1. International Health Policy Program -Thailand 1 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

2. International Health Policy Program -Thailand 2 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?

3. Monitoring & Evaluation of health systems reform /strengthening A general framework Data sources Indicator domains Analysis & synthesis Communication & use Administrative sources Financial tracking system; NHA Databases and records: HR, infrastructure, medicines etc. Policy data Facility assessments Population-based surveys Coverage, health status, equity, risk protection, responsiveness Clinical reporting systems Service 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 Financing Infrastructure / ICT Health workforce Supply chain Information Intervention access & services readiness Intervention quality, safety and efficiency Coverage of interventions Prevalence risk behaviours & factors Governance Inputs & processesOutputsOutcomesImpact

4. Data available for tracking HSPA in Thailand (1) InputoutputOutcomeImpact HC F HR H Infra struct ure Gover nance Med / H tech HI S acc ess qual ity safe ty effic ienc y Interv coverag e Risk factor H outco me Re spo nsi ve Equit y Fin protec t VR Biennial SES Biennial HWS Census / SPC NHES MICS NHA

5. Data available for tracking HSPA in Thailand (2) InputoutputOutcomeImpact HC F HR H Infra struct ure Gover nance Med / heal th tec h HI S acc ess qua lity safe ty effi cien cy Interve n covera ge Risk factor s H outco me Re sp on siv e Equit y Fin prote ct Facility- based report H resource survey HIS electronic IP database Dis surveillance Behavioral H survey Sero- sentinel Survey Specific dis.regist Quality assurance (HA)

6. International Health Policy Program -Thailand 6 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 4 th round in 2009-2010.

7. International Health Policy Program -Thailand 7 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.

8. International Health Policy Program -Thailand 8 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.

9. International Health Policy Program -Thailand 9 Structure of Health Information System Development Plan in Thailand MOPH Thai Health Promotion Foundation Health System Research Institute (HSRI) Health Information System Development Plan and Networking NHSO NESDB Civil societies NGOs Professionals NSO Academics Data owners Steering committee Management office

10. Network and coordination Reviews for HIS Demands and indicators Data analysis and synthesis for report production and publication Utilization mechanism Research and development for improving health information system Data quality assessment Reviews for health information systems

11. International Health Policy Program -Thailand 11 Expected outputs of HIS Development Strategic Plan of Thailand

12. International Health Policy Program -Thailand 12 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.

13. International Health Policy Program -Thailand 13 Acknowledgement 13 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