MLGP Module One. Introduction to HLGP and MLGP
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1 MLGP Module One Introduction to HLGP and MLGP
2 Session Objectives By the end of the session, the participants will be able to: 1. Discuss HLGP as a replication strategy that involves the adoption of the ZFF Health Change Model to improve health outcomes; and 2. Discuss the MLGP as a capacity building intervention for local health leaders to transform their municipal health systems
3 MLGP MLGP Module Module One One HLGP The Beginnings DOH-ZFF The DOH-ZFF Experience Health Health Leadership Leadership and the The ZFF Experience and and Beginnings Governance Governance of Program HLGP Program
4 Introduction to ZFF VISION To be a catalyst for the achievement of better health outcomes for the poor through sustainable healthcare programs and services, with a primary focus on health inequities in rural areas of the Philippines MISSION To enhance the quality of life of the Filipino by focusing on the achievement of targets in the country s Millennium Development Goals for health, in partnership with government and other stakeholders in the health sector
5 ZFF Development Strategy: The Health Change Model and the Bridging Leadership Framework LEADERSHIP AND GOVERNANCE IMPROVED HEALTH SYSTEM TARGETED AND PRO-POOR HEALTH PROGRAMS BETTER HEALTH OUTCOMES: LOWER IMR, MMR & MALNUTRITION RATES; LOWER INCIDENCE OF COMMUNICABLE & NON-COMMUNICABLE DISEASES
6 Framework of Intervention STRENGTHEN QUALITY AND RESPONSIVE HEALTH SERVICES HEALTH LEADERSHIP AND GOVERNANCE Municipal Accountability Barangay Accountability Coaching, Mentoring and Monitoring Improved Health Indicators HEALTH EMPOWERMENT AND ENTITLEMENT EDUCATION ENHANCE SUPPLY SIDE Human Resource Facilities Medicines Innovative Programs DEMAND SIDE Health Seeking Behavior INCREASE INCREASED UTILIZATION OF RELEVANT HEALTH PROGRAMS AND SERVICES
7 Municipal Basic Health Systems Technical Roadmap
8 Maternal Mortality Ratio and Maternal Death Cases: CHPP Maternal death cases Cohort 1 (poor with 4 ARMM LGUs) Cohort 2 (poor non-armm) Cohort 3 (ARMM) Cohort 4 (poor) Cohort 5 (GIDA) Total Home deliveries 17 Deaths in RHU/BHS 4
9 Distribution of Maternal deaths in LGUs Distribution of Deliveries Distribution of Deaths RHU/BHS 19% Home deaths 81% 0 Home 3rd Delay 38% '11 '12 '13 2nd Delay 12% 1st Delay 50% RHU/BHS Distribution of Maternal Deaths in Cohort 5 Of total deaths (37): RHU/BHS = 8; Home deliveries = 29 Interventions: Build capacity of barangay leaders and community health teams as pregnancy trackers Engage hilots, teachers, Church leaders, etc as strong advocates of facility-based deliveries and pre-natal check ups or other Innovations Intensify IECs Ensure Philhealth coverage and other incentives Adopt and institutionalize Wireless Access for Health among LGUs
10 Maternal Death Review with Hospital Deaths Total Deaths = 75 (Cohorts 1 to 5, UMak 1 & 2, Zambo 1 &2) Maternal Deaths, 2013 Referral Hospital: 51% RHU/BHS: 10% Home: 39% Interventions within Inter-Local Health Zone Review referral systems within ILHZ and between LGUs Prioritize ILHZ strengthening among PLGP participants Improve transportation services going to the health facilities Address gaps in human resource (adequacy and competency) and facilities in district and provincial hospitals Establish functioning communication between referral hospitals Provide capacity building feedback to referring facilities Gravida Status Gravida % Prima Gravida 26% % Multi Gravida 40% Deaths by Wealth Quintile Quintile Number % 1 (Poorest) (Richest) 0 0 Maternal Deaths by 4Ps Membership Nonmember 89% Member 11%
11 Infant Mortality Rate and Infant Death Cases: Cohorts 1 to 5 Infant Death Cases Cohort 1 (poor with 4 ARMM LGUs) Cohort 2 (poor non-armm) Cohort 3 (ARMM) Cohort 4* (poor) Cohort 5 (GIDA) Total
12 Infant Death Review Total Deaths = 277 (Cohorts 1 to 5, UMak 1 & 2, Zambo 1 &2) Referral Hospital 19% Infant Deaths, 2013 RHU/BHS 21% Top 5 causes of infant deaths Home Type and of hilot infant assisted death 60% 1. Pneumonia 2. Sepsis 3. Acute Gastroenteritis 4. Prematurity 5. Congenital Abnormalities 27% 15% 12% 11% 10% Age Group % Early neonatal (less than 7 days) 44% Late neonatal (7 to less than 28 days) 14% Infant (28D to less than 1 year) 42% Interventions: 1. Access to facilities with complete medicines 2. Access to competent healthcare worker who can provide home-based/community-based medical care Preventive measures: 1. Increase FBD & SBA 2. Improve quality of prenatal care & nutritional status of mothers, addressing illnesses during pregnancy
13 Bringing down MMR Leadership and Governance Generating Demand: Ordinances and Policies Addressing the Supply Side: Birthing Facilities and equipments Monitoring and Surveillance Coaching and Mentoring System Improved Health Information System Incentives for Very Poor Mothers Referral System Introduction of Roadmap: 6 Building Blocks
14 MLGP Module One DOH-ZFF Health Leadership and Governance Program
15 DOH-ZFF Partnership Agreement Department of Health Convention Hall (May 16, 2013)
16 HLGP Objectives The Program aims to create an immediate impact on achieving the health MDGs by improving local health systems in the 609 priority municipalities. Department of Health 1. Support and promote the leadership and governance capability building to complement the existing technical expertise of DOH-CHDs in supporting provincial and municipal health leaders 1. Institutionalize national policies and programs that support strengthening the health leadership and governance at the local level Local Government 1. Develop the health leadership and governance capabilities of local chief executives needed for a sustainable health system; 2. Improve health outcomes 3. Mobilize public-private collaboration to facilitate sharing of resources and replication of best practices for sustainability
17 Program Management ZFF Bridging Leadership Resource Partner OVERSIGHT COMMITTEE DOH Central Office Program conceptualization, financing, implementation plan and policy support PHILHEALTH Technical support on health financing ZFF PROJECT MANAGEMENT COMMITTEE DOH Central Office (BLHD, HHRDB, NCHFD, HPDPB, NCDPC, NEC, BIHC, NCHP) OPERATIONS ZFF Bridging Leadership Resource Partner DOH BLHD Mandate and Accountability to CHD ACADEMIC PARTNER Training Partner DOH-CHD Program Manager and Leadership and Governance Coach PROVINCE Co-Program Manager CITY/MUNICIPALITY Implementation of Community Health Activities
18 Operational Framework Z F F ZFF and DAP Health Leadership & Management for the Poor (HLMP) Training of Coaches Change Management Program ZFF and DAP Health Leadership & Management for the Poor (HLMP) Trainers Training; Training of Coaches; Change Management Program ACADEMIC INSTITUTIONS ACADEMIC INSTITUTIONS Municipal Leadership and Governance Program (MLGP) ZFF Provincial Leadership and Governance Program (PLGP) Oversight Committee (DOH, PhilHealth, LPP, LMP, ZFF) Training Evaluation Training Evaluation PRACTICUM Oversee Training evaluation PRACTICUM Coach Oversight, program direction Training evaluation Coach and Support CHD Core Team : Regional Directors, HRDU Head, LHAD Head, PHTLs Supervision, Coach Coach DOH Central Office BLHD, HHRDB, NCDPC, HPDPB, NCHFD Mayors, MHOs Governors PHOs DOH REPRESENTATIVES PRACTICUM Support: technical, financial, logistical Feedback Improved Municipal Health System Improved Provincial Health System Feedback Feedback, program evaluation Feedback BETTER HEALTH OUTCOMES Lower MMR/IMR Lower incidence of communicable and non-communicable disease P r o j e c t M g t C o m
19 Replicating the Health Change Model at the Region by the CHD Provide tertiary health care programs and services and support primary health care programs of LGUs HEALTH LEADERSHIP AND GOVERNANCE Municipal Accountability Barangay Accountability Coaching, Mentoring and Monitoring Improved Health Indicators Help the poor navigate the provincial and municipal health systems to avail of health programs and services SUPPLY SIDE Human Resource Facilities Medicines Innovative Programs DEMAND SIDE Health Seeking Behavior Increase Utilization of Affordable and Quality Health Programs and Services
20 Program Components Regions Provinces Municipalities Cities Health Leadership and Governance Program Health Leadership and Management for the Poor Program (HLMP) Provincial Leadership and Governance Program (PLGP) Municipal Leadership and Governance Program (MLGP) MLGP-Short Course on Urban Health Equity (MLGP-SCUHE) One-year, two-module leadership program (Six-month Practicum: Coaching and Monitoring) Three-year, three-module program (Six-month Practicum: Coaching and Monitoring) One-year, two-module leadership program (Six-month Practicum: Coaching and Monitoring) One-year, two-module leadership program (Six-month Practicum: Coaching and Monitoring) Participants CHDs, PhilHealth Regional Office, DSWD Regional Office, DILG Regional Office, Regional and Provincial Chief of hospital, Academic Partner Governor and PHO Mayor and MHO City Mayors and City Health Officers
21 Municipal Leadership and Governance Program (MLGP) Municipal Leadership and Governance Program One-year, 2-module leadership program for Mayors and MHOs, with training and coaching on local health system development Program Management - CHD as program owner and manager - Academic partner as training provider Good governance in the health sector Healthcare financing Access to essential medicines Health Human Resources Health Information Health Service Delivery
22 MLGP Module One Benefits for Mayors
23 Leadership Development Personal development in Health Leadership and Governance Translate Health Outcomes into Political Gains
24 Municipal Health System Barangay Health System Multi-stakeholder and Community Involvement Ordinance & Policies Improvement of Municipal Health Outcomes Health Budget PhilHealth Financing scheme Access to Essential Medicines BEFORE AFTER PARTNERSHIP: Governance Financing Shared Mission and Vision LGU more or less 15% Functional and Expanded Local Health Board BLGU Barangay Health Board 4-in-1 Accreditation Referral System Cluster of Barangays Activation of LHB BHW Retention Births attended by skilled professional Facility-based deliveries Brgy Health Health Summit/ Fair Assemblies Capitation & Reimbursement Enrolment & Utilization of Benefits by Indigents Medicines/ Technology Availability of Medicines Adequate Number of Medicines Botika ng Barangay Brgy. Health Scorecard Citizens Charter Local Health Financing Scheme Drug Management System Family Health Card Entitlement Education
25 Credible Data Information Campaign RHU Management Improvement of Municipal Health Outcomes Materna Health Facilities & Services l and Child Nutrition Child Health Health Health Information Human Resource Service Delivery Accurate Baseline Adequate Manpower Ratio Reliable data Competent Health gathering Workers Computerized and systematic records Performance Translate data info Management into action System LGU Health Data Board PregnancyData board Nutrition Data board Barangay Data Board l and Infectious Feedback System/ Diseases Citizen s Scorecard Water, Sanitation & Hygiene Magna Carta Implementation Others Proportionate # of health facilities Regular manpower assigned Essential medical equipment & supplies Available mode of transportation Purok System/ Pregnancy Mapping Community Health Team Buntis Congress Maternal/ Infant Audits Malnutrition Data Board PABASA sa Nutrisyon Food Always in the Home Indigenous Supplementary Mixture (INSUMIX) Nutrition Congress Sustainable Feeding Program Tuberculosis HIV/AIDS Malaria NTD/ Dengue Municipal WASH Task Force Sanitation & Hygiene Practices Access to Safe Water Lifestyle Diseases Oral Health Family Planning Emergencies
26 Expansion of Social Capital Networking and partnerships
27 Incentives and Awards Opportunity for Health Program Grants Opportunity for Seal of Health Governance Recognition
28 Critical Factors for the Success of the Program Selection of LGUs and commitment of local health leaders (Mayors and MHOs) Quality of Training Intervention by academic partners Accountability for Deliverables during Practicum Presence: Monitoring and Coaching Performance-based Grants and Incentives (e.g., Health Facilities)
29 MLGP MLGP Module Module One One HLGP The Beginnings Salamat po! DOH-ZFF DOH-ZFF Health Health Leadership Leadership The ZFF Experience and and Governance Governance Program Program
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