Abstract
This research employed a research and development approach with mixed methods
for data collection. The objectives were to: 1) analyze the situation and management factors
affecting surveillance, prevention, and control systems for communicable diseases in provinces
where Sub-district Health Promoting Hospitals (HPHs) have been transferred to Provincial
Administrative Organizations (PAOs); and 2) develop systems and provide recommendations
concerning regulatory improvements and operational linkages between PAOs, transferred
HPHs, and Ministry of Public Health agencies during both normal and emergency response
situations. The study was conducted from March to December 2024.The sample was divided
into four groups: 1) provinces where 100% of HPHs were transferred to PAOs (Khon Kaen,
Prachinburi, and Suphan Buri); 2) provinces with at least one district where all HPHs were
transferred to PAOs (Sakon Nakhon, Maha Sarakham, Lamphun, and Uttaradit); 3) provinces
with some HPHs transferred to PAOs but no district with 100% transfer (Nakhon Pathom,
Sukhothai, Nakhon Phanom, and Prachuap Khiri Khan); and 4) provinces with no HPHs
transferred to PAOs (Udon Thani, Phang Nga, and Phra Nakhon Si Ayutthaya). The research
utilized the 6BB+1 framework (consisting of seven components) and was conducted in three
phases: 1) situation analysis using questionnaires, in-depth interviews, and focus group
discussions; 2) system development through focus group discussions based on the A.I.C
process; and 3) system evaluation through expert panel seminars.
The findings revealed several situations and problems related to surveillance,
prevention, and control systems for communicable diseases. Regarding governance, there were
coordination limitations between agencies, particularly in provinces with 100% transfer where
linkages were lacking between HPHs, Provincial Health Offices (PHOs), and District Health
Offices (DHOs). Local regulations did not support certain operations. In provinces with partial
transfer, legal limitations restricted Local Administrative Organizations' budget utilization and
operational flexibility. In service delivery, all provincial groups faced limitations in collaborative
mechanisms and reporting systems. The D506 system was limited to hospitals, not covering
transferred HPHs, and PAOs lacked readiness to assume disease surveillance responsibilities.
For health workforce, all groups had limitations in staffing adequacy and expertise. PAO Public
Health Divisions had insufficient personnel, particularly in disease control, and HPH personnel
lacked academic development opportunities. Regarding health information systems, problems
with data linkage and access were evident. There was inadequate communication of
epidemiological data from district epidemiology centers, staff could not connect to the D506
system, and disease surveillance data was incomplete. In the financial system, issues with
financial regulations and procedures were identified. Budget approval processes were time consuming, and personnel hesitated to use budgets due to concerns about audit procedures.
For access to essential medicines and technologies, problems with vaccine procurement and
distribution were found. Vaccines were insufficient and required allocation from hospitals, and
disease control material procurement was delayed. In community health systems, challenges
existed in mobilizing community health initiatives and coordinating networks. Village Health
Volunteers (VHVs) remained under the Ministry of Public Health, causing operational inflexibility
and duplicated work assignments.
The development of surveillance, prevention, and control systems based on the 6BB+1
framework resulted in several approaches. For governance, focus was placed on joint
development of strategic plans and action plans, utilizing provincial communicable disease
committees, and establishing clear command and monitoring systems. In service delivery, the
recommendation was to continue using Ministry of Public Health legal standards, knowledge,
and practical guidelines, develop clear workflow charts, and enhance field operation teams.
For health workforce, emphasis was placed on recruiting personnel with disease control
expertise and developing personnel capabilities jointly between PAOs and PHOs without
organizational discrimination. In health information systems, development focused on efficient
province-wide connected disease information systems, utilization of the D506 system, and
building understanding of data reporting requirements. Regarding financial systems, joint
budget planning to reduce duplication, creation of clear budget disbursement guidelines, and
budget integration between agencies were recommended. For access to essential medicines
and technologies, focus was placed on controlling standards for medicines and vaccines,
establishing district-level coordination units for basic vaccine requisition from community
hospitals, and developing guidelines for medical supplies support according to regulations. In
community health systems, building cooperation among all sectors, developing community
networks, establishing Sub-district Surveillance and Rapid Response Teams (SRRT) with multisectoral composition, and developing VHV capabilities were emphasized.
The evaluation of the surveillance, prevention, and control systems for normal and
emergency situations in provinces with HPHs transferred to PAOs showed high levels of
feasibility, utility, appropriateness, and comprehensiveness, indicating that the developed
model is suitable for practical implementation. Based on the research, several policy
recommendations were made. For provinces with HPHs transferred to PAOs, recommendations
included: 1) integrating communicable disease control plans between government and local
agencies and developing operational monitoring systems with concrete action plans; 2)
developing interconnected disease databases between agencies; 3) accelerating personnel
development using standardized curricula; 4) planning and integrating budgets between PHOs
and PAOs; 5) developing Standard Operating Procedures (SOPs) and clear workflow charts; 6)
promoting health technology assessment before implementation; and 7) creating effective
community health networks. For provinces without transferred HPHs, recommendations to
prepare for potential transfers included: 1) assessing PAO readiness for communicable disease
control before accepting transfers; 2) evaluating HPHs before they apply for transfer; and 3)
adjusting PHO and DHO roles to provide mentoring and consultation.
