Journal of Health Systems Research

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

Jirayudh Sinthuphan — 2026-09-05

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.

Systemic Factors influencing the Continuity of Home-Based Palliative Care Network following the Transfer of Sub-District Health Promoting Hospitals to the Provincial Administrative Organization: A Case Study of Phitsanulok Province

Varitsara Tangtrakul — 2026-09-05

The transfer of sub-district health promoting hospitals (SHPHs) to provincial administrative organizations (PAOs) is a major decentralization policy in Thailand that may affect the continuity of home- and community-based palliative care services. This qualitative study aimed to examine the continuity of service delivery systems and factors influencing palliative home care following the transfer of SHPHs in Phitsanulok province. The study applied a framework based on four key pillars of the service system: health workforce, health information systems, medical supplies and equipment, and community participation. The study was conducted within secondary- and tertiary-care service networks in Phitsanulok. Participants included 20 informants selected purposively among healthcare providers, family caregivers, and stakeholders involved in community palliative care. Data were collected through in-depth interviews and meeting observations. Content analysis was employed, and data credibility was ensured through triangulation. The findings revealed that continuity of home-based palliative care services was maintained despite changes in administrative governance. Patients and families generally did not perceive differences in service providers after the transfer. Continuity of care was evidenced in four major dimensions. 1) Workforce: home visits and care coordination continued, although nursing workload remained a significant challenge. 2) Health information systems: effective referral processes and inter-facility data linkage were essential for seamless continuity of care. 3) Medical supplies and equipment: access to morphine and high-cost medical equipment remained limited in some areas. 4) Community participation: village health volunteers played a crucial role in screening, follow-up, and coordinating community-based care. In conclusion, sustaining continuity of palliative care services following the transfer of SHPHs requires strengthening workforce management, integrated health information systems, medical resource support, and community participation mechanisms. These factors are essential for developing a seamless and sustainable local health service system.

Awareness and Effectiveness of the 2020 Ministry of Education Announcement and the 2021 Office of the Basic Education Commission Announcement on School Environments to control Sugar Intake and Health Promotion in Schools in Chiang Mai Province

Rakchanok Noochpoung — 2026-09-05

Background & Rationale: Creating school environments conducive to health is a key strategy for school-age children health promotion. The Ministry of Education (MOE) announced the measures and guidelines for promoting oral health literacy in 2020, and the Office of the Basic Education Commission (OBEC) issued a directive on the sale of health promoting food and beverages in school in 2021.

Objective: To study the level of awareness of both announcements and to examine the relationships between the awareness and the school’s managed environments, knowledge, behavior, and health conditions of students.

Methodology: A mixed-methods study with a cross-sectional design, consisting of 1) quantitative research by surveying directors and health teachers from 81 schools and 715 sixth-grade students using questionnaires, analyzed with chi-square statistics and binary logistic regression, and 2) qualitative research of in-depth interviews with 30 administrators and health teachers, and 5 representatives from educational service areas, analyzed with thematic analysis.

Results: Administrators including health teachers were aware of the MOE and the OBEC announcements at 49.4% and 72.8% respectively. Awareness schools managed to have higher health promoting environments than non-awareness schools. Students in awareness schools were more likely to have a higher level of food knowledge (over 80%) than students in non-awareness schools (odds ratio=2.18, 95% confidence interval: 1.43-3.32). They were more likely to practice daily post-lunch tooth brushing (OR=2.15, 95% CI: 1.37-3.37), and had lower sugary drink consumptions. Awareness schools had stricter control over the sale of snacks and beverages compared to non-awareness schools (p<0.01). In-depth interviews revealed that awareness and adherence to guidelines was related to the support from administrators, the monitoring systems, and the coordination with public health agencies.

Summary: Awareness of the 2021 OBEC announcement was related to the creation of health promoting environments and better student health literacy and behaviors. These findings suggest that accessible policy guidelines may serve as a key enabling factor for school-level implementation. Continuous promotion of both announcements, supported by practical guidelines and systematic monitoring mechanism, is recommended.

Effects of a Value-Based Oral Health Service Model on Caries Risk Reduction and Caries Progression among Children Aged 0–5 Years: A Quasi-Experimental Study in Two Provinces of Thailand

Sunee Wongkongkathep — 2026-09-05

Background: Early childhood caries remains a major public health problem in Thailand. Although oral health promotion activities have been continuously implemented, routine activity-based services have shown limited effectiveness in sustainably reducing caries risk and disease progression. Evidence regarding the implementation of value-based and risk-based oral health service models within Thailand’s primary care system remains limited.

Objectives: To evaluate the effects of a value-based oral health service model on oral health behaviors, caries risk, and caries progression among children aged 0–5 years.

Methods: A quasi-experimental study comparing intervention and control groups was conducted in Nan and Krabi provinces across the well-child clinics and the child development centers. A total of 1,209 children aged 0–5 years participated. The mean age was 46.9 months, with a comparable sex distribution between groups. The intervention consisted of risk assessment, risk-based service delivery, and continuous follow-up care. Outcomes included oral health behaviors, caries risk levels, early carious lesions, and decayed-missing-filled teeth (dmft) before and after implementation. Follow-up period averaged 1 year on the same children.

Results: At baseline, most children were classified as high or very high risk for caries, with more than 80% of children in some of the child development centers in Krabi categorized as very high risk. Following implementation, children in the intervention group received more continuous risk-based follow-up and preventive care than controls. Improvements in toothbrushing frequency, fluoride toothpaste use, and oral cleanliness were greater in the intervention group. Caries risk scores and early carious lesions also showed decreasing trends in several intervention settings. Changes in dmft varied across settings and service delivery models, with a smaller increase in dmft in the intervention group than in the control group in some settings. These findings suggest that the effects of the service model varied across implementation contexts.

Conclusions: The value-based oral health service model supported improvements in oral health behaviors, reductions in caries risk, and slower caries progression among young children. The findings supported integrating risk-based and outcome-oriented oral health care into primary care services and child development centers to strengthen sustainable early childhood oral health systems.

Pharmacovigilance Patterns of Unsafe Medicines and Health Products in Communities, and Community Participation in Northern Thailand: A Case Study of Border Medicines, Community Medicines, and Antibiotic Use in Aquatic Animals

Ratanaporn Awiphan — 2026-09-05

Background and rationale: The distribution of unsafe medicines and health products in communities in Thailand’s Northern region remains a persistent problem with widespread public health impacts. Surveillance management is implemented in line with the national strategy to promote rational drug use. This study aimed to examine the implementation patterns of community surveillance for unsafe medicines and health products, as well as the roles of network partners in addressing three key drug-related problems in the North: border medicines, community medicines, and antibiotic use in aquatic animals.

Methodology: This qualitative study collected data through focus group discussions to extract lessons learned from stakeholders involved in surveillance implementation. Data were collected from November 2023 to May 2024. Informants comprised 56 representatives, including primary care pharmacist leaders and local network partners. The border-medicine case was studied in Chiang Rai and Phayao provinces; the community-medicine case in Chiang Mai and Mae Hong Son provinces; and antibiotic use in aquatic animals in Phayao province. Data were analyzed qualitatively, and inductive conclusions were drawn.

Results: Three distinct surveillance implementation patterns were identified across the case studies. All patterns comprised four main themes representing the surveillance process: (1) situational survey in the area, (2) communication of situational information to the network, (3) development of tools and operational guidelines for surveillance, and (4) coordination to jointly address problems with the community. In the case of unsafe medicine at border, the primary care pharmacist team assessed the situation and found the smuggling of dangerous drugs and products without Thai FDA (Food and Drug Administration) approval, with incorrect labeling, passing border checkpoints, reaching border markets, and then distributed via mobile vendors and online channels. Information on unsafe products and their impacts was communicated to network partners. Tools were developed targeting various product types and using LINE chats for rapid risk alerts. Coordination with communities and security and authoritative officers was undertaken to confiscate at informal crossing points and issuing local ordinances as the control measures. In the case of unsafe medicine in community, primary care pharmacists assessed the situations by reviewing complaints received by the Council of Consumer Organizations (CCO) Thailand, conducting inspections of groceries and patient home visiting with multidisciplinary teams. The information was presented as distribution route maps of unsafe medicines and disseminated to network partners to reflect the problems to maintain shared surveillance roles and responsibilities. Tools were developed to help data collection and generate context-appropriate communication materials and registered as trigger tools. Coordination with communities was carried out through the district health system (DHS) policy board, and the Rational Drug Use (RDU) Community mechanisms, along with community leader strengthening for household-level surveillance. In the case of unsafe antibiotic use in aquatic animals, primary care pharmacists, together with the CCO and the provincial health office, conducted an in-depth assessment of antibiotic use and water management at the tilapia farms, including antibiotic residue tests in fish, water, and feed. Findings were communicated to the provincial fisheries office, the cooperatives, and farmer groups, to formulate systemic corrective measures. Tools were developed as supporting documents and manuals for good agricultural practice (GAP) standards. Coordination with communities used cooperative mechanisms for quality control, promoting safe-food policy, and providing “chemical-free” certification to establish market mechanism. This served as a model of community-based management of antimicrobial resistance example.

Conclusion: Across the three Northern case studies on community surveillance of unsafe medicines and health products, the implementation patterns differed depending on the context, while the key operational steps were similar. Public health agencies were the main drivers, with primary care pharmacists serving as coordinators. Administrative and security agencies, local administrative organizations, civil society networks, education institutions, and private sectors jointly participated.

Mapping Built Environment Characteristics for Active Living in Urban Asia: A Scoping Review

Thitikorn Topothai — 2026-09-05

Physical inactivity and sedentary behavior are major public health concerns in Asia’s rapidly urbanizing cities. Built environments influence these behaviors, yet regional evidence remains fragmented. This scoping review mapped built environment characteristics examined in relation to physical activity and sedentary behavior among adults in urban Asia. The review followed PRISMA guidelines and was registered in PROSPERO (CRD42023396292). Five databases (Medline, Embase, Web of Science, Scopus, and Cochrane Library) were searched for English-language articles published between 2012 and 2024. Eligible articles assessed at least one built environment characteristic in relation to physical activity or sedentary behavior. Ninety-eight articles were included, yielding 356 reported built environment characteristics. The most commonly examined characteristics were land use mix and accessibility (n = 63), recreational facilities (n = 58), aesthetic qualities (n = 50), street connectivity (n = 48), residential density (n = 44), and safety (n = 38). These characteristics were typically assessed through measures such as destination diversity and proximity, park and sports facility availability, greenery and cleanliness, intersection density, population density, and traffic- or crime-related safety. Public transport accessibility, pedestrian infrastructure, and cycling infrastructure were examined less frequently. Only three articles assessed sedentary behavior. This review highlights important imbalances in the evidence base on built environments and active living in urban Asia, with some domains receiving substantial attention while others remaining underexplored. The findings can help policymakers identify environmental attributes relevant to their local contexts and guide future research and urban planning strategies to promote active living.

Grand Re-Design Ideal Thai Health Systems

Supasit Pannarunothai — 2026-09-05

ระบบสุขภาพที่ดีควรมีวงจรเรียนรู้และปรับตัวเพื่อรับมือกับความท้าทายต่างๆ ได้อย่างมีประสิทธิผล ระบบสุขภาพไทยเกิดการเปลี่ยนแปลงครั้งใหญ่เมื่อ 25 ปีที่แล้ว จากการสร้างระบบหลักประกันสุขภาพถ้วนหน้า สถานการณ์ความท้าทายระบบสุขภาพปัจจุบันย่อมเปลี่ยนไปจากเดิมมากแล้ว ทั้งส่วนที่เป็นเรื่องใหม่ เช่น ภาวะโลกร้อนกับผลกระทบต่อสุขภาพ ปัจจัยการค้ากำหนดสุขภาพ การเสพติดสื่อสังคมดิจิทัลที่มีผลกับสุขภาพจิตของเด็กและวัยรุ่น ฯลฯ กับส่วนที่เป็นเรื่องเดิม เช่น การคลังขาดแคลนเพราะมีจำกัด ไม่สามารถจัดสรรให้ด้านอุปทานของระบบบริการ (ทั้งกำลังคนและทรัพยากรเทคโนโลยีทางสุขภาพ) ได้เพียงพอกับอุปสงค์ต่อสุขภาพที่ไม่จำกัด ปัจจัยสังคมกำหนดสุขภาพการด้อยโอกาสทางสุขภาพข้ามรุ่น เศรษฐศาสตร์การเมืองของการอภิบาลระบบ สถาบัน องค์กร กรรมการ อำนาจและการกระจายอำนาจ การจัดสรรทรัพยากร ข้อมูลข่าวสาร ฯลฯ วงจรเรียนรู้และปรับตัว ณ ปัจจุบันจะนำไปสู่การออกแบบระบบสุขภาพไทยในทิศทางไหน

เมื่อใช้ตัวช่วยปัญญาประดิษฐ์ (artificial intelligence, AI) Claude ให้เสนอแนะ “suggest grand design Thai health systems 2030” ผู้ช่วย AI ให้ความเห็นหลายอย่าง 5 อันดับแรกคือ หลักประกันสุขภาพถ้วนหน้า 2.0 โครงสร้างสุขภาพดิจิทัล ความพร้อมรับสังคมสูงวัย ระบบสุขภาพปฐมภูมิ และการพัฒนากำลังคน เมื่อถามลึกถึงต้นทุนส่วนเพิ่มของ grand design ผู้ช่วย AI ให้คำตอบอย่างรวดเร็วว่า หลักประกันสุขภาพถ้วนหน้า 2.0 ที่จะทำให้เกิดความกลมกลืน (universal coverage scheme harmonization) ต้องการงบรายหัวเพิ่ม 40-60 บาทต่อคนต่อปี จนถึงปี 2573 โครงข่ายสุขภาพดิจิทัลต้องการงบลงทุน 30-50 บาทต่อคนและงบบำรุงรักษา 5-8 บาทต่อคนต่อปี ความพร้อมรับสังคมสูงวัยต้องการงบรายหัวเพิ่ม 60-100 บาทต่อคนต่อปีจนถึงปี 2573 การสร้างระบบสุขภาพปฐมภูมิให้เข้มแข็งต้องการงบรายหัวเพิ่ม 20-30 บาทต่อคนต่อปีจนถึงปี 2573 การพัฒนากำลังคนให้เพียงพอต้องการงบรายหัวเพิ่ม 15-25 บาทต่อคนต่อปีจนถึงปี 2573 (ผลิตภัณฑ์มวลรวมประเทศ [gross domestic product, GDP] ปีฐาน 2568 มูลค่า 18.5 ล้านล้านบาท ประชากร 65.8 ล้านคน) ทั้งหมดนี้ประเทศจะมีรายจ่ายสุขภาพเพิ่มเป็นร้อยละ 5.2-5.7 ของ GDP ซึ่งบรรณาธิการเห็นคล้อยตามข้อความที่ผู้ช่วย AI เสนอมาในย่อหน้านี้ เพราะการพัฒนาให้ถึงเป้าหมายที่เพิ่มขึ้นมักตามมาด้วยต้นทุนที่ต้องเพิ่มขึ้นด้วย ประเด็นสุดท้ายขอให้ผู้ช่วย AI ทำนายโอกาสที่จะสำเร็จ คำตอบคือ digital health infrastructure โอกาสสำเร็จสูงสุดร้อยละ 60-70 รองลงมาคือ primary care strengthening ร้อยละ 50-60 workforce development ร้อยละ 40-50 aging/long-term care preparedness โอกาสสำเร็จร้อยละ 20-35 ส่วน UCS harmonization โอกาสสำเร็จต่ำสุดคือร้อยละ 15-25

บทบรรณาธิการและบทความในฉบับนี้ ขอออกแบบระบบสุขภาพไทยเชิงอุดมคติใหม่ให้กว้างขวางกว่าที่ผู้ช่วย AI เสนอ ถ้าสิ่งท้าทายสุขภาพคือ สิ่งแวดล้อม ปัจจัยการค้ากำหนดสุขภาพ วิถีชีวิต การใช้ดิจิทัลแบบเสพติด ฯลฯ มาตรการสุขภาพในทุกนโยบาย (health in all policies) หรือ healthy public policy ของ Ottawa Charter ยังเป็นชุดนโยบาย กฎหมาย ที่พรรคการเมือง สถาบันรัฐและเอกชน ต้องถือเป็นมาตรการที่มีผลกระทบต่อสุขภาพอันดับแรกที่มีประสิทธิผล และมีโอกาสคุ้มค่า บทความในวารสารฉบับนี้ แสดงตัวอย่างความเชื่อมโยงของสิ่งแวดล้อมสรรค์สร้างมีผลต่อสุขภาพของทุกคนในเมือง⁽¹⁾ ประกาศกระทรวงศึกษาธิการมีผลต่อสุขภาพเด็กนักเรียนและพฤติกรรมสุขภาพตลอดช่วงชีวิต⁽²⁾ การกระจายอำนาจในระบบสุขภาพปฐมภูมิเล็กสุดอยู่กับองค์กรปกครองส่วนท้องถิ่น แต่ระบบบริการสุขภาพส่วนใหญ่ยังอยู่กับราชการส่วนกลาง ก่อให้ระบบความสัมพันธ์การสื่อสารของหน่วยงานส่วนกลางและส่วนท้องถิ่นราบรื่นหรือสะดุด⁽³⁾ ก็จะทำให้การดูแลสุขภาพแม้วาระสุดท้ายที่ทุกข์ทรมานและสิ้นเปลือง ยังคงเป็นการดูแลที่ผสมผสานกับหลักเวชศาสตร์ครอบครัวที่เกิดประสิทธิผลกับประชาชนและครอบครัว⁽⁴⁾ การปรับระบบบริการสุขภาพช่องปากให้คำนึงถึงคุณค่ามากกว่าปริมาณและสัมพันธ์กับคะแนนภาวะเสี่ยงทางสุขภาพ⁽⁵⁾ การบูรณาการผสมผสานหน่วยงานส่วนกลาง ส่วนภูมิภาค กับภาคประชาสังคมเพื่อให้ประเทศไทยใช้ยาสมเหตุผล⁽⁶⁾ เหล่านี้ล้วนเป็นองค์ประกอบของระบบสุขภาพไทยเชิงอุดมคติ ที่ควรมีอย่างครอบคลุม