Development of System and Decentralization of Responsibility Mechanisms on Queen Sirikit Health Center and Health Promoting Hospital to the Roi-Et Provincial Administrative Organization

Abstract

          This research was a collaborative action research. The research objective were to study the situation, develop and evaluate systems and mechanisms for transferring  the Queen Sirikit Health Centers and Subdistrict Health Promotion Hospitals to the Roi-Et Provincial Administrative Organization. The key informants were consisted 12 of executives, 20 of stakeholders involved in mission transfer, 15 of representatives of primary health service operators, 180 of operators, and 200 of service recipients, derived from purposive sampling. Data were collected using questionnaires, work performance record form , questions guideline to ask for group discussions. Data were analyzed using descriptive statistics and content analysis. Summary of the research findings; 1) Situation analysis; The results of prioritizing necessary needs in the sub-issues of systems and mechanisms and processes found that teaching and subdistrict health promotion hospitals had essential needs with a PNI index of 0.30 and above in all 4 issues, with essential needs in Primary health care (NHS) and primary care provision were the most (PN I= 0.44), financial budget and accounting (PNI = 0.37), organizational structure (PNI = 0.32), and personnel (PNI = 0.31, respectively). 2) Mission transfer systems and mechanisms include (1) assessing readiness of mission transferee (2) reporting the results of readiness assessment of mission transferee Provincial Administrative Organization to transferring mission (3) Providing mission information, budget framework, and personnel rates. and supplies and equipment (4) practicing understanding of management guidelines and (5) supervision and impact assessment, and 3) results of system and mechanism evaluation. After transfer of mission, problems were encountered regarding the unpreparedness of related regulations and laws. Budget allocation for personnel wages purchasing materials insufficient equipment and medical supplies Concerned about job security, some executives in both transferring and receiving units oppose and do not support mission transfers. and viewed that large transfers would affect the service system and operating results according to most indicators decreased.