การพัฒนารูปแบบผสมผสานการดำเนินงาน งานป้องกันและควบคุมโรค ระดับอำเภอ อำเภอวัดโบสถ์ จังหวัดพิษณุโลก

Abstract

Model development for integration of disease prevention and control at the district level, Watbat district, Phitsanulok province Disease prevention and control at district level was divided into communicable disease (CD) and non-communicable disease (NCD) prevention and control. Organization, personnel, operational process and project planning of CD and NCD were clearly separated by emphasizing to specific problems ordiseases. Lack of integration by target groups, health resources, personnel use, timing of activity methods caused low efficiency, working overlaps, inappropriate time and resources usage. Objective of this study was to develop integrated model of disease prevention and control at Watbot district, Pitsanulok province for increasing efficiency of health projects and decreasing waste of resources. This study design is action research followed by six steps. Situation analysis of organizational structure, health projects and disease problems information at district level was the first step. Study of natural history of disease prevention and control process for analyzing relevancy of CD and NCD was the second. Priorities and disease scope setting was the third. Integrated model design of organizational structure, disease surveillance, disease prevention and control, information system, management and personnel development was the fourth. the fifth step was integrated project planning in major 5 projects consisted of integrated management and personnel development project, integrated active disease surveillance project, health education and health promotion project, disease information system development project and comprehensive health service system development project. The step was evaluation of budget, personnel, resource and activity integration, work load decreasing, efficiency of service and cost of project operation. Study of disease nature and disease prevention and control process in target group. area, timing and activity methods found some similarities between CD and NCD , that cause possibility to design integrated projects in both academical and managerial aspects: (1)Management integration was done by organization setting, flexible budget sharing, personnel and resource sharing. (2)Integrated active disease surveillance in11 diseases of both CD and NCD improved effectiveness by increasing coverage of service from 2.67 to 6.75(percent) for over 15 years old people and from 2.84 to 11.36(percent) for over 35 years old people. The integrated method decreased 32.3 percent of provider costs and 70.58 percent of client costs, and decreased personnel work load as well saw use of resources.(3) Health education integration by activity model and target groups caused decreasing of activity costs, time use and work load.(4) Integrated disease information system was designed between CD and NCD. (5) Home health care service in both CD and NCD in community, disease investigation, epidemic control and chronic disease service system in health center were developed.