Abstract
Public participation (PP) has been promoted in Thailand in order to increase the level of democracy and human rights. However, progress has been slow and PP has done little to enhance either social or human rights development. In 1997, the Thai Ministry of Public Health (MoPH) launched a policy to promote PP at all levels of the MoPH’s organisation, which resulted in a significant problem for Thai hospitals: identifying the procedure to promote PP and ways to ensure appropriate implementation in the hospital setting has proven to be a challenge. Therefore, this research aims to investigate major issues related to PP in local health policy in Thailand. This research employed a sequential mixed-method strategy for the empirical investigation: beginning with quantitative and followed by qualitative methods. Both the ladder of participation and CLEAR models were used to complement each other: the ladder of participation model was used to identify the level of PP, and the CLEAR model was used to identify the factors that influenced the possibility for PP implementation. The quantitative stage used an online survey to review the current situation of PP at local level and to identify the hospitals with the highest levels of PP development for further investigation in the qualitative study. The online survey was carried out at all Thai public hospitals (n=830) with a response rate of 33.86%. The qualitative stage used in-depth interviews with 25 key stakeholders at different levels (national level, hospital level and the public level) to explore in-depth detail about PP factors in the health policy-making process. Key findings showed that PP in local health policy development was either at a low level or underdeveloped. The meaning of PP was still unclear, as there was no generally agreed-to definition and there was a lack of clear procedures and models to guide hospitals in promoting PP. The hospitals were using a low level of PP activities, which focused on oneway communication. As a result the public still lacked power and opportunity to become involved in decision-making. Nevertheless, the stakeholders had a positive perception of PP as a useful practice to be developed for solving problems. The findings revealed five facilitating factors: law and international organisations, hospital policy, community context and social cohesion, relationships between the public and hospital, and the motivational factors for the public to engage in PP. Conversely, there were seven impeding factors: the government direction, national policy, leadership/director factors, staff perceptions and ability to promote PP, the representatives of the public, public factors and the response/feedback system.