Assessing the operational effectiveness of village health volunteers in Thailand: A structural equation modeling analysis

Background: Village health volunteers (VHVs) play an essential role in Thailand’s primary healthcare system by promoting health, preventing diseases, and ensuring community well-being. However, their operational effectiveness is influenced by several key factors, including transformational leadership, employee commitment, and job satisfaction. This study investigates these relationships and their implications for sustainable community health systems. Methods: A mixed-methods approach was utilized, combining quantitative data from 280 VHVs across Thailand’s lower central region with qualitative insights gained from focus group discussions (FGDs). Structural Equation Modeling was employed to evaluate the relationships among transformational leadership, employee commitment, job satisfaction, and operational effectiveness. Results: The findings reveal that transformational leadership significantly predicted employee commitment (β=0.80, P<0.001) and job satisfaction (β=0.65, P<0.001). Operational effectiveness was significantly predicted by employee commitment (β=0.49, P<0.001), transformational leadership (β=0.26, P<0.001), and job satisfaction (β=0.13, P=0.04). Together, these variables explained 68.0% of the variance in operational effectiveness. A new model termed T-E-J Performance (where T=Transformational Leadership, E=Employee Commitment, and J=Job Satisfaction) has been developed to guide strategic improvements. Conclusion: To sustain effective community health programs, it is vital to enhance leadership capabilities, improve job satisfaction, and foster commitment among VHVs. These findings offer actionable insights for policymakers to create leadership training programs, enhance incentives, and implement strategies for workforce retention. Strengthening VHV systems can significantly contribute to sustainable healthcare delivery and health equity in Thailand.