The Elderly as Providers and Recipients of Primary Healthcare: A Case Study of Subdistrict Health-Promoting Hospitals in Thailand

Saifon  Su-indramedhi; Wasan Luangprapat; Nattawat  Chansrithada; Chardchawin Tantivejjavanch

Authors

Saifon Su-indramedhi College of Interdisciplinary Studies, Thammasat University, Thailand
Wasan Luangprapat Faculty of Political Sciences, Thammasat University, Thailand
Nattawat Chansrithada Independent researcher, Thailand
Chardchawin Tantivejjavanch Independent researcher, Thailand

Keywords:

devolution, primary healthcare, Sub district Health-Promoting Hospitals, older adults, community participation, local health governance, Thailand

Abstract

Rapid growth of Thailand’s elderly population presents challenges for the country’s healthcare system, particularly regarding the equity and accessibility aspects of the primary healthcare services. This research investigates the impact of Thailand’s primary healthcare decentralization policy on these services, focusing on the dual roles of an elderly individual as both a provider and a healthcare recipient. The decentralization reform in Thailand, which began in 12001, has resulted in the gradual transfer of the subdistrict health-promoting hospitals to local governments, including the popularly eleted provincial administrative organizations, municipalities, and subdistrict administrative organizations. These subdistrict health-promoting hospitals serve an instrumental role in taking care of the elderly population health. This study seeks to identify the specific challenges faced by the primary healthcare service system in catering to the diverse needs of the elderly and to explore the effectiveness of decentralized subdistrict health-promoting hospitals in delivering appropriate care. A mixed-methods approach was employed, combining qualitative and quantitative data collection techniques. In-depth interviews and focus group discussions with healthcare professionals, elderly individuals, community representatives, and local policymakers were conducted alongside surveys to gather specific data on healthcare access, service utilization, and health outcomes among the older population. The study results reveal critical barriers to effective service delivery, including a shortage of healthcare personnel trained in geriatric care, imbalances in health resource distribution, and a lack of integrated healthcare service delivery. While the subdistrict health-promoting hospitals are integral in providing accessible healthcare, they often lack the necessary resources and skilled staff to adequately support the elderly. The study concludes that a collaborative approach is essential, particularly the integration of the contributions of elderly individuals and neighborhoods in community health planning and policy implementation. This integration fosters ownership among stakeholders and enhances health interventions. The findings contribute to the field of public health administration by advocating for comprehensive strategies that prioritize the elderly's health and well-being while addressing systemic deficiencies within the primary healthcare system. Ultimately, the research highlights the need for policies that improve healthcare access and service integration, ensuring that the elderly population in Thailand receives the quality care necessary for their health outcomes.

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