Abstract
This is a report of a review of the situation of decentralization in health and to recommendations for
further steps that need to be taken. Documents, news and information from 1999 to 2007 were reviewed.
Key persons from the organization concerned were interviewed. The study revealed that the decentralization
process was operated slowly and that the infrastructure among the local administrative organizations
to support decentralization was not well prepared and well established. The analysis showed that
decentralization still has strengths and advantages because of the higher local administrators’ capability,
the increase in budget and a transfer of some public health personnel to the local level. Moreover, monitoring
and external audits could be easily conducted since the local authorities’ structures and functions
are less complex compared with that of the government structure. On the contrary, there are some weaknesses
in decentralization. These weaknesses include questions of transparency and lack of skill in public
health affairs among the existing staff. Also, the public health division has not yet been structured in most
sub-district administrative organizations. To consider opportunities, a health security system and health
promotion system from the Thai Health Promotion Foundation, as well as a health-care reform system
that could be possibly established, all would increase the opportunities of the public to participate in
health-care initiation at local levels. An internal audit of the system by the community and the general
public was also counted as an opportunity. Nevertheless, there can also be some obstacles. Currently, the
Thai government does not pay much attention to decentralization and does not really focus on decentralization
management. Therefore, it is possible that the “CEO Governor” system could be a system that
hinders and interferes with the local administration system. Moreover, there is a lack of cooperation
among government officers, and currently many public health personnel still have no confidence in decentralization.
A clear conceptual framework is therefore needed. Recommendations are: (1) Decision-making should
be done by the local administrative organizations; (2) the system needs to be efficient and autonomous; (4)
equity in health is needed; (4) good governance, transparency and accountability are very important; (5)
Public participation and responses to community needs should be focused; and (6) the relationship between
local authorities and the government need to be well established. Additionally, it is recommened
that the Ministry of Public Health be changed into a “standardization authority” with the roles and responsibilities
of monitoring, advising, and providing technical support to local administrative organizations.
At the same time, the local administrative organizations should be authorized with clear roles and
responsibilities to provide suitable public health services directly and specifically for the population in
their own areas. In addition, it is necessary to strengthen capacity-building among local administrative
organizations and capability development of public health personnel to support a good public health
system at the community level. Revision of laws and regulations also needs to be focused and carried out
together with the decentralization process among well-prepared local organizations. For monitoring the
outcomes, the ultimate goal of “health-care services with equity, good governance, efficiency, good quality,
and satisfactory standards” should be used as indicators for the evaluation.
