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INSPIRATIONAL MESSAGE On 2ND Provincial Health Assembly

November 19, 2012

TIME: 9:00- 9:30 AM
VENUE: H20 Hotel, Luneta, Manila

Members of the Executive Committee, Regional Directors, Dr. Ricardo Ramos, the President of Provincial Health Officers’ Association of the Philippines, my fellow health workers,

Good morning.

It has been said that a chain is only as strong as its weakest link. The Philippine health system is one big chain composed of links that are the municipal and provincial health systems up to the Central office. Ensuring the capabilities of our local health systems is thus imperative for a strong national health system.

Critical to the attainment of Kalusugan Pangkalahatan is the support and cooperation of our local health authorities: the local chief executives and you, the local health officers.

I am thus happy to address our partners, our provincial health officers in this assembly today. In your shoulders rest the challenge of translating the three strategic thrusts of Kalusugan Pangkalahatan, namely: (1) ensuring financial risk protection from illnesses through expansion in PhilHealth membership and benefits, (2) providing quality health services through the upgrading and modernization of our hospitals and other health facilities and (3) strengthening existing public health programs for the attainment of our health related Millennium Development Goals of reducing infant, child and maternal mortality and morbidity; into direct health service delivery for better health outcomes among your constituents.

In the two years since we launched Kalusugan Pangkalahatan, significant successes have been achieved.

In automatically enrolling the 5.2 million poorest families to PhilHealth, we have given financial risk protection to the poorest 20% of our population or the so-called Q1. These families are now entitled to no-balance billing or walang dagdag bayad when admitted to government hospitals. Hopefully very soon even to the private hospitals these services can be extended. They can also avail the primary care benefits in rural health units and selected district hospitals. And hopefully, with the passage of the sin tax, we will be able to cover another 5.7 million families or Q2 to PhilHealth. And I am sure I will be asking you to come back again and discuss with you prioritizing of funds that will be generated by sin tax whatever amount will be.

In rehabilitating and enhancing our government hospitals, rural health units and barangay health stations, we hope to and we are going to banish the stereotype of decay and deficiency associated with these facilities. For our Health Facilities Enhancement Program (HFEP) for 2013, we will be allocating a total of P 13.55 billion.  Of which sixty five percent (65%) will be used to fund infrastructure projects and the rest of which to fund necessary equipment.

The reason why it is very important for us to meet today and the next day is for us to decide whether indeed the numbers we have are exactly what we really need.  For example, we need to improve, rehabilitate or even build 541 Barangay Health Stations (BHS), 1,635 Rural Health Units (RHUs), 220 Municipal and District Hospitals, as well as 24 Provincial Hospitals and of course including our own 66 DOH Health Facilities that will benefit from the HFEP projects on 2013. Tama ba ito? And I think it is very important to review therefore our provincial health plans, although it has been checked and rechecked with you, we need to revisit these plans to make sure these are the numbers.

With strengthened public health services, such as the deployment of community health teams, our RN Heals program and the introduction of new vaccines such as rotavirus and pneumococcal vaccines for our children, will we meet our health related Millennium Development Goals of reducing infant, child and maternal mortality? We are almost on the third year of KP implementation, it is therefore important to review to know where we are today. Like for example, by the end of this year, we will be hiring 32 more doctors to the barrios to add to the 112 physicians we have already deployed earlier this year. By then, we will be able to declare that there will be no more “doctorless municipalities” in our country. But when I go around and asked, totoo ba ito?; I get different answers. Where is the truth about all these data?

Yet after two years of implementing Kalusugan Pangkalahatan, we recognize that much has to be done. Many of our NHTS poor families have yet to be informed of their PhilHealth benefits. We need to bridge the gap between PhilHealth’s report of 85% coverage and the reports of our hospitals claiming that 20-30% of their patients are PhilHealth members. Due in part to a devolved system with autonomous local governments, we are having difficulties in the implementation of our Health Facilities Enhancement Program (HFEP). There are delays in bidding, procurement and ultimately, utilization of HFEP funds. The initial results of our CHT mobilization on the ground are mixed at best.

This assembly of provincial health officers, the second this year, reaffirms our collective understanding that health is a shared responsibility of both the national and the local governments. For the next two days, we will review the progress made by our provinces in the pursuit of our KP thrusts, learn best practices as well as determine the bottlenecks impeding our progress and find solutions to these.

In particular, we must review and clarify the working relationships with regard to KP key program thrusts, we must identify the push and pull factors in the implementation of the Health Facility Enhancement Program (HFEP) in the provinces, and formulate recommendations and strategies to address identified pull factors on the HFEP implementation. We will also discuss other commitments and initiatives that are vital to the achievement of KP and that impact greatly on health care services utilization and health outcomes like: what are Philhealth enrolment problems and actions for the reduction of maternal, neonatal and infant mortality.

We talk about the issue of fragmentation of health services due in part to municipal health systems autonomous of the province, and provincial health systems autonomous of the DOH regional offices, is a reality our people face. Even with devolution, I always stress that the DOH must re-assert its supervisory and regulatory powers as the national health agency. At the same time, however, the DOH and the local health systems must find effective ways of working closely together, closely together as one, given political realities on the ground to ensure that our health service delivery network is functional.

I always believe that the best way to go forward is to instill the sense of partnership and shared responsibility between the national and local government for the health of its constituents. You, our frontliners in the local health systems have the advantage of local knowledge and familiarity with the nuances of their localities. National government programs, such as the Health Facilities Enhancement Program, should not be seen as avenues for dole-outs but as opportunities for counterparting by the local government units.

Eventually, in our review of devolution, one question we have to answer is this: At what level should we consolidate our local health systems to address fragmentation and ensure viability, sustainability and reasonable economies of scale? I have a sense that limiting devolution to the provinces and putting the municipal health systems under the provincial government is a better alternative to what we have at present. Pero hindi kailangang magpalakpakan lamang tayo. We have to agree and do something about it. I think we have been talking, you have talking so long about it. If I have to take it from your reaction that this is what should be done, then, may we request your piece on what should we do after this.

You, our provincial health officers, are in a good position to advise us how best to go forward.

Let me say something about public- private partnership and corporatization of government hospitals. Among another so called “controversial” issue that we are pursuing in our health sector reform.  PPP or public- private partnership is just but another term for Build- Operate- Transfer. Something that has been on-going for so long. Something that we have shown certain successes in a small scale. And yet the provincial and some of our DOH hospitals still don’t seem to understand that it is the only way we can go forward to modernize our health facilities in the shortest possible time. And that we cannot expect the passage of the sin tax to have enough money to modernize our health facilities the way it should be today. Kapag maghihintay pa tayo nang manggagaling sa national government,  darating na ang mga apo ninyo hindi pa din natin nagagawa ito.

And there is nothing new about PPP. This has been done by several countries for the last 20 years. As I said, it is not privatization; it is just working with the private sectors so that we can adopt some of the efficiencies and the strategies that they do without having always to contend with COA or Civil Service Commission. I will tell you there is just no other way other than partnering with those who takes care of half of the population so that the efficiencies that they know and have can be brought to our department, something, as I’ve said that all the departments have been doing for quite sometime.

Despite these challenges, I end with optimism about our nation’s health. With a President and an administration committed to significantly improve the health of our people, the dream of Kalusugan Pangkalahatan can be a reality. And the promise of accessible, affordable and quality health care will soon be at the grasp of our people. And I can tell you, it is in your hands, it is iin your hands.

Thank you and good morning.