Strategic Framework and Implementing Guidelines for FOURmula One Plus for Health (F1+)

May 30, 2018

DOH ADMINISTRATIVE ORDER NO. 2018-0014

 

I. BACKGROUND AND RATIONALE

In response to the challenges brought about by the devolution of health services to local government units (LGUs) as mandated by RA 7160 (Local Government Code of 1991) and the enactment of RA 7875 (National Health Insurance Act of 1995) providing all citizens with mechanism to gain financial access to health services, the DOH developed in 1999 the Health Sector Reform Agenda (HSRA) as the policy framework for crucial reforms in the health sector. The HSRA culminated in the adoption of the FOURmula One (F1) for Health as the implementing framework for health reforms for 2005-2010. F1 for Health established four major pillars, namely, financing, service delivery, regulation and governance, as a single package of targeted reforms in the health sector. As a result of its implementation, service capacities and performance of government health facilities at national and local levels were enhanced. This resulted in improvement of health outcomes among Filipinos and made the DOH one of the most trusted government agencies by 2009. Building on the successes of F1 for Health, the DOH adopted the Universal Health Care or Kalusugang Pangkalahatan (KP) as its strategic framework for 2011-2016. KP expanded the National Health Insurance Program (NHIP) and intensified investments in health infrastructure in line with the increased fiscal space from sin taxes. In 2016, with the change of administration, the Philippine Health Agenda 2016-2022 was issued to make health services better felt by the Filipino people. HTcADC

With the fiscal space provided by the sin taxes, the coverage of the National Health Insurance Program (NHIP) rose from 51 percent in 2010 to 91 percent in 2016 (PhilHealth Stats and Charts, 2010 and 2016),while total health expenditures grew from about 381 billion pesos in 2010 to 655 billion pesos in 2016 (Philippine National Health Accounts, 2016).Despite the increase in health expenditures, improvement of health outcomes has been marginal, where the NDHS shows infant mortality rate lower at 21 per 1,000 live births in 2017 compared to 25 in 2008; 33.4 percent of children under-five are stunted compared to 32.3 in 2008; and the proportion of children aged 12-23 months given all basic vaccinations at 69.9 percent in 2017 compared to 79.5 percent in 2008 (NDHS, 2008 and 2017).Also, protection from financial risk has continued to be inadequate with NHIP support value averaging at 50 percent and compliance to no balance billing policy for indigent and sponsored members at 63 percent (PhilHealth Stats and Charts, 2016).

With the aim of attaining the goals outlined in the Philippine Development Plan 2017-2022, Ambisyon Natin 2040, and the Sustainable Development Goals, and building on the concept of FOURmula One for Health 2005-2010, the medium-term strategic framework for 2017-2022 expands the four pillars of health reforms and highlights greater focus on performance accountability towards the Filipino people, thus, FOURmula One Plus for Health or F1+,with its tagline "Boosting Universal Health Care."

II. OBJECTIVES

This Administrative Order aims to:

A. Provide the overall policy directions for DOH offices, its attached agencies, and local government units in terms of prioritizing activities related to the FOURmula One Plus for Health 2017-2022; and,

B. Provide guidance to development partners, other government agencies, and private stakeholders in identifying priority areas for health services and support.

III. SCOPE AND COVERAGE

This issuance shall apply to the DOH central office bureaus and units, regional offices, hospitals and attached agencies; all public and private health care facilities; health care providers and support staff; LGUs; other national government agencies; development partners; civil society organizations; academic institutions; medical societies and organizations; and all other institutions relevant for the implementation of the F1+ for Health.

IV. GENERAL GUIDELINES

A. F1+ for Health shall organize critical initiatives in health into four strategic pillars, namely: Financing, Regulation, Service Delivery, Governance, plus a cross cutting initiative on Performance Accountability.

B. The implementation of F1+ for Health shall focus on sustainable, manageable, and critical interventions that optimize available resources, supported by evidence and sufficient groundwork, and produce tangible results that are felt by Filipinos.

C. The reforms shall be implemented under the concept of a whole-of-society, whole-of-government, and whole-of-system approach that encompasses the entire health sector and other social determinants impacting health.

D. The functional management arrangements shall be defined in terms of specific offices and institutions having clear mandates, performance targets, and support systems, within well-defined time frames in the implementation of reforms within each pillar.

V. POLICY FRAMEWORK

A. Vision — The DOH envisions Filipinos as among the healthiest people in Southeast Asia by 2022, and in Asia by 2040.

B. Mission — The DOH shall lead the country in the development of a productive, resilient, equitable, and people-centered health system.

C. CoreValues — The DOH shall embody at all times integrity, excellence, and compassion in carrying out its tasks and responsibilities.

D. Goals — The F1+ for Health aims to ensure better health outcomes, a more responsive health system, and a more equitable health care financing.

E. StrategicPillars — The DOH shall organize health sector initiatives into four (4) pillars, namely: Financing, Service Delivery, Regulation, Governance, plus a cross-cutting initiative on Performance Accountability.

Each strategic pillar shall have its own objective, sub-pillars and key interventions, as follows: aScITE

a. Strategic Pillar 1: Financing

i. Objective — The objective of the financing pillar is to secure sustainable investments to improve health outcomes and ensure efficient and equitable use of health resources.

ii. Sub-pillars and Key Interventions

1. Efficiently mobilize and equitably distribute more resources for health

a. Sustainable resources for health shall be secured and equitably distributed by making NHIP premiums more progressive, improving efficiency in collecting premiums, and increasing revenue allocation from innovative health taxes.

b. Fiscal autonomy and income retention shall be pursued in all government-owned health facilities to ensure that income generated is used for health services.

c. Financial coverage from health maintenance organizations and private health insurance shall complement that of the NHIP.

2. Rationalize health spending

a. The financing of health interventions shall be clearly delineated, where population-based interventions is financed through line item budgetary sources (national and local),while personal insurable health interventions shall be financed through the NHIP.

b. National resources allocated for financing medical services for the poor and vulnerable (e.g.,PCSO, PAGCOR, DSWD Medical Assistance, etc.) shall be consolidated into a single fund to prevent overlaps of financing, and provide easier access by the poor.

c. Fixed co-payments for selected health packages shall be collected to prevent overutilization of health products and services.

d. No additional co-payments shall be charged for patients in wards or basic accommodation, while only fixed co-payments shall be allowed for additional amenities and higher-level accommodation.

e. A multi-year budget scheme shall be developed to support selected priority programs that require long term financing.

3. Focus financial resources towards high impact interventions

a. A unified, transparent and explicit process of identifying priority programs to be funded by the DOH, LGUs, and PhilHealth shall be institutionalized with a focus on the following:

i. basic and essential primary care services;

ii. health services and programs for the poor, marginalized and vulnerable; and

iii. programs and services to achieve the Sustainable Development Goals, Philippine Development Plan, and AmBisyon Natin 2040.

b. The financing and payment of health services shall be linked to performance that is based on good quality services and better health outcomes.

b. Strategic Pillar 2: Service Delivery

i. Objective — The service delivery pillar's objective is to ensure the accessibility of essential quality health products and services at appropriate levels of care.

ii. Sub-pillars and Key Interventions

1. Increase access to quality essential health products and services

a. A comprehensive essential health service package for all life stages and specialized health services shall be made available through designated health providers in strategic locations.

b. Implementation strategies to reduce public health threats shall be intensified through:

i. disease-free zone initiatives for diseases targeted for elimination as public health problems; HEITAD

ii. disease prevention and control strategies for endemic communicable, non-communicable, and emerging and re-emerging diseases;

iii. disease surveillance and monitoring strategies;

iv. health promotion and communication strategies; and

v. resilient health systems and provision of essential health goods and services during times of disasters and emergencies.

c. Access to quality diagnostic and therapeutic products and services shall be ensured by:

i. engaging pharmacies to provide selected essential medicines to specific population groups under a revitalized Botika ng Bayan program;

ii. capacitating local health centers to ensure access to basic laboratory services; and

iii. facilitating access to quality and affordable health products and medicines (i.e.,promotion of generics).

2. Ensure equitable access to quality health facilities

a. Access to quality basic and specialized health facilities shall be assured through:

i. upgrading of existing and constructing new health facilities based on a comprehensive needs assessment of service delivery networks (SDNs);and

ii. compliance of health facilities to accepted standards of care and clinical practice guidelines.

b. Facilities for step-down and chronic care, and synergies provided through novel medical technologies shall be explored and developed.

3. Ensure equitable distribution of human resources for health (HRH)

a. HRH requirements commensurate to the needs of the population shall be mapped and aligned with the strategies for expanding health facilities.

b. Other government agencies (such as CHED, TESDA, and PRC) and professional societies shall be engaged to ensure adequate production of quality HRH especially in health professions with insufficient supply, and to attain a high level of competency and ethical standards in the practice of the health professions.

c. Equitable distribution of HRH shall be assured through competitive compensation and benefit packages, and good working conditions for those assigned in geographically isolated and disadvantaged areas (GIDAs).

4. Engage SDNs to deliver comprehensive package of health services

a. Public and private providers shall be organized into SDNs that will be responsible for the health needs of a defined population, including GIDAs.

b. All families and individuals shall be assigned to a primary care provider in the SDN.

c. Gatekeeping mechanisms at the primary level of the SDN shall be strengthened.

d. Two-way referral mechanisms at all levels of the SDN shall be strengthened through an effective and efficient information, communication, and transport system.

c. Strategic Pillar 3: Regulation

i. Objective — The objective of the regulation pillar is to ensure high quality and affordable health products, devices, facilities and services.

ii. Sub-pillars and Key Interventions

1. Harmonize and streamline regulatory systems and processes

a. Mechanisms to streamline regulations through a one-stop-shop licensing, interagency data sharing, automation of systems and processes, regulatory impact assessments, and removal of overlaps and unnecessary regulatory requirements shall be established. ATICcS

b. Mandates and enforcement mechanisms to regulate health facilities, products and services, including emerging technologies, systems, and processes shall be expanded and strengthened.

c. Conflicts of interest among regulatory bureaus and their officers, staff, and consultants shall be reviewed and managed.

d. Third party accreditors shall be engaged to improve accountability and performance of health care providers.

e. Health regulations shall be harmonized, benchmarked, and made compliant with regional and international standards.

f. The public and consumers shall be informed and educated on the safety, quality, and prices of health goods and services.

2. Develop innovative regulatory mechanisms for equitable distribution of quality and affordable health goods and services

a. Regulation-specific capacity building and training shall be provided for the staff of regulatory bureaus and offices.

b. A national fee schedule to regulate prices of health goods and services shall be advocated and pursued.

c. Network licensing and network accreditation of health facilities shall be adopted.

d. Regulatory agencies shall apply risk and outcome-based regulation.

e. Regulatory measures on the production and distribution of HRH shall be advocated and pursued to ensure equity of distribution and access.

d. Strategic Pillar 4: Governance

i. Objective — The governance pillar aims to strengthen leadership and management capacities, coordination, and support mechanisms necessary to ensure functional, people-centered and participatory health systems.

ii. Sub-pillars and Key Interventions

1. Strengthen sectoral leadership and management

a. The DOH shall step up its leadership and stewardship role in the health sector through a stronger position on the social determinants of health and strategic oversight on policies that impact health.

b. Participatory governance shall be fostered in the health sector through community and patient engagements, public-private partnerships, and citizen's charters.

c. The DOH shall assess and prepare for possible shifts in governance structures that impact on the health sector (e.g.,federalism, re-nationalization, devolution, etc.).

d. Technical assistance from the DOH shall be consolidated and matched with the needs outlined in the Local Investment Plans for Health.

2. Improve organizational development and performance

a. Responsive organizational structure, staffing patterns and skill-mix shall be adopted at all levels of the health system.

b. Competency-based learning and development interventions linked to succession planning shall be implemented at all levels of the public health system.

3. Improve processes for procurement and supply chain management to ensure availability and quality of health commodities

a. Systems for planning, forecasting, coordination and determination of health goods and commodities shall be improved.

b. The entire procurement and logistics management system shall be strengthened to ensure timely delivery of health goods and commodities at all service points.

c. Electronic procurement and logistics IT system shall be institutionalized at all levels (e.g.,tagging of commodities with barcodes, QR codes). TIADCc

4. Ensure generation and use of evidence in health policy development, decision making, and program planning and implementation

a. A culture of research and evidence use shall be instilled in the DOH and its attached agencies.

b. The public shall be provided access to quality and timely research and health data in compliance with data access policies.

c. Regular surveys shall be commissioned and regular implementation reviews and impact evaluations of health-related laws and DOH programs and projects shall be conducted.

d. Regular submission of encoded clinical, administrative, and financial data shall be required for all health-related entities enabling the integration of public and private sector data.

e. Capacity for high quality evidence generation and appraisal shall be built in the health sector.

f. DOH officials and employees shall be provided access to international and local research and other publications.

g. Health technology assessment shall be institutionalized to inform policy and program development.

e. "PLUS":Performance Accountability across all Pillars

i. Objective — The objective of the Performance Accountability initiative is to use systems that would drive better execution of policies and programs in the DOH while ensuring responsibility to all stakeholders.

ii. Sub-pillars and Key Interventions

1. Institute transparency and accountability measures at all levels

a. Performance and reporting tools, systems, and processes shall be integrated to improve management of the health sector and DOH performance.

b. Performance accountabilities in all health programs, projects, and activities shall be fostered by identifying performance metrics and assigning units or individuals primarily responsible for the attainments of targets.

c. User-friendly scorecards and performance reports shall be published in easily accessible platforms.

d. Monitoring and evaluation of health sector performance shall be aligned and linked to the Philippine Development Plan, Sustainable Development Goals, and AmBisyon Natin 2040.

2. Shift to outcome-based management approach

a. Regular monitoring and performance reviews and assessments shall be conducted.

b. The mechanisms to link performance to incentives shall be improved by the DOH.

VI. IMPLEMENTING GUIDELINES

A. All DOH offices, units, hospitals, and attached agencies shall align their policies, programs, and activities to the F1 Plus for Health. Policies, programs and activities that are adherent to the F1 Plus for Health are to be leveled-up and enhanced. They shall advocate as well for the F1 Plus for Health to all stakeholders and partners.

B. All national government agencies/entities with funds and activities related to health, such as, but not limited to, the GSIS, PCSO, PAGCOR, PGH, hospitals of state universities and colleges, DepEd, DSWD, agencies under the Housing and Urban Development Coordinating Council, and DOLE, are strongly encouraged to align their policies, programs, and funds for health with the F1 Plus for Health.

C. The DOH shall use the Performance Governance System (PGS) along with other performance management systems such as Quality Management System, Integrity Management Program, and Strategic Performance Management System in ensuring the implementation of F1 Plus for Health. The DOH shall be proficient on the use of PGS by 2019 and be institutionalized by 2022.

D. The FOURmula One Plus for Health shall be supplemented by the National Objectives for Health, which shall provide the specific objectives, targets and strategies for each pillar. Performance Scorecards that are stratified to different levels shall also be developed to ensure accountability of all stakeholders in the implementation of F1 Plus for Health. AIDSTE

VII. REPEALING CLAUSE

All orders, rules, regulations, and other issuances inconsistent with or contrary to this Order are hereby repealed, amended, or modified accordingly. All provisions of existing issuances which are not affected by this Order shall remain valid and in effect. In the event that any provision or part of this Order is declared unauthorized or rendered invalid by any court of law or competent authority, those provisions or parts not affected by such declaration shall remain valid and in effect.

VIII. EFFECTIVITY

This Order shall take effect immediately.

(SGD.) FRANCISCO T. DUQUE III, MD, MScSecretary of Health