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
rtm
ent o
f Hea
lthPh
ilipp
ine
Heal
th In
sura
nce
Corp
orati
on(N
ation
al/C
entr
al O
ffice
s)
DOH
Cent
ers f
or H
ealth
Dev
elop
men
tPh
ilHea
lth R
egio
nal O
ffice
s
Loca
l Gov
ernm
ent U
nits
(Pro
vinc
es a
nd C
ities
)
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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Open Forum / Q&A
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