EXECUTIVE SUMMARY The Five-Year Investment Plan for Health embodies the four implementation components of the Health Sector Reform Agenda (HSRA): governance, health financing, service delivery and regulation. The presentation of the Plan is patterned after the format developed and prescribed by the European Commission Team, observing the standard process and cycle which involves situation analysis, gaps and deficiency/problem identification, strategic goals and objective setting, target setting, financing/costing and implementation. There are six Inter-Local Health Zones (ILHZ) in the province. They are: CVGLJ which includes the five northernmost city and municipalities of Canlaon, Vallehermoso, Guihulngan, La Libertad and Jimalalud. BinaTa ILHZ composes the towns of Bindoy, Ayungon and Tayasan. MaMaBaTaPa ILHZ covers the central town and cities of Manjuyod, Mabinay, Bais, Tanjay and Pamplona. ValeDaLanSaDaCongBulan ILHZ embraces the central towns of Valencia, Dauin, Amlan, San Jose, Dumaguete and Sibulan. SiaZam ILHZ includes the towns of Siaton and Zamboangita. Lastly, StaBayaBas ILHZ is the group of the three southernmost towns of Sta. Catalina and Basay and the city of Bayawan. A general picture of the province shows that the causes of morbidity are a result of poor environmental sanitation, unsafe drinking water, unhealthy lifestyle, lack of vitamin supplementation or malnutrition. Likewise, CVD tops the ten leading causes of mortality which is attributed to unhealthy lifestyle. Infant and under five mortality remain high due to inadequate supply of medicines, untrained hilots assisting deliveries, failure to give pregnant mothers tetanus toxoid and non performance of newborn screening. Maternal deaths could be attributed to lack of training of some RHMs and untrained birth attendants. Some mothers do not submit to prenatal care and some do not have access to adequately-equipped health facility. There is a need for a Maternal Death Review to ascertain factual causes of maternal deaths. Not one of the RHUs and hospitals are BEMOC or CEMOC capable so that referral to higher levels of care are necessary. Lack of manpower in all categories especially doctors, inadequate facilities and equipment and insufficient supply of affordable medicines are the major gaps identified in the hospital service delivery in the province. There is also a need for a well implemented referral system to partly solve the overcrowding in the higher level facilities and underutilization in primary and secondary facilities. Another gap is the need for trainings and continuing education for health care professionals. In terms of health financing, public health and community-based health financing need to be made acceptable and implementable. There is a lack of compulsory insurance plan to address the increasing cost of medical care, limited population coverage, limited service coverage and low level support. Under governance, major external factors that hinder the efficiency, effectiveness and relevance of the provincial health system include low priority and low allocation of resources for health, the negative impact of the devolution of health services as mandated by the Local Government Code, and the general lack of health consciousness among the people. One major deficiency in the hospital system is the non-operational Provincial Health Information System. Oriental Negros Health Investment Plan 2006-2010 1 Another gap is the non-functionality of structures. There is a need to strengthen and reorganize different committees such as the Therapeutics Committee, Infection Control Committee, among others. Another deficiency is the lack of training on service areas among health personnel. Tedious process in drug procurement as well as assuring safety and efficacy of drugs are some issues under the regulation component. Other concerns have to do with the manner of distribution of medicines, and the non compliance with the Generics Act. The overall goal of the province is to improve the health status of its population. The province aims to reduce prevalence of morbidity by 25 percent (caused by lifestyle-related diseases and others), reduce infant mortality by 17 percent, reduce maternal mortality by 15 percent and reduce malnutrition by 5.1 percent. To attain such improvement, the investment plan aims to ensure the following: access to quality, integrated, comprehensive, continuous, affordable health care services, goods and facilities in partnership with the community; effective and efficient allocation, generation and mobilization of resources; improvement in the unified technical direction and operational coordination of all providers at all levels and sectors province-wide; and strengthened regulatory functions at provincial and municipal level through ordinances and legal mandates. The specific goals under service delivery include: all RHUs and hospitals are SS certified/Philhealth accredited; all health facilities have adequate and competent HHR; and all private health facilities and providers are regulated. Under health financing, specific goals are: per capita expenditures would increase by 5 percent every year; Philhealth indigent coverage would increase by 25 percent; Philhealth capitation would increase from P 11 million to P 18 million; benefits from Community Based Health Financing Scheme would complement Philhealth benefit packages; socialized users’ fees are institutionalized in both public hospitals and RHUs; and DRF/BnB/HPO are established. For governance, the specific goals comprise: sector-wide approach to health is implemented in all components of the local health system; and there is functional organizational structure and systems in the various levels of governance. The specific goals under regulation include the following: ILHZ Therapeutic Committees are established; there are policies relative to the detailing of midwives; outsourcing of doctors are carried out; compliance to SS certification and PHIC accreditation is achieved; and policies on revenue generation are adopted through appropriate local legislations. Activities under service delivery include rationalization of services and human resources in public health facilities, upgrading of health facilities and equipment for SS certification and PHIC accreditation, advocacy on the provincial health implementation plan, capability/capacity building, intensification of campaign on dengue, diarrhea, rabies, STI/HIV, control and management of emerging infectious diseases, intensify early detection of cancer, improvement of potable water supply system, health care waste management, provision of drugs and medicines. Oriental Negros Health Investment Plan 2006-2010 2 Under health financing, activities are: review of local accounts for health; interface community based HCF with SHI; achievement of universal coverage; establishment of community based, community managed health care financing; ensure fiscal and managerial autonomy of hospitals; standardization of users’ fees; and establishment of drug revolving fund. For governance, activities comprise: establishment and operationalization of appropriate management systems; management structure, financial management and management support systems for ILHZ; and community based programs and projects. Regulation activities include strengthening policy on drug procurement and management, and adoption of national policies/laws through local ordinances/resolutions for implementation. Investment Costs by Source as against CO and MOOE (In thousand pesos) BY SOURCE Capital Maintenance TOTAL % Outlay and Other Operating Expenses PLGU 1,070 43,435 44,505 10% M/CLGU 244,923 244,923 55% DOH 50,350 50,350 11% EC 80,181 19,769 99,950 23% LEAD 1,611 1,611 0% UNICEF 1,268 1,268 0% BIARSP 1,613 1,613 0% TOTAL 81,251 362,971 444,222 100% % 18% 82% 100% Total investment cost of the province amounts to P 444 million with 65 percent being shouldered by the LGU (provincial and municipal/city combined). The EC grant share is at 23 percent while that of the DOH is 11 percent. A large portion (82 percent) is for MOOE while only 18 percent is set for Capital Outlay. By Year 2006 2007 2008 2009 2010 TOTAL % Service Delivery 15,667 60,379 67,060 60,876 46,706 250,688 56% Health Financing 18,111 22,444 25,041 32,253 39,643 137,493 31% Governance 9,319 10,728 16,543 9,466 9,466 55,522 12% Regulation 129 300 30 30 30 519 0% TOTAL 43,226 93,852 108,674 102,625 95,845 444,222 100% % 10% 21% 24% 23% 22% 100% Service delivery has the highest share among components at 56 percent followed by health financing at 31 percent. Governance comprises 12 percent while regulation does not require much investment compared to the other components. Oriental Negros Health Investment Plan 2006-2010 3 INTRODUCTION This 5-Year Investment Plan on Health is a document that presents the condition and status of the health sector, highlighting the district health system otherwise known as the Inter-Local Health Zone. This is a product of a series of orientation seminar-workshops conducted by a Team from the European Commission and the Department of Health Regional Office in the context of the Health Sector Reform Agenda (SHRA) and in the implementation of the health reform package as Fourmula ONE for Health. The format is framed such that it shows the logical sequence and organization of its content. Background and information on the planning area is provided by a brief demographic and socio-economic profile. Highlighted is the health situationer which details the health needs, delivery system,