บทคัดย่อ
Several health system reform initiatives have been implemented in
Thailand during the past decade. These include the establishment of Health
Promotion Fund from sin tax, establishment of Universal Healthcare Coverage
System and Emergency Medical Services System, enactment of the National
Health Act, and etc. As a result, Thai health systems have been improved in
many areas including access to essential healthcare, increase of people
participation in health promotion activities and health policy process. Among
all health reform initiatives, decentralization of healthcare management has
less progress as compared to the others.
Thai Constitution of 1997 accelerated process of healthcare
decentralization through the development of the Decentralization Action Plan.
This plan indicates which public services should be transferred to be managed
by local authorities. And because of these transferred responsibilities, related
government budget and staff will be transferred accordingly. However, after 10
years of implementation, only 28 from more than nine thousand health centres
have been transferred to sub-district or Tambon administrative organizations
and municipalities. Most of public health facilities remain with the Ministry of
Public Health.
Healthcare decentralization does not mean only the transfer of public
health facilities to local authorities although it is the main focus as indicated in
the Constitution. Health Systems Research Institute (HSRI) has supported
many research projects to clarify this issue and also propose recommendation
on appropriate model of healthcare decentralization. This document is part of
our effort to review historical development of healthcare decentralization in
Thailand. We believe that based on thorough review of past experience, both
nationally and internationally, we can move forward with strong confidence
that Thai people would benefit from this reform initiative.
