1. Proposed strategies for future National Health Exam Survey

2. Background Several differences in survey methodology between NHES I, II and III; Sampling & target population Questionnaires and measurement Usually focus on a particular health issue, e.g. child health, elderly Limitation is that information on a particular health problem is only measured very rarely over time

3. NHES III 2003-2004 “Thailand Health Survey Office (THSO)”was established under the umbrella of HSRI, co-funding from BPS and HSRI Main objective is: to conduct the third NHES and plan for assessment of future trends of population health To plan for repeated cross-sectional health surveys at appropriate intervals to produce continuously representative, reliable estimators for measuring level and trend of health outcomes and related health determinants.

4. Proposed structure of renewal THSO as one project under HSRI Governing Board Standing core panel of experts THSO THSO networks in 5 regional academic institutions

5. To maximize cost-effectiveness of the health exam survey Important to maintain sample size for key measurements, e.g. emphasize on part of health examination and blood testing Allows sub-national assessment → important for health planning at provincial/district levels in line with moves to decentralize Random sub-sample for more specialized areas of interest to reduce cost Avoid duplication across other surveys (HWS, SES) Further refinement/development of concise and validated survey instruments Proper storage of blood serum for future testing, e.g. gene typing is critical Decentralization reduces travel cost but adequate quality control measures must be put in place

6. Sub-sample surveys Random sub-sample surveys, for instance: reproductive health, socio- economic determinants, etc. should be conducted in parallel by other institutes in close collaboration with THSO

7. Director and technical personnel Medical epidemiologist is preferred as qualification of the Director A combination of survey research specialist and data managers and statisticians are required among associate and colleague

8. Capability buildings of technical staff Long-term planning for THSO personnel both in number and qualification. Nurture/training of young staff as health surveys specialist Capability building on technical skills of personnel at THSO and regional networks Team of data management specialists and statisticians

9. Special concerns arising from NHES III Data management system to adequately store and catalogue specimens and questionnaires Proper collection of response and completion rates Ethical concerns and confidentiality regarding identifying information Linkage to health outcomes

10. HSRI HSRI is responsible for fund raisings long-term planning for future health exam surveys generation of the results as inputs for burden of disease and population health

11. 1. Repeated cross- sectional surveys 2004 20092014 Refine/develop & validate tools Training Research networks NHES IV Core measurements Sub-sample topics NHES V Core measurements Sub-sample topics 2. “Passive” cohort via record linkage NHES III cohort NHES IV cohort NHES V cohort 3. “Active” or true cohort NHES III.1 2008 NHES III.2 (re-examination) NHES V? 2013 NHES III.3 (re-examination) Active follow-up (fatal & non-fatal) Assess completeness of linkage Note: alternate years