Abstract
Health service provision in urban area is a key challenge in Thailand as there is only tertiary care
hospital and a network of health center provides curative and health prevention services. As a result,
primary care services seem to be neglected. Recently, there are interventions to upgrade health health promotion services in Mueang districts of Nakhon Ratchasima and Burirum provinces. Capitation
budget for out-patient care is now transferred to CUP instead of provincial hospital. This study aims
to explore process in setting up those autonomous CUPs as well as key success factors and remaining
challenges in these provinces to be lessons learned for other provinces.
We reviewed documents and interviewed key informants who involved in setting up autonomous
CUPs or were working in those CUPs. Results showed that main purposes of autonomous CUPs were
to reduce crowdedness of provincial hospitals and to improve quality and access of health services
at health centers. One major change after the implementation was the increased numbers of staff
especially those of medical doctors and supporting staff. Key success factors are consistent with
policy direction at provincial and district levels as well as availability of retired medical doctors who
were key human resources. The remaining challenges were to increase active role of District Health
Coordinating Committee, integrate district health system principle and appoint responsible persons to
coordinate health service system within the district.
