Gov Salceda cbms-feb 08 2011anciensite.pep-net.org/fileadmin/medias/pdf/CBMS_country_proj... · Proportion of facility-based deliveries 88 70 80 90 100 ... – created by ordinance

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ALBAY HEALTH ALBAY HEALTH STRATEGY STRATEGY

towardstowardsSAFE AND SHAREDSAFE AND SHARED

DEVELOPMENTDEVELOPMENT

Governor Joey Sarte SalcedaProvince of Albay

MDG is all about dignity.

Engaging dignity, Empowering dignity

Ennobling dignity

Albay MDG Achievements

Albay Health Strategies

Story LineStory Line

Albay Health Strategies MDG – make it a goal, the rest follows

Goal Indicator Bicol Region Albay

1 Poverty Incidence M H

Subsistence Incidence H H

Underweight (IRS) H H

2 Participation - Elementary L M

Cohort survival - elementary M L

3 Gender parity - elementary H H

4 Under-five mortality H H

Infant mortality H H

MDGs are achieved ahead of 2015 exc. MDG 2 and 7

Infant mortality H H

Proportion of fully-immunized children M H

5 Maternal mortality rate L H

Contraceptive prevalence rate L M

Condom use rate L M

6 Deaths due to TB L H

Malaria positive cases H H

7 Household with access to sanitary toilets H L

Household with access to safe drinking water H H

Legend:

L low probability H high probability

M medium probability no data

24%

22

1615

20

25

Proportion of 0 - 5 years old who are malnourished

Achievements on MDG, 2009

0

5

10

15

1992 2009


133

100

120

140

Maternal Mortality Ratio

59

0

20

40

60

80

1998 2009

90/ 100,000 LB

33

25

30

35

Infant Mortality Rate


12

0

5

10

15

20

1998 2009

17/1,000 LB

2

80%

Proportion of facility-based deliveries

88

70

80

90

100


11

0

10

20

30

40

50

60

1998 2009

80%

Proportion of births attended by skilled health personnel

90

60

70

80

90

100


29

0

10

20

30

40

50

60

1998 2009

65%

29

25

30

35

Contraceptive Prevalence Rate


8

0

5

10

15

20

1990 2009

28

20

25

30

Child Mortality Rate

27/1,000 LB


18

0

5

10

15

1998 2009

95%

96

92

94

96

98Fully-Immunized Children


86

80

82

84

86

88

90

1990 2009

Achievements on MDGAchievements on MDG

40

50

60

TB Mortality RateTB Mortality Rate

•44/100,000 pop

0

10

20

30

1997 2009

3

80

100

120

Case Detection Rate for TBCase Detection Rate for TB

••Achievements on MDGAchievements on MDG

0

20

40

60

1999 2009

•70%

60

70

80

90

Cure Rate for TB

••Achievements on MDGAchievements on MDG

•85%

0

10

20

30

40

50

1999 2009

IndicatorsNational

Average (2006)National

Target (2010)Performance ALBAY (2009)

Gaps/ Gains

Intensified Disease Prevention and Control: TB

Mortality (per 100,000 pop)

28,000 44 26 (18)

••Health OutcomesHealth Outcomes

TB Case Detection Rate, % (NTP Register)

72 70 100 30

TB Cure Rate, % 81 85 81 (4)

Make MDG a goal

Ordain policies and Give it a Budget

Execute programs and projects

Build institutions

AlbayAlbay MDG StrategyMDG Strategy

Nurture partnerships

VisionVision Safe and shared development

Albay as most liveable province known for good education, good health and good environment to secure safe and shared development

Vision for Health: longer life expectancy Vision for Health: longer life expectancy, wellbeing in itself, wellbeing for laborproductivity

Albayanos as healthy and happy, well-educated, well-trained

Low-rise, low-carbon, low-energy intensity = green development model

Albay Development Goal Albay Development Goal 1. Shared development: operationally defined as:

compliance with MDG and improvement in HDI.

Climate change and disaster risks are key obstacles to MDG and HDI.

2. Safe development: Disaster risk reduction and li i b il i l f h l

1. Shared development: operationally defined as: compliance with MDG and improvement in HDI.

Climate change and disaster risks are key obstacles to MDG and HDI.

2. Safe development: Disaster risk reduction and li i b il i l f h lclimate action are built-in elements of the central

economic strategy, not a contingency plan.

a. Disaster risk reduction is guided by Hyogo Framework for Action

b. Climate action is guided by UNFCCC.

3. Structural governance x safe development = shared economic growth.

climate action are built-in elements of the central economic strategy, not a contingency plan.

a. Disaster risk reduction is guided by Hyogo Framework for Action

b. Climate action is guided by UNFCCC.

3. Structural governance x safe development = shared economic growth.

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2000 2003 2006 2000 2003 2006 2000 2003 2006 2000 2003 2006 2000 2003 2006

PHILIPPINES 11,458 12,309 15,057 27.5 24.4 26.9 1.6 1.3 1.3 4,146,663 4,022,695 4,677,305 1.6 1.4 1.3

Region V 11,375 12,379 15,015 45.3 40.6 41.8 4.2 3.6 3.5 407,176 383,625 422,278 4.7 4.3 4.3

Albay 12,144 12,915 16,128 40.3 34.4 37.8 11.5 8.1 8.4 83,398 76,200 88,676 11.2 8.5 10.1

Region/Province

pPoverty Threshold (in

Pesos)Poverty Incidence Am ong Fam i l ies (%) Magni tude of Poor Fam il ies

Estim ates (%) Coeffic ient o f Varia tion Estim ates Coefficient o f Varia tion

POVERTY AS AN INITIAL CONDITION IS A MAJOR POVERTY AS AN INITIAL CONDITION IS A MAJOR OBSTACLE TO HEALTH OUTCOMESOBSTACLE TO HEALTH OUTCOMES

yCamarines Norte 11,505 12,727 14,854 52.7 46.1 38.4 10.9 14.4 18.8 50,670 44,874 39,421 11.8 14 22.6Camarines Sur 11,054 11,873 14,634 40.8 40.1 41.2 9.3 7.0 5.6 120,762 121,936 134,599 11.8 7.7 6.6Catanduanes* 11,587 11,815 13,654 43.9 31.8 37.3 10.9 10.3 22.1 18,541 13,604 16,999 10.4 29.3 33.3Masbate 11,019 12,504 14,248 61.3 55.9 51.0 5.8 5.7 6.5 83,660 81,804 80,512 5.9 7.4 8.0Sorsogon 11,146 12,452 15,687 41.4 33.7 43.5 7.3 10.3 5.4 50,146 45,207 62,071 7.6 14.5 5.6* Coefficient of Variation (CV) of 2006 poverty incidence is greater than 20%

•19

•Albay poverty incidence at 37.8%, while lowest in region, remains high

Average annual losses to infrastructure and agriculture in 10 most vulnerable provinces vs. their 2006 local calamity funds

•Source: World Bank

Net resource outflow to cities

•21

Objectives for Health, 2011

1. To decrease maternal mortality ratio from 59/100,000 to 50/100,000.

2. To decrease infant mortality rate from 10/1,000 to 8/1,000.

3. To decrease child mortality rate from 18/1,000 to 15/1,000.

4. Increase FIC coverage from 84% to 88%.

5. To increase CPR from 33% to 40%.

6. To increase voluntary blood donation to 1% of the provincial population.

7. To reduce soil-transmitted helminthiasis to below 50% among children.


8. To reduce prevalence of malnutrition from 19% to 17%.

9. To reduce TB mortality rate by 3%.

10. To sustain TB case detection at 90%.

11. To sustain TB cure rate at 85%.

12. To reduce the incidence of STI/HIV by 2% points annually.

13. To eliminate incidence of filaria to zero.


14. To increase multi drug administration for filariasis control by 2%.

15. To reduce rabies incidence from 5/million population to 2.5/million population.

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16. To sustain leprosy prevalence at less than 1/10,000 population.

17. To increase leprosy cure rate by 2%.

18. To reduce the mortality and morbidity of


y ylifestyle-related diseases by 2% annually.

19. To increase proportion of HH with access to safe drinking water from 94% to 95%.

20. To increase proportion of HH with sanitary toilets from 69% to 89%.

Total Health BudgetTotal Health Budget2007 2007 -- 20102010

120 000 000

140,000,000

160,000,000

180,000,000

135,673,326 134,566,903

161,373,128

24% of provincial budget

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

2007 2008 2009 2010

101,669,158

Source: PBO, Albay

Resources for Institutionalized MDG Resources for Institutionalized MDG OfficeOffice

• Program office: AMDGO– created by ordinance in 2009 with regular provincial budget

– Oversight to MDG performance and secretariat to MDG Supercom

– Management MDG projects

• Manages relocation programg p g

• Social assets programs esp livelihood like SEA-K, ETODA

• CRABS or coastal and marine resources management

• AIDS Council – HIV/AIDS advocacy

• Sources of Funds– Regular allocation from the annual provincial budget (IRA)

– Intermittent but steady flow of technical and logistical assistance from NG agencies, UNDP and other UN offices, INGOs, NGOs for capacity building and skills training

•2

Albay MDG Albay MDG SupercomSupercom

•2

Provincial Initiatives• 2011- P178m (exc PHIC) for health PS and

MOOE essentially for hospital care and public health

• Universal health coverage at P59m pa

• Acquisition of 57 ambulancesq

• 19 BeMoNCs

• Modernization of provincial hospitals: Ziga (80-bed) and Duran (60-bed)

• Modernization of BRTTH (300-bed)

• Merger of BRTTH, Ziga and Duran into a 500-bed capacity

InitiativesInitiativesUniversal Phil Health Coverage: 2007-2010

Number of Families Enrolled

180,000 158,000173,262

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

2007 2008 2009 2010

18,510

122,600

Source: PSWDO, Albay

6

33%

54%

•BRTTH: PHIC REIMBURSEMENT FOR 2010

13% HOSPITAL INCOME

MEDICINES

PROFESSIONAL FEEPHIC REIMBURSEMENTS

HOSPITAL INCOME 67,403,506.73

DRUGS AND MEDICINES 16,929,387.25

PROFESSIONAL FEES 42,339,658.00

TOTAL 126,672,551.98

BRTTH earns P127m from PHIC vs P59m by province

Ambulance DeploymentAmbulance Deployment

•2

•2

2

•6

•6 •2

•RHUs & BEmONC

•Hospitals

•Source: PHO, Albay

•2•1

•4

•3

•2

•1

•2

•4

•2

•3

•2

•1

•2•1

•2

•2

•1

•4

Medical Mobile AssetsHealth Facilities: 15 Health Facilities: 15 BEmONCSBEmONCS

•Hospitals

•BEmONC

•RHUs/CHOs

•Source: PHO, Albay

JBDMHJBDMH JBDMHJBDMH

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JBDMHJBDMH JBDMHJBDMH

ZIGA Memorial District HospitalZIGA Memorial District Hospital ZDMHZDMH

ZDMHZDMH ZDMHZDMH

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ZDMHZDMH ZDMHZDMH

ZDMHZDMH •2007 - Renovated under the B-CARE project

•BRTTH Main Building

•Salceda Wing / Philhealth/Surgery Ward •Out-Patient Department

•Emergency Room

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•Maintenance Building •Laundry

•Dorm •Isolation Ward

•Emergency Room •Trauma Unit

•Services Offered

•Philhealth Ward •Surgery Ward

•OB-Gyne Ward •Private Ward

•Pedia Ward •Medical Ward

•CT Scan•Delivery Room

•Dialysis •ECG/EEG

•Cath Lab •2D Echo

•Ultrasoud •X-Ray

•ICU•CCU

•NICU •PICU

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•Operating Room – Room 1 - 4 •Laboratory

•Electric Power Substation

Prov’l Gov’t ofAlbay, project ofGov. Joey Salceda

•Pharmacy

•Dietary •Pastoral

•Rehab CenterEstablishment of Regional Oncology Center (P400m)

•BRTTH and Beyond

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•3. Extension of PHIC ward

•4. Diagnostic Center

•5. ER and Trauma Unit

•6. Bicol Cancer Center•2. Communicable Disease Building

•1 . Waste and Infectious Treatment Plant

•8. Commercial Building

•7. Bicol Regional Blood Center

•Proposed Facilities

•1•23

•7•2•3

•4

•5•6

•8

Health Capital ExpendituresHealth Capital ExpendituresSource

Committed by Source (from

AOP)

Amount Received by the province

Received by the province (in kind)

Amount UtilizedNumber of Recipient

MunicipalitiesPLGU 134,566,903.00 134,566,903.00 134,566,903.00 18 M/C LGUs

M/C LGUs (15 MLGUs/ 3 CLGUs)

188,470,320.51 170,905,125.99 18 M/C LGUs

DOH-regular fund 24,372,850.33 24,372,850.33EPI vaccines, Vit. A, antihelminthics,

TB drugs, Iron24,372,850.33 18 M/C LGUs

DOH- special fund

>MNCHN 2,419,320.00 2,419,320.00 18 M/C LGUs> start-up 2,000,000.00 2,000,000.00 18 M/C LGUs> HEMS 9,100,000.00 9,100,000.00 18 M/C LGUs

> Health Facilities Dev't/RAT Plan

97,608,000.00 71,191,000.00 71,191,000.00 6 District Hospitals

> Health Systems Dev't

2,000,000.00 2,000,000.00 18 M/C LGUs

> RHU/BHS Facility Devt/Eqpt

7,350,000.00 5,900,000.00 8 M/C LGUs

Others:

> USAID 134,823,414.00Technical assistance

18,600,000.00 18 M/C LGUs

> AECID 43,000,000.00 24,000,000.00 24,000,000.00 9 M/C LGUs> capitation (for CSR + drugs)

18,473,296.71 5,000,000.00 18 M/C LGUs

> PCSO 7,984,000.00 drugs, medicines &

ambulances7,984,000.00 18 M/C LGUs

TOTAL 630,191,487.84 296,107,370.04 460,439,199.32

AMDGOAMDGO• Program office started as Ayuda Albay in 2007,

renamed as Albay Mabuhay Task Force to manage the cluster approach to Reming rehabilitation

• Reorganized in June 2009 as Albay Millenium Development Office or AMDGO to (a) monitor and oversight MDG progress (b) coordinate MDG g p g ( )programs within functional units and program offices of the provincial government and with NGAs, NGOs and INGOs and (c) manage social assets program of the province including SEA-K, E-TODA

• Staff complement of 15 personnel with a senior staff (rank Assistant Department Head)

• 2010 organic budget of P2m. for Listeningfor Listening

Strategies on Maternal Health Care 1. Formulation of the PIPH. (Province-wide

Investment Plan for Health) inc MNCHN (Maternal, Newborn and Child Health Care) Program

2. Advocacy Campaign: Birth Plan/FBD by Skilled Health WorkerHealth Worker

• Bench Conferences• Buntis Congress• Buntis Pageant• IPCC (Interpersonal Communication and Counseling)Training of Health Personnel and BHW’s on MNCHN

• Mothers’ Classes• Radio announcement/ plugging• Health Education Classes• Establishment of breastfeeding stations in private andgovernment institutions including evacuation centers

3. Maternal Deaths Review• Reviews maternal deaths• Give recommendation and feedback to LGUs withmaternal deaths

• Maternal death reporting

Strategies on Maternal Health Care

4. Facility based deliveries (FBD):• Barangay Health Stations• Lying-In Clinics• Birthing homes• Rural Health Units• Hospitals (public or private)

5. REB (Reaching Every Barangay)

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6. Rationalization planning and health facility

mapping• Upgrading of CEMONC facilities. (ComprehensiveEmergency Obstetric and Newborn Care)

• Construction of BEMONC facilities. (Basic EmergencyObstetric and Newborn Care)


)• Hiring of Staff Complement to fill up vacancies and/or augment personnel

7. Organization of Women’s Health Teams in everybarangay:

• Pregnancy tracking & birth planning• Reporting of maternal deaths• Referral of pregnant women to deliver at health facility• Stewardship to the family of the pregnant mother

8. Capacity building• NBS training (Newborn Screening)• ENC training (Essential Newborn Care)• LSS training (Life-Saving Skills)• BEMONC training (Basic Emergency Obstetric and

N b C )


Newborn Care)• WHT training (Women’s Health Team)• CMMNC training (Community-Managed Maternal and

Newborn Care)

9. Sustain Universal Phil HealthEnrollment/Coverage

10. MCP Accreditation of LGU’s birthing facilities

(Maternity Care Package)

11. Enact ordinances on FBD and User’s Fee


12. Sustain MBDs (Mass Blood Donation)in all LGUs.

Strategies on Family Planning

1. Establish a system of monitoring FP users with

private providers and other stakeholders• inventory of FP private providers & other stakeholdersin the municipality/ city

• conduct one day orientation to identified FP privateproviders & other stakeholdersp

2. Validation of current FP users (data cleaning)

3. Review/assess CDLMIS of LGUs (ContraceptiveDistribution, Logistics, Management InformationSystem)


4. Planning workshop to draft plan to

operationalize modified CDLMIS

5. Capacity BuildingFP Competency based training• FP-Competency-based training

• NSV Training ( non scalpel vasectomy ) BTL Training ( bilateral tubal ligation)

• Training on FP Counseling for health personnel• Training of health personnel on IPCC


6. Provision of FP Commodities• Targeting, costing and forecasting FP commodities

requirements based on validated current users• Procurement and Provision of 50% of FP commodities

requirements (Pills, DMPA, Condom, NFP to LGUs• Provision of medicines and supplies for BTL & NSV toProvision of medicines and supplies for BTL & NSV to

District Hospitals providing surgical sterilization

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7. Intensify and Improve FP Promotion andEducation Integration of FP in EPI (ExpandedProgram on Immunization)

• Conduct regular RPM ( Responsible ParentingMovement)C d t l AHYD (Ad l t H lth d Y th)• Conduct regular AHYD (Adolescent Health and Youth)Development) classes in high schools

• Conduct regular PMC (Pre-Marital Counseling)• Conduct FP counseling to new acceptors and follow-up by BHWs of FP current users & defaulters

• Conduct ICV (Informed Choice and Volunteerism)• Conduct Men’s Congress (Usapang Macho)


8. Enactment of CSR+ Ordinance (Commodities

Self Reliance)• Advocacy with the LCEs/SBs for CSR+ ordinance• One day orientation with LCEs, MHOs, LFC re:

formulation, CSR implementation and drafting ofCSR+ ordinanceCSR+ ordinance

• Training of SB/SP Committee on Health on Evidence-based legislation

• Present proposal to the PHB and seek SP Committeeon Health Chair’s sponsorship

• Strengthen 2-way referral system for FP (BTL-NSV-IUD) Provision of referral form


9. Monitoring and Supervision• Regular visits to 18 LGUs monthly • Revisit CSR Plans• Collection, recording and reporting of FP activities

through FHSIS (Field Health Services InformationSystem)System)

Strategies on Nutrition Program

1. Operation Timbang (OPT)• Identification of malnourished children thru massweighing of 0-71 mos. old children

2. Micronutrient supplementation• Provision of Vitamin A capsules & iron• Provision of Vitamin A capsules & iron supplementation to:

a. infantsb. preschool childrenc. pregnant womend. lactating womene. sick children


3. Food Fortification• Monitoring of fortified food products in the markets, sari-sari stores, groceries & household utilization of iodized salts

4 Local Level Nutrition Program Implementation4. Local Level Nutrition Program Implementation•Local Plan of Action for Nutrition at the municipal and barangay level

5. Capacity building• IYCF Infant and Young Child Feeding• CGS (Child Growth Standard)

6. Accelerated Hunger Mitigation Program• Milk feeding (tie up with NDA) • Supplemental feeding• Distribution of growth monitoring charts• Pabasa sa Nutrisyon Classes• Promotion of child rearing practices during GP


Promotion of child rearing practices during GP• Distribution of IEC materials• Feeding during disasters• Breastfeeding initiatives

7. Monitoring and supervision

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Strategic Imperatives

Policies

Institutions

Public-Private Partnerships

Resources

Champion

Other Provincial Initiatives

InitiativesA. Beneficiary-led Procurement :

Universal Phil Health Coverage: 2007-2010

Universal Anti-Rabies Immunization

InitiativesB. Safe Hospitals:

Upgrading of structures and equipment of Provincial Hospital System

Modernization of the Bicol Regional Teaching Modernization of the Bicol Regional Teaching and Training Hospital [BRTTH]

Rationalization Plan & Health Facility Mapping

Establishment of BEMONC/CEMONC facilities

Merging of district and regional hospitals

InitiativesC. Partnership with NGOs:

Health Program Management (USAID,

PTSI, Intervida, MIDAS, WHSMP2, CSCDI)

Health Promotion (PRRM, PBSP)

Discounted Medicines (Pfizer, RNMD)

Health Infrastructure (AECID, PODER, WHSMP2)

InitiativesD. Partnerships with LGUs:

Inter-local Health Zones [ILHZ]

Commodity Self-Reliance Strategy [CSR]

Botika ng Barangays [BnBs]

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InitiativesE. Disaster Risk Management - Health:

Preemptive Health Care – Medical Missions

targeted at APSEMO identified vulnerable areas

Albay Health Emergency Management [AHEM]Albay Health Emergency Management [AHEM]

• Emergency Paramedic Training Unit [EPTU] – in cooperation with the Bicol University [BU], BRTTH &n DOH

• Operation Centers [OPCEN] in all three districts

• Evacuation Camp Management

InitiativesAmbulance Project: Provision of

ambulances (57) to:

Provincial Hospital System

& C Off Rural Health Units & City Health Offices

Basic Emergency Obstetrical and Newborn Care Facilities

Operation Centers

Geographically-Isolated and

Disadvantaged Areas [GIDA]

Strategic Priorities: Public Health

Strategic Priorities Funding Gaps

Health Care Waste Management under BOT

40 M

Establishment of another 9 BEMONC facilities

45 M

Renovation of 30 BHS 15 M

Establishment of PhilHealth Desks 2 M

Capacity Building 10 M

Provision of Sanitary Toilet 40 M

Strengthening of Public Health Program Management

30 M

TOTAL 182 M

Strategic Priorities: Hospital

Strategic Priorities Funding Gaps

Merging of ZMDH and JBDMDH to BRTTH

200 M

Upgrading of PDMDH and PDH into a secondary (inc. safe

50 M

hospitals)

Conversion of VMH into a Birthing Home

5 M

Modernization of BRTTH: Oncology Center under BOT

240 M

TOTAL 495 M

GRAND TOTAL 677 M

MEET Albay Medical

BRTTH modernization

Educational

Bicol University modernization Bicol University modernization

Eco-cultural Tourism

Magayon Festival

Infrastructure Development

Transportation facilities by National Government

Tourism facilities by private sector

MEET AlbayEDUCATIONAL MEDICAL ECO-CULTURAL TOURISM

VISION Bicol University as first class higher education institution

Bicol Regional Training and Teaching Hospital as wellness Center

Albay as prime destination for culture and nature

Albay as hub to tourist destinations of Bicol

SUPPLY SIDE

Bicol University modernization

Bicol University School of M di i

Province to gatekeep thru facilities upgrading

Bi l U i it

Magayon Festival

Albay History Project

Mayon Resort House

Southern Luzon International Airport

Pantao PortMedicine Bicol University

Medical CenterLigñon Hills

Mayon Trek

Wildlife Park

Albay Donsol Access Roads

Andaya Highway

DEMAND SIDE

AHECS

Seek more scholarship funds for Albay studies

Universal PhilHealth

Responsible Agencies

Bicol University

EQUAL

DOH/BRTTH

PHO

DOT/NCCA

PTCAO/ACAC

DOTC, PPA

PPDO, PEO

AHECS – Albay Higher Education Contribution Scheme EQUAL – Education Quality for Albayanos

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Health Sector Reform Framework

Service Delivery

Governance

Regulation

Health Care Financing

Health for AllHealth for All

Goal for Health Sector

Capacity Building for:B tt h lth t Better health outcomes More responsive health system Equitable health care financing

Opportunity-seeking for: Medical tourism

for Listeningfor Listening

Documents

Gov Salceda cbms-feb 08 2011anciensite.pep-net.org/fileadmin/medias/pdf/CBMS_country_proj... · Proportion of facility-based deliveries 88 70 80 90 100 ... – created by ordinance