The evaluation of the effectiveness of diabetes and hypertension prevention and control with the mechanism of the District Health Board in Thailand

Abstract

Background: Chronic non–communicable diseases are a growing health problem. The active involvement of multiple sectors through the District Health Board (DHB) could be an important mechanism. Therefore, the objective of this research is to evaluate the result of preventing and controlling diabetes and hypertension with the mechanism of the District Health Board (DHB) in Thailand.
Methods: This evaluation research had randomly selected 8 districts, covering 4 regions, for the study, between October 2022 to March 2023. Quantitative data were collected from 992 people aged equal or above 35 years. Qualitative data were collected through a focus group discussions with 80 members of DHB committee and 80 members of the Sub–District Health Board along with the review of relevant documents. The tools used included tests, questionnaires, and document evaluations. The quantitative data were analyzed using descriptive statistics and the qualitative data used content analysis to analyze.
Results: We found 2 groups of working mechanisms: (1) planning with DHB involvement, and (2) a plan developed by the Non–Communicable Disease (NCD) Board. Every area has a standard screening and treatment plans for patients, with Subdistrict Health Promoting Hospitals being the main units. Relevant laws can be enforced through legal mechanisms, implemented by officials in areas designated by law while only cooperation in complying with the law is used in the communities. Many areas have undergone physical environmental changes, for example, the construction of exercise facilities. The changes in the social environment mostly arised from community awareness, for example, the alcohol-free merit-making event. Knowledge transfer and risk communication in all areas were carried out mainly by public health officers and village health volunteers. Majority of the sample groups, normal, at-risk, and patient, had a moderate level of healthy eating behavior, with percentages of 57.8%, 51.6%, and 56.8%, respectively. In addition, the self-care behavior of the patient group was high at 52.27%. In terms of health status, the incidence rate of new cases of diabetes and hypertension in areas with strategic plans and supported from the DHB shows a downward trend.
Recommendations: Through the mechanism of DHB, participation from various sectors including the government, private sector, and community was generated. The authorities at the policy level should drive the NCD Board at the district level to develop plan for the prevention and control of diabetes and hypertension through the mechanism of the District Health Board (DHB) to enhance the efficiency of addressing chronic non–communicable health problems.