MLGP Module One

Introduction to
HLGP and MLGP
 Session Objectives

By the end of the session, the participants

will be able to:
1. Discuss HLGP as a replication strategy
that involves the adoption of the ZFF
Health Change Model to improve health
outcomes; and
2. Discuss the MLGP as a capacity building
intervention for local health leaders to
transform their municipal health systems
 MLGP
MLGPModule
ModuleOne
One
HLGP The Beginnings
DOH-ZFF
The ZFF Experience
DOH-ZFF Health
HealthLeadership
and the
Leadership
andThe ZFF Experience
Beginnings
Governanceof Program
HLGP
and Governance Program
 Introduction to ZFF

VISION MISSION
To be a catalyst for the To enhance the quality of
achievement of better life of the Filipino by
health outcomes for the focusing on the
poor through sustainable achievement of targets in
healthcare programs and the countrys Millennium
services, with a primary Development Goals for
focus on health inequities health, in partnership with
in rural areas of the government and other
Philippines stakeholders in the health
sector
 ZFF Development Strategy: The Health
Change Model and the Bridging
Leadership Framework

LEADERSHIP AND
GOVERNANCE

IMPROVED HEALTH SYSTEM

TARGETED AND PRO-POOR

HEALTH PROGRAMS

BETTER HEALTH OUTCOMES:

LOWER IMR, MMR &
MALNUTRITION RATES;
LOWER INCIDENCE OF
COMMUNICABLE &
NON-COMMUNICABLE
DISEASES
 Framework of Intervention
STRENGTHEN

HEALTH
LEADERSHIP AND
GOVERNANCE
HEALTH EMPOWERMENT
QUALITY AND Municipal Accountability AND ENTITLEMENT
RESPONSIVE HEALTH Barangay Accountability EDUCATION
SERVICES Coaching, Mentoring and
Monitoring
Improved Health Indicators

ENHANCE INCREASE
SUPPLY SIDE
Human Resource DEMAND SIDE
Facilities Health Seeking
Medicines Behavior
Innovative Programs

INCREASED UTILIZATION OF
RELEVANT HEALTH PROGRAMS
AND SERVICES
Municipal Basic Health Systems
Technical Roadmap
 Maternal Mortality Ratio and
Maternal Death Cases: CHPP
Maternal death cases 2011 2012 2013
Cohort 1 (poor with 4 ARMM LGUs) 3 2 2
Cohort 2 (poor non-ARMM) 4 4 6
Cohort 3 (ARMM) 8 3 1
Cohort 4 (poor) 8 3 7
Cohort 5 (GIDA) 10 10 5
Total 33 22 21
Home deliveries 17
Deaths in RHU/BHS 4
 Distribution of Maternal deaths in LGUs

Distribution of Deliveries Distribution of Deaths 2013

80 72.2
61.3
60 RHU/BHS
48.7 51.3
19%
38.7
40 Home
27.8
deaths
20 81%

0
Home RHU/BHS
'11 '12 '13 Of total deaths (37):
RHU/BHS = 8; Home deliveries = 29
Distribution of Maternal Deaths Interventions:
in Cohort 5 Build capacity of barangay leaders and community
health teams as pregnancy trackers
Engage hilots, teachers, Church leaders, etc as strong
3rd Delay advocates of facility-based deliveries and pre-natal
38% 1st Delay check ups or other Innovations
50% Intensify IECs
2nd Delay Ensure Philhealth coverage and other incentives
12% Adopt and institutionalize Wireless Access for Health
among LGUs
 Maternal Death Review with Hospital Deaths
Total Deaths = 75
(Cohorts 1 to 5, UMak 1 & 2, Zambo 1 &2)

Maternal Deaths, 2013 Gravida %

Prima Gravida 26%
Referral Home: Gravida Status
24 34%
Hospital: 39%
51% Multi Gravida 40%
RHU/BHS:
10% Deaths by Wealth Quintile
Quintile Number %
Interventions within Inter-Local Health Zone 1 (Poorest) 65 87
2 9 12
Review referral systems within ILHZ and between
3 1 1
LGUs
4 0 0
Prioritize ILHZ strengthening among PLGP participants 5 (Richest) 0 0
Improve transportation services going to the health
facilities Maternal Deaths by 4Ps Membership
Address gaps in human resource (adequacy and
competency) and facilities in district and provincial Non-
hospitals member
89%
Establish functioning communication between referral
hospitals
Provide capacity building feedback to referring Member
facilities 11%
 Infant Mortality Rate and
Infant Death Cases: Cohorts 1 to 5
Infant Death Cases 2011 2012 2013
Cohort 1 (poor with 4 ARMM LGUs) 19 13 20
Cohort 2 (poor non-ARMM) 54 57 47
Cohort 3 (ARMM) 20 15 13
Cohort 4* (poor) 43 36 35
Cohort 5 (GIDA) 48 49 38
Total 184 170 153
 Infant Death Review
Total Deaths = 277
(Cohorts 1 to 5, UMak 1 & 2, Zambo 1 &2)

Infant Deaths, 2013

1. Pneumonia 27%
2. Sepsis 15%
RHU/BHS Top 5 causes of
3. Acute Gastroenteritis 12%
21% infant deaths 4. Prematurity 11%
Referral 5. Congenital Abnormalities 10%
Hospital
19% Age Group %
HomeType
and of Early neonatal (less than 7 days) 44%
hilotinfant
assisted
death Late neonatal (7 to less than 28 days) 14%
60% Infant (28D to less than 1 year) 42%

Interventions: Preventive measures:

1. Access to facilities with complete medicines 1. Increase FBD & SBA
2. Access to competent healthcare worker who can 2. Improve quality of prenatal care &
provide home-based/community-based medical nutritional status of mothers, addressing
care illnesses during pregnancy
 Bringing down MMR

Leadership and Governance

Generating Demand:
Ordinances and Policies

Improved Health
Information
System
Incentives for
Addressing the
Very Poor Mothers
Coaching
Supply Side: Monitoring Referral System
and and
Birthing Facilities Mentoring
Surveillance
and equipments System

Introduction of
Roadmap: 6
Building Blocks
 MLGP Module One

DOH-ZFF Health Leadership

and Governance Program
 DOH-ZFF Partnership Agreement
Department of Health Convention Hall (May 16, 2013)
 HLGP Objectives

The Program aims to create an immediate impact on achieving the health

MDGs by improving local health systems in the 609 priority municipalities.

Department of Health Local Government

1. Support and promote the
leadership and governance
capability building to complement
the existing technical expertise of
DOH-CHDs in supporting provincial
and municipal health leaders
1. Institutionalize national policies
and programs that support
strengthening the health
leadership and governance at the
local level
1. Develop the health leadership
and governance capabilities of
local chief executives needed for
a sustainable health system;
2. Improve health outcomes
3. Mobilize public-private
collaboration to facilitate sharing
of resources and replication of
best practices for sustainability
 Program Management

OVERSIGHT COMMITTEE
ZFF DOH Central Office PHILHEALTH
Bridging Leadership Program conceptualization, financing, Technical support
Resource Partner implementation plan and policy support on health financing

PROJECT MANAGEMENT COMMITTEE

ZFF DOH Central Office (BLHD, HHRDB, NCHFD, HPDPB, NCDPC, NEC, BIHC, NCHP)

OPERATIONS
ZFF DOH BLHD
Bridging Leadership Resource Partner Mandate and Accountability to CHD

DOH-CHD
ACADEMIC PARTNER
Program Manager and
Training Partner
Leadership and Governance Coach

PROVINCE
Co-Program Manager

CITY/MUNICIPALITY
Implementation of Community Health Activities
 Operational Framework
Oversight Committee (DOH, PhilHealth, LPP, LMP, ZFF)
Oversight, program direction Feedback
ZFF and DAP
Health Leadership & Management DOH Central Office
for the Poor (HLMP) Training BLHD, HHRDB, NCDPC, HPDPB, NCHFD P
Training of Coaches Evaluation
Change Management Program Coach and Support Feedback, program evaluation r
CHD Core Team: o
ZFF and DAP
Health Leadership & Management
Regional Directors, HRDU Head, LHAD Head, PHTLs j
for the Poor (HLMP) Supervision, Coach Feedback e
Trainers Training; Training
Training of Coaches; Evaluation
DOH REPRESENTATIVES c
Z Change Management Program
t
F PRACTICUM
ACADEMIC INSTITUTIONS
F Coach Feedback M
ACADEMIC INSTITUTIONS PRACTICUM Improved g
Mayors,
Municipal BETTER HEALTH
Municipal Leadership and Oversee MHOs t
Health System OUTCOMES
Governance Program (MLGP) Training evaluation Lower MMR/IMR
Support: technical, Lower incidence of C
financial, logistical communicable and
PRACTICUM non-communicable
o
ZFF Improved
Coach Governors Provincial disease m
Provincial Leadership and
PHOs Health System
Governance Program (PLGP) Training evaluation
 Replicating the Health Change
Model at the Region by the CHD

HEALTH
LEADERSHIP AND
GOVERNANCE
Municipal Accountability Help the poor navigate the
Provide tertiary health care provincial and municipal
Barangay Accountability
programs and services and health systems to avail of
Coaching, Mentoring and
support primary health care health programs and services
Monitoring
programs of LGUs

Improved Health Indicators

SUPPLY SIDE
Human Resource DEMAND SIDE
Facilities Health Seeking
Medicines Behavior
Innovative Programs

Increase Utilization of Affordable

and Quality Health Programs and
Services
 Program Components

Health Leadership and Governance Program Participants

Regions Health Leadership One-year, two-module CHDs, PhilHealth Regional Office,
and Management for leadership program DSWD Regional Office, DILG Regional
the Poor Program Office, Regional and Provincial Chief
(HLMP) (Six-month Practicum: of hospital, Academic Partner
Coaching and Monitoring)
Provinces Provincial Leadership Three-year, Governor and PHO
and Governance three-module program
Program (PLGP)
(Six-month Practicum:
Coaching and Monitoring)
Municipalities Municipal Leadership One-year, two-module Mayor and MHO
and Governance leadership program
Program (MLGP)
(Six-month Practicum:
Coaching and Monitoring)
Cities MLGP-Short Course One-year, two-module City Mayors and City Health Officers
on Urban Health leadership program
Equity (MLGP-SCUHE)
(Six-month Practicum:
Coaching and Monitoring)
 Municipal Leadership and
Governance Program (MLGP)

Municipal Leadership
and Governance
Program

One-year, 2-module leadership program

for Mayors and MHOs, with training and Good governance in the
coaching on local health system health sector
development Healthcare financing
Access to essential
medicines
Health Human
Resources
Program Management Health Information
Health Service Delivery
- CHD as program owner and manager
- Academic partner as training provider
MLGP Module One

Benefits for Mayors

 Leadership Development

Personal development in Health Leadership and Governance

Translate Health Outcomes into Political Gains

 Improvement of Municipal
Health Outcomes
Medicines/
BEFOREPARTNERSHIP:
AFTER PARTNERSHIP: Governance
Governance Financing
Technology
LGU more or less
Municipal

Shared Mission and Vision

Budget
System
Health

Health
15% Availability of

Access to Essential Medicines

Functional and Expanded Local Health Medicines
BLGU
Board
Barangay

Barangay Health Board 4-in-1 Accreditation Adequate

System
Health

Referral System Capitation & Number of

Medicines

PhilHealth
Cluster of Barangays Reimbursement
Activation of LHB
Ordinance &

BHW Retention Enrolment &

Policies

Botika ng
Utilization of
Births attended by skilled professional Barangay
Benefits by Indigents
Facility-based deliveries
Brgy Health
Multi-stakeholder and

Health Summit/ Fair Financing scheme

Assemblies
Involvement
Community

Brgy. Health Local Health Drug Management

Citizens Charter Financing Scheme System
Scorecard

Entitlement
Family Health Card
Education
 Improvement of Municipal
Health Outcomes
Health Information Human Resource Service Delivery
Proportionate # of health facilities

& Services
Facilities
Health
Adequate Regular manpower assigned
Accurate Baseline
Manpower Ratio Essential medical equipment & supplies
Available mode of transportation
Credible Data

Purok System/

Materna
Reliable data

Health
Competent Health Pregnancy Mapping

Child
l and
Community Health Team
gathering
Workers
Buntis Congress Maternal/ Infant Audits
Computerized and
Malnutrition Data Board
RHUManagement
Management

systematic records PABASA sa Nutrisyon

Nutrition
Performance
Food Always in the Home
Translate data info Management
Indigenous Supplementary Mixture (INSUMIX)
into action System Nutrition Congress
RHU

Sustainable Feeding Program

Information Campaign

LGU Health Data Board Tuberculosis HIV/AIDS

Infectious
Feedback System/
Diseases Malaria NTD/ Dengue
Citizens Scorecard
PregnancyData board Municipal WASH Task Force
Water, Sanitation
Sanitation & Hygiene Practices
& Hygiene
Nutrition Data board Magna Carta
Magna Carta Access to Safe Water
Implementation
Implementation Lifestyle Diseases Oral Health
Barangay Data Board Others
Family Planning Emergencies
 Expansion of Social Capital

Networking and partnerships

 Incentives and Awards

Opportunity for Health Program Grants Opportunity for Seal of Health

Governance Recognition
 Critical Factors for the Success of
the Program

Selection of LGUs and commitment of local health

leaders (Mayors and MHOs)

Quality of Training Intervention by academic partners

Accountability for Deliverables during Practicum

Presence: Monitoring and Coaching

Performance-based Grants and Incentives (e.g., Health

Facilities)
 MLGP
MLGPModule
ModuleOne
One
HLGP The Beginnings
Salamat po!
DOH-ZFF
DOH-ZFFHealth
HealthLeadership
Leadership
andThe ZFF Experience
andGovernance
GovernanceProgram
Program