ปัจจัยการอภิบาลระบบที่มีอิทธิพลต่อการดําเนินงานเขตสุขภาพเพื่อประชาชนของประเทศไทย

Sumalee Hengsuwan; Vinai Leesmidt; Supasit Pannarunothai

Authors

Sumalee Hengsuwan Khanu Woralaksaburi Hospital, Kamphaeng Phet Province
Vinai Leesmidt Centre for Health Equity Monitoring Foundation, Phitsanulok Province
Supasit Pannarunothai Centre for Health Equity Monitoring Foundation, Phitsanulok Province

Keywords:

participatory health region, system governance, good governance, soft power, network

Abstract

This study aimed at analyzing the level of system governance of the participatory health region and the committee roles on system governance; and categorizing system governance of the participatory health regions at national level. Mixed methods of both quantitative and qualitative studies were used. The study covered 13 health regions. The study population consisted of 638 committee members and secretariat teams. Quantitative data were collected by self-administered questionnaires designed according to United Nations’ good governance criteria, and analyzed by descriptive statistics and exploratory factor analysis. Qualitative data were collected by in-depth interview, focus group discussion, report review and observation, and analyzed by content analysis. The study took 15 months from October 2018 to December 2019.

Quantitative analysis showed that the participatory health regions had high system governance level since all components got scores greater than 2.5. The top three highest scores consisted of following the rules of law (score 4.01), equity and inclusive coverage (score 3.91) and transparency (score 3.81). The three least scores included efficiency and effectiveness (score 3.65), accountability to people (score 3.66) and responsiveness to target population (score 3.72). Qualitative data analysis revealed 20 important committee roles on the system governance. Holistic care provision and regular meeting reporting got the same highest levels (score 4.04) while the least achievement role was on fulfilling the setup plans (score 3.48). By factor analysis, two categories of system governance were found: the planning and the implementation process. The present study suggests that the network governance can be used to strengthen both the National Health Security Office’s area health and the regional health of the Ministry of Public Health. Public relations, experience sharing in working with soft power, and building collective leadership are recommended for improving system governance. The weakness of the present study was the lack of impact evaluation.

References

Leesmidt V, Leethongdee S, Bumrungkhet W, Chimnoi S. Research and development of locality health system management in the universal coverage system. Nonthaburi: Health Insurance System Research Office; 2011. (in Thai)

Leesmidt V, Chunharas S. The appropriate roles of the Ministry of Public Health within health care decentralization. Nonthaburi: Health Systems Research Institute; 2010. (in Thai)

Sheaff R. Governance in gridlock in the Russian health system: the case of Sverdlovskoblast. Social Science & Medicine [internet]. 2005 [cited 2015 Sep 21];60:2359-69. Available from: http://www.elsevier.com/locate/socscimed.

Tangcharoensathian V, Jongudomsuk P. Future challenges. In: Tangcharoensathian V, Jongudimsuk P, editors. From policy to implementation: historical events during 2001-2004 of Universal Coverage in Thailand. Bangkok: S.R.C. Envelope; 2004. p. 153-67.

World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies [internet]. 2010 [cited 2018 Nov 12]. Available from: http://www.who.int/healthinfo/systems/monitoring/en/.

Stoker G. Governance as theory: five propositions. International Social Science Journal [internet]. 1998 [cited 2018 Sep 13];50(1):17-28.

KJÆR AM. Governance. Cambridge: Polity Press; 2004.

Carver J. A theory of governing the public’s business: redesigning the jobs of boards, councils and commissions. Public Management Review 2001;3:3-24.

United Nations Economic and Social Commission for Asia and the Pacific. What is good governance [internet]. 2006 [cited 2018 Nov 13] Available from: http://www.unescap.org/pdd/index.asp.

Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health [internet]. 2007 [cited 2018 Sep 12];30(4):459-67. Available from: https://www.researchgate.net/publication/6185294_Is_the_CVI_an_acceptable_indica-tor_of_content_validity_Appraisal_and_recommendations.

Cronbach LJ. Essential of psychological test. 5th ed. New York: Harper Collins; 1970.

Tavakol M, Dennick R. Making sense of Cronbach’s alpha. International Journal of Medical Education [internet]. 2011 [cited 2018 Sep 12];2:53-55. Available from: https://www.ijme.net/archive/2/cronbachs-alpha.pdf.

Yin R K. Case study research: design and methods. 3rd ed. London: SAGE Publications; 2003.

World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. 2008 [cited 2022 Apr 20]. Available from: https://caribe.observatoriorh.org/sites/caribe.observatoriorh.org/files/webfiles/fulltext/WHO_MBHSS_2010.pdf.

Wikipedia. Governance [internet]. 2006 [cited 2022 Apr 14]. Available from: http://en.wikipedia.org/w/index.php?ti-tle=Governance.

Ewalt J AG. Theories of governance and new public management: links to understanding welfare policy implementation [internet]. 2001 [cited 2018 Nov 12]. Available from: https://www.academia.edu/66578764/Theories_of_Gov-ernance_and_New_Public_Management_Links_to_Under-standing_Welfare_Policy_Implementation.

Sheaff R. Governance in gridlock in the Russian health system; the case of Sverdlovsk oblast. Social Science & Medicine [internet], 2005 [cited 2018 Nov 13];60:2359-69. Available from: http://www.elsevier.com/locate/socscimed.

Arnwine DL. Effective governance: the roles and responsibilities of board members. Proc (Bayl Univ Med Cent) [internet]. 2002 [cited 2022 Apr 21];15(1):19–22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276331/.

World Health Organization. Health systems performance assessment: a tool for health governance in the 21st century [internet]. 2012 [cited 2022 Apr 20]. Available from: https://www.euro.who.int/__data/assets/pdf_file/0019/160813/HSPA_A-tool-for-health-governance-in-the-21st-century.pdf.

Murray C JL, Frenk J. A framework for assessing the performance of health systems. Bulletin of the World Health Organization [internet], 2000 [cited 2022 Apr 20];78(6):717-31.

Papanicolas I, Rajan D, Karanikolos M, Soucat A, Figueras J. Health system performance assessment: a framework for policy analysis [internet]. 2022 [cited 2022 Apr 20]. Available from: https://www.who.int/publications/i/item/9789240042476.

Provan KG, Milward HB. Do networks really work? A framework for evaluating public-sector organizational networks. Public Administration Review [internet]. 2001 [cited 2019 Jul 9];61(4):414-23. Available from: https://www.sparc.bc.ca/wp-content/uploads/2020/11/do-networks-really-work-arti-cle.pdf.