Abstract
This research aims to develop an integrated model for collaboration between by
Contracting Unit of Primary Care board (CUP Boards) and District Health Board (DHB) to prevent
and control non-communicable diseases in areas where subdistrict Health Promotion Hospital
have been transferred to provincial administrative organizations (PAOs). Phase 1: aimed to study
the current situation and Synthesis of Problems for the prevention and control in non -
communicable diseases at the district level, as carried out by Contracting Unit of Primary Care
board (CUP Boards) and District Health Board (DHB) and Phase 2: Development and Evaluation of
the Integrated Model. The results of the study showed that
1. After the transfer of subdistrict Health Promotion Hospital, the operational
mechanisms between the DHB and CUP Board remained largely unchanged because of there
were primarily conducted at a policy level, with broad frameworks and guidelines. In addition,
the implementation of various activities and budget allocation at the sub-district level do not
have significant budget integration at the district level. The monitoring and evaluati on
mechanisms began at the sub-district level, with the DHB, in collaboration with CUP Boards or
NCD Boards, monitoring sub-district areas.
2. The development of this model consists of four components: 1) planning,
2) implementation, 3) observation, and 4) reflection. To develop this model, five activities were
carried out: 1) data collection for decision-making: selecting minimal variables for problem
analysis; 2) Identification of problem: identifying problems and collaboratively seeking solutions
for integrated operations; 3) Outcome setting: setting outcome levels to address integration
challenges; 4) Analysis of activities and outcome linkages: determining network partner activities
and resources for implementation; and 5) Outcome setting and monitoring
3. The integration model comprises Policy-level integration, involving key organizations
such as the Provincial Administrative Organization (PAO), District Health Board (DHB), and
Contracting Unit of Primary Care board (CUP Boards) . These organizations collaboratively
manage and promote various district mechanisms to the public, streamline operations, and
communicate policies. They also establish budget integration frameworks, develop district-level
indicators, monitoring and evaluation. To facilitate policy-level operations, various committees or
subcommittees have been established to like a drive operations between district and sub-district
levels. Community-level implementation involves translating broad policies into actionable
plans at the grassroots level, using district-level operational plans and indicators. At this level,
there is a sub-district-level integrated development plan that designs the sub-district's operations
through collaborative discussions among community members, Village Health Volunteer ,
sub-district offices, Subdistrict Administrative Organization, and sub-district health board.
They comprehensively assess sub-district issues, strengths, weaknesses, and resource constraints.
This leads to horizontal activities and resource integration to address specific problems. The core
of this level's operations is the sub-district health board, Subdistrict Administrative Organization,
and Public Health Technical Officer from Subdistrict Health Promotion Hospital. Additionally, for
non-communicable diseases, the CUP Board actively collaborates with the sub-district level,
providing necessary equipment for healthcare services and continuously developing the capacity
of primary healthcare center personnel.
4. This public policy proposal aims to enhance coordination among different
organizations within the district to improve operational efficiency and ensure that all people,
regardless of age, including healthy individuals, at-risk groups, and patients, have appropriate
access to diabetes and hypertension prevention and control services. This is expected to
enhance safety, satisfaction with services, and ultimately improve the quality of life of the
district's population. Therefore, at the policy level, there should be a strong emphasis on
upstream integration, meaning that administrators should have a shared vision and perspective
in policymaking, focusing on overall outcomes for the area. They should also jointly agree on
performance indicators that emphasize the quality of upstream operations to guide downstream
collaboration. Additionally, there should be joint efforts to improve regulations and procedures,
as well as joint monitoring and evaluation of outcomes. Policy-level budget integration should
be prioritized. Horizontal and vertical relationships should be strengthened. At the sub-district
level, emphasis should be placed on horizontal coordination mechanisms, capacity building of
personnel, and the importance of outcomes at the community level, as the community is the
ultimate stakeholder in all aspects of this work.
