Remarks of Hon. Enrique T. Ona, Secretary of Health at the DOH and USAID/Philippines Health Projects Launch

March 16, 2013

Pan Pacific Hotel, Manila

I am very pleased to be here today to join in officially launching the USAID-DOH bilateral health program in the Philippines.  

Let me start by expressing my appreciation of the support that USAID has provided to the Philippine health sector. This is reflective not only of the long-standing partnership between the DOH and USAID, but that of our country and the American people throughout our many years of shared history.  The USAID-DOH Bilateral Agreement signed last September 2012 is the most recent embodiment of our partnership that contains our mutual aspirations towards improving the health of Filipino families through Universal Health Care or Kalusugan Pangkalahatan.

I would also like to acknowledge the very close working relationship between the DOH and USAID, under the able leadership of Mission Director Gloria Steele. I am particularly pleased by how USAID designed its new set of projects for 2012-2017 in support of UHC/KP implementation.

USAID has made many significant contributions to improve the health of Filipinos in the past 50 years.  The list would be long but we would be remiss if we fail to acknowledge the role that USAID played in the early 1980s which led us down the path of primary health care financing, social health insurance and ultimately, the transformation of the Philippine Medical Care Commission to PhilHealth; the development of a child survival strategy that led to the institutionalization of the Expanded Program on Immunization (EPI); the introduction of oral rehydration therapy (ORT) and Zinc for the treatment of diarrhea; and Vitamin A supplementation through the Garantisadong Pambata.  USAID support to health reforms has continued throughout from the conceptualization of the Health Sector Reform Agenda, a decade ago, until the current implementation blueprint which is the UHC/KP.

I appreciate the assistance of USAID in improving systems to support KP implementation which includes strengthening the logistics system, particularly the Supply Management and Recording System (SMRS), now integrated into the National Online Stock Inventory Reporting System (NOSIRS).  The DOH looks forward to your continued support in logistics management.  Various initiatives like the Expenditure Tracking System and KP operations monitoring have also helped improve performance monitoring and reporting to guide UHC/KP implementation.  I am also thankful to USAID for helping us craft critical policy documents such as the Philippine Plan Action to Control TB and in developing innovations for TB control such as the remote smearing station to ensure that people in hard to reach areas are able to access microscopy services, be diagnosed and treated early.

The bilateral health program, and all of the projects we will see later today, are anchored on the three pillars of KalusuganPangkalahatan, whichincludes first, the expansion of the National Health Insurance Program, both in coverage and health benefit delivery; second, the improvement of access to quality health care facilities and services; and thirdly, the attainment of health-related Millennium Development Goals – specifically the reduction of maternal mortality ratio, under five mortality rate, and TB prevalence.

The Department of Health, particularly in USAID supported sites, aims to improve the following indicators within the next five years:

  • Modern contraceptive prevalence rate;
  • Percent of births attended by skilled birth attendants;
  • Percent of births delivered in health facilities;
  • Percent of infants exclusively breastfed in the first six months;
  • Use of the Essential Intrapartum and Newborn Care protocol;
  • TB detection and cure rates; and
  • Number of people treated for MDR TB.

I also am pleased that the sites selected under the program are those with high unmet need for health services and high number of poor families. 

After two plus years of KP implementation, we have made significant achievements in realizing the goals of KP, but considerable challenges remain. I believe USAID’s program of support to KPwill help us achieve our goals.

I have always maintained that the cornerstone of universal health care is a strong social health insurance system that will ensure steady financing for the health sector. We are reaching more people and we are more inclusive of the poor as reflected in the increased Philhealth enrolment, from 70 million Filipinos in 2010 to about 81 million Filipinos as of December of last year.

While we have subsidized the premiums for all of the 5.3 million poorest families, many of them have yet to be informed of their PhilHealth benefits. At least 85% of Filipinos are already enrolled, but this begs the question as to how many can actually use benefits. I challenge all of us, as well as the USAID CAs to help DOH and PhilHealth in making sure that the poorest of the poor are covered by PhilHealth and are able to access services. USAID support, through social marketing of PhilHealth benefits, the deployment of community health teams, and other communication channelswill help get the message out to the poor families that they are covered and can access care.  Expanding PhilHealth is critical to guarantee the fiscal sustainability of our health system.  I look forward to USAID support for PhilHealth, in terms of enrollment of the poor, more accredited facilities, both in the public and private sector, and of course, greater availment of benefits.

With regard to improving access to quality health care facilities and services, from 2010 to 2012, the DOH has supported the upgrading and rehabilitation of more than 3,000 hospitals, rural health units (RHUs), and barangay health stations (BHS).For this year, 2013, the DOH has programmed anotherP13.5 billion for facilities upgrading.We look forward to USAID support in helping us monitoring the progress of implementing these projects, assisting CHDs in fast tracking upgrading and ensuring that facilities are accredited, have trained staff,and are connected to a functional service delivery network.  

The third thrust of KP is achieving our MDGs.  Achieving our MDGs is our ultimate measure of success.  We are going to be judged by our MDG targets when 2016 comes along, and that will be how we are going to be graded not only by the President – but by our constituents as well as by the international community.

I am pleased to note that today’s launching of USAID projects coincides with our celebration of Mother’s Day last week and the Safe Motherhood Month this May. Not only is this a fitting tribute to Filipino women, but also an expression of our commitments to realizing our dream that no mother should die while giving birth.

A major focus of mine since taking office is to markedly reduce maternal mortality. And that’s the reason why in every region I visit, the first thing that I ask: What is the maternal mortality of this region, province, or maybe even the particular community?Allow me to share with you some of my thoughts on how to truly confront this problem of maternal mortality.

Our maternal mortality is at 221 maternal deaths per 100,000 live births, and this is as of 2011. This is a formidable number to reduce given that we have barely eighteen months of full-scale implementation of UHC/KP before the reality of preparations for the 2016 nationalelections will set in and slow downfield work. So how then can we maximize the available time given known or proven interventions at our disposal?

If we are to be consistent with UHC/KP, then we should focus our efforts in reducing the unmet needs of around two million women that belong to the NHTS poor households. I find this goal more realistic,as these two million poor women can be readily identified and reached. In fact, half of them attend regular monthly Family Development Sessions as CCT/4P beneficiaries.

We must also hasten the scaling up of facility-based deliveries, to further reduce maternal mortality. We recognize that it is not enough to build and equip health facilities. We have to be very certain about the quality of services as birthing facilities must be offering obstetric care at par with international standards. This can be achieved only if we have a program wherein the referral system is flowing seamlessly and quality services are available. 

We also need to scale up Essential Intrapartum and Newborn Care to end preventable deaths in women and newborns.  Finally, we need to train our midwives and provide them adequate supervision.  I look forward to partnering with USAID on scaling up the use of oxytocin to prevent post-partum hemorrhage, including the testing of the use of oxytocin in Uniject that can be used even in our remote areas.  I believe that amendments to the Midwifery Law may not be absolutely necessary if physician supervision is shown using modern IT.

Is this doable? I strongly believe that it is. First, because we have the additional funds for commodities, train staff and upgrade facilities – thanks to this administration’s unprecedented priority for health care. We have started to put in place enabling mechanisms such as the deployment of CHTs to assist families in health use planning, set up training programs, among many. We have also restructured the DOH organization to have four operations clusters, either headed by our undersecretary or assistant secretary.

I am asking theUSAID CAs, especially the regional USAID health projects to help the Operations Clusters in operationalizing this strategy within the next 18 months starting in areas where the poor are most concentrated and where unmet needs are highest in each of the regions. I also would like our Operations Clusters to draw up quarterly performance benchmarks leading to elimination of unmet needs among our very poor families. It would be proper for all of us here to meet again maybe one year from now, where I expect Operations Clusters and all concerned to report how they have eliminated the identified unmet needs for FP and perhaps for other areas.

I understand that following this formal launch will be a consultation workshop among the CAs and the CHDs to further flesh out our next steps and coordination mechanisms.  I hope that we will use the workshops to move forward with our plans in supporting the scale up of Universal Health Care implementation nationwide.  I would like to ask that all cluster heads and their staff to prioritize effective coordination between and among DOH clusters, Centers for Health Development (CHDs), and the USAID health projects, as well as our other foreign partners to develop a true and real collaboration in our effort to achieve universal health care and reduce both child and maternal mortality.

Together, let us pull all stops, pool our resources and put our collective talents towards a fruitful and productive partnership for health.

Thank you so much and good morning.