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FOURMULA ONE FOR HEALTH:Implementation Framework for HealthSector ReformFOURMULA ONE FOR HEALTH as OverallFrameGoals Better health outcomes

More responsive health system Equitable health care financing

Four Thrusts Financing (increased, better and sustained) Regulation (assured quality and affordability) Service Delivery (ensured access andavailability) Governance (improved performance)

Strategic Guideposts Building upon gains and lessons from majorreform initiatives

Focus on critical interventions to beimplemented as a single package Sector wide management of FOURMULA ONEimplementation NHIP as the primary instrument

Constraints and Opportunities (1)Restricted government health budgets:

Inflexible allocation across categories Allocation among programs not linked to

performanceDifficulty in managing a highly decentralized system:

steering various stakeholders (i.elocal systems,private markets)Managing health finances from multiple sources

Deeper understanding of and increasing leverage ofthe NHIP over health system performance Inroads in health reforms in at least 30 provinces

resulting in improvements in health outcomes andproviding invaluable lessons

Growing support for health sector reformimplementation from partners government

agencies, external Deeper understanding of reform implementation

requirements Revitalized support from national leadership

Critical Components to Jump Start FOURmulaONE ImplementationIdentifying critical components

Doable given available resources Sufficient groundwork and buy-in

Triggers a chain reaction to spur otherFOURmula ONE interventions

Produces tangible results Generates public support

FINANCINGRationalization of Sources of Health Financing Out-of-Pocket

Shift of OOP to outpatient care (e.g check-up,consultation, etc)

Local Government Focus subsidy on preventive and promotivehealth services

National Government Shift resources on regulation, governance andto teaching/training tertiary hospitals

Social Health Insurance Focus on in-patient care

Local Health Financing ReformsEarmarking funds and prioritizing health services

Social marketing/advocacy to LGUs, NGOs &private sector to earmark funds for priorityhealth programs Identify tools for prioritizing health services(eg. segmentation and targeting the poor) Rationalize pricing/costing policies for priorityprograms

Management/coordination of LGU health fund

Integrate national and local investment plan Cost-sharing arrangements among LGUs National and local coordination of funds (eg.counter parting arrangements) Rapid estimation of local health accounts

National Health Financing ReformsPublic finance management systemInstitutionalization of revenue-enhancementmeasures

Full retention of income

Asset managementDevelopment of efficient and equitable allocationmechanisms

Priority health programs Geographic Income Population groups

Performance based-budgeting system Develop models for hospital, public health andregulatory agencies

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Reform financial management andprocurement system

Develop / implement performance audit andreview system

Expansion of the NHIP Increase membership and collections Enhance benefit package

Improve utilization of reimbursements Enhance systems for regulation and governance

REGULATIONStrategiesHarmonizing & streamlining of systems, processes

for licensing & accreditation & certificationDeveloping a seal of approval systemPursuing cost recovery with income retention for

health regulatory agencies & other revenuegenerating mechanisms

Ensuring access of the poor to essential healthproducts

ComponentsPrograms include:

One-stop shop

Philhealth-Sentrong Sigla seal

Unified seal of approval

Botika ng Barangay/Pharma 50

SERVICE DELIVERYStrategies

Making available basic and essential healthservice packages by designated providers instrategic locations

Assuring the quality of both basic andspecialized health services

Intensifying current efforts to reduce publichealth threats

Components

Public health development plana)Disease-free zones mopping upleprosy, schistosomiasis, filariasis, malaria,

rabiesb)Intensified disease programs VPD, TB,HIV/AIDS, emerging infectionsc) Improving reproductive health outcomesMMR, IMR, U5MR, TFR, CPRd)Intensified promotion of healthy lifestyle DM, HPN, CVD, breast and cervical cancer,anti-smoking, safe water, sanitation, amongothers

Health facilities development plan Rationalizing facilities

Critical upgrading of facilities through fundpool

Rationalizing services in DOH-retained,local government & private facilities insidethe 16 sites

Integrating wellness services in hospitals

Strengthening disaster and epidemicmanagement system to include improvedsurveillance

Intensification of health promotion/Establishment of National Health PromotionFoundation

GOVERNANCEComponents

Sectoral Development Approach for Health

Health Human Resource Masterplan

Establishment of 4-in1- F1 Sites

Philippine Health Information System

Procurement and Logistics ManagementSystem

Public Finance Management System (E-NGAs,etc)

Sectoral Development Approach for Health

To strengthen government leadership inimplementing a sector program wheredevelopment partners cooperate andcontribute accordingly

Effective donor and LGU coordinationtowards financing a sector program

Harmonizing procedures among donors

and national governmentHealth Human Resource Masterplan

To implement a national HHR Masterplan insupport of national & local health systems

HHR Information System

Competency-based recruitment andselection systems

Training and development need analysis

Performance management system

Career development and management

Advocacy Plan

Developing a localized health human resourcestrategy

Developing a localized health human resourcestrategy

Health professional development andcareer track

Identifying and providing venue forposting of vacancies

Actively promoting LGU vacancies,

Support for developing local HR strategy

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Establishment of 4-in-1 Convergence Sites

Establishment of 4-in1 convergence sites

Health investment planning

Developing appropriate governancestructures and mechanisms i.e. ILHZconvergence sites,

Helping mobilizing extra-budgetaryresources for health at the local level

Improving procurement, devolvingregulatory functions, linking, localregulatory policies with health programs &financing

Nationalizing the health delivery network,provision of basic health services

Monitoring & evaluation i.e. LGU ScoreCard

Philippine Health Information System

Establishment, operationalization, & use ofhealth portal & development of Philippine

Health Information Infrastructure Harmonization of info systems

Human resource info systems

Vital registries, health statistics

Disease surveillance

Health accounts

Health regulations

Health Facilities

Development of KM systemsDOH Procurement and Logistics Management System

Inventory system, supply-chain mechanism

Efficient storage Database of goods/ supplies (standard

specifications)

Database of suppliers with performancemonitoring

Standardization of specifications anddocuments

Implementation of ethical practicesframework

Immediate Term Time Frame

August-Issuance of formal policy document-DOH to announce the scaling up of intensified

disease control programsSeptember-Launch of quality seal systems for drugs,facilities and servicesOctober-Validation and Consolidation of the

submitted initial drafts of the central &local investment plans

December-Completion of an overall investment planfor FOURmula ONE

2005 F1 Accomplishments

Aug Issuance of F1 AO andDPO

Sept Review of LGUInvestment Plans

Sept-Oct Orientation andPlanning Workshops

per Team Nov National Staff

Meeting-F1 Resolutions

Dec Initial TechnicalAssistance Mapping

Medium Term Time Frame1stQuarter 2006 F1 Priority Activities

Formulation of National Investment Plan

Finalization of LGU Investment Plans

Sectoral Policy matrix/ Mapping of TA

Requirements Designation of F1 Fulltime Point Persons

Formation of teams at all levels

F1 orientation/ advocacy

Development of F1 Performance AssessmentFramework (M&E)