The Impacts of Transferring the Mission of the Sub-district Health Promoting Hospitals to the Provincial Administrative Organizations on the Disease Prevention and Control Management System in Thailand

Abstract

        This mixed-methods research aimed to compare the disease prevention and control management systems, their outcomes, and the public health outcomes of Subdistrict Health Promoting Hospitals (SHPHs) that have and have not transferred their responsibilities to the Provincial Administrative Organization (PAO). It also explored proposals for developing disease prevention and control management systems for SHPHs that have transferred their responsibilities to the PAO. Quantitative data were collected from 4 groups: directors of SHPHs, citizens aged 18 and older, citizens aged 35 and older, and parents of children aged 0–5 years, using a questionnaire validated by experts for content validity and reliability according to standard criteria. Statistical analyses included descriptive statistics presenting means and standard deviations, and inferential statistics involving Chi-square tests and t-tests. Additionally, qualitative data were collected from 8 key informants using semi-structured interviews and analyzed by content analysis.

        The study indicated that, from the perspective of directors of Subdistrict Health Promoting Hospitals (SHPHs) that have and have not transferred their responsibilities to the Provincial Administrative Organization (PAO), the disease prevention and control management systems based on the six pillars of the health system showed no significant differences in (1) service provision, (2) human resources, and (3) financial resources. However, significant differences were observed in (4) data for disease prevention, (5) access to necessary medications, vaccines, and technology, and (6) leadership and governance. When comparing the outcomes of the disease prevention and control management systems from the perspectives of directors of SHPHs, significant differences were found. From the public's perspective, the quality of disease prevention and control services, and satisfaction with the services received showed no differences. Additionally, the study found differences in public health outcomes related to disease prevention and control between SHPHs that had transferred their responsibilities and those that had not. The incidence rate of dengue fever in 2022-2023 was lower in SHPHs that had transferred their responsibilities compared to those that had not. Screening for diabetes and hypertension, as well as immunization enhancement for children aged 0-5 years, showed no differences. Proposals for developing the disease prevention and control management system of SHPHs that have transferred their responsibilities to the PAO should focus on important areas such as (1) personnel and personnel development, (2) budgeting, (3) resources, and (4) data systems, to maximize the effectiveness of disease prevention and control by SHPHs in the future.