DECODING THE NATIONAL HEALTH SYSTEM CHARTER

Abstract

The aims of this article were 1) to examine the participation mechanisms and process in designing the First National Health System Charter B.E. 2559 and 2) to decode the key lessons in the designing process of the National Health System Charter. This qualitative study deployed document analysis of related documents and in-depth interviews with people in charge of designing 2 versions of the National Health System from key informants of 12 people. The findings revealed that :

1) The design of 2 versions of the National Health System Charter showed the mechanisms and processes consistent to the New Public Governance (NPG) that underpinned the participation of all stakeholders. The participation involved unit, organization, networks which illustrated the reciprocal connectivity, and assignment of tasks charged by the related units without handing over the public services to be handled by people or letting people make decisions. The participation mechanisms honored idealism and hearing people's opinion in believing that people are best in understanding their own problems, so the problem management is managed by people. Each stage of the mechanism and the process of designing the National Health System Charter as well as the policy implementation demonstrated clear principles and guidelines. It was found that the committee members and the designing team incorporated the concept of “triangle that moves the mountain” which employed participation from all stakeholders. The working process adhered to a participatory approach proposed by Cohen and Uphoff (1980) which emphasizes participation in all stages of policy implementation. This process also included studying mechanisms and processes underpinning constitutionalism, ideological domination, post-structuralism, language-game and communication.

2) Concepts, methods and systematic principles, individual knowledge and experience-based opinion, local wisdom, institutional or organization or group knowledge were summarized and synthesized to formulate a set of knowledge, handbook, and variety of media. This led to collaborative learning for an adjustment of mindset of participants and changing their working style for creativity and efficiency. This process evolved the lessons derived from the charter designing process that illustrated the changes in health issues and were accepted by all stakeholders. The charter consisted have Clear policy and guidelines derived from involvement of all stakeholders (Policy Statements), Authorized people and involved people offer full support for the National Health Commission. The host organization is ready in regard to budget, staff, and management flexibility. Operation officers showed positive and clear mindset, motivation, and attitudes towards their jobs. The leader is well accepted by involved people and is able to coordinate individuals and organizations at different levels of operation. Policy assessment and evaluation systems promoted efficiency and enhancement of the working committees.