Abstract
This study aimed to evaluate the quality of area-based health promotion and disease
prevention projects (PPA) under the National Health Security Office (NHSO) in Thailand during
fiscal years 2020–2023, and to identify factors influencing project performance in order to
generate policy recommendations. A mixed-methods design was employed, integrating
quantitative and qualitative data under the RE-AIM framework (Reach, Effectiveness, Adoption,
Implementation, and Maintenance).
A 22-item project quality assessment tool was developed through a Delphi process
involving 22 experts and applied to 459 PPA projects nationwide. The findings indicated that
most projects were implemented at the provincial level, with non-communicable diseases
(NCDs) receiving the largest share of funding. The mean RE-AIM score (unweighted) was 11.3
out of 22, indicating moderate quality, with only 9–10% of projects consistently achieving highquality levels. When weighted by budget, the mean score increased slightly to 12.0, with a
modest upward trend over time (β = +0.19 points/year, p<0.05).
Across RE-AIM dimensions, Implementation scored the highest, reflecting strong
adherence to planned activities, whereas Reach and Maintenance consistently scored the
lowest across all health regions, indicating limitations in population coverage and
sustainability. Qualitative findings revealed that the transfer of subdistrict health-promoting
hospitals to provincial administrative organizations had both positive and negative effects,
enhancing local alignment while introducing disparities in capacity and workforce continuity.
Key enabling factors included the use of evidence-based data, strong governance structures,
and multi-sectoral collaboration, whereas major barriers included discontinuity of funding,
short project duration, and incomplete information systems.
In conclusion, although the quality of PPA projects has slightly improved over time, it
remains at a moderate level, with persistent weaknesses in Reach and Maintenance. The
primary policy recommendation is to discontinue PPA funding and integrate effective
components into the PP Basic system, with systematic knowledge transfer, standardized
service packages, and outcome-oriented monitoring without increasing administrative burden.
However, if PPA funding is retained, its role should be reoriented toward a quality-driven
mechanism by reducing the number of projects, increasing funding intensity per project,
applying RE-AIM criteria in project selection, and strengthening technical support and longterm outcome monitoring systems.
