COUNTRY ACCOUNTABILITY FRAMEWORK: · PDF fileCOUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Philippines ... Health Policy Development and Planning Department of Health ... NSO currently

COUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* PhilippinesManila, Philippines Accountability Workshop, March 19-20, 2012Information updated: April 3, 2012

Policy Context

Global strategy on women and children/

commitment

National Health Sector Plan and

M&E Plan

Country team present at the Philippines Accountability Workshop, March 19-20, 2012

GOVERNMENT

Ms Carole Bandahala

Chief Health Programme Officer

National Center for Disease Prevention and Control

Department of Health

Email: [email protected]

Dr Lilibeth David

Director IV

Health Policy Development and Planning



Ms Jessamyn Encarnacion

Director

Social Statistics Office

National Statistical Coordination Board

Ms Sotera de Guzman

Statistician IV

National Statistics Office


Ms Redencion Ignacio

Division Chief

Social Sectors Division

National Statistical Coordination Board

GOVERNMENT (CONTINUED)

Dr Maria Rosario Clarissa S. Vergeire

Medical Officer V

Planning Division

Health Policy Development and Planning



WHO COUNTRY OFFICE

Dr Mariella Castillo

Technical Officer

Office of the WHO Representative in the Philippines

Ms Lucille Nieverra

Programme Officer

Office of the WHO Representative in the Philippines


LIKHAAN CENTER FOR WOMEN'S HEALTH, INC.

Ms Junice L.D. Melgar

Likhaan Center for Women's Health, Inc.

E-mail: [email protected]

WORLD VISION DEVELOPMENT FOUNDATION

Dr Yvonette Serrano Duque

Child Well Being Programme Manager


H4+

Ms Ugochi Daniels

UNFPA Country Representative

United Nations Population Fund – Philippines


Ms Rena Dona

UNFPA Assistant Representative


Dr Willibald Zeck

Chief of Health and Nutrition

UNICEF Philippines


Mr Christopher B. Estallo

Manager

Advocacy and Public Partnerships


Situation Analysis

National Health Policy Strategy and Plan: 2011 - 2016. Review and evaluation was done before the creation of the plan.

*Please note this is a draft that will be finalised and validated through a national accountabilty workshop involving a broader stakeholder group Page 1/8

KEY:

1

2

3

5

Situation analysis

(strengths, weaknesses/gaps)Priority Actions

Assessment & Plan 3Coordinating Mechanism 3Hospital reporting 2Community reporting 2Vital statistics 3Local studies for mortality 1

Already present/no action needed

Philippines

Not present, needs to be developed

Needs a lot of strengthening

Needs some strengthening

COUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard*

Civil registration & vital statistics

systems

- Rapid assessment done using WHO VRA and Health

Metrics Tool with recommendations provided.

- Rapid assessment results integrated into the PHIN

strategic plan.

- Full assessment of the status and practices of CRVS is

ongoing.

- Birth and death registration forms and manual are being

revised.

- Philippine Health Information Network.

- Inter Agency Committee led by NSO and DOH.

- Inter Agency Committee on Health and Statistics reporting

to NSCB Executive Board.

Hospital reporting of deaths is incomplete and inaccurate:

(1) There is minimal private sector data, and (2) reports are

done manually.

ICD-10 is used in hospital reporting but validation for quality

data is needed.

- Community reporting of births and deaths are done

manually: (1) NSO currently updating Barangay Civil

Registration System (electronic), and (2) there is a weak

system for registration of indigenous people (IP's) and

Muslims.

- Minimal verbal autopsies are currently done and there is

no uniform standards set.

- Vital statistics are published every year for national and

sub national, with 2 years time lag, with limited data quality

assessment undertaken.

- There is no current surveillance site.

1. Dissemination of results

2. Full CRVS assessment finalized and development of improvement plan

3. Strengthen processes for interagency coordinating committee involving all

key stakeholders

4. Improve hospital reporting, use electronic reporting system

5. Training of doctors in ICD 10; regular quality control of certification;

improve coding practices.

6. Private data should be captured.

7. Leverage electronica data from private facilities using PHIC, Professional

Societies, etc.

8. Strengthen community reporting of births and deaths, implement

innovative approaches: (1) Barangay Civil Registration System and (2)

Provincial Maternal Death Review Committees.

9. Strengthen community reporting through use of VA by community workers.

10. Include NCIP and OMA in Inter Agency Committees.

11. Strengthen the analytical capacity of vital statistics office, including data

quality assessment.

12. Reduce time lag in publication to 1 year.

13. Electronic system of reporting in the Municipal level.

14. Develop the HDSS system:

15. Sentinel sites for surveillance for ARMM, Urban Slums

16. Validate 2007 birth and death registration from the CRS using 2007 census


PhilippinesCOUNTRY ACCOUNTABILITY FRAMEWORK: Scorecard*

Situation analysis


M&E Plan 3M&E Coordination 2Health Surveys 4Facility data (HMIS) 2Analytical capacity 2Equity 2Data sharing 2

Monitoring of results

- There is a National Objectives for Health (2011-2016), and

a Monitoring and Evaluation for Equity and Effectiveness

(ME3)

- All 11 RMNCH core indicators are included into the

mechanisms for M&E in the health sector, M&E plan is

aligned with NOH.

- There is no institutionalized functional committee for

M&E.

- Health Surveys: FHS: 2011; NDHS: 2013; Plan for National

Health Survey existsL NDHS every 5 years; Philippine

Statistical Program (2011-2017): NDHS, FHS, MICS.

- FHSIS: (1) does not include the hospitals and private

sector, (2) data quality is poor: there is no validation and no

timeliness, (3) there are numerous data sources that may

report different results.

- Annual DOH reports are available but they need to be

improved.

- LGU Scorecard is disaggregated for equity considerations

(income quintile).

- FHSIS is disaggregated according to age and sex.

- Philippine Health Statistics is published yearly -->

timeliness.

- Philippine National Health Accounts --> latest 2007 data.

Repository exists: DOH website, NSCB website, but data is

not always updated.

1. Strengthen the M&E component of the NHS.

2. Review the RMNCH M&E plan(s) and align with the M&E of the NHS.

3. Harmonization of sources of data and methods (a lot of different

systems/mechanisms).

4. Establish M&E coordinating body with representation from all sectors.

5. Plan for coordinating committee for MNCHN should be integrated into

National M&E Committee.

6. Philippine Health Information Network.

7. Develop a 10 year health survey plan.

8. Plan for a national coverage survey 2012-13, that includes RMNCH

interventions.

9. Strengthen analytical capacity, annual compilation of statistics from

facilities with data quality assessment.

10. Conduct annual facility survey for data verification and service readiness.

11. Electronic data to ease up processes.

12. Strengthen analytical capacity, involve key institutions; review contents,

analyses and presentation.

13. Develop an analytical framework.

14. Strengthen equity analyses for reviews.

15. Develop/strengthen national data repository with all relevant data and

reports.



Situation analysis


Notification 1Capacity to review and act 2Hospitals / facilities 2Quality of care 3Community reporting & feedback 1.5Review of the system 1

Maternal death surveillance &

response

NOTIFICATION:

- Strengths: all deaths are registered (civil registry)

- Weakness: (1) definition of notifiable deaths, maternal

deaths not included, (2) facilities do not report deaths on

time (more than 24 hours).

CAPACITY TO REVIEW AND ACT:

- Strengths: (1) National: mechanisms to review maternal

deaths, (2) guidelines for MNCHN disseminated (guidelines

and training done).

- Weakness: (1) Indigenous People (IP's) in the country don’t

have registration for maternal deaths, (2) other sectors of

the population are not monitored for maternal deaths.(3)

degree of maturity across levels: Foreign Assisted Projects in

selected LGU's.

HOSPITALS / FACILITIES:

- Strengths: (1) use of ICD-10 in hospitals. (2) Coverage:

>90% of deaths reported thru standardized forms (46%

FBD's). (3) POGS (medical society) have database of

maternal deaths from their accredited hospitals.

- Weakness: (1) death reports not within 24 hours. (2) poor

quality of reporting of causes of deaths. (3) Not all maternal

deaths are reviewed in Hospitals, only special cases are

reviewed.

QUALITY OF CARE:

- Strengths: (1) Assessment standards for birthing facilities

linked with PHIC, (2) survey on functionality of BeMONcs

and CeMOncs.

COMMUNITY REPORTING & FEEDBACK:

(1) No reporting of maternal deaths from communities. (2)

Plans for: Use of Mobile Phones, TeleHEALTH, WOMB

project, SPEED project, Community Health Teams, etc. (3)

Plans for Verbal Autopsies, trainings done--Provincial

Maternal Death Communities. (4) Plans for feedback to

communities on review of maternal deaths.

REVIEW OF SYSTEM:

There is no review of maternal death surveillance and

response system.

1. Advocate/ develop national policy on maternal death notification: (1) Policy

Issuance from the DOH (fastest way-->within 6 months), coverage/scope

includes all facilities--National, LGU, and private sector.

2. Joint Circular between DOH and DILG to cover for LGU Managed facilities.

3. Strengthen national capacity through training in MDSR: (1) greater

leadership role for NCDPC-DOH, (2) legal framework for protection of families

and providers.

4. Strengthen district capacity through training in MDSR: (1) strengthen MDSR

in CHD's (oversight role) and specific population levels and (2) Financing for

Provincial MDSR Committees.

5. Improve reporting by hospitals: (1) Training in ICD certification and coding

(links with CRVS) (2) establish a mechanism for maternal deaths reporting

within 24 hours.

6. Strengthen hospital capacity and practices, including private sector:

monthly maternal death review meetings.

7. Support a regular system of QoC assessments, with good dissemination of

results for policy and planning.

8. Develop / strengthen a community system for maternal death reporting

and response, using ICT.

9. Develop / strengthen a system for maternal death reporting and response

initiation by electronic devices.

10. Develop / strengthen VA for maternal deaths in communities.

11. Develop system to involve communities in review and response.

12. Need to harmonize and systematize all mechanisms on reporting for

maternal deaths in communities.

13. Support and strengthen review system including dissemination and use of

the report.



Situation analysis


Policy 2Infrastructure 3Services 1.5Standards 3Governance 3Protection 3

Innovation and eHealth

- eHealth strategic framework is not specific for MNCHN.

- WOMB, SHINE, TeleHealth for MNCHN under pilot

implementation.

- Connectivity (Internet, Mobile, Infrastructure, DOH IMS

distributing computers for LGU's) is available in most areas.

However, it is limited for GIDA areas

- eHealth services and applications are used in a pilot basis.

- There is minimal data sharing (eg. 1. UMIS) eg. 2. LGU

Scorecard integrated into DILG system (LGPMS)

- Presence of the following standards: (1) National Data

Dictionary, (2) PHIC Data Dictionary SPEED Project: health

facility coding. PHIS (Philippine Health Information Strategy)

and (3) ICT for Health recommendations for standards

development.

- There is a national eHealth coordinating mechanism:

Philippine Health Information Network: ICT for Health

included (hospitals not included). Interagency Committee

led by NSCB.

- About data protection: There is a confidentiality provisions

for statistical data (Existing law)

- There is a full enforcement of confidentiality provisions for

statistical data (institutional) and medical records/maternal

deaths (individual): (1) PHIN Standards and Policy Sub

Committee, (2) Data protection part of PHIC accreditation

standards and (3) Freedom of information Act (pending).

1. Revisit and consult national eHealth strategy.

2. Determine desired outcomes and priorities for infrastructure deployment

to support health services delivery and information flows.

3. Establish infrastructure in GIDA areas.

4. Determine the eHealth services required to support the country’s priority

programs and goals, particularly with respect to information flows.

5. Implement DOH ICT for Health Committee recommendations.

6. eHealth standards and interoperability components required to support

eHealth services, applications and infrastructure, as well as to support

broader changes to health information flows.

7. Implement eHealth standards and interoperability components.

8. Strengthen eHealth coordination mechanism.

9. CSO inclusion in governance mechanisms' (eg PHIN).

10. Inclusion of hospital information.

11. Assure health sector, ministerial and government leadership and support.

Ensure that the required program development skills and expertise are

available.

12. Review and update Health Information Security policies.

13. Facilitate access to information, support to FOI.

14. Adopt an information security plan.



Situation analysis


National health accounts 3Compact 3Coordination 3Production 2Analysis 3Data Use 3

- Presence of an approved NHA framework based on

international guidelines: (1) PNHA 2008-2010 due to be

released this year (2012), (2) PNHA disaggregation as to age,

sex and region, amd (2) LHA for provinces.

- National Statistical and Coordination Board -- highest

policy making body for statistical data: (1) IAC endorses to

the NSC Board, and (2) Lack of human resources for timely

compilation of NHA

- There is no formal agreement between government and

partners, but there is mechanism through the IAC.

- Sources of data for PNHA: COA, DBM, PCSO-->no formal

agreement among agencies

- Development Partners: SDAH

a. Policy

b. PMO

c. DP Scorecard.

- There is an Interagency Committee for Nutrition and

Health which is under NSCB.

- Stakeholder involvement for the production of the NHA is

done through the membership in IAC and the Board

- Production is mandated to NSCB and stakeholders are

involved in the processes.

- There are inadequate human resources to produce the

PNHA.

- Provincial planning and health personnel for LHA

- PNHA and LHA has excel tool, but encoding requires

manual data extraction (COA codes in forms changes all the

time, changes in activities)

- PNHA with time series and policy analysis

- LHA with policy analysis

- FIES for equity analysis

- NHA indicators and analyses are publicly accessible.

Monitoring of resources

1. Update NHA based on new SHA.

2. DOH to fund personnel to augment staff for PNHA.

3. Contract Agent (UNFPA) to do RMNCH Sub Accounts: short term (DOH to

lead in coordination w NSCB).

4. Continue development of LHA.

5. MOA among National Agencies (DBM, DOH, PCSO, PHIC, NSCB, NEDA).

6. Update ratios, shares from private data sources.

7. Ensure inclusion of all key stakeholders in resource tracking /NHA:

Increased CSO participation in RMNCH Sub Accounts.

8. Regional Validation Team for LHA --> hire accountants.

9. Bilateral meeting with COA to resolve coding changes.

10. Update central database and methods for production of PNHA.

11. Develop IT tools for mapping and conversion of health expenditure data

to health accounts to reporting formats.

12. Strengthen analytical capacity in government and other institutions.

13. Disseminate report and analyses on public website.

14. Beneficiary Analysis: Reproductive and Child Health.

15. Advocate for and promote the use of NHA data in policy making process

for CSO's, Legislators, and other partners.



Situation analysis


Reviews 2.3Synthesis of information & policy context 2From review to planning 2Compacts or equivalent mechanisms 3

- The following meetings are conducted: National Health

Sector Meeting, Health Partners Meeting, JAPI (Joint

Assessment and Planning Initiative), Joint Appraisal

Committee (JAC): National and Regional Level.

- There is limited participation of CSO's and other partners

in the preparation and execution of the reviews.

- Program Implementation Reviews and MDG reviews for

the health sector.

- There is a lack of evidence from the sub national level

(provincial level) to inform health sector performance

reviews.

- Health sector reviews done by DP's.

- The current thrusts of the KP is based on recent health

sector reviews (e.g MDG breakthrough areas; focus on the

poor; 609 municipalities/cities)

- PIPH/AOP's are used for LGU investment planning.

- CSO participates in BUB (Bottom UP Budgeting).

- SDAH: JAPI, JAC, Health Partners Meeting

- PDP, NOH, PIP, HSEF

- UNDAF aligned to PDP.

Review processes

1. Advocate for annual reviews that are based on the goals, targets of the

NHS: structure meetings to reflect expenditures and performance.

2. Define at country level a calendar event to ensure better quality of the

annual review process.

3. Ensure that the RMNCH appraisals are held and that findings feed into the

health sector reviews: joint appraisal of mother and child programs for the

health sector.

4. Strengthen linkage with CSO's, legislators and other partners.

5. Strengthen the capacity to prepare analytical reports prior to the reviews.

6. Develop/strengthen mechanism to compile all policy / qualitative

information to inform annual reviews.

7. Provincial review mechanisms for provincial performance and provincial

performance distribution.

8. Develop system for sub national/cluster reviews.

9. Strengthen the use of review results for planning purposes.

10. Ensure greater involvement of all stakeholders.

11. Ensure the existence of a single M&E framework that fits into the single

national health plan: Harmonize all existing M & E mechanisms.



Situation analysis


Parliament active on RMNCH issues 3Civil Society Coalition 3Media role 2Countdown event for RMNCH 3

Advocacy & outreach

- There is a committee on Health with subcommittee for

MDG's (Lower House).

- The Committee on Health and Demographics actively push

for RMNCH (Senate).

- Committee on Women, Children’s Welfare, Population,

Youth.

- Senate resolution on maternal mortality.

- Public hearings on health.

- No institutionalized mechanisms for consultation on

specific health issues.

- Civil society coalitions exist, are funded, and meet

regularly with other stakeholders.

- Bottom Up Budgeting is done with substantial roles of

CSO's at national and local levels.

- Evidence-based advocacy messages are produced by

CSO's.

- Media reporting is sporadic.

- Media reporting upon stimulation of performance reports,

and some champions.

- PCIJ focused on MDG 2 and 5.

- ANC channel sponsored Adolescent.

- Regional Media Groups (PNGOC).

- DOH provides weekly Press Conferences with Official

Spokesperson.

- Streamline: Asia Pacific Conference for RH (2014), Women

Delivers (2013), 162 to 52 Summit (2012).

- Countdown Report/Profile produced for 2010.

- Progress report on MDG's every 3 years (2010 latest).

1. Various committees are mobilized to engage in RMNCH accountability.

2. Facilitate the organization of public hearings/forums for sharing of

information on RMNCH.

3. Institutionalized mechanisms for consultations, for obtaining public input.

4. Sub committees on MDG's for Senate.

5. Support /strengthen coalition.

6. Support capacity of civil society to synthesize evidence and disseminate

messages, and to strengthen sense and operationalization of accountability.

7. Institutionalize mechanism for expanded CSO participation specially

Women, Youth, RH CSO's

8. Work with the media to strengthen their capacity to report on RMNCH

related issues.

9. Work with the media to strengthen their capacity to report on the

monitoring the implementation of the Global Strategy.

10. Improve information flows to media.

11. Partner with Philippine Information Agency, Journalist Orgs for stronger

regional media networks and forums.

12. Countdown Coordinating Committee, UN agencies (H4+), and other

partners encourage/support national stakeholders to plan national

Countdown integrated with other RMNCH events.

13. Regularly update Countdown report / profile using all evidence.


Documents

COUNTRY ACCOUNTABILITY FRAMEWORK: · PDF fileCOUNTRY ACCOUNTABILITY FRAMEWORK: Assessment* Philippines ... Health Policy Development and Planning Department of Health ... NSO currently