Abstract
This qualitative study aimed to propose options to develop urban health services system in Health Region 3. The study’s scope involved only primary care systems in urban areas of Nakhon Sawan and Kamphaeng Phet provinces. Literature review, case studies, in-depth interviews, and focus group discussions were administered to collect the data, which focused on 260 participant’s recommendations and collaborative decision-making. The data were analyzed by thematic and content analysis. The Social Medicine Departments of the Regional and Provincial Hospitals were the major organizations responsible for management of primary care services delivery in urban areas. Though public, private, and local government sectors also provided these services. However, under the primary care cluster policy, primary care service planning was done mainly by those under the management of the Ministry of Public Health (MOPH). At present, despite the improvement of curative service quality, it cannot cover all areas nor create a sense of ownership for those in other sectors. The major challenge both at present and in the future is the increasing service demand due to the increase in the number of aging population and patients with non-communicable diseases. Also, there is a problem of not being able to use the budget to effectively promote health and disease prevention because of incomprehensible understanding between the service units and the Office of the Auditor General and the lack of policy communication focused on the development of urban health services. The result showed that there could be three major options for urban health services system development: (1) Management through single leadership of the MOPH (the current model), (2) Management by collaboration between sectors through District Health Board (DHB), and (3) Management through transfer of health mission to the local government. The assessment of the options showed that the current model may not be able to respond to the challenge effectively. The ideal option proposed by the key informants is management through the transfer of health mission to the local government, mainly because they are close to the people and can understand the context of the area well, and encourage the people to take responsibility for their health effectively. However, limitations were identified as: the unclear government policy to transfer health services mission from the MOPH to the local government; the lack of local administration and personnel capacity to manage health services; and the leadership of local government executives. The present study proposes that a model of collaboration between sectors through DHB is the best option to move forward. This option can encourage all sectors to become involved in the development of the primary care system in an urban setting. It can encourage all related sectors, including the people, to have a better understanding of the roles and responsibilities of each sector and lead to better self-management of the people in the future.
