Resilient Local Health Systems

Ernesto D. Garilao President, Zuellig Family Foundation

10 July 2014

ZFF Development Strategy:

Health Change Model & WHO’s Six Building

Blocks for a Better Health System

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

SERVICE

DELIVERY

HEALTH WORKFORCE

ACCESS TO

ESSENTIAL

MEDICINES

FINANCING HEALTH

INFORMATION

SYSTEM

LEADERSHIP & GOVERNANCE

Modular Training for Mayors and Municipal Health Officers (Bridging Leadership as Leadership Approach)

ZFF Health Change Model

WHO’s Six Building Blocks for a Better Health System

Intervention

Practicum in between Modules to fix their Local Health System

ZFF Presence & Initial Results in Alumni Municipalities

Poor regions with high health burden

Eastern Visayas, Zamboanga Peninsula, CALABARZON,

MIMAPORA, Bicol Region, Davao Region, ARMM, CAR, Western

Visayas, Central Visayas, Northern Mindanao, SOCCSKSARGEN,

CARAGA

Health & Leadership Governance is being replicated with the Department of Health in 609 poor municipalities.

Mothers and Infants in Samar are at Higher Risk in post-disaster situations.

• Eastern Visayas is the country’s 3rd poorest region (NSCB, 2012)

• Poverty incidence for Eastern Samar is at 59.4%, which is higher than the regional (45.4%). (NSCB, 2012)

• Without interventions, maternal mortality, infant

mortality, and malnutrition among children is expected to go up because of the rise in poverty incidence

ZFF partner-LGUs in Samar Island

Partner/ Program

Provinces No. of Municipalities

Year of Engagement

MSD for Mothers Global Giving Program

Northern Samar; Western Samar

21 municipalities 2013

UNFPA Eastern Samar 8 municipalities (including Salcedo,

Giporlos, Gen. MacArthur)

2013

How Municipalities Prepared for Typhoon Haiyan

• Activated the Municipal Disaster and Risk Reduction Management Council

• Prepositioned relief goods and medical supplies

• Information campaign on the dangers of the typhoon, especially to high risk barangays

• Evacuation to “safe” areas (e.g. municipal hall, schools)

Basey

Marabut

Lawaan

Hernani

Balangiga Mercedes

Guiuan

Balangkayan

12 Partner Municipalities Affected by Haiyan

Eastern Samar: Balangiga, Balangkayan, Gen. MacArthur, Giporlos, Guiuan, Hernani, Lawaan, Mercedes, Quinapondan, Salcedo; Western Samar: Basey, Marabut

Giporlos

Gen. MacArthur

Quinapondan Salcedo

Impact of Typhoon Haiyan on LGU partners

Province Municipality % of Affected

Barangays

No. of Affected Families

No. of Damaged

Houses

No. of Fatality

Damage to Agriculture

(Php, in Millions)

Damage to Infrastructure

(Php, in Millions)

E. Samar Gen. MacArthur

100% 3,903 3,666 0 3.908 33.237

Giporlos 100% 3,611 2,914 12 10.266 633.130

Salcedo 100% 5,405 4,186 29 51.016 548.120

Balangiga 100% 3,576 3,070 13 412.215 241.245

Balangkayan 100% 2,332 2,035 0 0.575 22.150

Guiuan 100% 14,193 13,410 101 27.681 351.500

Hernani 100% 2,345 1,928 74 No data 618.400

Lawaan 100% 3,208 2,880 11 0.981 29.765

Mercedes 100% 1,954 1,394 1 0.057 90.700

Quinapondan 100% 3,399 3,236 10 85.717 92.150

Samar Basey 45% 13,706 12,223 235 679.000 178.0

Marabut 100% 6,281 4,245 31 2,056.050 1,952.1

Total 63,913 55,187 517 3,327.469 4,790.498

Source: PDRRMOs of E. Samar and Samar as of December 2013

Extent of devastation in Salcedo, E. Samar (November 2013)

Extent of damage in coastal barangays of Giporlos, E. Samar (November 2013)

Province Municipality Actual No. of Pregnant

and Lactating Women

as of Jan 2014 (RHU Data)

Damaged Health Centers

Rural Health Unit (RHU)

& Brgy Health Station (BHS)

Partial

Damaged

Major

Damaged

Totally

Damaged

E. Samar Balangiga 216 3 BHS 1 RHU

Balangkayan 161 1 RHU 2 BHS

Gen. MacArthur 254

Giporlos 187 1 RHU; 2 BHS

Guiuan 267 2 RHU; 7 BHS

Hernani 83 1 BHS 1 RHU; 1 BHS

Lawaan 190 2 BHS 1 RHU; 1 BHS

Mercedes 92 1 BHS 1 RHU

Quinapondan 242 1 RHU; 3 BHS 1 BHS

Salcedo 233 1 RHU; 2 BHS

Samar Basey 688 1 RHU 6 BHS 1 BHS

Marabut 305 1 RHU; 9 BHS 10 BHS

Subtotal 2,890 23 6 33

Sources: DSWD, December 2013/ DOH, WHO, PHO-Eastern Samar, RHUs, January 2014

Impact of Typhoon Haiyan on Health for LGU Partners

Extent of damage to Barangay Health Station in Salcedo, November 2013

Extent of damage to Giporlos Rural Health Unit, November 2013

ZFF Response for Pregnant and Lactating Mothers

• Dec 2013 – Jan 2014: Initiated Recovery Assistance Program for Mothers in 12 municipalities in Samar Island

Funding Partner: U.S. – Philippines Society (US$463,776) Implementing Partners: LGUs, CARD-MRI, CCT Inc.

Tabang Visayas/ZFF Response

• February 2014: Convened Partners Meeting with Tabang Visayas for the 12 Samar Island municipalities due to clamor of municipal mayors for non-health assistance

Municipality

MFI Integrated Area

Development

Livelihood Technical Assistance

Education Governance

Child Protection

Solar Lamps & Solar

Suitcases

CARD-MRI CCT PBSP PDAP PEF Synergeia Foundation

Consuelo Foundation

Solar Energy Foundation

Basey

Marabut

Balangiga tentative

Balangkayan

Gen. MacArthur

Giporlos

Guiuan AsiaDHRRA

Hernani

Lawaan tentative

Mercedes

Quinapondan

Salcedo

Partners who Responded to Tabang Visayas/ ZFF’s Call for Support

INTERMEDIATE (1 to 2 years)

LONG TERM (2 years onward)

DEVELOPMENT PHASES

IMMEDIATE (6 months to 1 year)

Reconstruction

HEALTH

LIVELIHOOD

EDUCATION

CHILD PROTECTION

Restore operational capacity of LGUs

Institutionalizing policies, systems and programs on disaster resiliency

Sustaining disaster-resilient systems

• Restored health services • Provision of water &

sanitation kits

• Provision of cash incentives; short-term jobs

• Class Resumption • School feeding &

nutritional assessment

• Psychosocial stress debriefing

• Protection from abuse & violence

• Provision of temporary shelters, child friendly spaces

• Re-establishment of health systems

• Restoration, diversification of livelihood & income

• Value chain integration

• Responsive educational programs

• School-based health programs

• Construction of classrooms

• Permanent shelters • Law enforcement • Active coordination,

monitoring, & response to abuse & violence towards children

Resilient & equitable health systems

Resilient & responsive educational systems

Mainstreamed child protection programs

Relief & Recovery

Improved health

outcomes

Improved educational outcomes

Reduction in cases of abuse,

neglect, exploitation, and violence

towards children

Resilient local economy

Reduced poverty

incidence

IMPACT LE

AD

ERSH

IP A

ND

GO

VER

NA

NC

E

Resiliency-based planning and development References: ZFF’s Health Change Model, Plan International/Save the Children March 2013 inter-agency links, UNDP, UNICEF

Working Paper on Resilience, Synergeia Reports, Discussions with Livelihood NGOs and MFIs (Feb 7 2014)

MLGP Conceptual Framework for

Disaster Resiliency Adaptation & Transformation

ZFF

PBSP, PDAP, PEF, CCT, CARD

Synergeia Foundation

Consuelo Foundation

ZFF Response

March 2014: ZFF conducted the Municipal Leadership and Governance Program (MLGP) Module 1 Training

for the 12 municipalities

Municipal Basic Health System’s Technical Roadmap August 2013 (Salcedo, Eastern Samar)

Leadership & Governance

Health Financing Health Human Resource Access to Medicine &

Technology Health information

System Health Service Delivery

Mu

nic

ipal

Hea

lth

Go

vern

ance

Municipal Health Action

Plan H

ealt

h R

eso

urc

e G

ener

atio

n a

nd

Man

agem

ent LGU Budget for

Health (15% IRA)

RH

U a

nd

BH

S R

eso

urc

e m

anag

emen

t

Health Human Resource Adequacy at

the RHU (MD 1:20,000)

(Nurse 1:20,000)

Dru

g M

anag

emen

t Sy

stem

Presence of Essential

Medicine at the RHU

(Stock Basis)

Dat

a C

olle

ctio

n, U

tiliz

atio

n a

nd

Info

rmat

ion

Dis

sem

inat

ion

Accomplished Baseline Data

Collection

Bar

anga

y H

ealt

h

Infr

astr

uct

ure

Presence of Brgy. Health Station (1 BHS:1 Barangay or 1 BHS per Catchment)

Maintenance and Operations

Utilization

RHU HHR Competency

Actual budget Utilization

(95% Utilization)

Available and Accessible Transportation for Emergency

Regular Data Gathering and

Recording

Mat

ern

al a

nd

Ch

ild C

are

Sustainable Maternal Health Care Initiatives

Expanded and Functional

Local Health Board

Full Implementation of

Magna Carta for Public Health

Workers

Pre-Natal Services (at least 80%)

BLGU Health Budget

(5% of Barangay

IRA) RHU Medicine Tracking and

Inventory System

Post Natal Services (at least 80%)

Facility-Based Deliveries (85%)

Maternal/ Infant Death

Review

Skilled Birth Attendants (85%)

Sustainable Breastfeeding Initiatives

Installed Performance Management

System

Exclusive Breastfeeding for Infants (70%)

Bar

anga

y H

ealt

h G

ove

rnan

ce

Functional Barangay

Health Governance

Body (with

functional CHT)

Loca

l Ph

ilhea

lth

Ad

min

istr

atio

n

4-in-1 Accreditation

Newborns Initiated Breastfeeding (85%)

Monthly Updated

Health Data Board

Sustainable Essential Intrapartum and Newborn Care Initiatives

Health Human Resource Adequacy in

BHS

(1 Midwife: 1 Brgy; with consideration to

GIDA) (BHW to HH 1:20HH)

Regular IEC for Enrolled Indigent

(for Q1 and Q2)

Sustainable Infant and Child Care Initiatives

Fully Immunized Child (95%)

Under-5 Malnutrition Prevalence Rate (Below 17.3%)

Ratio of Community-

Based Pharmacy

(1 BNB/CBP

catchment or 1 BNB per

barangay)

Accomplishment, Utilization and

Dissemination of the DILG, DOH

LGU Scorecards

Rep

rod

uct

ive

Hea

lth

Sustainable Adolescent Reproductive Health Initiatives

Implemented and

Integrated Barangay

Health Plan

Reimbursement Filing

(PCB, MCP, TB-DOTS)

BHS HHR Competency (Basic BHW Training

Course and CHT Training)

Teenage Pregnancy Rate (4%)

Sustainable Family Planning Initiatives

Creation of Citizen’s Charter

Provision of FP Commodities and Services (RHU)

System for BHW Recruitment and

Retention Mechanisms Ordinance and

System for Claims Disposition and

Utilization Monitoring

Contraceptive Prevalence Rate (63%)

Unmet Needs (50% under NHTS)

Ordnance and Timely Provision of BHW

Honorarium WaS

H

Sanitary Toilets (86% of HH)

Access to Safe Water (87% of HH)

Municipal Basic Health System’s Technical Roadmap as of March 13, 2014 (Salcedo, Eastern Samar)

Leadership & Governance

Health Financing Health Human Resource Access to Medicine &

Technology Health information

System Health Service Delivery

Mu

nic

ipal

Hea

lth

Go

vern

ance

Municipal Health Action

Plan H

ealt

h R

eso

urc

e G

ener

atio

n a

nd

Man

agem

ent LGU Budget for

Health (15% IRA)

RH

U a

nd

BH

S R

eso

urc

e m

anag

emen

t

Health Human Resource Adequacy at

the RHU (MD 1:20,000)

(Nurse 1:20,000)

Dru

g M

anag

emen

t Sy

stem

Presence of Essential

Medicine at the RHU

(Stock Basis)

Dat

a C

olle

ctio

n, U

tiliz

atio

n a

nd

Info

rmat

ion

Dis

sem

inat

ion

Accomplished Baseline Data

Collection

Bar

anga

y H

ealt

h

Infr

astr

uct

ure

Presence of Brgy. Health Station (1 BHS:1 Barangay or 1 BHS per Catchment)

Maintenance and Operations

Utilization

RHU HHR Competency

Actual budget Utilization

(95% Utilization)

Available and Accessible Transportation for Emergency

Regular Data Gathering and

Recording

Mat

ern

al a

nd

Ch

ild C

are

Sustainable Maternal Health Care Initiatives

Expanded and Functional

Local Health Board

Full Implementation of

Magna Carta for Public Health

Workers

Pre-Natal Services (at least 80%)

BLGU Health Budget

(5% of Barangay

IRA) RHU Medicine Tracking and

Inventory System

Post Natal Services (at least 80%)

Facility-Based Deliveries (85%)

Maternal/ Infant Death

Review

Skilled Birth Attendants (85%)

Sustainable Breastfeeding Initiatives

Installed Performance Management

System

Exclusive Breastfeeding for Infants (70%)

Bar

anga

y H

ealt

h G

ove

rnan

ce

Functional Barangay

Health Governance

Body (with

functional CHT)

Loca

l Ph

ilhea

lth

Ad

min

istr

atio

n

4-in-1 Accreditation

Newborns Initiated Breastfeeding (85%)

Monthly Updated

Health Data Board

Sustainable Essential Intrapartum and Newborn Care Initiatives

Health Human Resource Adequacy in

BHS

(1 Midwife: 1 Brgy; with consideration to

GIDA) (BHW to HH 1:20HH)

Regular IEC for Enrolled Indigent (for Q1 and Q2)

Sustainable Infant and Child Care Initiatives

Fully Immunized Child (95%)

Under-5 Malnutrition Prevalence Rate (Below 17.3%)

Ratio of Community-

Based Pharmacy

(1 BNB/CBP catchment or 1

BNB per barangay)

Accomplishment, Utilization and

Dissemination of the DILG, DOH LGU

Scorecards

Rep

rod

uct

ive

Hea

lth

Sustainable Adolescent Reproductive Health Initiatives

Implemented and

Integrated Barangay

Health Plan

Reimbursement Filing

(PCB, MCP, TB-DOTS)

BHS HHR Competency (Basic BHW Training

Course and CHT Training)

Teenage Pregnancy Rate (4%)

Sustainable Family Planning Initiatives

Creation of Citizen’s Charter

Provision of FP Commodities and Services (RHU)

System for BHW Recruitment and

Retention Mechanisms Ordinance and

System for Claims Disposition and

Utilization Monitoring

Contraceptive Prevalence Rate (63%)

Unmet Needs (50% under NHTS)

Ordnance and Timely Provision of BHW

Honorarium WaS

H

Sanitary Toilets (86% of HH)

Access to Safe Water (87% of HH)

• Evidence-based all

Hazards Local and

Regional Integrated

Risk Analysis :

(H)Hazards x

(E)Exposure x

(V)Vulnerability

• Impacts to Health

System identified

and communicated

to all staff and

community

members

• Health staff trained

in basic life support

• Prepositioned relief

goods, medical

supplies and rescue

equipment

• Located evacuation

zones, centers, set

routes and protocols

Adaptation drives transformation in individuals, communities, institutions, and societies.

LEA

DER

SHIP

AN

D G

OV

ERN

AN

CE

TRA

NSF

OR

MA

TIV

E C

HA

NG

E

Resiliency-based approach to planning and development

Time: 12 to 36 months Time: 0 to 1 month

Restore operational capacity

Institutionalizing policies, systems and programs on

disaster resiliency

• Immediate post- disaster assessment

• Availability of commodities to address basic needs

• Mobilization of medical services

• Availability of WASH facilities

• Debris and waste clearing

• Psychosocial interventions

• Disease control • Restoration of

logistics and communications

• Repair of health infrastructure

• Coordination mechanisms are established

• Post-disaster assessment

• Risk re-mapping • Re-institutionalize

health information system

• Rehabilitation of public infrastructure, logistics, and communications

• Strengthened health systems

• Completion of leadership and governance trainings

• Implementation, monitoring, evaluation of rehabilitation plans and post-disaster policies

• Operational disaster resiliency strategies and processes per health facility

• Climate- and disaster-resilient Health facilities ,i.e. situated and constructed based on risk-sensitive comprehensive land-use plan and zoning (e.g. no build/hazard zones)

• Resilience-based development and investment (budget) plans for health

• Cloud-based health information system

Relief Phase Adaptation Phase

Time: 1 to 6 months

Recovery Phase

Addressing concerns of vulnerable groups

• Identified interventions

• Disease control • Rebuilding health

information systems • Normalization of

RHU operations • Incentives program • Established

coordination mechanisms for rehabilitation

• Re-establish long-term food security

• Initiate training of leaders on disaster management and resiliency

• Re-establishment of hospital referral networks

Time: 6 to 24 months

Reconstruction Phase

Re-establishment and re-building/ rehabilitation

Emerging Framework of a Resilient Local Health System

Preparedness Phase

Readiness to respond to emergencies

Pre-disaster

Sources: Framework based on inputs from Zuellig Family Foundation and Ms. Antonia Loyzaga, Executive Director, Manila Observatory

THANK YOU.