International Health Policy Program -Thailand 1 Phusit Prakongsai, MD. PhD. International Health Policy Program (IHPP) Ministry of Public Health, Thailand.

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Phusit Prakongsai, MD. PhD.International Health Policy Program (IHPP)

Ministry of Public Health, Thailand

Presentation to the 2010 Prince Mahidol Award Conference

Centara Grand Hotel, Bangkok 29 January 2010

Tracking Country Health Systems Performance:

Institutionalization of monitoring health and health system performance in

Thailand

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Health system performance assessment in Thailand

• Objectives of HSPA– To assess performance and achievements of the country's

health system,– To improve management and accountability of the

responsible institutes/organizations,– Learning to do better: assess the gap between achievements

and national health goals / international benchmark,– Identify key challenges of the health systems and gaps in

data quality. • Monitoring & evaluation of health care system

reforms– Short term expectation:

• What are people getting from the increased inputs and recent country's reform policies?

– Long term expected benefits: • Have the effects on improving access, quality, coverage,

financial protection, equity in health, and patient satisfaction over time?

• Have these results in health impacts, that is reduced mortality and morbidity, and health status of the population?

Monitoring & Evaluation of health systems reform /strengtheningA general framework

Data sources

Indicatordomains

Analysis & synthesis

Communication & use

Administrative sourcesFinancial tracking system; NHADatabases and records: HR, infrastructure, medicines etc.Policy data

Facility assessments Population-based surveysCoverage, health status, equity, risk protection, responsiveness

Clinical reporting systemsService 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

Fina

ncin

gInfrastructure

/ ICT

Health workforce

Supply chain

Information

Interventionaccess & services

readiness

Interventionquality, safety and efficiency

Coverage of interventions

Prevalence risk behaviours &

factors

Gov

erna

nce

Inputs & processes Outputs Outcomes Impact

Data available for tracking HSPA in Thailand (1)Data available for tracking HSPA in Thailand (1)

Input output Outcome Impact

HCF

HRH

Infra structure

Gover

nance

Med/H

tech

HIS

access

quality

safety

efficiency

Interv covera

ge

Risk facto

r

H outco

me

Responsive

Equity

Fin prote

ct

VR

Biennial SES

Biennial HWS

Census / SPC

NHES

MICS

NHA

Data available for tracking HSPA in Thailand (2)Data available for tracking HSPA in Thailand (2)

Input output Outcome Impact

HCF

HRH

Infra structure

Gover

nance

Med/

health tech

HIS

access

quality

safety

efficiency

Interven

coverage

Risk facto

rs

H outcome

Responsive

Equity

Fin prote

ct

Facility-based report

H resource survey

HIS electronic IP database

Dis surveillance

Behavioral H survey

Sero-sentinelSurvey

Specificdis.regist

Quality assurance (HA)

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Selected key outputs of HIS development for HSPA in Thailand

• Civil registration and vital statistics by Ministry of Interior and Bureau of Policy and Strategy, MOPH,

• A series of National Health Accounts of Thailand from 1994-2008 by IHPP and HSRI,

• Thailand Health Profile 2001-2007, and ongoing 2008-2010 by MOPH and its alliance,

• A series of Thai Health 2005-2009 by IPSR and THPF, • Assessment of the impact of Thai universal coverage

policy on health equity since 2002 until present, • Burden of disease in Thailand 1999 and 2004,• A long series of biennial nationally representative of

hh surveys on socio-economic status (SES), health service use, and welfare of Thai households (HWS),

• Three rounds of National Health Examination Survey (NHES), and the 4th round in 2009-2010.

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Key factors contributing to institutionalization of HSPA in Thailand

• Gradual evolving culture among policy makers in using evidence for decision making,

• Demand from users e.g. policymakers, health strategic planners, directors of policy and planning division, researchers, etc.

• Adequate financing and skilful human resources for HIS,

• Long-term capacity building and skills in some institutes in data generation, compilation, processing, synthesis & analyses, dissemination, communication to the public and policymakers,

• Good collaboration and close relationship between data producers and data users, and policymakers,

• Networking at sub-national, national, and international levels.

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Remaining key challenges in institutionalizing HIS in Thailand

• Many HIS institutes/organizations are responsible for different components of HSPA 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 is needed,

• Variations in level of technical capacity in data generation, compilation, data processing, data analysis & synthesis, and communication, in some responsible institutes,

• Problems in standardization of data generation, collection, and analyses,

• Low utilization of evidence from HIS by some policymakers,

• Need long term capacity building and champions in HIS of each component of HSPA.

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Structure of Health Information System Development Plan in Thailand

MOPH

Thai Health Promotion Foundation

Health System Research Institute (HSRI)

Health Information System DevelopmentPlan and Networking

NHSO NESDB

Civil societies

NGOs

Professionals

NSO

Academics

Data owners

Steering committee

Management office

Network and coordination

Reviews for HIS Demands and indicators

Data analysis and synthesis for report

production and publication

Utilization mechanism

Research and developmentfor improving health information system

Data qualityassessment

Reviews for health information systems

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Expected outputs of HIS Development Strategic Plan of Thailand

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Priority areas and expected outcomes for HIS Development Strategic Plan of

Thailand

Improved organization/ environment

• Create platforms and strengthening network of institutions responsible for HIS at central, regional, and provincial levels.• Roles and responsibilities of institutions involved in HIS at different levels are clearly defined and avoid duplication of work.• Adequate budget and financing for HIS.

Improved technical design

• A set of national health indicators would be developed and regularly used for HSPA.• Integrated essentials data set and standardization are developed.• Developing tools for data generation, compilation, synthesis, and reporting.• Developing tools for information management and use.

Improved behaviour

• Creating conducive environment to improve motivation of all stakeholders to implement HIS effectively.• Personnel involved in HIS at different levels are deployed and trained. • Creating opportunities for pre-service training (under / post graduate education) for health personnel.

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Acknowledgement

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• 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)• Department of Health Statistics and Informatics, WHO-

HQ