Deepening Local Government Unit Engagement towards Healthier Communities:

Will the poor have better health prospects under the Duterte administration?

Ernesto D. GarilaoPresident

Zuellig Family Foundation

BringingHealthtoJuanandJuanaUniversalHealthCareintheCommunities

May18,2017AsianDevelopmentBankHeadquarters

The Philippine Health Agenda 2016 - 2022

GOALS

Guarantee1:AllLifeStages&TripleBurdenofDiseaseGuarantee2:ServiceDeliveryNetworkGuarantee3:UniversalHealthInsurance

Source:DepartmentofHealth,AdministrativeOrderNo.2016-0038

Maternal and Child Health Indicators by Wealth Quintile, NDHS 2013

Source:PhilippineNDHS,2013

90.7

97.3 9799.5 99

33.9

55.8

70

82.1

91.8

49.7

75.7

85.5

93.496.9

52

33

22 23

17

36

2217

21

13

05101520253035404550556065707580859095100105

Quintile1(Poorest) Quintile2 Quintile3 Quintile4 Quintile5(Wealthiest)

%SkilledBirthAttendants %FacilityBirthDeliveries %Postnatalcheck-up Under-fivemortalityRate InfantMortality

DevolutionofthePhilippinehealthcaresystem(1991)

FragmentationofHealthServices

PoorLocalLeadership

Challenges of Devolution

PreventiveCare CurativeCare

+

PoorHealthOutcomes

Challenges of the Devolution

Sec. 16 of RA 7160 (Local Government Code of 1991“Within their respective territorial jurisdictions, local government units shall ensure and support,

among other things, the preservation and enrichment of culture, promote health and safety, enhance the right of the people to a balanced ecology…”

Philippine Health System Landscape (1991-2010)Philippine Health System Landscape (1991-2010)

Surviving Childbirth in Asia

Maternal Mortality Ratio (per 100,000 live births)*

Pre-PHC PHC Adoption Devolution HSRA Fourmula1 KP& Expansion

*availabledatapoints:1990,1995,2000,2005and2013Source:TheWorldBank(2015).Maternalmortalityratio(modeledestimate,per100,000livebirths)

Maternal Mortality Ratio (per 100,000 livebirths)*

Responsibilities of LGUs (Based on Section 17 of LGC)

Source:UnionofLocalAuthoritiesofthePhilippines(2016).AddressingHealthDevolutionGapsandMainstreamingthePhilippineHealth AgendatoLocalGovernments

Spurce:SDHWeights:WisconsinUniv.,InstituteofPublicHealth2010

Social Determinants of Health

ZFFHealthChangeModel

LEADERSHIP AND GOVERNANCE

IMPROVED HEALTH SYSTEM

TARGETED AND PRO-POOR HEALTH PROGRAMS

BETTER HEALTH OUTCOMES FOR THE POOR

BridgingLeadershipasaProcesstoAddressHealthInequities

The ZFF Response to Devolution: Health Change Model and Bridging Leadership Framework

OBJECTIVESTrainlocalhealthleaderstoestablishequitable&effectivelocalhealthsystemsandtoberesponsiveandaccountableforbetterhealthoutcomesforthepoor.

CRITERIA• Leaderscommittedtochange• Highhealthburden• HealthSystemDeliverables

Health Leaders for the Poor training• Four-module training every 6 months• Practicum in-between modules• Coaching and monitoring during practicum• Continuous coaching and monitoring after modules

Prototyping LGUs(as of 2015)

PoorARMMGIDA/MSD

381618

Total 72

Prototyping the ZFF Health Change Model

Source:WHO’sSixBuildingBlocksofHealth,asmodified

Intervention in Health Systems Transformation: Municipal Building Block Roadmap

Results of Owning the Health Issues

Maternal Health Indicators of 72 ZFF Prototyping LGUs

33%

43%

57%

69%

56%

65% 73%

79%

74

63

48

29

0

10

20

30

40

50

60

70

80

90

Baseline Afteryear1 Afteryear2 Afteryear3

FBD SBA MaternalDeaths

FBD

SBA

MaternalDeaths

Sources:FHSISdata,CHPPClosingReport

DELAY1Delayindecidingtoseekmedicalcare

DELAY2Delayinidentifyingandreachingappropriate

healthfacility

DELAY3Delayinreceivingappropriateandadequatecareinthefacility

SocialProtectionProgram(Incentives)

BehaviorChangeCommunication

4-in-1PhilHealthaccreditationandIncreasecoverage

Providetransportation

Haveaplaceforamotherand/orherrelativestostaybeforeand/orafter

delivery FixreferralsystembetweenRHUs&Hospitals

EnsureRHUshave-adequatemedicalsupplies-24/7operations-BEmONCcertification-adequateskilledhealthprofessionals

MobilizeCommunityHealthTeams

Trackpregnanciesandinitiateprenatalcare

EnsureReferralFacilitiesareCEmONC- Capableofhighrisk

emergencysurgicalinterventions

- HaveBloodmanagementSystems

Owning the Challenge and Making a Response

> 5, 39%

2 - 4, 42%

Primi,20%

< 19,11%

20 - 34, 53%

> 35, 36%

byno.ofpregnancies**

byage***

**basedon200deaths

***basedon305deaths

ANo.ofreportingareas:384 localgovernmentunitsfromprototype&partnershipprogramswithUNFPA,UNICEF&USAID;partial-unofficialdata

Toomany!

Tooyoungortooold!

ü Family Planningü Adolescent Sexual

and Reproductive Health

Maternal Deaths in ZFF areasA, 2014-2015

Provincial Leadership and Governance Program

Pangasinan Consolidated Hospital Scorecard (Baseline, 2015)

Pangasinan Consolidated Hospital Scorecard (After the program, 2016)

Mayors,MHOs,RuralHealthUnitsPREVENTIVECARE

PHTLs&DMOsHospitals

CURATIVECARE

GOVERNORProvincialHealthSystem

ü Accountabilityforhealthü CurrentRealityü ExecutiveSessionwithDOHRegionalDirectorü DeepDiveActivityü Visioningü CoreGroupFormation

ü QualityServicesü UpgradeProvincialhospitaltolevel2,

Districthospitalstolevel1ü Nobalancebillingü Pointofcareenrollment

ü Sharingthevisionü Engagingmayorsü Provincialbudgetcounterpartü QualityandAccessibleServicesü AccreditedRHUs

ZFF Health Change Model and PHADOHCENTRAL

Philippine Health Agenda (“All for Health towards Health for All”)

Health Change Model

HLP/2MLGP/2BHLMP

DOHRegionalDirector

PLGP/1HLMP

HLGP

BLFP

PLGP/2

ZFF Health Change Model in support of thePhilippine Health Agenda

Ongoing efforts to improve the health system for better health outcomes for the poor

1. Directthereformstomakesystemspro-poor

2. Makelocalchiefexecutivesandhealthleaderscommittedtomakethepoortheirpriorityinimprovinghealthoutcomes

Interventions to deepen local government accountability for pro-poor health system

1. Monitor the progress of the 12 PHA legacies2. Make the poor active agents in health system reforms3. Improve quality of DOH’s engagement with local chief

executives4. Have a system of incentives and sanctions for mayors5. Give poor municipalities with committed mayors more

resources6. Fix the linkage between preventive and curative care

Mayors,MHOs,RuralHealthUnitsPREVENTIVECARE

PHTLs&DMOsHospitals

CURATIVECARE

GOVERNORProvincialHealthSystem

ü Accountabilityforhealthü CurrentRealityü ExecutiveSessionwithDOHRegionalDirectorü DeepDiveActivityü Visioningü CoreGroupFormation

ü QualityServicesü UpgradeProvincialhospitaltolevel2,

Districthospitalstolevel1ü Nobalancebillingü Pointofcareenrollment

ü Sharingthevisionü Engagingmayorsü Provincialbudgetcounterpartü QualityandAccessibleServicesü AccreditedRHUs

ZFF Health Change Model and PHA

Philippine Health Agenda (“All for Health towards Health for All”)

Health Change Model

HLP/2MLGP/2BHLMP

PLGP/1HLMP

PLGP/2

Linking preventive care and curative care

Our collective challenge is to make the

Philippine Health Agenda work

so that by 2022, health inequities are reduced

and the poor truly have better health indicators.

Deepening Local Government Unit Engagement towards Healthier Communities:

Will the poor have better health prospects under the Duterte administration?

Ernesto D. GarilaoPresident

Zuellig Family Foundation

BringingHealthtoJuanandJuanaUniversalHealthCareintheCommunities

May18,2017AsianDevelopmentBankHeadquarters