Abstract
The district health system (DHS) was a key mechanism for strengthening primary health care
delivery in Thailand through integrated collaboration among local stakeholders. However, DHS
performance and its impact on service quality varied across districts. This study aimed to examine the
implementation, problems, obstacles, and success factors of DHS affecting the quality of primary health
care services in Surin Province. A mixed-methods approach, combining qualitative and quantitative
research, was employed. Data were collected through in-depth interviews with 24 administrators
and service providers, using content analysis. For consumers, a comparative study of satisfaction was
conducted among 400 participants in 4 districts by health facilities (200 at hospitals and another 200
at sub-district health promoting hospitals [SHPHs]), using independent t-tests and one-way ANOVA. The
qualitative findings revealed that DHS enhanced integration of operations, participation of network
partners, and responsiveness to local health problems. However, in specific local contexts, limitations
were identified in terms of workforce, budget, and continuity of monitoring and evaluation. These issues
were reflected in public satisfaction levels. SHPHs showed significantly higher satisfaction scores than
hospitals (p < 0.001), and the high-performing districts had significantly higher satisfaction levels than
the low-performing districts (F = 6.71, p < 0.001). Therefore, strengthening workforce capacity, allocating
resources appropriately, developing standardized monitoring and evaluation systems, and continuously
promoting the participation of network partners were essential strategies to enhance DHS, ensure
equity, improve the quality of primary health care services, and reduce disparities among the population.
