Abstract
In Thailand, the devolution of subdistrict health promoting hospitals to provincial administrative organizations (PAOs) depends on the readiness and willingness of each PAO. In Fiscal Year 2022, six PAOs took full responsibility of all the subdistrict health promoting hospitals in their provincial areas: Khon Kaen PAO, Nongbua Lumphu PAO, Mukdahan PAO, Prachinburi PAO, Roi-et PAO, and Suphanburi PAO. This study sought to develop a model of primary care for the PAOs that possess limited revenue streams and have agreed to take charge of all the subdistrict health promoting hospitals. A strategic framework for citizen engagement and intersectoral collaboration in primary care was also formulated for these PAOs. The research instruments used in this study included focus group discussions, in-depth interviews with primary care experts and local government scholars, workshops, and a survey of subdistrict health promoting hospital personnel and health volunteers in Prachinburi and Suphanburi provinces. Based on the research findings, Prachinburi province has more administrative capacity and social capital than Suphanburi province. Administrative capacity and social capital enabled the Prachinburi PAO to manage the transition period much more effectively. The Prachinburi PAO executives and leaders in the provincial health system followed the “shared leadership” style, while their counterparts in the Suphanburi province used the “paralleled leadership” style. Also, the PAO and provincial health authority in Prachinburi had a more robust working relationship prior to the devolution of subdistrict health promoting hospitals. When we used the “six building blocks” concept and the “ten building blocks of a high-performing primary care” concept to assess the two PAOs’ readiness to run their primary care systems, we found that the Prachinburi PAO performed better than the Suphanburi PAO in terms of service plans, personnel, medicine, information system, financial resources, and leadership and governance. In the end, we developed a model of primary care, which consists of the primary care management unit within the PAO Public Health Department, as well as three alternative models of primary care operations at the sub-provincial level. In addition, policy recommendations for other PAOs, the Ministry of Public Health, the Decentralization Commission, and the Department of Local Administration Promotion were offered.
