Abstract
Background: The Local Health Committee (LHC) has the duty to promote, support,
supervise, and evaluate the performance of the 60th Anniversary Queen Sirikit Health Center
(SHC) and the Sub-district Health Promoting Hospital (SHP) that have transferred their
responsibilities to the Provincial Administrative Organization (PAO). During the transition
period, the operations of the LHC in each area may not be in accordance with the intention
of decentralization.
Objectives: 1) to examine the roles and desired functions of LHCs; 2) to analyze the current
situation and operations of LHCs following the transfer of THPH to PAOs, using case studies
in Nan, Rayong, Prachinburi, Nakhon Ratchasima, Songkhla, and Phuket provinces; and 3) to
develop policy recommendations for the operations of LHCs after the transfer of THPH to
PAOs.
Methods: The study employed a case study research design with purposive sampling to
select six provinces: Nan, Rayong, Prachinburi, Nakhon Ratchasima, Songkhla, and Phuket.
The research was conducted in three stages: (1) a document review of decentralization
policies and LHCs roles, involving input from 106 stakeholders and analyzed using content
analysis; (2) an assessment of LHCs roles post-transfer, using the Modified CIPP Model and
Six Building Blocks Plus One (6BB+1) framework to evaluate work processes and external
factors; and (3) the development of policy recommendations for improving LHC operations
based on content analysis.
Research Findings:
1. The result of the study of the roles and functions of Local Health Committees
(LHCs) reveal that: 1) The structure and composition of LHCs in each area adhered to the
guidelines provided by the Office of the Decentralization to Local Government Organization
Committee, under the Office of the Prime Minister, for transferring the CPHC and THPH to
PAOs; 2) the roles and functions of LHCs varied by area, depending on the interpretation of
the transfer guidelines by PAOs and Provincial Health Offices (PHOs). This resulted in differing
practices across regions, including unclear meeting agendas; 3) The Memorandum of
Understanding (MOU) differed across areas, leading to varied practices in primary healthcare
service delivery; 4) LHCs lacked consistent promotion, support, supervision, and
performance evaluation for CPHC and THPH. However, it was found that some provinces
have appointed subcommittees to support the work to make it more efficient.
2. The evaluation results using the Modified CIPP Model to assess the operational
processes of the Local Health Committees (LHCs), with an analysis of external factors
through the Six Building Blocks Plus One (6BB+1). For good practices in each area, it was
found that: 1) The health service delivery system has various innovative service
arrangements depending on the readiness of the area, which is influenced by experience
and resources. Budget allocation for the purchase of medicines, non-drug medical supplies,
and equipment to support the operations of the THPH is provided. Including specifying
health services that are consistent with the indicators of the Ministry of Public Health as
indicators for overall and personal operations. 2) Health Workforce: Subcommittees
managed personnel-related tasks, including workforce planning and hiring of additional staff
such as physicians, dentists, and pharmacists to enhance primary healthcare services; 3)
Health Information System: Data from THPHs was centralized into a dashboard for
monitoring, evaluation, and performance assessment; 4) Access to Essential Medicines:
There was limited clarity in managing medical technology during the transition phase; 5)
Health Financing: THPH budgets increased, and subcommittees were formed to manage
population-based financial allocations using PAO financial systems. However, compliance
with PAO regulations caused delays in some processes; 6) Leadership and Governance:
Management relied on the experience of key personnel and leaders from PAOs and PHOs,
who had prior collaboration experience. This facilitated practical and concrete LHC
operations; 7) Participation: While the LHC structure encouraged multi-sectoral participation,
public involvement, particularly from community members, remained limited.
3. Policy Recommendations for the Roles and Functions of Local Health
Committees (LHCs)
Scenario 1: PAOs Can Operate Independently
1) Establishment of 6 sub-committees to support operations, consisting of
(1) Personnel Management, (2) Financial and Budget, (3) Infrastructure and Resource
Allocation, (4) Strategic Planning, Monitoring, and Evaluation, (5) Management of Medicines
and Non-Medicine Supplies, and (6) Primary Health Service Provision. This can be done
according to item (11) according to the guidelines for transferring the mission of the
Subdistrict Health Promotion Hospital to the PAOs by having an equal number of
committee members from both the PAOs and the Provincial Public Health Office.
2) Establishment of health zone groups to be responsible for coordination and
supervision in order to promote decentralization of workers. The LHCs can be established
according to the guidelines for performing duties in item (2).
Scenario 2: PAOs Cannot Operate Independently
The structure and composition of the LHCs should be adjusted. Specifically, the
qualifications and number of committee members should be clearly defined, with an
emphasis on including representatives from the public who possess relevant knowledge
or experience in public health. Furthermore, the proportion of sub-district health
promotion hospital directors included in the committees should be increased, reflecting
the number of transferred health facilities. This would ensure that local issues are
adequately represented and addressed, leading to more effective and context-appropriate
management.
Additional Recommendations:
1) A comprehensive operational manual for the LHCs should be developed. This
manual should clearly outline procedures for preparing local health development plans
and support the committees in fulfilling their responsibilities, including promoting,
supporting, supervising, and evaluating the transferred health services. and 2) training
programs for LHCs members should be introduced to standardize understanding and
ensure alignment with key principles. Such training should also accommodate the
flexibility to adapt management approaches based on the unique contexts of each
locality.
