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Strengthening CRVS through stakeholder engagement:Experiences from Thailand

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

Ministry of Public Health, Thailand

Global Summit on Civil Registration and Vital StatisticsPlaza Athenee Hotel, Bangkok, Thailand

19 April 2013

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0

20

40

60

80

100

120

140

160

180

200

220

240

260

U5

MR

per

1,0

00

live

bir

ths

5 10 20 50 100 200 400Total health expenditure per capita (USD, logarithm)

Top ten MDG4 performersTop ten MDG4 performers

Source: Analysis of World Health Statistics

Thailand 2000-05

Source: Rohde et al. (Lancet 2008)

Good Health at Low Cost !Good Health at Low Cost !

Thailand – Good health at low costsThailand – Good health at low costsUsing CRVS for monitoring reduction in child mortalityUsing CRVS for monitoring reduction in child mortality

* GNI < USD5,000 per capita; Births > 100,000/year

U5MR vs. THE per capitaLow- and middle-income countries

Rank

30

50

100

150

200

250

300

350

400

450

MM

R p

er 1

00,

000 li

ve b

irth

s

Year

MMR 1960-2006: six sources of references

BPS

BHP

RAMOS

TDRI

Lancet 2010

WHO

Reduction of U5MR and MMR in Thailand, 1960-2008

Achieving UHC

Source: Why and how did Thailand achieve good health at low cost? (2011) http://ghlc.lshtm.ac.uk/

Life expectancy at birth (years) of Thais

1964-2030

Sources: * Reports on Population Change Surveys 1964-1965, 1974-1976, 1985-1986, 1989, 1991, 1995-1996, and 2005-2006. National Statistical Office ** Population Projection for Thailand 2000-2030, Office of the National Economic and Social Development Board, 2007 in Thailand Health Profiles 2008-2010 page 149

Male

1964-1965*

1974-1976*

1985-1986*1989*

1991*

1995-1996*

2005-2006*

2005-2010**

2010-2015**

2015-2020**

2020-2025**

2025-2030**

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Using CRVS for monitoring and projection of changes in demographic profiles and

population pyramid of Thais from 1990 to 2030

5

19902000

2030

2008

Top-ten cause of deaths by age groups in 2009

6Source: Burden of Disease Study in Thailand, 2012

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CRVS and health information system in Thailand

• CRVS is part of the Thai health information system (HIS) which is not a single system, but consists of multiple sub-systems of health information with involvement of many key stakeholders:– Civil registration from Ministry of Interior (MOI);– Facility-based data on births and deaths from several

Departments of MOPH, National Health Security Office (NHSO), CGD;

– Community-based household surveys from National Statistical Office (NSO), MOPH, research institutes;

– Disease surveillance and investigation from Department of Disease Control of MOPH,

• From SPC 2005-2006, the coverage of birth registration was 96.7% and death registration was 95.2%

• Main financing sources for CRVS and HIS in Thailand:– Regular government budget;– Sin tax, 2% earmarked tax fund from tobacco and alcohol

consumption through Thai Health Promotion Foundation;– Direct payments from data users, either public or private

organizations.

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Lessons learnt from CRVS development in Thailand

• Long-term development of CRVS with some degree of political support and commitment high coverage of birth and death registration,

• CRVS is the backbone for HSPA, monitoring progress of health system development, and the impact of health policies,

• Analysis of CRVS with other data sources will help facilitate HSPA and monitoring of progress of health system development,

• Challenges of CRVS:– High unregistered deaths (40%) with high ill-defined cause

of deaths, – under-reporting of maternal mortality, – lack of SE parameters for analysis of health equity, – limited capacity in policy advocacy, and translation of

evidence and research 8

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Structure of Health Information System Development and Networking 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

Data availability for M&E system in ThailandData availability for M&E system in Thailand

Input Output Outcome Impact

HCF HRH

Infra struct

ure

Gover

nance

Med/Health tech

HIS access

quality

safety

efficienc

y

Interven

coverage

Risk factor

s

H outco

me

Responsive

Equity

Finan prote

ction

Civil registration and vital statistics

Biennial SES Biennial HWS Census / SPC NHES MICS Reproductive H survey NHA

Note: SES = household socio-economic survey, HWS= Health and Welfare survey, NHES = National Health Examination survey, MICS = Multiple Indicator Cluster survey, NHA = National Health Accounts, HA = Hospital accreditation, SPC= Survey of Population Changes

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Using CRVS to update beneficiaries among three public health insurance schemes in Thailand

Network and coordinationbetween data producers and users

Reviews for HIS Demands and indicators

Data analysis and synthesis for report

production and publication

Utilization mechanismAccountability, M&E

Research and developmentfor improving health

information system, esp COD

Data qualityassessment

Reviews for health information systems

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Key challenges in strengthening CRVS in Thailand

• Accuracy and coverage, particularly causes of death (COD) in health facilities and community,

• Gaps in data quality and availability, particularly data of the non-Thai and stateless people,

• Low utilization of evidence by some policymakers and program managers effectiveness of the government policies, HSPA, and health equity monitoring etc.

• Despite some extent of financing, more investment in maintaining quality and coverage of CRVS – both human and financial resources are needed,

• Variations in level of technical capacity in terms of – data generation, compilation, data processing, data

analysis & synthesis, and communication, in responsible institutes,

• Need long term capacity building in data compilation, analysis, for M&E.

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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) • National Health Security Office (NHSO)• Health Information System Development Office (HISO)• Thai Health Promotion Foundation (THPF) • Prince Mahidol Award Foundation of Thailand