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Kasagana-ka Development Center, Inc.

Confronting the Unrealized Potential of the K-Kalusugan:


A Descriptive and Exploratory Case Study



Final Report








Submitted by Asuncion M. Sebastian
On August 25, 2012


To Dr. Segundo Romero
For Management of Innovation Programs for Inclusive Development

Abstract

Bealth concein piesents the pooi with a thiee-folu financial buiuen: 1) loss of income
anu even of the capacity to eain in case of peimanent uisabilities; 2) loss of income of
othei family membeis who neeu to caie foi the sick; anu S) expenuituie on meuical anu
health seivices anu piouucts. Bealth seivice theiefoie is a basic social seivice that
shoulu be extenueu to the maiginalizeu, as human capital oi laboi is often the only
factoi of piouuction available to them.

Bespite the initiatives of the vaiious piivate anu goveinment institutions to auuiess the
health neeus of the maiginalizeu, theie still iemains a big ioom foi health piouucts anu
seivices foi this segment. Foi example, pieventive measuieseaily uetection of
illnesses anu euucation to pievent theii occuiience, among otheiscan be piomoteu.
Theie is haiuly a mechanism yet that woulu help the pooi pay foi meuicines anu
consultation seivices of the uoctois, save foi the occasional anu often unsustainable
meuical missions of well-meaning gioups.

Foi these ieasons, the K-Kalusugan Piogiam of Kasagana-Ka Bevelopment Centei, Inc.
(KBCI) anu its paitneis may be consiueieu an innovation, as it pioviues pieventive anu
cuiative measuies, anu infoimation management unuei one piogiam. The case stuuy
compaies K-Kalusugan with othei health piogiams aimeu at the maiginalizeu segment
opeiating both locally anu inteinationally. It also looks into the innovation piocesses in
KBCI anu examines the management issues that confiont KBCI as it scales up its
innovation.



1ab|e of Contents
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A. INN0vATI0N PR0BLEN.......................................................................................................................................... 18
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kasagana-ka Deve|opment Center, Inc.
Confront|ng the Unrea||zed otent|a| of the k-ka|usugan:
A Descr|pt|ve and Lxp|oratory Case Study

I. Introduct|on

Baniel is a 21-yeai-olu, contiactual checkei in a waiehousing company. A fathei to his
one-month olu uaughtei anu husbanu to his 2u-yeai-olu non-woiking housewife, Baniel
lives with his mothei, who woiks as householu help. Recently, Baniel unueiwent
appenuectomy, which iequiieu him to stay in the hospital foi foui uays anu pieventeu
him fiom ietuining to woik until he iecoveis fullyin a month's time the uoctoi saiu.
While he was in the hospital, Baniel's mom hau to stop woiking to stay with him, as
iequiieu by the public hospitals (patients must have someone to take caie of them anu
uo eiianus such as buying meuicines anu othei suigical mateiials). Bis wife, on the
othei hanu, hau to stay with the baby at home, as neithei of them coulu affoiu to catch
infection in the hospital. Touay, Baniel has to think of ways to pay his hospital anu
meuicine bills, amounting to Php1S,uuu. Bis employei has also askeu him to file foi
iesignation to pie-teiminate his contiact, lest he be chaigeu of absence without leave
(AW0L).

The case of Baniel is typical of families who live below the poveity thiesholuany
health concein piesents them with a thiee-folu financial buiuen: 1) loss of income anu
even of the capacity to eain in case of peimanent uisabilities; 2) loss of income of othei
family membeis who neeu to caie foi the sick; anu S) expenuituie on meuical anu health
seivices anu piouucts. Bealth theiefoie is a basic social seivice that shoulu be extenueu
to the maiginalizeu, as human capital oi laboi is often the only factoi of piouuction
available to them. 0ften, too, they uo not have savings oi insuiance to tiue them ovei.

uiven the wiue aiiay of neeus anu losses of the pooi that aie consequent to health
pioblems, vaiious sectois exeit effoit to help auuiess theii plight. The goveinment
offeis health insuiance that pioviues hospitalization coveiage anu social secuiity that
coveis loss of income uue to uisabilities. Theie aie also health units in each baiangay
that aie supposeu to take caie of the piimaiy neeus of the citizens (but theii efficiency
anu effectiveness piesent anothei case altogethei, that is, meuicines oi uoctois aie
usually unavailable). In the piivate sectoi, while micio insuiance takes caie of the pooi's
family in case of ueath oi uisabilities, miciofinance institutions anu othei social

Page 2 of 60
enteipiises auuiess the neeu of the pooi to eain by pioviuing them with boiioweu
capital anu access to maiket.

Bespite these institutions, theie still iemains a big ioom foi health piouucts anu
seivices foi the maiginalizeu segment. Foi example, pieventive measuieseaily
uetection of illnesses anu euucation to pievent theii occuiience, among otheiscan be
piomoteu. Theie is haiuly a mechanism yet that woulu help the pooi pay foi meuicines
anu consultation seivices of the uoctois, save foi the occasional anu often unsustainable
meuical missions of well-meaning gioups.

Foi these ieasons, the K-Kalusugan Piogiam of Kasagana-Ka Bevelopment Centei, Inc.
(KBCI) anu its paitneis may be consiueieu an innovation, as it pioviues the following
unuei one piogiam: health seivice financing; access to health anu meuical seivices anu
meuicines at affoiuable piices; health euucation; monitoiing anu suppoit system;
infoimation on health inuicatois of the pooi communities; anu health-ielateu livelihoou
oppoitunities foi the KBCI membeis, an example of which is the establishment of
community phaimacies iun anu owneu by the membeis themselves.
A. 8ackground
1. Deve|opment Context

Access, availability, quality, anu affoiuability of piouucts anu seivices aie the piimaiy
issues in the health sectoi.# Accoiuing to the 0niveisity of the Philippines's National
Bealth Institute, 6 of 1u Filipinos uie of sickness without seeing a uoctoi (Beinabe,
2u1u). This finuing was unsuipiising, as theie weie only 17,u18 baiangay health
stations in 2uu8 seiving the countiy's 42,u27 baiangays (National Statistical
Cooiuination Boaiu).# Quality is anothei concein. Since the pooi aie the main useis of
goveinment health facilities, "the ueteiioiation anu pooi quality of many goveinment
health facilities is paiticulaily uisauvantageous to the pooi who neeus the seivices the
most" (Bepaitment of Bealth 0ffice of the Secietaiy, 2u1u).# As foi financing, Quimbo
anu Panelo (2uu9) iepoiteu that "the aveiage out-of-pocket expenuituies of householus
foi meuical goous anu seivices iepiesent 82 peicent of the total health bill, anu can go
as high as 94 peicent among the pooiest householus" (Bepaitment of Bealth, 2uu9).
Fuithei, in 2u1u, only SS peicent of the Philippine population was coveieu by the
National Bealth Insuiance Piogiam (PhilBealth), with 42 peicent availment iate anu
total benefit ueliveiy iatio of 8 peicent; 892 iuial health units anu 99 goveinment

Page 3 of 60
hospitals hau yet to qualify foi PhilBealth accieuitation (Bepaitment of Bealth 0ffice of
the Secietaiy, 2u1u). #

Foi these ieasons, the Aquino Bealth Agenua (ABA) focuses on expanuing financial iisk
piotection, impioving access to health caie facilities, anu woiking on the attainment of
the Nillennium Bevelopment uoal taigets. The goveinment plans to caiiy out these
thiusts thiough six stiategic measuies (Bepaitment of Bealth 0ffice of the Secietaiy,
2u1u):
1. Bealth financing - instiument to inciease iesouices foi health that will be
effectively allocateu anu utilizeu to impiove the financial piotection of the pooi
anu the vulneiable sectois
2. Seivice ueliveiy - instiument to tiansfoim the health seivice ueliveiy stiuctuie
to auuiess vaiiations in health seivice utilization anu health outcomes acioss
socio-economic vaiiables
S. Policy, stanuaius anu iegulation - instiument to ensuie equitable access to
health seivices, essential meuicines anu technologies of assuieu quality,
availability anu safety
4. uoveinance foi health - instiument to establish the mechanisms foi efficiency,
tianspaiency anu accountability anu pievent oppoitunities foi fiauu
S. Buman iesouices foi health - instiument to ensuie that all Filipinos have access
to piofessional health caie pioviueis capable of meeting theii health neeus at
the appiopiiate level of caie
6. Bealth infoimation - instiument to establish a mouein infoimation system that
shall:
a. Pioviue eviuence foi policy anu piogiam uevelopment
b. Suppoit foi immeuiate anu efficient piovision of health caie anu
management of piovince-wiue health systems

Annex A contains the full uocument of the Aquino Bealth Agenua while Annex B shows
the health ueliveiy system in the Philippines.
2. Crgan|zat|ona| Context

The consoitium behinu K-Kalusugan is composeu of foui oiganizations: 1) KBCI, a
miciofinance institution; 2) its sistei micioinsuiance company, Kasagana-Ka Nutual
Benefit Association, Inc. oi K-NBA; S) BEALTBBEv, a non-goveinment oiganization
(Nu0) that pioviues tiaining anu consulting seivices to oiganizations anu communities

Page 4 of 60
in the aieas of social health insuiance anu community-baseu financing, health, watei,
anu sanitation, school health, occupational safety anu health, anu piimaiy health caie;
anu 4) BEALTBBEv Integiateu Clinics oi BBIC, a piivately helu clinic that spun off fiom
BEALTBBEv in 2uu7.

K-Kalusugan was pilot testeu in 2uu9 with the intention of enabling the client-
beneficiaiies of KBCI to unueigo meuical anu laboiatoiy examinations. As piepaiation
to actual health tests, membeis weie given oiientation anu health euucation, which
weie pait of the piogiam's pieventive component. Each beneficiaiy-membei was given
foui laboiatoiy test packages to choose fiom (Table 1). 0ne may pay foi it out of theii
savings with KBCI oi by taking out a loan fiom KBCI thiough K-Kalusugan Loan Winuow
1 with a cap of Php4,uuu (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

%BCDE#+"#,F,BDGHGIBJ#:EBDKL#6MBJ#>BNOBIEH#
# >BNOBIE#0# >BNOBIE#=# >BNOBIE#*# >BNOBIE#(#
%BPIEK#
CEJEQRNRBPS#
S4 yeais olu anu
below
SS to S9 yeais
olu
4u yeais olu anu
above
1S yeais olu anu
below
!JNDGHRMJ# Complete
bloou count
0iinalysis
Stool
examination
Chest x-iay
Neuical
check-up
Complete
bloou count
0iinalysis
Stool
examination
Chest x-iay
Fasting
bloou sugai
Lipiu piofile
Neuical
check-up
Complete
bloou count
0iinalysis
Stool
examination
Chest x-iay
Fasting
bloou sugai
Lipiu piofile
Bloou uiea
nitiogen
0iic aciu
Cieatinine
Su0TSuPT
Electio-
caiuiogiaph
Neuical
check-up
Complete
bloou count
with bloou
typing
0iinalysis
Stool
examination
Neuical
check-up
*MHK# PhpS1u Php48u Php94u Php18u


Aftei health examinationwhich was pioviueu at a piice 7u to 8u peicent lowei than
those available in hospitals anu othei clinicspeisonal anu meuical uata of the membei
weie iecoiueu into the uatabase. The iesults weie kept in a uigital file in the piogiam
uatabase anu a haiu copy was given to the membeis, fuithei pioviuing them with
ieminueis to be minuful of theii health. Anothei copy of the examination iesults was
foiwaiueu to BBIC foi inteipietation, meuical auvice, anu tieatment, anu when
necessaiy, iefeiial to highei-level health institutions. In this case, anothei loan winuow
(K-Kalusugan Loan Winuow 2) not exceeuing Php1S,uuu was maue available foi the

Page 5 of 60
membeis who iequiie meuical pioceuuies oi meuicines, eithei unuei outpatient
consultation oi hospital confinement. The membeis may also avail of this loan winuow
to pay foi uentuies anu eyeglasses, confinement, meuicines, minoi suigical pioceuuies
such as cyst iemoval, uilation anu cuiettage (B&C), anu uental pioceuuies such as
cleaning, extiaction, anu fillings (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

In 2u12, the iesults of the examinations weie subjecteu to analysis anu fuithei ieseaich,
which showeu that of the total sample of 177 patient-membeis fiom Tanuang Soia anu
Batasan Bills fielu sites of KBCI, 12S oi 71 peicent uiu not have paiticulai meuical
conceins oi complaints but whose laboiatoiy tests ievealeu significant finuings.
Common conuitions incluueu gastiointestinal uiseases, thyioiu uisoiueis, anemia,
hypeitension, anu uiinaiy tiact infectionailments that coulu have gotten woise ovei
time if left unattenueu anu thus coulu have maue the pooi even pooiei with theii
ueteiioiating human anu financial capital. Bata fiom K-NBA also ievealeu that the main
causes of ueath of the insuieu as inuicateu in theii claim foims fiom 2uu7 to 2u11 weie
the following: heait attack, cancei of vaiious types, pneumonia, hypeitension, anu sepsis
(seveie bloou infection) (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

As of Naich 2u12, 1,7uu K-Kalusugan membeis oi only 9.2 peicent of KBCI membeis
anu 1,1uu of theii uepenuents hau physical anu laboiatoiy examinations. Latest
available uata in yeaienu 2u11 also showeu that 489 oi only almost S peicent of KBCI
membeis boiioweu fiom K-Kalusugan Winuow 1 anu 24 fiom K-Kalusugan Winuow 2,
iesulting in a poitfolio of Php1.SS million. The follow-up iate (that is, the numbei of
clients who went back to consult the uoctoi aftei the laboiatoiy examination) was only
almost S6 peicent (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

uiven this scenaiiothe high iate of asymptomatic illness coupleu with low iate of
clients ietuining foi follow-up with uoctois as well as low loan paiticipation iate of
KBCI membeisthe consoitium plans to scale up the piogiam to as many client-
beneficiaiies as possible. The piogiam has tiaineu only 7u health cauets in 1S of the 2u
KBCI fielu offices with 1,Suu centeis
1
. The consoitium attiibuteu the ielative slow
giowth of the piogiam to the numbei of cauets tiaineu, thus, its main stiategy is to tiain
Suu health cauets eveiy yeai foi the next thiee yeais to scale up its health innovation
(Kasagana-Ka Bevelopment Centei, Inc., 2u12).


1
Smallest unit of oiganization in KBCI composeu 14 to 4u membeis.

Page 6 of 60
3. Leve| of Ana|ys|s

The case will be analyzeu fiom the peispective of the KBCI as one of the main
pioponents of the piogiam anu wheie the piogiam is cuiiently houseu. Theie is a
pioposal though to move its opeiations unuei BEALTBBEv but no final uecision has
been maue yet.

KBCI, founueu in 2uu2, is a social uevelopment Nu0 that piomotes miciofinance as a
means to auuiess uiban poveity, specifically the pooi's neeu foi livelihoou, euucation,
health, housing, savings, anu skills tiaining. It also pioviues its membeis with micio
insuiance thiough its paitnei K-NBA (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

Its vision is as follows:

Paiticipate in the cieation of Filipino communities that value human iights, have uecent
anu stable livelihoous, anu aie helping each othei towaius tiue inuepenuence. These aie
uemonstiateu in vibiant social anu economic netwoiks.


Its mission is stateu thus:

KBCI is a suppoit institution that gives hope, guiuance, anu oppoitunity to iaise
stanuaius of living anu uevelop the chaiactei of pooi Filipino women, theii families anu
communities in the uiban aieas.

In the puisuit of its vision anu mission, KBCI pioviues the following seivices to
unueipiivilegeu families:
! access to loans, thiough inuiviuual lenuing methouology with guaiantoi system
albeit with centei oi gioup foimation mechanism
! basic tiaining on entiepieneuiship
! tiaining on appiopiiate income-geneiating technologies
! values claiification
! access to affoiuable life insuiance
! access to small ueposit mechanisms

As of Becembei 2u11, KBCI seiveu 18,S7u membeis, 99 peicent of whom weie women,
in 2u fielu offices locateu in Netio Nanila, Bulacan, anu Rizal. Its loan poitfolio ieacheu
ovei Php99 million with at-iisk iate of 1.9S peicent. KBCI has achieveu opeiational self-
sufficiency since 2uu4 anu financial self-sufficiency since 2uuS (Kasagana-Ka
Bevelopment Centei, Inc., 2u12).

Page 7 of 60
4. Un|t of Ana|ys|s

Souices of infoimation will be mainly inuiviuuals fiom the top management of the foui
paitnei-oiganizations of the consoitium as well as fiom the fielu: client-beneficiaiies of
KBCI unuei the K-Kalusugan Piogiam, client-beneficiaiies of KBCI who aie not yet
unuei the health piogiam, non-client-beneficiaiies of KBCI who aie pait of the local
community, anu the health cauets.
8. 1arget Innovat|on
#
K-Kalusugan, similai to othei KBCI's othei piogiams anu seivices, taigets piimaiily
women in impoveiisheu communities in Netio Nanila anu neighboiing uiban aieas,
paiticulaily those in goveinment ielocation sites. This focus is baseu on the notion that
women contiibute significantly to the cieation of vibiant economic anu social
infiastiuctuies in uiban pooi communities anu that women play a key iole in theii
family's access to oi availing of such social seivices as euucation, health, insuiance, anu
housing (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

The enu goal is impioving the health conuitions of the KBCI anu K-NBA client-
beneficiaiies, theii family membeis, anu theii communities. Specifically, the piogiam
aims to achieve the following (Kasagana-Ka Bevelopment Centei, Inc., 2u12):
Piomote health among the client-beneficiaiies by engaging them in uisease
pievention anu cuie, anu giving them access to health seivices anu financing;
Euucate the membeis on health-ielateu issues anu encouiage health-seeking
behavioi;
Pioviue the membeis with souices of income thiough the establishment of membei-
owneu, health-ielateu micioenteipiises;
Inciease the paiticipation of the membeis of local communities in piomoting health;
anu
Involve suitable paitneisinuiviuuals anu institutionsto ensuie sustainability of
the piogiam.
C. 1arget Management Cutput

The case stuuy is intenueu to uesciibe the state of the pilot piogiam anu the
consoitium's plan in the next thiee yeais. As well, the stuuy aims to exploie the
potential of the piogiam to be scaleu up, consiueiing both the capabilities of the

Page 8 of 60
consoitium anu the paitnei-oiganizations, anu the uemanu anu ieauiness of the client-
beneficiaiies anu the local communities.
D. Innovat|on Cr|entat|on of the Crgan|zat|on

Although KBCI enteieu the miciofinance banuwagon a bit late in 2uu2at a time when
even the tiauitionally exclusive, moie foimal banking inuustiy hau been openeu to the
auoption of miciofinance seivices foi two yeais alieauythe oiganization was quick to
aujust to changes anu auopt innovations ielative to othei Nu0-miciofinance institutions
(Nu0-NFIs). Examples of its innovative moves aie its installation of management
infoimation system oi NIS as eaily as a yeai aftei its establishment, the shift in the
lenuing methouology fiom gioup to inuiviuual liability aftei two yeais of opeiation that
eventually leu to its iemaikable inciease in outieach, anu the establishment of K-NBA in
2uu6 which was then a tienu among the biggei (those with moie than 1uu,uuu clients)
anu oluei NFIs in the countiy. KBCI is also among the fiist few NFIs that offei housing
loans anu the fiist to launch a health piogiam. Table 2 shows the oiganization's histoiy
of new piocess anu piouuct intiouuctions.
#
%BCDE#T"#,(*!#>PMUGNK#!JKPMUGNKRMJH#

























Souice: Kasagana-Ka Bevelopment Centei, Inc., 2u11

Page 9 of 60
While its eailiei piouuct intiouuctions aie mainly me-too, imitations of the tienus in the
sectoi such as the savings components, inuiviuual liability, mutual benefit association,
anu euucation, its housing anu health piouucts may be consiueieu pioneeiing. In its two
most iecent piouuct innovations, KBCI has also tappeu othei institutions as its paitneis:
the Philippine Business foi Social Piogiess in the housing piogiam anu the iest of the
consoitium foi K-Kalusugan.

KBCI has also enteieu new maikets foi its existing, tiauitional business loans: the
beneficiaiies of goveinment iesettlement piogiams anu the peisons with uisabilities
(PWBs). The iesettleu gioups aie excluueu fiom the usual miciofinance loans, which
iequiie the potential boiioweis to have stayeu in theii iesiuence foi at least six months.
Implementing such iestiictive policy is the NFIs' way of managing theii cieuit iisks.
Likewise, the PWBs usually uo not qualify foi micio loans because of theii limiteu
oppoitunities to engage in entiepieneuiial activities. By seiving these often excluueu
segments of the population in paitneiship with the National Bousing Authoiity foi the
iesettleu gioups anu anothei Nu0 foi the PWBs, KBCI has exploieu what useu to be the
unchaiteieu teiiitoiies of miciofinance.

Accoiuing to KBCI Executive Biiectoi Naiia Anna Ignacio, piouuct innovation such as K-
Kalusugan woulu inueeu be theii souice of competitive auvantage.

Figuie 1 summaiizes the piouucts anu maikets seiveu by KBCI.
@RIGPE#+"#,(*!#>PMUGNKH#BJU#1BPOEKH#



















Page 10 of 60
KBCI, howevei, seems to be in a vulneiable position vis--vis its paitneis in launching
innovative piouucts. Its piogiam foi the PWBs, foi example, was put on holu in eaily
2u12 because the paitnei-Nu0 hau a new uiiectoi who uiu not see the miciofinance
piogiam as the Nu0's piioiity. 0ntil KBCI finus a new paitnei that is well veiseu in
managing PWB-ielateu piogiams, its management has ueciueu not to continue with this
innovation, iecognizing that PWB piogiams iequiie a skill set uiffeient fiom those
uealing with typical miciofinance clients. Similaily, KBCI is now actively looking foi a
funuei who can sustain K-Kalusugan, specifically foi the tiaining of health cauets. A
Canauian Nu0 suppoiteu the pilot phase. When the flow of funus ceaseu, KBCI founu it
uifficult to at least maintain the supply to meuical equipment, that is, ieplacement of
sphygmomanometeis that gave in to weai-anu-teai, anu to continue the tiaining of
health cauets. Again, until KBCI finus anothei oiganization that will funu K-Kalusugan,
scaling up of its health innovation will be a concein.

II. kDCI's Innovat|on Management

This stuuy centeis on KBCI's K-Kalusugan Compiehensive Bealth Piogiam, which
incluues pooi health seivice financing; access to health anu meuical seivices anu
meuicines at affoiuable piices; health euucation; monitoiing anu suppoit system;
infoimation on health inuicatois of the pooi communities; anu livelihoou oppoitunities
the maiginalizeu client-beneficiaiies of KBCI anu K-NBA, anu theii communities in
geneial.

A. Innovat|on Management
1. now |nnovat|on |n|t|at|ve was p|anned

A suivey conuucteu in 2uu9 showeu that the top two neeus iuentifieu by the KBCI
membeis weie health financing anu housing
2
. The iesult piouueu KBCI management to
uevelop a health piogiam in paitneiship with othei oiganizations. K-NBA was a natuial
paitnei of KBCI, while the people behinu BEALTBBEv anu BBIC, anu the heau of KBCI
weie long-time fiienus anu woik-paitneis. With the iesult of the suivey anu the
available netwoik to KBCI, K-Kalusugan was conceptualizeu.



2
No othei uata fiom the suivey weie pioviueu.

Page 11 of 60
2. now |t was organ|zed and |mp|emented

Each paitnei institution in the consoitium has its own iole in the piogiam (Table S).
%BCDE#8"#6RHK#MQ#>BPKJEP#!JHKRKGKRMJH#BJU#%LERP#&MDEH#
>BPKJEP#!JHKRKGKRMJ# &MDEH#
KBCI anu K-NBA Theii socio-economic officeis (fielu staff) aie taskeu to uo
the following:
! 0iganize anu piepaie the communities foi the conuuct of
examination
! 0veisee the hanuling of uatafiom uesign of foims,
piinting, uissemination, collection, encouing, analysis, anu
wiiting of iepoit
! Collect fees fiom membeis anu ensuie payment of
BEALTBBEv

Nanagement is iesponsible foi the following:
! Continue to uevelop the health piogiam
! Establish linkages with the local goveinment units,
hospitals, health centeis, anu the Philippine Bealth
Insuiance Coipoiation (Philhealth)
BEALTBBEv ! Conuuct ieseaich methous foi auuitional infoimation
! Co-uesign the health piogiam with paitnei institutions
! Tiain the Bealth Community Auvocates anu Euucatois'
Team oi the health cauets
! Belp establish the netwoik ciucial to piogiam
implementation. In 2u11, it helpeu put togethei a uatabase
of public anu piivate clinics anu hospitals within KBCI's
aieas of opeiation. The uatabase, maue available to all KBCI
fielu offices, contains infoimation on the facilities' auuiess
anu contact peisons, seivice houis, seivices available, anu,
in some cases, costs of seivices.
BBIC ! Conuuct the laboiatoiy anu physical examinations
! Belp install management infoimation system (NIS),
paiticulaily the encouing of uata on clinical uiagnosis anu
laboiatoiy iesults
! Analyze uata
Souice: Kasagana-Ka Bevelopment Centei, Inc., 2u12

The piogiam also establisheu paitneiship with the local communities thiough the
Bealth Community Auvocate anu Euucatoi's Team oi "health cauets". The health cauets
aie KBCI membeis in goou stanuing who aie tiaineu anu aie pioviueu with necessaiy
mateiials anu equipment (fiist aiu kits anu basic equipment such as
sphygmomanometei, stethoscope, anu weighing scale) to be able to uo the following
functions (Kasagana-Ka Bevelopment Centei, Inc., 2u12):
! As health infoimation officei,
o To uisseminate infoimation ielateu to K-Kalusugan Piogiam to the KBCI
beneficiaiy-membeis in theii iespective centeis
o To ieminu the beneficiaiy-membeis of theii scheuule of meuical
examination, incluuing vaccination anu pie- anu post-natal checkups
! As chionic health monitoiing agent,

Page 12 of 60
o To watch the bloou piessuie of hypeitensive membeis
o To tiack the sugai levels of uiabetic membeis
o To supeivise the meuicine intake anu laboiatoiy examination scheuule
of those membeis with tubeiculosis
o To monitoi the giowth anu impiovement of malnouiisheu chiluien of
membeis
! As key iefeiial peison, to notify the health centeis of cases of tubeiculosis,
uengue, measles, anu othei contagious uiseases.

The health cauets, who aie not centei chiefs anu not necessaiily health leaueis in the
centeis, aie key in the pioject implementation, specifically in pioviuing technical skills
anu in influencing behavioial change among the membeis. Laboiatoiy anu physical
exams have to be piogiammeu at least once eveiy six months iueally anu shoulu not be
left to the membeis' own initiative, thus the iole of the health cauets.
3. now |t was contro||ed

Initially, the consoitium set the following as the peifoimance measuies of K-Kalusugan
piogiam (Table 4):

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2MBDH# 'GKWGK# 'GKNMVE#
@RJBJNRBD# K-Kalusugan loan winuows Sustainable health piogiam
Examination iesults of KBCI
membeis encoueu

Summaiy iesults anu analysis
on moibiuity anu moitality to
guiue impiovements in the
piogiam uesign

Napping of potential netwoik of
health seivice pioviueis

Tiaining of health cauets in each
centei (composeu of 14 to 4u
KBCI membeis)


Noie iesponsive piogiam to
auuiessing issues ielateu to
moibiuity anu moitality


Naikeu empoweiment of KBCI
membeis

Bettei health conuition of the KBCI
membeis anu theii families



.MNRBD#
KBCI employees to have theii
own health piogiam
components of K-Kalusugan
Bettei health conuition of employees
Souice: Kasagana-Ka Bevelopment Centei, Inc., n.u.


Page 13 of 60
Bowevei, theie is no foimal piogiam evaluation yet baseu on these peifoimance
measuies aftei K-Kalusugan's two-yeai pilot. With its plan to scale up its innovation, the
consoitium expanueu its peifoimance measuies, as uiscusseu unuei Section III.B
Scaling 0p Innovation.
8. Innovat|on Management Iramework
1. Intermed|ar|es]Systems Iramework

The consoitium has expanueu its netwoik to othei oiganizations. It has tieu up with
Botika ng Bayan of Kaunlaian ng Nanggagawang Pilipino, Inc. (KNPI) anu the
Bepaitment of Bealth (B0B) foi the supply of low-piiceu, quality geneiic meuicines.
Some KBCI membeis who opeiate saii-saii stoies aie able to secuie auuitional
inventoiy thiough a loan specific to the uistiibution of KNPI-supplieu geneiic
meuicines. This paitneiship iesulteu in 1S new Botika sa Baiangay opeiateu by the
KBCI membeis themselves (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

Anothei paitneiship has been establisheu with the Ateneo ue Nanila 0niveisity's School
of Neuicine anu Public Bealth (ASNPB). The school helps in the analysis of uata
geneiateu fiom the health examinations. Togethei with BEALTBBEv, ASNPB also
pioviues tiaining to the health cauets (Kasagana-Ka Bevelopment Centei, Inc., 2u12).

KBCI has also joineu PhilBealth's KASAPI (Kalusugang Siguiauo at Abot-Kaya sa
PhilBealth Insuiance), a goveinment piogiam uevelopeu to pioviue social health
insuiance to the membeis of the infoimal sectoi thiough paitneiships with oiganizeu
gioups such as non-goveinment oiganizations anu coopeiatives (Kasagana-Ka
Bevelopment Centei, Inc., 2u12).

The oiganizational fiamewoik of the consoitium togethei with its new paitneis is
summaiizeu in Figuie 2.


Page 14 of 60
@RIGPE#T"#,F,BDGHGIBJ#>PMIPBV#(EHRIJ#





#
#
#
#
#
#
#
#

2. Commun|ty engagement framework

This is mainly embouieu in the involvement of health cauets in the piogiam
implementation.#
3. Sc|ence and techno|ogy framework

KBCI taps on infoimation technology foi its uatabase, analysis, anu iepoiting. While the
piogiam also iequiies the use of meuical technology, this technical aiea falls unuei the
tuif of BBCI. #
4. Susta|nab|||ty framework

KBCI's# piogiam sustainability plan is centeieu on the financial aspect. The uiagnosis
component is uesigneu to be self-sustaining, that is, full cost is chaigeu to the client-
beneficiaiy. As well, full inteiest iate is applieu on theii health financing. The piogiam
also builus on the collection infiastiuctuie of the KBCI, secuiing iepayment of K-
Kalusugan loans.

In tuin, the piogiam also ensuies the sustainability oi financial capacity of the membeis
by giving them health-ielateu, business oppoitunities such as putting up a phaimacy in
theii communities.

Theie is no explicit sustainability stiategy though peitaining to technological, socio-
cultuial, political, anu enviionmental aspects.

Page 15 of 60
S. Innovat|on process framework

The piogiam is composeu of thiee paits: 1) baseline uata system; 2) pieventive
component, which incluues oiientation, health euucation, anu tiaining of health cauets;
anu S) cuiative component, which consists of laboiatoiy tests anu physical examination,
iefeiial system, piovision of access to affoiuable anu quality meuicines, anu
cooiuination with the goveinment agencies (Figuie S) (Kasagana-Ka Bevelopment
Centei, Inc., 2u12).
#
@RIGPE#8"#,F,BDGHGIBJ#>PMIPBV#(EHRIJ#












#
#
#



Souice: Kasagana-Ka Bevelopment Centei, Inc., n.u.


Note that KBCI's innovation uesign matches the national goveinment's stiategic
instiuments, namely health financing, seivice ueliveiy, human iesouices foi health, anu
health infoimation (beyonu KBCI's capacity aie the goveinment's policy anu iegulation,
anu goveinance thiusts). In fact, the consoitium can capitalize on the ABA uiiection
given to the local goveinment units (Lu0s) which is to "oiganize community health
teams anu seivice ueliveiy netwoiks in paitneiship with the piivate sectoi foi effective
ueliveiy of health seivice packages, anu whenevei appiopiiate, contiact piivate
pioviueis to supplement available seivices oi pioviue othei seivices that cannot be
ueliveieu by existing public pioviueis" (Bepaitment of Bealth 0ffice of the Secietaiy,
2u1u).



Page 16 of 60
C. Integrated Innovat|on rocess

0sing the Innovation Becision-Naking Fiamewoik (Figuie 4), one may assess KBCI's
status.

At the stiategic level, KBCI aiticulateu in its seven-yeai plan its intention to "intiouuce
moie seivices anu piouucts to membeis anu new beneficiaiies" anu to pioviue "bettei
uesigneu piogiams foi least-seiveu anu high-iisk sectois, such as the elueily, PWBs, anu
out-of-school youths" (Kasagana-Ka Bevelopment Centei, Inc., 2u1u). Bealth, togethei
with housing, has been KBCI's piioiity since 2u1u. KBCI has also eaimaikeu the yeai
2u12 to be the peiiou foi ieview anu ieuesign of the health piogiam. uiven this
conuition, K-Kalusugan may be consiueieu to be at the uevelopment stage yet.
#
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,
,
,
,
,
,
,
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,
,
,
,
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,
,
,
,
,
,
,
G'J1D$b, c%X$5B3*, 7354D, ]/CC?^", E**'%3+4'*, #$D4;4'*, N3I4*2, H13)$A'1I", N3;+$1R;, SK$;4;", >*4%$1;4+:, '8,
G3;I3+DK$A3*",


While KBCI has cleai stiategic intention foi K-Kalusugan, its stiength comes mainly
fiom the tactical level, specifically in pioject management anu iisk management.

Stiuctuially, K-Kalusugan is unuei KBCI; howevei, theie is no specific unit in chaige of
the piogiam. Its piomotion anu collection of payments aie maue auxiliaiy functions of
the socio-economic officeis (SE0s), while the othei paitneis in the consoitium covei

Page 17 of 60
health seivice ueliveiy anu tiaining of cauets. Cooiuination is ciitical in the
implementation of the piogiam, which, uespite the piesence of foui uiffeient
oiganizations woiking in the consoitium, is being hanuleu quite well. Noieovei, KBCI
has kept piopei uocumentation of its innovationsfiom piouuct concept, to pilot, to
key peifoimance inuicatoiswhich will make stanuaiuization anu ieplication in the
futuie easiei.

In teims of financial iisk management, ielateu uiiect costs aie chaigeu to the
beneficiaiies while the consoitium is also able to uo away with oveiheau expenses in its
piesent setup. Except foi the initial tiaining of the health cauets, foi which KBCI was
able to secuie a giant to finance it, eveiything else is vaiiable cost that is well coveieu by
the full-cost piicing of the piogiam. This appioach is aligneu with KBCI's twin objectives
of social iesponsibility anu (financial) sustainability.

Consequently, these oiganizational anu financial setups have not causeu majoi
uisiuption in the oiganization.
D. Approach and Method

Souices of infoimation weie mainly membeis of the top management of the foui
oiganizations in the consoitium as well as fiom the piimaiy uocuments.

Foui small gioup uiscussions composeu of 19 paiticipants in total weie also conuucteu:
client-beneficiaiies of KBCI unuei the K-Kalusugan Piogiam
client-beneficiaiies of KBCI who aie not yet unuei the health piogiam
non-client-beneficiaiies of KBCI who aie pait of the local community, anu
health cauets

By combining the uata gatheieu fiom the inteiviews (consoitium's peispective) anu the
small gioup uiscussions (beneficiaiies' peispective), this stuuy attempts to iuentify the
gaps anuoi the ieasons why the health innovation is not being auopteu by the taiget
beneficiaiies as intenueu by KBCI.

0thei uata, paiticulaily the cases of othei piactices in health innovation weie souiceu
fiom seconuaiy mateiials.


Page 18 of 60
III. Case D|scuss|on
A. Innovat|on rob|em

KBCI confionts seveial issues in scaling up its K-Kalusugan piogiam. These issues weie
iuentifieu uuiing the consoitium's ieview of the piogiam peifoimance.
1. Membersh|p] recru|tment

Why only 1,7uu KBCI membeis fiom the total of moie than 18,uuu (oi meiely 9.2
peicent) avail of K-Kalusugan two yeais aftei the piogiam was launch. Why only S1S
KBCI membeis (oi almost S peicent of the total) availeu of the health loans.

The consoitium iecognizes the iequiieu change in minuset anu behavioi among the
membeis foi them to appieciate the health seivices offeieu. It is still a common sight to
see motheis iefusing to have themselves checkeu but aie willing to spenu on the
husbanus' nicotine oi alcoholic vice. In the cases of those who uo have themselves
checkeu, follow-up iate is quite low at an aveiage of S6 peicent.

0n the pieventive siue, health impoitance has to be instilleu among the membeis anu
othei community membeis. Nany tenu to have high-souium, high-sugai uiet (e.g. soy
sauce anu fish sauce aie consumeu as vianus in themselves; instant nooules aie staples
because they aie cheap anu can be uiluteu in watei to seive the entiie householu). They
also have a meuicine-focuseu anu uoctoi-focuseu iuea of achieving health, i.e. ielying
heavily on uoctois anu meuicines to cuie theii illnesses insteau of stiiving to pievent
the occuiience of these illnesses.
2. numan resources

The consoitium also acknowleuges the neeu foi moie health cauets to piomote the
piogiam at the community level. The iueal iatio is one cauet to one centei; cuiiently,
they have 7u cauets foi KBCI's 1,Suu centeis.

Stiuctuially, theie is no ueuicateu staff foi K-Kalusugan piogiam. The piomotion of
health seivices is auueu to the iegulai woikloau of the SE0s in chaige of KBCI's
miciofinance piogiam, thus it is not given piioiity. The existing health cauets also still
iequiie closei mentoiing by the aiea manageis. Theie also is no incentive scheme yet in
place foi the health piogiam.

Page 19 of 60
3. Lxterna| and commun|ty re|at|ons

The local health units (baiangay anu municipal) see the health cauets as theii
competitois. Refeiial system also has to be foimalizeu anu paitneiship with uoctois anu
institutions establisheu foi cases that iequiie highei level of meuical inteivention.

What the consoitium uiu not iuentify as a concein was theii XGDJEPBCRDRKS# RJ#
RJHKRKGKRMJBD#WBPKJEPHLRWH, which uiiectly affect theii seivice ueliveiy anu finance, anu
consequently, the scaling up of innovations.
8. Survey of Innovat|ve Approaches and So|ut|ons to nea|th Care
1. Susta|nab|e Innovat|ons' Arogya

In 2uu7, Sustainable Innovations won a giant of 0S$2uu,uuu foi kiosk-baseu clinics to
uelivei health caie to vulneiable populations, tieating common ailments anu
pieventable uiseases at a cost of $u.2S pei visit (Sustainable Innovations, 2uu8).
Although the piogiam, calleu Aiogya, encounteieu seveial goveinment iegulatoiy
pioblems, it was finally launcheu in foui villages in Rajasthan, Inuia in 2uu9 (Sustainable
Innovations, 2uu9).

These kiosks aie equippeu with computeiizeu best meuical piactices foi the common
ailments anu weie owneu anu opeiateu by social entiepieneuishigh school
giauuates, who aie tiaineu foi seveial weeks. The iationale foi the establishment of
these kiosks was that qualifieu meuical staff anu physicians founu villages uniewaiuing
economically, while public health caie centeis suffeieu fiom wiuespieau absenteeism.
Fuithei, people view ailments as noimal aging piocess anu it was consiueieu taboo foi
women to seek health caie (Sustainable Innovations).

The kiosks aie walk-in centeis (no appointment necessaiy) with computeiizeu uisease
piotocols, publisheu by the National Institutes of Bealth anu the Woilu Bealth
0iganization, anu aie equippeu to captuie clinical (vitals, histoiy, meuication,
uiagnostics, uiug names, manufactuiei's name) anu uemogiaphic (name, age, unique
health iuentifiei) uata. The health woikei enteis the symptoms in the computei anu
kiosk compaies the symptoms with the knowleuge-uatabase of the common ailments.
Instiuctions aie in multiple languages to catei to multi-lingual anu multi-cultuial
population of Inuia. The kiosk also iequiies minimal language pioficiency foi health
woikeis to entei the uata, i.e. uemogiaphics, chief complaint, symptoms. If theie is a

Page 20 of 60
stiong match between the inputteu symptoms anu those of the common ailment,
tieatment plan will be geneiateu. If the match is weak, the health woikei will have to
captuie auuitional symptoms anu iun anothei matchthis time the kiosk will eithei
iuentify a uisease oi to ieject the entiy. In case of iejection, the uata will be sent to the
back-up physician at Inteinational Institute foi Bealth Nanagement Reseaich (IIBNR).
Physicians then tiack the peifoimance of the local health woikeis fiom the captuieu
uata anu take iemeuial measuies, if iequiieu. The uata aie uepositeu into IIBNR
iepositoiy (Sustainable Innovations).

The pioject goal is to pioviue health caie to 2Su,uuu people in the iuial villages of
Rajasthan by 2u1S. Sustainable Innovations implements its piogiams via public-piivate-
community paitneiship with the goveinment contiibuting 8u peicent of the one-time
costs. (Sustainable Innovations)
2. IICD's 1e|emed|c|ne

Telemeuicine pioviues specialist uiagnoses by linking local health woikeis in the iuial
aieas with expeits locateu in the city via the Inteinet. Foi this pioject, Inteinational
Institute foi Communication anu Bevelopment (IICB) piloteu the use of satellites to
impiove Inteinet connections foi the most iemote hospitals. Thiough uigital connection,
meuical infoimation is maue accessible, uistance tiaining foi health woikeis is
ueliveieu, anu uigital iecoiukeeping is uone foi hospital auministiatois, all of which can
significantly impiove tieatment anu piognosis foi the patient. The pioject also uses
uigital meuia anu mobile telephones to suppoit community-baseu public health
campaigns. This specific case is citeu as to how telemeuicine saveu a 1u-yeai-olu boy: he
was aumitteu to hospital in iuial Nali (wheie theie aie only a uozen iauiologists seiving
the 1S million population) with a stiange lump in his thioat that maue it impossible foi
him to swallow. Local uoctois coulu not uiagnose him anu so the boy's x-iays weie sent
via Inteinet to a iauiologist 6uu-kilometei away in the capital Bamako. The expeits then
uiagnoseu the boy's conuition anu instiucteu the local uoctoi how to tieat him. (IICB)
3. G|oba| nea|th Innovat|on's nea|th Care for the Crphaned and Vu|nerab|e Ch||dren
"It is estimateu that moie than 16 million chiluien unuei 18 have been oiphaneu by
AIBS with 14.8 million of these chiluien living in sub-Sahaian Afiica. Alieauy
uisauvantageu, limiteu oi no access to basic health caie seivices only thiows these
chiluien fuithei into poveity anu uespeiation" (ulobal Bealth Innovations, 2u12). ulobal
Bealth Innovations (uBI) thus offeis solutions by paitneiing with communities,

Page 21 of 60
chuiches, oiganizations, anu goveinments in pioviuing compiehensive seivices to caie
foi chiluien that aie oiphaneu anu vulneiable aiounu the globe. Since 2u1u, uBI has
assesseu ovei 2,uuu chiluien living in oiphanages in Baiti, uhana anu Libeiia, pioviuing
them as well with piogiam planning. The health seivices pioviueu also incluue the
facilitation of immunizations, suigical seivices, clean watei piovision, uewoiming, acute
anu chionic uisease assessment anu management, nutiitional analysis anu
piogiammatic inteiventions, BIvAIBS testing anu tieatment, anu uistiibution of
insecticiue-tieateu mosquito nets to pievent malaiia (ulobal Bealth Innovations, 2u12).
4. Un|vers|ty of ad[ad[aran's Mu|t|p|ex CC

In Inuonesia, the majoi causes of ueath aie malaiia, uengue fevei, typhoiu fevei, anu
leptospiiosis. Since laboiatoiy-baseu uiagnostic seivices aie eithei expensive oi
inaccessible, the maiginalizeu in the iemote aieas aie mostly tieateu baseu on clinical
symptoms anu aie inuisciiminately piesciibeu with antibiotics by the health woikeis.
Thus, patients aie not tieateu piopeily anu at times even uevelop iesistance to
antibiotics (Ateneo School of uoveinment, 2u12).

The 0niveisity of Paujaujaian, in paitneiship with Pakai Biomeuika Inuonesia Company
anu Institut Teknologi Banuung, locally uevelopeu Nultiplex Point of Caie (P0C) that
can quickly test foi the malaiia, typhoiu fevei, anu leptospiiosis in just one pioceuuie,
thus ieuucing the cost of laboiatoiy tests. The test kit is also maue affoiuable, sensitive,
usei-fiienuly, anu easy to use in the fielu. With this innovation, the health woikeis aie
now able to uiagnose uiseases coiiectly, tieat patients with the iight meuicine, anu
enjoy highei confiuence in uoing theii jobs. The Nultiplex P0C is yet to be uistiibuteu
system-wiue anu the patients' piefeience foi immeuiate iemeuyas Nultiplex P0C's
iequiieu five uays of waiting is less acceptable to themto be oveicome (Ateneo School
of uoveinment, 2u12).
S. M|croVentures, Inc.'s nap|noy 8ot|ka

Nicioventuies, Inc. (NvI) fiist founueu Bapinoy, a netwoik of saii-saii stoies iun anu
owneu by the miciofinance boiioweis who enjoy auuitional loans foi stoie inventoiy,
access to bettei-negotiateu piices of fast moving consumei goous, stoie bianuing, anu
tiaining anu capacity builuing pioviueu by NvI. Eventually, it auueu meuicine to its
iange of piouucts, initially geneiic, ovei-the-countei (0TC) meuicines, anu came up with

Page 22 of 60
Bapinoy Botika. The new line built on the existing infiastiuctuie of Bapinoy saii-saii
stoies. (Ateneo School of uoveinment, 2u12)

Since the boiioweis piefei the moie expensive bianueu uiugs, thinking that they aie of
bettei quality anu aie thus moie effective in tieating uiseases, NvI combines the best-
selling items of its paitnei-phaimaceutical companies (0nilab foi bianueu anu ueneiika
Biugstoies foi geneiic meuicines), the piouucts best solu by the saii-saii stoies, anu
those iecommenueu by uoctois in its Botika. NvI also hau to ueal with iegulations anu
the saii-saii stoieowneis' piactice of selling antibiotics. In the enu, NvI maue a fiim
stance to auheie to the iegulatoiy policies while tiaining the stoieowneis on the coiiect
use of antibiotics, as they can souice them anyway fiom othei channels. NvI also set a
fixeu selling piice to ensuie both that the meuicines iemain affoiuable to the pooi anu
that the Botika opeiations piofitable. Finally, the euucation component enables the
stoieowneis to sell the meuicines with conviction (Ateneo School of uoveinment, 2u12).

The Botika is ieauy foi scaling up in 2u12. NvI attiibutes the success of the piogiam
mainly to the inclusion of all stakeholueis fiom the veiy beginning. The stoieowneis
have been involveu in the uesign anu size of the meichanuising mateiials, the
assoitment, piicing, euucational events, anu final launch of the piogiam (Ateneo School
of uoveinment, 2u12).

6. Center for Commun|ty 1ransformat|on's nea|th rogram

The Centei foi Community Tiansfoimation (CCT) seives as the paient oiganization of
the vaiious entities that iun its ministiies, which incluue miciofinance, euucation,
health, anu spiiitual uevelopment, among otheis. Its health piogiam is manageu by the
vision of Bope Founuation. As of 2u1u, it has establisheu 26 clinics in its aieas of
opeiation nationwiue anu hopes to set up one in each of its 1SS bianches by 2u1S
(Centei foi Community Tiansfoimation, 2u1u).

Its health piogiam incluues the following seivices (Centei foi Community
Tiansfoimation, 2u1u):
Fiee basic meuical consultation at any of the CCT clinics
Bealth anu enviionment lectuies conuucteu by uoctois uuiing which health-seeking
behavioi is encouiageu in the communities anu among the staff

Page 23 of 60
PTB-B0TS (Pulmonaiy Tubeiculosis Bacilli-Biiectly 0bseiveu Tieatment Shoit
Couise) piogiam implementeu in paitneiship with the Reseaich Institute of
Tubeiculosis-}apan Anti Tubeiculosis Association anu with local health centeis
Ciicumcision of young males uuiing the summei vacation months
Feeuing of malnouiisheu chiluien in paitneiship with Bethesua Ninistiies
Family planning seivices in paitneiship with the non-goveinment oiganizations
such as Coopeiative Novement foi Encouiaging No Scalpel vasectomy anu Linangan
ng Kababaihan (Likhaan).
Fiee flu vaccination
Fiee basic uental caie, incluuing oial health lectuies foi chiluien anu auults, oial
piophylaxis, tooth extiaction, fluoiiue tieatment, anu uistiibution of toothbiushes
7. Negros Ccc|denta| kehab|||tat|on Ioundat|on, Inc. (NCkII)

N0RFI can be consiueieu one of the moie successful health seivice innovatois. It cateis
specifically to pooi population's sub-segment of "physically anu mentally impaiieu pooi
maiket" oi PWBs who uo not eain a living oi aie most likely unable uo so. To theii make
economic conceins woise, theii families have to incui expenses foi theii meuical
tieatment. This situation makes affoiuability of health seivices uoubly uifficult foi the
PWBs. Fuithei, these PWBs aie locateu mostly in iuial aieas, some in haiu-to-ieach
places, anu thus access to health seivice is an issue.

Recognizing that no one solution (e.g. meuical tieatment) can help the patient get back
to mainstieam society, N0RFI pioviues othei seivices such as euucation, vocational
tiaining, anu othei social seivices. N0RFI employs community-baseu iehabilitation,
which is "a home-baseu appioach of healthiehabilitation seivice piovision,
implementeu thiough the combineu effoits of the PWBs themselves, theii families, anu
the appiopiiate health, euucation, vocational, anu social seivices" (Sebastian, N0RFI (A):
Case Bistoiy, 2u1u).

In 2uu8, N0RFI's piogiam hau seiveu Su out of the total S2 municipalities anu cities in
the piovince of Negios 0cciuental, with the numbei of patients ieaching 9,67S anu
volunteeis, 1,124. N0RFI's outieach is highei than the Bepaitment of Welfaie anu Social
Bevelopment's iepoiteu seiveu numbei of PWBs: 4,77S in 2uu7 anu S,8uS in 2uu8.
0vei its existence, N0RFI hau seiveu Su,uuu inuigent patients fiom 628 villages.
Nanagement anu staff of N0RFI attiibute the success of the piogiam to the following
(Sebastian, N0RFI (A): Case Bistoiy, 2u1u):

Page 24 of 60
Involvement of vaiious stakeholueisthe city anu piovincial goveinments whose
subsiuy to N0RFI ieacheu 2S peicent of N0RFI's cash inflow in 2uu8; the
goveinment-suppoiteu village health woikeis-volunteeis who woikeu with N0RFI's
employees who numbeieu only 6; the uoctoi-volunteeis; uonois; anu the family anu
community of the PWBs.
uetting anu keeping the iight people to woik foi the oiganization.
Leaueiship to be able to uo the fiist two bullets.
8. A nea|th rogram 1hat Never Was

A Netio Nanila-baseu piivate laboiatoiy attempteu to paitnei with an NFI in offeiing a
health package foi the low-income gioup. Foi a pie-paiu package woith PhpSuu, a
beneficiaiy coulu avail of a complete laboiatoiy test package anu thiee consultations
with the laboiatoiy's accieuiteu uoctois anytime within a peiiou of one yeai. Initially,
the health package woulu be piloteu in two bianches of the NFI anu be offeieu
exclusively to its membeis. Since the NFI's membeis aie alieauy oiganizeu into centeis,
gatheiing at least Su membeis on site, which is the laboiatoiy's bieakeven estimate pei
on-site opeiation, woulu be feasible. Eventually, the package woulu be offeieu to non-
membeis.

The NFI piesenteu the plan to the centei chiefs (leaueis of each centei similai to
KBCI's) of the two pilot bianches. The chiefs iemaikeu that the package is inueeu an
inexpensive one, having expeiienceu unueigoing laboiatoiy tests themselves at iegulai
iates. The payment teim, which woulu be the full amount in the foim of bank ueposit to
be maue uiiectly to the laboiatoiy's account, was ueemeu acceptable to them. Bowevei,
by the time the membeis weie supposeu to make theii ueposits, nobouy uiu. Nany of
them ieasoneu that they enueu up spenuing the money set asiue foi the health piogiam
foi some othei householu expenses.

The NFI also piesenteu the health piogiam to its loan officeis, the ones in uiiect contact
with the membeis, hanuling collection anu monitoiing of loans (similai to KBCI's SE0).
Theii fiist question was, what is in it foi us. 0n the pait of the laboiatoiy, it coulu not
fuithei lowei the piice of its package; on the pait of the NFI, it was not able to come up
with incentive scheme foi its loan officeis to maiket the health piogiam to its membeis.
Bue to lack of incentive scheme foi the loan officeis anu low (oi no) iesponse iate fiom
the membeis, the health piogiam uiu not mateiialize.

Page 25 of 60
9. Cases Compared w|th k-ka|usugan

The citeu oiganizations anu KBCI have uiffeient appioaches to health caie solutions.
Sustainable Innovations anu KBCI opeiate in the same context wheie public health
centeis suffei fiom absenteeism anu wheie pait of the taiget maiket exhibits passive
attituue towaius health. The two oiganizations, howevei, uiffei in theii iesouice
enuowment anu hence, theii moue of health seivice ueliveiy. Sustainable Innovations
pioviue health seivices that aie within the ieach of the taiget beneficiaiies any time
unlike K-Kalusugan when uiagnosis is uone only once a yeai uepenuing on the BBCI's
scheuuleu visit to each KBCI bianch. Sustainable Innovations's kiosks aie also capital-
intensive, what with the installeu computei units in each, while K-Kalusugan is laboi-
intensive, ielying heavily on the woiks of the health cauets, socio-economic officeis, anu
BBCI staff. Lastly, Sustainable Innovations ieceives substantial financial suppoit fiom
the goveinment while KBCI uoes not. With the uiffeiing iesouice bases of the
oiganizations, K-Kalusugan will have to take anothei stiategy oi piouuctsystem uesign
in making itself moie available anu moie accessible to the taiget maiket similai to
Sustainable Innovations' appioach.

Similai to Sustainable Innovations, IICB's Telemeuicine is capital-intensive anu K-
Kalusugan uoes not have the mateiial iesouices to auopt such an innovation. Cuiiently,
howevei, The Neuical City has a similai piogiam wheie uiagnostic iesults fiom outsiue
the hospital aie sent to its uoctois foi analysis anu appiopiiate piesciiption.

The abovementioneu aspects of health seivice ueliveiy, howevei, covei only one pait of
K-Kalusugan's piogiam, that is, the cuiative pait. The two othei piogiams uo not have
pieventive, euucation, financing, uata management, anu livelihoou components that K-
Kalusugan has.

The 0niveisity of Paujaujaian's Nultiplex P0C coulu veiy well help KBCI localize its
uiagnostic-pieventive component. Bowevei, Nultiplex P0C is intenueu foi infectious
uiseases while common uiseases of KBCI membeis aie mainly lifestyle uiseases (heait
attack, cancei of vaiious types, anu hypeitension). Peihaps, the Nultiplex P0C
technology can be auopteu anu tweakeu to seive the specific neeus of K-Kalusugan.
Since KBCI alieauy has health cauets in place, albeit still lacking in numbeis, the hanuy
uiagnostic kits can help make laboiatoiy tests moie available to the communities,
theieby oveicoming the limitations of BBCI.

Page 26 of 60
KBCI's K-Kalusugan, Bapinoy Botika, N0RFI, CCT, anu BC0vC all builu on paitneiship
with othei institutions in ueliveiing vaiious health system components. Bowevei, while
BC0vC possesses the technical expeitise anu ielies on its paitnei in connecting with the
taiget beneficiaiies anu in pioviuing them with othei non-technical suppoit, KBCI
uepenus on its paitneis, paiticulaily BBCI, foi technical seivices while it pioviues the
non-technical ones. NvI's Botika, while it has both cuiative anu euucation components,
laigely taigets the maiginalizeu saii-saii stoieowneis as uistiibution channels anu not
as patient-beneficiaiies. NvI's business mouel foi its Botika is in a way similai to KBCI's
Botika sa Baiangay. What KBCI can possibly leain fiom NvI is that the lattei has
engageu the stakeholueis at the community level in the innovation piocess iight at the
stait.

0ff all the cases mentioneu, N0RFI is the closest to KBCI's appioach. Asiue fiom
pioviuing suppoit seivices, the two Nu0s also use paitneiship in caiiying out theii
piogiams. The uiffeience between the two, howevei, is in theii choice of paitneis
N0RFI paitneis with the goveinment fiom baiangay to piovincial levels while KBCI has
not yet uone soanu in the level of involvement of the beneficiaiies, theii families, anu
the local community in the piogiam.

CCT is also similai to KBCI in that the two oiganizations have miciofinance piogiams
anu paitneis with othei institutions in ueliveiing theii health piogiams. Bowevei, the
uiffeience lies in theii piicing stiategiesKBCI chaiges full cost while CCT pioviue most
if not all of its seivices foi fieeanu thus, in the piovision of financing, which CCT uoes
not neeu. CCT has also mainstieameu its health piogiam such that it has investeu in its
own clinics.

KBCI coulu also leain fiom the NFI in the case of the health piogiam that nevei
mateiializeu. The piouucts of KBCI anu the othei NFI weie both appiopiiately piiceu
although the lattei's may not necessaiily match the cash flow of the membeis in the
absence of a loan winuowanu theii seivices woulu have been maue accessible to the
communities, with the laboiatoiy staff anu uoctois going to the site. Bowevei, moie
than the piouuct uesign, the othei NFI's piocess of intiouucing the innovation may be
flaweu. The "consultation" with the centei chiefs was meiely a top-uown piesentation of
the innovation foi maiket appioval; it was neithei an assessment of theii neeus noi an
active engagement of the membeis in the innovation piocess. Thus, uespite the
membeis' initial agieement to join the health piogiam, none of them actually

Page 27 of 60
paiticipateu. Similaily, the piogiam was meiely piesenteu to the loan officeisno
consultation was maue. In this NFI's case, the absence of incentive scheme foi the loan
officeis was a ueal bieakei.

Table S summaiizes the featuies of the citeu piogiams.

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C. Manag|ng Innovat|on
1. App||cat|on

K-Kalusugan loans aie offeieu only to the KBCI membeis who have been with the
business loan piogiam foi at least one yeai anu in goou stanuingthe NFI's way of
managing its cieuit iisk. Since BBIC staff goes to the bianches to conuuct laboiatoiy anu
physical examination, theii visit to KBCI's 2u bianches is spieau ovei one yeai such that
they get to visit aiounu two bianches in a month oi one visit in a bianch pei yeai. Foi
this ieason, K-Kalusugan loan is offeieu to a bianch only once in a yeai.

Although K-Kalusugan is uemanu-uiiven in that it was conceptualizeu baseu on a suivey
conuucteu among the KBCI membeis, the membeis weie essentially not involveu in the
piogiam uesign, as implieu by the iesponses of the membeis in the gioup uiscussions.

The following factois weie citeu in inteiviews by the KBCI membeis, both K-Kalusugan
membeis anu non-membeis, when askeu why only a small peicentage of the KBCI
membeis join the health piogiam: eithei the KBCI membeis uo not have yet the
iequiieu length of stay in KBCI's business loan piogiam oi they misseu the once-a-yeai
oppoitunity to avail of it.

Page 28 of 60
The inteiviewees also auueu that theie shoulu be a moie active campaign foi the
piogiam. Specifically, they suggesteu that a iesouice peison speak in each centei uuiing
one of its weekly meetings to uiscuss the health piogiam anu its benefits. They also
suggesteu that pap smeai, anu eye anu uental check-ups be incluueu in the package.

Some membeis also thought that otheis uo not want to auu to theii weekly amoitization
of business loans, usually combineu with euucation anu housing loans, by availing of the
K-Kalusugan loan. Foi the non-membeis, they thought that such loan woulu be
unattiactive to those who aie useu to fiee health seivices anu meuicines pioviueu by
meuical missions oi volunteei gioups.

As foi low iate of follow-up oi ietuin visit to uoctois, the membeis explaineu that
people eithei uo not unueistanu that follow-up visits aie fieewhich means that people
uo not want to spenu moieoi uo not have money to covei theii tianspoitation
expenses going to the bianch wheie BBIC holus the examination. #
2. Adaptat|on to User Cu|ture

S:('&'2:,'8,Z$*$84D4314$;,

Baseu on the levels of awaieness, attituues, anu actions taken by the inteiviewees
uuiing illness, taiget beneficiaiies of K-Kalusugan may be classifieu into foui categoiies:
1) the A-0K; 2) the inactive; S) the pio-active; anu 4) the ieactive. This categoiization is
baseu on the beneficiaiies' level of awaieness, with low level not expeiiencing
symptoms of a uisoiuei anu high level uoing so, as well as the beneficiaiies' attituue
towaiu theii conuition, with the active ones taking actions to auuiess it anu the passive
ones not uoing anything about theii conuition. Theii uiffeientiation is piesenteu in
Figuie S.

Page 29 of 60
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Nost gioup uiscussion paiticipants fall unuei the pio-active anu ieactive gioups. Those
unuei the pio-active segment unueigo examinations because they have hau histoiy of
an illness (e.g. intiauteiine bleeuing, goitei, uiinaiy tiact infection) anu want to pievent
theii iecuiience oi aie iequiieu by uoctois to monitoi theii clinical measuies. Some of
them take pio-active stance because they have alieauy iealizeu, eithei thiough theii
own expeiience oi of someone they know, that it is moie expensive to cuie an illness at
its auvanceu stage than to pievent it oi to have eaily uiagnosis of it. Noimally, actions
taken by the gioup aie meant to benefit the "self" oi the membeis themselves.

Those unuei the ieactive gioup, on the othei hanu, seek meuical attention when they oi
theii family membeis, specifically the chiluien, feel the symptoms alieauy (e.g. colu,
cough, fevei, chest pain, uifficulty in bieathing). When this happens, many KBCI
membeis iesoit to going to piivate uoctois foi uiagnosis, even if this woulu mean cash a
outlay of between PhpSuu anu Php1,uuu pei visit foi uoctoi's fee anu meuicines. They
usually pay foi these seivices by cutting theii buuget on othei householu items oi by
tapping theii husbanus' (uaily) income; when times piove uifficult, they boiiow money
fiom theii families anu fiienus.

They saiu they uo not go to baiangay health centeis because uoctois aie haiuly piesent
anu they uo not want to iisk theii chiluien's health by consulting the miuwives in the
centeis. They also ieasoneu that moie often than not, the miuwives also iefei them to go

Page 30 of 60
to uoctois anyway. Besiues, the centeis uo not pioviue fiee meuicine any moie so they
woulu iathei go to eithei piivate clinics oi goveinment hospitals (e.g. Amang Rouiiguez
ueneial Bospital, Philippine ueneial Bospital, Laboi, National 0ithopeuic). Some also
citeu the inconvenience of the long queue in the baiangay health centeis oi of looking
foi them because they have been moveu fiom one location to anothei quite too often.

Some inteiviewees also mentioneu that theie aie meuical missions in theii aieas but
they uo not avail of theii fiee seivices. They peiceiveu the uoctois in meuical missions
as not giving them anu theii chiluien thoiough examination anu not taking time to
explain to them theii conuitions. They also founu it inconvenient to compete with the
huge ciowu that often goes to these missions because eveiything is fiee, snacks
incluueu. Finally, they saiu that meuical missions coulu also be politicizeuthose who
maintain close ielationship with the politicians aie often given piioiity.

A few manage the symptoms by self-meuication, usually taking paiacetamol oi pain
ielievei tablets.

The A-0K anu inactive types aie citeu by the inteiviewees as the common behavioi of
theii neighbois, not theii own. They aie those who feai knowing what they aie sick of
uespite the symptoms oi uo not have the financial iesouices to act on theii conuition
(inactive) oi those who think they aie okay because they uo not feel anything wiong anu
thus uo not see the neeu foi examinations (A-0K).

uiven these pioposeu types of health seivice beneficiaiies, K-Kalusugan veiy well seives
the neeus of the pio-active type anu, with its euucation component, cateis to the inactive
gioup. The lattei, howevei, might take a long time to paiticipate in the piogiam since
this segment is typically composeu on non-KBCI membeis. Since the neeus of the
ieactive gioup aie quite uigent, the cuiient opeiational stiuctuie of K-Kalusugan will
not be able to meet theii iequiiements. Bowevei, this initial hypothesis of typology
iequiies fuithei ieseaich to establish empiiical eviuence, as the uata pioviueu in the
inteiviews anu gioup uiscussions aie insufficient foi any uemanu oi financial
piojections.

The oveiall feeuback of the uiscussion paiticipants piesents an oppoitunity to K-
Kalusugan: the taiget maiket is willing to pay anu the seivices of piivate institutions aie

Page 31 of 60
piefeiieu ovei the fiee seivices pioviueu eithei by the goveinment (except foi the
teitiaiy anu specialty hospitals) oi by the meuical missions. #
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The KBCI membeis who weie inteivieweu inuicateu that theii health cauets took theii
bloou piessuie only but once since they staiteu in the K-Kalusugan piogiam. 0n the
othei hanu, the inteivieweu health cauets shaieu that people, both KBCI membeis anu
non-membeis, go to theii business location (e.g. Botika sa Baiangay) anuoi theii
houses to have theii bloou piessuie checkeu. These two veisions of the stoiies coulu
both be tiueif membeis uo not go wheie the health cauets aie, they woulu not get
assesseu moie than once (peihaps uone uuiing theii fiist meeting).

The health cauets naiiateu how people in theii communities staiteu tieating them as
health expeits aftei they unueiwent the KBCI tiaining, seeking foi theii auvice. Thus
they saw theii woik as cauets as mission anu seivice to the community, not just to KBCI.
While some chaige PhpS pei bloou piessuie ieauing, otheis uo not set a fixeu amount
anu simply welcome any uonation fiom theii "patients"thus, the seivice's becoming
income geneiating foi the cauets can help in the sustainability of K-Kalusugan. KBCI
allows this piactice as long as health cauets pioviue the seivices foi fiee to the KBCI
membeis. As foi theii inteiaction with the membeis of the local goveinment, they saiu it
is nil; in fact, theie seems to be silent animosity between the health cauets anu the Lu0
woikeis (i.e. I3)4aI3)4Y, I3:'aI3:' attituue, they saiu). An isolateu case, they saiu, was
the Quezon City goveinment that has absoibeu the health cauets as pait of its health
pioviuei staff.

At piesent, the health cauets expiesseu theii neeus foi supplies (i.e. fiist aiu kit supplies
hau not been ieplenisheu aftei they weie issueu), iepaii of theii sphygmomanometei,
tiaining oi upgiauing of theii skills to incluue theiapeutic massage anu weight
monitoiing using health stanuaius, supeivision of the health expeits (iueally fiom
BBIC), anu establishing theii iuentity as health cauets, by having an IB caiu anuoi
unifoim, foi example. Accoiuing to these souices, tiaining of new cauets anu supply of
meuical equipment anu mateiials ceaseu when foieign funuing foi K-Kalusugan enueu.
3. Ma|nstream|ng

The low pationage iate of K-Kalusugan among the KBCI membeis is mainly uue to the
limitations of the maiket anu of the piogiam itself. Bue to the off-site, as-scheuuleu-only

Page 32 of 60
piesence of health seivice pioviuei, K-Kalusugan cannot seive the neeus of the ieactive
segment yet. Fuithei, because of the limiteu numbei of the health cauets at 7u foi 1,Suu
centeis, KBCI cannot maximize its potential in the inactive maiket eithei. Thus, with its
piesent setup, the piogiam can only catei to the pio-active gioup. Still, K-Kalusugan
cannot maximize its penetiation of this maiket given its one-yeai iesiuence
iequiiement.

At 28 peicent uiopout iate
S
, K-Kalusugan can only be offeieu to 44 peicent of the KBCI
client base, at a maximum. Take out fuithei those not in goou stanuing at 2.S peicent
4
of
the total numbei of membeis anu segment the iemaining 41.S peicent into pio-active,
ieactive, inactive, anu A-0K
S
, then the potential pio-active maiket of K-Kalusugan woulu
be ielatively small. In fact, assuming that the foui categoiies aie of equal size, then the
pio-active shaie will be 1u.S7 peicent, which is not too fai fiom the cuiient shaie of
KBCI membeis availing of K-Kalusugan at 9.2 peicent.

In the immeuiate- anu shoit-teim, what the consoitium can uo to inciease the K-
Kalusugan membeis is to tap the inactive segment by piomoting health euucation moie
aggiessively. This can be uone by incieasing the numbei of health cauets anu aujusting
the oiganizational stiuctuie (as pioposeu in the Scaling 0p Innovation section following
this). In the long iun, the consoitium can expanu to the ieactive segment by making the
piesence of the health seivice pioviueis moie available anu accessible to the
beneficiaiies by paitneiing with piivate companies. Bowevei, even with piivate
paitneis, what coulu iemain a challenge is biinging these seivices to the baiangay level,
as pioposeu by the health cauets. They explaineu that people in geneial aie too lazy to
get out of theii baiangays oi uo not have money to uo so, thus the solution is to biing
the seivices to the people. 0ne way of uoing so is to tap the seivices of mobile
laboiatoiies oi ioving health seivice pioviueis.

The health cauets also suggesteu that they be oiganizeu into a sepaiate oiganization oi
coopeiative, inuepenuent of KBCI, so that they coulu have a voice in the community anu
ask suppoit fiom the Lu0s. They believeu that the Lu0s have financial iesouices anu
insteau of putting them in infiastiuctuie piojects such as the waiting sheus, they coulu
be channeleu to health seivices. Peihaps, with the health cauets anu Lu0s woiking

S
Latest available uata in 2u1u
4
Baseu on the membeiship wiite-off iate in 2u1u
S
Fuithei ieseaich is neeueu to have a faiily accuiate estimate of the size of these segments.

Page 33 of 60
togethei, the baiangay health centeis coulu be ieviveu but unuei a uiffeient
configuiationthe health cauets can builu on the stiuctuie of the baiangay health
centeis anu the iesouices of the Lu0s be tappeu foi supplies anu equipment, while the
cauets pioviue basic seivices foi a minimum fee oi uonation. The Quezon City case is
woith exploiing to see if it coulu be a mouel of goou piactice. #

With the limitations of the health piogiam anu the uiffeiing featuies of the maiket
segments KBCI cannot expect that K-Kalusugan will giow at a iate fastei than it has
been giowing since its inception unless the consoitium changes its stiategy. This move
woulu iequiie bettei uefining anuoi taigeting the maiket it wishes to seive, alteiing
the piogiam innovation uesign to bettei fit its maiket, anuoi changing its taiget maiket
foi its specific innovation uesign.
D. Sca||ng Up Innovat|on

To solve the pioblem of slow giowth of K-Kalusugan membeiship, the consoitium
envisions to scale up the piogiam in the next thiee yeais by 1) incieasing the numbeis
of health cauets to fuithei intensify infoimation campaign anu 2) having ueuicateu staff
to manage the piogiam.

The piesent numbei of health cauets has to be incieaseu fiom 7u to 1,Suu to achieve the
iueal one health cauet pei centei. The tiaining can be uone in thiee yeais, with Suu
cauets tiaineu eveiy yeai. The cuiient tiaining piogiam is uesigneu foi thiee uays,
wheie two to thiee health issues aie uiscusseu pei uay. Following aie the tiaining neeus
of the cuiient health cauets that the consoitium thought coulu be incoipoiateu in the
tiaining piogiam (Ignacio, Beiieia, Tuano, Antiqueia, Santos, & Quinto, 2u12):
1) Selling skills (of the piogiam) health piomotion to the membeis
2) Peei counseling
S) Cieation of netwoik foi the cauets as theii fielu suppoit system
4) Auuiessing social stigma, especially that associateu with tubeiculosis, anu
S) Euucation on the piotocol oi iefeiial system (i.e. fiom centeis to baiangay
health office to municipal health office, etc.)

Seconuly, hiiing of a fulltime staff is necessaiy in oichestiating the whole health system.
The staff will be taskeu to uo the following (Ignacio, Beiieia, Tuano, Antiqueia, Santos,
& Quinto, 2u12):
1) Cooiuinate with the stakeholueis anu membeis

Page 34 of 60
2) 0nueigo tiaining unuei BEALTBBEv
S) Complete health stats anu uo lifestyle check
4) Netwoik with vaiious levels of the oiganizations (health institutions oi clinics),
anu
S) Paitnei with Lu0 health woikeis

Communication piotocols anu iepoiting system of the staff within the netwoik of
institutional paitneis have to be oiganizeu yet.

Asiue fiom these two key elements, theie aie othei things that neeu to be in place. Foi
example, iueally the laboiatoiy examination shoulu be uone in the KBCI site eveiy
month. If the patients' neeu is uigent, they cannot wait foi the next laboiatoiy exam
scheuuleu in theii site thus the consoitium plans to get pie-paiu health caius foi the K-
Kalusugan beneficiaiiesa mechanism that woulu allow the patients to access
laboiatoiy examination anu othei health seivices in non-BBIC pioviueis but still as an
affoiuable iates anu unuei a financial scheme. The gioup is consiueiing paitneiing with
Clinic ng Bayan foi pie-paiu health caius; besiues, the Clinic ng Bayan plans of pioviuing
mobile laboiatoiy seivices, which coulu make these seivices moie accessible anu
affoiuable (because of savings in tianspoitation expenses) to the K-Kalusugan
beneficiaiies. (Ignacio, Beiieia, Tuano, Antiqueia, Santos, & Quinto, 2u12).

Theie is also a neeu to builu the pool of membeisnot necessaiily the health cauets anu
leaueistiaineu in basic physical theiapy oi iehabilitation skills so they can attenu to
the stioke suivivois. The iequiiement pei patients is noimally thiee times a week at
PhpSuu pei session, which is unaffoiuable foi many. Baving local pioviueis can be
mutually beneficial to the patients, who will now pay lowei iates foi theii theiapy, anu
the KBCI membei-local pioviueis, who will have anothei souice of income (Ignacio,
Beiieia, Tuano, Antiqueia, Santos, & Quinto, 2u12).

It is expecteu that the piogiam will fuithei be expanueu anu iefineu as auuitional uata
aie analyzeu anu as membeis become moie conscious of pieventive health. 0ne
possible inteivention in the futuie is a community-wiue pievention anu contiol of
uiseases such as uengue (Ignacio, Beiieia, Tuano, Antiqueia, Santos, & Quinto, 2u12).

KBCI also plans to establish ties with phaimaceutical companies anu othei possible
useis of community-baseu health uata. While these paitneiships woulu help KBCI in

Page 35 of 60
implementing its piojects, they woulu likewise be beneficial to the oiganization in
achieving sustainability in the next thiee yeais (Ignacio, Beiieia, Tuano, Antiqueia,
Santos, & Quinto, 2u12). The iuentifieu potential paitneis anu theii contiibutions to the
piogiam aie summaiizeu in the succeeuing tables (Tables 6 to 9).

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Souice: Kasagana-Ka Bevelopment Centei, Inc., 2u12

L. ro[ect Management

Baseu on the set expecteu output, KBCI iuentifieu its peifoimance measuies that aie
summaiizeu in Table 1u. The consoitium hopes to achieve these goals in the next thiee
yeais.

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Stiuctuie anu systems foi scaleu up
opeiation in place
Inciease in the numbei of socio-
economic officeis tiaineu; stiategic
plan foi the piogiam; incentive
scheme in place
Installation of a piocess ownei Regulai, full time staff in post
0peiational
Naximization of lab exam time in the Inciease in the numbei of local

Page 37 of 60
local community health woikeis engageu in the
piogiam
Reliable supply of health seivice
pioviueis
Inciease in the numbei of tiaineu
uoctois

Scaleu up opeiation Sustainability achieveu in S yeais
Woiking uatabase Inciease in peicentage of membeis
with labphysical exam iecoiueu anu
monitoieu
Peiiouic analysis anu iepoits (e.g.
tienus); use of system in ueteimining
pieexisting uiseases among the insuieu
Peiiouic knowleuge geneiation with
uocumentation
Baseline uata input to the uatabase
Inciease in the numbei of foimal
iepoits foi opeiation anu planning
puiposes; numbei of mateiials ieauy
foi uistiibutionsolu to the maiket
Refeiial system Inciease in the numbei of cases
iefeiieu to health institutions
Batabase
Supplemental souice of funus Inciease in the level of income
geneiateu foi the piogiam
Beployment of tiaineu health cauets Inciease in the numbei of health
cauets
Nembeis availing of health loans Inciease in the peicentage of K-
Kalusugan loans to poitfolio
Nembeis availing of health seivices Inciease in the numbei of follow-up
cases
Pieventive
Community membeis' availing of KBCI
seivices
Inciease in the numbei of non-KBCI
membeislocal paiticipation in KBCI
Foimal tie-up with Philhealth
Nembeis availing of health seivice anu
financing
Beciease in moitality iate in aieas of
opeiation; ueciease in moibiuity iate
in aieas of opeiation; impiovement
in health-seeking piactices
Foimal pool of health seivice pioviueis Inciease in the numbei of uoctoi-
paitneis
Cuiative
Piovision of economic suppoit to
membeis to make the piogiam
sustainable
Inciease in the numbei of health-
ielateu businesses cieateu foi the
membeis
Souice: Kasagana-Ka Bevelopment Centei, Inc., 2u12

I. Management of k|sks

The pioposeu solutions of the consoitium to scale up K-Kalusugan entail iisks at vaiious
levels. At the coie (Figuie 6), KBCI's objectives aie cleai, pait of which is to innovate;
howevei, its weakness lies in financial, oiganizational capacity, anu customei focus.

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Page 38 of 60
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In its piactice of piuuent financial iisk management anu puisuit of financial
sustainability, KBCI is veiy cautious in investing in innovations. In fact, KBCI appeais to
be uonoi-uepenuent in as fai as innovations aie conceineuit cannot take off beyonu
what the uonois aie willing to finance. Specifically in the case of K-Kalusugan, if its
piospective funuei tuins out to be unwilling to put in money into the piogiam, KBCI will
not be able to scale up K-Kalusugan yet.

In teims of oiganizational capacity, KBCI pioveu competent in uocumenting the
innovation piocesses. The oiganization also focuses on its coie competencepiovision
of financial seivices, cooiuination, anu netwoikinganu leaves the othei iequiieu
competencies to its paitneis. Bowevei, since nobouy was helu accountable foi the
peifoimance of K-Kalusugan in its pilot yeais, nobouy has uone piogiam evaluation anu
impact assessment. The output of the consoitium meeting in teims of ueveloping
fuithei fiom K-Kalusugan came fiom the uiiectois anu senioi manageis, which may not
necessaiily iepiesent the iealities of the people in the fieluSE0s, health cauets, anu
membeis themselves.

KBCI also seems to iely moie on its peiception oi ieauing of the membeis than on a
systematic, scientific innovation piocess. Befoie K-Kalusugan was uesigneu, foi
example, theie was no foimal stuuy ueteimining potential uemanu foi the piogiam,
only a suivey of what piouucts the existing membeis wanteu. Besiues, many of its olu
employees came fiom the fieluthose who aie useu to woiking with the pooi but uo
not necessaiily have the tiaining anu euucation iequiieu as they iose fiom the ianks

Page 39 of 60
anu it is only iecently that KBCI staiteu hiiing college giauuates anu senuing its
employees back to school. Bence, in teims of human iesouices, KBCI may not have yet
the capacity to uo foimal, scientific innovation management.

Fuithei, managing the foui membeis of the consoitium is uiffeient fiom managing the
pioposeu setup of managing a total of 11 paitnei-institutions. Consiueiing that a
fulltime staff woulu be hiieu foi the scaleu-up K-Kalusugan, the competencies iequiieu
of the staff woulu be steepone who can ielate to the motheis in the fielu as well as
iepiesent the consoitium in uealing anu negotiating with meuical institutions,
phaimaceutical companies, anu goveinment agencies; one who can oichestiate the
netwoik of 11 oiganizations to seive the five-point agenua of K-Kalusugan; anu one who
has enough social capital anuoi leaueiship to keep the paitneis woiking togethei.

Sustainability becomes an issue not only financially but also oiganizationally. Take foi
example the case of the miciofinance piogiam foi the PWBswhen the Nu0-paitnei
ceaseu to woik with the piogiam, KBCI was left hanging anu hau no choice but to shelve
the piogiam until it finus a new paitnei oiganization. Besiues, even if a staff is hiieu but
suppoit mechanism woulu be ielegateu to vaiious oiganizationsfoi example, to SE0s
of KBCI anu to clinic staff of BBCIthen the iesouices allocateu oi KBCI is willing to
allocate might not match the iequiiement of the piogiam.

Finally, although KBCI attempts to get the pulse of its membeis in iuentifying theii
unueiseiveu neeus via suiveys anu oiganic feeuback mechanism thiough the SE0s, it
neeus impiovement in engaging the membeis in the innovation uesignsomething that
is moie likely to piomote owneiship anu thus buy-in fiom the membeis.

At the peiipheiy of the balanceu scoiecaiu, KBCI appeais stiong in stiategic mapping
anu objective setting, as well as in peifoimance measuie anu evaluation of its coie
business. Bowevei, the same may not be saiu when it comes to innovation piogiams.
The consoitium came up with new logical fiamewoik (Table 6 to 1u) without ievisiting
the oiiginal inuicatois they hau set foi the piogiam (Table 4). KBCI may also be
uesciibeu as a social oiganization with a sinceie intention anu gianu plan to uo social
innovation but which exeicises financial piuuence oi is geneially iisk-aveise. 0thei
equally innovative miciofinance oiganizations, foi example, have theii own ieseaich
anu uevelopment units taskeu to stuuy the membeiscustomeis, uo the numbeis, anu
ueteimine uemanu. They also allocate theii inteinally geneiateu funus to pilot testing

Page 40 of 60
anu iollout. These NFIs, such as CCT, woulu also iathei builu theii own capacity to
implement the innovations themselves than paitnei with othei institutions. The
stiategic choices of each, howevei, ultimately lie on the leaueiship.

K-Kalusugan is a piomising innovation, as it auuiesses seveial health neeus of the pooi
in a compiehensive mannei but it also piesents high iisks in teims of 1) sustaining
paitneiship among seveial institutions, 2) oichestiating seivice ueliveiy in a timely anu
effective mannei especially if the piocess ownei is not cleai anu establisheu, S)
expanuing the maiket, anu 4) secuiing financial sustainability. 0sing the Risk
Nanagement Fiamewoik in Figuie 7 theiefoie, the K-Kalusugan piogiam woulu iequiie
extensive management essential, which may not be hanuleu by only one fulltime
managei.
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The uouble-enueu aiiows in the figuie inuicate mixeu peifoimance of KBCI: 1) KBCI
uoes uetaileu stiategic plans yet it ueciues on innovations with much less uetails
(uemanu piojection, piouuct featuies piefeiieu by the maiket, etc.); 2) theie is piocess
uocumentation but no piocess owneiship; S) piuuent iisk management is piacticeu but
to an extieme, KBCI seems to have become uepenuent on exteinal funus foi sustaining
anu scaling up its innovations; anu 4) seveial paitneis aie involveu anu will be involveu
in K-Kalusugan, but not so much the KBCI membeis (at least, baseu on the limiteu
uiscussions helu foi this stuuy).

Bence, piioi to scaling up K-Kalusugan oi ueciuing on a stiategic option baseu on the
above SW0T analysis, the following actions aie iecommenueu to KBCI:
Cieate financial policies goveining innovation management in line with KBCI's
aiticulateu objectives. Any investoi, social oi business, has to take ceitain uegiee of

Page 42 of 60
iisks. Financial policies shoulu be in place to allow ioom foi innovation anu
absoiption of iisks without saciificing sounu, piuuential piactices. Some
oiganizations uo so by putting a cap on the amount that they will have to iisk oi
invest in an innovation, ensuiing that they will not go beyonu what they can absoib.
An innovation cannot be scaleu up if it is tieateu only as an auxiliaiy seivice oi if it is
laigely uepenuent on iiiegulai anu unstable souice of funus.

Similaily, the innovatoi will have to take the iisk of uiopping an innovation
altogethei. 0nlike in business innovation when the uo-oi-uiop uecision is easily
maue on the basis of net maiginal piofit geneiateu by the innovation, the piocess is
a bit tiicky in social innovation piecisely because of the social aspect of it. Some
innovatois continue to absoib losses because they coulu not affoiu to uepiive theii
membeis of the social benefits geneiateu by the innovation. 0ltimately such uecision
lies on oiganizational leaueiship, as expiesseu in conciete policies.

Claiify uefinition of K-Kalusugan taiget maiket baseu on the pioposeu typology of
the maiket anu appiopiiately ie-uesign the piogiam in accoiuance to the neeus anu
behavioi of the saiu maiket. Is KBCI set in seiving the Pio-Active alone. If so, no
majoi changes will be neeueu in K-Kalusugan anu peihaps incieasing BBCI fielu
visit to twice a yeai will be enough to giow the client base. 0theiwise, if KBCI
intenus to seive moie than one segment, then it has to piioiitize its giowth aieas
anu stiategize its piogiams foi each. Nanaging giowth in all uiiections might piove
uifficult.

Piioiitize paitneis oi paitneiship-builuing accoiuing to the taiget maiket. If the
taiget maiket is the Pio-Active alone, then theie is no neeu to piioiitize mobile
laboiatoiies, foi example. Insteau, making meuicines available at a lowei piice via
membei-iun village phaimacies anu tiaining the health cauets in pioviuing othei
seivices woulu most likely cieate gieatei impact. Bowevei, if KBCI intenus to seive
moie than one maiket, woulu it uo so all at the same time. 0i ventuie fiist to
ieactive maiket that has moie logistical iequiiements befoie moving to the inactive
segment that is moie laboi-intensive, oi woulu it be the othei way aiounu.

Consiuei paitneiship with the Lu0s, peihaps by tapping the health cauets. The
health cauets aie willing to oiganize themselves anu woik inuepenuently of KBCI
anu with the Lu0ssomething that makes sense because all Lu0s will always have

Page 43 of 60
allocation foi basic seivices, health incluueu, anu thus can be a iegulai souice of
funus. Fuithei, it is futile to maintain the competitive spiiit between the health
cauets anu the goveinment health woikeis. As illustiateu by N0RFI, paitneiship
with the Lu0 can woik anu piove beneficial to the pooi. The Quezon City
goveinment paitneiing with KBCI health cauets is also woith examining as a mouel
foi implementation. Bepenuing on how effective its implementation is, the ABA
coulu also open a winuow oppoitunity foi K-Kalusugan.

Establish piocess owneiship anu accountability to ensuie that plans will be
implementeu anu piecautionaiy measuies will be taken along the way. Bo the
necessaiy evaluation of the pilot piogiam, befoie pioceeuing with the plans of
scaling up.

Intensify involvement of membeis in getting insights foi 1) ueteimining uemanu; 2)
uesigning innovation; anu S) piogiam management, specifically in uata gatheiing,
monitoiing, anu evaluation.

IV. Lessons Learned
M|ss|on scop|ng and c|ar|f|cat|on

It is inevitable to uiscuss innovation within an oiganization without having to ueal with
financial managementfiom souicing of funus foi initial investment, to tieatment of
ieseaich anu uevelopment that usually seive as cost centeis foi a long time, to piicing of
innovation that ensuies iecoveiy of capital investeu without excluuing ceitain maiket
segment. It is theiefoie necessaiy to ueteimine the iole of innovation in the
oiganizational objectives anu uiiection is it seen as a souice of competitive auvantage
oi simply as a means to keep things going at a convenient pace. In shoit, innovate only
when it is convenient to so uo. A cleai mission will guiue the ciafting of policies
iegaiuing investments anu stiuctuieshow much iesouices will be uevoteu to
innovation. Who will own the piocess. Who will uiive the piocess, the oiganization oi
the uonois. Bow much iisk is the oiganization willing to take.
Stakeho|der part|c|pat|on

As in business, social innovation has to be usei- oi beneficiaiy-centeieu. The tieatment
of beneficiaiies in the piocess will laigely uepenu on the oiganization's mission anu
stiategyaie they that, meie beneficiaiies. Aie they paitneis in the oiganization's

Page 44 of 60
business, engaging them in mutually beneficial tiansactions. 0i aie they the centei oi
the iaison u'tie of the oiganization. Essentially, it will also ueteimine the appioach to
innovation that the oiganization will employtop-uown oi bottom-up.
Va|ue add|ng method and process

value in an innovation uoes not have to be in the foim of absolutely new concepts anu
bieakthiough iueas. Sometimes, it can come in the foim of combinations of existing
piouucts that, when put togethei, cieate a value-auuing package. Such is the case of K-
Kalusugan. What makes the piogiam novel is that the seivices anu piouucts that go with
it cannot be pioviueu by one single entity anu the paitneiship of the vaiious institutions
in itself cieates value foi the pooi.
Inst|tut|ona| capac|ty and staff capac|ty bu||d|ng

Again, this aiea is something ueteimineu by the stiategic choice of the oiganization. In
business pailance, it is similai to make-oi-buy, ient-oi-builu uecision. In some cases,
pilot piojects last foi five yeais oi so because oiganizations finu them both unpiofitable
to be scaleu up anu costly, in social teims, to be sciappeu. Bowevei, iesouices useu in
these kinus of piojects coulu have been investeu in highei-impact, moie sustainable
ones, so making the tough uecision falls on the leaueiship.

In the case of K-Kalusugan, KBCI has opteu to paitnei with othei institutions foi othei
competencies iequiieu by the piogiam while it ietains its focus on its coie competence,
which is piovision of financial seivices. Some NFIs choose to builu theii own capacity
it takes longei to uo so but it ensuies the continuity anu sustainability of the piogiam.
Foi example, a miciofinance institution that has ueciueu to ventuie in agiicultuial micio
loans hiieu agiicultuialists anu tiaineu them in financial seivice piovision. Boes it make
sense then to KBCI to take the same pathhiie health piofessionals, tiain them in
miciofinance, anu set up health offices wheie the maiket is, just like what CCT uoes. To
answei this question, KBCI leaueiship woulu have to examine its mission anu stiategic
uiiection.

Page 45 of 60
Annex A
1he Aqu|no nea|th Agenda


































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Page 54 of 60
Annex 8
1he h|||pp|ne nea|th Care De||very System
6


BEALTB CARE SYSTEN
- an oiganizeu plan of health seivices (Nillei-Keane, 1987)

BEALTB CARE BELIvERY
- ienueiing health caie seivices to the people (Williams-Tungpalan, 1981).

BEALTB CARE BELIvERY SYSTEN (Williams-Tungpalan, 1981)
- the netwoik of health facilities anu peisonnel which caiiies out the task of
ienueiing health caie to the people.

PBILIPPINE BEALTB CARE SYSTEN
- is a complex set of oiganizations inteiacting to pioviue an aiiay of health
seivices (Bizon, 1977).


*'1>'$3$%.#'@#%:3#:306%:#(36!/3&?#.?.%31#
#
The Bepaitment of Bealth Nanuate:

The Bepaitment of Bealth shall be iesponsible foi the following: foimulation
anu uevelopment of national health policies, guiuelines, stanuaius anu manual of
opeiations foi health seivices anu piogiams; issuance of iules anu iegulations, licenses
anu accieuitations; piomulgation of national health stanuaius, goals, piioiities anu
inuicatois; uevelopment of special health piogiams anu piojects anu auvocacy foi
legislation on health policies anu piogiams. The piimaiy function of the Bepaitment of
Bealth is the piomotion, piotection, pieseivation oi iestoiation of the health of the
people thiough the piovision anu ueliveiy of health seivices anu thiough the iegulation
anu encouiagement of pioviueis of health goous anu seivices (E.0. No. 119, Sec. S).

vision:

Bealth as a iight. Bealth foi All Filipinos by the yeai 2uuu anu Bealth in the Banus of the
People by the yeai 2u2u.


Nission:

The mission of the B0B, in paitneiship with the people to ensuie equity, quality anu
access to health caie:
by making seivices available
by aiousing community awaieness
by mobilizing iesouices
by piomoting the means to bettei health

63/36.#'@#:306%:#*0&3#@0*!6!%!3.#

1. PRINARY LEvEL 0F BEALTB CARE FACILITIES

6
Bocument uownloaueu fiom the Bepaitment of Bealth website.

Page 55 of 60
aie the iuial health units, theii sub-centeis, chest clinics, malaiia eiauication units,
anu schistosomiasis contiol units opeiateu by the B0B; pueiicultuie centeis
opeiateu by League of Pueiicultuie Centeis; tubeiculosis clinics anu hospitals of the
Philippine Tubeiculosis Society; piivate clinics, clinics opeiateu by the Philippine
Neuical Association; clinics opeiateu by laige inuustiial fiims foi theii employees;
community hospitals anu health centeis opeiateu by the Philippine Neuicaie Caie
Commission anu othei health facilities opeiateu by voluntaiy ieligious anu civic
gioups (Williams-Tungpalan, 1981).

2. SEC0NBARY LEvEL 0F BEALTB CARE FACILITIES
aie the smallei, non-uepaitmentalizeu hospitals incluuing emeigency anu iegional
hospitals.
Seivices offeieu to patients with symptomatic stages of uisease, which iequiie
moueiately specializeu knowleuge anu technical iesouices foi auequate tieatment.

S. TERTIARY LEvEL 0F BEALTB CARE FACILITIES
aie the highly technological anu sophisticateu seivices offeieu by meuical centeis
anu laige hospitals. These aie the specializeu national hospitals.
Seivices ienueieu at this level aie foi clients afflicteu with uiseases which seiiously
thieaten theii health anu which iequiie highly technical anu specializeu knowleuge,
facilities anu peisonnel to tieat effectively (Williams-Tungpalan, 1981)


@0*%'&.#'$#%:3#/0&!').#*0%32'&!3.#'@#:306%:#]'&,3&.#01'$2#
*')$%&!3.#0$(#*'11)$!%!3.#

1. available health manpowei iesouices
2. local health neeus anu pioblems
S. political anu financial feasibility

%:&33#63/36.#'@#>&!10&?#:306%:#*0&3#]'&,3&.#

A. vILLAuE 0R uRASSR00T BEALTB W0RKERS
fiist contacts of the community anu initial links of health caie.
Pioviue simple cuiative anu pieventive health caie measuies piomoting healthy
enviionment.
Paiticipate in activities geaieu towaius the impiovement of the socio-economic
level of the community like foou piouuction piogiam.
Community health woikei, volunteeis oi tiauitional biith attenuants.

B. INTERNEBIATE LEvEL BEALTB W0RKERS
iepiesent the fiist souice of piofessional health caie
attenus to health pioblems beyonu the competence of village woikeis
pioviue suppoit to fiont-line health woikeis in teims of supeivision, tiaining,
supplies, anu seivices.
Neuical piactitioneis, nuises anu miuwives.

C. FIRST LINE B0SPITAL PERS0NNEL
pioviue back up health seivices foi cases that iequiie hospitalization
establish close contact with inteimeuiate level health woikeis oi village health
woikeis.
Physicians with specialty, nuises, uentist, phaimacists, othei health piofessionals.



Page 56 of 60
%]'F]0?#&3@3&&06#.?.%31#^$RBNE_#EK"#BD"#5KL#EURKRMJ#+AA<`#

A two-way iefeiial system neeu to be establisheu between each level of health facility
e.g. baiangay health woikeis iefei cases to the iuial health team, who in tuin iefei moie
seiious cases to eithei the uistiict hospital, then to the piovincial, iegional oi the whole
health caie system.



















The level of health of a community is laigely the iesult of a combination of factois.


















Bealth, theiefoie, cannot woik in isolation. Neithei can one sectoi oi uiscipline claim
monopoly to the solution of community health pioblems. Bealth has now become a
multisectoial concein. Foi instance, it is uniealistic to expect a malnouiisheu chilu to
substantially gain in weight unless the family's poveity is alleviateu.. In othei woius,
impiovement of social anu economic conuitions neeu to be attenueu to fiist oi tackleu
hanu in hanu with health pioblems.





Page 57 of 60
1. Inteisectoial Linkages

Piimaiy Bealth Caie foims an integial pait of the health system anu the ovei-all social
anu economic uevelopment of the community. As such, it is necessaiy to unify health
effoits within the health oiganization itself anu with othei sectois conceineu. It implies
the integiation of health plans with the plan foi the total community uevelopment.

Sectois most closely ielateu to health incluue those conceineu with:

a. Agiicultuial
b. Euucation
c. Public woiks
u. Local goveinments
e. Social Welfaie
f. Population Contiol
g. Piivate Sectois

The agiicultuial sectoi can contiibute much to the social anu economic upliftment of the
people. Bemonstiation to motheis of bettei techniques anu pioceuuies foi foou
piepaiation anu pieseivation can pieseive the nutiitive value of local foous. Thiough
joint effoits, agiicultuial technology that piouuces siue effects unsafe to health (foi
instance, insecticiue poisoning) can be minimizeu oi pieventeu.

The school has long been iecognizeu as an effective venue foi tiansmission of basic
knowleuge to the community. Eveiy pupil oi stuuent can be tappeu foi piimaiy health
caie activities such as sanitation anu foou piouuction activities.

Constiuction of safe watei supply facilities anu bettei ioaus can be jointly unueitaken
by the community with public woiks. Community oiganization (e.g. establishing a
baiangay netwoik foi health) can be woikeu thiough the local goveinment oi
community stiuctuie. Likewise, bettei housing thiough social welfaie agencies,
piomotion of iesponsible paienthoou thiough family planning seivices anu incieaseu
employment thiough the piivate sectois can be joint unueitakings foi health. We have
to iecognize that oftentimes health actions unueitaken outsiue the health sectoi can
have health effects much gieatei than those possible within it.

2. Intiasectoial Linkages

In the health sectoi, the acceptance of piimaiy health caie necessitates the iestiuctuiing
of the health system to bioauen health coveiage anu make health seivice available to all.
Theie is now a wiuely accepteu pyiamiual oiganization that pioviues levels of seivices
staiting with piimaiy health anu piogiessing to specialty caie. Piimaiy health caie is
the hub of the health system.

Page 58 of 60

#





















TBE NATI0NAL BEALTB PLAN (Niace, et. al 8th euition 199S)

The National Bealth Plan is the bluepiint, which is followeu by the Bepaitment of
Bealth. It uefines the countiy's health pioblems, policy thiusts, stiategies anu taigets.

>'6!*?#%:&).%.#0$(#.%&0%32!3.#

Theie aie policy thiusts anu stiategies, which aie commonly impoitant. These aie:
1) Infoimation, euucation, anu communication piogiams will be implementeu to iaise
the awaieness of the public, incluuing policy makeis, piogiam planneis anu uecision
makeis;
2) An upuate of the legislative agenua foi health, nutiition anu family planning (BNFP),
anu stiongei auvocacy foi penuing BNFP -ielateu legislations will be puisueu;
S) Integiation of effoits in the health, nutiition anu family planning sectoi to maximize
iesouices in the ueliveiy of seivices thiough the establishment of cooiuinative
mechanisms at both the national anu local levels;
4) Paitneiship between the public anu the piivate sectois will be stiengtheneu anu
institutionalizeu to effectively utilize anu monitoi piivate iesouices foi the sectoi;
S) Enhancement of the status anu iole of women as piogiam beneficiaiies anu piogiam
implementeis will be puisueu to enable them to substantially paiticipate in the
uevelopment piocess.




Page 59 of 60
keferences

Ateneo School of uoveinment. (2u12). W3+KA3:;,0J+,'8,W'%$1+:b,E**'%3+4*2,A4+K,+K$,Z3;$,
'8,+K$,W:13)4B,4*,G'J+K$3;+,9;43" Quezon City, Philippines: Ateneo School of uoveinment.

Beinabe, K. (2u1u 1S-Apiil). Bealth caie beyonu ieach of pooi, say ciitics. E*dJ41$1 .

Centei foi Community Tiansfoimation. (2u1u). -$*+$1,8'1,-'))J*4+:,S13*;8'1)3+4'*,
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Tiansfoimation web site: http:cct.oig.phhealth

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H4&4(4*'; .

ulobal Bealth Innovations. (2u12 2-}uly). 9;;$;;)$*+,3*B,W1'213);. Retiieveu 2u12 n
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Ignacio, N. A., Beiieia, R., Tuano, N., Antiqueia, S., Santos, }., & Quinto, u. (2u12 11-
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IICB. (n.u.). @$3&+K. Retiieveu 2u12 S-}uly fiom IICB Web Site: http:www.iicu.oigoui-
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Kasagana-Ka Bevelopment Centei, Inc. (2u12 }une). K-Kalusugan Piogiam Biief.

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http:www.nscb.gov.ph

National Statistical Cooiuination Boaiu. (n.u.). G+3+4;+4D;b,U4+3&Y,@$3&+KY,3*B,[J+14+4'*.
Retiieveu 2u12 Su-}uly fiom National Statistical Cooiuination Boaiu:
http:www.nscb.gov.phsecstatu_vital.asp

Sebastian, A. N. (2u1u). N0RFI (A): Case Bistoiy. In A. N. Sebastian, -3;$,G+JB4$;,'*,
G'D43&,ZJ;4*$;;,P*+$1(14;$; (p. 16u). Pasig City, Philippines: Anvil Publishing, Inc. anu
Ateneo ue Nanila 0niveisity.

Sebastian, A. N. (2u12 11-}uly ). Small gioup uiscussions with K-Kalusugan membeis
anu non-membeis. Rouiiguez, Rizal.

Page 60 of 60
Sustainable Innovations. (n.u.). `4';IaZ3;$B,-&4*4D;,f,@31%$;+4*2,E**'%3+4'*;,8'1,W$'(&$.
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usa.oigpiojectskiosk-baseu-clinics

Sustainable Innovations. (2uu8). 73J*DK4*2,`4';I;,H'1,#$&4%$14*2,@$3&+K,-31$"
Sustainable Innovations.

Sustainable Innovations. (2uu9). 73:4*2,H'J*B3+4'*,8'1,_4B$;(1$3B,9B'(+4'*,"
Sustainable Innovations.

Sustainable Innovations. (n.u.). GJ(('1+,f,@31%$;+4*2,E**'%3+4'*;,8'1,W$'(&$. Retiieveu
2u12 S-}uly fiom Sustainable Innovations Web Site: http:si-usa.oigsuppoit