ALBAY HEALTH STRATEGY Albay MDG Achievements Albay

Story Line
ALBAY HEALTH
STRATEGY
 Albay
towards
SAFE AND SHARED
DEVELOPMENT
MDG is all about
dignity.
Engaging
dignity, Empoweri
ng dignity
Ennobling dignity
 Albay Health Strategies
MDG – make it a
goal, the rest follows
Governor Joey Sarte Salceda
Province of Albay
MDGs are achieved ahead of 2015 exc. MDG 2 and 7
Goal
Indicator
1
2
Bicol Region
Albay
Poverty Incidence
M
H
Subsistence Incidence
H
H
Underweight (IRS)
H
H
Participation - Elementary
L
M
Cohort survival - elementary
M
L
3
Gender parity - elementary
H
H
4
Under-five mortality
H
H
5
6
7
MDG Achievements
Infant mortality
H
H
Proportion of fully-immunized children
M
H
Maternal mortality rate
L
H
Contraceptive prevalence rate
L
M
Condom use rate
L
M
Deaths due to TB
L
H
Malaria positive cases
H
H
Household with access to sanitary toilets
H
L
Household with access to safe drinking water
H
H
Achievements on MDG,
2009
Proportion of 0 - 5 years old who are malnourished
25
24%
22
20
16
15
10
5
0
Legend:
1992
L
low probability
M
medium probability
H
no data
Achievements on MDG,
2009
Achievements on MDG,
2009
Infant Mortality Rate
Maternal Mortality Ratio
140
2009
high probability
35
33
133
30
120
25
100
90/ 100,000 LB
80
20
59
60
15
12
40
17/1,000 LB
10
20
5
0
1998
2009
0
1998
2009
1
Achievements on MDG,
Achievements on MDG,
2009
2009
Proportion of births attended by skilled health personnel
Proportion of facility-based deliveries
100
100
90
90
90
88
80%
80
80%
80
70
70
60
60
50
50
40
40
30
29
30
20
20
10
11
10
0
1998
2009
0
1998
2009
Achievements on MDG,
Contraceptive Prevalence Rate
Achievements on MDG,
2009
2009
Child Mortality Rate
65%
30
35
28
27/1,000 LB
25
30
29
25
20
18
20
15
15
10
10
8
5
5
0
0
1990
2009
Achievements on MDG,
1998
2009
2009
Achievements on MDG
Fully-Immunized Children
TB Mortality Rate
98
60
96
96
95%
94
50
•44/100,000
pop
92
40
90
30
88
86
86
20
84
10
82
0
80
1990
2009
1997
2009
2
•Achievements on MDG
•Achievements on MDG
Case Detection Rate for TB
Cure Rate for TB
120
90
•85%
80
100
70
80
60
•70%
50
60
40
30
40
20
20
10
0
0
1999
1999
2009
Albay MDG Strategy
•Health Outcomes
Indicators
National
National
Performance Gaps/
Average (2006) Target (2010) ALBAY (2009) Gains
Intensified Disease Prevention and Control: TB
Mortality
(per 100,000
28,000
44
26
TB Case Detection
Rate, % (NTP Register)
72
70
100
30
TB Cure Rate, %
81
85
81
(4)
pop)
(18)
Vision
 Safe and shared development
 Albay as most liveable province known for good
education, good health and good environment
to secure safe and shared development
 Vision for Health: longer life expectancy
expectancy,
wellbeing in itself, wellbeing for labor
productivity
 Albayanos as healthy and happy, well-educated,
well-trained
 Low-rise, low-carbon, low-energy intensity =
green development model
2009
Make MDG a goal
Ordain policies and Give it a Budget
Execute programs and projects
Build institutions
Nurture partnerships
Albay Development Goal
1. Shared development: operationally defined as:
compliance with MDG and improvement in HDI.
Climate change and disaster risks are key
obstacles to MDG and HDI.
2. Safe development: Disaster risk reduction and
li
action
i are b
built-in
il i elements
l
off the
h centrall
climate
economic strategy, not a contingency plan.
a. Disaster risk reduction is guided by Hyogo
Framework for Action
b. Climate action is guided by UNFCCC.
3. Structural governance x safe development =
shared economic growth.
3
Average annual losses to infrastructure and agriculture in 10 most vulnerable
provinces vs. their 2006 local calamity funds
POVERTY AS AN INITIAL CONDITION IS A MAJOR
OBSTACLE TO HEALTH OUTCOMES
Region/Province
p
Poverty Threshold (in
Pesos)
2000
PHILIPPINES
2003
2006
Poverty Incidence Am ong Fam ilies (%)
Estim ates (%)
2000
2003
Magnitude of Poor Fam ilies
Coefficient of Variation
2006
2000
2003
2006
Estim ates
2000
Coefficient of Variation
2003
2006
2000
2003
2006
11,458 12,309 15,057
27.5
24.4
26.9
1.6
1.3
1.3
4,146,663
4,022,695
4,677,305
1.6
1.4
Region V
11,375 12,379 15,015
45.3
40.6
41.8
4.2
3.6
3.5
407,176
383,625
422,278
4.7
4.3
4.3
Albayy
12,144 12,915 16,128
40.3
34.4
37.8
11.5
8.1
8.4
83,398
76,200
88,676
11.2
8.5
10.1
Camarines Norte
11,505 12,727 14,854
52.7
46.1
38.4
10.9
14.4
18.8
50,670
44,874
39,421
11.8
14
22.6
Camarines Sur
11,054 11,873 14,634
40.8
40.1
41.2
9.3
7.0
5.6
120,762
121,936
134,599
11.8
7.7
6.6
Catanduanes*
11,587 11,815 13,654
43.9
31.8
37.3
10.9
10.3
22.1
18,541
13,604
16,999
10.4
29.3
33.3
Masbate
11,019 12,504 14,248
61.3
55.9
51.0
5.8
•Albay
5.7
6.5 poverty
83,660
81,804
80,512
5.9
7.4
8.0
Sorsogon
11,146 12,452 15,687
41.4
33.7
43.5
7.3
45,207
62,071
7.6
14.5
5.6
* Coefficient of Variation (CV) of 2006 poverty incidence is greater than 20%
incidence at
5.4
50,146
37.8%, while
lowest in
region, remains
high
10.3
1.3
•19
•Source: World Bank
Objectives for Health,
Net resource outflow to cities
2011
1. To decrease maternal mortality ratio from
59/100,000 to 50/100,000.
2. To decrease infant mortality rate from
10/1,000 to 8/1,000.
3. To decrease child mortality rate from
18/1,000 to 15/1,000.
4. Increase FIC coverage from 84% to 88%.
5. To increase CPR from 33% to 40%.
•21
Objectives for Health,
2011
6. To increase voluntary blood donation to 1%
of the provincial population.
Objectives for Health,
2011
12. To reduce the incidence of STI/HIV by 2%
points annually.
7. To reduce soil-transmitted helminthiasis to
below 50% among children.
13. To eliminate incidence of filaria to zero.
8. To reduce prevalence of malnutrition from
19% to 17%.
14. To increase multi drug administration for
filariasis control by 2%.
9. To reduce TB mortality rate by 3%.
15. To reduce rabies incidence from 5/million
population to 2.5/million population.
10. To sustain TB case detection at 90%.
11. To sustain TB cure rate at 85%.
4
Objectives for Health,
Total Health Budget
2011
2007 - 2010
16. To sustain leprosy prevalence at less than
1/10,000 population.
180,000,000
17. To increase leprosy cure rate by 2%.
24% of provincial
budget
161,373,128
160,000,000
135,673,326
134,566,903
140,000,000
18. To reduce the mortalityy and morbidity
y of
lifestyle-related diseases by 2% annually.
120,000,000
120 000 000
101,669,158
100,000,000
19. To increase proportion of HH with access to
safe drinking water from 94% to 95%.
80,000,000
60,000,000
40,000,000
20. To increase proportion of HH with sanitary
toilets from 69% to 89%.
20,000,000
0
2007
2008
2009
2010
Source: PBO, Albay
Resources for Institutionalized MDG
Office
Albay MDG Supercom
• Program office: AMDGO
– created by ordinance in 2009 with regular provincial budget
– Oversight to MDG performance and secretariat to MDG
Supercom
– Management MDG projects
• Manages
g relocation p
program
g
• Social assets programs esp livelihood like SEA-K, ETODA
• CRABS or coastal and marine resources management
• AIDS Council – HIV/AIDS advocacy
• Sources of Funds
– Regular allocation from the annual provincial budget (IRA)
– Intermittent but steady flow of technical and logistical assistance
from NG agencies, UNDP and other UN offices, INGOs, NGOs
for capacity building and skills training
•2
•2
Initiatives
Provincial Initiatives
• 2011- P178m (exc PHIC) for health PS and
MOOE essentially for hospital care and public
health
Universal Phil Health Coverage: 2007-2010
Number of Families Enrolled
• Universal health coverage at P59m pa
173,262
• Acquisition
q
of 57 ambulances
180,000
158,000
160,000
• 19 BeMoNCs
122,600
140,000
120,000
• Modernization of provincial hospitals: Ziga (80bed) and Duran (60-bed)
100,000
80,000
60,000
• Modernization of BRTTH (300-bed)
40,000
18,510
20,000
• Merger of BRTTH, Ziga and Duran into a 500bed capacity
0
2007
2008
2009
2010
Source: PSWDO, Albay
5
Ambulance Deployment
•BRTTH: PHIC REIMBURSEMENT
FOR 2010
33%
•RHUs & BEmONC
•2
•Hospitals
•2
54%
•6
•2
•6
13%
MEDICINES
PHIC REIMBURSEMENTS
PROFESSIONAL FEE
•4
•2
•1
•1
•2
•2
•4
•2
HOSPITAL
INCOME
67,403,506.73
DRUGS AND
MEDICINES
16,929,387.25
PROFESSIONAL
FEES
42,339,658.00
TOTAL
126,672,551.98
•2
2
•1
•3
HOSPITAL INCOME
•2
•4
•3
BRTTH earns P127m
from PHIC vs P59m
by province
Medical Mobile Assets
•2
•2
•1
•1
•Source: PHO, Albay
Health Facilities: 15 BEmONCS
•Hospitals
•BEmONC
•RHUs/CHOs
•Source: PHO, Albay
JBDMH
JBDMH
6
JBDMH
ZIGA Memorial District Hospital
ZDMH
JBDMH
ZDMH
ZDMH
7
ZDMH
ZDMH
ZDMH
•2007 - Renovated under the B-CARE project
•BRTTH Main Building
•Salceda Wing / Philhealth/Surgery Ward
•Out-Patient Department
•Emergency Room
8
•Maintenance Building
•Dorm
•Laundry
•Services Offered
•Emergency Room
•Trauma Unit
•Philhealth Ward
•Surgery Ward
•Isolation Ward
•OB-Gyne Ward
•Private Ward
•Delivery Room
•CT Scan
•Pedia Ward
•Medical Ward
•Dialysis
•ECG/EEG
•Cath Lab
•2D Echo
•CCU
•ICU
•Ultrasoud
•X-Ray
•NICU
•PICU
9
•Operating Room – Room 1 - 4
•Electric Power Substation
•Laboratory
Prov’l
Gov’t
of
Albay, project
of
Gov. Joey Salceda
•Dietary
•Rehab Center
•Pharmacy
•Pastoral
•BRTTH and Beyond
Establishment of Regional Oncology Center (P400m)
10
Health Capital Expenditures
•Proposed Facilities
•1 . Waste and Infectious Treatment Plant•5. ER and Trauma Unit
•6. Bicol Cancer Center
•2. Communicable Disease Building
•7. Bicol Regional Blood Center
•3. Extension of PHIC ward
•4. Diagnostic Center
•8. Commercial Building
Committed by
Source (from
AOP)
134,566,903.00
Source
PLGU
M/C LGUs (15
MLGUs/ 3 CLGUs)
188,470,320.51
DOH-regular fund
24,372,850.33
Amount Received Received by the
Amount Utilized
by the province province (in kind)
134,566,903.00
134,566,903.00
Number of
Recipient
Municipalities
18 M/C LGUs
170,905,125.99
18 M/C LGUs
24,372,850.33
18 M/C LGUs
2,419,320.00
2,000,000.00
9,100,000.00
2,419,320.00
2,000,000.00
9,100,000.00
18 M/C LGUs
18 M/C LGUs
18 M/C LGUs
71,191,000.00
71,191,000.00
6 District Hospitals
2,000,000.00
2,000,000.00
18 M/C LGUs
5,900,000.00
8 M/C LGUs
24,372,850.33
EPI vaccines, Vit.
A, antihelminthics,
TB drugs, Iron
DOH- special fund
•7
•3
3
•8
•2
•1
>MNCHN
> start-up
> HEMS
> Health Facilities
Dev't/RAT Plan
97,608,000.00
> Health Systems
Dev't
> RHU/BHS Facility
Devt/Eqpt
7,350,000.00
Others:
•4
•6
•5
> USAID
134,823,414.00
> AECID
> capitation (for
CSR + drugs)
43,000,000.00
> PCSO
TOTAL
Technical
assistance
18 M/C LGUs
24,000,000.00
9 M/C LGUs
5,000,000.00
18 M/C LGUs
7,984,000.00
18 M/C LGUs
7,984,000.00
630,191,487.84
18,600,000.00
24,000,000.00
18,473,296.71
drugs, medicines &
ambulances
296,107,370.04
460,439,199.32
AMDGO
• Program office started as Ayuda Albay in 2007,
renamed as Albay Mabuhay Task Force to manage
the cluster approach to Reming rehabilitation
• Reorganized in June 2009 as Albay Millenium
Development Office or AMDGO to (a) monitor and
oversight
g MDG p
progress
g
((b)) coordinate MDG
programs within functional units and program
offices of the provincial government and with NGAs,
NGOs and INGOs and (c) manage social assets
program of the province including SEA-K, E-TODA
• Staff complement of 15 personnel with a senior staff
(rank Assistant Department Head)
for Listening
• 2010 organic budget of P2m.
Strategies on Maternal Health Care
1. Formulation of the PIPH. (Province-wide
Investment Plan for Health) inc MNCHN
(Maternal, Newborn and Child Health Care)
Program
2. Advocacy Campaign: Birth Plan/FBD by Skilled
Health Worker
• Bench Conferences
• Buntis Congress
• Buntis Pageant
• IPCC (Interpersonal Communication and Counseling)
Training of Health Personnel and BHW’s on MNCHN
• Mothers’ Classes
• Radio announcement/ plugging
• Health Education Classes
• Establishment of breastfeeding stations in private and
government institutions including evacuation centers
Strategies on Maternal Health Care
3. Maternal Deaths Review
• Reviews maternal deaths
• Give recommendation and feedback to LGUs with
maternal deaths
• Maternal death reporting
4. Facility based deliveries (FBD):
• Barangay Health Stations
• Lying-In Clinics
• Birthing homes
• Rural Health Units
• Hospitals (public or private)
5. REB (Reaching Every Barangay)
11
Strategies on Maternal Health Care
Strategies on Maternal Health Care
6. Rationalization planning and health facility
mapping
8. Capacity building
• Upgrading of CEMONC facilities. (Comprehensive
Emergency Obstetric and Newborn Care)
• Construction of BEMONC facilities. (Basic Emergency
Obstetric and Newborn Care))
• Hiring of Staff Complement to fill up vacancies and/or
augment personnel
7. Organization of Women’s Health Teams in every
barangay:
• Pregnancy tracking & birth planning
• Reporting of maternal deaths
• Referral of pregnant women to deliver at health facility
• Stewardship to the family of the pregnant mother
Strategies on Maternal Health Care
10. MCP Accreditation of LGU’s birthing facilities
(Maternity Care Package)
11. Enact ordinances on FBD and User’s Fee
12. Sustain MBDs (Mass Blood Donation)
in all LGUs.
• NBS training (Newborn Screening)
• ENC training (Essential Newborn Care)
• LSS training (Life-Saving Skills)
• BEMONC training (Basic Emergency Obstetric and
N b
Newborn
C
Care))
• WHT training (Women’s Health Team)
• CMMNC training (Community-Managed Maternal and
Newborn Care)
9. Sustain Universal Phil Health
Enrollment/Coverage
Strategies on Family Planning
1. Establish a system of monitoring FP users with
private providers and other stakeholders
• inventory of FP private providers & other stakeholders
in the municipality/ city
• conduct one day orientation to identified FP private
providers & other stakeholders
p
2. Validation of current FP users (data cleaning)
3. Review/assess CDLMIS of LGUs (Contraceptive
Distribution, Logistics, Management Information
System)
Strategies on Family Planning
Strategies on Family Planning
4. Planning workshop to draft plan to
operationalize modified CDLMIS
6. Provision of FP Commodities
5. Capacity Building
• FP-Competency-based
FP Competency based training
• NSV Training ( non scalpel vasectomy )
BTL Training ( bilateral tubal ligation)
• Training on FP Counseling for health personnel
• Training of health personnel on IPCC
• Targeting, costing and forecasting FP commodities
requirements based on validated current users
• Procurement and Provision of 50% of FP commodities
requirements (Pills, DMPA, Condom, NFP to LGUs
• Provision of medicines and supplies for BTL & NSV to
District Hospitals providing surgical sterilization
12
Strategies on Family Planning
Strategies on Family Planning
7. Intensify and Improve FP Promotion and
Education Integration of FP in EPI (Expanded
Program on Immunization)
8. Enactment of CSR+ Ordinance (Commodities
Self Reliance)
• Conduct regular RPM ( Responsible Parenting
Movement)
• Conduct
C d t regular
l AHYD (Ad
(Adolescent
l
tH
Health
lth and
dY
Youth)
th)
Development) classes in high schools
• Conduct regular PMC (Pre-Marital Counseling)
• Conduct FP counseling to new acceptors and followup by BHWs of FP current users & defaulters
• Conduct ICV (Informed Choice and Volunteerism)
• Conduct Men’s Congress (Usapang Macho)
• Advocacy with the LCEs/SBs for CSR+ ordinance
• One day orientation with LCEs, MHOs, LFC re:
formulation, CSR implementation and drafting of
CSR+ ordinance
• Training of SB/SP Committee on Health on Evidencebased legislation
• Present proposal to the PHB and seek SP Committee
on Health Chair’s sponsorship
• Strengthen 2-way referral system for FP (BTL-NSVIUD) Provision of referral form
Strategies on Family Planning
Strategies on Nutrition Program
9. Monitoring and Supervision
1. Operation Timbang (OPT)
• Regular visits to 18 LGUs monthly
• Revisit CSR Plans
• Collection, recording and reporting of FP activities
through FHSIS (Field Health Services Information
System)
• Identification of malnourished children thru mass
weighing of 0-71 mos. old children
2. Micronutrient supplementation
• Provision of Vitamin A capsules & iron
supplementation to:
a. infants
b. preschool children
c. pregnant women
d. lactating women
e. sick children
Strategies on Nutrition Program
Strategies on Nutrition Program
3. Food Fortification
6. Accelerated Hunger Mitigation Program
• Monitoring of fortified food products in the markets,
sari-sari stores, groceries & household utilization of
iodized salts
4 Local Level Nutrition Program Implementation
4.
•Local Plan of Action for Nutrition at the municipal and
barangay level
• Milk feeding (tie up with NDA)
• Supplemental feeding
• Distribution of growth monitoring charts
• Pabasa sa Nutrisyon Classes
• Promotion of child rearing practices during GP
• Distribution of IEC materials
• Feeding during disasters
• Breastfeeding initiatives
5. Capacity building
• IYCF Infant and Young Child Feeding
• CGS (Child Growth Standard)
7. Monitoring and supervision
13
Strategic Imperatives
 Policies
 Institutions
 Public-Private Partnerships
Other Provincial
Initiatives
 Resources
 Champion
Initiatives
A. Beneficiary-led Procurement :
 Universal Phil Health Coverage: 2007-2010
Universal Anti-Rabies Immunization
Initiatives
B. Safe Hospitals:
 Upgrading of structures and equipment of
Provincial Hospital System
 Modernization of the Bicol Regional Teaching
and Training Hospital [BRTTH]
 Rationalization Plan & Health Facility Mapping
 Establishment of BEMONC/CEMONC facilities
 Merging of district and regional hospitals
Initiatives
C. Partnership with NGOs:
Initiatives
D. Partnerships with LGUs:
 Health Program Management (USAID,
PTSI, Intervida, MIDAS, WHSMP2, CSCDI)
 Inter-local Health Zones [ILHZ]
 Health Promotion (PRRM, PBSP)
 Commodity Self-Reliance Strategy [CSR]
 Discounted Medicines (Pfizer, RNMD)
 Botika ng Barangays [BnBs]
 Health Infrastructure (AECID, PODER,
WHSMP2)
14
Initiatives
Initiatives
E. Disaster Risk Management - Health:
Preemptive Health Care – Medical Missions
targeted at APSEMO identified vulnerable areas
Ambulance Project: Provision of
ambulances (57) to:
 Provincial Hospital System
Albay Health Emergency Management [AHEM]
• Emergency Paramedic Training Unit
[EPTU] – in cooperation with the Bicol
University [BU], BRTTH &n DOH
• Operation Centers [OPCEN] in all three
districts
• Evacuation Camp Management
 Rural Health Units & C
City Health Off
Offices
 Basic Emergency Obstetrical and Newborn
Care Facilities
 Operation Centers
 Geographically-Isolated and
Disadvantaged Areas [GIDA]
Strategic Priorities:
Public Health
Strategic Priorities
Strategic Priorities:
Hospital
Funding Gaps
Strategic Priorities
Funding Gaps
Health Care Waste Management
under BOT
40 M
Merging of ZMDH and JBDMDH
to BRTTH
200 M
Establishment of another 9
BEMONC facilities
45 M
50 M
Renovation of 30 BHS
15 M
Upgrading of PDMDH and PDH
into a secondary (inc. safe
hospitals)
Conversion of VMH into a
Birthing Home
Modernization of BRTTH:
Oncology Center under BOT
240 M
Establishment of PhilHealth Desks
2M
Capacity Building
10 M
Provision of Sanitary Toilet
Strengthening of Public Health
Program Management
40 M
30 M
TOTAL
182 M
MEET Albay
 Medical
TOTAL
495 M
GRAND TOTAL
677 M
MEET Albay
MEDICAL
ECO-CULTURAL
VISION
Bicol University
as first class
higher education
institution
EDUCATIONAL
Bicol Regional
Training and
Teaching Hospital
as wellness
Center
Albay as prime
destination for culture
and nature
Albay as hub to
tourist
destinations of
Bicol
SUPPLY
SIDE
Bicol University
modernization
Province to
gatekeep thru
facilities
upgrading
Magayon Festival
Southern Luzon
International
Airport
Mayon Resort House
Pantao Port
Bi l University
Bicol
U i
it
Medical Center
Ligñon Hills
Mayon Trek
Albay Donsol
Access Roads
Wildlife Park
Andaya Highway
 BRTTH modernization
 Educational
Bicol University
School of
M di i
Medicine
 Bicol University modernization
 Eco-cultural Tourism
 Magayon Festival
 Infrastructure Development
 Transportation facilities by National Government
 Tourism facilities by private sector
5M
Albay History Project
TOURISM
DEMAND
SIDE
AHECS
Responsible
Agencies
Bicol University
DOH/BRTTH
DOT/NCCA
DOTC, PPA
EQUAL
PHO
PTCAO/ACAC
PPDO, PEO
Seek more
scholarship funds
for Albay studies
Universal
PhilHealth
AHECS – Albay Higher Education Contribution Scheme
EQUAL – Education Quality for Albayanos
15
Health Sector Reform
Framework
Goal for Health Sector
Health for All
 Service Delivery
Capacity Building for:
 Better
B tt h
health
lth outcomes
t
 More responsive health system
 Equitable health care financing
 Governance
 Regulation
 Health Care Financing
Opportunity-seeking for:
 Medical tourism
for Listening
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