HEALTH SECTOR REFORM AGENDA, FOURMULA ONE, & NATIONAL OBJECTIVES FOR HEALTH

I. BRIEF BACKGROUND

A. Primary Health Care approach in the late 1970s. The goal was health in the hands of the people through community empowerment and strengthening of Barangay Health Workers (BHW). B. Generics Act in the late 1980s. This act made quality medicines cheaper through prescription of generic name, giving people a choice in having the equivalent active ingredient. C. Devolution of public health systems in the early 1990s. The Local Government Code devolved the delivery of health care services to the local government units instead of the Department of Health (DOH), giving a sense of ownership to the local leaders. D. National Health Insurance Act of 1995. This law gives the same benefit package for all members across all sectors. Its aim is universal coverage of all Filipinos including the indigents, through subsidization of the sickly by the healthy. Also, outpatient packages are made available.

Though the health of the Filipinos significantly improved over the last 50 years, many challenges remained for the health sector to effect further health gains such as: y y y y y y y y Slowing down of the decline of infant and maternal mortality rates; High threat from infectious diseases; Environmental and workplace health hazards; Large variation in health status; Inadequate capacities of curative care facilities; Inadequate funding and management systems; Lack of coordination among LGUs, compromising the effectiveness of devolution Weak ability of the government to regulate the quality and cost of health care services; and y Inadequate resources and funding.

II.

HEALTH SECTOR REFORM AGENDA

The Health Sector Reform Agenda (HSRA) was conceptualized in the late 1990s to address these problems. It describes the major strategies, organizational, and policy changes and public investments needed to improve the way health care is delivered, regulated, and financed.

Ultimately, the HSRA aims to improve the health status of the people. IT shall be the catalyst that will bring the country toward the realization of a shared vision of health for all Filipinos. The five major reforms of HSRA are: Provide fiscal autonomy to government hospitals. Government hospitals

must be allowed to collect socialized user fees so they can reduce the dependence on direct subsidies from the government. Such capacities will allow hospitals to supplement priority public health programs, and as a result, they will be more competitive and responsive to health needs. Secure funding for priority public health programs. Multi-year budgets must be provided to eliminate or significantly reduce the burden of infectious diseases, and investments must be made to advance health promotion and prevention programs. Promote the development of local health systems and ensure its effective performance. LGU must enter into cooperative and cost sharing arrangements to improve local health services. Participation of the private sector and volunteer groups must be tapped for more effective performance. Strengthen the capacities of health regulatory agencies. Health regulatory agencies must be strengthened to ensure safe, quality, accessible, and affordable health services and products. Appropriate legislation must be enacted to fill regulatory gaps. Expand the coverage of the National Health Insurance Program. Social

health insurance must expand to extend protection to a wider population especially the poor.

Since the inception of the HSRA, health reforms have made inroads in at least 30 provinces.  In health financing, LGUs have increased contributions needed to enrol indigents into the social health insurance program.  In health regulation, LGUs have pooled their procurements to lower the price of essential drugs.  In health service delivery, key LGU facilities have been upgraded to meet accreditation requirements and be entitled for capitation or reimbursements from PhilHealth.  In health governance, municipalities have joined together to form inter-Local Health Zones (ILHZs) to optimize sharing of resources and maximize joint benefits from local health initiatives.

While developments in the health sector have given rise to opportunities, the following existing constraints remain as roadblocks: o Very restricted DOH budget, 60 percent automatically spent for personal services, leaving very little to provide for operational and capital needs. o Most LGUs spend at least 70 percent of resources for salaries and benefits of personnel, leaving very little for operational expenses and capital investment. o DOH continues to face the difficult mandate of steering the highly decentralized and fragmented local public health systems and private health care markets. o Need for DOH to manage the total national health financing requirements from a multitude of resources.

III.

FOURMULA ONE

Fourmula One (F1) is the implementation framework for health sector reforms in the Philippines. Its Over-all Goals are better health outcomes, more responsive health system, and more equitable healthcare financing. The general objective of this program is to achieve critical reforms with speed, precision, and effective coordination directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by Filipinos, especially the poor. The strategies with the component-specific objectives are:

F1 Component No. 1: HEALTH FINANCING Objective: to secure increased, better, and sustained investments in health to provide equity and improve health outcomes, especially for the poor Strategies:      Mobilizing resources from extra budgetary sources Coordinating local and national health spending Focusing direct subsidies to priority programs Adopting a performance-based financing system Expanding the NHIP

F1 Component No. 2: HEALTH REGULATION Objective: to assure access to quality and affordable health products, devices, facilities, and services, especially those commonly used by the poor.

Strategies:     Harmonizing licensing, accreditation and certification Developing quality seals Pursuing cost recovery with income retention Assuring the availability of low-priced quality essential medicines commonly used by the poor

F1 Component No. 3: HEALTH SERVICE DELIVERY Objective: to improve the accessibility and availability of basic and essential health care for all, particularly the poor, which shall cover all public and private facilities and services. Strategies:  Ensuring availability of basic and essential health service package s in all localities  Making available specific and specialized health services in strategic locations  Intensifying current efforts to reduce public health threats

F1 Component No. 4: GOOD GOVERNANCE IN HEALTH Objective: to improve health systems performance at the national and local levels Strategies:   Establishing Four-In-One advanced implementation sites Developing on LGU FOURmula One for Health Scorecard

Institutionalizing a FOURmula One for Health Professional Development and Career Track

IV.

NATIONAL OBJECTIVES FOR HEALTH

The development of the National Objectives for Health (NOH) for the period 2005 to 2010 builds on and integrates many of the lessons learned from previous experiences while ensuring that gains are sustained and institutionalized. In essence, the NOH provides the road map of key ideas, targets, indicators and strategies to bring the health sector to its desired outcomes. It also defines the collective and individual roles that the various stakeholders policy makers, program planners and managers, service providers, local government executives, development partners, the academe and civil society play in shaping the future of our countrys health system and in bringing better health outcomes for our people.

Primary Goals of the Health Sector

(Excerpts from the document National Objectives for Health, Philippines, 2005-2010) Better health outcomes. Better health for the entire population is definitely the primary goal of the health system and its main reason for being. This means making the health status of the people as good as possible over the entire life cycle, taking into consideration the occurrence of disabilities and premature deaths. While other factors

like economic, social and environmental conditions affect health, the activities of the health sector are the ones that have direct significant impact on health status. Although a good health system generally contributes to good health, it is not enough that the health sector settles for an improvement of the average health of the population. The greater challenge is the reduction of inequalities by improving the health of the worseoff, wherever these inequalities are caused by conditions amenable to intervention. The objective of good health is therefore two-fold attaining the best average level of health for the entire population (goodness) and attaining the smallest feasible differences in health status among individuals and groups (fairness) (WHO2000).

More responsive health system. The second goal of the health system is related to how it performs in meeting the peoples expectations of how it should be treated by providers of health services. This goal is closely associated to the degree by which people are satisfied with the performance of the health system and the services it provides. Generally, the responsiveness of the health system contributes to health by promoting utilization of health services. The general notion of responsiveness relates to the respect for human beings as persons and to how the health system meets the commonly expressed concerns of patients and their families as clients of the health system. Respect for persons includes respect for the dignity of the person, confidentiality of ones personal health information, and autonomy to participate in choices about ones own health. On the other hand, client orientation includes prompt attention in the provision of care, amenities of adequate quality, access to social support networks, and freedom to choose a health provider (WHO2000). It has been identified

that the poor and those from the rural areas are often treated with less respect, less choice of providers, and poorer quality of amenities compared with the rich and those from the urban centers. Therefore, as with the objective of better health status, it is not only attaining the best average level of responsiveness that matters (goodness), but more challenging for the health sector is attaining the smallest feasible differences in terms of responsiveness of the health system for every individual and group in the population (fairness).

More equitable health care financing. Financial risk protection anchored on the fairness of the health financing system is another major goal of the health sector. Fair health care financing means that the risks each individual faces due to the cost of health care are distributed according to ability to pay rather than to the risk of illness. A health system in which individuals or families are forced into poverty through their purchase of needed health care, or forced to do without care because of the cost, is unfair (WHO 2000). Payment for health care is unfair if the system exposes the individual to large unexpected expenses in which costs have to be paid out-of-pocket at the time of utilization of health services, or if the system imposes a regressive payment scheme in which those least able to contribute pay proportionately more than the better-off. What is relevant for achieving financial risk protection is helping people avoid the large and unpredictable costs of a serious illness by providing a risk-spreading strategy for financing health care, where revenues from the people are pooled and used to pay for care for those who get ill. This is best achieved by relying more on prepayment schemes (or insurance schemes) in place of out-of-pocket expenditure and by

establishing a more progressive contribution scheme related to capacity to pay rather than to health risk or utilization of health services.

Specifically, the National Objectives for Health are measured by the disease or issue, making them measurable. Examples are:

Goal: Morbidity and mortality from tuberculosis are reduced. National Objectives for 2005 - 2010 Objective Indicator Case detection rate Case detection rate of for smear positive TB sputum positive cases is increased Target 70 percent Baseline Data and Source 61 percent NTP Accomplishment Report, DOH, 2003 174.6 cases per 100,000 population Philippine Health Statistics, 2000

Mortality rate from TB Morbidity rate from TB 137.3 cases per is decreased per 100,000 100,000 population population

Goal: Mental health in the general population, risks and prevalence of mental disorders are reduced, and the quality of life of those who are suffering from such conditions is promoted is improved. National Objectives for 2005 - 2010 Objective Mortality from suicide and intentional selfharm is reduced. Indicator Mortality rate from suicide and intentional self-harm per 100,000 population Target Reduce to 1.5 deaths per 100,000 population Baseline Data and Source 1.8 deaths per 100,000 population Philippine Health Statistics, 2000

Goal: The survival, health and well-being of mothers and their unborn are ensured. National Objectives for 2005 - 2010 Objective Indicator Maternal mortality is Maternal mortality reduced ratio per 100,000 live births Target 90 maternal deaths per 100,000 live births Baseline Data and Source 172 maternal deaths per 100,000 live births NDHS1998

References:

Department Of Health. Annual Report 2005: Shifting Gears Towards a More Efficient, Responsive, and Sustainable Health Care Systems. Manila, Philippines: June 2006.

Department Of Health. Health Sector Reform Agenda: Philippines, 1999-2004. Manila, Philippines: December 1999.

www2.doh.gov.ph/noh2007

A Written Report On Health Sector Reform Agenda, Fourmula One, and National Objectives for Health

In Partial Fulfillment Of The Requirements In Nursing In Community Development

Submitted to: Prof. Leah L. Zamora, RN, MAEd

Submitted by: Joanna Kaye B. Remolar MAN

November 8, 2008