Abstract
Community Participation in Government Hospital Administration The primary purpose of this study is to explore the current situation of community participation in government hospitals in Thailand. This concerns community participation in the context of hospital development and management, as well as its underlying factors. The methods of data collection include both quantitative and qualitative.A nation-wide mailed questionnaire survey was carried out to determine the extent of participation in government hospitals with at least 60 patient-beds. The questionnaires were mailed to the total number of 212 eligible hospitals and 209 completed questionnaire were returned, or the response rate was 98.8 percent. The qualitative data collection aims at in-depth investigation of the process and underlying factors of community participation in hospital development and management. The survey result indicated that community participation in any specific health program organized by the hospitals has been developed at a certain level, but not in the hospital administration except Ban Peaw community hospital in the central part of the country. The most popular form of participation reported by hospitals is community leaders participating as hospital consultative committee members. The main activity of the committee is to help fund raising and mobilize local resources for hospital development. On the part of hospitals, the reported significant reasons underlying community participation development was to strengthen hospital accessibility by the community they served (89.8 percent). The other important reasons reported included inadequacy of the government budget (47.4 percent) and communities’ interest (43.0 percent). The majority of hospitals (95.9 percent) appeared to recognize the importance and benefits of community participation. About one-third reported no problems in hospital development as a result of community participation, and about one-fourth had plans to reform the administration to become autonomous hospitals. Four hospitals experienced with community participation in development and management including 3 government community hospitals and one private-non profit foundation hospital were purposively selected as case studies for qualitative data analysis. The hospital administrators and key staff members as well as community leaders were given in-depth interviews. The major findings are that the communities have competence in hospital development and management in the direction they need. The four major existing forms of community participation include 1) community participation in the decision making process of hospital development plans and policy formulation for the health service system, 2) community participation in hospital management of infrastructure and non-medical activities, 3) community involvement in health care service implementation, and 4) community involvement as coordinators to bridge gaps between hospitals and communities. The factors facilitating community participation are threefold: 1) hospital related factors, 2) community related factors and 3) quality of relationship between hospitals and communities they served. The crucial hospital related factors are the policy of community involvement expressed by the hospital administrators, the competence and leadership of hospital administrators, the inadequacy of the government budget for hospital development, the hospital administrators’ expression of his or her sincere welcoming of community members to participate in hospital development/ administrative/consultative committees, as well as strategies for mobilizing local resources through the integration of religious beliefs held by the community. On the part of community, the critical factors are community health needs, community competence, community faith and trust in hospital administrator, sense of belonging to hospital, and community satisfaction with the services provided. Lastly, but very important, is the good relationship between hospital administrators/staff and community members. To sustain effective community participation, the government sector, including government hospitals should construct communities’ social and economic conditions to facilitate community participation in government hospital administration. The concepts of civil society, good governance based upon democratic ideology, equity and patient’s rights, and sense of belonging to government hospitals are recommended as strategies to be promoted in the communities. In addition, the health promotion hospital policy of providing out-reach health promotion services should be strengthened. To empower community members with sufficient potentiality to actively participate in hospital administration, the government sector and government hospitals should promote comprehensive development projects, both health-based and community-based economy, based in the communities they serve. This should be coordinated with the existing community organizations, both government and non-government, including community temples.To facilitate community power in decision making in hospital administration, the present hospital administrative structure needs to be reformed. All, or at least more than half of the total number of the administrative committee members should be selected from among the representatives of community members. Practical rules and regulations for community participation, for instance, the composition of the hospital administrative committee members, the characteristics of eligible representatives of the community members and selective procedures, should be developed and considered through the process by which the community has equity participation in decision making.
