Achieving the targets for universal health coverage: how is Thailand monitoring progress?

Abstract

Universal health coverage (‎UHC)‎ is one of the targets within the Sustainable Development Goalsthat the Member States of the United Nations have pledged to achieve by 2030. Target 3.8 has twomonitoring indicators: 3.8.1 for coverage of essential health services, for which a compound index from16 tracer indicators has recently been developed; and 3.8.2 for catastrophic expenditure on health.The global baseline monitoring of these two indicators in 2017 shows that the progress in many lowandmiddle-income countries is unlikely to be on track and achieved by 2030. The monitoring andevaluation mechanism for UHC progress is a crucial function to hold governments accountable andguide countries along their paths towards UHC. This paper outlines key monitoring and evaluationtools that Thailand uses to track UHC progress; compares the strengths and limitations of each tool;and discusses monitoring gaps and enabling factors related to development of the tools. Thailanduses several data sources to monitor three UHC dimensions: population coverage; service coverage;and financial risk protection. The four key sources are: (‎i)‎ national surveys; (‎ii)‎ health facility andadministrative data; (‎iii)‎ specific disease registries; and (‎iv)‎ research. Each source provides differentadvantages and is used concurrently to complement the others. Despite initially being developedto track progress for national health priorities, these tools are able to monitor most of the globalUHC indicators. Key enabling factors of Thai monitoring systems are a supportive infrastructure andinformation system; a policy requirement for routine patient data records; ownership and commitmentof the key responsible organizations; multisectoral collaboration; and sustainable in-country capacities.The areas for improvement are monitoring in the non-Thai population; tracking access to essentialmedicines; and maximizing the use of collected data. Lessons learnt from the Thai experience couldbe useful for other low- and middle-income countries in developing their UHC monitoring platforms.