Abstract
At present, the Royal Thai Government tends to instigate policies to downsize civil servant posts with a purpose to reduce its budget burden and increase system flexibility and efficiency. These policies affect not only supporting/administrative health staff, but also the health professionals themselves, including doctors, dentists, pharmacists and nurses. The objective of this study is to explore the current situation and types of employment for the Thai health personnel under the Office of Permanent Secretary of the Ministry of Public Health (MOPH). Cross-sectional mixed-method design was used. Data collection techniques comprised document reviews, indepth individual interviews with policy makers and health personnel users, and group interviews with, and self-administrative questionnaire survey on, health personnel. The interview questions focused on advantages, disadvantages, and recommendations for each employment type. The study also included analysis on health personnel retention and budget implication for paying salary to doctors, dentists, pharmacists and nurses in the next 15 years. The results revealed that according to policy makers’ and health personnel users’ perspectives, hiring health personnel as civil servants faced a number of constraints, including rigid bureaucracy and inflexibility in adjusting personnel’s positions to match their expertise. Yet civil servant posts should continue in certain functions, for instance, those dealing with legal issues and authoritative work. From the views of health personnel, civil servant employment is a crucial determinant in making them retain in the public sector because of work security and attractive benefits, especially treatment benefit for themselves and their family members. In the future, there should not be too many employment alternatives. If new civil servant posts are not available, the replaced employement choices should guarantee increased startup salary and additional benefits that are not inferior to the regular benefits for civil servants. Overall, the design of employment benefits should minimize discrepancy and inequity between employment types and between professionals. The MOPH should shift its role from being health care providers to being health policy regulators. Local health facilities should have more flexibility in designing employment benefits that suit their own staff while engaging local administrative authorities since the inception stage of the design. Besides, there should be mechanisms that provide opportunities for younger generations of health care providers to design and choose their employment benefits that fit their need before entering the labor force.
