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Host: Dr. Catherine Chung, ZFF Portfolio Director

Speaker:

Dr. Leslie Luces-Sedillo, Provincial Health Officer II, Aklan

Languages: English, Filipino

Transcription:

PART 1

From policy to practice, Dr. Leslie Luces-Sedillo, provincial health officer II of Aklan, walked us through the unique process of building a health care provider network in her province.

Dr. Cathy: Hi. This is Dr. Catherine Chung, ZFF Director for Local Health System and with us today is Dr. Leslie Luces-Sedillo, provincial health officer II of Aklan. Hi, Dr. Leslie. Good afternoon.

Dr. Leslie: Magandang hapon. It’s good to see you, Dr. Cathy.

Dr. Cathy: Our topic for today is relevant to the goal of Universal Health Care Law na napirmahan noong 2019. In particular, we will talk about how to set up a health care provider network that is mandated by the law. The UHC Law defines a health care provider network as a group of primary–so, from the rural health units–to tertiary health care providers, offering people-centered and comprehensive care in an integrated and coordinated manner. The Department of Health has set the standards and guidelines for the formation of health care provider networks, but what does the process look in practice?

Dr. Leslie: For Aklan, the health care provider network or HCPN is operationalized in our province through the institutionalization of our district health system. We have six districts here in Aklan and each district is composed of several primary care facilities and one district hospital. We are now in the process of crafting our manual of operations to guide the flow of referrals from one facility to another in each district and so, the direction of our province is that each primary care facility will be licensed and each identified district hospital are all upgraded to level I hospital. Furthermore, there will also be a governing body in each district wherein the mayor will be the chairperson and it will be co-chaired by the chief of the district hospital in that district.

Then, there will also be an organization or a body wherein we call a support unit, which will be composed of our development management officers and district health managers assigned in that district.

What is also unique in Aklan is that to save some place sa huge part in the operations of our hospitals, we have our economic enterprise which handles our jetty port and some of our hospitals. A huge percentage of the income from our jetty port sustains the operations of our hospitals. So, every time na bumibisita po kayo sa Boracay, you’re supporting the improvement of our hospitals.

Dr. Cathy: Dr. Leslie, hindi ba ‘yong six district health system mo, it is not the original six district health system. Bakit nagkaroon ng iteration?

Dr. Leslie: Well, as you’ve mentioned Doc, we reorganized again our district health system. It’s essentially ‘yong reason nito when we crafted the district health system is that para ‘yong mga tao within that district will have easy access to the health facilities within their areas. So, we look into on how we divided the areas, especially in the municipalities kung saan po mas malapit ‘yong mga barangays sa pinakamalapit na primary care facilities. For example, in our municipality which is Nabas, the northern part of Nabas ay malapit po doon sa isang district hospital which is located up north and ‘yong southern part of Nabas is more accessible in another district hospital in another district naman. That’s why, when we check again, when we met again with the mayors and through the provincial health board, it was discussed again that we’ll have to separate this municipality into two districts. Operationally, it’s more challenging for the municipality, but for the Aklanons, or for those that are staying Nabas, it would be easier for them and more accessible if we arrange it in such a way that we are looking after their access. That’s why, there are some reconfigurations, and even in some districts wherein there are no district hospitals, there were agreements within the district to construct a new hospital. Iyon ‘yong mga magagandang developments that I’m proud to share because really in every district, it’s very unique. But what’s similar is that all are collaborating, all are cooperating, especially our leaders in health and they are in one page as to the direction when we presented this district health plan with them.

Dr. Cathy: Sa mga PHOs talagang dapat pag-isipan at pag-usapan ‘yong bubuuing district health system or inter-local health zone, depende sa context ng province kasi importante ito as a foundation to the establishment of the health care provider network. May isa pang follow-up question doon, Dr. Leslie, on that note. I think mayroon isang unique sa Aklan sa kaniyang district health system. Kasi noong una, alam ko mayroong part ng Antique na municipalities or barangays na part ng inyong district health system. Baka pwede mo rin i-share iyon?

Dr. Leslie: That’s true. Although, it’s difficult to operationalize, again at the end of the day, what we wanted is better access for every Filipino. There is one area or a town in another province na dito po sa Aklan sila talaga pumupunta, or they are seeking their health care services here in Aklan dahil po mas malapit po sila sa amin in terms of transportation. Kaya po, we decided that part of re-constructing our district health system is involving, or including municipalities of other provinces. Again, it’s in the works on how we will operationalize it, but it’s the direction that we are taking, not just in Antique, but also in Capiz because there is also one area in Capiz or another town in Capiz wherein their constituents are also accessing our health services. This will be challenging in terms of health financing as to how we are able to share resources but for now, this is what we’ve planned so that our Aklanons or even non-Aklanons can access health care easily and have better access to our health facilities.

Dr. Cathy: Laliman natin ‘yong discussion, Dr. Leslie. Isa-isahin natin kung nasaan na talaga si Aklan ngayon in terms of the health care provider network. So, let’s start with your facilities–kung nasaan na ba kayo in terms of licensing, in setting up of your network with your private sector. Can you tell us more about that, Dr. Leslie?

Dr. Leslie: Currently, we are in the process of profiling our health facilities. Very important ito kasi ito ‘yong bahay na kailangan natin ma-upgrade. So, we are profiling the health facilities to document the services that are available in each facility. Ang reason for this is that this aid us in whatever gaps in services that each facility needs to allocate budget on in the next few years. As I’ve mentioned, we are targeting that our primary care facility will be licensed by next year and we are also targeting yearly upgrades for our district hospitals.

As of now, we still need to build approximately 200 barangay health stations, and 11 primary care facilities and we need to expand our district hospitals. The health facility enhancement program or the HFEP of the Department of Health plays a huge part in realizing this goal.

Dr. Cathy: Alam ko, Dr. Leslie, kasama rin ‘yong private sector doon sa inyong na-identify sa district health system. Per district, parang mayroong isang private sector na tutulong sa inyo.  Baka pwede mo pang i-share about that, Dr. Leslie?

Dr. Leslie: One of the plans that we are having is that we are engaging the Aklan Medical Society. We are engaging them through dialogues. Once we’ve established the system already, then we will be asking for help from them as to the specialists; dahil po very important po ito dahil those that are seeking help in our health facilities, once na hindi na po ito kaya ng ating primary care facilities, they will be referred to our specialists or to our hospitals and again, for easy referral and to facilitate a better system, we are looking at partnering with our private doctors, especially in the Aklan Medical society to realize again this goal so that everything will be interconnected and even the financing side will also be incorporated in this partnership.

Dr. Cathy: Ang goal ninyo ba, Dr. Leslie, is mixed health care provider network? Hindi ba sa law, ang sinasabi niya ay pwedeng government or public-public or pwedeng mix, public-private and private-private, pero dito parang mix ‘yong plano ng Aklan?

Dr. Leslie: Eventually, Doc, we would really need to partner with the private sector kasi hindi lang naman ito kaya lahat ng government so, we really need help from our partners in the private sector, most especially tapping our special T-doctors and once we’ve established our system, as I’ve mentioned, we will be really outsourcing some of the services, specialized services to these private partners.

Dr. Cathy: Para sa mga listeners natin, pwede mo i-outsource or i-MOA (memorandum of agreement) ‘yong x-ray, pwedeng mga laboratories and pati nga mga pharmacies, hindi ba, Dr. Leslie? ‘Yong mga private pharmacies?

Dr. Leslie: Yes. Pwedeng-pwede talaga kasi as of now, syempre we cannot really fast-track the structures of our primary care facilities. It entails a lot of investments and so, the easier way is really to outsource these services that are not currently available lalo na ‘yong mga laboratories. Kailangan kasi niyan–of course, you’ll have to procure your laboratory equipment’s. You’ll have to hire med techs and mahirap po ito as of this time na madaliin po natin, but in the meantime that we are still establishing the structure; we are investing in the infrastructure; we are hiring more manpower, the easier way to go is really to partner with them, with our laboratories. As you’ve mentioned, ‘yong mga x-ray, our hospitals with x-ray facilities and actually, even transport services Dr. Cathy, if they don’t have an ambulance that is licensed, even this can be outsourced para at least, while we are waiting to really have all these services within our primary care facilities, in the meantime, we can really outsource and the Department of Health is even advocating also for this partnership with our private sector.

Dr. Cathy: Now, we go to the health workers naman, Dr. Leslie. Alam natin, ‘yong establishment ng isang health care provider network ay hindi lang structure ‘yong importante doon or ‘yong kailangan doon. Kailangan din ng mga tao. Baka gusto mo kaming i-update regarding the health workers’ preparation naman ng Aklan?

Dr. Leslie: Mahirap i-operationalize ang isang primary care facility na walang tao at even ‘yong at the minimum requirements of a primary care facility, that’s already a lot and even in the current devolution transition plan, ang dami pong mga recommendations to add on to our organizational structure and this puts a toll on our municipalities; and in our discussions with the mayors and the MHOs, this is really one of their clamors that, “Doc, hindi po namin kaya ito na maibigay lahat nang ito in just a short period of time.” And so, again really financing is a problem, but of course, as you’ve mentioned, doc. Very important ‘yong how we take care of the people who is caring for others. We understand this. We feel this, especially during the pandemic dahil po sila po talaga ‘yong mga soldiers and the frontline workers that really battled COVID. They were there at the front lines and so, it’s also a time to really appreciate them and really give proper compensation. One off the discussions is also pushing for the full implementation of the Magna Carta for health workers and of course, even if it’s difficult, we are also prioritizing and lobbying for positions for our health workers in the municipalities as well as the hospitals; dahil as I’ve mentioned earlier, hindi tatakbo ‘yong mga health facilities if there is no one who will man these facilities in the respective municipalities and hospitals.

Dr. Cathy: Yes, and early on naging witness ako noon prinesent mo ‘yong mga kailangan talaga na HHR or health human resource sa mga munisipyo. Wala pa nga ‘yong mga hospitals diyan. So, talagang marami kailangan. Siguro ‘yong follow-up question ko doon, may target dates ba, for example, itong issue or challenge on HRH ay ma-address natin with the municipalities, Dr. Leslie?

Dr. Leslie: Well, it’s a constant dialogue. We will be discussing this in the succeeding health boards dahil napakaimportante po itong pag-usapan. But then again, we will always go back to the available resources that we have in our municipalities and our province. Again, we will have to be reasonable as well as to what we are asking because hindi lang naman health kung baga, ang binabudgetan ng munisipyo at ng probinsya. There are also other sectors that need also attention and budget and so, slowly we are elevating these concerns and we are actually waiting for the right time as well to really push for this, when the finances are stable kasi as of this time, with the Mandanas Ruling, we understand that the IRA is kung baga, mas konti po in the next two and that is a challenge, as well for us.

Dr. Cathy: Yes, lalo na ngayon na nasa new normal with COVID pa, but at least, you have your initiatives and plans na for the province of Aklan and naging witness ako doon, na talagang maganda ‘yong relationship ninyo with the Association of the Municipal Health Officers (MHOs) at regular ‘yong mga meetings sa FB ninyo. Palagi kong nakikita iyon. Just like the rest of the country, ‘yong health human resource talaga ay isang challenge in the implementation of UHC. Ganoon din sa establishment ng health care provider network.

Dr. Leslie: I would like to add, Dr. Cathy, I just remembered na in our current executive meeting the other day, we will be implementing the upgrading of the salary grade of our nurses in the hospitals. ‘Yong Nurse I kasi po ay nasa salary grade XI iyan and starting January, we will be implementing the new proposal which is the Nurse I will be salary grade XV and the Nurse II will be elevated to salary grade XVI. So, that is a huge help to our manpower, especially our nurses. We are very thankful also to the finance team of the province and of course, to the governor for really making sure that this will be implemented next year. Matutuwa po ‘yong mga nurses namin po dito.

Dr. Cathy: Yes, sigurado matutuwa sila syempre, ang laki noong increase ng kanilang salaries and deserve naman nila iyan dahil nga sa talagang dedication and sa dami rin kanilang mga ginagawa sa health programs natin, especially sa hospitals and sa rural health unit.

Dr. Cathy: And that marks the end of the first part of our three-part episode on the health care provider network with Dr. Leslie. But we still have two more episodes with her so don’t miss them. Wishing all of you good health. Thank you for listening.

PART 2

Dr. Leslie Luces-Sedillo, provincial health officer II of Aklan, shared how the province is working on its health information system, financing mechanisms, and primary health care system. She also gave tips on how to win the cooperation of mayors in building a province-wide health system.

Dr. Cathy:  Hi. This is Dr. Catherine Chung, ZFF director for the Local Health System. Welcome to the second part of our three-part episode on the health care provider network with Dr. Leslie Luces-Sedillo, provincial health officer II of Aklan.

Dr. Cathy: Dito naman, Dr. Leslie, pwede mo ba kaming makuwentuhan regarding the health information system in preparation to the health care provider network? Hindi ba kasi ang goal talaga is to really have an integrated health information system from the grounds up to the hospitals?

Dr. Leslie: Yes, Dr. Cathy. Ever since kasi problema talaga ito. Magpapakunsulta ka sa RHU, kukunan ka ng data then, i-refer ka sa ospital, kukunan ka ulit ng data. So, parang ang hirap. Why not really merge with all these information systems to make the transaction seamless and faster? So, we are thankful that the Department of Health has made electronic information systems for hospitals as well as at the level of primary care facilities, to RHUs so, i-ClinicSys for municipalities, and iHOMIS (Integrated Hospital Operations and Management Information System) hospitals. For the province of Aklan, in the past few years with concentrated on making iHOMIS functional. As of now, talagang nagagamit na po ’yong IHOMIS. Malaking tulong po ito sa mga hospitals to fast-track the transactions at the same time, even the PhilHealth reimbursements. Now, we are focusing our efforts on the implementation of iClinicSys. We have currently organized a team to oversee this. We did a full assessment of all facilities and we identified the number of computers, printers, servers, and manpower needed for its full operation. So, we are hoping and also, DOH will be providing us assistance in terms of providing this hardware like the printers, and computers, but I think, the province will also invest in this. Kailangan kasi may anim na computers bawat primary care facility para bawat station, computerized na siya. Hindi ka na paulit-ulit. Hindi na siya by paper and then, you can generate data in the fastest possible time and you can also submit it to PhilHealth easier. Then, later on, ‘yong fusion ng iHOMIS and iClinicSys na once each of these systems are in place. It will be a long journey, but again, we need to start somewhere and that’s where we are as of this time for our health information system.

Dr. Cathy: Maganda ‘yong nag-needs assessment na ang Aklan at sinasabi ni Dr. Leslie anim na computers ang kailangan. Baka may mga listeners tayo, Dr. Leslie, na mga private sector or ibang groups na makapag-provide nito sa Aklan. Iyon lang, malaking cost na iyan at napakalaking bagay pag nabigyan ‘yong mga rural health units natin.

Dr. Leslie: And we appreciate really the help of DOH sa regional office because talagang bumababa sila sa amin and they have committed to go to each municipality so that they can train the health workers on how to use the system. The Internet system will also be available in our health facilities.

Dr. Cathy: Yes, kasi ang daming GIDA (geographically isolated and disadvantaged areas) areas din sa Aklan. May mga areas na wala talagang signal and tingin ko, may napuntahan na rin kami dati noong pumunta diyan sa isang barangay or city na wala talagang signal. Mahihirapan ipadala sa PhilHealth lalo na kung kailangan ng reimbursement doon sa payment. So, importante iyon, ‘yong hardware, software, Internet at syempre ‘yong taong gagawa at mag-operationalize ng health information system. May laptop ka nga, wala namang taong marunong. So, importante na…

Dr. Leslie: Na-train.

Dr. Cathy: Kasama rin iyon sa plans ng mga municipalities at kasama rin dun sa pinondohan nila and may support ang ating Department of Health. Nababanggit na natin itong kaperahan, Dr. Leslie. How about ‘yong financing mechanism; kasi nasabi mo na rin, in development fund, may kasunduan na rin ba ‘yong mga munisipyo ninyo sa Aklan para masimulan itong special health fund or pooling of funds?

Dr. Leslie: Yes. Alam mo pag usaping pera, it’s challenging, Dr. Cathy, but what we are doing here in Aklan, we are currently in the process of finalizing our memorandum of agreement on the pooling of funds from our municipalities and of course, si province din po mag-share. So, as part of our special health funds, what we are doing is that in the MOA, each municipality and the province will be sharing 10% of their development fund to be used as an operation funds for the districts. So, iyon po ‘yong medyo unique po namin na strategy dito sa Aklan to ensure that there are really funds for health. Hindi po ba ‘yong development fund is can be used naman as to any development projects and including health. So, if talagang naka-stipulate na 10% of that will be for health, so that will be sustained. It will be every year that the province will have this pool of funds that we can really use to upgrade our health facilities to hire more manpower and general operations in health. Malaking tulong po ito once this will be operationalized and this will be signed by our municipalities. So, on the works lang po kami as to finalizing it. I think, in the next health work, we will be presenting this again to the body for approval.

Dr. Cathy: In relation to that, dahil nga pipirma nga ‘yong mga munisipyo, itutuloy na natin sa follow-up question. Importante ‘yong kaperahan, ‘yong pirma nila sa MOA, pagbibigay ng 10% na development fund doon sa sisimulan na special health fund. Kumusta naman ‘yong partnership with your municipalities? Kasi dapat pumirma talaga sila lahat to signify their commitment or terms of partnership sa probinsya. Ito ay nasa batas to signify and nagko-commit sila to a province-wide health system with Universal Health Care Law.

Dr. Leslie: Yes, Dr. Cathy. Very important iyon kasi again, this is a financial resources and nag-aagawan lahat para makakuha ng part ng IRA, ‘yong funds ng munisipyo at ng probinsya and so, there were series of discussions. We’ve talked with MHOs. We’ve talked with the mayors during their League of Municipal Mayors Meeting. We’ve talked with the municipal budget officers. Hindi siya madali. It was a series of discussions and meetings with them so as to fine-tune the memorandum of agreement and we have a legal team on board which is part of our local health board. Kaya po sila din po ‘yong tumutulong sa amin in finalizing this. So, a lot of behind the scene work is being done; a lot of rehashing and editing is being done so as to finalize this agreement. Pag na-approved po ito and everyone will sign the agreement, sa totoo lang, this will be a huge development for Aklan dahil malaking concern kasi po on where we are going to source funds to finance all these things that we want to do for Universal Health Care and if we have these funds really allotted for them, per district, it will also help to build the relationships because sila within the district, we will be planning on how they will utilize this fund. Hindi po kami makikialam sa kanilang pera. They will actually be planning and deciding on how they can use the budget. Of course, according to the guidelines set by the Department of Health. So, iyon po, Dr. Cathy. I’m really hoping that this will be successful and everyone, well so far, there were verbal agreements already coming from the mayors, from the MHOs as to these agreements. So, hopefully, there will be – ma-sign na siya para at least, it will be really sealed agreement from everybody.

Dr. Cathy: Dr. Leslie, hindi ba alam natin sa isang probinsya, hindi naman lahat iyan makakasama sa isang political party? Alam naman natin that’s a reality. Dito sa sinasabi mo, nagkakaroon ng series of dialogues and then, nag-signify naman sila ng commitment. Baka madagdagan mo pa ‘yong tips naman sa ating mga provincial health officers na nakikinig para mas makuha ‘yong commitment ng mga mayors?

Dr. Leslie: Piling-pili po ‘yong mga meetings that we are attend – kumbaga, pinipili namin kung saan na meeting kami pupunta to lobby for this. Medyo crucial na mga usapin lalo na sa pera. So, during we’ve found that very important ‘yong meeting ng mga mayors during their League of Municipal Mayors. They are regularly meeting up. Well, we, here in Aklan po, madalas po ‘yong meetings nila and doon po kami pumapasok dahil at least, it’s just that team, ‘yong audience namin. Wala nang ibang tao. It’s just the mayors. So, mas directed, mas focused po ‘yong discussion, especially if naka-agenda po sa kanila. Sinasabihan po namin ‘yong kanilang GAD (gender and development) that we will be talking about the sharing and the pooling of funds and so, mas directed po ‘yong discussions, less distractions–rather than doing it in a bigger group. Mas mahirap po iyon and also, if mahirap pa rin in that level, we will go to every municipality, we will visit the mayors in their offices and really share ito, kunwari, hindi sila naka-attend, they were prior commitments and they were not able to make it during meetings, we will visit the offices of the mayors and we will personally lobby to them para at least, naintindihan po nila kung ano po ‘yong mga current concerns that needs to be on their table and needs other decision-making, also. It’s more personal atake po on this very important concerns na kailangan po natin i-lobby lalo na finances.

Dr. Cathy: Maganda ‘yong naging strategy ng team nina Dr. Leslie aside sa maraming pag-uusap talaga. Ang dami na rin na-mention ni Dr. Leslie kaninang mga challenges niya with regards to the implementation of UHC in general and also, sa HCPN or the health care provider network establishment. Baka mayroon ka pang other challenges na naiisip mo, Dr. Leslie, and paano mo iyon na-overcome with your team?

Dr. Leslie:  Even before kasi Doc, ang passage of the Universal Health Care Law, kakaumpisa na rin ‘yong Aklan in re-organizing our health care provider network way back pa. So, but one of the challenges really was when pandemic hit us, so parang tumigil lahat, nandoon sana ‘yong momentum to do all of these activities to fully implement ‘yong UHC, but here comes the pandemic and everyone and everything was stopped and put on hold. Lahat ng resources; lahat ng plans and efforts were channeled in COVID operations. So, I think that was a huge challenge for us kasi alam mo iyon, nandoon ka sa momentum, tumigil ulit and then, you have to shift again your focus in another area which is COVID operations, but now, medyo nag-stabiliz na ‘yong ating COVID. We are again going back on track where we left off in the implementation. Siguro, paulit-ulit natin itong na-mention ‘yong finances. Mayroon talaga naman mahirap talaga ‘yong financial resources lalo na we went through a huge challenge of the pandemic. So, talagang na-drain ‘yong resources. I’m sure other provinces can relate to this–an added burden which is because of the Mandanas Garcia Ruling, we will have a lower IRA in the next two years and this will definitely have a huge impact in our UHC targets because again, syempre kailangan ng malaking investment in health so that in the next few years when we have lower IRA, syempre we cannot fully allocate our budget to these health needs. I think, those are the challenges for now, major challenges. But again, we are finding ways and means through partnerships, private partnerships to help us with the needs and the gaps that we have para at least, hindi tayo nakatengga kahit konti ‘yong IRA in the next two years. We will find other means to support the health system.

Dr. Cathy: Alam din namin, Dr. Leslie, ‘yong ating probinsya has been strengthening its primary health care system and then, sa iyo nga namin nakita ‘yong isang comprehensive primary health care facility ni-represent mo iyan noong 2019. Iyan ‘yong ini-envision natin sa ating mga rural health units. Why is this important in setting up a health care provider network? Nasaan na si Aklan ngayon since noon 2019 na na-discuss natin iyan sa isang provincial health board, Dr. Leslie?

Dr. Leslie: Alam mo, sobrang importante ‘yong ating strengthening ng primary care system. Ito ‘yong heart ng entire health care system. It is the initial point of contact of our patients and our clients. So, when we facilitate a good gatekeeping mechanism, ‘yong bawat tao, each person will be directed to the proper health facility that can cater to the health services that they need at that time. In effect, with proper gatekeeping and with the strengthening of our primary care facilities, our hospitals would be decongested and our hospital beds will be allocated and made available for those that really need this for the patients that need secondary and tertiary levels of care. Kaya, Dr. Cathy, talagang we’re really emphasizing down to the municipal level to the mayors na importante ito. We really need to invest in this. We really need to expand our primary care facilities because there is no Universal Health Care without primary health care.

Dr. Cathy: That’s the real foundation of UHC. Kailan ninyo target, Dr. Leslie, na ma-license lahat ng itong primary care facilities natin sa Aklan?

Dr. Leslie: Well, we really aim to have it license all of our primary health care facilities by next year. So, we’re really hoping to reach the target. Currently naman, mine-mentor and kino-coach sila ng ating mga DMOs on the ground and we are thankful that they are really hands-on with this. Talagang tinututukan natin ito and we’re hoping that we can reach the target that by next year, we can have a more comprehensive primary care facility and in partnership of course with PhilHealth, through their financing mechanism din. You know, PhilHealth is very supportive here in Aklan; with constant dialogue and discussions with them, balitaktakan ng mga concerns and problems on the ground. They’re very fast in addressing this and fixing the system. Sana po tuloy-tuloy po ‘yong ganoon partnership and even down to the level ng ating mga primary care facility, they can fast-track also the reimbursements that is needed also for our primary care facility. If mayroon na kasi tayong kunsulta package, malaking tulong po iyon sa mga tao because there are free services that will be provided; free medicines that will really be provided. Kaya po, binabalanse po natin iyon, that the health facility and the municipality will also have stable finances, but at the same time, they’re able to provide these free services also to their communities.

Dr. Cathy: And that’s it for part two of our three-part episode with Dr. Leslie. Don’t miss the last part, where she will share tips on onboarding a new governor and takeaways on the implementation of Universal Health Care. Wishing all of you good health, and thank you for listening.

PART 3

Learn from the experience of Dr. Leslie Luces-Sedillo, provincial health officer II of Aklan, in onboarding a new governor in line with the implementation of Universal Health Care.

Dr. Cathy:  Hi. This is Dr. Catherine Chung, ZFF director for the Local Health System. Welcome to the last part of our three-part episode on the health care provider network with Dr. Leslie. Today’s questions will surely solicit a lot of learning so let’s get things started.

Dr. Cathy: Alam natin na ang Aklan ngayon ay may bagong governor, siguro ang tanong ko lang is the former Governor Joven Miraflores was often described as a hands-on leader. What active roles did he play to get to where you are right now in the health care provider network or the UHC attainment as a whole Dr. Leslie?

Dr. Leslie: Alam mo, we are really lucky to have former Governor Joeben Miraflores as our leader, most especially during the trying times of the pandemic. You know, he is really a bridging leader by heart and he has developed these adaptive leadership skills through the coaching and mentoring of the ZFF team. Governor Joeben as a visionary leader makes sure that all his plans that he co-planned with his team and co-created with us become really a reality. So, his secret is he frequently engages with the municipal mayors and the MHOs, especially when major decision-making is on the table and he will even go out of his way to find private partners to help us finance our projects. Also, he is a very good listener. He listens to expert opinions, but at the same time, he also listens to the voices of the people on the ground. I will never forget the time when he did his deep dive into one of the farthest municipalities in Buruanga, the team together with him, visited a family of a mother who died because of childbirth and he intently listened to the difficult journey of the mother through the storytelling of the husband and through those stories, he looked at how the mother really suffered because of the situation at that time and so, he visited all the facilities that the mother went to in order to really see first-hand the gaps on the ground and after that experience of the deep dive, every time that we will have meetings with him, he will always reference back to that glaring inequity problem that he saw first-hand and he would challenge us to take part in solution building in this health concerns. Ganoon po si former Governor Miraflores and we are really thankful to really be working with him as our leader.

Dr. Cathy: Na-experience rin namin iyan. He’s really a good listener and nag-collaborate talaga siya sa mga kasama niya sa Aklan. Naging witness ako ng mga provincial health board meetings ng Aklan at talagang ang dami kasama, ang daming nag-attend and talagang dini-discuss with his leadership ‘yong mga issues and challenges and syempre, ‘yong mga kailangan gawin sa probinsya. Ngayon, Dr. Leslie, nabanggit ko na may bago na tayong governor. Can you describe how you and your health team are adjusting under the new provincial leadership and please give us idea on how you are on boarding him? Alam kasi natin baka ‘yong mga ibang listeners natin, ‘yong mga PHOs may ganitong experience din tulad ng Aklan.

Dr. Leslie: Alam mo, ang swerte ng Aklan because I think the transition was so smooth. What’s good is the new governor has sustained all the efforts and the gains of the previous administration. So, our new governor is also a graduate of the Municipal Leadership and Governance Program or MLGP of ZFF, and similar to his father, he is also a very good bridging leader. Again, still, health is a priority of the new administration and in fact, on his first day of office, he visited us in our office and asked us personally for updates on our ongoing programs and kung ano ‘yong mga plano for our health system reforms in the succeeding years. So, you can really see his dedication and his commitment to further the gains of what we already did in the past few years and he is pushing for more reforms and for more innovations as his term unfolds. So, we are really looking forward to working closely with the new governor.

Dr. Cathy: Aside sa na-mention mo, Dr. Leslie, ‘yong working closely with the governor, may additional tips ka pa ba sa mga PHOs natin lalo na kung bago ‘yong kanilang mga governor?

Dr. Leslie: I think, it’s really basic. Constant communication is really the key to a good working relationship between the governor and us in the health sector. So, what we would always do is we would regularly give him updates on important developments and the current situation of the areas that he wants to be monitored and through the conduct of the regular provincial health board meeting. It’s an important avenue where the governor can hear concerns from the municipalities and the hospitals; and so, that’s an avenue where we co-create policies and strategies to address the issues that are raised during the session.

Dr. Cathy: Ang swerte talaga ng Aklan and we are excited to meet the governor sa kaniyang session sa October and kasama ‘yong team ni Dr. Leslie.

We are nearing the end of our program today. Dr. Leslie, please share with us your most important learning in UHC from the law’s enactment in 2019 to the start of your province’s implementation, until now.

Dr. Leslie: Alam mo, Universal Health Care implementation is really doable naman, but it just needs a lot of behind the scene work. It entails a lot of collaborative work and relationship-building amongst our fellow health workers. Importante iyon, hindi ba, Dr. Cathy, the adaptive part.

Dr. Cathy: Yes.

Dr. Leslie: Sobrang mahalaga iyon. Of course, collaborating with the crucial stakeholders to move forward with our UHC agenda. So, there are a lot of challenges to be hurdled and finances to be put in place so that our goals will be met and we really need to communicate and share a common understanding in this collaborative work.

Dr. Cathy: Seeing that you are doing a great job in implementing UHC in the province, is there any additional assistance you still hope to get from the government, Dr. Leslie?

Dr. Leslie: In terms of additional assistance, Dr. Cathy, We’ve raised this to them that we are asking for their help with their health facilities enhancement program or HFEP to sustain their assistance with us in establishing our health facilities, and our health infrastructures. As I’ve mentioned earlier, we still need to construct 200 BHS, 11 primary care facilities and we need to expand our hospitals so that they become level I facilities. Hindi po namin kaya po iyon, ‘yong probinsya at ng mga munisipyo to really finance all of these infrastructures. Talagang mahirap po dahil this entails a lot of investments and kaya po, humihingi po talaga kami ng help with them to really help us with financing all of these health facilities and aside from infrastructures support, we would also need assistance and guidance and policy support in moving forward ‘yong health financing part naman, Dr. Cathy, specifically in operationalizing the special health fund dahil I think, in the works naman na po ito, but I think in the next few months, we will have more news as to how we really can handle, or ano pa bang funds that we can pool so that our special health fund can be operationalized.

Dr. Cathy: I-emphasize natin 200 BHS at 11 primary care facilities. Baka marinig ito ng marami at masuportahan si Aklan ng DOH.

Sa mga listeners natin, kailangan ni Aklan ng 200 BHS at 11 primary care facilities. Marami iyan, Dr. Leslie.

Dr. Leslie: Yes, sobrang dami.

Dr. Cathy: Syempre, responsive na mga hospitals.

Dr. Leslie: Dapat. The mandate really is one BHS per barangay, hindi ba, Dr. Cathy?

Dr. Cathy: Oo.

Dr. Leslie: If we want to achieve that mandate, then we really need all the help that we can get in establishing and building all these health facilities.

Dr. Cathy: How about from non-government organizations like ZFF, mayroon ka pa bang assistance na kailangan ng probinsya ng Aklan at ano iyon mga assistance na iyon?

Dr. Leslie: Sobrang helpful ng ZFF, alam mo iyan, from the very start and we are very thankful for our collaboration since 2016 from PLGP, nag-move forward na tayo hanggang ngayon.  Across the years, including pandemic–challenging times– the ZFF team has really invested a great foundation in building up our municipal and provincial health leaders, and because of this investment, it has really translated into better health outcomes here in the province of Aklan. Now that we are jumpstarting again, Universal Health Care implementation, of course, we would still need your guidance and support, most especially in operationalizing our district health system and to achieve our UHC goals, and of course, there are some mayors na bago and since we feel that the MLGP and the bridging leadership program is really very important sa ating mga leaders kaya po, we are again asking support from you to help us train our health leaders, our mayors on this. Kaya po, malaking tulong po iyon sa probinsya ng Aklan.

Dr. Cathy: Thank you very much for your valuable insights, Dr. Leslie.

Dr. Leslie: Nice talking to you, Dr. Cathy. Maraming salamat for your time. Dr. Cathy: And that wraps up our three-part episode on the health care provider network with Dr. Leslie. In future episodes, we will talk more about Universal Health Care. So, don’t miss them. Again, this is Doc Cathy, wishing you good health. Thank you for listening.

We asked Agusan del Sur Gov. Santiago B. Cane Jr. and his provincial health officer, Dr. Jacqueline Momville about the province’s current status in terms of building its health care provider network, its homegrown health care information system, and how the they are pooling their budget for the implementation of the Universal Health Care.

Title: Agusan del Sur | Health care provider network (Part 1 of 3)
Host: Dr. Catherine Chung, ZFF Portfolio Director
Speakers:

• Gov. Santiago B. Cane Jr., Agusan del Sur

• Dr. Jacqueline Momville, Provincial Health Officer, Agusan del Sur

Languages: English, Filipino

Length: 53.95 minutes

TRANSCRIPTIONS:

Dr. Cathy: Hi. This is Dr. Catherine Chung, ZFF director for the Local Health System and with us today, are Agusan del Sur Gov. Santiago B. Cane Jr. and his provincial health officer, Dr. Jacqueline Momville. Good afternoon, Gov. Cane and Dr. Jackie. Kumusta po kayo?

Gov. Cane: Okay lang naman, Dr. Catherine.

Dr. Cathy: Our topic for today is relevant to the goal of Universal Health Care Law. So, alam naman natin na na-implement siya since 2019. And in particular, we will talk about how to set up a health care provider network, which is mandated by the law. The UHC law defines a health care provider network as a group of primary to tertiary health care providers–so, from the rural health unit up to the hospitals–offering people-centered and comprehensive care in an integrated and coordinated manner. The Department of Health has set the standards and guidelines for the formation of health care provider network. But, what does the process look like in practice? Dr. Jackie, if you do away with the technical terms, how would you describe to me what a health care provider network is?

Dr. Jackie: I think the health care provider network is like a family taking care of a child, a very precious child, that we need to have a very good working relationship so that we can take care of this child. So, when we are family, we mean that we don’t leave anyone behind. We ensure that in our family of health care provider network, everyone is capable; everyone is knowledgeable; and everyone is compassionate and passionate about what we are doing in taking care of the people.

Dr. Cathy: Thank you, Dr. Jackie. In terms of building a health care provider network, nasaan na ba ‘yong Agusan del Sur ngayon?

Dr. Jackie: We are right now in strengthening our inter-local health zone and actually we ensure that the stakeholders within the inter-local health zone has good working relationships and that they are supportive with one another. We are hoping to amalgamate this inter-local health zone into one big province-wide health care provider network. To add to that, what we are trying to also to do is to deepen the trusting relationship and the working relationship because as we all know, we have health workers in the hospital and we have health workers in the public side. There are differences in perspective. With the differences in perspective, comes sometimes conflict and misunderstanding, so that is why we are endeavoring really to have this activities or avenues where they could strengthen their bond and makuha nila ‘yong loob ng isa’t isa and to understand the experience in the context of each side so far.

Dr. Cathy: Let’s drill down to that. In terms of the inter-local health zones that you have mentioned, can you please discuss further ‘yong specifics nito in terms of its functionality and the different requirements according to Department of Health? In terms of establishment of health care provider network, Dr. Jackie?

Dr. Jackie: Agusan del Sur has four inter-local health zone. So, this inter-local health zone is a clustered group of municipalities and in the clustered group of municipalities, there are around maybe three to five municipalities and in every inter-local health zone, we have a hospital. So, the hospital serves as the vice-chairman while one of the mayors serves as the chairman and with that, they meet at least once every six months, or if we could push further quarterly, in order to discuss the prevailing health realities of the inter-local health zone. So, in that inter-local health zone, since we have rural health units and we have hospitals. We are also capacitating them in such a way that as much as they could, they could take care of the people within their inter-local health zone before actually sending them to our core referral hospital in the province and aside from that, the team of health workers in the inter-local health zone, we have these agreements. So far, in the last three years, we have active inter-local health zone. Three of these inter-local health zones are active while one still needs to be assisted to be more active in meeting and discussing stuff for the health of the people.

For the three inter-local health zone that are really active, actually the municipalities provide funding. They pool a fund in order too ensure that the people in the inter-local health zone have access to maybe out-patient care in the hospital or if they need medicines that is in the out-patient basis or when it’s in the in-patient, they are also being assisted. So, this one is pooled in the hospital and the hospitals give feedback to the inter-local health zone meeting every time that there is a meeting, and also, in the inter-local health zone meeting, we discuss statistics; how they are doing and discuss priorities in terms of public health services and even how we can set the hospital services to cater to the needs of the people.

Dr. Cathy: Ang dami ng naging initiative ng Agusan del Sur. Na-mention mo, Dr. Jackie, mayroon ka pa rin medyo hindi functional na inter-local health zone, baka pwede mong mabanggit ‘yong challenges doon?

 Dr. Jackie: I think there are two major factors: number one is the leadership of the chairman which is one of the local chief executives; and second is the partnership being provided by the hospital who is the vice-chairman. These two will really stir the direction of the meetings. It is really important that there is a feedback mechanism between the municipalities and the hospitals because we know that the patients admitted in the hospital reflects the state of health of these municipalities. But I have big hope na this will be functional in the next three years.

Dr. Cathy: So, ibig sabihin ‘yong ibang inter-local health zone sa Agusan del Sur in terms of its licensing of the facilities, ‘yong mga primary care facilities, okay na sila lahat doon, Dr. Jackie? And ‘yong in terms of health workers’ capacities and competencies, syempre ‘yong ratio din nila, ‘yong quality nila sa isang inter-local health zone nasa standard na ba ng hinahanap ng batas natin sa UHC and its implementation of the health care provider network, or in the preparation to the implementation of a functional health care provider network?

Dr. Jackie: Actually, we are in the stage of assessment. So, we had a province-wide baseline assessment of the human resource for health and we already have that data and also, we had a baseline assessment of all barangay health stations in the rural health unit. We are still working gon for the accreditation to be a primary care health facility, and since we already have assessment, we included it in the local investment planning for health so that in the near future, we can implement that, and on the pipeline actually is there are also included rural health units to be super rural health units by next year.

Dr. Cathy: Wow, super rural health units, Dr. Jackie. Before I go to the Gov., ang alam ko mayroong homegrown information system ang Agusan del sur, Dr. Jackie? Pwede mo ba ma-share sa amin iyan?

Dr. Jackie: Actually, we have this very ambitious plan. For the first phase of this big plan, we are fixing the information system in our hospitals because we would like an information system that captures essential information that is cutting across the board as recommended by the Department of Health and also, to capture information that is unique to our province. So far, for the health information system for the hospital, three out of the five hospitals have implemented it and we are going towards two more and then, we are working on for the part of the public health information system. The provincial health office is also boosting our health information system within the office. In fact, we have monitoring and evaluation team, composed of three members. Three years ago, wala siya and it was just erected just before the pandemic. So, very lucky. Iyan ‘yong mga information system and I think, one of the most successful information system is our COVID testing information system wherein the people who would like to be get tested can input their data online so that they will be scheduled for testing and upon the receipt of their specimen, their results will be released in less than 24 hours. And the fastest we could is actually four hours, released through text message. We have also connected with the rural health units because there are people here who doesn’t have contact numbers and email. So, the rural health unit has also the access to the specimen that they sent to us to help those people who doesn’t have contacts. So far, that’s for the health information system.

Dr. Cathy: Wow. Big accomplishments from the Agusan del Sur team.

Dr. Jackie: If I may add, Dr. Cathy, in the health information system, it’s also important that we have a hardware. We have ensured our hardware at the level of the provincial health office and hospitals and hopefully, across the board in our rural health units. And also, we will be venturing and ensuring and capacitating our workers to be computer literate.

Dr. Cathy: Hopefully, ‘yong Agusan del Sur ay isa sa models na mayroong integrated health information health system toward a functional, province-wide health system kasi importante ‘yong information health system in terms of planning and lalo na ‘yong database pag lalabas na ‘yong PhilHealth reports, ‘yong financing part naman ng ating health care provider network, doon din manggagaling ‘yong mga gagastusin ng ating mga primary care provider networks and the primary care facilities in terms of other logistics, purchase of medicines and support to incentives and health human resources.

Dr. Cathy: Ngayon, dahil nandito ang ating dashing Gov., na binigyan tayo ng time for this session. Gov., I want to ask you. I know implementing the law requires resources and given the responses from Dr. Jackie, mayroon nang mga municipalities na talagang nag-allot and nag-share ng kanilang national tax allocation to health para ma-pool in terms of the inter-local health zone funding. How did you get the budget support naman to start setting up the health care provider network in the province aside doon sa nabanggit ni Dr. Jackie?

Gov. Cane: In terms of the the budget na gagamitin natin for the provision of the medical health sa mga tao dito sa probinsya ng Agusan del Sur, I’ll start muna with the provincial level. Dito sa probinsya namin for the current year 2022, ang budget namin dito for the entire year is 3.5 billion sa annual budget. Now, 32% of that 3.5 billion is appropriated for health care services, kasama na dito ang pag-operate ng ating limang hospitals sa probinsya at saka ang mga pangangailangan ng provincial health office, lahat-lahat na.

Sa mga munisipyo naman and the lone city of Bayugan, mayroon din po silang budget kasi it is a requirement in the formulation of your budget. Kailangan mayroon din sa health services. Although, I am not very certain about the exact amount that they have appropriated in the respective local government units, but in my talks with the component municipal and city mayors, I have emphasized to them that it is very, very important to appropriate an amount doon sa annual budget nila kasi component na po iyan.

Now, sa mga mayors naman namin dito ay wala naman pong problema sa pakikipag-coordinate and pakikipag-collaborate sa kanila. Hindi lang sa aspeto ng kalusugan, kung hindi sa lahat ng aspeto. I have emphasized with my component municipal and city mayors that we, elected officials have this power and this is the power to serve the very people who put us where we are. Kaya ‘yong health care services is a very, very important component in our public service. So, nilalagyan talaga namin ng sapat na pondo para sa panahon ng pangangailangan lalung-lalo na sa mga local levels, sa munisipyo at saka sa city at even sa barangay level ay may pondong magamit nila to implement our medical programs, preventive medicine ika nga. Kami naman sa province, pag kinukulang ‘yong budget nila, ang role po ng province is to augment what they lack at their level. Kaya maganda ‘yong collaboration namin between the municipal, the city and even the barangay levels at saka ‘yong provincial level. Kaya in the province of Agusan del Sur, Dr. Cathy, the municipal mayors, the city and municipal health officers are included, kasama po namin sila sa provincial health board. So, during our meetings ay kasama sila sa mga usaping pangkalusugan, kaya madali kaming nagkakaintindihan dito kasi nga we belong to one province. We have the same constituents at iyon ang pledge namin sa mga taong-bayan, that we will work for them. Kaya there is symbiosis. Nagtutulungan kami dito. That’s why hindi lang pareho ang level of appropriations na intended for health services, but lahat po ng component from the barangay level, municipal, city and provincial level mayroon po kaming budget para diyan.

Dr. Cathy: Ang swerte ng Agusan del sur. Hindi lahat ganito ‘yong nangyayari sa iba’t ibang probinsya lalo na makuha mo ‘yong 100% cooperation and commitment of the municipalities down to the barangays and si Gov. lalo na ‘yong support niya to really provide 32.5% of the budget or the NPA, the National Plot Allocation ng probinsya ng Agusan del Sur to health programs. Kitang-kita ‘yong priority ni Gov. ang health talaga.

Dr Cathy: And that brings us to the end of this episode, but we still have two more episodes on the health care provider network with Gov. Cane and Dr. Jackie. So, don’t miss them. Wishing all of you good health. Thank you for listening.

Title: Agusan del Sur | Health care provider network (Part 2 of 3)

Description: Get tips in engaging mayors and the private sector from Agusan del Sur Gov. Santiago B. Cane Jr. and his provincial health officer, Dr. Jacqueline Momville.

Transcription:

Dr Cathy:  Hi. This is Dr. Catherine Chung, ZFF director for the Local Health System. Welcome to the second part of our three-part episode on the health care provider network with Agusan del Sur Gov. Santiago B. Cane Jr. and his provincial health officer, Dr. Jacqueline Momville. Let’s pick up where we left off.

Doc Cathy: Governor baka mayroon ka pang ibang tips sa ating mga listeners kung paano ma-fully get ‘yong cooperation at makuha ‘yong collaboration ng mga municipalities ng mga mayors lalo na ngayon UHC na, province-wide health system. ‘Yong Gov. na talaga ‘yong chairman of the provincial health board and mag-lead nito sa mga susunod na taon at simula na ngayon. Gov., may mga tips ka pa ba?

Gov. Cane: That’s right, Dr. Cathy. As a matter of fact, mayroon na kaming provincial health board meeting. If I’m not mistaken, it will be this coming October 4, wherein we will further discuss the Universal Health Care law. At bago mangyari ‘yong provincial health board meeting namin, I asked our provincial health officer, Dr. Jackie Momville to gather all our health officers in the entire province, kasama na ‘yong mga doctor to the barrios program na na-assign in the different municipalities and city at saka ‘yong mga chiefs of hospital. Pag-uusapan ang plano namin on how we can more effectively implement the Universal Health Care para mas lalo pang mag-benefit ‘yong mga tao na nangangailangan ng health care dito sa probinsya ng Agusan del Sur. So, if it is not too much of an asking, Dr. Cathy, we would like to invite you into that gathering para makapag-contribute ka rin ng mga brilliant ideas mo on how to further improve the delivery of health care services at hindi lang sa mga MHOs, hindi lang sa aming mga chiefs of hospitals, kasama rin namin dito ‘yong mga barangay health workers. Dr. Cathy, kasi nga po the barangay health workers are our front liners in the delivery of our health services. Kaya ang masasabi ko lang po dito sa Agusan del Sur ay hindi natin pwede balewalin ‘yong role ng mga barangay health workers. They are very, very important. Their role is just as important as any doctor assigned in the province.

Ang ginawa namin dito sa Agusan del Sur since early 2000, gumawa kami ng isang ordinansa na nagbibigay ng libre paeskwela doon sa mga eestudyante namin dito na taga-Agusan del Sur na gusto maging doctor katulad ninyo. Lalo na ‘yong mga interested young students who would like to dream to becoming medical professionals like you, pero hindi kaya ng mga magulang nila na paaralin sila because of financial constraints. So, we came up with an ordinance, providing for a full medical scholarship program and from then on, after four years, five years of the scholarship program and every year thereafter ay mayroon po kaming mga graduates sa medicine at pumasa po–100% po ‘yong mga graduates namin ay pumasa po talaga sila sa physician licensure examination. Wala pa pong bumagsak sa awa ng Diyos because hindi po biro itong scholarship na ito. Wala pong pulitika. Pag may isang politician na nag-recommend ng isang constituent niya na papasukin namin sa medical scholarship ay hindi po namin tinatanggap iyan, lahat ng applicants have to undergo the screening process which include interview, written examination at higit sa lahat ay ini-examine namin ‘yong applicant bago sila maging medical scholar ay talagang may puso na magsilbi sa Agusan del Sur. Kasi nga in that scholarship program, kasama po diyan ang walong taon na return service dito sa Agusan del Sur. Kaya sa ngayon, Dr. Cathy, more than 80% of our doctors working in our hospitals and in other municipalities and city are already products of our medical scholarship program. That is the only way na maiwasan natin na magkaroon tayo ng shortage of doctors at saka nurses din. Mayroon din kasi nga, in early 2000, there was an exodus of medical doctors, medical workers. ‘Yong mga doctor nag-enrol sa nursing tapos, nag-abroad kaya sumakit ang ulo namin doon. Kasi matagal na ako dito sa Agusan del Sur nag-serve, since 1998, at na-experience namin ‘yong shortage of doctors and nurses at that time, early 2000. Kaya we came up with this scholarship program and it is ongoing already. Every year mayroon kaming graduates and every year may pumapasa sa licensure examination at every year din kung may mga bakanteng position for medical officers ay tinatanggap namin sila dito and we provide them with the right salary, intended for medical officers.

Dr. Cathy: Ang ganda ng inyong naging strategy in terms of the shortage of health human resources in year 2000. And alam natin, noong nagka-COVID lalong naging challenge iyan sa mga probinsya and ang maganda dito talagang na-sustain siya. From 2000 hanggang ngayon may mga napro-produce na mga doctors and, sabi ninyo nga, may nurses pa. Ang pinakamaganda doon sa program na iyon, sabi ninyo nga ay 80% ng inyong health human resource ay from the scholarship. So, napakaganda ma-replicate ito at marinig ng ibang mga Gov.s. Baka pwede rin nilang gayahin kasi sa iba’t ibang lugar sa Pilipinas isa ‘yong health human resources na challenge. Lalo ngayon sa Universal Health Care, isa iyan sa napakalaking requirements in terms of the restructuring ng ating probinsya to really achieve ‘yong goal ng UHC sa atin in the next 10 years. Nabanggit din ni Gov. kanina, everyone is involved sa Agusan del Sur from the barangay health workers up to the municipalities, to the mayors, municipal health officers. Dine-date daw niya at talagang gina-gather.

Gov. Cane: At the height of COVID nga pala, because you were mentioning about the pandemic. Nag-hire po ako ng 32 additional nurses para sa mga hospitals namin at saka sa mga isolation facilities kasi nga kahit na marami na kaming mga nurses, dumami din po ‘yong mga cases ng COVID. Napuno ‘yong mga hospitals namin, kaya si Dr. Jackie mangiyak-ngiyak na dahil kinukulang ‘yong mga nurses niya at I fully understood her sentiment. So, nag-emergency hiring po kami ng 32 additional nurses, med techs, even ‘yong mga doctors may field of specialization. Wala pong hiningi si Dr. Jackie para sa hospital at saka sa provincial health office na hindi namin ibinigay. Kasi nga we fully understood the predicament of the good Dr. Jackie. Ginagawa niya ito para sa health ng mga tao. So, paano mo naman sasabihin na “No”?

Dr. Jackie: Totoo po iyan na during the pandemic, I really saw Gov. Cane leading the whole province. And to realign budget for health and hindi lang sa human resource, but in the aspects of medicines, everything that we need, and testing and all. To the point na we need to allocate also budget for the food and the people, just to make sure that we can surmount itong pandemic. What’s really amazing is kaya naman pala. Basta ‘yong akin lang nakita is Gov. really listens to the cry of the health sector during those times and even beyond until now. Kaya palang mag-amass ng ganoong budget just to make sure that we can survive beyond the pandemic so, here we are, doing our podcast. Na-survive namin iyon.

Gov. Cane: May gusto lang akong idagdag Dr. Cathy. Dito sa probinsya namin, ako, being the Gov. at saka ‘yong mga doctors, nurses and other medical workers natin, I see to it that the lines of communication are always open between and among us. Very important po iyon kasi kapag gobernador ka at mahirap kang hagilapin, mahirap kang kausapin, kanino sila magsusumbong sa mga problema? So, hindi naman kayang makuha ng isang gobernador kung ano ang mga problema sa mga ospital and other health offices kung hindi ka open sa communication, kaya kami ni Dr. Jackie mayroon kaming group chat at every day halos may mga bago information, doon namin pinag-uusapan ‘yong hindi namin napag-usapan when we’re physically meeting with each other or among us. Tinatapos namin sa mga group chat namin, kaya doon ko malalaman kung anu-ano ang mga problema ng mga doctors sa kanilang mga areas of responsibility. Kaya doon sa social media, sa Facebook, doon pino-post namin kung ano ‘yong mga nararamdaman namin; ano ang mga pagkukulang; ano ang dapat gawin. Kaya ‘yong lines of communication very open and that is one of the most important component in succeeding your plans, not only for health, but for everything connected with public service.

Dr. Cathy: Ang dami natin ng nakuha kina Gov. and Dr. Jackie. Siguro kung i-summarize ko ‘yong ating discussions: una, everyone is involved and informed–from the barangay health workers up to the province; second, ‘yong importance ng open communication kasi kung hindi nga sila informed sa nangyayari, paano nila maiintindihan ‘yong mga bagay-bagay lalo na sa health program implementation.

Siguro ‘yong next ko na question: Alam ko marami rin tayong mga private sectors na tumutulong sa Agusan del Sur, Gov. Baka pwede mo kaming kuwentuhan kung paano mo na-build ‘yong partnerships mo with the private sector naman, Gov.?

Gov. Cane: Ganito iyon, Dr. Cathy, when I first assumed as governor in 2019, siguro less than two weeks pa ako when I first assumed ay inimibitahan na po ako ng Zuellig Family Foundation sa isang napakahalagang meeting. At doon ko po nakuha ‘yong importance of collaboration and working with other organizations. Dahil in-introduce nga sa akin ng Zuellig Family Foundation, I had the chance of meeting with the LCFs doon sa meeting na iyon. At napakaganda ng resulta noon kasi it gave the province the opportunity to ask for some assistance from this LCFs or –

Dr. Cathy: The League of Corporate Foundations, Gov.

Gov. Cane: Yes, League of Corporate Foundations. At marami kaming natatanggap na biyaya mula sa kanila. So, importante pala na kapag marunong kang mag-reach out at masabi mo kung ano ang mga pagkukulang, may mga corporate foundations na maawain, katulad ng Zuellig at saka ng iba pa. Mention ko lang talaga ang ZFF kasi during the height of the pandemic, nagpagawa po kami ng molecular laboratory at ang Zuellig Family Foundation naman ang nag-donate ng RT-PCR machine. Saan ka pa diyan? Kung wala kaming connection doon sa ZFF or sa ibang mga corporate foundations, baka kami mismo ang bumili ng RT-PCR machine. Mahal pa naman iyon. So, this is not to expand the heart or the ego of ZFF, pero iyon ang totoo. Maraming naitulong ang ZFF sa amin, not only in terms of medical instruments, kung hindi even sa capability-building. At dahil sa Zuellig Family Foundation, naka-experience ako ng deep dive. Ang sarap to immerse with your people in the lowland or in the community or in the different communities. Doon ko na-realize na ibang klase talaga kapag naka-experience ka to be with your people who are in need of government intervention.

Dr. Cathy: Yes, Gov. Baka si Dr. Jackie may gusto idagdag.

Dr. Jackie: To add to that, majority naman na-mention ni Gov. I think, Agusan del Sur has a very good track record of delivering their commitment with the partners. Ang pinakaimportante din kasi when we deal with our private partners, we also communicate ‘yong pangangailangan talaga ng probinsya. Because it is really important na magtugma ‘yong pangangailangan ng probinsya at ‘yong kayang ibigay din ng private sector. To add to the other partners, aside from Zuellig Family Foundation and League of Corporate Foundations, we are also partners with World Health Organization and also, AmeriCares. So, what’s amazing is nakakatuwa dahil itong mga different partners namin sa health will really make an effort kahit saang munisipyo sila papasok. They really made an effort to have a courtesy with appearance and collaborative, exploratory talk with the province and meet our Gov. and meet me as the provincial health officer. With this, with the League Corporate Foundations na adopting an inter-local health zone, that is composed of three municipalities; while World Health Organization adopted one inter-local health zone naman, which is ‘yong I was mentioning, ‘yong inter-local health zone that still needs to be strengthened. And another partner, ‘yong AmeriCares going to the farthest municipality. And for other partners, mayroon kaming partners sa mga ibang aspeto to improve the social determinants of health. Iyon lang po.

Dr. Cathy: Ang dami na palang private sector rin na pumapasok sa Agusan del Sur. Siguro sa segment na ito bago tayo mag-proceed doon sa next questions, para lang mas marinig at makapag-share or mabigyan ng tips ‘yong ating mga listeners, Gov. Sabi mo kasi ‘yong mga mayors, ‘yong municipalities hanggang barangays ay talagang nagko-collaborate at talagang as one kayo na gumagalaw in terms of health programs, or sa pag-implement ng health programs. Ano ba or paano mo ba nakuha ‘yong mga kiliti nila, ‘yong talagang makipag-cooperate sa iyo as a Gov.?

 Gov. Cane: The first and the most important tip is show yourself as an example to them. Bihira mo akong makita ma-late sa isang appointment. I always emphasize to all the mayors kung kasama ang mga mayors na the reason why we are in public service is due to the trust and confidence in our people and we should not destroy that trust and confidence. Kaya totohanin natin lahat ng mga ginagawa natin. Isasapuso ang lahat ng mga ginagawa natin dito because not everybody is given the opportunity to win in the election. Lagi kong sinasabi sa kanila, “if you want na tatagal ka sa public service as an elected official, you have to walk your talk.” Nagkataon lang, Dr. Cathy, kami dito sa Agusan del Sur from the provincial level, city, municipal level–we belong to the same party. Kaya madali kaming magkaintindihan kasi walang iringan dito sa pulitika, maliban lang kung may election, pero after the election, we forget about politics.

Dr. Cathy: Ramdam ng mga kasama mong mayors at barangay, kaya siguro sabi nila, “join na lang tayo.”

Governor, having gone this far with all your innovative solutions, we want to know what are the province’s next step pa to achieve a fully functional health care provider network sa inyong probinsya? Syempre, with the partnership with the private sector kasi ‘yong iba talagang kailangan ng ating mga private sector. And when do you see this happening, Gov.?

Gov. Cane: Actually, sa preparatory level, we’re done more than, 100% already. Sa organizational, nakasama na po ito sa aming BTP, that is on-going already, the transition plan. ‘Yong functionality, I hope this will be fully functional before the end of my second term. In Shala. Hopefully. Pero confident ako na baka makukuha namin ito because we have close cooperation. We have coordination with our local chief executives in the lower levels, plus our provincial health office is closely working with everybody else towards this. So, sana lalo na kung hindi kami papabayaan ng ZFF, baka nga fully functional kami by 2025, hopefully. We’re praying for that. We will work on that, of course.

Dr. Cathy: So, hopefully by 2025, functional na ‘yong ating mga health care provider networks, depende kung ilan ‘yong naplano ng ating provincial health officer and the province in general

Dr Cathy: And that’s it for part two of our three-part episode with Gov. Cane and Dr. Jackie. Don’t miss the important lessons that they will share in the last part. Wishing all of you good health. Thank you for listening.

Title: Agusan del Sur | Health care provider network (Part 3 of 3)

Description: Agusan del Sur Gov. Santiago B. Cane Jr. and his provincial health officer, Dr. Jacqueline Momville shared the importance of health promotion and other lessons in the implementation of Universal Health Care.

Transcription:

Dr Cathy:  Hi. This is Dr. Catherine Chung, ZFF director for the Local Health System. Welcome to the last part of our three-part episode on the health care provider network with Agusan del Sur Gov. Santiago B. Cane Jr. and his provincial health officer, Dr. Jacqueline Momville. Get ready and take note of the tips and learnings that they will share today. So let’s begin.

Dr. Cathy: Dr. Jackie, Alam natin na ‘yong Agusan del Sur ay mayroon kayong napakagandang practice in terms of health promotion. Baka pwede mo ma-share ‘yong experience na iyan at kung ano ‘yong mga nagawa ninyo in terms of health promotion. Dr. Jackie?

Dr. Jackie: With regards sa health promotion, before our governor started, wala pa talaga kaming staff. So, when governor entered as our governor, isa sa mga in-open talaga na position even before the pandemic is the health education and promotion officer. Really important din ‘yong investment sa human resource para mapatakbo ‘yong isang programa and after that, itong aming health promotion activities goes beyond our office because we need other expertise. So, the provincial public information office also helped us and the provincial information management office helped us. So, it’s a collaboration of the three offices to push forward the health promotion programs and to reach to the most far-flung areas. Because ‘yong isang office namin is in charge of the TV and radio broadcasting and getting the news from the field and helping us capture any important health promotion materials, capture and toss it into the public. And we have this another office which is really expert in IT staff and helping us capture this information and make it useful to the public. And during the pandemic din, we were able to establish a very good social media platform. So, we have a Facebook page, the provincial health office, and from 30 followers, I think we have now 20,000 followers. Malaking help doon ng buong provincial government for a strategy to share the real news in health. So, isa lang iyan. And we capture stories from the field, and also stories of our leaders para mapaabot sa taong-bayan. We reached out to different partners, schools, other radio stations. Iyan ‘yong mga ginawa namin and itong lahat nagawa namin because our health education promotion officer together with the PHO team really wrote a plan. Nagsimula kami sa assessment and then, sa plan for health education.

Dr. Cathy: Para marinig ng ating mga listeners, gaano ba kaimportante ‘yong health promotion or health literacy in the implementation of UHC sa ating probinsya, Dr. Jackie?

Dr. Jackie: I think, important siya in such a way na we just don’t communicate about how to prevent a disease. We also communicate how we can work together to prevent disease. So, I think iyon ‘yong importance of communicating Universal Health Care sa taong-bayan para maging part din po sila and they will participate in making it a reality. Right now, we are meeting different stakeholders to really communicate the goals and the steps to realize Universal Health Care in the province of Agusan del Sur.

Dr. Cathy: That’s beyond the prevention of a disease, sabi nga ni Dr. Jackie. It is really communicating the entire UHC goals and how other will implement this and how they will help the province put this Universal Health Care into a reality with your help and collaboration. Thank you Dr. Jackie. By the way, mayroon naging policy paper tayo diyan sa Agusan del Sur in terms of their health promotion, intervention and practices sa Agusan del Sur. So, we can try that. Naka-upload na iyan sa site ng ZFF. ‘Yong ating mga listener ay madali lang nila ma-download iyon para ma-adapt din nila. We are also nearing to the end of our program.

Gov. Cane: I forgot one very important thing that may help other local government units in improving health information. Dito sa aming probinsya, sometime January or February this year, we institutionalized the barangay health workers as barangay HEPOs or the health education and promotion officers at the municipal level. Ito kasi mga barangay health workers, they are assigned in the respective barangay. They know the area. They know the people. So, informing their own people anything about health ay mas effective sila kaysa magpadala ka ng isang tao sa isang barangay na hindi naman taga roon, mahirapan pa siya kung saan siya pupunta. Mahirapan siya makipag-usap sa mga tao na hindi niya kilala. But with the barangay health workers being assigned as health education and promotion officers, they become more effective sa mga ganoong paraan. Kaya dito sa Agusan del Sur institutionalized na po iyan.

Dr. Jackie: We also advocate that the barangay captain passed a barangay executive order, or make it a barangay resolution designating the barangay health workers as health education promotion officers in their communities.

Dr. Cathy: Sa ating mga listeners, marami silang makukuha sa mga na-share nina Gov. and Dr. Jackie in terms of health promotion and its importance lalo na na-mobilize ‘yong ating mga barangay health workers as health promotion officers kasi sila ‘yong first touch sa ibaba. So, importante ‘yong ating mga BHWs.

Gov. Cane: First line of defense po natin sila. Kaya nga dito sa Agusan del Sur, for almost two decades already, marami kaming ginawa para din sa kanila for them to benefit from mga programs. Halimbawa, we give them insurance coverage. If they met an accident in line of their duty, or if they die for example, in line of duty, ang pamilya po nila ay may matatanggap po from the insurance, out of this insurance coverage. Pangalawa po, if the barangay health workers decide to retire from public life as BHW, mayroon po silang matatanggap galing sa probinsya na livelihood assistance after retirement. Hindi naman kalakihan, P25,000 upon retirement ay makukuha nila. At least, kung mag-retire man sila, wala na silang honorarium na makukuha from the barangay, from the municipality and from the province, mayroon din silang konting puhunan for their livelihood.

Dr. Cathy: Wow, may incentive pa ‘yong mga BHWs.

Dr. Jackie: In fact, Dr. Cathy, recently lang we just passed an ordinance, increasing their honorarium of the barangay health workers. So, we are reflecting it for our budget next year and to go along side with that, we partnered with World Health Organization to give training to our barangay health workers and in partnership iyon sa isang local NGO here in our province.

Dr. Cathy: Napakarami natin na-discuss at ang dami natin napulot from the Gov. and Dr. Jackie. We are nearing the end of our program today. Can you please share to us your most important learning in the UHC implementation sa inyong probinsya upon the enactment of the law? Since 2019, Gov. or Dr. Jackie?

Dr. Jackie: I think, ‘yong important learning ko is to work closely with your Gov.. We know that sometimes tayong mga career executives, syempre mag-change talaga ‘yong ating local chief executives every three years, but it’s really important that we connect to our Gov. kasi the Gov. was elected by the people out of their confidence. So, I think important iyon na makuha rin natin ‘yong vision ng ating leader and really important on my part that I listen to my leader. So far, basta mayroon wisdom din talaga si gov. mag-share siya. Magsabi lang talaga ako sa kaniya, “yes, gov.” although, at the back of my mind, parang paano kaya ito, pero dahil sinabi ng leader, gagawin. Aside kay gov. mayroon din siguro kaming mga teammates dito, helping us in the provincial government because as PHO, I cannot do it alone. I need Gov.. I need the provincial administrator, the chief of staff, the budget officer, the planning, the accounting. Everybody in the bureaucracy needs to collaborate.

Dr. Cathy: Gov. naman, ang kaniyang most important learning dito sa ating UHC implementation since 2019.

Gov. Cane: Working closely with the provincial health office and vice. dapat two-way iyan. Hindi pwede ‘yong provincial health officer lang ang open line communication with the governor. It should be the governor who must open his line of communication with the provincial health office. Dalawa iyan. Hindi pwede one-way. Now, I learned from 2019 that we need Universal Health Care in our respective government units in order to have a healthy and happy community. If you have a happy and healthy community, that will lead to progress and development because sabi nga ng mga lolo’t lola ko, mama’t papa ko, health is wealth. You want to make your people wealthy, make them healthy first.

Dr. Cathy: ‘Yong isa pang question ko, any other assistance pa na kailangan natin sa government in terms of the UHC implementation?

Gov. Cane: From the national government kamo, Dr. Cathy? Dami pa po. Infrastructure doon sa mga hospitals natin. We really still need the national government, particularly the Department of Health. Kailangan po namin sila kahit na mayroon na kaming devolution transition plan, but then, the funds out of the Mandanas Ruling are not enough sa health at saka sa iba pang mga agencies on government, tulad ng social welfare, lahat-lahat.

Dr. Jackie: To add to that, maybe we also need help and guidance in the human resource for health development and health financing mechanism with regards to PhilHealth reimbursement, how we can be more efficient on that and how can we boost the health financing aspect of financing health care.

Dr. Cathy: Sa mga non-government organizations naman, Gov. and Dr. Jackie, mayroon pa ba kayong mga additional assistance na kailangan?

Gov. Cane: Kailangan-kailangan namin ang tulong ng lahat. I can only assure them, if you will help the province of Agusan del Sur with material or otherwise, aabot ito sa mga tao.

Dr. Cathy: May particular assistance ba na kailangan from the non-government organizations?

Dr. Jackie: Actually, timing, Dr. Cathy, we envision our province in vision of one functional barangay health station in every barangay which include infrastructure, medical equipment, medicines and other medical supplies and of course, a human resource for health. Na-envision namin na if we have this barangay health stations, there must be a midwife or a nurse there and the basic equipment for that. We have around 314 regular barangays, but to include their special barangays, we have 322. We have around initial assessment pa lang ito doc. 275 infrastructure na barangay health station, but still needs to be assessed as to its integrity. So, if we will be able to be partnered with organizations, we will welcome with open arms and everything open to their assistance to us. Ang masisigurado lang namin, sabi nga ni gov. if you will partner with us, in Bisaya, “digmo magmahay.” hindi kayo magsisisi na kami ang partner ninyo dahil ang partnership natin ay magbubunga pa talaga. Maraming salamat.

Dr. Cathy: Well-noted Dr. Jackie and Gov. Cane. Thank you very much for your valuable insights.

 

And that wraps up our three-part episode on the health care provider network with Gov. Cane and Dr. Jackie. In the next episode, we will hear from the provincial health officer of Aklan. So don’t miss it! Again, this is Doc Cathy, wishing all of you good health. Thank you for listening.

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