Contributions of national and global health estimates to monitoring health-related Sustainable Development Goals in Thailand

Abstract

The millennium development goals triggered an increased demand for data on child and maternal mortalities for monitoring progress. With the advent of the sustainable development goals and growing evidence of an epidemiological transition toward non-communicable diseases, policymakers need data on mortality and disease trends and distribution to inform effective policies and support monitoring progress. Where there are limited capacities to produce national health estimates (NHEs), global health estimates (GHEs) can fill gaps for global monitoring and comparisons. This paper discusses lessons learned from Thailand’s burden of disease (BOD) study on capacity development on NHEs and discusses the contributions and limitations of GHEs in informing policies at the country level. Through training and technical support by external partners, capacities are gradually strengthened and institutionalized to enable regular updates of BOD at national and subnational levels. Initially, the quality of cause-of-death reporting in death certificates was inadequate, especially for deaths occurring in the community. Verbal autopsies were conducted, using domestic resources, to determine probable causes of deaths occurring in the community. This method helped to improve the estimation of years of life lost. Since the achievement of universal health coverage in 2002, the quality of clinical data on morbidities has also considerably improved. There are significant discrepancies between the Global Burden of Disease 2010 study estimates for Thailand and the 1999 nationally generated BOD, especially for years of life lost due to HIV/AIDS, and the ranking of priority diseases. National ownership of NHEs and an effective interface between researchers and decision-makers contribute to enhanced country policy responses, whereas subnational data are intended to be used by various subnational partners. Although GHEs contribute to benchmarking country achievement compared with global health commitments, they may hamper development of NHE capacities. GHEs should encourage and support countries to improve their data systems and develop a data infrastructure that supports the production of empirical data needed to underpin estimation efforts.

Global estimates of country health indicators: useful, unnecessary, inevitable?

“…A frequently cited problem is the lack of consultation with countries by global agencies producing estimates [22]. Country decision makers and technical experts have a deep understanding of the data sources and health system context in their countries, and have to make important policy decisions.…”

“…Technocrats in countries that perform badly compared with countries with similar socioeconomic profiles can use global rankings to needle politicians into action, improving both data systems and programme implementation (historically in Chile, more recently in South Africa and Iran). The most positive views of global estimates are expressed by countries such as Brazil [18], Chile [26], Mexico [18], South Africa and Thailand [22] that have been stimulated to bring the estimation process home by taking on the global estimates and producing their own country estimates based on country data and nationally determined assumptions.…”

“…Several high-income countries and some middle-income countries such as Thailand have conducted national burden of disease exercises and have been able to focus on the application of the methods to their own circumstances rather than getting involved in disputes about particular indicator values [22]. Even when there is insufficient capacity to conduct a comprehensive national burden of disease exercise, countries in health transition such as Bangladesh and Ghana have applied the methods using country data to highlight emerging health challenges such as noncommunicable diseases (NCDs), violence, mental health and road traffic accidents.…”

Implementation of health and health-related sustainable development goals: progress, challenges and opportunities – a systematic literature review

“…Assessment and strengthening of statistical system capacity to ensure availability of data for monitoring progress on chosen indicators is also underway. For instance, Thailand has conducted national burden of disease study and health estimates 43 and has devised a comprehensive methodology to assess progress towards universal health coverage using data from household surveys, facilities, disease registries and research. 44 Where data for monitoring are not available, various approaches being used to enhance data availability are: using data from global databases until country systems are more mature; 45 reconsidering the periodicity of national surveys to allow frequent availability of data; 16 using data from alternate sources such as think tanks and civil society organisations 12 17 and using technology to make data collection more efficient, for example, satellite technology for household surveys.…”

Bridging the data gaps: do we have the right balance between country data and global estimates?

“…An introductory paper considers the usefulness of the expanding volume of global estimates [9]. Three country-specific papers consider the role of estimates in the specific contexts of Chile, Bangladesh and Thailand, respectively [10–12]. Pisani and Kok reflect on the need to socially contextualise estimates in order to make them locally useful [13].…”