Abstract
The mechanism and process for coordinating and managing primary health care services
under the Primary Health Care System Act B.E. 2562 is a new mission that has been transferred
and assigned power and duties to Provincial Administrative Organizations (PAOs) under the
decentralization laws. To ensure high-quality health services for the public, there is a critical
need for administrators with strong management skills. This research sets out three key
objectives: 1) to study the management situation of provincial public health directors in relation
to the transfer of primary health care responsibilities, 2) to study different models for enhancing
the capabilities of these directors in managing the primary health care system, and 3) to develop
a comprehensive training curriculum for improving the capabilities of public health directors; by
utilizing a mixed-method approach. Qualitative data will be collected from four regions, two
provinces per region. The study involves five groups of informants, four of which are qualitative
key informants selected through purposive sampling. These groups are: 1) 120 policy key
informants participating in in-depth interviews; 2) 40 operational key informants involved in the
transfer of tasks, also participating in in-depth interviews; 3) 40 key informants representing the
public health sector in focus group discussions; and 4) 56 citizen key informants engaged in
focus group discussions. Data collection considered data saturation and was conducted in
alignment with the research objectives. The fifth group includes 27 expert informants who
participated in a seminar to evaluate the curriculum, scoring its importance, appropriateness,
and feasibility. The curriculum evaluation used expert opinion scores, with a coefficient of
variation (CV) value of ≤ 25% determining item selection for curriculum development.
The research findings reveal that the components of administrative structure of the
Public Health Division, as well as the division of work duties, varies significantly depending on
the readiness in term of the capabilities of public health administration of the transferred PAO
president, the Director of the Public Health Division, the number of personnel, the number of
Queen Sirikit's 60th Birthday Anniversary Health Center, and the number of sub-district health
promoting hospital. Most organizations adhere to the structure outlined by the Department of
Local Administration. Additionally, many have also adapted their administrative frameworks to
prioritize quality in areas such as operations, supervision, monitoring, and evaluation of health
services—tasks that often exceed the capacity of the Public Health Division Director alone,
including the consideration of resource readiness and/or planning to support advancement in
human resource management. To design an effective organizational structure, the Public Health
Division should establish sections with responsibilities covering universal health insurance rights.
The main focus is to achieve standards and indicators that ensure the quality of health services,
as mandated by the National Health Security Office. Moreover, personnel should be equipped
with relevant knowledge, skills, and experience matching their responsibilities, work group, and
work.
Regarding workload division according to the structure, in addition to having personnel in
the designated work groups, there also is a local health committee responsible for supervising,
controlling, and regulating policies, as well as evaluating outcomes. In some provinces, the PAO
president establishes a local committee by grouping Queen Sirikit's 60th Birthday Anniversary
Health Center and sub-district health promotion hospitals within the same area. This committee
is tasked with managing human resources, finances, and supplies to ensure efficient public
service delivery, while optimizing resources used within the local area. In case of personnel
shortages, strategies such as rotating staff within the area, requesting support from other
hospitals within the network, rehiring retired doctors, and utilizing telemedicine systems are
implemented. For long-term solutions, certain provinces have partnered with
Praboromarajchanok Institute to train new medical personnel.
Service standards issues in the dimension of primary health care system, after the
transfer of Queen Sirikit's 60th Birthday Anniversary Health Center and sub-district health
promotion hospitals to the PAO, gaps have emerged in the primary health care syst em,
particularly in academic support, service, and monitoring. These cause gaps which directly
impact the service qualities received by the public. Besides, the transfer has led to a reduction
in the key health indicators set by the Ministry of Public Health. Consequently, communities in
these regions may experience diminished access to quality health care where the indicators are
missing.
Coordination with agencies under the Ministry of Public Health is crucial to ensure that
outcomes align with national policy priorities (Agenda-based), local goals (Area-based), and the
objectives of the primary health care system (Function-based). After the transfer, however, the
roles of the Provincial Health Office and District Health Office have decreased or, in some areas,
produce no tangible outcomes. To address these challenges, the National Health Security Office
has provided financial support to help manage risks and solve problems in health service
delivery through the use of innovation units to develop referral systems, which is the gap, for
services that are essential to the local area, such as childbirth and dental care.
After the transfer, gaps in the operation of the District Health Coordinating Committee
(DHCC) have emerged, particularly due to the absence of a clear mechanism for transferring
responsibilities to local areas. A problem-solving approach involves the appointment of a
provincial central committee by key organizations from the Ministry of Interior, Ministry of
Education, Ministry of Agriculture, and others based on the specific needs of the area. The
provincial governor chairs the committee, with the Provincial Health Officer serving as the
secretary, responsible for managing quality of life for the local population that leads to action.
The organization of services and coordination as a health network, where the PAO acts
as a sub-node and the Ministry of Public Health serves as the main node, has several advantages.
Besides the support and management of budgets from the National Health Security Office
(NHSO) within the network, it also includes the ability to support healthcare personnel both in
terms of quantity and quality. In cases where the PAO serves as the main node itself, there are
distinct advantages, such as full budget management, leading to greater flexibility. However,
caution must be exercised in managing healthcare personnel, vaccines, medicines, and medical
supplies, as well as health information systems. Moreover, the PAO lacks permanent service
units to support patient referrals, making it challenging for the health department to manage its
role as a main node. In the role of a sub-node, it was found that the management within each
province depends on pre-existing relationships and the personalities of the executives on both
sides. During the transfer of Queen Sirikit's 60th Birthday Anniversary Health Centers and subdistrict health promotion hospitals, issues related to the universal health coverage system were
encountered.
The roles and responsibilities of the Director of the Public Health Division under the PAO
in managing the transferred primary health care unit should include seven key areas: 1) Strategic
management of primary health care; 2) Management of resources related to primary health care
systems which covers the program management; 3) System design and the establishment of
management mechanisms; 4) Management of relationships when working with commanders; 5)
Establishing a health operation network working with agencies both inside and outside the
Ministry of Public Health; 6) Building primary health care knowledge and skills in managing
primary health care systems and related networks; and 7) Development of health information
technology.
The development model for enhancing the capabilities of the Director of Public Health
under the PAO in managing the transfer of the primary health care service responsibilities should
adopt an active learning approach which stimulates management of the learning process,
knowledge creation from collaborative learning while having interactions in the form of
collaboration, imagination, problem-solving skills, and application of knowledge. The
development activities include: 1) Community-based learning; 2) Brainstorming; 3) Practicing;
4) Discussion; 5) Exchange of ideas; 6) Lesson learned sessions; and 7) Presentation.
The curriculum for enhancing the capabilities of the Director of the Public Health Division
under the PAO focuses on developing competencies in three areas:
The curriculum for enhancing the capabilities of the Director of the Public Health Division
under the PAO focuses on developing competencies in three areas:
1. Leadership (72 hours): This module focuses on developing the organizational
leadership competencies of the trainees, leadership mindset in changing situations, problemsolving skills, communication and presentation skills, relationship building, decisio n-making
processes in administration, negotiation, mediation, and conflict management.
2. Primary Healthcare Management (144 hours): This module aims to strengthen the
organizational development capacity of Public Health Division Directors in managing the
healthcare system and driving primary healthcare organizations forward.
3. Strategic Management for Primary Healthcare (144 hours): This module focuses on
enhancing the strategic management capabilities of Public Health Division Directors in PAOs by
analyzing both external and internal environments to develop area-based healthcare strategic
planning.
From an expert seminar, feedback indicated high approval (CV < 25%), except for the
feasibility of conducting activities to develop a management plan for primary health care unit,
where the CV exceeded the 25% threshold (27.35%).
