Abstract
The Phase 2 evaluation project aims to assess the health impacts on the population
potentially resulting from the transfer of Tambon Health Promoting Hospitals (THPH) in the
2023 fiscal year. This includes impacts from primary healthcare services and public health
operations. It also aims to monitor and review the predictability of early warning signals or risk
factors for health impacts linked to the THPH transfer. The study will explore changes in
resource management, healthcare service delivery, and public health operations of the THPHs
transferred to Provincial Administrative Organizations (PAOs) concerning health impacts, as well
as analyze and synthesize necessary systemic management approaches. Additionally, it
proposes the use of financial, fiscal, informational, and legal tools to create a public health
ecosystem around THPHs that is responsive to health impact situations.
The project employs a mixed-methods research approach, consisting of two parts. Part
1 involves conducting case studies in 10 provinces covering 12 areas, which include areas with
full THPH transfers, partial transfers, and areas with no transfers as controls. Five specific case
studies will also be conducted, focusing on drugs, nursing, primary care units, dengue fever
control, and the role of district public health. Data will be collected through group discussions,
interviews with responsible parties, and document reviews at provincial public health offices
(PPHOs), PAOs, community hospitals, and THPHs.
Part 2 involves a retrospective cohort study using secondary data from the Ministry of
Public Health's health database (52 files), with cooperation from the National Health Security
Office (NHSO). The data will cover the fiscal years 2018–2022 as the baseline, and fiscal years
2023–2024 (if available) will represent post-transfer outcomes. The study focuses on key
indicators related to healthcare access, process effectiveness, and health outcomes
concerning primary care and communicable disease control. Phase 2 of the project will be
conducted from October 2023 to September 2024.
Findings from the case studies indicate the following key health impact warning signs:
(1) general characteristics of THPHs, such as size relative to the population served and their
relationship with primary care networks (CUP hospitals); (2) transfer characteristics, such as the
proportion of transferred THPHs compared to non-transferred ones; (3) health service funding
allocations, including the management of outpatient care (OP) and health promotion/disease
prevention (PP) budgets under the national health insurance system and the financial status
of the network, the MOPH “30-baht to go anywhere” policy initiative and the NHSO service
innovation clinics; (4) human resource management, including staff rotation, medical
personnel, nurses, and THPH staff capabilities; (5) support for drugs and medical supplies, such
as procurement, equipment, and infection control; (6) primary care service models, such as
general healthcare, health promotion, chronic disease clinics, dental care, home, and
community services; (7) public health management, including communicable disease control
and district public health roles; (8) village health volunteers (VHVs), including their
coordination, care, and development; and (9) monitoring and health planning based on
indicators and the preparation for health emergencies.
The data provided by the NHSO for fiscal year 2023 showed partial completeness. The
complete analyses include, for example, diabetes (DM) and hypertension (HT) screenings,
elderly health screenings, chronic disease outpatient service data, child development
screenings, chronic disease care effectiveness (QCB for DM, HT, COPD, CKD), cervical cancer
screening and treatment, dental care data, and data on dengue fever. However, there was
incomplete data submission across all service units, and the trend showed a decrease in data
submission in 2024 compared to 2023 and previous years. The findings suggest that the
population in areas where THPHs were transferred to PAOs faces higher health risks compared
to non-transferred areas, especially in key indicators such as child development screening,
DM/HT risk screening, elderly screenings, and chronic disease care quality. The early results
from the Health Performance Warning Index for Provincial Management and National Health
Systems Oversight (HPW-PN) suggest that this tool can be used for provincial-level
management and national health system oversight. It tracks performance based on pretransfer indicators, changes or trends, and performance during the first-year post-transfer,
including changes compared to fiscal year 2022.
