Abstract
This research attempts to analyze the effects of collaborative
efforts between the Ministry of Public Health (MPH) agencies
and the provincial administrative organizations (PAOs) on the
quality of primary healthcare services provided by the subdistrict
health-promoting hospitals (SHHs), which have been devolved to
the PAOs since 2022. A quasi-experimental research design was
used to compare and contrast four distinct groups of provinces:
(1) provinces with the province-wide experimentation of the
MPH-PAO collaboration, (2) provinces with the district-level
experimentation of the MPH-PAO collaboration in a district
where all SHHs were transferred to the PAOs, (3) provinces with
the district-level experimentation of the MPH-PAO collaboration
in a district where not all SHHs were devolved, and (4) a province
with a PAO that created its own contracting units for primary
care (CUPs). Eleven PAOs were selected: Chiang Mai, Nan,
Lampang, Sakon Nakhon, Ubonratchathani, Kamphaeng Phet,
Phetchabun, Sukhothai, Prachinburi, Rayong, and Pattani. These
PAOs were instructed to collaborate with the MPH agencies in
their respective provinces to improve the quality of primary care
services through innovative programs and projects.
Data were collected in these provinces, using a combination of
qualitative and quantitative methods. Two sets of survey
questionnaires developed based on the Johns Hopkins University
Primary Care Assessment (PCAT) tools were used to collect from
1,864 primary healthcare personnel (934 personnel in the pretesting stage and 930 in the post-testing stage) and 3,439
patients (1,757 patients in the pre-testing stage and 1,682
patients in the post-testing stage). Secondary data on ten
population health indicators were retrieved from the MPH health
data center (HDC). Additionally, the primary healthcare
personnel in each province were recruited to participate in a
series of workshops between June and September 2024 to
provide qualitative assessment of the collaborative primary care
services.
The study results show improved quality of primary care services
in all four groups of PAOs. However, improvements were more
pronounced in the provinces with the province-wide
experimentation of the MPH-PAO collaboration and provinces
with the district-level experimentation of the MPH-PAO
collaboration in a district where not all SHHs were devolved.
The most pronounced improvements were in the “gatekeeping
role” of SHHs and the quality of referrals from SHHs to the
MPH hospitals.
This study suggests that the MPH and PAOs can and should
work together to ensure the quality and continuity of devolved
primary care services. High-echelon bureaucratic officials in
Bangkok should stop their press releases and interviews with
the media in order to avoid any misunderstanding by frontline
healthcare workers. Further, in addition to attempting to fill
up vacancies in devolved SHHs, the Ministry of Interior (MOI)
should concentrate on the capacity-building efforts for the
PAO and SHH officials, while the MPH should enhance the
collaborative leadership and interorganizational
communication skills for their frontline officials.
