FOURMULA ONE FOR HEALTH: Implementation Framework for Health Sector Reform FOURMULA ONE FOR HEALTH as Overall

Frame
Goals Better health outcomes More responsive health system Equitable health care financing Four Thrusts Financing (increased, better and sustained) Regulation (assured quality and affordability) Service Delivery (ensured access and availability) Governance (improved performance) Strategic Guideposts Building upon gains and lessons from major reform initiatives Focus on critical interventions to be implemented as a single package Sector wide management of FOURMULA ONE implementation NHIP as the primary instrument

Triggers a chain reaction to spur other FOURmula ONE interventions Produces tangible results Generates public support

FINANCING
Rationalization of Sources of Health Financing Out-of-Pocket Shift of OOP to outpatient care (e.g check-up, consultation, etc) Local Government Focus subsidy on preventive and promotive health services National Government Shift resources on regulation, governance and to teaching/training tertiary hospitals Social Health Insurance Focus on in-patient care

Local Health Financing Reforms

Earmarking funds and prioritizing health services Social marketing/advocacy to LGUs, NGOs & private sector to earmark funds for priority health programs Identify tools for prioritizing health services (eg. segmentation and targeting the poor) Rationalize pricing/costing policies for priority programs Management/coordination of LGU health fund Integrate national and local investment plan Cost-sharing arrangements among LGUs National and local coordination of funds (eg. counter parting arrangements) Rapid estimation of local health accounts

Constraints and Opportunities (1)

Restricted government health budgets: Inflexible allocation across categories Allocation among programs not linked to performance Difficulty in managing a highly decentralized system: steering various stakeholders (i.e local systems, private markets) Managing health finances from multiple sources Deeper understanding of and increasing leverage of the NHIP over health system performance Inroads in health reforms in at least 30 provinces resulting in improvements in health outcomes and providing invaluable lessons Growing support for health sector reform implementation from partners government agencies, external Deeper understanding of reform implementation requirements Revitalized support from national leadership

National Health Financing Reforms

Public finance management system Institutionalization of revenue-enhancement measures Full retention of income Asset management Development of efficient and equitable allocation mechanisms Priority health programs Geographic Income Population groups Performance based-budgeting system Develop models for hospital, public health and regulatory agencies

Critical Components to Jump Start FOURmula ONE Implementation

Identifying critical components Doable given available resources Sufficient groundwork and buy-in

Reform financial management and procurement system Develop / implement performance audit and review system

Expansion of the NHIP

Increase membership and collections Enhance benefit package Improve utilization of reimbursements Enhance systems for regulation and governance

Critical upgrading of facilities through fund pool Rationalizing services in DOH-retained, local government & private facilities inside the 16 sites Integrating wellness services in hospitals Strengthening disaster and epidemic management system to include improved surveillance Intensification of health promotion /Establishment of National Health Promotion Foundation

REGULATION
Strategies Harmonizing & streamlining of systems, processes for licensing & accreditation & certification Developing a seal of approval system Pursuing cost recovery with income retention for health regulatory agencies & other revenue generating mechanisms Ensuring access of the poor to essential health products Components Programs include: One-stop shop Philhealth-Sentrong Sigla seal Unified seal of approval Botika ng Barangay/Pharma 50

GOVERNANCE
Components Sectoral Development Approach for Health Health Human Resource Masterplan Establishment of 4-in1- F1 Sites Philippine Health Information System Procurement and Logistics Management System Public Finance Management System (E-NGAs, etc) Sectoral Development Approach for Health To strengthen government leadership in implementing a sector program where development partners cooperate and contribute accordingly Effective donor and LGU coordination towards financing a sector program Harmonizing procedures among donors and national government Health Human Resource Masterplan To implement a national HHR Masterplan in support of national & local health systems HHR Information System Competency-based recruitment and selection systems Training and development need analysis Performance management system Career development and management Advocacy Plan Developing a localized health human resource strategy Developing a localized health human resource strategy Health professional development and career track Identifying and providing venue for posting of vacancies Actively promoting LGU vacancies, Support for developing local HR strategy

SERVICE DELIVERY
Strategies Making available basic and essential health service packages by designated providers in strategic locations Assuring the quality of both basic and specialized health services Intensifying current efforts to reduce public health threats Components Public health development plan a) Disease-free zones mopping up leprosy, schistosomiasis, filariasis, malaria, rabies b) Intensified disease programs VPD, TB, HIV/AIDS, emerging infections c) Improving reproductive health outcomes MMR, IMR, U5MR, TFR, CPR d) Intensified promotion of healthy lifestyle DM, HPN, CVD, breast and cervical cancer, anti-smoking, safe water, sanitation, among others Health facilities development plan Rationalizing facilities

Establishment of 4-in-1 Convergence Sites Establishment of 4-in1 convergence sites Health investment planning Developing appropriate governance structures and mechanisms i.e. ILHZ convergence sites, Helping mobilizing extra-budgetary resources for health at the local level Improving procurement, devolving regulatory functions, linking, local regulatory policies with health programs & financing Nationalizing the health delivery network, provision of basic health services Monitoring & evaluation i.e. LGU Score Card Philippine Health Information System Establishment, operationalization, & use of health portal & development of Philippine Health Information Infrastructure Harmonization of info systems Human resource info systems Vital registries, health statistics Disease surveillance Health accounts Health regulations Health Facilities Development of KM systems DOH Procurement and Logistics Management System Inventory system, supply-chain mechanism Efficient storage Database of goods/ supplies (standard specifications) Database of suppliers with performance monitoring Standardization of specifications and documents Implementation of ethical practices framework Immediate Term Time Frame August -Issuance of formal policy document -DOH to announce the scaling up of intensified disease control programs September -Launch of quality seal systems for drugs, facilities and services October-Validation and Consolidation of the submitted initial drafts of the central & local investment plans December -Completion of an overall investment plan for FOURmula ONE

2005 F1 Accomplishments Aug DPO Sept Investment Plans Sept-Oct Planning Workshops

Issuance of F1 AO and Review of LGU Orientation and per Team National Staff

Nov Meeting-F1 Resolutions Dec Initial Technical Assistance Mapping

Medium Term Time Frame 1st Quarter 2006 F1 Priority Activities Formulation of National Investment Plan Finalization of LGU Investment Plans Sectoral Policy matrix/ Mapping of TA Requirements Designation of F1 Fulltime Point Persons Formation of teams at all levels F1 orientation/ advocacy Development of F1 Performance Assessment Framework (M&E)