Role Structure and Workforce of Provincial Public Health Offices and District Public Health Offices after the Transfer of Sub-district Health Promoting Hospitals to Local Administrative Organizations

Abstract

This mix-method study aimed to review the legal mandates, organizational size and structure; and investigate changes in roles, structure and staffing frameworks of the provincial public health office (PPHOs) and District public health offices (DPHOs) following the transfer of sub-district health promoting hospitals (SHPHs) to the local government office (LGOs). This study consisted of two steps. The first step was a review of law assigning the Minister of Public Health as the legal authority, along with an analysis of workforce data drawn from Human Resources Office of Permanent Secretary System (HROPS). Data were collected using structured data recording forms and analyzed though content analysis, supplemented with descriptive statistics including frequency, percentage, and measures of central tendency. Step 2 was a qualitative case study, in which 19 informants were purposively selected. Data were collected though focus group interviews and analyzed using content analysis. Study finding revealed that there were five laws related to the PPHOs, DPHOs, and LGOs. However, the content of these laws did not clearly delineate the specific mandates assigned under each legal provision. Therefore, the central administration of Ministry of Public Health should issue directives or set key performance indicators for implementation. Regarding the human resource situation in the PPHO and DPHO, it was found that both offices did not have fully in line with staffing framework, the roles and responsibilities for, PPHOs and DPHOs could not perform implementation effectively following the transfer of sub-district health promoting hospitals (SHPHs) to LGOs, as they were unable to supervise or monitor performance indicators at the SHPHs level. The staffing of PPHO were not significantly affected after the transfer, However, in some DPHOs, staffing level were not the same as before due to personnel unwilling to transfer and decided to remain in DPHOs in some of which remained and continued to operate and provide medical and public health services. Thus, Ministry of Public Health should prepare and implement regional administration in compliance with the decentralization law, so as to be consistent with the national direction.