Abstract
Roles of municipality in health developmentThe objectives of this study were to examine the implementation of health and health related activities undertaken by municipality according to the roles and responsibilities defined by law, to examine the readiness of health resources in the health and health related activities, and to gather municipality administrators/personnel opinions on municipality roles towards health development. A survey research design was used and mail questionnaires were sent to 149 municipalities and Pattaya City in Thailand. The response rate was 78.7 percent (118 municipalities). There were 538 municipality personnel responded to the survey questionnaires on municipality roles. The majority of the municipalities agreed on the present organization structure of the municipalities of provide health and health related activities to their populations, 57.9 percent and 74.2 percent by muang and tambon municipality respectively. However, 45.5 percent of nakorn municipalities suggested that the organization structure should be changed to a higher level. Moreover, the analyses were based on 1) roles according to Municipality Law B.E.2496; 2) roles according to Ministry of Interior's regulations B.E.2535; 3) activities in which more than 50 percent of the municipalities could perform 4)municipality personnel opinions towards the roles and activities in reality and decentralization in health activities. The finding shows that most of the municipalities could perform activities in sanitation and environmental health, solid wastedisposal, prevention and communicable disease, health education, nutrition, family planning, immunization, prevention and control of non-communicable diseases, primary health care, dental health, veterinary medical car. The results show that there were some activities that only few municipalities would do such as medical care after the office hours, inpatient care, surgery, delivery, specialized care for specific diseaes, mobile medical and dental clinic, medical laboratory and diagnosis, toxicology microbiology laboratory, occupational health, antenatal and postnatal care, mental health, and waste-water treatment and quality control. The majority of municipality personnel (75.1 percent) agreed that it was appropriate to decentralize the role and activities in health care to municipality and the resources were moderately sufficient. The opinion on building municipality hospitals was 38.9 percent and medical centers 95.9 percent. However, the utilization rates at hospital/medical centers were very low : nakorn municipality 65 patients/day, muang municipality 14 patients/day, and tambon municipality 7 patients/day. Moreover, if health problems according to important health indicators (Basic Minimum Need : BMN) were considered, they were quite good. However, there are still many problems in which lack of resources especially human resources for health, lack of clear policy, roles and activities, management, and cooperation of related agencies and people were problems in implementation of majorhealth projects.The implications from this study were suggested as follow : 1)Municipality should have the major role in taking care of the health of the population in the municipality area. 2)Municipality should emphasize on health promotion and disease prevention more than curative care and should provide a proactive service by focusing on purchaser's role more than provider's role. The municipality should let other potential public and private facilities being providers.3)Expansion of hospital and medical center should be undertaken only with the case of insufficiency of health care facility, resource capacity, and the need of local people. 4)Municipality should promote and support people to be partnerships in health and health care for individual, family, and community. 5)Central gevernment should allocate resources and promote municipality to increase sources of income. 6)In the future, government should fully decentralize authority to municipality and empower community organizations and people. 7)Futher studies should focus on qualitative and quantitative aspect to cover the areas and health facilities including general population on roles of municipality on health development.
