Measuring community empowerment as a process and an outcome: preliminary evaluation of the decentralized primary health care programs in northeast Thailand

Abstract

In 1997, Thailand began to devolve essential public service functions to a local level. However, the implementation process has been slow, especially in the public health domain. Public concerns with local government ineffectiveness and corruption have prompted the Ministry of Public Health to launch a pilot decentralization program whereby a small number of local communities across Thailand were chosen to receive the budget and management authority over basic health services. To evaluate the outcome of health decentralization in these pilot communities, this paper argues that the conventional health outcome measures (e.g. infant mortality rate, fertility rate, and average life expectancy) are inadequate for understanding the dynamics of community learning and development. To address this inadequacy, the community empowerment concept is used to analyze the social and political aspects of public health decentralization. Qualitative techniques, including participant observation, focus group interviews, and face-to-face interviews, are used to analyze the impact of localized public health programs on community empowerment in four communities in northeast Thailand.