Evaluation of the Sub-district Health Promotion Hospital Development Policy on a Pilot Scale in Fiscal Year 2009 - การประเมินผลนโยบายการพัฒนาโรงพยาบาลส่งเสริมสุขภาพตำบลในระยะนำร่องของปีงบประมาณ 2552

บทคัดย่อ

             This study was aimed at evaluating the implementation of the policy on development of subdistrict  or tambon health promotion hospitals (THPHs) during the pilot phase in fiscal year 2009 using the logic model via a set of mailed questionnaire sent to 1,001 sub-district health centers that had been upgraded as THPHs as well as in-depth interviews and focus group discussions with THPHs’ administrators, operating staff, and supporting officials as well as local residents in 12 selected subdistricts from August to December 2009. The results showed that the communications and understanding about the policy were unclear as there were some over-expectations and unconfidence in the policy. The grouping of THPHs based on five variables (population, workforce, revenue, remaining revenue, and equipment) revealed that the proportions of large, medium, and small THPHs were 0.3, 18.7, and 81.0 percent, respectively; that was different from the population-based proportions of 37.7, 55.4, and 6.9 percent, respectively. Moreover, the policy movement regarding organizational structure and management policy, changes in hospital signboards, and administrators’ positions were different; the use of THPH’s service manual was little, but there were problems and needs for additional support with regard to workforce, equipment, infrastructure and financing. Not much difference was noted for health-care delivery in some localities. Most of the people went for medical and health services at THPHs and had an expectation for better service quality development. Regarding policy recommendations, it is suggested that there should be communications, public relations and public hearings on the THPH policy and a long-term THPH development policy with clear criteria and standards for evaluation, legislation for the development, specific organization structure and mechanism, and development targets in a realistic and gradual manner. Overall, emphasis should be placed on resolving workforce problems, developing service networks, deploying a proactive (rather than passive) service approach, transferring missions to local agencies, and conducting evaluative research to determine suitable scale and level of development.

Key words: health center, tambon health promotion hospital development policy, primary care system, policy evaluation