Abstract
This research was undertaken to evaluate the devolution of health centers and hospital autonomy in Thailand. The assessment team conducted literature and document review and interviews with the Provincial Health Office (PHO), District Health Office (DHO), Provincial Governor’s Office and Department of Local Administration (DLA), the Contracting Unit for Primary Care (CUP) Hospital, Tambon Administrative Organization (TAO) and health center (HC) staff in five devolved health centers and five nondevolved health centers and a hospital-owned primary care unit (PCU) in six provinces. In relation to the three stated objectives of decentralization, the team’s findings concerned changes in flexibility, responsiveness and participation following devolution of health centers to TAOs.
Findings on the devolution of health centers were as follows: (1) increased management flexibility: three of the devolved health centers had positive perceptions of improvement in management flexibility, in the sense that future decision-making is expected to be faster and there should be greater scope for initiative; (2) increased responsiveness to the community and to patients: three devolved health centers could point to a number of ways in which service delivery had improved and new services had been provided in response to the needs and preferences of the community; and (3) increased participation of the community: all five TAO CEOs and Councils were active in obtaining community input on health and health service delivery.
Findings on hospital autonomy were as follows: (1) the Ban Phaeo Hospital model was found to be well-designed, clear and consistent. Its performance in improving service quality and increasing its revenue had been highly successful; (2) community support for the hospital has been a major success factor but mechanisms for patient and community feedback on priorities and service delivery performance could be strengthened to improve accountability and better align service priorities with the needs and preferences of users; (3) this model should be replicable in other MOPH hospitals, except small community hospitals serving small, dispersed populations.
