District Health System Implementation on the Quality of Primary Health Care Services in Surin Province

Abstract

The district health system (DHS) was a key mechanism for strengthening primary health care delivery in Thailand through integrated collaboration among local stakeholders. However, DHS performance and its impact on service quality varied across districts. This study aimed to examine the implementation, problems, obstacles, and success factors of DHS affecting the quality of primary health care services in Surin Province. A mixed-methods approach, combining qualitative and quantitative research, was employed. Data were collected through in-depth interviews with 24 administrators and service providers, using content analysis. For consumers, a comparative study of satisfaction was conducted among 400 participants in 4 districts by health facilities (200 at hospitals and another 200 at sub-district health promoting hospitals [SHPHs]), using independent t-tests and one-way ANOVA. The qualitative findings revealed that DHS enhanced integration of operations, participation of network partners, and responsiveness to local health problems. However, in specific local contexts, limitations were identified in terms of workforce, budget, and continuity of monitoring and evaluation. These issues were reflected in public satisfaction levels. SHPHs showed significantly higher satisfaction scores than hospitals (p < 0.001), and the high-performing districts had significantly higher satisfaction levels than the low-performing districts (F = 6.71, p < 0.001). Therefore, strengthening workforce capacity, allocating resources appropriately, developing standardized monitoring and evaluation systems, and continuously promoting the participation of network partners were essential strategies to enhance DHS, ensure equity, improve the quality of primary health care services, and reduce disparities among the population.