Abstract
This project aims to (1) search for early warning signs or risk factors related to health impacts associated with the transfer of tambon health promoting hospitals (THPHs), (2) study changes in resource management, health service provision, and public health operations of THPHs that have been transferred to provincial administrative organizations (PAOs), including necessary systemic management approaches, and (3) analyze and synthesize financial, treasury, information, and legal tools to establish an environmental public health system framework for the transferred PHFs to respond to post-transfer health impact situations. The study employs a mixed methods approach, consisting of (1) a qualitative case study conducted in 12 areas across 6 provinces, and (2) a retrospective cohort study with a focus on the first-year post-transfer (fiscal year 2566). It emphasizes baseline data analysis from fiscal years 2561 to 2565 to identify risks and develop measurement sets and information for monitoring future impacts. The project's duration is from September 1, 2022, to August 31, 2023. Key findings from the study reveal that the evaluation framework for health impacts of the THPH transfer should include (1) health outcomes, (2) costs of care, (3) public health outcomes, (4) primary care access, (5) effectiveness or adherence to medical guidelines and timely care, (6) alignment with public health activity frameworks and goals, and (7) resources and management models. This framework can serve as early warning indicators for monitoring post-transfer health impacts. Furthermore, statistical indicators on various aspects of operational differences, trends, and post-transfer changes were identified between transferred THPHs and those that were not transferred, or areas having varying proportions of the transfer. However, it should be noted that certain indicators in the proposed framework lacked data readiness due to limitations in data collection. The surveys with low response rate, despite being conducted by district health officers, might reflect the challenges in executing their existing duties under the new context of decentralized health systems. Additionally, changes in resource management of THPHs transferred to PAOs led to health service reductions, including public health activities. The Ministry of Public Health, the National Health Security Office, the Local Administration Organization Empowerment Committee, the Prime Minister's Office, and the Department of Local Administration, along with relevant agencies, should collaborate to review, plan, and design a monitoring and response system to prevent and address health impacts on the public resulting from the transfer of THPHs to PAOs. This also includes reviewing and re-designing a system for supervising the area-based public health system.
