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Deepening Local Government Unit Engagement towards Healthier Communities:
Will the poor have better health prospects under the Duterte administration?
Ernesto D. GarilaoPresident
Zuellig Family Foundation
BringingHealthtoJuanandJuanaUniversalHealthCareintheCommunities
May18,2017AsianDevelopmentBankHeadquarters
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The Philippine Health Agenda 2016 - 2022
GOALS
Guarantee1:AllLifeStages&TripleBurdenofDiseaseGuarantee2:ServiceDeliveryNetworkGuarantee3:UniversalHealthInsurance
Source:DepartmentofHealth,AdministrativeOrderNo.2016-0038
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Maternal and Child Health Indicators by Wealth Quintile, NDHS 2013
Source:PhilippineNDHS,2013
90.7
97.3 9799.5 99
33.9
55.8
70
82.1
91.8
49.7
75.7
85.5
93.496.9
52
33
22 23
17
36
2217
21
13
05101520253035404550556065707580859095100105
Quintile1(Poorest) Quintile2 Quintile3 Quintile4 Quintile5(Wealthiest)
%SkilledBirthAttendants %FacilityBirthDeliveries %Postnatalcheck-up Under-fivemortalityRate InfantMortality
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DevolutionofthePhilippinehealthcaresystem(1991)
FragmentationofHealthServices
PoorLocalLeadership
Challenges of Devolution
PreventiveCare CurativeCare
+
PoorHealthOutcomes
Challenges of the Devolution
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Sec. 16 of RA 7160 (Local Government Code of 1991“Within their respective territorial jurisdictions, local government units shall ensure and support,
among other things, the preservation and enrichment of culture, promote health and safety, enhance the right of the people to a balanced ecology…”
Philippine Health System Landscape (1991-2010)Philippine Health System Landscape (1991-2010)
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Surviving Childbirth in Asia
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Maternal Mortality Ratio (per 100,000 live births)*
Pre-PHC PHC Adoption Devolution HSRA Fourmula1 KP& Expansion
*availabledatapoints:1990,1995,2000,2005and2013Source:TheWorldBank(2015).Maternalmortalityratio(modeledestimate,per100,000livebirths)
Maternal Mortality Ratio (per 100,000 livebirths)*
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Responsibilities of LGUs (Based on Section 17 of LGC)
Source:UnionofLocalAuthoritiesofthePhilippines(2016).AddressingHealthDevolutionGapsandMainstreamingthePhilippineHealth AgendatoLocalGovernments
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Spurce:SDHWeights:WisconsinUniv.,InstituteofPublicHealth2010
Social Determinants of Health
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ZFFHealthChangeModel
LEADERSHIP AND GOVERNANCE
IMPROVED HEALTH SYSTEM
TARGETED AND PRO-POOR HEALTH PROGRAMS
BETTER HEALTH OUTCOMES FOR THE POOR
BridgingLeadershipasaProcesstoAddressHealthInequities
The ZFF Response to Devolution: Health Change Model and Bridging Leadership Framework
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OBJECTIVESTrainlocalhealthleaderstoestablishequitable&effectivelocalhealthsystemsandtoberesponsiveandaccountableforbetterhealthoutcomesforthepoor.
CRITERIA• Leaderscommittedtochange• Highhealthburden• HealthSystemDeliverables
Health Leaders for the Poor training• Four-module training every 6 months• Practicum in-between modules• Coaching and monitoring during practicum• Continuous coaching and monitoring after modules
Prototyping LGUs(as of 2015)
PoorARMMGIDA/MSD
381618
Total 72
Prototyping the ZFF Health Change Model
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Source:WHO’sSixBuildingBlocksofHealth,asmodified
Intervention in Health Systems Transformation: Municipal Building Block Roadmap
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Results of Owning the Health Issues
Maternal Health Indicators of 72 ZFF Prototyping LGUs
33%
43%
57%
69%
56%
65% 73%
79%
74
63
48
29
0
10
20
30
40
50
60
70
80
90
Baseline Afteryear1 Afteryear2 Afteryear3
FBD SBA MaternalDeaths
FBD
SBA
MaternalDeaths
Sources:FHSISdata,CHPPClosingReport
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DELAY1Delayindecidingtoseekmedicalcare
DELAY2Delayinidentifyingandreachingappropriate
healthfacility
DELAY3Delayinreceivingappropriateandadequatecareinthefacility
SocialProtectionProgram(Incentives)
BehaviorChangeCommunication
4-in-1PhilHealthaccreditationandIncreasecoverage
Providetransportation
Haveaplaceforamotherand/orherrelativestostaybeforeand/orafter
delivery FixreferralsystembetweenRHUs&Hospitals
EnsureRHUshave-adequatemedicalsupplies-24/7operations-BEmONCcertification-adequateskilledhealthprofessionals
MobilizeCommunityHealthTeams
Trackpregnanciesandinitiateprenatalcare
EnsureReferralFacilitiesareCEmONC- Capableofhighrisk
emergencysurgicalinterventions
- HaveBloodmanagementSystems
Owning the Challenge and Making a Response
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> 5, 39%
2 - 4, 42%
Primi,20%
< 19,11%
20 - 34, 53%
> 35, 36%
byno.ofpregnancies**
byage***
**basedon200deaths
***basedon305deaths
ANo.ofreportingareas:384 localgovernmentunitsfromprototype&partnershipprogramswithUNFPA,UNICEF&USAID;partial-unofficialdata
Toomany!
Tooyoungortooold!
ü Family Planningü Adolescent Sexual
and Reproductive Health
Maternal Deaths in ZFF areasA, 2014-2015
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Provincial Leadership and Governance Program
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Pangasinan Consolidated Hospital Scorecard (Baseline, 2015)
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Pangasinan Consolidated Hospital Scorecard (After the program, 2016)
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Mayors,MHOs,RuralHealthUnitsPREVENTIVECARE
PHTLs&DMOsHospitals
CURATIVECARE
GOVERNORProvincialHealthSystem
ü Accountabilityforhealthü CurrentRealityü ExecutiveSessionwithDOHRegionalDirectorü DeepDiveActivityü Visioningü CoreGroupFormation
ü QualityServicesü UpgradeProvincialhospitaltolevel2,
Districthospitalstolevel1ü Nobalancebillingü Pointofcareenrollment
ü Sharingthevisionü Engagingmayorsü Provincialbudgetcounterpartü QualityandAccessibleServicesü AccreditedRHUs
ZFF Health Change Model and PHADOHCENTRAL
Philippine Health Agenda (“All for Health towards Health for All”)
Health Change Model
HLP/2MLGP/2BHLMP
DOHRegionalDirector
PLGP/1HLMP
HLGP
BLFP
PLGP/2
ZFF Health Change Model in support of thePhilippine Health Agenda
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Ongoing efforts to improve the health system for better health outcomes for the poor
1. Directthereformstomakesystemspro-poor
2. Makelocalchiefexecutivesandhealthleaderscommittedtomakethepoortheirpriorityinimprovinghealthoutcomes
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Interventions to deepen local government accountability for pro-poor health system
1. Monitor the progress of the 12 PHA legacies2. Make the poor active agents in health system reforms3. Improve quality of DOH’s engagement with local chief
executives4. Have a system of incentives and sanctions for mayors5. Give poor municipalities with committed mayors more
resources6. Fix the linkage between preventive and curative care
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Mayors,MHOs,RuralHealthUnitsPREVENTIVECARE
PHTLs&DMOsHospitals
CURATIVECARE
GOVERNORProvincialHealthSystem
ü Accountabilityforhealthü CurrentRealityü ExecutiveSessionwithDOHRegionalDirectorü DeepDiveActivityü Visioningü CoreGroupFormation
ü QualityServicesü UpgradeProvincialhospitaltolevel2,
Districthospitalstolevel1ü Nobalancebillingü Pointofcareenrollment
ü Sharingthevisionü Engagingmayorsü Provincialbudgetcounterpartü QualityandAccessibleServicesü AccreditedRHUs
ZFF Health Change Model and PHA
Philippine Health Agenda (“All for Health towards Health for All”)
Health Change Model
HLP/2MLGP/2BHLMP
PLGP/1HLMP
PLGP/2
Linking preventive care and curative care
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Our collective challenge is to make the
Philippine Health Agenda work
so that by 2022, health inequities are reduced
and the poor truly have better health indicators.
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Deepening Local Government Unit Engagement towards Healthier Communities:
Will the poor have better health prospects under the Duterte administration?
Ernesto D. GarilaoPresident
Zuellig Family Foundation
BringingHealthtoJuanandJuanaUniversalHealthCareintheCommunities
May18,2017AsianDevelopmentBankHeadquarters