1. InternationalHealthPolicyProgram-ThailandInte
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 Statistics
Plaza Athenee Hotel, Bangkok, Thailand
19 April 2013

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T00T01 T02T03T04T05
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0
20
40
60
80
100
120
140
160
180
200
220
240
260
U5MRper1,000livebirths
5 10 20 50 100 200 400
Total 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 costs
Using 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 capita
Low- and middle-income countries
Rank

3. 3
0
50
100
150
200
250
300
350
400
450
MMRper100,000livebirths
Year
MMR1960-2006: 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/

4. 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**

5. InternationalHealthPolicyProgram-ThailandInte
Using CRVS for monitoring and projection of
changes in demographic profiles and population
pyramid of Thais from 1990 to 2030
5
1990
2000
2030
2008

6. Top-ten cause of deaths by age groups in 2009
6Source: Burden of Disease Study in Thailand, 2012

7. InternationalHealthPolicyProgram-ThailandInte
7
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.

8. InternationalHealthPolicyProgram-ThailandInte 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

9. InternationalHealthPolicyProgram-ThailandInte
9
Structure of Health Information System
Development and Networking 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. Data availability for M&E system in ThailandData availability for M&E system in Thailand
Input Output Outcome Impact
HCF HR
H
Infra
struct
ure
Gov
er
nan
ce
Med/
Healt
h tech
HIS acc
ess
qual
ity
safe
ty
effic
ienc
y
Interve
n
coverag
e
Risk
factor
s
H
outco
me
Res
po
nsi
ve
Equit
y
Finan
prote
ct
ion
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

11. 11
Using CRVS to update beneficiaries among three
public health insurance schemes in Thailand

12. Network and coordination
between data producers and users
Reviews for HIS
Demands and indicators
Data analysis and
synthesis for report
production and
publication
Utilization mechanism
Accountability, M&E
Research and development
for improving health
information system, esp COD
Data quality
assessment
Reviews for health
information systems

13. InternationalHealthPolicyProgram-ThailandInte
13
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.

14. InternationalHealthPolicyProgram-ThailandInte
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Acknowledgement
14
• 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