Abstract
Decentralization is an important management strategy to improve local government efficiency and services. However, such efficiency will not occur without the self-governing ability of local authorities and communities. This study analyzes the capacity and preparedness of local administrative organizations and communities in taking over the healthcare responsibilities from the national government. The local health management capacity is divided into two (2) elements. First, institutional capacity refers to a local administrative organization’s ability to offer high-quality and adequate health services. The institutional capacity consists of three (3) dimensions: (1) political leadership and local executives’ attitude towards healthcare, (2) organizational structure and adequacy of local healthcare personnel, and (3) local fiscal capacity. Second, community capacity refers to a local community’s ability to participate meaningfully in the local policy-making process. This consists of two (2) dimensions: (1) local citizens’ attitude towards their health and (2) forms of citizen participation in social and political activities. Based on these two (2) elements of local health management capacity, this study examines six (6) local administrative organizations: Nongbua Lumphu Provincial Administrative Organization, Udornthani Provincial Administrative Organization, Udornthani Nakorn Municipality, Nongbua Lumphu Muang Municipality, Naphu Tambon Administrative Organization, and Nasee Tambon Administrative Organization.
This study finds that the three (3) “model communities” –including the Nongbua Lumphu Provincial Administrative Organization, Udornthani Nakorn Municipality, and Naphu Tambon Administrative Organization—demonstrate more institutional capacity than the other three (3) local administrative organizations. The model communities’ mayors exhibit positive attitudes towards healthcare responsibilities and the need to collaborate with the Ministry of Public Health and civil society. Also, research findings indicate that each model community has a local health department with adequate healthcare personnel to serve its constituents. Nonetheless, all six (6) local administrative organizations in this study encounter difficulty with revenue collection. Even the model communities still rely heavily on intergovernmental transfers to finance their operations and services.
In terms of community capacity, the model communities are more prepared than the other three (3) local administrative organizations. This is due to the diversity and enthusiasm of civil society organizations that offer a variety of health-related activities in the model communities. Such diversity and enthusiasm come from a wide range of news media outlets and other information sources that make local citizens aware of the importance of maintaining healthy lifestyle. Also, the local healthcare personnel’s proactive approach plays an important role in inculcating health awareness among local citizens.
