Abstract
This research study concerns the situation, potential and readiness of local government organizations,
communities and networks of health service units at the primary health care level which work in partnership
for local health. It is aimed at bring about improvements in the direction of and the role played by networking
of the tripartite members of the community health system. The study emphasizes the process of both the quantity
and quality approaches. The selection of the study area was made using the purposive method, with the
distribution being two provinces each in four regions of Thailand. They were included in both the primary area
with regard to their experience with the transfer of the mission of primary health care units to local government
organizations and with the cooperative efforts of 12 sub-districts. The method of this qualitative study involved
the use of a questionnaire with guidelines for interviews and focus group discussions, all of which had been
passed and tested by professionals. With regard to the study of the potential and readiness of local government
organizations, a scale was set up concerning the criteria and use of descriptive analysis.
The study resulted in significant information on the situation, capacity, and readiness of the network of
health services relating to policy dimensions and the system of support for health service providers, which still
has an incomplete structure, especially at the provincial level. However, at the district and sub-district levels,
the clearing structure has worked more effectively in some of the study areas with regard to the principles or policies governing the transfer of the health service mission to local government organizations in a different
manner. The number of health service providers, their capacity regarding knowledge, and their experience,
including duration of work, all have had a positive impact on their work as partners because, while individual
relationships are important, the supporting system still lacks capacity for the development of more effective
health officers working in communities and local areas. However, most health personnel possess understanding
regarding the management and use of information; they can report on the level of the working unit more
effectively than use the information for planning to solve problems at the area level. The capacity and the
readiness of individual communities were found to depend on the variety, role, and strengths of the community
leaders and the development groups within those communities. This observation includes the level of acceptance
of health service units and the local government organization in the area concerned, as well as the focus on
management, and bringing about good governance. Concrete negotiations on health from the community level
are still limited, particularly with regard to funding. The capacity and the readiness of the local government
organizations regarding the structure of the health system in most of the study areas varied by specific unit of
management capacity. The entire study unit was accepted by the communities with regard to the local politics.
However, the ability to obtain local revenues and generate income differs according to the size of each organization.
For expenses on health development in those areas, each obtains a little over 6.6 percent of the total
expenses from the study area. It was found that participation in the universal health insurance coverage scheme
in these areas was still limited, with regard both to policy setting in the area in order to extend the coverage to
all people in the areas concerned, involvement in providing and purchasing health services, including service
monitoring and practice management.
Important suggestions arising from the study as it concerned the health service network and communities
comprised the following: (1) support is needed for learning more about the local mechanisms for working
cooperatively for health; (2) improvement in capacity-building should be promoted in each sector clearly and
continuously according to their capacity and ability; (3) a mechanism and support system should be developed
such as a management system, and information system for planning, and implementing, and for monitoring
and evaluation.
Other suggestions called for (1) modifying the development goal regarding the transfer of the responsibility
for providing health services to the local government organizations in order to promote the concept and
process of partnership development among those in the health sector, local government organizations, and
community; (2) advocating policy mechanisms and organizational management at the district and provincial
levels for developing public policy on health, as it relates to social marketing and public communication on
health; (3) supporting clear and continuous capacity-strengthening measures for local governments, such as
databases developed to cover interesting case studies, and organizing appropriate activities for improving the
learning process on networking issues in all sectors.
