Session 7 - Thailand

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  • In terms of health outcome achievements, life expectancy at birth of Thais increased significantly both male and female. On average, life expectancy at birth increased from around 59 years in 1965 to be 79 years in 2010.
  • From M&E framework, the reviews on existing reports and facility-based data in Thailand show that Thailand has a wide range of household survey data and routine information from many institutes and organizations to assess almost all areas of health system capacity and its performance, except governance and health system responsiveness. These data are conducted by different institutes and organizations in Thailand which require coordination and networking. These data are useful for assessment of health reform policies in Thailand.
  • After achieving UHC in 2002, there are three public health insurance schemes providing health insurance for the whole population. CSMBS for 6 million of civil servants and their dependants, SHI for 9 to 10 million of formal sector employees, and UHC for the rest of population around 48 millions of Thais who are neither CSMBS nor SHI beneficiaries. These three insurance schemes have similar benefit package, but different sources of finance and provider payment methods.
  • Session 7 - Thailand

    1. 1. InternationalHealthPolicyProgram-ThailandInteStrengthening CRVS throughstakeholder engagement:Experiences from ThailandPhusit Prakongsai, MD. Ph.D.International Health Policy Program (IHPP)Ministry of Public Health, ThailandGlobal Summit on Civil Registration and Vital StatisticsPlaza Athenee Hotel, Bangkok, Thailand19 April 2013
    2. 2. ** * * * ** ** * * ** * * * * * * * ** ** * * *** ** * ***** *** ** * * *** * * * ***** *** * * * * ** * * * * ** * * * * ** ** * ****** * **** * * ***** * *** * * ** * * * ***** * * ** * * * * *** * * *** * * * **** * * * ***** * *** * ** ** * * * * ** * *** *** * * * * ** * *** ** ** * * ** * * * * ****** ********* * ***** * *** * * *** ** * * *** ** * **** * * *********** ******** * * ** * **** * **** ** * *** * * * ****** *** ** * * **** * * * * ** * * * * **** * ****** ****** * *** * * * **** ** ** * * * * ** * * ** ***** * **** * * ** **** **** ** **** * * ** ** * **** * ** * * *** * * * ** * * * * **** ** **** * * ** * **** * * * ****** *** * * ****** **** ** * *** *** *** * * ********* * * ** **** * ********* ** * * ** *** * ****** *** ** * *** ** * *** ** ****** * **** * ****** * ** * * ***** *** * * * * ** * * * * **** * * **** * * * * *** * * ***** ***** ***** ** * **** ** * ** * **** * ******* ** ** * * ** * * * **T00T01 T02T03T04T05***** ** * * * * ********* * **** *** * * * ***** * ** *** * ** * * * * * ******* * *** ** ****** * ** ** * * *** * * * ** ** * * **** * **** * * *** * * * ** * ****020406080100120140160180200220240260U5MRper1,000livebirths5 10 20 50 100 200 400Total health expenditure per capita (USD, logarithm)Top ten MDG4 performersTop ten MDG4 performersSource: Analysis of World Health StatisticsThailand 2000-05Source: Rohde et al. (Lancet 2008)Good Health at Low Cost !Good Health at Low Cost !Thailand – Good health at low costsThailand – Good health at low costsUsing CRVS for monitoring reduction in child mortalityUsing CRVS for monitoring reduction in child mortality* GNI < USD5,000 per capita; Births > 100,000/yearU5MR vs. THE per capitaLow- and middle-income countriesRank
    3. 3. 3050100150200250300350400450MMRper100,000livebirthsYearMMR1960-2006: six sources of referencesBPSBHPRAMOSTDRILancet 2010WHOReduction of U5MR and MMR in Thailand, 1960-2008Achieving UHCSource: Why and how did Thailand achieve good health at low cost? (2011)http://ghlc.lshtm.ac.uk/
    4. 4. Life expectancy at birth (years) ofThais1964-2030Sources:* Reports on Population Change Surveys 1964-1965, 1974-1976, 1985-1986, 1989, 1991, 1995-1996,and 2005-2006. National Statistical Office** Population Projection for Thailand 2000-2030, Office of the National Economic and SocialDevelopmentBoard, 2007 in Thailand Health Profiles 2008-2010 page 149Male1964-1965*1974-1976*1985-1986*1989*1991*1995-1996*2005-2006*2005-2010**2010-2015**2015-2020**2020-2025**2025-2030**
    5. 5. InternationalHealthPolicyProgram-ThailandInteUsing CRVS for monitoring and projection ofchanges in demographic profiles and populationpyramid of Thais from 1990 to 203051990200020302008
    6. 6. Top-ten cause of deaths by age groups in 20096Source: Burden of Disease Study in Thailand, 2012
    7. 7. InternationalHealthPolicyProgram-ThailandInte7CRVS and health information system in Thailand• CRVS is part of the Thai health information system (HIS) whichis not a single system, but consists of multiple sub-systems ofhealth information with involvement of many key stakeholders:– Civil registration from Ministry of Interior (MOI);– Facility-based data on births and deaths from several Departmentsof MOPH, National Health Security Office (NHSO), CGD;– Community-based household surveys from National StatisticalOffice (NSO), MOPH, research institutes;– Disease surveillance and investigation from Department of DiseaseControl of MOPH,• From SPC 2005-2006, the coverage of birth registration was96.7% and death registration was 95.2%• Main financing sources for CRVS and HIS in Thailand:– Regular government budget;– Sin tax, 2% earmarked tax fund from tobacco and alcoholconsumption through Thai Health Promotion Foundation;– Direct payments from data users, either public or privateorganizations.
    8. 8. InternationalHealthPolicyProgram-ThailandInte Lessons learnt from CRVS developmentin Thailand• Long-term development of CRVS with some degree of politicalsupport and commitment  high coverage of birth and deathregistration,• CRVS is the backbone for HSPA, monitoring progress of healthsystem development, and the impact of health policies,• Analysis of CRVS with other data sources will help facilitateHSPA and monitoring of progress of health system development,• Challenges of CRVS:– High unregistered deaths (40%) with high ill-defined cause ofdeaths,– under-reporting of maternal mortality,– lack of SE parameters for analysis of health equity,– limited capacity in policy advocacy, and translation ofevidence and research 8
    9. 9. InternationalHealthPolicyProgram-ThailandInte9Structure of Health Information SystemDevelopment and Networking in ThailandMOPHThai HealthPromotion FoundationHealth System ResearchInstitute (HSRI)Health InformationSystem DevelopmentPlan and NetworkingNHSO NESDBCivil societiesNGOsProfessionalsNSOAcademicsData ownersSteering committeeManagement office
    10. 10. Data availability for M&E system in ThailandData availability for M&E system in ThailandInput Output Outcome ImpactHCF HRHInfrastructureGovernanceMed/Health techHIS accessqualitysafetyefficiencyIntervencoverageRiskfactorsHoutcomeResponsiveEquityFinanprotectionCivilregistration andvital statistics Biennial SES   Biennial HWS    Census / SPC  NHES  MICS    Reproductive Hsurvey NHA   Note: SES = household socio-economic survey, HWS= Health and Welfare survey, NHES = National Health Examination survey,MICS = Multiple Indicator Cluster survey, NHA = National Health Accounts, HA = Hospital accreditation, SPC= Survey of PopulationChanges
    11. 11. 11Using CRVS to update beneficiaries among threepublic health insurance schemes in Thailand
    12. 12. Network and coordinationbetween data producers and usersReviews for HISDemands and indicatorsData analysis andsynthesis for reportproduction andpublicationUtilization mechanismAccountability, M&EResearch and developmentfor improving healthinformation system, esp CODData qualityassessmentReviews for healthinformation systems
    13. 13. InternationalHealthPolicyProgram-ThailandInte13Key challenges in strengthening CRVS in Thailand• Accuracy and coverage, particularly causes of death (COD) inhealth facilities and community,• Gaps in data quality and availability, particularly data of the non-Thai and stateless people,• Low utilization of evidence by some policymakers and programmanagers  effectiveness of the government policies, HSPA,and health equity monitoring etc.• Despite some extent of financing, more investment inmaintaining quality and coverage of CRVS – both human andfinancial resources are needed,• Variations in level of technical capacity in terms of– data generation, compilation, data processing, data analysis& synthesis, and communication, in responsible institutes,• Need long term capacity building in data compilation, analysis,for M&E.
    14. 14. InternationalHealthPolicyProgram-ThailandInte14Acknowledgement14• Ministry of Public Health (MOPH) of Thailand• National Statistical Office of Thailand (NSO)• Health Systems Research Institute (HSRI)• National Health Security Office (NHSO)• Health Information System Development Office (HISO)• Thai Health Promotion Foundation (THPF)• Prince Mahidol Award Foundation of Thailand

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