Co-production of public healthcare service in local communities: a case study of the family care team

Abstract

The objectives of this research study are 1) To study the structure and operation of the Family Care Team, a network of health promotion and disease prevention services under Thai health security system, 2) To study the components of public co-production in the management of public healthcare services for Thai local communities by the Family Care Team, and 3) To study the factors of the coproduction of public healthcare services for Thai local communities. This study is a qualitative research using the methods of document study, in-depth interviews, focus groups, observation, and qualitative data compilation using descriptive data analysis. The scope of this study is the primary care service provision under the Family Care Team with the participating private sector limited to the private pharmacy. Three health service centers and their respective service areas were selected for the case studies: Khlong Sala Urban Community Healthcare Center in Phetchabun municipality; Ban Klang Health Promoting Hospital, Nong Phai District, Phetchabun; and Public Healthcare Service Center No. 45, Bangkok Metropolitan Administration, for additional information regarding the participating pharmacy. The study results show that the public health service provided under Family Care Team can be considered a form of co-production with the people and the private sector, i.e. the private pharmacy, participating in the community service provision. However, the operation of Family Care Team does not stress the role of the patient in the participation, in spite of their being the person who understands their own strength and weakness as the owner of their health. As a result, Thailand’s public health service provision is still in the process of moving toward the old form of the service provision, which is viewing the service as a merchandise to be delivered to the service recipient, even though there has been an attempt to increase the role of other sectors in the service provision. The study finds the organizational structure between the officials and the volunteers is still in the form of a vertical hierarchy, while the structure between the government and the private sector is more independent. The problem of favoritism is also found to be an obstacle preventing the participants from having the smooth operation. In terms of the factors leading to the participation in the health service provision in the community, the government sector is driven by the laws but still has a limitation of accessibility of all population groups. For the factors of the people sector, the volunteer mindset plays a role leading to the participation with the desire to have an opportunity to help fellow community members. The use of free time for a good cause, the acceptance and praise from the community, and certain “privilege” received from the government are also the factors leading to the people’s participation with the government. For the private pharmacy, the acceptance from other professionals, the volunteer mindset of the pharmacist owner of the pharmacy, and its proximity to the health service center are the major factors leading to the participation with Family Care Team in the government’s health service provision. The author proposes a management model of primary care toward the healthy and sustainable community by introducing the service recipient, i.e. the patient, to be an additional basic element and participant of co-production. Such element must possess a mechanism encouraging the collaboration, in which the author proposes the mechanism with the characteristics of familiarity and closeness among the participants, mutual reliance, freedom of working of government officials, and relevant knowledge base. Finally, the co-participation must be in the horizontal organizational structure, and the participants must be willing to assist in the comprehensive health service provision in the area of prevention, treatment, and health care of the community.