Chapter 1 The Provincial Health Situation introduction




старонка6/22
Дата канвертавання24.04.2016
Памер2.6 Mb.
1   2   3   4   5   6   7   8   9   ...   22

Rural Health Units (RHUs). All municipalities in the province maintain their respective Rural Health Units. Most of the municipalities however, cannot sustain the ideal ratio of 1 RHU per 20,000 of the population. Only the municipalities of Calayan, Rizal and Sta. Teresita meet the standard.

Barangay Health Stations. A total of 245 Barangay Health Stations were established in all the municipalities of the Province, except Sta. Praxedes. These stations provide basic health services to the barangay populace. Most of the municipalities, however do not meet the standard of having 1 BHS per 5,000 of the population. Usually, one BHS has a catchments area of three (3) to five (5) barangays

HEALTH FINANCING

Expansion of the National Health Insurance

Social Health Insurance (SHI) is one form of financing health care. It is considered as “prospective” financing where funds are pooled or collected in advance, mainly in the form of regular contributions from insurance fund members, employers and the government. It addresses inequities in health financing where “the healthy pays for the sick” and “those who can afford medical care, subsidizes those who cannot”.



The Philippine Health Insurance Corporation (PHIC), a government owned and controlled corporation (GOCC), is the country’s biggest Social Health Insurance provider. Along with other private SHIs, the PHIC provides the biggest and widest health insurance plan, covering almost all members of society and provides the only health insurance footprint in Cagayan. Current provincial total projected indigent households, with varying number of providers / sponsors and a range of customers enrolled among the different municipalities.

Universal Coverage – Enrollment of the Poor- A review of PHIC coverage revealed multiple enrollments among indigent families and the employed sectors. The provincial government sought the assistance of the local Association of Municipal Health Officers (AMHOP) in assessing and validating to rectify or purge the roster of superfluous beneficiaries in an effort to maximize the efficient use of resources of the LGUs concerned. The AMHOP established criteria in determining the poor in conformity with PHIC adopted means testing.

Table 17: PHIC Coverage for Indigent Household by Municipality as of October 2007

LGU

Indigent HHs

2006

2007

Abulug

3416

1130

Alcala

1044

600

Allacapan

2792

0

Amulung

2044

3400

Aparri I

3667

600

Aparri II







Baggao

1

579

Ballesteros

2666

269

Buguey

943

874

Calayan

239

0

Camalaniugan

612

1440

Claveria

2344

1107

Enrile

1239

2229

Gattaran

2

0

Gonzaga

233

814

Iguig

970

2550

Lallo

401

942

Lasam

1917

576

Pamplona

1167

0

Peñablanca

1652

88

Piat

1698

701

Rizal

1620

420

Sanchez Mira

1495

285

Sta. Ana

1061

1654

Sta. Praxedes

694

128

Sta. Teresita

320

843

Sto. Niño

1811

0

Solana

2230

0

Tuao I

2005

0

Tuao II







CAGAYAN

40283

21229



Table 18: PHIC Enrollees by Sponsorship, 2002-2006

YEAR

REGULAR

LEGISLATIVE

PCSO

EPCSO

PRIVATE

OPLAN 2.5 TRACK 3

OPLAN 2.5 PMGMM SLOT

SPECIAL DISCOUNT

TOTAL

2003

9782

8972

9703

-

-

-

-

-

28457

2004

11176

12584

9920

34950

-

-

-

-

68630

2005

12740

25888

2185

-

-

-

-

-

40813

2006

13734

16841

-

-

147

3246

3901

8273

46142

2007

8033

13196

-

-

100

-

-

-

21329

Table 19 - PHIC Coverage by Membership, 2003-2006

YEAR

REGULAR

LEGISLATIVE

PCSO

EPCSO

PRIVATE

OPLAN 2.5 TRACK 3

OPLAN 2.5 PMGMM SLOT

SPECIAL DISCOUNT

TOTAL

2003

9782

8972

9703

-

-

-

-

-

28457

2004

11176

12584

9920

34950

-

-

-

-

68630

2005

12740

25888

2185

-

-

-

-

-

40813

2006

13734

16841

-

-

147

3246

3901

8273

46142

2007

8033

13196

-

-

100

-

-

-

21329

Table 20 - Comparative PHIC Receipts, EBMC and District Hospitals, 2002 – 2006

HOSPITAL

2006

2007

Alcala Municipal Hospital

 

59,410.00

Alfonso Enrile Memorial Hospital

33,611.00

35,830.50

Aparri Provincial Hospital

891,893.79

704,197.45

Ballesteros District Hospital

902,041.00

606,347.65

Lasam District Hospital

349,758.50

429,751.10

Matilde Olivas District Hospital

96,414.00

72,555

Northern Cagayan District Hospital

920,087.74

543,453.42

NSPDH

845,046.83

461,330.85

Tuao District hospital

27,059.00

140,433.54

REGULATION

Implementation/Enforcement of Health and Health-Related Laws

Milk code – The province of Cagayan is seemingly lax in the implementation of the Milk Code. Despite the fact that all hospitals were awarded mother-baby friendly initiatives, the province recorded only 80% implementation.

ASIN law – The ASIN Law is fully implemented in the Province of Cagayan. There is a high percentage of compliance among households and its commercial distribution. This may be due to the fact that the Province of Cagayan is a consistent regional outstanding winner in nutrition (CROWN) awardee and the use of iodized salt by the barangay as one of the criteria. This may also be due to ASIN checkpoints in Enrile, Sta. Praxedes and Nammabalan, Tuguegarao City.

Accreditation & Licensing of Facilities – The DOH and the PHIC are the two agencies involved in the licensing and accreditation of hospital facilities. Many government maintained hospital facilities are in danger of being downgraded by the DOH due to their inability to meet the stringent requirement of manpower and facilities.



Advocacy for the Legislation of Health Related laws at the Local Level

Implementation of Rabies Ordinance – Despite the passage of a law on rabies which require among others, the vaccination of all dogs by their pet owners, the provision of an impounding area in municipalities and proscribing penalties, there is weak implementation of the law.

Policy Formulation on Dengue Prevention Program – Among the policies being implemented to prevent dengue are the following: 4 o’clock habit in all schools and community; and the organization/activation of the Municipal and Barangay Dengue Task Force.

Law Regulating Practice of TBA’s – Administrative Order No. 22 provides that only skilled health workers and midwives can attend to the delivery babies thus totally barring Traditional Birth Attendants from delivering babies. Their role now shifted from birth attendant to pregnancy tracking.

Policy Formulation on the Establishment of Social Hygiene Clinic and Operation of Entertainment Parlors – Social Hygiene Clinics have been established in Aparri and Tuguegarao City, the two areas with the most active nightlife. Operation of entertainment parlors have also been regulated in these two localities.

Drug Therapeutics Committee – There is an existing Drugs Therapeutics Committee in the Province. It is composed of all Chiefs of Hospitals and the Provincial Health Officer and its main task is to peruse, go over and study the listing of all medicines that are to be procured by the Province.



Access to Low-Cost Medicines

Botika Ng Barangay - Out of the 820 barangays in the province there are only 136 Botika Ng Barangay existing. This means that there are still 684 barangays which have yet to establish their Botika ng Barangay. The CHDII, trained the Barangay Health Workers (BHW) in the implementation of the Botika ng Barangay. A seed capitalization of P25,000.00 worth of medicines was given by the CHD. In the Memorandum of Agreement (MOA) between the barangays, LGUs and CHD, the RHUs will be responsible in monitoring and supervising the said program.



GOVERNANCE

LGU Sectoral Development

The Inter-Local Health Zone –The ILHZ was piloted in Sanchez Mira serving four municipalities with the Sanchez Mira District Hospital as the core referral hospitals. As of 2007, four more ILHZs are planned to be established and made functional by 2009. Part of the plan is to merge Sanchez Mira with Ballesteros. These five ILHZ will be located in the five core hospitals of Tuguegarao, Piat, Gonzaga, Camalaniugan and Ballesteros. The DCAC or DOH Center for Health Development Action Center will be located in these identified core referral hospitals. This will be adopted as a key strategy/intervention to improve governance in local health system. It will be expected to enhance effectiveness towards public-private partnership and improve their capacities at the local level to manage their own health sector.

Health Referral System – At present, there is a weak referral system that needs to be strengthened. Referral forms are not being returned to the referring unit. There is therefore a need for a training on the two-way referral system.

LGU Scorecard – Before 2007, there was no Performance Appraisal System institutionalized in the LGU. By the end of 2007, there was an initial orientation on the use of the LGU scorecard in the RHU level.

Local Health Information System – In 2007, the CHD and DOH Manila conducted a training for encoders and program coordinators on the accomplishment of the FHSIS.



INTERNAL MANAGEMENT

Financial and Procurement System –Currently, the procurement of medicines and medical supplies are centralized, with the Provincial Government acting as the main procurement agency for all the fifteen devolved hospitals. The arrangement saw its inception in 2004 using as enabling instrument, the National Health Insurance Act. A modus vivendi among the officers and members of the Association of Municipal Health Officers of the Philippines (AMHOP) and the Provincial Chief Executive as parties has also been established to streamline and facilitate the centralized procurement of medicines for the LGUs through the Provincial Bids and Awards

Committee (BAC), which was reorganized to comply with the provisions of RA 9184 otherwise known as the Philippine Government Procurement Reform Act.

Eighty percent of the capitation funds for the provincially–sponsored PHIC Indigency Program are pooled for the procurement of drugs and medicines for the RHU. The BAC Cagayan initiated some reforms in an effort to do away with the many red tapes besetting the local government. This was adopted by hospitals in its negotiated procurement of drugs and medicines from a parallel drug importation (PDI) company, Pharma, Inc. or from the Philippine International Trading Corporation (PITC) to avail of high quality but low priced medicines.

Logistics Management –At present the LGUs is adopting the “stock card” system in determining the level of supply stocks, equipment, and medicines. For an effective and efficient inventory system, the province has hired IT programmers and started its acquisition of computers to improve and come up with a systematic inventory that shall be replicated in all hospitals including the RHUs.

Internal Audit –Currently, all internal audit work is placed with the Office of the Provincial Accountant, which provides only basic audit work for financial transactions. Although RA 7160 mandates the establishment of an internal control unit, not many LGUs have managed to comply. Post audit is provided by the Commission on Audit and performance audit is evaluated through the Performance Evaluation System (PES) through the Human Resources Office.

Chapter 2
Gaps & Deficiencies

GENERAL HEALTH STATUS

Health indicators show that the provincial health situation is at par with other provinces: not much better, but not much worse either. Actually, there are a number of health indicators where the Province has performed rather well and which are lower than the national level like maternal, infant and child mortalities.

Tuberculosis remains to be a public health threat. The number of dengue cases continues to rise yearly. Rabies has now become a major problem because of the alarming number of reported cases of dog bites and deaths due to rabies.

The province showed low Maternal Mortality Ratio of 67/100,000 LB compared to the national figure of 90/100,000. But it was also noted to be increasing from 6 maternal deaths in 2002 to 12 in 2007.

While it cannot be categorically stated that the maternal care program had been poorly implemented, it cannot be said either that implementation was very good. There is a high percentage of home deliveries. On the other hand, there is average TT coverage, average iron supplementation coverage and average performance for pre- and post natal visits.

As to child health, there have been no cases of measles for the last three years. While the Province achieved 83% FIC implementation which is below the benchmark of 95%, there are issues being raised regarding the use of 3% in computing projected targets. Infants exclusively breastfed for six months exceeded DOH benchmarks.

Although overall there is high access to potable water and sanitary toilets, there are still communities without access to potable water supply, sanitary toilets and without solid waste management program. Thus, diarrhea is still one of the leading causes of illness.

1   2   3   4   5   6   7   8   9   ...   22


База данных защищена авторским правом ©shkola.of.by 2016
звярнуцца да адміністрацыі

    Галоўная старонка