Abstract
This mixed-method study aimed to 1) study and compare the performance of subdistrict health-promoting hospitals after the transfer of missions according to the 2023 primary
care service quality standards of the Ministry of Public Health and the six components of the
World Health Organization's health system within the province and between 3 provinces. Data
were collected from 144 sub-district health-promoting hospitals in 3 provinces using the 2023
primary care service quality assessment form of the Primary Health Care System Support
Office, Ministry of Public Health. Moreover, data from 465 sub-district health-promoting
hospital staff were collected using an online questionnaire on administrative data in subdistrict health-promoting hospitals according to the concept of the six components of the
health system. Objective 2) To study the service quality and perception of the quality of life
of service recipients after the transfer of duties. Data were collected from 3,583 service
recipients using an interview form. Data was collected between April and June 2024.
Quantitative data were analyzed using descriptive statistics and the Kruskal-Willis and ChiSquare tests. Objective 3) To explore the policies and guidelines for management services
within the province and the three provinces, and 4) to present the policies and procedures
for managing sub-district health-promoting hospitals transferred to the provincial
administrative organization in different contexts. A qualitative method was used to collect
data from provincial administrative organization executives, personnel at sub-district healthpromoting hospitals, and 68 service recipients at sub-district health-promoting hospitals
between April and September 2024. Qualitative data was analyzed using content analysis.
The quantitative study results found that when comparing the performance of subdistrict health promotion hospitals after the transfer of missions according to the primary care
service quality standards criteria of 2023 of the Ministry of Public Health between 3 provinces
using the Kruskal Wallis test. It was found that the average results of the primary care service
quality assessment of all three provinces in all eight parts were statistically significantly
different in 4 parts: Part 1 ) Management system, 2 ) Personnel arrangement and service
potential, Part 5) Primary health care service system, with a statistical difference level of
p < 0.001, and Part 6) Medical and public health laboratory system, with a statistical difference
level of p < 0.05.
The results of the study of service quality and perception of quality of life of
the people receiving services after the transfer of duties found that the people using
services at the sub-district health-promoting hospitals where duties were transferred
in the three provinces perceived after using the services that the reliability of the
services, building confidence in the services, and the care and attention were at the
highest level. For the overall quality of life of the people using services at the subdistrict health-promoting hospitals where duties were transferred in the three
provinces, it was found that the quality of life was at a reasonable level in all three
provinces.
The results of the qualitative study can analyze the management as follows:
In terms of manpower, the Provincial Administrative Organization must analyze the
manpower of each group of personnel to be sufficient, including setting a clear
framework for the number of personnel to be hired as civil servants, including
determining the guidelines for personnel development. Regarding procuring support
for operations, the PAO should survey the need for various tools and equipment
and plan for procurement. In terms of participation, there should be a committee
to coordinate work between the Provincial Administrative Organization and the subdistrict hospitals by appointing a committee at the local level of each district. In
terms of creating cooperation with various networks in secondary and tertiary
hospitals, the National Health Security Office, and educational institutions, and
strengthening the Public Health Division, the Provincial Administrative Organization.
The policy proposal and management guidelines for sub-district healthpromotion hospitals transferred to provincial administrative organizations consist of
6 policies: 1) Sub-district health promotion hospital management, whereby subdistrict health promotion hospital executives must develop their own potential to
work according to the regulations of the Ministry of Interior and create a work plan
that is consistent with the needs of the agencies and the context of health problems
in the area. The executives must change the management approach from following
the leading network to thinking in a new way, doing it, and emphasizing efficiency.
2) Personnel, whereby sub-district health promotion hospital executives must
analyze the workforce of each agency and present it to the Provincial Administrative
Organization for an overall analysis, which will lead to the determination of the
workforce framework and allocation to the sub-district health promotion hospitals
sufficiently. 3) Determination of indicators for the work of sub-district health
promotion hospitals, where sub-district health promotion hospitals must conduct
an analytical study of the area to determine clear indicators, reduce the quantity,
and focus on quality, especially problems that are consistent with the context of
the area. 4) Network creation, whereby the Provincial Administrative Organization
and PHO coordinate their work as a network with the original leading network,
secondary and tertiary hospitals, to create continuous and seamless care.
5) Development of the potential of village health volunteers, whereby the potential
of village health volunteers is developed by providing knowledge in performing their
duties. and study and observe the exchange of experiences from the prototype
source, and 6) develop the potential of the people through the sub-district
hospital's organizing activities to provide knowledge in various forms.
