Opening Speech of the Secretary of Health at the 8th National Staff Meeting in Ormoc, Leyte (as delivered on 17 March 2014) My fellow health workers: It is not without reason that the Department of Health is holding its 8th National Staff Meeting here at Ormoc, Leyte. We are doing this as a symbolic gesture to show our support to the “Tindog Visayas” effort. Today, we stand side-by-side at ground almost zero (dapat kasi gusto natin sa sa Tacloban), but Ormoc suffered just as much devastation just a few months ago because of super typhoon Yolanda. For the many lives that were lost, and also for the heroism, bravery, and generosity of all - even our friends from abroad - who came together to help in the spirit of service to humanity, I invite everyone to spend a few moments with me in dignified silence. [moment of silence] As we raise our bowed heads and open our eyes from that brief reflection, let us ponder even more: have we really done enough? Yes, we were on the ground last November, December, and some even up to now in order to attend to the sick and rescue the dying. Yes, we facilitated the flow international aid both in cash and in kind – and we thank the international community for this. And yes, we worked to secure as much funding and resources as we could for rehabilitation efforts. However, the answer to the question on whether we have done enough or not risks turning into a “maybe” if we will not keep track and learn from what we have done. More importantly, we need to properly plan, execute and monitor our rehabilitation efforts even if public interest on Yolanda would have eventually waned. While the theme of this NSM is to report on what we have done in response to Yolanda, you and I will all be remiss if we forget that at the end of the day the Department of Health exists not only to serve the Visayas, but also to ensure that the coordination, financing, and delivery of health services for all Filipinos from Aparri to Jolo (or maybe more accurately, Batanes to Tawi-tawi) does not turn into a disaste; and hopefully that disaster does not visit us again. Let me start off by describing where we are in terms of KP implementation. Recall that we have commissioned a third-party independent effort to validate performance through a carefully designed and executed quarterly survey known as “KP Operations Monitoring” or “KP OM”. The quarterly validation has focused on select operational indicators that serve as instant barometers of how well KP implementation is ongoing. Drawing from the baseline results of KP OM surveyed last September 2013, I have given instructions to everyone to use the information for planning, budgeting, and monitoring of performance. The results of the survey round 2 done in December 2013 have just been released. The KP OM details will be presented to you in greater detail later, but this early let me share with you some of the findings along the three strategic thrusts of KP, at our national level. Regarding public health efforts to attain the MDGs: For example, on family planning, the province level average reported by RHUs and health centers was reported at 56 new acceptors in round one. In round two the province level average is at 44 new acceptors. This suggests that a wide variation in FP program performance still remains among our facilities. We should study the nature of these variations across provinces and regions and initiate measures to narrow the performance gap across areas. A cause for concern is that some of our public facilities do not provide family planning services in spite of the fact that, for those of you cognizant of the fact, that these services we do are legal. Among the district hospitals sampled in both rounds, 65 percent do not provide any family planning services. Over 90 percent of sampled RHUs in both rounds have reported commodity stock-outs. Commodity stock-outs are simply unacceptable, as we have procured sufficient amounts of FP commodities to serve all poor women with unmet need in this country. I know for a fact that we have around six million cycles of oral contraceptive pills and 500,000 DMPA vials in our warehouses as of last month. I know that right now they still have to be delivered. Our Materials Management Division and the Family Health Office should ensure that these remaining stocks are delivered directly to service delivery points, such as RHUs, starting with those that have reported stock outs. Direct delivery to service points will also save us money from renting additional warehouse space. We need to accept the fact that these stock outs are due to our limited capacity in the public sector to do logistics management. Related to this, take note that we have begun preparations to fully outsource logistics management starting this year. Let me mention about TB control, province level averages show that RHUs are only able to find 9 new TB cases, and that only 8 of these are able to complete treatment. We should be seeing around 17 cases to further bring down TB. The number of TB cases detected and cured has also remained the same across two survey rounds. The National TB Program should intensify its prevention and control efforts by prioritizing high burden areas, and by introducing new technologies to detect TB. I was informed that DOH is introducing GeneXpert to diagnose mainly drug resistant TB cases. More than that however, we should see how GeneXpert can be used as a screening test to possibly replace sputum microscopy, which we all know has limited sensitivity. Another fact is that among the RHUs sampled, 12 percent reported TB medicine stock outs in round 1; in the round 2 sample, 8 percent reported stock-outs. As with logistics management for FP commodities, MMD and the National TB Program should facilitate the delivery of stocks on hand direct to service delivery points or RHUs. This will free up much needed storage space and allow us to accept fresh deliveries of TB and other commodities from our suppliers. Regarding efforts to improve the quality of care: In the sample of RHUs, eto minsan ang nakaka-worry, in both rounds, it was found that only half are providing normal delivery services. And yet we are pursuing that all RHUs should have birthing facilities. From the sample of district facilities in both rounds, only 20 percent are able to provide cesarean section services. On the good news naman, for our Family Health Survey, from the reported 200-250 deaths per 100,000, we are now down to 67 deaths per 100,000. But we need to validate this so that we can officially report this to the President. We really need to see these numbers go up if our investments in HFEP are to be considered as successful. To ensure that this would happen, we need to prioritize HFEP investments in priority areas and facilities. We need to ensure that the facilities prioritized for upgrading have the adequate infrastructure, equipment, and skilled personnel to attain a desired functionality such as being able to do lifesaving surgeries. We have learned our lesson that spreading HFEP investments thinly across many facilities will just mean that we have more projects, not necessarily better access to quality care. We need to remind ourselves that it is not enough that we count the hollow blocks, crates, and boxes. HFEP implementation should be accounted for all the way to a facility’s ability to provide health services. Regarding efforts to improve financial risk protection through PhilHealth: Our latest figure is that 82 percent of our poorest families are covered, not just enrolled in PhilHealth. But we should continue to keep on increasing that number. And we should tap the LGUs to point out who the poorest of the poor really are, as well as the CHTs. On a positive note, I would like to point out that we have deployed by now almost 11,000 nurses in our country; and, in Region VIII alone, we have deployed more than 800 RNHEALS plus. The DSWD has repeatedly expressed willingness for us to make use of their Family Development Sessions as a venue to reach 4Ps households. The 4Ps is a captive market that already accounts for two thirds of the poorest households listed in the NHTS. This has been demonstrated as an effective venue to reach the poor in Mindanao. I would like to see this strategy replicated in the rest of the country. CHTs report that families with IDs or MDRs or some form of acknowledgement of enrollment or coverage have gone up from 74 percent to 88 percent. Again, this number should be 100 percent. I understand that around a fourth of NHTS households could not be located by our CHTs. I want us to consolidate reports of these missing cases so that we can advise DSWD of the situation. More importantly, PhilHealth should step up efforts in providing IDs or MDRs to members. For the poor, this seemingly ordinary piece of paper could spell the difference between life and death. A cause for concern is that 23 percent of the CHTs reported that poor families confined in supposedly no balance billing hospitals still had to make out-of-pocket payments. We have already issued orders for public hospitals to provide services with no balance billing. Why is there non-compliance? I would really to know the details of these barriers to full NBB implementation so that we can institute the necessary measures. Another cause for concern is that the proportion of patients in public hospitals who used PhilHealth to pay for medical charges remain slightly lower than 50 percent. This figure is too low compared to the reported PhilHealth coverage of 81 percent. Our MHOs and hospital chiefs should introduce measures that will facilitate the identification of members and provide assistance in filing claims at the point of care. CHD VIII has been known to have introduced various innovations along these lines. We should learn from their experience and even outdo them in our own respective regions. In addition, there is 35 billion pesos worth of premium subsidy for 2014; PhilHealth should come up with a complete marketing plan on how to properly spend that amount by informing members of benefits and how to use these entitlements. Are your own reports on KP implementation consistent with the results of this validation? I look forward to hearing from you on how we can help each other in improving KP performance. Given this report on KP performance, I am instructing the members of the Execom to ensure that the 2014 procurement plans and allocated budgets are properly applied to meet our set targets. With a 66 percent increase in our budget this 2014, we have no excuse as to why KP performance will not significantly improve in the next quarter. I’d like you to tell me in this NSM what you need me to do to remove policy and system barriers. I trust your expertise and recognize your better grasp of operational realities in the field. I have instructed our finance people to immediately release the bulk of 2014 funds to CHDs, consistent with the General Appropriations Act. I challenge all CHDs and the respective operations clusters to demonstrate that you can utilize our budgets better if given more leeway on how to spend it. We are now preparing our 2015 budget, and we are proposing a budget of 104 billion pesos. We need to back up this proposal with programs and interventions that will generate the most gain from our required investments. We have to be reminded that along with the increase in budgets is the expectation of better performance and improved health and well being for Filipinos. I’d like to be reminded, for example, of how expansion of the budget for vaccines will result in better health for our people. I wish to highlight that as part of this NSM, there will be time to discuss the DOH budget for 2014, covering items such as clarifications on the confusion in regional allocation and steps to improve utilization, among others. The Sin Tax, for your information, was able to generate money of 6 to 9 billion Pesos. So how do we use these funds properly? We need to plan. We need to find the gaps. We need to find the opportunities for the next two years. So on this note, kaya ba natin ito? [pause for crowd response] Dahil kaya natin ito, I now declare this 8th NSM open.
Posted on: Mon, 17 Mar 2014 10:09:28 +0000
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