Abstract
This cross-sectional study aimed to investigate the effect of management factors the implementation of health promotion and disease prevention in the Universal Coverage Health Insurance Program. The study was conducted in 61 Contracting unit for Primary care (CUP) among 118 CUP of all 7 provinces of Regional 6. These provinces are Khon Kaen, Undornthani, Nongkai, Skolnakorn, Loei, Kalasin and Nongbualampoo. The qualitative methods were applied for data collection. The results revealed that in The 2002 Fiscal Year, all 7 provinces of regional 6 followed the health for all policy of the Ministry of Public Health closely. Some provinces modified organization structure of the division responsible for this task, some province added more unit or additional committee. Each province set up PCU to provide curative, health promotion, disease prevention, rehabilitation and dental public health with proactive work based on family medicine principle. However, there are slightly difference in focus point of this policy which came from different basic thinking of administrator and previous health promotion work. There was adaptation of concept to be based mainly on benefit package. Additional works which clearly showed were family file, house call, and exercise. There was personnel distribution form provincial level to CUP including sending new nursing graduates to work at PCU in some provinces, There were personnel development, budget allocation for health promotion and disease prevention based on individual card or proportional budget resulting in more budgets for both CUP and PCU and additional supplies for PCU and health center if compared with before project implementation. However, there were still some problems with finance regulation, not much public participation, communication of officers about health promotion. The outcome depended on concepts and supports of chairman of primary health care network which majority of them are still focused on curative rather than health promotion and discase prevention. Budget allocation to PCU had important problem from conflicts between hospital directors and public health district chief. However, there was overall increase in health promotion and disease prevention. Some CUP had project to analyze try to help solving community problems. In 2003 budget year, fix cost distribution of budget helped reduce the conflicts between PCU and hospital director and easier implementation, but it reduced incentive to write project to do the work that suit the area. The policy of the Ministry of Public Health to carry out health promotion and disease prevention by separating activities and duration may not suit every area. The reduction of budget allocation to the provinces in the Northeast effected health promotion work especially exercise.
