Abstract
The transfer of Sub-district Health Promoting Hospitals (SHPHs) to Provincial
Administrative Organizations (PAOs) has created notable competency gaps among healthcare
personnel, compounded by the absence of standardized frameworks and tools for staff
development. This research and development (R&D) study investigated those competency
gaps, developed a curriculum framework, evaluated its effectiveness, and formulated policy
recommendations. The study targeted administrators, professional practitioners, and newly
transferred personnel in four representative provinces: Phrae, Khon Kaen, Suphan Buri, and
Pattani. Data were collected using mixed methods—focus groups, in-depth interviews, and
questionnaires—and analyzed through content analysis, descriptive statistics, and Wilcoxon
signed-rank tests.
Findings showed that after the transfer, all three groups experienced declines in
competency across multiple dimensions while facing increased workloads and insufficient
preparation. Administrators exhibited significant gaps in leadership, strategic planning, and
financial regulation. Practitioners demonstrated weaknesses in community networking,
research skills, and information technology. Newly transferred personnel—often coming from
secondary or tertiary care—lacked primary health care (PHC) experience, community
communication skills, and struggled to adapt to the new organizational culture. The resulting
competency framework for PHC support comprises three domains: (1) Essential Competency
for Change (ECC), emphasizing positive attitudes, IT/AI application, and risk management;
(2) Advanced Core Competency (ACC), covering strategic planning and financial regulation;
and (3) Specific Competency for PHC (SCP), addressing clinical practice, emergency
management, and community mental health. A prototype curriculum tailored to each group
proved effective: post-training evaluations showed significantly higher competency scores
across all groups compared with pre-training levels. Participants demonstrated increased AI
awareness and improved digital skills. Administrators reoriented their human resource
management approaches, practitioners strengthened teamwork and participatory learning,
and new personnel built professional networks that helped mitigate culture shock during the
transition to PAO oversight.
Policy recommendations include establishing formal collaborations between PAOs
and existing primary care networks, defining clear competency frameworks for post-transfer
roles, and ensuring adequate PAO budget allocations to adopt this curriculum as a
mandatory standard for personnel development.
