Abstract
Decentralisation is a fundamental of the state policy; it is a one of main scheme that dedicated in the Constitution of the Kingdom of Thailand B.E. 2540. The plan and the process of Decentralisation to local government Act B.E. 2542, was enacted as a sub-constitution law under the Constitution Act. The important principles is a determining the procedures and timing period to transfer power from the central government to the local government organisation (LGOs). The Decentalisation plan is an important and systematic mechanism of successfully the Decentralisation policy. Although later it was announced the new Constitution in the year of 2550 the principle of decentralization is to remain unchanged additionally it is a major reason has been given the decentralised in health care reform occurs.
The concept of decentralisation in health, as shown in the decentralisation plan B.E 2543, it is the first issue states that a public health is a priority, one of which appears in the promotion of quality of life function. The mission identified several public health activities need to be transferred to the LGOs. This is part of the decentralisation of health is an important and concrete result in a major transformation of the Thai health care reform. Data from the study and follow-up operations shows that after promulgation of the decentralisation plan (first edition) in the year 2543 was the decentralisation of health, there is yet no clear and concrete progress as much. Despite there were some public health activities to be transferred to local governments. However, the evaluation was not operating in accordance with the procedures and methods set forth in the Plan. The National Board of Decentralisation-NBD as a national policy organization who’s acted as supervising and monitoring body of the policy are often and call for an operations on the issue of decentralisation in health. As a result, the Ministry of Health-MoPH has a fine way for the decentralisation of health in the year 2549, which important issues arise. The proposed models of transferring the mission to the local government on a variety of forms to suit the availability and circumstances of each area of four types: 1) transfer Split 2) transfer to Network 3. ) establish a public organisation, and 4) establishment of the Service Delivery Unit. In case of split transfer model as a separate unit has offered to transfer facilities in areas under the LGOs at different levels. This is an important turning point was an idea that is proposed to transfer the health centre to the LGOs at the different levels. The decentralization plan in Volume 2, published in the Year 2551 issue of the health centre has to transfer to the LGOs has been clearly defined in the Plan. The Health centre-HC determining the complete the final phase of the plan is that if the end of year 2553 can not proceed to completion, and then transferred to the Provincial Administration Organisation- PAO. The direction of health decentralisation is to focus on health centre transferred to local governments is critical to that time have undergone significant changes. The NBD has approved the transfer of the health center to local governments then in the late of year 2550 has been seriously driven and living an intensely driven political leadership of the senior administrators of the MoPH were successfully completed on issue of the Health Centre transfer to the LGOs. Perfectly targeted transfers by the total number of 35 and has transferred 22 of the Health Centre has completed at the first time and followed for 6 of the later included as a transfer 28 of the Health Center to the LGOs. It is an interesting and has been watching a lot of people involved. Regarding on evaluation found that in the first phase of the transfer of the obstacles in the nature of the connection that many unsettled, however, it was solved by approach manage well on a certain level. Yet the problem is a lack of planning and problem solving in a systematic way is to develop the strength and capabilities of the LGOs staff both the executive and operative level. Including uncertainty and policy advocacy that is not good enough that result of the Health Center from 7 to target the transfer of the first stage had to cancel the transfer with caused both by reason of the transferor and the transferee of the same. In later stage of the Health Centre transfers to local governments scheme has not been driven very strongly and clearly enough, especially in the central policy of the MoPH. Additionally in the local governments administrators that they are no clear in the uncertainty and ensure the sustainability of policies, there are many areas has changed the attitude of willing to transfer to the staff recruit plan by themselves. As well as find a way to produce and develop their own staff which wide affect the overall efficiency and fairness of the health resources allocation and distribution in the countries.
Overall progress on the issue of health decentralisation was beginning to change slowly and has accelerated in the late plan. Although the health decentralisation that occurred in the Thai health system will have been trying to format a variety of models, such as the Local Area Health Broad-LAHB, public organisation hospitals-POH, the Local Health Fund-LHF, etc. With regard to the Health Center under the local governments, this is a form of decentralisation by transferring a separate facility that have received attention and watch over both may have the option of decentralised system for health care appropriate to the context and reality. Due to health services that are specific, and public goods that much affect society. In this study, It is therefore proposed to review and select a form of decentralisation and careful analysis is very comprehensive. It should not be the single blueprint as a model nationwide. This is important topic that should be studied and analysed in terms of actual practice in each model carefully. Alternatively of the area health administration is one of health decentralisation it would be the alternative of interest can be integrated guidelines and form of decentralization in a variety of areas with problems and resource constraints similar. Each form of decentralization has been a body of knowledge and developed a certain level in Thai society. In the beginning, in the process of decentralisation of health, this is an issue that might be a solution that should be analysed and were taken to a form appropriate to the context of each area. The health decentralisation is based on knowledge, evidences and a participation of stakeholders at all levels.
