Measuring community empowerment as a process and an outcome: preliminary evaluation of the decentralized primary health care programs in northeast Thailand

Decentralization of public health responsibilities to a local level has been advocated by public health reformists as a policy instrument to improve efficiency, equity, and quality of services (Bossert, 1998). As defined by World Health Organization (WHO), “health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (World Health Forum, 1998, p. 21). This definition begs the question of how health-related policies and programs should be designed to have the greatest influence on both individual behavior and community lifestyle. Contemporary public health literature points to the importance of a proactive approach that involves health promotion and ill-health prevention.