Relationship Management and Facilitative Leadership Communication for Healthcare Services Provision of the Decentralized Sub-District Health Promoting Hospitals

Abstract

The decentralization of sub-district health promoting hospitals (SHPHs) to local administrative organizations (LAOs) represents more than an administrative shift—it constitutes a complex transformation in institutional relationships, leadership roles, and communication systems. This study aimed to explore how relationship management and facilitative leadership communication contributed to effective public health service delivery during this transitional period. It focused on understanding the dynamics of trust, meaning-making, and organizational alignment across key actors involved in the transfer process. The research employed a qualitative approach combining document analysis, in-depth interviews with frontline practitioners, and focus group discussions with communications, leadership, and public health experts. Data were collected from case studies of pioneered provinces that had undergone or were preparing for decentralization process. The analysis followed the frameworks of facilitative leadership, systems theory of communication, and social capital theory.  Findings revealed that successful decentralization depended not only on structural readiness but also the cultivation of trust, open dialogue, and cross-institutional meaning-making. Leaders who engaged with stakeholders through deep listening, transparent communication, and inclusive decision-making reduced institutional anxiety and fostered collaborative commitment. The study proposes a three-phased relational model: (1) preparation marked by open-mindedness toward change, (2) transfer characterized by co-creation of shared goals, and (3) post-transfer rooted in mutual trust and sustained collaboration.  The study also recommends integrating communication architecture, change-agent development, and participatory relationship-building into the national decentralization strategy. These elements should be viewed not as supplementary, but as central to sustainable and context-sensitive primary healthcare reform. However, the findings and recommendations from this research are based on the analysis and synthesis of case studies specific to a particular area. Recommendation from this study can be used as a basis for future studies to cover a wider area and context.