Abstract
This study utilized qualitative study papers and reports on the process of decentralizing health care. The study employed a quantitative method, using questionnaires on 8,199 villagers. It was aimed at understanding the process of the transfer system of public health centers (PHCs) to a local government organizations (LGOs). Specifically, the study focused on the process of setting up the transfer mechanism, monitoring the product and output, analyzing and summarizing the lessons learned, as well as providing policy recommendations relating to the mechanism and structure for transferring the PHCs to the LGOs. The research was conducted from September 2007 to October 2008.
Research results confirmed that the PHCs under study followed the mechanism and process of the transfer system to the LGOs. However, some difficulties pertinent to time constraints and communication problems at all levels were encountered. With respect to the product, we have discovered that there were four types of transfer system: (1) the complete transfer of PHCs and personnel; (2) the complete transfer of PHCs and some personnel; (3) the transfer of some PHCs with all the personnel of those PHCs; and (4) the transfer of some PHCs with some personnel. The majority of the PHCs employed the second type. Different types impacted the management of work, budget, personnel and materials differently. Relating to the output, we have learned that the ideas and paradigms of public health decentralization to local areas were significant and made the transfer system efficient by generating people’s participation and coordinating consistently with the public health network. In terms of policy and development strategy implemented at the local level, we have discovered that they emphasized the idea of ervice to all, stimulated proactive work, and improved policy, strategy and planning for public health and environmental activities parallel to the development of the infrastructure. Also, we discovered some problems relating to the management of work, budget, personnel, property, aterial, medicine and medical supplies following the imprecise rules and regulations issued by the Ministry of Public Health and the Ministry of Interior. Factors contributing to the success of the transfer included cooperation, leadership ability, having organizational vision and management ability in the LGOs.
Recommendations for transferring the PHCs to the LGOs are as follows. At the policy level, the national decentralization committee should have a clear integrated policy and establish a national coordinating body to be responsible for informing the public of the value, ideas and benefits of public health decentralization. At the provincial and district levels, it is necessary to have a proper academic supporting mechanism based on the participation of all parties concerned for monitoring and supporting the transfer of the PHCs to the LGOs smoothly and to communicate efficiently with all parties concerned during and after the transfer. At the community level, we suggest that the LGOs and the PHCs should abide by the principle of people’s participation, starting from local public organizations to local civil societies in decision-making for the transfer of the PHCs to the LGOs and in supporting community health development planning.
