A situational analysis of primary health care system management by directors of public health divisions in provincial administrative organizations following the transfer of responsibilities from the Ministry of Public Health: a policy-level perspective
Keywords:
การถ่ายโอนภารกิจ, ระบบบริการสุขภาพปฐมภูมิ, ผู้อำนวยการกองสาธารณสุข, การบริหารจัดการสุขภาพAbstract
The transfer of public health responsibilities to Provincial Administrative Organizations (PAOs) has expanded the role of Public Health Division Directors in managing primary health care systems at the local level, particularly in service governance and health network coordination. This descriptive qualitative study aimed to analyze the primary health care management situation of Public Health Division Directors in PAOs following the transfer of responsibilities from the Ministry of Public Health. The study covered eight provinces across four regions of Thailand. A total of 256 informants participated, comprising policymakers, practitioners, transferred primary care unit personnel, and community representatives, with Public Health Division Directors serving as the primary informants. Research instruments comprised the researchers, semi-structured interview guides, focus group guides, and a related-data record form. Data were collected through in-depth interviews, focus group discussions, and document review, and analyzed using content analysis. Trustworthiness was established through triangulation, member checking, and peer debriefing. The findings revealed that the role of Public Health Division Directors had shifted from general public health administrators to "system managers" responsible for coordinating service units, regulatory bodies, and health system stakeholders. Five key themes emerged: (1) structural and administrative adaptation to local contexts, (2) human resource management and competency development, (3) challenges in service standards and quality governance, (4) network coordination and governance mechanisms, and (5) primary health care system organization as a network under the National Health Security system. Policy recommendations include developing clear governance mechanisms and health information systems, strengthening health system governance competencies among Public Health Division Directors, and fostering inter-agency collaboration at the local level to ensure quality, continuity, and equitable access to primary health care services.
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