Policy proposals for prevention and control of disease and health hazards after the transfer of the Subdistrict Health Promoting Hospital to the Provincial Administrative Organization in Health Zone 4
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Abstract
This study aimed to assess the impacts, challenges, and barriers related to disease prevention and control following the transfer of Subdistrict Health Promoting Hospitals (SHPHs) to the Provincial Administrative Organizations (PAOs) and to develop policy recommendations within the context of Health Region 4, Thailand. A mixed-methods study was conducted. Data were collected from 170 stakeholders at the provincial, district, and subdistrict levels through in-depth interviews, focus group discussions, stakeholder meetings, and structured questionnaires. Qualitative data were analyzed using interpretative thematic analysis, while quantitative data were analyzed using descriptive statistics including frequency, percentage, mean, and standard deviation. The findings indicated that transferred SHPHs demonstrated increased administrative flexibility in the management of budgets, medical supplies, and human resources. However, several challenges were identified, including policy discontinuity between central and local authorities, limited technical capacity of PAO personnel in disease surveillance prevention and control, the absence of long-term strategic plans for disease prevention and surveillance, and the lack of a clear monitoring and evaluation framework for disease control programs. Based on these findings, five policy recommendations were proposed: strengthening integrated health surveillance information systems; enhancing workforce capacity in disease surveillance, prevention, control, and public health emergency management; promoting proactive disease and health hazard prevention strategies; developing PAO public health emergency response systems; and ensuring adequate and timely resource allocation for disease prevention and control. Pilot implementation demonstrated feasibility, with over 80% of community members reporting satisfaction with access to health services and disease prevention activities, and more than 80% of stakeholders agreeing that the proposed policies enhanced collaborative disease control efforts and improved responsiveness to local health needs.
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