dr. yolanda e. oliveros mph mhsa director iv national center for disease prevention and control

Bringing Health Reforms to the Next Level : Recommendations on Service Delivery for Public Health Development Program

Dr. Yolanda E. Oliveros MPH MHSADirector IV

National Center for Disease Prevention and Control

12th National Health Sector MeetingManilaNovember 4-5, 2009

Objectives for Health Reforms

– Promote Equity– Enhance Effectiveness– Improve Efficiency– Nurture Responsiveness– Increase Sustainability

Objectives for Reforms

1. Enhance Effectiveness – outputs and results achieved by the health system and its impact on the health of the population.

Objectives for Reforms

2. Improve Efficiency – maximizing the PH benefits through the best use of existing resources.

Technical Efficiency- “ doing things right”Allocative Efficiency –” doing the right things”

Objectives for Reforms

3. Promote Equity - increasing access for and utilization by marginalized populations by focusing on health concerns/diseases of poverty, or through other means.

“ Health For All ”

Objectives for Reforms

4. Nurture Responsiveness – there are variations in health status, health seeking behavior, health care preferences and quality perceptions requiring nurture context- specific approaches to health service delivery.

Objectives for Reforms

5. Increase Sustainability – sustained financing, institutional building of the public health system, and sustained demand for quality service.

RECOMMENDED AREAS FOR ACTION TO ENHANCE EFFECTIVENESSA. POLICY OPTIONS• Consistent with the MDG

commitments, policy development must take into consideration, country’s capacity to effectively deliver health services

RECOMMENDED AREAS FOR ACTION TO ENHANCE EFFECTIVENESS

A. POLICY OPTIONS1. MDG 4 and 5 a. MNCHN Policy localization- facility upgrading/capacity/functionality

- skills development - appropriate staffing - adequate financing - demand generation

RECOMMENDED AREAS FOR ACTION TO ENHANCE EFFECTIVENESS

A. POLICY OPTIONS2. MDG 6

a. Pursue disease-free zone initiatives and institute strong disease surveillance mechanism (LQuAS)

• Drugs for MDA and treatment must be funded by the national government

RECOMMENDED AREAS FOR ACTION TO ENHANCE EFFECTIVENESS

A. POLICY OPTIONS2. MDG 6

b. Multi-year budgeting to pursue reduction of priority diseases such as TB, HIV-AIDS, Dengue, emerging infectious diseases, VPD

• Financing support clearly identified• Procurement gap avoided

RECOMMENDED AREAS FOR ACTION TO ENHANCE EFFECTIVENESS

A. POLICY OPTIONS 3. MDG 7 a. Water, Sanitation and Hygiene - Water Roadmap - Sanitation Roadmap - P1.5B fund for waterless municipalities - Revisiting Sanitation Code

RECOMMENDED AREAS FOR ACTION TO ENHANCE EFFECTIVENESS

A. POLICY OPTIONS4. MDG Max :Lifestyle Related Diseases a. disease registry b. service delivery package c. regulatory mechanism d. financing mechanism e. health promotion package

RECOMMENDED AREAS FOR ACTION

A. POLICY OPTIONS

Development of service delivery package appropriate for each level of health care facility focusing on life cycle approach and special groups of population

RECOMMENDED AREAS FOR ACTION

A. POLICY OPTIONS Development of a Quality Assurance

Mandatory Mechanism for Public Outpatient Facilities (RHUs/BHS)

• Input, Process• Patient and Staff Safety• Service Excellence

RECOMMENDED AREAS FOR ACTIONA. POLICY OPTIONS Mainstreaming Climate Change

Adaptation and Mitigation in Health Program Development and in Health Emergency Preparedness and Response

RECOMMENDED AREAS FOR ACTION

A. POLICY OPTIONS

Health Promotion Foundation? Essential and timely

information for effective policy and decision making

RECOMMENDED AREAS FOR ACTION

A. POLICY OPTIONS Development and Dissemination

of Updated National Standards with Professional Societies Endorsement for Public and Private Health Providers’ Use

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE1. Capacity Development of DOH for

Emerging New Roles and Functions in Facilitating the Health Reform Initiatives particularly in Leveraging Resources for Health Outcomes and Local Health Systems Development

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE2. Restoring province wide operation

system in addressing health needs and reducing health status disparity among its municipalities. DOH to support identified interventions by the province.

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE

3. Reinforcing the Technical Leadership of DOH Central Office and CHD as Health Expert/ Management Specialist

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE

4. Technical Leadership for Health of DOH could also mean Capacity to Build and Transfer Technology to other Stakeholders (LGUs, Academic institutions, NGO’s, CS)

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE

5. Health Promotion Strategies have to be localized and risk communication capacity must be strengthened

6. Surveillance system (clinical, laboratory, community-based, event based)

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE

7. Service delivery package in the workplace, school, prison, institutions, etc

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE

8. Contracting of Technical and Management Services to Private Sector ( e.g. Vaccinator, Malaria Household Spraying, Diagnostic Services, Training, Facility Design, etc.)

RECOMMENDED AREAS FOR ACTION TO IMPROVE EFFICIENCY

A. POLICY OPTIONS

1. Investment Plan for Public Health harmonizing all sources of funds including identification of programs that require multi-year budgeting

2. Performance Based Budgeting for Public Health including Performance Based Grants to LGUs

RECOMMENDED AREAS FOR ACTION

A. POLICY OPTIONS

3. Enhancement of PHIC Benefit Package for PH, Out Patient and Package for Catastrophic Diseases

RECOMMENDED AREAS FOR ACTION

A. POLICY OPTIONS4. DOH Exemption from the $100,000

Central Bank Ceiling for Dollar Payment to Facilitate the Most Economical International Procurement Process

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE 1. Improvement in the organization of

PH program packages ( services, logistics, skills/availability of providers)

2. Central procurement of PH goods using the most cost-effective and advantageous mode

RECOMMENDED AREAS FOR ACTION

B. PROCESSESS/STRUCTURAL CHANGE 3. Reviewing the current PHIC

benefit packages and improve promotion of these packages to increase utilization

RECOMMENDED AREAS FOR ACTION TO ENSURE EQUITY

A. POLICY OPTIONS

1. Development of a Customized Facility Mechanism in Providing Technical and Logistic Support to ARMM for Improved Health Outcomes

RECOMMENDED AREAS FOR ACTION TO ENSURE EQUITY

A. POLICY OPTIONS2. Addressing the needs of special

population such as the disabled, the adolescents, the indigenous people, the elderly, people in difficult circumstances , urban and rural poor

RECOMMENDED AREAS FOR ACTION TO ENSURE EQUITY

A. POLICY OPTIONS3. Inclusion of RH commodities such as

contraceptives as PH goods4. Health human resource production,

recruitment, distribution and retention (HHR Master Plan)

RECOMMENDED AREAS FOR ACTION

A. PROCESSESS/STRUCTURAL CHANGE

1. Strengthening the Health Service Delivery Network of Public and Private Health Providers under provincial health system to Ensure Access and Availability of Quality Health Services. The Province with the CHD, shall lead the assessment and support for its establishment

RECOMMENDED AREAS FOR ACTION

A. PROCESSESS/STRUCTURAL CHANGE

2. Targeting government subsidy to the marginalized groups with unmet needs

RECOMMENDED AREAS FOR ACTION TO NURTURE RESPONSIVENESS

A. Process/Implementation

1. Support for Internally Driven Continuing Quality Improvement Initiatives of Health Facilities Featuring Strong Customers’ Participation in this Endeavour.

2. Restore Primary Health Care Approach

RECOMMENDED AREAS FOR ACTION TO NURTURE RESPONSIVENESS

A. Process/Implementation

3. Client centered policy development and implementation

RECOMMENDED AREAS FOR ACTION TO ENSURE SUSTAINABILITY

A. POLICY OPTION1. Financial support and resource

mobilization for priority health programs (MDGs)

2. LGU financing reforms3. Private sector share in health

financing 4. Social health insurance

RECOMMENDED AREAS FOR ACTION

A. Process/Implementation1. Nurture partnership with

stakeholders to establish collaboration and networking

2. Incentive mechanism for health workers

3. Local Health System strengthening4. Regional Capacity Building Initiative