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Uses of civil registration and vital statistics to guide policy-making and planning in 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

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Uses of civil registration and vital statistics to guide policy-making and planning in Thailand

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

  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) 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)

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

  8. Using vital statistics for monitoring and projection of changes in demographic profiles and population pyramid of Thais from 1990 to 2030 1990 2000 2008 2030

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

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

  11. Additional health workforce requirementfor elderly care (based on workload method)

  12. Projected total expenditure on personal healthcare by age group, 2009 to 2015

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

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

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

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

  17. Financial risk protectionTrend of health impoverishment 1996-2008

  18. 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 Inequity in geographical distribution of Health workforce in 2007 Pharmacists Nurses

  19. Good Health at Low Cost in Thailand U5MR vs. THE per capita Low- and middle-income countries Top ten MDG4 performers 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)

  20. U5MR and health systems development: 1970-2010

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

  22. 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.

  23. 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

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

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

  27. Acknowledgement • 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 27

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