Governance roles and capacities of Ministries of Health Framework:

A practitioner’s perspective

Manuel M. Dayrit MD, MSc

Secretary of Health (2001-2005)

Republic of the Philippines

Adjunct Professor & former Dean

Ateneo de Manila University

School of Medicine & Public Health

Republic Act 11223

UNIVERSAL HEALTH

CARE LAW2019

President Rodrigo Duterte signed the bill into Law on February 20,

2019

Outline

1. Managing 2 transitions (1991-2018)> decentralization > social health insurance

2. Managing transition to UHC (2019 and beyond)> Universal Health Care

4

Socio-demographic profile

Area: 298,170 sq. km

7107 islands

Population: 104.9 million

13th populous country

Rural (55.8%)

GDP per capita: $ 8342.8 (PPP, current)

GDP growth rate: 6.7%

Literacy rate: 96.5%

HDI rank: 113

Governance of a devolved public health system has been a big struggle since 1992 …

It has been a struggle to widen and deepen the coverage of social health insurance.

In 2014, PhilHealth share of Total Health Expenditure was 14%, short of the 30% target set in 1998 (UPecon, 2017).

Senator Aquilino Q. Pimentel Jr. Principal Author, Local Government Code of 1991

9

De jure governance processes

Preparation for and response to changes in

context

Relationship management

Values propagation and goal alignment

Implementation of de jure responsibilities

Resilience and relevance

Leadership and diplomacy

Values management

Wo

rkload

Cap

acity

Ro

le Cap

acity

Structu

ral Cap

acity

Perform

ance C

apacity

Sup

ervisory C

apacity

Person

al Cap

acity

GOVERNANCE ROLES PERFORMANCE AREAGOVERNANCE CAPACITIES

Department of Health, Philippines

Universal Health Care means EVERYONE WINS!

Patients receive effective

care without financial

hardship

Providers earn a positive

margin for efficiently

treating patients and

producing good outcomes

Suppliers of drugs, devices, and diagnostic tests that improve

outcomes and/or lower total costs find their products incorporated into

the treatments used by effective and efficient providers

Payers (private insurers, governments, or

self-pay individuals) able to shape provider

behavior towards efficiency and

effectiveness

Physicians can earn predictable income

and pursue career paths

Will UHC Law enable effective ways of

governance? Among its provisions are:1) province- and city-wide health provider

networks

2) PhilHealth as strategic purchaser

3) new ways to collaborate with private sector

Department of Health, Philippines

SPECIAL HEALTH FUND-WFP

-Allocation Guidelines

Provincial Health Office

Provincial/District/City/Mun. Hospitals

Subsidiary Ledgers

City Health Offices (CCs) Health Centers BHS

Municipal Health Offices Health Centers BHS

Private ProvidersMOA

Provincial Budget for Health

Human Resources

Operations

Appropriation OrdinanceLIPH

PhilHealthIndividual-based ServicesPopulation-based Services

DOH Grants

ODA, NGO and FBO

Grants/Donations

LIPH

Department of Health, Philippines

PhilHealth Purchasing Role:

Three Complementary Decisions

Identifying the interventions or

services to be purchased

Choosing

service providers

Determining how services will

be purchased

How quickly will new capacities be developed?

1) Upgrade primary care facilities nationwide

eg. Rural Health Units (RHUs)

2) Produce primary care providers fit

for purpose

To strengthen primary care, RHUs need to be upgraded and better supported.

Department of Health, Philippines

Progressive Realization of Universal Health Care

2019UNIVERSAL

population coverage

2028COMPREHENSIVE

service coverage

2022HIGH support value

(government as a

single purchaser)

2030Full Support Value

Pool of Funds

Summary and concluding statement:

“Ministries typically undertake an array of de jure roles, including

• the formulation of a strategic vision for health,

• the balancing of centralized and decentralized authority for decision-making,

• the management and implementation of policies, programs and interventions, regulation and oversight, and

• monitoring and evaluation, notably of performance, quality and equity”

Section 1.2 WHO Working Paper on Governance