1. Policy Matrix for FOURmula One for Health Maylene Beltran MPA Director IV Health Policy Development and Planning Bureau

2. Background To support and sustain reform initiatives in the health sector, a policy agenda was defined in 2004 on : –Service Delivery Public Health Hospital – Regulation – Financing –Governance Local Health System

3. Background (2) Development of this agenda was leveraged through the ADB Health Sector Development Program loan signed by ADB and GOP on January 10, 2005 Loan provides for the amount of $200M for the GOP to be released in 2 tranches thru the DOF

4. Background (3) As of October 10, 2006, 46 policies/ guidelines/ plans have been completed

5. Major Policies A. Service Delivery Institutionalization of CQI Program in all DOH hospitals, and as basis for Philhealth Accreditation (AO No 2006-0002 / Philhealth Circular No. 12 2006) Establishment of Governing Boards to improve managerial capacity/ autonomy for public hospitals (AO NO. 2006-0007)

6. Service Delivery … Rationalizing the Health Care Delivery System based on Health Needs (AO NO. 2006-0029) Public-Private Collaboration as a strategy for the effective implementation of public health programs such as Reproductive Health (AO No. 2006-0020)

7. Major Policies B. Health Regulation Essential Drug Price Monitoring System is an effective strategy in regulating the prices of essential drugs and medicines in the country vis-à-vis the Drug Price Reference Index of Philhealth (AO No. 20006-0009) Systems and Procedures of the PNDF System as the basis for procurement of Drug Products by the Government (AO No 2006- 0018)

8. Health Regulation… Certificate of need as the basis for establishment of new hospitals (AO No. 2006-0004) Legislative Bill on amendments on the mandates of regulatory agencies to increase efficiency in health care provision

9. Major Policies C. Health Financing The Guidelines on Financing for F1 provides the framework for prioritizing funds for F1 investments anchored on budget reforms. It also serves as a reference for donor partners (AO NO. 2006-0017)

10. Health Financing … The PBB for both Public Health and Hospitals are new mechanisms for linking fund allocation and utilization of all priority public health programs and health facilities with specific outputs and outcomes (AO No 2006-0022 & 0027)

11. Major Policies D. Governance Assessment tool for Consumer Participation Strategies for F1 (AO. NO. 2006- 0020) Incentive Schemes for enhancing inter-LGU coordination and in ensuring sustainable operations (AO NO. 2006-0017 ) Legislative Bills on Inter Local Health Zone and creation of a National Health Planning Committee

12. Next Steps/Challenges Operationalization of the policies –Development of clear implementation guidelines –Design/ implementation of capacity building strategies –Advocacy to the LGUs and other partners Updating / harmonizing with other F1 related policies Development of a formal implementation monitoring scheme

13. Thank You

14. Accomplishments Health Care Financing Reforms (Complied) –inclusion of allocation for SS in 2006 –financing plan allocates subsidies SS in 2006 –market segmentation study on the informal sector –LGU monitoring and evaluation system of SS –designed information campaign (Premium) –performance report on the status of utilization of 10 CPG’s –expands PhilHealth Organized Groups Interface (POGI) for national implementation

15. Accomplishments Health Care Financing Reforms (Work in Progress) –New premium policy allowing progressive premium structure –Progressive premium contribution scheme based on individuals capacity to pay –Revised benefit package –Baseline Study on status of CPG use in accredited hospitals –Medium Term Plans for 2005-2012 including actuarial forecast on revenues and payments –Informal Sector develop MOA in all Health Sector Development Program (HSDP) provinces to implement POGI

16. Accomplishments Hospital Reforms (All Complied) –UMIS for pilot testing and MOA w/ selected hospitals –AO on implementation of CQI –PhilHealth endorses CQI as accreditation criteria for hospitals –AO to adopt a policy on governing boards of all public hospitals –Evaluation Report on progress and experience of corporatizing 2 selected DOH hospitals –AO to adopt performance-based allocation of national subsidies for 2006 –guideline on revenue retention for DOH hospitals

17. Accomplishments Hospital Reforms (All Complied) –Human Resource Assessment for 30% f DOH hospitals –AO to state a policy on rationalizing local public hospitals based on need –Provincial ordinances from 3 HSDP provinces authorizing their hospitals to earn, retain and use their income –AO to implement the public and private hospital waste management guidelines

18. Accomplishments Public Health Reforms (All Complied) –AO to adopt the revised expenditure targets for public health spending and hospital-based services –framework to establish long term performance-based budgeting for priority public health programs –bill for Congress review to institutionalize long-term performance- based budgeting for priority public health programs –revision of Philippine National Drug Formulary to include contraceptives (pills, injectibles and IUD’s) –AO on partnerships w/ the private sector for delivery of public health programs, specially TB and Family Planning –MOA on public-private partnerships on TB, Womens Health and Safe Motherhood

19. Accomplishments Health Regulation Reforms (All Complied) –Bill for Congress review proposing amendments of the mandates of DOH regulatory agencies to increase efficiency in health care provision –DOH and PHIC reviewed and updated administrative issuances and circulars on licensing and accreditation standards of health facilities –AO on certification mechanism for primary health care services providers based on service capacity and quality –AO and new regulations on drug management in order to reduce drug prices

20. Accomplishments Health Regulation Reforms (All Complied) –DOH and PHIC established a regularly updated and published drug price reference/monitoring system involving related public and private agencies, consumer organizations and the academe, among others –DOH and PHIC reviewed and issued Department Orders and Circulars in updating PNDF based on drug management needs of PHIC benefit packages and LGU’s

21. Accomplishments Local Health Systems Reforms (Complied) –DOH, PHIC and LGU’s approved a MOA w/c committed to: establish ILHZ’s enroll the poor in PHIC Indigency Program setting up of enrollment centers upgrade strategic health facilities to meet PHIC accreditation and licensing requirements and the DOH certification standards for RHU’s and BHS’s

22. Accomplishments Local Health Systems Reforms (Complied) –AO to approve incentive schemes supporting sustainable operations of ILHZ’s –Convert EO205 (1999) (that mandates DOH and DILG to form a National Health Planning Committee and the ILHZ) into a Republic Act, already submitted a draft plan to Congress for review –MOA to establish ILHZ in at least 3 of the 13 areas identified by DOH in the 5 project provinces –Licensing and accreditation of ILHZ as an integrated network including private health service providers (system accreditation)

23. Accomplishments Local Health Systems Reforms (Work in Progress) –ILHZ’s business plans in project provinces developed for 2006

24. Accomplishments Health Sector Governance (All Complied) –Approved a comprehensive plan for health human resource assessment and capacity development –first update of short and medium term plans for DOH and project provinces in support of HSRA implementation –developed, tested and approved a standard instrument for measuring the effectiveness of consumer participation –DOF and DOH shall submit a report on the investment in the health sector, including proceeds of the program loan in support of the HSRA and policy implementation

25. Next Steps

26. Challenges