Development of a Holistic Health Service Model for the Primary Health System in Maha Sarakham Province after transferring the Subdistrict Health Promoting Hospital to the Provincial Administrative Organization

Abstract

Background and Aims: Thailand’s recent devolution of the 60th Anniversary Queen Sirikit Commemorative Health Stations and Subdistrict Health Promoting Hospitals to Provincial Administrative Organizations (PAOs) has substantially reshaped primary health care governance. In Maha Sarakham Province, this raises questions about how to sustain and strengthen holistic primary health care within a new administrative structure. This paper aims to (1) examine coordination mechanisms of local health networks for basic public health and primary care after transfer to the PAO, (2) identify conditional factors influencing holistic health service delivery in the primary health system, and (3) develop and validate a holistic health service model for the primary health system in Maha Sarakham Province following the transfer of primary care units.

Methodology: A mixed-methods study was conducted in four phases. Phase 1 used qualitative approaches—document review, Future Search Conference–based participatory workshops, and field studies—with 905 key informants to construct a conceptual framework and initial hypotheses. Phase 2 was action research using workshops that applied Future Search and PAOR cycles (Plan–Act–Observe–Reflect) with 520 participants across 13 districts to design and implement holistic primary care service models. Phase 3 was a quantitative survey of 400 public health executives and personnel sampled from 1,435 staff using structured questionnaires; data were analyzed with descriptive statistics, Pearson correlation, and multiple linear regression at a 0.05 significance level. Phase 4 comprised expert workshops with 20 purposively selected experts to verify the appropriateness and feasibility of the draft model using content analysis and analytic induction, with acceptance criteria of mean ≥3.50 and IR <1.5.

Results: Six core components of a holistic primary health service model were synthesized: (1) comprehensive health service system, (2) service provider system, (3) medical product system for primary care units, (4) financial and fiscal system, (5) health information system, and (6) governance system. Overall development of holistic health service delivery was rated at a high level (mean 4.24, SD 0.14). Eight key conditional factors significantly influenced model development: structural change in the primary health service system, internal management system, human resources, budget management, physical and material resources, information technology, coordination and participation of health network partners, and quality of work life. These eight predictors jointly explained 60.9% of the variance in holistic primary care service development (R = 0.714, R² = 0.609, p < 0.05).

Conclusion: The validated holistic primary health service model consists of 6 main service components and 32 subcomponents, and 8 conditional factor components with 52 subcomponents. Experts rated the model as highly appropriate and feasible for implementation. The model offers a practical framework to guide policy formulation, capacity building, and strengthening of primary health care units under PAOs, supporting an integrated, equitable, and resilient primary health system in Thailand after the transfer of health facilities to local government.