Abstract
Background and Rationale: The Decentralization Act B.E. 2542 mandates the transfer of health
responsibilities to local government organizations (LGOs). This research aimed to investigate the standards
and readiness for service provision of sub-district health promoting hospitals (SHPHs) that wanted to be
transferred to the provincial administrative organizations (PAOs).
Methodology: This mixed-methods qualitative research included in-depth interviews and focus
group discussions with policymakers (n = 6), public health representatives (n = 28), PAO representatives
(n = 16), and public sector representatives (n = 24) selected purposively. For the quantitative research,
the sample consisted of SHPH directors or representatives (n=430), selected through random sampling
and by size of PAOs. Research instruments included a semi-structured interview guide and a questionnaire
on primary care capacity standards and readiness. Content analysis was used for qualitative data, while
descriptive statistics and chi-squared test were used for quantitative data.
Results: 1. SHPHs reported adequate or high structural service readiness; however, staffing levels
particularly health professionals and supporting finance/account personnel were inadequate. 2. Most
SHPHs anticipated maintaining or even increasing service quantity post-transfer to the PAOs, except in dental care where reductions were expected. 3. Recommendations from SHPHs to enhance the transfer
of health responsibilities included ensuring that health services to the public maintaining the pre-transfer
level, especially the provision of chronic disease treatments such as diabetes, hypertension, and dental
care, should continue status-quo health service networks.
Conclusion: PAOs and the provincial health offices should develop local health plans, recruit
both health professionals and supporting personnel, and sign agreements to maintain existing service
models during the transition period. They should also prepare to promote, support, oversee, and evaluate operations according to professional standards and facilitate community-driven initiatives.
