Abstract
This study aimed to 1) assess the lessons in relation to decentralization process and outputs from the decentralization of subdistrict health promoting hospitals (SHPH) to provincial administrative organizations (PAO) and 2) develop the policy recommendations in order to strengthen the decentralization process and to mitigate negative effects of decentralization. The study was carried out in 5 provinces where all SHPH in a province were decentralized to PAO. Both qualitative and qualitative data collection techniques were employed. Data collection tools comprised semi-structured interview guide, questionnaire survey for health personnel working at SHPH and questionnaire survey for people using services at SHPH. Seventy key persons from provincial, district and sub-districts levels were interviewed. Five hundred health personnel from SHPH and five hundred patients receiving services from SHPH were the target of the survey. The results showed that, in the first year of the decentralization, key problems encountered were: (1) lack of effective administer mechanism including, incapability of the Health Area Board (HAB) to function as expected, (2) lack of mechanism to coordinate multi-stakeholders in district levels, and ineffective Health Division of PAO, (3) reduction of health service utilization after decentralization, especially for dental services, health promotion services and disease prevention activities, and (4) health workforce management problems in relation to recruitment process, career advancement, incentive support, capacity building and supervision. In addition, the decentralization seemed to affect the relationship / coordination between the so-called “3 Doctors”, namely village health volunteers, SHPH personnel and doctors from district hospitals. To address these challenges, the recommendations were: 1) strengthening key administrative mechanisms of HAB, Health Division of PAO, and administrative authority at district levels, 2) developing effective health workforce planning and management, and 3) developing key performance indication by national authorities according to The National Primary Health Care Services Plan and cascading down to provincial levels and sub-district levels, so that the primary health care services will be able to operate coherently
