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(HSRA) Implementation Progress January 2003 A Review of the Health Sector Reform Agenda (HSRA) Implementation Progress Orville Solon, Carlo Panelo, and Edwin Gumafelix This study was funded by the U.S. Agency for International Development (USAID) under the terms of Contract No. HRN-I-00-98-00033-00 Delivery Order No. 804. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID. Contents Contents…………………………………………………………………………………. i Tables……………………………………………………………………………………. ii Box………………………………………………………………………………………. iii Acronyms………………………………………………………………………………... iv Acknowledgments……………………………………………………………………….. vi Overview………………………………………………………………………………... 1 Section 1 HSRA and Its Implementation Strategy……………………………………………… 3 Section 2 Progress in Convergence Site Development………………………………………….. 7 Section 3 Progress in Off-site Reforms…………………………………………………………... 13 1. DOH Hospitals…………………………………………………………………… 13 2. Public Health Programs………………………………………………………….. 16 3. Health Regulation………………………………………………………………... 19 4. National Health Insurance Program ……………………………………………... 21 Section 4 Progress in Crosscutting Reform Activities…………………………………………... 25 Section 5 Summary of the Progress of HSRA Implementation………………………………... 29 Section 6 Recommendations for Future Implementation of Activities………………………… 35 Annex A Summary of HSRA Implementation Progress in the Eight Primary Convergence Sites……………………………………………………………………………………… 39 A Review of the HSRA Implementation Progress i Tables Table 1. Number of convergence sites, by targets and accomplishments……………. 7 Table 2. Desired outcomes and critical activities, by specific concerns, in convergence sites…………………………………………………………… 9 Table 3. Best practices in convergence site development……………………………. 12 Table 4. Accomplishments in DOH hospital reforms………………………………... 14 Table 5. Target and actual number of public health facilities for critical upgrading… 15 Table 6a. DOH budget allocation by type of service (in billion pesos), 1999-2003…. 16 Table 6b. DOH budget share (in per cent), by type of service, 1999-2003…………... 16 Table 7. Number of cases screened for TB, by region, 1996-2001………………….. 18 Table 8. Target outcomes and accomplishments for NHIP reforms…………………. 22 Table 9. Status of critical activities for NHIP reforms………………………………. 24 Table 10. Status of critical activities for crosscutting reforms……………………….. 26 Table 11. Status of HSRA bills in the Philippine Senate and House of Representatives……………………………………………………………... 28 Table 12. Summary of HSRA implementation progress……………………………… 29 Table 13. Reasons why HSRA targets are not met, as perceived by DOH regional directors……………………………………………………………………... 31 Table 14. Bases for setting CHD budget perceived as appropriate by DOH regional directors……………………………………………………………………... 34 Annex Table 1. Progress in convergence site development in Pangasinan…………………. 39 Annex Table 2. Progress in convergence site development in Capiz……………………….. 40 Annex Table 3. Progress in convergence site development in Bulacan…………………….. 41 Annex Table 4. Progress in convergence site development in South Cotabato……………... 42 Annex Table 5. Progress in convergence site development in Negros Oriental…………….. 43 Annex Table 6. Progress in convergence site development in Misamis Occidental………... 44 A Review of the HSRA Implementation Progress ii Annex Table 7. Progress in convergence site development in Pasay City………………….. 45 Annex Table 8. Progress in convergence site development in Nueva Vizcaya……………... 46 Box Box 1. Primary and expansion convergence sites………………………………….. 7 A Review of the HSRA Implementation Progress iii Acronyms AO administrative order BFAD Bureau of Food and Drugs BHDT Bureau of Health Devices and Technology BHFS Bureau of Health Facilities and Services BHW barangay (village) health worker BLHD Bureau of Local Health Development BnB botika ng barangay (village drugstore) BPS Bureau of Product Standards BQIHS Bureau of Quarantine and International Health Surveillance CDD Control of Diarrheal Diseases Program cGMP current good manufacturing practice CHD Center for Health Development CO central office CPG clinical practice guidelines DAR Department of Agrarian Reform DBM Department of Budget and Management DOF Department of Finance DOH Department of Health DOLE Department of Labor and Employment DOTS directly observed treatment, short course DSWD Department of Social Welfare and Development EO executive order EPI Expanded Program on Immunization GMA Greater Medicare Access HB House Bill HFDP Health Finance Development Project HP health passport HPDPB Health Policy Development and Planning Bureau HSRA Health Sector Reform Agenda ILHZ Inter-local Health Zone IPP Individually-Paying Program IT information technology ITRMC Ilocos Training and Regional Medical Center LGU local government unit LHAD Local Health Assistance Division MEWAP Malaria Eradication Workers Association of the Philippines MOA memorandum of agreement MSH-HSRTAP Management Sciences for Health – Health Sector Reform Technical Assistance Project MSW medical social worker NCDPC National Center for Disease Prevention and Control NCR National Capital Region A Review of the HSRA Implementation Progress iv NDP National Drug Policy NGO non-government organization NHIP National Health Insurance Program NOH National Objectives for Health NSVD normal spontaneous vaginal delivery NTP National Tuberculosis Program OSEC Office of the Secretary PCA Philippine Coconut Authority PDI parallel drug importation PHIC/PhilHealth Philippine Health Insurance Corporation PHO Provincial Health Office PITC Philippine International Trading Corporation PMO Project Management Office QA quality assurance QMMC Quirino Memorial Medical Center RD regional director RHU rural health unit RITM Research Institute for Tropical Medicine RUV relative unit value SB Sangguniang Bayan (Municipal Council); Senate Bill SEMP Social Expenditure Management Project SHI social health insurance SP Sangguniang Panlalawigan (Provincial Council) SV support value TA technical assistance TB tuberculosis TC therapeutics committee TCG technical coordination group TQM total quality management UP-NIH University of the Philippines – National Institutes of Health USAID United States Agency for International Development USEC undersecretary WHO World Health Organization A Review of the HSRA Implementation Progress v Acknowledgments The authors would like to acknowledge the support of Management Sciences for Health – Health Sector Reform Technical Assistance Project (MSH-HSRTAP) and the Health Policy Development and Planning Bureau of the Department of Health. The invaluable assistance of John Julliard Go, Napoleon Espiritu II, and Alma Lou de la Cruz is highly appreciated. The authors would also like to acknowledge the comments and suggestions of the reactors in and participants to the November 7, 2002 conference titled “Presentation of the Progress Review of the Overall HSRA Implementation.” A Review of the HSRA Implementation Progress vi Overview This report presents the findings of the review of the implementation progress of the Department of Health’s (DOH) Health Sector Reform Agenda (HSRA). The review was commissioned specifically to 1) provide an overview of the progress of HSRA implementation, 2) analyze the factors affecting what has been accomplished thus far, and 3) present recommendations for future implementation activities. The review covered the period dating from 1999 when the HSRA monograph was published up to the last quarter of 2002. The review compared activities undertaken and outcomes realized with the targets defined in the HSRA implementation plan, and the observed variance analyzed. Recommendations for future activities were then derived from the analysis. Information used in this review came from reports, secondary data, and key informant interviews. The conclusions and recommendations made here are, therefore, based on soft data and include value judgments exercised by the authors. Three groups of HSRA implementation activities were reviewed: 1) convergence site development, 2) off-site reform activities, and 3) crosscutting reform activities. Conver- gence site development refers to activities directed at meeting the targeted number of convergence sites as well as initiatives designed to meet targets and desired outcomes in a particular site. Off-site reform activities refer to non-site related work in the five HSRA areas – hospitals, the National Health Insurance Program (NHIP), public health, health regulation, and local health systems development. Crosscutting reform activities refer to reorganization or reengineering; finance and budget reforms; pursuit of the DOH legislative agenda; and overall HSRA implementation management, coordination, and monitoring. The review found that while target activities and outcomes have largely been unmet, there has been significant progress in convergence site development. Progress in off-site reform areas has slowed down, save for advances made in NHIP. The least progress was found in crosscutting reform activities. It must be pointed out, however, that HSRA implem- entation, while delayed and pursued at a much slower pace than planned, has gone beyond the critical first steps. What makes this accomplishment remarkable is that this was achieved under adverse conditions – disruptions owing to political change, severe budget cuts, and inadequate management infrastructure. Its accomplishments notwithstanding, HSRA implementation is not yet out of the woods. While HSRA’s accomplishments may not
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