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Governance roles and capacities of Ministries of Health ...
Transcript of Governance roles and capacities of Ministries of Health ...
Governance roles and capacities of Ministries of Health Framework:
A practitioner’s perspective
Manuel M. Dayrit MD, MSc
Secretary of Health (2001-2005)
Republic of the Philippines
Adjunct Professor & former Dean
Ateneo de Manila University
School of Medicine & Public Health
Republic Act 11223
UNIVERSAL HEALTH
CARE LAW2019
President Rodrigo Duterte signed the bill into Law on February 20,
2019
Outline
1. Managing 2 transitions (1991-2018)> decentralization > social health insurance
2. Managing transition to UHC (2019 and beyond)> Universal Health Care
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Socio-demographic profile
Area: 298,170 sq. km
7107 islands
Population: 104.9 million
13th populous country
Rural (55.8%)
GDP per capita: $ 8342.8 (PPP, current)
GDP growth rate: 6.7%
Literacy rate: 96.5%
HDI rank: 113
It has been a struggle to widen and deepen the coverage of social health insurance.
In 2014, PhilHealth share of Total Health Expenditure was 14%, short of the 30% target set in 1998 (UPecon, 2017).
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De jure governance processes
Preparation for and response to changes in
context
Relationship management
Values propagation and goal alignment
Implementation of de jure responsibilities
Resilience and relevance
Leadership and diplomacy
Values management
Wo
rkload
Cap
acity
Ro
le Cap
acity
Structu
ral Cap
acity
Perform
ance C
apacity
Sup
ervisory C
apacity
Person
al Cap
acity
GOVERNANCE ROLES PERFORMANCE AREAGOVERNANCE CAPACITIES
Department of Health, Philippines
Universal Health Care means EVERYONE WINS!
Patients receive effective
care without financial
hardship
Providers earn a positive
margin for efficiently
treating patients and
producing good outcomes
Suppliers of drugs, devices, and diagnostic tests that improve
outcomes and/or lower total costs find their products incorporated into
the treatments used by effective and efficient providers
Payers (private insurers, governments, or
self-pay individuals) able to shape provider
behavior towards efficiency and
effectiveness
Physicians can earn predictable income
and pursue career paths
Will UHC Law enable effective ways of
governance? Among its provisions are:1) province- and city-wide health provider
networks
2) PhilHealth as strategic purchaser
3) new ways to collaborate with private sector
Department of Health, Philippines
SPECIAL HEALTH FUND-WFP
-Allocation Guidelines
Provincial Health Office
Provincial/District/City/Mun. Hospitals
Subsidiary Ledgers
City Health Offices (CCs) Health Centers BHS
Municipal Health Offices Health Centers BHS
Private ProvidersMOA
Provincial Budget for Health
Human Resources
Operations
Appropriation OrdinanceLIPH
PhilHealthIndividual-based ServicesPopulation-based Services
DOH Grants
ODA, NGO and FBO
Grants/Donations
LIPH
Department of Health, Philippines
PhilHealth Purchasing Role:
Three Complementary Decisions
Identifying the interventions or
services to be purchased
Choosing
service providers
Determining how services will
be purchased
How quickly will new capacities be developed?
1) Upgrade primary care facilities nationwide
eg. Rural Health Units (RHUs)
2) Produce primary care providers fit
for purpose
Department of Health, Philippines
Progressive Realization of Universal Health Care
2019UNIVERSAL
population coverage
2028COMPREHENSIVE
service coverage
2022HIGH support value
(government as a
single purchaser)
2030Full Support Value
Pool of Funds
Summary and concluding statement:
“Ministries typically undertake an array of de jure roles, including
• the formulation of a strategic vision for health,
• the balancing of centralized and decentralized authority for decision-making,
• the management and implementation of policies, programs and interventions, regulation and oversight, and
• monitoring and evaluation, notably of performance, quality and equity”
Section 1.2 WHO Working Paper on Governance