Abstract
The study and summary of a case study of an experiment to transfer a health center to local administration organization, from a health center to Bangnomkho Municipality, Sena district, Phranakhon Si Ayutthaya. The objectives of the study are: 1) to study the process of establishment, techniques, and the actual transfer compared with determined principles, criteria, and important conditions; 2) to follow up product, result, and impact occurring from the transfer; 3) to analyze and summarize a lesson which has been transferred by comparing the expectation and actual events, and 4) to create policy suggestion, techniques, structure, conditions, and components of the transfer. A purposive sampling was used and consisting of provincial locals, experts, public health officers of the province, public health officers of the district, health center officers, public health volunteers, people’s representatives, and health center’s service users from the levels of province, district, and locals, from local administration organization, public health, people from 3 villages with a total of 377 people. The study covers 3 phases: before the transfer, during the transfer, and after the transfer. Research tools were unstructured interview, After Reaction Review (AAR), and structured interview.
The result reveals that the transfer which relates to quality of life promotion follows the Royal Act which determines plans and procedures of power decentralization to local administration organizations 1998. According to a resolution of the committee of power decentralization to local administration organizations, the main factor is law. The reasons are: 1) the readiness of Bangnomkho Sub-district Administration Organization, which received an outstanding award in management in 2006; 2) the Organization has been appointed as a pioneered Sub-District Administration Organization in transferring missions, and 3) from the evaluation, the community is ready and has received the approval from the committee of Sub-District Administration Organization Council. The second factor is the volunteering wills of health center officials.
The process of transferring includes the meeting of the province’s sub-committee before the transfer. They helped each other to study the transfer according to the mission in order to build up confidence of the officers who received the transfer. After the transfer, the Bangnomkho Sub-District Municipality gave the importance to health of people in the community by allocating the budgets to be used to promote quality of life, to support the purchase of materials, buildings, and others as well as following the plan which was set in the sub-district development plan. Concerning the arrangement of a stage to analyze and summarize the lesson using AAR, the expectation from people concerned, their roles, and participation in the transfer of health center in the provincial level showed that Bangnomkho had a strength and also a weakness which could obviously be improved in a national level. At a district level, it is believed that people’s ways of life did not change. After the health center was transferred, there would be more chance to take care of people’s health. The health center officials were confident that it would be improved. The health center’s service users hoped that the services would be better. Regarding the change of services in health care before and after the transfer and its processes, people were interested in following the news of the transfer the health center to be under the supervision of the municipality. They were aware of the result of the transfer of Bangnomkho Health Center. As for the level of people’s participation in the transfer both before and after, it was found that they did not participate in any aspect. Concerning the effect of health services, comparing before and after the transfer, both overall and in each aspect were found better. After the transfer, the level of change was positively higher.
The suggestions from the research in transferring public health in a district level based on the central policy are: 1) high ranking authorities should have a meeting, consultation, and discussion and work together to set up cooperative policy both from the Ministry of Public Health and Local Administration Organizations to make the transfer clearer in terms of length, clauses in law, measures which can lead to real situations; 2) the public health offices in the province and local area should initially promote the transfer to related people so that they can understand the policy and guidelines as well as providing information and consultation about administration, personnel, and budgets; 3) operational suggestions pertaining to health services in the municipality area, study of public health knowledge, lack of medical personnel, strategic plans to produce personnel, develop, promote, and support personnel in terms of knowledge, behavior, attitude in order to prevent diseases, self-caring rather than depending on medical treatment; 4) the analysis of the effect of health care services comparing before and after the transfer, the overall change indicated better condition, though it was not much because the study period was only 5 months, and 5) the participation of people in the transfer should not be only for awareness or receiving services, they should take part in the process of planning, providing more operational support so as to create more self-dependence in community health care
