Abstract
The devolution of health centers to Local Government Units (LGUs) in Thailand has been one of the many tools that the Ministry of Public Health (MOPH) used in its healthcare decentralization policy. Fifty-one out of 9,787 health centers have been devolved since 2007. This study aimed to (1) understand devolution process; (2) evaluate outcomes of the devolution; (3) analyze strengths, weaknesses, enabling factors, and threats of the devolution of health centers in Thailand and (4) make policy recommendations on the provision of primary health care that fits with the Thai context. The study employed qualitative and quantitative approaches consisting of literature review, data analyses of four selected quality indicators and self-administered questionnaires by health personnel at devolved health centers, in-depth interviews and focus-group discussions in four representative provinces.
The study showed that the rates of screening for diabetes mellitus, hypertension, and cervical cancer in devolved health centers were lower than those in non-devolved health centers (p-value = 0.0400, 0.0438, and 0.0000 respectively). The analysis found no statistically significant result for the rate of early access to antenatal care (p-value = 0.1974).
The findings from 41 questionnaires suggested that budgets, medical supplies and equipments, and facilities in devolved health centers were sufficient although some health centers still lacked adequate health personnel. Some devolved health centers could extend the range of their medical services. 75.61 percent of the respondents reported that quality of care and responsiveness were improved after the devolution. The short chain of command between LGUs and devolved health centers could contribute to less bureaucratic management but might also involve local politics. Although the relationship between devolved health centers and Public Health Organizations remained close after the devolution, only 19 devolved health centers reported to have routine audit by Public Health Organizations. Seven respondents indicated they would prefer to move back to MOPH. Lastly, it was reported that the devolution process lacked the participation from people and frontline health personnel.
Successful healthcare decentralization requires clearer devolution policy and supportive laws and regulations from the government. The MOPH should maintain its roles of supervision and regulation in all devolved health centers and collectively address any arising challenges with the LGUs. The devolution of health centers should maintain within the LGUs with sufficient capacities and people participation must be strongly promoted.
