ETHELYN P. NIETO, MD, MPH, MHA, CESO III Undersecretary of Health

ETHELYN P. NIETO, MD, MPH, MHA, CESO IIIETHELYN P. NIETO, MD, MPH, MHA, CESO IIIUndersecretary of HealthUndersecretary of Health

Health Program Development ClusterHealth Program Development ClusterDEPARTMENT OF HEALTHDEPARTMENT OF HEALTH

PRESENTED AT THE 1ST NATIONAL STAFF MEETING2007

FOURFOURMULA MULA ONE FOR HEALTHONE FOR HEALTHUpdates on the ImplementationUpdates on the Implementation

Service Delivery – Service Delivery – Public Health Program DevelopmentPublic Health Program Development

1. Disease – Free Zone Initiatives

a. Malaria

b. Filariasis

c. Schistosomiasis

d. Rabies

e. Leprosy

2. Intensified Disease Prevention & Control

a. TB

b. VPI

c. HIV/AIDS

d. Emerging & RE-Emerging Infectious Diseases

e. Dengue

Service Delivery – Service Delivery – Public Health Program Public Health Program

DevelopmentDevelopment

3. Maternal & Child Health

4. Healthy Lifestyle & Risk Management

Service Delivery – Service Delivery – Health Facilities Development Health Facilities Development

ProgramProgram

1. Rationalization of Local Health Facilities

2. Upgrading of Local Health Facilities

3. Health Human Resource Capacity Building

4. Rationalizing Services & Strengthening Management Systems in Health Facilities

5. Integrating wellness services in hospitals

Service Delivery – Service Delivery – Strengthening Surveillance & Strengthening Surveillance & Epidemic Management SystemEpidemic Management System

1. Creation & Strengthening of Epidemic and Surveillance Units

2. Setting up of Surveillance Systems

3. Linkage with private sector

Service Delivery – Service Delivery – Strengthening of Disaster Strengthening of Disaster Preparedness & Response Preparedness & Response

SystemSystem

1. Advocacy/BCC

2. Localization of IEC messages

3. Reproduction of localized IEC messages

Service Delivery – Service Delivery – Health PromotionHealth Promotion

UPDATESUPDATES

NSM ResolutionNSM Resolution Actions TakenActions Taken Resp. Resp. OfficeOffice

Issues/Difficulties Issues/Difficulties EncounteredEncountered

Operationalization Operationalization of Priority of Priority ProgramsPrograms

Disease-Free Zones Disease-Free Zones InitiativesInitiatives

MalariaMalaria 16 Malaria-free 16 Malaria-free provinces as of Jan. provinces as of Jan. 20072007

NCDPCNCDPC -Need to strengthen -Need to strengthen surveillance in 16 surveillance in 16 Malaria-free prov.Malaria-free prov.

SchistosomiasisSchistosomiasis Drafting of Criteria for Drafting of Criteria for Schistosomiasis-free Schistosomiasis-free ZonesZones

- Some RHUs not - Some RHUs not equipped to equipped to diagnose (lack of diagnose (lack of microscopes)microscopes)

- No buffer stocks - No buffer stocks of Praziquantel of Praziquantel from CO & CHDsfrom CO & CHDs

RabiesRabies Preliminary assessment Preliminary assessment of possible Rabies-free of possible Rabies-free zoneszones

- Strict enforcement - Strict enforcement of Rabies control of Rabies control ordinanceordinance





Rabies (cont.)Rabies (cont.) Rabies curriculum Rabies curriculum integration in 7 high integration in 7 high incidence regionsincidence regions

- Establishment of - Establishment of functional ABTCfunctional ABTC

- Need to - Need to strengthen IEC strengthen IEC campaigncampaign

LeprosyLeprosy - Prevalence rate - Prevalence rate maintained at <1/10,000maintained at <1/10,000

- Conduct of the 1- Conduct of the 1stst National Leprosy National Leprosy SummitSummit

- Strengthening of - Strengthening of Surveillance Surveillance systemsystem

FilariasisFilariasis - Integrated Mass - Integrated Mass Treatment Campaign w/ Treatment Campaign w/ STHSTH

Need support & Need support & commitment from commitment from CHDs & LGUs toCHDs & LGUs to





Filariasis (Cont.)Filariasis (Cont.) -Mass Treatment in 35 Mass Treatment in 35 provinces; Conduct of provinces; Conduct of Mid-MDA Survey to det. Mid-MDA Survey to det. MFR as a result of mass MFR as a result of mass treatmenttreatment

Results:Results:

a. 42/43 sentinel sites a. 42/43 sentinel sites with reduced MFRwith reduced MFR

b. 8 endemic provinces b. 8 endemic provinces w/ reduced MFRsw/ reduced MFRs

NCDPCNCDPC ensure high MDA ensure high MDA coveragecoverage

- Need to - Need to strengthen strengthen Disability Disability Prevention aspect Prevention aspect of elimination of elimination programprogram




Intensified Disease Intensified Disease Prevention and Control Prevention and Control InitiativesInitiatives

TuberculosisTuberculosis - Nationwide - Nationwide implementation of DOTSimplementation of DOTS

- TB in Children - TB in Children expanded to 1 city/ expanded to 1 city/ regionregion-100 PPMD Units 100 PPMD Units installedinstalled- 470 DOTS facilities 470 DOTS facilities certified, 370 accreditedcertified, 370 accredited-Programmatic MDR-TB Programmatic MDR-TB ManagementManagement-Training on Hospital-Training on Hospital-based NTP DOTSbased NTP DOTS

NCDPCNCDPC Funding for Funding for expansion of expansion of Childhood TB & Childhood TB & MDR - TBMDR - TB





HIV-AIDSHIV-AIDS - Establishment of - Establishment of Social Hygiene Clinics & Social Hygiene Clinics & Local AIDS CouncilsLocal AIDS Councils- Community-based Community-based programsprograms- Home-based careHome-based care-Preliminary activities for Preliminary activities for the integration with MCH the integration with MCH ProgramProgram

NCDPCNCDPC Drafting of HIV Drafting of HIV Benefit Package Benefit Package GuidelinesGuidelines

NSM ResolutionNSM Resolution Action TakenAction Taken Resp. Resp. OfficeOffice




Vaccine-Vaccine-Preventable Preventable IllnessesIllnesses

-Adoption of Reaching Adoption of Reaching Every Barangay strategy Every Barangay strategy (60% of health facilities)(60% of health facilities)-Memo to CHDs to Memo to CHDs to prioritize top 31 prioritize top 31 provinces/cities w/ high provinces/cities w/ high unimmunized childrenunimmunized children-100% fund availability 100% fund availability for EPIfor EPI-Integration through 4Bs Integration through 4Bs (Bakuna, Bitamina A, (Bakuna, Bitamina A, Breastfeeding, purga sa Breastfeeding, purga sa Bulate)Bulate)

NCDPCNCDPC -Pockets of low -Pockets of low immunization immunization coveragecoverage

-Reported data in -Reported data in cities disparate cities disparate from validated datafrom validated data-Inventory Inventory managementmanagement-Increasing routine Increasing routine OPV3/DPT3/AMV OPV3/DPT3/AMV from current 80% to from current 80% to 95% to achieve 95% to achieve eliminationelimination





EREIDs (Avian EREIDs (Avian Influenza)Influenza)

- Establishment of AI - Establishment of AI Task Forces (Nat’l, Task Forces (Nat’l, Reg’l, Prov’l, Mun’l)Reg’l, Prov’l, Mun’l)-Development of Development of Preparedness & Preparedness & Response Plans (up to Response Plans (up to Mun’l level)Mun’l level)-Capability-building Capability-building activities up to the activities up to the Barangay levelBarangay level-Procurement of Procurement of antivirals, PPEsantivirals, PPEs-IEC materials IEC materials developeddeveloped

NCDPCNCDPC - Advocacy to LCEs - Advocacy to LCEs to allocate funds for to allocate funds for Preparedness & Preparedness & Response act.Response act.

- Adequacy of - Adequacy of supplies (antivirals, supplies (antivirals, vaccines, PPEs)vaccines, PPEs)

- Readiness of - Readiness of referral facilitiesreferral facilities

- M & E of initiatives - M & E of initiatives by various sectorsby various sectors




Healthy Lifestyle & Healthy Lifestyle & Risk ManagementRisk Management

-Capability-building act -Capability-building act on Promotion & on Promotion & Advocacy of HLAdvocacy of HL

-Development of -Development of National Tobacco National Tobacco Control Prog. – Smoking Control Prog. – Smoking Cessation Clinics; Cessation Clinics; Integrated NCD Integrated NCD Prevention & Control Prevention & Control ProgramProgram

-Development of the -Development of the National Environmental National Environmental Health Action PlanHealth Action Plan

-Technical Assistance in -Technical Assistance in the Guimaras Oil spillthe Guimaras Oil spill

NCDPCNCDPC -Strong influence of -Strong influence of MNCsMNCs

-Availability of low--Availability of low-priced anti-HPN priced anti-HPN drugsdrugs

-Lack of -Lack of organizational/ organizational/ financial/facility financial/facility preparedness to preparedness to address chemical address chemical accidentsaccidents




Maternal & Child Maternal & Child HealthHealth

- Modeling of Mother-- Modeling of Mother-Baby Friendly Baby Friendly Community & Community & WorkplaceWorkplace-Institutionalization of Institutionalization of IMCI training modules in IMCI training modules in training institutionstraining institutions-Manual & Trng. on Salt Manual & Trng. on Salt Iodization Tech. & QAIodization Tech. & QA-Strategic Plan for Strategic Plan for Integrated Helminth Integrated Helminth Control ProgramControl Program-Policy & Plan on Child Policy & Plan on Child Injury PreventionInjury Prevention

NCDPCNCDPC -TRO on IRR of EO -TRO on IRR of EO 5151-Low immunization Low immunization coverage for TT coverage for TT (37%)(37%)-Exclusive BF (’03): Exclusive BF (’03): 33.5%33.5%-Ave. Length of Ave. Length of Exclusive BF (‘03): Exclusive BF (‘03): 0.8 mos.0.8 mos.-Difficulty of getting Difficulty of getting Garantisadong Garantisadong Pambata & Patak Pambata & Patak sa Asin Reportssa Asin Reports




Maternal & Child Maternal & Child HealthHealth

- Public-Private - Public-Private Partnership in Women’s Partnership in Women’s Health (part. FP)Health (part. FP)

- Inclusion of SDM- Inclusion of SDM

- Policy & TA on CSR - Policy & TA on CSR StrategyStrategy

- Pilot implementation of - Pilot implementation of Pre-Pregnancy PackagePre-Pregnancy Package

- Facility Mapping & - Facility Mapping & Fac. Needs Assessment Fac. Needs Assessment for EmOC facilitiesfor EmOC facilities

- Establishment of - Establishment of BEmOC Training BEmOC Training CentersCenters

NCDPCNCDPC -Need to replicate Need to replicate trainings on trainings on BEmOC & Revised BEmOC & Revised FP Manual FP Manual nationwidenationwide-Not all LGUs are Not all LGUs are providing full providing full support for their support for their contraceptive contraceptive suppliessupplies- Need for active Need for active participation of participation of private sector in private sector in NFP (e.g. church)NFP (e.g. church)

NSM NSM ResolutionResolution

Action TakenAction Taken Resp. Resp. OfficeOffice


NHIP Benefit NHIP Benefit PackagesPackages

Development of the Development of the following packages:following packages:

TB TB NCDPC, NCDPC, PHICPHIC

Need to develop Need to develop more evidence-more evidence-based packagesbased packages

MaternalMaternal

SARS/AISARS/AI

MalariaMalaria

HIV-AIDSHIV-AIDS

Newborn Package–Hep BNewborn Package–Hep B

Performance Performance & Need-Based & Need-Based Allocation & Allocation & Financing Financing SystemSystem

Development of Central Development of Central Office *PIF indicators to Office *PIF indicators to for Performance-Based for Performance-Based Budgeting SystemBudgeting System

NCDPC, NCDPC, HPDPDHPDPD

Technical assistance Technical assistance neededneeded

*PIF:Performance Indicator Framework



Strengthening of Strengthening of Surveillance & Surveillance & Epidemic Mngt. Epidemic Mngt. SystemSystem

Creation/ Creation/ Strengthening of Strengthening of Epidemic Epidemic Surveillance UnitsSurveillance Units

-Creation of team of -Creation of team of Nat’l EPI Surveillance Nat’l EPI Surveillance OfficersOfficers

-Conduct of trainings on -Conduct of trainings on the ff.:the ff.:

a.a.NESSS (2 batches)NESSS (2 batches)

b.b.EPI Info. SystemEPI Info. System

c.c.Course for CodersCourse for Coders

-Conduct of Reg’l EPI -Conduct of Reg’l EPI Surv. Assessment & Surv. Assessment & Supportive Supervision Supportive Supervision (11 regions)(11 regions)

NECNEC Funding & Funding & overlapping of overlapping of activitiesactivities




Creation/ Creation/ Strengthening of Strengthening of Epidemic Epidemic Surveillance UnitsSurveillance Units

-FETP: 7 enrolled (‘06)-FETP: 7 enrolled (‘06)

-FMTP: 57 graduates -FMTP: 57 graduates (’06)(’06)

NECNEC

Setting up of Setting up of Surveillance Surveillance SystemsSystems

-Conduct of the ff. -Conduct of the ff. Dissemination For a:Dissemination For a:

a.a.2005 Integrated HIV & 2005 Integrated HIV & Behavioral Surveillance Behavioral Surveillance SystemSystem

b.b.New Protocol of HIV & New Protocol of HIV & AIDS RegistryAIDS Registry

Delayed reports Delayed reports from sitesfrom sites




Setting up of Setting up of Surveillance Surveillance SystemsSystems

-Pilot Testing of Forms -Pilot Testing of Forms for new Protocol of HIV for new Protocol of HIV & AIDS Registry & AIDS Registry

-Completed the Baseline -Completed the Baseline Survey of 5Survey of 5thth Round Round GTFAM (18 HIV sites)GTFAM (18 HIV sites)

-Software support to -Software support to Malaria Info. SystemMalaria Info. System

-Conduct of PHIL-MIS -Conduct of PHIL-MIS Training in Global Fund Training in Global Fund Malaria SitesMalaria Sites

NECNEC Funding & Funding & overlapping of overlapping of activitiesactivities



Strengthening of Strengthening of Disaster Disaster Preparedness & Preparedness & Response SystemResponse System

-Development of the ff.:-Development of the ff.:

a.Weapons for Mass a.Weapons for Mass Destruction Hospital- Destruction Hospital- Based ManualBased Manual

b.Guidelines on b.Guidelines on Expanded Utilization of Expanded Utilization of BP 5 Compact FoodBP 5 Compact Food

c.Guidelines for c.Guidelines for Performance Evaluation Performance Evaluation of CHDs on HEMof CHDs on HEM

d.Standards for d.Standards for developing Emergency developing Emergency Preparedness & Preparedness & Response Plans as Response Plans as requirement for hospital requirement for hospital licensinglicensing

HEMSHEMS




-TA to the following act.:-TA to the following act.:

a.Skills Benchmarking for a.Skills Benchmarking for CHDsCHDs

b.Conduct of EMT Basic b.Conduct of EMT Basic & Instructor’s Training & Instructor’s Training CourseCourse

-Organization & conduct -Organization & conduct of the following trngs.:of the following trngs.:

a.BLS-CPR (DOH a.BLS-CPR (DOH personnel-5 batches)personnel-5 batches)

b.BLS-TOT (37 trainors b.BLS-TOT (37 trainors produced)produced)

c.2c.2ndnd Nat’l PHEMAP Nat’l PHEMAP Course (34 Health Course (34 Health Emergency Managers Emergency Managers produced)produced)

d.HEM Trng. (3 batches)d.HEM Trng. (3 batches)

HEMSHEMS




-Strengthening of CHD 3 -Strengthening of CHD 3 OPCENOPCEN

-Review & Publication of -Review & Publication of “Pocket Emergency “Pocket Emergency Tool” – 2Tool” – 2ndnd ed. ed.

-Logistic Support -Logistic Support (Mayon, Nitrate (Mayon, Nitrate poisoning, etc.)poisoning, etc.)

HEMSHEMS


Issues/Issues/Difficulties Difficulties

EncounteredEncountered

Strengthening Strengthening of Health of Health Promotion to Promotion to effect behavior effect behavior changechange

-.) developed a -.) developed a health promotion plan health promotion plan for the promotion of for the promotion of F1 packageF1 package-Prepared script and Prepared script and produced AVP for F1produced AVP for F1-Composed the F1 Composed the F1 jinglejingle

NCHPNCHP





-.) developed health -.) developed health promotion and promotion and communication plans communication plans for the major health for the major health events especially events especially those geared those geared towards:towards:-disease-free zone disease-free zone initiativesinitiatives-- promotion of - promotion of Healthy Lifestyle Healthy Lifestyle

NCHPNCHP - Lack of budget - Lack of budget to sustain tri-to sustain tri-media campaignmedia campaign-Lack of CHD Lack of CHD budget to trickle budget to trickle down national down national campaigns to campaigns to LGU levelsLGU levels-Lack of LGU Lack of LGU activities on face-activities on face-to-face to-face communication to communication to change behaviorchange behavior





-.) Conducted -.) Conducted meetings and meetings and workshops to pave workshops to pave the way for the the way for the creation of a Health creation of a Health Promotion Promotion FoundationFoundation

NCHPNCHP - Lack of top - Lack of top management management supportsupport

- Lack of budget - Lack of budget to initiate to initiate preparatory preparatory activitiesactivities



Rationalization of Rationalization of Local Health Local Health Facilities to Facilities to include facility include facility mapping for mapping for BEMOCs & BEMOCs & CEMOCsCEMOCs

A.O. #2006-0029 dated A.O. #2006-0029 dated June 15,2006 issued: June 15,2006 issued: Guidelines on Guidelines on Rationalization of Health Rationalization of Health Care Delivery System Care Delivery System Based on Health NeedsBased on Health Needs

*On-going development *On-going development of Implementation of Implementation Manual (Manual of Manual (Manual of Procedures).Procedures).

*Coordination with *Coordination with Regulatory Bureau Regulatory Bureau (BHFS) requirement for (BHFS) requirement for Certification of Needs Certification of Needs (CON)(CON)

*Used in evaluation of *Used in evaluation of House & Senate Bills on House & Senate Bills on Hosp establishment, Hosp establishment, upgrading, upgrading, renationalization.renationalization.

NCHFDNCHFD Different application Different application due to geographical due to geographical differences.differences.



Upgrading of Upgrading of Local Health Local Health Facilities – Facilities – Infrastructure, Infrastructure, EquipmentEquipment

Under the PGMA Under the PGMA Priority Hospital Priority Hospital Upgrading Project: 22 Upgrading Project: 22 LGU Hospitals for LGU Hospitals for upgrading, amounting to upgrading, amounting to P371.797M; funds sub-P371.797M; funds sub-allotted to CHDs as of allotted to CHDs as of Jan 22, 2007.Jan 22, 2007.

NCHFDNCHFD

Health Human Health Human Resource Capacity Resource Capacity Building for LGU & Building for LGU & National Govt National Govt HospitalsHospitals

-Conducted Training Conducted Training Courses:Courses:

1. Healthy Hospital 1. Healthy Hospital InitiativeInitiative

2.Quality Management 2.Quality Management System System

3. Implementation of 3. Implementation of CQI ProgramCQI Program

4. Accurate Nursing 4. Accurate Nursing DocumentationDocumentation

NCHFDNCHFD



(cont’n):(cont’n):

Health Human Health Human Resource Resource Capacity Building Capacity Building for LGU & for LGU & National Govt National Govt HospitalsHospitals

Conducted Training Conducted Training Courses:Courses:

5. Qualitative & 5. Qualitative & Quantitative Analysis of Quantitative Analysis of In-patient Medical In-patient Medical Records; Analysis of Records; Analysis of Hospital Statistical Hospital Statistical ReportReport

6. Clinical Toxicology for 6. Clinical Toxicology for Doctors & Nurses (DOH Doctors & Nurses (DOH Hospitals)Hospitals)

7. Occupational Health 7. Occupational Health & Safety for Hospital-& Safety for Hospital-based Workforce in MM based Workforce in MM Hospitals.Hospitals.

8. Preparedness for 8. Preparedness for Avian/Pandemic Avian/Pandemic Influenza for DOH HospInfluenza for DOH Hosp

NCHFDNCHFD



Health Human Health Human Resource Resource Provision/Capacity Provision/Capacity Building for LGU & Building for LGU & National Govt National Govt HospitalsHospitals


9. Mother-Baby Friendly9. Mother-Baby Friendly

Hospital Initiative Hospital Initiative (MBFHI) for Regional (MBFHI) for Regional Assessors, Lactation Assessors, Lactation Management Trainers, Management Trainers, LGU & Private Hospital LGU & Private Hospital Administrators. Administrators.

10. Extended Child Care10. Extended Child Care

11. Hospital Billing 11. Hospital Billing Procedures & Patient Procedures & Patient Classification (AO 51-A)Classification (AO 51-A)

12. Roles & Functions of 12. Roles & Functions of Hospital Medical Social Hospital Medical Social Workers.Workers.

NCHFDNCHFD



Health Human Health Human Resource Resource Provision/Capacity Provision/Capacity Building for LGU & Building for LGU & National Govt National Govt HospitalsHospitals


14. Implementation of 14. Implementation of Integrated Hospital Integrated Hospital Operations & Operations & Management Program Management Program (IHOMP) & Hospital (IHOMP) & Hospital Operations & Mx Operations & Mx Information System Information System (HOMIS) software(HOMIS) software

NCHFDNCHFD

Rationalizing Rationalizing Services & Services & Strengthening Strengthening Management Management Systems in Health Systems in Health FacilitiesFacilities

Updating of Manuals of Updating of Manuals of Operations: Nursing Operations: Nursing Service, Pharmacy, Service, Pharmacy, Dietary Service, Medical Dietary Service, Medical Records, Medical Social Records, Medical Social Service, Administrative Service, Administrative Procedures. Procedures.

Manual of Standards for Manual of Standards for Infection Control issued.Infection Control issued.

NCHFDNCHFD




-Strategies for reducing -Strategies for reducing high % of primary & high % of primary & secondary services in secondary services in DOH tertiary care DOH tertiary care facilities (“devolution of facilities (“devolution of primary & secondary primary & secondary services”).services”).

-Devolution of primary -Devolution of primary licensed hospital.licensed hospital.

-Continued -Continued implementation of implementation of hospital upgrading hospital upgrading projects to establish projects to establish tertiary care & specialty tertiary care & specialty services in DOH services in DOH Hospitals (Phil. Hospital Hospitals (Phil. Hospital Development Program)Development Program)

NCHFD, NCHFD, selected selected HospitalsHospitals

CHD-CHD-NCR, NCR, NCHFDNCHFD

NCHFD, NCHFD, BIHC, BIHC, selected selected HospitalsHospitals

Resistance from Resistance from hospital staff; Need hospital staff; Need for longer social for longer social preparation to preparation to influence patient influence patient health seeking health seeking behavior.behavior.




-Financial Management -Financial Management Systems in Hospitals: Systems in Hospitals: Cost-finding, Rate-Cost-finding, Rate-settingsetting

_ Coordination with _ Coordination with PHIC for new benefit PHIC for new benefit Packages & Financing Packages & Financing opportunities for opportunities for Hospitals:Hospitals:

- PhilHealth Preferred - PhilHealth Preferred provider Program, provider Program, Overseas Workers Overseas Workers Program.Program.

- Implementation of - Implementation of performance-based performance-based budgeting in Hospitals budgeting in Hospitals (2007)(2007)

NCHFD, NCHFD, PHICPHIC

NCHFD, NCHFD, HPDPB, HPDPB, FSFS

Need to revisit Need to revisit process.process.



Integrated Integrated Wellness services Wellness services in Hospitalsin Hospitals

Drafting of AO to Drafting of AO to strengthen MBFHI strengthen MBFHI (inclusion of (inclusion of “mother-friendly” “mother-friendly” strategies.strategies.

TB DOTS Referral TB DOTS Referral System established System established in Hospitals.in Hospitals.

Conducted Advocacy Conducted Advocacy activities:activities:

1.1. Healthy LifestyleHealthy Lifestyle

2.2. Primary Health Primary Health CareCare

3.3. Occupational Occupational Health & SafetyHealth & Safety

4.4. Hospitals as Hospitals as Centers of Centers of Wellness Wellness

NCHFD NCHFD & & Hospitals Hospitals in in support support to to NCDPC NCDPC & NC.HP& NC.HP

Thank you very much!Thank you very much!

Documents

ETHELYN P. NIETO, MD, MPH, MHA, CESO III Undersecretary of Health