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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