A whole-of-society approach for UHC amid pandemic

A whole-of-society—not just a whole-of-government—approach was the main solution to achieve a Universal Health Care (UHC), which guarantees equitable access to quality and affordable health care for all Filipinos, amid the pandemic. All three governors under the Provincial Leadership and Governance Program (PLGP) of the Zuellig Family Foundation (ZFF) shared this lesson during the colloquium held on April 19.

But it takes good leadership and governance to orchestrate a successful whole-of-society approach to health. Just as ZFF Chairman Ernesto D. Garilao puts it: “Committed, competent, and dedicated executives play critical roles in improving the health indicators of constituents.” This is where the work of ZFF comes into play. PLGP helps develop the bridging leadership (BL) competencies of provincial health leaders in establishing the necessary structures and policies to implement the mandates under the UHC law. The BL framework, through the three processes of ownership, co-ownership, and co-creation, fosters greater personal accountability for social health issues and harmonious collaboration with different stakeholders to overcome challenges.

Compared to other UHC sites, the three provinces under PLGP—Agusan del Sur, Aklan, and Bataan—are progressing faster toward attaining UHC despite the pandemic, making them possible models for the rest of the country when Congress reviews the UHC law’s implementation in 2025.

Multisectoral engagement
The three provinces collaborated with stakeholders from different sectors, including the government and private sectors and the communities to ensure the sustainability of programs and the resilience of communities. This meant building strong ties with indigenous and tribal communities, integrating health services to COVID-19 response, and improving access to health care services in far-flung areas, among others. These efforts helped the provinces complete vital preparatory activities based on the UHC maturity model of the Department of Health (DOH). As of March 2022, Agusan del Sur has achieved 87%, and Aklan and Bataan are at 75%. The maturity model is used to monitor the progress of local health systems integration as provided by the UHC Act and its implementing rules and regulations.

According to Agusan del Sur Gov. Santiago Cane, Jr., “I have to make sure that my line of communication was always open. The most effective way of leading a bureaucracy is to see to it that you are always understood. I asked the employees to march with me in realizing the mission and vision of a quality health care system with empowered healthy and happy people.”

The province also concentrated on establishing a health promotion office, which is aligned to the UHC goal of attaining health literacy. It also established an inter-local health system, and an online information system. Agusan del Sur was a top-performing province in population testing rate for tuberculosis in the Caraga region for 2021 and the best performing local government unit for national COVID-19 vaccination days among provinces with second dose coverage.

“We had to get all the players on board, including the private sector, to make them realize that they also have to share their resources. We were able to communicate to them effectively that we are all in this together,” said Aklan Gov. Florencio Miraflores: “The people of Aklan cooperated with us that is why we are able to control the surge of the Delta variant in 5 weeks,” he said.

Aklan allocated 40% of its provincial budget to health. It also built a molecular laboratory and launched a mental health program as part of its COVID-19 response.

Before the pandemic, Bataan has been establishing a service delivery network (SDN) connecting barangay and municipal health facilities to the hospitals when the province was under the second cycle of PLGP. Bataan General Hospital and Medical Center was designated as the apex hospital or the main referral hospital. During the pandemic, the province partnered with private hospitals to upgrade the system. It also launched a COVID-19 real-time dashboard monitoring system and a hospital bed tracker app for the efficient referral of COVID and non-COVID patients. With an SDN already in place, Bataan has a head start in building a health care provider network (HCPN), which is the backbone of UHC.

Bataan is number 1 in COVID-19 herd immunity in Region 3 because of its pandemic response efforts, including building a mega treatment facility and an RT-PCR (reverse transcription-polymerase chain reaction) laboratory. The 1Bataan seal of COVID-free barangay, an incentive-based engagement program for villages that meet COVID-19 targets, is being adapted to strengthen primary health care.

In congratulating the three provinces on their accomplishments under PLGP, Health Undersecretary Myrna C. Cabotaje reiterated Gov. Garcia’s statement that “UHC is being implemented not just for the sake of implementation but for people to live long and healthy.” As Director Irma L. Asuncion of the Bureau of Local Health Systems Development-DOH pointed out: “The success of UHC can only be measured by the wellbeing of our fellow Filipinos.” Under PLGP, the improvement of maternal and child indicators, epidemiologic parameters, and access to noncommunicable disease services were monitored and evaluated for the provinces to make outcomes-oriented decisions. In 2021, the infant mortality rate (infant deaths per 1,000 live births) for the three provinces under PLGP were below the 2022 national target of 15. For the same year, Agusan del Sur and Aklan recorded maternal mortality ratios (maternal death per 100,000 live births) of 51 and 16, respectively, which are well below the 2022 national target of 90.

For more insights on the challenges and innovations of UHC implementation amid the pandemic, watch the recording of the colloquium on ZFF’s Facebook Page: https://bit.ly/3EoDKZA.