Operationalizing WHO Health Systems Framework : Imperatives for Sustainable Implementation
Martha B. Cayad-an, MD, MPH, CESO 111Deputy Chief of Party, MindanaoHealth Project
USAID-MindanaoHealth Project
WHO Health Systems Framework
AccessCoverage
QualitySafety
Systems Building Blocks
1. Leadership/Governance2. Health Care Financing3. Health Workforce4. Medical Products and
Technologies5. Information and
Research6. Service Delivery
Improve Health Level and Equity
Responsiveness
Financial Risk Protection
Improved Efficiency
MindanaoHealth Project: Integrated Maternal, Neonatal & Child Health and Nutrition/ Family Planning Project
3
v USAID-funded; implemented by Jhpiego-an affiliate of Johns Hopkins University based in Baltimore, Maryland, USA
v Target Areas: 19 provinces and Cities of Davao, and Zamboanga, across 5 regions and ARMM.
v Project Components:§ FP/MNCHN/AYRH Service Delivery Strengthening§ Increasing Demand for MNCHN/FP Services§ Removal of Policy and Systems Barriers to Service Delivery
and its Utilization§ Strengthening Capabilities of DOHROs and PHOs in Program Development
and Oversightv Overall Goal: Contribute to reduction of maternal and child deaths, and
improvement of family health.
Strengthening/Scaling Gains in Health Workforce
TrainingSupportive
Supervision/ PTE
Certification PhilHealth Accreditation
Capacity building (Training, Supportive Supervision/PTE)Manuals and tools for training and supportive supervision, Coordination mechanisms to mobilize trainers for training and PTE and mechanisms for
DOHRO certification and Philhealth Accreditation (Provider/Trainer)Strengthening/Expanding Centers for Excellence (PPIUD FP Programs in Hospitals)Systems and Guidelines for Recognition of Clinical Practice SitesTraining Information Management Systems – Track distribution, non-practice, organize supportive supervision visits to ensure quality and practice
Increased SDPs with services
Reduction in non-practicing providers
Quality of practiceEquity in distribution of quality trained providers
Health workers satisfaction
Incentive to continue quality practice
PPIUD ClientsReached 2013 2014 2015 2016 TOTAL
IsabelaCity 1 1
ZamboangaCity 22 854 581 520 1,997
Zambo CityMedCenter 22 760 529 520 1,,831
OtherSDPs 94 52 0 146
ZamboangadelNorte 249 400 547 1,196
ZamboangadelSur 2 214 859 376 1,451
ZamboangaSibugay 183 231 267 681
Basilan 2 121 102 106 331
Sulu 6 28 60 94
Tawi Tawi
TOTAL 26 1,628 2,201 1,876 5,731
ExpansionofPPIUDthroughCentersofExcellenceinZamboanga&BASULTA
1,041Total HSPs trained on
PPIUD
75%(227 out of
366)Percent of
Municipalities/Cities with a
PPIUD Provider
Additional624 SDPs (480 public
and 144 private with capacity on
PPIUD)
Philippines – MindanaoHealth Project
SCALING-UP PPFP/PPIUD SERVICES
23,394WOMEN PROVIDED
PPFP/PPIUD SERVICES
From 107 to 731 service delivery
points in 4 years
23,394WOMEN PROVIDED
PPFP/PPIUD SERVICES
• Centers of Excellence as training institutions• Training and supportive supervision • FP program in hospitals• Clinical Practice Sites
INCREASING SUPPLY•• Harmonizing database & progressive profiling
and tracking of women with unmet need• Community-based and hospital based USAPAN
(group discussions) Sessions/Behavioral Change Communication ,
• Partnership – Muslim Religious Leaders - ARMM
GENERATING DEMAND
• DOH Certification and PhilHealth accreditation• DOH Guidelines in Setting up Family Planning
Services in Hospitals• DOH Guidelines on the Recognition of FP
Training Providers• Social health insurance (PhilHealth) coverage
and benefits for women about to give Birth.• Localization of policies and guidelines
SUSTAINABILITY THROUGH POLICY &
FINANCING
Key Strategies and Support Areas
Moving from ACCREDITATION to UTILIZATION of PhilHealth MCP/NCP Reimbursements
Accreditation Use of Reimbursements
MINDANAOHEALTH/Development Partners
• Health Facility Improvements
• EINC/BEmONCTraining
• Assessment of status &compliance to requirements
• Advocacy on use of PhilHealth guidelines
• Draft policies and fund disposition guidelines
• Advocacy through Local Health Board
DOH REGIONAL OFFICE
97%Increase in MCP/NCP accredited
facilities407 in 2013 to 802 in 2016
88%323/365 of LGUs with an LGU
Policy on use of MCP NCP reimbursement in 2016
S
53%Increase in MCP/NCP
reimbursement from PhilHealth(Php 274 M in 2013 to Php 419 M
in 2015)
ource: PhilHealth 2014 &2016 reports c/o HPDP
Better Quality and Use of Data for Decision Making
Data Utilization
Investment Planning
Data Quality Checks
Information Systems
Development
Routine cleaning of FHSIS reports
Tailored analysis and strategic
directions
Use of health systems framework
Improved monitoring and evaluation
82%LGUs conducting data
quality checks
ARMM, 8 Provinces and 36 municipalities with Executive Order
on DQC
Reports from 10 Private implementing partners, Iligan City SDN, integrated in
FHSIS
§ Training of Regional and LGU partners on DQC § Conduct DQCs – initially in public facilities expanding to partner private facilities§ Development of Dashboards using cleaned data/reports§ Use of Dashboards: Program Reviews, Local Investment Planning for Health,
Advocacy meetings
Strengthening Service Delivery Networks
Mapping of Facilities &
Service Network
ID of Entry Points & Options for SDN Service
Delivery Strengthening
Formation of SDN Structures at the DOHRO and LGU levels
Public-Private Partnership
Development
Agreements on collaboration,
identification of priority population,
plan of actions
SDN Strengthening Options / Entry Points Identified
Assessments of Functionality/Oper
ationalization of SDN
Private sector resources mobilized
SDN Referral & Management
Systems
Integrated SDN policies, plans,
resource sharing, referral, M & E
systems
• SDN Operational Guide• Referral Systems Development• SDN Management Structure & Systems
• Trainors Pool at DOHRO and PHO• DOH RO Advisory Committee on SDN• Capacity Building
PhP 7.85MTotal cost sharing generated from 8 SDNs
Lessons Learned§ There are emerging practices worth replicating§ Post-training Evaluation is vital in capacity building § Varied capacities of DOHROs/LGUs on Data and Logistic
Management and Utilization; Health Systems § Demand generation and its links to service provision needs
strengthening § Changes in the political-administrative environment has
impacted continuity of gains§ Gap: National policies/guidelines & appreciation and
localization at Regional and LGU levels
Lessons Learned
§ Health Systems Strengthening requires multi-sectoral and multi-level collaboration
§ Build on existing resources and opportunities; know the situation, strengthen/redirect existing plans, innovate, identify champions,
§ Operationalizing Health Systems Framework is tedious and process-oriented. Balance processes for significant results/outcomes
Recommendations
§ Build capacities of regional, medical centers, and selected provincial hospitals on supportive supervision/post-training evaluation
§ Strengthen skills of primary TA providers (DOH ROs and PHOs) on health systems strengthening, equity-focused approaches, Public-Private Partnership; Data Management
§ Rapid assessment: localization & extent of implementation of national laws, policies, and guidelines
§ Strengthen functionality and coordination across/among existing structures/bodies (ex: NIT/RIT/SDC/RDC/PDC/LHB)
Recommendations
§ Strengthen structures/mechanisms at the SDN level; start with MNCHN gradually expanding to integrate FP, AY, NCD, etc.
§ Document & replicate good/emerging practices; § Improve on-the-job mentoring/field monitoring, with built-in
feedback; data management for action at all levels
Balancing Processes for Significant Results
Trends in Facility-Based Delivery and Fully Immunized Children, By Region, 2012-2016
A generally increasing trend in FBD performance, but FIC is declining except in ARMM