จากรูปแบบเหมาโหลสู่การมีส่วนร่วมของชุมชนและกลไกอภิบาลสุขภาพ ในการจัดบริการปฐมภูมิของโรงพยาบาลส่งเสริมสุขภาพตำบลหลังการถ่ายโอนภารกิจไปสู่องค์การบริหารส่วนจังหวัด

Weerasak Krueathep; Preeda Taearak; Pranom  Aosan

Authors

Weerasak Krueathep Department of Public Administration, Faculty of Political Science
Preeda Taearak National Health Commission of Thailand
Pranom Aosan Academic Supports, National Health Commission Office, Thailand

Keywords:

community health center, the devolution of CHC, health governance, asymmetric devolution, provincial administrative organization

Abstract

The devolution of community health center (CHC) from Ministry of Public Health to provincial administrative organizations (PAOs) has significantly embarked on a new ecosystem for community health services. PAOs now have more autonomy and discretion to provide primary health care that better fits constituency needs and health conditions. This research attempts to examine whether the changing milieu helps stimulate civic participation and community health governance in desirable ways. Twelve CHCs from six PAOs around the country are selected and provided guidelines in designing their own management sandboxes. Findings show that the devolution contexts provide new legal and management platforms that help to develop civic engagement and innovations in primary health services. Communal residents are now widely and actively involved in the new governance model of CHCs; for example, analyzing community’s health situation, setting health service priorities, designing new service schemes, and engaging in monitoring processes. This research suggests that the devolution of CHCs brings about better health outcomes attributable to the careful, asymmetrical designs of health services to fit varying needs. Thus, government and relevant agencies shall advance the community health devolution policy into a wider scale and help eradicate legal and management obstacles for the PAOs.

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