A SYNTHESIS OF A MANAGEMENT MODEL FOR THE DISTRICT HEALTH SYSTEM AFTER THE DEVOLUTION OF SUB-DISTRICT HEALTH PROMOTION HOSPITALS TO PROVINCIAL ADMINISTRATIVE ORGANIZATION : A CASE STUDY CHONBURI PROVINCE

Abstract

This research aimed to synthesize of a management model for district health system after the devolution of Sub-district Health Promotion Hospitals to the Chonburi Provincial Administrative Organization. The objective were to study the current situation of district health system management, to synthesize an effective management model, and develop the district health system after the devolution. The research employed participatory action research and mixed-methods approaches. Data were collected from both quantitative and qualitative sources, involving 130 participants, including district public health officers, directors of Sub-district Health Promoting Hospitals, directors of community hospitals, and operational staff from the District Public Health Office. Quantitative findings revealed that, after the transfer of responsibilities, all respondents (100%) annually reviewed their strategic plans, implemented policies, jointly drove the operations of the District Health Coordinating Committee (DHCC), and coordinated with Sub-district Health Promoting Hospitals and other networks. Qualitative data from interviews indicated that the District Public Health Office shifted its role from command and control to coordination, creating flexibility in operations. However, challenges remained in monitoring and evaluation. Service provision transformed from direct provision to oversight and support roles, which affected service quality standards. Contributing factors included a shortage of specialized personnel—such as legal officers, pharmacists, and traditional medicine practitioners—and limited budgets, leading to reduced capacity in quality control. The study recommends enhancing personnel competencies in systematically evaluating the quality standards of primary care services and developing the District Public Health Office into a consultant and mentoring body to elevate the quality of district health system management under the new context with professionalism.