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Progress in achieving the health-related MDGs: Lessons from Thailand

Progress in achieving the health-related MDGs: Lessons from Thailand. Phusit Prakongsai, MD. Ph.D. International Health Policy Program (IHPP) Ministry of Public Health, Thailand Health in the Post-2015 Development Agenda The side event prior to the Prince Mahidol Award conference

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Progress in achieving the health-related MDGs: Lessons from Thailand

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  1. Progress in achieving the health-related MDGs:Lessons from Thailand Phusit Prakongsai, MD. Ph.D. International Health Policy Program (IHPP) Ministry of Public Health, Thailand Health in the Post-2015 Development Agenda The side event prior to the Prince Mahidol Award conference Centara Grand & Bangkok Convention Centre, Bangkok, Thailand 29 January 2013

  2. Where is Thailand standing at? MDG4 - Child mortality Top ten MDG4 performers Good Health at Low Cost ! U5MR vs. THE per capita Low- and middle-income countries Rank Thailand 2000-05 * GNI < USD5,000 per capita; Births > 100,000/year Source: Analysis of World Health Statistics Source: Rohde et al. (Lancet 2008)

  3. Progress in achieving MDG5 Improving maternal mortality: MMR 1960-2008 Per 100,000 live births

  4. MDG6 - Coverage of universal access to ART in Thailand, 2006-2009

  5. Key contributing factors (1) • Development of health systems: • First strand: expansion of strong district health systems both infrastructure and workforces • More resource allocation to district and provincial levels, • Government bonding “mandatory public health services” by all health-related graduates. • The MOPH high level production capacity of nursing and other health-related personnel contributed significantly to the functioning of rural health services. 5

  6. Suwit Wibulpolprasert, MD., Ministry of Public Health, Thailand Adequate and appropriately manned rural health facilitieis Rural health centers with 3-6 nurses n CHWs cover 2,000-5,000 population Extensive production of appropriate cadres and motivated health personnel with mandatory public works and adequate support are essential. Rural community hospital with 2-8 doctors cover 30-80,000 population

  7. Four decades of infrastructure and workforce development The advent of district hospitals (1977) First batch of two-year technical nurses (1982) Now fully upgraded to RNs Public service mandate of new MDs (1972) Source: Health Resource Surveys (various years)

  8. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand Provincial hospitals 46.2% (5.5) 1977 Community hospitals 24.4% (2.9) Rural health centers 29.4% (3.5) Provincial hospitals 27.7% (10.9) Community hospitals 1989 32.8% (12.9) Rural health centers 39.4% (15.5) 18.2% (20.4) Provincial hospitals 35.7% (40.2) 2000 Community hospitals 46.1% (51.8) Rural health centers Promoting the use of primary health care From reverse to upright triangle: PHC utilization (OP visits) Budget shift Peace, econ gwt, democracy Source: Rural Health Division, MoPH ( ) : Number of OPD visits (millions) 8

  9. Key contributing factors (2) • Development of health systems: • Second strand: the extension of financial risk protection through piece-meal targeting approach, addressing the poor and vulnerable, and gradually extended to formal and informal sectors until universal health coverage for the entire population was reached in 2002. 9

  10. Strong political commitment to expand financial risk protectionLong march towards universal health coverage in Thailand GNI per capita and health insurance coverage, 1970-2009

  11. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand More government budget to Health 77,720.7 mil. ฿(78x) (8.1%) 986.6 mil. ฿ (3.4%) 16,225.1 mil. ฿ (4.8%) 2010 Public health budget rose to 14% of National budget 29,000 mil. ฿ 1972 335,000 mil ฿ 1,028,000 mil ฿ (35x)) 1990 National budget 2004 Public health budget 11

  12. Contributions of non-health sectors • Poverty: sharp drop of poverty incidence with growth of economy Source: Thai National Economic and Social Development, profile of poverty • Education • Better in youth literacy than adult literacy in term of level of average literacy and gender gap Source: UNESCO website

  13. Key challenges in moving towards health system development and sustainable development in Thailand

  14. Life expectancy Life expectancy gain was significant during 1975-2005 but stagnated in men in 1990s due to adult mortality from HIV/AIDS, road traffic injuries and increasing NCDs Source: Synthesis from NSO survey of population changes for 1975, 1985, 1995 and 2005, and MOPH-DOH-THP 2003 for 2000 14

  15. Future challenges: adult health Top five of all-age mortality, by gender in 2004 Source: Analyzed by Thai Working Group on Burden of Diseases Can the current health systems cope with increasing proportion of BOD attributable from injuries, use of alcohol, unsafe driving, NCD and HIV/AIDS? There is a need for a major policy review how Thailand controls risk factors contributing to adult mortality. 15

  16. Mismatch between increasing burden of disease from NCD and low investment in HP and disease prevention DALYs attributable to risk factors

  17. Majority of health care finance is still for curative care  universal access to ARV(Source: UNGASSReports 2008 & 2010) 17

  18. Inequity in geographical distribution of health workforce in Thailand Physicians 800-3,305 3,306-6,274 6,245-9,272 9,243-12,300 Nurses 280 - 652 653 - 904 905 - 1,156 1,157 – 1,408 Dentists 5,500-15,143 15,144-25,767 25,768-36,390 36,391-47,011

  19. Different figures on MMR in Thailandfrom different data sources and RAMOS technique 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.

  20. The principle of “Triangle that moves the mountain” Knowledge generation & management Social and civic movement Political commitment/Policylinkages

  21. Lessons learned • Public health policies: pro-poor, pro-rural ideology • Strong commitment by the government • Explicit five year National Health Plans (1960-2010): consistent development of district health system in line with rural development • Long-term investment and continuous development of district health system and PHC, • Increasing participatory process of civil society through several mechanisms, • Strong implementation capacity and a pragmatic and learning approach to policy implementation • Participatory of MOPH and others e.g. education, agriculture, economic and employment, transport as well as private sector, civil society and communities

  22. Thank you for your attention

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