Story Line

ALBAY HEALTH
STRATEGY  Albay MDG Achievements
towards
SAFE AND SHARED  Albay Health Strategies
DEVELOPMENT
MDG – make it a
goal, the rest follows
MDG is all about
dignity.
Engaging
dignity, Empoweri Governor Joey Sarte Salceda
ng dignity Province of Albay
Ennobling dignity

MDGs are achieved ahead of 2015 exc. MDG 2 and 7

Goal Indicator Bicol Region Albay Achievements on MDG, 2009

1 Poverty Incidence M H
Proportion of 0 - 5 years old who are malnourished
Subsistence Incidence H H 25
24%
Underweight (IRS) H H
2 Participation - Elementary L M 22
Cohort survival - elementary M L 20

3 Gender parity - elementary H H

4 Under-five mortality H H
16
Infant mortality H H 15

Proportion of fully-immunized children M H

5 Maternal mortality rate L H
Contraceptive prevalence rate L M 10

Condom use rate L M

6 Deaths due to TB L H
Malaria positive cases H H 5

7 Household with access to sanitary toilets H L

Household with access to safe drinking water H H
0
Legend:
1992 2009
L low probability H high probability

M medium probability no data

Achievements on MDG, 2009 Achievements on MDG, 2009

Maternal Mortality Ratio Infant Mortality Rate
35
140
133 33
120 30

100 25

90/ 100,000 LB
80 20

60
59 15
17/1,000 LB
12
40
10

20
5

0
1998 2009 0
1998 2009

1
 Achievements on MDG, 2009 Achievements on MDG, 2009
Proportion of births attended by skilled health personnel
Proportion of facility-based deliveries
100
100

90 90
90
88
80% 80 80%
80
70
70
60
60
50
50
40
40
30
29
30
20

20
10

10 11
0
1998 2009
0
1998 2009

Achievements on MDG, 2009 Achievements on MDG, 2009

Contraceptive Prevalence Rate Child Mortality Rate
65% 30
35
28
27/1,000 LB
30 25
29

25
20

18
20
15

15

10
10

8
5
5

0 0
1990 2009 1998 2009

Achievements on MDG, 2009 Achievements on MDG

Fully-Immunized Children TB Mortality Rate
98
60

96 96
95% 50
94
•44/100,000
pop
92
40

90

30
88

86 86 20

84
10

82

80 0
1990 2009 1997 2009

2
 •Achievements on MDG •Achievements on MDG
Case Detection Rate for TB Cure Rate for TB
120
90

•85%
80
100

70

80 60

•70% 50
60
40

40 30

20

20
10

0
0
1999 2009
1999 2009

•Health Outcomes Albay MDG Strategy

National National Performance Gaps/
Make MDG a goal
Indicators
Average (2006) Target (2010) ALBAY (2009) Gains Ordain policies and Give it a Budget
Intensified Disease Prevention and Control: TB
Execute programs and projects
Mortality (per 100,000
28,000 44 26 (18)
pop) Build institutions
TB Case Detection
Rate, % (NTP Register)
72 70 100 30 Nurture partnerships
TB Cure Rate, % 81 85 81 (4)

Albay Development Goal

Vision
1. Shared development: operationally defined as:
 Safe and shared development compliance with MDG and improvement in HDI.
 Albay as most liveable province known for good Climate change and disaster risks are key
education, good health and good environment obstacles to MDG and HDI.
to secure safe and shared development
2. Safe development: Disaster risk reduction and
 Vision for Health: longer life expectancy
expectancy,
li
climate action
i are bbuilt-in
il i elements
l off the
h centrall
wellbeing in itself, wellbeing for labor
productivity economic strategy, not a contingency plan.
a. Disaster risk reduction is guided by Hyogo
 Albayanos as healthy and happy, well-educated,
Framework for Action
well-trained
b. Climate action is guided by UNFCCC.
 Low-rise, low-carbon, low-energy intensity =
green development model 3. Structural governance x safe development =
shared economic growth.

3
 Average annual losses to infrastructure and agriculture in 10 most vulnerable
POVERTY AS AN INITIAL CONDITION IS A MAJOR provinces vs. their 2006 local calamity funds
OBSTACLE TO HEALTH OUTCOMES
p
Poverty Threshold (in Poverty Incidence Am ong Fam ilies (%) Magnitude of Poor Fam ilies
Region/Province Pesos) Estim ates (%) Coefficient of Variation Estim ates Coefficient of Variation
2000 2003 2006 2000 2003 2006 2000 2003 2006 2000 2003 2006 2000 2003 2006

PHILIPPINES 11,458 12,309 15,057 27.5 24.4 26.9 1.6 1.3 1.3 4,146,663 4,022,695 4,677,305 1.6 1.4 1.3

Region V 11,375 12,379 15,015 45.3 40.6 41.8 4.2 3.6 3.5 407,176 383,625 422,278 4.7 4.3 4.3

Albayy 12,144 12,915 16,128 40.3 34.4 37.8 11.5 8.1 8.4 83,398 76,200 88,676 11.2 8.5 10.1
Camarines Norte 11,505 12,727 14,854 52.7 46.1 38.4 10.9 14.4 18.8 50,670 44,874 39,421 11.8 14 22.6
Camarines Sur 11,054 11,873 14,634 40.8 40.1 41.2 9.3 7.0 5.6 120,762 121,936 134,599 11.8 7.7 6.6
Catanduanes* 11,587 11,815 13,654 43.9 31.8 37.3 10.9 10.3 22.1 18,541 13,604 16,999 10.4 29.3 33.3
Masbate 11,019 12,504 14,248 61.3 55.9 51.0 5.8 •Albay
5.7 6.5 poverty
83,660 81,804 80,512 5.9 7.4 8.0
incidence at
Sorsogon 11,146 12,452 15,687 41.4 33.7 43.5 7.3 10.3 5.4 50,146 45,207 62,071 7.6 14.5 5.6
37.8%, while
* Coefficient of Variation (CV) of 2006 poverty incidence is greater than 20% lowest in
region, remains
high

•19 •Source: World Bank

Objectives for Health, 2011

Net resource outflow to cities
1. To decrease maternal mortality ratio from
59/100,000 to 50/100,000.
2. To decrease infant mortality rate from
10/1,000 to 8/1,000.
3. To decrease child mortality rate from
18/1,000 to 15/1,000.
4. Increase FIC coverage from 84% to 88%.
5. To increase CPR from 33% to 40%.

•21

Objectives for Health, 2011 Objectives for Health, 2011

6. To increase voluntary blood donation to 1%
of the provincial population. 12. To reduce the incidence of STI/HIV by 2%
points annually.
7. To reduce soil-transmitted helminthiasis to
below 50% among children. 13. To eliminate incidence of filaria to zero.

8. To reduce prevalence of malnutrition from 14. To increase multi drug administration for
19% to 17%. filariasis control by 2%.

9. To reduce TB mortality rate by 3%. 15. To reduce rabies incidence from 5/million
population to 2.5/million population.
10. To sustain TB case detection at 90%.
11. To sustain TB cure rate at 85%.

4
 Objectives for Health, 2011 Total Health Budget
2007 - 2010
16. To sustain leprosy prevalence at less than 24% of provincial
1/10,000 population. 180,000,000 budget
161,373,128
17. To increase leprosy cure rate by 2%. 160,000,000

135,673,326 134,566,903
140,000,000

18. To reduce the mortalityy and morbidity

y of 120,000,000
120 000 000
101,669,158
lifestyle-related diseases by 2% annually. 100,000,000

19. To increase proportion of HH with access to 80,000,000

safe drinking water from 94% to 95%. 60,000,000

40,000,000

20. To increase proportion of HH with sanitary 20,000,000

toilets from 69% to 89%.
0
2007 2008 2009 2010

Source: PBO, Albay

Resources for Institutionalized MDG Albay MDG Supercom

Office
• Program office: AMDGO
– created by ordinance in 2009 with regular provincial budget
– Oversight to MDG performance and secretariat to MDG
Supercom
– Management MDG projects
• Manages
g relocation p
program
g
• Social assets programs esp livelihood like SEA-K, ETODA
• CRABS or coastal and marine resources management
• AIDS Council – HIV/AIDS advocacy

• Sources of Funds
– Regular allocation from the annual provincial budget (IRA)
– Intermittent but steady flow of technical and logistical assistance
from NG agencies, UNDP and other UN offices, INGOs, NGOs
for capacity building and skills training

•2 •2

Provincial Initiatives Initiatives

• 2011- P178m (exc PHIC) for health PS and
MOOE essentially for hospital care and public Universal Phil Health Coverage: 2007-2010
health
Number of Families Enrolled
• Universal health coverage at P59m pa
173,262
180,000
• Acquisition
q of 57 ambulances 158,000
160,000

• 19 BeMoNCs 140,000 122,600

120,000

• Modernization of provincial hospitals: Ziga (80- 100,000

bed) and Duran (60-bed) 80,000

60,000

• Modernization of BRTTH (300-bed) 40,000

18,510
20,000

• Merger of BRTTH, Ziga and Duran into a 500- 0

2007 2008 2009 2010
bed capacity Source: PSWDO, Albay

5
 •BRTTH: PHIC REIMBURSEMENT Ambulance Deployment
FOR 2010
33%
•RHUs & BEmONC
•2
•Hospitals
•2
54% •6

•2
•6
•2
2
•3 •1

13% HOSPITAL INCOME •4

•1 •2
MEDICINES •1
PHIC REIMBURSEMENTS •2
PROFESSIONAL FEE •2
•2 •4
•2
HOSPITAL
INCOME 67,403,506.73 •4
•3
DRUGS AND •2 •1
MEDICINES 16,929,387.25 BRTTH earns P127m •1
•2
PROFESSIONAL
FEES 42,339,658.00
from PHIC vs P59m
TOTAL 126,672,551.98
by province
•Source: PHO, Albay

Health Facilities: 15 BEmONCS

Medical Mobile Assets •Hospitals

•BEmONC

•RHUs/CHOs

•Source: PHO, Albay

JBDMH JBDMH

6
 JBDMH JBDMH

ZIGA Memorial District Hospital ZDMH

ZDMH ZDMH

7
 ZDMH ZDMH

ZDMH •2007 - Renovated under the B-CARE project

•BRTTH Main Building

•Salceda Wing / Philhealth/Surgery Ward

•Out-Patient Department

•Emergency Room

8
 •Maintenance Building •Laundry
•Services Offered
•Emergency Room •Trauma Unit

•Dorm •Isolation Ward

•Philhealth Ward •Surgery Ward

•OB-Gyne Ward •Private Ward •Delivery Room •CT Scan

•Pedia Ward •Medical Ward •Dialysis •ECG/EEG

•Cath Lab •2D Echo •CCU •ICU

•Ultrasoud •X-Ray •NICU •PICU

9
•Operating Room – Room 1 - 4 •Laboratory

Prov’l Gov’t of •Pharmacy

Albay, project of
•Electric Power Substation
Gov. Joey Salceda

•Dietary •Pastoral

•Rehab Center •BRTTH and Beyond

Establishment of Regional Oncology Center (P400m)

10
•Proposed Facilities Health Capital Expenditures
Committed by Number of
Amount Received Received by the
Source Source (from Amount Utilized Recipient
•1 . Waste and Infectious Treatment Plant•5. ER and Trauma Unit AOP)
by the province province (in kind)
Municipalities
•2. Communicable Disease Building •6. Bicol Cancer Center PLGU 134,566,903.00 134,566,903.00 134,566,903.00 18 M/C LGUs
•7. Bicol Regional Blood Center M/C LGUs (15
•3. Extension of PHIC ward 188,470,320.51 170,905,125.99 18 M/C LGUs
MLGUs/ 3 CLGUs)
•4. Diagnostic Center •8. Commercial Building EPI vaccines, Vit.
DOH-regular fund 24,372,850.33 24,372,850.33 A, antihelminthics, 24,372,850.33 18 M/C LGUs
TB drugs, Iron

DOH- special fund

•7 >MNCHN 2,419,320.00 2,419,320.00 18 M/C LGUs
•1 > start-up 2,000,000.00 2,000,000.00 18 M/C LGUs

•3
3 •2 > HEMS 9,100,000.00 9,100,000.00 18 M/C LGUs

•8 > Health Facilities

Dev't/RAT Plan
97,608,000.00 71,191,000.00 71,191,000.00 6 District Hospitals

> Health Systems

2,000,000.00 2,000,000.00 18 M/C LGUs
Dev't
> RHU/BHS Facility
7,350,000.00 5,900,000.00 8 M/C LGUs
Devt/Eqpt
Others:

•4 > USAID 134,823,414.00

Technical
assistance
18,600,000.00 18 M/C LGUs
> AECID 43,000,000.00 24,000,000.00 24,000,000.00 9 M/C LGUs
> capitation (for
•6 •5 CSR + drugs)
18,473,296.71 5,000,000.00 18 M/C LGUs

drugs, medicines &

> PCSO 7,984,000.00 7,984,000.00 18 M/C LGUs
ambulances
TOTAL 630,191,487.84 296,107,370.04 460,439,199.32

AMDGO
• Program office started as Ayuda Albay in 2007,
renamed as Albay Mabuhay Task Force to manage
the cluster approach to Reming rehabilitation
• Reorganized in June 2009 as Albay Millenium
Development Office or AMDGO to (a) monitor and
oversight
g MDG p progress
g ((b)) coordinate MDG
programs within functional units and program
offices of the provincial government and with NGAs,
NGOs and INGOs and (c) manage social assets
program of the province including SEA-K, E-TODA
• Staff complement of 15 personnel with a senior staff
(rank Assistant Department Head)
• 2010 organic budget of P2m. for Listening

Strategies on Maternal Health Care Strategies on Maternal Health Care

1. Formulation of the PIPH. (Province-wide
Investment Plan for Health) inc MNCHN 3. Maternal Deaths Review
• Reviews maternal deaths
(Maternal, Newborn and Child Health Care)
• Give recommendation and feedback to LGUs with
Program maternal deaths
2. Advocacy Campaign: Birth Plan/FBD by Skilled • Maternal death reporting
Health Worker
• Bench Conferences 4. Facility based deliveries (FBD):
• Buntis Congress • Barangay Health Stations
• Buntis Pageant • Lying-In Clinics
• IPCC (Interpersonal Communication and Counseling)
• Birthing homes
Training of Health Personnel and BHW’s on MNCHN
• Mothers’ Classes • Rural Health Units
• Radio announcement/ plugging • Hospitals (public or private)
• Health Education Classes
• Establishment of breastfeeding stations in private and
government institutions including evacuation centers
5. REB (Reaching Every Barangay)

11
Strategies on Maternal Health Care
6. Rationalization planning and health facility
mapping
• Upgrading of CEMONC facilities. (Comprehensive
Emergency Obstetric and Newborn Care)
• Construction of BEMONC facilities. (Basic Emergency
Obstetric and Newborn Care))
• Hiring of Staff Complement to fill up vacancies and/or
augment personnel
7. Organization of Women’s Health Teams in every
barangay:
• Pregnancy tracking & birth planning
• Reporting of maternal deaths
• Referral of pregnant women to deliver at health facility
• Stewardship to the family of the pregnant mother
Strategies on Maternal Health Care
10. MCP Accreditation of LGU’s birthing facilities
(Maternity Care Package)
11. Enact ordinances on FBD and User’s Fee
12. Sustain MBDs (Mass Blood Donation)
in all LGUs.
Strategies on Family Planning
4. Planning workshop to draft plan to
operationalize modified CDLMIS
5. Capacity Building
• FP-Competency-based
FP Competency based training
• NSV Training ( non scalpel vasectomy )
BTL Training ( bilateral tubal ligation)
• Training on FP Counseling for health personnel
• Training of health personnel on IPCC
Strategies on Maternal Health Care
8. Capacity building
• NBS training (Newborn Screening)
• ENC training (Essential Newborn Care)
• LSS training (Life-Saving Skills)
• BEMONC training (Basic Emergency Obstetric and
N b
Newborn C
Care))
• WHT training (Women’s Health Team)
• CMMNC training (Community-Managed Maternal and
Newborn Care)
9. Sustain Universal Phil Health
Enrollment/Coverage
Strategies on Family Planning
1. Establish a system of monitoring FP users with
private providers and other stakeholders
• inventory of FP private providers & other stakeholders
in the municipality/ city
• conduct one day orientation to identified FP private
providers & other stakeholders
p
2. Validation of current FP users (data cleaning)
3. Review/assess CDLMIS of LGUs (Contraceptive
Distribution, Logistics, Management Information
System)
Strategies on Family Planning
6. Provision of FP Commodities
• Targeting, costing and forecasting FP commodities
requirements based on validated current users
• Procurement and Provision of 50% of FP commodities
requirements (Pills, DMPA, Condom, NFP to LGUs
• Provision of medicines and supplies for BTL & NSV to
District Hospitals providing surgical sterilization
12
Strategies on Family Planning Strategies on Family Planning

7. Intensify and Improve FP Promotion and 8. Enactment of CSR+ Ordinance (Commodities

Education Integration of FP in EPI (Expanded Self Reliance)
Program on Immunization) • Advocacy with the LCEs/SBs for CSR+ ordinance
• Conduct regular RPM ( Responsible Parenting • One day orientation with LCEs, MHOs, LFC re:
Movement) formulation, CSR implementation and drafting of
• Conduct
C d t regular
l AHYD (Ad(Adolescent
l tH
Health
lth and
dYYouth)
th) CSR+ ordinance
Development) classes in high schools • Training of SB/SP Committee on Health on Evidence-
• Conduct regular PMC (Pre-Marital Counseling) based legislation
• Conduct FP counseling to new acceptors and follow- • Present proposal to the PHB and seek SP Committee
up by BHWs of FP current users & defaulters on Health Chair’s sponsorship
• Conduct ICV (Informed Choice and Volunteerism) • Strengthen 2-way referral system for FP (BTL-NSV-
• Conduct Men’s Congress (Usapang Macho) IUD) Provision of referral form

Strategies on Family Planning Strategies on Nutrition Program

9. Monitoring and Supervision 1. Operation Timbang (OPT)
• Regular visits to 18 LGUs monthly • Identification of malnourished children thru mass
• Revisit CSR Plans weighing of 0-71 mos. old children
• Collection, recording and reporting of FP activities
through FHSIS (Field Health Services Information 2. Micronutrient supplementation
System) • Provision of Vitamin A capsules & iron
supplementation to:
a. infants
b. preschool children
c. pregnant women
d. lactating women
e. sick children

Strategies on Nutrition Program Strategies on Nutrition Program

3. Food Fortification 6. Accelerated Hunger Mitigation Program

• Monitoring of fortified food products in the markets, • Milk feeding (tie up with NDA)
sari-sari stores, groceries & household utilization of • Supplemental feeding
iodized salts • Distribution of growth monitoring charts
• Pabasa sa Nutrisyon Classes
4 Local Level Nutrition Program Implementation
4. • Promotion of child rearing practices during GP
•Local Plan of Action for Nutrition at the municipal and • Distribution of IEC materials
barangay level • Feeding during disasters
• Breastfeeding initiatives
5. Capacity building
• IYCF Infant and Young Child Feeding 7. Monitoring and supervision
• CGS (Child Growth Standard)

13
Strategic Imperatives
 Policies
 Institutions Other Provincial
 Public-Private Partnerships Initiatives
 Resources
 Champion

Initiatives
Initiatives B. Safe Hospitals:

A. Beneficiary-led Procurement :  Upgrading of structures and equipment of

Provincial Hospital System
 Universal Phil Health Coverage: 2007-2010
 Modernization of the Bicol Regional Teaching
and Training Hospital [BRTTH]
Universal Anti-Rabies Immunization
 Rationalization Plan & Health Facility Mapping

 Establishment of BEMONC/CEMONC facilities

 Merging of district and regional hospitals

Initiatives Initiatives
C. Partnership with NGOs:
D. Partnerships with LGUs:
 Health Program Management (USAID,
PTSI, Intervida, MIDAS, WHSMP2, CSCDI)  Inter-local Health Zones [ILHZ]

 Health Promotion (PRRM, PBSP)  Commodity Self-Reliance Strategy [CSR]

 Discounted Medicines (Pfizer, RNMD)  Botika ng Barangays [BnBs]

 Health Infrastructure (AECID, PODER,

WHSMP2)

14
 Initiatives Initiatives
E. Disaster Risk Management - Health:
Ambulance Project: Provision of
Preemptive Health Care – Medical Missions ambulances (57) to:
targeted at APSEMO identified vulnerable areas
 Provincial Hospital System
Albay Health Emergency Management [AHEM]
 Rural Health Units & C
City Health Off
Offices
• Emergency Paramedic Training Unit
 Basic Emergency Obstetrical and Newborn
[EPTU] – in cooperation with the Bicol
Care Facilities
University [BU], BRTTH &n DOH
• Operation Centers [OPCEN] in all three  Operation Centers
districts  Geographically-Isolated and
• Evacuation Camp Management
Disadvantaged Areas [GIDA]

Strategic Priorities: Strategic Priorities:

Public Health Hospital
Strategic Priorities Funding Gaps Strategic Priorities Funding Gaps
Health Care Waste Management 40 M Merging of ZMDH and JBDMDH 200 M
under BOT to BRTTH
Establishment of another 9 45 M Upgrading of PDMDH and PDH 50 M
BEMONC facilities into a secondary (inc. safe
Renovation of 30 BHS 15 M hospitals)
Establishment of PhilHealth Desks 2M Conversion of VMH into a 5M
Birthing Home
Capacity Building 10 M
Modernization of BRTTH: 240 M
Provision of Sanitary Toilet 40 M
Oncology Center under BOT
Strengthening of Public Health 30 M
TOTAL 495 M
Program Management
GRAND TOTAL 677 M
TOTAL 182 M

MEET Albay
MEET Albay EDUCATIONAL MEDICAL ECO-CULTURAL TOURISM
VISION Bicol University Bicol Regional Albay as prime Albay as hub to
 Medical as first class
higher education
Training and
Teaching Hospital
destination for culture
and nature
tourist
destinations of
institution as wellness Bicol
 BRTTH modernization Center
SUPPLY Bicol University Province to Magayon Festival Southern Luzon
SIDE modernization gatekeep thru International
 Educational Bicol University
facilities
upgrading
Albay History Project Airport
School of Mayon Resort House Pantao Port
 Bicol University modernization M di i
Medicine Bi l University
Bicol U i it Ligñon Hills Albay Donsol
Medical Center
Mayon Trek Access Roads

 Eco-cultural Tourism Wildlife Park Andaya Highway

DEMAND AHECS Universal
 Magayon Festival SIDE
Seek more
PhilHealth
scholarship funds
 Infrastructure Development Responsible
for Albay studies
Bicol University DOH/BRTTH DOT/NCCA DOTC, PPA
 Transportation facilities by National Government Agencies
EQUAL PHO PTCAO/ACAC PPDO, PEO

 Tourism facilities by private sector AHECS – Albay Higher Education Contribution Scheme EQUAL – Education Quality for Albayanos

15
 Health Sector Reform Goal for Health Sector
Framework

 Service Delivery Health for All

Capacity Building for:
 Governance
 Better
B tt h health
lth outcomes
t
 Regulation  More responsive health system
 Equitable health care financing
 Health Care Financing
Opportunity-seeking for:
 Medical tourism

for Listening

16