Presented by: Asst. Prof. Phudit Tejativaddhana, College of Health Systems Management (NU-CHSM), Naresuan University, Thailand

Adj. Prof. Zhanming Liang, NU-CHSM and La Trobe University, Australia

Adj. Prof. Peter Howard, NU-CHSM and La Trobe University, Australia

Adj. Prof. David Briggs, NU-CHSM

Dr. Kamolnat Muangyim, Sirindhorn College of Public Health, Ministry of Public Health, Thailand.

Presented at 6th Annual Global Healthcare Conference (GHC 2017)

Hotel Fort Canning, Singapore, 24 July 2017

Strengthening the district health system

management: Challenging facing Thailand and Thai health managers

Outline

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Implications to health services management workforce

development

Overview of Thai health system and challenges it faces

Current development and way forward

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• Thailand’s health system is based on primary health care and the network of health services provides good overall coverage with solid evidence of its ‘pro -poor’ effect. (WHO 2014)

• Universal Health Coverage (UHC) achieved by 2002 with comprehensive benefit package free at point of services, almost zero co-payment.

• The UHC policy aims at strengthening primary care.

• Public sector dominant role in services provision, extensive geographical coverage of DHS

• DHS as main contractor for Out-Patient, Prevention, Promotion, and Gate keeping functions. (Pongsupap 2013; Tangcharoensathien 2016)

Overview of significant reforms in Thai health system in the past decade

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• The DHS is the entity that provides access and delivers health services to

local communities, in order to improve health and quality of life

• In its extensive networks of Provinces there are hospitals and health

structures of a relatively good standard within some 700 districts that

have responded well in reducing the prevalence of communicable

diseases.

• Moving towards a ‘good health orientated system,’ which ‘guarantees

access to adequate quality healthcare for all’

• Reforming DHS

• Stronger collaborative health networks to build a healthy

district and to better respond to new health challenges

• Improving quality health services at a standard level and,

improved patient’s satisfaction and health professionals’

happiness in their daily work.

• Strengthening primary care with better quality 10

District Health Services

Source: Tangcharoensathien V. (2016)

District Health System: hub for pro-poor outcomes

The lancet 2013;381:2118-33.

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There have been significant increase in access to health services pressuring district health system to be more efficient and effective in sustainably meeting healthcare needs of the population

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• There has been continuous increase in health expenditure which threaten the sustainability of the universal health coverage

Proportions of health providers per 10,000 population, 2015

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Doctors

Pharmacists

Professional

nurses

Technician

nurses

Dentists

1 21 3 4 5 6 7 8 9 10 11 12 BKK

Shortage of health workforce particularly in rural areas

Source: Health at a Glance Thailand 2016, Ministry of Public Health (2017)

PCCPrimary care

cluster

Health systems based on PHC which

focuses on health promotion and

disease prevention

Healthy People and Community

District/Local Health Board

Source: Ministry of Public Health (2016)

Complex health system governance and management at district level of

Thailand

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Community Hospital

District Health Office

CUP Board

Provincial Hospital

Provincial Health Office

Chief of District

Pharmacies Private Clinics

National Health Security Office

(Regional Branch)

Local Governments

Health

Centre

Community

PHC

Community

PHCCommunity

PHCCommunity

PHCCommunity

PHC

Private SectorDistrict

Sub-district

Province

Thai District Health System

Village

Health services operated by health professionals

Services operated by Village Health Volunteers in

the community

Health Centre

Health Centre

Health Centre

Health Centre

Health Centre

Health Centre

Community

PHC

Community

PHC

Sub-district health fund

People and CommunitySource: Tejativaddhana (2014)

CUP Board

DHB

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• In the Thai health system, health management as a profession is not well known and the focus has been on curative care.

• Clinician VS Manager Roles

• All hospital directors are medical doctors which have been trained mainly in curative care

• Most of them carried medical mindset while they had to manage their hospitals and health service networks. (Taytiwat et al. 2011)

• Bureaucratic management style of the Thai health system

• Centralized decision making

• Rigid and monopoly. (Tejativaddhana et al 2013)10

Barriers to the implementation of

primary health services at district level

• Unclear roles, responsibilities and authorities at district level:

• Within district health team from different organizations (Community Hospital VS District Health Office and Sub-district Health Promoting Hospitals).

• Between health team and local government as well as others sectors. (Tejativaddhana et al 2013)

• They need to change the way they think, manage, lead and engage in effective delivery of service within a DHS structure.

(Tejativaddhana, Briggs & Tonglor 2016)

Barriers to the implementation of primary

health services at district level (Cont’d)

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• Thai health managers require modern management and leadership competencies.

• Building and strengthening research capacity in sustaining the Thai health system.

Implications to health services management workforce development

• Understanding of management competency development needs of Thai health managers

• A leadership and management competency framework to guide the design of training and development for Thai health management workforce.

Implications to health services management

workforce development (Cont’d)

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Current Development- Learning from

Expertise and Collaboration

• Naresuan University (NU) established NUCHSM to build

capacity in Thailand and the sub region in the leadership and

management of health systems management.

• Establish masters research and PhD in health systems

management:

• MSc and PhD students commenced;

• Supported by International Academic Advisory Committee;

• Collaborative research project on MCAP with Latrobe

University, Australia and the Praboromrachanok Institute (PBI),

Ministry of Public Health, Thailand.

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NU-College of Health Systems

Management (NUCHSM) Initiatives

The programs provided the opportunity for students todiscuss with international and national experts throughface-to-face and video-teleconference seminar as wellas field trips to study from real experiences of Thaihealth managers in managing their DHSs.

Way forward.

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To further develop and strengthen the NUCHSM to

achieve its goals in strengthening health management

for health managers in Thailand and other countries in

this sub-region, requires collaborative and sustained

partnership with other international organizations,

particularly in research and health management

education development.

Thank you for your kind attention

College of Health Systems Management

Naresuan University

Phitsanulok 65000 Thailand

facebook.com /chsm.nu/

chsm@nu.ac.th +66 5596 206617

www.chsm.nu.ac.th

List of References

• Bureau of Information, Ministry of Public Health. Four organizations hand in hand to improve quality of life of people by using area-based and

participation of all sectors approach (in Thai). 30 March 2016. Ministry of Public Health. 2016. Available from

http://pr.moph.go.th/iprg/include/admin_hotnew/show_hotnew.php?idHot_new=81337 [Accessed 8th October 2016].

• Ministry of Public Health. Guideline on the Operation of Primary Care Cluster for Health Providers (in Thai). Nondhaburi, Ministry of Public

Health. 2016. Available from http://bps.moph.go.th/new_bps/sites/default/files/Guidelines%20PCC.pdf [Accessed 8th October 2016].

• Pongsupap, Y. Family medicine and community orientation as a new approach of quality primary care in Thailand, in Kidd, M. (eds), The

Contribution of Family Medicine to Improving Health Systems: A Guidebook from the World Organization of Family Doctors, 2nd edn.,

Radcliffe Publishing, London, pp. 231-240. 2013

• Saelee D, Tiptaengtae Sh, Tonsuthepweerawong C, Yana T, editors. Karn Kub Kluen Rabob Sookkapab Amphur Chabub Prated Thai (The

Movement of District Health System, Thailand version) (in Thai). 1st revised ed. Nondhaburi: Ministry of Public Health. 2014. P. 4.

• Tangcharoensathien V. Thailand UC Scheme: Achievement and challenges. Presentation at Health Systems Management: Health Security and

Financing Management for Better Health Equity Seminar. National Health Commission Office. Bangkok. Thailand. 26th August 2016. Available

from http://chsm.nu.ac.th/en/2016/?p=454 [Accessed 8th October 2016].

• Tangcharoensathien V, Pitayarangsarit W, Patcharanarumol. Achievements and Challenges. Policy Note-Thailand Health System in Transition.

Asia Pacific Observatory on Health Systems and Policies. Health Systems Review: World Health Organisation. 2016.

• Taytiwat, P., Briggs, D S., Fraser, J., Minichiello, V. & Cruickshank, M. Lessons from understanding the role of community hospital director in

Thailand: Clinician versus manager, International Journal of Health Planning and Management, 26(2), e48-e67. 2011.

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List of References (cont.)

• Tejativaddhana, P., Briggs, D S., Fraser, J., Minichiello, V. & Cruickshank, M. Identifying challenges and barriers in the

delivery of primary health care at the district level: A study in one Thai Province, International Journal of Health Planning

and Management, 18(1), 16-34. 2013.

• Tejativaddhana, P., Biggs, D. S. The establishment of College of Health Systems Management, at Naresuan University,

Thailand. 2016. Available from http://chsm.nu.ac.th/en/2016/?p=367 [Accessed 8th October 2016].

• Tejativaddhana, P., Briggs, D. & Tonglor, R. From global to local: Strengthening district health systems management as

entry point to achieve health-related sustainable development goals, APJHM, Vol. 11, Iss. 3, 2016. pp. 81-86.

• WHO. The Challenge of Implementing District Health Systems for Primary Health Care, WHO/SHS/DHS. Geneva. 1988

Available from http://www.ais.up.ac.za/med/pcm870/challenge.PDF [Accessed 8th October 2016].

• WHO. Thailand health profile, WHO. 2014 Available on http://www.who.int/countries/tha/en/, Accessed on 1 September

2014.

• WHO. From MDGs to SDGs. A new era for global public health 2016-2030. 2016. Available from

http://www.who.int/about/finances-accountability/funding/financing-dialogue/MDGstoSDGs_Summary.pdf?ua=1

[Accessed 8th October 2016].

• Why district health systems should be strengthened. In: Saelee D, Namtadsanee S, Tiptaengtae Sh, Sumamal T,

Tonsuthepweerawong C, Yana T, editors. Karn Kub Kluen Rabob Sookkapab Amphur Chabub Prated Thai (The Movement

of District Health System, Thailand version) (in Thai). 1st ed. Nondhaburi: Ministry of Public Health. 2014. p. 4. 19