Abstract
This study was conducted to learn of the changes that had occurred during the five-year period of
the transfer of subdistrict (tambon) health centers to Tambon Administrative Organizations (TAOs) and
municipalities. Both quantitative and qualitative data were collected from primary and secondary sources;
and then data were processed and policy recommendations were synthesized for submission to highlevel
administrators of the Ministry of Public Health (MoPH) and other relevant agencies in the next phase. Documentary review was conducted on program implementation documents of agencies concerned,
various evaluative research papers, and reports on program monitoring and evaluation carried out continuously
by administrators of the local government organizations (LGOs), the transferred health officials,
and the people who had received health services from the health centers before and after the transfer,
and the participatory observation of the transfer process especially to the LGOs as the management
agencies. The results in the three dimensions are as follows: (1) The progress of the transfer, over the past
five years, have shown positive changes in most of the local health programs as their services are responsive
to the needs of the communities. Of all 26 transferred health centers, only 2 health centers had only 1
health official transferred to each of them, which was too few and the recruitment of additional staff by the
local agencies was constrained by the local context. (2) The lessons learned from transfer with regard to
specific cases and overall common lessons are the information that can be used for consideration for
policy and operation improvements. (3) The policy recommendations for MoPH and the Office of the
Decentralization to Local Government Organizations Committee (DLOC) regarding the options of transfer
are: (a) transfer in the old pattern, but with the revision of criteria, conditions, and process to prevent
negative effects; and the roles and responsibilities of relevant agencies have to be made clearer by an
independent mechanism; (b) the new model of transfer, i.e. MoPH has to take this matter seriously especially
in the pilot-scale decentralization and the synthesis of lessons learned; and the DLOC has to have a
strong and adequate support mechanism and procedures; and (c) non-transfer but working together
collaboratively by MoPH and LGOs with clearly specified roles and responsibilities.
