Abstract
Monitoring situation of health information system and designing appropriate health
information system management under the transfer of subdistrict health promoting hospitals
(SHPHs) to provincial administrative organizations (PAOs) is a study aiming at monitoring the effect
of transferring SHPHs to PAOs in the first 2 years on health information system. The study
analyzed health service data such as out-patient service data and health promotion and disease
prevention service data sent to health data center (HDC) of the Ministry of Public Health and
studied work processes related to health information system as well as related factors influencing
health information. Qualitative study took place in 6 provinces with different proportion of SHPHs
transferred to PAOs. Disease surveillance data was also assessed after transferring SHPHs to PAOs.
The result of study showed that health service data was mostly sent to HDC as before.
More than 95% of SHPHs transferred to PAOs sent out-patient data every month in fiscal year (FY)
2024 with less than 1% of months missing. The situation of out-patient data after excluding
COVID-19 patients and service ICD-10 codes, which include disease screenings, revealed that outpatient data reduced by only 2.8% in FY 2023 compared to FY 2022 for SHPHs transferred in FY
2023 and reduced by 4% in FY 2024 compared to FY 2023 for SHPHs transferred in FY 2024.
However, out-patients reduced in some groups of disease for SHPHs transferred to PAOs. Diabetic
patients reduced by 9.6% in FY 2023 compared to FY 2022 for SHPHs transferred in FY 2023 and
reduced by 13.9% in FY 2024 compared to FY 2023 for SHPHs transferred in FY 2024. This situation
was similar to patients with Hypertension. The coverage of complete antenatal care (5 times)
decreased by 13,5% in FY 2023 compared to FY 2022 for SHPHs transferred in FY 2023 and
decreased by 9.4% in FY 2024 compared to FY 2023 for SHPHs transferred in FY 2024. The
coverage of complete vaccination among children at age 1 decreased by 7.8% in FY 2023
compared to FY 2022 for SHPHs transferred in FY 2023 and decreased by 7.2% in FY 2024
compared to FY 2023 for SHPHs transferred in FY 2024. The coverage of screening for Diabetes
among people aged >= 35 decreased by 21.4% in FY 2023 compared to FY 2022 for SHPHs
transferred in FY 2023 and decreased by 31.4% in FY 2024 compared to FY 2023 for SHPHs
transferred in FY 2024. This situation was similar to screening for Hypertension. For disease
surveillance data, data from SHPHs reduced in FY 2024 compared to FY 2023 similarly for all
groups of provinces with different proportion of SHPHs transferred to PAOs with 63.4% reduction
in average. Changing of the system to D506 (online), which was not widely implemented in SHPHs,
was the major cause of such reduction.
Factors influencing service data included service-related factors and data-related factors.
Service-related factors for curative service were financial allocation model which affected support
of health personnel, medicines and medical supplies. This affected directly the capacity of
treatment of SHPHs. In case of chronic diseases patients, hospitals in some provinces sent doctors
for service at SHPHs but recorded service as hospital service. This might result in reduction of
chronic disease patients at SHPHs. Service-related factors were, therefore, more likely to influence
service data more than data-related factors. Service-related factors for health promotion and
disease prevention service were financial incentive from health security system and monitoring
system related to key performance indicators (KPIs) linked to SHPHs or personnel evaluation.
Other factor was understanding of personnel in data recording and data transferring including
incomplete data recording and transferring such as incomplete vaccination data in some SHPHs.
Data support system, data utilization for administrative purpose, policy and agreement of sending
data to health data center were also factors influencing efficiency of information system.
Design and development of primary health information system should include resource
information, standard of SHPHs information, health service information, disease and injury
surveillance information, health status information, health risk information. Integration of all
related information and appropriate data visualization system for supporting primary health
system should be developed along with appropriate data exchange system for both curative
services and health promotion and disease prevention services. Policy suggestions included 1)
development of supporting mechanisms under Primary care Act, B.E. 2562 (2019) at national level
consisting of sub-committee and taskforce (for setting strategies, monitoring and evaluation
system, and information system), scope of standard services, key performance indicators (KPIs),
monitoring and evaluation system, agreement about information for primary health system,
procedure for data exchange, adjustment of standard on data collection 2) development of
supporting mechanisms at provincial level consisting of establishment of sub-committee and
taskforce at provinces, development of provincial KPIs, provincial monitoring and evaluation
mechanism, and supporting mechanism for primary health information and 3) management of
service delivery and financial system consisting of setting appropriate service delivery for primary
health system, and study for appropriate financial mechanism for primary health system.
