Abstract
The study of policy briefs to service management in health promotion hospital after transfer to provincial administrative organization is a mixed-methods research, with the objectives of 1) extracting lessons learned from service provision in Sub-district Health Promoting Hospitals transferred under the Provincial Administrative Organization, 2) studying factors affecting service provision in Sub-district Health Promoting Hospitals transferred under the Provincial Administrative Organization, and 3) developing policy proposals on service provision in Sub-district Health Promoting Hospitals transferred under the Provincial Administrative Organization. Both quantitative and qualitative data were collected from randomly selected provinces with transfers, divided into 3 groups: Group 1 (100% transfer), Group 2 (50-93% transfer), and Group 3 (<50% transfer). The quantitative sample consisted of 340 nurses, 400 citizens, and 88 local health committee members. The qualitative informants included Chief Executive of the PAO, directors of Provincial Public Health Office, directors of Division of Public Health and Environment, directors of Sub-district Health Promoting Hospitals, public health professionals, nurses working in Sub-district Health Promoting Hospitals, and citizens who had previously received services at Sub-district Health Promoting Hospitals. The study found that: 1) extracting lessons learned from service provision in Sub-district Health Promoting Hospitals transferred under the Provincial Administrative Organization 1.1) The comparison of service data from the medical and public health data warehouse of primary care units before fiscal year 2022 and after the transfer in fiscal year 2023 found that the mean values of all services decreased after the transfer, with a statistically significant difference at the 0.05 significance level. 1.2) The comparison of differences in primary care unit outcome indicators across targets, by transfer groups 1, 2, and 3, found that for all three indicators, there was at least one group with a statistically significant difference at the 0.05 significance level. 1.3) In providing services to the public according to the duties of the Transferred Sub-district Health Promoting Hospitals (SDHPs), the nurses working in all 3 groups did not differ from before, as these remain the main duties of SDHPs. However, the difference in service provision after the transfer will focus on providing services based on the local area's problems, where the health indicators are set by the local health committees. As for indicators from the Ministry of Public Health that are not relevant or do not represent local issues, service provision will not emphasize those. 2) studying factors affecting service provision in Sub-district Health Promoting Hospitals transferred under the Provincial Administrative Organization 2.1) The attitudes of the service provider teams after the transfer, and the competency roles of professional nurses in all aspects, were significantly related to the perceived quality of service provision in primary care units after the transfer, at the 0.05 statistical significance level. 2.2) The formulation of health development and service policies, leadership and managerial competencies of the public health director, health workforce and competencies of nurses, finances, budgeting, and the management of drugs, medical supplies, and vaccines are crucial factors in the health service provision of Subdistrict Health Promoting Hospitals transferred under the Provincial Administrative Organizations. 3) developing policy proposals on service provision in Sub-district Health Promoting Hospitals transferred under the Provincial Administrative Organization 3.1) Develop the management of health service units of new Sub-district Health Promoting Hospitals/primary care units by adjusting the management system with community participation, emphasizing area-based primary care services that are people-centered, in the form of local/district health committees. 3.2) Provision of quality health services in service units based on an area based, people-centered approach, emphasizing essential primary medical care by professional staff, and a quality referral system linked to secondary care units. 3.3) Provision of proactive community services using the "Create, Lead, Repair Health" strategy, especially promoting quality life skills (Lifestyle). 3.4) Here is the translation to English: Elevate the quality of health services in accordance with the community and social context, provided by professional health professionals. Reshape the new image of health service delivery, especially proactive, close to home and heart. Allow local communities to participate in design and self-management, with appropriate models for large sub-district health promoting hospitals or urban communities, medium-sized subdistrict health promoting hospitals or semi-urban communities, or rural communities.
