Abstract
This research is aimed to achieve this following objectives (1) to analyze and design measures to support and drive health area development of pilot health areas (regulatory sandboxes) including criteria/ indicators to monitor operations and evaluate achievement from developments, (2) to monitor implementation of regulatory sandbox measures in pilot health areas with health area teams, (3) to evaluate results from implementing regulatory sandboxes in pilot health area, and (4) to propose proposal to improve rules and regulations to support area health developments to become integrated and co-responsible development mechanism. This is an analytical, operation, and evaluation research with Health Area 1, 4, 9, and 12 as pilot health areas. Research team worked with ministry of public health executives, health area executives, and other related ministry of public health staffs to draft regulatory sandbox proposal to drive health area development in pilot health areas. The regulatory sandbox proposal covered 5 dimensions of health development building blocks which were (1) leadership and governance, (2) human resource, (3) health financing, (4) information and communication technology, and (5) health technology and innovation leading to delivering expected results in solving national level health agendas (Big Rock). Moreover, the research team also designed monitoring and evaluation framework by setting criteria and indicators for monitoring and evaluations adopting Objectives and Key results (OKRs) concept which allowed all relevant sectors from operators to executives to participate in operations, and express their opinions regarding problem solving, and improving overall operations in health area development to more innovative and creative development. Results of regulatory sandbox evaluation are as follows: 1) Comparative Evaluation between Before and After Pilot Health Area Development: It was found that pilot health areas had progresses in several issues which were leadership and governance, human resource management and development, and health financing as measures in the sandbox allowed easier and faster managements. Regarding information and communication technology, all health areas had significant development leading to faster and more convenience services. However, there was no significant progress nor operation that leads to introducing new investments in financing innovation or health technology that could match what was expected in reform purpose. But if we considered overall achievement of having health areas that could absolutely manage within their areas, we concluded that health area succeeded at their beginning phases, and the ministry level push is needed in improving rules and regulations that were obstacles to expected health area management, as well as integrating health policies with other health related agencies which would lead to absolute health area management. 2) Comparative Evaluation between With (Pilot or with regulatory sandbox) and Without (Non-Pilot or no regulatory sandbox) Health Area Development: It was found that Leadership and Governance: Pilot health areas could achieve all targets in this aspect while most of non-pilot health areas were in processes of appointing health area board of directing committees, and health area board of managing committees. However, non-pilot health areas already had their annual action plans which were guidelines of health area operations. Human Resource: Pilot health area’s integrated management and service mechanism allowed pilot health areas to have management tools to solve human resource management problems of each pilot health area, took shorter time, and had flexibility in human resource management, and allocation as health area board of directing committees were empowered to manage human resources in their health areas. On the other hand, non-pilot health areas still faced human resource management problems such as unclear manpower, and unmatched to health context changes in the health areas. Health Financing: All 12 health areas attempted to integrate sources of funds in health management with other health related agencies within health area such as National Health Security Office, Social Security Office, and Local Government Units. This was a key success factor for solving insufficient resources (especially budgets) in the areas as it would allow the health area to implement and emphasize in activities/ projects that could deal with specific problems or respond to health needs in the area. However, even the pilot health areas had measures from sandbox for integrated service providing and management in the area, they could not enhance the pilot health areas to have absolute financing management. Information and Communication Technology (ICT): In general, the pilot health areas had more concrete actions compared to non-pilot health areas as there were electronic patient health record development, health area database system, and digital transformation planning in hospitals in pilot health area. However, there was significant ICT development in Health Area#8 such as R8 Anywhere to connect all patients’ information in the health areas. Health technology and innovation: Pilot health areas had clearer attempts to uplift their service standards, and resource management, as well as more numbers of projects. However, researchers found significant operations in this aspect in Health Area#8 such as One Stop Service, public health developments for those in jails and foreigners. On the other hand, both pilot health areas, and non-pilot health areas still managed under single source of fund (budget), and had not considered having private sector participate in health service arrangement in the health areas, which might not be enough for solving resource scarcity and sustainable health financing within health areas. Evaluation results also indicated that rules and regulations were one of reasons behind problems and obstacles in health area development as it related to status of the health area office, as well as health area administration. In order to find solutions to clear these obstacles, the researchers proposed approaches to improve laws, rules, regulations, and notices to enhance integrated service provisions., and absolute administration in the health areas to achieve targets as follows: 1) Proposal to improve rules and regulations regarding leadership and governance such as Ministry of Public Health Regulation regarding Health Area Establishment for Health Area Development B.E. … 2) Proposal to improve rules and regulations regarding human resource management such as management within health area office, seeking and appointing people, exemption of rules and regulations in management. And 3) Proposal to improve rules and regulations regarding health financing such as allowing health area office to integrate all funds in the area.
