Factors Influencing the Implementation of the 50 Districts 50 Hospitals Policy: A Case Study of the Strategy and Planning Division

Abstract

This study examined 1) the implementation process of the “50 Districts, 50 Hospitals in Bangkok and the Metropolitan Area” policy within the Strategy and Planning Division, Department of Medical Services, in 2024, and 2) the key factors influencing its successful implementation. A qualitative research design was employed. Data were collected through in-depth interviews with 15 purposively selected key informants from the Strategy and Planning Division, including executives, policy and planning analysts, and experienced personnel involved in policy formulation, implementation, and monitoring. In addition, relevant policy documents were reviewed. The interview and documentary data were analyzed using reflexive thematic analysis guided by a policy implementation framework. The findings reveal a structured and continuous implementation process comprising five stages: national policy formulation, operational planning, monitoring and evaluation, policy communication, and inter-organizational integration. Six major factors were found to affect implementation success: policy clarity, effective communication, organizational capacity, administrative mechanisms, good governance, and public support. The study highlights the critical role of the Strategy and Planning Division as a strategic intermediary that bridges central policy direction with local action. This role integrates formal authority, technical expertise, coordination functions, and discretionary capacity to manage cross-agency collaboration. The findings suggest that policy design should integrate clear operational guidelines, systematic communication strategies, strengthened inter-organizational mechanisms, and a shared data system to support evidence-based decision-making and sustainable service delivery.