Health impact assessment of decentralization of Emergency Medical Services: a case study in Chonburi Province, Thailand

The decentralization of Emergency Medical Services (EMS) to local administrative organizations is a critical policy initiative in Thailand aimed at enhancing service responsiveness and community participation. This study applied a prospective Health Impact Assessment (HIA) to identify positive and negative health impacts of EMS decentralization in Chonburi Province and develop evidence-based policy recommendations to guide the transition from the Ministry of Public Health to local governance. A mixed-methods approach was designed based on the six-step HIA framework. The study involved 562 participants, including EMS providers, recipients, and policymakers. Qualitative participants were selected through purposive sampling for interviews and focus groups, and quantitative participants through stratified random sampling for surveys. Qualitative data were thematically analyzed, and quantitative data were analyzed descriptively. Findings revealed both positive and negative impacts across four pre-hospital care activity domains (dispatch, incident response, referral, and administrative management) and four dimensions of well-being (physical, mental, social, and spiritual). Positive impacts included improved responsiveness, collaboration, and staff motivation, while negative impacts involved personnel shortages, communication gaps, and limited budgets. The derived policy recommendations emphasize structured workforce planning, upgraded communication systems, sustainable financing, and participatory monitoring to strengthen decentralized EMS. The use of HIA provided a systematic and participatory process that translated empirical evidence into actionable policy guidance for health service decentralization in Thailand and similar contexts.