local health systems development (shared using visualbee)
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Local Health Systems DevelopmentStrengthening the Building Blocks of Your Local Health System
Presented by Bien Nillos, MDProject Associate
Zuellig Family Foundation
Objectives
o To discuss the explicit processes of basic sub-systems that would improve the Municipal Health System as a whole
o To draw insights from successful technical innovations and emerging “best practices” in public health care that can be replicated/adopted.
o To identify roles, contributions and leadership development plans in support of the achievement of identified objectives and outcomes
What Is A Local Health System
o “All the activities whose primary purpose is to promote, restore or maintain health.” (WHO, 2000)
o “It involves the formal health services…as well as traditional healers…health promotion and health enhancing interventions … encompasses several political and civil organizations.”
What are the Functions of a Local health system?
o Financingo Organization and
deliveryo Regulationo Stewardshipo Ability to modify
consumer and provider behavior through persuasion
o Ethics and values
“A health system, like any other system, is a set of inter-connected parts that must function together to be effective. Changes in one area have repercussions elsewhere. Improvements in one area cannot be achieved without contributions from the others. Interaction between building blocks is essential for achieving better health outcomes.”
Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources.Question: Among the tri-leaders, who takes
responsibility of this building block?
Health Services
o The actions and decisions of health managers influence many things:o where facilities are locatedo when they are openo how they are staffed, funded
and equipped o the range of services provided
including support services and outreach activities
o use of treatment protocols and guidelines
o use of quality systemso referral mechanisms between
different services and at different levels of the system.
o In many developing countries, people who have the responsibility to manage service delivery often may not have any, or very much, management training.
o Training to be a doctor, a nurse or a pharmacist, usually does not include how to manage finances, or staff, or how to institute major changes.
Question: Cite one example of an actual experience regarding your struggle/challenge in this building
block
“A well-performing health workforce is one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances.”Question: Among the tri-leaders, who
takes responsibility of this building block?
Health Workforce
Health workers are INDISPENSABLE - the cornerstone of health care delivery system, influencing access, quality and costs of health care, and effective delivery of interventions for improved health outcomes, including progress towards the achievement of the health Millennium Development Goals and Health For All.
Checklist
o Do I have enough workforce?
o Are they distributed equitably?
o Are they well-trained/well equipped?
o Are they well compensated?
o Are they accountable/responsible?
Question: Cite one example of an actual experience regarding your struggle/challenge in this building
block
“A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status.”
Question: Among the tri-leaders, who takes responsibility of this building block?
Health Information System
“(We) still use a wide range of data collection and analysis tools, some of which collect the same data. An increasing volume of data is available, but coverage and quality are variable. Linking information to policy-making at the national level remains a critical, but elusive, goal. “
The Story of Bago City, Negros Occidental
Bago CHO visited Paranaque City to observe their Epidemiology and Disease Surveillance Unit.
In Oct. 2000, workshop conducted among CHO staff, identified diseases to be monitored and the needed surveillance personnel
Question: Cite one example of an actual experience regarding your struggle/challenge in this building
block
Access To Medicines/Equipments
“A well-functioning health system ensures equitable access to essential medical products , vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.”
Question: Among the tri-leaders, who takes responsibility of this building block?
“There are indeed several factors that will contribute to the success of operating the BnB. While there are available funds to finance the operation of a BnB, the management capability of operators, the support and role of local government units, the efficient mentoring, monitoring, and supervision of concerned government agencies, and the support and consciousness of the people are key elements of a successful BnB operation.” (ZamboTimes, Oct. 2010)
The Botika ng Barangay Case Story
“A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them.”Question: Among the tri-leaders, who takes responsibility of this building
block?
Health Financing
Sustainable
healthcare financing
for the poor
Accredited health facility
Trained and patient-centered
health workers
Available essential
medicines, products and technologies
Established referral system
Instituted social marketing strategy
(to improve health-seeking
behavior)
Established information system to
identify the poor
PhilHealth enrollment of
the poor
Outpatient Benefit Package
Assumption (hypothetical case)Population 26,616Number of Household (HH) 4,871Estimated Number of Indigent Household (HH) (25%)
1,218
Computation TotalLGU premium(No. of enrolled HH* P120/HH)
P146,160
Capitation(No. of enrolled HH* P300/HH)
P365,400
LGU net gain P219,240
Package ReimbursementsMaternal Care Package (P6,500-delivery)(P1,500-prenatal care)
P8,000.00
Newborn Care Package P1,750.00
Sample Calculations Reimbursements
Average number of deliveries in a year Philhealth reimbursements for MCP (100 x 8,000 pesos)Newborn Care reimbursements (100 x 1,750 pesos)
100800,000.00
175,000.00
Gross Revenue for LGU 975,000.00 annual
Strategies to make your TB DOTS generate revenue:1. Active Case Finding2. TB for children3. DepEd collaboration
Sample Calculation for TBDOTS ReimbursementsNew TB cases detectedPhilhealth reimbursement/new case
104,000.00
End-of-course LGU total gross revenue
P40,000.00
Steps
1. Identifying the True Poor2. Setting an allocation for their
enrolment3. Investment in facilities and Skills
training4. Accreditation of Facilities and
Personnel5. Passing of a Philhealth Capitation
Fund Ordinance6. Establishing a Monitoring
Team/Philhealth Committee
Question: Cite one example of an actual experience regarding your struggle/challenge in this building
block
Health Leadership and Governance
Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system-design, and accountability.
Governance is responsible attention to something entrusted to one's care. In the context of health it refers to the wide range of functions carried out by governments in their work to achieve national health goals to improve population health while ensuring equity in access to services, quality of services, and patients' rights.
Question: Cite one example of an actual experience regarding your struggle/challenge in this building
block
To Make a Local health system that is…
o Effective – doing the right things
o Efficient – doing things right
o Equitable – pro-poor and fair
o Empowering – active ownership, participation, transparent decision-making
Question: Is my current local health system effective? Efficient? Equitable? Empowering?
Question: Of the 6 building blocks of a local health system, where should I focus my energies/investments more in order to gain my desired positive health outcomes for my community?
“Always remember that the future comes one day at a time.” – Dean Acheson