‘Health Declarations’

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Health Declarations
DS Briggs, P Tejativaddhana and N Kitreerawutiwong
REVIEW
ARTICLE
Asia Pacic Journal of Health Management 2010; 5: 1 25
Abstract
The Thai–Australian Health Alliance was established in
2004. [1] The Alliance was primarily developed from a
Memorandum of Understanding between Naresuan
University, Phitsanulok, Thailand and the University
of New England, Australia, with a primary objective
of working to develop health management capacity
and capability in health professionals working in rural-
based health services in Thailand. The Alliance has
demonstrated ve years of sustained collaboration,
the outcomes of which are described elsewhere. [2]
The Alliance determined to celebrate those ve years
of successful collaboration and to further reinforce the
importance of eectively trained health managers to
the delivery of health services by conducting the First
Dr David Briggs1,2,4 BHA, MHM(Hons), PhD, FCHSM, CHE,
FHKCHSE
Dr Phudit Tejativaddhana1, 2, 3, 4, 5 MD, DHSM, MPA, FCHSM,
CHE
Dr Nithra Kitreerawutiwong3,4 BNS, MPH, PhD (Public
Health)
1 University of New England
2 Asia Pacic Journal of Health Management
3 Naresuan University, Thailand
4 Centre of Expertise on Leadership in Health Management,
Naresuan University
5 The recent change in name from Prawit Taytiwat represents
an honour bestowed by the King of Thailand, His Majesty
King Bhumipol.
Correspondence:
dsbriggs@northnet.com.au
Introduction
The Thai–Australian Health Alliance was established in
2004. [1] The Alliance was primarily developed from a
Memorandum of Understanding between Naresuan
University, Phitsanulok, Thailand and the University of New
England, Australia, with a primary objective of working
to develop health management capacity and capability
in health professionals working in rural-based health
services in Thailand. The Alliance has demonstrated ve
years of sustained collaboration, the outcomes of which
are described elsewhere. [2] The Alliance determined to
celebrate those ve years of successful collaboration and to
further reinforce the importance of eectively trained health
managers to the delivery of health services by conducting
the First International Conference of Health Service Delivery
Management in Phitsanulok, Thailand in October 2009. A
major outcome of the conference was the development
and adoption of the Phitsanulok Declaration. This paper
describes the process adopted at the conference to develop
and adopt that Declaration.
Health declarations
Consistent with a more global response to health challenges,
a number of declarations have been created and adopted
in recent decades as a means to raise awareness of health
issues and inequalities and to provide a more focussed and
often global response to the challenges presented. Probably
International Conference of Health Service Delivery
Management in Phitsanulok, Thailand in October 2009.
A major outcome of the conference was the
development and adoption by the conference of the
Phitsanulok Declaration. This paper describes the
process adopted at the conference to develop and
adopt that Declaration.
Abbreviations: OR- Operations Research; PHC – Primary
Health Care; R2R – Research to Routine; SHAPE – Society
for Health Administration Programs in Education;
WHO – World Health Organization.
Key Words: primary healthcare; health management;
declarations.

Health Declarations
26 Asia Pacic Journal of Health Management 2010; 5: 1
the most recognised of these declarations was the signing of
the Alma Ata Declaration in 1978, by 134 health ministries,
focussed on primary healthcare, that set a deadline of ‘health
for all’ by the year 2000. [3] This declaration is credited with
‘bridging the gap between declarative/symbolic politics,
on the one hand, and substantive policy development’. [4
p.190] There have been other intermediary declarations
and then a focus on health promotion with the adoption of
the Charter for Health Promotion at the rst International
Conference on Health Promotion in Ottawa in 1986. [5]
A further important declaration for the Asia Pacic was
the 1997 Jakarta Declaration on Health Promotion, a rst
to come from a developing country that attempted to re-
examine determinants of health and to propose directions
and strategies for promoting health in the 21st Century. [3]
This was followed by a signicant number of resolutions at
national and global level including The Bangkok Charter for
Health Promotion in a Globalised World. [6]
Declarations suggest ‘high importance’ and raise an issue
beyond normal debate to ‘create a universal and bold
statement’. [7 p.1867] There are a variety of declarations
developed for a range of issues or health challenges such as
medical ethics, public health, mental health, health rights,
and development, for nutrition, women and children. [8]
With the exception of the SHAPE Declaration [9] few if any
focus on the importance of eective health management
in addressing health challenges and in improving universal
access to health services. However, management is alluded
to in some declarations in the sense of management
of systems, a disease state, and governance [4] and in
improving ‘national and regional research capacity and
the management capacity of public health systems’. [10
p.6] The lack of an emphasis on the importance of health
management to eective healthcare delivery has occurred
despite the World Health Organization (WHO) placing an
emphasis on management and leadership capacity building
so that health professionals can be eective, particularly in
implementing primary healthcare reform. [11]
The First International Conference on Health
Services Delivery Management
The conference had as its aim ‘strengthening the
management of primary healthcare and district health
services in uncertain times’. [12] Papers presented over
the four days addressed human resource management
and health policy, health nancing, social and behavioural
aspects of health service management, and organisational
behaviour, quality assurance, leadership and innovations
for health services development. The conference attracted
450 delegates from 17 countries and 14 organisations. There
were six keynote/invited speakers from Thailand, eight from
Australia and one each from Bhutan, Hong Kong, Indonesia
and Malaysia. More than 30 oral presentations were made
in parallel sessions of peer reviewed submitted papers and
a further 23 poster presentations were displayed. These
parallel session papers were presented by speakers from
Australia, Saudi Arabia, Nepal, Cambodia, India and Indonesia
as well as Thailand. The cultures of all of these countries,
including a delegation from Sudan, was also celebrated at
the welcoming reception.
The conference organisers intended that an outcome of the
conference would be a heightened awareness in the Asia
Pacic of the importance of health management to eective
health service delivery and the need to develop health
management as a profession in its own right rather than
it being seen as an ‘add on’ to an existing clinical role. This
view is consistent with that of the WHO in its endeavours to
strengthen primary healthcare generally. [11,13] To achieve
this outcome it was proposed that a Declaration would be
developed from the conference.
Methods
To achieve this outcome a background brieng paper [14]
was prepared prior to the conference and included in the
conference satchel distribution to all delegates. In addition, a
draft declaration was developed prior to the conference that
contained a preamble and some ten possible declaration
points that the conference might consider. This draft was
displayed in a prominent position in the main conference
venue with a post-a-note board for delegates to make
contributions. Speakers were encouraged to challenge
delegates to reect on and to consider what the potential
outcomes of the conference might be. In addition, at the
start of the rst session of each day at the conference, a
delegate was tasked with the responsibility of providing
a reection to conference delegates on the previous day’s
presentations.
In the nal plenary session on the nal day of the confer-
ence, the delegates were organised into four focus groups
on the conference oor and asked to provide feedback and
contributions to the proposed declaration. Each of these
four focus groups provided feedback to the conference
delegates and in front of an expert panel convened to
help nalise a Declaration. The focus groups were asked to
respond to three questions about the conference and the
Declaration within a theme of ‘how best to respond to the
WHO challenge – developing health management capacity

Opportunity to share feelings, compare
health systems
Research and viewpoints in primary
healthcare
R2R
Work as a network
Work by heart
Resource in shortage setting
Hear the voices
Develop HSM models
Shifting focus to patients
and community
Importance of general practitioners
The need for systems and processes
The need for leadership
Teamwork – advanced training in
teamwork and community engagement
Valued international learning and
adapting it to our needs
Innovation through new models
More investment in human resources
Lower emphasis on infrastructure
Learn new ways to do things
Value of teamwork
Collaborative across countries and
respectful of culture
Finding good people – recruitment
Need to support primary healthcare
The importance of healthcare
management
Human resource development
Group 1 Group2 Group3 Group 4
Dicult to understand the concept
Need to move the agenda forward
Missing – empowering
researchers and greater emphasis
on qualitative research
Greater emphasis on partnerships
Greater emphasis on high quality research
Need to support and reinforce CPD
Greater government support to move
forward
More emphasis on health volunteers
Research across the breadth
Health Declarations
Asia Pacic Journal of Health Management 2010; 5: 1 27
Table 1. Focus group responses to the questions
What do we like about this Declaration?
Greater emphasis on the future
Opportunities to support and resource
countries needed
Invest more in young people, the future
leaders
Build all healthcare team
More emphasis on valuing community
competencies for health managers
to engage communities
Forum for research across countries
Stronger on utilising research
Research to routine R2R
Include local government in point 4
Leadership is a central tenant
Political and community partnership
Dot point 2 of the declaration around the
importance of leadership, management,
education and research are essential
The need for networking and
empowering managers
What is missing from this Declaration?
New models of healthcare
Support for health management
Emphasis on research and OR
priority setting
Need for HM experience and knowledge
Come together at the conference
and declare something
Change allocation of resources
and policy
Align leaders and managers
Change words in Thai version as the
direct translation of some English words
has no meaning.
Empowering communities
Emphasise qualitative research
partnerships
Rigor and quality in research
HS support CPD and life-long learning
of HSM workers
Support governments and WHO
No. 2 should have qualitative research,
not only action research
More emphasis on health volunteers
All research methods, both qualitative
and quantitative are useful for translation
to implementations in HSM
Deliver to all levels (health professionals
and managers)
Quality leadership for all levels
In-depth to primary healthcare level
Focus on disciplinary, include education
management and health management
Added quality evaluation for leader
in health system
What have we learnt from the conference?
– a response from the conference’. [12] While the conference
was conducted using the English language, there was also
translation of conference documents into Thai, the major
language group at the conference. Simultaneous translation
into Thai of presentations, questions and answers, focus
group and panel discussion occurred on screens through
PowerPoint slides to ensure eective participation and
contribution of all delegates.
Results
The focus groups responses to the three questions are sum-
marised for each question and group in Table 1 below. The
three questions asked of the focus groups were:
What have we learnt from the conference?
What do we like about this Declaration?
What is missing from the Declaration?

Health Declarations
28 Asia Pacic Journal of Health Management 2010; 5: 1
In addition the panel, the membership of which is detailed
in the conference program, were asked to comment about
the presentations from the focus group and provide further
input to the nal Declaration. The responses from the
panel included the Declaration being seen in a virtual web
based context so there could be continuing contributions
and dialogue; that delegates take the Declaration to their
own country and translate into the national language and
further disseminate; and increased emphasis on values and
the building blocks of primary healthcare. The responses of
the focus groups and the input from the panel were then
incorporated into a revised Declaration that was distinct
from the original draft circulated at the commencement of
the conference and as far as possible incorporated the main
themes arising from the focus groups and the panel. As a
consequence of these deliberations a nal Declaration was
adopted and formally signed at the closing session of the
conference. Space was allowed for individual delegates to
insert their own signature to the document and for them to
post the declaration to other relevant websites and to have
the Declaration published in this Journal.
Discussion
Declarations have become a useful approach to highlighting
specic health issues or objectives to a broader group of
stakeholders and in galvanising those groups to take action
often, in a global context and through an inter-sectoral
approach. The Phitsanulok Declaration and the conference,
although recent, have certainly provided an increased
prole to health management both in Thailand and the sub
region and it is anticipated that this prole will generate
further interest in training, education and research in health
management. The process of developing the Declaration
throughout the conference and the engagement of
delegates through post-a-note, daily reections and the
focus group and panel sessions produced a distinctive,
concise and focussed Declaration to which the delegates
can claim authorship and ownership. The Declaration is
included as Figure 1.
In many Asian countries, public health and primary
healthcare paradigms about approaches to health issues
and service delivery predominate. These approaches have
made signicant, positive impact on population health status
and there are now increased calls for a more systemised and
devolved approach to healthcare delivery at a time when
there are global health workforce shortages and a scarcity
of resources. There are also calls for a renewed focus on
primary healthcare [15] and a greater horizontal investment
in strengthening primary healthcare by 2015. [16]
The conference and the Phitsanulok Declaration support
these calls by suggesting a better investment in leadership,
management and governance to strengthen health systems
development; empowered leadership with appropriate
positive personal and professional values and, being
encouraged to engage with individuals and communities;
the provision of high quality education and training and a
research culture based on collaborative networks of research.
The success of the Declaration will not be measured in the
short term and to a great extent success will be dependent
on the commitment of the signatories and the delegates to
work towards longer-term goals. This will most likely require
a continued emphasis on networking, capacity building,
advocacy [8] and continued collaborative activity across
national health systems.
Competing Interests
The authors declare that they have no competing interests.

Health Declarations
Asia Pacic Journal of Health Management 2010; 5: 1 29
Figure 1: The Phitsanulok Declaration.

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Health Declarations
30 Asia Pacic Journal of Health Management 2010; 5: 1
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