DOH soups up "Fourmula 1"
Health-care financing, regulations, governance, and service delivery make up the four wheels of reform agenda for the health sector
By Grace Roxas, Contributing Writer
With new legislation in the pipeline and accords with cooperative local government units (LGUs), the Department of Health (DOH) hopes to fuel up its "Fourmula 1" initiative, said to be a more realistic reformatting of the original health-sector reform agenda instituted under the Estrada administration.
"When we started the reform agenda in 2000, we were too ambitious with targets, and so we've learned from that experience. The concept is still there but we are implementing it in more bite-size portions," said Dr. Maria Soledad Antonio, DOH chief legislative liaison.
She disclosed that the department has endorsed a number of bills to Congress to institutionalize specific measures under the reform initiative that runs on four wheels: health-care financing, regulations, governance, and service delivery. It has also entered into special agreements with LGUs that have shown willingness and flexed some muscles in meeting goals under the initiative.
The department seeks immediate congressional approval to turn three DOH-retained hospitals, deemed ready to stand on their own, into corporations. These are the East Avenue Medical Center, Quirino Memorial Medical Center, and the Ilocos Training Hospital.
"We need the corporatization bills because if you are a corporation, you have a charter of your own. Mas matindi ang ngipin," Antonio explained. Even local-government hospitals are encouraged to become independently solvent. Antonio cited the case of a La Union regional hospital that was corporatized by the 12th Congress.
The corporatization move falls in with the goal to enforce a performance-based regime for assisting government hospitals and other DOH-aided entities. Corollary to this, Antonio said that since 2002, the department has been asking Congress to put in a provision in the General Appropriations Act that will allow DOH-retained hospitals to retain their income and use it to improve services instead of remitting it to the national treasury.
"We are injecting a performance-based approach to assistance because the historical budget was so inefficient. We need to have better public-finance management and this includes a performance-based system," Antonio said.
DOH also hopes to pose quasicompetition in the market between public and private hospitals, if only to help control the cost of medical services. At the same time, public hospitals will still be guided by their social responsibility as government entities.
Underperforming government hospitals will be assisted in building up their capabilities. "They have to learn from other hospitals who are performing better than them. DOH will provide technical assistance which is really its forte as a national government agency," she added.
Income retention for service improvement by regulatory agencies such as the Bureau of Food and Drugs and the Bureau of Health Facilities is also a major spoke of three regulatory bills pending with Congress. The bills also provide for quasijudicial powers for the concerned agencies to put more teeth into their enforcement activities.
The department is eyeing the legislative route as well to effectively set up the so-called "inter-local-government health zones," a vehicle to carry out reforms in the local-government health systems within a devolved setting.
"After decentralization, we have fragmented services. Not all LGUs can stand on their own. Merong magaling, kaya lang with only three years in their term, [local officials are] not motivated to invest in health because if you invest in health, you can see the impact only after five to 10 years," Antonio noted.
While the legislative mill is rolling, partnerships have been formed with 16 provinces whose leaderships have shown the right political will, and have agreed to give a counterpart fund of at least 10 percent of what the national government and foreign donors can provide.
These LGUs should also be currently implementing programs cascaded by DOH in their areas, especially those geared to preventive and promotive health, and their performance will be monitored through a scorecard.
Antonio noted that most of the 16 LGUs tend to be the more progressive provinces-a turnaround from the erstwhile approach of helping the poorest of the poor first-but that they intend the reforms to snowball in a programmed way.
"We cannot go national on these reforms and help all the provinces due to limited resources. We have to prioritize. The national government will help the eldest child that can stand on his own and then, pag nakatayo na sya, saka tutulong sa iba namang mga kapatid," she added.
National health expenditures in 2003 totaled PhP136 billion, representing 2.9 percent of the gross national product, but still way below the five percent set by the World Health Organization.
Making devolution work
DOH is looking at each province as a convergence site for the four wheels of the Fourmula 1 initiative. Other systemic changes and enhancements not necessarily within the purview of further legislation have been articulated.
Antonio observed that under health-care financing, the goal of shifting the source of funding from out-of-pocket to health insurance not only entails expanding membership but enhancing the benefit package to entice members. A big chunk of the 2003 national health expenditure (44 percent) was generated out-of-pocket, although on a positive note, the contributions of local governments and the social health insurance were also increasing.
For service delivery, the government hopes to leverage existing LGU partnerships to correct disease-focused spending reflected by the 75 percent share of personal health in the national expenditure pie.
A national health-facilities development plan will rationalize facilities and services as well as integrate wellness services for all hospitals in the 16 sites partnering with DOH. The plan will also encompass improved disaster and epidemic management system through better surveillance.
A public-health development plan includes identifying "disease-free zones" to mop up infectious diseases such as leprosy, schistosomiasis, filariasis, malaria, and rabies and intensifying existing national disease programs for vaccine-preventable diseases, tuberculosis, HIV-AIDS, and emerging infections.
Antonio noted that although the health sector is doing better in general, the country now suffers from a double burden of diseases, infectious and degenerative, in equal measures. "Even though we have all the paraphernalia to eliminate infectious diseases, we cannot. And humahabol pa ang degenerative diseases and emerging health risks like those caused by natural calamities."
Improving reproductive-health outcomes (i.e. mortality rates for infants, children under five, and mothers) and intensifying healthy-lifestyle promotion are the two other arms of the public-health plan. A new foundation might be established to spearhead national health promotion.
Aside from upgrading the capacity and quality standards of government agencies, the health-regulation wheel of Fourmula 1 will also concern itself with developing an efficient drug-management system to improve the public's access to low-priced essential drugs via the existing Botika ng Barangay/Pharma 50 projects.
As part of governance, there will be a shift in the terms of engagement with foreign funding agencies wherein the government will have a more active say in the parameters of assistance through a sectoral development approach.
The establishment of four-in-one convergence sites will involve a rationalized tack toward health delivery, health-investment planning, development of governance structures for inter-local-government health zones, mobilization of extrabudgetary resources for health services, and linking local health policies with national programs and financing.
Improving management support systems through a human-resources-development master plan to address needs at the national and local health level, the upcoming Philippine health-information system, monitoring/evaluation, logistics, procurement, and financial management will also fall under governance concerns.
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