1. International Health Policy Program -Thailand Uses of civil registration and vital statistics to guide policy-making and planning in Thailand Phusit Prakongsai, MD. Ph.D. International Health Policy Program (IHPP) Ministry of Public Health, Thailand Presentation to the CRVS workshop Dusit Thani Hotel, Bangkok, Thailand 25 September 2012

2. International Health Policy Program -Thailand 2 CRVS and health information system in Thailand CRVS is part of the Thai health information system (HIS) which is not a single system, but consists of multiple sub-systems of health information with involvement of many key stakeholders: – Vital registration from Ministry of Interior (MOI); – Facility-based data on births and deaths from several Departments of MOPH, National Health Security Office (NHSO), CGD; – Community-based household surveys from National Statistical Office (NSO), MOPH, research institutes; – Disease surveillance and investigation from Department of Disease Control of MOPH, Main financing sources for HIS – Regular government budget, – Sin tax, 2% earmarked tax fund from tobacco and alcohol consumption through Thai Health Promotion Foundation, – Direct payments from data users, either public or private organizations.

3. Monitoring & Evaluation of health systems reform /strengthening A general framework Data sources Indicator domains Analysis & synthesis Communication & use Administrative sources Financial tracking system; NHA Databases and records: HR, infrastructure, medicines etc. Policy data Facility assessments Population-based surveys Coverage, health status, equity, risk protection, responsiveness Clinical reporting systems Service readiness, quality, coverage, health status Vital registration Data quality assessment; Estimates and projections; In-depth studies; Use of research results; Assessment of progress and performance of health systems Targeted and comprehensive reporting; Regular country review processes; Global reporting Improved health outcomes & equity Social and financial risk protection Responsiveness Financing Infrastructure / ICT Health workforce Supply chain Information Intervention access & services readiness Intervention quality, safety and efficiency Coverage of interventions Prevalence risk behaviours & factors Governance Inputs & processesOutputsOutcomesImpact

4. WHO’s framework for monitoring health system strengthening and outcomes Source: WHO. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action. 2007, Geneva, World Health Organization.

5. Data availability for M&E system in Thailand (1) InputOutputOutcomeImpact HCFHR H Infra struct ure Gov er nan ce Med/ Healt h tech HISacc ess qual ity safe ty effic ienc y Interve n coverag e Risk factor s H outco me Re sp on siv e Equit y Finan prote ct ion Civil registration and vital statistics Biennial SES Biennial HWS Census / SPC NHES MICS Reproductive H survey 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 Population Changes

6. Data availability for M&E system in Thailand (2) InputOutputOutcomeImpact HC F HRHInfra structu re Gove r nanc e Med/ Health tech HISacc ess quali ty safet y effici ency Interven coverage Risk factors H outco me Res pon sive EquityFinan protect ion Facility-based report H resource survey HIS electronic IP database Dis surveillance Behavioral H survey Sero-sentinel Survey Specific dis registration Quality assurance (HA)

7. 7 Life Expectancy at Birth (1950-2050) Source: UN (constant fertility)

8. International Health Policy Program -Thailand Using vital statistics for monitoring and projection of changes in demographic profiles and population pyramid of Thais from 1990 to 2030 8 1990 2000 2030 2008

9. International Health Policy Program -Thailand 9 2000 2005 2010 2015 2020 2025 2030 The increasing rate of Thai population by age groups from 2000 to 2030 Note: The year 2000 is the baseline data of 100

10. 10 Using mortality and disability data for the estimate of DALY loss in pre-elderly and elder people Source: Thai BOD study 2004 45-59 yrs 60+ yrs

11. 11 Additional health workforce requirement for elderly care (based on workload method) Workforce 20102020 Formal care providers Nurses (1:200) 23,88833,880 Physio-Therapists (1:200) 2,4993,708 Social workers (1:5000) 1,5282,155 Non-formal care providers Family members (1:1) 499,873741,766 Care givers (1:7) 71,410105,967

12. International Health Policy Program -Thailand 12 Projected total expenditure on personal healthcare by age group, 2009 to 2015

13. International Health Policy Program -Thailand 13 Long-term financial projection, 2006-2026 based on 1994-2005 NHA, by ILO and Thai experts in 2008

14. International Health Policy Program -Thailand 14 Health financing arrangements and three public health insurance schemes in Thailand after achieving UHC in 2002 Source: Tangcharoensathien et al. (2010) Traditional FFS for OP Direct billing FFS (2006+) for OP FFS until 2006, DRG for IP Capitation for OP DRG with global budget Full capitation

15. International Health Policy Program -Thailand Public health insurance scheme beneficiaries by income quintile, 2003 and 2007 UC scheme covers mostly the poor, approx 50% in Q1 & Q2

16. Distribution of government subsidies for health: BIA from 2001 to 2007 More pro-poor health care system after achieving UC preventing budget cut from the Thai government during the economic crisis in 2007-2008

17. International Health Policy Program -Thailand 17 Financial risk protection Trend of health impoverishment 1996-2008

18. International Health Policy Program -Thailand Inequity in geographical distribution of Health workforce in 2007 Pharmacists 4,600-8,432 8,433-12,274 12,275-16,115 16,116-19,956 Nurses 280 - 652 653 - 904 905 - 1,156 1,157 – 1,408 PharmacistsNurses

19. International Health Policy Program -Thailand Good Health at Low Cost in Thailand 19 Thailand 2000-05 Rank Top ten MDG4 performers U5MR vs. THE per capita Low- and middle-income countries * GNI 100,000/year Source: Rohde et al. (Lancet 2008) Source: Analysis of World Health Statistics

20. 20 U5MR and health systems development: 1970-2010 

21. International Health Policy Program -Thailand Good Health in Thailand 21 Good Maternal Health: MMR 1960-2008 Per 100,000 live births

22. Different figures on MMR in Thailand from different data sources and RAMOS technique 19901995199720002004200520062008 BPS – MOPH25.010.79.713.213.312.211.711.5 TDRI44.537.441.6 RAMOS * & verbal autopsy 44.336.5 WHO & UNICEF50.052.063.051.048.0 Lancet (IHME)44.043.047.0 Source: Bureau of Health Promotion 2006 & WHO Note: BPS = Bureau of Policy and Strategy MOPH = Ministry of Public Health TDRI = Thailand Development Research Institute * The reproductive age mortality studies (RAMOS) technique identifies and investigates all deaths of women of reproductive age (15-49 years) using multiple data sources. This method includes interviewing household members and health care providers.

23. International Health Policy Program -Thailand Lessons learnt from CRVS development in Thailand Long-term development of CRVS with some degree of political support and commitment  high coverage of birth and death registration, CRVS is the backbone for HSPA, monitoring progress of health system development, and the impact of health policies in Thailand, Analysis of CRVS with other data sources will help facilitate HSPA and monitoring of progress of health system development, Challenges of CRVS: – under-reporting of maternal mortality, – lack of SE parameters for analysis of health equity, – limited capacity in policy advocacy, and translation of evidence and research 23

24. International Health Policy Program -Thailand 24 Key challenges in strengthening and institutionalizing HIS in Thailand Many HIS institutes/organizations are responsible for different components of M&E  duplication, inefficiency, and difficulties in networking and standardization, Gaps in data quality and availability, particularly data of the private sector, Despite adequate financing, more investment in HIS – both human and financial resources are needed, Variations in level of technical capacity in data generation, compilation, data processing, data analysis & synthesis, and communication, in responsible institutes, Problems in standardization of data generation, collection, and analyses, Low utilization of evidence by some policymakers and program managers, Need long term capacity building and champions in HIS for M&E

25. International Health Policy Program -Thailand 25 Structure of Health Information System Development and Networking in Thailand MOPH Thai Health Promotion Foundation Health System Research Institute (HSRI) Health Information System Development Plan and Networking NHSO NESDB Civil societies NGOs Professionals NSO Academics Data owners Steering committee Management office

26. Network and coordination between data producers and users Reviews for HIS Demands and indicators Data analysis and synthesis for report production and publication Utilization mechanism Accountability, M&E Research and development for improving health information system Data quality assessment Reviews for health information systems

27. International Health Policy Program -Thailand 27 Acknowledgement 27 Ministry of Public Health (MOPH) of Thailand National Statistical Office of Thailand (NSO) Health Systems Research Institute (HSRI) Health Information System Development Office (HISO) Thai Health Promotion Foundation (THPF) National Health Security Office (NHSO) WHO long-term fellowship program of WHO-SEA region Department of Health Statistics and Informatics, WHO-HQ