DEVELOPMENT OF THE ORGANIZATIONAL MANAGEMENT MODEL AND RESTRUCTURING OF PRIMARY CARE MISSION OF DISTRICT PUBLIC HEALTH OFFICE AFTER THE TRANSFER OF THE SUB-DISTRICT HEALTH PROMOTING HOSPITALS IN ROI ET PROVINCE

Abstract

This action research aimed to develop a model for organizational management and adjust the primary care mission of the District Public Health Office (DPHO) following the transfer of Sub-district Health Promoting Hospitals (SHPH) in Roi Et Province. The study was divided into 3 phases. The 549 purposively selected participants included executives from the Provincial Public Health Office (PPHO) and Provincial Administrative Organization (PAO), DPHO personnel, SHPH directors, and Village Health Volunteer (VHV). Instruments included 3 qualitative sets, validated by 3 experts, and 4 quantitative sets. Content validity was verified using the Item-Objective Congruence (IOC) index, and reliability analysis yielded a Cronbach's alpha coefficient of 0.804. Data was collected from July 2023 to June 2024. The findings revealed that: 1) The transfer of SHPHs to the PAO caused staffing shortages at SHPHs, as non-transferring personnel relocated to DPHOs. This led to coordination problems and adversely affected primary care development. 2) The developed model, applying participatory public administration principles, comprised 4 stages: (1) situation assessment and partnership development; (2) implementation based on the "ROI ET Model"; (3) progress monitoring using empowerment strategies; and (4) outcome reflection through lesson-learned meetings and data feedback. 3) Results of the model's implementation demonstrated high-level participation (Mean = 1.40, SD = 0.51), which narrowed the operational gap in primary care. Consequently, 14 joint primary care performance indicators (66.66%) showed higher coverage than in the pre-transfer period. This indicates that the public received more comprehensive primary care services, enabling the appropriate resolution of local health issues. This reflects the significant change and confirms the tangible outcomes of the developed model.