Informal relationship patterns among staff of local health and non-health organizations in Thailand

BACKGROUND Co-operation among staff of local government agencies is essential for good local health services system, especially in small communities. This study aims to explore possible informal relationship patterns among staff of local health and non-health organizations in the context of health decentralization in Thailand. METHODS Tambon Health Promoting Hospital (THPH) and Sub-district Administrative Organization (SAO) represented local health and non-health organizations, respectively. Based on the finding from qualitative interview of stakeholders, a questionnaire was developed to explore individual and organizational characteristics and informal relationships between staff of both organizations. Respondents were asked to draw 'relationship lines' between each staff position of health and non-health organizations. 'Degree of relationship' was assessed from the number that respondent assigned to each of the lines (1, friend; 2, second-degree relative; 3, first-degree relative; 4, spouse). The questionnaire was distributed to 748 staff of local health and non-health organizations in 378 Tambons. A panel of seven experts was asked to look at all responded questionnaires to familiarize with the content then discussed about possible categorization of the patterns. RESULTS Responses were received from 73.0% (276/378) Tambons and 59.0% (441/748) staff. The informal relationships were classified into four levels: strong, moderate, weak and no informal relationship, mainly because of potential impact on local health services system. Strong informal relationship existed when the Chief Executive of SAO had any relationship degree with any THPH staff. When the Deputy Chief Executive of SAO or Chairman of the SAO Council had such relationship, the Tambon was classified as moderate level. Tambon with some other relationship patterns was categorized as weak. Approximately 58.5, 12.0, 7.4 and 22.2% of the surveyed Tambon have strong, moderate, weak, and no informal relationship, respectively. CONCLUSION The finding suggested that informal relationships between the staff of local health and non-health agencies can potentially affect the operations and development of the local health services system.