Abstract
Since 1999, the Ministry of Public Health (MOPH) has transferred 28 health centers to 28 local governments (LGs). There were both success and failure. Most of LGs accepted that they lack capability in both health care management and financing. It was essential that MOPH find out other alternatives for decentralization as the law assigned. This was the rationale why needed a study. The research had four important objectives including 1) finding out the alternatives for managing health care units of the MOPH after decentralization. 2) analyzing the appropriate roles of the MOPH linking with the LGs for health promotion and disease prevention in local areas. 3) analyzing the roles of the MOPH’s different organizations after decentralization and 4) analyzing the appropriate overall system governance after decentralization in order to achieve better health care. The research methods consisted of reviewing the national and international experiences on health care decentralization, and brainstorming of the representatives from MOPH, NHSO, LGs, NGOs, experts and community. The obtained data was analyzed with content analysis technique. Then the results of analysis was synthesized and presented descriptively, complementing with relevant tables and figures.
The result of the study pointed out six important issues comprising, first, health care decentralization in the Thai context was a means rather than an end. The definition was far more meaningful than just the transfer of health care units to LGs, concentrating on population’s beneficiaries. Second, area health, under the responsibility of the area health board supporting by the MOPH, was the most appropriate option for decentralization since the health care system was united ,not fragmented, especially the referral system. There was economy of scale. The area health was very flexible allowing all stakeholders to join in both service administration and delivery. Good governance was feasibly developed. It could solve the problem of conflict of interest at both policy and operational levels. However, there was a lack of legal statute to support. The area health required expertise recruited as a board member which was very scarce in local area. Third, the appropriate roles of the MOPH connecting with LGs for health promotion and disease prevention should focus on quality of life improvement, the specific target group services, endemic disease control, and social services provision which were the social determinant of health. The MOPH needed to take responsibility for the pandemic disease control and advanced epidemiological technique development. Fourth, roles of the MOPH changed much after decentralization. The MOPH had important roles in policy setting, law regulation and collaboration with international agencies. The units of the MOPH played an important role for putting the declared policy into practice via health care planning, monitoring and evaluation, resource allocation, technical support and coordination with other organizations. Fifth, the overall system governance needed a combination of formal bureaucratic system, market mechanism to improve efficiency, and partnership in health working for good governance. And, finally, it should be bewared that there were some effects of decentralization concerning health personnel’s tenure and motivation, and the incapability of some LGs. The study recommended that the meaningful definition of health care decentralization should be publicly advocated. The area health should be more deeply studied and proposed as a national policy. The national board of health care decentralization was essential that it needed to be taken into consideration for the sake of continuous decentralization planning and development. The relevant regulations and laws needed to be revised and mandated in order that the decentralization could be implemented flexibly, especially the establishment of area health and the designing of the new roles of MOPH and its organizations. Finally, it was recommended that the area health need urgently studied in terms of the relations of the structure, authority and service delivery to be clearly figured out.
