Implementation Guidelines for the Phase II of the Support to the Philippine Health Sector Reform and Population Management Programs (GTZ) ( DOH Administrative Order No. 2004-0188 )

December 19, 2004

DOH ADMINISTRATIVE ORDER NO. 2004-0188

 

I. Rationale

The Philippine German Cooperation Program (GTZ) entitled, "Support to the Philippine Health Sector Reform and Population Management Programs" has completed its first phase of implementation (formerly called: Unified GTZ Support to the Philippine Health Sector). A program review was carried out by a team composed of DOH, Philhealth and external evaluators to assess the achievements of the program, identify areas for improvement, and offer recommendations for enhancing the program's performance and strengthening the impact of its intended objectives in a second phase of four years. ESTDcC

In the previous structure (2001-2004), there were four (4) main components: a) Local Health Development Component, b) Family/Reproductive Health, (c) Social Health Insurance, (d) Pharmaceuticals.

A new framework for German Development Cooperation (AURA) presents a sharpened focus on program impact and an amended role of the GTZ from being a contributor to being a co-equal with partners (DOH, Philhealth, POPCOM) in the responsibility for achieving the program objectives. Corollary to this framework, GTZ will sign an agreement with the Philippine partners (DOH, PHIC, POPCOM) that will embody the implementing arrangements.

Based on the AURA challenge of program responsibility and impact, a revision of the current program structure was proposed and agreed upon. The program's result areas or deliverables were consolidated under two major components: 1) Policy support component, and 2) Local health systems development component. The proposed structure for 2004-2008, needs to further increase the synergy among the components, focus of GTZ support and make it more responsive to central level policy needs.

II. Goals and Objectives

A. Goals: The Health of the population, in particular the poor, is enhanced

B. Objectives:

1. To improve effectiveness and quality of decentralized health services and population programs;

2. To improve efficiency and synergy of program components for sharper directions of implementing the GTZ Program Planning Matrix objectives;

3. To improve quality of collaborative process for institutionalization and sustainability.

III. Components of the GTZ Program Phase II

A. Policy Support Component

The objective is to ensure the formulation of responsive policies, strategies and guidelines for local health system and population management based on field experience, policy research and evidence.

Specific objectives/activities under this component based on the DOH/GTZ program planning matrix, shall include the following:

1. Institutionalization of an effective mechanisms for translating LHS and population management experience into policy; cESDCa

2. Development of a method/tool for systematic assessment and analysis of experiences from LHS and population management;

3. Development of an infrastructure for knowledge sharing and management;

4. Prioritization and implementation of operations research supported by management.

B. Local Health Systems Development Component (implemented in Eastern Visayas)

The objective is to establish local health systems and local government-based population programs that ensure quality services, equitable and sustainable financing mechanisms, and effective resource management.

Specific objectives/activities under this component shall include the following:

1. Improvement of quality of health service provision by ILHZ;

2. Ensure equitable and sustainable financing of population and health programs/services;

3. Ensure an efficient and integrated management of ILHZ resources;

4. Strengthen the practice of population and development approach for local development planning.

A detailed program planning matrix is presented as annex A to this Administrative Order for reference.

IV. Implementing Arrangements:

The 2nd Phase of the Support to the Philippine Health Sector Reform and Population Management Programs shall be implemented according to the organizational structure shown in Annex B. The roles and responsibilities of the offices/committees reflected in the organogram shall include the following:

A. External Affairs Cluster

The head of this cluster, shall make important decisions and take necessary action to promptly and effectively carry out program implementation activities. Likewise, he/she shall determine important matters that require actions/decisions by the Execom, and/or the Secretary of Health together with the concerned officials or key staff within the DOH as well as other Government Agencies.

B. Program Steering Committee (PSC)

Under the Phase II GTZ program, the Health Sector Reform Agenda — Technical Coordination Group (HSRA-TCG) created under A.O. No. 227-G s. 2002 (mandated to oversee the overall implementation of all health sector reform related projects and activities), shall be the PSC. It shall perform the defined roles and functions provided under Administrative Order 73 s. 2003, for this purpose. Specifically, it is directed to manage and provide the venue for technical and policy discussions in the development of policies, plans and programs for the Phase II GTZ program. An implementation agreement shall be approved between GTZ, DOH, PHIC and POPCOM. cCSDaI

The HSRA-TCG meeting is regularly set every end week of the month. As such, it shall be the responsibility of the BIHC to: 1) ensure inclusion into the agenda the essential concerns of the GTZ program requiring PSC policy decisions/actions, and 2) monitor and provide feedback on the policy actions taken by the PSC as well as implementation of the agreements. The HSRA-TCG may be expanded on a case to case basis in accordance with the Program requirements that is elevated to its level for policy action.

C. HSRA-TCG Special Technical Partners Groups (STPG)

1. The HSRA-TCG shall create two (2) technical partners groups, fulfilling specific roles. This shall include:

a. Policy Support — this group shall be responsible for developing policy mechanisms pertaining to the Philippine health sector, decentralized health system and population management. The Health Policy Development and Planning Bureau (HPDPB) shall take the lead in this group.

b. Local Health System Development — this group shall be responsible for developing the local health systems component of the program. The Bureau of Local Health Development (BLHD) shall take the lead for the Local Health Systems Development Component.

2. The members of the STPGs shall include representatives from: GTZ Health Team, PhilHealth-FACO, DOH-BHIC, POPCOM, Centers for Health Development for Eastern Visayas, Philhealth Regional Office for Eastern Visayas and PopCom Regional 8 Office, NEDA representative and LGU representative.

3. The functions of the HSRA-TCG Special Technical Partners for Policy Support and Local Health Systems Development shall include the following:

a. Provide venue for technical and policy discussions in the development of plans and guidelines for Phase II GTZ Program in terms of:

i. Implementation of program components

ii. Formulation of research agenda and priority setting and research utilization plan

iii. Capacity building

iv. Monitoring and evaluation

b. Prepare inputs vital to each component for presentation and discussion with the TCG HSRA for final review and endorsement to External Affair Cluster Head and/or Execom

D. GTZ Health Team

This group shall be led by the Program Manager and the advisors. They shall be responsible for the day to day management of the Program, in particular:

1. Establish an effective financial, procurement and contract management system;

2. Establish a mechanism for coordination with the DOH and other concerned offices/agencies towards the formulation of Work and Financial Plans of the Program;

3. Monitor actual program implementation and regularly submit reports to DOH-BIHC;

4. Strengthen coordination with the DOH technical program key players;

5. Develop and maintain an effective filing, recording and inventory system for project documents, technical papers and project assets.

E. Unified Project Management Division, Bureau of International Health Cooperation (UPMD-BIHC) ETHaDC

This office shall have oversight functions over the administrative aspects of the program including monitoring the implementation progress and reporting the same to the oversight agencies of government. Likewise, this office shall ensure inclusion into the TCG meeting agenda of program issues/concerns, as well as monitoring the policy actions taken by the PSC and providing feedback accordingly.

V. Financing Arrangements

The German Technical Cooperation shall be responsible for the financial requirements of the 2nd Phase of the said Program with counterparts from the Philippine Government thru the Department of Health, POPCOM and the Philippine Health Insurance Corporation (Philhealth) based on the budget that the respective units allocate from its budget line.

VI. Monitoring and Evaluation

The Baseline Monitoring System shall be implemented to place data on Indicators in the Project Matrix. The baseline for Phase II shall be the result of the conduct of the Household survey and different data gathering shall be performed to monitor the development of the program indicators. The periodic indicators will be generated by the GTZ support Health Team with the guidance of DOH, PHIC and POPCOM.

VII. Repealing Clause

The provisions under Administrative Order No. 73 s. 2002 which are inconsistent or contrary with the provisions of this Order are hereby revised, modified accordingly and/or repealed. All other provisions of existing issuances which are not affected by this Order, shall remain valid and in effect.

VIII. Effectivity

This Order shall take effect immediately.

 

(SGD.) MANUEL M. DAYRIT, MD, MScSecretary of Health

ANNEX A 

	Title: GTZ Support to the Health Sector	Estimated	Sheet No. 1
	Reform and Population Management	period:
	Program		2000-2008
DOH/PhilHealth/GTZ	Country: PHILIPPINES	Prepared on:
	No.: PN 2004.2047.1	August 4, 2004
Summary of Objectives/	Indicators		Means of	Assumptions
Activities			Verification
Development Goal:
The Health of the population,
in particular the poor, is
enhanced
Purpose:	By the end of the program (2012)		Exodus of
				doctors and
The quality of decentralised				nurses does not
health services and	•	Ind. P.1.: Utilization of RHU for	Annual BMS	reach critical
population programs is		curative care by the poor increases		levels affecting
improved		to 60% in 2012 in pilot areas (Scope:		essential posts.
		SOGOD ILHZ; BL 2002: 16%)
	•	Ind. P.2.: Modern Contraceptive	Annual BMS and
		Prevalence Rate is-increased to	facility based
		40 % in pilot areas (Scope: pilot
		ILHZ; BL 2002: 18%)
	•	Ind. P.3.: User satisfaction with	Annual BMS	LGU
		RHUs and public hospitals for (i)		expenditures for
		availability of drugs, (ii) cost of drugs		health are not
		and medical supplies, and (iii)		reduced to
		attitude of personnel is at least 80%		critical levels.
		for RHUs and remains at least
		identical for hospitals (Scope:
		SOGOD ILHZ)
		- Availability of drugs: BL2003		Change in
		RHU: 41%, Hosp: 95%		political
				leadership does
		- Cost of drugs: BL2003 RHU: 66%,		not hamper
		Hosp: 87%		achievement of
				program
		- Attitude of personnel: BL2003		objectives
		RHU: 72%, Hop: 90%
Component 1: POLICY SUPPORT
Objective	By the end of the second phase		National level
				demand for
				assistance in
				policy
				development
				continues
To ensure the formulation	•	Ind. C1. 1.: Criteria for institutionalizing	List of criteria
of responsive policies,		experiences are defined	approved
strategies and guidelines			by DOH
for local health system/	•	Ind. C1. 2.: 30% of AO/DO	Count of issuances
population management		(DOH & PhilHealth) based	from the time the
based on field experience,		on local health system experience	system is in
policy research and		underwent the selection criteria	place
evidence		for institutionalization (BL: 0%)
Result 1	By the end of the second phase:	Agency budgets
				are maintained at
An effective mechanism	•	lnd. R1.1.: The mechanism is a regular	The effective	present level
for institutionalization		agency activity with a corresponding	mechanism for LHS/
of LHS/population		appropriate budget and resource	population
management experience		allocation	management
into policy is in place			must be in the Work	HSRA and PPMP
			and Financial Plans	remain a priority
			of the concerned
			offices and the policy
			is in the DOH current
			thrust and priorities
Result 2	By the end of the second phase	Agency budgets
				are maintained
Experience from LHS	•	Ind. R2. 1.: A yearly review of	Check if yearly	at present
and Population		LHS and population management	reviews take	level
management development		experience takes place with	place/HPDPB,	HSRA and PPMP
is systematically analyzed		participation of central and regional	HSRA TCG minutes	remain a
and assessed for future		offices, and LGUs		priority
institutionalization	•	Ind. R2. 2.: A list of experiences	Check on availability
		proposed for institutionalization is	of yearly list/HPDPB
		submitted on a yearly basis to
		DOH/POPCOM/PhilHealth
Result 3	By the end of the second phase
The infrastructure for	•	lnd. R3. 1.: A system for knowledge	Based on the criteria	Hardware can be
knowledge sharing and		management and sharing is	for an appropriate	sourced from
management is more		defined and established	KM system that will	outside GTZ
effective			be defined during	support
			the second phase
	•	Ind. R3. 2.: Utilization of the	Count number of hits
		internet-based knowledge
		management center increases by
		10% yearly (BL: 0%)
Result 4	•	Ind. R4. 1.: Operations research
The program Management		supported by program	Check on relevance of
supports selected relevant		management at central level is in	operations research
operations research		line with priorities related to local	within the framework of
		health system development and	GTZ support
		population programs
Component 2: LOCAL HEALTH SYSTEMS DEVELOPMENT
Objective	By the end of the second phase:	Count functional ILHZs
Establish local health	•	Ind. C2. 1.: 8 Functional (cf DOH	based on DOH
systems and LGU-		definition) ILHZs in 4 provinces	list/CHD8
based population programs		(BL: 1)
that ensure quality services,
equitable and sustainable	•	Ind. C2. 2.: A model of PopDev	Check if model is
financing mechanisms,		approach in ILHZ is developed and	operational
and effective resources		implemented in at least two provinces
management
	•	Ind. C2. 3.: The proportion of referred	BMS
		hospital cases to total cases
		increased by 50 % compared to
		baseline level in Pilot areas
		(Scope: SOGOD ILHZ; BL 2003:
		6.8%)
	•	lnd. C2. 4.: 95% of RHUs are awarded
		Sentrong Sigla status or accredited	CHD8/PRO8
		by Philhealth in ILHZ that are
		operational for at least a
		year (Scope: all ILHZ: BL2003: 75%)
Results 5:	By the end of the second phase:
Quality of Health Service	•	lnd. R5. 1.: Health staff satisfaction in		Appropriate
provided by ILHZ		RHUs and public hospitals with		health
significantly improved		(i) working conditions. (ii) availability		personnel are
		of medicine for therapy, and	BMS	in place
		(iii) availability of laboratory instruments
		and materials is at least 60% (Scope:
		SOGOD ILHZ)
		- Working conditions: BL2003 RHU: 23%,
		Hop: 20%
		- Availability of medicines for therapy:
		BL2003 RHU: 2%, Hosp: -35%
		- Availability of laboratory instruments
		and materials: BL2003 RHU: 22%,
		Hosp: -24%
Results 6:	By the end of the second phase:		LGU commitment
				to health
Financing of population	•	Ind. R6..1.: Total coverage of SHI		sustained
and health programs/		(formal, informal, indigents) is	PRO8
services is more		increased by 50% (Scope: S. Leyte;
equitable and		BL 2003: 20%)		Economic
sustainable	•	Ind. R6.2.: Share of SHI on local		situation is
		health expenditure increased by		favorable or does
		150 % compared to baseline level in		not deteriorate
		pilot areas (Scope: SOGOD	PhilHealth:
		ILHZ; BL 2002: 2.16%)	(capitation &
	•	Ind. R6. 3.: LGU expenditures on	reimbursement for
		purchase of modern contraceptives	hospitals); OOP:
		is 10% of market value of modern	yearly
		contraceptives in RHUs (Scope: 3	extrapolation;
		selected ILHZ; BL2003: 0%)	DOH/CHD8
	•	Ind. R6. 4.: 40% of enrolled indigent
		and individually paying members	BMS
		utilizing PhilHealth benefits
		(Scope: Sogod; BL2003:	PR08, BMS
		25%)
Results 7:	By the end of the second phase
ILHZ resources are	•	Ind. R7. 1.: Proportion of LGU MOOE
managed more		pooled is increased by 100 %	BMS
efficiently and in an		(Scope: SOGOD ILHZ; BL 2003: 7%)
integrated manner	•	Ind. R7.2.: Average price level of
		selected LGU-pooled procured
		medicines compared with non-pilot
		areas is lower (Scope:	Survey (methodology	LGUs procure
		SOGOD&Biliran ILHZ; drugs:	to be determined)	through pooled
		cotrimoxazole tablet, amoxycilline		procurement
		tablet; paracetamol tablet;
		contraceptive pills)
	•	Ind. R7. 3.: 10% increase in yearly
		average sales in HEALTH Plus
		Outlets (Scope: S.Leyte, Biliran, Leyte;
		BL2003: S.Leyte: P.23,743,	NPF
		Biliran: P.32,117; Leyte: P.33,678)
Results 8:	By the end of the second phase:		LGUs are open
Population and	•	Ind. R8. 1.: Increase in the	To be determined	to population and
development approach		number of youth who seek/use	when services will	development
to local development		services and information sources	be available	issues and
planning is practiced		(Scope: pilot ILHZ; BL:?)		concerns in their
in the ILHZ.	•	Ind. R8.2.: A model where	Check if report on	locality
		additional aspects in population	model testing is
		development approach (e.g.	available	Youth-led
		Adolescent Reproductive Health,		initiatives will
		non-clinical FP/RH services; ) are		overcome
		specified in the local development		opposition from
		plans through/within the framework		religious groups
		of the ILHZ structure is
		developed and tested (BL: no model)

 

ANNEX B

Organizational Structure for GTZ Program Phase II Implementation