Abstract
The decentralization of Sub-district Health Promoting Hospitals (SHPHs) to local
administrative organizations (LAOs) under Thailand’s public health reform policy represents
more than an administrative shift—it constitutes a complex transformation in institutional
relationships, leadership roles, and communication systems. This study aims to explore how
relationship management and facilitative leadership communication contribute to effective
public health service delivery during this transitional period. It focuses on understanding the
dynamics of trust, meaning-making, and organizational alignment across key actors involved in
the transfer process. The research employed a qualitative approach combining document
analysis, in-depth interviews with frontline practitioners, and focus group discussions with
communication, leadership, and public health experts. Data were collected from case studies of
provinces that had undergone or were preparing for decentralization. The analysis was guided
by frameworks of facilitative leadership, systems theory of communication, and social capital
theory.
Findings reveal that successful decentralization depends not only on structural readiness
but critically on the cultivation of trust, open dialogue, and cross-institutional meaning-making.
Leaders who engage stakeholders through deep listening, transparent communication, and
inclusive decision-making reduce institutional anxiety and foster collaborative commitment. The
study proposes a three-phase relational model: (1) preparation marked by open-mindedness
toward change, (2) transfer characterized by co-creation of shared goals, and (3) post-transfer
rooted in mutual trust and sustained collaboration.
The study also recommends integrating communication architecture, change-agent
development, and participatory relationship-building into the national decentralization strategy.
These elements should be viewed not as supplementary, but as central to sustainable and
context-sensitive primary healthcare reform.
