Abstract
The objective of this study is to examine access to and obstacles in accessing health promotion and disease prevention services in health-promoting hospitals Sub-district transferred to the Provincial Administrative Organization (PAO), Kamphaeng Phet Province. The data was collected through in-depth interviews, questionnaires, and group discussions. The participants were selected based on specific criteria through in-depth interviews and group discussions with service providers, recipients, and stakeholders, totaling 70 people. The questionnaire was distributed to 418 service recipients. Content analysis and statistical analysis were used to analyze the data. The study found that during the transfer of the Sub-district Health Promoting Hospitals to the provincial administration in Kamphaeng Phet, the primary healthcare services provided to socially isolated elderly people through the hospital network remained unchanged. For example, community hospital or hospital network continued to provide support in terms of medicine, medical supplies, and medical equipment to the health center just as before the transfer. However, there were still some obstacles to service delivery, including 1) Insufficient personnel for service delivery, particularly in cases where health centers did not have enough staff to support the transfer or did not meet the required staffing levels. 2) No family medicine physicians were available to provide services at health centers as required by law. 3) Delayed and restricted budget allocation for supporting health centers. 4) Personnel were concerned about compliance with the Ministry of Public Health regulations. 5) Village health volunteers were concerned about work practices. 6) Communication of information was not comprehensive. 7) In the long term, community hospital or hospital network may not be able to allocate resources (people, money, materials) to health centers outside its jurisdiction. On the patient side, the study found that patients without transportation or who worked on a daily basis were unable to access services/activities. In addition, it has been found that the public places importance on promoting health and preventing diseases. According to a survey of factors influencing the decision to use basic healthcare services among socially isolated elderly people in Kamphaeng Phet province, they generally expressed a high level of satisfaction with the basic healthcare services, at 67.7%. They also had a high level of interest in overall activities, at 51.9%, with the top five activities they wanted organized being group exercise, elderly schools, elderly clubs, vocational training for the elderly, and monthly meetings to reduce stress among the elderly. Furthermore, the majority of the elderly people believed that if the health-promoting hospitals Sub-district transferred to the PAO, the quality of service would improve, at 72.8%. This is because it would be a change in management and service delivery to a larger organization that would be better able to manage budget, personnel, vehicles, and equipment to provide better service. The desired activities after the transfer, ranked in order of importance, were having a resident physician at the public hospital, having exercise/health promotion activities for the elderly while waiting for medication, and having more staff available at the public hospital. The results of this study will be useful for guiding service provision in the context of health-promoting hospitals Sub-district under the PAO that are responsive to the needs of the population, comprehensive, and integrated, which will improve the quality of life of the people.
