Editor's note: This blog post is the third in a series of posts about the Development Policy Research Month that CHMI partner the Philippines Institute of Development Studies held in Manila during September 2013. Stay tuned over the next few weeks to learn more about take-aways from the event! Here are links to the first and second blog posts in the series.
In the Philippines, health services have been devolved to the local governments by virtue of the Local Government Code of 1991. The devolution has its boons and banes. In the case of healthcare, most local governments have been struggling to provide quality services to their constituents. This may be due to the fact that some local leaders do not prioritize health. They spend most their energy and money on infrastructure and invest heavily on roads, waiting sheds, and schools, among others. This is coupled with the various challenges that the local governments face in the provision of health services. One problem is the fragmentation of healthcare. There is a huge gap in health services between the central government and the devolved local government. Hence, there is a need to find better ways on how to solve this problematic state of healthcare at the local level.
During our first visit to Tacloban City, Leyte in 2012, an hour travel by air from Manila, the health team met with then Governor Carlos Jericho Petilla. This was part of our Visayas-leg fieldwork for the Health Market Innovations Project (HMIP). We interviewed him about the programs in the province that were shortlisted as finalists for the 2nd Galing Likha-Kalusugan (GLK) Awards. For the second year of the HMIP, 10 innovative schemes have been shortlisted as finalists. Out of these ten, three programs are in Leyte, the two initiated by the Provincial Government and the other is spearheaded by PhilHealth Regional Office with strong support from the Province. These programs are the Mother Bles Birthing Clinics, Hospital Incentive Scheme: Special Service Fee (SSF), and PhilHealth Link.
Our interview with the good governor lasted for almost two hours. Talking that long with a high-level public official is a rare experience for us researchers. We know that high-level officials typically have limited time in their schedule. But he gave that ample time to us and that is something! It simply means that our purpose interests him. From our conversation, I can say that Governor Petilla knows what he is doing. He is also a man with a vision. A vision for healthcare.
The interventions of the provincial government on health have been successful. It all started in 2004 with the creation of the Provincial Ad Hoc Committee on Health and the conception of the Hospital Enhancement for Leyte’s Progress (HELP) Program. In the case of SSF, it was able to incentivize the doctors in government hospitals to serve full-time; maximize PhilHealth collection; and contribute to the income of hospitals for the improvement of its facilities. The SSF program thus answers the problems on the shortage of doctors, lack of facilities and poor service in government hospitals.
The other program of the province, in partnership with Sister Eloisa of the KaKaK Foundation, Inc., is the Mother Bles Birthing Clinics (MMBC). This program was initiated as a Public-Private Partnership (PPP) in response to the Millennium Development Goal of reducing child mortality and improving maternal health. It also aims to decongest the Out-Patient Department of the Leyte Provincial Hospital and other district hospitals of the Provincial Government from OB patients. MBBC has contributed in the increase of facility-based delivery in the province, reducing maternal and infant mortality. The program was also able to increase employment of the midwives. When we met with Sister Eloisa last July, we saw the newly constructed learning center for pre-school children and IT students. She told us that with the profit from the expansion of MBBC, they are able to carry out their CSR. The last program is the PhilHealth Link which aims to connect patient and health facilities to PhilHealth in partnership with the local government units. This program was able to increase availment and utilization of PhilHealth benefits in the province. The success of PhilHealth Link got the attention of PhilHealth Central Office. The program was adopted nationwide through the PhilHealth CARES (Customer Assistance Relations and Empowerment Staff) program.
These efforts of the Provincial Government paid off. For its accomplishment and potential for replication, the three programs were recognized as among the top five of most innovative programs during the GLK Awarding Ceremony. Before becoming the Secretary of Energy, Governor Petilla has saw his projects come to fruition. And everyone must watch out for the so-called “Petilla Model.”
Picking up from the experience of the Provincial Government of Leyte, I will enumerate some of the factors why innovations in health fostered and succeeded at the local level.
Local governments have the leverage to promote health and provide health services. Leaders are in great position to initiate innovation. They are in direct contact with the people and have the opportunity to build good relationship among them as well as with other stakeholders. Local authorities can make strategic action to engage their communities in the improvement of their health. When there is a problem, there is always an opportunity to make it better. Local leaders must not think of themselves as the poor victim of the problem, instead they should think of themselves as the solver of the problem.
How necessary are the doctors, good facilities, and IT in healthcare? Indeed, they are very important. The life of the hospitals depends on the availability of doctors. Consequently, patients prefer good quality health facilities. And in the information age, IT is very useful to do things easier and better. Another aspect of this need to innovate is the alarming status of health in the province. There is a need to improve the old system to have better health outcomes.
Political will and leadership
Political will and leadership are critical in promoting health. Departing from the traditional way in favor of a new system requires determination of the local leaders. In addition, an effective leader can influence the people to make a change. They must put health at the forefront of their advocacies and spearhead innovative programs that will incorporate health in the local agenda. The success of the programs requires heavy involvement of the local leader at the start, but will run better without politicians in the future if the system is orderly in place.
Local leaders can collaborate with non-traditional partners across civil society and sectors. They must be willing to work with others especially if they lack resources. Bear in mind that it always pays off to keep your options open.
Creativity can be used as a tool to improve the old system and make it work. You innovate existing mechanism because the traditional way of doing things does not produce good outcomes. This is where creativity comes in. How do you improve the system? A leader with creative mind can solve that.
Photo (top): Carlos Jericho Petilla, the current Secretary of Energy and former Governor of Leyte in the Philippines, passionately talks about the innovative health schemes that he helped to start in his province. He worked to create Mother Bles Clinics, PhilHealth Link and Hospital Incentive Schemes.