Abstract
This mixed-method research aimed to identify early warning signs of fundamental changes associated with the transfer of Tambon (subdistrict) health promoting hospitals (THPH) to provincial administrative organizations (PAOs). The study focused on the health-related impact risks including changes in resource management, health service provision, and public health operations of THPH after the transfer. The research consisted of two parts. In the qualitative part, data collection involved interviews with key informants from provincial health offices, hospitals, THPHs, and PAOs in the 6 provinces case study strategically selected for in-depth analysis. Data were analyzed through content analysis. In the retrospective analytical-study part, pilot indicator sets and information along the cause-and-effect chains were synthesized with respect to the study framework. They linked measures of access, service utilization, healthcare quality, health outcomes, and care costs to early warning signs of health-related risks after the transfer. Using the databases collected by the National Health Security Office (NHSO), the data from the fiscal years 2018-2022 were utilized as the baseline data while the 2023 data were the first-year post-transfer. Key findings from this study reveal that the evaluation framework for health impacts of the THPH transfer should include (1) health outcomes, (2) costs of care, (3) public health outcomes, (4) primary care access, (5) effectiveness or adherence to clinical practice guidelines and timely care, (6) alignment with public health activity frameworks and goals, and (7) resources and management models. This framework served as early warning indicators for monitoring post-transfer health impacts. Furthermore, statistical indicators on various aspects could reflect operational differences, trends of pre- and post-transfer to PAOs. The Ministry of Public Health, NHSO, the Office of the Prime Minister (Committee for the Delegation of Authority to Local Administrative Organizations), and the Ministry of Interior (Department of Local Administration), as well as other related agencies, are recommended to collaborate in reviewing, planning, and designing a surveillance system to prevent and address health impacts on the population resulting from the transfer of THPHs to PAOs. Additionally, a review and redesign of a system for overseeing the local public health system should be in place.
