Abstract
The transfer of the Chaloem Phrakiat 60th Anniversary Nawamintharachini Health Centers (CHCs) and Sub-district Health Promoting Hospitals (HPHs) to Provincial Administrative Organizations (PAOs) marks a significant shift in the primary healthcare system, involving multiple stakeholders. This study aims to monitor the situation of the mission transfer and compile relevant research. The specific objectives include compiling academic data to illustrate the transfer situation, developing a research mapping on the transfer, communicating academic findings to stakeholders through the Health System Intelligent Unit (HSIU) mechanism, and formulating policy recommendations.
The study comprises two main components: research and academic communication. The research component involves two key activities: developing a research mapping on the transfer of CHCs and HPHs to PAOs and analyzing outpatient service and health promotion and disease prevention services data following the transfer. The academic communication component supports knowledge sharing through the HSIU’s activities, including 14 meetings with the core working group, two meetings of the HSIU working group, two practitioner network meetings, and continuous updates on the HSIU Dashboard to reflect the latest data on the mission transfer.
The research mapping identified 67 relevant studies, including 28 articles from the Thai Journal Online (ThaiJO) database and 39 research reports from the Health Systems Research Institute (HSRI). The most studied topic was health governance, covered in 30 studies (44.8%), followed by human resources and health service systems, each with 21 studies (31.3%). Health financing was examined in 11 studies (16.4%), while pharmaceutical systems were covered in 8 studies (11.9%). The least studied area was health information systems, with only 6 studies (9.0%). Most research has focused on health system components in aspects of structural, input, and operational models rather than health system outcomes, such as health security, health equity, and system responsiveness. Among the 67 studies, research has been conducted in 55 provinces, whereas eight provinces Chanthaburi, Narathiwat, Trang, Tak, Phang Nga, Phetchaburi, Mae Hong Son, and Yasothon have not yet been studied.
The analysis of CHCs', HPHs' and community hospitals’ out-patient (OP) and disease prevention and health promotion (PP) visits compared to the pre-transfer period found that OP and PP visits tended to decline after the transfer, particularly in the first year. Specifically, groups of HPHs transferred to the PAO in 2023 and 2024 have shown a reduction in OP visits by more than 15% and a reduction in PP visits by more than 30%. Meanwhile, the number of OP and PP visits at community hospitals has shown an increasing trend across all groups, regardless of whether HPHs in the area were fully transferred, partially transferred, or not transferred. However, further studies are needed to understand the causes and factors contributing to this decline, which may vary depending on the local context.
This study recommends that relevant agencies analyze the reasons behind the decline in service volume at transferred HPHs to PAOs, particularly in terms of outpatient services and health promotion and disease prevention services, to improve the healthcare service system in the future. Additionally, it suggests developing a local health information system to monitor public health operations and health system outcomes. Furthermore, recommendations are provided for research funding agencies and researchers to focus on studying health system outcomes, particularly in relation to health equity.
