HEALTH AMBASSADORS UNIVERSITY 3rd floor Hansel Arcade, Aurora Blvd.

, Cubao , Quezon city Tel no: 352-6558

INSTRUCTOR: Dra. Ellani Roldan November 2,3, & 4, 2010

FOURMULA ONE FOR HEALTH: Implementation Framework for Health Sector Reform Compiled by: Research Division HEALTH AMBASSADORS UNIVERSITY (SEAMPRO-Philippines) Co. Ltd. School of Nursing Review and Specializations SLIDE 1: LEGAL BASIS
y y y y Administrative Order No. 2005-0023 dated August 30, 2005. FOURmula One for Health (F1) was adopted as the implementation framework for health sector reforms for the medium term period. designed to implement critical health interventions supported by effective management infrastructure and financing arrangements. Its implementation is geared towards achieving health systems goals of the World Health Organization, the Millennium Development Goals (MDGs), and the Medium-Term Philippine Development Plan (MTPDP) for (a) better health outcomes; (b) more responsive health system; and (c) more equitable health financing.

SLIDE 2: FOURmula One for Health has three major goals: 1. Better health outcomes 2. Greater responsiveness of the health system 3. Fairness in health financing

SLIDE 3
SLIDE 4 The four thrusts are: a. Health financing by fostering greater, better and sustained investments in health. This component will be led jointly by the PhilHealth through the NHIP, and the DOH through sector-wide policy support on health financing. b. Health regulation through assuring the quality and affordability of health goods and services. This will be jointly implemented by PhilHealth and the Health Regulation cluster of DOH. c. Health service delivery by ensuring the accessibility and availability of basic and essential health care. This will be led jointly by Health Program Development cluster and the field operations clusters, with support from PhilHealth. d. Good governance in health by enhancing the performance of the health system. This will be implemented jointly by the External Affairs cluster through the BLHD and BIHC and the Sectoral Support cluster particularly by the HPDPB.

SLIDE 5
FOURmula ONE for Health intends to implement critical interventions as a single package backed by effective management infrastructure and financing arrangements. Each implementation thrust will be managed by offices with clear mandates, performance targets and support, all within well-defined time frames. More importantly, the four implementation components will be managed and financed following a sector-wide approach. This implies that the management perspective covers the entire health sector, and that financing portfolio management encompasses all sources. 1

HEALTH AMBASSADORS UNIVERSITY 3rd floor Hansel Arcade, Aurora Blvd., Cubao , Quezon city Tel no: 352-6558

INSTRUCTOR: Dra. Ellani Roldan November 2,3, & 4, 2010

A key feature of the FOURmula ONE for Health implementation strategy is the engagement of the National Health Insurance Program (NHIP) as the main lever to effect desired changes and outcomes in each of the four implementation components. The NHIP supports each of the FOURmula ONE elements in terms of the following: y Financing reduces financial burden of Filipinos y Governance as prudent purchaser of health care thereby influencing the health care market and related institutions y Regulation accreditation and payments based on quality as driver for improved performance in the health sector y Service delivery fair compensation for cost of care directed at providing essential goods and services in health The main functions of the NHIP including enrollment, accreditation, benefit delivery, provider payment and investment must be employed to leverage the attainment of the targets for each of the four components. SLIDE 6: The FOURmula ONE program is confronted by the following constraints: 1. the government health budget has been very restricted with 70% automatically going to the payment of salaries and leaving very little for operational and capital requirements. Furthermore, these public subsidies are also inflexible in terms of its allocation across the major expense categories of personal services, MOOE and capital outlay, if ever available. 2. The government has also been cash strapped and the DOH has experienced delays in the release of its budget to the detriment of some of its programs and services. 3. Lastly, budgets have also been poorly allocated across agencies and across programs with releases having no clear bearing on meeting performance targets. 4. The other constraint faced by the FOURmula ONE program is the reality that the DOH is now mandated to manage a highly decentralized health system (PARTLY BECAUSE OF DEVOLUTION). This therefore calls for very novel and creative means of implementing programs in partnership with LGUs and the private sector.

SLIDE 8
Today there is greater public support for the implementation of the Health Sector Reform Agenda (HSRA) as a framework for the reforms. This provides the DOH with the opportunity to articulate the implementation strategy for the reforms through the FOURmula ONE for Health as an optimal approach. However, there is as yet no comprehensive articulation of its implementation strategy. Along with this seemingly growing political buy in with the reforms is the need to show tangible results within the immediate and medium term period of the next three to five years so as to sustain the build up of a momentum for change in the health sector. SLIDE 9 Given the constraints and the opportunities that were identified, the following mechanisms are proposed to jumpstart the FOURmula ONE implementation: 1. First, there is a need to focus efforts on the most critical interventions. Critical interventions are defined as those that are doable given the available resources; have the potential to show tangible results within the immediate and medium term period of the next three to five years; 2. have sufficient groundwork already done with its interventions already defined in packages that are ready for implementation and that the interventions have the ability to trigger a chain reaction that will spur implementation of other FOURmula ONE interventions.

SLIDE 14:
Programs under the regulations include: 1. The One-Stop Shop for harmonization of all regulatory activities 2. The unification of the Philhealth and Sentrong Sigla seals

HEALTH AMBASSADORS UNIVERSITY 3rd floor Hansel Arcade, Aurora Blvd., Cubao , Quezon city Tel no: 352-6558

INSTRUCTOR: Dra. Ellani Roldan November 2,3, & 4, 2010

3. the development of a unified seal of approval system that would send market signals to influence consumer demand for quality health products such as food, drugs and devices, as well as health facilities and establishments such as drug establishments and medical facilities. 4. In the pursuit of equity, access of the poor and the vulnerable sectors to essential health products will be pursued by expanding access points for low-cost drugs through programs such as the Botika ng Barangay.

SLIDE 17:
A major component of the health service delivery plan which directly target MDGs is the public health investment plan: The development of a public health investment plan will involve: a) Undertaking disease-free zone initiatives that will aim to mop up such diseases as leprosy, schistosomiasis, filariasis and malaria. This would include doing a stratification of areas according to the burden of disease, the validation of status of potential disease-free areas, and identification of appropriate interventions based on the stratifications b) Implementing an intensified disease prevention control and strategy specifically for vaccine-preventable diseases, tuberculosis and HIV/AIDS c) Activities that will improve reproductive health outcomes such as the Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR), Under 5 Mortality Rate, Total Fertility Rate (TFR), Contraceptive Prevalence Rate (CPR) d) Intensifying the promotion of healthy lifestyle for the prevention of diabetes mellitus (DM), hypertension (HPN), cardiovascular diseases (CVD), breast and cervical cancers; and the promotion of anti-smoking, safe water, sanitation, and other such campaigns. SLIDE: 18 Further supporting the improvement of health service delivery is the development of health facilities investment plan which include rationalizing services in DOH-retained facilities, local government and private facilities inside the 16 sites by maximizing the structure brought about by decentralization. SLIDE 20: Major components of governance include the Sectoral Development Approach for Health, the Health Human Resource Masterplan, the Establishment of 4-in1 convergence Sites, the Philippine Health Information System, and the improvement of the DOH Procurement and Logistics System SLIDE 21 The Sectoral Development Approach for Health is a major strategy and program which the Department is now spearheading. It is a main governance strategy to make sure that there is coordinated national effort towards the thrusts and strategies of the country. SLIDE 22 By now, we are all well acquainted with the sector s issue on human resource. Most of us would have heard of the Health Human Resource Masterplan which the Department has developed together with other stakeholders. 1. We are going to develop a recruitment and selection system based on actual job competencies. 2. Ensure that existing health workers, health leaders, are trained according to the service they have to deliver. 3. A rewards and incentive mechanism to motivate our health professionals to continue improving themselves and do their jobs well 4. Another motivation for our health team is actual career development and management by doing retention planning, individual career planning, a career pathing and succession management. SLIDE 25 5. we will develop a local health human resource strategy. Efforts would include development of a heath professional development and career track. An example is the preference for local health workers in hiring for central office and CHD positions 6. identifying and actively promoting LGU vacancies and providing resources in support of the development of this local HR strategy SLIDE 24 3

HEALTH AMBASSADORS UNIVERSITY 3rd floor Hansel Arcade, Aurora Blvd., Cubao , Quezon city Tel no: 352-6558

INSTRUCTOR: Dra. Ellani Roldan November 2,3, & 4, 2010

The main activity will be the establishment of 4-in-1 convergence sites where we hope to see governance, regulation, financing and service delivery efforts work together. The first 16 sites will be the pilot for applying corresponding principles and strategies. Here we hope to apply and later develop for others the following: 1. Investment planning 2. Governance structures and mechanisms which include a responsive and relevant local health information system 3. Means of mobilization of resources 4. Development of regulatory policies that help and not hinder service delivery 5. Procurement systems 6. And most importantly, development of the means to deliver the best health services for all of our people LGU score card will be used to ensure that there is a monitoring and evaluation component to our work. This will be through the information system vital to all components of FOURmula to monitor our progress and have access to adequate and timely information by which we base our plans. Efforts in this regard would include harmonization of information systems of different stakeholders in health, and inclusion of info systems on Human resource Vital registries and health statistics Disease surveillance National and local health accounts Health regulations And health facilities SLIDE 26 Also vital in support of F1 is the development of the DOH Procurement and logistics management system. The vital components as identified in the workshops include: An inventory system and a supply chain mechanism Efficient storage Database of goods and supplies with standard specifications Pooling, monitoring, and feedback mechanisms incorporated in the procurement systems SLIDE 27 The extent of the challenge for governance is obvious. It is also the impetus for us to do things efficiently and rationally in response to real needs at the level of families and individuals. As leaders in the health sector, together with our local counterparts, it is our responsibility and privilege to steward the health of those whom we serve. Thank you very much.