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Interagency Coordination and Effectiveness of the Human Immuno-Deficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) Prevention and Alleviation Program on Hilltribes People of Northern Thailand
Dissertation Abstract:
The study was conducted primarily to determine the program effectiveness of HIV/AIDS national program of Thailand, and the extent to which three kinds of types of intersectoral and institutional coordination mechanism was used in relation to the program effective of HIV/AIDS project on hilltribes villages of Northern Thailand. Specifically, it aimed to (1) assess the status, issues and problems in the implementation of the HIV/AIDS program, and the measures undertaken; (2) determine the various organizational mechanism used to make the program effective in preventing and controlling sustainably the HIV/AIDS; (3) identify the determinants of an effective HIV/AIDS health delivery program in relation to social, cultural, economic and physical/environmental conditions of the community; and (4) recommend measures which will enhance the effectiveness of the program.
The study was conducted among participating institutions/agencies under the HIV/AIDS program, namely: national, regional, provincial, district, sub-district, village committee, nongovernment organizations, PWHAs/PLWHAs, and two hilltribe villages of Chiang Mai province, Northern Thailand.
Data were gathered through individual and focused interviews, and secondary sources of information. Descriptive and inferential statistics were used in the data analysis. The Spearman-rank correlation, t-test, and path analysis were used to measure the interrelationship among variables as well as to determine whether the variables significantly contributed to the program effectiveness.
Inter-organizational factors showed that goal complementarity was “moderate/ fair”, resources were “inadequate”; while interaction was “frequent”, and there was “always” an administrative arrangement of the program. Complexity of inter-agency coordination was “fair/moderate”; the pattern of communication was of “moderate” extent. Overall inter-organizational factors were “moderate”. Intra-organizational factors such as centralization, formalization, and behavioral commitment were generally “moderate” in extent, while leadership showed “high commitment”.
Overall intra-organizational factors were “very high”. With regard to the type of intersectoral and institutional coordination mechanisms, there was a “high” extent of coordinated relationship, a “great” extent of reciprocal interdependence, and “very adequate” resource sharing.
Village respondents perceived the effect of the program as generally “moderate” in terms of the indicators of effectiveness, compared to the institutional respondents who rated the level of effectiveness as “high”. However, the village respondents still felt that the number of HIV/AIDS cases had not been reduced or still remained the same, while institutional respondents indicated that it was “less than before”.
Reciprocal interdependence was negatively and significantly related to increased knowledge about HIV/AIDS; it was highly significant with overall program effectiveness. Resource sharing was highly significant in relation to overall program effectiveness in a negative direction. The combined intersectoral/institutional coordination mechanisms were negative but significantly related to increased knowledge about HIV/AIDS.
Inter-organizational factors identified to have indirect relations were goal complementarity, adequacy of resources, frequency of interaction, administrative arrangement and complexity to nature and type of intersectoral and institutional mechanisms of reciprocal interdependence and resource sharing as mediating variables with indicators of program effectiveness, namely: increased awareness, reduced number of PWHAs, increased knowledge about HIV/AIDS, change in negative attitude of people toward PWHAs, and increased capability of people to prevent contracting HIV/AIDS.
Intra-organizational variables such as centralization, formalization, behavioral commitment, and leadership were found to be indirectly related to type of intersectoral and institutional mechanisms through reciprocal interdependence and resource sharing as mediating variables, singly or in combination. Likewise, all the intraorganizational variables were directly related to the different indicators/measure of program effectiveness either singly or in combination.