FOURMULA ONE for FOURMULA ONE for Health:Health:

Gauging Performance After Year OneGauging Performance After Year One

an interim F1 Report Card presented by :

FRANCISCO. T. DUQUE III, MD, MSc.Secretary of Health

Department of Health

Happy 2007!Happy 2007!Welcome to 4Welcome to 4thth National Staff National Staff MeetingMeeting !

Outline of Presentation

A Season of Milestones : F1 Key Accomplishments

The Challenge Ahead : Why we must be better leaders for health

More Races to Win : F1 Targets 2007-2010

A Season of Milestones: A Season of Milestones: F1 Key AccomplishmentsF1 Key Accomplishments F1 charted a clear road map for comprehensive

health sector reforms

F1 set targets & identified PPAs to plan better for the medium- and long-term

F1 has driven efficiency in the health system through budget/corporate/human restructuring

- Performance-based budgeting for Public Health & Hospitals - DOH Budget Restructuring linked with core functions and desired organizational outcomes (CY 2008) - 100 % Income retention & utilization of hospitals - DOH Rationalization Plan - Retooling/Retraining of personnel - National Human Resource for Health Master Plan

A Season of Milestones: A Season of Milestones: F1 Key AccomplishmentsF1 Key Accomplishments F1 has boosted partnerships & stakeholder

participation at all levels

- 16 F1 sites are on board with PIPH finalized - Effective donor coordination pooled some $530 M worth

of ODA through SDAH - Public –private partnerships have strengthened the fight against some priority diseases: TB, malaria, filariasis, NCDs, avian flu - Inter-sectoral collaboration was forged to tackle

concerns with obvious impact on health *Human Resources for Health *Hunger Mitigation Program *Sanitation & Safe/sustainable water supply *Environmental disasters

A Season of Milestones: A Season of Milestones: F1 Key AccomplishmentsF1 Key Accomplishments

F1 has enabled us to improve health and reach the poor more effectively

* Philhealth reached out to 77% of total population

- New benefit packages targeted MDG priorities: MCH, TB, malaria, HIV/AIDS

* Poor has greater access to low-cost, high-quality medicines - 53% of Filipinos now using generics - nearly 7,500 Botika ng Barangays are functional nationwide - 1,263 Botika ng Bayan (PITC) outlets are now accredited nationwide - Parallel importation generated consumer savings up to 82%

Opinion on the Current Cost of Opinion on the Current Cost of MedicinesMedicinesSWS Survey (3SWS Survey (3rdrd Quarter 2006) Quarter 2006)

Dec 99 Sep 01 Sep 03 Sep 06

Very cheap / Somewhat

cheap

11% 7% 43% 45%

Very Expensive / Somewhat expensive

88% 93% 57% 55%

Type of Medicine Bought in the Past 6 Type of Medicine Bought in the Past 6 MonthsMonthsSWS Survey (3SWS Survey (3rdrd Quarter 2006) Quarter 2006)

TYPE OF MEDICINE September 2003

September 2006

Generics 39% 44%

Branded 28% 27%

Both generics/branded

16% 19%

Did not buy medicine 17% 10%

A Season of Milestones: A Season of Milestones: F1 Key AccomplishmentsF1 Key Accomplishments

And still more strides to improve health…

* TB control effective and sustained * Benguet, Masbate & Cavite were declared Malaria-Free * Emerging diseases kept at bay : HIV/AIDS, Bird Flu * Massive assault vs vaccine preventable diseases (VPD) - EPI coverage raised to 84% - RP is 13 out of 55 countries with high FIC rate - Hepa B vaccine now part of national immunization * RP Breastfeeding campaign won us local and global partners to safeguard maternal and child health

* DOH responded quickly to 21 major disasters/events out of 381 health emergencies monitored in 2006

A Season of Milestones: A Season of Milestones: F1 Key AccomplishmentsF1 Key Accomplishments

F1 has ushered in increased transparency and accountability of DOH, curbed graft and corruption and boosted public confidence in the health sector

- DOH is least corrupt line agency of government (PAGC, SWS 2005-2006)

- DOH is #1 government agency in terms of overall performance (Pulse Asia, 3rd Quarter 2006)

PAGC : DOH is #1 Government PAGC : DOH is #1 Government agency agency in fighting corruption in fighting corruption

COMPARATIVE PERFORMANCE RATINGS OF SELECTED GOVERNMENT AGENCIES Pulse Asia (July 2005-July 2006)

Selected Gov’t Agencies

Net Approval Rating Undecided

Supreme CourtSenateHouse of Rep

Jul 05

+6+4+5

Oct 05

+8+10

Mar 06

+160

+3

Jul 06

+1200

Jul 05

282828

Oct 05

273030

Mar 06

253231

Jul 06

242928

DOHDSWDDepEdDOTDept. of Land ReformDOE

+40+46+30+9___-9

+50+53+42+22___-13

+48+57+48+22___

+13

+49+49+45+22+15+10

15111925__36

12111721__39

15121523__32

121013182222

CHEDPNPAFPMMDABIRNapocorComelecPCGG

__+6

+12+13+9-20______

__+10+19+17__

-19______

__+19+19+13__-1______

+32+17+20+14-6+8-5+3

__2926243743____

__302521__42____

__252525__34____

1524212127253423

The Challenge AheadThe Challenge AheadWhy we must be better leaders for healthWhy we must be better leaders for health

Good governance in health matters.

And we need to exert even more…

to turn evidence into action to make right policy decisions to implement health reforms to get to our targets to win greater political support to influence other health players to unify health and non-health initiatives from other sectors to turn promises into better health for all

..……………. More Races More Races to Winto Win

F1 TARGETS F1 TARGETS 2007-20102007-2010

Target 1Target 1Mothers, babies and children at the center of reformsMothers, babies and children at the center of reforms

Time to make the case… for improved maternal, newborn and child health

• RP is on-track to meet MDG-4 but way off-target to achieve MDG-5 (lower MMR)

• Get on with what works!- Continuum of MCH services important but…

- Focus on intrapartum care w/c will lower MMR by 74% (skilled attendant at birth, facility-based delivery)

- FP services for unplanned pregnancies will prevent 25-40% of maternal deaths

- 16 known low-cost essential interventions will cut IMR by 72% - Lancet Series 2005

• Re-think & re-launch Safe Motherhood (20th year)

• Facility / human resource mapping and needs assessment for CEmOC/ BEmOC facilities

• Link accreditation of birthing clinics to Philhealth

• Enhance referral networks for complicated pregnancies

• Improve maternal behavior to avail complete MCH services

More of the same is not enough.More of the same is not enough. Let’s think out of the boxLet’s think out of the box … …and do our business right!and do our business right!

The Diagonal Approach for M^CH : Full package of proven high-impact maternal, newborn and child health

services that will bridge clinics, hospitals and homes

Strong maternal and child health services will transform the entire health system!

NAmuasi, J. , from the essay Moving from Combating Disease to Winning Against Disease

Target 2Target 2Universal Social Health Insurance CoverageUniversal Social Health Insurance Coverage

• Social health insurance still the driver of reforms in HCF

• Improved collection efficiency

• Wider reach toward the poor and informal sectors

• More interventions, more conditions covered with excellent quality and enhanced benefits based on changing needs --- e.g. catastrophic cases, NCDs

Target 3Target 3Medicines for the MassesMedicines for the Masses

1) Hype promotion of Generics

2) Unify DOH-PITC efforts to set up more BnB outlets nationwide (1 BnB : 2 Barangays)

5) Fast track processing of essential, low cost, high quality essential drugs (BFAD)

6) New National Pharmaceutical Policy Service to lead in initiatives to lower drug prices in the country

4) Develop drug benefits/reimbursementschemes w/ PHIC for commonly usedgenerics

3) Make the National Drug Formulary responsive to prevailing needs of local communities

Target 4Target 4Safe and Well HospitalsSafe and Well Hospitals

• Patient-centered care & patient safety must become a national priority and a core agenda to improve quality of care in all hospitals.

• System-wide reforms to protect both patients and doctors from faulty systems that promote preventable medical errors

- Strengthen hospital Ethics, Grievance & Infection Control Committees - Patient safety programs must be part of requirement for hospital licensing - Sharpen regulatory oversight to enhance compliance to safety/quality standards - Create a nationwide reporting system for alleged medical mishaps and an independent Nat’l Grievance Committee to study merit of malpractice reports - Open Policy: Disclosure of preventable medical errors to families and compensate patients when necessary - Reward/publish high-performing & safe hospitals and/or give sanctions to erring ones

Target 5Target 5Empowered Local Health SystemsEmpowered Local Health Systems

• Revive / strengthen ILHZ in non-F1 sites

• CHDs to develop local health systems plan with LCEs

• Implement the Hospital Development Program for selected LGU hospitals nationwide

• Ensure smooth integration of reform pillars in F1 Convergence sites

• Yearly benchmark reports (LGU scorecard) using coverage of essential services as gauge for performance and basis for incentives

Target 6Target 6Evidence-based Health ReformsEvidence-based Health Reforms

“Evidence is good for your health system.” --- Mexican Health Reform Series, Lancet 2006

New Health Information Center (former BFAD building) shall be the nerve center of DOH and the information hub of the entire health sector

Leadership can bridge the gulf between knowledge and action.

• Create a culture of evidence in DOH (KM culture)

• Use available global knowledge goods to advance local health

• Generate local research/knowledge for health system transformation

• Strengthen DOH capacity for health research, information management and then translation of research into action through PNHRS

• PHIN / NEC to harmonize fragmented sources of health data (i.e. LGUs, private sector) and promote health information sharing

• Document F1 experience as a source of local & global lessons on health reforms

Perspective of the DOH Health Info Center (former BFAD)

Target 7Target 7Communicate Health EffectivelyCommunicate Health Effectively

• Creation of a Speakers’ Bureau

• Step up Health Promotion and advocacy campaign for key programs of DOH

Year-round campaigns for the followingprograms:- Dengue - Generics- Healthy Lifestyle - Breastfeeding- Anti-tobacco campaign - MCH programs

• Development of Health Promotion Foundation

The goal of effective communication should be for listeners to say, "Me, too!" versus "So what?” -- Jim Rohn

44thth NSM’S Programme NSM’S ProgrammeF1 National

Investment PlanPIPH Implementation& Roll Out

SDAH

Re-tooling/Re-training Plan

F1 M & E + Score CardAccountability &

Integrity Development

Philippine Health Information System

Financial Asset Mgt./Internal Audit Reforms

Procurement Reforms

Logistics Management Reforms

GOOD GOVERNANCE

Thank you!… and participate actively

in the discussions!