Resilient Local Health Systems. Ernesto D. Garilao President, Zuellig Family Foundation 10 July 2014

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1 Resilient Local Health Systems Ernesto D. Garilao President, Zuellig Family Foundation 10 July 2014

2 ZFF Development Strategy: Health Change Model & WHO s Six Building Blocks for a Better Health System ZFF Health Change Model LEADERSHIP AND GOVERNANCE IMPROVED HEALTH SYSTEM TARGETED AND PRO- POOR HEALTH PROGRAMS BETTER HEALTH OUTCOMES: LOWER IMR, MMR & MALNUTRITION RATES; LOWER INCIDENCE OF COMMUNICABLE & NON-COMMUNICABLE DISEASES Intervention Modular Training for Mayors and Municipal Health Officers (Bridging Leadership as Leadership Approach) Practicum in between Modules to fix their Local Health System WHO s Six Building Blocks for a Better Health System LEADERSHIP & GOVERNANCE SERVICE DELIVERY HEALTH WORKFORCE ACCESS TO ESSENTIAL MEDICINES FINANCING HEALTH INFORMATION SYSTEM

3 ZFF Presence & Initial Results in Alumni Municipalities Poor regions with high health burden Health & Leadership Governance is being replicated with the Department of Health in 609 poor municipalities. Eastern Visayas, Zamboanga Peninsula, CALABARZON, MIMAPORA, Bicol Region, Davao Region, ARMM, CAR, Western Visayas, Central Visayas, Northern Mindanao, SOCCSKSARGEN, CARAGA

4 Mothers and Infants in Samar are at Higher Risk in post-disaster situations. Eastern Visayas is the country s 3 rd poorest region (NSCB, 2012) Poverty incidence for Eastern Samar is at 59.4%, which is higher than the regional (45.4%). (NSCB, 2012) Without interventions, maternal mortality, infant mortality, and malnutrition among children is expected to go up because of the rise in poverty incidence

5 ZFF partner-lgus in Samar Island Partner/ Program MSD for Mothers Global Giving Program Provinces Northern Samar; Western Samar No. of Municipalities Year of Engagement 21 municipalities 2013 UNFPA Eastern Samar 8 municipalities (including Salcedo, Giporlos, Gen. MacArthur) 2013 How Municipalities Prepared for Typhoon Haiyan Activated the Municipal Disaster and Risk Reduction Management Council Prepositioned relief goods and medical supplies Information campaign on the dangers of the typhoon, especially to high risk barangays Evacuation to safe areas (e.g. municipal hall, schools)

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7 12 Partner Municipalities Affected by Haiyan Balangkayan Basey Hernani Gen. MacArthur Lawaan Quinapondan Salcedo Marabut Balangiga Giporlos Mercedes Guiuan Eastern Samar: Balangiga, Balangkayan, Gen. MacArthur, Giporlos, Guiuan, Hernani, Lawaan, Mercedes, Quinapondan, Salcedo; Western Samar: Basey, Marabut

8 Impact of Typhoon Haiyan on LGU partners Province Municipality % of Affected Barangays E. Samar Gen. MacArthur No. of Affected Families No. of Damaged Houses No. of Fatality Damage to Agriculture (Php, in Millions) Damage to Infrastructure (Php, in Millions) 100% 3,903 3, Giporlos 100% 3,611 2, Salcedo 100% 5,405 4, Balangiga 100% 3,576 3, Balangkayan 100% 2,332 2, Guiuan 100% 14,193 13, Hernani 100% 2,345 1, No data Lawaan 100% 3,208 2, Mercedes 100% 1,954 1, Quinapondan 100% 3,399 3, Samar Basey 45% 13,706 12, Marabut 100% 6,281 4, , ,952.1 Source: PDRRMOs of E. Samar and Samar as of December 2013 Total 63,913 55, , ,

9 Extent of devastation in Salcedo, E. Samar (November 2013)

10 Extent of damage in coastal barangays of Giporlos, E. Samar (November 2013)

11 Impact of Typhoon Haiyan on Health for LGU Partners Province Municipality Actual No. of Pregnant and Lactating Women as of Jan 2014 (RHU Data) Damaged Health Centers Rural Health Unit (RHU) & Brgy Health Station (BHS) Partial Damaged Major Damaged Totally Damaged E. Samar Balangiga BHS 1 RHU Balangkayan RHU 2 BHS Gen. MacArthur 254 Giporlos RHU; 2 BHS Guiuan RHU; 7 BHS Hernani 83 1 BHS 1 RHU; 1 BHS Lawaan BHS 1 RHU; 1 BHS Mercedes 92 1 BHS 1 RHU Quinapondan RHU; 3 BHS 1 BHS Salcedo RHU; 2 BHS Samar Basey RHU 6 BHS 1 BHS Marabut RHU; 9 BHS 10 BHS Subtotal 2, Sources: DSWD, December 2013/ DOH, WHO, PHO-Eastern Samar, RHUs, January 2014

12 Extent of damage to Barangay Health Station in Salcedo, November 2013

13 Extent of damage to Giporlos Rural Health Unit, November 2013

14 ZFF Response for Pregnant and Lactating Mothers Dec 2013 Jan 2014: Initiated Recovery Assistance Program for Mothers in 12 municipalities in Samar Island Funding Partner: U.S. Philippines Society (US$463,776) Implementing Partners: LGUs, CARD-MRI, CCT Inc.

15 Tabang Visayas/ZFF Response February 2014: Convened Partners Meeting with Tabang Visayas for the 12 Samar Island municipalities due to clamor of municipal mayors for non-health assistance

16 Partners who Responded to Tabang Visayas/ ZFF s Call for Support Municipality MFI Integrated Area Development Livelihood Technical Assistance Education Governance Child Protection Solar Lamps & Solar Suitcases CARD-MRI CCT PBSP PDAP PEF Synergeia Foundation Consuelo Foundation Solar Energy Foundation Basey Marabut Balangiga tentative Balangkayan Gen. MacArthur Giporlos Guiuan AsiaDHRRA Hernani Lawaan tentative Mercedes Quinapondan Salcedo

17 LEADERSHIP AND GOVERNANCE MLGP Conceptual Framework for Disaster Resiliency Relief & Recovery IMMEDIATE (6 months to 1 year) DEVELOPMENT PHASES Reconstruction INTERMEDIATE (1 to 2 years) Adaptation & Transformation LONG TERM (2 years onward) IMPACT Restore operational capacity of LGUs Institutionalizing policies, systems and programs on disaster resiliency Sustaining disasterresilient systems HEALTH Restored health services Provision of water & sanitation kits Re-establishment of health systems Resilient & equitable health systems Improved health outcomes ZFF LIVELIHOOD PBSP, PDAP, PEF, CCT, CARD EDUCATION Synergeia Foundation Provision of cash incentives; short-term jobs Class Resumption School feeding & nutritional assessment Restoration, diversification of livelihood & income Value chain integration Responsive educational programs School-based health programs Construction of classrooms Resilient local economy Resilient & responsive educational systems Reduced poverty incidence Improved educational outcomes CHILD PROTECTION Consuelo Foundation Psychosocial stress debriefing Protection from abuse & violence Provision of temporary shelters, child friendly spaces Permanent shelters Law enforcement Active coordination, monitoring, & response to abuse & violence towards children Mainstreamed child protection programs Reduction in cases of abuse, neglect, exploitation, and violence towards children Resiliency-based planning and development References: ZFF s Health Change Model, Plan International/Save the Children March 2013 inter-agency links, UNDP, UNICEF Working Paper on Resilience, Synergeia Reports, Discussions with Livelihood NGOs and MFIs (Feb )

18 ZFF Response March 2014: ZFF conducted the Municipal Leadership and Governance Program (MLGP) Module 1 Training for the 12 municipalities

19 Municipal Health Governance Barangay Health Governance Local Philhealth Administration Health Resource Generation and Management Municipal Basic Health System s Technical Roadmap August 2013 (Salcedo, Eastern Samar) RHU and BHS Resource management Drug Management System Data Collection, Utilization and Information Dissemination Barangay Health Infrastructure Maternal and Child Care Reproductive Health WaSH Leadership & Governance Health Financing Health Human Resource Access to Medicine & Technology Health information System Health Service Delivery Municipal Health Action Plan Expanded and Functional Local Health Board Functional Barangay Health Governance Body (with functional CHT) Implemented and Integrated Barangay Health Plan LGU Budget for Health (15% IRA) Actual budget Utilization (95% Utilization) BLGU Health Budget (5% of Barangay IRA) 4-in-1 Accreditation Regular IEC for Enrolled Indigent (for Q1 and Q2) Reimbursement Filing (PCB, MCP, TB- DOTS) Ordinance and System for Claims Disposition and Utilization Monitoring Health Human Resource Adequacy at the RHU (MD 1:20,000) (Nurse 1:20,000) RHU HHR Competency Full Implementation of Magna Carta for Public Health Workers Installed Performance Management System Health Human Resource Adequacy in BHS (1 Midwife: 1 Brgy; with consideration to GIDA) (BHW to HH 1:20HH) BHS HHR Competency (Basic BHW Training Course and CHT Training) System for BHW Recruitment and Retention Mechanisms Ordnance and Timely Provision of BHW Honorarium Presence of Essential Medicine at the RHU (Stock Basis) RHU Medicine Tracking and Inventory System Ratio of Community- Based Pharmacy (1 BNB/CBP catchment or 1 BNB per barangay) Accomplished Baseline Data Collection Regular Data Gathering and Recording Maternal/ Infant Death Review Monthly Updated Health Data Board Accomplishment, Utilization and Dissemination of the DILG, DOH LGU Scorecards Creation of Citizen s Charter Presence of Brgy. Health Station (1 BHS:1 Barangay or 1 BHS per Catchment) Maintenance and Operations Utilization Available and Accessible Transportation for Emergency Sustainable Maternal Health Care Initiatives Pre-Natal Services (at least 80%) Post Natal Services (at least 80%) Facility-Based Deliveries (85%) Skilled Birth Attendants (85%) Sustainable Breastfeeding Initiatives Exclusive Breastfeeding for Infants (70%) Newborns Initiated Breastfeeding (85%) Sustainable Essential Intrapartum and Newborn Care Initiatives Sustainable Infant and Child Care Initiatives Fully Immunized Child (95%) Under-5 Malnutrition Prevalence Rate (Below 17.3%) Sustainable Adolescent Reproductive Health Initiatives Teenage Pregnancy Rate (4%) Sustainable Family Planning Initiatives Provision of FP Commodities and Services (RHU) Contraceptive Prevalence Rate (63%) Unmet Needs (50% under NHTS) Sanitary Toilets (86% of HH) Access to Safe Water (87% of HH)

20 Municipal Health Governance Barangay Health Governance Health Resource Generation and Management Local Philhealth Administration Municipal Basic Health System s Technical Roadmap as of March 13, 2014 (Salcedo, Eastern Samar) RHU and BHS Resource management Drug Management System Data Collection, Utilization and Information Dissemination Barangay Health Infrastructure Maternal and Child Care Reproductive Health WaSH Leadership & Governance Health Financing Health Human Resource Access to Medicine & Technology Health information System Health Service Delivery Municipal Health Action Plan Expanded and Functional Local Health Board Functional Barangay Health Governance Body (with functional CHT) Implemented and Integrated Barangay Health Plan LGU Budget for Health (15% IRA) Actual budget Utilization (95% Utilization) BLGU Health Budget (5% of Barangay IRA) 4-in-1 Accreditation Regular IEC for Enrolled Indigent (for Q1 and Q2) Reimbursement Filing (PCB, MCP, TB- DOTS) Ordinance and System for Claims Disposition and Utilization Monitoring Health Human Resource Adequacy at the RHU (MD 1:20,000) (Nurse 1:20,000) RHU HHR Competency Full Implementation of Magna Carta for Public Health Workers Installed Performance Management System Health Human Resource Adequacy in BHS (1 Midwife: 1 Brgy; with consideration to GIDA) (BHW to HH 1:20HH) BHS HHR Competency (Basic BHW Training Course and CHT Training) System for BHW Recruitment and Retention Mechanisms Ordnance and Timely Provision of BHW Honorarium Presence of Essential Medicine at the RHU (Stock Basis) RHU Medicine Tracking and Inventory System Ratio of Community- Based Pharmacy (1 BNB/CBP catchment or 1 BNB per barangay) Accomplished Baseline Data Collection Regular Data Gathering and Recording Maternal/ Infant Death Review Monthly Updated Health Data Board Accomplishment, Utilization and Dissemination of the DILG, DOH LGU Scorecards Creation of Citizen s Charter Presence of Brgy. Health Station (1 BHS:1 Barangay or 1 BHS per Catchment) Maintenance and Operations Utilization Available and Accessible Transportation for Emergency Sustainable Maternal Health Care Initiatives Pre-Natal Services (at least 80%) Post Natal Services (at least 80%) Facility-Based Deliveries (85%) Skilled Birth Attendants (85%) Sustainable Breastfeeding Initiatives Exclusive Breastfeeding for Infants (70%) Newborns Initiated Breastfeeding (85%) Sustainable Essential Intrapartum and Newborn Care Initiatives Sustainable Infant and Child Care Initiatives Fully Immunized Child (95%) Under-5 Malnutrition Prevalence Rate (Below 17.3%) Sustainable Adolescent Reproductive Health Initiatives Teenage Pregnancy Rate (4%) Sustainable Family Planning Initiatives Provision of FP Commodities and Services (RHU) Contraceptive Prevalence Rate (63%) Unmet Needs (50% under NHTS) Sanitary Toilets (86% of HH) Access to Safe Water (87% of HH)

21 LEADERSHIP AND GOVERNANCE TRANSFORMATIVE CHANGE Emerging Framework of a Resilient Local Health System Preparedness Phase Relief Phase Recovery Phase Reconstruction Phase Adaptation Phase Pre-disaster Time: 0 to 1 month Time: 1 to 6 months Time: 6 to 24 months Time: 12 to 36 months Readiness to respond to emergencies Restore operational capacity Addressing concerns of vulnerable groups Re-establishment and re-building/ rehabilitation Institutionalizing policies, systems and programs on disaster resiliency Evidence-based all Hazards Local and Regional Integrated Risk Analysis : (H)Hazards x (E)Exposure x (V)Vulnerability Impacts to Health System identified and communicated to all staff and community members Health staff trained in basic life support Prepositioned relief goods, medical supplies and rescue equipment Located evacuation zones, centers, set routes and protocols Immediate postdisaster assessment Availability of commodities to address basic needs Mobilization of medical services Availability of WASH facilities Debris and waste clearing Psychosocial interventions Disease control Restoration of logistics and communications Repair of health infrastructure Coordination mechanisms are established Identified interventions Disease control Rebuilding health information systems Normalization of RHU operations Incentives program Established coordination mechanisms for rehabilitation Re-establish longterm food security Initiate training of leaders on disaster management and resiliency Re-establishment of hospital referral networks Post-disaster assessment Risk re-mapping Re-institutionalize health information system Rehabilitation of public infrastructure, logistics, and communications Strengthened health systems Completion of leadership and governance trainings Implementation, monitoring, evaluation of rehabilitation plans and post-disaster policies Operational disaster resiliency strategies and processes per health facility Climate- and disasterresilient Health facilities,i.e. situated and constructed based on risk-sensitive comprehensive land-use plan and zoning (e.g. no build/hazard zones) Resilience-based development and investment (budget) plans for health Cloud-based health information system Resiliency-based approach to planning and development Sources: Framework based on inputs from Zuellig Family Foundation and Ms. Antonia Loyzaga, Executive Director, Manila Observatory Adaptation drives transformation in individuals, communities, institutions, and societies.

22 THANK YOU.