งานนำเสนอเรื่อง: "Financing Health promotion Experiences from Thai Health Promotion Foundation Supreda Adulyanon."— ใบสำเนางานนำเสนอ:
Financing Health promotion Experiences from Thai Health Promotion Foundation Supreda Adulyanon
Health Promotion Finance Health Promotion: current concept Differences from other health care finance Establishment HP financing mechanism : utilizing earmarked sin-tax : utilizing earmarked sin-tax
Macro Financial Figure (2008) GDP 240 Billion $, 3,800 $ per capita Health Expenditure 6.1(3.5)% of GDP (8.4 – 14.6 Billion $) Total Gov. Budget 52.8 Billion $ Gov. Health Budget >10% of Gov. Budget MoPH 2008 4,300 Million $(8.5%) MoPH 2,000 Million $ UC Fund 2,300 Million $ TTM Fund 4.3 Million $ Emergency Fund 11.1 Million $ Thai Health Fund 75 Million $
The proportion of different types of national health expenditure in 2005
Two kinds of HP Finance HPF as the activator HPF as the preventive and promotive care provision
Two kinds of HP Finance HPF as the activator - create and coordinate HP activities of related sectors - create and coordinate HP activities of related sectors - social determinants approach - social determinants approach - activated mostly through policy advocacy and social mobilization - activated mostly through policy advocacy and social mobilization HPF as the preventive and promotive care provision
Two kinds of HP Finance HPF as the activator HPF as the preventive and promotive care provision - Focus on services to individual or group or communities - Focus on services to individual or group or communities - Mostly are vertical activities/ within health service sectors - Mostly are vertical activities/ within health service sectors
Optimal health พัฒนาสู่สุขภาพดี เปลี่ยนแปลงสังคม / ชุมชน ยกระดับคุณภาพ ชีวิต ขจัดปัจจัยเสี่ยง วินิจฉัยในระยะ เริ่มแรก และรักษาทันที ฟื้นฟูสภาพพิการ Minimal disease ลดโรค การป้องกันโรค ระดับปฐมภูมิ ระดับทุติยภูมิ ระดับตติยภูมิ การส่งเสริม สุขภาพ ระดับตติยภูมิ ระดับทุติยภูมิ ระดับปฐมภูมิ เน้นที่โรค medical field เน้นที่สุขภาพ health field
การเพิ่มสมรรถนะของประชาชนให้สามารถบรรลุ ภาวะสุขภาพดี ต้องกระทำในสิ่งสำคัญ 5 ประการ การสร้างนโยบายสาธารณะเพื่อสุขภาพ. การก่อให้เกิดสิ่งแวดล้อมที่ เอื้ออำนวยต่อสุขภาพ. เสริมสร้างกิจกรรมชุมชนให้ เข้มแข็ง. พัฒนาทักษะส่วนบุคคล. การปรับเปลี่ยน บริการสุขภาพ กฏบัตรออตตาวาเพื่อการส่งเสริมสุขภาพ Ottawa Charter for Health Promotion, 1986
Two kinds of HP Finance HPF as the activator: thus requires - More flexibility and autonomous body to work across sectors - More flexibility and autonomous body to work across sectors - More independency & sustainability assurance to secure political pressure - More independency & sustainability assurance to secure political pressure HPF as the preventive and promotive care provision
Starting point: tobacco control In 1997 : Thailand Successes in Enacting law Policy development including tax increases (Activities which are not budget dependent, need lobbying processes and political will) (Activities which are not budget dependent, need lobbying processes and political will)
2 Steps Approach Movement for tobacco tax increase (1988 - 1993) Movement for dedicated tax (1995 - 2001)
Thailand : before 2000 For effective Health Promotion We need 1. Adequate and regular funding source. 2. More flexible means to allocate budget. 3. More efficient health promotion strategy influenced by financial measure
Why have a health promotion foundation? As an advocate for tobacco control and for other aspects of health promotion As a bridge and facilitator - across government departments - Between sectors - Between NGOs and governments As an innovator Rob Moodie VicHealth
20 Our rationale 1. The government is making over 2,750 million US$ per year from alcohol and tobacco taxes. Yet provided only less than 3 million US$ (=0.1%) for alcohol, tobacco control and health promotion combine Yet provided only less than 3 million US$ (=0.1%) for alcohol, tobacco control and health promotion combine
2. The World Bank recommend countries to control alcohol and tobacco for health as well as for economic gain
3. We are not asking money from the government, 3. We are not asking money from the government, but from the tobaccoand alcohol companies but from the tobaccoand alcohol companies
4. This money will be use to support health promotion, alcohol and tobacco control, the result will be improved health status for Thais, the result will be improved health status for Thais, as well as decrease government health care expenditure as well as decrease government health care expenditure
Financing mechanism and Infrastructure to fund Tobacco control Alcohol control Traffic accident prevention If we succeed in reducing health care expenditure in these three areas by 10% Thailand would save 500 million US$ per year If we succeed in reducing health care expenditure in these three areas by 10% Thailand would save 500 million US$ per year
5. In passing this legislation, the government will be praised by the public to have acted responsively and wisely in the handling of “Sin Tax” the government will be praised by the public to have acted responsively and wisely in the handling of “Sin Tax”
Key decision The Ministry of Health : would like the new agency to be within the Ministry of Health’s system and jurisdiction The Ministry of Finance : would like the funding to come from the regular budget
Why an autonomous health promotion foundation? Why an autonomous health promotion foundation? 1. The nature of the work (Health Promotion) 1. The nature of the work (Health Promotion) Development vs Established services Development vs Established services Project based vs Service based Project based vs Service based Herizontal coordination vs Vertical implementation Herizontal coordination vs Vertical implementation 2. Success is based on innovation and collaboration 2. Success is based on innovation and collaboration 3. Not achievable through bureaucrative 3. Not achievable through bureaucrative management with this little additional budget management with this little additional budget (+ 2 %) (+ 2 %) 4. Needs flexible management for easier synergistic act among sectors 4. Needs flexible management for easier synergistic act among sectors
Why a dedicated form of funding? 1. Health promotion needs regular and sustainable budget 2. Less susceptible to diversion of funding for other purposes.
Health Promotion Foundation Act 2001 -Setting up of Health Promotion Office -Funding health promotion related activities with 2% surcharge of alcohol and cigarette taxes. - Annual budget = 75 m US $ ( = 2 % of MOPH budget) -An autonomous state agency.
ThaiHealth acts as a catalyst to help lubricate all health promotion mechanisms to function most effectively.
Triangle that moves the mountain Knowledge Social movement Policy mobilization ThaiHealth’s Strategies
JANUARY Launch ETV, TV for children. Public sector places announced as smoke-free zones. MAY To start and urge the trend for labeling child’s snacks continuously. SEPTEMBER To make trimming to be a part of benefit of a National Health System FEBRUARY First national Clean Concert. JUNE Ministry of Education announced policy for no-drinking in freshmen ceremony. OCTOBER Cooperated academic institutes to urge for no selling alcohol and beer around institutes within a radius of 500 meters. MARCH The Chief of the Thai Muslims signed a statement that cigarette is prohibited in principle in Islam. JULY ‘No-soda’ drinks in school. Whale-browser, to protect children from inappropriate website. NOVEMBER Launch the best online Knowledge Encyclopedia Tank in Thailand. APRIL Stop sweeten milk market for infants in Thailand. AUGUST Cooperate with Ministry of Cultural to urge TV Rating. Campaign for hospitals to stop giving powder milk. DECEMBER Urge a “New barrier- free society” to improve basic facilities for disabilities.
Some achievements in 2008 Alcohol Control Act 2008 Smoke free pubs and bars, open-air markets and restaurants 2007 Liability to damage caused by unsafe product Act Child toy control system Television program rating Public Broadcasting Television Dangerous behavior stimulating material suppression Act Prohibition on speaking on mobile phone while driving without aid accessory
Public Diaster Act Creating over 200 researches in health Safe and clean internet cafe’ Media monitoring mechanism Some achievements in 2008
Creating health promotion innovations and models eg. Traffic injuries prevention at provincial level Health promotion universities Self sufficiency campaign Some achievements in 2008
Key Types of Monitoring
Building a Results-Based Monitoring and Evaluation System
Monitoring and evaluation of Communication/ Social marketing reception rate/ effective channel response rate and direction sending message/ snow ball effect attitude / behavioral change estimated economical gain social / policy impact
Reception of messages Yes 4,041 samples (84.1%) No 765 samples (15.9%) 84.1 % ‘Branding’
Do you have a talk about it with other? Yes 69.8 % No 30.2 %
Awareness of avoid or quitting or reduction of alcohol drinking
Acessibility of message through media channels most accessible least accessible 4,041 samples 97.9% 92.5% 78.4% 21.2% 31.5% 33.0%
Comparison of the direction of news: May 2005 positiveneutralnegative
Number of news in various health issues: November 2004 tobacco alcohol Physical activities
20012003 3,600 million baht 4,600 million baht 11.8% 15% Stop drink reported 2001 : 11.8 % (1.8 m) 2003 : 15.0 % (2.3 m) +3.8 % Stop drink in Buddist lent: estimation of financial saving from reported questionnaire 1000 m bath saved only from direct payment
Alcohol policy outcomes Before the establishment of ThaiHealth and triangle network There were 6 national alcohol control policies in 50 years national alcohol policies (1950- 2002) 1.Alcohol act 1950 2.Limited sale time (1961) 3.Prohibit sale to intoxicated person (1966) 4.Drunk driving (1979) 5.Warning message(19p97) 6.Free trade (1999) After the establishment of ThaiHealth and triangle network There are 9 national alcohol control policies in 4 years national alcohol policies (2003- 2007) 1.Prohibit sale for under 18 (2003) 2.Partial ad ban (2003) 3.Establishing the national alcohol control committee (2003) 4.Prohibit sale in school (2004) 5.Warning message in outdoor billboard and movies (2004) 6.Prohibit sale in fuel station (2005) 7.Increase warning messages (2005) 8.Increase excise tax (2005) 9.Alcohol control act (2006 – 2007) 8 yrs per 1 policy 2 policies per 1 year
Lesson learned Three main factors were discussed for ThaiHealth’s early achievement in Health promotion; these are flexibility, financial security effective strategy and approach ‘supplementary rather than replacement’ ‘supplementary rather than replacement’
Current limitation and challenge of ThaiHealth of ThaiHealth - a very new concept of governance & operation operation - lack of understanding by some politician, expect quick result, want more political receptive expect quick result, want more political receptive -perceived by some policy maker as “easy money” ‘overlapping role’ “easy money” ‘overlapping role’ - still in learning curve: in the process of building.. - health promotion manager, advocator & expertise - health promotion manager, advocator & expertise - proactive innovative catalytic management - social immunity, moving to be a ‘social institution’
International Network of Health Promotion Foundations www.hp- foundations.net
Health Promotion Foundation s in: LegislationYear set up Yearly funds 2006-7 in USD (per person) 1. Austria Health Promotion Act 1998 9,700,000 (1.18) 9,700,000 (1.18) 2. Switzerl and Health Insurance Act 1994 14,000,000 (1.90) 3. Thailand Health Promotion Act 2001 63,000,000 (0.96) 4. Victoria (Australia) (Australia) Tobacco Act 1987 26,000,000 (5.10) 5. Western Australia Australia Tobacco Control Act 1990 14,400,000 (7.00) 6. Malaysia Malaysian Health Promotion Board Act 2006 10,000,000 (0.45)
SEATCA Bungon Ritthiphakdee Director Working Together to Advance Tobacco Control in ASEAN
Member of network Cambodia Indonesia Lao PDR Malaysia Philippines Thailand Vietnam
From WHO – PROLEAD PROLEAD I - 6 countries (Fiji, Tonga, Malaysia, Philippines, Mongolia, Shanghai- China) Request came through INHPF ThaiHealth matched with Shanghai and Mongolia Formal arrangement with a contract done
Conclusion Lessions learned from ThaiHealth 1. The control of tobacco, alcohol and other risk factors need adequate and continuous funding, attempt should be made to secure a sustainable funding sources, preferably by legislation.
2. Obtaining a dedicated tax for health promotion is more appealing to policy maker than for tobacco control or one specific risk control only
3. The dedicated tax and the autonomy of the health promotion agency should be legislated, to better guard the system from political interferences and for maximum efficiency of the foundation.
4. Some international supports for establishment of HPF are available, but need more initiative support but need more initiative support from WHO etc. from WHO etc.