Pursuing PPP in Health in the Philippines

Ms. Rosa Gonzales, Department of Health

The Role of Non-State Providers in Delivering Basic Social Services for Children Regional Workshop

April 19-20, 2010, ADB Headquarters

The Drivers for PPPs

• Achievement of health outcomes, rising demand for better/improved health

• Ongoing and sustaining/complementing the gains achieved from parallel health reforms

-2000 DOH Reengineering espousing leadership in the health sector, shift in roles and functions -Present reforms on health governance/financing stress on performance and “value for money” (eg PBGs, fiscal autonomy of health facilities and capitation schemes)

The Drivers for PPPs

• Initial step towards formulating a policy and operational framework for PPPs are addressed through Administrative Orders for key processes and programs: 2000-2008 Examples: - Chapter on PPP in the NOH - Electronic Procurement System using a Private Sector Platform - The National and Regional Coordinating Committee on Public-Private MIX Dots - Public-Private Collaboration in Delivery of Health Services (incldg FP, Repro Health) - Rapid Reduction of Maternal and Neonatal Mortality - DOH and Dept of Labor (DOLE) Partnership: Strengthening Support for Workplace Health Programs

The Drivers for PPPs

• Initial step towards assessing PPPs in Health in a more comprehensive manner was started in 2008 with assistance form the ADB Support for Health Sector Reform, specifically, aiming to:

- benchmark Philippine experience with international - identify and characterize PPP initiatives: strengths /weaknesses - identify opportunities for expanding PPPs - identify the PPP policy options for DOH

• The follow up technical assistance from ADB started in 2010 to assist DOH in formulating a policy framework and strategic direction for PPP in Health

PPP Types and Objectives Addressed(Sample: 10/30 PPPs Identified)

Type Example Health Objectives/Features

Corporate Partnerships

KLM: Movement Against Malaria

Reduce malaria morbidity & moratlity by 70% in 5 provinces

Support to PhilhealthInsurance Scheme

KASAPI Provide access to health care for members of MFIs and cooperatives

Primary Health CareServices Provision (2)

TB-DOTS (PPMD) Increase case detection, synchronize TB mgt among all TB care providers in Province of Cavite

SAFEMOM Fill the gaps in Maternal, FP and Child Health in Bohol

Type Example Health Objectives/Features

Outsourcing of Hospital Services (2)

La Union Medical Center

Operate an economic and corporate enterprise in a devolved set-up as provided by RA 9259; Equipments were operated in joint venture with private sector

National Kidney & Transplant Center

Improve the Hemodialysis Unit applying BOT features

Interlocal Health Zones Development (2)

Carmen Health District Hospital

Expand coverage and access to health services (eg drugs through the mini pharmacies or BnBs

New Capiz Integrated Health Services Council

Sets policy direction for mgt and implementation of integrated health services, generates resources, etc.

Type Example Health Objectives/Features

Drug Distribution Health Plus Provide access for lower priced drugs by the poor

Education & Training Leaders for Health Support the educational formation of future health managers; develop competencies in changing the health system

SAFEMON

Program Overview: Provide quality & affordable FP Services and upgrade the practice of midwifery (ie capacitate midwives for entrepreneurship and Private practice.

• IMAP (Bohol) started SAFEMOM, conducted baseline study to determine FP needs and scan existing PPPs• Secured technical assistance from PRISM in establishing the lying-in clinics• Initiated training service programs for midwives (ie BEST)• Secured Philhealth accreditation• Secured additional funding assistance from LGU • Systems in place: conduct of regular case conferences, referral, MIS, communications & marketing plan

Key Achievements:• Increase of clients by 60% and revenues by 40-60%. Earned credit-worthy status.

• Expansion of the referral system (to capital city in the region)

• Growth in IMAP (increased number of membership, more benefits and increased income for midwives, more employment, well capacitated through a packaged training program

• Partners Benefits: Increased incomes for doctors, and support for IEC advocacies. Provided policy inputs in DOH and collaborated closely with LGU in delivery FP/MCH services • Became an advocate and rescuer for FP/MCH programs in localities where it was least prioritized

Lessons Learned

• Engaged/maximized partnerships for services and resources that it could not assume well (local and and private hospitals)

• Applied business concepts (eg socialized pricing) to enhance operations and services)

• Contractual arrangements (MOUs) merit improvement in terms of more specific targets and deliverables. Other binding agreements such as penalties for non-compliance were not included

STRENGTHS of PPPs

• Offers richness of experience because of diverse types and forms

• Partnership can be tripartite or more (eg with the corporatized ILHZ & emphasis on people or community responsibility)

• Some have been scaled-up with new funding because of encouraging results (eg SAFEMOM, KLM: Movement Against Malaria)

• Support systems (eg IT) improved operations (eg LUMC)

WEAKNESSES of PPPs

• Informality of governance structures: absence of long-term planning, weak contractual arrangements and accountability

• Relies heavily on charismatic leadership rather than putting premium on strengthening of institutional structures

• Relies on foreign donors for funding

• Can duplicate in some instances because objectives are not well integrated into the broader health system

The Challenges for DOH

• As leaders or overseers: capacity for contract management, monitoring and evaluation

• Institutionalizing the PPP Unit in DOH with an overstretched staff and undersized DOH: In doing ME, should we contract PPP monitor solely for this?

• Developing a policy framework with more and sound evidence. Hence, a PPP Research Agenda?

• Access to vital resource on PPP documentation and institutionalizing these in the policy process of DOH that PPP concerns/updates are reported in the Execom