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Chapter INTRODUCTION 1
1.1 Background/Rationale Health facilities are very important institutions for the economic and social wellbeing of society. Their curative and rehabilitative functions and a share of preventive mission as well, enable them to restore individuals to being productive members of society and fully enjoy the benefits that can be derived from it. The success of health facilities is therefore essential to attaining health sector reforms as they are integral part of healthcare delivery system in the country. This success is highly dependent on the availability of health facilities that are adequately equipped and supplied with medicines, and providing quality specialized services that are readily available and reasonably affordable. Since the hospital system is composed of government and private hospital sectors, with the latter generally perceived as superior in quality aspects, at par with government health facilities on convenience and location, but not as good on cost aspects, the interface between them needs further definition and their collaboration strengthened. Thus, private health facilities got significantly higher satisfaction or appreciation ratings than government. On the whole, LGU-owned health facilities are characterized as: poorly equipped, poorly staffed, and congested in the context of a very inadequate hospital networking and patient referral system with heavy reliance of direct national and local government subsidies, and uncoordinated implementation of public health programs in hospitals. Thus, past and current reform efforts are focused on developing and upgrading systems among government hospitals to make them more responsive to their clients’ needs and expectations. At the macro level, reforms are focused on addressing the disparity between public and private health facility performance as well as rural-urban inequities through the rational upgrading of critical capabilities of selected LGU and DOH hospitals, expanding hospital financing mechanisms, restructuring LGU hospitals into a corporate set-up, integrating public health programs into hospital services, and developing and/or improving hospital management systems, among other reform measures. 1.2 Legal Bases and Mandates

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The Philippine Constitution under Article II, Section 15 thereof provides that the State protect and promote the right of health of the people and instill health consciousness among them. In promoting people’s health, government must operate health facilities primarily for curative and rehabilitative treatment and secondarily for preventive care, as privately owned hospitals cannot alone provide the much needed medical services and facilities in terms of access by the poor, thereby filling a void in peoples health needs, as well as, increasing accessibility to hospital care and services. Thus, addressing the needs of government hospitals in terms of its facilities, equipment and human resources are current imperatives of health sector reforms. 1.2.1 The Health Sector Reform Agenda

The Department of Health (DOH) has begun implementing the health reforms under its Health Sector Reform Agenda (HSRA) in selected cities and provinces in the country. The HSRA is the framework of the major strategies, organization and policy changes, and public investments to improve the country’s hospital systems, public health programs, local health systems, health regulatory systems and health financing systems. Considering that the overall reform process which covers a comprehensive agenda such as the HSRA takes some time to be fully implemented at a national scale, the DOH set up so-called convergence sites. The convergence sites were chosen based on the strong interest of local executives and their level of commitment on health, particularly in establishing dynamic health systems. Their number was defined by the capacity of the DOH and PhilHealth to provide enabling resources. The first batch of convergence sites are located in Pangasinan, Nueva Vizcaya, Bulacan, Pasay City, Capiz, Negros Oriental, South Cotabato, Misamis Occidental, Palawan, Southern Leyte, Agusan del Sur, Baguio City and Ifugao. In addition, twenty-one more convergence sites were identified as roll-out sites (second batch) including the province of Zamboanga del Sur. The reforms being implemented in convergence sites cover various aspects of the five key areas identified in the HSRA. For instance, the hospitals in the convergence sites are now implementing programs to improve management systems and quality of services. They are also pursuing measures to increase and retain revenues they generate to
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augment their budgets. 1.2.2 The National Objectives for Health (NOH)

The DOH has crafted the National Objectives for Health (NOH) for 20052010. The NOH, the road map for the health sector in the medium term, lays out the health status of the country, presents the health objectives in the near term and identifies the means by which to realize the objectives. 1.2.3 The “Fourmula One” (F1) for Health

The Fourmula One (F1) for Health is the guiding implementation framework for health sector reforms during the second half of this decade. Health interventions will be implemented as a consolidated package, backed by effective management infrastructure and financing arrangements. The entire health sector (public and private, national agencies, LGUs, the donor community and civil society) will be engaged in the implementation of health reforms. F1 for Health is intended to achieve three main goals: 1) better health outcomes, 2) more responsive health system, and 3) more equitable health care financing. The Five-Year Province-wide Investment Plan for Health of Zamboanga del Sur (PIPH-ZDS:2008-2012) focuses on addressing challenges in the health sector under the four reform areas of the Health Sector Reform Agenda (HSRA) being implemented through the F1 Framework. The Health Facilities Development Program is a among the major interventions under the Service Delivery Component, which include Facility Upgrading for Hospitals and Health Human Resource Provision and Capability Building, among other program/projects/activities (PPAs). 1.3 Current Issues on Public Hospital Management and Performance

Based on certain studies, the need to reform major components of the management practices of government hospitals appears necessary. These include practices on planning, budgeting for capital expenditures and for operating expenditures, purchasing, pricing, personnel policies and management, as well as control systems. Observations and comparisons made on management practices and performance of government and private hospitals point out that the system under which government hospitals are operating, that is subsidized by public funds, leads to inefficiencies. Such that under heavy resource constraints,
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government hospital managers must undergo intensive training on essential tools of management coupled with excellent leadership skills and appropriate attitude toward the job. Studies indicate that autonomy in hospital budgeting and funding may also prove advantageous in terms of economizing hospital operations given scarce financial resources. Under the present administrative structure, planning in local public hospitals must take into consideration the involvement of other key players outside the domain of the LGU by involving them and taking in their inputs and/or soliciting resources in order to augment limited budget. This could be in the form of joint venture undertaking between the government and the private sector. A critical factor though is the identification of private sector groups whose motivation is not solely for profit but also a strong interest and commitment to providing best medical care to the community. Results of studies on hospital management and performance suggest that public health facilities can be efficiently operated under “private entity” mode with government representation in the board as a minority owner. In this set-up, public hospitals can accordingly run efficiently under market conditions with full private incentive systems for its staff and employees and pricing. Under the scheme, the government share of the profits may fully cover the cost of about 25 percent of hospital’s occupancy which can offset the cost for charity patients; thus, the LGU will not have to make allocations to cover the cost of rendering services to charity patients. 1.4 Needed Hospital Sector Reforms

To address many challenges that still remain for the health sector, the agenda for health sector reforms have been developed by the Department of Health (DOH). The Health Sector Reform Agenda (HSRA) describes the policies, public investments, and organizational changes needed to improve the way health care is delivered, regulated, and financed in the country. Specifically, the HSRA also seeks to provide fiscal autonomy to government hospitals. The conversion of government hospitals into corporate entities will promote fiscal autonomy by allowing them to collect socialized user fees. This move will take a great chunk off the DOH's and LGUs’ yearly appropriation for hospital operations. Thus, the government could use this savings to finance preventive public health programs. However, there is a need to enhance the capacities of government hospitals such as their diagnostic equipment, laboratory and medical staff to effectively exercise fiscal autonomy. Such investment must be cognizant of complimentary capacity provided by public-private networks. Most importantly, safety measures shall be carefully put into place to protect the interest of the indigents such as enrolling them in the National Health Insurance Program (NHIP).
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Zamboanga del Sur Province

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Though it is gifted with mountains. 2.1 The Province Zamboanga del Sur province is located in the Zamboanga Peninsula Region in the western part of Mindanao. Misamis Occidental to the northeast. Republic Act 8973 embodies the legal creation of the said province. one (1) city with 369 barangays while Congressional District II comprises 15 municipalities with 312 barangays. The mother province is now left with 26 municipalities and one city with 681 barangays. the city’s coastal barangays and those of its neighboring municipalities are considered high-risk areas particularly on tsunamis and earthquake-related calamities and disasters. Congressional District I comprises 11 municipalities. Zamboanga Sibugay to the west. Its vast plains which are constantly flooded during the rainy season contribute to the further spread of schistosomiasis in Salug Valley. Pagadian. two (2) Congressional Districts have been left. All in all. and Lanao del Norte to the east. it is vulnerable to disease transmission from its neighbors. It lies along the earthquake belt. wet lands in some areas makes Avian Flu a threat to its inhabitants. The province borders Zamboanga del Norte to the north. Having common borders among the four (4) provinces previously mentioned. while. and Capillariasis. Filaria. To the south is the Moro Gulf. thus. After the sub-division of Zamboanga del Sur into two (2) provinces.Provincial Health Facility Development Plan 2008-2015 Chapter HEALTH SECTOR SITUATION IN ZAMBOANGA DEL SUR 2 2.2 Demographic and Socio-Economic Trends Zamboanga del Sur Province Page 6 . Its inhabitants voted to create a new province out of the Third Congressional District-named the Zamboanga Sibugay Province. it has 26 municipalities and one (1) city with a total of 681 barangays. forestlands and rivers. Political developments in February 2001 saw another major change in the territorial jurisdiction of Zamboanga del Sur. the province’s capital city. it makes the province endemic to Malaria. is the center of commerce and the seat of provincial government and regional offices.

key road sections still need to be upgraded. Ethnic diversity is considered to be one of the most important elements in understanding the province's development potentials as well as its problems. while. The Pagadian Domestic Airport is the province’s gateway to key growth centers in the country. hence. The congestion and pollution in urban areas are harmful to health. In remote communities.74 percent. Fishing provides the second major source of livelihood. Piracy. shelter. sanitation and education. At the said rate. the province’s population density was 204 persons per sq.and deaths due to vehicular accidents are also rising.28 percent which is lower than the previous growth rate (1995-2000) at 1.Provincial Health Facility Development Plan 2008-2015 In the span of seven (7) years (2000-2007).477. cases of injuries. Rural-to-urban migration and rural-to-rural migration put so much pressure on providing basic social services like health care. However. the Pagadian Sea Port also serves as the province’s gateway to the BIMPEAGA. water. respiratory infections and drowning. The male/female ratio in 1995 was 104:100 while in year 2000.278 registering a growth rate of 1. filariasis and capillariasis.km. especially those servicing the network of basic health and medical facilities. The province is shaped historically by various migration patterns with the Subanen people being the longest established group.147 to 914. and even to Schistosomiasis. This was followed by the Muslims and then by the Visayans. the population of the province increased from 836. Agriculture. its major economic activity. exposes farmers to poisoning due to predominant use of pesticides and fertilizers. The province is now directly linked to the trading hub of Mindanao–Davao City via the newly-constructed Pagadian–Cotabato National Highway. Other notable migrations came in later adding Zamboanga del Sur Province Page 7 . the people’s health is affected by difficult access to health services and presence of locally endemic diseases like malaria. These trade routes are possible entry routes of smuggled poultry and poultry products from Avian Influenza (AI) infested Southeast Asian Countries. A number of provincial roads are already improved (concreted) providing all weather access to key production centers and markets. the province is expected to double its population in year 2054. Roads provide the basic transport infrastructure.36 km2. it was 103:100. With a total land area of 4. in 2007 from 187 persons per square kilometer in 2000. blasting and natural forces make fisher folks prone to injuries.

Families are closely knit and loyalties to clans are common features. Peace and order problem is also a factor that brought about high incidence of injuries and accidents. Zamboanga del Sur Province Page 8 .Provincial Health Facility Development Plan 2008-2015 to accelerate development of the area. Philippine National Police (PNP) needs to be done.75 per 100. identifying potential interventions for injury prevention. however. These are the Chavacano. hence documentation of fatal and non-fatal injury outcomes are obviously needed. This relationship. lack of knowledge on road safety. There is no existing injury surveillance system. One in five (5) deaths in the province is due to injuries. which is somehow reflective of the overall problem of injuries in the Philippines. The diversity in culture and mobile living tradition of Subanens influence the health-seeking behavior of the people. has alarmingly threatened ZamboSurians over time. births. the present leading cause of death in the province. This is attributed to inadequate road signs. 2.3. lack of street lights and driving under the influence of alcohol.3 Vital Health Indicators Despite considerable health sector reforms being introduced by government for the past 30 years including the devolution of health service delivery function to local government units.000 in 1989 to 36. from 28. lack of sidewalks and pedestrian lanes.32 per 100. provides a strong support system especially during deaths. as well as. poor enforcement of laws like wearing of seatbelts and helmets.000 in 2006. Intentional and motor vehicle crashes account for most of the recorded injuries. The province’s Injury Mortality Rates considerably increased by 26.3 percent. the overall health system in the Zamboanga del Sur continue to face low quality and inefficiency issues as well as insufficient progress on major health program areas and service delivery modalities. and Muslims from neighboring provinces. 2. Collaboration with other government agencies like the Land Transportation Office (LTO) and the Department of Public Works & Highways (DPWH). and major illnesses.1 Leading Causes of Mortality and Morbidity Injuries/wounds/accidents. Tagalog.

2. cancer patients could not avail of appropriate curative and preventive care.4 deaths per 100. One third of all cancers are curable if detected early and treated promptly.000 population from 2001-2005 to only 24. death rate from pneumonia among infants remained at the top of the leading causes though the trend is decreasing from the average of 2. while.2 Births In 2006.7 was reported in the municipality of Kumalarang. Due to high cost of health care.27 births per 1000 population.93 per 100. Cancer is the fifth most frequent disease after pneumonia and diseases of the heart. Zamboanga del Sur Province Page 9 . Hereditary factors result in a higher susceptibility of an individual to acquire specific cancers. the lowest CBR of 9.93 per 1. Among children under five-years of age.3. and some households do not have access to safe potable water supply and toilet facilities. It ranked third among the causes of mortality and fifth among the causes of morbidity in 2006. These may be due to poor health seeking behavior of the constituents and distance from health facilities.19 was reported in Midsalip.000 under 5-years old children for the period 2001-2005 to 1. For other causes of morbidity in the province. This reflects improvements in diagnostics and treatment. Diarrhea and Tuberculosis came out to be high. The mortality rate from pneumonia also decreased from 34. from the average of 2.41 per 1. However.41 per 100. A very high CBR of 35. but patients seek consultation at the late stage of the disease because of lack of information on the warning signals of cancer. nutritional and environmental factors are also contributory factors to the development of cancers.000 livebirths in 2006.000 in 2006. such as Bronchitis. Influenza. There is a decreasing trend of morbidity from pneumonia in the general population from 2001 to 2006.000 live births for the period 2001-2005 down to 1. Acute Respiratory Infection. the crude birth rate (CBR) in the province was a low 19. pneumonia cases followed a downward trend since early 2000s.000 in 2006.1 average deaths per 100.Provincial Health Facility Development Plan 2008-2015 Pneumonia remains in the list of the leading causes of morbidity and mortality in the province.

18 with 4 to 5 deaths per 1000 high CDR of 5. Of the number of deaths. the provincial CDR was also lower than the region’s CDR during the same reference year. Most normal and other types of births were attended at home rather than in health facilities. Daily death occurrence was one death every three hours. A relatively in the city of Pagadian.129 or 40. This calls for more intensified advocacy on maternal health care. 2.3 Deaths The crude death rate (CDR) in the province deaths per 1000 population as compared population at national average. Record shows that Infant death had declined from 57% in 1990 to 24% in 2006 and hopefully to attain 19% in the year 2015. 1. there was a higher proportion of males born in 2006 compared to females.804 deaths reported in 2006.3 percent were females. As in the previous years. only 48.4 Infant Under-Five Mortality Our country has a high probability of achieving the Millennium Development Goal (MDG) in reducing the rate of infant and under-five mortality.Provincial Health Facility Development Plan 2008-2015 The total number of livebirths reported in 2006 was 17. as well as. About 7.3.47 was reported in There were 2.38 percent of deliveries were attended/handled by skilled health personnel. micronutrient supplementation to pregnant women. In 2006. resulting in a birth-sex ratio of 107 baby boys born for every 100 girls born. an addition of 1 baby to the province’s population every 30 minutes. 2. the lowest Dimataling.842 or 52 percent were males and 8. Provincial CBR in 2006 was still below the regional CBR. was also relatively low at 3.53 percent of infants born were less than 2500grams which may be due to lack of prenatal care and poor nutritional status of the mother.3.12 was reported CDR of 0.259 or 48 percent were females.7 percent were males and 1. a death-sex ratio of 148 males per 100 females dying in 2006. while. Likewise.101of which 8. The daily average of birth occurrence was 47.675 or 59. However in Zamboanga del Sur Province Page 10 .

Pulmonary embolism (2).6 per 100. Recent study based on the maternal causes of deaths in the civil registry estimated MMR at 138 per 100. while all private hospitals located in Pagadian City were providing Newborn Screening.3. Most of the deaths came from rural barangays of low socioeconomic status. 2.68 per 1000 LB to 3. and lack of poor access to well equipped birthing facilities contribute to the situation. Infant and under-five mortality differ in socio-economic and demographic factors.Provincial Health Facility Development Plan 2008-2015 the province of Zamboanga del Sur. Cultural factors attributed to under reporting (e. and under five death rate from 9.g. Muslim Culture immediate burying of the dead).56 per 100.000 live births while the regional MMR recorded at 73. High mortality rate was higher among infants with uneducated mothers. provincial IMRs for Infants and Under Five Children were still below the regional rates in 2006 by 13% and 21% respectively. These may be due to under reporting. Nonetheless. The lacks of prenatal care and births handled by untrained traditional birth attendants (Hilots).90 per 1000 LB to 4.000 live births. Eclampsia (2).90 per 1000 LB. Highest leading causes are postpartum hemorrhage (7). Likewise. Poor BF and complementary feeding practices among mothers remains a priority concern. Despite the improved country’s picture of MMR based on survey and study. has a higher maternal mortality rate (MMR) in 2006 than the regional rate by 27%. Abortion (1) and Uterine Atony (1). Lack of awareness on the importance and value of registration and lack of legislative support are also contributory factors to under reporting. Zamboanga del Sur Province Page 11 . Zamboanga del Sur on the other hand.000 live births in 2002. The province has 16 registered maternal deaths with an MMR of 93. there was a significant decrease in infant death rate in 2003 from 5. Only Aurora General Hospital provided Newborn Screening Services.72 per 1000 LB in 2004.5 Maternal Mortality Result of the National Demographic and Health Survey illustrated an improved mortality rate of the country from 1991 to 1997.

On leprosy. Lakewood. and likewise the highest 3 areas which consistently contributed to the reported cases of malaria.Provincial Health Facility Development Plan 2008-2015 Again.48/10. It is expected to be high in Margosatubig. Mahayag and Dumingag. Pagadian City. This is an indication that we have coped with the elimination level of less than one (1) case per 10. 3 out of 26 municipalities were found positive for Filariasis (Bayog.4 Infectious Diseases In an endemic mapping conducted in 2003. Midsalip.000 population. Malaria is a persistent mosquito-borne infection. Zamboanga del Sur Province Page 12 . Highly endemic municipalities are Bayog. Kumalarang and Tigbao. Midsalip. That means that all deaths registered in these areas are not truly coming only from such areas. affecting seven (7) municipalities with a total of 94 barangays in the province. In JSMART ILHZ.. Aurora and Pagadian City because hospitals are located in these areas. Among the municipalities with high maternal deaths are Margosatubig. Municipalities of Bayog. Dumingag. it is prevalent in the municipalities of Aurora. the issue on multi-parity. death is registered where it occurred. Hence. Lakewood and Kumalarang). lack of prenatal care and deliveries attended by unskilled health professionals are pointed out as most contributory factors. It also has become a leading cause of consultation among government hospitals designated as Animal Bite Treatment Centers (ABTCs) in the province. i. Schistosomiasis is endemic in 6 municipalities that belong to two ILHZs. What is notable in the province is the zero deformity grade which means that patients sought early consultation before physical deformities set in. the province is consistently declining its prevalence rate in 2005 and 2006 which is . Wounds secondary to animal bites belong to the top leading cause of morbidity.000 population and . Lakewood constitute 60 percent of the risk share. Tabina and Tigbao. Aurora.41/1000 population respectively. a system needs to be established to tract Maternal Death Review in order to define the delays in maternal care. The Province of Zamboanga del Sur and City of Pagadian are endemic of Rabies. Tambulig and Ramon Magsaysay while at Yllana ILHZ it is positive at the municipalities of Molave.e. 2. The protocol in death registration is “de facto”.

there is an apparent low and slow progression of the HIV infection in the province. deaths decreased from 9 to 8 during the same period. Tuberculosis (TB) is still a major health problem in the prvince. Global Fund Malaria component provide support to municipal and Provincial Malaria Program. poultry and poultry products from infected Southeast Asian countries has a probability of entry to the province via there routes. Cagayan de Oro City. TB is 7 th leading cause of mortality in 2007.Provincial Health Facility Development Plan 2008-2015 Disease transmission is perennial but generally higher during the rainy season than the dry season. Other respiratory diseases are among the top causes of sickness and death in the province. The two and their two children were referred to San Lazaro Hospital for treatment. In 2007. Midsalip and Bayog) in the province. while. very limited care and support services provided. Municipality of Dumingag. However. A main river (Ecuan River) and other tributaries connect the two provinces. In the province. Pagadian City reported the highest number of cases of Dengue which is 175. Capillariasis is one of the causes of parasitosis that continue to affect three (3) municipalities (Dumingag. The tiny infective worm is Capillaria Philippinensis. Increasing incidence in Bayog. Cotabato and Lanao Provinces make it vulnerable to the threat of Avian Influenza. Capillariasis was first noted in the province in 2004. one person with AIDS was confirmed and treated at the Zamboanga City Medical Center. Just like the Philippines. although. In late 2005. among the municipalities with high incidence of this Zamboanga del Sur Province Page 13 . Ecuan River connects Zamboanga del Norte and Zamboanga del Sur provinces. it is no longer among the top 10 causes of illness. after an outbreak of diarrhea was reported in Barangay Gumpingan. Emerging disease in the province. eggs of game fowls. as there has only three reported cases until 2006. An NGO. The geographic location of the province being part of the long coastline of Zamboanga Peninsula and its easy accessibility by trade routes on land and water from Zamboanga City. Davao. There is poor contract tracing of partners of these HIV positive cases. The number of dengue cases has remarkably decreased from 529 to 271 from 2005 to 2006. two persons (couple) were identified as HIV positive in the Provincial Hospital located in Pagadian City. and limited monitoring of condition of their children. Smuggling of birds . where the disease is widely endemic in some municipalities. In 2006. It is believed that Capillariasis in Zamboanga del Sur is a spill-over effect of Zamboanga del Norte. in 2007.

Sagun 14.97%) and Dumalinao (18.35%). Diphtheria.23 percent. Top 5 municipalities are Tabina (19. urban children are less likely to be breastfed compared to rural children. Lapuyan (19. More than half of these children (59%) belong to the age group 2 to below 5 years old. The sector Zamboanga del Sur Province Page 14 .92%). the prevalence rate of malnutrition among preschool children 0-71 months (0-below 6 yr. Issues on adolescent health care still revolve around the less attention given to adolescent population. poor caring behavior of mothers. 2. Dinas 13. Tabina 16.23 percent of infants seen at 6 th month were breastfed. Tigbao (19.40% (11. Causes of high incidence of malnutrition in these municipalities include having large family size.845 children). Another contributory factor is use of inaccurate weighing scales during OPT.49%). Labangan 13. V. It has been noted that adolescent-related health programs remain marginal as compared to those provided to other age groups. and San Pablo 11. which are divided in the following age bracket: 24-35 mos.Provincial Health Facility Development Plan 2008-2015 disease were Margosatubig 47. Hepatitis B and Poliomyelitis.-18% There are 14 municipalities recognized as nutritionally-at-risk in terms of high prevalence. This means that 90. Pitogo (18. Tetanus. Children of mothers in the wealthier households are better educated and are likely to breastfeed their infants. such as Tuberculosis. Measles. Pertussis. 36-47 mos -21% and 48-59 mos. Based on monitoring and actual interviews.5 Child Health Expanded Program on Immunization (EPI) is a critical public health intervention and remains the most effective strategy in reducing illnesses and deaths among children especially from the most common childhood diseases. Breastfeeding practice is poor among those infants delivered by trained personnel than those TBAs. The prevalence of breastfeeding (BF) in the province based on the 2006 FHSIS is 90. Based on the results of Operation Timbang (OPT) 2007. – 20%. Dengue cases persist year-round but with tendencies to increase during rainy season.64%). old) in the province is 12.

NFP 8.Provincial Health Facility Development Plan 2008-2015 is most susceptible to drug addiction and sexually-transmitted diseases (STDs). The Integrated Provincial Health Office had been considering the establishment of “Adolescent Clinics” or “Teen Centers” but failed because of many constraints. Among the currently married women in 2006. Though the current achievement level is still not very far from the national average.81 percent do not use any form of contraceptive method at all. BTL 0. improving health services and health care delivery to adolescent population is a key objective under the present thrusts. as it is believed that there could be under-recording of Iron and Vitamin A Supplementation among target women’s group. On Vitamin A supplementation. These figures may not be the true picture of the province.75%. 2. This fact may have some bearing on the quality of maternal and newborn care. falling below the national target.04%. 2. Pills got the highest of 41.51 percent of pregnant women were given complete Iron dosage. Thus.19 percent use any form of contraceptive method and 57. teenage pregnancy. certain municipalities do have very low quality pre-natal care.26% followed by IUD 23.56%.63%.6 Maternal Health The national target for pregnant women having four (4) or more prenatal visits is at 80 percent.48%.74 percent. Injectable 8. it was found that 42. visits the province occasionally to provide BTL services.7 Healthy Lifestyle and Management of Health Risk Page Figure 3-5 Planning Family Zamboanga del Sur Province 15 . and breastfeeding outcomes in the future. Our local data shows that women 18-19 years old who are getting married are pregnant.74% and VAS 0.07 percent of pregnant women and 61. About the same proportion of lactating women were also provided complete Iron dosage (39. In 2006. LAM 12. However. Of all the current users in 2006. 8. This level of accomplishment is also below compared to 2001 (78. adventurism and peer pressure.55 percent). The lack of OB-gyne/ Physician in public hospitals contributes to the low coverage on BTL. Condom 4.51%. 39. is foremost in attaining reproductive health because it allows couples to freely CONTRACEPTIVE METHOD MIX (%) decide on the number and spacing of their children. a private institution. At present only Marie Stopes. pre-marital sex which are due to curiosity.5 percent of lactating mothers were given Vitamin A capsule.7%). the provincial data in 2006 only recorded 76.

Two (2) Administrative Officers and one (1) Nutritionist are detailed to the IPHO from the Provincial Hospital. These chronic and non-communicable diseases which are largely attributed to life style are becoming a major health problem in the province.Provincial Health Facility Development Plan 2008-2015 Death rates due to hypertensive disease (HPN). It serves as the planning for health in the province and conducts monitoring and evaluation throughout the province. It also provides administrative and technical supervision over six (6) hospitals devolved to the provincial government. The Administrative Section provides support to the PHO II and the Technical Division.predisposed diseases. being the 2nd.1 Integrated Provincial Health Office The IPHO that is mandated to oversee the Provincial Health System does not have a Health Human Resource Development Plan. respectively.8 Health Service Delivery The Health System of the province is divided into two (2) services: the Public Health and the Hospital Services. two (2) supervising sanitarians and one (1) statistician composing the Technical Division. which is currently vacant.8. After the reorganization of the provincial government in 2002. it calls for the active involvement of the affected person in the preventive program. acts as Chief of the Technical Division. There are five (5) nurses. They form as Health Program Managers. while the hospitals provide mainly curative and rehabilitative care. hence. the continuing need for immediate and intensified preventive measures considering the staggering and astronomical cost of medical care that is beyond the reach of the general population. 2. As lifestyle. The Integrated Provincial Health Office (IPHO) provides technical supervision over health units in the city and municipalities. one (1) dentist. A Medical Specialist III position. IPHO was left with one administrative plantilla position: storekeeper. The Technical Division provides data analysis and feedback to Health Units but because of lack of Zamboanga del Sur Province Page 16 . Public Health provides primarily preventive and promotive services. 2. It is headed by the Provincial Health Officer II. 4th and 6th leading causes of death in the province. other forms of cardiovascular disease (CVD) and ischaemic heart disease (IHD) increased enormously for men and women.

It lacks manpower hence its effectiveness is diminished. It can also facilitate delivery of health commodities to the municipalities. the IPHO warehouse needs major repair. personnel safety. Health Economics.8. scanner. as well as for Disaster Response. computer units with internet connection. Thus. encoding. Drugs. and NGOs are allocated for the province need proper storage prior to their distribution to RHUs. namely: photocopier. camera. Presentation Skills Training. human fatigue. 2. and health resource development. records. Most of the indigents and underprivileged seek hospital care in the government hospitals while the private sector owns most of the beds caring for the upper and middle class constituents. much remains to be done. Epidemiology. At present. The private sector mainly composed of hospitals is market-oriented. and bad road conditions especially in rural barangays. Data Analysis. The lack of hospital bed is worsened by the fact that the provincial and Zamboanga del Sur Province Page 17 . The province including Pagadian City has an average ratio of 1785 people per hospital bed of which is above the standard ratio of 1000 per 1 hospital bed. Donor agencies. document camera. It is deficient in the following equipment.2 Local Health Facilities The province has a dual health system which consists of the public sector and the private sector. The lack of Provincial Pharmacist is a also reason for delays in implementing the “Botika sa Barangay” program. The public sector is largely financed through a tax-based budgeting system and where health care is generally given free. Training needs identified include Computer Literacy.Provincial Health Facility Development Plan 2008-2015 skills in this area. laptop (WIFI ready). Knowledge management is inefficient because of lack of program for data banking. On monitoring and evaluation. ensuring the safety. justifies the need for a monitoring vehicle. medicines and other health supplies from DOH. and Personality Development. where health care is paid through user fees. bookkeeping. maintain potency and efficacy of drugs and medicines is imperative. transportation. Program Management and Supervisory Skills Training. The lack of Provincial Medical Technologist hinders the establishment of a Provincial Validation Center for sputum and malaria microscopy. documentation. The Administrative Section provides support in terms of communication. Planning Skills Training. fax machines. Health Promotion Skills. high cost of transportation. although socialized user fee charges have been introduced recently for certain type of services.

and maintenance still pose problems because its priority and intended use still remain an issue. Among the three inter-local health zones. communication facilities are still weak in most RHUs having to rely on single side band for official communication. lack of medicines and supplies and long lead agencies in the procurement of supplies and medicines. In 2006 the ratio of BHS to population is 1:4. These public health facilities have inadequate laboratory supplies and equipments. Moreover. Rural Health Units (RHUs) also face great challenges in terms of access in the delivery of accessible.670. Zamboanga del Sur Province Page 18 . Mostly of the BHSs in all areas of the province need to be renovated. Most of the national government hospitals are in urban and better off areas outside of the province. There are 190 Barangay Health Stations (BHS) in the province. Yllaña Health Alliance ILHZ has the most numbered BHS of 92. Existing health facilities building and structure need to be improved and renovated to provide health care. equitable and quality health services to the populace due to budgetary constraints. worsening the inequity in access to these facilities by residence of poorer and rural areas. improving their quality services is tantamount to improving health condition of the poor and the under served. Since public primary facilities are frequented by the poor. medicines are scarce and inferior. There are also municipalities that propose for construction of new BHS to extend health services to many constituents. Old beliefs and practices that treat government hospitals as provider of free health services and too much dependence on political leaders in seeking special treatment are the issues and concerns that merits due attention. More patients are forced to bypass local government hospitals and seek out better equipped and better-staffed national government hospitals. There are inherited challenges after the devolution. But its acquisition. efficient.Provincial Health Facility Development Plan 2008-2015 district hospitals have inadequate budgetary support after devolution and have lost managerial autonomy. Just like government hospitals. inadequate infrastructure development in municipal hospitals. These BHSs have the same predicament with the Rural Health Units in terms of unavailability of medicines and equipments. Most of these health facilities have vehicles like ambulances for community outreach and referral. These would also reduce the bulk of patients who will seek consultation in public hospitals. use. inadequate manpower. inadequate laboratory and diagnostic equipment. These are budget deficit.

Somehow.8. there is one thing to consider if the contract ends. majority of which are located in Pagadian City. supplies and human resource. bed-to-population ratio is 1:1. of which 30 (61%) doing private practice. The total number of bed capacities of the private hospitals/clinics reached 185. high costs of care remain a big burden. and if they have. In all. Most of the private facilities offer good quality services.785. Among the nurses and midwives and medical technologists. Out of the 26 municipalities and 1 city. The private sector’s involvement in maintaining the people’s health is enormous. the province has a total of 49 dentists. 12. four are Level 2. For dentists. municipalities have dental clinics of which 3 of these clinics are having visiting dentists only. The municipalities are not assured of the continuity of their services and aside from that some LCEs do not bother to allocate budget for this position as well as the differing views of giving health services between the doctors and LCEs. 60 percent are employed by LGUs but most of them are applying/ going abroad. 6 (12. one (1) is Level 3.5%) in the public health. the DOH deployed physicians in “doctor less municipalities” (DTTB) of whom the province is a beneficiary.Provincial Health Facility Development Plan 2008-2015 Sixty-seven percent of hospitals in the province are privately owned. government hospital beds total 497. leaving their positions vacant and where some LGUs do not prioritize to allocate budget. 2. 11 are Level 1 and 1 is infirmary.4%) rendering dental services to school children and 13 (26. Public hospitals need improvement in physical structure. The province socio-economic and political situations have not helped much in retaining skilled health professional in the country. but in this case. 40 (20%) are in the government hospitals and the rest are private practitioners. while. As to service capability. however. there are 191 medical doctors in the province of which 27 (or 14%) are in the public health. Zamboanga del Sur Province Page 19 . equipment. There are 16 private hospitals/clinics in the province. leaving some municipalities without doctors to attend to their health needs. Relative low cost of care is still a significant advantage of government facilities over private ones. they divert it to other activities/ projects.3 Health Human Resource Based on the FHSIS and statistical survey.

there are 31 Sanitarians in the entire province but even then. total LGU Premium Zamboanga del Sur Province Page 20 .97 compared to PhP83.1 Health Care Expenditure Budget allocation of 6. 2. Some LGUs implemented partial subsidy scheme. Budgetary requirements for counter parting by LGUs and PHIC for the next 5 years as well as is determined vis-à-vis projected LGU incomes of RHUs in the form of Outpatient Benefit Package (OPB) and PhilHealth Capitation Fund (PCF). not only budgetary allocation for IPHO.2 Social Health Insurance (SHI) Universal Coverage Provision of basic health services is a national priority program of the government.Provincial Health Facility Development Plan 2008-2015 On the other hand.954 Barangay Health Workers (BHWs) and 854 Barangay Nutrition Scholars (BNS) assisting at the grassroots level. 2. Provincial and District Hospitals but also from the Provincial Governor’s Office.9. these could not cope up with the sanitation demands because of lack of training s as well as due to political interest.943. thus.9. they opted to adapt different schemes per municipality as authorized through a local ordinance.938.24 in 2007.168.332.9 Health Financing 2. This also holds true to 2. PhilHealth reimbursements. However. there was as an increase in health expenditures in the amount of PhP87. Provincial Social Welfare and Development Office and even in the Annual Investment Plan (AIP) Allocation of 17 percent for health sector. In 2006 first quarter. These expenditures were specifically allocated for various medicines used in medical outreach missions in far-flung barangays. Nonetheless. Another thing is the designation only of Municipal Nutrition Action Officer as well as for the Health Education and Promotion Officer giving extra workloads to health personnel. provision of medicines and discounts on hospital bill. Some LGUs require counterpart fund from component Barangays though sharing is not clearly stipulated in the PHIC-LGU Memorandum of Agreement (MOA). Health activities for hospital patients are benefited in the form of financial assistance.75 percent of the Internal Revenue Allotment (IRA) for health activities under the General Fund were allocated taking into consideration. the provincial government aims to target 100 percent coverage of poor population by year 2012 and sustaining enrollment of families each year.

and auditing and accounting rules. 2. the first OPB accredited in Region 9 is the RHU of Ramon Magsaysay.3 PHIC Accreditation of Hospitals The Outpatient Benefit Package (OPB) was exclusively designed to augment RHU budget for health in a form of PhilHealth Capitation Fund (PCF) with an equivalent value of P300 per family per year. The target for PhilHealth coverage in the Formal and Informal Sector is estimated as 25-30 percent of the total population. The LGU’s are expected to formulate and enact Implementing Rules and Regulation (IRRs) based on PHIC Circulars. no LGU has come up with one yet. most of the LGUs did not appreciate its revenue or may not convinced of this potential to increase their income. The TB Dots and Maternity Care Package (MCP) were included in the list of other financing source of the LGU. which includes the Employed under the Government and Private Sector as well as the Selfemployed or the Individually Paying Members. It is also observed that poor constituents still seek assistance from local public officials for transportation and even food while hospitalized.9. ZDS which is until now has sustained its accreditation. However. Record shows that only San Pedro RHU of Pagadian City is TB-DOTS accredited in the province for the past 2 years. however. Zamboanga del Sur Province Page 21 . Two other RHUs then followed but were unable to sustain primarily because the PCF share due for RHU personnel was not granted.Provincial Health Facility Development Plan 2008-2015 counterpart bears out to be the total LGU Share as the total amount remitted to PHIC. It is noted that some LGUs decided to stop the Indigent Program primarily because of increasing premium. MOA. In 2002.

679 by 2012 and 364. the province’s bed-to-population ratio is lower than other provinces in the country. Thus. the total population of 329.022 in 2007 is projected to reach 350. it’s worthy to note on the adequacy of hospital beds in the province. and about 490 Health & Nutrition Posts (HNPs).278.Provincial Health Facility Development Plan 2008-2015 Chapter PUBLIC HOSPITALS IN ZAMBOANGA DEL SUR: 3 A SITUATIONER With a total of 191 public and private physicians provincewide. capital outlay and personal services. Increasing the level of authorized bed capacities (ABCs) would mean more budgetary allocation for operating expenses. Europe and the Middle East where they earn ten times as much as their salaries in the province. 190 Barangay Health Stations (BHSs).1 Hospital Bed Requirements Determining adequacy of hospital beds throughout the plan period requires projection of population within the catchment area. the province’s bed-to-population ratio remains significantly lower than the standard of one bed per 1000 population.540 provincial constituents in 2007. However. the provincial population will reach 974.1 Projected Primary and Secondary Catchment Population The province’s total population based on the 2007 Census Report was 914. there are other medical establishments in the province that includes 30 RHUs.452 by 2015. Comparatively. Expectedly. With a computed average annual growth rate (AAGR) of 1. 3. The health conditions in the province would have improved a lot had all doctors opted to stay in the province or the country. there is only one doctor for every 4.787 Zambosurian and one hospital bed for 2. nurses and medical personnel working in the province opted to go to the U. as in majority of localities in the country.S.259 by 2012 and 1. Zamboanga del Sur Province Page 22 .28% per annum from 814.247 in 2000. Future bed requirements can be determined by multiplying present bed requirements and the ratio of future population to present population..1.352 by 2015. as hospital budgets are tied up with the number of beds authorized for a particular health facility. 3. leaving only a few doctors attending to the needs of the large population in Zamboanga del Sur. In the primary catchment area. A number of physicians.012.

Magsaysay.781 648.280 29. ZDS 36.243 Area** R.616 20.177 B.939 37.000 40.790 Kumalarang.239 38.821 Dumingag.496 37.278 974. ZDS 16.940 Tabina.984 21.312 A.124 Tambulig.256 in 2007 is projected to reach 623.Provincial Health Facility Development Plan 2008-2015 In the secondary catchment area.959 37.772 32.364 26.012.791 V.28% for the Period 2000-2007 *.925 Tigbao. ZDS 48. Table 1. ZDS 10.389 53. ZDS 19.321 26.930 178.452 city Average Annual Growth Rate (AAGR) 1. including about 35 beds that existing hospitals are currently applying for license to operate/expand.919 Molave. ZDS 28.562 19.039 49.100 by 2015.981 18. Primary Catchment 171.738 35.679 364.907 21. ZDS 27.118 27.231 26.955 Lakewood. Projected Primary and Secondary Catchment Population: 2012 & 2015 Population Catchment Area City/Municipality 2007 2012 2015 (Census) (Projected) (Projected) Pagadian City 161.444 18.353 Dimataling.598 40.069 50.781 by 2012 and 648.507 11. Sagun 19.784 20. the total population of 585.040 Sominot.1. ZDS 16. ZDS 30.299 22. ZDS 44.361 Pitogo.635 Tukuran.520 Dumalinao.634 Area* Labangan.076 Mahayag.597 31.989 48.258 28.367 17.352 Aurora.459 1.673 29.822 20. ZDS 18.689 32. ZDS 47.902 28.215 51.282 52. ZDS 26.691 Dinas. Zamboanga del Sur Province Page 23 . Secondary Catchment 50. ZDS 23. ZDS 25.256 623.321 Sub-total 329.598 19.099 18. ZDS 29. ZDS 46.722 San Pablo.2 Inventory of Hospital Beds and Bed-to-Population Ratios Total hospital beds in the province as of December 2007 was recorded at 395. ZDS 26.392 Midsalip.555 Bayog.798 34.575 27.591 39.707 30.988 28. ZDS 25.804 Lapuyan.087 46. ZDS 18.242 36.100 26 Municipalities + 1 Total 914.732 31.022 350.798 25.refers to city/municipality serviced by Level 2 hospitals **. ZDS 37.refers to other geographic areas that have access or contiguous to the primary catchment area/s 3.130 Sub-total 585.595 Guipos.073 41. ZDS 34. ZDS 34. ZDS 25.837 28. ZDS 33.983 Josefina.209 San Miguel.923 Margosatubig.076 30.796 11.892 27.

Inc. In all. The Aurora General Hospital (AGH) has also an ABC of 50. 3. Mahayag District Hospital 4. Aurora General Hospital 2. the Euser Medical Clinic in Tambulig has the lowest of 5. Table 2. Inventory of Hospital Beds in Primary and Secondary Catchment Areas: 2007 Hospitals A. Lakewood Municipal Hospital 7.1 Government Hospitals 1. SS Lumapas Hospital (New) 3. Francis Clinic 8. Tagaloguin Clinic 2. Blancia Hospital 4. Metro Pagadian Hospital. St. Zamboanga del Sur Province Location ABC* Level of Hospital Aurora Labangan Mahayag Tambulig Pagadian Lakewood Dinas Margosatubig 50 20 5 10 50 5 10 25 175 6 15 10 22 10 10 6 10 15 Secondary Primary Primary Primary Secondary Primary Primary Secondary Dumingag Molave Molave Molave Pagadian Pagadian Pagadian Pagadian Pagadian Primary Primary Primary Secondary Primary Primary Primary Primary Secondary Page 24 . Zamboanga Del Sur Provincial Hospital 6.2. Existing Hospital Beds A.Provincial Health Facility Development Plan 2008-2015 3. Igano Community Hospital 5. The Pagadian City Medical Center (PCMC) has the highest ABC of 50. Inc. with a combined ABC of 185. Hosp. Dinas Municipal Hospital 8.2 Private Hospitals 1. Tambulig Municipal Hospital 5. while.2.1. 6. The ZDSPH has the highest number of authorized beds of 50. existing government and private hospitals in the province has a combined ABC of 360. while.1. though the facility is operating at more than 100 beds. both the Mahayag and Lakewood Municipal Hospitals have ABCs of only 5 each. 9. a Existing Hospital Beds Existing hospitals include eight (8) government-owned facilities with a combined ABC of 175. ZDS Health Services Coop. Margosatubig Regional Hospital Sub-total Government (1) A. Kuta Major Sang-an Station Hospital 3. b Hospitals Currently Applying for License to Operate About 35 additional beds are to be authorized pending issuance of license by DOH. Borbon General Hospital. Hofileña Clinic 7. About 14 of existing hospitals are privately-owned and are located in four (4) municipalities and in the city of Pagadian.

452 1012 3.1.4 Projected Bed Needs (PBN) Given the projected population levels.5 Unmet Bed Needs (UBN) Existing and projected unmet bed needs (UBN) are computed as 514 beds in 2007. Zamboanga del Sur Province Page 25 . then the BPR criterion has been met Value 395 914. Table 3.1 hospital bed for every 1 thousand population Particular Value 2012 974. Table 4.if BPR is less than 1.Singidas Medical Clinic Sub-total Private (2) Sub-total Government + Private (3) B. As such. Other Primary Hospitals Sub-total Application (4) C.43 3.Pagadian Community Hospital 14. 2012 & 2015 2007 Population (P) 914. Cabahug Hospital 12.012 for years 2012 and 2015. Inventory of Hospital Beds (IHB)=(3)+(4) *. the PBN are 974 and 1. respectively. Obviously.J. projected bed needs (PBN) can also be determined using the same standard ratio of one hospital bed per one thousand population. 574 beds in 2012. Pagadian City Medical Center 2.Euser Medical Clinic 13.1.1.0.Authorized Bed Capacity Pagadian Pagadian Tambulig Pagadian Lakewood 50 10 5 10 6 185 360 20 10 5 35 395 2008-2015 Tertiary Secondary Primary Secondary Primary Pagadian Pagadian Pagadian Tertiary Secondary Primary 3. the inventory of hospital beds fall short of the required one bed per 1000 population.43 indicating a ratio lower than the ideal of 1. the provincial bed-to-population ratio is computed at .3 Bed-to-Population Ratios (BPR) As of 2007. Projected Bed Needs (PBN): 2007.012.Provincial Health Facility Development Plan 10. Other Secondary Hospitals 1. and 612 beds in 2015.459 974 2015 1.Pagadian City Medical Center 11.278 .0.278 Projected Bed Need* (PBN)= P x 1/1000 914 *. Provincial Bed-to-Population Ratio: 2007 Particular Inventory of Hospital Beds (IHB) Population (P) Bed-to-Population Ratio* (BPR)=(IHB/P)x1000 *. Hospitals Currently Applying for License to Operate 1.

it should be less than an hour of travel from another health facility. This indicates overutilization of said health facilities as against their authorized budgets and suggests the need for more ABCs in the province to be able to meet service standards during the plan period. 2015 Particular Projected Bed Needs (PBN) Inventory of Hospital Bed (IHB) Unmet Bed Need* (UBN)= PBN-IHB *. Table 6. strategically (geographically) located based on existing road network vis-à-vis catchment population. On the other hand. the facility should be readily accessible by the usual means of transportation. Zamboanga del Sur Province Page 26 . 2007 Occupancy Rate Existing Hospitals ABC Average (2 2006 2007 years) Aurora General Hospital 50 Kuta Major Sang-an Station Hospital 20 Mahayag District Hospital 5 Tambulig Municipal Hospital 10 Zamboanga Del Sur Provincial Hospital 50 Lakewood Municipal Hospital 5 Dinas Municipal Hospital 10 Margosatubig Regional Hospital 25 Overall Average Occupancy Rate of Existing Government Hospitals Source: IPHO. Overall Average Occupancy Rates of Existing Hospitals for the Past Two Years: 2006. For a facility to be considered cost-effective.2 Occupancy Rates of Existing Hospitals The average occupancy rate of existing hospitals in the province is recorded at ___ percent.Provincial Health Facility Development Plan Table 5. as well as its strategic location given a catchment area are important determinants for decision makers in so far as feasibility and viability of establishing or developing/upgrading a higher level health facility. as well as. Unmet Bed Needs (UBN): 2012. ZDS 3.3 Hospital Accessibility and Strategic Location Accessibility of a hospital facility in terms of physical distance from a lower-level level health facility.1 hospital bed for every 1 thousand population 2007 914 400 514 Value 2012 974 400 574 2008-2015 2015 1012 400 612 3.

Table 7.3 Strategic Location In Terms of Catchment Areas In terms of strategic location. the provincial health facility is not isolated nor biased to a particular district as it is located in Pagadian City which is centrally located as far as geographic location is concerned.1 Travel Time From Provincial Health Facility to Existing Government Hospitals The average travel time from the provincial health facility to any existing public hospital is recorded at 52 minutes.3. Table 9. Travel Time from Provincial Health Facility to Existing Government Hospitals Travel Time to Existing Government Hospitals Location Provincial Health Facility (In Hour & Minutes) Aurora General Hospital Aurora 0 hour 45 minutes Kuta Major Sang-an Station 25 minutes Hospital Labangan Mahayag District Hospital Mahayag 0 hour 55 minutes Tambulig Municipal Hospital Tambulig 0 hour 50 minutes Lakewood Municipal Hospital Lakewood 1 hour 30 minutes Dinas Municipal Hospital Dinas 1 hour 0 minutes Margosatubig Regional 1 hour 30 minutes Hospital Margosatubig Average Travel Time  0 hours 52 minutes 3.3. Accessibility (Accessible by the usual means of transportation during most part of the year) 3. Accessibility of Provincial Health Facility Criterion Yes  No Remarks Existing road network facilitates access to the provincial health facility. Table 8.3.Provincial Health Facility Development Plan 2008-2015 3.2 Accessibility by Usual Means of Transportation The provincial health facility is readily accessible by means of land transportation as existing road network can facilitate multi-point access. indicating accessibility to such a facility as a referral health institution at the provincial level. though some sections require immediate rehabilitation and/or upgrading for greater access. albeit some road segments/sections require rehabilitation and/or upgrading to reach the optimum service level. Strategic Location of Provincial Health Facility Criterion Strategic Location Yes  No Remarks The provincial health facility is located in Pagadian City which is Page Zamboanga del Sur Province 27 .

and the Tambulig Municipal Hospital (TMH). Of the total.4. Table 11. 27 are medical doctors.4 Acceptable Track Record by Hospital 3. ZDS Provincial Hospital Pagadian City  3. 3. namely: the Dinas Municipal Hospital (DMH). 32 belong to administrative positions. There are no major violations ever committed by the facility. ZDSPH has 114 personnel.1 Compliance to Licensing Requirements Historically. Lakewood Municipal Hospital (LMH). except for minor deficiencies that were eventually rectified and complied with. (Please refer to Annex G for details).Provincial Health Facility Development Plan 2008-2015 geographically central to both the 1st and 2nd congressional districts. and 41 are technical support personnel. As to position classification. Mahayag Municipal Hospital (MMH).1 Existing Hospital Personnel (All Hospitals) The total number personnel of the Zamboanga del Sur Provincial Hospital reached 175 including personnel from the four (4) municipal hospitals. 31 are clinical support personnel. both the LMH and MMH have 15. Table 10. the provincial health facility has complied with licensing requirements despite resource limitations inherent to LGUs. Track Record of Provincial Health Facility Good Compliance to Existing License Provincial Health Location Requirements Facility Yes No Remarks Despite limitations on resources.5. while. Number of Personnel (All Public Hospitals in ZDS): 2008 Positions Administrative ZDSPH 18 DMH 3 LMH 4 MMH 3 TMH 4 Total 32 Zamboanga del Sur Province Page 28 . the provincial health facility endeavors to comply with established licensing requirements by DOH. DMH has 14 and TMH has 17.5 Hospital Personnel Complement 3. all of which are part of the provincial government hospital system. 44 are nurses.

Table 12.2 Required Hospital Personnel Complement A 100-bed capacity hospital facility (tertiary level) requires a total of 329 personnel. and supplies & procurement. 61 medical. Clinical support personnel are necessary to be able to respond to the increasing number of patients seeking medical care and laboratory examination and analysis. 86 nursing. 50 clinical.Provincial Health Facility Development Plan Medical Doctors Nurses Clinical Support Technical Support Total 21 28 19 28 114 1 4 3 3 14 1 4 3 3 15 2 4 3 3 15 2 4 3 4 17 2008-2015 27 44 31 41 175 3. and 79 technical personnel. consisting of 53 administrative. as well as additional staff for medical records. Number of Personnel in ZDSPH and Proposed ZDSMC ZDSMC Positions ZDSPH Gap (Proposed) Administrative 32 53 21 Medical Doctors Nurses Clinical Support Technical Support 27 44 31 41 61 86 50 79 34 42 19 38 Zamboanga del Sur Province Page 29 . nursing positions are needed to address the wide gap on nurse-to-patient ratio which is only 1:5. billing & supplies. Administrative positions are needed for the maintenance of the building and all other facilities within the hospital compound. Medical equipment technicians are required to operate and maintain newly acquired medical equipment donated and/or purchased for use by the medical health facility. while. PhilHealth.5. Medical specialists are needed to head the different medical departments to cater to the different areas or fields of specialties.

Provincial Health Facility Development Plan Total 175 329 154 2008-2015 Zamboanga del Sur Province Page 30 .

Understandably.2 . it being the referral hospital under the established Inter Local Health Zone (ILHZ) System in the province. The situationer has implications on the sufficiency and competence of existing hospital center as to administrative. there is a great need to upgrade the Provincial Hospital from its present classification into a Tertiary Hospital with the capacity of 100 to 150 beds.1.769 out-patients and 3. 1. nursing and ancillary services.1.1 Adequacy of Hospital Beds To meet current and future care call of the rapid growth of population of the province of Zamboanga del Sur. 4. patients from the catchment/component municipalities. 4.48 percent.Provincial Health Facility Development Plan 2008-2015 Chapter THE ZAMBOANGA DEL SUR MEDICAL CENTER 4 (Health Facility Development Project) 4.a Administrative Services Zamboanga del Sur Province Page 31 .1. Of these patients. Hospital Statistics Report as of June 2008 reported that the average daily admission reached 639 patients.1 Rationale & Situationer The Zamboanga del Sur Provincial Hospital (ZDSPH) has been issued a secondary level DOH License with an authorized bed capacity (ABC) of 50. the hospital had 13. ZDSPH is serving more than a hundred patients daily on the average. 4. Thus. and even from the neighboring regions/provinces. otherwise the quality of health care and services will be compromised.294 out-patients were provided subsidies under the National Health Insurance Program (NHIP) through the Philippine Health Insurance Corporation (PHIC). despite the fact that historical occupancy rate was already more than 200 percent of its ABC for a number of years. sought the services of the hospital. From January to June of 2008.607 in-patients with an average occupancy rate of 162. clinical.2 Appropriateness of Provincial Hospital Services Provided It is worthy to note on the appropriateness of services being provided by the ZDSPH in order ascertain the current capacity level of the health facility vis-à-vis projected service level standards of a tertiary level facility.507 in-patients and 2.

Unresolved complaints/conflicts were elevated to the Provincial Grievance Committee. property and supply. housekeeping.2 . 4. The Hospital Waste Management Committee (HWEMC) and the Preventive Maintenance and Disaster Control Committee (PMDCMC) were also created to respond appropriately when the need arises.1. policies.b Clinical Services The Medical Clinical Services responded to the urgent problems regarding hospital operations and attended promptly to emergency cases especially from depressed areas following established referral system procedures among public and private hospitals and medical centers. other government and private agencies and professional groups. billing. cashiering. clients. Zamboanga del Sur Province Page 32 . 7305. inadequate administrative support has compromised quality clerical and logistic support services that are critical to the prompt and appropriate provision of various services to providers. However. budget. given resource limitations and a stretched budget due to over-capacity issues. personnel. Republic Act No. security. transport. etc. rules and regulations and with internal guidelines and policies formulated by the Provincial Hospital through consultation and integration of shared goals and values in conformity with the rules and regulations of the Provincial Government. laundry. including the provision of adequate personnel benefits. Committee actions were guided by CSC rules and regulations including Sangguniang Panlalawigan resolutions and/or ordinances. the provision of adequate and timely financial and support services such as accounting. A Grievance Committee was organized and tasked to attend to matters concerning personnel relations and discipline by hearing personnel complaints and grievances as well as client complaints and resolving conflicts between or among departments or units or individual employees.Provincial Health Facility Development Plan 2008-2015 Administrative support services were provided in accordance with the Civil Service Commission (CSC) guidelines. At the operational level. engineering and maintenance remained wanting.

Periodic reporting was sustained on drugs dispensed and issued to patients both for PhilHealth or Non-PhilHealth assisted by a licensed physician and dentist. Requisitions were prepared for awarded drug items and other supplies for procurement. therapeutic and other hospital clinical and support committees had uphold good linkages and networking status with the other sections of the hospital and other offices.2 . Maintained the safe keeping of patients’ medical records that are documented accurately and in timely manner. 4.1. 14.1.854 patients were served with laboratory services. biological and medical supplies were maintained and manufacture and expiration dates and labels of drugs routinely checked. Medical. Of the out-patients. The medical records officer and the record clerk has maintained the appropriate medical records of patients who are treated. Active members of the hospitals pharmacy. Medical Records Services. including statistical data. ambulatory care patients.d Ancillary Services Pharmacy Services. evaluated as inpatient. and OB-Gyne cases.2 . Proper storage for all drugs. Although there were some minimal lapses and errors committed by some of the pharmacy staff. there were 26. are made readily accessible. 427 out-patients and 7.c Nursing Services Nursing services are adequately provided as the service unit favorably benefited from the services of nursing interns from existing nursing schools in Pagadian City. Pedia.Provincial Health Facility Development Plan 2008-2015 Patients coming from the different municipalities of our province including the municipalities of Zamboanga Sibugay. or emergency patients. Lanao del Sur and Zamboanga del Norte were being served by the hospital. due to lack of manpower rather than negligence. medical records contains sufficient information Zamboanga del Sur Province Page 33 .847 in-patients who were admitted as having Surgical. and permit prompt retrieval of information. 4. As such. In 2007.696 were seen by Dentists and about 39.

3 . investigation and case study preparations for each patient were carried out for the proper classification of indigent patients.1. the existing 9 personnel for maintenance. Medical Social Services.3 . There is felt need to hire regular employees for maintenance and related works rather than outsource them from service providers. support the diagnosis. CIAF and other national/provincial/city/municipal officials.1. PCSO. Evaluation.3 Sufficiency and Competence of Provincial Hospital Personnel 4. careful planning and wise procurement made possible the provision of nutritious and fresh foods required for a balanced and satisfying meal. the existing 11 personnel shall be increased to 25. It is encouraged that Universal Coverage for social health insurance in the province must be significantly expanded to maximize benefits from both the supply and demand side. Dietary Services. engineering services shall be increased to 57.Provincial Health Facility Development Plan 2008-2015 as to the identity of patients. housekeeping.b Clinical Services Zamboanga del Sur Province Page 34 . the Dietary Unit has promoted optimal nutrition of patients and hospital personnel whose tour of duty is on a 24-hour schedule. Although. Medical Certificate or document/s for court hearing. 4.1. The ZDSPH extended services to indigent patients for assistance by referring/recommending them to different offices/officials like PSWDO. With their present work force. and document the course and results accurately for them to act promptly to requesting party who ask for issuance of Medico Legal. justify the treatment.a Administrative Services Shortfalls in the area of administrative support require the hiring of additional health manpower. through provision of high quality and nutritious foods. 4. while. For administrative services. the dietary services experiences tight budgetary constraints vis-à-vis soaring prices of commodities.

the number of nurses should be increased in order to meet service level standards.1. However. given the actual number of beds served vis-à-vis ABC. 4. and to ensure the provision of quality curative services. This includes but not limited to direct Zamboanga del Sur Province Page 35 . 4. there is a need to increase dietary personnel from 4 to 14 which is commensurate to the requirement of a 100-bed health facility. For Dietary Services.3 .4 Status of Provincial Hospital Networking and Referral System Being a core referral hospital. Dental Aide (1). Medical Laboratory Technician (10). two (2) General Surgeons and two (2) Internists and one (1) Pediatrician.3 . there is an urgent need to hire the services of Medical Specialists offering seven (7) major clinical specialties for the provincial health facility.1.Provincial Health Facility Development Plan 2008-2015 Plantilla/regular positions under the ZDSPH include the following: Physicians (20). Given the ideal number of clinical staff. 4. there is only one (1) OB-Gyne Specialist working as full time in the hospital. • Based on the presented scenario. • Prompted by the very high hospital occupancy rate. Patients are regularly linked to health facilities that can best attend to their needs. Dentist III (1). there is a need to upgrade manpower complement of the record section form 1 to 4 personnel. For Medical Record Services.d Ancillary Services For Pharmacy Services. • Nine (9) pharmacists are needed serving on a shifting 24 hours schedule. Laboratory Aide (3). and Radiologic Technologist (1).c Nursery Services Ideally. the Provincial Hospital is implementing the Two-Way Referral System.1.

Internal referrals were also done or within the health facility and from one personnel or another. d. Defined functions and responsibilities of each level of care and the agreed roles and responsibilities of the stakeholders properly observed. Chief of Hospital of the core referral hospital and the Municipal Health Officers of the catchments RHU’s were clearly defined to ensure full operationalization of the comprehensive two–way referral system—that is respected and adapted by all stakeholders. All these referrals were of patients consent. administrative guidelines to support the referral system were followed. or a Midwife referring patients to a Public Health Nurse for the purpose of providing any of the following: opinion or suggestion. The roles and functions of the Provincial Health Officer as coordinator. STAKEHOLDERS Functions as defined: a.g. and (d) patients that require in–patient care. and available mode of transportation to move patients from one facility to another. Referrals were done under the following conditions: (a) patients that needs expert advice. resident physician to a medical specialist.Provincial Health Facility Development Plan 2008-2015 patient care.g. c. use of communication facilities for updates and information gathering on available health facility services needed by patients. The linkages and lines of administrative communication/supervision were managed by the ILHZ. doctor to doctor (involving different fields of specialties). external referrals refer to linking patients to another health facility vertical or horizontal referrals. Agreed standard case management protocols (treatment protocols and guidelines) referral policies. access to various social support services. and capability building activities). and further evaluation for specialty care. Conducted regular evaluation of the system (e. program implementation reviews. (c) patients that require a technical intervention that is beyond the capability of the local health facility. quality of care. On the other hand. Conducted regular monitoring and supervision at all level. Nurse to Municipal Health Officer. program updates. referral practices and support mechanisms) e. (b) patients that need technical examination that is not available at the health facility. case management. b. Enhanced establishment of a feed backing mechanism at all levels (e. Zamboanga del Sur Province Page 36 .

transport. Meetings or conference 2. Providing information through letters and other form of communication by mail. CT SCAN. radio communication equipment. return slips. Zamboanga del Sur Province Page 37 .7 Present State of Provincial Hospital Management Systems 4. Special Orders d. LABORATORY. ULTRASOUND. Other Offices within the province and neighboring communities a. Advisory / Inter-office communication 4. email or fax through a liaison officer c. particularly on synchronizing linkages and networking of primary and secondary referring facilities to higher level referral facilities. PHARMACY.a Hospital Management Information System The Provincial Hospital Information System is operated through the following: 1. As a core referral health facility. Periodic meetings/conferences and monitoring and evaluation activities were done equipping the Provincial Hospital core referral system team members.7 . social services and monitoring system. Assisted in facilitating advocacy meetings and other activities involving the key stakeholders of the referral system implementation.1.1.b Hospital Billing and Collection System Admitted patients due for release or discharge are required to secure clearance slip from the Nurses Station duly signed by the CSR. Memorandum and other form of communication c.1. referral log book. Paging system b. discharge summary / follow-up slips). X-RAY. For information within the hospital a.7 .Provincial Health Facility Development Plan 2008-2015 f. the Provincial Hospital provided and maintained referral slips (clinical referral slips. Radio communication services managed by a trained Communication Equipment Operator II b. Meetings or conferences d. 4.

31 s. Patients’ accounts charge to PCSO. Rx/Prescriptions shall pass thru the Pharmacy Department for pricing and pay to the Cashier/Billing and for issuance of Official Receipts and back to pharmacy for dispensing. provided measures governing the Revised System in Fiscal Management of Hospitals repealing Provincial Ordinance No. PSWD. For Out Patient Collections.7 . 4. the Clearance Slip shall be routed to the departments concerned then validated by the Cashier/Billing for issuance of Discharge Slip.c Hospital Financial Management System Provincial Ordinance No.1. For those who cannot afford to pay. Cashier Section issues a bill according to the patient’s case based on the Revenue Code of the province. The Cashier/Billing issue Official Receipts for payments made by the different concerned agencies. The Cashier/Billing Section automatically issue Official Receipts to patients who can pay in full.Provincial Health Facility Development Plan 2008-2015 DIALYSIS and MEDICARE Departments. CIAF and etc. must be billed and signed by the Cashier and send to the different agencies concerned for collection. For OPD and In-Patients. patient shall be referred to MSS for financial evaluation. After payment. Nurses Station releases the patient upon presentation of Discharge Slip. For those who can not pay in full shall be referred to the MEDICAL SOCIAL SERVICE for financial evaluation before issuance of OR by the Cashier.1997 declaring fiscal and operational autonomy of hospitals and authorizing the sub-allotment of funds. Thus. 2005. All collections (OPD and IN-PATIENTS) are automatically remitted to the Provincial Treasurer’s Office. effective calendar year 2006 and up to present. payments are based on services rendered and rates according to the New Approved Revenue Code of the Province.12-2005 dated September 8. all financial Zamboanga del Sur Province Page 38 .

It is also the policy of the government to adopt a standard and uniform set of rules and regulation governing the procurement of infrastructure projects. standardization and the regulation of the procurement activities of the government.7 . goods and consulting services.9184 otherwise known as the Government Procurement Reform Act for the purpose prescribes the rules and regulation for the modernization.d Hospital Logistics Management System The Implementing Rules and Regulation (IRR) Part A. Competitiveness by extending equal opportunity to enable private contracting parties who are eligible and qualified to participate in public bidding. promulgated pursuant to Section 75 of Republic Act No. Government procurement principles were adhered to. 3. goods and consulting services shall be competitive and transparent and therefore should be through public bidding. the books of accounts are still consolidated as one in the General Fund. Fiscal transactions of the Provincial Government starting April 2007 were already inputted in the Electronic-New Government Accounting System (E-NGAS). except as otherwise provided in this IRR-A. this IRR-A covers all fully domestically funded procurement activities from procurement planning contract and termination.Provincial Health Facility Development Plan 2008-2015 transactions of ZSPH are under the care of the Provincial Government including the preparation of financial reports. It is the policy of the government that procurement of infrastructure project. Zamboanga del Sur Province Page 39 . as follows: 1. hospital operation is one of the economic enterprises of the Provincial Government.1. Although. Streamline procurement process that will uniformly apply to all government procurement. 4. Transparency in the procurement process and in the implementation of procurement contracts through wide dissemination of bid opportunities and participation of qualified non-government organization. 2.

effective and integrated delivery system for hospital services to achieve better and equitable health outcomes is instituted. preventive and responsive holistic curative tertiary health services. e. Zamboanga del Sur Province Page 40 .Provincial Health Facility Development Plan 2008-2015 Chapter STRATEGIC DIRECTIONS FOR HEALTH FACILITY DEVELOPMENT 5 5. Maintain the symbiotic networking with private and non-government health sectors for a proactive satisfactory clinical protocol and better implementation of national health thrust programs.1 Vision A center for excellence in health care and training that integrates promotive. d. b. espousing the promotive and preventive public health concerns for effectiveness.2 Mission a.3. 5. c. The Zamboanga del Sur Medical Center shall strive towards the attainment of high standards and ethics of hospital services and health care in the province. 1 Overall (National/Regional) Goal An efficient.3 Goals 5.3. To establish a service oriented high caliber manpower resource training program for assured better health interventions and outcomes. 2 Provincial Goal To develop a specialized health care delivery system in the province with training component for the allied professions and disciplines and gradually convert the facility into a fiscally viable institution with strong networking with the private sector for sustainability and growth. 5. 5. Develop an equitable health care financing system for sustainable efficient quality health care delivery and fiscal viability. Attainment of financial viability as an economic enterprise with strong commitment to its social responsibility.

5 Strategies a. Reduce LGU subsidies and dependence by sound fiscal management towards sustainability and unhampered growth b gradual autonomy. Orthopedics. d. retain and allocate revenue from socialized users fees and other forms of revenue- Zamboanga del Sur Province Page 41 . c. Pathology. palliative and rehabilitative modalities to maximize professional intervention/s for better or excellent outcomes. Reinforce the convergence efforts of the Inter-Local Health Zones toward a functional and very effective referral system in the public and private health sectors with active promotive and preventive health services for public health programs by the Hospital Public Health Unit. Surgery. c. Procurement of additional basic equipment and upgraded diagnostic instruments. e. Strengthen the paramedical professions training programs as the premier practicum/ training institution in the province. OB-Gynecology. Expansion of hospital financing system. Pediatrics.Provincial Health Facility Development Plan 2008-2015 5. Departmentalization of essential medical services with corresponding Specialist-Head in Internal Medicine. 5. Opthalmology. b.4 Objectives a. Establish a very competent and responsive staff to answer to the challenges of a core referral hospital in the province and other areas of the region. Nephrology and Physiatry with enhanced capabilities of the Emergency Section and OutPatient Department and sub-specialty in Cardiology in the next 5 years through a programmed human resource training and support reinforcement. f. Financial viability through expanded health insurance coverage of our clientele and consumers of health care. Government Hospital shall be allowed to collect. b. Radiology. Upgrade the medical professional capabilities through specialist-headed departments of health care and diagnostics services and support sections.

c.Provincial Health Facility Development Plan 2008-2015 generating activities. etc. Patients in our government hospital can avail of the services of medical specialist working part-time as contractees and likewise bringing in their patients for state of the art diagnostic procedures in the new hospital as the CT-Scan and palliative care in the Hemodialysis for end stage kidney ailments. Expand the source of hospital revolving funds as proceeds from sales of drugs and medicines. Also. Procurement by consignment should be established and sustained. private rooms and Doctor’s OPD clinics and expanded hospital services for ambulatory surgical care.2 c. c.7 d.5 c.1 Revenue enhancement through increased number of pay wards.6 c.) This can be done by decreasing the turn-around time from the Provincial Treasurer’s Office to the Budget Office. Review and implement the appropriate hospital fees and charges. x-ray. Improvement of our Affiliates facilities to cater our increasing number of students learning exposure in the different hospital section for sustained upscale of affiliation revenues. c. Hospital Pharmacy needs to be upgraded and competitive to increase income from the paying public. Expand the health insurance coverage to include the Out-Patient Benefit package of PhilHealth for reimbursement by the health insurance system. Strengthening of the existing government hospital networking and patient referral system to include private hospitals and private medical practitioners.4 A stricter collection of hospital services fees through voucher system and other effective means. delivery room. More efficient utilization of the hospital income from the incomegenerating areas (laboratory. operating room. the possibility of making hospital income as revolving funds. The establishment of the Medical Arts Center within the provincial health facility compound at the Provincial Government Complex at Dao by 2009 for all medical practitioners in the province will augment our revenues Zamboanga del Sur Province Page 42 .3 c.

Pharmacies and health spas are potential revenue centers for the open areas surrounding the main facility. possibly too. Developing the parks and recreational area within the hospital site in 2013-2015 will entice private investors to lease and rent spaces and sites for businesses that are related and complementary to health services.Provincial Health Facility Development Plan 2008-2015 from lease and space rentals of private practitioners as well as the OutPatient Benefit (OPB) package services financed by PHIC. Corollary to the above. Integration of public health program into our hospital services. f. The simultaneous development of a full complement Physical Therapy and Rehabilitation Unit by 2009-2010 will eventually establish a functional Physiatry Department in the provincial health facility. notwithstanding the early intent of food chain franchise. A Hospital Public Health Unit shall be established to serve as the main venue for the provision of promotive and preventive health services in the provincial health facility. Zamboanga del Sur Province Page 43 . Health educators and public health nurses and staff will man this unit with strong linkage with the Inter-Local Health Zones and its programs in resource pooling and sharing. 24-hour convenient stores and mini-malls. provision of private rooms in 2009-2010 will bring in patients of private physicians to our facility. e. catering service outlets and facilities to establish thereat. for confinement and its expected utilization of our services and revenue generation. Sports facilities for watchers and visitors are amenities very attractive and conveniently proximal to the Amusement and Heritage Complex nearby.

g. directly accountable to the Board for their decisions and actions. The Board engages in oversight by monitoring decisions and actions to ensure they conform to policies and produce intended results. vision/mission/goals/strategies). in turn. precise and transparent operations to really govern effectively the different hospital units.Provincial Health Facility Development Plan 2008-2015 Chapter HOSPITAL ADMINISTRATION & MANAGEMENT 6 Operating a third level health facility as an economic enterprise entails legislative support. Zamboanga del Sur Province Page 44 . It has to delegate tasks and authority to the medical staff which are. ensuring high levels of executive management performance. and the responsibility for itself—its own effective and efficient performance. While the Board assumes ultimate accountability. among other responsibilities of the Board. and (3) to assume responsibility of its affairs as a corporate entity.. and (2) how does it ascertain that high-quality care is being provided. it has no ability to perform the actual work of its organizational units. the Board of the provincial health facility system must have clear.1 Hospital Management Structure The development of a tertiary hospital/medical center revolves around a board of directors or board of trustees. decision making and oversight. (2) to make sure that management and the medical staff function in ways that further the mission and goals. the Board formulates policy with respect to each of its responsibilities to provide direction and as means by which authority and tasks is delegated to management and medical staff. The other responsibilities of the Board include: envisioning and formulating organizational ends (e. On policy formulation. Ensuring the quality of patient care is the ultimate responsibility it must assume. 6. its professional and technical capabilities fully backed by creation of funded plantilla positions for qualified medical specialists. On decision making. as they are empowered to perform three basic functions. its financial viability thoroughly studied. ensuring the medical center’s financial soundness/viability. It has to answer two basic questions: (1) does the medical center provide high-quality care. it must be carried out by the Board in each area of responsibility and regarding recommendations forwarded to them by management and the medical staff. to wit: (1) to represent the owners or stakeholders of the medical center and provide the means of ensuring that the facility act on the “stakeholders” behalf. nurses and support services to effectively and efficiently deliver valued services by the different departments. Needless to say. The Board shall have three (3) roles: policy formulation.

While the Committee may prove effective to respond to the challenges. a. It includes coordination with Specialty Societies. permanency and continuity. Addressing the complex problem of health human resource. 6. 6.1.2 Hospital Human Resource Management & Development Rationalize development and utilization of health human resource.Provincial Health Facility Development Plan 2008-2015 6. needs coordination of current efforts to recruit the best in the profession and augment hospital staffing in accordance to the Department of Health standards.1. ZDS Medical Center Management Board (ZMCMB) 6. b. c. Hospital fiscal and management autonomy will greatly improve hospital systems and sub-systems Zamboanga del Sur Province Page 45 . human resources etc. 1 ZDS Medical Center Management Committee (ZMCMC) The Zamboanga del Sur Medical Center Management Committee will continue to function as established for technical support and monitoring as. f. there is a need to transform the body into an organization that suggests authority. 2 Eventually. paramedical professionals and support staff. develop mechanism for coordination and networking with the InterLocal Health Zones and the private health sector for a strong referral system. d. residency dispersal. This will harmonize health human resource development in the province for equitable service capability upgrading in the true spirit of networking. consortium of hospitals in the premise for sharing of consultants and specialists and incentive for doctors. e.3 Hospital Systems and Procedures Institutionalize financial and procurement system. the ZMCMB (Board) shall be organized replacing the Committee. equipment. to formulate internal policies and guidelines for our third level hospital formulates a development plan for the next (5) five years recommend reforms towards fiscal autonomy provide technical assistance in fiscal management and audit possible technical support in development of health facility resources as infrastructures.

Procurement by consignment is ideal for our hospital. 6.Provincial Health Facility Development Plan 2008-2015 particularly in financial management and procurement. but retain its social responsibility.4 Hospital Budget and Financial Management Grant fiscal autonomy to our third level health facility. bidding procedures and sound supply management will lead to maximum utilization and prioritization of hospital resources. Zamboanga del Sur Province Page 46 . Improvement in the implementation of accounting. Financially viable government hospital can be sustained as an economic enterprise with the objective of maintaining quality service provision to its clientele not for profit.

Medical Arts Building Construction Project (Phase I) i.1. Cardiac Diagnostic Center Project Zamboanga del Sur Province Page 47 . 1 Construction of Physical Facilities This will include construction the following facilities: a. make it more competitive and enable our hospital to effectively exercise fiscal autonomy. Communicable Diseases and Logistics Building Project j. Hospital Transport System Improvement Project (Phase I) d. Teaching Facility Project m. Site and Parks Development Project (Phase II) q. Doctors and Nurses Residence Inn Project h. These improvements is geared to make our hospital more responsive to the health needs of our clientele aboveall. It includes upgrading of physical plant and provisions of additional equipment.1 Rational Upgrading of Hospital Facilities & Utilities Upgrade critical capabilities of our hospital. Centralized Hospital Information System Project (Phase II) o. b. Motorpool and Garage Project n. 7. PT-Hemo Dialysis Building Construction Project f. by an aging population and increasing life expectancy. Hospital Equipment Acquisition Project (Phase II) p. 7. Centralized Hospital Information System Project (Phase I) e.Provincial Health Facility Development Plan 2008-2015 Chapter HEALTH FACILITY DEVELOPMENT PRIORITIES 7 Enhance health facility development. Hospital Equipment Acquisition Project (Phase I) Comprehensive Emergency Obstetric and Newborn Care (CEmONC) Facility Project c. Morgue/Autopsy Room Project k. The decline in service capability effected by the devolution and some constraints in the LGUs calls for the development of a third level health facility in the province to cope with the ever increasing demand for specialized hospital services brought about the economic disparity.Watchers Utility Area Rehabilitation Project g. Site and Parks Development Project (Phase I) l.

2. 7. Zamboanga del Sur Province Page 48 . facilities and other resources between the government and the private health professionals and facilities must be sustained.Perimeter Fence and Guardhouses Construction Project s. Hospital Departmentalization Project 7. 2 Teaching and Training Capacity a. Professional Capability Upgrading Project b. b.3. c.4 Integrating Hospital Management Information Systems (MISs) Investment is necessary to expand networking and patient referral system between the public and private sectors in health.2.3 Hospital Quality Assurance Establishment Program Medical Officers Training Program Paramedical and Staff Training Program Hospital Financial Management Systems Installation and Upgrading 7.Provincial Health Facility Development Plan 2008-2015 r. Sharing of expertise. 2 Installation of Automated Billing and Collection System Upgrading and Maintenance of Financial Management System 7.Hospital Facility Maintenance Program 7. 7. 1 Training and Retooling Human Resource a. Medical Arts Building Expansion & Leasing Project (Phase II) t. 1 7.2 Human Resource Capability Building Human resource development is integral to developing modern health facility.3. Hospital Information system is to be developed and linked from one facility to another.

2 Annual Service Level Agreements (ASLAs) for the Implementation of the 5-Year Provincewide Investment Plan for Health (PIPH) for 2008-2012 Memoranda of Agreements (MOAs) Institutionalizing Enrolment of the Poor to the National Health Insurance Program (NHIP) 8. 2007.1. 2008) budgetary allocation will eventually reduce our dependence to the provincial government and freeup Provincial LGU resources for other health priorities.2.1.1 Local Legislations to Support Critical Reforms 8. 1 Social Health Insurance (SHI) Multi-Payor Scheme Ordinance Zamboanga del Sur Province Page 49 .Provincial Health Facility Development Plan 2008-2015 Chapter POLICY SUPPORT MEASURES NEEDED 8 8. 3 8. 2 8. 1 Revolving Drug Fund Ordinance A Sangguniang Panlalawigan Ordinance allowing our hospital to retain portion revolving funds to augment our decreasing (2 million MOOE budget decrease in 2006. 8.1.

49 billion under the Hospital Development Investment Program (HDIP) for 2008 to 2015 as the first tranche of investment towards the goal – “An efficient. hospital infrastructure will need to be configured differently.3 15 2011 140. C.6 47 2014 161. Cost Summary of Investments By Year of Implementation: 2008-2015 Major Component A.492.2. 0 9.8 23 15-Year Investment Program for CY2008-2015 [In P'000] Short-Term Medium-Term Long-Term 2008 48. Maintenance and Other Operating Expenses (MOOE) and Capital Outlay (CO) requirements. includes the provision of personal services (PS). health facility development and upgrading and health financing. Health Human Resource Provision.0 52 2012 147. The entire investment. thus. The investment will provide for redeveloping and reconfiguring the provincial health facility—and its satellite or annex units—and establish a highly effective and efficient hospital facility network system. 9.98 2 2009 135. however. Development & Upgrading Project Cost (In P'000) 1. Health Human Resource Provision. Provisions are being made for health human resource development and upgrading.6 100. There will be new technologies and equipment and different models of hospital care.534 % to Total 73.1 The Eight-Year Provincial Hospital Development Investment Program (PHDIP) 9. The government (national and local) will allocate about PhP1.0 22.911 1.8 13 2010 133.800 67. effective and integrated delivery system for hospital services to achieve better and equitable health outcomes”. 1 Cost Summary of Investments By Component Table 13.823 334. B.089.4 4. Development & Upgrading Health Facility Development & Upgrading Health Financing TOTAL Project Cost (In PhP'000) 1. 2 Cost Summary of Investments By Year Table 14.2.50 Zamboanga del Sur Province Page 50 . D.089. Cost Summary of Investments By Components Component A.Provincial Health Facility Development Plan 2008-2015 Chapter HOSPITAL DEVELOPMENT INVESTMENT PROGRAM: 2008-2015 9 An effective provincial health facility system in the next decade will look quite different from the health system of today.1 34 2013 153.3 78 2015 169.

DOH PG-ZDS.000 3.500 2. DOH Project Cost (In PhP'000) 1. DOH PG-ZDS.000 150.30 0 6.439 1.7 70 156.454 8. DOH PG-ZDS. 01 02 03 04 05 B. C.070.Provincial Health Facility Development Plan 2008-2015 2 B.652 224.000 5. DOH PG-ZDS. 01 02 03 04 05 06 07 08 09 10 11 12 13 HEALTH HUMAN RESOURCE PROVISION.500 15.500 7.089.000 67.2 29 178. D .5 34 103.000 1. DOH PG-ZDS. DEVELOPMENT & UPGRADING Professional Capability Upgrading Project Hospital Departmentalization Project Hospital Quality Assurance Establishment Program Medical Officers Training Program Paramedical and Staff Training Program HEALTH FACILITY DEVELOPMENT & UPGRADING Hospital Equipment Acquisition Project (Phase I) CEmONC Facility Project Hospital Transport System Improvement Project (Phase I) Centralized Hospital Information System Project (Phase I) PT-Hemo Dialysis Building Construction Project Watchers Utility Area Rehabilitation Project Doctors and Nurses Residence Inn Project Medical Arts Building Construction Project (Phase I) Communicable Diseases and Logistics Building Project Morgue/Autopsy Room Project Site and Parks Development Project (Phase I) Teaching Facility Project Motorpool and Garage Project EC.287 5.958 5.300 15. DOH USAID. PG-ZDS DOH/PCSO EC.823 6. DOH DOH.594 10.492. DOH PG-ZDS PG-ZDS.000 Zamboanga del Sur Province Page 51 .39 9 180.911 7.417 334.457 16.000 5.000 2. Health Facility Development & Upgrading Health Financing TOTAL 334. DOH USAID. EC. EC.5 00 6. USAID.103 7.1 00 187.2. Cost Summary of Investments By Source of Fund MAJOR COMPONENT Fund Source/s Project / Activity Title A.2 77 11.000 2.50 0 7. DOH PG-ZDS. DOH EC.00 0 9.500 7.3 65 163. 3 Cost Summary of Investments By Source of Fund Table 15.9 17 155.94 1 9.000 2.500 4.161 2. DOH PG-ZDS. EC.000 15.000 17.813 8.800 50. DOH PG-ZDS.9 34 366.800 48. DOH PG-ZDS.

31 5 Medium-Term 201 1 140.000 3.593 131.000 7.089.911 1. HOR/PDAF.534 9.50 0 Medium-Term 2011 7. 01 D. DOH EC. (b) X-ray Machine. HEALTH FACILITY DEVELOPMENT & UPGRADING Hospital Equipment Acquisition Project (Phase I) Fund Source/s Implem entatio n Year/s Projec t Cost (In P'000) 334. DOH USAID.300 2009 224. hiring and training of medical and nursing professionals to meet minimum personnel requirements for a 3rd-level health facility Departmentalization of hospital services.287 200 220 242 266 293 322 354 390 5.1 61 47. PHIC.0 00 500 550 605 666 732 805 Paramedical and Staff Training Program 5.390 152.8 00 15-Year Investment Program for CY2008-2015 [In P'000] Short-Term 2008 48. DOH 20082015 20102015 20102015 2. (Inclusive of PS-MOOE-CO Requirement of the whole medical center facility) Clinical cases review.492.911 67. EC. 0 1 HEALTH HUMAN RESOURCE DEVELOPMENT & UPGRADING Professional Capability Upgrading Project Screening.65 160.000 2. EC.307 9 0 3 0 4 0 5 Hospital Quality Assurance Establishment Program Medical Officers Training Program PGZDS.292 168. Centralized Hospital Information System Project (Phase II) Hospital Equipment Acquisition Project (Phase II) Hospital Transport System Improvement Project (Phase II) Site and Parks Development Project (Phase II) Cardiac Diagnostic Center Project Perimeter Fence and Guardhouses Construction Project Medical Arts Building Expansion & Leasing Project (Phase II) Hospital Facility Maintenance Program HEALTH FINANCING Hospital Financing System Improvement Project TOTAL PG-ZDS. Training of medical officers for residency in preferred specialization Programmed training for paramedical and support services staff PGZDS.958 100 2.500 67. DOH 20082009 50.00 0 Long-Term 2014 8.Provincial Health Facility Development Plan 14 15 16 17 18 19 20 21 C.000 20. Detailed Investment Program By Component By Project/Activity By Year By Source of Fund MAJOR COMPONENT Brief Description Project / Activity Title A . EC. 823 6.500 2013 15. DOH EC.0 00 3.00 0 200 9 135.00 0 5.2.070. grand medical rounds and peer review.873 138.13 4 201 3 153.3 78 2015 169.500 2012 7. etc.000 5.0 00 2010 133.466 145. BLGUs. EC. each department to be headed by a medical specialist. DOH PG-ZDS 2008-2015 1. DOH USAID. DOH PG-ZDS EC. (c) Echo EC. DOH PG-ZDS. DOH PG-ZDS 20082009 Fund Source/ s Imple menta tion Year/s Project Cost (In PhP'000 ) 1. C/MLGUs.000 15-Year Investment Program for CY2008-2015 [In P'000] Short-Term 200 8 48.000 6.6 47 Long-Term 201 4 161.000 17. 4 Detailed Investment Program By Component By Project/Activity By Year By Source of Fund Table 16. USAID.500 2015 7.98 2 1.000 01 Procurement of additonal equipment for diagnostics and active intervention such as: (a) Ultrasound machine.417 100 700 770 847 MAJOR COMPONENT Brief Description Project / Activity Title B.50 2 0 2 Hospital Departmentalization Project 20082015 1.000 201 0 16.8 13 5.000 Zamboanga del Sur Province Page 52 .0 52 2012 147. DOH PG-ZDS.582 125.50 0 45.

000 13 14 15 Motorpool and Garage Project Centralized Hospital Information System Project (Phase II) Hospital Equipment Acquisition Project (Phase II) Hospital Transport System Improvement Project (Phase II) Site and Parks Development Project (Phase II) Cardiac Diagnostic Center Project PG-ZDS.000 2. acquisition of dialysis machines. DOH PG-ZDS.000 4. DOH PG-ZDS.000 06 Watchers Utility Area Rehabilitation Project Doctors and Nurses Residence Inn Project Medical Arts Building Construction Project (Phase I) Communicable Diseases and Logistics Building Project Morgue/Autopsy Room Project Site and Parks Development Project (Phase I) Teaching Facility Project PG-ZDS.500 500 500 EC. DOH 2.9 41 10/5/2011 2:26 a10/p10 Zamboanga del Sur Province Page 53 . DOH EC.000 C.77 0 156.000 500 1. 534 103.457 6.1 00 180.000 EC.000 5. 2008-2015 02 CEmONC Facility Project DOH 20082009 20082009 20082009 15. DOH 20082009 20082009 20082009 20082009 20082009 20082009 20082009 2.000 11 12 2. HOR/PDAF.000 2.91 1 6.000 07 4. 01 HEALTH FINANCING Hospital Financing System Improvement Project Establishment of a Multi-Payor Scheme for social health insurance (NHIP) to contribute to universal coverage objectives. Dietary Kitchen and Private Room Facilities.594 8.000 2.594 9. DOH 3. Upgrading of installed IT hardware and software Acquisition of New Hemodialysis Machines (Fresinios) Establishment of hospital shuttle services Construction of stall outlets and recreational facilities Construction of building to serve as diagnostic center.000 130.000 17 18 PG-ZDS EC. 917 155.000 2. CT Scan Construction of perimeter fence and guardhouses to secure the hospital facility Expansion of building and lease arrangements.000 1.00 0 17.91 1 67.500 20.000 2.000 1. etc.300 10.500 12. DOH PG-ZDS.439 11. (d) Mamography Machine. DOH PG-ZDS. PHIC.500 2.000 10.454 10. DOH PG-ZDS 20102012 20132015 20082015 5.2 77 187.00 0 5.000 1.000 03 04 Hospital Transport System Improvement Project (Phase I) Centralized Hospital Information System Project (Phase I) PT-Hemo Dialysis Building Construction Project Acquisition of New Ambulances and Service Vehicles Acquisition and installation of new IT hardware and software including Collection & Billing System Construction of additional 2storey building for PT-Rehab.399 10.813 8. and (e) Complete PT-Rehabilitation Unit Equipment Establishing a CEmONC facility. vehicles and equipment within the hospital compound DOH/PCSO 2. 20082015 67.000 500 1. DOH PG-ZDS. TOTAL 1. BLGUs.0 00 5. DOH PG-ZDS. DOH 300 3. Rehabilitation of existing workshop building to serve as workshop facility for watchers Construction of building facility to serve as doctors' and nurses' living quarters Construction of building facility to serve as doctors' clinics Construction of building to serve as treatment facility for cmmunicable diseases Construction of building to serve as cadaver holding and autopsy facility Landscaping works Construction of amphi theater and function hall and acquisition of shuttle bus for use by affiliates.500 1.439 D .652 6. DOH 20092010 20102012 20102012 20102012 20102012 20102012 2. C/MLGUs.454 9.000 3.492.000 5.000 5. Expansion of SHI coverage and/or re-enrlment of beneficiaries PG-ZDS.00 0 4.000 08 150.2 29 178.500 4.500 500 2.000 15.3 65 163.00 0 17.000 1.000 5.000 09 1.000 16 EC.500 500 2.00 0 3.000 1.000 1. DOH PG-ZDS.000 3.000 19 20 21 Perimeter Fence and Guardhouses Construction Project Medical Arts Building Expansion & Leasing Project (Phase II) Hospital Facility Maintenance Program PG-ZDS.652 6.50 0 1. Hemo-Dialysis.000 20.103 7. Construction of mtorpool and garage facility. DOH 6.000 10 2. DOH 20082009 15.Provincial Health Facility Development Plan Cardiography Machine.399 11.000 2.813 7.000 05 EC.457 7.000 2. Maintenance works for all hospital structures.000 7.9 34 366.000 1.103 7.000 3.00 0 3.000 500 1.