Through the Lens of Networks: Health Promotion Policy Implementation for the Elderly at the Local Level in Thailand
The Thai government has included health promotion in its national policies and strategies to directly address the health of the elderly. Multiple government organisations at various levels are involved in this health promotion policy and its related efforts. With an emphasis on ensuring that the elderly in the community benefit from national health promotion policies, and have access to health promotion services, the policies directed government organisations to work together as a network to implement the health promotion policy for the elderly at the local level. The Local Administrative Organisations (LAOs), decentralised government organisations, acted as the centre of the networks in each sub-district across the country. Networks play a role as an essential mechanism in the health promotion policy implementation for the elderly and in reaching out to the smallest unit of the community: individual older people. However, there are known gaps in the functioning of the decentralised governance arrangements and in coordination between organisations to implement the health promotion policy. Policy implementation can be improved to ensure that key goals and objectives are met. The objective of this research was to analyse the ways in which the LAOs and other government organisations together implement the health promotion policy for the elderly at the local level in Thailand. Using a network perspective, the governance structure and governance characteristics, including relationships and the functioning of the policy implementation network, are identified and analysed. How the observed network characteristics affect network collaboration, policy outcomes, and actors’ capacity in policy implementation are then explored. Within an interpretivist perspective, the research employed multiple network analysis approaches and mixed methods data collection such as network mapping, non-participant observation, interviews, and questionnaire surveys, across two case study sites. A combination of thematic analysis and constant comparative methods were employed to analyse the data. The networks in this study were found to have a hybrid governance form, being a combination of lead organisation-governed and shared governance. However, it is not possible to predict the likelihood of achieving good policy outcomes based on the form of network governance alone; other networks characteristics must also be studied. At the network level, influential factors indicative of policy outcomes were found to be the exchanges of political and cultural capitals between network actors, with the latter differentiating the policy outcomes across the two cases. To improve the network actors’ capacity in policy implementation, learning and resource exchanges between actors were found to be important. Based on the study findings, an intervention to improve policy outcomes should be encouraged through financial capital exchanges between network actors as this is when administrative authority is most dominant. The research provides an empirical review to inform policymakers and practitioners that the most influential factors should be embedded during the funding process so that the policy implementation can better support health for the elderly and the aged society that Thailand is entering.