Primary Care Service Standards and Readiness of Sub-District Health Promoting Hospitals Transferring to the Provincial Administration Organizations
Keywords:
readiness, capacity, primary care service provision, health promoting hospital, devolutionAbstract
Background and Rationale: The Decentralization Act B.E. 2542 mandates the transfer of health responsibilities to local government organizations (LGOs). This research aimed to investigate the standards and readiness for service provision of sub-district health promoting hospitals (SHPHs) that wanted to be transferred to the provincial administrative organizations (PAOs).
Methodology: This mixed-methods qualitative research included in-depth interviews and focus group discussions with policymakers (n = 6), public health representatives (n = 28), PAO representatives (n = 16), and public sector representatives (n = 24) selected purposively. For the quantitative research, the sample consisted of SHPH directors or representatives (n=430), selected through random sampling and by size of PAOs. Research instruments included a semi-structured interview guide and a questionnaire on primary care capacity standards and readiness. Content analysis was used for qualitative data, while descriptive statistics and chi-squared test were used for quantitative data.
Results: 1. SHPHs reported adequate or high structural service readiness; however, staffing levels particularly health professionals and supporting finance/account personnel were inadequate. 2. Most SHPHs anticipated maintaining or even increasing service quantity post-transfer to the PAOs, except in dental care where reductions were expected. 3. Recommendations from SHPHs to enhance the transfer of health responsibilities included ensuring that health services to the public maintaining the pre-transfer level, especially the provision of chronic disease treatments such as diabetes, hypertension, and dental care, should continue status-quo health service networks.
Conclusion: PAOs and the provincial health offices should develop local health plans, recruit both health professionals and supporting personnel, and sign agreements to maintain existing service models during the transition period. They should also prepare to promote, support, oversee, and evaluate operations according to professional standards and facilitate community-driven initiatives.
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