Improving the Quality of Health Services in a

Decentralized Health System:

Lessons Learned from a National Certification Program

Philippines Sentrong Sigla

Movement
 Introduction
• Definition

– SS is a quality improvement initiative through a

certification/recognition program. Health
facilities are certified based on a set of
standards
– SS also promotes continuous quality
improvement as a complementing strategy
 Introduction
• Steps in the Certification Process
– Philippines Department of Health (DOH) provides
copies of quality standards to local government
units (LGUs)
– LGU facility conducts self assessment
– Mayor/Governor sends letter of intent to participate
– DOH SS teams conducts assessment
– LGU facility gets certified, receives SS seal
– Certified facility gets monitored twice a year and
tries to strive for higher level standards
 Lessons Learned
• Interest in QI is universal but a supportive
environment is needed to make it happen

– Everyone likes the idea of QI

– SS provided simple, practical steps to improve
quality of health services
– SS provided motivation through certification
 Lessons Learned
• SS became a successful model of how a
national government can influence local
behavior under devolution

– Getting LGUs to comply with national

standards and policies: major challenge
– LGUs resent “heavy-handed approach”
– SS respects local interest and priorities without
compromising standards of quality
 Lessons Learned
• Political support is a critical success factor

– Applies both at the national and local level

– Program should have a political value and
appeal
 Lessons Learned
• Champions for quality in health care come
from many sectors

– Politicians, planners, private sector representatives,

community influentials championed the cause for
SS
– Multisectoral interest interest and support prodded
health workers to take action
 Lessons Learned
• Development of standards required
extensive consultations

– Consensus building through consultation

– Bridging gap or balancing between technical
requirements and realities in the field:
provider’s perspective and client’s perspective
 Lessons Learned
• Progressive standards are needed to sustain
interest in SS certification and to provide
guidance to LGU facilities

– Experience with Baby Friendly Initiative

– CQI interface with “static” standards
 Lessons Learned
• Cash incentives maybe counterproductive

– Divert attention away from doing real quality

improvement work
– Demoralize facilities not given cash incentives in
spite of being certified
– Not sustainable
 Lessons Learned
• Credibility of certification depends on
quality of assessment

– Assessment should be accurate

– Develop further skills of assessors
 Lessons Learned
• Minimal involvement of private sector
reduced program impact

– Enhance credibility of certification program if

private sector is involved
 Lessons Learned
• Link with Philippine Health Sector Reform (HSR)
enhances value and sustainability of SS

– Interface with Philippines’ HSR initiatives

– Adopted by Philippine Health Insurance Corporation:
SS certified facilities are eligible to be reimbursed for
selected primary health care services
– Integrate with HSR