Investing in Health v5

8/8/2019 Investing in Health v5

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Investing in Health:

Building Partnerships for HealthClark Special Economic Zone

August 2010

the Role of LGU Officials in

Health Sector Development


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HealthGov August 2010 2

Outline

Health in the context of overall localdevelopment Role of government in the health sector

Health sector goals

Means of achieving health sector goals Strengthening local governance in health

Health sector reform (FOURmula ONE)

Province-wide investment planning

Finding the Money to Finance Health Programs

USAID technical assistance

Key ideas for local policy action

thank you


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Health and LocalDevelopment


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Two ways of looking at health

Health as a component of development

that is valued in its own right.

Health as an asset that generates wealth.


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Health as a component

of development

Development is the sustained capacity toachieve a better life.

Better life includes the length of life and thequality of life that people succeed in living

Quality involves capabilities to do and to be To be free from premature death

To be free from preventable illness

To be free from avoidable disability

To be free to achieve ones fertility goals (desiredfamily size number and spacing)

Hence development is also about expandingfreedom and the range of choices.

Adapted from Amartya Sen (1988)


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Development is freedom from premature death

Male Female

Singapore 77 81

South Korea 74 81Malaysia 72 76

Thailand 68 75

Vietnam 69 73

Philippines 66 71

Indonesia 66 70

Source: Estimates from UN ESCAP (2006)

Life expectancy at birth is lower thanneighboring countries

Life expectancy at birth is the average number of years that a person

can expect to live from birth given the mortality conditions of the time.


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Maternal mortality has

declined in the past 20

years

Maternal mortality ratio (MMR)estimated for Philippines

NDHS (1987-1993): 209

NDHS (1991-1997): 172

FPS (1999-2006): 162

MMR = maternal deaths per100,000 births

Sources: 1993 and 1998 NDHS;

and 2006 FPS

Estimates for other countries in2006:

South Korea: 20 Malaysia: 41

China: 56

Thailand: 24

Vietnam:130

Indonesia: 230

Source: UN ESCAP 2006


But it still remains high

compared to other

countries

Status


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Infant and child mortality rates are still highcompared to other countries in 2006


Infant Child

Singapore 3 4

South Korea 4 5

Malaysia 9 12

Thailand 17 21

Vietnam 18 24

Philippines 25 29

Indonesia 36 45

Source: Estimates from UN ESCAP (2006)

Infant mortality is the number of infant deaths per 1,000 births.

Child mortality is the number of deaths of children under five years per 1,000 children under five

years.


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Indicator

Wealth status

TotalLow Second Middle Fourth High

Total fertility rate 5.9 4.6 3.5 2.8 2.0 3.5

Desired fertility rate 3.8 3.1 2.6 2.2 1.7 2.5

Difference (total less

desired) 2.1 1.5 0.9 0.6 0.3 1.0

Development is freedom to achieve ones fertility goals

(The poor are less able to achieve their

fertility goals than the rich)

Source: NSO and ORC Macro, 2003 NDHS, 2003

Total fertility and desired fertility rate by wealth status, 2003


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Economic

resources

Health sector

Non-health

sectors:

Education,agriculture,

environment,

infrastructure, etc.

Health outcomes

Non-health sector

outcomes

Health as an asset:

its role in local development

Key idea 2:

Better health increases theproductivity of investments in

non-health sectors, e.g.,

education, agriculture and

industry contributing to better

non-health outcomes.

Key idea 1: Better non-health sectoroutcomes, e.g., higher

education, higher incomes,

better infrastructure, facilitate

healthy behavior and access

of health care services,

contributing to better health

outcomes.


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Health as an asset:

recent scientific findings

High economic cost of TB: productivity losses inthe Philippines due to premature deaths from TBestimated at PhP 26B yearly (Peabody, 2003, cited

inNOH

2005) Nutrition and health in early childhood affect

future success of children in education,employment and productivity, and health in laterlife (Studies in Bukidnon and Cebu)

Unforeseen large spending for health carereduces consumption of other goods andservices that promote well-being.


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The Health Sector and theRole of Government


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Local Health SectorWhat is the role of government?

PhilHealth,

other financing

agents

Consumers/

households:

economic &social groups

Local and

national

government

Providers/

dispensers:

Public andprivateuser charges

subsidy

premium

premium

reimbursements;

capitation funds

services

taxes

Imperfect

information

Public goods,e.g., disease

surveillance;sanitary

regulationsServices with large

externalities, e.g., childimmunization; treatment of

infectious disease

Insurance

market

failure

Unequal

distribution

of income


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Role of government in health care

markets: efficiency and equity

To correct formarket failure arising from (and

the nature of possible response):

Imperfect information (public information)

Public goods (public financing and/or production)

Externalities (public subsidies or regulation)

Insurance market failure (development of social

health insurance)

Improve equity - provision of cost-effective

services to the poor as an effective and socially

acceptable approach to poverty alleviation


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Local Health Sector

PhilHealth;

other financing

agents

Consumers/

households:

economic &

social groups

Local and

national

government

Providers/

dispensers:

Public and

privateuser charges

subsidy

premium

premium

reimbursements;

capitation funds

services

taxes

Outline


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Part II

Health Sector Developmentand the Role of Local

Governance


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Local Health Sector

PhilHealth;

other financing

agents

Consumers/

households:

economic &social groups

Local and

national

government

Providers/

dispensers:

Public andprivateuser charges

subsidy

premium

premium

reimbursements;

capitation funds

services

taxes

Strengthen

local

governance

for health

Implementhealth sector

reform

Adoptprovince-wide

investment

planning for

health

How do we achieve our goals?

Outline


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Local officials as the stewards

of the health sector

Stewardship = the careful and

responsible management of

something entrusted to ones care


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PIPH

MIPH ILHZ

CSRplan

Nutrition plan

HIV/AIDSplan

PHIC plan

Facility

rationalization

plan

Systems

(logistics,

procurement,

financing, qualityimprovements,

etc.)

Policies

Budgets

Systems

Services

Health

sector

performance

and

outcomes

Management

information system(field services,

hospital, income &

expenditures, local

surveys, program

reviews, M&E)

LGU decision

making:

(LHB, LCE,

Sanggunian)

Stakeholder

participation LGUofficials Public/private

providers

NGOs/CSOs

Strengthening Local Governance for Healththrough evidence-based participatory local decision making process


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PIPH

MIPH ILHZ

CSRplan

Nutrition plan

HIV/AIDSplan

PHIC plan Facility

rationalization

plan

Systems

(logistics,

procurement,

financing,

qualityimprovements,

etc.)

PoliciesBudgets

Systems

Services

Health

sectorperformance

and

outcomes

Management

information system(field services,

hospital, income &

expenditures, local

surveys, program

reviews, M&E)

LGU decisionmaking:

(LHB, LCE,

Sanggunian)

Stakeholder

participation LGUofficials Public/private

providers

NGOs/CSOs

Strengthening Local Governance for Healththrough evidence-based participatory local decision making process

LGU

officials

DOH,CHD,

PHIC,

partners

Achieving ..


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Health SectorReform

An implementation framework that

consists of strategies, organizational and

policy changes, and public investments

needed to improve the way health care is

delivered, regulated, and financed

It has four instruments: financing,

regulation, service delivery, andgovernance


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Health SectorReform

Goals:

Better health

outcomes Equitable health care

financing

More responsive

health system

Reform instruments:

1. Financing (more, better and

sustained financing for

health)2. Regulation (assured quality

and affordability of health

goods/services)

3. Service delivery (ensured

access and availability of

essential basic healthpackages)

4. Governance (improved health

system performance)

Achieving


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Investment Plan for Health

(PIPH/MIPH/CIPH) The IPH provides the framework for the development of

public investment plans in health covering utilization,mobilization and rationalization of the LGUs resources,capabilities, and stronger institutions to attain health

system goals. A plan prepared and adopted by LGUs within a province

and agreed to be supported by DOH and itsdevelopment partners in health, that defines local healthsystems improvements to be attained in the province

through the proposed application of public investmentsjointly funded by LGUs, DOH and development partners.


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PIPH: Key Features and Steps


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Key features of Province-Wide

Investment Plan for Health (PIPH)

Health sector perspective

Planning using a health sector/F1 frame

Province-wide* with component LGUs and ILHZ

Medium-term strategic time frame

Well-defined critical interventions and targets

Sound financial plan

Implementation through performance-drivenagreements

Source: DOH Guidelines in PIPH Development, 2007

*Region-wide in the case of ARMM Achieving ..


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Where are you now?

Provinces have completed their PIPH

Municipalities/Cities have their MIPH

Preparation of the Annual InvestmentPlans for Health (AOP) for 2011

Completion of the Health FacilityRationalization Plans as a subplan of the

PIPH Utilization of the MNCHN grants (2008,

2009, 2010)


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Finding the Money to Finance

Health Programs


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Local Budget

PIPH BudgetRegular

Health

Budget

1. PIPH/MIPH

increase health

budget

2. IRA will be too

crowded

3. MHOs/PHO willneed assistance

4. Lots of advocacies

will be required

5. The LGC provides

opportunities to

generatesustainable

resources

6. Hard decisions

have to be made

by the LGU

Reality Check at the LGU Level


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Health StakeholdersOffice Role

LGU Health Office Proponent and Main Driver

Governor / Mayor Issuance of Mandate and Authority

to Implement

Sangguniang Provision of Supportive Ordinances

Planning and Development Office Integration to the Plan and Overall

Development Strategy

Treasury Raising of Revenues/Cashiering

Budget Office Preparation of Funding Allocation

Accountants Office Identify fund support/ Rendering of

Financial Reports

General Service Office Administration of Procurement and

Distribution Systems


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Approaches to Sustainable

Financing

Track 1-- Develop financing sources for

Health

Improve the collection of local taxes, fees and

charges

Create new sources for health

Access grants and other forms of assistance

Develop facilities into an economic enterprise

Take advantage of private sector support


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Sustainable Local Funds

Central Transfers Internal Revenue Allotment

Others (share from wealth, etc)

Internally Sourced Revenues Local Taxes

Regulatory and Fees

Charges

Economic Enterprise

Other Taxes, Fees and Charges (sec 186) Philhealth Capitation & Reimbursements


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INTERNAL REVENUE ALLOTMENTINTERNAL REVENUE ALLOTMENT

1994 & succeeding

years = 40%

1993 = 35%

Gross Internal Revenue Collections based

on third preceding Calendar Year

Provinces

23%

Cities

23%

Municipalities

34%

Barangays

20%

50% Population (NSO)

25% Land Area (LMB)

25% Equal Sharing

(1) Total BRGY.SHARE BRGYs. with 100inhabitants = NET Brgy.Share

(2) Net Brgy.Share

1992 1993 1994 forward

40% Pop. 50% Pop. 60% Pop.

60% E.S. 50% E.S 40% E.S.

A. Base

B. Level

C. LGU Allocation

D. Intra LGU Allocation

1992 = 30%


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Local Taxes

ProvincesReal Property Amusement Places Transfer of Real Property

Professionals Sand, Gravel & Quarry Delivery Vans & Trucks

Franchise Printing & Publication Idle Lands

Municipalities

Business Taxes Community Tax

Cities

All taxes which can be imposed by the Provinces and Municipalitiescombined and the rates can be 50% higher

Note: 1) Tax Rates can be increased once every five (5) years at the rates not exceeding 10%.2) Section 186 of the LGU allow LGUs to impose other taxes, fees and charges under certain

limitations


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Fees and ChargesBuilding Permit Agricultural

Machinery

Mayors Permit Burial Permit Fishing Permit Market

Electrical permit Other Heavy

Equipment

Mining Claims Reg. of Large

Cattle

Hawkers Hospital fees

Mechanical

Permit

Carts and

Sledge

Parades Parking Mineral Lands Health

Services

Plumbing

Permit

Cockpits Pedicab

Operations

Tax Clearance Video Tape

Rental

Terminal Fees

Demolition

Permit

Special

Cockfighting

Tricycle

Franchising

Civil Registry

Fees

Secretarys

Certification

Traffic

Violations

Sanitary

Permit

Gaffers and

Cockpit Pers.

Weights and

Measures

Exhumation of

Cadaver

Tuition Fees for

LGU Colleges

Towing

Charges

Fire Certification Filmmaking Court Fees Firearms

Permit

Garbage Fees Water and

Power

Annual

Inspection

Bicycle Permit Sheriffs Fees Police

Clearance

Overnight P.

Fees

Slaughterhouse

& CorralsCaretela and

Calesa

Boats Permit Fiscals

Clearance

Holding of

Benefits

Toll Fees &

Charges

Bus Terminals

Storage of

Flammable

Materials

Marriage

Permit &

Solemnization

Impounding of

Stray Animals

Fee on

Occupation or

Calling

Physical Exam

&Medical

Certification

Rental of

Facilities


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Revenue Reforms

Coverage

Assessment

Collection


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Expanding Coverage

Updating Local Revenue Codes

General Revision of Real Property Assmt

Explore Section 186 Revalidate Exemptions

Investment Incentives Code

Fiscal Cadastre/GIS Mapping Special Levies and Variants


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Improving Assessment Methods

Examination of Books of Accounts

Technical Trainings

Use Presumptive Income Levels Market Based Valuation in RPT


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Improving Collection

Tax Information

Issuance of Demand Letters

Field Collections Enforcement of Civil & Adm. Remedies

One Stop Shops

Billing Through Barangays Computerization


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Support of MHO/PHO to Revenue

Collections

MHO/PHO can be actively involved in

supporting revenue collections.

User fees for cost recovery Strict enforcement of health fees

Requiring CTC to those seeking health

care in RHUs, Public Hospitals


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Earmarking Funds for Health

Budgetary Share from Proceeds of Collection of

Taxes and Fee

Retention of Income (user fees) fromOperations of Health Facilities

Convert Health Facilities to EconomicEnterprises

Note: LGUs may need to pass a specific ordinance allocating share of theproceeds to health and putting the proceeds to a special accountunder the general fund


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External Support

Grants

NGAs

DonorsOther Sources

Borrowings

Internal (GFIs, PFIs, MDFO, Bond Float)External

Public-Private Partnership


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Grant Assistance (NG) DOH (wide range of health support in cash and kind

through CHDs) Regular assistance (vaccines, drugs, medicines and medical

supplies etc)

MNCHN, FP and other forms

Technical Assistance

Philhealth

Capitation fund for enrolment of indigents in the sponsored

programs

Reimbursements of health facilities for the conduct of benefit

packages


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Grant Assistance (Donors)

Foreign (USAID, EU, AusAID) Technical assistance (e.g. CSR; advocacy andpromotion; capability building of providers;identification of the poor; health systems development; public finance management; monitoring and

evaluation; etc) Commodity support

Charitable Institutions (PCSO)

Congressional Funds

Premium payment of families to Philhealth sponsoredprograms

Other grant support

Corporations, NGOs and Private Individuals


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Critical Steps for External Support

Knowledge on the coverage and rules ofassistance

Proposal/applications

Approval

Written instrument

Delivery report/Impact assessment

Liquidation of Funds


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Borrowings

LGUs can borrow funds from any of thefollowing sources:

Government Financial Institutions(GFIs)

Private Financial Institutions (PFIs) Municipal Development Fund Office (MDFO)

Other LGUs

Maximum debt service shall not exceed20% of annual regular income


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Windows Eligible LGUs Focus Terms Repayment

HSRA Provinces Health 11% With grant

depending on

income class

PROLEND Provinces Policy

Development,

Infrastructure

Fixed interest

based on 10 year

T-bond

Max of P200M

MDGF Prov, Cities,

Municipalities

Support to MDG

Goals

7.5%-8.0% fixed

interest

Max of 10years

MDFP Prov, Cities,Municipalities

Urban Infra 9% fixed 15 years with 3 yrsgrace period on

the principal

MBUSSP Prov, Cities,

Municipalities

Urban Services 9% fixed 15 years with

grace period of

principal

DMAF Prov, Cities,

Municipalities

Climate Change

Adaptation

0%-5% 3 yrs for category

1; Other max 15

years with grace

period

PWRF Prov, Cities,

Municipalities

Water Supply,

Sanitation

Variable rate Max of 20 years

PTACF Prov, Cities,

Municipalities

Project

Preparation and

Contingency

0%-1.5% Full payment

during the term of

LCE

OtherWindows Prov, Cities,

Municipalities

To be prepared

MDFO-Facilities


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Public-Private Partnership

Arrangements

BOT and its Variations

Joint Venture

Service Contract

Management Contracts

Lease or Affermage

Concession Arrangements

Combinations


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Approaches to Sustainable

Financing

Track 2 Lessen expenses and optimize

effectiveness of the health budget

Focused Service Targets

Enhance Efficiency of Operations

Additional Support from lumps sums and

other departments budgets

Results oriented allocation


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Location of the LGU Funds

Internal (Province and Component LGUs)

Regular Budget

Lump Sum Appropriations

Supplemental

External (Assistance passing the LGU)

DOH/NGAs Support

Projects

Direct Assistance (e.g.PDAF, private sector)


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Focused Costing

Service Targetting (e.g. population vspoor only; clear indicators of indigents)

Policy Initiatives (e.g. requiring tricycle

drivers to enroll to philhealth as a requisitefor renewal of franchise)

Cost Efficiency in Operations (e.g. Tie-up

instead of outright purchases to supportaccreditation of facilities; time sharing orjob orders instead of plantilla positions)


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Lump Sums and Parallel

Appropriations

20% Development Fund

5% Gender and Development Fund

5% Calamity Fund

10% Sangguniang Kabataan

RPT Special Education Fund

2% RPT Discretionary Fund

Funds for the Elderly

Others


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Justifying for Lump Sum

While the slant is health, charging from the lump sums willbe possible if the focus for its creation can be retainedsuch as the following:

GAD purchase of FP commodities; FP Promotion

gender sensitive activities SK Adolescent and Youth Health Programs on FP; Vit

A; feeding program

SEF School Based IEC activities

However, charging from lump sums will always requirenegotiations


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Support from other Departments

The other departments may have health

oriented programs which the MHO/PHO

can support:

Traffic enforcement and engineering

Potable water supply

Sanitation and cleanliness drives

Support to healthy lifestyle

Outline


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Conclusion


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1. Health as a component of well-being is valued

in its own right. (People have basic right to

health and government has the responsibility

to make essential health services available.)2. Health as an asset generates wealth. Ill health

contributes to income poverty. (Additional

rationale for policy to invest in health.)

3. The poor are more handicapped by poor

health. (Policies to better target government

subsidies towards the poor.)


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4. Large unforeseen household out-of-pocket paymentsfor health care reduces consumption of other goodsand services that promote well-being. (Policies to

provide financial protection to the poor.)

5. Individual interventions implemented in isolation will notwork, it might even do more harm. (Implement anintegrated package of mutually supporting interventions

health sector reform.)

6. Health sector reform is a complex undertaking; it

requires participatory decision-making for it to succeed.(Strengthen stakeholder participation in local decisionmaking.)

Outline


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Health is not valued until sickness

comes Dr. Thomas Fuller

He who has health, has hope.

And he who has hope, has

everything - Arabian Proverb


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Thank Youand

Mabuhay

Documents

Investing in Health v5