Chapter 1 The Provincial Health Situation introduction




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HEALTH REGULATION
Enforcement of & compliance to National Health Legislation and Standards – Health related laws are not fully implemented and enforced in the province. These laws are the following: ASIN Law, Food Fortification Law, Milk Code and Sanitation Code, The Anti-Rabies Act and the Generics Law.
Legislation of Health Related Laws at the Local Level – If health related laws are not fully implemented and enforced at the provincial level, more so are they not implemented in the local level maybe because they are following the example of their superiors.

Improvement of Access to Low Cost Quality Drugs/Commodities – There is poor access to low cost quality drugs and majority of the people are unable to pay for the highly priced medicines. This is due to the failure of municipalities to put up Botika ng Bayan in their locality especially in hard to reach areas. Reasons cited are usually the unavailabity of funds to sustain BnB and they lack the initiative to encourage NGOs to set up BnB by providing the initial capital outlay as initiatives. On the side of the provider, they need to be trained on BnB management and records keeping and the absence of a functional Drugs and Therapeutics Committee for rational logistic management.

GOVERNANCE
Local Health Development System – There is only one functional ILHZ. Five more are in various stages of organization. The ILHZ is beset with problems like the non-existence of an integrated health plan within the ILHZ and members are inactive or they lack involvement, no coordination between private and public health provider and no regular monitoring and evaluation because of logistical problems.
Local Human Resource Strengthening There is an inadequate number of health service providers, midwives and nurses and are below planning standards. This is because personnel complement of health facilities required by law are not created or are not being filled up. Most health workers feel that there is no career development in public health. In some municipalities magna carta benefits are not enjoyed by the health workers because of lack of funds. In the barangay level, BHWs receive a measly sum of a few hundred pesos which is clearly not commensurate to the amount of work that they put in.

LGU Scorecard Implementation – Most RHUs do not use the LGU scorecard. This is because there has only been one orientation training on the use of the LGU scorecard. Another reason is that most LGUs lack the resources to produce the required forms.

Local Health Information System Development – There is no established health management information system installed in the province because of the funding requirement of the project.

INTERNAL MANAGEMENT

Public Finance Management – All hospitals being operated and maintained by the Provincial Government are continuously being subsidized due to their poor revenue generating capacity. This is because most of the patients have limited capacity to pay and they are of the mindset that health services are free. Also, there is limited enrolment to the Philhealth Indigency Program. On the other hand, the hospitals do not have a proper cost finding and rate setting. They also do not have a patient classification scheme and no cost recovery scheme. They are also impeded with the lack of a revolving fund and they do not have a systematic billing system. On the part of the Province, the tax code ordinance is old and outdated and tax collection drive is at a minimum. The government hospitals are not given fiscal autonomy.

Procurement Management – Procurement Management is hounded by the problems of irregular supply chain, non-functional Drugs and Therapeutics Committee, and long and tedious process of procurement of medicines and supplies. This is true not only in municipalities but in the provincial level as well. In the case of the Province, procurement is centralized: all purchase requests from the different hospital facilities are first gathered and consolidated before being bidded.

Logistic Management System – All offices in the Provincial Government including all hospitals are required to prepare a Procurement Plan which is the basis for all purchases by these offices. All these procurement plans are being compiled by the General Services Office into the Annual Procurement Plan which is the basis for government purchases be it supply or property. This is because the GSO is the mandated procurement services office. Problem usually occurs because of the inordinate time spent in bidding so that most of the time supplies and medicines do not come at the time that they are needed.

Internal Audit – The Provincial Accountant’s Office which is tasked to conduct internal audit do not conduct regular review of the financial operations of health facilities due to the sheer volume of work that is being accomplished by the office and the inadequate personnel complement.

Chapter 3
Outcomes, Goal and Objectives, Critical Targets and Interventions

INTRODUCTION

The greatest challenge that the Province of Cagayan is presently facing is the delivery of public health care and hospital services. This is to ensure a better life, better opportunities and better health for all Cagayanos.

How to go about achieving the above is basically guided by the goals and targets set in the Millenium Development Goals. In addition, it is also guided by the 10-K Agenda of the present administration. It must also adhere to the DOH Fourmula 1 thrusts of service delivery, financing, regulation and governance.

The Provincial Government of Cagayan through the Provincial Health Office will have to institute reforms in order to achieve its goals and objectives. This would include rehabilitation of its hospital facilities and equipment, filling up of vacant positions and hiring of additional health personnel, overhauling of its present internal management system and other painful but necessary adjustments.



VISION STATEMENT: Good health for all Cagayanos through disease prevention and control to enable them to live a progressive life.

MISSION: To provide quality, efficient, effective, accessible, equitable and sustainable health services for all Cagayanos.

The Province of Cagayan is committed to achieving the above vision and mission in order to achieve the health goals as identified by the Millennium Development Goals, the Philippine Development Plan and the 10-K Agenda of the present administration.



SERVICE DELIVERY:

Public Health Development

Disease Free Zone Initiatives – Includes intervention for the elimination of schistosomiasis, rabies, dengue, leprosy and malaria.

For schistosomiasis: the objective is to eliminate schistosomiasis cases from 10 to 0 by the end of 2014 through: the translation, production and distribution of IEC materials and conduct of IEC during Barangay Assemblies, tri-media campaign, installation of signage in affected barangay, training of RHU Gonzaga staff on serological testing for schisto, training of BHW and BNS on snail survey/hunting, enhancement and strengthening of community participation, training of RMT on integrated microscopy and ELISA. Also, there will be training of RHU staff on the two-way referral system, mass stool examination and deworming in high risk areas and deworming of suspected animal’s hosts. There will also be continuing networking and collaboration with NGOs and other agencies like the UP College of Public Health. The affected barangays should make a concerted effort in modifying the snails’ breeding places. The LGU should procure sanitary toilet bowls and/or plastic toilet bowls for the affected barangays. Monthly monitoring and supervision of schistosomiasis program will also be conducted to be followed by a semi-annual review of the Schistosomiasis Program.

For rabies: the objective is to eliminate rabies in the province by the year 2014 through: the provision of vaccines to animal bite victims; the translation, production and distribution of IEC materials and the conduct of IEC during Barangay Assemblies; tri-media campaign; installation of signage’s or billboards. The Province will also initiate the conduct of training on RA 9482 (Anti-Rabies Act of 2007) and on the Revised Guidelines on the management of animal bite patients (AO 0029 s.2007). There is also a need to conduct facility mapping and needs assessment for the identification of strategically located areas for the establishment of additional Animal Bite Centers per ILHZ cluster. Two more ABC facilities will be established in Aparri and Ballesteros to complement the existing ABC facility at the Provincial Capitol. It may also establish one ABC per ILHZ clusters should there be a need to do so. The existing animal rabies laboratory diagnostic capabilities of the DA should also be upgraded. We should also look into the routine immunization (PEP) of school children aged 5-14 in areas with high incidence of rabies. In collaboration with the Provincial Veterinary Office, there should be mass dog immunization and a central database system should be established for registered vaccinated dogs. Dog impounding areas should be established in strategic locations that are accessible to clustered municipalities for the unregistered, stray and unvaccinated dogs. Responsible pet ownership should likewise be promoted.

For Leprosy: the objective is to eradicate the disease by 2014 through active case finding, contact tracing and immediate and early treatment of positive cases; increase community awareness through intensive IEC and advocacy; training of health workers on diagnosis and case management; networking/collaboration with NGOs like Franciscan apostolate and monthly monitoring and supervision of Leprosy Program. A semi-annual PIR for the Leprosy Program will also be conducted.

For Malaria: there are two objectives: to decrease malaria cases from 1,162 to 813 and deaths from 8 to 0 at the end of 2014. This will be done through intensive IEC and advocacy and reactivation of Municipal/Barangay Action Committee; intensification of barangay vector control activities and community active case findings. Spray-men will be trained on spraying operations and clinicians and MHOs will be trained on management of severe malaria cases. Health personnel and Barangay Health Workers will also be given refresher courses on malaria prevention and control program. The Local Government Unites will see to it that there are enough malaria medicines, insecticides and laboratory reagent and to conduct semi-annual PIR for Malaria Control Program.

Intensified Disease Prevention and Control – Includes intervention for the control of the following diseases:

TB: There are two objectives: to increase Case Detection Rate from 65% to 70% and increase Cure Rate from 87% to 90% by 2014. This will be accomplished through an intensive IEC and advocacy especially during Barangay Assemblies; organization or reactivation of TB Task Force; intensification of TB active case finding at the community level; training of newly hired health personnel on the TB-DOTS program; conduct of QAS and Sputum microscopy training for Med Techs and Microscopists; training of RHMs on sputum smearing and fixing; intensification of “Tutok Gamutan” at the community level; networking and collaboration with other agencies like the Philippine Tuberculosis Society and the CVMC for the services of pulmonologists and radiologists; ensure availability of Anti-TB drugs, reagents, microscopes, Medical Technologists and other equipments; conduct of monthly monitoring and supervision of the National Tuberculosis Program and conduct of semi-annual PIR for NTP.

STI, HIV/AIDS: The objectives are: to sustain 91% coverage of individuals reached through IEC; to decrease SM(+) GC cases by 50% from 871 to 436; to decrease SM (+) NGC cases by 50% from 993 to 497; to be able to provide 100% treatment to all diagnosed STI cases by the end of 2014 and to maintain the non-prevalence of HIV/AIDS among the general population through intensive IEC and advocacy; conduct of survey and master listing of high risk individuals; conduct of training on STI/HIV risk management, clinical screening and diagnosis; training of Med Techs on serologic testing; procurement of medicines, equipments, reagents and condoms; strengthening the implementation of ordinances regarding bars employing EEWs e.g., monthly testing, etc. and conduct of semi-annual PIR on STI/HIV/AIDS.

Dengue: The objective is to reduce dengue cases by 50% from 851 t0 423 and deaths from 7 to 0 by the end of 2014 through: intensive IEC and advocacy; intensification of active community surveillance, strengthening of Dengue Task Force in the Barangays, environmental sanitation, environmental manipulation and implementation of 4 o’clock habit. Public Health workers will be trained on dengue prevention and control while doctors will be trained on the management of dengue cases in the hospital setting. Med Techs will be trained on blood component separation. All dengue cases will be treated at the hospital level. Drugs, medicines, insecticides and laboratory reagents will be procured. The LGU will see to it that all stakeholders will be involved in its fight against dengue. There will be a monthly monitoring and supervision and a semi-annual PIR on Dengue Control Program will also be conducted.

Other infectious diseases These include typhoid fever, cholera and other enteric disease the goal of which is to reduce morbidity and mortality through upgrading the capability of the CVMC and the other district hospitals of the province.

Child Health Program
Goal – To decrease infant and under-five morbidity and mortality.

EPI: To increase FIC coverage from 86% to 95%by the end of 2014 through IEC and advocacy to parents especially during Barangay Assemblies; capability building of RHU and hospital personnel on cold chain, logistics management and data banking analysis and data generation; institutionalization of REB strategy through effective plan implementation of vaccination mapping activity and vaccination scheduling activity; provision of vaccines, supplies and materials, refrigerator, generator sets and service vehicle; conduct of monthly monitoring and supervision of the EPI activities and conduct of semi-annual PIR on EPI activities.

Breastfeeding: To increase coverage of infants initiated to breastfeeding within one hour after birth from 63% to 85% and to increase coverage of exclusive breastfeeding for the first six months from 88% to 100% by the end of 2014 through intensive IEC and advocacy to parents especially during Barangay Assemblies; training and reorientation of health workers on breastfeeding and the Milk Code; strict implementation of the Milk Code in all hospitals and communities and to conduct semi-annual PIR on the implementation of the Milk Code.

IMCI: The objective is to reduce mortality due to pneumonia from 50 to 10 deaths and to reduce 75% of child morbidity due to pneumonia and diarrhea by 2014 through IEC and advocacy especially during Barangay Assemblies; reorientation/training of all MHOs, RHMs and PHNs on IMCI; and provision of drugs and medicines especially cotrimoxazole, amoxicillin, paracetamol, salbutamol, reformulated ORS, dextrose and other basic drugs and medicines; provision of apparatus and equipment like BP for children, thermometer and IMCI timer; strengthening of the two-way referral system and monthly monitoring and supervision of the program.

Nutrition: The objective is to reduce the prevalence of BNVL/BNL pre-schoolers from 8.78% to 4% by the end of 2014. This will be done through the increase in micronutrient supplementation coverage in the priority target groups: Vitamin A among 6-71 months pre-schoolers from 78% to 95%, iron supplementation coverage from 54% to 85% low birth weight infants from 4.90% to 3%. Also, deworming coverage among 12-71 months will be increased from 87% to 95%.

Newborn Screening: The objective is to ensure that newborn screening services will be available in all hospitals and some RHUs through the passage of a local ordinance, training of health personnel and IEC and advocacy on the importance of NBS, provision of NBS kits; and conduct of monthly monitoring and supervision of the program.

Safe Motherhood: Its goal is to provide quality holistic care to all women with an objective of maternal mortality ratio reduction by 3/4 from 67/100,000 LB (12 deaths to 3 deaths) by the end of 2014:

Prenatal and Postnatal Care:

The objectives are: to increase pre-natal coverage (at least 4) from 72% to 85%, to increase AP mothers given complete iron supplement from 56% to 85%, to increase AP mothers given complete Vit. A supplementation from 10% to 85% and to increase Postpartum mothers given Vit. A supplement from 48% to 85% and Iron supplement from 52% to 85% by the end of 2014; to increase TT coverage from 52% to 80% by the end of 2014.



Natal Care:

The objective is to increase the percentage of deliveries in health facilities from 20% to 80% with skilled birth attendants from 72% to 80%. To increase the percentage of at least two post partum visits from 58% to 80%.



Contraceptive Prevalence Rate - The objective is to increase CPR from 47% to 80% by the end of 2014 through: IEC and Advocacy; Capability Building on NFP, FP Basic Compre, FP (CBT0 Level 1, ICV, Pre-Marriage Counseling, LSS, Interpersonal Communication Skills, BTL and non-scalpel vasectomy for hospital based MDs; provision of FP/MCH supplies and equipment of health facilities; Networking and establishment of Pop Shop; Strengthen CSR plan and Policy development; Upgrading of Health Facilities and Improvement of Health Financing Scheme and Monitoring and PIR using SDIR tools.

Advocacy for Risk Behavior – Its goals are: to decrease morbidity and mortality due to lifestyle related diseases; to decrease the number of mortality due to cardiovascular diseases by 30% from 1512 to 1059 and to prevent CVD cases by 30% through IEC and advocacy of good health practices of diet and exercise.

Surveillance and Epidemic Management System

Strengthening of Disease Surveillance and Epidemic Management System – Its goal is to strengthen disease surveillance and epidemic management system through the establishment of active MESUs in the 28 municipalities and a PESU at the provincial level through capability building and establishment of a data bank system.

Disaster Preparedness and Response System – Its goal is to strengthen disaster preparedness and response system through the formulation of a Disaster Plan in all the 15 hospitals and 30 RHUs.

Health Promotion & Advocacy

Dental Health Program – The goal is to reduce the prevalence of dental caries and periodontal diseases. Specifically, it aims to increase the number of orally fit children under 6 years old to 90% by 2014. It also aims to reduce the prevalence of dental caries in pregnant women and other adults by 10% by 2014. This will be done through intensive IEC and advocacy on the importance of oral health and to remove the fear of dental procedures.

Mental Health Program – The goal is to reduce the risk and prevalence of mental disorders and improve the quality of life through IEC and advocacy on mental health, trainings on mental health management and establishment of a database and information system to determine the magnitude of mental illness in the province

Occupational Disease – The goal is to reduce work-related injuries and deaths through IEC and advocacy; training of health workers on work-related diseases; provision of medicines for work-related diseases and monthly monitoring and supervision of the program.

Health Facilities Development

Rationalization of Health Facilities - Its goal is to rationalize health facilities based on health needs and to ensure delivery of quality health care. This will be accomplished through facility mapping, health needs analysis and health resources management, human resources for health, social mobilization and investment planning. For hospitals, the following will be done: funding/creation of positions, implementation of Magna Carta; and compliance to Philhealth standards for accreditation.

Rationalization of Services – The goal is to provide all health facilities and RHUs with adequate, competent and committed health care providers through: upgrading and human resource development, creation/filling-up of vacant plantilla positions especially for Med Techs, malaria spraymen and midwives; and full implementation of MC benefits and compliance to licensure and accreditation standards of the DOH and PHIC.

HEALTH FINANCING

Expansion of the National Health Insurance Program

Universal coverage – The goal is to increase access to quality health service through accreditation of local health facilities and to enroll all indigents in the Province of Cagayan in the Philhealth program by the end of 2014.

Identification of indigents – Since local officials tend to interfere in choosing the PHIC enrollees such that the list of enrollees have become politicized, there is a need to sanitize the listing by adopting a tool to identify the real poor so that only the really needy segment of society are included. The goal is to maintain the 26,567 household that are enrolled in the Philhealth indigency program.

Accreditation of Facilities – The objectives are: to increase the number of RHU Philhealth accredited under Out Patient Benefit (OPB) package from 26% (8 RHUs) to 100% (30 RHUs) and TB DOTS accredited from 10% (3 RHUs) to 100% (30 RHUs), and MCP accredited from 0% to 90% by end of 2014. For Hospitals, there is also a need for all of them to be accredited. As of 2007, only 8 devolved hospitals have passed the accreditation requirements equivalent to 47% leaving the 7 hospitals non-accredited. Repair and rehabilitation of hospitals as well as putting the required manpower, supplies and equipment to meet PHIC standards are some interventions to be done for accreditation purposes.

HEALTH REGULATION

Implementation and Adoption of Health-Related Laws

Enhancement of and Compliance to National Health Legislation and StandardsIts goal is to adopt and fully implement health related laws by 2014 including the following: Milk Code, Asin Law, and Food Fortification Law.

Legislation of Health Related Ordinances at the Local LevelIts goal is to see to it that health related laws are adopted and implemented up to the barangay level.

Improvement of Access to Low Cost Quality Drugs and CommoditiesIts objective is to increase access of the population to low cost medicines by establishing additional 274 Botika ng Barangay by 2014.

HEALTH GOVERNANCE

LGU Sectoral Management

ILHZ – The goal is to have the five Inter Local Health Zones fully functional and integrated by 2014 through re-organization and reactivation activities, conduct of regular meetings and capability building.

Implementation of LGU ScorecardThe goal is to be able to institutionalize and harmonize SDIR-LGU Scorecard in all municipalities by 2014.

Development and Utilization of Local Health Information SystemThe goal is to improve access to quality health information system through the operationalization of the Health Management Information System and the procurement of computers and other IT equipments.
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