Local Administration Journal

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

Saifon Su-indramedhi — 2026-06-27

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.

The Role of Local Administrators in Developing Water User Organizations through Community Participation in Najak Subdistrict, Mueang Phrae District, Phrae Province

PhraThongchai Pichai — 2026-06-30

This research aimed to: (1) study the roles of local administrators in developing water user organizations through community participation; (2) analyze the community participation processes contributing to the successful establishment and development of these organizations; and (3) propose guidelines for enhancing administrative effectiveness in Na Chak Subdistrict, Mueang Phrae District, Phrae Province. A qualitative case study approach was employed. Data were collected from 45 key informants through in-depth interviews, focus group discussions, participant observation, and document analysis. Data trustworthiness was verified through triangulation. Findings revealed that: (1) local administrators perform seven crucial roles—policy formulation, participation support, resource allocation, network coordination, monitoring, good governance, and the application of Iddhipāda 4—functioning effectively as both "Facilitators" and "Boundary Spanners"; (2) a five-stage participation process led to the establishment of two water user organizations comprising 245 member households, achieving equitable water allocation and conflict reduction; and (3) enhancement guidelines encompass five dimensions: personnel development, participation mechanisms, appropriate technology, partnership networks, and sustainability through community water funds.

Analysis of The Cost and Economic Returns in Rice Cultivation Investment for farmers in Derm Bang Nang Buat District, Suphan Buri Province

Thatsanee Srikrua — 2026-06-28

This research is designed to 1. examine the production costs and investment returns of rice cultivation, and 2. compare and analyze the costs and returns experienced by farmers in Derm Bang Nang Buach District, Suphan Buri Province. Data was collected from a sample of 384 farmers. The research was conducted through structured interviews using convenience sampling. Statistical methods employed included frequency, mean, percentage, and financial ratio analysis. The research found that: 1) Farmers in Derm Bang Nang Buach District, Suphan Buri Province, mostly invest in rice growing by cultivating rented land ranging from 31 to 60 rai. Financial support is derived from bank or cooperative loans, and the agricultural technique employed is broadcast sowing. Rice farming production costs are categorized into: variable costs amounting to 20,988 baht/year (including seed expenses, labor, plowing, sowing, fertilization, weed management, harvesting, and transportation to the mill), fixed costs totaling 257,193 baht/year (covering depreciation and maintenance of tractors, lawn mowers, sprayers, and water pumps), resulting in total production costs of 278,181 baht/year, and operating costs of 243,000 baht/year, culminating in an overall cost of 521,181 baht/year. The return on investment from rice cultivation is also examined. The annual revenue, at a selling price of 10,500 baht per ton, amounts to 1,260,000 baht. 2) The annual net profit amounts to 738,819 baht. The gross profit margin is 77.92%, the net profit margin is 58.64%, the return on investment is 153.92%, and the return on assets is 49.98%. The break-even sales volume is 2,491 units.

Transfer of Primary Healthcare Service Provision to Local Governments: A Policy Capacity Analysis of Lessons from Eight Countries

Tatchalerm Sudhipongpracha — 2026-06-28

Health decentralization involves more than transferring budgets, personnel, facilities, and service-delivery responsibilities to local governments. This article applies Wu, Ramesh, and Howlett’s Policy Capacity framework and Bossert’s Decision Space framework to analyze the primary healthcare functions and authority transferred to local governments. The study systematically compares documentary evidence from eight countries selected through a Most Different Systems Design (MDSD): Portugal, Russia, Japan, the Philippines, Indonesia, Mexico, Brazil, and Chile. The analysis follows the READ framework and the transparency principles of PRISMA 2020 and PRISMA-S. The findings show that deficient systemic operational capacity is the most recurrent bottleneck in primary healthcare decentralization across the eight countries. Key challenges include intergovernmental grant systems, workforce preparedness, availability of medicines and medical supplies, referral systems, coordination among diverse service providers, and enforcement of the healthcare service standards. Analytical capacity at the individual, operational, and systemic levels is also essential to decentralization. This includes the ability of all actors in the local health systems to analyze data, plan services, and engage in policy learning. Meanwhile, political capacity helps build legitimacy and strengthen stewardship during the transition to decentralized governance. Among the dimensions of decision space, mechanisms for enforcing primary healthcare service standards emerge as a key factor in successful decentralization across the eight country cases. Two other important conditions are adequate government grants to local governments and a publicly funded universal health coverage system that provides a social safety net for vulnerable populations.

Challenges in the effectiveness of Provincial Waterworks Authority in an era of change

Wutichai kawee — 2026-06-28

In the transition to the 21st century, public utility agencies face complex challenges from economic, social, and environmental changes, climate change, natural resource scarcity, digital technological advancements, and heightened stakeholder expectations. This article aims to analyze the framework of organizational effectiveness to identify strategic factors for enhancing the capabilities of public water service agencies, using the Provincial Waterworks Authority (PWA) as a case study, a key mechanism for improving the quality of life for citizens. The study found that four key dimensions are critical factors affecting organizational effectiveness amidst these changes: (1) Adaptability to respond to economic, social, technological, and environmental fluctuations; (2) Goal Achievement in delivering comprehensive and equitable access to clean water that meets standards; (3) Efficiency through resource management and reducing losses in the production process; and (4) Stakeholder Satisfaction, emphasizing transparency and responsiveness. The findings indicate that to achieve sustainable effectiveness, organizations need to drive all four factors holistically, coupled with accelerated investment in digital infrastructure and the cultivation of an innovative culture. And the development of human capital is essential to creating a strategic advantage and ensuring long-term sustainability in public service delivery.