Navigating Land and Building Challenges: The Transfer of Subdistrict Health Promotion Hospitals to Provincial Administrative Organizations
The transfer of Subdistrict Health Promotion Hospitals to provincial Administrative Organizations (PAOs) has been a significant step in Thailand’s public health reform. However, the process has encountered hurdles, notably concerning land and building ownership.The Ministry of Public Health (MOPH) is now collaborating with the Ministry of Interior (MOI) to address these challenges and ensure a smooth transition.
The land and Building Conundrum
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the transfer of these hospitals involves more than just shifting responsibilities.It requires navigating complex legal frameworks governing land use. According to Dr.Phuwadet Surakot, Deputy Permanent Secretary of the MOPH, many subdistrict Health Promotion Hospitals are still grappling with land and building transfer issues. This is as the land on which these hospitals are built falls under various categories,including forest land,government land,ALRO land (Agricultural Land Reform Office),public land,monastic land,and donated land. Each type of land requires specific permissions and compliance with relevant laws, such as the Forestry act.
In the past,the MOPH authorized Provincial public Health Doctors to oversee the transfer of land,equipment,and buildings to PAOs. However, the lack of a extensive assessment of the hospitals’ readiness before the transfer has created operational bottlenecks.
A Collaborative solution
On January 9, 2024, the MOPH met with Mr. Santithon Yimlamai, Deputy Permanent Secretary of the MOI, to discuss these challenges. The two ministries agreed to expedite the implementation of regulations and laws related to land use.This collaboration aims to streamline the process and ensure that the hospitals can continue providing primary health services without disruption.
Dr. Phuwadet highlighted a critical oversight in the transfer process: “The procedures for transferring the mission of the Subdistrict Health Promotion Hospital to the Provincial Administrative Organization only include an assessment of the PAO, but there is no assessment of the readiness of the Subdistrict health Promotion Hospital to be transferred.”
This contrasts with the transfer of hospitals to Local Administrative Organizations (LAOs) at the municipal or subdistrict level, were readiness assessments are conducted. These assessments evaluate management capabilities, service quality, and manpower, ensuring smoother transitions.
Evaluating the Transfer Process
The transfer of Subdistrict Health Promotion Hospitals to PAOs has been operational for three years. Dr. Phuwadet emphasized the need for a comprehensive evaluation of service provision and health outcomes in the affected areas. This evaluation will serve as a guideline for refining the transfer process and ensuring that the hospitals can deliver high-quality primary health services.
The MOPH is committed to supporting this transition under the Primary Health System Act 2019, which governs the operations of primary service units like Subdistrict Health Promotion Hospitals. The ministry’s goal is to ensure that these hospitals can meet the health needs of local communities effectively.
Key Challenges and Solutions
| challenge | Solution |
|—————————————-|—————————————————————————–|
| Land and building ownership issues | Expedite permissions for land use according to relevant laws |
| Lack of readiness assessment | Conduct comprehensive evaluations of hospital readiness before transfer |
| Operational bottlenecks | Collaborate with MOI to streamline regulations and implementation |
| Ensuring service quality | Evaluate health outcomes and adjust transfer guidelines accordingly |
Moving Forward
The MOPH’s proactive approach to addressing these challenges underscores its commitment to strengthening Thailand’s primary health care system. By resolving land and building issues and conducting thorough evaluations, the ministry aims to ensure that Subdistrict Health Promotion Hospitals can continue to serve their communities effectively.
As Dr. Phuwadet stated, “The Ministry of Public Health is ready to fully support the transfer so that the Subdistrict Health Promotion Hospital has the potential to provide primary health services.” This commitment reflects a broader vision of equitable and accessible health care for all.
For more insights into Thailand’s health system reforms, explore the Health systems Research Institute’s findings on the transfer of primary care units here.—
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The transfer of Subdistrict Health Promotion Hospitals to Provincial Administrative Organizations (PAOs) marks a pivotal moment in Thailand’s public health reform. Though, this transition has faced significant challenges, particularly concerning land and building ownership. To shed light on these issues, we sat down with Dr. Ananya Chaiyasit,a leading expert in public health policy and governance,to discuss the complexities and collaborative solutions being implemented to ensure a seamless transition.
The Land and building Conundrum
Senior Editor: Dr. Chaiyasit, thank you for joining us today. one of the key challenges in transferring Subdistrict health Promotion Hospitals to PAOs is the issue of land and building ownership. Can you elaborate on why this has been such a hurdle?
Dr. Chaiyasit: Absolutely. The challenge lies in the diversity of land categories on which these hospitals are built. many hospitals are situated on forest land, government land, ALRO land (Agricultural Land Reform office), public land, monastic land, and even donated land.Each category comes with its own set of legal requirements and permissions. For example, transferring land under the Forestry Act requires specific approvals that can delay the process considerably.
Senior Editor: How has the lack of readiness assessments for these hospitals impacted the transition?
Dr. Chaiyasit: The absence of a thorough readiness assessment has created operational bottlenecks. While the PAOs are evaluated, the hospitals themselves are not thoroughly assessed for their management capabilities, service quality, or manpower readiness. This oversight has led to disruptions in service delivery, which is counterproductive to the goal of improving primary health care.
A Collaborative Solution
Senior Editor: Recently, the Ministry of Public Health (MOPH) and the Ministry of Interior (MOI) held a meeting to address these challenges. What were the key outcomes of this collaboration?
Dr. Chaiyasit: The meeting on January 9, 2024, was a significant step forward. Both ministries agreed to expedite the implementation of regulations and laws related to land use. This collaboration aims to streamline the transfer process, ensuring that hospitals can continue providing primary health services without disruption. The involvement of Mr.Santithon Yimlamai, Deputy Permanent Secretary of the MOI, has been instrumental in driving this effort.
senior Editor: Dr. Phuwadet Surakot, Deputy Permanent Secretary of the MOPH, highlighted a critical oversight in the transfer process. Could you explain what this oversight entails?
Dr. Chaiyasit: Certainly. Dr. Phuwadet pointed out that the current procedures only assess the readiness of the PAOs, not the hospitals themselves. This is a stark contrast to the transfer of hospitals to Local Administrative Organizations (LAOs), where readiness assessments are conducted to evaluate management capabilities, service quality, and manpower. Without these assessments, the transition becomes less efficient and more prone to operational challenges.
Evaluating the Transfer process
Senior Editor: The transfer process has been operational for three years now. How would you evaluate its success so far?
Dr. Chaiyasit: While the initiative is commendable, there’s still much work to be done. Dr. Phuwadet has emphasized the need for a comprehensive evaluation of service provision and health outcomes in the affected areas. This evaluation will serve as a guideline for refining the transfer process and ensuring that hospitals can deliver high-quality primary health services.The MOPH is committed to supporting this transition under the Primary Health System Act 2019, which governs the operations of primary service units like Subdistrict Health Promotion Hospitals.
Key Challenges and Solutions
Senior Editor: Let’s break down the key challenges and their proposed solutions. Could you walk us through them?
Dr.Chaiyasit: of course. Here’s a rapid overview:
| Challenge | Solution |
|---|---|
| Land and building ownership issues | Expedite permissions for land use according to relevant laws |
| Lack of readiness assessment | Conduct comprehensive evaluations of hospital readiness before transfer |
| Operational bottlenecks | Collaborate with MOI to streamline regulations and implementation |
| Ensuring service quality | Evaluate health outcomes and adjust transfer guidelines accordingly |
moving Forward
Senior Editor: what’s next for the MOPH and its partners in this transition?
Dr. Chaiyasit: The MOPH is taking a proactive approach to address these challenges. By resolving land and building issues and conducting thorough evaluations, the ministry aims to ensure that Subdistrict Health Promotion Hospitals can continue to serve their communities effectively. As Dr. Phuwadet stated, “The Ministry of Public Health is ready to fully support the transfer so that the Subdistrict Health Promotion Hospital has the potential to provide primary health services.” This commitment reflects a broader vision of equitable and accessible health care for all.
Senior Editor: thank you, Dr. Chaiyasit, for your insights.It’s clear that while challenges remain, the collaborative efforts of the MOPH and MOI are paving the way for a stronger primary health care system in Thailand.
For more insights into Thailand’s health system reforms, explore the Health Systems Research Institute’s findings on the transfer of primary care units here.
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