46
My Leadership My Leadership Journey Journey Bien Eli Nillos, MD Bien Eli Nillos, MD Former Doctor to the Barrios Former Doctor to the Barrios Municipality of Candoni, Negros Occidental Municipality of Candoni, Negros Occidental

My Leadership Journey

Embed Size (px)

DESCRIPTION

for my presentation for Zuellig at the University of Makati

Citation preview

Page 1: My Leadership Journey

My Leadership My Leadership JourneyJourney

Bien Eli Nillos, MDBien Eli Nillos, MDFormer Doctor to the BarriosFormer Doctor to the Barrios

Municipality of Candoni, Negros OccidentalMunicipality of Candoni, Negros Occidental

Page 2: My Leadership Journey

Bien Nillos, MDBien Nillos, MDM.D. – 2006, University of Saint La SalleM.D. – 2006, University of Saint La SalleBS Biology – 2002, University of Saint La BS Biology – 2002, University of Saint La

SalleSalleDoctor to the Barrio – 2007 – 2010, Doctor to the Barrio – 2007 – 2010,

DOH/Municipality of Candoni, Negros DOH/Municipality of Candoni, Negros Occidental.Occidental.

Currently an Associate Professor for Currently an Associate Professor for Family and Community Medicine Family and Community Medicine (University of Saint La Salle)(University of Saint La Salle)

Fellow, Zuellig’s HLMP TrainingFellow, Zuellig’s HLMP TrainingAlumnus, U.S. State Department Alumnus, U.S. State Department

(Northern Illinois University)(Northern Illinois University)Alumnus, Global Health Course, Alumnus, Global Health Course,

University of Tampere (Finland)University of Tampere (Finland)

Page 3: My Leadership Journey

Candoni, Negros OccidentalCandoni, Negros Occidental

Population: 21,000Population: 21,0004-hour bus ride from 4-hour bus ride from

Bacolod City, 1 Bacolod City, 1 and half hours and half hours away from away from Kabankalan CityKabankalan City

Surrounded by other Surrounded by other towns and cities towns and cities (CHICKS)(CHICKS)

Page 4: My Leadership Journey

Problems EncounteredProblems Encountered

Poor Health IndicatorsPoor Health Indicators

Inaccessible health Inaccessible health care servicescare services

Limited Human and Limited Human and Financial ResourcesFinancial Resources

Poor Health Seeking Poor Health Seeking BehaviorsBehaviors

Page 5: My Leadership Journey

Maternal Mortality Maternal Mortality per 1,000 LBsper 1,000 LBs

3.6

5.8

0.920.63

0

1

2

3

4

5

6

2006 2007

CandoniRegion 6National

Facility based deliveries – 24% in 2007Skilled birth attendant deliveries – 74% in 2007Top Causes of MM – post-partum bleeding, Pregnancy Induced Hypertension

Page 6: My Leadership Journey

Infectious (Pulmonary Infectious (Pulmonary Tuberculosis)Tuberculosis)

0

20

40

60

80

2006 2007

Case Detection Rate

Candoni

National

Cure Rate – 93% in 2007No med. Tech. – only 1 midwife microscopistPracticing TB DOTS but not Philhealth accredited

Page 7: My Leadership Journey
Page 8: My Leadership Journey
Page 9: My Leadership Journey

Infant Mortality Infant Mortality per 1,000 LBsper 1,000 LBs

26.5

10.1 9.2

0

5

10

15

20

25

30

2007

CandoniRegion 6National

Top Causes of Mortality: Severe Pneumonia, Severe Diarrhea

Page 10: My Leadership Journey
Page 11: My Leadership Journey

Compounding FactorsCompounding Factors

“The greatest intelligence is precisely the one that suffers most from its own limitations” – Andre Gide (Nobel Prize for Literature, 1947)

POLITICS

ACCESS

LACK OF…

Page 12: My Leadership Journey

““We are limited but we can push back the borders We are limited but we can push back the borders of our of our limitationslimitations” – Stephen Covey” – Stephen Covey

Page 13: My Leadership Journey

““Change will come Change will come when those who when those who have the resources have the resources learn that they do learn that they do not have all the not have all the answers…they need answers…they need to learn how to to learn how to listen.” – Desmund listen.” – Desmund TutuTutu

Page 14: My Leadership Journey

Alma Ata DeclarationAlma Ata Declaration

“The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.” - Alma Ata Declaration of 1978

Page 15: My Leadership Journey
Page 16: My Leadership Journey

COMMUNITY HEALTH INITIATIVES COMMUNITY HEALTH INITIATIVES PARTNERS (CHIP)PARTNERS (CHIP)

Members: Barangay Captains, Brgy. Kagawads for Health, SK, BHW Federation

Role: Coordinate all health program implementation at the barangay level, initiate community-based health programs through original approaches.

Page 17: My Leadership Journey

Relations and Advocacy Managers (RAM)Relations and Advocacy Managers (RAM)

Members: Teachers, Faculty-in-charge, church-based organizations, PNP and other NGO’s

Role: help in the promotion of health advocacies in schools and communities through integration.

Page 18: My Leadership Journey

Legislative Action Network (LAN)Legislative Action Network (LAN)

Members: Political leaders, councilors, department heads, NGO’s

Role: provide strong legislative support for health programs, influence policy in favor of health initiatives

Page 19: My Leadership Journey

MONITORING team (MONITOR)MONITORING team (MONITOR)Members: Program coordinators, DOH representative, PHO/CHD/Philhealth, Public health managers, MPDO, Budget Officer

Role: Monitor progress of initiatives, plot outcomes and results and provide feedback to community at large.

Page 20: My Leadership Journey

Engaging the CommunityEngaging the Community

Assembly of hilots and Assembly of hilots and revival of Women’s revival of Women’s Health TeamHealth Team

Legislative support – Legislative support – barangay ordinancesbarangay ordinances

Increased advocacy Increased advocacy and social awarenessand social awareness

Training of midwives Training of midwives and nurses and nurses (refresher’s course)(refresher’s course)

Page 21: My Leadership Journey

““There go my people.  I must find out where they There go my people.  I must find out where they are going so I can lead them.”  ~ Alexandre are going so I can lead them.”  ~ Alexandre Ledru-RollinLedru-Rollin

Page 22: My Leadership Journey

““Example, whether it be good or bad, has a powerful Example, whether it be good or bad, has a powerful influence” – George Washington, quoted from his letter influence” – George Washington, quoted from his letter to Lord Stirling (March 1780)to Lord Stirling (March 1780)

Page 23: My Leadership Journey

Upgrading A Local Upgrading A Local Health SystemHealth System

Part Two on Candoni CasePart Two on Candoni Case

Bien Eli Nillos, MDBien Eli Nillos, MD

Former Municipal Health OfficerFormer Municipal Health Officer

Page 24: My Leadership Journey

Consider this…Consider this…

All 3 components are essential. All 3 components are essential. Hardware = equipments, logistics, physical environmentHardware = equipments, logistics, physical environment

Software = local health system, predominant cultureSoftware = local health system, predominant culturePeopleware = ActorsPeopleware = Actors

Page 25: My Leadership Journey

Why “Upgrade?”Why “Upgrade?”

Excellent Hardware and Software but illiterate Peopleware

Excellent Software and Literate Peopleware but Poor Hardware

Excellent Hardware and Efficient Peopleware but Poor Software

Slow rendering of output

Useless, ImpotentFrustrated, Lost,

Apathetic

Page 26: My Leadership Journey
Page 27: My Leadership Journey

Community Health Initiative Community Health Initiative Partners (CHIP)Partners (CHIP)

Relations Advocacy ManagersRelations Advocacy Managers(RAM)(RAM)

Legislative Action Network (LAN)Legislative Action Network (LAN)

MONITORing teamMONITORing team

Page 28: My Leadership Journey

3.6

5.8

0.920.63

0

1

2

3

4

5

6

2006 2007

Maternal Deaths per 1,000 Lb

Candoni

Region 6

National

26.5

10.1 9.2

0

5

10

15

20

25

30

2007

Infant Deaths per 1,000 Lb in 2007

Candoni

Region 6

National

01020304050607080

2006 2007

TB Case Detection Rate

Candoni

National

No Botika ng Barangays

Dilapidated RHU

Low number of deliveries attended by skilled birth attendants

No indigents enrolled in Philhealth

High malnutrition rate

Page 29: My Leadership Journey

Internal and External EnvironmentsInternal and External Environments

Challenge: Motivation to work (feeling of insufficiency, routine work, professional jealousies)

Strategy: Treating them as partners, important contributors

Activities: Workshops, team building, SOP’s, assignment of program coordinators, trainings and seminars

Page 30: My Leadership Journey

Internal and External EnvironmentsInternal and External Environments

Challenge: direct interest Challenge: direct interest and attention to health and attention to health (dole-out mentality, (dole-out mentality, political patronage, etc)political patronage, etc)

Strategy: Validation and Strategy: Validation and affirmation of Vision – affirmation of Vision – hopes for Candoni.hopes for Candoni.

Approach: Gather Approach: Gather influential leaders in the influential leaders in the community, and community, and empowering of empowering of community through community through these leaders.these leaders.

Page 31: My Leadership Journey

Issue No. 1: Maternal Mortality Issue No. 1: Maternal Mortality RatioRatio

““Hardware” – Dilapidated RHU, BHS not Hardware” – Dilapidated RHU, BHS not capable of handling normal deliveries, lack capable of handling normal deliveries, lack of supplies, inaccessible puroks, sitiosof supplies, inaccessible puroks, sitios

““Software” – poor referral system, lack of Software” – poor referral system, lack of tracking system for pregnant clients, tracking system for pregnant clients, policies on policies on hilot hilot delivery, “cultural”delivery, “cultural”

““Peopleware” – predominance of TBA, no Peopleware” – predominance of TBA, no Women’s Health TeamWomen’s Health Team

Page 32: My Leadership Journey

Assembly of Assembly of HilotsHilotsIntegrating the TBA’s Integrating the TBA’s

in the “new set-up”. in the “new set-up”. Important partners Important partners

and collaborators and collaborators (WHT)(WHT)

Support of the Support of the Barangay CaptainsBarangay Captains

Barangay Barangay OrdinancesOrdinances

Page 33: My Leadership Journey

New Protocols for RHU New Protocols for RHU StaffStaff

9 barangays with 9 9 barangays with 9 midwivesmidwives

1 midwife-in-charge of 1 midwife-in-charge of DRDR

BHW catchment BHW catchment areas (atrition policy)areas (atrition policy)

SOP on referral SOP on referral systemsystem

Lifesaving skills and Lifesaving skills and Perineal suturingPerineal suturing

Page 34: My Leadership Journey

Upgrading RHU/ Upgrading RHU/ equipping BHSequipping BHS

Page 35: My Leadership Journey

Selling the Idea to the CommunitySelling the Idea to the Community

““Alkansiyang Alkansiyang Pampamilya”Pampamilya”

““Buntis Baby Bags”Buntis Baby Bags”

Page 36: My Leadership Journey

24

58

5.8

7479

0

85 87

00

10

20

30

40

50

60

70

80

90

2007 2008 2009

FBD

SBA

MMR

FBD = Facility Based Delivery

SBA = Skilled Birth Attendant

MMR = Maternal Mortality Ratio

THE OUTCOMES

Page 37: My Leadership Journey

26.5

10.19.2

21.8

4.14

0

5

10

15

20

25

30

2007 2008 2009

Candoni

Region 6

National

Infant Mortality Rate Trend

Page 38: My Leadership Journey

Issue No. 2: Inaccessibility to Issue No. 2: Inaccessibility to Cheaper MedicinesCheaper Medicines

Hardware: “geographically challenging”Hardware: “geographically challenging”

Software: “dole-out mentality” “Credit is Software: “dole-out mentality” “Credit is good because I don’t have cash” mottogood because I don’t have cash” motto

Peopleware: “Barangay captains hesitant to Peopleware: “Barangay captains hesitant to start up a BnB due to fear of lack of start up a BnB due to fear of lack of sustainability” sustainability”

Page 39: My Leadership Journey

Establishment of Botika ng Establishment of Botika ng Barangays 9/9Barangays 9/9

Establishment of Botika ng Establishment of Botika ng Barangay Monitoring Barangay Monitoring Team: DOH Team: DOH representative, Municipal representative, Municipal Accountant, BnB Operator, Accountant, BnB Operator, Nurse Coordinator, Brgy. Nurse Coordinator, Brgy. CaptainCaptain

Under the LHB Under the LHB

Page 40: My Leadership Journey

Issue No. 3: TB or not TBIssue No. 3: TB or not TB

Hardware: “dilapidated RHU, Microscopy Hardware: “dilapidated RHU, Microscopy lab”lab”

Software: “while practicing TB DOTS, lack of Software: “while practicing TB DOTS, lack of aggressiveness in tracking symptomatics”aggressiveness in tracking symptomatics”

Peopleware: “less motivated(?) staff” Peopleware: “less motivated(?) staff” “community unaware”“community unaware”

Page 41: My Leadership Journey

One additional One additional midwife trained midwife trained as Microscopistas Microscopist

Aggressive TB Aggressive TB awareness awareness campaigncampaign

Lung Month Lung Month CelebrationsCelebrations

Philhealth Philhealth AccreditationAccreditation

Page 42: My Leadership Journey

TB DOTS ProgramTB DOTS Program

0102030405060708090

100

2007 2008 2009

CDR

Cure Rate

CDR = Case Detection Rate

Page 43: My Leadership Journey

My Role, The PontiffMy Role, The PontiffLatin Latin PontifexPontifex – pons (bridge) + facere (to make) = “bridge builder” – pons (bridge) + facere (to make) = “bridge builder”

"I pray that I may never meddle, interfere, dictate, give advice that is not wanted, or assist when my services are not needed. If I can help people, I'll

do it by giving them a chance to help themselves; and if I can uplift or inspire, let it be by example,

inference and suggestion, rather than by injunction and dictation. That is to say, I desire to be Radiant

-- to Radiate Life!"-- Elbert Hubbard

Page 44: My Leadership Journey

Struggles/ChallengesStruggles/Challenges

““Anything worth doing is Anything worth doing is difficult” – Patch Adamsdifficult” – Patch Adams

Page 45: My Leadership Journey

Quo Vadis, Doctor?Quo Vadis, Doctor?

“I seldom end up where I wanted to go, but almost always end up where I need to be.” – Douglas Adams

Page 46: My Leadership Journey

“It is the time you have wasted for your rose that makes your rose so important.“ – The Fox (The Little Prince, Chapter 21)