Abstract
The transfer of Subdistrict Health Promoting Hospitals (SHPHs) to Provincial
Administrative Organizations (PAOs) has substantially restructured the primary
healthcare system in Thailand, directly affecting the role and mission of Village
Health Volunteers (VHVs), who serve as the frontline mechanism for householdlevel disease prevention and health promotion. However, post-transfer
implementation has revealed several systemic gaps, including fragmented health
data integration, discontinuity in supervision, the absence of field mentoring
mechanisms, and non-secured budgeting for VHV capacity building.
This study aimed to develop supportive mechanisms and strengthen VHV
capacity for community health management under the post-transfer context; assess
readiness and feasibility across administrative levels; analyze capacity enhancement
outcomes based on the VCITE framework; and synthesize policy recommendations
for national scale-up. A mixed-methods design was applied, consisting of a synthesis
of 32 scientific documents and field implementation in four northeastern pilot
provinces with 100% SHPH transfer: Khon Kaen, Roi Et, Mukdahan, and Nong Bua
Lamphu. Four respondent groups were included: VHVs, SHPH personnel,
district/provincial health officers, and local administrative representatives,
accounting for 100% of key stakeholders. Research instruments included
questionnaires, interviews, and focus groups. Content validity was confirmed with
IOC ranging from 0.89–1.00 and reliability with Cronbach’s alpha between 0.87–
0.94. Quantitative data were analyzed using descriptive statistics, t-tests, and
ANOVA, whereas qualitative data were analyzed using content analysis.
Findings from evidence synthesis revealed that current VHV support systems
remain fragmented, resulting in unequal operational performance among areas. The
conceptual framework “One System – One Standard – One Goal” is therefore
proposed, consisting of four essential supportive systems: (1) One Integrated Data
System via a One-Dashboard mechanism linking Smart VHV, HDC, NHSO, and
PAO in real time; (2) Unified Mentor System driven by District Mentor Hubs to
provide continuous coaching–monitoring–feedback; (3) Result-based Budgeting for
capacity strengthening; and (4) Joint Governance System using a unified health KPI
set.
Readiness and feasibility assessments showed that district-level public health
offices had the highest potential to support VHVs, with an overall mean score of
4.08 (SD = 0.10), reflecting a high level. However, challenges remain in field data
systems and workforce availability to support proactive supervision.
Implementation of VHV capacity development using the VCITE Framework
(Volunteer–Collaboration–Innovation–Technology–Empowerment), together with
Smart VHV digital tools, demonstrated significant improvements in VHV
knowledge and skills for NCD management (knowledge increased from 67.4 to 84.6;
skills increased from 71.2 to 88.1; p < 0.01). Among community members, fasting
blood glucose levels significantly decreased from 100.36 to 97.50 mg/dL (p <
0.001), while BMI and body weight showed favorable trends. These outcomes
indicate that “mentorship + digital data + continuous empowerment” can truly
generate household-level health benefits.
Urgent policy recommendations include: developing a national OneDashboard system and Data Sharing Agreement (DSA) with a unified Data
Dictionary and PDPA workflow; upgrading District Health Offices to serve as
District Mentor Hubs integrating SHPH–LAO–VHV operations; establishing a
national competency-based training and certification system through MicroCredential and Re-certification; creating a dedicated and recurrent OSM-Capacity
Fund within PAOs to support training–digital tools–knowledge exchange; and
reinforcing outcome-based incentives linked to screening coverage, follow-up
continuity, and data quality.
