health centers: synthesis lesson learnt from 51 health centers and policy options. Nonthaburi: International Health Policy Program Foundation; 2018. (in Thai)

Parliamentary Budget Office. Budget analysis for fiscal year 2022: local government organizations. Bangkok: Office of the Secretariat of the House of Representatives; 2022. (in Thai)

Constitution of the Kingdom of Thailand B.E. 2560 (2017) [internet]. Available from: https://cdc.parliament.go.th/draftconstitution2/more_news.php?cid=128. (in Thai)

Primary Health Care Act B.E.2562 (2019) [internet]. Available from: http://www.https://ratchakitcha.soc.go.th/documents/17087273.pdf. (in Thai)

Letter No. MT. 0819.3/W 3380 Subject: Guidelines for hiring Ministry of Public Health employees and other types of employees transferred according to the mission of the Chaloem Phrakiat 60th Anniversary Nawamintharachini Health Station and Subdistrict Health Promoting Hospitals under the Office of the Permanent Secretary, Ministry of Public Health. to the Provincial Administrative Organization Fiscal year 2023, (2022 Oct 21). (in Thai)

Narattharaksa K, Narattharaksa T, Sirilak P, Sirilak S. A study of duties and powers of the Phitsanulok Provincial Administrative Organization regarding the transfer of subdistrict health promotion hospitals to Phitsanulok Provincial Administrative Organization Case study to make recommendations for reforming the law and amending related provisions. Nonthaburi: Health Systems Research Institute; 2023. (in Thai)

Sornkasetrin A, Sriyasak A, Chandra R, Krirkulthon T, Nimwattanakul S, Thanyaporn Chuenklin, et al. Policy proposal for health manpower management during the transition period from the transfer of subdistrict health promotion hospitals to the Provincial Administrative Organization. Nonthaburi: Health Systems Research Institute; 2022. (in Thai)