|Status of Implementation Progress (Outputs, Activities, and Issues)
The project consisted of six outputs implemented through two funding streams. DOH financed consultancy and capacity building activities and investment to support the health sector reform agenda. MDFO financed civil works activities undertaken by participating provinces in terms of upgrading health facilities.
(i) Health Financing Reform the project developed and implemented both at national and local level an increase in membership coverage and utilization of PhilHealth benefits, information campaign, especially targeting the poor. At project completion there was (i) an increase in the health budget of participating provinces, however only a minimum increase in the percentage share of the provincial budget; (ii) an increased awareness in the National Health Insurance Program among the households in the participating provinces; and (iii) although there was a decrease in the number in PhilHealth sponsored membership but the percentage coverage vis-a-vis population of poor households exceeded 100% in the participating provinces. Utilization of benefits remains an issue.
(ii) Hospital Reform HSDP supported the construction and upgrading of health facilities. At completion, (i) the project upgraded 8 health facilities. 5 in Ilocos Norte (Nueva Era RHU, Dingras RHU, Dingras District Hospital; Bangui District Hospital; Gen. Roque B. Ablan Sr. Memorial Hospital and 3 in Oriental Mindoro (Pinamalayan District Hospital, Roxas District Hospital Oriental Mindoro Provincial Hospital), consisting of 4 district hospitals, 2 rural health units, and 2 provincial hospitals, and 3 DOH retained hospitals(Batangas Medical Center, Batangas, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte and Veterans Regional Hospital, Nueva Vizcaya. Cvil works included construction of obstetric ward, emergency room, private wing, and others, and are fully operational. However, there are design problems in terms of space, location of services, and also quality problems of fixtures, floors and doors. Overall quality of civil works appears good; (ii) procured various medical equipment amounting to $2.2 million for the 3 DOH retained hospital to improve the quality of maternal and child health services and emergency care, and enhance hospital operations. There was no change in the proportion of public hospitals with existing governing boards, however there was an increase in public hospitals with existing policy on hospital autonomy. With regard to the proportion of public hospitals/municipalities with a management information system (MIS), the project achieved an increase but lower than expected. It was however noted that RHUs and CHOs have an existing Field Health Service Information System that function as the MIS.
(iii) Public Health Reform the project reviewed, developed and implemented social marketing and advocacy plans. It has also developed guidelines for planning and managing health programs for indigenous communities. It was noted that the proportion of LGU spending on health allocated to public health reform programs and activities, showed a decrease or no change at all; some eligible RHU staff were trained on management guidelines while a number of all eligible hospital staff were trained on clinical procedure guidelines (CPGs).
(iv) Regulatory Reform - HSDP supported the approval of DOH AO No 2011-09 (National Pharmacovigilance Program) which outlines the general and specific guidelines on the implementation arrangements, identification of concerned government agencies to be involved and their respective responsibilities. It also facilitated the localization of some regulatory laws such as health codes, facility based delivery, newborn screening and accreditation of health facilities at LGU level. At completion, PhilHealth accreditation for OPB, MCP and TB-DOTS of sample RHUs increased.
(v) Local Health System Reform there was limited progress achieved under this component. The basic overall functionality of ILHZs in the project provinces existed only in name where structural pre-requisites dominated over functional components. The indicator on ILHZs having a formal referral system is the same from 2007 to 2011. There was an increase in the public-private partnerships in project provinces.
(vi) Health Sector Governance HSDP supported the development of two resource and learning centers in DOH. The Resource Center for Health Systems Development (RCHSD) has been operational since 2009 as the main resource center. It initiated various capacity building and knowledge sharing activities such as health expenditure tracking system, burden of illness and economic evaluation of diseases, standards of health and human rights-based approach, and performance governance system to strengthen capacity to support health sector reform implementation. It was noted that policies on accountability were already built in other agencies' guidelines such as Commission on Audit and Civil Service Commission. On the development of HSIS, there was no change for both the project and control provinces but both achieved the target of having at least one HSIS developed to improve the reliability of health data .