Policy analysis of prevention and control focuses on the decentralization to the provincial administrative organization (PAO) in region 3 according to 593 model concept

Abstract

This research aimed to analyze the implementation process and success of policy execution by the Department of Disease Control. The study employed a policy research methodology using a mixed-methods approach, incorporating both qualitative and quantitative data collection through surveys and interviews. Three core missions were selected for analysis: (1) diabetes and hypertension prevention and control, (2) disease reporting under the Communicable Disease Act B.E. 2558, and (3) road traffic accident prevention. Sample included 728 participants from both the Ministry of Public Health and the Ministry of Interior and consisted of 5 groups: 50 provincial-level policy administrators, 90 district-level policy administrators, 60 sub-district-level policy administrators, 108 health disease contractors and 420 village health volunteers. They were selected using the 30-cluster sampling technique. The research instruments had index of Item-Objective Congruence (IOC) values between 0.5 and 1.0 and a cronbach’s alpha of 0.92. Data were analyzed using percentage and mean values. The research results found the following four main issues. 1) Information System: Central guidelines were found to be clear and communicated annually. The policies of local political administrators emphasized the importance of disease control data. The information of the provincial administrative organization used the same base as the public health office. There were mismatches in indicators between the two ministries, and the role of district health offices in monitoring had diminished. The work at the district level was driven through the district quality of life development committee. Data reporting from transferred sub-district health promoting hospitals (SHPHs) was inconsistent. The results were lower than those not transferred. Provincial administrative organizations did not have clear supervision. It was also found that some SHPHs did not request to be monitored in the monthly meeting. 2) Disease Investigation System: Transferred SHPHs were appointed as communicable disease control officers. Approval from local administrative leaders was required when having a patient, causing delays entering to the area. Workload often led to prioritization. Effective outbreak control was found in areas where district health offices remained supportive. Emergency operation centers were established at sub-district levels. Sub-district administrative organizations and sub-district municipalities continue to support epidemic control. 3) Monitoring and Evaluation System: Monthly monitoring meetings occurred across all levels—provincial governors held meetings with local administrators. The provincial public health offices held a monthly planning and evaluation meetings. At the district level, there were meetings of the district public health coordination committee, the SHPHs director, the district government department heads, and community leaders. 4) Operational Outcomes: village health volunteers (VHVs) reported high satisfaction with prevention and control policies and demonstrated good knowledge and implementation levels. The study recommended the creation of agreements and models for driving disease prevention and control work between provincial health offices and local administrative organizations at all levels. In addition, Interconnected information systems, responding to public health emergencies, and monitoring and evaluating work should be focused.