Assessment of Health Impacts on the Population Following the Decentralization of Sub-district Health Promoting Hospitals to Provincial Administrative Organizations: A Case study of Mahasarakham Province
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Abstract
Abstract
This study aimed to evaluate the health impacts on the population following the transfer of Sub-district Health Promoting Hospitals (HPHs) to Provincial Administrative Organizations (PAOs). The researchers employed a mixed-methods design that included both quantitative and qualitative approaches. The study was conducted between January and October 2024. The sample consisted of 30 administrators, 150 public health personnel, and 560 service recipients. In addition, 88 informants participated in in-depth interviews and focus group discussions. The researchers used validated questionnaires with content validity (IOC = 0.85–0.88) and reliability (α = 0.86), along with interview guides with a validity score of 0.96. Data were analyzed using descriptive statistics, inferential statistics, and content analysis.
The findings showed that the average Charlson Comorbidity Index (CCI) in fully transferred areas was 506.21 per 1,000 population, which was higher than in partially transferred and non-transferred areas. The average age of the population was 42.20 years. Health service accessibility declined across all dimensions of the 4A Framework. The availability dimension was the most negatively impacted (β = -0.36), with a statistically significant reduction in resource availability (p < 0.05). The incidence rates of new cases of diabetes and hypertension were significantly higher after the transfer than before (1,155.14 vs 897.42 per 100,000 population, p = 0.042). The Quality of Care for Basic-Diabetes Mellitus (QCB-DM) scores were lower than pre-transfer levels. The researchers proposed five strategic recommendations: (1) development of a participatory digital health system; (2) establishment of integrated community health networks; (3) development and retention of qualified personnel; (4) implementation of a transparent and digital quality assurance system; and (5) development of financial security and sustainability mechanisms. These strategies aim to create a balance between decentralization and the maintenance of sustainable standards in primary healthcare services.
Keywords: Health impacts, Sub-district Health Promoting Hospitals, Decentralization
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References
Reference
Office of the Decentralization to the Local Government Organization Committee. Guidelines for the transfer of missions of the 60th Anniversary Queen Sirikit Health Center and Subdistrict Health Promotion Hospital to the Provincial Administrative Organization. [Internet], 2023 [cited 2023 July 24]; Available from: คู่มือแนวทางการดำเนินการถ่ายโอนภารกิจสถานีอนามัยเฉลิมพระเกียรติ 60 พรรษา นวมินทราชินี และโรงพยาบาลส่งเสริมสุขภาพตำบลให้แก่ อบจ. – ก.ก.ถ.. Thai.
Primary Health Care System Support Division. Operation Manual for Primary Care Units and Primary Care Unit Networks under the Primary Health Care System Act B.E. 2562. [Internet], 2023 [cited 2023 March 12]; Available from: https://pcustandard.moph.go.th/login.php. Thai.
Jiruth Sriratanaban, Noppcha Singweratham, Daoroong Komwong, Mano Maneechay. Assessment of Population Health Impacts from the Transfer of Sub-District Health Promoting Hospitals to the Provincial Administrative Organizations in 2023: Phase 1 Potential Warning Signs. J Health Syst Res [internet]. 2024 [cited 2025 Jan. 24]; 18(2):152-72. available from: https://he04.tci-thaijo.org/index.php/j_hsr/article/view/1462. Thai.
Napassawan Puripanpinyo. Development of system and decentralization of responsibility mechanisms on Queen Sirikit Health Center and Health Promoting Hospital to the Roi-Et Provincial Administrative Organization. J Roi Kaensarn Acad. 2024; 9(6). 793-812. Thai.
Tatchalerm Sudhipongpracha, Wittaya Choksettakij, Pakawat Phuripongthanawat, Ukkrit Kittayasophon, Nathanop Satthatham & Yaowawanya Onphothong. Synthesis of proposals and policy design for transferring sub-district health promotion hospitals to provincial administrative organizations. [Internet], 2023 [cited 2023 March 20]; Available from: https://kb.hsri.or.th/dspace/handle/11228/5552?locale-attribute=th. Thai.
Udom Thumkosit, Li Renliang, Ratiporn Teungfung, Jirawat Sriruang. The Evaluation of Primary Health Care Servicing by Subdistrict Health Promotion Hospitals Transfered to Provincial Administrative Organization in Fiscal Year 2023. JSDMS [internet]. 2024 Oct. 31 [cited 2025 Jun. 28];26(2):1-38. available from: https://so04.tci-thaijo.org/index.php/jsd/article/view/272838. Thai.
Songkramchai Leethongdee. Implementation of Health decentralization : Progress Evaluation and Impact Analysis 2011. [Internet], 2023 [cited 2023 March 20]; Available from: https://kb.hsri.or.th/dspace/handle/11228/3103?locale-attribute=en. Thai.
Greer, S. L., & da Fonseca, E. M. Decentralization and Health System Governance (pp. 409–424). Palgrave Macmillan, London. https://doi.org/10.1057/9781137384935_25.
Jimenez, D., & Smith, P. C. Decentralisation of Health Care and Its Impact on Health Outcome (Vol. 10). Department of Economics and Related Studies, University of York. 2005.
de Biase, P. and S. Dougherty. Federalism and public health decentralization in the time of COVID-19. OECD Working Papers on Fiscal Federalism 2021; 33. https://doi.org/10.1787/b78ec8bb-en.
Durmus V. Does the healthcare decentralization provide better public health security capacity and health services satisfaction? An analysis of OECD countries. Journal of health organization and management 2024; 10: 1108/JHOM-01-2023-0021. https://doi.org/10.1108/JHOM-01-2023-0021.
Bilouseac I. Applying the Principle of Decentralization Within Public Health Services. European Journal of Law and Public Administration 2016; 1(2): 17-24.
Sunanta Kanchanapong. Policy Recommendations from Impact Assessment of Transferring Queen Sirikit Health Centers (QSHC), and Sub-District Health Promoting Hospitals (SHPH) to Local Government Organization. Journal of Health Science of Thailand 2024; 33(3): 537-48. Thai.
