Opinion and Perspectives of Relevant Personnel on the Roles, Missions, and Organizational Structures of Provincial and District Public Health Offices Following the Transfer of Subdistrict Health Promoting Hospitals to Local Administrative Organizations

Abstract

This study employed a descriptive research design to explore the perspectives of relevant personnel regarding the roles, functions, and organizational structures of Provincial Public Health Offices (PPHO) and District Public Health Offices (DPHO) following the transfer Sub-district Health Promoting Hospitals (SHPHs) to local administrative organizations (LAOs). The investigation examined three perspectives: (1) self-assessment by PPHO and DPHO, (2) mutual assessment between PPHO and DPHO, and (3) assessment of PPHO and DPHO by regional/general hospitals. The study sample consisted of Provincial Chief Medical Officers, directors of regional and general hospitals, and DPHO personnel nationwide, totaling 752 participants selected through purposive sampling. Data were collected using an electronic questionnaire comprising three sections: general information, perceptions regarding the roles and functions of DPHO, and perceptions regarding the roles and functions of PPHO. The questionnaire demonstrated an index of item-objective congruence ranging from .67 to 1.00 and a reliability coefficient of .73. Data were analyzed using descriptive statistics.

Results indicated that perceptions toward restructuring the roles and functions of PPHO were largely consistent, except for the issue of downsizing and reducing workforce capacity in units previously responsible for SHPHs operations. PPHO and DPHO personnel disagreed with this adjustment, whereas regional/general hospital directors agreed. Regarding DPHO, most participants shared similar views except on issues such as reducing positions to essential ones only, merging DPHOs into district clusters, and integrating DPHO roles under PPHO supervision. PPHO and DPHO personnel opposed these measures, while regional/general hospital directors were supportive.

These findings suggest that structural and managerial reforms of PPHO and DPHO should be considered with a flexible approach, independent of administrative district boundaries. Possible strategies include establishing clusters or merging selected DPHOs with PPHO, adjusting organizational size to match health functions and population health needs rather than geographical areas, thereby enhancing efficiency and responsiveness in public health service delivery.