The Developmental Model for the Health Service System of Early Childhood Through the Participation of Family and Community in Damneon Saduak District, Ratchaburi Province

Abstract

        Objectives: 1) To study the situation of health conditions of early childhood in Damnoen Saduak District, Ratchaburi Province. 2) To investigate the strategy of the development process for early childhood health services. 3) To analyze the outcome of the health services for early childhood.

        Method: The action research comprised three phases of the continual development processes under systems theory framework for the health service system. The three phases were: phase 1—situation analysis, studying and analyzing the health circumstances of early childhood from the medical records and from unstructured focus group discussion in registered nurses and responsible staff for early childhood services in three consecutive fiscal years from 2013 to 2015. Then to summarize the development model in accordance with systems theory from the findings. Phase 2—study conduct, initiating conceptual framework of the development of the early childhood health services in compliance with systems theory from Phase 1 data. Three steps were involved: step 2.1- educating and promoting the participation; step 2.2- expanding the network and integrating into the routine work; and step 2.3- developing the sustainability of the health service. Phase 3—study evaluation, identifying the elements of the development system of health service gained from the tacit knowledge from the study results.

        Results: The data from phase 1, showed people lacking of knowledge and understanding how to access the services, the expertise deficiency of the staff, the inadequacy of distinct service system, the shortage of networking between families and community. The cycles of development process were detected in phase 2, such as the assessment of child health status and child development by the hospital’s and its network’s staff, the screening system, the joint assessment of children, the care guidelines for suspected developmental delay and real developmental delay in children including the reporting system. The study evaluation in phase 3 presented changes in service system on service providers, service receivers, and the elements in the health service system for early childhood which were the analysis of service access status, the consistence and continuity of service use, the capability development of relevant staff in service team, the child development clinic, the persistence of caring system, the multidisciplinary model of clinical service, the structural change and performance development.

        Conclusion:  The development process or cycle of the health service for early childhood involves three parties which are the servicers, the users, and the service system. The servicers in the hospital and its network experience changes in their structure and performance development plan. The users have the faster access to the service and the consistency and the continuity of service use. The service system turns to the proper one consisting of providing child development clinics, implementing multidisciplinary care team, integrating the service assessment to one stop service model, stimulating the network of the primary health care for the risky early childhood caregivers, promoting the participation of the caregivers to be responsible for early childhood health status.