MDGs on health and the need for partnerships

Forging National-Local Partnerships to attain Health MDGs Public Private Partnerships in Health Blueprint for the National Health Information System Creating Impact: Improving MMR in ZFF Partner Municipalities Undevolved Health in ARMM: An Issue in Attaining MDGs?
www.zuelligfoundation.org

In his piece here. and an increase in knowledge. Marcelo. our Foundation has five groups composed of private and public individuals and organizations working on five different pertinent health issues .org 2 . By improving government health service delivery in local communities. Dr. he shares what strategies can be adopted in ARMM where. No article in this publication may be reproduced or reprinted without prior written permission from Zuellig Family Foundation. MD Contributing Editors Eddie G. Already. As director of the University of the Philippines Manila National Telehealth Center. Garilao Executive Editor-in-Chief Maricar D. MD Alvin B. one of the first government agencies to form such a group to fast-track PPP programs and thus.and with various government agencies and private organizations. Alvin Marcelo. Faraon.Private Partnerships in Health Blueprint for the National Health Information System Technical ICT Group for Health Provincial Health Partnership Program: Converging Priorities Governors and Partners towards MDGs Creating Impact: Improving MMR in ZFF Partner . suggestions and contributions to communications@zuelligfoundation. Health Intel intends to provide relevant information. citizen empowerment and excellence in local governance. you will start increasing your participation in endeavours that work towards improving the lives of poor Filipinos. Dr. about the health intel A publication of Zuellig Family Foundation. Villamor Anthony Rosendo G. MD As former health secretary and now. Marcelo not only tells what these benefits are. MD Technology has dramatically changed the business and communication landscape. Dr. bring much needed improvements in the country’s health sector. as president of a foundation assisting local governments in healthcare management. MD Ernesto Domingo. MD Contributors Jovito M. Dorotan.now numbering 30 . Having witnessed poverty across the country and seeing how local governments responded through innovations. Galvez-Tan. 1 health intel 2011 www. Galvez-Tan knows the complications in the health system of the Autonomous Region in Muslim Mindanao.private partnerships (PPPs) and agenda of Universal Health Care for all Filipinos. MD our contributors Eddie Dorotan. Autonomous Region in Muslim Mindanao. MD Dr. Go Managing Editor Juan A. sustainability. These benefits strengthened our resolve to actively promote the formation of various multi-stakeholder partnerships for health. Please send your comments. In his article. a resource institution that promotes innovation. then our partner-municipalities must show improved health indicators relating to maternal health. health financing and capability-building for municipal mayors. Filipinos can expect similar immeasurable benefits. We also have the Zamboanga Health Alliance. Teodoro Herbosa is the chairman of the Public-Private Partnership Taskforce of the Department of Health. MD Dr. particularly in health. one will find a model that worked abroad and that could very much succeed in our country. child health and infectious diseases.zuelligfoundation. The views and opinions expressed in this publication do not necessarily reflect those of the Foundation or the Zuellig subsidiaries and affiliates. unlike in the rest of the country. The publication also serves as an advocacy mechanism for more responsive health leadership that can transform the Philippine healthcare system to be more equitable. he also gives us how we should go about building the proper information system for the whole country. Juan Wesley T. MD Jaime Z. Villanueva Staff Writers Alberto G. If our programs have been effective. We hope that like us. MD Benny Reverente. health is not devolved to local government units. working to improve the lives of residents in the Zamboanga Peninsula. We are pleased to say that our first batch of nine partner-municipalities did not fail us. In this issue of the Health Intel.Localizing MDGs. these rural municipalities . Romualdez. We have experienced efficient sharing and deployment of resources. he shares what these partnerships are. an expansion in influence and reach. Should the right information and communication technology be in place in the health sector. Undersecretary Gerardo Bayugo. Tolosa Editor-in-Chief Ana Katrina A. We owe the success to our very rewarding partnerships with ISSN 2243-7126 Editorial Board Ernesto D. MD Advisory Board Members Undersecretary Teodoro Herbosa.org. Herbosa. We use the Millennium Development Goals in health as objective measurements of our programs’ success (or failure). Jimmy Galvez-Tan. MD Undersecretary Teodoro J. information and communications technology. Dy Mike U. Dorotan knows only too well that public-private collaborations are critical. a partnership with the Department of Health and the Department of Social Welfare and Development.Municipalities Undevolved Health in ARMM: An Issue in Attaining MDGs? SLAM wins Galing Pook Award 3 14 17 19 20 22 23 25 26 29 34 Message froM the President It has been three years since the Zuellig Family Foundation decided to recast its strategy in an effort to help speed-up reforms in the local public health systems. Dorotan is the Executive Director of Galing Pook Foundation. insights and analyses for incisive policy discussions on critical health issues. In this issue.proper healthcare. more poor people receive what they rightfully deserve .Local Partnerships to attain Health MDGs Philippine Health Outlook Forum: Responding to Health Inequities through Multi-stakeholder Partnerships Public . we try to give readers a better appreciation of PPPs on health by presenting successful experiences on partnerships and arguments for PPPs.table of contents MDGs on health: Where are we now? Forging National . which is aligned with the Aquino administration’s call for public .

3 health intel 2011 www. while allowed to grow unimpeded. President Benigno Aquino III.” At the rate things are going. The present administration. Philippine status in terms of attaining the MDGs on health targets MDGs on HEAlTH: WHErE ArE WE noW? s ince adopting the Millennium Development Goals in 2000.org 4 .Private Partnerships into social services. The same was pronounced by Health Secretary Enrique Ona during the Second Health Outlook Forum when he said. in his speech during the 65th United Nations General Assembly in September 2010. the Philippines has made significant improvements in the general health of the population. the country will likely attain the targets of reducing child mortality and halting malaria and other diseases. “I don’t intend to miss the (MDG) targets. Despite the gains. education. These include targets in reducing the maternal mortality ratio. and poverty alleviation. though. Aquino said that his government will ensure that private businesses. the country will still likely miss some of the MDGs. reiterated his administration’s focus on ensuring the achievement of the MDGs.zuelligfoundation.zuelligfoundation.org www. however. like those in health. “Our administration’s pledge: To channel the gains we might reap from Public .” During his speech. In fact. achieving universal access to reproductive health services and stopping the spread of HIV/AIDS. must recognize and fulfill their social responsibilities.Table 1. stressed that its priority is to meet the MDGs. There is also medium probability of attaining universal access to treatment for HIV/AIDS (see Table 1).

the ARMM had the highest U5MR at 94. inequities plague the delivery of maternal and reproductive health services. The IMR of 34. respectively.17 and 1.” the rate of decline of maternal mortality. The poor and more vulnerable segment of the population have low to medium access to healthcare. particularly the geographically isolated and depressed areas. inadequate and incompetent health providers. IMR and U5MR stood at 57 and 80. levels of income and natal care The NDHS report showed that 98% of pregnant women in the highest quintile receive antenatal care compared to 77% in the lowest quintile. NCR had the lowest at 24. in 2008. In rural areas U5MR is 46 and IMR is 35 but in urban areas.org www. have to endure home deliveries by hilots (traditional birth attendants). is very low such that the country is unlikely to meet its target on maternal health. Likewise. translates to 80. Romualdez said that while less than half of the poor pregnant women in the country receive iron supplementation. less than two percent undergo caesarian sections compared to 20% among their rich counterparts. Children whose mothers had elementary education are three times more likely to survive than those whose mothers had no education.zuelligfoundation. given the pace by which the rates have been decreasing. a mother’s educational attainment plays a crucial role in reducing early childhood mortality rates. child mortality rate is seven times higher and U5MR four times higher for uneducated mothers than B ased on the “Philippines Fourth Progress Report-2010. the figures are 17 and 15. During a lecture that former Health Secretary Alberto Romualdez delivered at the University of the Philippines. Mothers in poor rural communities. leading to 3.MDG 4: reduce by two-thirds between 1990 and 2015 the under-five mortality rate MDG 5: reduce by three-quarters. He added that “among poor women giving birth. The same indicators stood at 34 and 25. Among the regions.000 Filipino women dying unnecessarily every year. Based on the 2008 National Demographic Health Survey (NDHS).20. U5MR is 59 and IMR is 40 while among the highest quintile.zuelligfoundation. respectively. the maternal mortality ratio and achieve universal access to reproductive health by 2015 s ignificant strides have been made in reducing child mortality for the past two decades. The figure also masks the great disparity between children from rich and poor families. In 1990. Children whose mothers have attained relatively higher education have higher chances of survival. the same indicators are 28 and 20. According to Romualdez.org 6 .000 children dying annually of preventable causes. Manila on September 2008. Rich urban communities and those in the upper wealth quintile have greater access to maternal and reproductive health services. This reflects the inequity in access to child health programs and services. The country will likely attain its 2015 infant (IMR) and under-5 (U5MR) mortality targets of 1. followed by Eastern Visayas at 64. Among the lowest quintile. however. at 0.47%.” 5 health intel 2011 those whose mothers reached high school. respectively. respectively. 80% of pregnant women from the top quintile get this vital supplement. between 1990-2015.” (see also Figure 1) “Child mortality is seven times higher for uneducated mothers. The gap is even bigger for those whose mothers have college education. respectively. and lack of access to essential medicines and reproductive health products.” www. “3. he said that 83% of children from top quintile homes get the Expanded Program on Immunization vaccines while only half of those from the low quintile families get the vaccines.000 Filipino women die unnecessarily every year. dilapidated health facilities.

maternal and child health and nutrition.zuelligfoundation.5 TFR and 18.7% of pregnant women in the ARMM receive antenatal care from skilled health providers compared to the 85-97% of women in majority of the regions. reproductive health Limited access to reproductive health services also impedes the reduction of maternal and early child mortality rates. prevention and treatment of breast cancers. and AIDS. The NDHS report also showed that women with college or higher education have TFR of 2.1 in NCR. Despite the significance in curbing maternal and early child mortality rates.1 compared to TFR of 2. prevention and treatment of reproductive 7 health intel 2011 www. Data showed that total fertility rate (TFR) and CPR is shaped by socio-economic and geographic factors. According to Romualdez. and prevention and management of violence against women. male reproductive health. recent fertility rate figures showed that rich women on average have only two children. adolescent reproductive health. The NDHS showed that mothers with no education were two times more unlikely to seek antenatal care from skilled health providers. Figure 2 shows that family planning and birth spacing is critical to reducing child mortality rates. and delivery by skilled provider. while poor women at the bottom quintile of income groups have 6 or 7 during their reproductive years. Reproductive health services include family planning. HIV.1 in contrast to the 4. only 46. ensuring access to reproductive health services remain a low priority.Education and maternal care Contraceptive prevalence rate (CPR) over the years has remained Educational attainment also affects a woman’s health-seeking behavior. the ARMM had the highest fertility rate at 4.3 and lowest CPR at 15. particularly in poor rural areas. facility-based delivery. and other gynecological conditions. Among the country’s regions.5 CPR of women with only elementary education. protection against neonatal tetanus.3 and CPR of 53. prevention and appropriate treatment of sexual disorders.3 and CPR of 54. The same correlation goes for the likelihood that mothers will get iron supplementation. low (see Figure 3). The survey showed that the country is likely to miss the target for ensuring universal access to reproductive health by 2015.org 8 . tract infections including STDs. counseling and education on sexual health. Among the regions.

by 2015. leaving local governments of the 58 other provinces to work towards totally being malaria-free (see Figure 7). the DOH declared 22 provinces as malaria-free. it rose to an average of two new cases a day in 2009 and then to four new cases a day in 2010 (see Figure 5). the National Epidemiology Center reported 159 new cases. and achieve. MDG 6: Have halted. a high probability of attaining the target by 2015. This rapid increase was attributed to increased risky behavior and low coverage of HIV interventions.zuelligfoundation. and begun to reverse the incidence of malaria and other major diseases The rate of progress towards eradicating malaria incidence indicates from 1990 to 2009. From an average of one new case a day in 2007. Access of those with HIV infection to anti-retroviral therapy was only 82% according to the 2010 report of the Philippine National AIDS Council. Although considered to have low-HIV-prevalence. the previous year. by 2015. In February 2011. and begun to reverse the spread of HIV/AIDs. 22% higher than Data from the 2009 Integrated HIV Behavioral and Serologic Surveillance revealed that only 38% of the most-at-risk populations were reached by the HIV prevention programs. In 2008. by 2010.Target: Have halted. Figures 6a and 6b show the continuous decline of malaria morbidity and mortality rate 9 health intel 2011 www. the current rate of increases in new cases coupled with the slow rate of progress indicates that the country may not meet its 2015 target.org 10 . universal access to treatment for HIV/AIDs for all those who need it Experts expressed alarm over the rapid increase in the number of new HIV/AIDS positive cases during the past two years.

The country’s TB prevalence.TB remains a major concern While there were gains in the detection and cure of tuberculosis. five are in Luzon. the country was still at the 9th place among the 22 high-burden countries.” source: Philippine Progress report on Millennium Development Goals 2010 11 health intel 2011 www. one is in the Visayas and five are in Mindanao. TB prevalence and mortality remain a concern. Figure 7. Central Luzon. There have also been increasing new cases of Multi-drug Resistant TB (MDR-TB) from 2005-2009 and varying MDR-TB that developed from previously treated cases. According to the 2010-2016 Philippine Plan of Action to Control Tuberculosis of the DOH. had the lowest cure rate.zuelligfoundation. Breaking down the data into regions show that 11 out of 17 regions are below the national average cure rate of 82%. Of the 11 regions. incidence and mortality rates remained higher than the average global and regional levels (see Figure 8). at 69%. including the National Capital Region.org 12 . 6-year average (2003-2008) “58 provinces still have to strengthen efforts to address Malaria. Distribution of malaria cases in the Philippines.

local governments can forge effective.000 live births while maternal mortality ratio (MMR) is at 162 per 100. were new to the task of health given to them. The DOH has been slowly implementing health sector reforms at the local level. targets.zuelligfoundation.Forging national-local Partnerships to attain Health MDGs by: Eddie Dorotan. the establishment of the Center can lead to more infrastructure projects in the country’s health sector. The Alliance will work to improve the health situation in 51 Zamboanga Peninsula municipalities that are also recipients of DSWD’s conditional cash transfer program. while that of preventive care to the municipalities and cities.Private Partnership Center Executive Director Last April. for some local officials. among others. So the question is: can we attain the MDGs in health by 2015? My optimistic answer is yes we can – but only if national and integration and coordination of health services. Philamer Torio. 5 and 6).Private Partnership (PPP) Specialist Center for Health in Manila. Fragmented Health system One of the problems confronting the health system is the fragmentation as a consequence of the Local Government Code of 1991. It further delineated the task of hospital care to the provincial governments. The challenge now is how to make our health system work better. manage the sector specific PPP Research Program. AIDS/HIV. are 19 for IMR and 52 for MMR. The Center is part of UNECE’s program of establishing an International Center for Excellence on PPP in Geneva and then various sectoral specialist centers in different countries. The targets. Across geographic and income groups particularly the poor. The Center will. The Philippine Health Insurance Corporation has devised a sponsored program giving capitations and reimbursements to local government units. but to alleviate the conditions of poor Filipinos as well. Specifically. countries can benefit from the advice and support of experts and gain the professional capability to successfully implement PPPs. Department of Health and Department of Social Welfare and Development.000 live births (2005 FPSA and 2008 NDHS). by 2015. Worse. Eddie Dorotan facilitates the Health Leaders for the Poor training program participated by mayors and health leaders from ZFF partner-municipalities. there are significant differences in outcomes and program performances in these three health Millennium Development Goals (MDGs 4. Confusion on the roles played by regional DOH officials and local elected officials ensued.zuelligfoundation. The Code devolved the functions of health service delivery from the Department of Health to the local government Dr. how do we forge national and local partnerships in health so that we can achieve our health targets by 2015? What are the most important areas for forging partnerships? Pursuing 2015 MDG targets through Partnerships A s the country continues to struggle in meeting some of the By having the Center. This set-up led to difficulties in the coordination and integration of the delivery of health services. And local governments are working together through interlocal health alliances and zones. efficient and empowering partnerships. Governors and mayors. Ona announced that the United Nations Economic Commission for Europe (UNECE) approved the establishment of an International Public . Other PPPs for health include the formation of the Zamboanga Alliance between the Zuellig Family Foundation. the country has seen slow progress in the mortality and maternal mortality. Centers of Health Development (DOH Regional Health Offices) personnel were accustomed to a vertical health implementation for years. According to Public . the country is still lagging behind in reducing infant units. given the mandate of devolution. 13 health intel 2011 www. MPA C urrently.org www. and manage the Specialist Centre Membership. fund the development and updating of specific best practice guides under the direction by the UN PPP Secretariat. tuberculosis and other diseases still pose threats to the population. Through the years. there is a need for greater private participation not just to help the country meet its targets. on the other hand.org 14 . Infant mortality rate (IMR) is still at 25 per 1. MD. health was not a priority.

and performance monitoring and evaluation. every Filipino can demand basic health services from the government.work hand in hand in securing the health welfare of the The DOH must exert its technical-political leadership in public health. The remaining 25% should be sponsored by local governments. everyone should contribute to the well-being of all. arthritis and the concerns of the elderly must also be addressed. Education Greater emphasis should be made on educating the public about healthy lifestyles. This would entail a total cost of just about P10-11 billion a year from the national government! Everybody then. can demand basic preventive and curative health services from accredited government and private providers. functional local health boards. Maternal and Child Care Mothers and children should not die without being attended to by appropriate health personnel. financing and coordinating a continuum of services from preventive to hospital care within a province. therefore. In the same manner. It can be done through a tripartite partnership among government. A strong regulation of medical and medical products should secure efficacy and safety of these products. effective and empowering stakeholders. Improving accountability relationships among politicians. partnerships In this among national and local way. municipalities and barangays have to work together in delivering.government. Community-based health initiatives have to be reinvigorated. 4. Water and sanitation are very important determinants of health. On the other hand. The benefits under the Magna Carta for Public Health Workers must be given right away. Given the challenges and Environmental Sanitation Every family should have access to potable water and safe sanitation facilities. among others. including catastrophic) are delivered by accredited government and private providers across the land in the most effective and efficient manner.zuelligfoundation. The number of community health workers and parents and community organizations must be increased so they can be mobilized for preventive care in the countryside. efficient and empowering health interventions are carried out nationwide. even the poor. There is no other way. Inter-lGU Cooperation Securing health insurance coverage for all is a must. managing Dao Mayor Joselito Escutin (middle) together with his municipal health officer. immunization and birthing facilities. Health programs and projects. This can be done by having the national government enroll all the poor (50% of the population) to the National Health Insurance Program (NHIP) of the Philippine Health Insurance Corporation (PHIC) through the DOH. and where and when to get medical assistance. By concentrating on primary health. being the biggest purchaser of healthcare. health providers and the community should help in making health services work by having more access to information. private. as the main players in health reforms. Maternal and child care should include responsible parenthood. family planning. Treatment and management of Common and Chronic Diseases Malaria. so that the most effective. preventing diseases. will have choices and be empowered to take care of their family’s health needs. It is essential that DOH and PHIC work very closely with local government units in localizing these health reforms. should craft incremental upgrading of quality benefit packages to its members and make sure these benefits (preventive and curative. Tuberculosis. health intel 2011 15 www. the PHIC. should concentrate on what matters most: the ELEMENTS of Primary Healthcare. This encompassing principle all the more gives impetus to the need for more effective partnerships between national and local stakeholders in healthcare.entire population. Together. feedback mechanisms. social Health Insurance 3. Self-Reliance/Community Initiatives Areas for Partnerships President Aquino’s program of “Universal Health Care for All Filipinos” aptly affirms that health is a basic human right. Here are the areas where partnerships have to be forged: 1. opportunities ahead. Nutrition Malnutrition in this country should be minimized if not eliminated. But health is also a responsibility of every citizen. These must be controlled significantly and the same must be done with HIV/AIDS and other emerging diseases. We must also incentivize the work in the countryside and minimize brain drain and maximize brain gain. non-government and civil society . by tackling activities on other non-health MDGs. Ensuring the quality and the right utilization of these medicines is also very important. at all levels. hypertension. This may be in the form of performance-based grants or awards and recognition. Schistosomiasis are still with us. 5.org 16 . Health human resource The people who deliver the health services must be appreciated and be given incentives in performing their noble task of uplifting the health of our people. rallies his townmates to support government’s various health programs illnesses. Twenty-five percent of the population (the employed sector) is currently covered by government and private agencies. As such. I am optimistic we can attain MDGs not only in health but in all MDGs as well by 2015. Humblelyn Horneja and Vice Mayor Lorie Eslaban. Less people will get sick from water-fecal-borne diseases if only people have these basic necessities in life. the way forward is universal healthcare through efficient. DoH-PHIC-lGU Collaboration The universal healthcare strategy has to put primary healthcare into its core thrust so that people from different sectors . the DOH and PHIC. cities. we do not only hit MDGs in health but the rest of the MDGs as well. Livelihood Providing the poor with income generating activities and livelihood opportunities should be a component of any comprehensive health program as this will increase the purchasing power of the family. Information and dissemination of health programs and projects should be popularized so that people will be more aware. are more health conscious. Inter-local health zones and alliances have to be further incentivized to improve performance. Essential Drugs Essential quality medicines should be accessible to all. non-government and private sectors. we improve further the attainment of MDGs in health (as these non-health MDGs are part of the social determinants of health outcomes). Bringing down the cost of medicines should be a priority. Primary Healthcare 2. should partner in a seamless way so that innovations and implementation are done better and faster. The chronic diseases of diabetes. Provinces. hospital care and regulations. Dr.

Faced with this scenario.” Aside from the factors mentioned. the Philippine Health Outlook Forum also emphasizes the need for public-private collaboration to jumpstart improvements in programs. pregnant women. Infant Mortality Rate (IMR) of less than 10. studies showed that under Pursuing strategic Partnerships I n a bid to help the country achieve the MDGs on health.the current social health financing scheme. drives the poor out of the healthcare system. “Drug prices in the Philippines is among the highest in the world. Rosette Vergeire. Cebu. Dr. Other RTD participants. Recognizing the depth of the problem in the country’s health situation. the poor continues to suffer as a result of an inequitable health system. The partnership entails capability building for governors. Eric Tayag. Recent evidence documents that procurement costs are higher than international reference standards and mark-ups from distribution to the retailer vary widely reaching up to 355%. pursuing strategic partnerships became imperative following the two forums. Director of the National Epidemiology Center of the DOH. coupled with inequity in the current health system. and Health Financing. and affordable essential medicines.” He stressed the need for stronger public-private partnership toward shared understanding and collaborative action to ensure sustainable gains in the health sector. Poverty. IMR over 90. the Foundation will provide eight towns in the region with leadership training. and other resources for health innovative programs. Policies and programs in the past have failed to target the areas and vulnerable groups of the population that need the assistance most. Follow through mechanisms for the Forum initiatives involve a series of roundtable discussions.zuelligfoundation. Localizing MDGs. Revisions of policies and programs. and affordable. proposed the “Sight for a Child Program” of the Optometric Association of the Philippines. The root cause of the country’s poor health system is the prevalence of inequities. accessible. the poor are so poor that they do not even have pockets. “To begin with. poor governance structure and regulatory mechanisms were presented and analyzed. and children.e. there are four technical working clusters. Executive Director of the Center for Legislative Development. the Foundation gave its commitment to support the government’s efforts to improve the health situation in the ARMM. lowering the prices of medicines by 50 percent has not addressed the poor’s problem on access to medicines. and Davao have outcomes comparable to those of developed countries i. As part of the cluster. the poor are placed at a great disadvantage as the number of health workers is disproportionately employed in the private sector. The former Health Secretary’s report also showed that while rich urban communities with access to modern facilities like those in Metro Manila. ICT for health. also reiterated in the second Health Outlook Forum the need for advocacy support to pursue the Healthcare Financing Strategy 2010-2020 that would include mobilizing resources for healthcare spending that will be effectively allocated and utilized to ensure improved financial risk protection. During the Forums. officer-in-charge of the Health Policy Development and Planning Bureau in the Department of Health. Merck Sharp & Dohme Philippines and CARD-MRI.org www.zuelligfoundation. “Contrary to the intention of the law. The richest quintile benefit the most from PhilHealth reimbursements at P5. contributing factors such as the fragmented healthcare delivery system.e. committed to support scholarships and long-term health human resource development programs. and ensures the sustainability of gains. Even the social health financing scheme in the country contributed to the wide disparity between the rich and poor income quintiles. much less money for medicines. infrastructure and equipment grants. and health leaders. Suzette Lazo. should have effective implementation strategies especially because experiences have shown that past and even present efforts have not been benefitting the poor. Medical Officer IV of the Health Policy Development and Planning Bureau of the DOH. This entails early vision screening and visual impairment detection among elementary school children in the ARMM. “Seventy percent of the country’s health workers are employed in the private sector serving only 30 percent of the population. “It is not surprising that the poor have the worst health outcomes and are most vulnerable to infectious and communicable diseases.4 billion among the poorest quintile. the Samar provinces and ARMM.. the Zuellig Family Foundation urged the government to step up its efforts and start engaging the private sector.org 18 . Joselito Acuin. including representatives of the University of Manila. as well as technical support. According to the ZFF President Ernesto Garilao. executive director of the Foundation for Sight. during the Forum. Currently. “The poor has to go to hilots or traditional healers for medical attention since these are widely available.” said Dr. They will also call on other stakeholders to get involved in the development interventions for the ARMM. PHIlIPPInE HEAlTH oUTlook ForUM: rEsPonDInG To HEAlTH InEQUITIEs THroUGH MUlTI-sTAkEHolDEr PArTnErsHIPs I n the country’s health system. the remaining 30 percent of workers are in the government services catering to majority of the Filipinos.” noted Dr. each focusing on a particular area: ARMM. According to former Health Secretary Alberto Romualdez. Dr. and MMR over 150. the Zuellig Family Foundation (ZFF) provided an avenue to raise the level of discussions on national health issues as common concerns. According to her. community mental health programs and health infrastructure plans. Data shows that the poor. Two Forums held last year (January and October) tackled challenges in the health sector and the response of the new Aquino administration through its health agenda of Universal Health Care. These were conducted to pursue the recommendations and action plans taken up and aimed at building consensus on how to best move forward and create greater impacts that address gaps in the health sector. who have the greatest need for healthcare. high costs of medicines. effective. Four other municipalities in Maguindanao have received similar support from the ZFF. More than being a platform for discussion. the newborn. The ARMM Cluster was formed to focus on and help address the health inequities in ARMM. For instance. Emmanuel Leyco.. inefficient social health financing scheme. Dr. there is a need to mend the current set-up although “there is no one fix. almost 60% of Filipinos die without seeing one. namely. 17 health intel 2011 health intel 2011 www. however.” He added that for a country that produces a good number of the world’s health professionals.” explained by Mr. presented the inability of regulatory bodies to ensure availability of quality. Presented with these issues. such as those in Bicol.2 billion compared to P1. The Foundation forged a partnership with the League of Provinces of the Philippines to scale up localization initiatives addressing MDGs for health. poor rural communities. Life Expectancy at Birth (LEB) of over 80 years. the poor’s health seeking behavior also contributes to the poor health indicators. are underserved. Director of the Food and Drug Administration. Through its Community Health Partnership Program. have results that approach those of the least developed countries – i. Cosette Realica. provincial health officers. and Maternal Mortality Ratio (MMR) of less than 15. They either have limited or no access at all to basic health services that are readily available to people with financial means. Leizel Lagrada. the poor subsidizes the rich. LEB under 60 years. infants. Health Secretary Enrique Ona emphasizes the advantage of harnessing public-private partnerships during the Second Philippine Health Outlook Forum. The fragmentation of healthcare service delivery has resulted to discrimination against the poor.” noted Clinical Epidemiologist and Senior Management Officer of Medical City.

While this led to notable successes as we now see a decrease in communicable diseases. It is therefore customary to prepare a blueprint prior to construction. the owner is satisfied. In partnership with the Philippine Oncology and Cancer Center. Adding to the anxiety is the fact that they do not know each other nor trust each other that much. the country had the most modern hospital system in Asia. The country is also seeing the rise of non-communicable diseases like heart attacks. roads and ports. and memorandum of understanding Craft and implement monitoring and evaluation tools based on defined objectives and parameters for PPP’s Act as a clearinghouse for collecting experiences.org 20 . these diseases. and manage. with responsibility remaining in the public sector. Department of Health Blueprint for the national Health Information system By Alvin Marcelo. the Department of Health. the Private Finance Initiative (PFI). The UK’s PPPs included construction and operations of different social services.zuelligfoundation. analysis and dissemination of best practices The DOH is also one of the first government agencies under the present administration to conduct an agency-wide seminar on PPP concepts and principles. the Philippines can regain its competitiveness in the region. most hospitals in UK were established through PPP and are run under its National Health Service trust. Under the Universal Health Care of the Aquino administration. Indonesia and Vietnam have overtaken the existing technology in our government-owned hospitals. Making PhilHealth efficient and widening both coverage and benefits are key to financial risk protection. countries. The encouraging response of the private sector led Ona to create the PPP taskforce within the DOH. MD FPCS FACS Undersecretary. the poor will be provided financial risk protection through the National Health Insurance Program or PhilHealth. launched a PPP for a cancer treatment facility. These are the Vaccine Self Sufficiency Program (VSSP) of the Research Institute of Tropical Medicine (RITM) and the Modernization of the Philippine Orthopedic Center (POC). Among the early PPP projects involved power generation. strokes. In the 1960s. There are two projects included in the priority projects for 2011. memorandum of agreements. These two projects have technical specifications and are due for feasibility studies through an assistance fund from the PPP Center. instead of building new hospitals. For the engineer and the contractors. which are expensive to treat Dr. This is because the costs tend to be beyond his means and he probably will need to take a loan from the bank. headed by Secretary Enrique Ona. a flagship hospital of the DOH. These were executives of financial institutions. cancer and trauma. 2. Chairman. social marketing and capacity building activities for DOH and local government unit (LGU) health facilities in establishing PPP’s 3. Coupled with transparency and good governance. a form of PPP has been used extensively since the 1990s. In the United Kingdom. are major killers of Filipinos. gave a well-received presentation on its ten priority public-private projects (PPPs). the projects became successful. these soon included social services. It was formerly contracts for school buildings. Past administrations. the approach left the country behind its ASEAN neighbors. As we improve financial risk protection though. Another reason is that the building process itself is complex. airports and seaports. At present. then it’s the interior designers’ turn to put in the appropriate furniture and fixtures in each room. it now offers the very first linear accelerator and high dose brachytherapy in a government hospital. diabetes. These used to be the problem of rich. Public-Private Partnership Taskforce. if the blueprint is followed faithfully.Public Private Partnerships in Health Teodoro Herbosa. The blueprint serves as a common reference point for every stakeholder involved in the project. Emmanuel Lallana. Through PPP. The taskforce’s objectives are: 1. hypertension. we need to capacitate our hospitals and modernize the services. the Jose Reyes Memorial Medical Center. While PPPs used to largely involve power. Promote sound contracts. concentrated on the less costly preventive and promotive healthcare. MD I n November last year. Recently. It will be a coherent structure built by many hands pursuing a common goal of a comfortable home for a family. W hen a man decides to build a house. they share the same vision of how the whole structure will appear and function. Develop policies and appropriate approaches for engaging the private sector in attaining health goals Embark on advocacy. Once the structure is built. It also engaged collaborative efforts with the Department of Finance and the PPP Center of the Philippines (PPP Center). inside a room packed with CEOs and called Build Operate Transfer (BOT) scheme or joint venture. Previously. industrialized Now. The new facility also allows for the training program of radio oncologists. Executive Director of Ideacorp. 4. 19 health intel 2011 www. we call on the private sector to help provide the boost to improve the infrastructure and services in all the different DOH and government hospitals. the country’s DOH-retained hospitals vary from very modern ones like the specialty hospitals. the blueprint tells them what materials will be used. tollways. involving huge investments and commitment from many people ranging from the architect who designs the house to the plumber who lays down the pipes to the owner who will eventually live there. now Filipino surgeons go to Vietnam for training in laparoscopic surgery. hospitals and even prisons. Now. he does so with great apprehension. The blueprint serves as a contract of sorts. this training was only available abroad or in private or university hospitals. The concept of PPP is not new to the Philippines. facilitates the breakout group on leveraging the use of ICT for Health. Between the owner and the architect. PPP is not privatization. At the end of it all. 5. As the government cannot fully fund such modernization. to the very old and dilapidated hospitals with circa 1960s design and technology.

Commission on Information and Communications Technology. non-government organizations and civil society groups. then come up with proposals and recommendations to promote and expand ICT for health programs both at the national and local levels. IT Association of the Philippines. This participation is crucial for the following reasons: first. National Telehealth Center. Second. If the country had this blueprint. Several countries have successfully crafted their Enterprise Architecture. The owners of the national health information system are the Filipino people. knowing these systems are also compliant with the sector-wide Enterprise Architecture. Architecture is a specialization that is both science and art. the more DOH creates the software. ICT standards and protocol. To use another analogy. Health Secretary Enrique Ona has empowered Assistant Secretary Nemesio Gako to chair a multi-sectoral technical working group on information and communications technology for health (ICT4H).over. Medilink and Segworks Technologies Corporation. Juan dela Cruz can enter any health facility and get the service he needs without worrying about whether it will be covered by PhilHealth or not. It is a well-accepted fact that a significant number of Filipinos access private healthcare facilities. they have the flexibility to implement the Enterprise Architecture and the accompanying standards in their local health systems. ICT-based health information system. Governance and leadership of DOH is a key component of the whole process. and the health system is financed more viably because it is more efficient. Ideacorp. Lastly. At the minimum. and begin to understand universal healthcare.org 22 . Philippine Long Distance Telephone Company. Ignoring the data accrued from these facilities will result in epidemiologically flawed analysis and we will not be able to see the complete picture of the country’s health situation. The group must also obtain feedback and inputs from stakeholders. TECHnICAl ICT GroUP For HEAlTH In support of the Aquino Health Agenda. they should have documented everything. effective.zuelligfoundation. Since the Forum last October. In the end. They benefit the most from having an efficient. it is best to identify people and organizations that have done this before. Some of them are in Africa with direr situations than the Philippines.” It will detail the major elements in the architecture. how they work within and with other elements in the larger health system. Filipinos can now appreciate their health system. It must be pointed out that a national health information system must involve the public and private sectors. and have failed and succeeded many times so what’s next? The DOH needs to carry this responsibility seriously and involve other stakeholders to make this happen. the Department of Health.” Secretary Ona emphasized during the Forum held last October 22. Let’s then identify the counterparts of this analogy to the national health system. specifically. These were attended by stakeholders from the public and private sectors and the academe. Lallana of Ideacorp. 21 health intel 2011 www. They can start confidently interacting with outside systems. policy-making and health service delivery. Once this sector-wide Enterprise mandate) rather than software development (which is not its core competency). The resulting blueprint is called the “Health Sector Enterprise Architecture. The author’s contact details are Alvin Marcelo (info@universalhealthcare. Any Juan will be happy to live in a home like this. As a significant stakeholder in the larger health system. and responsive system. it recognizes the importance of the private sector in collecting and submitting data from their respective institutions. various stakeholders from the public and private sectors can contribute to building their own specific systems that can fit the larger national health information system. The Enterprise Architecture process is not cheap but it is also not impossible. they can come up with the sector-wide Enterprise Architecture. when it comes to selecting an architect for the national health information system. Upon implementation of the programs. if DOH does the right thing right now. In effect. “We have to determine what ICT for health projects and strategies are best done through public-private partnership (PPP) mechanisms to maximize its benefits.” Ideacorp Executive Director Emmanuel Lallana stressed during one roundtable discussion (RTD). the academe. Its purpose is to pose a certain view of an abstract thing called the national health information system. Collegially. the group has to evaluate and monitor the execution. which can then serve as a guide for all other stakeholders in the national health information system. Other views should be considered as well. The ICT4H Technical Working Group is tasked to undertake inventory and assessment of ICT4H projects and initiatives in the country. Architecture is published. The technical working group is co-chaired by Director Crispinita Valdez of the DOH-Information Management Service. the private sector has extensive experience with Enterprise Architecture methodologies. As they are a diverse set of people. they are represented in this process by the Government of the Philippines. The department must practice openness to become a responsible and trustworthy representative of the people in the blueprinting process. DOH should not be producing drugs because it may compromise its regulatory function especially when its own drug fails the quality tests. the private sector should be involved as soon as the organizational structure and processes for the sector-wide enterprise architecture efforts are clarified. Internal informational need of the DOH is a mere component of the larger system. The cluster has tackled (Note that since this is an analogy. Health Secretary Enrique Ona ordered the creation of a technical working group on ICT for health (ICT4H) chaired by Assistant Health Secretary Nemesio Gako with members from the ICT4H Cluster that was formed during the Philippine Health Outlook Forum. it can serve as a guide for organizations when they start building their own local health information systems from the large PhilHealth membership database to the rural health unit electronic medical records system. More fundamentally. DOH then shifts to technical assistance and monitors if the blueprint is being implemented correctly. telemedicine. but they should also be subjected to the same level of scrutiny that this will receive. a series of round table discussions have been convened by Dr. This analogy works well for the ideal national health information system. A true and sincere partnership with the private sector will result in faster deployments which can redound to more effective information systems on the ground. the less credible it becomes as a regulatory body on information systems. Other members include representatives from the Information Technology and Management Department of PhilHealth. This may require re-orienting DOH into a regulatory and supervisory role (which is its primary issues on ICT-enabled PhilHealth processes. it is by no means perfect nor comprehensive. especially the failures so that the Philippine process can avoid the same pitfalls.ph).“ Information and Communications Technology (ICT) plays a vital role in ensuring that universal healthcare is achieved through efficient and effective data gathering. Repetitive lab tests are detected and avoided.

zuelligfoundation. LGUs have been given major responsibility in improving governance in the country by bringing the decision-making process closer to the people to develop policies and programs responsive to the needs of their communities. needs-based. This program seeks to target areas where there is greater need to address the MDGs so investments and improvements are likely to have a greater impact on the overall performance of the country. Anthony Faraon. and vetted by the community To assist in the implementation of the health projects To facilitate continuous learning and capacity building as the programs are being implemented To assist in evaluating the gains of the program and in making sure the gains are sustained beyond the program period. Zubiri. During the second Health Outlook Forum held last 22 October 2010. The DOH already said that the Health Facilities Development Program and Universal Health Coverage through PhilHealth are programs that can be fast-tracked for the areas included in the program. PUrsUInG PArTnErsHIPs AnD sTrEnGTHEnInG loCAlIzATIon sTrATEGy MOU signing between Zuellig Family Foundation and League of Provinces of the Philippines. the Zuellig Family Foundation (ZFF) and the Department of Health and develop the initial framework of a program envisioned to improve health conditions in the Philippines. ZFF Director Juan Villamor The LPP and ZFF propose a two-year program that will have the following objectives: 1. A pre-selection process shall be undertaken to make sure areas included in the program have a balance of need and leadership potential. This paved the way for the first “Provincial Leaders for Health” program last June wherein 16 governors across the country learned about public health governance and best practices from resource speakers Albay Governor Joey Salceda. 2007 and 2010. The LPP believes that governors are in a unique position to enable the achievement of the MDGs in their provinces. will be maintained far into the future. achieving the MDGs in health will require a concerted effort of different stakeholders aside from the province. Provincial targets will be clearly defined and roadmaps will be developed and can be appraised by the public. This strategy recognizes the significant role that Local Government Units play in achieving the Millennium Development Goals. Governor Alfonso Umali Jr. the group pointed out the need for stronger governance and capability building mechanisms at the local government level to ensure that the country will be able to reach the targets by 2015. 5. Therefore. Also. Bukidnon. The strategic approach includes replication of existing best practices that have allowed some provinces to make significant inroads in achieving their provincial MDG targets. 2005. made the achievement of the MDGs its priority program. and its Secretary General. By virtue of the Local Government Code of 1991. Surigao del Sur Governor Johnny Pimentel and Bukidnon Vice Governor Jose Ma. and Negros Occidental show the different possibilities available for provinces to have a great impact over a wide area in a relatively short period of time. of Oriental Mindoro. The LPP is likewise interested in achieving the MDGs. One partnership forged was with the ZFF. ZFF and LPP will liaise with the Department of Health (DOH) and other interested organizations to augment the resources of the provincial government. The LPP has. a series of round table discussions were convened to bring together the League of Provinces of the Philippines (LPP). ZFF Trustee Reiner Gloor. Work will also be done to ensure that the improvements. To assist the health leaders in the selected provinces understand the state of the MDGs for health To develop the capacity of the leaders to address the identified needs To assist in the development of plans that are technically sound. The MDGs contribute to transparency and accountability in the work of achieving better quality of life.day workshop that will be conducted to develop the leadership and management capacities of health leaders within the provinces selected. 2. and ZFF President Ernesto Garilao. once achieved. 23 health intel 2011 www. A Memorandum of Understanding was signed last February between the parties. This same principle will guide this partnership program. 6. ProVInCIAl HEAlTH PArTnErsHIP ProGrAM ConVErGInG PrIorITIEs By Mike Juan 3. However. Alfonso Umali Jr. in fact. Governor Josephine Sato of Occidental Mindoro. Implementation will be monitored and results will be reported back to the program partners and to the public. standing from left: ZFF Director Dr. the program is envisioned to be a venue for convergence in the work to achieve the MDGs in health. The current research of the ZFF from areas where there have been significant progress in the achievement of the MDGs suggests that the provincial government is an important actor to achieve the MDGs. ZFF consultant Mike Juan. completed a road trip during which Umali visited provinces with best practices in health service delivery. especially in health. The group identified initial efforts to achieve the MDGs both at the national and local level. However. This is the quality of change required for the Philippines to have a chance of achieving its MDG targets by 2015. Seated from left: ZFF Chairman Roberto Romulo. Umali’s chief of staff Marifi Hernandez. Provincial governments of Albay. As post-forum initiative.org 24 . Gov. the work requires strong leadership and the willingness to commit to making the necessary changes to the health delivery system within the province. a breakout session was devoted to localizing MDGs on Health. The current national board. led by its National President. 4. This approach will be the basis of the initial two . l ocalization strategy has been repeatedly highlighted in the four Philippine Progress Report on MDGs released in 2003. This is an effort to increase awareness of health delivery best practices among its members.The League has also been reaching out to potential partners who would be interested in developing the capacities of provinces around the achievement of the MDGs especially in health.

With funding from the ZFF. Padre Burgos (Quezon) and the Maguindanao municipalities of Datu Paglas. and In 2008. In fact. particularly the mayors. their average MMR could go down to 52 by 2014. “We see this as a great opportunity for the local government to contribute to the national agenda of President Noynoy Aquino to prioritize and meet the MDGs.” Umali said. investments in competent and accountable leadership. upgrade the skills of frontline health workers. efforts to hit the Millennium Development Goals by 2015. gave their full support to the various innovative programs and poured substantial resources to make sure the programs are successfully implemented. In 2008. Creating Impact: Improving MMR in ZFF Partner-Municipalities M aternal healthcare in the country is still wanting despite To their credit.org 26 .zuelligfoundation. and generation of policies reflective of the real needs of the people. maternal mortality ratio (MMR) in the country was still high at 162 deaths for every 100. Mayors from Cohort 1 partner-municipalities together with municipal health officers and socio-civic leaders rally to show solidarity in efforts to improve health outcomes particularly among the poor Last June. Two years after the ZFF started its engagement though.GoVErnors AnD PArTnErs ToWArDs MDGs A partnership to equip governors and provincial health officers with skills and knowledge in public health leadership and governance was forged between the Zuellig Family Foundation and the League of Provinces of the Philippines. with one municipality actually registering an MMR of 460. Figure 1 below shows the decreasing trend in the average MMR of Cohort 1.33. following the latter’s presentation on Bukidnon’s exemplary practice on Healthcare Financing and facilities development.3%. birthing clinics were also built to encourage deliveries attended by skilled health personnel. the average MMR of the nine partner-municipalities went down to 136. six municipalities recorded zero maternal death. Dao (Capiz). Zubiri Jr. hitting the MDG target a year earlier. There were programs to educate pregnant women through the “Buntis Congress. Should the linear trend continue. the partnership is actually a step towards improvements in government that mirrors the direction that President Aquino outlined: forging private-public partnerships.000 live births and will not likely go down to the 52.2 target by 2015. Signing the Memorandum of Understanding on behalf of the LPP was its national president Oriental Mindoro Governor Alfonso Umali Jr.000 live births. healthcare for mothers was worse in the nine municipalities that form the Zuellig Family Foundation’s first batch of partner-municipalities. who expressed optimism that the partnership will bring the needed improvements in governance that will lead to the attainment of the health Millennium Development Goals on time. hopefully in the appointed time. 25 health intel 2011 www. If they achieve an annual decrease of 21. These are Bacolod (Lanao del Norte). As Umali stated. the first batch of governors and their provincial health officers undertook the pilot training program. Zamboanga Del Sur Governor Antonio Cerilles poses a question to Bukidnon Vice Governor Jose Ma. MMR could fall to 57. Average MMR of the municipalities was 167 per 100. Paglat and Sultan sa Barongis.” closely monitor pregnancies through pregnancy mapping and data boards.. The training introduced participants to best practices in public health that governors can use as models for replication in their provinces. health leaders. Needs-based health action plans were developed by the health leaders to address the existing gaps in the provincial health system and inter-local health zones.

The developments have been significant but other issues still need to be addressed. Cases of tuberculosis and diarrhea must also be reduced. For Lucy Yturalde. After attending the leadership training.” said Dao. encouraging commitment and passion of health workers. the nine municipalities out-performed other rural.zuelligfoundation. dati kahit walang suporta kinakaya namin na lakarin ang ilang kilometro para magbigay lang ng bakuna sa mga bata. “Mas nadagdagan ang dedication namin ngayon sa pagbigay nang serbisyo sa mga tao.14% in 2008 (Figure 2). similarly-classed municipalities from the same provinces in terms of improvements in MMR and facility-based deliveries (FBD) for the years 2008 and 2009. particularly those due to pneumonia and malnutrition. barangay health systems must be further strengthened. The average percentage of births attended by skilled health personnel also increased from 54. I felt guilty because it took total strangers like the Zuellig Family 27 health intel 2011 www.88% (Figure 3).org 28 . of our constituents. Capiz Mayor Joselito Escutin. S. mas lalo na ngayon na may suporta na si Mayor at nakikita namin na may pagbabago sa aming datos (We used to walk kilometers just to be able to give vaccines to kids. now that we have the support of our Mayor and we see improvements in our data. Foundation to care so much about our health outcomes.” said Nurse Milma Gedo-Cruz of Bacolod. Two other health indicators that constitute the Maternal Health Index (MHI) showed similar improvements since 2008. 2 “People do value and appreciate health programs if delivered regularly and expanded. if not all. Child mortality is still a major concern. To ensure that programs reach the grassroots.Aside from the aggregate increases in MHI. The number of frontline health workers increased. our dedication to serve was heightened. the mayors’ views on the value of health and the important role that health workers play changed. Average facility-based deliveries posted a 104% increase from its baseline of 20. Relational and leadership changes were also observed in the nine municipalities. Innovative and responsive health programs would greatly benefit a great number. her mayor’s concern for health gave her and other midwives reason to serve the people. “I came in with very little expectations but after the seminar. a midwife from Gen.52% to 56. The ratio of facility-based deliveries in the partner-municipalities rose by 58% but fell by 8% in non-partner municipalities.” Yturalde said. Municipalities also started providing honorariums to their barangay health workers as added incentives. Lanao del Norte.). Pendatun.K.

volunteer organizations. thereby creating another health intel 2011 www. An effective strategy in increasing community participation is conducting technical assistance on advocacy to Muslim Religious Leaders (MRLs). health services remained a transitory provision under the regional government. This way. targeting LGUs and identifying loan opportunities. The report further stated that. Though an LGC was eventually passed. addressing as well the slow progress in maternal mortality reduction. and Department of Education. The regional government gets its funding from the national budget through the General Appropriations Act while local governments are funded through the Internal Revenue Allotments under the Local Government Code (LGC). When this is achieved. particularly health. These agencies increased the amount of resources for the implementation of national programs and projects which otherwise would have been more efficiently and effectively carried out by the LGUs. an innovative approach encouraged the active participation of women by engaging women MRLs or the Alimas. are enhanced. This addresses the international cooperation (Goal 29 30 . the level of implementation of services remained under other national oversight agencies such as the Department of Health. This will be truly beneficial to the Autonomous Region in Muslim Mindanao (ARMM). The reason for this was that the ARMM Regional Legislative Assembly had not passed its own LGC. In Basilan. This is still in effect today. regional health authorities and LGUs should strengthen their partnership with the DOH while at the same time. “the ARMM show the worst health statistics that are way-off desired standards. including health. Department of Agriculture. the LGUs of ARMM have forgotten what the increases were for. This holds tremendous potentials for ARMM as well as responds to and supports the Public-Private Partnerships (PPP) in Health of the Aquino Administration. However. or the Pantawid Pamilyang Pilipino Program (4Ps) of the Department of Social Work and Development (DSWD). mechanisms should be made available not only to more formally-organized and registered NGOs but also to the informal but more operational and relevant indigenous and Muslim groups. At best.org roles of lGUs to achieve MDGs In its research. LGUs were given powers to more effectively provide basic services. Efforts should be commensurate with the development of relevant and necessary capacities and competencies of civil society organizations (CSO). the LGUs serve only as the conduit of the NG projects that were designed and formulated with either very little or no input from the local stakeholders in the ARMM. Department of Environment and Natural Resources. the opportunities for citizens to work together with their LGUs in the delivery of basic social services.” Uniqueness of the health system in the ArMM Governance in ARMM is uniquely funded as the regional government and the local governments are independent of each other. and community-based people’s organizations.zuelligfoundation. The national government (NG) devolved health to the regional level and not to the local government level as is the case for other LGUs in other regions. This aligns with the MDGs of providing health and education through direct financial support to the poorest families who keep their children in school and ensures that children and pregnant women get regular health checkups.a local government system which sadly does not include much needed health services. In the ARMM. increase their interaction with international development agencies and broaden multi-stakeholder involvement and participation. the Foundation found out that eighty-five percent of barangays in the region have no barangay health stations. After increases in IRA. all sectors sustain the gains from the achievement of other goals. thus.UNDEVOLVED HEALTH IN ARMM: An IssUE In ATTAInInG MDGs? by Jaime galvez-tan The Millennium Development Goals were crafted such that some of the goals also serve as means to other ends as expressed in MDG 8: Developing a Global Partnership for Development. bureaucracy . To increase the involvement of the community. participatory The LGUs have adopted the conditional cash transfer program There is a vast potential in the decentralization policy enshrined in the LGC and the devolution process that ensued. The DSWD ties up the 4Ps program with the Credit for Better Health Care Project in partnership with the Development Bank of the Philippines (DBP).

and the Integrated Provincial Health Office-LGU Good Governance Caravan in Tawi Tawi – provide evidence that LGU support can be had. Lanao del Sur. The Local Government Support Programme in ARMM . and 6 (combating HIV/AIDS. Both local governments and the regional health authorities must then assist the remaining poor and informal sectors in the next economic bracket to become PhilHealth members as well. a staggering “I was shocked. After getting oriented on the advocacy. Inside a duyan (makeshift hammock).” Thanks to the PhilHealth card the local government of Datu Paglas provided her. Little did she Usop is only one among 5. the DILG’s “Seal of Good Housekeeping” award allows winning LGUs to have access to the Performance Challenge Fund. Another challenge is getting more indigent families enrolled in the Philippine Health Insurance Corporation (PhilHealth). peacefully. Soliciting LGU support pose a challenge. One of the factors considered for the award is the degree of citizens’ participation. it behooves the present government’s leadership to mandate the LGUs and the ARMM to urgently work cooperatively with the DOH and international partners to facilitate the achievement and progress of health services in the ARMM towards achieving the MDGs.zuelligfoundation. malaria. she ended up paying only P120 to the provincial hospital where she gave birth. and Marawi City. Effective advocacy materials must also be developed. InVolVED lGU DEsPITE non-DEVolUTIon by Wesley Villanueva 31 health intel 2011 www. Maguindanao. such as the ARMM Strategy for Health Improvement (ASHI).Goals 4 (reducing child mortality rates). Datu Paglas Municipal Health Officer Dr. little Adjulamin sleeps More importantly. being rocked to sleep by his mother.000 indigents in Datu Paglas town in Maguindanao enjoying the benefits of PhilHealth. Agustina Almirante (in white shirt) listens intently as local health leaders discuss health issues and possible solutions during the municipal health summit.Canadian International Development Agency (LGSPA-CIDA) addressed the issues of poverty by localizing the MDGs as a strategy to improve citizens’ participation.700. “He came as a blessing to us. Similarly. he realized the benefits of the program and supported its implementation.org 32 .GSKP Mayor Bonnie Kali spearheads the vitamin supplementation program in his municipality 8) as well as the other health components of the MDGs . 5 (improving maternal health). but experiences in Basilan.” said Usop who narrated her difficult childbirth which left the doctor no other choice but to perform a caesarean operation. jobless mother. a city mayor initially opposed family planning as he believed that Muslims needed to increase their population. and other diseases). The Aquino administration is working towards enrolling the bottom 20% of the population through the National Household Targeting System. amount for the poor. In the Islamic City of Marawi. with national agencies and the regional ARMM authorities having failed to resolve the devolution issue for over a decade now. 20-year-old Marina Usop. He eventually had proceeds from the Philippine Health Insurance capitation funds used to procure family planning materials for the city. I do not have work and I could not afford it. “This came know that the cost of the surgery was P19.

” she said while expressing thanks to their local government who is paying the annual premium of P120 per indigent family. Datu Mohammad Paglas (Mayor of Datu Paglas). which in turn. With the Foundation’s support. business representatives. slAM WIns GAlInG Pook AWArD THE ZUELLIG Family Foundation’s four partner-municipalities in Maguindanao were recently named winners of the prestigious Galing Pook Award for their health programs. while the “Buntis Congress” enabled pregnant women and their partners to learn about proper natal care. page 26) present their health plans to their constituents and get quick feedback. (L-R) Dr. Late that same year. The LGU owned the issue and developed innovative ways to respond to the health challenges. the religious sector and After the ZFF’s two-year partnership with these towns. “Community Health Summits” allowed government leaders to Mayors of these four towns--Datu Paglas. During times of hospitalization.org 34 . Allandatu Angas (Mayor of SSB). Based on the Foundation’s data analysis. maternal health and infant mortality statistics have shown improvements. Pendatun.K. manages and implements the public sector health program. The health professionals have been working independently from the LGUs.000 indigent heads of households with socialized health insurance. civic leaders. Datu Paglas invested in upgrading its Rural Health Unit (RHU) in order to meet the standards set by Philhealth for accreditation. Datu Paglas partnered with PhilHealth to provide 5. Datu Paglas intends to continue the partnership with PhilHealth and ZFF in order to achieve better health for all its citizens. the improvements in maternal health in the SLAM were also significantly higher than those of the other Maguindanao towns. The refurbishment of the ward was sourced from the PhilHealth capitation fund. 33 health intel 2011 www. The Department of Health-ARMM (DOH-ARMM) administers. Abdulkarim Langkuno (Mayor of Paglat). With accredited facilities and enrolment to the Indigent Program. The community pharmacies were set-up in partnership with the Philippine Charity Sweepstakes Office (PCSO) and the DOH-ARMM. ordinary citizens in the health activities raised awareness and improved the chances of success of planned programs. S. the minimal role given to the LGUs resulted to the growing apathy and lack of ownership among the LGUs particularly on the issues of health. Despite the challenge of non-devolution. Anthony Faraon.as another blessing. the expectant mothers now have access to a ten-bed ward when they recover after giving birth at the Zuellig Family Foundation-provided birthing unit at the Barangay Poblacion. Datu Boniao Kali (Mayor of GSKP). Datu Paglas is making innovations to strengthen its health systems and processes with the support of Zuellig Family Foundation’s Community Health Partnership Program. Datu Paglas is a 4th class municipality in the province of Maguindanao in the Autonomous Region of Muslim Mindanao.zuelligfoundation. the heads of households and their families can now rely on PhilHealth. This has been the case for years. ZFF Director. Paglat and Sultan sa Barongis--formed the Southwestern Ligawasan Alliance of Municipalities (SLAM) in 2008 so they can pool their resources together in solving their common problems. The LGU and barangays equally shared the cost of the modest monthly honorarium and allowances of the rural health workers to enable community members to benefit from health education. Promotive and preventive healthcare was also given focus by increasing the frequency of visits of 25 BHWs and midwives to all 23 barangays. The PCSO also provided Datu Paglas with a municipal ambulance as part of the grant to support their health program. is hesitant to assert their initiatives as they believe that they do not have the mandate. SLAM created health programs which encouraged the participation of various stakeholders in their respective towns. some municipalities have suffered from the separation of health workers with the LGUs. Datu Paglas also allocated part of the capitation to stabilize the supply of primary care medicines at the RHU and its refurbishment. With the significant reduction in the number of citizens asking for medical dole-out from the LGU and the upgrading of health facilities and improvement in health services. (see related article. In most cases. As an unintended outcome of non-devolution. ARMM Health Secretary Kadil Sinolinding congratulates the four SLAM mayors for the gains achieved in improving health indicators. Gen. they also became the partners of the Foundation. where provision of health services are not devolved to the local government units. The participation of government officials. Using local funds. Citizen’s access to affordable and reliable medicines is improved through the establishment of six Botika ng Barangay (Community Pharmacies).

org . But working with a staff of less than 30. Leadership training programs have been given to 157 health leaders.municipalities. Well-equipped village health centers funded by the ZFF can be used by close to a million people living in our partner . 14 West Service Road Brgy. Linkages with groups that provide better education. Metro Manila .zuelligfoundation.about the Zuellig faMily foundation The Zuellig Family Foundation (ZFF) refocused its efforts in 2008 to address health system inequities to bring better health outcomes for the poor Filipinos.org http://www. Philippines Tel. the ZFF has partnered with 30 rural municipalities coming from the most impoverished regions having serious health challenges. (632) 776-4727 communications@zuelligfoundation. 821-4428. The ZFF uses the Health Change Model that works on the premise that outcomes can only improve if local political and health leaders are responsive. and medical skills upgrade programs have trained 535 frontline health workers. Since 2008. 8213329 Fax No. Sun Valley Parañaque City. increase incomes and adopt technology can lead not just to better health but the overall development of quality human life. zuellig Family Foundation 5/F Zuellig Pharma Head Office Km. (632) 821-4332. and health interventions are targeted and institutionalized. No. the ZFF seeks more partnerships with public and private sector groups to reach more people.