Collaboration and working in synergy are critical in achieving Universal Health Care (UHC), emphasized Undersecretary Myrna Cabotaje during the network training for the Department of Health’s Field Implementation and Coordination Team (DOH-FICT) in northern Luzon.

Among the challenges in the implementation of UHC in northern Luzon is establishing a health care provider network (HCPN). HCPN is a vital ingredient in improving access and availability of health care in the regions because it links local health providers for coordinated and comprehensive delivery of health care programs and services.

To address this, the training provided the regional health teams and medical center chiefs from the Cordillera Administrative Region (CAR), Ilocos Region, and Cagayan Valley the venue to firm up their HCPN development plans and work together in ensuring inclusive and responsive health services in the context of UHC.

The training held last June 8 to 10 in Baguio City is part of the Leadership Development Program for Universal Health Care (LDP-UHC), a partnership between the DOH-FICT in northern Luzon and the Zuellig Family Foundation (ZFF).

HCPN development plans
The three-day activity helped participants sift through the challenges in UHC implementation, recognize the important role of regional health teams in communicating the importance of achieving UHC, and identify the collaborative work needed to reach the shared regional health vision.

The regional teams developed their improved HCPN development plans after sessions on having a shared vision, systems thinking, stakeholder mapping and analysis, and team synergy.

CAR will create a regional HCPN that may eventually include an inter-regional HCPN. It also identified strategic actions to fast-track its UHC milestones, such as strengthening the capacity of the regional health promotion unit and licensing of levels 2 and 3 health facilities.

Ilocos Region will capacitate its provincial health team leaders (PHTLs) to coach and mentor local chief executives in operationalizing UHC.

Cagayan Valley will institutionalize the hospitals identified as apex hospitals–Cagayan Valley Medical Center, Southern Isabela Medical Center, and Region 2 Trauma Medical Center. It also plans to eventually upgrade Batanes General Hospital to an apex hospital. Apex hospitals serve as end referral facilities for patients in need of higher and specialized levels of care. They also provide the HCPN with performance monitoring and technical assistance, including training of human resources, and research.

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Plans set to get UHC back on track in provinces

Key local health leaders of the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) came up with action plans to accelerate the family planning (FP) program in BARMM during a leadership training with the Zuellig Family Foundation (ZFF). The region targets to increase the modern contraceptive prevalence rate among all women from 24.9% in 2017 to 30% by 2024.

Hampering the implementation of the FP program in BARMM are weak forecasting and distribution, ineffective inventory management and reporting of FP commodities, limited consultation on budget allocation, and an insufficient number of skilled workers to provide quality FP services.

To address these issues, the two-day training under the BARMM-Health partnership program of the ZFF and the University Research Company (URC) is designed to develop bridging leadership (BL) competencies among local health leaders. 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.

BARMM-Health will help capacitate the regional implementation team for the Responsible Parenthood and Reproductive Health (RPRH) Law that will provide technical assistance on supply chain management, health human resource, and financing to FP priority areas. The program focuses on sexual and reproductive health (SRH) but is ultimately aimed at strengthening provincial health systems to contribute to the implementation of Universal Health Care (UHC). UHC requires a resilient health system that gives fair access to high-quality, inexpensive health care goods and services, including SRH programs.

Participants in the sessions held on May 18 and 19 in Davao City included the Bangsamoro Darul Ifta (BDI), Ministry of Health (MOH), and Ministry of Interior and Local Government. The BDI, an influential advisory council, will reproduce the fatwa (a legal ruling in Islamic law) on FP in the BARMM to reach the grassroots. It will also translate the fatwa into khutbah (sermon delivered by the imam or Muslim prayer leader) to reconcile the opposing perspectives on FP of the Muslims.

There were also representatives from the Bangsamoro Planning and Development Office, the Bangsamoro Women Commission, and the Bangsamoro Planning and Development Authority. All the participants will discuss their action plans in the quarterly meeting of the BARMM Regional Implementation Team (BRIT) in June 2022. The action plans include organizing the regional supply chain management committee and warehousing FP commodities.

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.

Provincial health officials reconnected with their life’s purpose and agreed to work toward attaining Universal Health Care (UHC) after attending a two-day leadership training. As one group of provincial health team leaders (PHTLs) declared for their region, “Sa CAR (Cordillera Administrative Region), saan mang sulok, kalusugan ay maabot.”

The training, attended by 18 PHTLs and three UHC coordinators from CAR, Ilocos Region, and Cagayan Valley region, is part of the Leadership for Development Program (LDP) to Accelerate UHC Implementation. This is a partnership between the Department of Health’s Field Implementation and Coordination Team (DOH-FICT) in northern Luzon and the Zuellig Family Foundation (ZFF).

The PHTLs will cascade their learnings to their teams of development management officers so they too build their leadership capacities. They defined the ways to win over their critical stakeholders in co-owning the challenges in attaining UHC, a crucial step given the arduous tasks to build province-wide health systems. To do this, they will localize the intent of the UHC law to make its relevance clearer to local officials who will hopefully be moved to take urgent actions.

These initial efforts are intended to attain within the second quarter of 2022 the objectives of having dedicated provincial teams for health promotion and disaster risk reduction and management in health, as well as functional epidemiologic and surveillance units in the provinces. Through these, provinces would have met at least 70% of the conditions set under the preparatory level for UHC.

PHTLs’ active and proper guidance will help local government units fulfill the conditions under the 2019 UHC law. They are responsible for carrying out the DOH functions that include planning, advocating, mobilizing resources, providing technical assistance, and collaborating with the provinces.

Unfortunately, many PHTLs have faced roadblocks. The pandemic forced all local government units to focus on COVID-19 management. There are also fundamental gaps in health promotion and education, information systems, and human resources.

The first module focused on applying the competencies under the bridging leadership framework of owning the issues, co-owning them with the stakeholders, and co-creating the solutions. Participating PHTLs underwent discussions and exercises in situational analysis, creating team vision, and planning stakeholder engagement and other next steps.

Undersecretary Myrna Cabotaje, who heads DOH-FICT northern Luzon and NCR clusters, reminded the PHTLs about their role in catalyzing improvements within the DOH and sharing their knowledge, especially with governors and mayors, since local chief executives’ policies and actions will determine the reduction of health inequities and sustainability of health improvements.

The next training for PHTLs will happen in July 2022. Cabotaje, a participant in ZFF’s past leadership program for DOH regional directors, asked ZFF to replicate its programs for three partner provinces that progressed considerably toward UHC despite the pandemic. The DOH regional leadership wanted similar transformations in the capacities of their key officials so they can also coach and mentor provincial and city health leaders on what and how things should be done to attain UHC.