Operationalizing WHO Health Systems Framework : Imperatives for Sustainable Implementation

Martha B. Cayad-an, MD, MPH, CESO 111Deputy Chief of Party, MindanaoHealth Project

USAID-MindanaoHealth Project

WHO Health Systems Framework

AccessCoverage

QualitySafety

Systems Building Blocks

1. Leadership/Governance2. Health Care Financing3. Health Workforce4. Medical Products and

Technologies5. Information and

Research6. Service Delivery

Improve Health Level and Equity

Responsiveness

Financial Risk Protection

Improved Efficiency

MindanaoHealth Project: Integrated Maternal, Neonatal & Child Health and Nutrition/ Family Planning Project

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v USAID-funded; implemented by Jhpiego-an affiliate of Johns Hopkins University based in Baltimore, Maryland, USA

v Target Areas: 19 provinces and Cities of Davao, and Zamboanga, across 5 regions and ARMM.

v Project Components:§ FP/MNCHN/AYRH Service Delivery Strengthening§ Increasing Demand for MNCHN/FP Services§ Removal of Policy and Systems Barriers to Service Delivery

and its Utilization§ Strengthening Capabilities of DOHROs and PHOs in Program Development

and Oversightv Overall Goal: Contribute to reduction of maternal and child deaths, and

improvement of family health.

Strengthening/Scaling Gains in Health Workforce

TrainingSupportive

Supervision/ PTE

Certification PhilHealth Accreditation

Capacity building (Training, Supportive Supervision/PTE)Manuals and tools for training and supportive supervision, Coordination mechanisms to mobilize trainers for training and PTE and mechanisms for

DOHRO certification and Philhealth Accreditation (Provider/Trainer)Strengthening/Expanding Centers for Excellence (PPIUD FP Programs in Hospitals)Systems and Guidelines for Recognition of Clinical Practice SitesTraining Information Management Systems – Track distribution, non-practice, organize supportive supervision visits to ensure quality and practice

Increased SDPs with services

Reduction in non-practicing providers

Quality of practiceEquity in distribution of quality trained providers

Health workers satisfaction

Incentive to continue quality practice

ZCMC:CenterofExcellence:ExpansionofFamilyPlanningServices

2013 2016

PPIUD ClientsReached 2013 2014 2015 2016 TOTAL

IsabelaCity 1 1

ZamboangaCity 22 854 581 520 1,997

Zambo CityMedCenter 22 760 529 520 1,,831

OtherSDPs 94 52 0 146

ZamboangadelNorte 249 400 547 1,196

ZamboangadelSur 2 214 859 376 1,451

ZamboangaSibugay 183 231 267 681

Basilan 2 121 102 106 331

Sulu 6 28 60 94

Tawi Tawi

TOTAL 26 1,628 2,201 1,876 5,731

ExpansionofPPIUDthroughCentersofExcellenceinZamboanga&BASULTA

1,041Total HSPs trained on

PPIUD

75%(227 out of

366)Percent of

Municipalities/Cities with a

PPIUD Provider

Additional624 SDPs (480 public

and 144 private with capacity on

PPIUD)

Philippines – MindanaoHealth Project

SCALING-UP PPFP/PPIUD SERVICES

23,394WOMEN PROVIDED

PPFP/PPIUD SERVICES

From 107 to 731 service delivery

points in 4 years

23,394WOMEN PROVIDED

PPFP/PPIUD SERVICES

• Centers of Excellence as training institutions• Training and supportive supervision • FP program in hospitals• Clinical Practice Sites

INCREASING SUPPLY•• Harmonizing database & progressive profiling

and tracking of women with unmet need• Community-based and hospital based USAPAN

(group discussions) Sessions/Behavioral Change Communication ,

• Partnership – Muslim Religious Leaders - ARMM

GENERATING DEMAND

• DOH Certification and PhilHealth accreditation• DOH Guidelines in Setting up Family Planning

Services in Hospitals• DOH Guidelines on the Recognition of FP

Training Providers• Social health insurance (PhilHealth) coverage

and benefits for women about to give Birth.• Localization of policies and guidelines

SUSTAINABILITY THROUGH POLICY &

FINANCING

Key Strategies and Support Areas

Moving from ACCREDITATION to UTILIZATION of PhilHealth MCP/NCP Reimbursements

Accreditation Use of Reimbursements

MINDANAOHEALTH/Development Partners

• Health Facility Improvements

• EINC/BEmONCTraining

• Assessment of status &compliance to requirements

• Advocacy on use of PhilHealth guidelines

• Draft policies and fund disposition guidelines

• Advocacy through Local Health Board

DOH REGIONAL OFFICE

97%Increase in MCP/NCP accredited

facilities407 in 2013 to 802 in 2016

88%323/365 of LGUs with an LGU

Policy on use of MCP NCP reimbursement in 2016

S

53%Increase in MCP/NCP

reimbursement from PhilHealth(Php 274 M in 2013 to Php 419 M

in 2015)

ource: PhilHealth 2014 &2016 reports c/o HPDP

Better Quality and Use of Data for Decision Making

Data Utilization

Investment Planning

Data Quality Checks

Information Systems

Development

Routine cleaning of FHSIS reports

Tailored analysis and strategic

directions

Use of health systems framework

Improved monitoring and evaluation

82%LGUs conducting data

quality checks

ARMM, 8 Provinces and 36 municipalities with Executive Order

on DQC

Reports from 10 Private implementing partners, Iligan City SDN, integrated in

FHSIS

§ Training of Regional and LGU partners on DQC § Conduct DQCs – initially in public facilities expanding to partner private facilities§ Development of Dashboards using cleaned data/reports§ Use of Dashboards: Program Reviews, Local Investment Planning for Health,

Advocacy meetings

Strengthening Service Delivery Networks

Mapping of Facilities &

Service Network

ID of Entry Points & Options for SDN Service

Delivery Strengthening

Formation of SDN Structures at the DOHRO and LGU levels

Public-Private Partnership

Development

Agreements on collaboration,

identification of priority population,

plan of actions

SDN Strengthening Options / Entry Points Identified

Assessments of Functionality/Oper

ationalization of SDN

Private sector resources mobilized

SDN Referral & Management

Systems

Integrated SDN policies, plans,

resource sharing, referral, M & E

systems

• SDN Operational Guide• Referral Systems Development• SDN Management Structure & Systems

• Trainors Pool at DOHRO and PHO• DOH RO Advisory Committee on SDN• Capacity Building

PhP 7.85MTotal cost sharing generated from 8 SDNs

Lessons Learned§ There are emerging practices worth replicating§ Post-training Evaluation is vital in capacity building § Varied capacities of DOHROs/LGUs on Data and Logistic

Management and Utilization; Health Systems § Demand generation and its links to service provision needs

strengthening § Changes in the political-administrative environment has

impacted continuity of gains§ Gap: National policies/guidelines & appreciation and

localization at Regional and LGU levels

Lessons Learned

§ Health Systems Strengthening requires multi-sectoral and multi-level collaboration

§ Build on existing resources and opportunities; know the situation, strengthen/redirect existing plans, innovate, identify champions,

§ Operationalizing Health Systems Framework is tedious and process-oriented. Balance processes for significant results/outcomes

Recommendations

§ Build capacities of regional, medical centers, and selected provincial hospitals on supportive supervision/post-training evaluation

§ Strengthen skills of primary TA providers (DOH ROs and PHOs) on health systems strengthening, equity-focused approaches, Public-Private Partnership; Data Management

§ Rapid assessment: localization & extent of implementation of national laws, policies, and guidelines

§ Strengthen functionality and coordination across/among existing structures/bodies (ex: NIT/RIT/SDC/RDC/PDC/LHB)

Recommendations

§ Strengthen structures/mechanisms at the SDN level; start with MNCHN gradually expanding to integrate FP, AY, NCD, etc.

§ Document & replicate good/emerging practices; § Improve on-the-job mentoring/field monitoring, with built-in

feedback; data management for action at all levels

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Maraming Salamat Po!

Thank You!

Balancing Processes for Significant Results

Trends in Facility-Based Delivery and Fully Immunized Children, By Region, 2012-2016

A generally increasing trend in FBD performance, but FIC is declining except in ARMM