ALBAY HEALTH STRATEGY Albay MDG Achievements

Story Line ALBAY HEALTH STRATEGY . Albay MDG Achievements towards SAFE AND SHARED . Albay Health Strategies DEVELOPMENT MDG – make it a MDG is all about goal, the rest follows dignity. Engaging dignity, Empoweri Governor Joey Sarte Salceda ng dignity Province of Albay Ennobling dignity

MDGs are achieved ahead of 2015 exc. MDG 2 and 7

Goal Indicator Bicol Region Albay Achievements on MDG, 2009 1 Poverty Incidence MH Proportion of 0 - 5 years old who are malnourished Subsistence Incidence HH 25 24% Underweight (IRS) HH 2 Participation - Elementary LM 22

Cohort survival - elementary ML 20 3 Gender parity - elementary HH 4 Under-five mortality HH 16 Infant mortality H H 15 Proportion of fully-immunized children MH 5 Maternal mortality rate LH Contraceptive prevalence rate LM 10 Condom use rate LM 6 Deaths due to TB LH Malaria positive cases HH 5 7 Household with access to sanitary toilets HL Household with access to safe drinking water HH 0 Legend: 1992 2009 L low probability H high probability M medium probability no data

Achievements on MDG, 2009 Achievements on MDG, 2009

Maternal Mortality Ratio Infant Mortality Rate 35 140 133 33

120 30

100 25 90/ 100,000 LB 80 20

60 59 15 17/1,000 LB 12 40 10

20 5

0 1998 2009 0 1998 2009

1 Achievements on MDG, 2009 Achievements on MDG, 2009 Proportion of births attended by skilled health personnel Proportion of facility-based deliveries 100 100 90 90 90 88 80% 80 80% 80 70 70 60 60 50 50 40 40 30 29 30 20

20 10

10 11 0 1998 2009 0 1998 2009

Achievements on MDG, 2009 Achievements on MDG, 2009 Contraceptive Prevalence Rate 65% Child Mortality Rate 30 35 28 27/1,000 LB 30 25 29

25 20 18 20 15

10 10 8 5 5

0 0 1990 2009 1998 2009

Achievements on MDG, 2009 Achievements on MDG Fully-Immunized Children 98 TB Mortality Rate 60

96 96

95% 50 94 •44/100,000 pop 92 40

30 88

86 86 20

84 10

80 0 1990 2009 1997 2009

2 ••AchievementsAchievements on MDG ••AchievementsAchievements on MDG

Case Detection Rate for TB Cure Rate for TB 120 90 •85% 80 100

80 60

•70% 50 60 40

40 30

20 10

0 0 1999 2009 1999 2009

••HealthHealth Outcomes Albay MDG Strategy

National National Performance Gaps/ Make MDG a goal Indicators Average (2006) Target (2010) ALBAY (2009) Gains Ordain policies and Give it a Budget Intensified Disease Prevention and Control: TB Execute programs and projects Mortality (per 100,000 28,000 44 26 (18) pop) Build institutions TB Case Detection 72 70 100 30 Nurture partnerships Rate, % (NTP Register)

TB Cure Rate, % 81 85 81 (4)

Albay Development Goal Vision 1. Shared development: operationally defined as:  Safe and shared development compliance with MDG and improvement in HDI.  Albay as most liveable province known for good Climate change and disaster risks are key education, good health and good environment obstacles to MDG and HDI. to secure safe and shared development 2. Safe development: Disaster risk reduction and  Vision for Health: longer life expectancy, climate act ion are bu ilt-ilin elements o fhf the centra l wellbeing in itself, wellbeing for labor productivity economic strategy, not a contingency plan. a. Disaster risk reduction is guided by Hyogo  Albayanos as healthy and happy, well-educated, Framework for Action well-trained b. Climate action is guided by UNFCCC.  Low-rise, low-carbon, low-energy intensity = green development model 3. Structural governance x safe development = shared economic growth.

3 Average annual losses to infrastructure and agriculture in 10 most vulnerable POVERTY AS AN INITIAL CONDITION IS A MAJOR provinces vs. their 2006 local calamity funds OBSTACLE TO HEALTH OUTCOMES

p Poverty Threshold (in Poverty Incidence Among Families (%) Magnitude of Poor Families Region/Province Pesos) Estimates (%) Coefficient of Variation Estimates Coefficient of Variation 2000 2003 2006 2000 2003 2006 2000 2003 2006 2000 2003 2006 2000 2003 2006

PHILIPPINES 11,458 12,309 15,057 27.5 24.4 26.9 1.6 1.3 1.3 4,146,663 4,022,695 4,677,305 1.6 1.4 1.3

Region V 11,375 12,379 15,015 45.3 40.6 41.8 4.2 3.6 3.5 407,176 383,625 422,278 4.7 4.3 4.3

Albay 12,144 12,915 16,128 40.3 34.4 37.8 11.5 8.1 8.4 83,398 76,200 88,676 11.2 8.5 10.1 Camarines Norte 11,505 12,727 14,854 52.7 46.1 38.4 10.9 14.4 18.8 50,670 44,874 39,421 11.8 14 22.6 Camarines Sur 11,054 11,873 14,634 40.8 40.1 41.2 9.3 7.0 5.6 120,762 121,936 134,599 11.8 7.7 6.6 Catanduanes* 11,587 11,815 13,654 43.9 31.8 37.3 10.9 10.3 22.1 18,541 13,604 16,999 10.4 29.3 33.3 •Albay poverty Masbate 11,019 12,504 14,248 61.3 55.9 51.0 5.8 5.7 6.5 83,660 81,804 80,512 5.9 7.4 8.0 incidence at Sorsogon 11,146 12,452 15,687 41.4 33.7 43.5 7.3 10.3 5.4 50,146 45,207 62,071 7.6 14.5 5.6 37.8%, while * Coefficient of Variation (CV) of 2006 poverty incidence is greater than 20% lowest in region, remains high

•19 •Source: World Bank

Objectives for Health, 2011 Net resource outflow to cities 1. To decrease maternal mortality ratio from 59/100,000 to 50/100,000. 2. To decrease infant mortality rate from 10/1,000 to 8/1,000. 3. To decrease child mortality rate from 18/1,000 to 15/1,000. 4. Increase FIC coverage from 84% to 88%. 5. To increase CPR from 33% to 40%.

•21

Objectives for Health, 2011 Objectives for Health, 2011 6. To increase voluntary blood donation to 1% of the provincial population. 12. To reduce the incidence of STI/HIV by 2% points annually. 7. To reduce soil-transmitted helminthiasis to below 50% among children. 13. To eliminate incidence of filaria to zero. 8. To reduce prevalence of malnutrition from 14. To increase multi drug administration for 19% to 17%. filariasis control by 2%. 9. To reduce TB mortality rate by 3%. 15. To reduce rabies incidence from 5/million population to 2.5/million population. 10. To sustain TB case detection at 90%. 11. To sustain TB cure rate at 85%.

4 Objectives for Health, 2011 Total Health Budget 2007 - 2010 16. To sustain leprosy prevalence at less than 24% of provincial 1/10,000 population. budget 180,000,000 161,373,128 17. To increase leprosy cure rate by 2%. 160,000,000 135,673,326 134,566,903 140,000,000

18. To reduce the mortalityyy and morbidity of 120, 000, 000 lifestyle-related diseases by 2% annually. 101,669,158 100,000,000

19. To increase proportion of HH with access to 80,000,000 safe drinking water from 94% to 95%. 60,000,000

40,000,000 20. To increase proportion of HH with sanitary toilets from 69% to 89%. 20,000,000 0 2007 2008 2009 2010 Source: PBO, Albay

Resources for Institutionalized MDG Office Albay MDG Supercom

• Program office: AMDGO – created by ordinance in 2009 with regular provincial budget – Oversight to MDG performance and secretariat to MDG Supercom – Management MDG projects • Managgpges relocation program • Social assets programs esp livelihood like SEA-K, ETODA • CRABS or coastal and marine resources management • AIDS Council – HIV/AIDS advocacy • Sources of Funds – Regular allocation from the annual provincial budget (IRA) – Intermittent but steady flow of technical and logistical assistance from NG agencies, UNDP and other UN offices, INGOs, NGOs for capacity building and skills training •2 •2

Provincial Initiatives Initiatives • 2011- P178m (exc PHIC) for health PS and MOOE essentially for hospital care and public Universal Phil Health Coverage: 2007-2010 health Number of Families Enrolled • Universal health coverage at P59m pa 173,262 •Acquisition of 57 ambulances 180,000 158,000 160,000 • 19 BeMoNCs 140,000 122,600 120,000 • Modernization of provincial hospitals: Ziga (80- 100,000 bed) and Duran (60-bed) 80,000 60,000 • Modernization of BRTTH (300-bed) 40,000 18,510 20,000

• Merger of BRTTH, Ziga and Duran into a 500- 0 2007 2008 2009 2010 bed capacity Source: PSWDO, Albay

5 •BRTTH: PHIC REIMBURSEMENT Ambulance Deployment FOR 2010 33% •RHUs & BEmONC •2 •Hospitals •2 54% •6

•2 •6 •2 •3 •1 13% HOSPITAL INCOME •4 •1 •2 MEDICINES •1 PHIC REIMBURSEMENTS •2 PROFESSIONAL FEE •2 •2 •4 •2 HOSPITAL INCOME 67,403,506.73 •4 •3 DRUGS AND •2 MEDICINES 16,929,387.25 BRTTH earns P127m •2 •1 •1 PROFESSIONAL from PHIC vs P59m FEES 42,339,658.00 by province TOTAL 126,672,551.98 •Source: PHO, Albay

Health Facilities: 15 BEmONCS Medical Mobile Assets •Hospitals •BEmONC

•RHUs/CHOs

•Source: PHO, Albay

JBDMH JBDMH

6 JBDMH JBDMH

ZIGA Memorial District Hospital ZDMH

ZDMH ZDMH

7 ZDMH ZDMH

ZDMH •2007 - Renovated under the B-CARE project

•BRTTH Main Building

•Salceda Wing / Philhealth/Surgery Ward •Out-Patient Department

•Emergency Room

8 •Maintenance Building •Laundry •Services Offered •Emergency Room •Trauma Unit

•Dorm •Isolation Ward

•Philhealth Ward •Surgery Ward

•OB-Gyne Ward •Private Ward •Delivery Room •CT Scan

•Pedia Ward •Medical Ward •Dialysis •ECG/EEG

•Cath Lab •2D Echo •CCU •ICU

•Ultrasoud •X-Ray •NICU •PICU

9 •Operating Room – Room 1 - 4 •Laboratory

Prov’l Gov’t of •Pharmacy Albay, project of •Electric Power Substation Gov. Joey Salceda

•Dietary •Pastoral

•Rehab Center •BRTTH and Beyond Establishment of Regional Oncology Center (P400m)

10 •Proposed Facilities Health Capital Expenditures Committed by Number of Amount Received Received by the Source Source (from Amount Utilized Recipient •1 . Waste and Infectious Treatment Plant•5. ER and Trauma Unit by the province province (in kind) AOP) Municipalities •2. Communicable Disease Building •6. Bicol Cancer Center PLGU 134,566,903.00 134,566,903.00 134,566,903.00 18 M/C LGUs M/C LGUs (15 •3. Extension of PHIC ward •7. Bicol Regional Blood Center 188,470,320.51 170,905,125.99 18 M/C LGUs MLGUs/ 3 CLGUs) •4. Diagnostic Center •8. Commercial Building EPI vaccines, Vit. DOH-regular fund 24,372,850.33 24,372,850.33 A, antihelminthics, 24,372,850.33 18 M/C LGUs TB drugs, Iron

DOH- special fund •7 >MNCHN 2,419,320.00 2,419,320.00 18 M/C LGUs •1 > start-up 2,000,000.00 2,000,000.00 18 M/C LGUs •2 > HEMS 9,100,000.00 9,100,000.00 18 M/C LGUs > Health Facilities •3 97,608,000.00 71,191,000.00 71,191,000.00 6 District Hospitals •8 Dev't/RAT Plan > Health Systems 2,000,000.00 2,000,000.00 18 M/C LGUs Dev't > RHU/BHS Facility 7,350,000.00 5,900,000.00 8 M/C LGUs Devt/Eqpt Others: Technical > USAID 134,823,414.00 18,600,000.00 18 M/C LGUs •4 assistance > AECID 43,000,000.00 24,000,000.00 24,000,000.00 9 M/C LGUs > capitation (for 18,473,296.71 5,000,000.00 18 M/C LGUs •6 •5 CSR + drugs) drugs, medicines & > PCSO 7,984,000.00 7,984,000.00 18 M/C LGUs ambulances TOTAL 630,191,487.84 296,107,370.04 460,439,199.32

AMDGO • Program office started as Ayuda Albay in 2007, renamed as Albay Mabuhay Task Force to manage the cluster approach to Reming rehabilitation • Reorganized in June 2009 as Albay Millenium Development Office or AMDGO to (a) monitor and oversiggpg()ht MDG progress (b) coordinate MDG programs within functional units and program offices of the provincial government and with NGAs, NGOs and INGOs and (c) manage social assets program of the province including SEA-K, E-TODA • Staff complement of 15 personnel with a senior staff (rank Assistant Department Head) • 2010 organic budget of P2m. for Listening

Strategies on Maternal Health Care Strategies on Maternal Health Care 1. Formulation of the PIPH. (Province-wide Investment Plan for Health) inc MNCHN 3. Maternal Deaths Review (Maternal, Newborn and Child Health Care) • Reviews maternal deaths • Give recommendation and feedback to LGUs with Program maternal deaths 2. Advocacy Campaign: Birth Plan/FBD by Skilled • Maternal death reporting Health Worker • Bench Conferences 4. Facility based deliveries (FBD): • Buntis Congress • Barangay Health Stations • Buntis Pageant • Lying-In Clinics • IPCC (Interpersonal Communication and Counseling) • Birthing homes Training of Health Personnel and BHW’s on MNCHN • Mothers’ Classes • Rural Health Units • Radio announcement/ plugging • Hospitals (public or private) • Health Education Classes • Establishment of breastfeeding stations in private and 5. REB (Reaching Every Barangay) government institutions including evacuation centers

11 Strategies on Maternal Health Care Strategies on Maternal Health Care 6. Rationalization planning and health facility mapping 8. Capacity building • • Upgrading of CEMONC facilities. (Comprehensive NBS training (Newborn Screening) • Emergency Obstetric and Newborn Care) ENC training (Essential Newborn Care) • • Construction of BEMONC facilities. (Basic Emergency LSS training (Life-Saving Skills) • Obstetric and Newborn Care) BEMONC training (Basic Emergency Obstetric and • Hiring of Staff Complement to fill up vacancies and/or NbNewborn Care ) • augment personnel WHT training (Women’s Health Team) • CMMNC training (Community-Managed Maternal and 7. Organization of Women’s Health Teams in every Newborn Care) barangay: • Pregnancy tracking & birth planning 9. Sustain Universal Phil Health • Reporting of maternal deaths Enrollment/Coverage • Referral of pregnant women to deliver at health facility • Stewardship to the family of the pregnant mother

Strategies on Family Planning Strategies on Maternal Health Care 1. Establish a system of monitoring FP users with 10. MCP Accreditation of LGU’s birthing facilities private providers and other stakeholders (Maternity Care Package) • inventory of FP private providers & other stakeholders in the municipality/ city • conduct one day orientation to identified FP private 11. Enact ordinances on FBD and User’s Fee providers & other stakeholders

12. Sustain MBDs (Mass Blood Donation) 2. Validation of current FP users (data cleaning) in all LGUs. 3. Review/assess CDLMIS of LGUs (Contraceptive Distribution, Logistics, Management Information System)

Strategies on Family Planning Strategies on Family Planning

4. Planning workshop to draft plan to 6. Provision of FP Commodities • Targeting, costing and forecasting FP commodities operationalize modified CDLMIS requirements based on validated current users • Procurement and Provision of 50% of FP commodities 5. Capacity Building requirements (Pills, DMPA, Condom, NFP to LGUs • FP-Competency-based training • Provision of medicines and supplies for BTL & NSV to • NSV Training ( non scalpel vasectomy ) District Hospitals providing surgical sterilization BTL Training ( bilateral tubal ligation) • Training on FP Counseling for health personnel • Training of health personnel on IPCC

12 Strategies on Family Planning Strategies on Family Planning

7. Intensify and Improve FP Promotion and 8. Enactment of CSR+ Ordinance (Commodities Education Integration of FP in EPI (Expanded Self Reliance) Program on Immunization) • Advocacy with the LCEs/SBs for CSR+ ordinance • Conduct regular RPM ( Responsible Parenting • One day orientation with LCEs, MHOs, LFC re: Movement) formulation, CSR implementation and drafting of • CdtConduct regu lAHYD(Adllar AHYD (Adolescen tHlthdYth)t Health and Youth) CSR+ ordinance Development) classes in high schools • Training of SB/SP Committee on Health on Evidence- • Conduct regular PMC (Pre-Marital Counseling) based legislation • Conduct FP counseling to new acceptors and follow- • Present proposal to the PHB and seek SP Committee up by BHWs of FP current users & defaulters on Health Chair’s sponsorship • Conduct ICV (Informed Choice and Volunteerism) • Strengthen 2-way referral system for FP (BTL-NSV- • Conduct Men’s Congress (Usapang Macho) IUD) Provision of referral form

Strategies on Family Planning Strategies on Nutrition Program

9. Monitoring and Supervision 1. Operation Timbang (OPT) • Regular visits to 18 LGUs monthly • Identification of malnourished children thru mass • Revisit CSR Plans weighing of 0-71 mos. old children • Collection, recording and reporting of FP activities through FHSIS (Field Health Services Information 2. Micronutrient supplementation System) • Provision of Vitamin A capsules & iron supplementation to: a. infants b. preschool children c. pregnant women d. lactating women e. sick children

Strategies on Nutrition Program Strategies on Nutrition Program

3. Food Fortification 6. Accelerated Hunger Mitigation Program • Monitoring of fortified food products in the markets, • Milk feeding (tie up with NDA) sari-sari stores, groceries & household utilization of • Supplemental feeding iodized salts • Distribution of growth monitoring charts • Pabasa sa Nutrisyon Classes 4. Local Level Nutrition Program Implementation • Promotion of child rearing practices during GP •Local Plan of Action for Nutrition at the municipal and • Distribution of IEC materials barangay level • Feeding during disasters • Breastfeeding initiatives 5. Capacity building • IYCF Infant and Young Child Feeding 7. Monitoring and supervision • CGS (Child Growth Standard)

13 Strategic Imperatives . Policies . Institutions Other Provincial . Public-Private Partnerships Initiatives . Resources . Champion

Initiatives Initiatives B. Safe Hospitals:

A. Beneficiary-led Procurement :  Upgrading of structures and equipment of Provincial Hospital System  Universal Phil Health Coverage: 2007-2010  Modernization of the Bicol Regional Teaching and Training Hospital [BRTTH] Universal Anti-Rabies Immunization  Rationalization Plan & Health Facility Mapping

 Establishment of BEMONC/CEMONC facilities

 Merging of district and regional hospitals

Initiatives Initiatives C. Partnership with NGOs: D. Partnerships with LGUs:  Health Program Management (USAID, PTSI, Intervida, MIDAS, WHSMP2, CSCDI)  Inter-local Health Zones [ILHZ]

 Health Promotion (PRRM, PBSP)  Commodity Self-Reliance Strategy [CSR]

 Discounted Medicines (Pfizer, RNMD)  Botika ng Barangays [BnBs]

 Health Infrastructure (AECID, PODER, WHSMP2)

14 Initiatives Initiatives E. Disaster Risk Management - Health: Ambulance Project: Provision of Preemptive Health Care – Medical Missions ambulances (57) to: targeted at APSEMO identified vulnerable areas  Provincial Hospital System Albay Health Emergency Management [AHEM]  Rural Health Units &C& City Health Offices • Emergency Paramedic Training Unit  Basic Emergency Obstetrical and Newborn [EPTU] – in cooperation with the Bicol Care Facilities University [BU], BRTTH &n DOH • Operation Centers [OPCEN] in all three  Operation Centers districts  Geographically-Isolated and • Evacuation Camp Management Disadvantaged Areas [GIDA]

Strategic Priorities: Strategic Priorities: Public Health Hospital Strategic Priorities Funding Gaps Strategic Priorities Funding Gaps Health Care Waste Management 40 M Merging of ZMDH and JBDMDH 200 M under BOT to BRTTH Establishment of another 9 45 M Upgrading of PDMDH and PDH 50 M BEMONC facilities into a secondary (inc. safe Renovation of 30 BHS 15 M hospitals) Establishment of PhilHealth Desks 2 M Conversion of VMH into a 5 M Birthing Home Capacity Building 10 M Modernization of BRTTH: 240 M Provision of Sanitary Toilet 40 M Oncology Center under BOT Strengthening of Public Health 30 M TOTAL 495 M Program Management GRAND TOTAL 677 M TOTAL 182 M

MEET Albay MEET Albay EDUCATIONAL MEDICAL ECO-CULTURAL TOURISM VISION Bicol University Bicol Regional Albay as prime Albay as hub to as first class Training and destination for culture tourist  Medical higher education Teaching Hospital and nature destinations of institution as wellness Bicol . BRTTH modernization Center SUPPLY Bicol University Province to Magayon Festival Southern Luzon SIDE modernization gatekeep thru International  Educational facilities Albay History Project Airport Bicol University upgrading School of Mayon Resort House Pantao Port . Bicol University modernization MdiiMedicine Bicol U ni versit y Ligñon Hills Medical Center Albay Donsol Mayon Trek Access Roads  Eco-cultural Tourism Wildlife Park Andaya Highway DEMAND AHECS Universal SIDE PhilHealth . Magayon Festival Seek more scholarship funds  Infrastructure Development for Albay studies Responsible Bicol University DOH/BRTTH DOT/NCCA DOTC, PPA Agencies . Transportation facilities by National Government EQUAL PHO PTCAO/ACAC PPDO, PEO . Tourism facilities by private sector AHECS – Albay Higher Education Contribution Scheme EQUAL – Education Quality for Albayanos

15 Health Sector Reform Framework Goal for Health Sector

. Service Delivery Health for All

. Governance Capacity Building for: . BttBetter hea lth ou tcomes . Regulation . More responsive health system . Equitable health care financing . Health Care Financing Opportunity-seeking for: . Medical tourism

for Listening