Provincial Investment Plan for Health

FOURMula One for Health

Province of South Cotabato

2

Table of Contents Page Number List of Tables 3 List of Figures 3 Acronyms 4-5 Executive Summary 6-9

I. Introduction 10 II. Demographic and Socio-Economic Profile 11 III. Health Situation, Problems and Gaps 14

A. General Health Status B. Service Delivery

C. Governance D. Financing E. Regulation

IV. Vision, Mission, Goals, and Objectives 40 IPHO Health Vision and Mission Overall Goal Objectives 2006 - 2010

V. Strategies and Interventions 43 VI. Logical Framework for Monitoring and Evaluation 53 VII. PIPH Costs 61 VIII. Program Management 68

Annexes: 1 - Government and Private Hospitals in the Province

2 - Leading Causes of Discharges in Government hospitals, 2004 3 - Leading Causes of Deaths in government hospitals, 2004

4 - Functions of the Members of the Expanded Provincial Health Board 5 - Table of Cost Assumptions

6 - Detailed List and Costing of Civil Works 7 - Detailed List and Costing of Equipment 8 - Detailed List and Costing of Training

9 - Detailed List and Costing of Technical Assistance Activities 10 - Projected PhilHealth Enrollment and Premium Contributions, 2006-2010

Deleted: ,

3

List of Tables

Table 1. Income Classification South Cotabato Province and Municipalities, as of May 2005 Table 2. Projected Provincial and Municipal Population Based on 2000 NSO Data, South Cotabato Table 3. Certification and Accreditation Status of RHUs, as of April 2005 Table 4. Ratio of Provincial Government–Operated Hospitals to Population Table 5. Number of RHUs, BHS, and Public Health Personnel in South Cotabato Municipalities, 2005 Table 6. Location of Deliveries, South Cotabato, 2004 and 2005. Table 7. Hospital Deliveries, 2004 Table 8. Delivery Attendants, South Cotabato, 2004 and 2005. Table 9: Annual Executive Budget by Sector, Province of South Cotabato Table 10: Percentage of the Hospital Budget out of the total Provincial Budget to Social Services Table 11: Hospital and Technical Services Budget vs. Expenditures, 2001-2004 Table 12: Health Budget vs. Total Budget of the Municipalities in South Cotabato Table 13: Statement of Income/Receipts in General Fund in the Different Hospitals of South Cotabato Table 14. Number of Indigents enrolled under the Sponsored Program of PhilHealth Table 15. Logical Framework for Monitoring and Evaluation the PIPH Table 16. Costs by Component per Year Table 17. Costs by Component by Source of Financing Table 18. Costs by Type of Expenditure by Year Table 19. Costs by Type of Expenditure by Source of Financing

List of Figures

Figure 1. South Cotabato LAHDZ Figure 2. Management Structure of LAHDZ Board Figure 3. Management Structure of Expanded Provincial Health Board Figure 4. Proposed Framework for the Provincial Health Resource Development Information Center Figure 5. Proposed organization of the Program Management Support Unit

4

Acronyms

BHS Barangay Health Station BHW Barangay Health Worker BFAD Bureau of Food and Drugs CARI Control of Acute Respiratory Infection CBMIS Community-Based Monitoring and Information System CDD Control of Diarrheal Diseases CHD Community Health Development CPR Certificate of Product Registration DOH Department of Health DUR Drug Use Review EC European Commission EPI Expanded Program on Immunization FHSIS Field Health Services and Information System HDMSU Health Development and Management Services Unit HHRDU Health Human Resource Development Unit HMIS Health Management Information System HOMIS Hospital Operations Management Information System HSRA Health Sector Reform Agenda ICHSP Integrated Community Health Services Project ICHSP- AA Integrated Community Health Services Project- Australian Aid IEC Information, Education Campaign IHPS Integrated Health Planning System ILHS Inter Local Health System IMR Infant Mortality Rate IMS Integrated Management System IMS-DOH Integrated Management System of the Department of Health IPHO Integrated Provincial Health Office IRA Internal Revenue Allotment LAHDZ Local Area Health Development Zone GU Local Government Unit LHA Local Health Account LMAMFES Lay Missionary Association of Mother Francisca del Espiritu

Santo LPHCC Lamian Primary Health Care Center LSMH Lake Sebu Municipal Hospital MCH Maternal Child Health MCP Maternity Care Package MHO Municipal Health Officer MMR Maternal Mortality Date MOA Memorandum of Agreement MOOE Maintenance and other Operating Expenses NDH Norala District Hospital NGO Non-Government Organization

5

NTP-DOTS National Tuberculosis Program- Directly Observe Treatment Short Course

OPT Operation Timbang PAS Performance Appraisal System PCCHC Provincial Coordinating Council for Health Concerns PDF Provincial Drug Formula PFM Public Finance Mission PHN Public Health Nurse PIR Program Implementation Review PMH Polomolok Municipal Hospital RHSIS Regional Health Services Information System RHU Rural Health Unit RISMH Roel I. Senador Memorial Hospital SCPH South Cotabato Provincial Hospital SOCOTECO I South Cotabato Electric Cooperative I SRHUS Simplified Rural Health Unit Information System STD Sexually Transmitted Disease SWOT Strength, Weaknesses, Opportunities & Threat UBM Unit Based Management

6

EXECUTIVE SUMMARY

With the implementation of the Local Government Code in 1991 that devolved health services from the national government to the local government units, support for health from the national government mostly came in the form of technical support while funding depended on the LGUs. With this, South Cotabato’s Integrated Provincial Health Office (IPHO) has been initiating innovations and interventions to be able to fulfill its mandate of giving quality health service to its clientele, and these have brought positive results to the health systems in the entire province through the years. Many of these were also in partnership with the community and also through technical and funding support from donor agencies including the AusAID, USAID, JICA, EU, World Bank, and others. This South Cotabato Province-wide Investment Plan for Health (PIPH) 2006-2010 updates the province’s health plan in the context of FOURmula ONE for Health, the DOH’s framework for implementing health reforms that is implemented under a sector-wide approach. South Cotabato is one of the first 16 FOURmula One for Health convergence sites that is being assisted by the DOH. The plan reiterates the province’s goal of contributing to the improvement of health status by ensuring access to basic health services that is efficiently and effectively delivered to its populations, especially the mothers and children, the socio-economically marginalized, and other vulnerable groups. It also states specific goals that are anchored on the Millennium Development Goals and the National Objectives for Health. An examination of the province’s health situation shows low levels but increasing levels of maternal mortality and infant mortality. Incidence of TB, dengue, and malaria are likewise increasing; and lifestyle-related diseases remain as the leading causes of death. The plan analyzes the problems gaps in terms of service delivery, governance, financing, and regulation that contribute to these poor health outcomes. In view of these problems and gaps, the systematic implementation of the four reform packages of FOURmula ONE for Health will be the main strategy in health investments for 2006-2010. In general, the thrust is empowering the people of South Cotabato for health and well-being. It therefore highlights strengthening the primary health care network and health information systems. These are complemented with interventions to strengthen governance, regulations, and equitable financing systems. To summarize, the following are the interventions lined up for each component: Component 1. SERVICE DELIVERY Subcomponents : 1.1 Capacity Building for priority programs :

• Disease-free initiatives on leprosy and filariasis • Reduction and control of malaria, dengue, schistosomiasis, rabies • Intensification of TB control • Healthy lifestyle initiatives

7

• Reproductive Health/Women’s Health/Safe Motherhood M/Family Planning

• Management of Common Childhood Illnesses • Addressing emerging health concerns: HIV/AIDS, Bird’s flu, SARS,

Meningococcemia, man-made calamities and terrorist activities

1.1.1 Needs Assessment for Service Delivery 1.1.2 Upgrading of facilities to meet health service delivery requirements, including standards for Sentrong Sigla certification; PhilHealth-accreditation for Maternity Care, TB- DOTS, NSV, Out-Patient Benefits Packages (OPB); and Designation for CEmOCs and BEmOCs 1.1.3 Improvement of primary health care service network 1.1.4 Strengthening the Capability of the SCPH as a Core Referral Hospital and Establishment of a Medical Rehabilitation Unit 1.1.5 Establishment of and Capacity-Building for a Provincial Medical Alert Unit 1.1.6 Definition of Core Competencies, Training Needs Assessment, and Formulation of Training Plan 1.1.7 mplementation of the Training Plan 1.1.8 Conduct of Operations for Public Health Concerns

1.2 Strengthening of Technical Support Systems for Delivery of Services Component 2. GOVERNANCE Subcomponents :

2.1 Facility Rationalization and Mapping and Strengthening of Health Referral System 2.2 Human Resource Planning and Strengthening of QA/QI Programs among All Facilities in a LAHDZ

2.3 Support for Contraceptive Self-Reliance Plan in All Municipalities 2.4 Enhancement of Public Finance Management 2.5 Establishment of and Capacity-Building for a Provincial Health Resource

Development and Information Center (PHRDIC) 2.6 Segmentation of the Market 2.7 Updating of Local Health Accounts and Advocacy of Results 2.8 Capacity-Building for Institutionalization of Developed Systems, including M&E and Advocacy of Results

Component 3. FINANCING Subcomponents :

3.1 Allocation of Funds for PhilHealth Sponsored Program in the Yearly Budget 3.2 Establishment of Enrolment Centers for Informal Sector 3.3 Inclusion of User Fees for Health Services in the Local Tax Revenue Code in all LGUs 3.4 Implementation of Revenue Retention in Health Facilities 3.5 Capacity Development of Health Finance Implementers

8

Component 4. REGULATION Subcomponents : 4.1 Engage Support of BFAD in the Development of a Quality Assurance Program on Procurement, Sampling, Proper Storage, and Awareness 4.2 Engage support of Task Force Kalusugan in the Compliance of Establishments to Quality Seals for Products and Services and Other Health Regulations 4.3 Expansion and sustenance of the Drug Revolving Fund 4.4 Compliance and Sustenance of Health Facilities to Sentrong Sigla and PhilHealth Standards

This plan is to be conducted complementarily with the Development Alternative Framework: The South Cotabato Convergence Model (Project DAF), the Provincial Government’s wholistic framework in the delivery of basic social services involving inter-linkage of the government with the community. The implementation and financing of interventions are to be done in collaboration with partners in the Department of Health, the private sector, community-based groups, and international organizations. Implementation of this plan will cost about P324 million over the five years. More than half of this will be spent for service delivery component, while more than 20 percent is comprised by the financing component largely due to the PhilHealth premium contributions. The combined spending of the municipal LGUs comprise almost half of the total cost for their expenses on PhilHealth premiums and maintenance and operating costs. More than 70 percent of the total cost are for maintenance and operating expenses (MOOE) that is comprised of PhilHealth premium payments, technical assistance, training, and maintenance and supplies for facilities. The province will also be a recipient of a grant from the European Commission for the implementation of this PIPH. This grant will be received in the form of budget support, as the Province passed the financial management standards set by the EC to qualify for budget support rather than a trust fund. The Governor, Vice-Governor, Local Chief Executives, Sangguniang Panlalawigan (SP), and provincial department heads have been oriented on FOURmula ONE for Health, the SDAH, and crafting of this PIPH. Every party was supportive of the plans and the provincial government is now currently crafting the roles and responsibilities of the LGUs, including financial obligations, for further discussion with the LGUs.

9

Investment Cost Summary by Source by CO/MOOE, in thousand pesos

BY SOURCE

Capital Outlay

MOOE TOTAL %

PLGU 12,055 12,055 4%MLGU 1,187 149,953 151,141 47%DOH 60,707 60,707 21%EC 85,254 5,530 90,784 26%MSH-LEAD 1,500 1,500 0%ECCD 4,550 3,100 7,650 2%PhilHealth 15 15 0%TOTAL 91,006 232,846 323,852 100%

27% 73% 100% Investment Cost by Component by Year, in thousand pesos Component by Year 2006 2007 2008 2009 2010 TOTAL % Service Delivery 17,343 45,706 54,858 36,191 20,599 174,699 54%Health Financing 5,847 12,896 20,654 28,545 36,574 104,517 33%Governance 6,060 10,245 10,851 5,230 1,404 33,791 11%Regulatory 200 376 5,120 120 - 5,815 2%Prog Mgt Support 3,430 400 400 400 400 5,030 2%TOTAL 32,880 69,624 91,883 70,486 58,978 323,852 100%

10

I. INTRODUCTION

The implementation of the Local Government Code in 1991 paved the way for the devolution of the health services from the national government to the local government units (LGUs). Receiving mostly technical support from the national government, the IPHO has to depend on the support from the LGUs concerned and other funding sources. Despite this situation, the health office still pushes through with its mandate of giving quality health services to its clienteles. Innovations and initiatives by the IPHO have significantly improved the delivery of health services through the years. Many of these were done in partnership with the community and through the technical and financial support coming from funding sources such as the AusAID, USAID, JICA, EU, World Bank and others. In 1994, the Local Performance Program (LPP) funded by USAID has provided support to the province. The project assisted the local government in enhancing its capacity in managing local health programs. The Integrated Community Health Services Project ICHSP –AusAID assistance came to the picture in 1998. During the time of ICHSP, various health system reforms were conceptualized, developed and implemented under the framework of the Inter Local Health System (ILHS). Along this line, the Health Sector Reform Agenda (HSRA) of the Department of Health was launched. The HSRA goals served as the springboard of the Provincial Health Office in initiating reform strategies and laying out the plan. The framework became the basis in the succeeding planning sessions conducted by all public health implementing units of the province.

In 2005, South Cotabato was chosen as one of the preparation sites of the DOH FOURMula One for Health Project with support from the European Commission. This was the result of exploratory talks with foreign funding agencies and rapid appraisal of the province that included reviewing the financial capabilites of the local government units (LGUs) of the province. It is the understanding of the province that foreign support, particularly from EC, will be for enhancement of the Primary Health Care Program and improvement of coordination links with the communities and partner NGOs.

On August 23-24, 2005, an orientation meeting was conducted by the DOH and EC Team on Fourmula One for Health and the Sector-Wide Development Approach for Health (SDAH). After this orientation, several workshops were conducted to update the 2005-2009 plan with this Province-Wide Investment Plan for Health (PIPH). In conjunction, an Orientation for Provincial Governor and Vice Governor, Local Chief Executives, SP Members and Provincial Department Heads was conducted. The orientation was relevant as it provided first hand information to local stakeholders on the benefits of the project. The LCEs were supportive of the plans and the provincial government is now currently crafting the roles and responsibilities of the LGUs, including financial obligations, for further discussion with the LGUs. Much work, discussions and deliberations were done, and with the unwavering support provided by the FOURmula ONE team, this PIPH has been successfully drafted.

11

II. DEMOGRAPHIC AND SOCIO-ECONOMIC PROFILE1 Geography South Cotabato is a landlocked province located at the southern part of the island of Mindanao, Philippines. It is bounded southeast by Gen. Santos City and the Province of Sarangani and northwest by the Province of Sultan Kudarat. It can be reached by sea and by air through the modern seaport and International Airport of General Santos City. Topography The province’s topography has many distinct features. It has a series of relatively high mountains, upland, lakes and some volcanoes. It is host to several watersheds, which has a combined area of approximately 193,941 hectares, which flows to several large rivers. Rainfall is evenly distributed throughout the year with air humidity that follows the rainfall pattern. The province now has a total land area of about 3,706 sq. km., a reduced size after the creation of Sarangani Province. The biggest municipality is Lake Sebu with a land area of approximately 891 square kilometers. This is followed by T’boli with an area of 809 sq. km., then by Polomolok with 340 sq. km. The smallest is Tantangan with a land area of 126 sq. km. Agriculture South Cotabato is considered the ‘bread basket’ of Southern Mindanao owing to its fertile agricultural lands that yield rich harvests of various crops both for local and foreign consumption. Corn is the predominant crop followed by rice, coconut and pineapple. The Province boasts a surplus of rice and corn. Other commercial crops include banana, mango, coffee, papaya, guava and cassava. It exports livestock and poultry meat to other parts of Mindanao and the big cities of Manila and Cebu. Political Subdivision, Administrative Jurisdiction, and Income Class The province comprises ten municipalities and one city, and a total of 199 barangays. Koronadal City is the province capital and seat of the provincial government, as well as the regional center of South Central Mindanao Region (Region XII). South Cotabato is under the administrative jurisdiction of Region XII and has two congressional districts. The following table identifies the income classification of the province and each of the city and municipalities. 1the basis of much of this information is the Socio-Economic Profile, Province of South Cotabato.PPDO,1996

12

Table 1. Income Classification South Cotabato Province and Municipalities, as of May 2005 Municipality Previous Current

Banga Fourth Third

Koronadal First First

Lake Sebu Fourth Third

Norala Fourth Fourth

Polomolok Second First

Sto. Niño Fifth Fourth

Surallah Second First

Tampakan Fourth Fourth

Tantangan Fourth Fourth

T'boli Fourth Second

Tupi Fourth Third

Province First First

Population The projected population of South Cotabato based on the 2000 census is 773,900 in 2005 (Table 2), resulting to a population density of 186/sq.km. The average household size is 4.88. The most populous municipality is Koronadal (also known as Marbel), which is the capital of South Cotabato, and the least populated municipality is Tantangan.

Table 2. Projected 2005 Provincial and Municipal Population Based on 2000 NSO Data, South Cotabato

Municipality Projected 2005 Population 1. Lake Sebu 60,661 2. Norala 45,650 3. Sto. Nino 40,590 4. Banga 77,455 5. Surallah 74,180 6. T’boli 68,001 7. Koronadal 149,896 8. Tampakan 36,986 9. Tantangan 36,566 10. Polomolok 124,040 11. Tupi 59,875 Provincial TOTAL 773,900

With a population growth rate of 2.38, the projected population of South Cotabato double to 1,381,000 by year 2030, which will result to a population density of 372 per square kilometer. A slowing down of the population growth rate, however, is observed and this may be attributed to the improving Responsible Parenthood Program of the local government units. From 1997 to 2004, the province

Formatted: Centered

13

reflected a decrease in rate of live births (LB) from 21 live births per 1000 population to 19.7 live births per 1000 population. In 1995 when the average provincial population growth rate was 2.85, the population growth rates of most of the municipalities was around this figure, except for T’boli and Lake Sebu which had significantly higher population growth rates of 10.86 and 6.75, respectively. The high rate of live births in these municipalities could be attributed to their customs and traditions of having large families. Moreover, these municipalities are far from the urban centers and the topogpraphy is mountainous, making implementation of the province’s family planning program difficult. Ethnicity and religion Before the turn of the 20th century, inhabitants of South Cotabato were predominantly Muslims, Bilaans, Manobos, Tagabilis and other ethnic groups from the same Malayan stock with similar physical structure and language. The first batch of Christian settlers came to the province in 1914. In the early 1920s, the National Migration Policy of the National Government precipitated influx of migrant settlers both from Luzon and Visayas. They settled in the open and fertile plains of the province and continuously developed it to its present state. There are 21 languages spoken in the province. Hiligaynon and Cebuano dominate the dialect spoken, accounting to 52 percent and 40 percent, respectively.

The most dominant religion in the province is Roman Catholicism, comprising 73 percent of the population. Islam accounts to at least 4 percent. Family Income In 2000, the average annual family income was P125,798 and the average annual family expenditure reached a total of P93,849. The peso purchasing power as of June 2005 is P0.80. Extent of Marginalization of Families The province’s poverty incidence of families stands at 37.3 percent. The annual per capita poverty threshold for urban areas is P12,803 while it is P11,659 for the rural areas.

Poverty incidence is more apparent in the municipalities of Lake Sebu and T’boli where majority of the population are indigenous peoples. These are also the municipalities where the illiteracy rates are relatively high at 64 percent and 69 percent, respectively. The municipalities of Lake Sebu, T’boli, Tantangan and Tampakan, on the other hand, get limited health services due to inaccessibility and non-availability of secondary level of care.

14

III. HEALTH SITUATION, PROBLEMS and GAPS A. GENERAL HEALTH STATUS Leading causes of morbidity and mortality Acute respiratory infection is still the leading cause of morbidity for all ages in the province. It reaches a total of 490 cases while cancer in all forms remains second, with a total of 314 cases. Other diseases, such as diarrhea, influenza, acute bronchitis and broncholitis, hypertensive and glomerular & renal diseases were also included in the top ten leading causes of morbidity. The province which is envisioned to become TB DOTS accredited still has to remedy the increasing number of TB cases, reaching to 1,488 cases in 2004. TB remains the 8th leading cause of morbidity and the 6th leading cause of mortality. Lifestyle related diseases, such as cardiovascular diseases, cancer in all forms and diabetes remain as the leading cause of death. Dengue and Malaria cases likewise drastically increased their number as compared to the past five years. Maternal Mortality Maternal deaths drastically increased in 2004. Records show that there were a total of 10 maternal deaths reported. For the past 5 years, maternal death had reached an average of 4.8 deaths. Most maternal deaths were due to post partum hemorrhage, uterine atony and ruptured uterus. This problem can be attributed to the fact that most women prefer to deliver birth at home rather than in the hospital. Infant Mortality There were a total of 104 infant deaths or 6.96/1000 live birth reported. Infant deaths were caused mostly by Asphyxia, 97, Tetanus Neonatorum, 40; Septicemia sepsis, 27; prematurity, 14; pneumonia, 13; and other causes, 11. B. SERVICE DELIVERY Service Delivery Network The province has a total of five government hospitals and 12 private hospitals. Four of the government hospitals are 10-bed capacity and caters to primary health care while the South Cotabato Provincial Hospital (SCPH) is a 100-bed capacity hospital and is the end-referral hospital.

A complete list of government and private hospitals in the province are in Annex 1.

15

All ten municipalities in the province have their own Rural Health Units. Koronadal City, which is a component City of the province likewise has its own City Health Office.

The province is divided into five inter-local health zones, referred to as the Local Area Health Development Zones or LAHDZ (Figure 1). The LAHDZ follows a two-way referral system that defines what services should be available at what level. The Comprehensive Two Way Referral System requires that the BHS and the RHUs shall offerprimary health care services at the community. Although the Municipal Hospitals and District Hospitals offer primary level of care, they also provide simple curative medical care. The SCPH which represents tertiary level of care provides curative and rehabilitative care.

The SCPH, Norala District Hospital, Lake Sebu Municipal hospital, and Polomolok municipal hospital serve as the core referral hospitals in four of the five LAHDZ. The remaining LAHDZ has three private hospitals as core referral hospitals. The SCPH in Koronadal serves as the end-referral hospital. Lake Sebu is the farthest municipality from Koronadal at 47 kilometers. Figure 1. South Cotabato LAHDZ LAHDZ Core Referral Hospital Areas Covered LAHDZ I Lake Sebu Municipal

Hospital Lake Sebu

LAHDZ II Norala District Hospital Norala and Sto. Nino LAHDZ III 3 Private Hospitals (one for

each of the 3 municipalities) Banga, T’boli and Surallah

LAHDZ IV South Cotabato Provincial Hospital

Tampakan, Koronadal and Tantangan

LAHDZ V Polomolok Municipal Hospital

Tupi and Polomolok

DOH Licensing, Sentrong Sigla Certification, and PhilHealth Accreditation At present, the SCPH is licensed by the DOH to operate as a Tertiary hospital, but is accredited by PhilHealth as a secondary hospital. It is a 100 - bed capacity hospital but operates in a 150-bed capacity. The three other government core referral hospitals are licensed to operate as primary hospitala by the PhilHealth and operate on a 10 - bed capacity. All four hospitals need improvement and upgrading.

Of the 10 Rural Health Units, seven are already Sentrong Sigla-certified. The RHUs of the municipalities of Tampakan, Banga, Norala, Surallah, Tupi, Sto Nino, T’boli are Level 1 Phase 2, while those of Koronadal City, Tantangan, Lake Sebu, and Polomolok are Level 1 Phase 1. Sentrong Sigla is the quality assurance/certification program of DOH. To become a certified Sentrong Sigla Health Center, RHUs must pass the basic standards. These include Integrated Public Health Services, Basic Curative Care Services, Regulatory Services and Facility & Environmental System.

16

All RHUs except Surallah are currently PhilHealth-accredited for the Outpatient Benefit Package. Municipalities with OPB-accredited RHUs are entitled to capitation payments for each indigent family enrolled in PhilHealth.

All RHUs are also undergoing self-assessment for accreditation for the TB-

DOTS and maternity benefit packages of PhilHealth. The package of basic primary and complementary services provided by the

hospitals and RHUs are in Annex 2. Table 3. Certification and Accreditation Status of RHUs, as of April 2006

Licensing and Accreditation

Province/Municipality SSII

TB-DOTS OPB As of 25

April 2006 Maternity Benefit Package

South Cotabato

Banga SSII on going/self assessment Accredited

on going/self assessment

Koronadal x on going/self assessment Accredited

on going/self assessment

Lake Sebu x on going/self assessment Accredited

on going/self assessment

Norala SSII on going/self assessment Accredited

on going/self assessment

Polomolok x on going/self assessment Accredited

on going/self assessment

Sto.Niño SSII on going/self assessment Accredited

on going/self assessment

Surallah SSII on going/self assessment for renewal on process

Tampakan SSII on going/self assessment Accredited

on going/self assessment

Tantangan x on going/self assessment Accredited

on going/self assessment

T'boli SSII on going/self assessment Accredited

on going/self assessment

Tupi SSII on going/self assessment Accredited

on going/self assessment

Personnel There is a total of 227 medical staff that serve as manpower complement of the four government hospitals managed under the provincial government. The SCPH has a total of 40 physicians, consisting of the Provincial Health Officer, the Chief of Hospital, 5 Medical Specialist; 22 Medical Officers and 11 visiting Consultants.

17

Table 4. Ratio of Provincial Government–Operated Hospitals to Population Manpower

Complement2 SCPH NDH PMH LSMH Total Ratio/Population

Physician 40 4 3 3 52 1:14,882 Nurses 92 7 4 4 107 1:6,094 Nursing Attendant

32 6 3 3 44 1:17,588

Dentist 1 1 2 1:64,491 Medical Technologist

13 1 1 1 16 1:48,368

Despite the fast turn-over of nurses, they remain as the biggest work force of

the hospital. There is a total of 92 nurses both permanent and on job order basis. Putting together all nurses in the four hospitals, the ratio to population is 1:6,094.

The ratios of manpower to population conform to the standards except for the nursing attendants.

A different picture is present for the RHUs. Almost all health staff listed in Table 5 are considered grossly below standard in terms of the ratio per population, including doctors and dentists. An exception is the Rural Health Midwives, which has a ratio of 1:3,486. The standard ratio is 1:5,000. The presence of the BHW, somehow, helped ease the lack of manpower complement in the local level. In 2004, there were 1,832 active BHWs in the province. Aside from the support coming from their respective municipalities, these BHWs are also being supported by the provincial government. Table 5. Number of RHUs, BHS, and Public Health Personnel in South Cotabato Municipalities, 2005

RHU BHS Doctor Nurse Dentist Med Tech

Midwife

Sanitary Inspector

Dental Aide BHW

Banga 1 22 2 3 1 2 27 2 1 265 Lake Sebu 1 18 1 2 1 1 16 1 267 Norala 1 14 1 2 1 1 15 1 1 234 Polomolok 1 27 2 2 1 1 22 3 1 236 Sto. Niño 1 9 1 1 1 1 11 1 1 285 Surallah 1 18 2 3 1 1 27 2 1 234 Tampakan 1 13 1 2 1 1 15 1 1 86 Tantangan 1 12 1 2 1 1 8 2 1 96 T'boli 1 24 1 2 1 1 17 1 1 117 Tupi 1 16 1 2 1 2 18 2 1 180 Koronadal City 1 33 4 9 1 4 28 4 1 78 Total 11 206 17 30 11 16 96 20 10 2078 Actual Population Standard Ratio 1:20 1:20 1:15

Utilization of Services

Public Health Programs Service delivery accomplishments for public health programs are as follows for 2004:

2 Contractual, job order, consultants and permanent manpower combined

18

� 16.9 % of pregnant women received quality prenatal care � 19.3% of pregnant women received Quality Postpartum services � 78.3 % Fully immunized mothers � 81.2 Fully Immunized Children � 84% OPT coverage � 63.2% Contraceptive Prevalence Rate � 85% NTP Cure rate � 92% NTP Case Detection Rate

Deliveries Deliveries at home are still the trend in the province at almost 75 percent forboth years 2004 and 2005. Table 6. Location of Deliveries, South Cotabato, 2004 and 2005.

Place of Deliveries 2004 2005 No. % No. % Home 11,360 74.79 11,799 72.17 Govt. Hospital 2,236 14.72 2,239 13.87 Private Hospital 1,102 7.26 1,059 6.48 Others 491 3.23 1,223 7.48 Total 15,189 100.00 16,348 100

Government hospitals in the province remain as the center for child birth for

those who prefer to be taken to hospitals. The South Cotabato Provincial Hospital tops the list with a total admission of 11,070 in 2004 (Table 6). Out of these admissions, 1,281 were normal deliveries. The Norala District Hospital comes second with 1, 893 total admissions with a total of 216 normal deliveries. However, in terms of percentage, Polomolok Municipal Hospitalhas the highest percentage of normal deliveries to total admissions at 17% or a total number of 174. Lake Sebu Municipal Hospital on the other hand, being a primary hospital, has a total of 998 admissions with 12 % or 104 normal deliveries. Table 7. Hospital Deliveries, 2004

SCPH NDH PMH LSMH RISMH Total Number of Admission Annual 2004

11,070 1893 1061 998

Total Number of In-patients Service days

44,523 5683 3336 3071

Total number of normal deliveries

1,281 216 174 104

Equivalent number of in patients service days

3,164 453 140 162

% percent equivalent of total no. of deliveries over total no. of admission

12% 12% 17% 11%

Meanwhile, midwives are the attendants of choice having the highest percentage with 35 percent or a total of 5,257 cases in 2004. Trained hilots come second with 4,570 or 30 percent, while deliveries handled by doctors comes third with 2,852 cases or 18.78%. Although a large percentage of the population seek professional help when it comes to deliveries, there is still a marginalized number

Deleted:

19

which seek the help of untrained hilots. This totals to 2,269 cases or 14.94%, while 164 or 1.08% undergo deliveries from unspecified services. The same trend is observed for 2005. Table 8. Delivery Attendants, South Cotabato, 2004 and 2005.

2004 2005 Deliveries Handled by: No. % No. %

MD 2,852 18.78. 2886 17.65 Nurses 77 0.51 52 .32 Midwives 5,257 34.61 5592 34.21 Trained Hilots 4,570 30.09 4532 27.72 Untrained Hilots 2,269 14.94 2546 15.57 Others 164 1.08 742 4.53 Total 15,189 100.00 16348 100

Leading Causes of Deaths and Discharges

The tables in Annexes 2 and 3 provide that the leading cause of discharge in

the five government hospitals is PUFT while it is various illnesses such as AGE, NSVD, and bronchopneumonia for the other government core referral hospitals. Leading cause of death on the other hand, is pneumonia for SCPH, and sepsis and bronchopneumonia for the other hospitals. Service Delivery Problems and Gaps

1. Low turn out of pregnant women who receive quality prenatal care and postpartum care

This is seen as a primary reason for the increasing maternal death cases. The

accomplishment of quality prenatal care and quality post natal care was only 16.9 percent and 19.3 percent, respectively. However, problems on the low turn-out of program accomplishments were due to the following reasons:

• The low-turn-out of pregnant women who receive pre-natal care was due to the non- availment of prenatal care at the first trimester of their gestation period. Most women visit the health center after the first tri-mester. Some women do not take the prescribed vitamins given to them by the RHUs and pregnant women do not regularly visit the RHUs for pre-natal check –up.

This is seen as a major cause for infant mortality as mothers are not able to avail of tetanus toxoid, vitamins, and regular check-up, among others.

• After delivery, mothers do not visit the Health Centers for follow-up check-up

and availment of family planning methods.

• Assigned midwives in the area are not residents, thus they cannot follow-up their clients for quality pre-natal and post natal care.

2. High percentage of home deliveries compared to hospital deliveries

Most pregnant women still prefer to deliver their babies at home. In 2004, out of the total 15,189 babies delivered, 11,360 or 74.79 percent were delivered at

Formatted: Bullets and Numbering

Comment [LAM1]: Some gaps not mentioned here specifically on need for health facilities upgrading/need for accreditation, etc.

20

home, as compared to only 2,236 or only a total of 21.98 percent-delivered in the hospitals. Although this is the trend, pregnant women still prefer to deliver through the assistance of trained professionals such as doctors, nurses, midwives and trained hilots. However, 16 percent or a total of 2,433 pregnant women seek assistance from untrained hilots and other individuals. These figures indicate that there is still a need for proper education and awareness on the importance of maternal and child care, as well as the package of services that they can avail through the RHUs and the BHS. Local Health Staff need to orient women of reproductive age groups of the importance of maternal health care. IEC should be strengthened.

3. Need for Capability Building of Health Personnel

Health personnel and service providers need to enhance their capability for effective and efficient delivery of health services.

Training, seminars and orientations are needed by the Health Personnel concerned especially with the implementation of programs, new systems and procedures in line with their duties and functions.

4. Unstable Status of Personnel Employment Lack of plantilla positions for health personnel continues to be a problem in the IPHO. Most of the manpower complement is on job order basis. The LGU concerned could not create more positions due to the ceiling in the Personnel Services (PS). The province is already above 45% of its PS. The fast turn-over of positions especially in the Nursing Unit of the hospitals continue. Doctors and other health personnel are presently enrolled in the nursing course. Hence, this leads to inequitable ratio of health personnel to population.

5. Procurement of essential logistics requirement Procurement of essential drugs and medicines and laboratory supplies are insufficient. Criticisms are constantly heard about a government hospital lacking in medicines. Although medicines are not always free their availability should be given priority concern for use of the patients when needed. Delivery of procured essential drugs, medicines and laboratory supplies are sometimes delayed due to the inefficiency of the procurement system. Logistics requirement need to be readied all the time.

6. Low turn-out of program accomplishments The turn-out of program accomplishments are considered low. Concerted efforts are needed to garner high percentage of accomplishments. Recently, the province has launched the Development Alternative Framework (DAF), which initiates wholistic approach of giving basic services to the community participated by different provincial government agencies.

Deleted: ,

21

C. GOVERNANCE The South Cotabato Provincial Government keeps the existing structure and manner of reporting since the onset of devolution in the year 1992. It also adopts the inter-local health zone framework that aims to provide a clear direction and goal which the province and municipalities can direct their attention and effort to. This serves as a vehicle for driving local level actions by the LGUs and communities towards the achievement of the potential of the devolution of health. It likewise provides conceptual framework to guide systems development and other activities of various reforms of the IPHO that can be coordinated and integrated to provide better linkage. The Inter-Local Health Zones are referred to as the Local Area Health Development Zones (LAHDZ) and each is governed by an Area Health Board. In turn, these health boards are governed by an Expanded Provincial Health Board (Figures 2 and 3). The functions of each member are in Annex 4.’ Figure 2. Management Structure of LAHDZ Board

Area Health Board

Rural Health Unit Core Referral Hospital

Community Based NGO’s

Private Medical Sector

Barangay Health Station

22

Figure 3. Management Structure of Expanded Provincial Health Board

All Local Health Boards across the province including the Expanded Provincial Health Board are functional. Regular meetings are conducted where various issues concerning LAHDZ operation are being discussed and resolved. The Expanded Provincial Health Board provides technical supervision to 5 Local Area Health Boards. The province allocates annual financial support to various LAHDZs as part of its financial management program for government-run hospitals. At least P200,000.00 each are earmarked annually to Roel I. Senador Memorial Hospital (RISMH) and Lamian Primary Health Care Center (LPHCC). The RISMH which is located in Tupi (LAHDZ V) is a municipality-managed hospital and the LPHCC in Surallah (LAHDZ III) is a community hospital managed by a barangay. Other financial support particularly the meals and other logistics during conduct of LAHDZ Board Meetings, is also provided by the province for the administrative operations of the LAHDZ. It is the province that solely assumes the financial responsibilities for the operation and sustainability of the LAHDZs.

Management Support Systems in the LAHDZ In order to strengthen governance and capabilities of the Local Government Units under the devolved set-up, various health system reforms were conceptualized, developed and implemented under the framework of the Inter Local Health System (ILHS). These are the following systems. Referral System Health Management Information system Integrated Health Planning system Human resource development System Monitoring and evaluation NGO/Community Participation

Expanded Provincial Health Board

Area Health Board

Technical Advisory

Committee

Area Health Board

Area Health Board

Area Health Board

Area Health Board

Comment [LAM2]: Is this P200,000 for each hospital?

23

1. Health Referral System

A two-way referral system was developed and implemented in the province. The system provides operational linkage to support and facilitate the development of appropriate referral of patients to each level of care. Associated management system and protocols linked to essential infrastructure support were put in place. The referral system was developed in the light of devolution where hospitals and rural health units are in close proximity with the former acting as referral center for clinical and in-patient services. Every level of care- BHS, RHU, Municipal/District and Provincial hospital, is defined to give each LGU the capabilities to determine the kind of care or health services that could be afforded to the constituents. A Minimum Package of Services at each level of care had been identified. The referral system ensures that patients should only be referred to a higher level of service or hospital when the lower level facilities cannot provide the necessary services. In South Cotabato a Health Referral System Manual was developed through the support of the Integrated Community Health Services Project (ICHSP) Australian Aid Assistance. The manual serves as guide for health workers in the proper referral of patients, thereby maximizing resources at the first level of care or appropriate facility. The manual contains the operational framework of the comprehensive two-way referral system, policies, guidelines and procedures. Along this, support mechanisms were also developed to support and strengthen the system. Orientation and trainings for health workers on the system of referral, advocacy and health promotion were conducted. Networking with the private hospitals was strengthened. Private hospitals are allowed to use the government ambulance in referring their patients with corresponding requests.

The IPHO also developed a Case Management and Treatment Protocol which serves as a guideline for clinical practitioners both in hospitals and public health for treatment and case management of priority health problems at each service level within the Inter Local Health zones. A Clinical Protocol Advisory Committee composed of a panel of expert clinicians were organized and tasked to regularly review the treatment protocols and guidelines.

2. Health Information System The province adopts the Health Management Information System (HMIS) for

the management support of its LAHDZ. Since 1999, the Integrated Community Health Services Project in collaboration with the Information Management Service (IMS) of the Department of Health (DOH) has continuously developed and implemented the Health Management Information Service (HMIS). The Health Management Information Service (HMIS) is a huge software system, which was created by the Department of Health (DOH) to facilitate and monitor essential health information and activities in the most efficient and effective method. It comprises the HOMIS, FHSIS, RHSIS, SRHUIS, CBMIS.

The Hospital Operations Management Information System (HOMIS) is an

integrated Windows based hospital information system designed for hospitals, which encompasses the patient’s medical records. It uses the latest information technology that facilitates the day-to-day- operations of the hospital. The system integrates the clinical, financial and administrative operations. The HOMIS software is installed in

24

three hospitals in the province (South Cotabato Provincial Hospital, Norala District Hospital, and Polomolok Municipal Hospital). However, the Norala District Hospital and Polomolok Municipal Hospital have a limited network system (Admitting and Billing Sections) due to insufficient capacity of its network server. On the other hand, the Lake Sebu Municipal Hospital has a stand-alone system, which means that all information is encoded in one computer only.

Generally, the HOMIS consists of three modules, namely: Module I, classified as Patient Management Module which covers billing, cashiering, medical records, out-patient department and emergency room; Module II, classified as Service Provision Module that facilitates the efficient provision of clinical services and covers nursing care/ward, laboratory, pharmacy, radiology, physical therapy, procedure & operation and central supply room; Module III, classified as Administration Module that covers the administrative and financing functions such as personnel information, logistics management and financial management information systems.

The installation of HOMIS in the South Cotabato Provincial Hospital (SCPH)

has provided reliable information which is useful in planning and implementing better health development initiatives. In the SCPH, Module I is already fully implemented and functional. Module II will soon be implemented, while Module III is still on the process of development and completion through the help of Integrated Management Service of the Department of Health.

The Field Health Services and Information System (FHSIS) is a major

component of information sources being developed by the DOH for the efficient management of its nationwide health service delivery activities. It is a facility-based information system that record clients who are provided health services at the health facility level. It was designed to provide the basic service data needed to monitor several activities in each of its public health services programs. It covers health service programs on Maternal and Child Health (MCH), Expanded Program on Immunization (EPI), Control of Diarrhea Diseases (CDD), Nutrition, Family Planning, Maternal Care, Tuberculosis, Malaria, Leprosy Control Program, and Dental Health & Environmental Health. The FHSIS has been revised into four main components, namely, Family Treatment Record, Target/Client List, Reporting Forms and Output Reports. The purpose of this is to provide subsequent data on health service delivery activities and selected program accomplishments, which can be used for program monitoring and evaluation purposes.

The province has followed the FHSIS software in the survey and monitoring

of the health services activities occurring in the rural health units. However, this software system is highly dependent on the DOH particularly on its technical efficiency. The technical assistance on the software is provided only by the IMS-DOH.

Furthermore, in order to facilitate easy access to the regional station, the DOH created the Regional Health Services Information System (RHSIS) which basically has the same purpose with the FHSIS. It is a carry over information system from Region XI which is still utilized by South Cotabato with the understanding that Region XII will adopt this system with assistance from Region XI. At present, the

25

province gathers and utilizes more useful data on health accomplishments taken from the RHSIS reports.

The Simplified Rural Health Unit Information System (SRHUS) is a software

component designed for managing information in the rural health units. Presently, nine (9) municipalities in the province are utilizing it. Only T’boli and Lake Sebu have not been installed with SRHUS.

The health information system in the provincial Rural Health Units (RHUs) is

managed under the Simplified Rural Health Unit System (SRHUS). This health information unit is composed of 11 computer encoders (one encoder per RHU) on a contractual basis of service. These contractual encoders are temporary in service lasting for 3-6 months only. The functions of the SRHUS include recording, encoding and storage of important data or information about patients, morbidity and mortality cases and other health circumstances happening within the RHU level. It generates reports on the number of consultations per barangay, number of referrals from and to another referral facilities and leading causes of consultation of main health facility or municipality.

The RHU information system is powered by software provided by the Department of Health (DOH), which is being served through the Provincial Health Office. The technical assistance for the SRHUS also comes from the Integrated Management System of the Department of Health (IMS-DOH). In cases of technical problems encountered, the software is sent to the IMS-DOH in Manila for repair. It is the province that provides the maintenance expense for the system. However, there are issues on hardware and technical assistance, which need continuous update and sustainability.

Another component of the HMIS is the Community-Based Monitoring and

Information System (CBMIS), which was designed to allow health care providers to identify eligible target clients who do not avail or access the appropriate health services in the remote areas and determine and undertake alternative interventions to respond to the needs of these groups of clients. It also generates program performance evaluation for proper management. All RHUs in the province have already conducted their CBMIS, which are now on the process of validation. This system helps service providers to prioritize and keep track of their clients until they are provided the necessary health services. More importantly, this system provides the basis for planning and implementing appropriate interventions for better developments.

The success of the CBMIS operation is primarily dependent on the data

gathered by the health providers which comprise the information needed in the planning system for better health services interventions. In the CBMIS process, data gathered is transcribed from the community/barangay level to the municipality and later to the provincial level. Any system involving the transmission of information from one support to another implies a risk of error in the transcription process. Presently, the province is working on the proper use of the CBMIS data validation tool in order to check the accuracy of the transcribed information relative to health services.

26

3. Integrated Health Planning System Since the Local Government Code of 1991 ceded the responsibility of delivering health services from the Department of Health to the respective Local Government Units, the devolution of health services paved the way for the creation of a standard planning tool, called the Integrated Health Planning System (IHPS). The IHPS was developed by the Department of Health to facilitate the health planning activity of the Local Government Units (LGUs). It was designed to strengthen the partnership of the DOH and LGUs for devolution and the efficient implementation of the re-integration of health services. Basically, the Integrated Health Planning System is intended to invigorate inter-LGU cooperation and collaboration through the development of integrated health plans.

The IHPS involves two types of planning, namely the strategic and annual health planning at the three levels of health service delivery (municipal, district and provincial/city). The planning process starts with the formulation of the vision and mission, conduct of environmental analysis including SWOT, identification of gaps/problems, creation of strategic goals and interventions. These steps shall be synthesized in the three-year Strategic ILHZ or LAHDZ Plan. Similarly, the Provincial Health Office and/or the Provincial Hospital will develop its own three-year strategic plan. The individual Health District Strategic Plan and the Provincial Health Office Strategic Plan will then be consolidated to become the Integrated Provincial Strategic Health Plan. After the strategic planning activities at the district/provincial levels, the preparation of the annual health plan follows. The process ends with the accomplishment of the final output, which is the Integrated Annual Health Plan.

4. Health Human Resource Development System The Integrated Provincial Health Office has established a Health Human Resource Development Unit that conducts training needs assessment and recommends necessary trainings to enhance skills and capability of health personnel. Likewise, it conducts inventory of trainings for different health programs in field health units. Lately, it undertook the hiring of Medical Consultants for different departments in South Cotabato Provincial Hospital including Surgery, Ob/Gyne, Pediatric and Medicine, to address the chronic problem of lack of personnel. These Consultants received a monthly honorarium in exchange for the services they rendered. The HHRDU also spearheaded the re-structuring of the IPHO organizational structure. It now adopts the Unit Based Management (UBM) Structure – Cost Center Approach that was introduced by ICHSP-AusAID. Unit Based Management is a method of strengthening an organization and is based on multi-disciplinary teams and cost centers. The UBM model seeks to coordinate all aspects of the various professional inputs to enhance the overall delivery of services3. One of the basic principles of team operations is to benefit from the broad and specialized skills of each team member. In a cost center structure, the expenses and revenues of each unit are monitored and reported individually. The cost center also looks at and reports the number and type of services the cost center performs. Thus, the organization’s 3 Unit Based Management Manual – “The New Organization. March 2003

Deleted: ;

Deleted: ;

27

knowledge of its own operations supports enhanced future planning and budget allocation. The Unit also institutes personnel appraisal system (PAS), which intends to monitor the performances of the personnel based on their identified target performances. The appraisal system follows the UBM method where cost center personnel are appraised by their respective Cost Center Managers. The HHRDU took part in the establishment of Family Medicine Residency Training Program of South Cotabato Provincial Hospital, which is now on its third year. This program is considered as one of the milestones of the IPHO.

5. Monitoring and Evaluation System

Program Implementation Review among hospital and field health services are regularly conducted as part of monitoring and evaluation activities. This built in monitoring system helps program implementers in identifying gaps that need to be addressed immediately. The IPHO Technical Services conducts feedbacking activities to Local Chief Executives as part of their functions to provide technical assistance to RHUs. This way, LCEs are informed of the health status of their respective localities.

At the municipal level, Municipal Health Officers and Public Health Nurses make their own supervisory plan. The supervisory plan is an action plan for RHU level which identifies strengths and weaknesses of the health programs. It is also a monitoring system which the MHO can use to prioritize the activities and programs they undertake. The system serves as a monitoring and evaluation registry.

6. NGO/Community Participation

Under this program, strategies were directed to establish and institutionalize a community-NGO-LGU partnership for health and health service development, as well as to pilot community based health promotion strategies, to develop and conduct Community Development Training, to support community participation and to manage health related development projects through Small Grant Scheme Projects. Coordination mechanism was institutionalized by the formation of a Provincial Coordinating Council for Health Concerns (PCCHC) whose members come from NGO/PO in each LAHDZ. This mechanism has become the venue of dialogue between the community and the LGU officials. A point person from the IPHO has been appointed as Help Desk Officer to coordinate with PCCHC.

A Provincial Health Promotion Team has been formed to handle all health

advocacies. The team is making use of all IEC materials in community-to-community health campaigns. A weekly radio program has also been approved through the IPHO by the provincial government.

Community Health Development (CHD) trainings were conducted for Health

Workers from the provincial to barangay level. These trainings have provided both the LGUs and the community broader understanding in Partnership, Roles and Responsibilities in Health. It also provided them skills in conducting community diagnosis, partnership building and communicating health related issues.

Deleted: ,

Deleted: ,

28

The Development Alternative Framework (DAF) of the Provincial Government also shows the strong inter-linkage of government personnel with the community in the delivery of basic social services. The DAF program encourages community organizers to stay in the community, where they can actually see and experience the needs and problems in the area. Governance Problems and Gaps

1. Need to Review the Clustering of LAHDZs and Health Referral System

A review of catchment flow showed that there is a need to rethink the

reclustering of the LAHDZs. For instance, the Norala District Hospital is bypassed because it is in fact only a primary and first-referral hospital, rather than a core-referral hospital.

2. Difficulties with the software Since the management and basic hospital operations in the South Cotabato Provincial Hospital are governed by the Hospital Operations Management Information System (HOMIS), several problems on the software’s technical efficiency and maintenance usually occur. In cases were there is a system troubleshooting, the software is sent to the system provider which is the Department of Health in Manila for repair. The system repair and maintenance entails a big expense, which is being shouldered by the province. There is limited option to upgrade the software and hardware due to insufficiency of funds or budget for its maintenance. The computer encoders who perform the basic operations of the system are only temporary in service and are hired on a contractual basis. Most of these contractual encoders lack proper training on the system. In the Rural Health Units, there is a fast turnover of contractual personnel, which causes interruption in the services and inaccuracy of the recorded information. The core IT personnel should be hired as permanent employees and thoroughly trained including on troubleshooting.

3. No established epidemiological services units

There are no established epidemiological services units in the province (i.e. PESU, CESU, DESU and MESU). This causes a big information gap on the health situation of the population.

4. Need for more HHRDU Personnel The IPHO management felt the need for three additional personnel in the HHRDU Unit. However, due to limitation set by the ceiling for Personnel Services, the province could no longer provide additional staff.

5. Poor Implementation of Monitoring and Evaluation Systems While the Program Implementation Review is regularly conducted, results are not communicated effectively to LCEs and policymakers. Hence, health policies are generally not based on health indicators.

29

At the municipal level, there is poor supervisory visit by MHOs and PHNs based on the assessment of technical personnel. Supervisory plans are not fully implemented. At the provincial level, monitoring and evaluation registry are not regularly updated and there are systems not fully implemented. However, Provincial Technical Staff continuously provide technical assistance and conduct monitoring to the different RHUs using their own monitoring checklist.

6. Unsustained Health Promotion and IEC of Health Systems Concerns Generally, health promotion and IEC for public health concerns subside after designated campaign period. D. FINANCING

A Local Health Accounts (LHA) for South Cotabato was generated in 1999 by the ICHSP and in 2001 by the NSCB Region 12. LHA was a potent tool used for policy review, policy analysis, and policy formulation. It informed policy makers about the status and patterns of health care spending in a given locality for a given year which was correlated with the health status of the people living in the locality, their health seeking behavior, and the performance of the health service delivery systems operating in the locality.4 LHA was used in conjunction with other data and statistics to determine the adequacy of total public and private spending for health, allocation efficiency in overall health care spending, and equity of distribution of the burden of financing and using health care. The local health accounts has not yet been updated since then. The discussion on health care financing can be divided into four topics: annual appropriations for health, user’s fees, PhilHealth enrollment, and other initiatives for health care financing. Annual Appropriations for Health The main source of financing for health services are the LGUs. The provincial government covers the hospitals, while the municipal governments cover their respective RHUs. The provincial budget for health services is a subset of the budget for Social Services. The offices covered under the Social Services sector are the Integrated Provincial Health Office, the Provincial Social Welfare and Development Office, the Provincial Veterinary Office, and Provincial Population Office. Table 9 below shows that Social Services comprised 30 percent of the total budget in 2004, and an average of 26 percent for the years 2000 to 2004. The budget for health in 2004 was only P101 million, or 21 percent of the P436 million total provincial budget. The budget for health services is considered far below the expected budget considering the wide area of coverage of the Integrated Provincial Health Office in the delivery of basic health services. Aside from the management of the four government hospitals, the IPHO is also providing support to Tupi Municipal Hospital,

4 Technical Report on Local Health Accounts of AUS-AID-ICHSP Provinces. November 1999

30

Lamian Primary Health Care Center, 10 Rural Health Units and the Koronadal City Health Office.

Experts recommend that health services should get about 30 to 35 percent of the province’s annual budget. Table 9: Annual Executive Budget by Sector, Province of South Cotabato

Although the budgetary allocation for hospitals and the IPHO increased from 2001 to 2004 (mainly due to Personnel Services), the same trend is not observed for the budget as a percentage of the total provincial budget (Table 10). In 2005, it was reported that the percentage dipped to 17 percent from 21 percent in the previous year. Table 10: Percentage of the Hospital Budget out of the total Provincial Budget to Social Services

Hospital CY 2001 CY 2002 CY 2003 CY 2004 CY 2005 Integrated Provincial Health Office/SCPH

12.93% 15.11% 13.97% 16.40% 13.01%

Norala District Hospital 1.78% 1.87% 2.27% 1.88% 1.75% Lake Sebu Municipal Hospital

1.06% 1.50% 1.33% 1.42% 1.23%

Polomolok Municipal Hospital

1.15% 1.39% 1.48% 1.32% 1.23%

Total 16.92% 19.87% 19.05% 21.02% 17.22% It has to be noted that in spite of the limited budget for health, this is underutilized as shown in the following table: Table 11: Hospital and Technical Services Budget vs. Expenditures, 2001-2004

Health Facilities Year Budget (PhP)

Expenditures (PhP)

Under-utilized allocations

(PhP) 2004 101,382,187 82,238,739 19,143,448 2003 86,035,681 76,478,958 9,556,723 2002 87,593,055 67,509,433 20,083,622 2001 72,857,028 59,365,205 13,491,823

Hospitals and Technical Services

Total 347,867,951 285,592,335 62,275,616

The above figures show that there is a need to evaluate the overall system of fiscal management, resource utilization and procurement for health services. For example, procurement requests made in the previous three quarters had not yet been fully delivered by the 4th quarter of 2005. As such, 4th quarter requests were frozen pending the delivery of previous requests until such time that 4th quarter requests could no longer be obligated as fiscal year book of accounts must be closed. The unused funds are then reverted as savings of the province.

Year 2000 2001 2002 2003 2004 Average

Sectors Appropriation % Appropriation % Appropriation % Appropriation % Appropriation % Appropriation %

General Services 109,367,737 34 122,333,606 33 122,456,606 33 129,084,708 33 136,739,028 31 122,465,473 32

Social services 86,838,974 27 80,682,861 21 103,426,664 27 104,677,286 26 130,450,941 30 96,060,614 26

Economic Services

89,815,367 28 119,182,283 32 115,988,143 31 128,393,695 32 125,230,808 29 115,722,059 31

Other Purposes 35,089,222 11 53,840,184 14 34,309,587 9 37,929,579 9 43,581,790 10 40,950,072 11

Total 321,111,300 100 376,038,934 100 376,181,000 100 400,085,268 100 436,002,567 100 375,198,218 100

31

As for the municipal governments, there is a declining trend in the percentage of annual budget allotted to health (Table 12), ranging from 13 percent in 2001 to only 9 percent by 2004. Only Tampakan, Norala, Tantangan, and Banga have consistently allotted more than 10 percent of their respective budgets for health in 2001-2004.

32

Table 12: Health Budget vs. Total Budget of the Municipalities in South Cotabato Municipality CY 2001 CY 2002 2003 2004 Average

Annual Budget

Health Budget

% Annual Budget Health Budget % Annual Budget Health Budget % Annual Budget Health Budget % %

Tupi Hospital Operation

2,048,943

5

2,686,825.00

7

2,586,573.00

5

3,200,153.00

6

5.75

Tupi RHU Operation

45,293,200

4,220,262

9

38,519,114.00

4,423,247.00

11

50,908,336.00

3,901,218.00

8

53,274,442.00

5,428,991.00

10

9.5

Tampakan

34,539,200

4,354,242

13

34,833,288.00

4,275,880.00

12

39,970,088.00

4,947,892.00

12

43,849,178.00

5,035,913.00

11

12

Sto. Nino

27,079,467

2,962,346

11

27,400,994.00

3,600,993.00

13

37,209,932.00

2,998,035.00

8

34,884,418.00

2,919,061.00

8

10

T’boli

55,024,296

4,872,135

9

55,748,909.00

5,402,319.00

10

26,751,160.00

4,876,115.00

18

83,610,993.00

5,766,441.00

7

11

Polomolok

79,992,358

5,770,245

7

93,114,478.00

7,092,069.00

8

100,629,913.00

8,736,357.00

9

118,569,359.00

9,277,797.00

8

8

Surallah

73,004,632

5,270,923

7

68,785,135.00

5,633,988.00

8

73,979,654.00

5,211,336.00

7

77,284,441.00

5,350,459.00

7

7.25

Norala

33,738,384

5,166,583

15

32,752,891.00

4,939,758.00

15

36,357,024.00

4,784,080.00

13

37,827,115.00

4,819,259.00

13

14

Tantangan

27,703,585

3,541,788

13

27,356,650.00

3,677,149.00

13

30,402,312.00

3,855,582.00

13

32,200,348.00

3,535,540.00

11

12.5

Koronadal

30,102,546

14,066,370

47

98,858,600.00

11,709,740.00

12

167,482,440.00

12,976,660.00

8

248,271,670.00

13,701,803.00

6

18.25

Banga

61,707,247

7,543,794

12

65,648,558.00

6,803,541.00

10

57,698,601.00

6,931,244.00

12

59,671,287.00

6,767,414.00

11

11.25

Lake Sebu

53,419,937

4,792,944

9

2,520,752.00

4,123,241.00

8

9,194,055.00

,344,043.00

7 63,485,465.00

,360,272.00

7

7.75

AVERAGE 13.08 10.58 10.00

8.75 10.60

33

User’s Fees

The cost of health services are recovered through the implementation of user’s fees on accessed healthcare services and facilities in government hospitals and RHUs. The underlying philosophy is that, those who can afford to pay will pay, while those considered as genuine indigents or needy are spared from paying. This is to instill in the minds of the people that healthcare service and facility is a shared responsibility of the government and the general public.

Table 13 shows that collection from hospitals steadily increased from a mere P 7 million in 2001 to P17 million in 2004. Table 13: Statement of Income/Receipts in General Fund in the Different Hospitals of South Cotabato

Hospital 2001 2002 2003 2004

South Cotabato Provincial Hospital

5,718,482 7,753,403 11,897,177 13,481,119

Norala District Hospital 514,124 843,300 1,074,485 1,499,604

Lake Sebu Municipal Hospital

460,193 590,670 640,725 733,757

Polomolok Municipal Hospital

434,041 448,315 744,245 1,029,381

Total 7,124,843 9,635,688 14,356,632 16,743,861

User fee rates are on a graduated basis. Ancillary services like laboratory exams,

x-ray procedures and ultrasound are charged higher at tertiary hospitals compared to secondary hospitals. The implementation of the user’s fee charges is governed by a local ordinance of the Sangguniang Panlalawigan approved in the year 1995 which was then amended in the year 2000. This aims to recover minimal cost of services as fund augmentation for health services provided by the facility. This also reinforces the health referral system so that patients would go to secondary facilities instead of proceeding at once to tertiary health facilities.

The aim to fund augmentation for health services has not yet been realized as the revenue from user fees, under the current provincial financial management setup, is collected as a general income of the province. Although there had been resolutions as to the retention of said revenue, this had not been practiced. The health budget system is treated the same as the budgeting procedure with other departments. As a result, the IPHO has to request and defend its proposed budget. The underlying and presumed issue regarding retention of revenue is the expected decrease in the projected annual provincial income. PhilHealth Enrollment

Among the goals of the province by year 2009 is to ensure that 90% of marginalized populations have access to affordable health services through the PHIC Sponsored Program. This is to minimize the out-of-pocket expenditures for health

34

spending in the province. The PHIC Sponsored Program was viably implemented in the province with the support of other Local Government Units who also ensure allocation of funds for indigency program in their yearly budget as counterpart for the premium share of the enrollees. Most of the indigent patients access health services of SCPH, NDH, PMH and LSMH.

For the year 2004, the indigent families in South Cotabato reached a total of 64,785. However, only 11,272 or 16 percent were enrolled in PhilHealth. Of the 11,272 enrolled families, premiums of 6,500 families are shouldered by the provincial government while the rest are financed by their respective Municipal and Barangay governments and by private entities. Table 14. Number of Indigents enrolled under the Sponsored Program of PhilHealth

LGU Projected Indigent HHs FY 2004

PhilHealth enrolled PhilHealth Capitation Fund (RHUs)

(PhP)

Banga 6,492 751 On process

Koronadal City 12,488 1,028 315,375 Lake Sebu 5,081 993 32,756 Norala 3,828 331 501,418 Polomolok 10,389 853 On process

Surallah 6,218 331 On process T’boli 5,702 538 On process Tupi 5,018 902 267,600

Tampakan 3,100 1386 573,051 Tantangan 3,066 1516 On process Sto. Nino 3,403 1702 602,010

Total 64,785 10,321 P 2,292,211

It can also be seen from Table 14 that capitation worth more than P2 million has

already been released to the different municipalities. As to the utilization in hospitals, the following are the number of claims paid by the PhilHealth Region XII to the hospitals for patients enrolled under the Sponsored Program. Table 15. Number of PhilHealth Claims of Government hospitals, 2004

Government Hospitals Number of claims South Cotabato Provincial Hospital 1,693 Norala District Hospital 566 Polomolok Municipal Hospital 141 Lake Sebu Municipal Hospital 156

Deleted: f

35

Other Initiatives for Financing Health Care

Other health financing options adopted by the province include public–private sector collaboration, inter-LGU cost sharing a Motorcycle Loan Program for mobility of health personnel, and improvement of tax collection for additional provincial funds (e.g. quarrying). The province has also allocated funds for the hospital drug revolving fund program to provide adequate, medical supplies, and for Cooperative Pharmacy for procurement of low cost medicines and additional income for health workers.

Public-Private Sector Collaboration

Strong inter-linkage with the private sector is best shown in South Cotabato through the Adopt a Ward Program of the Integrated Provincial Health Office. This initiative promotes involvement of the community, particularly the private sector in the health development pursuit of IPHO. It also creates an environment of understanding, collaboration, and rapport within the community by bridging the gap of the poor and the affluent through health-related programs. Through this program, a non-government organization or a civic group adopts a specific hospital ward in the South Cotabato Provincial Hospital and sponsors/spearheads the repairs, repainting, improvement of lightings and fixtures, and provision/donation of equipment for the comfort of confined indigent patients. It also allocates funds to maintain these wards. Among the civic groups that have adopted a ward are the South Cotabato Electric Cooperative I (SOCOTECO I), Kiwanis Club of Koroandal, DOLE Philippines, Inc., Order of Amaranth, Rotary Club of Marbel, South Cotabato Barangay Health Workers Association, Lay Missionary Association of Mother Francisca del Espiritu Santo (LMAMFES), Geodetic Engineers of the Philippines (Region XII), and Alliance Women of the Philippines (The Christian & Missionary Churches of the Philippines).

Inter-LGU Cost Sharing

An example of this is when the X-ray machine owned by the Polomolok LGU was situated in the Polomolok Hospital owned by the province. Proceeds from the use of X-ray machine is shared by the LGU and the province with the LGU getting 70% and the province getting 30%.

Motorcycle Loan Program

The zero-interest Motorcycle Loan Program for health personnel intends to improve access to health services through increased mobility of health workers involved in health service delivery. The recipients of this motorcycle dispersion program are qualified health workers who are involved in the delivery of primary health services to far-flung communities of the province. A committee was organized to enforce guidelines regarding the implementation of the Motorcycle Fund program and provisions of the Memorandum of Agreement (MOA) for compliance of borrowers. Qualified recipients pay the loan through salary deductions for a period of three or five years. At present, 63 health personnel have availed of the said program.

Formatted: Indent: First line: 0.33"

Formatted: Indent: Left: 0.5"

Formatted: Indent: First line: 0.5"

36

Drug Revolving Fund

In February 1999, a revolving drug fund program for hospitals and RHUs was initiated by the Integrated Community Health Services Project (ICHSP). The ICHSP provided seed money for the hospitals to secure medicines during emergency cases. An initial capital of P300,000.00 was allocated to South Cotabato Provincial Hospital and P100,000.00 each for Norala District Hospital, Polomolok Municipal Hospital and Lake Sebu Municipal Hospital and RHUs. In this case, the patients are required to pay on cash basis. Payments to the SCPH, NDH and PMH are then deposited in a Trust Account managed by the Provincial Treasurer’s Office as part of the revolving fund for use during emergency cases. The same process is observed by RHUs. The revolving fund also serve as a back up to the regular procurement process. At present, this program has provided assistance to health care facilities in rendering affordable and essential drugs and medicines to its clients both in hospitals and RHUs.

Cooperative Pharmacy

In March 1996, the South Cotabato Cooperative Pharmacy was registered as

business and operated at the South Cotabato Provincial Hospital basically to cater to the primary medical needs of the marginalized patients of the hospital. This cooperative was created and is composed of the Federation of Barangay Health Workers (BHWs) and the IPHO employees. The province provides the space for the pharmacy, but it is run as a private entity. Presently, it is managed by a five-member Management Board and its operation is manned by one pharmacist, three pharmacy aides, a bookkeeper, accounting clerk, and credit and audit officers. The pharmacy is purposely situated within the hospital vicinity in order to facilitate easy and accessible purchase of medicines at a lower and affordable price. In the procurement of its medicines, the pharmacy has the option to canvass and secure drugs from companies through consignment basis.

Today, the Cooperative Pharmacy continues to provide and benefit the South

Cotabato constituents through selling low cost medicines, and has generally provided employment and additional income opportunity to Barangay Health Workers (BHWs). Financing Problems and Gaps

1. Large share of out-of-pocket expenditures

According to the 1999 Local Health Accounts, household out-of-pocket payments is the largest source of funds for health care in the province at 48% percent. Likewise, PhilHealth is also considered a significant source of healthcare funds but enrollment is still at low levels, which is the next identified problem.

2. Low enrolment of Indigents to PhilHealth’s Sponsored Program LGUs need to increase enrolment of their indigents and renew the membership of existing ones to PhilHealth’s Sponsored program. Of the projected 64,785 indigent families in 2004, only 11,272 or 16 percent are enrolled in PhilHealth.

Formatted: Indent: First line: 0.5"

Formatted: Indent: First line: 0.5"

37

LGUs in the municipal and barangay levels are not supportive of the PHIC Sponsored Program. Aside from the non-renewal of their respective indigents’membership, they do not increase enrolment. Out of the total active enrollees of 11,272, a total of 6,500 are funded from the provincial government while the rest are financed by their respective municipal and barangay units and other private entities. LGUs in the municipal and barangay level seem to depend on the support of the provincial government on the plight of their indigents. This can be seen through the number of indigents supposed to be shouldered by their respective LGUs. Records show that most of these active enrollees are being shouldered by the provincial government. Premium sharing scheme for the Indigency Program seems hard for LGUs to sustain.

3. No room for fund augmentation due to fund management procedures The revenues generated from the user fee charges are remitted to the general fund of the province. It can only be accessed by the IPHO through a supplemental budget request. This limits the health department to immediately avail of the funds for the emergency and necessary health needs it has to provide to its clientele. Ideally, income retention will give autonomy to government health facilities to facilitate timely purchase of drugs and medicines for the patients. The current set-up does not comply with the Joint Circular regarding sub-allotment scheme for government hospitals. IPHO has long been lobbying for the retention of income for devolved hospitals so they can sustain their operations without delay in processing of documents. However, the Provincial Government could not come up with a decision whether to allow its devolved hospitals to retain their income to augment expenses for MOOE. E. REGULATION

Executive Order No. 13, amending Executive Order No. 2000-01, Series of 2000, provides the establishment of Therapeutic Committees in health offices and hospitals. The Therapeutic Committee is created to develop and maintain the Provincial Drug Formulary (PDF) based on the national drug formulary by ensuring that drugs and medicines procured by the province are those that are in the PDF. It performs as quality-checker by reviewing the annual drug procurement plan, carrying out the ABC analysis to ensure the rational prioritization of the planned purchases and validating these purchases to follow the VEN5 prioritization. It is also designed to monitor the conduct of Drug Use Reviews (DUR) in hospitals, develop prescribing guidelines for selected drugs and harmonize standard policies for the rational use of drugs.

At present, the Therapeutic Committee only exists and functions in SCPH. The

Provincial Therapeutic Committee is headed by the Provincial Health Officer and its members include the different doctors and hospital staff with related expertise on drug management. They perform the review and examination of selected drugs procured by the province in order to ensure quality drugs based on the PDF. There is a Provincial 5 Vital, Essential and Necessary

38

Drug Formulary used in the rational selection of drugs and medicines for hospitals as well as in the increase of drug supplies in the field health units.

Since there is only one Therapeutic Committee in the province, selection and

procurement of drugs in other hospitals and health facilities, especially in the RHUs, are not being checked or reviewed as to their standards and quality. The hospitals’ process of drug procurement is done through public bidding. The province has worked out a bulk procurement system for its hospitals and increased the budget for drugs. In the RHUs, the procurement of drugs is being done individually by each health facility through the municipal government.

There are two municipal hospitals that purchase drugs individually for their basic

health services. These hospitals are Lamian Primary Health Care Center and Hospital (LPHCC) in Surallah and Roel I. Senador Memorial Hospital (RISMH) which is located in Tupi. The Provincial Government occasionally provides some augmentation in the supply of drugs for these two municipal hospitals.

Another strategy adopted by the province to ensure availability of low-cost quality drugs is through the establishment of Botika ng Barangay (BnB) in hard to reach areas. At present, there are 42 licensed BnBs operating in the province. The DOH through the CHD – BFAD conducts training to organized groups such as cooperatives, people’s organizations and other NGOs signifying intention to operate a BnB. The training includes guidelines in operations and financial management. Initial BnB kits which contains common over the counter (OTC) drugs, low priced generic home remedies and two(2) prescription antibiotics (amoxicillin and cotrimoxazole) are provided by the DOH as seed capital. License to operate is issued by the CHD – BFAD to qualified trained operators. Compliance to national policies has been very well observed in the province. National laws such as the Sanitation Code of the Philippines, Food Fortification Law, Asin Law, Generics Act & the National Voluntary Blood Services Act among others have been localized at all levels in the province. In support to these laws the province has issued Executive Order No. 99-19 series of 1999 creating the “Provincial Task Force Kalusugan” composed of different regional and local agencies and support groups which is being chaired by the Provincial Health Officer, to ensure delivery of public health services as mandated by national and local ordinances. The task force is focused to monitor the implementation of these national laws. As a result, the active presence of the Task Force in the regulation and implementation of various health related ordinances coupled with proper information dissemination and health campaign as well as imposition of fines and penalties has enhanced awareness and assured compliance with these laws.

39

Regulation Problems and Gaps

1. Delay in the Procurement of Drugs

The procurement of drugs undergoes the public bidding process, which usually takes a long time due to many suppliers/bidders, different sources of drugs, as well as the unavailability of stocks and instability of prices and other factors. Moreover, the Parallel Drug Importation process also causes delay in the purchase of drugs since not all essential drugs are sourced out from it. The BFAD requires a Certificate of Product Registration (CPR), which takes a long time to secure and usually not utilized in the international bidding. This creates a bottleneck that eventually slows down the parallel import.

Faced with a recurrent problem on lack of medicines, the revolving drug fund for hospitals was set up to augment supply of drugs in special circumstances. This fund which provides seed money for hospitals and RHUs are supposed to be used only for emergency cases. However, due to longer delays in drug procurement, hospitals opt to utilize the revolving drug fund more often in order to supplement unavailability of drugs.

2. Infrequent Monitoring and Inefficiencies in the Operations of BnBs Monitoring of BnBs by government pharmacists has been a major problem in the implementation. Hospital pharmacists aside from the Regional Food and Drug Officers (FDRO) have been mandated to conduct inspection, supervision and monitoring of these established BnBs. But due to inadequate number of hospital pharmacists & FDROs and lack of financial support for their mobilization, this was not regularly done. Inefficient recording and posting of income were also noted in the operation of these BnBs. Re-ordering and remittance system were not in place thus resulting to delayed or non replacement of stock-out commodities.

40

IV. VISION, MISSION, GOALS and OBJECTIVES

The IPHO Health VISION and MISSION

The following remain as the health vision and mission statements for the Province of South Cotabato. These statements have been developed in the context of established Integrated Health System in the Province and strategic goals identified by each Local Area Health Development Zone (LAHDZ).

PROVINCIAL HEALTH VISION OF THE PROVINCE OF SOUTH COTABATO

“A better quality of life for the people of South Cotabato living harmoniously and participating in a developed sustained and integrated quality health care delivery system that is effective, accessible, affordable and environment-friendly”

PROVINCIAL HEALTH MISSION OF THE PROVINCE OF SOUTH COTABATO “To ensure a dynamic Provincial Integrated Health System where communities, non-government organizations including the private medical sector and local government units are active partners in providing quality health services that are equitably accessible to all citizens, especially those who are socio-economically marginalized.” OVERALL GOAL It is the overall goal of the South Cotabato Provincial Health Organization to contribute to the improvement of health status by ensuring access to basic health services that is efficiently and effectively delivered to its population, especially the mothers and children, the socio-economically marginalized and other vulnerable groups. These goals are anchored on the Millennium Development Goals. The marginally and vulnerable groups consist of:

Families falling within the 37 percent poverty incidence of the province Families situated in the hinterlands of the province mostly populated by indigenous

people with poor access to education and other basic services Families in remote areas which either lack transportation means or have very costly

transportation means Populations displaced due to peace and order situation Populations belonging to culturally-diverse groups with other influences in health

beliefs and health seeking behavior

Formatted: Centered, Indent: Left: 0", First line: 0", Numbered + Level:2 + Numbering Style: I, II, III, … +Start at: 4 + Alignment: Left +Aligned at: 1.5" + Tab after: 2" +Indent at: 2", Tabs: Not at 2"

Formatted: Bullets and Numbering

41

The following are the specific goals:

1. Sustain the low level of Maternal Mortality Rate of 100/100,000 live births 2. Reduction of Infant Mortality Rate from 7 per 1,000 live births to 6 per 1,000 live

births 3. Reduction of under 5 mortality from 84/10,000 live births to 80/10,000 live births 4. Decrease in TB mortality rate from 18 /100,000 population to 15 /100,000

population 5. Reduction in the following lifestyle-related causes of death:

a. cardiovascular deaths from 65/100,000 pop to 60/100,000 pop. b. diabetes from 12/100,000 pop to 8 /100,000 pop. c. cancer of all forms from 42 /100,000 pop to 35 /100,000 pop.

6. Control of the following emergent vector-borne diseases: malaria and dengue 7. Reduction in ARI cases among children below 5 years old from 313/1,000 live

births to 300/1,000 live births 8. Reduction in diarrhea cases among children below 5 years old from 284/1,000

live births to 200/1,000 live births. 9. Improved knowledge, attitude and practices of the communities on:

a. Nutrition b. Responsible Parenthood c. Healthy Lifestyle

10. Readiness to address emerging health concerns in the region including HIV/AIDS, Bird’s Flu Virus, SARS, Meningococcemia, and health concerns resulting from man made calamities and terrorist activities

Objectives 2006-2010 Service Delivery • For all service facilities to be fully equipped and capable of providing quality services

where: - Health delivery set-up is rationalized - Zones are set up to provide equitable access of population in the facilities - Two-way referral is internalized - Diagnosis are recorded in ICD 10 - Primary hospitals are strengthened and capable of providing emergency obstetric

care - Facilities are PhilHealth-accredited and utilized efficiently

Governance That rational delivery of health services is efficiently and effectively provided and

sustained at all levels of care with component LGUs and other health facilities participating to meet desired health status within particular health zones

That population is satisfied with the health systems of the province.

Formatted: Bullets and Numbering

Formatted: Bullets and Numbering

Formatted: Bullets and Numbering

42

Financing • That 90% of marginalized populations have access to health services through PHIC

Sponsored Program • That 100% of all Health facilities maintain their PHIC accreditation • To increase PHIC share in hospital care expenditure from 7% to20% • To increase provincial and municipal LGU health expenditures Regulations • That quality drugs and medicines are available at affordable prices in all government

health facilities • That PhilHealth-accreditation and Sentrong Sigla-certification of facilities are

sustained

Formatted: Bullets and Numbering

Formatted: Bullets and Numbering

43

V. STRATEGIES AND INTERVENTIONS

The systematic implementation of the four reform packages will be the main strategy in health investments for 2006-2010. In general, the thrust is empowering the people of South Cotabato for health and well-being. Hence, emphasis is made on strengthening the primary health care network and health information systems.

The planned strategies and interventions are a result of the analysis made on the health situation in the previous section. However, since the four reform areas are closely interrelated and some interventions encompass various concerns, there is no one-to-one correspondence of interventions with the problems and gaps identified. For instance, some concerns about financing are addressed through interventions on governance.

The implementation of interventions is to be done in collaboration with partners in the Department of Health, the private sector, community-based groups, and international organizations. Defining standards of service delivery and health systems, for instance, would require technical assistance from the Department of Health and other experts.

Some ongoing and potential projects are also integrated in this plan. Foremost are the Development Alternative Framework: The South Cotabato Convergence Model (Project DAF) and the Enhance Child Care and Development Project of the Provincial Local Government. Others include the LEAD Project of the MSH for population, TB, and Vitamin A concerns, the Helen Keller International also for Vitamin A concerns, the Plan International for children’s health concerns, and World Health Organization for emerging diseases. Also, as discussed in the situationer, many systems are already in place and therefore need only to be refined. Some initiatives, on the other hand, have already started. Component 1. SERVICE DELIVERY

The interventions for service delivery generally consist of building the critical capacities of health service providers and strengthening the support network in view of the objectives for health service delivery.

1.1 Capacity Building for:

• Disease-free initiatives on leprosy and filariasis • Reduction and control of malaria, dengue, schistosomiasis, rabies • Intensification of TB control • Healthy lifestyle initiatives • Delivery of Reproductive Health/Women’s Health/Safe

Motherhood/Family Planning • Management of Common Childhood Illnesses • Addressing emerging health concerns: HIV/AIDS, Bird’s flu, SARS,

Meningococcemia, man-made calamities and terrorist activities

44

Capacity building activities can be categorized into the following subcomponents: 1.1.1 Needs Assessment for Service Delivery

First and foremost is to assess the needs of health service providers to be able to deliver the desired health services. This will also serve as validation to ensure the appropriateness of the other interventions identified in this PIPH.

The Province will seek the assistance of the Department of Health and other sources of expertise in defining the critical requirements with which the existing capacity of the Province will be compared against.

The needs assessment should cover the requirements for certification and accreditation standards for DOH and PhilHealth services.

The needs assessment will also be done in conjunction with the results of the rationalization and mapping of facilities that is to be discussed under the Governance component.

1.1.2 Upgrading of facilities to meet health service delivery requirements, including standards for Sentrong Sigla certification; PhilHealth-accreditation for Maternity Care, TB-DOTS, NSV, Out-Patient Benefits Packages (OPB); and Designation for CEmOCs and BEmOCs

Upgrading involves building the infrastructure and purchase of the equipment to meet the corresponding accreditation or designation standards. All government hospitals will be upgraded to meet the desired licensing and accreditation levels. The SCPH will also be designated as the Comprehensive Emergency Obstetric Care (CEmOC) facility. All RHUs are aimed to be certified as Sentrong Sigla Phase II Level II, and PhilHealth-accredited for MCP, TB-DOTS, NSV, and OPB. All government hospitals and RHUs will also be designated as Basic Emergency Obstetric Care (BEmOC) facilities. These designations will be studied and updated during the conduct of facility mapping and rationalization.

1.1.3 Improvement of primary health care service network

The primary health care network needs to be strengthened for a most effective service delivery framework. This will also be an important factor in the success of the public health programs.

45

Barangay health stations or mini-health stations will therefore be built and equipped in barangays lacking such, particularly in geographically isolated and disadvantaged areas (GIDAs) and other farflung barangays. Capacity-building for the personnel and support groups will be discussed under the discussion on training.

Municipality Barangay Facility/ies to be Constructed

Tantangan Poblacion Upper Tanding

Mini Health Stations

Bukay Pait Sitio El Ulit Mini Health Stations

Dumadalig Sitio Elnap Mini Health Stations

Libas Sitio Mayada Mini Health Stations

Maibo Purok Paglaum Mini Health Stations

T'boli Dlanag New BHS

Kematu New BHS

Lambuling New BHS

Lamhaku New BHS

Tbolok New BHS

Lake Sebu Ned I New BHS

Poblacion 1 New BHS

Banga Cabuling New BHS

Improgo Village (Pob.) New BHS

Lam-apos New BHS

Lamba New BHS

San Jose (Bo. 7) New BHS

Yangco Poblacion New BHS

Koronadal City

Cacub New BHS

Carpenter Hill New BHS

Magsaysay New BHS

Mambucal New BHS

New Pangasinan (Bo.4) New BHS

Paraiso New BHS

Rotonda New BHS

Sarabia A (Bo. 8) New BHS

Zone III (Pob. B) New BHS

Polomolok Cannery site (2) New BHS

Landan Sitio Kaliong

New BHS

Maligo New BHS

Poblacion (1)(MHC)

New BHS

Surallah Buenavista New BHS

46

Duengas New BHS

Lambontong New BHS

Little Baguio New BHS

Talahik New BHS

Tubi-ala New BHS

Veterans New BHS

Tampakan Sta . Sruz New BHS situated in farflung area

Sta . Sruz New BHS situated in farflung area

San Isidro New BHS situated in farflung area

Tablu New BHS situated in farflung area

1.1.4 Strengthening the Capability of SCPH as a Core Referral Hospital and Establishment of a Medical Rehabilitation Unit

The current strengthening of the SCPH as the core referral hospital of the province as well as for the region, will be continued for the next five years. Medical doctors will undergo residency training on various tertiary-level services including internal medicine, surgery, pediatrics, and anesthesia. Nurses, medical technologists, and other auxiliary staff will also undergo extensive training on such areas as water analysis, dialysis management, and IV therapy. Furthermore, with the increasing concern in lifestyle-related diseases, a Medical Rehabilitation Unit will be established in the SCPH. This shall cater not only to the province but to the entire Region 12 where rehabilitation services are not available. Establishing this new unit would require a new building, new equipment, and extensive training for the staff.

1.1.5 Establishment and Capacity-Building for Provincial Medical Alert Unit

A Provincial Medical Alert Unit will be established and will be provided a vehicle and paramedical equipment. Its staff will be trained extensively in disaster preparedness and disease surveillance. This unit, on the other hand, will conduct orientation in all LGUs regarding notifiable and emerging diseases.

1.1.6 Definition of Core Competencies, Training Needs Assessment, and Formulation of Training Plan

The training needs assessment (TNA) and training plan prepared by the HHRDU will be reviewed in view of the areas of service delivery

Deleted: ,

47

concerns identified in 1.1. The core competencies required from the health staff to effectively perform these service delivery concerns will be identified and shall be the basis in the refinement of the TNA and training plan. This shall also take into consideration the fast changing nature and advances of science and technology and emerging diseases.

1.1.7 Implementation of the Training Plan

The training plan formulated in 1.1.6 shall then be implemented. The strategy includes the appropriate timing of training the various personnel to consider implications on finances and on availability of manpower in the respective offices. A list of the training sessions is in Annex 9. This list will be updated once the TNA has been conducted and training plan completed.

1.1.8 Conduct of Operations for Public Health Concerns

Efforts to address public health concerns will be intensified, particularly eradication of filaria; prevention and control of rabies, malaria, dengue, and schistosomiasis; and control of TB. The LGUs shall participate actively in social mobilization and advocacy. The LGUs will also provide the necessary drugs and medicines in addition to those provided by the CHD.

1.2 Strengthening of Technical Support Systems for Delivery of Services

The capacities built for services shall be coupled with the necessary support systems. It will be ensured that the existing technical support systems, i.e., the Therapeutic Committees, Executive committees and other technical staff will be continually active in performing their roles.

Component 2. GOVERNANCE The thrust of the governance component is rational delivery of local health services in a Local Area Health Development Zone. 2.1 Facility Rationalization and Mapping and Strengthening of Health Referral System The first subcomponent is to rationalize facilities such that each LAHDZ will contain a network of primary care, core referral, and end-referral facilities, where the desired package of basic and higher level of care will be most efficiently utilized. This entails a mapping of the facilities taking into account the existing capabilities,

48

geographic access to the facilities, and the distribution of the population. This can entail a re-clustering of the facilities and LGUs into different inter-local zones or LAHDZs. With the rationalized network of facilities, the existing referral system will then be reviewed. Providers will be trained and IEC will be conducted to ensure a strengthened implementation of the updated referral system. 2.2 Human Resource Planning and Strengthening of QA/QI programs among all facilities in a LAHDZ Human resource situation will be reviewed and necessary policies will be issued including those that can address availability of personnel at specific hours especially for pregnancy care concerns. Quality Assurance and Quality Improvement programs will be strongly implemented with the aim of improved competence of health staff in the delivery of health services, and a highly satisfied clientele. 2.3 Support for Contraceptive Self-Reliance Plan in All Municipalities With the withdrawal of contraceptive donations from USAID, it is imperative that LGUs undertake contraceptive self-reliance efforts if targets for population, contraceptive prevalence rate, and other related health indices are to be met. A province-wide contraceptive self-reliance (CSR) plan that aims for efficient and sustainable supply and allocation of family planning commodities has been formulated and is being implemented with the assistance of the LEAD Project of MSH. The commitment of all municipality LGUs is crucial for the success of CSR. 2.4 Enhancement of Public Finance Management

A review of the public finance management for health will be made to identify areas of improvement, particularly for internal control systems. The results are also expected to simplify and make more efficient the process flow of financial transactions. Furthermore, the procurement process is also expected to improve such that there will be low stock-out rates for essential commodities in the health facilities. 2.5 Establishment of and Capacity-Building for Provincial Health Resource Development and Information Center (PHRDIC) The PHRDIC shall be the “knowledge center for health, ” a repository of all health data and information, including disease surveillance data, the community-based management information system (CBMIS), and means tests and market segmentation information. It shall also manage the databank on profiles of service providers and health products.

49

It shall also develop and initiate innovations on information systems such as queries by text, and development of signages or information directories to be installed in the different communities. The PHRDIC shall also be responsible for the technical and technology aspects of information systems. It is proposed that this Center engage a technical assistance that can develop and install a program for a province-wide health information system that can address the current difficulties in the programs currently used, especially with the hospital software installed by the DOH. The PHRDIC shall ensure that all health advocacy and promotion concerns of the province are sustained. As holders of these important functions, it will be ensured that the PHRDIC will be provided with the necessary material resources, and its human resources will be provided with the necessary capacity-building for data banking, management information systems, and IEC from development of materials to conducting IEC activities. The figure below shows the proposed framework of the PHRDIC, where inputs are obtained from the various members of the health community, the PHRDIC formulates and implements information systems and plans, and results are communicated to the appropriate audience. Figure 4. Proposed Framework for the Provincial Health Resource Development Information

Center

Information/ Education Materials

PHRDIC Help

Directory

Plans

Disease Surveillance

NGO/ POS

Human Resource

Hospital Public Health

Consumer Products

Private Public Private Public FHSIS RSIS Botika Food Products Establish

ments

50

2.6 Segmentation of the Market A survey to segment the market according to its different characteristics such as income class, age, and other important groupings will be conducted to gain a full understanding of the clientele for health services. This will soundly back any plans on delivering health services, including user fees and subsidization schemes. 2.7 Updating of Local Health Accounts and Advocacy of Results The local health accounts will be updated to be able to analyze the patterns of financing health care in the province and determine whether the desired shares in health care spending is being achieved. Analysis will be made such as on the correlation of health care spending with the health status of the population, and on the adequacy and efficiency of public and private spending for health. It will also give indication of the returns on investment for health, e.g. whether the payment for PhilHealth premiums bring about considerable returns in terms of PhilHealth claims. The development of the LHA will have to be complemented with the advocacy of results such that the analysis will translate to policy formulation. 2.8 Capacity-Building for Institutionalization of Developed Systems, including M&E and Advocacy of Results Beyond local health accounts, results of monitoring and evaluation of the health systems will also be advocated for policymakers to translate these into policies and actions, and for the community to gain a better appreciation of the health systems and be on the look-out for their own health. Monitoring health systems will also utilize the local Government Performance Measurement System (LGPMS) that is administered by the DILG in monitoring the performance of the LGUs according to the standards set in the Local Government Code. It is important that key actors in installing the various systems will also have the know-how in institutionalizing these systems and making them sustainable and adaptable to change. This can be attained by undergoing study tours, seminars, and short courses for this purpose.

Component 3. FINANCING

The thrust of the financing component is improved access of marginalized population to affordable health services. Overall, the financing scheme aims for increased LGU spending for health, and increased share of health insurance and decreased share of out-of-pocket in health care spending.

51

It has to be noted that the improvement of facilities as described in Component 1 shall also contribute in achieving lower out-of-pocket spending since PhilHealth-enrolled indigents will be enticed to utilize the government facilities instead of private ones. It is assumed that the indigents will have no or very low out-of-pocket spending in government facilities beyond what is paid by PhilHealth for the services. 3.1 Allocation of Funds for PhilHealth Sponsored Program in the Yearly Budget The LGUs shall commit to allocate funds for enrolment to the PhilHealth Sponsored Program. The target is to enroll 64,785 indigent families by 2010 from the current enrollment of 11,272. The breakdown of target number of enrolled families and the corresponding LGU premium requirements is provided in Annex 10. 3.2 Establish Enrolment Centers for Informal Sector

The enrolment of the informal sector will also be promoted through the provision of space in hospitals where one can enroll in PhilHealth membership. This is seen to boost the enrolment of this sector which usually will not take the time to go to PhilHealth offices to enroll. The IPHO will also collaborate with PhilHealth in enticing private sector groups to sponsor PhilHealth membership of the members of the informal sector who have very limited capacity to pay for the premiums. 3.3 Inclusion of users fees for health services in the local tax revenue code in all LGUs The IPHO will push inclusion of user fees for health services in the local tax revenue code and its subsequent implementation. A study will first be made to set a graduated user fee scale that will charge according to a client’s capacity to pay, earn revenues for the facilities, and encourage clients to seek care at appropriate level of facilities. 3.4 Implement Revenue Retention in Health Facilities

The retention of revenues of government health facilities will be pushed. Revenue retention shall enable the facilities to plan on disbursements such that the common procurement and other logistical problems will be eliminated. The support of PhilHealth will also be engaged in advocating for the retention of hospital revenues from PhilHealth claims.

Deleted:

Deleted:

52

3.5 Capacity Development of Health Finance Implementers The implementers including accountants and administrative staff will be trained on the new financing systems that are implemented. These systems also include innovations in procurement and supply management.

Component 4. REGULATION

The regulation component aims that quality drugs and medicines are available at affordable prices in all government health facilities. 4.1 Engage support of BFAD in the development of a Quality Assurance Program on procurement, sampling, proper storage, and awareness

Linkages with BFAD will be strengthened and all the necessary assistance will be engaged in the various aspects of drug management. 4.2 Engage support of Task Force Kalusugan in the compliance of establishments to quality seals for products and services and other health regulations Linkage with the Task Force Kalusugan will likewise be strengthened to intensify implementation of health regulations. As described in the previous chapter, the Task Force Kalusugan is composed of different regional and local agencies and support groups, and aims to ensure delivery of public health services as mandated by national and local ordinances. 4.3 Expansion and Sustenance of the Drug Revolving Fund The Revolving Drug Fund will be expanded through the setting up of more Botika ng Barangay. Increased participation of the LGUs in Pharma 50 will also be solicited to be able to set up the BnBs and expand and sustain the revolving drug fund base. Effective financial management and highly efficient operations will be consciously strived for such that income from the BnBs can provide for contracting the necessary pharmacists.

4.4 Compliance and Sustenance of Health Facilities to Sentrong Sigla and PhilHealth standards

Efforts for all RHUs to be SS-certified at Phase 2 Level 2 and Philhealth-accredited will be coupled by monitoring and self-assessments to sustain these and thus ensure continuing quality and affordable services in these facilities.

Comment [LAM3]: There seems to be a missing paragraph here.

53

VI. LOGICAL FRAMEWORK FOR MONITORING AND EVALUATION Given the objectives and the program components, implementation will be compared against the following results framework. This will be incorporated with the M & E system that will be set for the Fourmula ONE for Health convergence sites. Overall Goal: It is the overall goal of the South Cotabato Provincial Health Organization to contribute to the improvement of health status by ensuring access to basic health services that is efficiently and effectively delivered to its population, especially the mothers and children, the socio-economically marginalized and other vulnerable groups and to achieve health related Millennium Development Goals Table 15. Logical Framework for Monitoring and Evaluating the PIPH

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

Component 1. SERVICE DELIVERY o Health delivery set-up is

rationalized o Zones are set up and are

providing equitable access to populations in the facilities

o Two-way referral is internalized

o Diagnosis are recorded in ICD 10

o Primary hospitals are strengthened and capable of providing emergency obstetric care

o Facilities are PhilHealth-accredited and utilized efficiently

Subcomponent 1.1 Capacity Building for:

Disease-free initiatives on

o Reduced no. of cases of leprosy

and filariasis

o No. of cases of

leprosy and filariasis

o HMIS/RHIS

54

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

leprosy and filariasis Reduction and control of

malaria, dengue, schistosomiasis, rabies

Intensification of TB control

Healthy lifestyle initiatives Reproductive

Health/WH/SM/FP Management of Common

Childhood Illnesses Emerging health concerns:

HIV/AIDS, Bird’s flu, SARS, Meningococcemia, man-made calamities and terrorist activities.

o Reduced cases of malaria,

dengue, schisto, rabies

o Improved TB cure rate o Improved case detection and

case holding for TB o Improved health knowledge and

health-seeking behavior

o Reduction of FP unmet needs

o More women giving birth in facilities, less in homes

o More men and women seeking

RH counseling and services

o Reduced Infant and Under 5 mortality rates

o Improved primary health care

services

o Increased participation of allied agencies

o Immediate and quick response to

emerging diseases, disasters, and calamities

o reduced cases of preventable

diseases in the hospitals

below incidence indeces

o No. of cases of malaria, dengue, schisto, rabies in a downward trend

o TB cure rate higher than baseline

o TB case detection rate higher than baseline

o utilization rate of facilities

o no. of support groups in LGUs

o % of MWRA with FP unmet needs

o % of pregnant women giving birth in facilities, in homes

o Rate of Infant Death and Under-5 Mortality in a reducing trend

o No. of men and women

seeking RH counseling and services

o no. of clients undergoing consultation and counseling in RHUs

o no. of allied agencies involved in public health activities

o Response time within ideal standard

o NTP Cohort/RHIS o Inventory report of

Supportive drugs for disease free and reduction control measures of priority programs

o Client lists and Individual treatment records

55

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

o No. of cases given timely response

o Appropriate referral guidelines

o No. of admissions due to preventable diseases

Subcomponent 1.2 Strengthening of Technical Support Systems for Delivery of Services

o Efficient and coordinated activities practiced at each level of health care

o Improved awareness and

participation of the community on government health programs

o No. of meetings with quorum

o No. of cases of technical assistance/support rendered

o No. of allied groups providing support

o PESU/CESU/MESU report

o RHIS report

Component 2. GOVERNANCE

o Rational Delivery of local health services in a Local Area Health Development Zone

Subcomponent 2.1 Facility Rationalization and Mapping and Strengthening of Health Referral System

o Rational use(right illness consulted and treated at the appropriate level) of facility

o Increased utilization o utilization rate o Utilization of specific

services at each level of facility

o RHIS reports

Subcomponent 2.2 Strengthening of QA/QI programs among all facilities in a LAHDZ

o Improved satisfaction of clients

o Improved recovery rate

o Utilization rate o Rating in patient

satisfaction survey/evaluation forms

o Recovery rate in facilities

o Patient Satisfaction survey o Health Statistical Report o PES

56

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

Subcomponent 2.3 Support for Contraceptive Self Reliance Plan in all Municipalities

o Reduced unmet need o Sustained availability of FP

commodities

o Rate of unmet need, current users

o Stock-out rates o Budget for FP

commodities

o CBMIS survey o Commodity Procurement

Report o Supply Status Report o Fund Utilization Report

Subcomponent 2.4 Enhancement of Public Finance Management (internal control systems)

o Improved process flow/tracking of transactions

o Improved procurement

o Transaction time o Stock-out rates of

drugs, medicines and other health commodities

o Audit Report o Procurent reports

Subcomponent 2.5 Establishment of and Capacity-Building for Provincial Health Resource Development and Information Center (PHRDIC)

o A well informed community on

health programs due to relevant and timely information

o Plans properly prepared with more reliable information available

o Improve utilization of

health facilities o Activities and

interventions implemented as planned

o No. of IEC materials

developed and distributed (including FAQ sheets, website postings)

o No. of communication modes utilized (web, text, etc.)

o Presence of signages and information directories in communities

o No. of FAQs and queries attended and responded

Subcomponent 2.6 Segmentation of the Market

o An efficient allocation by the govt. by spending more in providing public health goods and services and equity where health care needs of the poor are

o Allocation of commodities and services are appropriately prioritized and

o PHIC reports o Availability of master list

of marginalized and vulnerable groups

o Ordinances on user fees

57

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

adequately provided

sustained o Health packages that

are responsive to different population groups

o User fees are appropriately priced

o Ordinances pertaining to catering to marginalized groups

Subcomponent 2.7 Updating of Local Health Accounts and Advocacy of Results

o Efficiency in health budget utilization

o Well-informed policies regarding health care financing and expenditures

o Transparent sources and utilization of health resources

o Buy-in of LCEs on proposed policies based on results of LHA

o Increased share of health expenditures in LGU budgets

o Availability of updated local health account information

o Presentation of LHA results to LCEs and other policy makers

o Budget for health o Legislation of, or signed

MOAs regarding, proposed policies

Subcomponent 2.8 Capacity-Building for Institutionalization of Developed Systems, including M&E and Advocacy of Results

o Well-informed policies based on M&E results

o Buy-in of LCEs on proposed policies based on results of M&E

o Increased appreciation of LCEs of health indicators

o M & E plan implemented

o Legislation of, or signed MOAs regarding, proposed policies based on M&E results

Component 3. FINANCING o Improved access of marginalized population to affordable health services

58

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

Subcomponent 3.1 Allocation of Funds for PhilHealth Indigent Program in the Yearly Budget

o Increased enrolment to PHIC o Increased utilization of health

facilities by the informal sector

o Increased LGU budget for health

o Enrolment of Indigents in PhilEHalth Sponsored Program

o Utilization rate by informal sector

o Approved annual budget o Audit report

Subcomponent 3.2 Establishment of Enrolment Centers for the Informal Sector

o Increased enrolment to PHIC of IPPs

o Increased utilization of health facilities by the informal sector

o Enrollment of Informal sector

o Utilization rate by informal sector

o PHIC report

Subcomponent 3.3 Inclusion of users fees for health services in the local tax revenue code in all LGUs

o Improved revenue generation of Local Government Units

o Appropriate utilization of facilities (as a result of graduated fees)

o revenues from facilities

o utilization rate by income class

o Available Resolutions and Ordinances relative to membership to PhilHealth

o Treasurers report

Subcomponent 3.4 Implement Revenue Retention in Health Facilities

o Quality service in hospitals o Improved commodity and

logistics stock o Increased PhilHealth share in

Hospital expenditure

o Hospital improvements financed through retained revenues

o Stock-out rates of drugs, medicines, and other essential commodities

o Share of PhilHealth in hospital expenditures

o hospital care expenditure increased from 7% to20%

o Audit Report o Procurement Report o Supply delivery report

59

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

Subcomponent 3.5 Capacity development for health finance implementers

o Efficient fiscal management o Improved policies for health

financing

o Established measures for cost-efficiency

o Implemented Health Finance Policies

o Stock-out rates of drugs, medicines, and other essential commodities

o No. of ordinances or AOs on health financing

Component 4. REGULATION

o quality drugs and medicines are available at affordable prices in all government health facilities

Subcomponent 4.1 Engage support of BFAD in the development of a Quality Assurance Program on procurement, sampling, proper storage, and awareness

o Improved LGU procurement systems, sampling, proper storage of drugs

o Improved monitoring of quality and prices of drugs

o LGU procurement plan properly implemented

o Stock-out rates of drugs

o Prices of drugs

o Procurement plan o BFAD report o Drug-price monitoring

Subcomponent 4.2 Engage Support of Task Force Kalusugan in the compliance of establishments (retailing stores/stalls/supermart) to quality seals for products and services and other health regulations

o Reduced proliferation of substandard and counterfeit drugs in the market

o Reduced violators of laws on drugs, i.e., Pharmacy Law, Generics Act, PNDF, etc.

o No. of reports of counterfeit/fake and substandard drugs

o No. of reported violators of laws on drugs

o No. of products and

o Task Force Kalusugan Report/BFAD report

60

COMPONENT/KEY OUTCOME VERIFIABLE INDICATORS MEANS OF VERIFICATION

services with product seals

o No. of complaints about products and services

Subcomponent 4.3 Expansion and Sustenance of the Drug Revolving Fund

o Increased participation of LGUs to Pharma 50

o Sustained drug revolving fund

o BnBs Operational o BnBs supported by

revolving drug fund

o BFAD report o No. of operational BnBs o No. of BnBs supported by

revolving drug fund

Subcomponent 4.4 Compliance and sustenance of health facilities to Sentrong Sigla PhilHealth standards.

o Sustained delivery of services based on SS+ Quality standard

o Sustained PhilHealth-accreditation

o Upgraded SS-certification to Phase 2 Level 2

o No. of PhilHealth-accredited and Phase 2 Level 2 SS-certified facilities

VII. PIPH COSTS The implementation of the PIPH would cost P321 million over the next five years (Table 16). More than half of this will be spent for service delivery, while more than 30 percent is comprised by the financing component largely due to the PhilHealth premium contributions. The combined spending of the municipal LGUs comprise almost half of the total cost (Table 17), as more than 70 percent of the total cost consists of maintenance and operating expenses. The MOOE consists of PhilHealth premium payments, technical assistance, training, and maintenance and supplies for facilities. The assumptions used in deriving the costs are in Annex 5. Detailed cost tables, on the other hand, are in Annexes 6 to 10.

61

VIII. PROGRAM MANAGEMENT A Program Management Support Unit (PMSU) will oversee the timely and cost-effective implementation of this five-year PIPH. The unit will be provided with the necessary facilities, equipment, and supplies. Its personnel will also undergo the necessary capacity-building activities to manage this unit. Figure 5. Proposed Organization of the Program Management Support Unit

Terms of References: A. Project Executive Director – 1. Coordinates with Program Donors 2. Oversees the over all implementation of the program in the province 3. Sets program implementation directions 4. Calls and presides over Project Implementation meetings 5. Reports directly to the national office

Program Executive Director GOV. DAISY P. AVANCE FUENTES

Program Coordinator (IPHO-PHO)

EDGARDO R. SANDIG, MD,

EPHB EXPANDED FINANCE

COMMITTEE

PMSU

62

B. Expanded Provincial Health Board – 1. To propose to the Sanggunian concerned, in accordance with standards and criteria set by the Department of Health, annual budgetary allocations for the operation and maintenance of health facilities and services within the municipality, city, or province as the case may be 2. To serve as an advisory committee to the Sanggunian concerned on health matters such as, but not limited to, the necessity for, an application of, local appropriations for public health purposes. 3. Consistent with the technical and administrative standard of the DOH, creates committees which shall advise local heath agencies on matters such as, but not limited to, personnel selection and promotion, bids and awards, grievances and complaints, personnel discipline, budget review, operations review and similar functions. C. Expanded Finance Committee – 1. Provides ways and means for the program implementation 2. Improves public expenditure and public finance management 3. Develops guidelines and policies for allocation and use of grant funds 4. Advocates enrolment into PhilHealth 5. Strengthens financial management capacity 6. Supports the full development of Organizational Performance Indicator Frameworks (OPIF) at the IPHO 7. Provides assistance to the formulation of IPHO Medium Term Expenditure Framework/Medium Term Investment Plan and its linkage to the provincial Development Alternative Framework 8. Provides Incremental Operating Costs for project management, its miscellaneous expenses and additional technical staff if the magnitude of the work so requires it. 9. Drafts guidelines for fund access by the MLGUs and other departments especially the IPHO 10. Strengthens procurement, logistics and warehousing capacity 11. Supports the development of standard technical specifications for medical supplies, equipment and drug procurement 12. Facilitates procurement of the above 13. Provides technical and engineering support to constructions and rehabilitation works of the program D. Project Coordinator – 1. Lead Department for the Implementation of the Program 2. Coordinates the implementation of the program with all the Stakeholders 3. Provides Policy guidance and coordination between all departments and groups involved in the program. 4. Reviews the costed Integrated Provincial Plan and corresponding Annual Operating Plan

63

5. Reviews reform and spending priorities to improve provision of basic health services 6. Facilitates policy dialogue with the respective municipal LGUs and other Stakeholders 7. Recommends and Reports to the Project Executive Director 8. Directs the Program Implementation Unit E. Program Implementation Unit – The PIU shall be composed of technical personnel from the provincial government with direct relationship with the implementation of the program. The IPHO Health Development and Management System Office (IPHO- HDMSO) shall be the Lead Office of the PUI. 1. Under direction of Program Coordinator, coordinates all activities as agreed by the Program Executive Director, EPHB, Expanded Finance Committee and the Program Coordinator. 2. Handles the Monitoring and Evaluation of the Program 3. Facilitates the preparation of procurement and acquisition of logistics 4. Provides technical inputs for inter LGU cooperation, inter department 5. Prepares Reports to the Program Coordinator. a. Reports on the financial aspects of the budget support operation b. Reports regularly on the technical performance and the financial aspects of the programme, according to a standard format c. Annual report synthesizing field reports and presenting reform developments to the provincial level. 6. Designs system development and capacity building.