Abstract
This study aimed to develop health care delivery model in new normal era in subdistrict health promoting hospitals (SHPH) on the islands. The research and development were a method for this study. Data were collected by in depth interview and using the questionnaires in health care personal and people who came to receive care services at 53 SHPHs on the island. Focus group interviews were conducted among policy makers in 10 provinces to receive information related to structure, process, and care services. The preliminary analysis and the first draft prototype of health care delivery model in new normal era in SHPH on the island and the proposed policy were presented to local policy makers from 3 health zones to receive feedback and more recommendation. This process was conducted to make the health care delivery model and proposed policy relevant to each SHPH’s context and local people health need. The result of the study revealed that in Thailand, there are 58 SHPHs on the islands. During data collection process, the researchers were not allowed to collect data in 5 SHPHs in the southern part due to Covid-19 pandemic. In this study the report is based on 53 SHPHs on the islands including 50 SHPHs, 1 sub-district health station and 2 village health stations. About 87% of SHPHs were size S. the majority of people in the 6th health zone were Buddhists while the majority of people from the health zone 11th and 12th were Muslim and uses local dialogue to communicate. Local people were fishermen and agricultures while people from other places and living on the islands were wage workers. There were 201 health care personnel, 72.14 % were female with the ages ranged from 22 to 60 years (mean = 35.56 years). About 53% were community health personnel while 26.08% were professional nurses. In regard to work experiences in the studied SHPHs, the range of year were varied from less than 1 year to 30 years with the mean of 8.36 years. The majority of their responsibilities focused on providing primary medical care (86.34%), caring of people with chronic illnesses (85.30%) providing medical care procedures for patients with chronic illnesses at home. Work process barrios were staff shortage in particular nursing profession, communication with other health care staffs outside the islands, difficulty commute between islands and mainland and inadequate budgets. Work process facilitators were collaboration from local people and strong community network. All health care personnel stated that the workload was exceed manpower in SHPHs, they had to work overtime almost every day especially during the week ended and long holidays. In the famous tourist islands, health care personnel had to carry 3-4 folds of their workload during the holidays because of the large crowds of foreign and Thai tourists. After covid-19 pandemic, while Thai government encourage tourist business to booster country economic tourists flooded all famous tourist islands. In regard to their perception on work, they were very satisfying with their work because they realized that people in the community can rely on them. However, they were dissatisfying with their career advancement. Regarding the transferring of SHPHs from Ministry of Public Health to Provincial Administration Organization, all health care personnel had learned about this issue but most of them did not understand about the guidelines and did not assure their career advancement after the transfer. There were 642 people who come to receive care service and were invited to join in this study. The majority of them were female (78.66%) with the ages ranged from 20 to 90 years (mean = 49.80 years). Majority of them graduated from primary school, had chronic diseases, and received continuing care from SHPHs. Almost all of them stated that numbers of health care personnel should be increased and in every SHPHs nurses are main profession. During data collection we found that there was not a nurse in 16 SHPHs. High technology equipment was needed as well as the need for prompt emergency medical care while they have emergency and critical illnesses. Similarly, the local policy makers stated that people on the islands should receive standard care relevant to their health needs. Health equity is their right and access to health care services should be similar to ones who live on the mainland. In conclusion, in new normal era care services provided in SHPHs on the islands should be advanced the level of services up to the level of community hospitals. Three prototypes of SHPHs on the islands were developed based on the context of the islands including; SHPHs on the main tourist attraction island, SHPHs on the non- tourist spot island and SHPHs on the big island with a community hospital. The expected outcomes emphasize on rescuing patients with emergency and life-threatening illnesses and providing comprehensive care services for people living on the islands. The policy proposals from this study include, drafting the new standard for SHPHs on the islands using the 3 aforementioned prototypes, encourage people and community engagement, embed travel medicine in the foundation of SHPHs on the islands and allocate 2-3 emergency nurse practitioners for each SHPHs on the islands. Moreover, to make smooth transferring process of SHPHs to Provincial Administration Organization, definite guidelines should be announced to make all health care personnel become certain about this process.
