Abstract
This qualitative study aimed to propose options for developing urban health services system in Health Region 3. The study’s scope involved only primary care systems in urban areas of Nakhonsawan and Kamphaengphet provinces. Literature review, case studies, in-depth interviews, and focus group discussions were administered to collect the data, which focused on participants’ perceptions and collaborative decision-making. 260 informants were recruited purposively, including Mueang District Health Boards, senior health executives at regional and provincial levels, senior health managers from public, private and local government sectors, representatives from community, civil society and health system experts. Thematic and content analysis techniques were used for data analysis. This study showed that the Social Medicine Departments of the regional and provincial hospitals were the major organizations which were responsible for primary care services in urban areas. Though public, private and local government sectors also provided these services. Primary care service planning under the Primary Care Cluster policy was done mainly by the organizations under the Ministry of Public Health (MOPH). This study found that despite the improvement of the services quality, the services quality could not cover all areas nor created a sense of ownership for those in other sectors including civil society. The major challenge was the increasing service demand due to the increase in the number of aging population and patients with Non-Communicable Diseases. Also, there were a shortage of health workforces and lack of health promotion skills as well as a problem of not being able to use the budget effectively for health promotion because of incomprehensible understanding between the service units and the Office of the Auditor General and a lack of policy communication focused on the development of urban health services. The result showed that there could be 3 major options for urban health services system development in Health Region 3: 1) Management through single leadership of the MOPH (Current Model), 2) Management by collaboration between sectors through District Health Board (DHB), and 3) Management through transfer of health mission to the local governments. The assessment of the options showed that the current model may not be able to respond to the challenge effectively. The ideal option was management through the transfer of health mission to the local government, mainly because they were close to their people and could well understand their people’s health problem under the context of their areas, and can encouraged people to take responsibility for their health more effectively. However, these limitations were found; the government had yet to clarify the transfer of mission in relation to health services from the MOPH to the local governments, and, the local administration and personnel lacked the capacity to manage health services. This study proposed that a model of collaboration between sectors through DHB was the best option to move forward. This option could encourage all sectors to learn together and to become involved in the development of the primary care system in an urban setting collaboratively. It could encourage all related sectors, including the people, to have a better understanding of the roles and responsibilities of each sector and to lead to better self-management of the people in the future.
