VOICES from the REGION.pptx

7/28/2019 VOICES from the REGION.pptx

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Improving Operations for Comprehensive Public Health Actions

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

[email protected]


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Convening a PLANNING

GROUP

Stating the WHAT and WHY

Dreams for community

What Success would look like

How things ought to be

Health Impact Assessment

and Sectoral Consultations

Identify

STRATEGIES

Enhancing benchmarks

and baseline markers

Levels to be targeted

Universality of approach

Human Rights-based Approach

Targets of change; agents of

change; community sectors

Working on BEHAVIORAL

CHANGE

Targeted information and skills

training

Modifying barriers, exposures and

opportunities

Changing the consequences

Enhancing support systems andservices

Modifying policies and broader

systems

Identifying ACTION PLANS

UTILIZING THE STRATEGIC

PLAN


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How does the Evaluation/HIA Fit to the Strategic

Plan

Health ImpactAssessment

Nature and extent ofpotential impacts

How it will effectpotentially affectedcommunities

Consultation withprogram implementers

and recipients

Strategic Plan Equity

considerations

Range and depthof approaches

Utility and validityof healthprograms

Internal and External

Benchmarks Aquino Health Agenda

Millennium DevelopmentGoals

LGU and CHD Scorecards

CHD IV

BROAD MAP


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Key Informant Information and Hearing the End of the Value Chain



[email protected]


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Objectives

To identify behaviors, needs and opinion of various

stakeholders affected by CHD programs

To determine appropriate levels of decision making needed

for future programs and activities

To characterize the need or set of needs addressed by the

program and to provide an explicit logic model why

program activities are believed to result in expected

changes

To clearly define and articulate implementation status inthe fundamental principles that guide the focus and

structures of public health interventions


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METHODOLOGY

RECIPIENTS/

Target Clients

ProgramImplement

ers

OtherStakeholde

rs

INTEGR

ALRISKS

APPLICATI

ONS

DRIVERS


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Applications Infrastructure and Construction activity

Support and Enabling Services

Policy Contestability

Delivery of government services to the public

Provision of grants and other funding arrangements


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Infrastructure and Construction Activity Varies from a wide range of organizational paradigms

Evolved from sub-contracting work and managing projects

using public/private partnerships for funding and investing

more infrastructure projects such as roads as well as

social infrastructure including schools and hospitals


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Support and Enabling services

Clearcommercial

analogues andsubstitution of

provisions

Cost efficiencygains core

functions


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Policy Contestability Governments have increasingly sought policy advice and

external quarters input and public service

Recourse to think-tanks, research institutes, consultancy

companies, private sector lobbyists and communityadvocates


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Delivery of Government Services to Public A mix of service delivery methods evolved using direct

service provision as well as the funding of other bodies to

provide services

Subsidies to ensure availability of services of a reasonablestandard and applying licensing and regulatory

arrangements designed to influence market for particular

services (demand)

Creation of a new market for the delivery of services

(employment)


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Provision of grants and other funding arrangements a combination of wide arrangements has emerged across

the spectrum of government activity involving payment to

individuals, businesses, non-profit organizations,

institutions and other community-based groups for a rangeof a range of policy outcomes


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DRIVERS

Diverse and arise from institutional, economic and social history

Are largely historicalthe private sector or the charity sector were

active in certain areas prior to government involvement

Have emerged as government grew in which the market could

deliver many services otherwise provided by governments such as

ICT, defense and telecommunications

Come from an experience of government-delivered services which

suggests that the public service has not focused effectively on

services that needed to be tailored to an individual requirement

(advice and training)

Were responses to perceived public service inflexibilities Contain elements of cost-saving or budget efficiencies, such as

market testing government corporate services of funding imperatives


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DRIVERS

Diverse and arise from institutional, economic and social history

Increasing interest in and particular views about, competition and

micro-economic reform, stressing that public services would be

provided more efficiently and effectively, with greater client

satisfaction in a more market-oriented environment which provided

greater flexibility for management decision-making

Simply logistical, like using existing service providers to support

government service delivery in regional areas where government

may not be strongly represented

Policy of social inclusion has increased emphasis on the role and

benefits of a strong community sector and government strategies tosupport that role


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Focusing on the Large Scope Needs through Root/Causal

Assessment



[email protected]


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Respondents

RECIPIENTS/

Target Clients

ProgramImplement

ers

OtherStakeholde

rs

86

RESPONDENTS

through questionnaire

108 PROGRAM

IMPLEMENTERSFocus Group

Discussions/Interviews

21 Municipal Health Officers

24 Public Health Nurses

2 Public Health Managers

18 Staff from Provincial Health

Office

18 Staff from Provincial Health

Team Office

25 Staff from CHD IVB

23 STAKEHOLDERSInterviews (i.e. email)

5 from National Government

Agencies

18 from Non-government

Organizations

217RESPONDENT

S 1128/1300 (88%)


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Varied Nature of Devolved Government

(Additional Drivers and Applications)

Size and Complexity at the simple end of the spectrum

are arrangements varying from a single provider in a one-

to-one relationship to multiple providers

Level of network operations and integrations someare characterized by vertical relationships between LGU

and CHD

How the relationship between agency and provider is

governed can be via contract, grants or subsidies and

related requirements such as service standards and otherregulation with significant variation evident in the degree of

control exercised by government through these

mechanisms


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Service Contract governments use contractual

arrangements as organizational tools (including mental

health and welfare)

Supply chain formed to deliver a complex product

to government

Ad hoc activation of a network in response to a

specific situation, often an emergency

Channel Partnership non-government

organizations carry out transactions on behalf ofgovernment agencies

Civic switchboards facilitation by government of

connections between diverse organizations to

complement each other in delivering a public outcome

and producing new net value

Varied Nature of Devolved Government(Additional Drivers and Applications)


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Empowerment

FinancialOperations

Information

INTERNAL

EXTERN

AL


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Internal/External Center for Health Development IVB (Agency)



[email protected]


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1. Program Evaluation

Not practiced consistently across program areas norsufficiently well-integrated into the day-to-day management

of most programs

Necessary for fulfilling CHDs operating principles for

guiding public health activities Using science as a basis for decision-making

Expanding the quest for social equity through public health action

Performing effectively as a service (technical) agency

Making efforts outcome-oriented

Being accountable

Underscore the need for programs to develop clear plans,

inclusive partnerships, and feedback systems that allow

learning and ongoing improvement to occur


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Recommendations

Evaluation should be tied to routine program operationswhen the emphasis is on PRACTICAL, ONGOING

evaluation that involve all levels of the value chain

inclusion of evaluation in PES

Assign values to program activitiesmerit (quality), worth(cost-effectiveness) and significance (importance) at

the beginning of a program and revisit it through

implementation

In what context does the program exist?

What aspects shall be considered in program performance?

What standards shall be reached for the program to be

considered successful?

What evidence will be used to indicate how the program has

performed?

How will the observations be used to improve public health


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Recommendations

Performance management arrangements to supportdelivery of outcomes with and through providers are ought

to be built into the upfront design of approaches

Performance reporting requirements are as streamlined as

possible, focusing on data that is required for effectivemanagement and operation of any initiative and ensuring

that timing, content and mechanisms are not

counterproductive but user-friendly

Performance measures and reporting systems are

reviewed regularly and adjusted where required

Skills development in performance management is a

recognized area for project design and investment


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2. Policy Guidelines Implementation

Interpretation of guidelines from different value chainscompromises the validity of operations (localization of

national policies)

Transfer of guidelines from Regional office to DOH Reps are

not properly endorsed resulting to multiple voices in the

periphery

Implementation of guidelines are not in full cycle

programming, planning are okay but lacks monitoring

magaling lang sa una, matapos ang ilang linggo wala na

Policy Notes from Central Office are too rigid that are,most of the times, not applicable to Regional

Implementation


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Recommendations

CHD should find value in KM as a toolin systems analysis and in knowledge

sharing

DifferentiatedConte

xt

Independence

Understanding

Integrated

Data

Informati

on

Knowled

ge

Wisdom

FLO

W

Mundane

Interrelatedness


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Recommendations

Policy briefs can be an option for simplifying the guidelines

Leading a community dialogue - expand the base of

constituencies, reach common ground, sustain ongoing

community discussion, building the capacity to act on

ideas, focus organizational investment and inclusivelymonitor the initiatives

Establish and institutionalize feedback mechanisms along

communication lines


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3. Capability Requirements

Skills, systems and organizational culture is not inline with

the implementation mode adopted

SKILLS should center on public service working as an

enabler or facilitator, rather than a doer; having the skills to

deliver with and through others Interpersonal communication has been a perennial challenge

SYSTEMS needs to be rehashed by an in-depth and

evidence-based understanding of how systems work,

including trial and adjustment

ORGANIZATIONAL CULTURE - supportive organizationalsystems must be in place

Administrative - We hit the ground running!


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Recommendations

Zonal/TEAM Approach to public health programs andactivities

Developing effective relationships between CHD and

sectors in building social inclusion and ensuring of

consistency of treatment across all

Devising standards to guide accountability between CHD

and the sector

Recognizing the social and economic value of the sector,

as well as its independence (welfare of health workers

benefits and support)

Providing a vehicle for consulting about, and addressing,

social inclusion priorities

Creating opportunities to hear the views of disadvantaged

and marginalized residents of MIMAROPA

Strengthening sector capacity to deliver efficient andeffective services and promote innovative policy and


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Recommendations

Organizational leadership that provides strong strategicdirections on building public service capability and

demand-driven health services

ORGANIZATIONAL CULTURE forging connections in an

increasingly fluid environment of public sector delivery (inter-

agency and inter-jurisdictional collaborations) Complex network applications requiring significant investment of

resources

High-level management attention and stakeholder engagement

VOLUNTEER MANAGEMENT

Third Sector Parties Barangay Health Workers, SK Federation,

Community Organizers and Donors

STAKEHOLDER CONGRESS

Government, Prime Contractor, Third Party as Integrators

Develop baseline behavior patterns and find apt indicators to

measure it


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4. Generating Public Value

Prioritization of local health programs by LCEs are not

inline with Regional goals and directions due to public

value loss

further worsened due to programs without financial

counterparts

programs implemented is less flexible or not flexible at all to

local peculiarities

there is no joint accountability

there is no avenue of how can services of quality be

delivered, service continuity assured and access to public

scrutiny and redress when things go wrong


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Recommendations

A differentiated response to clients/citizens is needed;flexibility and innovation are favored more than

control;

Using PRECEDE/PROCEED participatory model

Phase 1: Social Diagnosis

Phase 2: Epidemiological Diagnosis

Phase 3: Behavioral and Environmental Diagnosis

Phase 4: Educational and Organizational Diagnosis

Phase 5: Administrative and Policy Diagnosis

Phase 6: Implementation Phase 7: Process Evaluation

Phase 8: Impact Evaluation

Phase 9: Outcome Evaluation


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Recommendations

Fostering strategic conversations on the practical implications foraccountability, particularly in initiatives involving the devolution ofdecision-making power and based on community collaboration

Fit for Purpose Accountability

Responsibilities and accountabilities of players are identified

Cost-sharing (degree of specificity and flexibility attached to health

services) Shared commitments and parameters and a strong sense of common

goals

Strong Local Governance arrangements and capability

Safeguarding citizen satisfaction and trust

Testing of citizen satisfaction and experience and the active use offeedback as a basis for service improvement, forms part of systemsdesign and ongoing implementation

Trialling models of coordination and joined up government from theCitizen Point of View

Fostering research and evaluation in order to know what worksincluding into both people and places policies


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Recommendations

Avenues for complaint and redress and information for serviceusers

Effective citizen complaint and redress are vital in building public

confidence

Quality of feedback mechanisms drives continues improvement in

health service delivery

Openness and transparency through public dissemination of

information on provider performance can play an important role in

strengthening public trust

Putting Citizens at the Center of public health programs

Developing services based on bureaucratic needs


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5. Policy/Delivery Splits

Implementation is inconsistent and not aligned with agency

objectives

Less mobility and interchange between sectors/division

Less avenues for interaction with network members

Minimal analysis on user experience information (client

surveys, analysis of complaints data)


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Recommendations

Involve an inherent revisiting of the nature and extent of

the purchase/provider split

Create more initiatives where decision-making power is shared


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6. Third Sector Capacity

Less involvement of critical agency partners

Establish documented partnerships among existing

engagements


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Recommendations

Volunteer Management can lead work across government,

enable the sector to campaign for change, deliver public

services, promote social enterprise and strengthen

communities

Drive cross-government action to improve partnershipworking and ensure better terms of engagement between the

third sector and the government

Invest in programs designed to develop and promote the

sector

Forge a policy and regulatory environment favorable to it

Develop a strong evidence base and analysis function for

third sector activities


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[email protected]


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1. Overly Onerous Reporting Requirements

Develops red tape and provider inefficiency

Unnecessary administrative burdens being imposed

on service providers, recipients and communities

arising from duplication between organizations

An overly rigid compliance paradigm with unthinkingadoption and application of standard procedures and

requirements stifling innovation and a collaborative

approach


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Recommendations

Require supportive organizational systems such as ICTplatforms to determine which systems can be systematized

through networks

This can involve multi-tierred arrangements comprising information

on providers performance; procurement system; budget requests

and financial plans; performance management; equipment

utilization, systems support, e-modules for programs, etc.

Optimization of newly procured information technology

equipment and take advantage of the data center to be

established in the region

CHD intranet where all office documents are stored, modified and

utilized


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2. ICT Skills Shortage and Minimal Service

Utilization

Lack of personnel to handle the many information

systems that DOH is implementing

Lack of collaborative approaches to systems

development


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Recommendations Develop a comprehensive database of monitoring systems

of programs, if not, an online COP (Community of Practice)

website for all monitoring systems

Continuous education on ICT technicalities possible

partnerships with educational institutions (PPPs) Partnerships with Third Sector organizations (NGOs) in

resources such as websites, making information readily

available

High-level strategic, project management and operational

ICT skills is critical to providers with the move andestablishing service standards


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1. Health Workers Welfare

Dismay among health workers in the LGUs on the

inconsistent implementation of the Salary

Standardization Law and magna carta benefits

ang dali lang ng implementation sa mga taga-region,

pero sa amin, pahirapan

front liners kami pero pag naghablahan na, wala na


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Recommendations

Enhance lobbying efforts through a TEAM

approach to Local Chief Executive discussing the

Magna Carta Benefits and the need to implement

the standards for SSL

A portion of the Inter-agency meetings (including

the local government unit) shall cover

orientation/implementation on the Magna Carta

Benefits


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2. Indirect authority/relationship over MHOs and

PHO

Resulted from public value loss of programs

Ang bilis humingi ng reportswho cares, hindi naman

namin kayo boss

One of the dimensions of a devolved agency in terms

of implementation

Ineffective feedback loops between program

development and delivery


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Recommendations

Fostering strategic conversations on the practical implications

for accountability, particularly in initiatives involving the

devolution of decision-making power and based on community

collaboration

Fit for Purpose Accountability Strong Local Governance arrangements and capability

Providing guidance on managing accountability in different

implementation approaches regarding lessons learnt and

pitfalls to avoid

Ensuring that program development is informed by on-the-ground intelligence and experience, including by means of

mobility and interchange, avenues for interaction with

network members, collection of provider and user views and

evaluations


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[email protected]


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Recommendations

Comprehensive public finance management that

is key/relevant for program implementers and

health personnel

Integration of internal control perdivision/section/unit can be helpful in monitoring

finances


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Logic Model

Surveillance

Research

Developmen

t

Public

Capacity

Enhanceme

nt

Communication

Partnership

Leadership

Change Physical

Environments

Change Social

Environments

PREVE

NT AND

CONTR

OL

PROBL

EM


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Past experience show that health

service is rarely a one-off task. It is best

being understood not as a linearprocess leading from policy ideas

through implementation to change on

ground but rather as a circular process

involving continuous learning,adaptation and improvement, with policy

changing in response to

implementations as well as vice versa.

Documents

VOICES from the REGION.pptx