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Case Study of Community Health Financing in Region XI

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Case Study of Community Health Financing in Region XI Philippine Institute for Development Studies Case Study of Community Health Financing in Region XI Institute of Primary Health Care DISCUSSION PAPER SERIES NO. 95-18 The PIDS Discussion Paper Series constitutes studies that are preliminary and subject to further revisions. They are be- ing circulated in a limited number of cop- ies only for purposes of soliciting com- ments and suggestions for further refine- ments. The studies under the Series are unedited and unreviewed. The views and opinions expressed are those of the author(s) and do not neces- sarily reflect those of the Institute. Not for quotation without permission from the author(s) and the Institute. June 1995 For comments, suggestions or further inquiries please contact: The Research Information Staff, Philippine Institute for Development Studies 3rd Floor, NEDA sa Makati Building, 106 Amorsolo Street, Legaspi Village, Makati City, Philippines Tel Nos: 8924059 and 8935705; Fax No: 8939589; E-mail: [email protected] Or visit our website at http://www.pids.gov.ph CASE STUDY OF COMMUNITY HEALTH FINANCING IN REGION XI MAIN REPOR T Submitted to: PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES Submitted by: Institute of Primary Health Care-Davao Medical School Foundation and the Development Academy of the Philippines TABLE OF CONTENTS 1.0 BRIEF DESCRIPTION OF THE PROJECT 1 1.1 Background of the Study 1 1.2 Objectives of the Project 1 1.3 Significance of the Project 2 1.4 Scope and Methodology 3 A. Locale of the Study 3 B. Definition of Terms 3 C. Data Collection Methods and Procedures 6 C.1 Comprehensive List of Existing Schemes 6 C.2 Selection of Sample Financing Schemes 7 C.3 Case Study of Selected Existing Schemes 8 C.4 Case Study of Control Groups and Failes Schemes 9 C.5 Description of Other Recent Effort 9 1.5 Proponents 9 A. The Institute of Primary Health Care (IPHC) 9 B. The Development Academy of the Philippines (DAP) 9 2.0 BASELINE SURVEY RESULTS AND SELECTION OF SCHEMES FOR CASE STUDY 10 2.1 Results of the Baseline Survey Results 10 2.2 Bases of Selection 14 2.3 Other Schemes 14 3.0 PRESENTATION OF FINDINGS 16 3.1 Cases in IPHC-assisted Organizations 16 3.1.1 The Community Health and Finance Associations: A Historical Background 16 3.1.2 The CHILD Project 16 2 3.1.3 The SHIELD Project 19 3.1.4 AADP 20 3.1.5 LDAP 20 4.0 SUMMARY OF FINDINGS 21 4.1 Organization 21 4.2 Goals and Objectives 23 4.3 Membership 23 4.4 Fund Sourcing 24 4.5 Benefits and Services 25 4.6 Access to Health Facilities and Services 26 4.7 Payment Scheme 27 4.8 Members’ Assessment of the Benefits and Services Extended and/or Availed of 27 4.9 Impact of Health Financing Scheme 28 5.0 CONCLUSIONS AND RECOMMENDATIONS 34 6.0 CASE STUDIES 38 Case Study No. 1 AN INCOME GENERATING SCHEME: THE MALALAG COMMUNITY HEALTH VOLUNTEERS CREDIT COOPERATIVE Malalag, Davao del Sur 38 Case Study No. 2 PERSONAL ONE-TIME PAYMENT AND AD HOC CONTRIBUTION: THE STO. NIÑO HELPING HANDS (SNHH) Sto. Niño, New Corella, Davao Province 64 Case Study No. 3 ONE-TIME PRE-PAYMENT AND AD HOC CONTRIBUTION FOR MEDICAL GRANT, MEDICAL LOAN AND FREE TABLETS: NEW SAMBOG HEALTH AND HOSPITALIZATION ASSISTANCE (NESAHHA) New Sambog, New Corella, Davao Province 85 Case Study No. 4 PERSONAL PRE-PAYMENT: THE COOPERATIVE HEALTH FUND OF THE MEDICAL MISSION GROUP HOSPITALS AND HEALTH SERVICES 3 COOPERATIVE, COOPERATIVE FEDERATION OF DAVAO CITY, AND THE COOPERATIVE BANK OF THE DAVAO CITY 92 Case Study No. 5 PERSONAL PRE-PAYMENT: KING COOPERATIVE Davao City 109 Case Study No. 6 FAILURE CASES OF THE DRUG SALES AND THE INCOME-GENERATING SCHEMES: THE BHW ASSOCIATION OF TACUL Tacul, Magsaysay, Davao del Sur 118 Case Study No. 7 A FAILURE CASE OF A PRE-PAYMENT SCHEME: “KAPUNUNGAN SA KASAKIT (KsK) SA BARANGAY,” Balasiao, Kiblawan, Davao del Sur 127 NON-HFS COMMUNITY: THE CASE OF BARANGAY LAGAO (An Urban Setting) 134 NON-HFS COMMUNITY: THE CASE OF BARANGAY TAMBOBONG (A Rural Setting) 141 THE MEDICARE PROGRAM II, Cantilan, Surigao del Sur 154 THE COMMON HEALTH FUND FOR DIAGNOSTIC AND DIRECT HEALTH CARE SERVICES OF THE BROKENSHIRE INTEGRATED HEALTH MINISTRIES, INC. (BIHMI) 168 THE COOP CARE OF THE MEDICAL SPECIALIST AND HEALTH SERVICES COOPERATIVE (MSHSC) 172 4 LIST OF ABBREVIATIONS AADP Accelerated Area Development Program BHS Barangay Health Station BHWs Barangay Health Workers CBHP Community Based Health Program CBHS Community Based Health Services CDA Cooperative Development Authority CFDC Cooperative Federation of Davao City CHFA Community Health Financing Association CHF Community Health Fund CHILD Community Health through Integrated Local Development CHO City Health Office CRB Cooperative Rural Bank DMSF Davao Medical School Foundation DOH Department of Health FHSIS Field Health Service Information System GOs Government Organizations HFS Health Financing Scheme IPHC Institute of Primary Health Care IPHO Integrated Provincial Health Office KC King Cooperative KsK Kapunungan sa Kasakit LDAP Local Development Assistance Program LGUs Local Government Units MACHEVCC Malalag Community Health Volunteers Credit Cooperative MGLF Medical Guaranty and Loan Fund MHO Municipal Health Office MMGHHSC Medical Mission Group Hospitals and Health Services Cooperative NESAHHA New Sambog Health and Hospitalization Assistance NGOs Non-Government Organizations PBSP Philippine Business for Social Progress PHO Provincial Health Office PMCC Philippine Medical Care Commission QLC Quality of Life Circle RESPOND Region Eleven Response to People’s Organizations National Development RHM Rural Health Midwife RHP Rural Health Physician RHU Rural Health Unit SDF Social Development Fund SHIELD Sustained Health Improvement through Expanded Local Development SNHH Sto. Niño Helping Hands 5 LIST OF FIGURES Figure 1. Location Map of Region Xi Figure 2. Map of Region XI Figure 3. Evaluation Framework for a CHFS Figure 4. Conceptual Framework in Setting Up a Suggested Model of Community-based Health Financing Scheme Figure 5. Location Map of Malalag, Digos, Kiblawan and Magsaysay Figure 6. Organizational Structure of MACHEVCC Figure 7. Location Map of New Corella Figure 8. Map of Davao City Figure 9. Map of General Santos City Figure 10. Location Map of Cantilan Figure 11. Organizational/Functional Set-up of Medicare Program II in Cantilan, Surigao del Sur 6 LIST OF TABLES Table 1. Number of Groups by Provincial Location Table 2. Number of Groups by Characteristics of Members Table 3. Number of Groups by Nature of Grouping Table 4. Number of Groups by Benefits and Purposes Table 5. Fund Sourcing Table 6. Year Started Operation Table 7. Selected Cases of Community/Self-financing Case Study No. 1 Table 8. Potable Water Supply, By Source/Barangay Table 9. Number of Household Served by Types of Toilet Table 10. Garbage and Sewage Disposal, By Method Employed Table 11. Distribution of Students, By Barangay/Educational Level Table 12. Communication, By Type Available Table 13. Type of Transportation Available, By Barangay Table 14. Source of Income/Livelihood Table 15. Distribution of Available Health Manpower Table 16. Ten Leading Causes of Morbidity in Bolton, Ibo and Tagansule, Malalag Table 17. Causes of Mortality in Bolton, Ibo and Tagansule, Malalag Table 18. Interest/Reflows Distribution Table 19. Loans Sourced from the Emergency Fund Case Study No. 2 Table 20. Distribution of Household and Household Population by Purok Table 21. Data on Availment of Hospitalization Assistance from Sto. Niño Helping Hands Table 22. Percentage of Actual SNHH members to Present Households, by Purok Table 23. Number of Households by Number of Household Members treated at the BHS Table 24. Number of Consultation and/or Treatment per Individual Patient Table 25. Number of Consultations and/or Treatment by Year Table 26. Percentage of Household as to SNHH Membership as of October 31, 1993 Case Study No. 3 Table 27. Members who have Availed of Medical Grant and Medical Loan Case Study No. 4 Table 28. MMGHHSC Complete History and Physical Examination Package Deal. Table 29. MMGHHSC Examination Charges/Fees 7 Table 30. MMGHHSC Laboratory Rates Table 31. MMGHHSC Hospital Accommodation Rates Table 32. MMGHHSC Nursing Procedures Charges/Fees Case Study No. 5 Table 33. Number of MGLF Depositors and Total Amount Deposited, 1989-1992 Table 34. Availment of Dental Assistance, Medical Assistance & MGLF, 1989-1992 Case Study No. 6 Table 35. Leading Causes of Mortality, 1992 and 1993: Tacul, Magsaysay Table 36. Quarterly Inventory and Net Income Apportionment of the Barangay sa Purok Case Study No. 7 Table 37. Cases of morbidity per age group in Balasiao Kiblawan, Davao del Sur, 1993 Table 38. Cases of morbidity per age group in Balasiao Kiblawan, Davao del Sur, 1992 Non-HFS Communities Lagao: Table 39. Leading Causes of Morbidity, All Ages, 1991-1992 Table 40. Leading Causes of Morbidity, 0-5 Age Group, 1991-1992 Tambobong: Table 41. Top Ten Illnesses/Ailments Tambobong Residents Suffer From Table 42. Report for General Medical Services and Treatment Table 43. Cantilan Medicare II Outpatient Services for the month of September Table 44. Cantilan Medicare II Inpatient Services as of September 30, 1993 8 EXECUTIVE SUMMARY Two important policy developments in the Philippines provide a strong basis for focusing attention to self-initiated health endeavors. One is the implementation of the Local Government Code of 1991 which involves the devolution of a broader range of powers and responsibilities of the national government to the local government units and regional offices of national line agencies. The other is the current thrust of the Department of Health (DOH) in striving to attain its vision of Health for All Filipinos by 2000 and Health in the Hands of the People by 2020, a key strategy being espoused in the propagation of community-managed health care.
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