BackgroundMandateThe DTTB ProgramImplementing ArrangementsCurrent StatusAreas for DeploymentDTTB Roles & ResponsibilitiesDTTB Challenges

The Doctors to the Barrios (DTTB) Program was created by the Department of Health (DOH) in 1993 to respond to the following health related issues:Inequitable distribution of scarce resources and a varying pace of development in the 271 doctorless municipalities identified in 1992Inability to provide adequate and quality health services, resulting to high morbidity and mortality ratesInaccessible health care services to marginalized areas of the country

VisionAll municipalities in the Philippines shall receive quality health care from competent physiciansMissionTo deploy competent, committed, community-oriented and dedicated physicians to the underserved municipalities

To ensure quality health care service to underserved areas through the deployment of competent and community-oriented doctors.

To effect changes in the approach to health care delivery by the stakeholders in health.Objectives

Strengthen the leadership and management capabilities of the DTTBs

Partnership with other stakeholders in health

Strengthen the management function of the Centers for Health Development including social preparation at the local government level

Partnership with local government units in the deployment of DTTBsStrategies

Health FinancingService DeliveryPolicy, Standards and RegulationHealth Human ResourceHealth InformationGovernance for Health

Provide the general policies and guidelines in the program management of the DTTB programStrengthen the CHD capacity for the DTTB program managementProvide technical assistance to CHDs for the efficient implementation of the DTTB programConduct periodic program implementation reviews for the continual improvement of the DTTB program

Provide over-all technical supervision in the DTTB program management.Collaborate with national and local level for the overall success of the DTTB program.Through the DTTB program, ensure the provision of competent physicians in areas of need.Monitor and evaluate the DTTB program and provide the central office regular feedback.

Provide the DTTBs the technical assistance in local health systems development.Conduct social preparation activities at the LGU level including:Orientation of LCE, RHU and personnel and Sangguniang Bayan on the Program.MOA signing between the CHD Director, LCE and the DTTB concerned before the deploymentConduct the DTTB to his/her area of assignment

Appoint the DTTB as head of the Rural Health Unit/MHOProvide technical assistance and logistics support to the DTTB in the conduct of their workAllow the DTTB to attend the MPM-HSD and other health related learning and development coursesDevice mechanisms to secure a permanent position for the DTTBs and provide appropriate resources for it

Now on its 20th year of implementation, the DTTB Program has served all 271 municipalities, many of which were served more than once due to exigency of service. In succeeding years however, other doctorless municipalities were identified as migration of much needed health care professionals was becoming more evident.

Thirty batches of DTTBs have been deployed with 667 physicians serving 500 hard-to-reach and critical municipalities since the start of the program.

Currently, the Program caters to 176 Municipalities in 16 Regions.

YearDTTB BatchExisting DTTBsDeployed DTTBsMunicipalities Served201025269926627232848482011251716126527232844297272

YearDTTB BatchExisting DTTBsDeployed DTTBsMunicipalities Served20122844115231297230115201329721872910301153191Grand Total235678

GraduatingFor DeploymentExtension

Source: 2008 and 2010 Health Human Resource Development Bureau surveyNote: 2010 data excluded higher income class municipalities

Doctor-less, depressed, hard-to-reach, economically underdeveloped and conflict areasNo doctors : 2 years 10 years Depressed : e.g. disaster prone areas, poor populations, marginalized and vulnerable populations Hard-to-reach : geographically isolated and disadvantaged areasEconomically underdeveloped : priority for 5th & 6th class municipalities, high poverty incidence (1,233 poorest municipalities)Conflict areas : insurgency prone areas

Other considerationsDoctor to population ratiosCurrent Municipal Health Officer on study leaveCurrent programs and projects requiring a doctor as program managerCommitment of the Local Government Unit to maintain and sustain a doctorCommitment of the doctor to serve the municipality and complete the contract

Gaining political support Training and building capacities of other health workersMobilizing Resources Organizing the community for social participation Educating the community Improving access to health servicesHealth leader/manager in developing local health systems in a devolved set-up.

Where we are.Cagayan Valley (19)Sabtang, Batanes Mahatao, BatanesBasco, BatanesItbayat, BatanesUyugan, BatanesIvana, batanesTumauini, IsabelaDinapigue, IsabelaBurgos, IsabelaDelfin Albano, IsabelaBenito Soliven, IsabelaSan Manuel, IsabelaSta. Maria, IsabelaSto. Tomas, IsabelaRizal, Cagayan Tuao, CagayanGattaran, CagayanSta. Praxedes, CagayanClaveria, Cagayan

Gen. Natividad, Nueva Ecija Llanera, Nueva Ecija Sto. Domingo, Nueva EcijaLaur, Nueva EcijaQuezon, Nueva EcijaMorong, BataanDingalan, Aurora

Central Luzon (7)Prieto Diaz, SorsogonPresentacion, Cam SurSan Fenrando, Masbate

Ilog, Negros OccToboso, Negros OccMoises Padilla, Negros OccCandoni, Negros Occ Buruanga, Aklan Altavas, Aklan Concepcion, Iloilo San Jose, Antique Patnongon, AntiqueWestern Visayas (9)Where we are.

Where we are.

Where we are.

All regions of the country exceptNCR

Level of a Municipal Health OfficerBasic pay following national ratesPhilHealth Insurance premiumGSIS accident InsurancePost-graduate education (Master in Public Management Major in Health Systems and Development) Local government unit counterpart (Honorarium, board and lodging, etc.) Develop a DTTB network with the rest of the country

An improved and more efficient rural health unit (RHU)Improved RHU systems, referral, disease surveillance, and emergency responseLocal Health Boards are actively and consistently convened by the mayorsAccess to adequate and effective basic health servicesImproved health seeking behavior by the communityMayors have a more consultative and participatory approach to planning and decision-making in health issues

At the Rural Health UnitMedicines and other supplies are not enoughEquipment may not always be availableHealth budget is not sufficientHealth may not be a priority of political leadersRHU staffing requirements are not metRHU staff may not work well with the DTTBAs a DTTBBeing a Municipal Health Officer was not taught in schoolAs a ProgramLow DTTB retention after the contract

* Leonardia, J.A1, Prytherch, H1, Ronquillo, K2, Nodora, R3, Ruppel, A1.2011. An assessment of the factors influencing retention in the Philippine National Rural Physician Deployment Program.

Pay it ForwardThe ServiceArea of AssignmentCommitment to the Filipino people

Deliberate attention to the needs of millions of poor Filipino families which comprise the majority of our population I cannot forgive myself for not doing my part when I still have my strength. DTTB

Goal: The implementation of Universal Health Care shall be directed towards ensuring the achievement of the health system goals of better health outcomes, fair health financing and responsive health system by ensuring that all Filipinos, especially the disadvantaged group, have equitable access to health care

General Objective: To promote equity in health through the provision of full financial protection and improvement of access to priority public health programs and quality hospital care especially for the poor.

Specific Objective: To utilize the instruments of Health Financing, Health Service Delivery System, Human Resources for Health, Health Regulation, Governance for Health and Health Information to achieve the following strategic thrusts:Improve financial risk protection through a revitalized National Health Insurance Program by expanding NHIP coverage, increasing availment of services and raising support value. Achieve Millennium Development Goal Max (MDGmax) targets on:maternal, neonatal and infant mortality; malaria, HIV and TB; accidents and injuries; lifestyle-related non-communicable diseases such as cerebro-vascular diseases, diabetes mellitus, chronic obstructive pulmonary diseases and cancers; and emerging and re-emerging diseases.Improve access to health services through upgrading of health facilities and capacities of clinical/hospital care to respond to accidents/injuries and emerging/re-emerging diseases, and to the most common causes of mortality and morbidity.

Out of the 452 DTTBs who took part in the program between 1993 and 2011, only 81 (18%) chose to remain in their rural posts and be absorbed by their respective LGUs. *The answer to this situation is Universal Health Care. Universal Health care builds on gains on the reform initiatives of the last decade.

Universal Health Care is a vision and a strategy:A Vision of how things ought to be, meaning 1) Filipinos are healthy, free from disease and infirmity; 2) Filipinos have access to quality health services.As a strategy, it is how the DOH will strive to achieve better health outcomes, make the health system more responsive, and reduce the inequities in health created by the widening gap between the rich and the poor.

Simply put, universal health care prioritizes the needs of millions and millions of poor Filipino families which comprise majority of our population.