Abstract
Transferring responsibilities of the Chaloem Phra Kiat 60 Years Nawamin Maharachini Health Centre (NHC) and the Tambon Health Promoting Hospital (THPH) to the Provincial Administrative Organization (PAO) is a dynamic situation and involves multiple stakeholders. Evidence will be crucial to support policy decision-making. The objectives of this study are: 1) develop a functioning mechanism for the Health System Intelligent Unit (HSIU) to generate evidence on health systems, thereby supporting policy decision-making, 2) monitor the situation of ongoing responsibilities transferring and relevant research initiatives, analyses and generate evidence 3) disseminate evidence to multi-stakeholders and facilitate collaborative efforts, and 4) develop policy recommendations based on the gathered evidence. The functioning mechanism of HSIU consists of 2 parts: 1) meetings of the worker ant team which is a core working group to monitor the situation of the transfer, review relevant research and map them with the 6 building blocks of health systems framework, analysis, compile as academic information, and 2) meetings of the HSIU working group to disseminate evidence to multi-stakeholders. In the fiscal year 2023, 3,263 (33.0%) facilities of NHCs and THPHs, out of the total of 9,878 facilities, were transferred to PAOs. This ongoing process continued in the fiscal year 2024, 933 (9.5%) facilities of NHCs and THPHs were transferred. In total, 4,196 (42.5%) facilities of NHCs and THPHs have been transferred to PAOs, and 5,598 (56. 7%) facilities remained under the Ministry of Public Health. Findings from situation monitoring and reviewing of 17 research projects related to the transfer were compiled, analysed, and presented across 7 key issues. 1) Human resources situation, there was insufficient personnel to handle the workload after the transfer. 2) Health financing situation, there were various budget allocation models for health services from the National Health Security Office. 3) Primary health care service situation, some THPH continue to provide services at the same level as before the transfer, while others have seen a decline. 4) Drug and medical supply situation, in several provinces, agreements have been made for community hospitals to continue managing drugs and medical supplies for transferred THPH, while in some provinces, PAOs handle procurement and management independently. 5) Information system situation, there has been a decrease in the submission of health indicator data. 6) Governance system situation, the approach has shifted from command-based to participatory working. 7) Public perspectives and expectations, there are expectations for good quality services, convenience, and sufficient personnel. Each of these issues leads to policy recommendations aimed at ensuring the continuity and improvement of primary healthcare systems after the transfer. Furthermore, the recommendations for developing the HSIU mechanism were identified: 1) using action research methodology that allows for concurrent research and problem-solving, 2) incorporating public sector participation, and 3) expanding information dissemination through various public communication channels.
