Synthesis of a Prototype Tool for Forecasting the Impact on Health Status and Health Service Delivery Resulting from the Transfer of Subdistrict Health Promoting Hospitals

Abstract

This mixed-methods research aimed to synthesize a prototype forecasting tool to predict impacts on health status and health service delivery that may arise from the transfer of Subdistrict Health Promoting Hospitals (SHPHs), and to assess its capacity. The study comprised two phases. Phase 1 involved synthesizing the prototype tool by analyzing secondary data from the Ministry of Public Health (MOPH) and from the National Health Security Office (NHSO). Baseline data were drawn from fiscal years 2018 – 2022, while fiscal years 2023 – 2024 provided post-transfer outcomes. Units of analysis included primary care contracting units and provinces. Indicators covered: a) access to primary care, b) adherence to clinical practice guidelines, c) continuity and timeliness of care, d) health outcomes, and c) treatment costs. Phase 2 assessed the tool’s predictive capacity through qualitative research. Thirteen provinces (15 areas) were purposively selected. Data were collected via focus group discussions with 120 participants from Provincial Public Health Offices, Provincial Administrative Organizations, Contracting Units for Primary Care (CUPs), and SHPHs. Content analysis was applied.

Results showed six prototype models for forecasting impacts on health status and health services delivery: 1) KPI performance comparison by transfer status 2) resource–outcome balance & risk stratification, 3) performance changes relative to baseline years, 4) single-indicator warning index, 5) dual-warning index, and 6) scope and severity of impact index. These six forecasting models demonstrated potential as proactive surveillance systems, reflecting systemic risks and prioritizing local problems at the district, provincial, and/or national level. Each of these models support policy decision-making in primary health care services following the transfer of SHPHs.

The tools can facilitate management during the transition period, enabling context-specific measures. Emphasis should be placed on using data for systemic development and support rather than solely for evaluating service unit performance.