Abstract
The objectives of this project are to develop patterns or mechanisms to support evidence-based policy decision-making, especially for issues that are complex, involve many stakeholders, and/or have a limited time frame. This project focuses on the transfer of the duties of Chaloem Phra Kiat 60 Years Nawamin Maharachini Health Center and Tambon Health Promoting Hospital (THPH) to the Provincial Administrative Organization (PAO), which occurred in the fiscal year 2023. There are four main processes: (1) building up two main teams, a small working group as a core team called “Working Ant Team” to monitor the situation of the transfer, and a larger working group called “Thailand Team” for stakeholder participation including policymakers, specialists, and academics; (2) monitoring the situation of the transfer of the duties of the health centers and THPHs to PAOs via several methods, such as literature review, attending training or meeting related to the transferring; 3) interviewing stakeholders; and 4) surveying the progress of policy implementation and opinions of PAOs and Provincial Public Health Offices (PPHO). Data were analyzed and consulted within the Working Ant Team for perspective sharing between researchers and policymakers. The concept of the six building blocks of the health system from the World Health Organization (WHO) was used as a framework for analysis. The concept of primary healthcare measurement framework and indicators from the WHO was used as a framework for monitoring the progress of related research and conducting a research mapping. The results revealed that, in the fiscal year 2023, three thousand two hundred and sixtythree health centers and THPHs transferred from the Ministry of Public Health to PAO in 49 provinces. The manual for transferring the duties of the Chaloem Phra Kiat 60 Years Nawamin Maharachini Health Center and THPH to the PAO in 2021 mentioned roles and responsibilities specified to responsible institutions. Analyzed the manual with the six building blocks of the health system, the issues of the drug and medical devices and health information systems were less detailed than other systems. Before the transfer, important activities were communicating the guideline in various methods such as official documents, orders for rehearsal of understanding, training workshops, or meetings, and introducing regulations for clarification procedures. One of the main problems to implement the manual was the lack of clarity in transferring health workforce issues, such as the issue of hiring, incentive, career path, and job description. The Ministry of Public Health’s employees faced the most impact of transferring because this type of hiring is specific to the regulation of the Ministry of Public Health while there has not been a regulation for hiring like this in the Ministry of Interior. The survey of readiness of PAO and PPHO for transferring the health centers and THPHs from August to September 2022 revealed that the three most ready activities of PAO are establishing “the Committee for Health in Area Level” (CHA), meeting of CHA, and documenting a plan for health in area level. Opinions those PAO and PPHO agree with are about the roles of PPHO. PPHO should 1) regulate and control the standard of care of the transferred health centers and THPHs 2) technical support and supervise the PAO, and 3) participate in the development of the health information system of PAO. Mapping of research related to transferring the health centers and THPHs revealed 18 research projects. Four projects finished are about the allocation of budget from the National Health Security Office, the standard of care, health workforce, and prototype of primary health care system. This study documented the situation before the transfer of the health centers and THPHs and after transferring on 2nd October 2022 to November 2023. There are 4 main issues to further follow up: (1) allocating of health workforces of both PAO and PPHO, (2) monitoring and regulating of transferred health stations and THPHs, (3) policy implementation of PAO such as management of health resource, development of health information system, and management of drug and medical devices system, (4) roles of the Ministry of Public Health according to the manual of transferring. For patterns or mechanisms to support evidence-based policy decision-making, the Working Ant Team and the Thailand Team should keep monitoring the situation continuously. The objectives for the further phase should be (1) to support evidence-based policy decision making for ensuring primary health care in Thailand keep progress with the least impacts from transferring and develop for better before transferring, (2) to monitor the situation after the transfer in the fiscal year 2023, as an overview of the country, connecting with stakeholders, and contextualizing with information in area level (3) to monitor the progress of research projects related to the transfer and update the research mapping (4) to expand stakeholder participating for both policymakers and implementers including the public health side, the local government side, and the academic side.
