Abstract
This research aims to explore intergovernmental relationships among key actors and
local government authorities in community health promotion and to develop community
health governance mechanisms that help to strengthen the efficacy of primary health care.
The context of service devolution of sub-district health promotion hospitals (SHPH) to
Provincial Administrative Organization (PAO) enables the sense of local community ownership
and wide participation among key stakeholders such that SHPH better performs and provides
meaningful and need-based primary health services.
The research comprises several mixed methods; both quantitative and qualitative, and
action research in order to experimenting need-based, innovative health services mechanisms
at the 12 sampled SHPH units in six PAOs; namely, Chiang Mai PAO, Khon-Kaen PAO, Nakorn
Ratchasima PAO, Patum Thanee PAO, Phuket PAO, and Songkhla PAO. After experimenting
with 12 community-owned sandboxes in the sampled cases, output and outcome evaluations
are also employed. Key data and informants incorporate public officials in several government
agencies related to public health service functions of Thailand. This includes officials from six
selected PAOs, Provincial Public Health Offices, District Public Health Offices, Community
Hospitals, Sub-district Health Promotion Hospitals, Community heath volunteers, Civic leaders,
Local authority, Patients, and Provincial health networks.
Findings show that all twelve community health sandboxes are very effective in
improving wide community engagement and quality of primary health services. For example,
an expansion of after-hour dental services, emergency and non-emergency medical services
in flood-prone areas, risk reduction in road accidents, the development of individual-level and
provincial-level health records for planning and monitoring purposes, the establishment of
community and village-level health stations, and the setting-up of community health networks
(CUP Split). All these health-care initiatives fit very well the community context and public
health conditions and help expand services to cover the wider numbers of vulnerable people.
This research suggests that the devolution of primary health services and the SHPH to local
authorities and the PAOs are beneficial to communal residents. Therefore, the State shall
advocate further devolution of the SHPH and eradicate legal obstacles so that the SHPH and
PAOs provide services in more effective and efficient manners in the near future.
