How Many People Experience Unsafe Medical Care in Thailand, and How Much Does It Cost under Universal Coverage Scheme?

Adverse events and medical harm comprise major health concerns for people all over the world, including Thailand. The prevalence and burden of medical harm must always be monitored, and a voluntary database should not be used to represent national value. The purpose of this study is to estimate the national prevalence and economic impact of medical harm in Thailand using routine administrative data from the inpatient department electronic claim database under the Universal Coverage scheme from 2016 to 2020. Our findings show that there are approximately 400,000 visits with potentially unsafe medical care per year (or 7% of all inpatient visits under the Universal Coverage scheme). The annual cost of medical harm is estimated to be approximately USD 278 million (approximately THB 9.6 billion), with an average of 3.5 million bed-days per year. This evidence can be used to raise safety awareness and support medical harm prevention policies. Future work should focus on improving medical harm surveillance using better data quality and more comprehensive data on medical harm.

COVID-19 Vaccine Hesitancy Among Health Care Workers in Thailand: The Comparative Results of Two Cross-Sectional Online Surveys Before and After Vaccine Availability.

Introduction: The arrival of COVID-19 vaccines in Thailand has supported the fight against the COVID-19 pandemic. This study examined COVID-19 vaccine acceptance among health care workers (HCWs) in Thailand before and after vaccines' availability and investigated factors (both enablers and barriers) affecting their decisions. Methods: Two online self-administered questionnaires were distributed to HCWs in two time-periods: (1) the pre-vaccine arrival period (prior to COVID-19 vaccines' arrival in Thailand, January 28 to February 16, 2021); and (2) the post-vaccine arrival period (April 21 to May 9, 2021). Descriptive analyses and multinomial logistic regression were conducted to examine factors associated with vaccine hesitancy. Results: There were 55,068 respondents in the pre-vaccine arrival period and 27,319 respondents in the post-vaccine arrival period. In the pre-vaccine arrival period, 55.0% of respondents were willing to accept the vaccines, 35.4% were uncertain, and 9.6% declined. In the post-vaccine arrival period, ~16% already received two doses of either the Sinovac or AstraZeneca vaccine, and 43% were administered one dose. Approximately 12% of those who had received the first dose were uncertain or not willing to accept the second dose. Demographic and socio-demographic factors of participants, including their sex, place of residence, and whether they were frontline COVID-19 workers, were found to be the significant factors explaining vaccination hesitancy. Moreover, when comparing the pre-vaccine arrival and post-vaccine arrival periods, it was found that older HCWs were more likely to decline a COVID-19 vaccine in the pre-vaccine arrival period; on the other hand, older HCWs were less likely to decline or be uncertain to receive a COVID-19 vaccine in the post-vaccine arrival period. Conclusion: Information on HCWs' acceptance of COVID-19 vaccines, including who is more likely to accept the vaccines, could assist in planning vaccine allocation to both HCWs and the general public, who often believe HCWs' recommendations. This study's findings set out how policies can be addressed to reduce vaccine hesitancy. This study also highlights HCWs' characteristics (including gender, work region, occupation, and history of receiving influenza vaccination) and the reasons they cited for their vaccine acceptance or hesitance.

Monitoring and Evaluation of National Vaccination Implementation: A Scoping Review of How Frameworks and Indicators Are Used in the Public Health Literature.

An effective Monitoring and Evaluation (M&E) framework helps vaccination programme managers determine progress and effectiveness for agreed indicators against clear benchmarks and targets. We aimed to identify the literature on M&E frameworks and indicators used in national vaccination programmes and synthesise approaches and lessons to inform development of future frameworks. We conducted a scoping review using Arksey and O'Malley's six-stage framework to identify and synthesise sources on monitoring or evaluation of national vaccination implementation that described a framework or indicators. The findings were summarised thematically. We included 43 eligible sources of 4291 screened. Most (95%) were in English and discussed high-income (51%) or middle-income (30%) settings, with 13 in Europe (30%), 10 in Asia-Pacific (23%), nine in Africa (21%), and eight in the Americas (19%), respectively, while three crossed regions. Only five (12%) specified the use of an M&E framework. Most (32/43; 74%) explicitly or implicitly included vaccine coverage indicators, followed by 12 including operational (28%), five including clinical (12%), and two including cost indicators (5%). The use of M&E frameworks was seldom explicit or clearly defined in our sources, with indicators rarely fully defined or benchmarked against targets. Sources focused on ways to improve vaccination programmes without explicitly considering ways to improve assessment. Literature on M&E framework and indicator use in national vaccination programmes is limited and focused on routine childhood vaccination. Therefore, documentation of more experiences and lessons is needed to better inform vaccination M&E beyond childhood.