Holistic Impact Assessment of the Primary Healthcare System Resulting from the Transfer of Subdistrict Health Promoting Hospitals to Provincial Administrative Organizations

Abstract

The purpose of this research is to assess the holistic impact on the primary healthcare system operated by Subdistrict Health Promoting Hospitals (SHPHs) that were transferred from the Ministry of Public Health (MoPH) to the Provincial Administrative Organizations (PAOs) during the 2023 fiscal year. The transfer involved 3,263 facilities across 49 provinces. The conceptual framework for the evaluation is based on the World Health Organization (WHO) model, which compares changes before and after the transfer across five key components: (1) values and attitudes, (2) structure, (3) inputs, (4) service delivery, and (5) outputs. The research employed a mixed-methods approach, with a primary emphasis on qualitative methodology and supplementary use of quantitative methodology to test the generalizability of preliminary findings. Data collection was conducted using a triangulation method. Qualitative data were analyzed using the ATLAS.ti program. The research findings revealed that, following the decentralization, 74.10% of Sub-district Health Promoting Hospitals (SHPHs) continued to adhere to the principles of the primary health care system as they had prior to the transfer. Meanwhile, 24.44% exhibited positive changes, primarily due to increased resource support. However, 11.46% showed a negative trend, as some personnel were not transferred along with the institutions. Overall, the study indicates a tendency toward positive adaptation to the primary health care system.