Philippine Health Information System: Review and Assessment. February - July 2007

Transcription

1 Health Metrics Network Philippine Health Information System: Review and Assessment February - July 2007 by The Philippine Health Information Network The Philippine Health Information Network c/o Ms. Charity Tan Information Technology Officer Information Management Service Department of Health

2 Table of contents List of Acronyms 4 List of Tables and Figures 7 1 Background 2 The Philippines Geography, Administrative Divisions and Government 8 The Climate 9 Demographic Characteristics 9 Economic Characteristics 10 Organization of the Health Care System 10 Health Care Facilities 11 Health Human Resources 12 3 Frameworks for Generating Health and Nutrition Statistics The Framework Based on the National Objectives for Health The Philippine Statistical Development Plan The Philippine Statistical System 21 4 Government Agencies Generating Health and Nutrition Statistics The Department of Health 23 The Food and Nutrition Research Institute 25 The National Nutrition Council 25 The Philippine Health Insurance Corporation 26 The National Statistics Office 26 The National Statistical Coordination Board 27 5 Previous Studies on the Assessment of Health Information in the Philippines Past Reviews/ Assessment of Health Statistics and Information System 27 in the Philippines Interagency on Health and Nutrition and PSDP Assessment 29 Issues on Health Information Presented in the National Objectives 30 for Health The Philippine Integrated Disease Surveillance and Response 34 6 Assessment of Health Information System of the Philippines Health Metrics Network Approach 52 Assessment of the Field Health Surveillance Information System and 56 the Civil Registration System in the Subnational Levels 7 Results of the Health Metrics Network Assessment 8 Recommendations References 78 Annex 1. Matrix of Available Health and Nutrition Statistics in 80 Agencies of the Department of Health Annex 2. Matrix of Available Health and Nutrition Statistics 91 in the Philippine Statistical System Annex 3. CD copy of the Instruments Used in the Assessment of the 97 Field Health Service Information System and the

3 Civil Registration System Annex 4. CD copy of the results of the HMN Assessment 98 Annex 5. List of Philippine Laws and Administrative Orders on 99 Vital Statistics and Generation of Health Statistics Annex 6. The Philippines MDGs Indicators 102 3

4 List of Acronyms AIDS Acquired Immune Deficiency LGU Local Government Unit Syndrome AO Administrative Order MCH Maternal and Child Health Survey API Annual Parasitic Incidence MCR Municipal Civil Registrar APSED Asia Pacific Strategy for Emerging Diseases MDG Millennium Development Goal ARMM Autonomous Region of Muslim Mindanao MFHSIS Modified Field Health Service Information System BAS Bureau of Agricultural Statistics MHO Municipal Health Officer BFAD Bureau of Food and Drugs MIMAROPA Mindoro, Marinduque, Romblon, Palawan BHS Barangay Health Station MMR Maternal Mortality Rate BIIS Bureau of Food and Drugs Integrated Information System MPDO Municipal Planning Development Officer BLES Bureau of Labor and Employment Statistics MTPDP Medium-Term Philippine Development Plan BNB Botika ng Bayan MTPPAN Medium-Term Philippine Plan of Action for Nutrition CALABARZON Cavite,Laguna,Batangas,Rizal,Quezon NCR National Capital Region CAR Cordillera Administrative Region NDHS National Demographic and Health Survey CBMIS Community Based Management Information System NEC National Epidemiology Center CCR City Civil Registrar NEDA National Economic and Development Authority CED Chronic Energy Deficiency NESSS National Epidemic Sentinel Surveillance System CHD Center for Health Development NGA National Government Agency CHO City Health Officer NGO Non-Governmental Organization CPDO CityPlanning Development Officer NHII National Health Information Infrastructure CRS Civil Registration System NHIP National Health Insurance Program DDMS Infectious Disease Data Management NNC National Nutrition Council System DFHSIS Decentralized FHSIS NNS National Nutrition Survey DHS District Health System NOH National Objectives for Health DOH Department of Health NSCB National Statistical Coordination Board DOHLIS DOH Licensing Information System NSO National Statistics Office 4

5 DOTS Directly Observed Treatment Short OPT Operation Timbang course DTIS Document Tracking Information PCHRD Philippine Council for Health System Research and Development DTOMIS Drug Test Operation and Management Information System PhilHealth Philippine Health Insurance Corporation e-ngas electronic-new Government Accounting System PHIN Philippine Health Information Network ENHR Essential National Health Research PHN Public Health Nurse EO Executive Order PHNIS Philippine Health and Nutrition F1 Fourmula One for Health Information System FBS Food Balance Sheet PHO Provincial Health Officer FGD Focus Group Discussion PHS Philippine Health Statistics FHSIS Field Health Service Information PIS Personnel Information System System FIVIMS Food Insecurity and Vulnerability Information and Mapping Systems PLHIS Philippine Local Health Information System FNRI Food and Nutrition Research Institute PMIS Philippine Malaria Information System FPS Family Planning Survey PNHA Philippine National Health Accounts FS Field Surveillance PNHRS Philippine National Health Research System GDP Gross Domestic Product POPCOM Commission on Population GIDA Geographically Isolated and Disadvantaged Area PPDO Provincial Planning Development Officer GNP Gross National Product PPMP-DP Philippine Population Management Program Directional Plan HAMIS Health and Management Iinformation System PSDP Philippine Statistical Development Program HDL-c High Density Lipoproteins cholesterol PSO Provincial Statistics Officer HIS Health Information System PSS Philippine Statistical System HIV Human Immunodeficiency Virus PSY Philippine Statistical Yearbook HMIS Health Management Information PWD Persons with Disabilities System HMN Health Metrics Network RA Republic Act HOMIS Hospital Operation and RHM Rural Health Midwife Management Information System HPDPB Health Policy Development and RHU Rural Health Unit Planning Bureau HSRA Health Sector Reform Agenda RHUMIS Rural Health Unit Information System 5

6 IAC-HNS Inter-Agency Committee on Health and Nutrition Statistics SEAMIC Southeast Asian Medical Information Center IBBIS Integrated Blood Bank Information SPR Slide Positivity Rate System ICD-10 International Classification of Diseases version 10 SRTC Statistical Research and Training Center ICT Information and Communications SS Sentrong Sigla Technology ILHZ Inter-Local Health Zones SSM Sentrong Sigla Movement IMR Infant Mortality Rate TB Tubercolosis IMS Information Management Service U5MR under 5 mortality rate IMST Internal Management Support Team UHMIS Unified Health Management Information System KM Knowledge Management UPPI University of the Philippines Population Institute LCR Local Civil Registrar WFPDS Work and Financial Plan Database System LDL-c Low Density Lipoproteins - cholesterol WNDRS Weekly Notifiable Disease LGC Local Government Code Reporting System 6

7 List of Tables and Figures Table page Table 1. Strategies for Health Information Systems under Fourmula One 15 Table 2. Statistical Framework on Health and Nutrition 19 Table 3. Implications of the Devolution and Health Sector Reform Agenda 32 on the Local health System Table 4. Strengths and Weaknesses of the Surveillance Systems of the 35 National Epidemiology Center Table 5. Targets in Knowledge Management in the Philippine Health Sector 38 Table 6. Matrix on Statistical Development Programs for Health and 42 Nutrition Information Systems Table 7. Participants in the Philippine Assessment using the HMN Procedure 56 Table 8. Data Producers of Field Health Service Information System and 58 Civil Registration System that participated in the Assessment in the Subnational Level Table 9. Data Users of Field Health Service Information System and 58 Civil Registration System that participated in the Assessment in the Subnational Level Table 10. Summary of Results of the Assessment of Health Information 59 System Resources Table 11. Problems on HIS Resources Identified by Regional FHSIS Regional 63 Coordinators With the Existing FHSIS at Different Administrative Levels Table 12. Summary of the Result of the Assessment of Indicators 63 Table 13. Summary of Results of the Assessment of Data Sources 64 Table 14. Summary of the Result of the Assessment of Data Management 67 Table 15. Summary of Results of the Assessment of Information Products 68 Table 16. Problems on Information Products Identified by Regional FHSIS Regional 70 Coordinators With the Existing FHSIS at Different Administrative Levels Table 17. Summary of Results of the Assessment of Dissemination and Use 71 Table 18. Problems on Dissemination and Use Identified by Regional FHSIS 73 Regional Coordinators With the Existing FHSIS at Different Administrative Levels Figure page Figure 1. Health and Nutrition Strategies and Expected Outcome 13 Figure 2. Framework for the Development of the Philippine Health 17 Information System Figure 3. The Philippine Statistical System 22 Figure 4. HMN Framework 53 Figure 5. Selected Indicators and Results 64 Figure 6. Assessment of Information Products 69 7

8 1 Background The monitoring and assessment of the status of the health and nutrition of the Philippine citizenry is a concern not just of the government but also of international donor agencies and other non-governmental organizations. Such monitoring and assessment require data that shall be used to generate measures/indicators on the health and nutrition status of the population over a period of time. In recognition of the importance of data that feed into the monitoring and assessment of its health system, the Philippines through the Philippine Health Information Network (PHIN) with the support of the World Health Organization and the Health Metrics Network conducted an assessment of the health information systems that generate health and nutrition data. The assessment started in November 2006 with the conduct of a Training of Trainers on the Health Metrics Network (HMN) framework and tools for assessing health information systems. The activities that followed included workshops to evaluate and customize the HMN assessment tool for the Philippines; pretesting and finalizing the customized tool; the actual assessment; workshop to discuss the result of the actual assessment; additional assessment in the subnational level of two specific systems that generate health information Field Health Service Information System of the Department of Health and civil registration system of the National Statistics Office; and, meetings to finalize the report on the assessment. This report presents the results of the assessment. 2 The Philippines To properly appreciate the discussions of health information systems in the Philippines, an understanding of the country s characteristics and health system is needed. This chapter presents the Philippines geography, administrative divisions, government, climate, demographic characteristics, economic characteristics, organization of its health care system, health facilities, and health human resources. Geography, Administrative Divisions and Government The Philippines is an archipelago of about 7,100 islands located in the western part of the Pacific Ocean off the coast of Southeast Asia. The country has a total land area of 300,000 square kilometers and is one of the largest islands groups in the world. The three island groupings are Luzon in the north, Visayas in the central area, and Mindanao in the south. Metropolitan Manila, also known as the National Capital Region (NCR), is located in the central part of Luzon. It is the biggest urban center in the country. It is made up of 14 highly urbanized cities and three municipalities. The country is divided into 17 administrative regions: Regions 1 to 5, NCR, Cordillera Administrative Region (CAR), CALABARZON (Cavite,Laguna,Batangas,Rizal,Quezon), and MIMAROPA (Mindoro, Marinduque, Romblon, Palawan) which are in Luzon; Regions 6 to 8 which are in the Visayas; and, Regions 9 to 12, Autonomous Region of Muslim Mindanao (ARMM), and Caraga which are in Mindanao. Regions are composed of 79 provinces headed by governors while provinces are divided into 117 cities and 1500 municipalities, collectively called local government units. The local government units, headed by mayors, make up the political subdivisions of the Philippines. They are divided into villages or barangays totaling 41,975. These are headed by barangay chairpersons (NSCB, 2004). It must be noted that regions are administrative units only and the political units aside from the national level are the provinces, cities and municipalities, and barangays. 8

9 The Philippines is a republican state with three branches of government- executive. legislative and judicial. The executive power is vested in the President, who is the head of state and the commander-in-chief of the Armed Forces. The President appoints the Cabinet members of who assist the President in executing laws, policies and programs of the government. The lawmaking power is vested in a bicameral Congress composed of the Senate and the House of Representatives. The Senate has 24 senators directly elected nationwide by the people. The House of Representatives has 250 members elected by congressional districts and by party list system. Judicial power is vested in the Supreme Court and a system of several lower courts. The Supreme Court is composed of the Chief Justice and 14 associate justices (NOH, ). The Climate The country s climate is generally hot and humid and favors the existence of disease vectors and parasites. On the average, the temperature is 32 o with March to June as the hottest months when temperatures may reach 38 o C. On the other hand, November to February provide cooler weather with temperatures around 23 o C. The Philippines is prone to natural disasters brought about by volcanic eruptions, earthquakes, floods and typhoons. Rains and typhoons prevail from July to October (NOH, ). Demographic Characteristics The population of the Philippines in the 2000 census was 76,504,077, a 58 percent increase from the 1980 census. The population grew at the rate of 2.4 percent annually between 1995 and 2000 while it grew at 2.1 percent between 2000 and The population is projected to increase to 91,868,309 in The NCR has an estimated 13.3 percent of the total population of the Philippines. It has the greatest population concentration with 16,091 people per square kilometer, a ratio that is 63 times the national average. The least population areas are the CAR and Region 2 with a population density of 70 and 90 people per square kilometer, respectively. Five out of the 17 administrative regions have growth rates higher than the national average: Region 3, MIMAROPA and CALABARZON, Region 7, Region 11 and ARMM. NCR has the lowest population growth rate of 1.06 percent and ARMM has the highest at 3.86 percent. In comparison with other countries, the Philippine ranked twelfth among the countries of the world in terms of total population. The Philippines is ranked fifth among Southeast Asian countries in annual population growth rate (PSY, 2004 and NOH, ). Approximately 52 percent of the Philippine population live in rural areas. However, urbanized areas now attract migrants from rural communities due to more economic, educational, recreational opportunities. Rural-to-urban migration causes much pressure on government to provide basic social services like health care, shelter, water, sanitation and education. The congestion and pollution in urban areas are harmful to health. In frontier areas where more migration is also noted, the people s health is affected by difficult access to health services and the presence of locally endemic diseases like malaria, filariasis and schistosomiasis (PSY, 2004 and NOH, ). The median age of the Philippine population is 21 years old. This makes the Philippines a country of young people with, half of its population below 21 years old. Males outnumber females with a sex ratio of males for every 100 females. There are more males than females in the age groups 0-19 and years.the age structure of the Philippine 9

10 population is typical broad base at the bottom consisting of large numbers of children and a narrow top made up fairly small numbers of older persons. The dependency ratio is 69, which means that every 100 persons in the working age group (15-64 years old) have to support about 63 young dependents and about six old dependents. Young dependents (65 years old and over) account for 3.8 percent, while 59.2 percent comprise the economically active population (15-64 years old). Women of reproductive age comprise around 51 percent of the total number of females in country (PSY, 2004 and NOH, ). Economic Characteristics The Philippines is a developing country. Per capita Gross National Product(GNP) was P56,109 and per capita Gross Domestic Product (GDP) was P52,241 in The GNP growth rate was 5.6 percent and GDP was 4.7 percent. In 2000, the annual per capital poverty threshold was estimated at P11,605, an 18 percent increase over the 1997 threshold of P9,843. With this threshold, a family of five members should have a monthly income of P4,835 to meet its food and non-food basic needs. Average annual family income reached P148,757 in 2003, increasing by 2.5 percent over the P145,121 average in As earnings rose across all income levels, from the 27.5 percent revised estimate from 2000 down to 24.7 percent in 2003 (NSCB, 2005). Unemployment and underemployment rates have increased in the past three years. Unemployment rates stood at 10.2 percent in October 2002, it has gone up to 10.9 percent as of October Underemployment has also gone up from 15.3 percent in October 2002 to 16.9 percent in October Average inflation rate has also gone up from 3.5 percent in 2003 to six percent in 2004 (PSY, 2004) Organization of the Health Care System The Philippines recognizes health as a basic human right. It protects and promotes the right to health of the people and instills health consciousness among them. Although this provision is guaranteed by the 1987 Constitution (Article II, Section 15) and the health care system in the Philippines is generally extensive, access to health services, especially by the poor, is still hampered by high cost, physical and social-cultural barriers (NOH, ). To address these concerns, reforms in the country s health care system have been instituted in the past 30 years: the adoption of Primary Health Care in 1979; the integration of public health and hospital services in 1983 (EO 851); the enactment of the Generics Act of 1988 (RA 6675); the devolution of health services to LGUs as mandated by the Local Government Code of 1991 (RA 7160); and the enactment of the National Health Insurance Act of 1995 (RA 7875). In 1999, the DOH launched the Health Sector Reform Agenda (HSRA) as a major policy framework and strategy to improve the way health care is delivered, regulated and financed(noh, ). The Philippines has a dual health system consisting of : the public sector, which is largely financed through a tax-based budgeting system national and local level and where health care is generally given free at the point of services (although socialized user charges have been introduced in recent years for certain types of services), and the private sector (consisting of for-profit and non-profit providers), which largely market-oriented and where health care is paid through user fees at the point of service. The expansion of social health insurance in recent years and its emergence as a potential major source of health financing 10

11 will have a positive and private sectors and in terms of the people s health-seeking behavior (NOH, ). Under this health system, the public sector consists of the DOH, LGUs and other national government agencies providing health services. The DOH is the lead agency in health. Its major mandate is to provide national policy direction and develop national plans, technical standards and guidelines on health. It has a regional field office in every region and maintains specialty hospitals, regional hospitals and medical centers. It also maintains provincial health teams made up of DOH representatives to the local health boards and personnel involved in communicable disease control (NOH, ). With the devolution of health services under the 1991 Local Government Code, provision of direct health services, particularly at the primary and secondary levels of health care, is the mandate of LGUs. Under this set-up, provincial and district hospitals are under the provincial government while the municipal government manages the rural health units (RHUs) and barangay health stations (BHSs). In every province, city or municipality, there is a local advisory body to the local executive and the sanggunian or local legislative council on health-related matters (NOH, ). The passage of the 1995 National Health Insurance Act expanded the coverage of the national health insurance program to include not only the formal sector but also the informal and indigentsectors of the population. The program founded under the principle of social solidarity where the healthy subsidizes the sick and those who can afford to pay subsidize those who cannot. PhilHealth, a government-owned and controlled corporation attached to the DOH, is the agency mandated to administer the national health insurance program and ensure that Filipinos will have financial access to health services (NOH, ). The private sector includes for-profit and non-profit health providers whose involvement in maintaining the people s health is enormous. Their involvement include providing health services in clinics and hospitals, health insurance, manufacture and distribution of medicines, vaccines, medical supplies, equipment, other health and nutrition products, research and development, human resource development other and other health-related services (NOH, ). Health Care Facilities Various health facilities serve the health needs of the Filipinos. The total number of hospital, both government and private, increase from 1,607 in 1980 to 1,738 in Though the number of hospitals increased nationwide, the number of beds per 10,000 population decreased from 18.2 in 1980 to 10.7 in 2002 (PSY 2004). The number of government hospitals nationwide increased from 623 in 2000 to 661 in 2002, while private hospitals slightly decreased from 1,089 in 2000 to 1,077 in Although only 661 or 38 percent of hospitals are government hospitals, these contribute 45,395 beds or 53.3 percent of bed capacity nationwide (PSY, 2004 and NOH, ). ARMM has the least number of hospitals, consisting of three private hospitals and 11 government hospitals in CALABARZON and MIMAROPA have the most number of hospitals with 176 private hospitals and 95 government hospitals (PSY, 2004 and NOH, ). 11

12 In terms of government hospital beds, NCR has the most number of 9,965 beds followed by CALABARZON and MIMAROPA at 6,295 beds and Region 3 at 3,385 beds. The regions with the least number of government hospital beds are ARMM at 870 beds, Region 10 at 1,150 beds and Region 12 at 1,195 beds. The government hospital bed to population ratio is worst in Region 11 in Mindanao with one bed for every 3,575 people while it is best in NCR with one bed for every 807 people (PSY, 2004 and NOH, ). There is increasing trend in the number of BHSs from 9,184 in 1988 to 15,343 in 2002 while there is a decreasing trend in the number of RHUs in the country from 1,962 in 1986 to 1,879 in NCR has the most number of RHUs while the Central Mindanao has the least number of RHUs. On the other hand, CALABARZON and MIMAROPA have the most number of BHSs while NCR has the least (PSY 2004). On the average, each RHU serves around 41,000 people while each BHS serves around 5,100 people (PSY, 2004 and NOH, ). Health Human Resources Human resources for health are central to managing and delivering health services. They are crucial in improving health systems and health services and in meeting the desired health outcome targets. Human resources for health are enormous but unevenly distributed in the country. Most health practitioners are in Metro Manila and other urban centers. Compared to most Asian countries, the Philippines is producing more and better human resources for health (NOH, ). The number of physicians per 100,000 populations slightly increased from in 1998 to in 2000, which translates into one physician for every 803 people in The number of dentist per 100,000 population almost remained unchanged at 54.2 in 1998 and 54.4 in 2000 or one dentist per 1,840 people in The number of pharmacists per 100,000 populations improved slightly from 55.8 in 1998 to 58.1 in This means one pharmacist for very 1,722 people in The number of nurses per 100,000 populations almost remained constant from in 1998 to in 2000, a ratio of one nurse per 226 people for both 1998 and 2000 (SEAMIC, 2003 and NOH, ). In 2002, there are 3,021 doctors, 1,871 dentist, 4720 nurses and 16,534 midwives employed by LGUs. Other health personnel employed by LGUs consist of 3,271 engineers/sanitary inspectors, 303 nutritionist, 1,505 medical technologist, 977 dental aides and 2,808 nontechnical staff. Assisting these health personnel at the grassroots are 195,928 volunteer barangay health workers and 54,557 birth attendants (FHSIS, 2002 and NOH, ). The Philippines has traditionally been a major source of health professionals to many countries because of their fluent English, skills and training, compassions, humaneness and patience in caring. The country is purportedly the leading exporter of nurses to the world (Aiken, 2004) and the second major exporter of physicians (Bach, 2003). Although the country is producing a surplus of health workers for overseas market since the 1960s, the large exodus of nurses in the last four years has been unparalleled in the migration history of the country. While Filipino physicians have been migrating to the United States since the 1960s and to the Middle East countries in the 1970s in steady outflows, the recent outflows are disturbing because they are no longer migrating as medical doctors but as nurses (NOH, ). 12

13 Based on the baseline survey of nursing-medics in the Philippines, more than 3,500 Filipino doctors have left as nurses since the year 2000 (Galves-Tan, Sanchez, Balanon,2004). A little more than 1,500 doctors have passed the national nurse licensure examination in 2003 and 2004 (PRC, 2002). An estimated 4,000 doctors are enrolled in nursing schools all over the country (Galves-Tan, Sanchez, Balanon, 2004). The Philippine socioeconomic and political situations have not helped munch in retaining licensed and skilled nurses and other health professionals in the country. (NOH, ). 3 Frameworks for Generating Health and Nutrition Statistics The Millennium Development Goals (MDGs), the Philippine Statistical Development Program (PSDP) , the Medium-Term Philippine Development Plan (MTPDP) for Health and other health and nutrition sectoral plans such as the National Objectives of Health (NOH) , the Medium-Term Philippine Plan of Action for Nutrition (MTPPAN), and the Philippine Population Management Program Directional Plan (PPMP- DP) provide very clear strategies and expected outcomes of international and national development goals and targets which require statistics and indicators. These frameworks serve as basis for identifying priority indicators/statistics for monitoring and evaluating the progress of the country s health and nutritional plans, programs and policies. Figure 1 summarizes the major strategies and expected outcomes for health and nutrition as drawn from the different plans and programs. Figure 1. Health and Nutrition Strategies and Expected Outcome 1 MILLENIUM DEVELOPMENT GOALS STRATEGIES (1) Eradicate extreme poverty and hunger (2) Reduce child mortality (3) Improve maternal health (4) Combat HIV and AIDS, Malaria and other diseases (5) Ensure environmental sustainability (6) Develop a global partnership for development EXPECTED OUTCOMES (1) Halve, between 1990 and 2015, the proportion of people who suffer from hunger (2) Reduce by two-thirds, between 1990 and 2015, the under five mortality rate (3) Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio (4) Have halted by 2015 and begun to reverse the spread of HIV/AIDS (5) Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases (6) Halve, by 2015, the proportion of people without sustainable access to safe drinking water (7) In cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries 1 from the Philippine Statistical Development Plan

14 Continuation of Figure 1 HEALTH STRATEGIES (1) Reduce the cost of essential medicines (2) Expand health insurance particularly for indigents (3) Strengthen national and local health systems through the implementation of the Health Sector Reform Agenda for health regulation reforms (4) Improve Health Care Management System; (5) Improve health and productivity through Research and Development; and (6) Establish drug treatment and rehab centers and expand existing ones. EXPECTED OUTCOMES (1) Fifty percent reduction in prices of 22 therapeutic classes essential medicines from 2004 prices by 2010; (2) Covered 5 million indigent families enrolled and sustained in National Health Insurance Program (NHIP); (3) One hundred percent of hospitals licensed by Department of Health; (4) Standardized training courses, registration, regulation and accreditation developed and institutionalized; (5) Seventy percent increase in utilization of health, nutrition and population related Research and Development results (6) Treatment and rehabilitation care NUTRITION STRATEGIES (1) Focus on adolescent females, pregnant and lactating women and children 1-3 years old (2) Complementation of nutrition interventions with other development programs (3) Geographical focus to needier areas (4) Food-based interventions for sustained improvement in nutritional status (5) Increased investments in nutrition. EXPECTED OUTCOMES (1) Reduced proportion of Filipino households with intake below 100% dietary energy requirement (2) Reduced prevalence of underweight children 0-5 and 6-10 years old (3) Reduced prevalence of stunting among children 0-5 years old (4) Reduced prevalence of chronic energy deficiency among pregnant women (5) Reduced prevalence of vitamin A deficiency disorders among children 6 mos.-5 years old, pregnant and lactating women (6) Reduced prevalence of iodine deficiency disorders among lactating women (7) Reduced prevalence of low birth weight 14

15 The Framework Based on the National Objectives for Health The DOH in its quest to strengthen the Philippine health system and make it a vehicle for social change, engineered the Fourmula One for Health (F1) in 2005 as the new implementation framework for vital health sector reforms as stated in its HSRA in F1 became the DOH s guiding philosophy and strategic approach to implement health reforms. On the other hand, the NOH provides the road map of key ideas, targets, indicators and strategies to bring the health sector to its desired outcomes. (NOH ). With the F1 in mind, the following was developed by the Information Management Service (IMS) of DOH as its major strategies for developing rationalized and more efficient national and local health information systems through strengthening networking mechanisms and referral systems, sharing of resources, organizational transformation and restructuring, capacity building. Table 1. Strategies for Health Information Systems under Fourmula One Key Result Areas Deliverables Unit Responsible Easy access to health information. PHIN established and operational Health Information standards developed and implemented Various information systems developed (Hospital Operations and Management Information System(HOMIS), FHSIS, Integrated Blood Bank Information System(IBBIS), Bureau of Food and Drugs Integrated Information System(BIIS), Drug Test Operation and Management Information System (DTOMIS), DOH Licensing Information System(DOHLIS), etc.) Data warehouse with the following health information: o Health service statistics and disease surveillance o Health regulation o Health statistics such as vital statistics, health accounts, health surveys, censuses o Health researches, best practices, lessons learned IMS, health programs, services, bureaus, other Health Information Generators (NSO, Philippine Council for Health Research and Development(P CHRD), NSCB, medical societies, etc) Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt 15

16 Key Result Areas DOH transformed to a knowledge organization Health data and infrastructure are interoperable Deliverables Health portal which is the repository of the health intellectual capital is established, operational and used Resource learning center operational with virtual health library and knowledge bases established and utilized Knowledge management(km) infrastructures established Knowledge is shared to stakeholders through knowledge networks Health workers imbibed KM qualities such that seeking, sharing and utilization of knowledge has become a habit. Information and Communications Technology(ICT) standards developed and used by stakeholders Interconnection of central office, Centers for Health Development(CHDs) and DOH retained hospitals DOH, Philippine Health Insurance Corporation(PHIC or PhilHealth) and private sector databases are interoperable Unit Responsible IMS, programs, sectoral support cluster, Internal Management Suppot Team(IMST) IMS with other units Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt Efficient, rational and appropriate use of funds Source: IMS, DOH Monitoring and evaluation of Fund resources electronic-new Government Accounting System( e-ngas) reports/work and Financial Plan Database System(WFPDB) Develop feedback mechanisms for fund utilization at regional level Installation of e-ngas in all regions Field Surveillance(FS )/ Planning Division Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt 16

17 The following framework is then suggested for an integrated Philippine Health Information System: Figure 2 FRAMEWORK FOR THE DEVELOPMENT OF THE PHILIPPINE HEALTH INFORMATION SYSTEM PERFORMANCE METRICS HEALTH AND VITAL STATISTICS HEALTH SERVICE DELIVERY Vital Statistics National Health Account Demographic and Health Surveys Executive Support System Public Health Disease Surveillance Hospital Operations and Management Health Emergencies Response HEALTH SYSTEMS MANAGEMENT HEALTH DATA WAREHOUSE HEALTH SYSTEM INFORMATION Local Health Systems Development Health Care Financing International Health Cooperation Management Health Regulation Decision Support System Human Resources Management Information Resources Management Logistics Health Facilities KNOWLEDGE SHARING HEALTH RESEARCH BEST PRACTICES / LESSONS LEARNED PORTALS (EXTRANET/INTRANET) 17

18 It is noted that in a DOH Health Information System (HIS) Integration Workshop on January , the following guidelines in constructing a Philippine Integrated Health Information System(PIHIS) was suggested: Build on existing health information systems to integrate content and information functions, Develop/Strengthen policy and regulation for data submission and/or information gathering, Compliance to government policy on ICT, and Compliance to DOH Department Order Standard Operating Procedure and Guidelines on ICT Works in the DOH. These guidelines are based on the conceptual framework of bringing together data from different information systems, to share and disseminate them, and to ensure that health information is used rationally, effectively and efficiently to improve health action or decision-making process. Additional guidelines are: Compliance to the General Standards on Statistical Information Dissemination (GSSID) per NSCB Board Resolution No. 8, s. 1999, and, Compliance to the IMF Data Assessment Quality Framework (DQAF). Furthermore, the following strategies were enumerated: Standardization common data indicators, definitions, data formats, data transmission protocols Data Warehousing central data repository Process Integration eliminate redundancies and/or duplications. Integrated Data Management Integrated Human Resource Integrated Financial Resources. It must be emphasized, though, that the integration workshop focused only on the information systems of DOH which are mainly administrative records and did not include the other health and nutrition data being generated by other government agencies auch as the NSO and the NSCB. The Philippine Statistical Development Plan The Philippine Statistical Development Program (PSDP) serves as the blueprint of all statistical activities that will generate the data requirements for all international and national development plans and programs. The PSDP chapter on Health and Nutrition is guided by the above development priorities for the health and nutrition sector. Table 2 depicts the statistical framework for the health and nutrition sector in the PSDP The framework has 6 components. These are: health status, health resources, health services, nutritional status, nutrition resources, and nutrition services. These components correspond to the major areas of concern and areas where the indicators to be used in monitoring will be identified. Thus, the framework shall serve as a basis for data production and dissemination as well as for coordination among the agencies producing the data. 18

19 Table 2. Statistical Framework on Health and Nutrition Sector/Components/ Key Indicators Sub-Components HEALTH Health Status Mortality Life expectancy Proportion surviving from birth by sex Proportion population 65 and over Crude Death Rate Infant Mortality Rate 2/ Child Mortality Rate Under-Five Mortality Rate 2/ Maternal Mortality Ratio 2/ Causes of Mortality Death rates for selected causes of deaths Morbidity Incidence of Specific Notifiable Diseases No. of bird or avian flu cases Causes of Morbidity Fully Immunized Children Proportion of 1 year-old children immunized against measles 2/ HIV prevalence among year old pregnant women 2/ Number of children orphaned by HIV/AIDS 2/ Prevalence and death rates associated with malaria 2/ Proportion of population in malaria risk areas using effective malaria prevention & treatment measures 2/ Prevalence & death rates associated with tuberculosis 2/ Proportion of tuberculosis cases detected & cured under directly observed treatment short course (DOTS) 2/ Condom use rate of the contraceptive prevalence rate 2/ Prevalence of Specific Drug and Substance Abuse Proportion of population with access to affordable essential drugs on sustainable basis 2/ Reported Cases of Drug Dependency DOH-retained and Local Government Unit- hospitals selling low-priced drugs 1/ Rate of increase / decrease in the number of mental health facilities upgraded 1/ Environmental Sustainability Disability Health Resources Facilities Proportion of households with Sanitary Toilet Facilities Proportion of population with sustainable access to improved water source 2/ Proportion of urban population with access to improved sanitation 2/ Prevalence of Disability Causes of Disability No. of government hospitals provided with training to improve their service capabilities 1/ No. of licensed hospitals 1/ Ratio to Population of Health Facilities Manpower Proportion of births attended by skilled health personnel 2/ No. of government doctors, nurses, dentists & midwives Physicians per 1,000 population 19

20 Sector/Components/ Key Indicators Sub-Components Ratio to Population of Health Manpower Financing Total Health Expenditure Share of Health Expenditure to GNP and GDP Health Expenditure by Source of Funds Health Expenditure by Use of Funds Gross Value Added on Health Per Capita Health Expenditure Health Services (Provision and Utilization) Health R & D No. of health & population related reaseach and development utilized 1/ Promotive Percentage of Population Availing of Health Services by Type Preventive Percentage of the Population Covered by Health Insurance 1/ Curative Percentage of population availing of health services by type of service Rehabilitative Percentage of population using health facilities Overall satisfaction with health facilities and services NUTRITION Nutrition Status Prevalence of Prevalence of underweight children under 5 years of age 2/ Malnutrition Prevalence of underweight adolescents Prevalence of underweight other age group Prevalence of underweight-for-age, underheight-for-age, underweight-for-height; overweight and obesity Prevalence of low birthweight infants Proportion of population below minimum level of dietary energy consumption 2/ Prevalence of low birthweight infants Prevalence of CED, overweight and obesity Prevalence of Prevalence of Vitamin A deficiency Micronutrient Deficiency Prevalence of anemia Prevalence of Iodine deficiency Food and Nutrient Intake Per Capita Energy/Nutrient Intake Percent nutrient adequacy Per capita food intake (total, by food groups, food source) Per capita consumption per day Per Capita Food Supply (per year, per day, per day energy, per day protein, per day fats) Prevalence of nutritionrelated risk factors to chronic degenerative disease Prevalence of Breastfeeding (BF) and Complementary Feeding Total Domestic Supply by Major food Group Prevalence of hypertension Prevalence of high total serum cholesterol Prevalence of high triglyceride Prevalence of low HDL-c Prevalence of high LDL c Prevalence of high fasting blood sugar among adults Prevalence of females with high waist-hip ratio Prevalence of exclusive breastfeeding (BF) among 0-6 monts old children Proportion of children not breastfed among 0-24 months Proportion of children receiving breast milk + water only among 0-6 and 6-9 months old children 20

21 Sector/Components/ Sub-Components Nutrition Resources Financing Facilities Manpower Key Indicators Proportion of children receiving breast milk + water-based liquids/juice among 0-6 and 6-9 months old children Proportion of children receiving breast milk + other milk among 0-6 and 6-9 months old children Proportion of children receiving breast milk + complementary food among 0-6 and 6-9 months old children NGA, NGO and LGU funding for nutrition programs/activities Proportion of Government Expenditures for Nutrition Programs No. of hospitals No. of RHUs and BHS No. of weighing stations No. of weighing scales Ratio to Population of Manpower and Facilities No. of medical personnel No. of dietitians, nutrition officers, nutrition action officers, barangay nutrition scholars, barangay health workers Ratio to population of manpower and facilities (nutrition related activities/program by government and private sector) Nutrition Services (Provision & Utilization) Nutrition R & D No. of health & population related research and development utilized 1/ Promotive Preventive Proportion of Population Availing Various Nutrition Programs/Services by Type Curative Percent of 0-5 year old children given vitamin A supplements Rehabilitative Percent of households using iodized salt Source: Philippine Statistical Development Plan Notes: 1/ Indicators to monitor MTPDP Goals/Priorities 2/ Indicators to monitor * - not available (what is available is percent of households with per capita energy less than 100% adequacy based on the 1993 National Nutrition Survey) The Philippine Statistical System Government and official statistics in the Philippines are generated by a decentralized statistical system called the Philippine Statistical System(PSS). This system is a government-wide decentralized system of government agencies that provide statistical information and services to the public. Statistical services include the gathering, compiling, processing, aggregation, analysis and dissemination of data. The set up is decentralized with the following main government agencies: the National Statistical Coordination Board (NSCB) which is the policy-making and coordinating body for the statistical system; the National Statistics Office (NSO) which is the single general purpose statistical agency conducting the censuses such as the Census of Population and Housing, the surveys such as the Labor Force Survey, and the civil registration of the country; 21

22 the Statistical Research and Training Center (SRTC) which is the statistical research and training arm of the system; Other major statistical agencies such as the Bureau of Agricultural Statistics (BAS) and the Bureau of Labor and Employment Statistics(BLES) ;and, all the departments, bureaus, offices, agencies and instrumentalities of the National Government and Local Government and Government Owned and Control Corporations and their subsidiaries that are engaged in statistical activities either as their primary functions or part of their administrative or regulatory functions. The following is the structure of the system: Figure 3 The official statistical unit of the DOH, the National Epidemiology Center (NEC), is DOH s focal point for the PSS under other departments statistical units. Being DOH s focal point, it should represent the statistical concerns of the DOH as a whole. There are at present, however, other units at the DOH that generate health statistics, e.g., Bureau of Health Facilities and Services, that may be considered as part of this system but are not actively involved in the PSS. The creation of an integrated Philippine Health Information System (PHIS) aims to correct this situation. This PHIS framework as presented in Figure 2 is envisioned to be part of the PSS in Figure 3. 4 Government Agencies Generating Health and Nutrition Statistics As presented in the different frameworks in the previous chapters, many government agencies are involved in generating health and nutrition statistics. This chapter presnts the different government agencies and the important data systems they maintain. 22

23 The Department of Health The DOH remains as the major source of data for the health sector. Its statistics are mostly derived from administrative reporting forms regularly furnished by public hospitals, rural health units and other health units in the lower administrative units of government. The Philippine Health Statistics (PHS) is a report of the NEC of DOH. It provides a summary of statistical data on births, deaths and notifiable diseases registered and reported through the Notifiable Diseases Registry of the FHSIS submitted by the RHUs and BHSs. Diseases, injuries and health conditions are coded using the International Classification of Diseases version 10 (ICD-10).The different data systems being generated by different offices in DOH may be classified as: 1. Health Service Delivery Systems The FHSIS serves as the major source of data for the DOH. The system provides information on the different public health programs such as: Maternal and Child Health; Nutrition; Family Planning; Expanded Program on Immunization; Dental Health; Communicable Disease Prevention and Control(TB, Malaria, Schistosomiasis, Leprosy); Environmental Health; Vital Statistics (Natality, Mortality, Population); and, Notifiable Disease Reporting System. Data are provided by the local field health personnel through the regional and provincial health offices, and consolidated at the Central Office. These are presented by province, city and region in a publication of the same title. The Health Management Information System (HMIS) consists of several subsystems, two of which are the HOMIS and the Rural Health Unit Information System (RHUMIS).The HOMIS generates information on hospitals to support the delivery of hospital services and the management of the hospital.the RHUMIS is a public health information system designed for the rural health units to efficiently and effectively monitor patient cases. A plan is to create a Unified Health Management Information System (UHMIS) which shall report statistical data of diseases/diagnosis from HOMIS and non-homis users on a daily basis for the Alert System and sending of data to the DOH central storage or database. Surveillance systems which include the two major disease surveillance systems that provide information on notifiable diseases are the Weekly Notifiable Disease Reporting System (WNDRS) which comes from the FHSIS and the National Epidemic Sentinel Surveillance System (NESSS). The WNDRS provides information on 17 diseases(anthrax, Cholera, Diphtheria, Viral Encephalitis, Viral Hepatitis, Leprosy,Leptospirosis,Malaria, Measles, Viral Meningitis, Neonatal Tetanus, Non-neonatal Tetanus, Meningococcal Infections, Paralytic Shellfish Poisoning, Rabies, Typhoid and Paratyphoid fever, Whooping cough or Pertussis) and 7 syndromes(acute Flaccid Paralysis, Acute Hemorrhagic Fever Syndrome, Acute Lower Respiratory Tract Infection and Pneumonia, Acute Watery 23