Evaluation of Oral Health Promotion Services in Primary Care After devolution of Duties to the Provincial Administrative Organization

Abstract

This mixed-methods research aimed to evaluate dental service delivery in primary care following the devolution of duties to Provincial Administrative Organizations (PAO) in terms of oral health promotion service provision, management and mechanism of service driving. Quantitative data were collected from 370 Health Promotion Hospitals after the devolution of duties to PAO (Subdistrict Health Promoting Hospital, Chaloem Phrakiat 60 th Anniversary Nawaminthrachini Health Station). Qualitative data were gathered through in-depth interviews and focus group discussions with executives and operational staff from eight provinces across four regions. Results indicated that after decentralization, basic dental service provision decreased by 6.5%. Support for dental equipment/instruments and materials also decreased by 24.1% and 20.6%, respectively. Data submission to the Health Data Center (HDC) system declined by 7.0%. Oral health examination service provisions for various age groups (pregnant women, preschoolers, schoolchildren and working-age adults) decreased by 5.4, 2.7, 3.0 and 4.1 respectively, A statistically significant relationship was observed between oral health examinations across all age groups before and after decentralization (p-value <0.05). Qualitative findings revealed increased flexibility in budget management and staff recruitment for primary care units. However, support from referral hospitals for dental personnel, budget, and medical supplies became more limited. Crucially, clear operational direction, strong cooperation, and positive relationships between primary care units and referral hospitals were continuous operations. Key facilitating mechanisms included MOU between PAOs and Provincial Public Health Offices, effective inter-agency coordinators, and ongoing support from referral hospitals, all contributing to successful primary oral health promotion and prevention services