The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms

Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

doi:10.1002/hpm.2113

Cited by 5 publications

(3 citation statements)

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“…THPHs continued this policy by maintaining sites in rural locations convenient to local populations [49], and these rural THPHs were the ones likely to be staffed by public health officers (80.7% of sampled patients in THPH PH were employed in agriculture compared with lower figures for the other two types). The fact that THPH PHs tend to be away from urban centres probably explains why they rated higher for accessibility than the other two types.…”

Section: Discussionmentioning

confidence: 99%

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand

2017

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BackgroundPoor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2).MethodsA cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses.ResultsTHPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22).ConclusionsDifferences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

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Section: Discussionmentioning

confidence: 99%

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand

2017

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“…(2) Establishment of regional outpost offices of the NHSO (2008NHSO ( -2011: by 2008, the control of budget had passed over to the NHSO from the MoPH, which then established regional outpost offices to manage distribution of funds to the primary care networks (Contracted Units for Primary Care or CUP). This resulted in a significant change in the role of the MoPH and the PHOs which shifted from a "command role" to "performance management role", providing oversight and review of CUP strategic and annual plans (Intaranongpai et al, 2012).…”

Section: Thailand Case Studymentioning

confidence: 99%

The link between UHC reforms and health system governance: lessons from Asia

Hort

Jayasuriya

Dayal

2017

JHOM

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Purpose The purpose of this paper is to examine how and to what extent the design and implementation of universal health coverage (UHC) reforms have been influenced by the governance arrangements of health systems in low- and middle-income countries (LMIC); and how governments in these countries have or have not responded to the challenges of governance for UHC. Design/methodology/approach Comparative case study analysis of three Asian countries with substantial experience of UHC reforms (Thailand, Vietnam and China) was undertaken using data from published studies and grey literature. Studies included were those which described the modifications and adaptations that occurred during design and implementation of the UHC programme, the actors and institutions involved and how these changes related to the governance of the health system. Findings Each country adapted the design of their UHC programmes to accommodate their specific institutional arrangements, and then made further modifications in response to issues arising during implementation. The authors found that these modifications were often related to the impacts on governance of the institutional changes inherent in UHC reforms. Governments varied in their response to these governance impacts, with Thailand prepared to adopt new governance modes (which the authors termed as an "adaptive" response), while China and Vietnam have tended to persist with traditional hierarchical governance modes ("reactive" responses). Originality/value This study addresses a gap in current knowledge on UHC reform, and finds evidence of a complex interaction between substantive health sector reform and governance reform in the LMIC context in Asia, confirming recent similar observations on health reforms in high-income countries.

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“…Sabatier (1999. P. 149) has written of the "desirability of longitudinal studies of a decade or more", and others have suggested that major health reform efforts may last for ten to twenty years (Intaranongpai et al, 2012;Al-Abri, 2019). Where there is an extended reform push as with UHC in Nigeria, we do not know whether it is more appropriate to theorize that a succession of policy windows open and close until an opportunity to complete implementation is taken, or if the problem for policy makers is to stretch a single window over a long time period.…”

Section: Future Research Recommendationsmentioning

confidence: 99%

Obstacles and Challenges affecting the move towards Universal Healthcare Coverage in Nigeria

Jenson¹

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There is increasing pressure for low and middle-income countries to move towards achieving universal healthcare coverage (UHC). According to WHO (2013), UHC guarantees the right to affordable health care for every individual, without financial hardship. The Director-General to the World Health Organization, Margaret Chan (WHO, 2010 p. 1), says UHC “is the single most powerful concept that public health has to offer”. In recent years, UHC has come onto the policy agenda, but Nigeria has been criticised for its slow progress. This study investigates why and how the UHC policy is developed by focusing on the roles and interactions of policy actors, their policy setting, and ‘how’ their actions influence the policy process and outcome of UHC so far in Nigeria. It will provide evidence of Nigeria’s policy process that will enhance the understanding of the politics of such health care policy implementation processes, which is fundamental to the success of policy networks of UHC in low- and middle-income settings. This is an empirical study using a mixed method approach involving quantitative and qualitative research components. The study combines the social network analysis (the quantitative component) with a more general policy process framework (the qualitative component). Data collected between March 2016 and February 2017 involved face-to-face structured interviews, face-to-face semi-structured interviews and documentary analysis to identify members of relevant policy networks and describe the pattern of relationships and influence within the UHC discourse. The SNA analysis displayed a full structural network taxonomy of the UHC policy process and identified key members of the UHC discourse into four key institutions and organisations- such as the power actors, peripheral actors, gatekeepers or brokers, isolated actors, and policy actors connected to the power actors. The theoretical policy process framework highlights five key gaps that exist as challenges and obstacles which impedes the implementation process of UHC Nigeria. These challenges and obstacles include, changing political climate, concerns about system capacity and finance, poor coordination between federal and state levels, corruption and problems with the private sector – HMOs. These challenges and obstacles limit the government’s ability to provide social and financial risk protection and access to quality health services to vulnerable Nigerian communities. Drawing on the theoretical framework and intervention, this thesis concludes that the political, policy, financial and organizational constraints of the health system limit UHC Nigeria implementation progress. Addressing the reasons why these issues ensue would be helpful in taking strategic steps towards achieving financial protection and access to basic health services through UHC for many Nigerians.

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The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms

Cited by 5 publications

References 30 publications

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand

The link between UHC reforms and health system governance: lessons from Asia

Obstacles and Challenges affecting the move towards Universal Healthcare Coverage in Nigeria

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