FOURMULA ONE FOR HEALTH Updates on the Implementation

FOURMULA ONE FOR HEALTH Updates on the Implementation ETHELYN P. NIETO, MD, MPH, MHA, CESO III Undersecretary of Health Program Development Cluster DEPARTMENT OF HEALTH PRESENTED AT THE 1 ST NATIONAL STAFF MEETING 2007

Service Delivery – Public Health Program Development 1. Disease – Free Zone Initiatives a. Malaria b. Filariasis c. Schistosomiasis d. Rabies e. Leprosy 2. Intensified Disease Prevention & Control a. TB b. VPI c. HIV/AIDS d. Emerging & RE-Emerging Infectious Diseases e. Dengue

Service Delivery – Public Health Program Development 3. Maternal & Child Health 4. Healthy Lifestyle & Risk Management

Service Delivery – Health Facilities Development Program 1. Rationalization of Local Health Facilities 2. Upgrading of Local Health Facilities 3. Health Human Resource Capacity Building 4. Rationalizing Services & Strengthening Management Systems in Health Facilities 5. Integrating wellness services in hospitals

Service Delivery – Strengthening Surveillance & Epidemic Management System 1. Creation & Strengthening of Epidemic and Surveillance Units 2. Setting up of Surveillance Systems 3. Linkage with private sector

Service Delivery – Strengthening of Disaster Preparedness & Response System Service Delivery – Health Promotion 1. Advocacy/BCC 2. Localization of IEC messages 3. Reproduction of localized IEC messages

UPDATES

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered NCDPC -Need to strengthen surveillance in 16 Malaria-free prov. Operationalization Disease-Free Zones of Priority Initiatives Programs Malaria 16 Malaria-free provinces as of Jan. 2007 Schistosomiasis Drafting of Criteria for Schistosomiasis-free Zones - Some RHUs not equipped to diagnose (lack of microscopes) - No buffer stocks of Praziquantel from CO & CHDs Rabies Preliminary assessment of possible Rabies-free zones - Strict enforcement of Rabies control ordinance

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered Operationalization Disease-Free Zones of Priority Initiatives Programs Rabies (cont. ) Rabies curriculum integration in 7 high incidence regions - Establishment of functional ABTC - Need to strengthen IEC campaign Leprosy - Prevalence rate maintained at <1/10, 000 - Conduct of the 1 st National Leprosy Summit - Strengthening of Surveillance system Filariasis - Integrated Mass Treatment Campaign w/ STH Need support & commitment from CHDs & LGUs to

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered Operationalization Disease-Free Zones of Priority Initiatives Programs Filariasis (Cont. ) -Mass Treatment in 35 provinces; Conduct of Mid-MDA Survey to det. MFR as a result of mass treatment Results: a. 42/43 sentinel sites with reduced MFR b. 8 endemic provinces w/ reduced MFRs NCDPC ensure high MDA coverage - Need to strengthen Disability Prevention aspect of elimination program

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered Operationalization Intensified Disease of Priority Prevention and Control Programs Initiatives Tuberculosis - Nationwide NCDPC implementation of DOTS - TB in Children expanded to 1 city/ region -100 PPMD Units installed - 470 DOTS facilities certified, 370 accredited -Programmatic MDR-TB Management -Training on Hospitalbased NTP DOTS Funding for expansion of Childhood TB & MDR - TB

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered Operationalization Intensified Disease of Priority Prevention and Control Programs Initiatives HIV-AIDS - Establishment of Social NCDPC Hygiene Clinics & Local AIDS Councils - Community-based programs - Home-based care -Preliminary activities for the integration with MCH Program Drafting of HIV Benefit Package Guidelines

NSM Resolution Action Taken Resp. Office Issues/Difficulties Encountered NCDPC -Pockets of low immunization coverage -Reported data in cities disparate from validated data -Inventory management -Increasing routine OPV 3/DPT 3/AMV from current 80% to 95% to achieve elimination Operationalization Intensified Disease of Priority Prevention and Control Programs Initiatives Vaccine. Preventable Illnesses -Adoption of Reaching Every Barangay strategy (60% of health facilities) -Memo to CHDs to prioritize top 31 provinces/cities w/ high unimmunized children -100% fund availability for EPI -Integration through 4 Bs (Bakuna, Bitamina A, Breastfeeding, purga sa Bulate)

NSM Resolution Action Taken Resp. Office Issues/Difficulties Encountered NCDPC - Advocacy to LCEs to allocate funds for Preparedness & Response act. - Adequacy of supplies (antivirals, vaccines, PPEs) - Readiness of referral facilities - M & E of initiatives by various sectors Operationalization Intensified Disease of Priority Prevention and Control Programs Initiatives EREIDs (Avian Influenza) - Establishment of AI Task Forces (Nat’l, Reg’l, Prov’l, Mun’l) -Development of Preparedness & Response Plans (up to Mun’l level) -Capability-building activities up to the Barangay level -Procurement of antivirals, PPEs -IEC materials developed

NSM Resolution Action Taken Resp. Office Issues/Difficulties Encountered -Capability-building act NCDPC on Promotion & Advocacy of HL -Development of National Tobacco Control Prog. – Smoking Cessation Clinics; Integrated NCD Prevention & Control Program -Development of the National Environmental Health Action Plan -Technical Assistance in the Guimaras Oil spill -Strong influence of MNCs -Availability of lowpriced anti-HPN drugs -Lack of organizational/ financial/facility preparedness to address chemical accidents Operationalization of Priority Programs Healthy Lifestyle & Risk Management

NSM Resolution Action Taken Resp. Office Issues/Difficulties Encountered - Modeling of Mother. NCDPC Baby Friendly Community & Workplace -Institutionalization of IMCI training modules in training institutions -Manual & Trng. on Salt Iodization Tech. & QA -Strategic Plan for Integrated Helminth Control Program -Policy & Plan on Child Injury Prevention -TRO on IRR of EO 51 -Low immunization coverage for TT (37%) -Exclusive BF (’ 03): 33. 5% -Ave. Length of Exclusive BF (‘ 03): 0. 8 mos. -Difficulty of getting Garantisadong Pambata & Patak sa Asin Reports Operationalization of Priority Programs Maternal & Child Health

NSM Resolution Action Taken Resp. Office Issues/Difficulties Encountered Operationalization of Priority Programs Maternal & Child Health - Public-Private NCDPC Partnership in Women’s Health (part. FP) - Inclusion of SDM - Policy & TA on CSR Strategy - Pilot implementation of Pre-Pregnancy Package - Facility Mapping & Fac. Needs Assessment for Em. OC facilities - Establishment of BEm. OC Training Centers -Need to replicate trainings on BEm. OC & Revised FP Manual nationwide -Not all LGUs are providing full support for their contraceptive supplies - Need for active participation of private sector in NFP (e. g. church)

NSM Resolution Action Taken NHIP Benefit Packages Development of the following packages: TB Maternal Resp. Office Issues/Difficulties Encountered NCDPC, PHIC Need to develop more evidence-based packages NCDPC, HPDPD Technical assistance needed SARS/AI Malaria HIV-AIDS Newborn Package–Hep B Performance & Need-Based Allocation & Financing System Development of Central Office *PIF indicators to for Performance-Based Budgeting System *PIF: Performance Indicator Framework

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered Strengthening of Surveillance & Epidemic Mngt. System Creation/ Strengthening of Epidemic Surveillance Units -Creation of team of Nat’l EPI Surveillance Officers -Conduct of trainings on the ff. : a. NESSS (2 batches) b. EPI Info. System c. Course for Coders -Conduct of Reg’l EPI Surv. Assessment & Supportive Supervision (11 regions) NEC Funding & overlapping of activities

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered Strengthening of Surveillance & Epidemic Mngt. System Creation/ Strengthening of Epidemic Surveillance Units -FETP: 7 enrolled (‘ 06) -FMTP: 57 graduates (’ 06) Setting up of Surveillance Systems -Conduct of the ff. Dissemination For a: a. 2005 Integrated HIV & Behavioral Surveillance System b. New Protocol of HIV & AIDS Registry NEC Delayed reports from sites

NSM Resolution Actions Taken Resp. Office Issues/Difficulties Encountered Strengthening of Surveillance & Epidemic Mngt. System Setting up of Surveillance Systems -Pilot Testing of Forms NEC for new Protocol of HIV & AIDS Registry -Completed the Baseline Survey of 5 th Round GTFAM (18 HIV sites) -Software support to Malaria Info. System -Conduct of PHIL-MIS Training in Global Fund Malaria Sites Funding & overlapping of activities

NSM Resolution Strengthening of Disaster Preparedness & Response System Action Taken Resp. Office -Development of the ff. : HEMS a. Weapons for Mass Destruction Hospital. Based Manual b. Guidelines on Expanded Utilization of BP 5 Compact Food c. Guidelines for Performance Evaluation of CHDs on HEM d. Standards for developing Emergency Preparedness & Response Plans as requirement for hospital licensing Issues/Difficulties Encountered

NSM Resolution Strengthening of Disaster Preparedness & Response System Action Taken Resp. Office -TA to the following act. : HEMS a. Skills Benchmarking for CHDs b. Conduct of EMT Basic & Instructor’s Training Course -Organization & conduct of the following trngs. : a. BLS-CPR (DOH personnel-5 batches) b. BLS-TOT (37 trainors produced) c. 2 nd Nat’l PHEMAP Course (34 Health Emergency Managers produced) d. HEM Trng. (3 batches) Issues/Difficulties Encountered

NSM Resolution Strengthening of Disaster Preparedness & Response System Action Taken Resp. Office -Strengthening of CHD 3 HEMS OPCEN -Review & Publication of “Pocket Emergency Tool” – 2 nd ed. -Logistic Support (Mayon, Nitrate poisoning, etc. ) Issues/Difficulties Encountered

NSM Resolution Strengthening of Health Promotion to effect behavior change Action Taken Resp. Office -. ) developed a NCHP health promotion plan for the promotion of F 1 package -Prepared script and produced AVP for F 1 -Composed the F 1 jingle Issues/Difficulti es Encountered

NSM Resolution Strengthening of Health Promotion to effect behavior change Action Taken -. ) developed health promotion and communication plans for the major health events especially those geared towards: -disease-free zone initiatives -- promotion of Healthy Lifestyle Resp. Office NCHP Issues/Difficulti es Encountered - Lack of budget to sustain trimedia campaign -Lack of CHD budget to trickle down national campaigns to LGU levels -Lack of LGU activities on faceto-face communication to change behavior

NSM Resolution Strengthening of Health Promotion to effect behavior change Action Taken Resp. Office -. ) Conducted NCHP meetings and workshops to pave the way for the creation of a Health Promotion Foundation Issues/Difficulti es Encountered - Lack of top management support - Lack of budget to initiate preparatory activities

NSM Resolution Rationalization of Local Health Facilities to include facility mapping for BEMOCs & CEMOCs Actions Taken Resp. Office Issues/Difficulties Encountered A. O. #2006 -0029 dated NCHFD June 15, 2006 issued: Guidelines on Rationalization of Health Care Delivery System Based on Health Needs *On-going development of Implementation Manual (Manual of Procedures). *Coordination with Regulatory Bureau (BHFS) requirement for Certification of Needs (CON) *Used in evaluation of House & Senate Bills on Hosp establishment, upgrading, Different application due to geographical differences.

NSM Resolution Actions Taken Resp. Office Upgrading of Local Health Facilities – Infrastructure, Equipment Under the PGMA Priority NCHFD Hospital Upgrading Project: 22 LGU Hospitals for upgrading, amounting to P 371. 797 M; funds suballotted to CHDs as of Jan 22, 2007. Health Human Resource Capacity Building for LGU & National Govt Hospitals -Conducted Training Courses: 1. Healthy Hospital Initiative 2. Quality Management System 3. Implementation of CQI Program 4. Accurate Nursing Documentation NCHFD Issues/Difficulties Encountered

NSM Resolution (cont’n): Health Human Resource Capacity Building for LGU & National Govt Hospitals Actions Taken Resp. Office Conducted Training NCHFD Courses: 5. Qualitative & Quantitative Analysis of In-patient Medical Records; Analysis of Hospital Statistical Report 6. Clinical Toxicology for Doctors & Nurses (DOH Hospitals) 7. Occupational Health & Safety for Hospitalbased Workforce in MM Hospitals. 8. Preparedness for Avian/Pandemic Influenza for DOH Hosp Issues/Difficulties Encountered

NSM Resolution Actions Taken Resp. Office Health Human Resource Provision/Capacity Building for LGU & National Govt Hospitals -Conducted Training NCHFD Courses: 9. Mother-Baby Friendly Hospital Initiative (MBFHI) for Regional Assessors, Lactation Management Trainers, LGU & Private Hospital Administrators. 10. Extended Child Care 11. Hospital Billing Procedures & Patient Classification (AO 51 -A) 12. Roles & Functions of Hospital Medical Social Workers. Issues/Difficulties Encountered

NSM Resolution Actions Taken Resp. Office Health Human Resource Provision/Capacity Building for LGU & National Govt Hospitals -Conducted Training NCHFD Rationalizing Services & Strengthening Management Systems in Health Facilities Updating of Manuals of NCHFD Operations: Nursing Service, Pharmacy, Dietary Service, Medical Records, Medical Social Service, Administrative Procedures. Manual of Standards for Infection Control issued. Courses: 14. Implementation of Integrated Hospital Operations & Management Program (IHOMP) & Hospital Operations & Mx Information System (HOMIS) software Issues/Difficulties Encountered

NSM Resolution Rationalizing Services & Strengthening Management Systems in Health Facilities Actions Taken -Strategies for reducing high % of primary & secondary services in DOH tertiary care facilities (“devolution of primary & secondary services”). -Devolution of primary licensed hospital. -Continued implementation of hospital upgrading projects to establish tertiary care & specialty services in DOH Hospitals (Phil. Hospital Development Program) Resp. Office Issues/Difficulties Encountered NCHFD, Resistance from selected hospital staff; Need Hospitals for longer social preparation to influence patient health seeking behavior. CHDNCR, NCHFD, BIHC, selected Hospitals

NSM Resolution Rationalizing Services & Strengthening Management Systems in Health Facilities Actions Taken -Financial Management Systems in Hospitals: Cost-finding, Ratesetting _ Coordination with PHIC for new benefit Packages & Financing opportunities for Hospitals: - Phil. Health Preferred provider Program, Overseas Workers Program. - Implementation of performance-based budgeting in Hospitals (2007) Resp. Office Issues/Difficulties Encountered NCHFD, PHIC NCHFD, HPDPB, FS Need to revisit process.

NSM Resolution Actions Taken Integrated Drafting of AO to Wellness services strengthen MBFHI in Hospitals (inclusion of “mother-friendly” strategies. TB DOTS Referral System established in Hospitals. Conducted Advocacy activities: 1. Healthy Lifestyle 2. Primary Health Care 3. Occupational Health & Safety 4. Hospitals as Centers of Wellness Resp. Office NCHFD & Hospitals in support to NCDPC & NC. HP Issues/Difficulties Encountered

Thank you very much!