prevention and health promotion activities; the NHSO contributes to a
community health fund with a condition that the local government provides
matching funding. Second, at least 50% of health centre staff must support
devolution of their health centre and be willing to transfer to LAO employment,
including the health centre head. With these exacting criteria, by 2009 only
28 of the 8,000 health centres owned by the MOPH had devolved to TAOs.
Regarding decentralization of hospital management, only one of more
than 600 district hospitals has become autonomous under the provisions
of the 1999 Public Organization Act.
In summary, at the end of 2011 continuing tensions were manifest not only
between the NHSO and MOPH, but also between the reformist and conservative
factions in the MOPH, between pro-poor and private-sector for-profi t ideologies,
between organizations at different levels of the system, and between different
sectional interest groups within the civil service and the medical profession.