Outcome Framework for Health Services: Case Study of HIV/AIDS Thailand Nichawan Nuankaew

Total population 63 million no. of people living with HIV610,000 Adults (15+)600,000 Women (15+)250,000 Children (0-15) 14,000 Estimated adult HIV prevalence 1.4% Estimated no. of AIDS deaths 31,000 in 2007 Situation Analysis

Age wise Distribution of AIDS patients

Goals To reduce the number of new HIV infections and the socio-economic impact of HIV/AIDS in Thailand Vision Zero HIV/AIDS in 2015

HIV/AIDS Strategies 1. Reform the health management system 2. Develop the efficiency & ability to access health services 3. Develop good health behavior practices for HIV/AIDS prevention control & health promotion 4. Develop system for customer protection in the areas of medical services & health-related products for HIV/AIDS 5. Produce & develop human resources for health programme in a systemic & continuous manner in all areas 6. Promote studies, research & development of health- related products & health technologies for HIV/AIDS

Do CheckAct Plan HIV/AIDS Control Programme: Building Outcome Data Base

Steps HACP ResearchTimeActivities Frame the question PlanCritical areas3 months - Frame the question from case study in target areas systematically observe the HIV/AIDS problem - Assess causative factors - Search for the available best practices

Steps HACP ResearchTimeActivities Test the best practices DoConduct the research 5 months - Conduct the best practice & assess the result - Go to target areas (vulnerable) Analyze the result & distribute the knowledge CheckAnalysis & publish result 2 Months - Determine, Analyze, Summarize the result - Publish & Promote the result (PoP & organization) HIV/AIDS Control Programme: Building Outcome Data Base

Steps HACP ResearchTimeActivities Implement the “Proved Best Practice” ActImplement the “Proved Best Practice” 2 months - Implement the “Proved Best practice” - Redo “Plan” as needed HIV/AIDS Control Programme: Building Outcome Data Base

Output – Outcomes Matrixs Outcome & IndicatorsOutput & Indicatorspartners Indicative resources by programme component Outcome: Improved HIV prevention through safer sexual practices among vulnerable groups Outcome indicators: In selected areas:  Percentage of young people demonstrating behavioural change towards safer sex practices  Percentage of commercial sex workers reporting consistent use of condoms with clients and non-client partners  Condom use at last high-risk sex Output 1: Improved access to information, counselling and services for HIV prevention among young people, commercial sex workers, clients of commercial sex workers and migrants in underserved areas Output indicators:  Percentage of service delivery points providing youth-friendly information, counselling and services for HIV prevention  Percentage of service delivery points providing high-quality voluntary counselling and testing for HIV infection  Percentage of young people, commercial sex workers, clients of commercial sex workers, and migrants (workers and dependents) having access to target group-specific information, counselling and services for HIV prevention  Percentage of young women who are confident they have the skills to get their partners to use condoms Ministry of Public Health Ministry of Education Provincial public health offices NGOs/civil society organizations $3.5 million Programme Component: HIV/AIDS

Output – Outcomes Matrixs Outcomes & indicatorsOutputs& indicators partners Indicative resources by programme component Outcome: Increased utilization of disaggregated data for policy and programme formulation at national and subnational levels for addressing maternal and newborn health, adolescent reproductive health, HIV/AIDS, gender, migration and population ageing Outcome indicators:  Key policies and programmes are evidence-based  Policymakers support formulation and implementation of elderly friendly policies and programmes Output 2: Enhanced capacity at national and subnational levels to collect and analyse data and to conduct policy research on issues relating to reproductive health, HIV/AIDS, gender, migration and population ageing Output indicators:  HIV/AIDS and gender issues are integrated into reproductive health and population and development policies  Effective policies and programmes to deal with population ageing formulated and implemented  Analytical reports on gender-related topics available and disseminated National Statistical Office Ministry of Public Health Ministry of Social Welfare and Human Security Provincial health offices Provincial statistical offices District administration offices NGOs/civil society organizations Academic institutions

Output – Outcomes Matrixs Outcomes & indicatorsOutputs& indicators partners Indicative resources by programme component Outcome: Improved knowledge- management and networking mechanisms for intercountry communication and action on population, reproductive health, HIV/AIDS, gender, migration and population ageing issues in the region Outcome indicators:  Regional-level programmes and projects addressing population- related issues  Increase in South-South cooperation with other countries Output 3: Enhanced capacity and improved mechanisms for South-South cooperation in sharing experiences, information, and professional and technical know-how in population-related areas Output indicators:  Statistical information on key population- related issues between countries available  Regional-level analyses of population- related issues available  Number of initiatives and activities involving more than one country on population-related issues Thailand International Development Agency/Ministry of Foreign Affairs Civil society organizations

Outcomes & indicatorsOutputs& indicators partners Indicative resources by programme component Outcome: Increased utilization of information & services by vulnerable groups & underserved areas Outcome indicators:  Percentage of in & out of school youth using information & services on HIV Output 4: Improve access counselling & services, including HIV prevention for vulnerable groups and underserved areas Output indicators: -Percentage of service delivery points in vulnerable groups, underserved areas counselling & services for HIV prevention -Percentage of vulnerable groups, underserved population having access to information and services for HIV prevention -Ministry of Public Health -Ministry of Education -Provincial public health office Output – Outcomes Matrixs

Outcome Oriented Budgeting Process Annual budget next year: Oct (current year) – Sept (next year) MoH (Plan+budget+time) next year MoF in sept (current year) MoF MoH Target areas (vulnerable:5 Provinces) money

Roadblocks Manpower Lack of Transportation Lack of Education Gov’t change subject activities Socio-economic factors (Poverty) Lack of infrastructure Social crisis (Conflict in target areas) Lack of information Lack of knowledge

Outcome Oriented Expenditure Management 1. Audit office Centre (in central level) 2. Internal audit group (in branch offices/local gov’t) ** Particular OOEM: MoH will make sure the local gov’t in target areas achive intended output

Monitoring & Evaluation Outcome Indicators will be check by MoH, SC, MoF, MoP Output Indicators will be check by local gov’t (Provinces) as well as by MoH Input Data will be maintained by local gov’t (District + Subdistricts level) monthly 3 months