Low- and middle-income countries (LMICs) face accelerating demand for long-term care (LTC) amid rapid population ageing, yet system readiness and managerial capacity remain uneven. Thailand’s decentralized LTC model relies heavily on local administrative organizations and frontline managers, underscoring the multifaceted managerial factors involved in translating policy into consistent implementation. However, empirical evidence identifying the specific determinants of implementation performance remains limited. This study examines the contributions of managerial processes, organizational capacity, intrinsic motivation, and work stress to LTC implementation performance. The findings offer policy-relevant insights to strengthen LTC systems in Thailand and other resource-constrained LMIC settings. A province-wide cross-sectional survey was conducted among all 131 LTC system managers in Prachuap Khiri Khan, Thailand. A validated instrument assessed administrative management (Drucker’s 4M and Fayol’s POCCC frameworks), motivation, supportive factors, and work stress. Ordinal logistic regression (three hierarchical models) identified determinants of LTC implementation. Model fit was evaluated using Deviance and Pearson goodness-of-fit tests. Motivation and administrative management emerged as significant predictors of LTC implementation, with AORs of 7.94 (95% CI 1.92-32.78) and 5.19 (95% CI 1.34-20.05), respectively, highlighting the centrality of human and managerial capacities. Within the 4M framework, only the Management domain remained statistically significant (AOR= 6.37, 95%CI 1.96-20.65), whereas manpower and material resources demonstrated no predictive value. Process-level analysis further identified Planning (AOR=5.47, 95%CI 1.06-28.28) and adaptive, moderate-level Controlling (AOR=3.97, 95%CI 1.13-13.90) as statistically significant managerial levers associated with higher implementation performance, reinforcing the pivotal role of targeted managerial functions in driving system-level outcomes. Findings demonstrate that strengthening LTC in decentralized LMIC systems requires focusing on managerial capability, intrinsic motivation, and adaptive governance—not merely expanding inputs or workforce numbers. Integrating 4M, POCCC, and motivational theory, this study presents a theory-informed implementation model that identifies planning quality and adaptive control as high-impact system levers. Policymakers should prioritize capacity-building architectures, performance learning systems, and participatory planning structures to enhance LTC governance and scalability. Thailand’s experience offers transferable insights for LMICs seeking to advance person-centered, community-based LTC amid fiscal and workforce constraints.
Thongngun et al. (2026) studied this question.