Abstract
Background and Rationale: Providing fringe benefits, welfare, and promoting career advancement
to health workforce of a sub-district health promoting hospital (SHPH) under the provincial administrative
organization (PAO) are crucial. The purpose of this research was: 1) to examine the fringe benefits, welfare,
and career advancement opportunities for SHPH personnel; 2) to investigate the problems, obstacles,
and proposals regarding fringe benefits, welfare, and career advancement for SHPH personnel; and 3) to develop policy recommendations related to fringe benefits, welfare, and career advancement for SHPH
personnel under PAO.
Methodology: This research employed a mixed-methods approach, incorporating quantitative
and qualitative research methodologies conducted from April to August 2023. The qualitative samples
selected purposively consist of policy-level executives including experts and executives of the Ministry of
Public Health (n = 15); local government organization executives, provincial health executives and regional
health executives (including health region inspectors, provincial chief medical officers, PAO presidents,
public health division directors, and representatives from local administrative organizations: n = 80);
operational health workforce of the transferred SHPHs (n = 120); and experts joining final policy meeting
(n = 20). Qualitative data were collected through in-depth interviews and focus group discussions. For
the quantitative study, the samples consist of 430 personnel from transferred SHPHs. The participants
were selected using purposive and stratified random samplings based on staff proportions. Quantitative
data were collected using an online questionnaire. Data were analyzed using descriptive statistics for
quantitative method and content analysis for qualitative method.
Results: 1. Overall fringe benefits, welfare, and career advancement were at moderate level. The
qualitative findings showed that these aspects generally followed the healthcare decentralization guidelines
of the SHPH (and the 60th Anniversary of Her Majesty Queen Sirikit Health Center). 2. Problems included
delays in compensation payments, unfair salary promotion evaluations, differences in welfare benefits,
and limited growth opportunities in certain job positions. 3. Key policy recommendations included: the
Department of Local Administration overseeing decentralization should organize knowledge-sharing
activities and review hindering regulations to ensure health workforce receiving appropriate benefits.
PAOs should develop and widely disseminate manuals, procedures, regulations, and practical guidelines.
Discussion and Conclusion: To boost staff morale and motivation, relevant agencies should
simplify and improve compensation payment rules for quicker processing, set clear and fair criteria for
salary increases, create clear career paths for all job titles, establish higher-level positions, especially for
professional nurses; and speed up academic performance reviews within 6 months.
