The Transfer of Subdistrict Health Promoting Hospitals to Local Government Organizations from 2008 to 2025

Abstract

This research article examines the performance, factors affecting success, and the problems and obstacles in the transfer of subdistrict health promoting hospitals (SHPHs) to local government organizations (LGOs) and investigates the approaches, policies, and measures to ensure that the transfer of SHPHs to LGOs is successful. The technique of qualitative research was employed. Data were collected using the techniques of documentary research and in-depth interview. Data analysis was conducted using the techniques of content analysis. Findings are as follows: (1)The Determining Plan and Process of Decentralization Act, B.E. 2542 (1997) , resulted in Thailand being able to transfer only 45.96 percent of SHPHs to LGOs. (2) The factors leading to the success in the transfer were the following three aspects. (2.1) The aspect of the structure of LGOs: LGOs receiving the transfer of SHPHs must possess a unit at a division or an office level to be directly responsible for public health work. (2.2) The aspect of personnel: LGOs must be prepared to provide a manpower plan of public health personnel and the readiness to employ personnel concerned with a sufficient unofficial budget. (2.3) The aspect of finance: LGOs must be able to analyze stability in finance and public finance as well as the budget of one’s own agency in a concrete manner. (3) Problems and obstacles in the transfer are connected at all levels of policy, administration, and operations. At the policy level, the central government has a clear policy in decentralization to the locality. However, unity is lacking in the process leading to a standstill. At the administration level, administrators from the center and the locality do not have a clear decision making and written orders. Communication is not fast enough. The transfer of the workforce or personnel is difficult and delayed. At the operational level, the old work system must be adjusted to meet with the new work system in the aspects of operations, finance, and personnel. All of these are problems in the operations leading to an increase in the responsibilities of the personnel. In addition, the local leaders without sufficient knowledge and ability in public health and without a vision on health as well as a change of leaders in the locality in accordance with their office terms are the problems and obstacles in the transfer of SHPHs as well. (4) The approaches, policies, and measures enhancing the transfer to become successful are as follows. The central government must establish a new department to be responsible for the transferred SHPHs. Attention must be paid to all professional advancement. Positions in SHPHs must be in consonance with the community’s health needs. This is to ensure that the public health operations are with quality and standards as well as being in accordance with the health needs at an area level to be in consonance with the nation’s health goals in a true manner.