The Philippines: Strategic Purchasing Strategies and Early Results
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The Philippines: Strategic purchasing strategies and early results THE PHILIPPINES COUNTRY TEAM JANUARY 2020 PROJECT OVERVIEW •An investment by the Bill & Melinda Gates Foundation (BMGF) implemented by ThinkWell SP4PHC with country learning partners •Project duration from 2017 to 2022 •Leverage strategic purchasing to improve primary healthcare (PHC) delivery in 5 countries, with a focus on family planning (FP) and maternal, newborn and child health (MNCH) Our Goal •Facilitate learning on strategic purchasing for PHC, FP and MNCH -- and the application of that learning to policy and practice -- at the national and global levels Burkina Faso The Philippines Indonesia Uganda Kenya 2 PROJECT INCEPTION TO IMPLEMENTATION EXPLORING LANDSCAPE DESIGN STRATEGIES COUNTY-LED In each country, We developed project IMPLEMENTATION ThinkWell conducted a strategies based on an We commenced rapid review of the understanding of implementation landscape, meeting with current challenges and following agreement a range of stakeholders critical opportunities with country and partners to with respect to strategic stakeholders and BMGF. understand the context. purchasing for PHC, FP and MNCH. 3 OUR APPROACH TO IMPLEMENTING THE SP4PHC PROJECT Country-based support Build local teams to Analytics support purchasing reforms Engage local research Policy dialogue organizations to Facilitate discussions Testing solutions undertake targeted between key Where appropriate, analytics Co-design, test, and embed technical stakeholders to advocate for adoption experts within key identify current of evidenced-based purchasing challenges and Track performance approaches to institutions at through M&E explore potential solutions strengthen national and local activities purchasing schemes level Network policy Partner with other makers, researchers, BMGF grantees and practitioners and development other stakeholders at agencies the national and global levels 4 DECK OBJECTIVES 1 Review the context in the Philippines in terms of strategic purchasing for PHC, FP and MNCH 2 Summarize key SP4PHC strategies 3 Showcase key results and findings to date 5 SECTION 2 SUBHEAD IN HERE IF REQUIRED The Philippines: Country Context ABOUT THE PHILIPPINES Indicator Value (2018) Total population (million) 106.7 Population growth (annual %) 1.4 Population ages 0-14 (% of total) 31.0 Population ages 15-64 (% of total) 63.9 Population ages 65 and above (% of total) 5.1 GDP growth (annual %) 6.2 GDP per capita, PPP (current international 9546.5 $) Poverty headcount ratio at national 21.6 poverty lines (% of population) (2015)* Source: World Bank Open Data, *Philippine Statistics Authority 7 COUNTRY HEALTH EXPENDITURE (CHE) Total Health Expenditure (2018): PhP 799.1B (15.6B USD) CHE Distribution among Health Care Providers Government Others hospitals 16% 21% Retailers 27% Private hospitals 22% Government Private clinics health centers 9% 5% Source: 2018 National Health Accounts 8 ORGANIZATION OF SERVICE DELIVERY IN THE PHILIPPINES . The Department of Health (DOH) is responsible for policy development, regulation of services, setting standards and guidelines for health, and providing highly specialized and tertiary-level hospital services . Local Government Units – provincial, city and municipal governments – are responsible for managing and implementing local health programs and services. Organizational structure showing the health offices Health facilities, 2016 devolved to local government units Government Private hospitals, 434 hospitals, 790 Rural health units, 2,587 Barangay health stations, 20,216 Source: Dayrit et. al 2018 9 PURCHASING LANDSCAPE IN THE PHILIPPINES . PhilHealth, the social health insurance program run by the government, accounts for approximately 13% of health spending in the Philippines, covering 92% of the population. PhilHealth purchases comprehensive hospital-level services and an expanding package of PHC benefits. Current health expenditure by financing scheme, 2018 …select PHC services from public sector Voluntary health facilities through capitation care payment arrangement. schemes 12% Government PhilHealth schemes and Household out- purchases…. compulsory of-pocket contributory payment health financing 54% …a comprehensive set of FP, maternity, schemes delivery and postnatal services from 34% public and private facilities (case-based payment). 10 Source: Philippines NHA 2018 A UNIQUE OPPORTUNITY: PHILIPPINE UHC LAW 2019 (RA 11223) ISSUES UHC LAW GOALS of UHC Confusing membership Guaranteed PhilHealth Every schemes Membership for all Filipino… Effective & well-resourced Poor prioritization of public …is prevented from health programs public health programs being sick. Overburdened RHUs, doing Primary Care Provider Health Promotion both primary care & PH for each Filipino Lack & misdistribution of HC Enough, competent …is managed well Professionals Health Professionals if sick, which means: Few resources & incentives Good, adequate facilities to improve facilities • Seen by an HCP • Seen at a facility Sustainable supply of Procurement failures, • Treated sufficiently High prices of medicines quality Medicines • Provided meds Unreliable, disconnected Reliable referral network Responsiveness referral networks that is easy to navigate Devolved health systems Effective planning, …with Good health have limited resources & leadership & technical know-how outcomes monitoring So much money, weak purchasing power Government as strategic …and protected purchaser of affordable, financially from High out of pocket despite quality services High health expenditures being poor 11 A UNIQUE OPPORTUNITY: PHILIPPINE UHC LAW 2019 (RA 11223) INTEGRATION UHC LAW GOALS of UHC ConfusingSIMPLIFIED membership Guaranteed PhilHealth Every Membershipschemes Types Membership for all Filipino… Effective & well-resourced ProvincialPoor prioritization Synergy of publicin the …is prevented from health programs public health programs Delivery of PH Services being sick. PUBLIC HEALTH Overburdened RHUs, doing Primary Care Provider INTEGRATION Health Promotion both primary care & PH for each Filipino Lack & misdistribution of HC Province-wide Health Enough, competent …is managed well Professionals Health Professionals Care Provider Networks if sick, which means: open to private sector Few resources & incentives Good, adequate facilities to improveparticipation facilities • Seen by an HCP • Seen at a facility CLINICAL INTEGRATION Sustainable supply of Procurement failures, • Treated sufficiently High prices of medicines quality Medicines • Provided meds Provincialize health Unreliable, disconnected Reliable referral network Responsiveness systemsreferral leadership networks and administration that is easy to navigate DevolvedMANAGERIAL health systems Effective planning, …with Good health haveINTEGRATION limited resources & leadership & technical know-how outcomes monitoring PoolingSo much of money money, into a weak purchasing power Government as strategic …and protected Special Health Fund purchaser of affordable, financially from FINANCIALHigh out of pocketINTEGRATION despite quality services High health expenditures being poor 12 FAMILY PLANNING IN THE PHILIPPINES: OUTCOMES SHOW INEQUITIES AND LAG BEHIND ASIAN COUNTRIES . Use of modern contraceptive methods among married women increased between 1993 and 2018. The modern contraceptive prevalence rate (mCPR) in the Philippines is lower than the average for Asia in 2018. Total fertility rate declines as women’s education and wealth increases. Total fertility rate 4.3 3.2 2.6 2.1 1.7 Number of of children Number Lowest Second Middle Fourth Highest Poorest → Wealthiest Source: Philippines DHS 2017 Source: FP2020 Annual Report 2016 – 2017, “The Way Ahead” 13 FAMILY PLANNING IN THE PHILIPPINES: SERVICE DELIVERY IS HEAVILY PUBLIC AND SARC-ORIENTED . The Philippines has a relatively imbalanced method mix, with a preference for short acting reversible contraceptives. More than half of the modern methods are provided through an overburdened public sector. Barangay health stations are the most common public sector sources for contraception with 25% of users obtaining their method from this source, primarily injectable. Pharmacies are the main private providers of contraceptives, serving 30% of users, primarily with pills and condoms. Method mix (modern methods), 2017 Sterilization (female) 7.4% IUD 3.5% Injection 5.0% Pill 20.9% Condom (male) 1.7% Implant 1.1% Other modern method 0.6% Source: Philippines DHS 2017 Source: Philippines DHS 2017 14 FAMILY PLANNING IN THE PHILIPPINES: LIMITED FP OPTIONS FOR POOR WOMEN • PhilHealth’s FP packages open access for poor women to Service Case Rate Approved Location Approved Provider long-acting and permanent contraception (LARCs) Bilateral tubal ligation 4,000 PhP ($77 USD) Hospitals and Physicians ambulatory surgical • Offered as an adjunct service package for eligible birthing clinics (ASCs) homes already accredited by PhilHealth’s Maternal Care No-scalpel vasectomy 4,000 PHP Hospitals and ASCs Physicians Package (MCP) Intrauterine devices 2,000 PhP ($39 USD) Hospitals, ASCs, Rural Physicians, midwives, Health Units (RHUs), and nurses • However, only 18.5% (355 out of 3159) of birthing homes Birthing Homes, Free- (both public and private) are accredited by PhilHealth to Standing FP Clinics provide FP services (that is one PhilHealth accredited facility Subdermal implants 3,000 PhP ($58 USD) Hospitals, ASCs, RHUs, Physicians, midwives, and nurses to offer FP for every 20,000 women of reproductive age). Birthing Homes,