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Suggested citation: Domingo, Albert Francis E. "Medical Governance, Health Policy, and Health Sector Reform in the Philippines.” De La Salle Health Sciences Institute (DLSHSI). DLSHSI College of Medicine, Dasmarinas, Cavite. 27 Jun. 2014. Lecture.
Citation preview
Medical Governance,Health Policy,
and Health Sector Reformin the Philippines
Updated 24 June 2014
Module IIntroduction: Governance, Policy, Reform
Structured approaches to health developmentReconciling the language games
INTRODUCTION: GOVERNANCE, POLICY, REFORM
What is health care?
• In caring for patients, the good physician dispenses time, sympathy, and understanding to his patients
• The physician also scientifically applies principles of diagnosis and treatment
• Medical care has become a mosaic of many health and non-health professionals executing the necessary skills
Reference: Larson EB, JP Willems, and WC Liles. (2001). Manual of Admitting Orders and Therapeutics. 4th ed. Philadelphia: WB Saunders
Healthcare Governance:Scope, Scale, and Stakeholders
Point of Care
Service Delivery
Networks
National and Local
Governments
Private Sector Dynamics
International/Global Health
Clinics as part of Health Systems
• Clinicians have the responsibility to monitor and manage their performance as part of the general management of healthcare organizations.
• Decision-making for populations is qualitatively different to that in clinical practice, even though the evidence used for both would be the same.
• Clinicians should worry about the quality of care they are performing; let the health system managers worry about resource management.
Reference: Gray, 2004 (p. 357-358), with modification
Personal Care vs. Public Health
• Improvement of health through the organized efforts of society (not individuals), through social interventions. Examples:– Disease screening programs– Immunization programs– Environmental protection
Reference: Gray, 2004 (p. 293)
The Epistemology of Public Health
Evidence-based
Epidemiology
Statistics
Aesthetic
Supernatural
ScriptureReference: Gray, 2004 (p. 307-318)
Public Health = Med.GovClinical Medicine Public Health Science / Expertise Needed
Anatomy Organization Organizational Design
Physiology Organizational DynamicsSocial Habits, Rules, and Law
Management and Administration
Biochemistry Resource FlowsIncentives and Restraints
Budgets and FinancingLogistics
Pathology Monitoring and Evaluation Statistics, Econometrics
Pharmacology Evidence-based Public HealthInnovation
Critical Appraisal and Application
“Pharmacology” of Public Health
• DYNAMICS and the mechanism of action:– Will an intervention reduce the risk?
• KINETICS and the response of the system:– Will the intervention for the main concern
increase other risks? (i.e., adverse effects)• THERAPEUTICS and delivery:
– Is it operationally possible to introduce the intervention?
Reference: Gray, 2004 (p. 296), with modification
Public Health Practice
The strategic, organized, and interdisciplinary application
of knowledge, skills, and competencies necessary
to perform essential public health services and other activities
to improve the population’s health.
Reference: Association of (US) Schools of Public Health, 1999
Ethics of Prioritization:The Individual or Society?
• It is important to recognize that at the end of each decision on a health policy, there is an individual.
• This is an unpleasant and difficult fact to accept, but those who make decisions about groups and populations must remain continually aware of it.
Reference: Gray, 2004 (p. 305)
Using Economics to Set Priorities
• Economic approach is to set priorities based on costs and benefits of health services: to do more of some things, we have to take resources from elsewhere
• Economists should also consider practical and ethical challenges that managers and doctors face in making rational priority setting decisions
• Need to balance clinical autonomy with financial responsibility
• Use national guidance, regional and local policy, and the community’s inputs; process should be transparent and accountable
Reference: Peacock, 2006
Demystifying and De-medicalizing
• The allocation of resources must be explicit• Decision-making at all levels must be open• Medicine must be de-mystified and health de-
medicalized, for professionals, patients, the general public and politicians alike
• Public health / health policy is thus multi-disciplinary, and multi-stakeholder
Reference: Gray, 2004 (pp. 317-318), modified
0 10025 x 1,000 km 75
Parameter 25 75 100
Life Event Manufacture to Prime
Middle Age Resale / Trade-in / Scrap
Care Provider “Casa” “Talyer” / Self-repair ?
Dx, Tx, Rx Preventive Maintenance
(e.g., Oil Changes)
Brake Pad Replacements, Recalibrations
Overhauls
Costs of Care + +++ +++++
Financing Co-pay Co-pay, Insurance Co-pay, Insurance
Catastrophe MV “Crash” (Damage)
Regulation LTO, LTFRDB, MMDA, etc.
0 10025 x 1 year 75
Parameter 25 75 100
Life Event Birth to Early Adulthood
Middle to Old Age (Very) Old Age
Care Provider Clinics(OB, Pedia, Surg)
Clinics / Hospitals(IM, Surg)
Hospitals(IM, Surg, Patho)
Dx, Tx, Rx Outpatient > Inpatient(Vaccines, Vitamins, etc)
Outpatient = Inpatient(“Maintenance” Meds, etc)
Outpatient << Inpatient(ACLS, Critical Care, etc)
Costs of Care + +++ +++++
Financing OOP vs. Insurance OOP vs. Insurance OOP vs. Insurance
Catastrophe MV “Crash” (Trauma)
Regulation PRC – Board of Medicine, DOH (incl. FDA), PHIC, etc.
RECONCILING THE LANGUAGE GAMES
Declaration of Alma Ata (USSR, 1978)
• Health is a fundamental human right
• Inequality in health status is unacceptable
• Economic and social development (“New International Economic Order”) is needed to attain health for all
• Governments are responsible for the health of their people
• “Primary health care” at the level of communities is key
• Policies of independence, peace, détente and disarmament will release additional resources for development, including primary health care
Reference: http://www.who.int/publications/almaata_declaration_en.pdf
Philippine Constitution (1987)
• The State shall protect and promote the right to health of the people and instill health consciousness among them. (Art II, Sec 15)
• The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. There shall be priority for the needs of the under-privileged, sick, elderly, disabled, women, and children. The State shall endeavor to provide free medical care to paupers. (Art XIII, Sec 11)
Reference: http://lawphil.net/consti/cons1987.html
Philippine Constitution (1987)
• The State shall establish and maintain an effective food and drug regulatory system and undertake appropriate health, manpower development, and research, responsive to the country's health needs and problems. (Art XIII, Sec 12)
Reference: http://lawphil.net/consti/cons1987.html
PNoy’s Social Contract: a promise of increased coverage of social health insurance, and access to health through improved health infrastructure
UN Millennium Declaration (2000)
• Reduce maternal mortality by three quarters, and under-five child mortality by two-thirds, of their current rates (MDGs 4, 5)
• Halt and begin to reverse the spread of HIV/AIDS, the scourge of malaria and other major diseases that afflict humanity (MDG 6)
Reference: http://lawphil.net/consti/cons1987.html
From MDGs to SDGs• Sustainable Development Goals (SDGs):
beyond 2015; still being crafted by the UN
Sustainable Development
Soci
al
Envi
ronm
enta
l
Econ
omic
Reference: South Centre, 2013
Module IIEvidence-based healthcare and the policy cycle
Translating mandated policiesinto budgets for execution
EVIDENCE-BASED HEALTHCARE AND THE POLICY CYCLE
Quality of Care and Health Systems
• In any country, one of the factors affecting the health and well-being of individuals and populations is the quality of care provided within the health service.
• In turn, the performance of any health system (including provider quality) is determined by the way in which it is designed, managed, and financed.
Reference: Gray, 2004 (p. 288), modified
Factors in Health Policy Change
OLD POLICY
NEW POLICY
Ideologicalinspirations
Change in circumstances
Evidence
Common sense
From researchFrom experience
Reference: Gray, 2004 (Fig 7.8, p. 291; p. 292)
NOTE: Policy makers operate on a timescale that does not generally admit of delays that research will take.
Using Evidence to Craft Health Policy
• Resource reallocation among disease management systems
• Resource reallocation within a single disease management system
• Managing innovation• Controlling increases in healthcare costs
without affecting the health of the population
Reference: Gray, 2004 (p. 269)
Evidence vs. Eminence
• “Experts” commit two sins that retard the advance of science and harm the young:– Adding prestige to opinions gives them greater
persuasive power than their inherent science– Reviewers tend to accept or reject new evidence
and ideas not based on science, but on their similarity to publicly-declared positions by experts
Reference: Sackett, 2000
The Roles of the Scientist• Ask (and seek to answer) the right questions• Be clear about the evidence• Show the balance of good to harm of an intervention
for the population
Reference: Gray, 2004 (p. 322; 328), with modification
The Roles of the Policymaker
• Clarify the relevant societal values• Make appropriate decisions using those values
(in relation to the evidence)
The Policy Cycle
Agenda Setting
Policy Formulation
AdoptionImplementation
Evaluation
STRUCTURED APPROACHES TO PHL HEALTH DEVELOPMENT
History of Philippine Health Reform
• 1960s: Medicare• 1970s: Population Policy• 1980s: Generics Act of 1988• 1990s:
– Local Government Code of 1991– National Health Insurance Act of 1995
• 2000s: HSRA, F1, Cheaper Meds, FDA• 2010s: KP, Sin Tax, RH Law, NHIA amendment
A Structured Approach:The Results Frame
• Critical Assumptions• Sound Development Hypotheses
Reference: USAID, 2000
Program Inputs/Interven
tions
Intermediate Results
Development Objective
Agency Objective
The Health Value Chain Approach:Translating Policies into Budgets and Resources for Execution
Policy Budget SpendingPlan
Interventions
SecuringSupply
GeneratingDemand
ImprovedHealth
Use of Goodsand Services
Information and Feedback
Reference: HPDP, 2014
The Health Value Chain Approach:Translating Policies into Budgets and Resources for Execution
Policy Budget SpendingPlan
Interventions
SecuringSupply
GeneratingDemand
ImprovedHealth
Use of Goodsand Services
Information and Feedback
Reference: HPDP, 2014
Three Fundamental Goals
• Improve the health of the population served;• Respond to people’s expectations;• Provide financial protection against the costs
of ill-health
*These are irrespective of the level of resources available and the organization of the health system
Reference: Gray, 2004 (p. 289)
(Berman, 2012)
Epidemiological Transition
1954
'55
'56
'57
'58
'59
'60
'61
'62
'63
'64
'65
'66
'67
'68
'69
'70
'71
'72
'73
'74
'75
'76
'77
'78
'79
'80
'81
'82
'83
'84
'85
'86
'87
'88
'89
'90
'91
'92
'93
'94
'95
'96
'97
'98
'99
'00
'01
'02
'03
'04
'05
'06
'07
2008
0
100
200
300
400
500
600
0
10
20
30
40
50
60
70
80
90
100
110
Communicable Diseases Malignant Neoplasm Diseases of the Heart
Year
De
ath
s p
er
10
0,0
00
po
pu
latio
n
(co
mm
un
ica
ble
dis
ea
ses)
De
ath
s pe
r 10
0,0
00
po
pu
latio
n
(no
n-co
mm
un
icab
le d
isea
ses)
Source: Philippine Health Statistics, various years
Families (specially the poor) have limited access to prenatal care, safe delivery, immunization, and family planning
Families (specially the poor) have not used modern clinic or hospital services due to lack of capital investments in facility upgrading
Maternal Mortality Ratio
1993 NDS 1998 NDHS 2006 FPS 2011 FHS0
50
100
150
200
250
300
Num
ber o
f dea
ths
per 1
00,0
00 li
ve b
irths
Data Source: FHS 2011 (NSO, DOH, USAID)
260
182
224
120
196
128
MDG Target: 52
Improved Health Outcomes and
Minimal Financial Risk
PhilHealth Coverage
Access to Professional Healthcare
Use of Quality Services
Payment of PhilHealth
Claims
Value of PhilHealth Benefits
Reduction of Exposure to Health Risks
2
35
6
1
4
The Continuum of Care
Health Risk exposure Risk contact
Latent disease/inju
ry
Early disease/
injury
Disease progression
Advanced disease/injury
Chronic disease
Impairmentor Death
Primary Prevention: Reduce risk exposure
Secondary Prevention:
Detection and intervene early
Tertiary Prevention:Reduce progress or
complications of established disease
Policy and Standards Developm
ent
UHC Interventions
48
Start with the Poor and Vulnerable
Q1 Poorest Q2 Poor Q3 Middle Income Q4 Rich Q5 Richest
39 M poor individuals 59 M non-poor individuals
Note: Population counts projected for FY 2013 (except for DSWD numbers); rounded off to the nearest million.
• Poverty incidence by NEDA/NSO is a statistical estimate without actual names or faces of poor individuals.
• DSWD’s NHTS-PR and 4Ps/CCT, while with identification and location data, may not have enlisted all who are genuinely poor and vulnerable (homeless/vagrants, PWDs, prisoners, etc).
• The DOH thus uses Q1 + Q2 for planning estimates, with reliance on the DSWD’s NHTS-PR and 4Ps/CCT for targeting/identification.
27 M individuals (NEDA)
30 M individuals (NHTS-PR)
18 M (4Ps/CCT)Identified by DSWD
Advantages of Focusingon a Discrete/Defined Population
• Facilitates the process of population needs assessment
• Enables a purchaser to integrate the health services that are purchased with a broad range of public health measures to prevent disease, promote health, and reduce inequalities
Reference: Gray, 2004 (p. 270)
The Health Value Chain Approach:Translating Policies into Budgets and Resources for Execution
Policy Budget SpendingPlan
Interventions
SecuringSupply
GeneratingDemand
ImprovedHealth
Use of Goodsand Services
Information and Feedback
Reference: HPDP, 2014
Purchasers vs. Providers
• In health services world-wide, there is a trend to separate the function of purchasing healthcare from that of providing healthcare– Purchasers decide which health services to buy– Providers deliver healthcare to individual patients within the
resources available• Purchasers aim to maximize the value obtained from
the resources available• Purchasers are not usually asked to reallocate resources
on the basis of specific diseases, but for particular patient groups
Reference: Gray, 2004 (pp. 269; 272)
Healthcare Financing
• Health systems are not just concerned with improving people’s health, but also with protecting them against the financial cost of illness (by reducing out-of-pocket expenses).
• The sources of financing usually dictates the system of healthcare provision. Two main sources are:– Insurance (risk-pooling) “pay as you go”; common in
low income countries – Taxation (subsidies)
Reference: Gray, 2004 (p. 278)
Total Health Expenditures as % of GDP
2010 (Actual) 2011 (Actual) 2012 (Estimated)0%
1%
2%
3%
4%
5%
0.50% 0.50% 0.70%
0.60% 0.70%0.60%
0.40% 0.40% 0.50%
2.20% 2.30% 2.20%
0.50%0.50% 0.50%
National Government Local GovernmentSocial Health Insurance (PhilHealth) Private OOPOthers
Perc
enta
ge o
f GD
P
Who pays for the cost of health care?National Government
12%
Local Government15%
Social Health Insurance (Phil-
Health)9%Private OOP
53%
Others11%
Source: 2011 Philippine National Health Accounts
Sources of Financing
• The Sources and their Uses– NG: Policy Support / Management– LG: Service Delivery (residual payor)– PhilHealth – single payer– PCSO, etc – catastrophic expenses– PPP – high capital investments– OOP – safeguard against moral hazard
• “5% of GDP” – correlation vs. causation issue
The Budget Cycleand Absorptive Capacity
• Budget Call• Agency Planning• Negotiations with DBM• NEP filed in Congress• Congressional Hearings
– “Power of the Purse”– PDAF
• Appropriations• Allotments and
ObligationsReferences: DBM, 2013; Rappler.com, 2013
FINANCIALPROTECTION
PROVIDED TO THE POPULATION
AccreditationEnrollmentClaims
Availment and Processing
Insurance Payments
PhilHealth as a Single Payer/Purchaser
• Concept of social health insurance– Pay-as-you-go / “paluwagan”
• Leverage resources on behalf of the many clients/patients
Source: Joint DOH-PhilHealth Benefit Delivery Review (2010)
The Health Value Chain Approach:Translating Policies into Budgets and Resources for Execution
Policy Budget SpendingPlan
Interventions
SecuringSupply
GeneratingDemand
ImprovedHealth
Use of Goodsand Services
Information and Feedback
Reference: HPDP, 2014
The Supply Side of the Health System
Measuring Quality of Care (1)
Typically done in terms of structural measures• Health care inputs
– Availability of drugs– Supplies and technology– Available health manpower
• Facility-level characteristics
Solon et al. (2009). A novel method for measuring health care system performance: experience from QIDS in the Philippines. Health Policy and Planning 1(8)
Measuring Quality of Care (2)
• Do structural measures have a direct impact on health outcomes?
• Are structural inputs dynamic and thus responsive to policy initiatives that affect daily clinical practice?
• What about the point and period of care?
structural measures = inputs
Solon et al. (2009). A novel method for measuring health care system performance: experience from QIDS in the Philippines. Health Policy and Planning 1(8)
Measuring Quality of Care (3)
Three basic elements of quality of care:• Structure• Process• OutcomeStructural measures are too distant to the interface between patient and provider and do not address whether the inputs are used properly to produce better health
Solon et al. (2009). A novel method for measuring health care system performance: experience from QIDS in the Philippines. Health Policy and Planning 1(8)
The Health Value Chain Approach:Translating Policies into Budgets and Resources for Execution
Policy Budget SpendingPlan
Interventions
SecuringSupply
GeneratingDemand
ImprovedHealth
Use of Goodsand Services
Information and Feedback
Reference: HPDP, 2014
Watch on Youtube
• FP advert: http://youtu.be/H7jq8ccQ450• TB advert:
http://www.youtube.com/watch?v=-B8E7uIx19k
The Health Value Chain Approach:Translating Policies into Budgets and Resources for Execution
Policy Budget SpendingPlan
Interventions
SecuringSupply
GeneratingDemand
ImprovedHealth
Use of Goodsand Services
Information and Feedback
Reference: HPDP, 2014
Monitoring & Evaluation in Health
MANDATE• Policies/
Issuances/ Orders
INPUTS• Budgets• Premium
Subsidies• Supplies and
Commodities
OUTPUTS• PhilHealth
Coverage• Facility
Upgrading• Logistics
Management• Demand
Generation
OUTCOMES• Use of quality
health services at affordable / no cost
IMPACTS• Health• Well-being• Improved
productivity
Can be tracked through real time operations monitoring
Ensuring Performance
Reference: Gray, 2004 (p. 327; 367)
P =
Where:P = performanceM = motivationC = competence
B = barriers
Options to achieve change:
• Incentives (carrots)• Disincentives (sticks) hit people with carrots
Module IIIImplementation arrangements in healthcare
Capacity building, sustainability,and knowledge management
There is a world
beyond the hospital
IMPLEMENTATION ARRANGEMENTS IN HEALTHCARE
Values (?) Dominate Policy-making
• Politics tends to be driven by beliefs patronage• It is the values returns on investment (ROI)
politicians believe to be important that dominate decision-making about policy. Such decisions will be tempered by the availability of resources.
• But, resource allocation can also be based on beliefs and values patronage and ROI
• Can a shortage of resources force policy-makers to consider the evidence and alter policy as a result?
Reference: Gray, 2004 (p. 287)
The Legislation Threshold
LEGISLATION THRESHOLD
Opp
ositi
on to
legi
slati
on
Reference: Gray, 2004 (Fig 7.9, p. 296)
There is an inverse relationship between the magnitude of a health problem and the strength of opposition to legislation framed to prevent it.
Number of people affected
Media interestStrong evidence
Opposition by industryPolicy has adverse effectsHigh cost of intervention
What legal adjustments are needed to implement UHC?
Restructuring of Excise Taxes of alcohol and tobaccoPassage of Responsible Parenthood BillStrengthening of the National Health Insurance
Program• Optimization of management of devolved health
services• Amendment of selected laws governing practice of
health professionals• Laws for corporate governance of hospitals
Note: An omnibus law on universal health care that shall contain specific provisions necessary to enact required policies or amend existing laws can also be legislated
Main Determinants of Health
Genetic inheritance
Health status
Physical environment
Biological environment
Social environment
Primary care
Reference: Gray, 2004 (Fig 8.1, p. 320)
Health services
Hospital careScreening
Healthcare Management and Policy,and Organizational Change
• Health policies relate mainly to the financing and organization of health services.
• Common objectives of organizational change:– Decentralize power;– Involve more people in decision-making;– Encourage cost control;– Reduce the number of managerial staff;– Encourage competition in order to reduce costs
and increase qualityReference: Gray, 2004 (p. 290)
Office of Secretary of Health
Attached Agencies
Regional Offices
Provincial Health Offices
City Health Offices(Component Cities)
Inter-local Health Zones
City Hospitals
Health Centers
Barangay Health
Stations
District hospitals
Municipal health offices/ Rural Health Unit
Barangay Health Stations
Provincial Hospitals
Regional hospital Medical Centers
Sanitaria
City Health Offices(Chartered Cities)
City Hospitals
Health Centers
Barangay Health
Stations
References: Kelekar and Llanto, 2013; Khemani, 2010
The Role of Civil Society Organizations
• Churches and Faith-based Groups• Advocacy Groups• Academe• NGOs• Provider/Professional Organizations
Public-Private Partnerships
• Frame:Profit = Revenue – Cost
• Private interest is to maximize profit: either increase revenue, or minimize cost
• Public interest is to ensure (by contract) provision of high quality social services, which entails costs
• Not just in infrastructure, but also elsewhere
PPPs in Health Systems
• Main purposes: increase capital finance; improve the efficiency and quality of service provision
• Note that an across-the-board presumption in favor of private sector solutions is not evidence-based; it has to be tailor-made
• Real gains in PPP are not realized upon signing, but during implementation of the contract which requires effective monitoring and oversight
Reference: Hellowell, 2012 and Hellowell, 2014
Making PPPs Work
• The procurement process and the structure of contracts must generate the right incentive framework
• Meaningful competition during bidding is essential so that the procurer gets high quality at a low price from a contract
• Government should enforce quality standards, and levy a financial cost upon the private sector in cases of underperformance
• Government should have significant financial and human resources for identifying and mitigating risks
Reference: Hellowell, 2012
PREVIEW OF A (FULL) POLICY CYCLE: THE RH LAW
OSG: The Reproductive Health Law
• 14+ years of debate in Congress• 26 years after the 1987 Constitution• State interest is to save mothers’ lives
– Population policy is elsewhere, in the POPCOM PD• The issue is not when life begins, but the
“political question” and judicial restraint (institutions affecting policy)
• RH Law is social legislation: more in law for those with less in life
Reference: Jardeleza, 2013
SC: What is the RH Law?
Despite efforts to push the RH Law as a reproductive health law, the Court sees it as principally a population control measure.… the RH Law does not sanction the taking away of life. It does not allow abortion in any shape or form. It only seeks to enhance the population control program of the government by providing information and making non-abortifacient contraceptives more readily available to the public, especially to the poor.
Reference: Decision, Imbong v. Ochoa, pp. 34, 101 Emphasis supplied
Indeed, at the present, the country has a population problem, but the State should not use coercive measures (like the penal provisions of the RH Law against conscientious objectors) to solve it.
Reference: Decision, Imbong v. Ochoa, p. 102 Emphasis supplied
SC: What is the RH Law?
SC: Who determines what contraceptivesare abortifacient or not?
While an abortifacient is outlawed by the Constitution and the RH Law, the practical problem in its enforcement lies in the determination of whether or not a contraceptive drug or device is an abortifacient. This is where expert medical opinion is imperative. The character of the contraceptive as an abortifacient or non-abortifacient cannot be legislated or fixed by law and should be confined to the domain of medical science.
Reference: Concurring Opinion, Leonardo-De Castro, J., Imbong v. Ochoa, pp. 7-8 Emphasis supplied
Passing the RH Lawis just the start of the value chain…
Policy Budget SpendingPlan
Interventions
SecuringSupply
GeneratingDemand
ImprovedHealth
Use of Goodsand Services
Information and Feedback
Reference: HPDP, 2014
CAPACITY BUILDING, SUSTAINABILITY, AND KNOWLEDGE MANAGEMENT
Image from Facebook (Seismologik Intelligence/Occupy Posters)
What is Development Work?
• Official Development Assistance (ODA) / Foreign Assistance Programs (FAPs)
• Shift from tangible commodities to technical assistance (TA)
Reference: Garrett, 2007
Agenda Setting
Policy Formulation
AdoptionImplementation
Evaluation
Areas for Management Consulting
Research Production
Research Management
Marketing / CommunicationImplementation
Monitoring & Evaluation
Health Policy Development Program(HPDP2 – Cooperative Agreement No. AID-492-A-12-00016)
• Five-year USAID health policy project (2012-2017) implemented by the UPecon Foundation, Inc.
• Supports the DOH-led policy formulation process for scaling up Universal Health Care (UHC)
• Goal is to strengthen a supportive policy and financing environment for FP/MNCHN and TB to enable the Philippines to achieve its MDGs in health, as well as expand and sustain its UHC initiative
• Two components: (1) establish an institutional platform to help DOH design, implement, monitor, and evaluate the UHC agenda; and (2) remove policy and systems barriers to FP/MNCHN and TB service delivery
HPDP Contact Information
Dr. Orville C. SolonChief of PartyHealth Policy Development Program (HPDP)Room 322, Encarnacion Hall, School of EconomicsUniversity of the Philippines DilimanDiliman, Quezon [email protected]
INTEGRATION
The Five-Star Doctor
Roles• Health Care Provider• Teacher• Researcher
• Social Mobilizer• Manager
Examples of Leaders• Pioneer Practitioners• Deans• Principal
Investigators• Politicians/Advocates• DOH Sec / Hospital
Chiefs
AlbertDomingo.comfacebook.com/aedomingo
twitter.com/AlbertDomingo
Open Forum / Q&A