Abstract
Background and Rationale: Prachinburi Province has successfully transferred sub-district health
promoting hospitals (SHPHs) to the provincial administrative organization (PAO), concurrent with the
adoption of new primary care standards. Maintaining and developing health services quality to ensure
continuing access to standardized healthcare is crucial. This study aimed to: (1) examine the outcomes
of health service quality development in SHPHs, (2) compare outcomes of the quality of health service
delivery in fiscal years 2023 and 2024, and (3) examine success factors and obstacles in developing the
quality of health services of SHPHs after devolution to the Prachinburi PAO.
Methodology: This was a mixed methods research study. The quantitative component involved
comparing secondary data of primary health care service quality assessment scores in 8 parts of 94 SHPHs
using descriptive statistics and Wilcoxon signed-rank test statistics. The qualitative component consisted
of in-depth interviews with a purposive sample of 31 SHPH directors registered as primary care units
and primary care networks. The qualitative data were analyzed using content analysis. This study was
conducted from February 2024 to July 2025.
Results: (1) The development of health service quality of the SHPHs after the devolution led
to overall sustained or improved standards across nearly all aspects, with enhanced management
agility. The provided services were consistent with the local context, and received support from network
partners, resulting in service units being able to better respond to the needs of the people. (2) Comparing
between fiscal years 2023 and 2024, the quality of health services of the SHPHs increased significantly
(p < 0.05), especially in terms of management, personnel management, information systems, and
pharmaceutical services. Clear PAO policies and objectives have created concrete direction and efficient
operation of the SHPHs. And, (3) key success factors included policy support and resources from the PAO,
effective management, and cooperation of personnel and communities. Obstacles included increased
paperwork, insufficient personnel, incomplete information systems, and some complex evaluation
criteria.
