Medical Governance and Health Policy in the Philippines

Medical Governance,Health Policy,

and Health Sector Reformin the Philippines

Module IIntroduction: Governance, Policy, Reform

Structured approaches to health developmentReconciling the language games

INTRODUCTION: GOVERNANCE, POLICY, REFORM

Clinical Governance

• Clinicians have the responsibility to monitor and manage their performance as part of the general management of healthcare organizations.

• Decision-making for populations is qualitatively different to that in clinical practice, even though the evidence used for both would be the same.

• Clinicians should worry about the quality of care they are performing; let the health system managers worry about resource management.

Reference: Gray, 2004 (p. 357-358), with modification

What is health care?

• In caring for patients, the good physician dispenses time, sympathy, and understanding to his patients

• The physician also scientifically applies principles of diagnosis and treatment

• Medical care has become a mosaic of many health and non-health professionals executing the necessary skills

Reference: Larson EB, JP Willems, and WC Liles. (2001). Manual of Admitting Orders and Therapeutics. 4th ed. Philadelphia: WB Saunders

Healthcare Governance:Scope, Scale, and Stakeholders

Point of Care

Service Delivery

Networks

National and Local

Governments

Private Sector

Dynamics

International/Global Health

Quality of Care and Health Systems

• In any country, one of the factors affecting the health and well-being of individuals and populations is the quality of care provided within the health service.

• In turn, the performance of any health system (including provider quality) is determined by the way in which it is designed, managed, and financed.

Reference: Gray, 2004 (p. 288), modified

Measuring Quality of Care (1)

Typically done in terms of structural measures• Health care inputs

– Availability of drugs– Supplies and technology– Available health manpower

• Facility-level characteristics

Solon et al. (2009). A novel method for measuring health care system performance: experience from QIDS in the Philippines. Health Policy and Planning 1(8)

Measuring Quality of Care (2)

• Do structural measures have a direct impact on health outcomes?

• Are structural inputs dynamic and thus responsive to policy initiatives that affect daily clinical practice?

• What about the point and period of care?

structural measures = inputs

Solon et al. (2009). A novel method for measuring health care system performance: experience from QIDS in the Philippines. Health Policy and Planning 1(8)

Measuring Quality of Care (3)

Three basic elements of quality of care:• Structure• Process• OutcomeStructural measures are too distant to the interface between patient and provider and do not address whether the inputs are used properly to produce better health

Solon et al. (2009). A novel method for measuring health care system performance: experience from QIDS in the Philippines. Health Policy and Planning 1(8)

The Service Delivery Network

RECONCILING THE LANGUAGE GAMES

Declaration of Alma Ata (USSR, 1978)

• Health is a fundamental human right

• Inequality in health status is unacceptable

• Economic and social development (“New International Economic Order”) is needed to attain health for all

• Governments are responsible for the health of their people

• “Primary health care” at the level of communities is key

• Policies of independence, peace, détente and disarmament will release additional resources for development, including primary health care

Reference: http://www.who.int/publications/almaata_declaration_en.pdf

Philippine Constitution (1987)• The State shall protect and promote the right to health of

the people and instill health consciousness among them. (Art II, Sec 15)

• The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. There shall be priority for the needs of the under-privileged, sick, elderly, disabled, women, and children. The State shall endeavor to provide free medical care to paupers. (Art XIII, Sec 11)

Reference: http://lawphil.net/consti/cons1987.html

Philippine Constitution (1987)

• The State shall establish and maintain an effective food and drug regulatory system and undertake appropriate health, manpower development, and research, responsive to the country's health needs and problems. (Art XIII, Sec 12)

Reference: http://lawphil.net/consti/cons1987.html

PNoy’s Social Contract: a promise of increased coverage of social health insurance, and access to health through improved health infrastructure

UN Millennium Declaration (2000)

• Reduce maternal mortality by three quarters, and under-five child mortality by two-thirds, of their current rates (MDGs 4, 5)

• Halt and begin to reverse the spread of HIV/AIDS, the scourge of malaria and other major diseases that afflict humanity (MDG 6)

Reference: http://lawphil.net/consti/cons1987.html

Personal Care vs. Public Health

• Improvement of health through the organized efforts of society (not individuals), through social interventions. Examples:– Disease screening programs– Immunization programs– Environmental protection

Reference: Gray, 2004 (p. 293)

“Pharmacology” of Public Health

• DYNAMICS and the mechanism of action:– Will an intervention reduce the risk?

• KINETICS and the response of the system:– Will the intervention for the main concern

increase other risks? (i.e., adverse effects)• THERAPEUTICS and delivery:

– Is it operationally possible to introduce the intervention?

Reference: Gray, 2004 (p. 296), with modification

Ethics of Prioritization:The Individual or Society?

• It is important to recognize that at the end of each decision on a health policy, there is an individual.

• This is an unpleasant and difficult fact to accept, but those who make decisions about groups and populations must remain continually aware of it.

Reference: Gray, 2004 (p. 305)

Using Economics to Set Priorities• Economic approach is to set priorities based on costs and

benefits of health services: to do more of some things, we have to take resources from elsewhere

• Economists should also consider practical and ethical challenges that managers and doctors face in making rational priority setting decisions

• Need to balance clinical autonomy with financial responsibility

• Use national guidance, regional and local policy, and the community’s inputs; process should be transparent and accountable

Reference: Peacock, 2006

Demystifying and De-medicalizing

• The allocation of resources must be explicit• Decision-making at all levels must be open• Medicine must be de-mystified and health de-

medicalized, for professionals, patients, the general public and politicians alike

• Public health / health policy is thus multi-disciplinary, and multi-stakeholder

Reference: Gray, 2004 (pp. 317-318), modified

Three Fundamental Goals

• Improve the health of the population served;• Respond to people’s expectations;• Provide financial protection against the costs

of ill-health

*These are irrespective of the level of resources available and the organization of the health system

Reference: Gray, 2004 (p. 289)

(Berman, 2012)

Module IIEvidence-based healthcare and the policy cycle

Translating mandated policiesinto budgets for execution

EVIDENCE-BASED HEALTHCARE AND THE POLICY CYCLE

The Epistemology of Public Health

Evidence-based

Epidemiology

Statistics

Aesthetic

Supernatural

ScriptureReference: Gray, 2004 (p. 307-318)

The Policy Cycle

Agenda Setting

Policy Formulation

AdoptionImplementation

Evaluation

Families (specially the poor) have limited access to prenatal care, safe delivery, immunization, and family planning

Families (specially the poor) have not used modern clinic or hospital services due to lack of capital investments in facility upgrading

Factors in Health Policy Change

OLD POLICY

NEW POLICY

Ideologicalinspirations

Change in circumstances

Evidence

Common sense

From researchFrom experience

Reference: Gray, 2004 (Fig 7.8, p. 291; p. 292)

NOTE: Policy makers operate on a timescale that does not generally admit of delays that research will take.

Using Evidence to Craft Health Policy

• Resource reallocation among disease management systems

• Resource reallocation within a single disease management system

• Managing innovation• Controlling increases in healthcare costs

without affecting the health of the population

Reference: Gray, 2004 (p. 269)

Evidence vs. Eminence

• “Experts” commit two sins that retard the advance of science and harm the young:– Adding prestige to opinions gives them greater

persuasive power than their inherent science– Reviewers tend to accept or reject new evidence

and ideas not based on science, but on their similarity to publicly-declared positions by experts

Reference: Sackett, 2000

Innovations

• Innovation occurs continually• Promoting innovation may lead to

– Promotion of completely novel interventions• e.g., stem cell therapy (?)

– Changing the provision of an established service• A purchaser must actively manage the

introduction of innovation

Reference: Gray, 2004 (p. 273; 276)

The Roles of the Scientist• Ask (and seek to answer) the right questions• Be clear about the evidence• Show the balance of good to harm of an intervention for

the population

Reference: Gray, 2004 (p. 322; 328), with modification

The Roles of the Policymaker• Clarify the relevant societal values• Make appropriate decisions using those values

(in relation to the evidence)

Maternal Mortality Ratio

1993 NDS 1998 NDHS 2006 FPS 2011 FHS0

50

100

150

200

250

300

Num

ber o

f dea

ths

per 1

00,0

00 li

ve b

irths

Data Source: FHS 2011 (NSO, DOH, USAID)

260

182

224

120

196

128

MDG Target: 52

Monitoring & Evaluation in Health

MANDATE• Policies/

Issuances/ Orders

INPUTS• Budgets• Premium

Subsidies• Supplies and

Commodities

OUTPUTS• PhilHealth

Coverage• Facility

Upgrading• Logistics

Management• Demand

Generation

OUTCOMES• Use of quality

health services at affordable / no cost

IMPACTS• Health• Well-being• Improved

productivity

Can be tracked through real time operations monitoring

Ensuring Performance

Reference: Gray, 2004 (p. 327; 367)

P =

Where:P = performanceM = motivationC = competence

B = barriers

Options to achieve change:

• Incentives (carrots)• Disincentives (sticks) hit people with carrots

STRUCTURED APPROACHES TO HEALTH DEVELOPMENT

A Structured Approach:The Results Frame

• Critical Assumptions• Sound Development Hypotheses

Reference: USAID, 2000

Program Inputs/Interve

ntions

Intermediate Results

Development Objective

Agency Objective

TRANSLATING POLICY INTO BUDGETS AND RESOURCES FOR EXECUTION

History of Philippine Health Reform

• 1960s: Medicare• 1970s: Population Policy• 1980s: Generics Act of 1988• 1990s:

– Local Government Code of 1991– National Health Insurance Act of 1995

• 2000-present:– HSRA, F1, KP

Reference: Romualdez, 2011

Continuity in Health Reform

Kalusugan Pangkalahatan

(2010 onwards)

Fourmula One for Health (2005 – 2010)

Health Sector Reform Agenda (1999- 2004)

Healthy Filipinos

Sought Professional

Care to Address Illness

Covered by PhilHealth

Provided Quality

Care

Inadequate NHIP coverage

High unmet need for public health services

Poor infrastructure and low quality of care

Low peso support from PhilHealth

?X

X X

Strategic Thrusts Intend to Eliminate the Barriers

Healthy Filipinos

Sought Professional

Care to Address Illness

Covered by PhilHealth

Provided Quality

Care

UHC will improve the health of beneficiaries

Focused public health services

Increased peso support from

PhilHealth

Facility upgrading and quality

improvementIncreased NHIP coverage

57

Universal Health Care (UHC)

Improved Health especially for the

Poor and Vulnerable

Secure access to quality care at

facilities

Achieve the public health MDGs

Provide financial risk protection

INTERVENTIONS OF CARE

Primary Prevention and

Health promotion

Tertiary Prevention and

Curative Health Care

Secondary Prevention and Primary Health Care

Disease Management Systems

• A disease management system consists of all those services and interventions designed to improve the health of individuals who have a particular disease or a group of diseases

• Managed care: all elements of the system are governed by the use of guidelines

Reference: Gray, 2004 (p. 270)

The Continuum of Care

Health Risk exposure Risk contact

Latent disease/inju

ry

Early disease/

injuryDisease

progression

Advanced disease/injur

y

Chronic disease

Impairmentor Death

Primary Prevention: Reduce risk exposure

Secondary Prevention:

Detection and intervene early

Tertiary Prevention:Reduce progress or

complications of established disease

Policy and Standards Development

UHC Interventions

60

UHC Strategies and Interventions

UHCStrategies

Public Health Personal CarePolicy and Standards

DevelopmentPrimary

PreventionSecondary Prevention

Tertiary Prevention

Achieve the public health MDGs

Family Health Programs; Health Promotion

Facility-Based Deliveries; Minor Medical and Surgical Management

Complicated Deliveries, Medical, and Surgical Management

Regulation and Financing Activities (Central and Regional)

Provide financial risk protection

Primary Care Benefits (PCB)Maternal Care Package (MCP)TB DOTS Package

Medical and Surgical Case RatesCase Type Z

Membership Services;Provider Services

Secure access to quality care at facilities

Barangay Health Stations;Rural Health Units

Rural Health UnitsDistrict Hospitals

Provincial and DOH-retained Hospitals

Facility Management Reforms

Evidence in Primary Care

• In primary care, the provision of healthcare is undertaken– Over a large area– At many scattered sites

• Decision-making covers a wide range of health problems, sometimes in situations where it is not possible to access support

• Hence, evidence-based decision-making is more difficult to organize in primary care

Reference: Gray, 2004 (p. 265)

Advantages of Focusingon a Discrete/Defined Population

• Facilitates the process of population needs assessment

• Enables a purchaser to integrate the health services that are purchased with a broad range of public health measures to prevent disease, promote health, and reduce inequalities

Reference: Gray, 2004 (p. 270)

Start with the Poor and Vulnerable

Q1 Poorest Q2 Poor Q3 Middle Income Q4 Rich Q5 Richest

39 M poor individuals 59 M non-poor individuals

Note: Population counts projected for FY 2013 (except for DSWD numbers); rounded off to the nearest million.

• Poverty incidence by NEDA/NSO is a statistical estimate without actual names or faces of poor individuals.

• DSWD’s NHTS-PR and 4Ps/CCT, while with identification and location data, may not have enlisted all who are genuinely poor and vulnerable (homeless/vagrants, PWDs, prisoners, etc).

• The DOH thus uses Q1 + Q2 for planning estimates, with reliance on the DSWD’s NHTS-PR and 4Ps/CCT for targeting/identification.

27 M individuals (NEDA)

30 M individuals (NHTS-PR)

18 M (4Ps/CCT)Identified by DSWD

Purchasers vs. Providers• In health services world-wide, there is a trend to separate

the function of purchasing healthcare from that of providing healthcare– Purchasers decide which health services to buy– Providers deliver healthcare to individual patients within the

resources available• Purchasers aim to maximize the value obtained from the

resources available• Purchasers are not usually asked to reallocate resources

on the basis of specific diseases, but for particular patient groups

Reference: Gray, 2004 (pp. 269; 272)

Behind the Scenes: Unit CostingComponent Significance Actors & Assistants Facilities, Equipment,

Commodities

Admission Order

Initiates the contractual relationships; inpatient health care formally begins. Physical space in the building is designated

• Attending Physician• Nursing Service• Hospital Admitting

Section• Billing / Accounting

Dept

• Hospital Ward / Room; Bed

• Standard commodities (e.g., cotton, alcohol, gauze, etc)

Diagnosis Communicates to team members the working impression; allows actors to plan interventions accordingly

• All Physicians• Nursing Service• Pharmacists• Nutritionist-Dietitians

• Special equipment as needed (e.g., compression stockings, pulleys, respirators, etc)

Condition; Allergies

Communicates to team members the level of attention needed as well as precautions

• All Physicians• Nursing Service• Pharmacists• Nutritionist-Dietitians

• Special considerations for food and drugs

Reference: Larson EB, JP Willems, and WC Liles. (2001). Manual of Admitting Orders and Therapeutics. 4th ed. Philadelphia: WB Saunders

Behind the Scenes: Unit CostingComponent Significance Actors & Assistants Facilities, Equipment,

Commodities

Vital signs Initiates the contractual relationships; inpatient health care formally begins. Physical space in the building is designated

• Nursing Service • Telemetry (if applicable)

• E-cart / Crash cart• Emergency Drugs

Activity Indicates what a patient is allowed to do, or conversely restrictions to mobility

• Nursing Service• Physical Therapists• Nursing Assistants• Orderlies

Special equipment as needed (special beds, wheelchairs, restraints)

Nursing Specifies what nursing staff is to do for the patient: I/O, temp, daily weights, incentive spirometry, CBG, etc

• Nursing Service• Nursing Assistants

• Monitoring equipment (stethoscope, sphygmomanometer, thermometer, etc)

• Special equipment as needed (suction, etc)

Reference: Larson EB, JP Willems, and WC Liles. (2001). Manual of Admitting Orders and Therapeutics. 4th ed. Philadelphia: WB Saunders

Behind the Scenes: Unit CostingComponent Significance Actors & Assistants Facilities, Equipment,

Commodities

Diet Prescribes the diet the patient will have (house/regular, low fat, NPO, etc), fluids allowed by mouth, as well as feeding precautions

• Nursing Service• Nutritionist-

Dietitians

• Dietary (kitchen, prep area, etc)

• Utensils• Special equipment

as needed (NGT, etc)

IV orders Prescribes intravenous solutions to be infused

• Attending Physician

• Nursing Service

• IV fluids (NSS, Ringer’s, Dextrose, etc)

• IV cannula (needle) and tubing

Medication orders

Prescribes drugs to be administered, including name (generic preferred), dose, route, and frequency or time

• Attending Physician

• Nursing Service• Pharmacists

• Drugs• Drug delivery

equipment (infusion pumps, etc)

Reference: Larson EB, JP Willems, and WC Liles. (2001). Manual of Admitting Orders and Therapeutics. 4th ed. Philadelphia: WB Saunders

Behind the Scenes: Unit CostingComponent Significance Actors & Assistants Facilities, Equipment,

Commodities

Laboratory studies

Specifies the diagnostic interventions (e.g., bloodwork, urinalysis, x-rays, etc) to be performed

• Nursing Service• Medical

Technologists

• Diagnostic laboratories (chemistry, radiology/imaging, etc)

• Special equipment as needed

Special orders Specifies ancillary services (respiratory, physical, or occupational therapy), consultations, special preparations for diagnostic studies, etc

• Referring Physicians

• Nursing Service• Respiratory

Therapists• Physical Therapists• Occupational

Therapists• etc

• Special equipment as needed

Reference: Larson EB, JP Willems, and WC Liles. (2001). Manual of Admitting Orders and Therapeutics. 4th ed. Philadelphia: WB Saunders

Healthcare Financing

• Health systems are not just concerned with improving people’s health, but also with protecting them against the financial cost of illness (by reducing out-of-pocket expenses).

• The sources of financing usually dictates the system of healthcare provision. Two main sources are:– Insurance (risk-pooling) “pay as you go”; common in

low income countries – Taxation (subsidies)

Reference: Gray, 2004 (p. 278)

Who pays for the cost of health care?

Source: 2010 Philippine National Health Accounts

11.2

15.3

8.952.7%

7.14.8

National GovernmentLocal GovernmentPhilHealthPrivate Out of PocketPrivate Insurance + HMOsOthers

Sources of Financing

• The Sources and their Uses– NG: Policy Support / Management– LG: Service Delivery (residual claimant)– PhilHealth – single payer– PCSO, etc – catastrophic expenses– PPP – high capital investments– OOP – safeguard against moral hazard

• “5% of GDP” – correlation vs. causation issue

FINANCIALPROTECTION

PROVIDED TO THE POPULATION

AccreditationEnrollmentClaims

Availment and Processing

Insurance Payments

PhilHealth as a Single Payer/Purchaser

• Concept of social health insurance– Pay-as-you-go / “paluwagan”

• Leverage resources on behalf of the many clients/patients

Source: Joint DOH-PhilHealth Benefit Delivery Review (2010)

The Double Financing Burden of LGUs

Note: This is pre-NHIA 2013.

The Budget Cycleand Absorptive Capacity

• Budget Call• Agency Planning• Negotiations with DBM• NEP filed in Congress• Congressional Hearings

– “Power of the Purse”– PDAF?

• Appropriations• Allotments and

Obligations

References: DBM, 2013; Rappler.com, 2013

Various Aims for Resource Allocation

Actor of Interest Aim for Resource AllocationIndividual patient • More resources to treat

his/her caseGroup of patients or providers who have the same problem

• More resources for the particular patient group

• Openness and equity in distribution of resources for that group

Representatives of the general public

• Openness and equity in distribution of resources across the entire range of patient groups

Reference: Gray, 2004 (p. 270)

Module IIIImplementation arrangements in healthcare

Capacity building, sustainability,and knowledge management

The Health Value Chain

IMPLEMENTATION ARRANGEMENTS IN HEALTHCARE

Values (?) Dominate Policy-making

• Politics tends to be driven by beliefs patronage• It is the values returns on investment (ROI)

politicians believe to be important that dominate decision-making about policy. Such decisions will be tempered by the availability of resources.

• But, resource allocation can also be based on beliefs and values patronage and ROI

• Can a shortage of resources force policy-makers to consider the evidence and alter policy as a result?

Reference: Gray, 2004 (p. 287)

The Legislation Threshold

LEGISLATION THRESHOLD

Opp

ositi

on to

legi

slatio

n

Reference: Gray, 2004 (Fig 7.9, p. 296)

There is an inverse relationship between the magnitude of a health problem and the strength of opposition to legislation framed to prevent it.

Number of people affected

Media interestStrong evidence

Opposition by industryPolicy has adverse effectsHigh cost of intervention

What legal adjustments are needed to implement UHC?

Restructuring of Excise Taxes of alcohol and tobaccoPassage of Responsible Parenthood BillStrengthening of the National Health Insurance

Program• Optimization of management of devolved health

services• Amendment of selected laws governing practice of

health professionals• Laws for corporate governance of hospitals

Note: An omnibus law on universal health care that shall contain specific provisions necessary to enact required policies or amend existing laws can also be legislated

Main Determinants of Health

Genetic inheritance

Health status

Physical environment

Biological environment

Social environment

Primary care

Reference: Gray, 2004 (Fig 8.1, p. 320)

Health services

Hospital careScreening

Healthcare Management and Policy,and Organizational Change

• Health policies relate mainly to the financing and organization of health services.

• Common objectives of organizational change:– Decentralize power;– Involve more people in decision-making;– Encourage cost control;– Reduce the number of managerial staff;– Encourage competition in order to reduce costs

and increase qualityReference: Gray, 2004 (p. 290)

Office of Secretary of Health

Attached Agencies

Regional Offices

Provincial Health Offices

City Health Offices(Component Cities)

Inter-local Health Zones

City Hospitals

Health Centers

Barangay Health

Stations

District hospitals

Municipal health offices/ Rural Health Unit

Barangay Health Stations

Provincial Hospitals

Regional hospital Medical Centers

Sanitaria

City Health Offices(Chartered Cities)

City Hospitals

Health Centers

Barangay Health

Stations

References: Kelekar and Llanto, 2013; Khemani, 2010

Depa

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Corp

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DOH

Cent

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Dev

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egio

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Loca

l Gov

ernm

ent U

nits

(Pro

vinc

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nd C

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)

Health CareProviders

Households

Health Outcomes

Secretary of Health

NCR & Southern

Luzon

Northern & Central Luzon Visayas Mindanao

Secretary of Health,DOH-ARMM

Centers for Health Development

Technical Clusters

Issues in the Public Sector

• Decentralization• Devolution• Public Finance Management• Procurement

Issues in the Private Sector

• (de)Regulation – big government vs. small government

• Incentives and Disincentives – Profit?

Public-Private Partnerships

• Frame:Profit = Revenue – Cost

• Private interest is to maximize profit• Public interest is to ensure (by contract)

provision of social services • Not just in infrastructure, but also elsewhere

The Role of Civil Society Organizations

• Churches and Faith-based Groups• Advocacy Groups• Academe• NGOs• Provider/Professional Organizations

PREVIEW OF A (FULL) POLICY CYCLE: CASE OF RA 10354

The Reproductive Health Law

• 14+ years of debate in Congress• 26 years after the 1987 Constitution• State interest is to save mothers’ lives

– Population policy is elsewhere, in the POPCOM PD• The issue is not when life begins, but the “political

question” and judicial restraint (institutions affecting policy)

• RH Law is social legislation: more in law for those with less in life

Reference: Jardeleza, 2013

Carpio

CAPACITY BUILDING, SUSTAINABILITY, AND KNOWLEDGE MANAGEMENT

Image from Facebook (Seismologik Intelligence/Occupy Posters)

What is Development Work?

• Official Development Assistance (ODA) / Foreign Assistance Programs (FAPs)

• Shift from tangible commodities to technical assistance (TA)

Reference: Garrett, 2007

Agenda Setting

Policy Formulation

AdoptionImplementation

Evaluation

Areas for Management Consulting

Research Production

Research Management

Marketing / Communicatio

n

Implementation

Monitoring & Evaluation

Need for an Institutional Platform (1)

• Implementing health reforms in the Philippines has become increasingly complex

• Strategic, operational, and transactional concerns have grown

• Staff capacities and time constraints continue to be limited

• Budgets are increasing; policies are aligning

Reference: USAID/Philippines, 2012

Need for an Institutional Platform (2)

• There should be an Institutional Platform (IP) that will help design, implement, monitor, and evaluate UHC initiatives– Accountable to the Secretary of Health, but

independent and objective– Funded by various sources (including , but not

impaired to provide competitive rates)– Can network and engage with other

institutions/individuals contributory to its objectives

Reference: USAID/Philippines, 2012

Health Policy Development Program(HPDP2 – Cooperative Agreement No. AID-492-A-12-00016)

• Five-year USAID health policy project (2012-2017) implemented by the UPecon Foundation, Inc.

• Supports the DOH-led policy formulation process for scaling up Universal Health Care (UHC)

• Goal is to strengthen a supportive policy and financing environment for FP/MNCHN and TB to enable the Philippines to achieve its MDGs in health, as well as expand and sustain its UHC initiative

• Two components: (1) establish an institutional platform to help DOH design, implement, monitor, and evaluate the UHC agenda; and (2) remove policy and systems barriers to FP/MNCHN and TB service delivery

INTEGRATION

The Health Value Chain

Policy Dev’t

Budget and Expenditure

Plans

Absorptive Capacity of Local Health Systems

Service Providers

Clients/Patients

Suppliers

Improved Health

Information, Feedback, Monitoring

The Five-Star Doctor

Roles• Health Care Provider• Teacher• Researcher

• Social Mobilizer• Manager

Examples of Leaders• Pioneer Practitioners• Deans• Principal

Investigators• Politicians/Advocates• DOH Sec / Hospital

Chiefs

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