Previous Steps On the Road of Health Decentralization : Review of Decentralization of Health Services to Local Government Organizations, 1999–2007

Abstract

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.