Engagement of the district health board in providing preventive measures for chronic kidney disease care in Thailand: The perspective of a multi-disciplinary team

Abstract

© 2020, Mahidol University - ASEAN Institute for Health Development. All rights reserved. Background: Promoting multi-sectoral collaboration to reduce the burden caused by non-communicable diseases (NCDs) has been a challenge to the global community as the policies of the non-health sectors also affect the determinants and risk factors for NCDs. In 2018, the Thai government introduced a new plan to reform District Health Boards (DHB) by encouraging collaboration between the health and non-health sectors at district level to promote health and well-being. Therefore, this study aims to explore the governance mechanisms of the reformed DHB and its contribution to the prevention and control of NCDs. Method: This study employed several approaches mainly focusing on using a qualitative process to evaluate the program in four piloted districts. Focus group discussion was used to collect data from four groups of key informants including the DHBs, multi-disciplinary teams, community bodies, and diabetic/hypertensive patients with CKD stage 1-2. Thematic analysis was employed for data analysis. Results: DHB committees consisted of members of public, private, and civil society sectors with the District Chief as the chairperson of the DHB and the District Public Health Officer (DPHO) as the secretary to the board. The roles of DHB members who were non-health sector focused more on addressing the social and environmental factors related to NCDs. The situation of NCDs in the district was shared and discussed at the DHB quarterly meeting and public hearing to enable community in health priority setting. Conclusion: Although the concept of expanded chronic care model and health of all policies should be related to the rationale behind the movements of the DHB, it remains unclear as to whether the movements under the optimal authorities of the DHB will only affect the area close to clinical practices. To our knowledge, this is the first study in the WHIO South-East Asia Region revealing a promising multi-sectoral NCD prevention and control model. More studies are needed prior to scaling up the model for wider application in the region.