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FCM3 WHO BUILDING BLOCKS.pptx.pdf

The document outlines the WHO's approach to strengthening health systems through six building blocks: service delivery, health workforce, information, medical products/vaccines/technologies, financing, and leadership/governance. For each building block, the document identifies priorities and actions needed to achieve objectives such as making services accessible and equitable, developing a well-performing health workforce, establishing national health information systems, ensuring access to essential medical products, developing sustainable financing mechanisms, and strengthening health sector policies and regulatory frameworks. The document provides a framework to guide WHO's work with countries in assessing health system needs and gaps.

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WHO BUILDING BLOCKS
Primary aim/purpose • Clarify and strengthen WHO’s role in the health system This Photo by Unknown Author is licensed under CC BY-SA
Purpose: ALLOW A DEFINITION OF DESIRABLE ATTRIBUTES IDENTIFY WHO’S PRIORITIES IDENTIFYING THE GAPS IN WHO SUPPORT
Health systems basic
What is a health system? A health system consist of all organizations, people and actions whose primary intent is to promote, restore or maintain health Expanded definition World Health report 2000
Guiding value and principles Alma Ata Declaration This Photo by Unknown Author is licensed under CC BY-NC-ND
Health system goals Improving health and health equity, in ways that are responsive, Financially fair, Make the best or most efficient , Use of available resources Intermediate goal: route from inputs to health outcomes is through achieving greater access to ad coverage for effective health interventions, without compromising efforts to ensure provider quality and safety
Desirable attributes Multiple, dynamic relationships Health system strengthening Access and coverage Is progress being made?
Access and coverage 3 dimension Countries try to broaden the range of benefits to which the citizens entitled to Extend access to these health goods and service to wider population groups – universal access Try to provide citizens with social protection against untoward financial and social consequences of taking up health care “universal coverage”
Primary Health care Alma Ata Declaration Underpinning values- universal access, equity participation and intersectoral action Primary of first contact level Effectively backed up by secondary level facilities that concentrate more on complex care; integrated
Challenges to the health system
Health system challenges Managing multiple objectives and competing demands A significant increase in funding for health “scaling-up” is not just about increasing spending Health system agenda is not static
WHO’s response to Health System Challenges A single frame work with six clearly defined blocks Health system and programmes: getting results A more effective role for WHO at country level The role of WHO in the international health systems agenda
Priorities by Building Block Service delivery: packages, delivery models, infrastructure; management, safety & quality; demand for care Health workforce : national workforce policies and investment plans; advocacy; norms; standards and data Information : facility and population based information & surveillance systems; global standards, tools Medical products, vaccines & technologies : norms, standards, policies; reliable procurement; equitable access ;quality Financing: national health financing policies; tools and data on health expenditures; costing Leadership and governance: health sector policies; harmonization and alignment; oversight and regularization
1. SERVICE DELIVERY This Photo by Unknown Author is licensed under CC BY-NC-ND
1. SERVICE DELIVERY •Good health service deliver effective, safe and good quality personal and none personal (population based services) care those that need it, when needed with minimum waste •Services – prevention, treatment or rehabilitation- delivered at home, community, workplace or in health facilities
Service delivery •Demand for service •User’s perspective, raising public knowledge, reducing barriers to care •Package integrated services •Based on picture of population health needs; barriers to the equitable expansion of access to services, available resources •Organization of the provider network
Service delivery •Organization of the provider network •Ensure close to client care •Contingent on the need for economies of scale •Promote individual continuity of care where needed •Avoid unnecessary duplication and fragmentation of services •Management •Infrastructure and logistics
Service delivery •Management: •Maximize service coverage •Quality and safety •Minimize waste •Autonomy vs policy and programmed consistency and accountability •Infrastructure and logistics
Service delivery •Infrastructure and logistics •Includes buildings, plant and equipment; utilities; waste management and transport and communication •Investment decisions, transport or technologies for recurrent cost, staffing levels, skills needs and maintenance of systems This Photo by Unknown Author is licensed under CC BY-SA
Service delivery Priorities INTEGRATED SERVICE DELIVERY PACKAGE SERVICE DELIVERY MODELS LEADERSHIP AND MANAGEMENT PATIENT SAFETY AD QUALITY OF CARE INFRASTRUCTURE AND LOGISTICS INFLUENCING DEMAND FOR CARE
This Photo by Unknown Author is licensed under CC BY-SA-NC 2. HEALTH WORKFORCE
DEFINITIONS HEALTH WORKERS •People engaged in actions whose primary intent is to protect and improve health HEALTH WORKFORCE •Health service providers and health management and support workers
Well performing health force Available Competent Responsive productive
Action to achieve well performing health workforce
Action address the following: How countries plan and, if needed, scale up their workforce How countries design training programmes so that they can facilitate integration across service delivery and disease control programmes How countries finance scaling-up of education programmes and of numbers of health workers in a realistic and sustainable manner and in a different contexts Ow countries organize their health workers for effective service delivery, at different levels of the system ( primary, secondary, tertiary), and monitor and improve their performance How countries retain an effective workforce, within dynamic local and international labor markets
Health workforce priorities International norms, standards and databases Realistic strategies Crisis countries Costing Training Evidence Advocacy Working with international health professional groups
3. INFORMATION
Key components of the information building blocks •Body of work to support development of health information and surveillance system •Development of standardized tools and instrument •Collation of international health statistics
3 Domains of Health Information •Health determinants •Health system performance •Health status
How to achieve domain? •Generate population and facility based data •Have the capacity to detect, investigate, communicate and contain events that threaten public health security •Have the capacity to synthesize information and promote the availability and application of this knowledge
Priorities of information block: •National information systems •Reporting •Stronger national surveillance and response capacity •Tracking performance •Standards, methods and tools •Synthesis and analysis of country, regional and global data
4. MEDICAL PRODUCTS, VACCINES AND TECHNOLOGIES
OBJECTIVES: •Ensure equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost effectiveness •And their scientifically sound and cost effective use
Needs to achieve objective • National policies, standards, guidelines and regulations that support policy • Information on prices, international trade agreements and capacity to set and negotiate prices • Reliable manufacturing practices and quality assessment of priority products • Procurement ,supply, storage and distribution systems that minimize leakage and other waste • Support for rational use of medicines, commodities and equipment, through guidelines, strategies to assurance adherence, reduce resistance, maximize patient safety and training
Priorities for Medical Products, Vaccines and Technologies •Establish norms, standards and policy options •Procurement •Access and use •Quality and safety •New products
5. SUSTAINABLE FINANCING AND SOCIAL PROTECTION
Good health financing system •Raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them
Interrelated functions •Collection of revenues •Pooling of prepaid revenues that allow risks to be shared •purchasing
Principles to guide country’s approach to financing: •Raising additional fund where health needs are high, revenues are insufficient, and where accountability mechanisms can ensure transparent and effective use of resources •Reducing reliance on out of pocket payments where they are high, by moving towards pre-payment systems involving pooling of fianncia risk across population groups •Taking additional steps, where needed, to improve social protection by ensuring the poor and other vulnerable groups have access to needed services, and that paying for care does not result in catastrophe
Principles to guide country’s approach to financing: •Improving the efficiency of resource use by focusing on the appropriate mix of activities and interventions •Promoting transparency and accountability in health financing systems •Improving generation of information on the health financing system and its policy use
Priorities of sustainable financing and social protection •Health financing option •Improve or develop pre –payment, risk pooling •Ensure adequate funding from domestic sources •Used funds •Promote international dialogue •Increase availabilityof key inforamiton
6.LEADERSHIP AND GOVERNANCE
•”Stewardship” •Role of the government in health and its relation to other actors whose activities impact health
Key functions •Policy guidance •Intelligence and oversight •Collaboration and coalition building •Regulation •System design •Accountability
Priorities of Leadership and governance •Develop health sector policies and frameworks •Regulatory frameworks •Accountability •Generate and interpret intelligence and research policy options •Build coalitions •Work with external partners
SELECTED SYSTEM CONSTRAINTS AND POSSIBLE DISEASE-SPECIFIC AND HEALTH SYSTEM RESPONSES CONSTRAINT POSSIBLE DISEASE-SPECIFIC RESPONSE POSSIBLE HEALTH SYSTEM RESPONSE Financial access difficult e.g inability to pay, informal fees Payment exemptions for an individual, for a specific disease Pooling pre paid funds (from households, external agencies, companies) in ways that allow risks to be shared, and decrease individual payments when sick Physical access difficult e.g distance to facility Out reach for specific diseases, engage private providers Revising plans for the location, construction or upgrading of health facilities Knowledge and skills low (public and private providers) Workshops and other continuing education for specific diseases Revised pre-service training curricula, systems for licensing, accreditation, supervision Staff poorly motivated Staff get financial incentives to deliver specific services Clear job descriptions, performance and salary review; fair, transparent promotion procedures Weak leadership and management Workshops to develop skills in managing staff, budgets etc (e.g in public and NGO facilities) Additional actions such as giving managers more control over resources; more accountability for results Ineffective intersectoral action and partneship Disease-specific cross sectoral committees usually national Building local government systems with cross-sector representation, and explicit
Health Reform Initiatives 1979 “Adoption of Primary Health Care” 1982 EO 851 “Reorganization of DOH” 1988 “The Generics Act” 1991 RA 7160 “Local Government Code” 1995 “National Health Insurance Act” 1999 Health Sector Reform Agenda 2005 FOURmula One (F1) for Health 2008 RA 9502 “Access to Cheaper and Quality Medicines Act” 2010 AO 2010-0036 “Kalusugan Pangkalahatan” Major areas of reform 1. Health service delivery 2. Health regulation 3. Health financing Health reforms targeted to address issues such as: Poor accessibility Inequity Inefficiency Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Reform Initiatives| Figure 4. Major Health Reforms in the Philippines Promoted participatory management of the local health care system Prescriptions are written using the generic name of the drug Integrated public health and hospital services Transfer of responsibility of health service provision to the local government units Aims to provide all citizens a mechanism for financial protection with priority given to the poor Major organizational restructuring of DOH to improve the way health care is delivered, regulated, and financed Adoption of operational framework to undertake reforms with speed, precision, and effective coordination Promote and ensure access to affordable quality drugs and medicines for all Universal health coverage and access to quality health care for all Filipinos 1 2 3
Leadership and Governance Department of Health Mandated to provide national policy direction and develop national plans, technical standards and guidelines of health Provides technical assistance, capacity building, and advisory services for disease prevention and control Supplies medicines and vaccines Devolution of Health Services Under the Local Government Code (1991), LGUs were granted autonomy and responsibility for their own health services National health programs are coordinated by the DOH through the LGUs (eg. TB, family planning) DOH Regional Office City Health Office (Chartered cities) Provincial Health Office City Hospitals Health Centers Barangay Health Stations Inter-local Health Zones Provincial Hospitals District Hospitals City Health Office (Component cities) Municipal Health Office City Hospitals Health Centers Barangay Health Stations Barangay Health Stations Challenges after the devolution Due to the devolved setup of the health system, health reforms must not only be implemented at the national level, these must also be promoted at the local government levels. Difficulties in coordination between the DOH and local governments often lead to poor policy implementation, and poorly functioning referral systems. Health is not a priority in most LGUs Lack of facilities and skilled health workers at the primary care level Lack of health referral system mechanisms among the LGUs themselves Under provincial govt. Under city govt. Under municipal govt. Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Leadership and Governance| March 2017 Figure 4. Seal of the Department of Health Figure 5. Organizational structure of the Philippine Health Sector after Devolution 1 2 3 4 Health system in ARMM Different health system from the other regions in the country; not devolved Lack of funding, insurgencies, and relative distance of some areas from the regional center (ie. Sulu, Basilan, and Tawi-tawi) appears to pose challenges and difficulties 5
Health Service Delivery The Philippines has a fragmented health system Health Facilities Secondary and Tertiary Services includes outpatient, inpatient, and hospital care, laboratory and special procedures, acute and emergency care, dental care, and mental care. Primary Care Services includes immunization, health and nutrition education, family planning services, treatment for minor illnesses and accidents, outpatient, dental, and laboratory services Rehabilitative Services includes acute inpatient rehabilitation, long term care and programs for the elderly and disabled, and palliative care Levels of care and services provided Level of Government Health Services Access and Quality Of Health Services 1. Preventive 2. Promotive 3. Curative Hospitals • General hospitals • Level 1 hospitals • Level 2 hospitals • Level 3 hospitals • DOH-retained hospitals • Specialty hospitals Other health facilities • Primary Care Facility • Custodial Care Facility • Diagnostic / Therapeutic facility Specialized outpatient facility Perception towards Government Health Services • Perceived as low quality • Poor diagnosis resulting to repeated visits • Health human resources are not available and sometimes lacking in medical and people skills • Long waiting time • Inconvenient facility schedule • Run down or worn out facilities WHO recommended 20 beds per 10,000 population Philippines 10.7 beds per 10,000 population Facility Government Private Rural Health Units 2588 N/A Hospitals 591 990 Birthing homes 629 798 Infirmary 207 273 “Quality” “Affordable” Why people go to private facilities Why people go to public facilities Despite the huge number, health facilities are mostly concentrated in cities and urban centers Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Service Delivery | March 2017 Figure 6. Philippine General Hospital Table 1. Health Facilities in the Philippines (2014) 1 2 3 4 6 5 d 7 • National Government • Local Government Units • Private Sector
Health Workforce Density • Essential for efficient management and operation of the public health system • Enormous but unevenly distributed in the country (most are in Metro Manila and urban centers) Distribution Migration • Philippines is a major source of health professionals in the world • Fluency in English and skills and training received • Compassion and patience in caring • Leading exporters of nurses to the world • Second major exporter of physicians but migrates as nurses • Socio-economic and political situations do not contribute to retaining of licensed and skilled professional in the country Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Workforce | March 2017 e 1 f Health Provider WHO Philippines Doctors 2.3 1.11 Nurses 4.43 Midwives 1.7 Dentists - 0.54 Figure 7. Distribution of Provider Affiliation in the Philippines According to Region (2014) Table 2. Density of Health Providers in the Philippines per 1000 population (2004)) 3 Human Resource for Health Deployment programs of DOH • Medical Pool Placement and Utilization Program (MP-PUP) • Doctors to the Barrios (DTTB) • Registered Nurses for Health Enhancement and Local Service (RN HEALS) • Rural Health Midwives Program • Rural Health Team Placement Program (RHTPP) 4 2
Health Financing National Health Accounts Per capita expenditure on health 4.2% increase at constant 2006 prices. National Health Insurance Program • Movement towards a single-payer premium-based financing or insurance system Track the activities of the health sector through its health expenditure and guide future decisions and actions Out-of-pock et spending • Burden of financing health care is still heaviest on individual families National and Local Government • Government health budgets are insurance funds Sources Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Financing | March 2017 of Health Financing Figure 8. 2010-2020 Health Care Financing Strategy (HCFS) goals indicators PHP 585.3B Total Health Expenditure (2014) PHP 5,859 (2014) PHP 5,400 (2013) 8.5% Figure 9. Per capita Expenditure on Health (2014) 1 2 3 g h
Health Information Health Information System Issues with Health Information in the Philippines Philippine Integrated Disease Surveillance and Response Project (PIDSR) • Early detection, reporting, investigation, assessment, and prompt response to emerging diseases, epidemics, and other public health threats closely reflects the larger health system Information gaps • National and local health information systems are poorly integrated and weakly managed Redundancies and duplication • Information systems are fragmented and lacks interoperability among systems • Vertical disease surveillance systems Lack of Information Standards • Private sector forms a large bulk of actual transactions with family physicians and general practitioners • Lacking or absent from DOH information system Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Information | March 2017 Major Health Information Systems in the Philippines Philippine Health Information System • integrated electronic system for storing and sharing vital health indicators. Real time Monitoring of Vital Maternal and Child Health Indicators through the Community Health Information Tracking System (rCHITS) • A free and open source software electronic health record system for local government health centers in the Philippines Surveillance in Post Extreme Emergencies and Disasters (SPEED) • mobile- and Internet-based disease surveillance system for disasters by the DOH HEMS and WHO • Conceptualized to provide real time health information reporting after a disaster Philippine Health Information Exchange a platform for secure electronic access and efficient exchange of health data and/or information among health facilities, health care providers, health information organizations, and government agencies in accordance with set national standards in the interest of public health. Field Health Service Information System (FHSIS) • Official information system of the Department of Health • Enables the collection and translation of information from local to national level • Information to policy formulation and decision making Data Privacy Act (2012) An act protecting individual personal information in information and communications systems in the government and the private sector i k 1 2 3 4 5 Figure 11. Integrated Clinic Information System Figure 10. Field Health Service Information System Integrated Clinic Information System (iClinicSys) • Supports the functions of a clinic, i.e. barangay health station, rural health unit, or other health care facility that is primarily devoted to the care of outpatients by storing electronic record of health related data or information on an individual • In-line with the PHIE and is interoperable with Philhealth Health Information System, HOMIS (for hospitals), and DSWD (4Ps and WOMB) RxBox • a telemedicine device capable of capturing medical signals through built-in medical sensors, storing data in an electronic medical record, and transmitting health information via internet to a clinical specialist in the Philippine General Hospital for expert advice j
Health Information Health Information System Issues with Health Information in the Philippines Philippine Integrated Disease Surveillance and Response Project (PIDSR) • Early detection, reporting, investigation, assessment, and prompt response to emerging diseases, epidemics, and other public health threats closely reflects the larger health system Information gaps • National and local health information systems are poorly integrated and weakly managed Redundancies and duplication • Information systems are fragmented and lacks interoperability among systems • Vertical disease surveillance systems Lack of Information Standards • Private sector forms a large bulk of actual transactions with family physicians and general practitioners • Lacking or absent from DOH information system Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Information | March 2017 Major Health Information Systems in the Philippines Philippine Health Information System • integrated electronic system for storing and sharing vital health indicators. Real time Monit oring of Vital Mater nal and Child Health Indicat ors throug h the Comm unity Health Inform Surveil lance in Post Extre me Emerg encies and Disast ers (SPEE D) • mobile- and Internet-based disease surveillance system for disasters by the DOH HEMS and WHO • Conceptualized to provide real time health information reporting after a disaster Philippine Health Information Exchange a platform for secure electronic access and efficient exchange of health data and/or information among health facilities, health care providers, health information organizations, and government agencies in accordance with set national standards in the interest of public health. Field Health Service Information System (FHSIS) • Official information system of the Department of Health • Enables the collection and translation of information from local to national level • Information to policy formulation and decision making Data Privacy Act (2012) An act protecting individual personal information in information and communications systems in the government and the private sector i k 1 2 3 4 5 Figure 11. Integrated Clinic Information System Figure 10. Field Health Service Information System Integrated Clinic Information System (iClinicSys) • Supports the functions of a clinic, i.e. barangay health station, rural health unit, or other health care facility that is primarily devoted to the care of outpatients by storing electronic record of health related data or information on an individual • In-line with the PHIE and is interoperable with Philhealth Health Information System, HOMIS (for hospitals), and DSWD (4Ps and WOMB) RxBox • a telemedicine device capable of capturing medical signals through built-in medical sensors, storing data in an electronic medical record, and transmitting health information via internet to a clinical specialist in the Philippine General Hospital for expert advice j
Medicines and Technology Pharmaceuticals Philippine Pharmaceutical Market – segmented market • Asymmetric information • Income disparities • Inadequacy of the regulatory system Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Information | March 2017 Major Constraints in Accessing Essential Drugs 1. Limited availability 2. Irrational use 3. High Cost 4. Local government are left to budget for medicines 5. Massive campaign by bigger manufacturing firms of their products 6. Better incentives given to prescribers and dispensers of particular products 7. Prolonged patent rights 8. Lack of education on generics and patent issues 9. Shortcoming of information and education on pharmaceutical issues High price of medicine Medical Devices Filipinos are one of the highest consumers of pharmaceuticals in Southeast Asia (P750-800 annually on medicine and drugs per person) General radiography (basic X-ray): Most basic equipment available across the country Local Government are left to budget for medical instruments, devices and equipment. Supply-driven distribution scheme • Drugstores: 80.1% • Hospitals: 9.7% (Gov’t: 2.3%) • Others: 10.2% Strong market orientation • Expensive branded medicine dominate the pharmaceutical market • 10,000 drugs are off-patent but only 500 drugs are being manufactured Poor compliance to Generics Law • Inadequacy to ascertain quality of medicine affects access to medicine and patient health outcomes • Claims better quality in comparison to more affordable and what are perceived to be “inferior” products Generally lax regulation with strong pharmaceutical or nutritiutical company lobbying influence. • Aggravated by the high promotion and gift-giving scheme done by drug companies to health professionals Inaccessible by the poor Figure 12. Medicines 1 2 3 4 l Rx Box reduces the overall cost of healthcare by enabling health workers to diagnose, monitor and treat patients within the rural health facility 5 m Figure 13. Devices in the Rx Box
The Philippine Health Agenda (DOH Administrative Order 2016-0038) Three key health system guarantees • Population- and individual-level interventions for all life stages that promote health and wellness, prevent and treat the triple burden of disease, delay complications, facilitate rehabilitation, and provide palliation; • Access to health interventions through functional Service Delivery Networks (SDNs), and • Financial risk protection when accessing these interventions through Universal Health Insurance. Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Direction of the Philippine Health System| March 2017 Directions of the Philippine Health Sector The Philippine Development Plan 2017-2022 NEDA AmBisyon Natin 2040 Sustainable Development Goals 2030 Expanded the scope of the Universal Health Care (UHC) directions, particularly through a whole-of-gover nment approach. “All for Health Towards Health For All” rally point for its vision of a Healthy Philippines by 2022. • a collective long-term plan which envisions a better life for Filipinos and the country in the next 25 years. • first of the four key medium term plans to translate the vision and aspirations for the Filipinos and the country • a compilation of 17 development goals that targets to end poverty, fight inequality and injustice, and confront issues involving climate change and its effects 1 2 3 4 n o p q r r

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FCM3 WHO BUILDING BLOCKS.pptx.pdf

  • 1.
  • 2.
    Primary aim/purpose • Clarifyand strengthen WHO’s role in the health system This Photo by Unknown Author is licensed under CC BY-SA
  • 3.
    Purpose: ALLOW A DEFINITIONOF DESIRABLE ATTRIBUTES IDENTIFY WHO’S PRIORITIES IDENTIFYING THE GAPS IN WHO SUPPORT
  • 7.
  • 8.
    What is a health system? Ahealth system consist of all organizations, people and actions whose primary intent is to promote, restore or maintain health Expanded definition World Health report 2000
  • 9.
    Guiding value and principles AlmaAta Declaration This Photo by Unknown Author is licensed under CC BY-NC-ND
  • 10.
    Health system goals Improvinghealth and health equity, in ways that are responsive, Financially fair, Make the best or most efficient , Use of available resources Intermediate goal: route from inputs to health outcomes is through achieving greater access to ad coverage for effective health interventions, without compromising efforts to ensure provider quality and safety
  • 12.
  • 14.
    Access and coverage 3 dimension Countriestry to broaden the range of benefits to which the citizens entitled to Extend access to these health goods and service to wider population groups – universal access Try to provide citizens with social protection against untoward financial and social consequences of taking up health care “universal coverage”
  • 16.
    Primary Health care Alma AtaDeclaration Underpinning values- universal access, equity participation and intersectoral action Primary of first contact level Effectively backed up by secondary level facilities that concentrate more on complex care; integrated
  • 17.
    Challenges to thehealth system
  • 18.
    Health system challenges Managingmultiple objectives and competing demands A significant increase in funding for health “scaling-up” is not just about increasing spending Health system agenda is not static
  • 19.
    WHO’s response toHealth System Challenges A single frame work with six clearly defined blocks Health system and programmes: getting results A more effective role for WHO at country level The role of WHO in the international health systems agenda
  • 20.
    Priorities by Building Block Service delivery:packages, delivery models, infrastructure; management, safety & quality; demand for care Health workforce : national workforce policies and investment plans; advocacy; norms; standards and data Information : facility and population based information & surveillance systems; global standards, tools Medical products, vaccines & technologies : norms, standards, policies; reliable procurement; equitable access ;quality Financing: national health financing policies; tools and data on health expenditures; costing Leadership and governance: health sector policies; harmonization and alignment; oversight and regularization
  • 21.
    1. SERVICE DELIVERY This Photoby Unknown Author is licensed under CC BY-NC-ND
  • 22.
    1. SERVICE DELIVERY •Goodhealth service deliver effective, safe and good quality personal and none personal (population based services) care those that need it, when needed with minimum waste •Services – prevention, treatment or rehabilitation- delivered at home, community, workplace or in health facilities
  • 23.
    Service delivery •Demand forservice •User’s perspective, raising public knowledge, reducing barriers to care •Package integrated services •Based on picture of population health needs; barriers to the equitable expansion of access to services, available resources •Organization of the provider network
  • 24.
    Service delivery •Organization ofthe provider network •Ensure close to client care •Contingent on the need for economies of scale •Promote individual continuity of care where needed •Avoid unnecessary duplication and fragmentation of services •Management •Infrastructure and logistics
  • 25.
    Service delivery •Management: •Maximize servicecoverage •Quality and safety •Minimize waste •Autonomy vs policy and programmed consistency and accountability •Infrastructure and logistics
  • 26.
    Service delivery •Infrastructureand logistics •Includes buildings, plant and equipment; utilities; waste management and transport and communication •Investment decisions, transport or technologies for recurrent cost, staffing levels, skills needs and maintenance of systems This Photo by Unknown Author is licensed under CC BY-SA
  • 27.
    Service delivery Priorities INTEGRATED SERVICEDELIVERY PACKAGE SERVICE DELIVERY MODELS LEADERSHIP AND MANAGEMENT PATIENT SAFETY AD QUALITY OF CARE INFRASTRUCTURE AND LOGISTICS INFLUENCING DEMAND FOR CARE
  • 28.
    This Photo byUnknown Author is licensed under CC BY-SA-NC 2. HEALTH WORKFORCE
  • 29.
    DEFINITIONS HEALTH WORKERS •People engagedin actions whose primary intent is to protect and improve health HEALTH WORKFORCE •Health service providers and health management and support workers
  • 30.
    Well performing healthforce Available Competent Responsive productive
  • 31.
  • 32.
    Action address the following: How countriesplan and, if needed, scale up their workforce How countries design training programmes so that they can facilitate integration across service delivery and disease control programmes How countries finance scaling-up of education programmes and of numbers of health workers in a realistic and sustainable manner and in a different contexts Ow countries organize their health workers for effective service delivery, at different levels of the system ( primary, secondary, tertiary), and monitor and improve their performance How countries retain an effective workforce, within dynamic local and international labor markets
  • 33.
    Health workforce priorities International norms, standards and databases Realisticstrategies Crisis countries Costing Training Evidence Advocacy Working with international health professional groups
  • 34.
  • 35.
    Key components ofthe information building blocks •Body of work to support development of health information and surveillance system •Development of standardized tools and instrument •Collation of international health statistics
  • 36.
    3 Domains ofHealth Information •Health determinants •Health system performance •Health status
  • 37.
    How to achievedomain? •Generate population and facility based data •Have the capacity to detect, investigate, communicate and contain events that threaten public health security •Have the capacity to synthesize information and promote the availability and application of this knowledge
  • 38.
    Priorities of informationblock: •National information systems •Reporting •Stronger national surveillance and response capacity •Tracking performance •Standards, methods and tools •Synthesis and analysis of country, regional and global data
  • 40.
    4. MEDICAL PRODUCTS,VACCINES AND TECHNOLOGIES
  • 41.
    OBJECTIVES: •Ensure equitable accessto essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost effectiveness •And their scientifically sound and cost effective use
  • 42.
    Needs to achieveobjective • National policies, standards, guidelines and regulations that support policy • Information on prices, international trade agreements and capacity to set and negotiate prices • Reliable manufacturing practices and quality assessment of priority products • Procurement ,supply, storage and distribution systems that minimize leakage and other waste • Support for rational use of medicines, commodities and equipment, through guidelines, strategies to assurance adherence, reduce resistance, maximize patient safety and training
  • 43.
    Priorities for MedicalProducts, Vaccines and Technologies •Establish norms, standards and policy options •Procurement •Access and use •Quality and safety •New products
  • 44.
    5. SUSTAINABLE FINANCINGAND SOCIAL PROTECTION
  • 45.
    Good health financingsystem •Raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them
  • 46.
    Interrelated functions •Collection ofrevenues •Pooling of prepaid revenues that allow risks to be shared •purchasing
  • 47.
    Principles to guidecountry’s approach to financing: •Raising additional fund where health needs are high, revenues are insufficient, and where accountability mechanisms can ensure transparent and effective use of resources •Reducing reliance on out of pocket payments where they are high, by moving towards pre-payment systems involving pooling of fianncia risk across population groups •Taking additional steps, where needed, to improve social protection by ensuring the poor and other vulnerable groups have access to needed services, and that paying for care does not result in catastrophe
  • 48.
    Principles to guidecountry’s approach to financing: •Improving the efficiency of resource use by focusing on the appropriate mix of activities and interventions •Promoting transparency and accountability in health financing systems •Improving generation of information on the health financing system and its policy use
  • 49.
    Priorities of sustainablefinancing and social protection •Health financing option •Improve or develop pre –payment, risk pooling •Ensure adequate funding from domestic sources •Used funds •Promote international dialogue •Increase availabilityof key inforamiton
  • 50.
  • 51.
    •”Stewardship” •Role of thegovernment in health and its relation to other actors whose activities impact health
  • 52.
    Key functions •Policy guidance •Intelligenceand oversight •Collaboration and coalition building •Regulation •System design •Accountability
  • 53.
    Priorities of Leadershipand governance •Develop health sector policies and frameworks •Regulatory frameworks •Accountability •Generate and interpret intelligence and research policy options •Build coalitions •Work with external partners
  • 56.
    SELECTED SYSTEM CONSTRAINTSAND POSSIBLE DISEASE-SPECIFIC AND HEALTH SYSTEM RESPONSES CONSTRAINT POSSIBLE DISEASE-SPECIFIC RESPONSE POSSIBLE HEALTH SYSTEM RESPONSE Financial access difficult e.g inability to pay, informal fees Payment exemptions for an individual, for a specific disease Pooling pre paid funds (from households, external agencies, companies) in ways that allow risks to be shared, and decrease individual payments when sick Physical access difficult e.g distance to facility Out reach for specific diseases, engage private providers Revising plans for the location, construction or upgrading of health facilities Knowledge and skills low (public and private providers) Workshops and other continuing education for specific diseases Revised pre-service training curricula, systems for licensing, accreditation, supervision Staff poorly motivated Staff get financial incentives to deliver specific services Clear job descriptions, performance and salary review; fair, transparent promotion procedures Weak leadership and management Workshops to develop skills in managing staff, budgets etc (e.g in public and NGO facilities) Additional actions such as giving managers more control over resources; more accountability for results Ineffective intersectoral action and partneship Disease-specific cross sectoral committees usually national Building local government systems with cross-sector representation, and explicit
  • 62.
    Health Reform Initiatives 1979 “Adoptionof Primary Health Care” 1982 EO 851 “Reorganization of DOH” 1988 “The Generics Act” 1991 RA 7160 “Local Government Code” 1995 “National Health Insurance Act” 1999 Health Sector Reform Agenda 2005 FOURmula One (F1) for Health 2008 RA 9502 “Access to Cheaper and Quality Medicines Act” 2010 AO 2010-0036 “Kalusugan Pangkalahatan” Major areas of reform 1. Health service delivery 2. Health regulation 3. Health financing Health reforms targeted to address issues such as: Poor accessibility Inequity Inefficiency Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Reform Initiatives| Figure 4. Major Health Reforms in the Philippines Promoted participatory management of the local health care system Prescriptions are written using the generic name of the drug Integrated public health and hospital services Transfer of responsibility of health service provision to the local government units Aims to provide all citizens a mechanism for financial protection with priority given to the poor Major organizational restructuring of DOH to improve the way health care is delivered, regulated, and financed Adoption of operational framework to undertake reforms with speed, precision, and effective coordination Promote and ensure access to affordable quality drugs and medicines for all Universal health coverage and access to quality health care for all Filipinos 1 2 3
  • 63.
    Leadership and Governance Departmentof Health Mandated to provide national policy direction and develop national plans, technical standards and guidelines of health Provides technical assistance, capacity building, and advisory services for disease prevention and control Supplies medicines and vaccines Devolution of Health Services Under the Local Government Code (1991), LGUs were granted autonomy and responsibility for their own health services National health programs are coordinated by the DOH through the LGUs (eg. TB, family planning) DOH Regional Office City Health Office (Chartered cities) Provincial Health Office City Hospitals Health Centers Barangay Health Stations Inter-local Health Zones Provincial Hospitals District Hospitals City Health Office (Component cities) Municipal Health Office City Hospitals Health Centers Barangay Health Stations Barangay Health Stations Challenges after the devolution Due to the devolved setup of the health system, health reforms must not only be implemented at the national level, these must also be promoted at the local government levels. Difficulties in coordination between the DOH and local governments often lead to poor policy implementation, and poorly functioning referral systems. Health is not a priority in most LGUs Lack of facilities and skilled health workers at the primary care level Lack of health referral system mechanisms among the LGUs themselves Under provincial govt. Under city govt. Under municipal govt. Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Leadership and Governance| March 2017 Figure 4. Seal of the Department of Health Figure 5. Organizational structure of the Philippine Health Sector after Devolution 1 2 3 4 Health system in ARMM Different health system from the other regions in the country; not devolved Lack of funding, insurgencies, and relative distance of some areas from the regional center (ie. Sulu, Basilan, and Tawi-tawi) appears to pose challenges and difficulties 5
  • 64.
    Health Service Delivery ThePhilippines has a fragmented health system Health Facilities Secondary and Tertiary Services includes outpatient, inpatient, and hospital care, laboratory and special procedures, acute and emergency care, dental care, and mental care. Primary Care Services includes immunization, health and nutrition education, family planning services, treatment for minor illnesses and accidents, outpatient, dental, and laboratory services Rehabilitative Services includes acute inpatient rehabilitation, long term care and programs for the elderly and disabled, and palliative care Levels of care and services provided Level of Government Health Services Access and Quality Of Health Services 1. Preventive 2. Promotive 3. Curative Hospitals • General hospitals • Level 1 hospitals • Level 2 hospitals • Level 3 hospitals • DOH-retained hospitals • Specialty hospitals Other health facilities • Primary Care Facility • Custodial Care Facility • Diagnostic / Therapeutic facility Specialized outpatient facility Perception towards Government Health Services • Perceived as low quality • Poor diagnosis resulting to repeated visits • Health human resources are not available and sometimes lacking in medical and people skills • Long waiting time • Inconvenient facility schedule • Run down or worn out facilities WHO recommended 20 beds per 10,000 population Philippines 10.7 beds per 10,000 population Facility Government Private Rural Health Units 2588 N/A Hospitals 591 990 Birthing homes 629 798 Infirmary 207 273 “Quality” “Affordable” Why people go to private facilities Why people go to public facilities Despite the huge number, health facilities are mostly concentrated in cities and urban centers Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Service Delivery | March 2017 Figure 6. Philippine General Hospital Table 1. Health Facilities in the Philippines (2014) 1 2 3 4 6 5 d 7 • National Government • Local Government Units • Private Sector
  • 65.
    Health Workforce Density • Essentialfor efficient management and operation of the public health system • Enormous but unevenly distributed in the country (most are in Metro Manila and urban centers) Distribution Migration • Philippines is a major source of health professionals in the world • Fluency in English and skills and training received • Compassion and patience in caring • Leading exporters of nurses to the world • Second major exporter of physicians but migrates as nurses • Socio-economic and political situations do not contribute to retaining of licensed and skilled professional in the country Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Workforce | March 2017 e 1 f Health Provider WHO Philippines Doctors 2.3 1.11 Nurses 4.43 Midwives 1.7 Dentists - 0.54 Figure 7. Distribution of Provider Affiliation in the Philippines According to Region (2014) Table 2. Density of Health Providers in the Philippines per 1000 population (2004)) 3 Human Resource for Health Deployment programs of DOH • Medical Pool Placement and Utilization Program (MP-PUP) • Doctors to the Barrios (DTTB) • Registered Nurses for Health Enhancement and Local Service (RN HEALS) • Rural Health Midwives Program • Rural Health Team Placement Program (RHTPP) 4 2
  • 66.
    Health Financing National HealthAccounts Per capita expenditure on health 4.2% increase at constant 2006 prices. National Health Insurance Program • Movement towards a single-payer premium-based financing or insurance system Track the activities of the health sector through its health expenditure and guide future decisions and actions Out-of-pock et spending • Burden of financing health care is still heaviest on individual families National and Local Government • Government health budgets are insurance funds Sources Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Financing | March 2017 of Health Financing Figure 8. 2010-2020 Health Care Financing Strategy (HCFS) goals indicators PHP 585.3B Total Health Expenditure (2014) PHP 5,859 (2014) PHP 5,400 (2013) 8.5% Figure 9. Per capita Expenditure on Health (2014) 1 2 3 g h
  • 67.
    Health Information Health Information System Issueswith Health Information in the Philippines Philippine Integrated Disease Surveillance and Response Project (PIDSR) • Early detection, reporting, investigation, assessment, and prompt response to emerging diseases, epidemics, and other public health threats closely reflects the larger health system Information gaps • National and local health information systems are poorly integrated and weakly managed Redundancies and duplication • Information systems are fragmented and lacks interoperability among systems • Vertical disease surveillance systems Lack of Information Standards • Private sector forms a large bulk of actual transactions with family physicians and general practitioners • Lacking or absent from DOH information system Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Information | March 2017 Major Health Information Systems in the Philippines Philippine Health Information System • integrated electronic system for storing and sharing vital health indicators. Real time Monitoring of Vital Maternal and Child Health Indicators through the Community Health Information Tracking System (rCHITS) • A free and open source software electronic health record system for local government health centers in the Philippines Surveillance in Post Extreme Emergencies and Disasters (SPEED) • mobile- and Internet-based disease surveillance system for disasters by the DOH HEMS and WHO • Conceptualized to provide real time health information reporting after a disaster Philippine Health Information Exchange a platform for secure electronic access and efficient exchange of health data and/or information among health facilities, health care providers, health information organizations, and government agencies in accordance with set national standards in the interest of public health. Field Health Service Information System (FHSIS) • Official information system of the Department of Health • Enables the collection and translation of information from local to national level • Information to policy formulation and decision making Data Privacy Act (2012) An act protecting individual personal information in information and communications systems in the government and the private sector i k 1 2 3 4 5 Figure 11. Integrated Clinic Information System Figure 10. Field Health Service Information System Integrated Clinic Information System (iClinicSys) • Supports the functions of a clinic, i.e. barangay health station, rural health unit, or other health care facility that is primarily devoted to the care of outpatients by storing electronic record of health related data or information on an individual • In-line with the PHIE and is interoperable with Philhealth Health Information System, HOMIS (for hospitals), and DSWD (4Ps and WOMB) RxBox • a telemedicine device capable of capturing medical signals through built-in medical sensors, storing data in an electronic medical record, and transmitting health information via internet to a clinical specialist in the Philippine General Hospital for expert advice j
  • 68.
    Health Information Health Information System Issueswith Health Information in the Philippines Philippine Integrated Disease Surveillance and Response Project (PIDSR) • Early detection, reporting, investigation, assessment, and prompt response to emerging diseases, epidemics, and other public health threats closely reflects the larger health system Information gaps • National and local health information systems are poorly integrated and weakly managed Redundancies and duplication • Information systems are fragmented and lacks interoperability among systems • Vertical disease surveillance systems Lack of Information Standards • Private sector forms a large bulk of actual transactions with family physicians and general practitioners • Lacking or absent from DOH information system Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Information | March 2017 Major Health Information Systems in the Philippines Philippine Health Information System • integrated electronic system for storing and sharing vital health indicators. Real time Monit oring of Vital Mater nal and Child Health Indicat ors throug h the Comm unity Health Inform Surveil lance in Post Extre me Emerg encies and Disast ers (SPEE D) • mobile- and Internet-based disease surveillance system for disasters by the DOH HEMS and WHO • Conceptualized to provide real time health information reporting after a disaster Philippine Health Information Exchange a platform for secure electronic access and efficient exchange of health data and/or information among health facilities, health care providers, health information organizations, and government agencies in accordance with set national standards in the interest of public health. Field Health Service Information System (FHSIS) • Official information system of the Department of Health • Enables the collection and translation of information from local to national level • Information to policy formulation and decision making Data Privacy Act (2012) An act protecting individual personal information in information and communications systems in the government and the private sector i k 1 2 3 4 5 Figure 11. Integrated Clinic Information System Figure 10. Field Health Service Information System Integrated Clinic Information System (iClinicSys) • Supports the functions of a clinic, i.e. barangay health station, rural health unit, or other health care facility that is primarily devoted to the care of outpatients by storing electronic record of health related data or information on an individual • In-line with the PHIE and is interoperable with Philhealth Health Information System, HOMIS (for hospitals), and DSWD (4Ps and WOMB) RxBox • a telemedicine device capable of capturing medical signals through built-in medical sensors, storing data in an electronic medical record, and transmitting health information via internet to a clinical specialist in the Philippine General Hospital for expert advice j
  • 69.
    Medicines and Technology Pharmaceuticals PhilippinePharmaceutical Market – segmented market • Asymmetric information • Income disparities • Inadequacy of the regulatory system Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Health Information | March 2017 Major Constraints in Accessing Essential Drugs 1. Limited availability 2. Irrational use 3. High Cost 4. Local government are left to budget for medicines 5. Massive campaign by bigger manufacturing firms of their products 6. Better incentives given to prescribers and dispensers of particular products 7. Prolonged patent rights 8. Lack of education on generics and patent issues 9. Shortcoming of information and education on pharmaceutical issues High price of medicine Medical Devices Filipinos are one of the highest consumers of pharmaceuticals in Southeast Asia (P750-800 annually on medicine and drugs per person) General radiography (basic X-ray): Most basic equipment available across the country Local Government are left to budget for medical instruments, devices and equipment. Supply-driven distribution scheme • Drugstores: 80.1% • Hospitals: 9.7% (Gov’t: 2.3%) • Others: 10.2% Strong market orientation • Expensive branded medicine dominate the pharmaceutical market • 10,000 drugs are off-patent but only 500 drugs are being manufactured Poor compliance to Generics Law • Inadequacy to ascertain quality of medicine affects access to medicine and patient health outcomes • Claims better quality in comparison to more affordable and what are perceived to be “inferior” products Generally lax regulation with strong pharmaceutical or nutritiutical company lobbying influence. • Aggravated by the high promotion and gift-giving scheme done by drug companies to health professionals Inaccessible by the poor Figure 12. Medicines 1 2 3 4 l Rx Box reduces the overall cost of healthcare by enabling health workers to diagnose, monitor and treat patients within the rural health facility 5 m Figure 13. Devices in the Rx Box
  • 70.
    The Philippine HealthAgenda (DOH Administrative Order 2016-0038) Three key health system guarantees • Population- and individual-level interventions for all life stages that promote health and wellness, prevent and treat the triple burden of disease, delay complications, facilitate rehabilitation, and provide palliation; • Access to health interventions through functional Service Delivery Networks (SDNs), and • Financial risk protection when accessing these interventions through Universal Health Insurance. Alliance for Improving Health Outcomes Inc. (AIHO) | The Philippine Health System in a glance | Direction of the Philippine Health System| March 2017 Directions of the Philippine Health Sector The Philippine Development Plan 2017-2022 NEDA AmBisyon Natin 2040 Sustainable Development Goals 2030 Expanded the scope of the Universal Health Care (UHC) directions, particularly through a whole-of-gover nment approach. “All for Health Towards Health For All” rally point for its vision of a Healthy Philippines by 2022. • a collective long-term plan which envisions a better life for Filipinos and the country in the next 25 years. • first of the four key medium term plans to translate the vision and aspirations for the Filipinos and the country • a compilation of 17 development goals that targets to end poverty, fight inequality and injustice, and confront issues involving climate change and its effects 1 2 3 4 n o p q r r