Primary Oral Health System in Thailand Under Decentralization : Lessons from the Past and Future Directions

Abstract

Abstract

           Currently, the thai public health system is entering a major turning point resulting from the enforcement of the determining plans and process of decentralization to local government organization act, b.e. 2542 (1999) and the second decentralization plan in b.e. 2551 (2008). this structural change directly impacts the primary care service system, including primary oral health system, in the dimensions of personnel, budget, quality regulation, and professional standards.

          This article is a narrative review aimed at analyzing the structural impacts of the decentralization policy on the primary oral health system, comparing the systemic differences between before and after the transfer of missions, and formulating systemic and policy proposals for strategic development guidelines through the "Past–Present–Future" conceptual framework. A search of relevant documents and research between B.E. 2560–2569 (2017–2026) was conducted from the central electronic journals database of Thailand, namely ThaiJo, in conjunction with policy documents, theses, and reliable websites, using keywords such as "public health dentistry," "transfer," and "Sub-district Health Promoting Hospital" for selection and content analysis and synthesis. Initially, a total of 430 documents and research papers were identified, consisting of 260 items from online sources and official websites, and 170 items from the Thai Journals Online (ThaiJO) database. Following the screening and selection processes, a final total of 16 items were included for content analysis and synthesis in this study. The study results revealed that the system in the past possessed strength in quality regulation, service standards according to professional principles, and the operation of preventive dentistry. Meanwhile, the current system after the transfer has increased management flexibility, yet still lacks a direct regulatory mechanism, resulting in variations in service quality and continuity across different areas. All of these findings have been used as crucial data to determine problem-solving guidelines and directions for systemic and strategic development toward quality and sustainability in the future.

          To ensure the quality and sustainability under the decentralized context, this article proposes several systemic development strategies. These include establishing provincial-level regulatory mechanisms, defining shared standard indicators, advancing personnel capacity and professional career progression, and fostering research and development skills. Additionally, enhancing flexibility in the procurement of dental supplies and equipment, developing integrated oral health data systems, and leveraging digital technology are recommended to maintain system continuity.