The District Health System Study, a three-year project funded by the Thai Health Promotion Foundation, builds on the success of the “Development of Primary Care and Community Health System in Saraphi, Chiang Mai”. The Saraphi study, also funded by the Thai Health Promotion Foundation, used participatory action research to improve the local health system and encourage the adoption of healthy behaviors of the Saraphi population. The original three-year Saraphi study was one of several pilot projects conducted throughout Thailand. Because of the Saraphi study’s success, the Chiang Mai University Faculty of Nursing was chosen to take part in a national research team to convince policymakers to adopt the District Health System as country policy. This study is led by Assoc. Prof. Dr. Decha Tamdee who is both the Principal Investigator and Project Director. Former Dean Assoc. Prof. Wilawan Senaratana is the Project Manager and brings along her experience as Project Manager of the Saraphi project. Both studies were conducted under the auspices of the Center for Community Health System Development where Assoc. Prof. Dr. Decha Tamdee serves as Chair. Other members of the research team include Dr. Jarass Singkaew, Assoc. Prof. Dr. Sivaporn Aungwattana, Assist. Prof. Wilawan Tuanrat, Assoc. Professor Dr. Waraporn Boonchieng, and Assist. Prof. Dr. Taweeluk Vannarit. The study is funded from March 2016-2019.
The objective of the District Health System Study is to improve quality of life at the amphur or district level through strengthening the local health system and pilot testing the formation and implementation of a District Health Board for each district Amphurs or districts are the next administrative division after provinces and are analogous to counties. The 8 districts chosen for this study represented a range of populations throughout Northern Thailand. One district represented Chiang Rai, Phrae, Phayao, Lumphun and Mae Hong Son provinces while three districts were included in Chiang Mai province. Each District Health Board integrated local leadership into its structure having the District Chief as Chair, the District Hospital Director as Co-Chair, and the District Health Chief as Secretary. The District Health Board leadership recruited additional members and membership from local government and local experts and membership was not to exceed 21 people. The Faculty of Nursing provided technical support to each district assisting with facilitating the participatory action research process and data analysis, and assisting with the development of sub-studies and grants at the local level.
The 8 district health boards worked together to conduct a situational analysis to identify priority health needs in their localities and to develop a guiding framework for how to address the needs. Each DHB worked collaboratively to create a health plan for their district and developed working groups to focus on specific issues. Once the plan was developed, each sub-district created their own sub-district health board within each sub-district, village level health boards were also created. This allowed for easier management and implementation at the local level and to better target needs at for the population.
After the first year, the 8 districts met in Chiang Mai to share lessons learned and success stories. Each district focused on 1-2 areas in which they excelled. These issues included: adolescent health, breastfeed, food safety, older adults, waste management, executive functioning for people with mental disabilities and those with dementia, alcohol abuse, occupational and industrial health, long-term care, medical tourism, and depression. The successful results from the first year provided the evidence needed to convince policy makers of the importance of the District Health System and DHBs. All districts in Thailand are required to form District Health Boards to work on quality of life issues.The 8 districts will work together to develop health policy to recommend to the Ministry of Public Health during the final phase of the project. As districts across the country are embarking on their own journey to address local health issues, many are seeking out the original 8 districts for guidance. At the end of the study, all District Health Boards will continue to run on their own. This study wonderfully illustrates the best aspects of participatory action research - capacity building to give communities the tools they need to tackle priority issues and empowering them so they can take the lead.