Abstract
This action research aiming to develop primary care model in Na-Mom district, Songkhla province consisted of 4 stages: 1) Situation analysis, 2) Design health service model based on community’s needs and resources, and develop action plan, 3) Implement the plan along with reflective cycle to continuously improve the services, and 4) Evaluation and synthesize what being learnt. Settings were all government health care agencies in the district. Informants included health care providers and key persons in the community. Data were collected from documents as well as reports and by in-depth interviews and group discussion. Content analysis with the validation of study conclusion were performed. The results were following: 1. Na-Mom is a small district with population of 20068. It is 10 kilometers from Hat Yai where people can easily come and get access to various health care agencies. Na-Mom people have good health and economic status. The common illnesses were mild and many of them could be prevented. Within the district, the number of health care providers and agencies met the criteria of Ministry of Health. People preferred to come to Na-Mom hospital when they were sick rather than the nearby health center. They wanted good medical care for the sick but were not much interested in health promotion and illness prevention. Despite many networks in agricultural and economic development, only few groups being actively involved in health development. 2. Researchers, administrative team and health care providers agreed to develop four primary care units (PCU), one unit one Tambon. One was new and the three were the previous health centers. The primary health care model was designed, based on the community’s needs and available resources. The Na-Mom hospital allocated a few nurses and health workers to work regularly at PCU. Health care Networking Committee at Na-Mom district had responsibility to create changes, monitor and evaluate the development of these 4 PCUs. In addition, the research team and the health care providers worked together and agreed on the principles of “Near House At Heart PCU”, tools to be used, tasks and activities in health promotion, illness prevention, primary medical care and rehabilitation, and work schedules at the units as well as in communities.The process to establish effective primary care units in Na-Mom district included: 3.1 Transforming health care policy by the administrative team to health care providers; 3.2 Shared perception of health care situation among administrative team, health care providers and community; 3.3 Experiential learning from the prior success primary care units; 3.4 Shared design of primary care model and guidelines; 3.5 Continuing personnel development such as meeting, conferences, training, study visits as well as sharing experiences; 3.6 Allocating resources; and 3.7 Monitoring, evaluation and reflecting the progress of PCU development to continuously improve the services and systems.Outcome and learned experiences: The new established PCU was the effective one which accomplished the goal and plan. The others three units, the health center based had less achievement. Each unit had its own limitations such as readiness, competencies and attitudes of heads of the units as well as health care providers, work load in documentation and inadequate supports. The nurses demonstrated high competencies in working at PCU particularly in providing primary medical care and family visit.Suggestions for health care networking committee at Na-Mom district are as followed:5.1 Developing an evaluation system, which is accountable in terms of evaluators, tools, methods and impacts on persons being evaluated.5.2 Promoting community participation in health system development.5.3 Strengthening a support system.
