Abstract
The Health Status Researcher Network Programs, one of the Health Intellegence Network programs, are immensely supported by Health Systems Research Institute, Thailand. The objective of this programme is to generate linkage among researchers, health experts and those who are interested in interlinked network collaboration, but organize independently, on the basis of data characteristics and their applications. The program, initiated in July, 2001 is of reviews for selecting suitable health status measures for Thailand. Further developing these indicators for use at the local and national levels is the program’s next step. It is proved that the importance of measures for assessing health status of population becomes ever greater. Firstly, findings from the process for preparation of REPORT on HEALTH of THE NATIONS,Thailand 2000 ,clarified that data were available but these scattered data are not systematically well-organized for shared usage. Data generation and analysis, besides data collection, is relied mainly on each individual organization or researcher’s interest, which leads to lack of overall consistency and reflection. Secondly, Thailand is currently in the midst of transitional environments such as devolution and health system reforms. Inevitably, such changes affect on national, provincial and local restructuring that encourages operational mechanisms of such levels to be more autonomous. The decision making process, therefore, requires locally specific data in order to manage to its fullest capacity. Also, preparing provinces or other subnational-levels for sufficing their own data for measuring health status, disease burden and system performance is needed. Lastly, standard concepts and definitions, most importantly, applied in the context of health care reforms, are needed to make a clear aligned understanding in describing or measuring health systems, health promotion or disease and injury prevention, which, in various countries, are currently adjusted for policy efforts. For instance, health promotion has become a critical procedure in monitoring public policies. In the new health systems, new tools are needed for making development at both national and local levels. The objectives of this program are toSearch for indicators measuring health status of Thai populations utilized appropriately at the national and provincial levels.Establish researcher networks for developing a consistent and sustainable system of population’s health status assessment.Develop local- area researchers through capability buildings and establish extensive networks at all levels.Generate a health status assessment manual that is for use at the provincial level.Disseminate health status and related reports periodically.The first phase of this program centers on reviews of global and national health status indicators, having consistently been developed, thereby, presenting proposed indicators that are appropriate for Thailand at the provincial and national level application. Moreover, such measures can be used for inter-country comparisons for overall and sub-level reflections by age and geographic distribution.Such reviews include 1) consideration of concepts, theories, definitions, advantages and disadvantages of each indicator used for measuring health status of the population, problem prioritization, cost-effectiveness, and equity. 2) consideration of data sources in respect to systematization and reliability. 3) consideration of feasibility of the indicator application at the local level. Based on researcher team’s expertise and indicator characteristics, the reviewed measures are broadly classified into 3 categories; namely, Basic Demographic Measurement, Negative Health Measurement and Positive Health Measurement.Basic Demographic Measurement, of which is not only themselves the fundamental indicators in directly reflecting the health state of population, but also the basis for calculating rate and other substantial health status indicators, in particular applied for use at sub levels such as the health service area or the provincial area. Quantitatively, ample data gathered from each sub area will be further aggregated into the national measures. Difficulty of sub-area measurement is a lack of data quality and reliability; therefore, development of database together with data generating agencies, such as Central Registration Office and National Statistics Bureau, is tremendously urged. Proposed indicators include number of population classified into size, age- sex structure , life table, infant mortality rate, maternal mortality rate, age-sex-specific-mortality rate, birth rate,total fertility rate, which are all presented at the provincial and national level.Negative Health Measurement defined by World Health Organization encompasses many different dimensions of health and functioning, and complex interaction with environment. At present, dynamic environmental transformation has brought greater evolution from single indicators to composite index and summary measures of population health, broadening area of health measurement. These measures are reflection of the unfinished health agenda and identify area where health gains can be made. This assists the national, as well as sub-level policy makers to make use of health policy and planning, including further determination of proper intervention. Proposed indicators regard cause-specific-mortality rate by age and sex, Year of Life Loss(YLL), incidence rate, prevalence rate, case-fatality rate, duration of disability, and natural courses of diseases and Year Loss due to Disability(YLD). Disability-Adjusted Life Years, the aggregate measure of YLD and YLL, and Disability-Adjusted Life Expectancy are included. 3. Positive Health Measurement mirrors the dimension of positive health in response to a paradigm shift in health system reforms from “cure-oriented health” to “promotion-emphasized health”. Life Expectancy or life longevity is not sufficient to measure life with good health. As a result, World Health Organization proposed Healthy Life Expectancy; that is, DALE or HALE in World Health Report 2000. In addition, developing indicators for measuring good health state of Thai persons at the individual level is necessarily encouraged in light of fully reflecting well beings covering physical, mental, social and spiritual dimensions, and, more importantly, being optimal for Thai society. This will result in accomplishment of health promotion policy. These developed measures are eventually called Healthy Thai indicators.The next step of this programme is to develop and test the proposed indicators, to develop health information system database in the targeted provinces, to establish local researchers and create extensive networks, to disseminate reports and data for interrelated communications among researchers and health experts, and to institutionalize of knowledge pools of measurements for assessing health status of Thai population.
