P H I L I P P I N E H E A LT H A G E N D A ACHILLES GERARD C. BRAVO, CESO III Undersecretary of Health
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1 P H I L I P P I N E H E A LT H A G E N D A ACHILLES GERARD C. BRAVO, CESO III Undersecretary of Health
2 GOALS The Health System We Aspire For FINANCIAL PROTECTION Filipinos, especially the poor are protected from high cost of health care BETTER HEALTH OUTCOMES Filipinos attain the best possible health outcomes with no disparity RESPONSIVENESS Filipinos feel respected, valued, and empowered in all of their interaction with the health system
3 VALUES The Health System We Aspire For EQUITABLE & INCLUSIVE TO ALL TRANSPARENT & ACCOUNTABLE USES RESOURCES EFFICIENTLY PROVIDES HIGH QUALITY SERVICES
4 During the last 30 years of Health Sector Reform, we have undertaken key structural reforms and continuously built on programs that take us a step closer to our aspiration. Milestones Devolution Use of Generics Milk Code PhilHealth (1995) DOH resources to promote local health system development Fiscal autonomy for government hospitals Good Governance Programs (ISO, IMC, PGS) Funding for UHC
5 Persistent Inequities in Health Outcomes 2000 Every year, around 2000 mothers die due to pregnancy-related complications. A Filipino child born to the poorest family is 3 times more likely to not reach his 5 th birthday, compared to one born to the richest family. Three out of 10 children are stunted.
6 Restrictive and Impoverishing Healthcare Costs Tiisin ko na lang ito.. Every year, 1.5 million families are pushed to poverty due to health care expenditures Filipinos forego or delay care due to prohibitive and unpredictable user fees or copayments Php 4,000/month healthcare expenses considered catastrophic for single income families
7 Poor quality and undignified care synonymous with public clinics and hospitals Long wait times Limited autonomy to choose provider Less than hygienic restrooms, lacking amenities Privacy and confidentiality taken lightly Poor record-keeping Overcrowding & under-provision of care
8 Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat
9 UNIVERSAL HEALTH COVERAGE STRENGTHEN IMPLEMENTATION OF RPRH LAW Investing in People Protection Against Instability WAR AGAINST DRUGS ADDITIONAL FUNDS FROM PAGCOR
10 PHILIPPINE HEALTH AGENDA FRAMEWORK Goals: Attain Health-Related SDG Targets Financial Risk Protection, Better Health Outcomes, Responsiveness Values: Equity, Efficiency, Quality, Transparency SERVICE DELIVERY NETWORK 3 Guarantees ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE UNIVERSAL HEALTH INSURANCE A C H I E V E
11 GUARANTEE #1 ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE Services for Both the Well & the Sick
12 All Life Stages & Triple Burden of Disease Pregnant Newborn Infant Child Adolescent Adults Elderly First 1000 days Reproductive and sexual health maternal, newborn, and child health exclusive breastfeeding food & micronutrient supplementation Immunization Adolescent health Health screening, promotion & information COMMUNICABLE HIV/AIDS, TB, Malaria Diseases for Elimination Dengue, Lepto, Ebola, Zika NON- COMMUNICABLE, INCLUDING MALNUTRITION Cancer, Diabetes, Heart Disease and their Risk Factors obesity, smoking, diet, sedentary lifestyle Malnutrition DISEASES OF RAPID URBANIZATION & INDUSTRIALIZATION* Injuries Substance abuse Mental Illness Pandemics, Travel Medicine Health consequences of climate change / disaster
13 GUARANTEE #2 SERVICE DELIVERY NETWORK Functional Network of Health Facilities
14 Services are delivered by networks that are FULLY FUNCTIONAL (Complete Equipment, Medicines, Health Professional) PRACTICING GATEKEEPING COMPLIANT WITH CLINICAL PRACTICE GUIDELINES LOCATED CLOSE TO THE PEOPLE (Mobile Clinic or Subsidize Transportation Cost) AVAILABLE 24/7 & EVEN DURING DISASTERS ENHANCED BY TELEMEDICINE
15 GUARANTEE #3 UNIVERSAL HEALTH INSURANCE Financial Freedom when Accessing Services
16 Services are financed predominantly by PhilHealth SIMPLIFY PHILHEALTH RULES PHILHEALTH AS THE MAIN REVENUE SOURCE FOR ALL HEALTHCARE FACILITIES No balance billing for the poor in basic accommodation Fixed co-payment for non-basic accommodation Expand benefits to cover comprehensive range of services with high support value Contracting networks of providers within Service Delivery Networks PHILHEALTH AS THE GATEWAY TO FREE OR AFFORDABLE CARE All Filipinos as members Formal sector premium paid through payroll and non-formal sector premium paid through tax subsidy
17 Our Strategy Advance health promotion, primary care and quality A Cover all Filipinos against financial health risk C Harness the power of strategic HRH H I E Invest in ehealth and data for decision-making Enforce standards, accountability and transparency Value clients and patients V Elicit multi-stakeholder support for health E
18 A Advance health promotion, primary care and quality 1. Annual health visits for all poor families 2. PhilHealth to contract with functional networks* of PCB providers and DOH provide additional resources* 3. Transform selected DOH hospitals into multi-specialty, endreferral mega-hospitals, i.e. teaching/training, reference laboratory 4. Enact/enforce measures to improve access to lifesaving interventions and reduce exposure to risk factors for premature deaths and disability 5. Establishing expert bodies for health promotion (Public Health Philippines) and surveillance and response (Philippine CDC) *District hospital paired up with 10+ RHUs or private clinics *HFEP, deployment vaccines, medicines, trainings
19 Facilitate the process of network forming Upgrade 3 DOH hospitals into megahospitals Expand primary care benefit to all members Limit contracting of PCB providers with functional networks (not stand-alone) LGU Conduct annual health visits for all poor families and special populations (NHTS, IP, PWD, Senior Citizen) Collaborate with others to form networks A Advance health promotion, primary care and quality
20 C Cover all Filipinos against financial health risk 1. Mobilize more funds Sin Tax PAGCOR, PCSO Increase Premium Collection Efficiency 2. Enroll remaining 8% from non-formal sector into PhilHealth 3. Expand PhilHealth benefits Outpatient diagnostics, drugs, blood & blood products 4. Recalculate case rates & link payment to quality 5. Improve contracting and enforce terms Primary care trust fund Network-based contracting
21 Support revenue generation measures Align all health financial assistance programs to support Universal Health Coverage (PAGCOR, PCSO) Undertake costing and revise case rates Increase premium rates and collection efficiency Design additional benefits for outpatient diagnostics, drugs, blood & blood products LGU Implement Health Trust Funds Provide income retention to health providers while retaining budgetary support C Cover all Filipinos against financial health risk
22 H Harness the Power of Strategic HRH 1. Make health professions curricula responsive to local and global needs 2. Review government HRH compensation package such that ARMM, IP, GIDA will have highest pay 3. Shift to competency versus profession-based frontline complement 4. Provide scholarships, financial incentives 5. Institute return service schemes *clinicians and allied health professionals, managers, researchers and policymakers
23 Form Legislative- Executive Health Human Resource Task Force Streamline compensation scheme for health workers LGU Provide the Magna Carta for HCW benefit H Harness the Power of Strategic HRH
24 I Invest in ehealth and data for decision-making 1. Require online data* submission as requirement for licensing & contracting of health facilities and drug outlets 2. Mandate the use of Electronic Medical Records (EMR) in all health facilities 3. Invest in nation-wide surveys, administrative data and disease registries 4. Automate major business processes 5. Facilitate open access to anonymized data * clinical and administrative
25 Revise licensing requirements to reflect regular electronic data submission requirement Open up data set for researchers Revise accreditation/ contracting rules to reflect regular electronic submission requirement Open up data set for researchers Provide incentives LGU Implement EMR in all health facilities Improve local civil registration and vital statistics data Submit data electronically I Invest in ehealth and data for decision-making
26 E Enforce accountability and transparency 1.Publish information that can trigger better performance Prices of common drugs and services Non-compliant / erring providers National Objectives for Health to guide strategies and investments by different stakeholders 2. Set up dedicated performance monitoring unit Ghost patients and/or surprise visits Medical audits or third-party monitoring
27 Collect and publish relevant information Publish annually accountability report card Publish annually accountability report card LGU Ensure transparent procurement process in all health facilities Regularly submit data to DOH E Enforce accountability and transparency
28 V Value clients and patients, especially the poor and vulnerable 1. Focus all efforts on the poorest 20 million Filipinos 2. Make all health entitlements simple and explicit 3. Set up participation & redress mechanism 4. Significantly reduce turnaround time and improve transparency of processes
29 Coordinate with PhilHealth in defining the healthcare entitlements of every Filipino and publish this Set up call center Streamline procedures for availing services LGU Set up complaints & redress mechanisms V Value clients and patients, especially the poor and vulnerable
30 E Elicit multi-sector multi-stakeholder support for health 1.Harness and align Private Sector in planning SDN, intervention, and supply side investments 2. Ensure convergence with other government agencies in delivering services (DOH, DENR, DSWD, DepEd, HUDCC) Advocate for Health in All Policies Multisectoral work with different agencies to build healthy living, working, schooling environments, healthy cities, and Health in All Policies Mandate Health Impact Assessment for large-scale, high-risk development projects, e.g. mining, power plants, oil rigs 3. Partake with CSOs in governance Budget Development Monitoring and Evaluation
31 LGU Develop policy agenda with NGAs, CSOs and private sector on mainstreaming Health in All Policies Institutionalize health impact assessment for large scale projects Expand contracting mechanisms to include the private sector (Z benefits, PCB) Implement healthy communities/cities interventions E Elicit multi-sector multi-stakeholder support for health
32 SERVICE DELIVERY NETWORK ATTAIN HEALTH- RELATED SDGs ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE UNIVERSAL HEALTH INSURANCE Financial Risk Protection Better Health Outcomes Responsiveness
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