Health as an Instrument Towards National Development

Youth Leaders for Health Conference October 24-26, 2013

Antipolo City

The Office of Senator TG Guingona

Session GoalTrends in health to anchor your initiatives. -> serves as an entry point in developing an agenda

Health and poverty are intimately connected. -> health a factor in poverty alleviation

Health is a complex issue which require leadership and technical solutions. -> a perspective that enable us to develop strategies that work.

Some things I have learned that work.-> pick up a few practices & strategies for your initiative

You need to see your work of promoting health as part of National Development

Our Public Health Context

Devolution of the Philippine Healthcare System in 1991

Fragmentation of Health Services

Inequities in Health Outcomes

Rich Urban

Poor Rural

Life expectancy >80 yrs. < 60 yrs.

Maternal Mortality Ration

<15 >150

Skilled Birth Attendant

92.4% 25.1%

MayorKey in

Improving the System

Health Responsibility in Devolved System

Government Policy & Spending

Systems Development

People Participation

how do we improve health?

Out-of-Pocket Spending

Thailand

Philippines

India

Malaysia

World

Source: World Bank

Public Health Expenditure

Source: World Bank

What are the current health needs of the country?

unhealthy statistics

Pneumonia Incidence

2001 2008 2010

652,000 Cases

780,000 Cases

Expected to be top 10 in the world

Philippines

18% of under 5 years old deaths due to pneumonia Top 2 leading cause of death over 60 yrs. old

unhealthy StatisticsSenior Statistics Survey

79 Barangays, 9,000 Seniors

Hypertension Diabetic

25% Hypertensive

40% Pre-hypertensive

15% to 20% range suffer from

Type 1 & 2 diabetes

WHO & NSO estimates

6.1% of population will be diabetic by

2030

DOH & DSWD estimates

that senior population will be at 10% by

2030

Senior health needs are inevitable

healthy Statistics

Philippines Thailand Malaysia Singapore

99 deaths per 100,000 live births in

2010 down from 170/100,000

in 1990’s

64 deaths per 100,000 live births in

2010 down from

54/100,000 in 1990’s

29 deaths per 100,000 live births in

2010 down from

53/100,000 in 1990’s

3 deaths per 100,000 live births in

2010 down from

6/100,000 in 1990’s

MDG Goal 55 deaths/100,000

live births

*source: CIA world factbook unfpa.org

41.7% 18.5% 45.2% 50.0%

Top 3 PhilHealth Claims 1st Quarter of 2011

Pneumonia 79,631

Chronic Renal Failure 68,739

Single Normal Spontaneous Delivery 55,519

Philhealth reduces out-of-pocket expenses at the same time it can serve as an instrument for PARTICIPATION.

PhilHealth Utilization

In District 3, Quezon City, only 17 people used PhilHealth out of the 600 we enrolled.

Philhealth reduces out-of-pocket expenses at the same time it can serve as an instrument for PARTICIPATION.

Participation leads to learning which changes behavior and improves the demand for health. This is key in

addressing the complexity.

Preview of Health Complexity

High Income/Urban Areas

Low Income/Rural Areas

Life expectancy at birth >80 <60

Infant Mortality Rate <10 >24

Maternal Mortality Ratio <15 >150

Disease & Health Burden of the Poor

Dr. Jaime Galvez-Tan, Former DOH Secretary

Health Complexity

47.9%

14.4%

1.8% 2.3%

19.1%

34.6%

46.9%42.7%

No#education# Elementary# High#School# College#

Vaccinations#

With%no%vaccinations%

Percentage%of%children%who%received%vaccines%

2008 NDHS* Report on Vaccinations of Children and their Mother’s Educational Attainment

Health Complexity

18.5%

45.3%53.2% 53.1%

81.5%

54.7%46.8% 46.9%

No%education%% Elementary%% High%school%% College%%

Contraceptive%Use%%

Use%of%any%Contraceptive%method% Not%currently%using%any%

2008 NDHS Report on Use of Contraception by Women of Reproduction Age and their Educational Status

Health Complexity

44

80.4 94.1 97

34.2

68.9 79.5 74.5

No Education Elementary High school College

Antenatal Care Trends

Percentage of women whose last live birth was protected against neonatal tetanus

Percentage of women with antenatal care from a health professional

2008 NDHS Preliminary Report on Maternal Care Indicators and their Relationship to Mothers’ Education

Health Complexity

2008 NDHS Report on Knowledge of Women of Reproductive Age of AIDS and their Educational Status

40.3%

84.1%96% 99.4%

No#education# Elementary# High#School# College#

Knowledge#of#AIDS#Percentage%of%women%who%have%heard%of%AIDS%

Supply & DemandHEALTH

LEADERSHIP AND GOVERNANCE

• Municipal Accountability • Barangay Accountability • Coaching, Mentoring and

Monitoring

DEMAND SIDE • Health Seeking

Behavior

SUPPLY SIDE • Human Resource •  Facilities • Medicines •  Innovative Programs

STRENGTHEN

ENHANCE INCREASE

HEALTH EMPOWERMENT AND ENTITLEMENT

EDUCATION QUALITY AND

RESPONSIVE HEALTH SERVICES

INCREASED UTILIZATION OF RELEVANT HEALTH PROGRAMS

AND SERVICES

Improved Health Indicators

Where is leadership in addressing this?

We need to position our initiatives to create a generative understanding of the complex

health issues in order to increase participation and ownership.

!We need to create engagement opportunities that enable people to discover their roles in the health development agenda and enable

them to see themselves fulfilled in accomplishing these roles.

What have I learned?

How have we done this?Let me tell you some of my stories that engage people.The Office of

Senator TG Guingona

San Isidro Story

Learning BHW Development

Building Accountability from the Ground-up

From: Political Appointees

LUISA L. IMBAG President of BHW & KaLiPi

BL Advocate

“NOON, inuutos ko ang pagsunod sa programang galing sa itaas. Maraming

intriga at reklamo, magulo ang talakayan at natatapos ang meeting ng

walang saysay.”

“NGAYON, ang meeting lahat ay nagmumungkahi at naka-focus na sa

programa. Ang mga issues related na sa program. Masaya ang mga BHW kasi may

solusyon na.”

“Nakagagawa na kami ng plano para sa susunod na

activities. Ipinaglalaban namin ang aming ginagawa.

MAY BOSES NA KAMI”

To: Program Advocates

LUISA L. IMBAG President of BHW & KaLiPi

BL Advocate

San Isidro Story

Maternal & Infant Mortality went to zero for a long time

Household income increased

Tax revenue increased

What happened?

San Isidro Story

When we strengthen frontline leaders, we deepen health ownership

and improve our program output.

What have I learned?

Kalusugan ni lolo at lola

Leadership in health is about empowerment.

!Ang ibig sabihin nito, ay ang pagbibigay ng halaga sa tao sa pagtugon sa

sariling kalusugan.

KN Senior Wellness Program

Engaging the Barangay Leaders and Seniors

KN Senior Wellness80-90% coverage of seniors in 79 Barangays, about 9,000 seniors engaged

Regular checkups to 4,500 seniors

Lifestyle change in our seniors

What happened?

KN Senior WellnessWe need to set regular, repetitive engagements to shift the existing mental models. These are action-

reflection venues that create transformative learning.

These venues deepen ownership and enable personal accountability.

What have I learned?

Quezon City Story

What happened?

The RH Dialogue

Health Leaders for Mothersa maternal health development initiative

MMR was zero for 2012 in District 3 In facility birthing and Pre-natal checkup went up

Quezon City Story

What have I learned?

Health Leaders for Mothersa maternal health development initiative

We need to go beyond the debate and establish areas of

deeper understanding.

What I do now.

Health Leadership & Governance Program

Engaging DOH Regions, Mayors, & Governors towards Primary Health Development

Bridging Leadership driven Public Health Development to address inequities

WHO 6 building blocks to improve Health Systems

Health Leadership & Governance Program

We need to strategically engage government to create

deeper change.

Engaging DOH Regions, Mayors, & Governors towards Primary Health Development

Bridging Leadership driven Public Health Development to address inequities

WHO 6 building blocks to improve Health Systems

What have I learned?

Finding a new kind of leadership

Region 11 DOH CHD Leadership Workshop

DOH Regional Director Dr. Abdullah "Okang" Dumama Jr. Keynotes the

leadership workshop of DOH Region 11.

"We cannot just be maintainers. HLMP* for the poor means we exercise our different ways to

lead to help the poor. Sometimes leaders tayo, sometimes followers

but we need to create new arrangements to improve health."

*HLMP - Health Leadership & Management for the PoorHealth Leadership & Governance Program