DOH Initiatives on

Kalusugan Pangkalahatan

FOR THE APPROVAL OF THE NEDA BOARD

May 28, 2012

slide 1 of 27

Kalusugan Pangkalahatan

The Aquino Health Agenda

to achieve universal health care by:

• Providing adequate financial risk protection,

especially for the poor*

• Ensuring sustainable access

to quality health care facilities and services

• Attaining Millennium Development Goals

(MDG) for health through focused public health

efforts

*refers to poor households listed in the NHTS-PR

slide 2 of 27

Financial

Risk

Protection

Access to

Quality

Health

Facilities

Attainment

of MDGs for

Health

Modernization

of the

Philippine

Orthopedic

Center

Vaccine

Self-

Sufficiency

Development

Objective

Agreement

between PHL

& USA on

Improved

Family Health

THE AQUINO

HEALTH AGENDA

slide 3 of 27

Financial Risk Protection

Access to Quality Health

Facilities

Attainment

of MDGs for

Health

Modernization of the

Philippine Orthopedic

Center

Vaccine Self-Sufficiency

Development

Objective

Agreement

between PHL

& USA on

Improved

Family Health

THE AQUINO

HEALTH AGENDA

slide 4 of 27

US-PHL Development

Objective Agreement

• Development agreement will help:

– Fulfill social contract with

the Filipino people

– Attain the MDGs on health

– Reduce inequities in health status

with a special focus on ARMM and CCT recipients

slide 5 of 27

US-PHL Development

Objective Agreement

• MOI signed by Sec. Ona and DA

Steinberg last May 5, 2012

• Agreement can be signed or

announced in Washington on

June 7, 2012

• Total project cost: US$ 197.25 M

(PhP 8.1 B)

• US $157.8 M (PhP 6.5B) of USG

grant via USAID (2012-2017)

• US $39.5 M (PhP 1.6B)

counterpart by PHL from DOH regular budget

slide 6 of 27

INDICATORBASELINE

2008 NDHS (%)DOH 2016

TARGET (%)

USAID 2017 TARGET (%)

USG Assisted-Areas

Component 1: Family Planning (FP) and Maternal and Child Health (MCH)

Contraceptive prevalence rate of modern methods

34 67 43

Unmet need for FP 20 10 14

Deliveries with skilled birth attendants 62 90 78

Facility-based deliveries 44 90 64

Pregnant women with at least 4 ANC 74 95 90

Infants exclusively breastfed (0-6 months) 34 70 63

Under 5-children with diarrheatreated with ORT

59 100 70

Fully immunized children 80 95 90

Vitamin A supplementation 76 90 90

Component 2: Tuberculosis (TB)

Case detection rate 73 (2011) 85 85

Cure rate 82 (2011) 85 90

slide 7 of 27

N

Priority Areas

• FP/MCH*

– 40 provinces/cities

including 25 current sites with high

unmet need for FP/MCH

• TB*

– 26 provinces & 10 NCR cities

with low case detection and cure

rates

* Including all ARMM provinces

slide 8 of 27

Financial Risk Protection

Access to Quality Health

Facilities

Attainment

of MDGs for

Health

Modernization of the

Philippine Orthopedic

Center

Vaccine

Self-

Sufficiency

Project II

Development Objective

Agreement between PHL &

USA on Improved

Family Health

THE AQUINO

HEALTH AGENDA

slide 9 of 27

Vaccine Self Sufficiency

Project II

• Construction of a current good

manufacturing practices (cGMP) vaccine

facility in the Research Institute for Tropical

Medicine through PPP (Build-operate-

transfer) for the production of combined

DPT, Hepatitis B and HIB vaccines;

Hepatitis B (single vaccine) and Tetanus

Toxoid

• DOH to procure from private partner for

Expanded Program for Immunization

vaccine requirements at 20% discount

slide 10 of 27

Objectives of VSSP II

Contribute to the reduction of under-5 mortality rate by:

• Ensuring adequate supply of the vaccines

• Reducing the cost of combined DPT, Hepatitis B and HIB vaccines;

Hepatitis B (single vaccine) and Tetanus Toxoid

• Ensuring acquisition of technologies in pooling and filling

of vaccines, establishment of facilities for filling, labeling and

packaging of vaccines as well as analytical laboratories

slide 11 of 27

Implementation Schedule

slide 12 of 27

Activity 2012 2013 2014 2015 2016-21

Tender Activities

Site Development / Permits

Engineering and Project Management

Production Building with Process Installation

Import (and Supply) of Naked Vials

Local Installation and Start-Up

GMP Certification and Validation

Start of Production

Cost and Financing

slide 13 of 27

ComponentForeign Component Local

Component (PhP)

Total (PhP)USD PhP

1. Basic Design Modules and Process 225,000 9,900,000 0 9,900,0002. Manufacturing Building, GMP 6,364,555 280,040,420 112,016,168 392,056,588a. Process Building, Installation & Transportation 2,205,555 97,044,420 38,817,760 135,862,188

b. Process Equipment & Piping (incl Installation) 4,064,000 178,816,000 71,526,400 250,342,400

c. Standby Power Supply 95,000 4,180,000 1,672,000 5,852,000

3. Engineering Manufacturing Bldg. & Process

800,000 35,200,000 0 35,200,000

a. Proj. Mgt., Design Mgt. & Engineering 800,000 35,200,000 35,200,000

4. Commissioning and Qualification - Bldg. & Process

130,000 5,720,000 0 5,720,000

5. Commissioning and Qualification Manufacturing Bldg. & Process VSSPI

100,000 4,400,000 0 4,400,000

6. Govt. Right-of-Way 16,500,000 16,500,0007. Site Preparation 3,000,000 3,000,0008. FS & Environmental Study 7,500,000 7,500,000Total Cost Estimate 7,619,555 335,260,420 139,016,168 474,276,588

(Exchange Rate: USD 1 = PhP 44)

Financial Viability &

Government Savings

Net present value PhP 1.08 B

Internal rate of return 24.56%

Total savings (2013-2021) PhP 6.06B

slide 14 of 27

Financial Risk Protection

Access to

Quality

Health

Facilities

Attainment of MDGs for

Health

Modernization

of the

Philippine

Orthopedic

Center

Vaccine Self-Sufficiency

Development Objective

Agreement between PHL &

USA on Improved

Family Health

THE AQUINO

HEALTH AGENDA

slide 15 of 27

Philippine

Orthopedic Center

• The proposed modernization of the Philippine Orthopedic

Center (POC) envisages its transfer into a new 700-bed

capacity facility to be located at East Avenue, Quezon City, to

be developed and operated by the private proponent along with

all required infrastructure.

• This will transform POC into the country’s leading

musculoskeletal & neurological medical services provider

comparable with global standards

slide 16 of 27

Implementation Arrangement

• Build-Operate-Transfer

• Concessionaire to design, construct, finance,equip, operate, maintain and transfer theHospital; responsible for all costs arising as aresult of its rights and obligations under theConcession Agreement

• DOH to bear the cost of site and half the annualcost of the Independent Consultant (IC)

• Voluntary transition of medical personnel to newPOC

slide 17 of 27

Site Location

slide 18 of 27

Need Gap Analysis for POCInfrastructure Constraints Solutions facilitated by Modernized POC

534 beds utilized out of 700 sanctioned beds, sub capacity operation at 70%-75% levels

Private sector efficiency in operations ensures capacity utilization at 90-95% levels

Staff to bed ratio presently at levels lower than ideal ratio

Staffing mix at New POC facility to ensure the ideal staff to bed ratio of 2.25 persons/bed

Only primary and secondary medical services being provided at present

Super specialty tertiary care with modern equipment and select medical staff

Lower than average period of discharge for admitted patients

Private sector efficiency enables reduction in discharge period from present 22 days to 6 days

Limitations in catering to non-citizen patients or medical travelers

Medical tourism patients identified as part of overall patient mix served at new facility

Present Status of POC slide 19 of 27

Plan for Modernized POC

Infrastructure Profile of New POC:

• Over 51,000 sq. mtrs const. area

• 2 blocks of 13 plus floors

• Interconnected at all floors

• 700 plus beds facility

• In house diagnostic facility

• Distinct functional services:

segregated areas for general &

specialized wards, (ICU, SICU, PICU,

etc.)

“SPECIALIZED NATIONAL ORTHEOPEDIC HEALTH CARE CENTRE”

Patient Profile:

• 70% of patients serviced comprise of Sponsored Category*

• Remaining 30% comprised of Pay patients, Medical travelers also targeted

Subsidy benefit utilized for servicing ‘needy’ sponsored category patients, in line with Universal Health Care agenda

*Sponsored Category Patients include Phil Health Service Patients & Pure Service Patientsslide 20 of 30

Total project cost: P 5,691.50 million

Government Sector counterpart: 257.70 million

Private Sector counterpart: 5,433.80 million

Total Project Cost Breakdown

Project Cost Breakdown per Component

slide 21 of 27

Key Project Costs

Estimated Patients Benefitted

Projected Cases 2013-15 2016 Operations Period 2038

In Patient Construction Period

33,000 34,750 36,500 38,250 40,000 40,500 40,500

204,500 211,750 217,000 222,000 225,500 226,750 227,500 Out Patient

Total Patients Served 237,500 246,750 253,500 260,250 265,500 267,000 268,000

Start of Operations End of

Contract

• More than 237,000 patients served each year by the

modernized POC facility in IPD & OPD

• Nearly 268,000 patients projected to be benefitted annually by

the end of the BOT contract

slide 22 of 27

Benefits for Patients Served

• Positive perception for

Government Health care - use of

latest technology & proficient staff

• Reduced duration of patient

hospitalization & quicker discharge

- operational efficiency

• Personalized care & improved

patient satisfaction – better staff to

bed ratio

Direct patient benefits

• Reduction in morbidity cases

• Reduction in mortality cases

• Improvements in work force

participation rate

• Enhanced disability adjusted life

years**

Macro level benefits

**Disability Adjusted Life Years (DALY) – Estimated life years after factoring reduction in life on account of disability. One DALY can be thought of as one lost year of "healthy" life

slide 23 of 27

Economic Benefit Head PhP Mn

Patient Satisfaction 25,536

Morbidity Related Health

Savings7,174

Mortality Related Health

Savings3,261

Medical Savings 22,943

Residual Value 2,224

Total Economic Benefit 61,138

Economic Viability Indicators

Economic Cost Head PhP Mn

Project Economic Cost 5,315

Economic O&M Costs 20,801

Equipment Renewal Eco.

Cost5,191

Total Economic Cost 31,307

Return Parameter Indicator*

Economic IRR 39.01%

NPV of Economic benefits PhP 6,740 Mn

Based on Economic Cost Benefit Analysis slide 24 of 27

O&M Period

Hospital Operator/

Project Proponent

Project Management

& Monitoring Team

• undertakes O&M in

accordance with

MPSS and O&M

Manual

• DOH representatives: POC &

NCHFD

• monitors compliance with MPSS

and O&M Manual

Private

Proponent/SPCDOH

• provides policy directions

• resolve disputes

Hospital Steering

Committee

Independent

Consultant

• Continues

providing

independent

third party

monitoring on

all operational

aspects

• Collectively constituted

with representation from

Pvt. & Govt.

slide 25 of 27

Summary

1. NEDA Board approval to sign the Development Objective

Agreement for Improved Family Health between PHL-USA

2. NEDA Board approval to enter into PPP agreement for VSSP II

3. NEDA Board approval to enter into PPP agreement for the

POC Modernization

slide 26 of 27

Maraming salamat po.

slide 27 of 27