Abstract
This research studied on manpower management of Chaloem Phrakiat 60 th Anniversary Nawaminthrachini Health Station and Subdistrict Health Promoting Hospitals in a case of transferring to the local government organization using the mechanism of the Primary Health System Act 2019 . The aims of this research were to study the situation of manpower management and manpower management needs. This research also proposed to develop manpower management policy proposals after transferring missions to local government organization. Qualitative research was conducted and divided into 3 phases. Data was collected in the provinces transferred to local government organization (Subdistrict Administrative Organizations and Municipalities) and provinces transferred to Provincial Administrative Organizations. The key informants were administrators from the Provincial Administrative Organizations and Provincial Health Offices which formed the policies for health manpower management and health personnel who were practitioners in teaching and Subdistrict Health Promoting Hospitals that have been transferred. This included representatives of village health volunteers and representatives from the public sector that used healthcare services Results The comparison of the health manpower after transferring to local government organization (Subdistrict Administrative Organizations and municipalities) indicated that there were an increase numbers of teaching professionals and Subdistrict Health Promoting Hospitals everywhere. However, the numbers of health manpower were not yet covered in full capacity. After transferring, a variety of health services were organized to cover both modern medicine and alternative medicine focused on people access to the services by "close to house and close to the heart". People were easier and more convenient than in the past. The services responded to the needs of clients. There were fast communication channels, modern equipment, decreasing the costs and having fairness. This was a quality primary health service. Administrators provided opportunities to create innovations in health service models based on the problem conditions in each area. which made the people satisfied. In overall, health manpower of teaching professionals and Subdistrict Health Promoting Hospitals transferred to Provincial Administrative Organizations revealed that all professional personnel were not transferred and there was less manpower than before transferring. As a result, health personnel were not enough for healthcare services, especially teaching professionals and small or medium sized health care hospitals. In addition, it was found that some teaching institutes and Subdistrict Health Promoting Hospitals had transferred their missions to Provincial Administrative Organizations. However, no health personnel were transferred. Policy recommendation for health workforce management to relevant parties were the issues as follows: 1) The Ministry of Public Health should play a key role on supporting necessary professional personnel for teaching and Subdistrict Health Promoting Hospitals to have a similar number of personnel before transferring and can provide seamless health services. There is no interruption in service provision. For government personnel who do not wish to transfer, they can temporally work on duty in the government service not more than 2 years and can receive the rights and welfare benefits the same as or more than in the past for the morale and encouragement of the workers. In addition, The Ministry of Public Health should create a personnel information system by connecting with the information systems of local government organizations. Further, The Ministry of Public Health should take responsibility for controlling and supervising the quality standards of the service unit as well as creating a curriculum for human resource development in collaboration with localities to develop competencies and capabilities of personnel that are standards for health service provision. 2) The Ministry of Public Health must consider an urgent agenda for preparation in order to adjust the structure, roles, missions and develop the skills of personnel in the District Health Office. This action is for adjusting their role on coordination in the future and to develop quality standards and supervise primary care units in accordance with the policy of the Ministry of Public Health that has established the Primary Care Division as a new unit to supervise the quality and standards of primary care units throughout the country. The Ministry of Public Health should accelerate the development of personnel, including mechanisms for supervision, monitoring, and evaluation of the performance of teaching and Subdistrict Health Promoting Hospitals, as well as providing opportunities for the public sector to participate fully. 3) The Ministry of Public Health should join with the Department of Local Administration to expedite the preparation of performance standards for teaching staff and Subdistrict Health Promoting Hospitals under the local government organizations throughout the country. The propose is to develop the quality and standards of local primary health care services and to respond to the overall health policy of the country. Further, it also solves the complex problem operations between primary and secondary healthcare services, and the separation of primary and secondary management including referral systems. 4) The Decentralization Committee to local government organizations should provide regulation in considering the readiness of teaching staff and Subdistrict Health Promoting Hospitals for personnel to be transferred. This helps to protect the impact on public services, especially teaching and Subdistrict Health Promoting Hospitals that can be transferred. The process should have voluntary personnel to be transferred at least 70 percent including professional personnel such as public health academics, professional nurse who are ready to work and provide health services to the people. 5) The Department of Local Administration should accelerate to study regulations and various rights that professional personnel previously received from the Ministry of Public Health. Additionally, Department of Local Administration should speed up the issuance of regulations to support the various benefits of the transferred personnel in order to receive various benefits that are not different from the original Transfer Act. This encourage to build confidence for personnel transferred to the local government organizations, especially career advancement, rights and welfare that they will receive as well as creating plan to promote position of personnel to the senior professional level. 6) The Department of Local Administration and Provincial Administrative Organization need to urgently formulate the appropriate PCU or NPCU, including (1) the manpower framework, chain of command, a clear progression of career path and resource support system, (2) fields of work in PCU or NPCU, (3) the maximum population that can provide quality care, personnel structure framework and appropriate population proportion in each area such as at the remote areas. 7) Provincial Administrative Organization needs to provided family physician services in primary care units and primary care networks to take care of the people in an appropriate proportion. The network of family doctor clinics must be expanded to cover all primary care units transferred. This enhances to create service access, increase service quality appropriately to the context in each area with the cost that the system can afford under the time frame specified in the Primary Health System Act 2019. 8) Provincial Administrative Organization should expedite to formulate health development plan, determine the strategy of the service system as well as recruiting knowledgeable personnel to serve as the director of the Public Health Division.
