(NAR) VOL. 20 NO.3 / JULY - SEPTEMBER 2009
The nationwide rollout of implementation of FOURmula One (F1) to 81 F1 sites requires a more efficient process for development, approval and implementation of Province-wide Investment Plans for Health (PIPH) and its Annual Operational Plans (AOP). Fast tracking F1 reforms under a Sectoral Development Approach (SDAH) for Health will accelerate achievement of Millennium Development Goals (MDG) in the country.
Resources and energies for F1 must be maximized. Various procedural delays experienced in the development, approval and implementation of PIPH and AOPs in the country must be addressed. Specific areas for improvement are seen in (i) Complex and confusing instructions and guidelines for PIPH development, (ii) very centralized management of processes from DOH Central Office and SDAH partners, (iii) duplication of transactions for approving AOP and SLA, (iv) repetitive review process at various levels, and (v) low fund utilization of (40-50%) emanating from various delays and many restrictions on the release of funds for Province-wide Health Systems (PWHS) to initiate implementation of their PIPH.
This Administrative Order seeks to provide guidelines for improving procedural efficiency relevant to development, approval and implementation of the F1 PIPH and AOP
1. Reduce duration of procedures involved
2. Omit duplication of functions and procedures
3. Delineate specific purpose, roles and functions for all relevant stakeholders
III. KEY PRINCIPLES & STRATEGIES
1. Streamlining of Process Flows to simplify and shorten the process of submission and approval of documents and facilitate the release of funds for reform implementation.
2. Empowerment of the CHD as a Major F1 Player by giving them a more active role in the appraisal of the PIPH and AOP.
3. Enhancement of Joint Appraisal Committee (JAC) Review with a more focused format that facilitates substantive application of JAC resources on PIPH/AOPs of local government partners.
IV. SCOPE AND COVERAGE
This Order shall apply to all bureaus, national centers, services and CHDs of the DOH. This shall also serve as a guideline for LGUs and ARMM with respect to the provision of the Memoranda of Agreement (MOAs) that has been consummated for purposes of the PIPH/AIPH. This shall also be binding upon members of the Joint Appraisal Committee (JAC), pursuant to the implementation of the Sectoral Development Approach for Health (SDAH). It shall also cover all transactions related with PIPH/AIPH development and implementation.
V. DEFINITION OF TERMS
1. F1 – FOURmula One for Health – a strategic framework for health reforms formulated by DOH using four pillars (Service Delivery, Health Care Financing, Health Governance and Health Regulation) in attaining the National Objectives for Health and the Millennium Development Goals for Health.
2. F1 Sites – provinces or highly urbanized cities considered as implementation sites for F1 for Health.
3. MDG – UN Millennium Development Goals – worldwide effort to attain the following goals by 2015: alleviate extreme poverty and hunger; achieve universal primary education; promote gender equality & empower women; improve maternal health; reduce infant mortality; combat HIV/AIDS, Malaria, TB, Filariasis, etc; ensure environmental sustainability; and develop a global partnership for development.
4. PIPH – Provincial-wide Investment Plan for Health – a five-year medium term plan prepared by F1 convergence provinces using the FOURmula ONE for Health framework to improve the highly decentralized system: financing, regulation, good governance and service delivery.
5. AOP – Annual Operation Plan - specifies program activities for the year including activities covered by Service Level Agreement, within the annual investment cost – as reflected in the five-year PIPH for all sources of funds (i.e. PLGU, MLGU, Development Partners Support, DOH budget support, PHIC, etc.)
6. JAC – Joint Appraisal Committee – a committee headed by the DOH Secretary, DOH Sectoral Management Cluster Head and PhilHealth President as co-chair; and the heads of the DOH National Centers and all government agencies involved in health programs as well as representatives from development partners as members. The committee appraise the PIPH before it is endorse to the development partners for funding, it also provides guidance and recommends appropriate action for investment planning in health reforms.
7. SDAH – Sectoral Development Approach for Heal th – a way of organizing the planning and management of international and national support for health reform under the Fourmula One framework. It aims to eventually involve all Partners supporting the Health Sector.
8. SLA - Service Level Agreement – a signed agreement between the DOH and each of the F1 sites that defines the outputs and milestones to be reached, the amount of funds to be provided through a grant from ODA Partners and the DOH’s counterpart contributions and requirements pertaining to the release of said funds.
9. MOA – Memorandum of Agreement – a signed agreement between the DOH and each of the F1 sites that formalize the collaboration in the implementation of the PIPH and to define the general roles and responsibilities of each of the two parties including financing support from DOH.
10. CHD – Center for Health Development – the regional office of DOH headed by the Regional Director.
11. PWHS – Provincial Wide Health System - a devolved health system headed by the Provincial Governor.
12. Primary TA Provider – Primary Technical Assistance Provider refers to a team or individual with technical expertise provided by Health Partners to assist the CHDs in the development and appraisal of PIPH and AOPs including the presentation of the plan appraisal report for JAC review.
13. MNCHN – Integrated Maternal, Neonatal, Child Health and Nutrition Strategy – this is a F1 Health approach that outlines the specific policies and actions for local health systems to systematically address health risk that lead to maternal and neonatal deaths.
V. GENERAL GUIDELINES
A. Development and appraisal of PIPHs and AOPs will be in accordance with existing guidelines, subject to revisions and focal themes provided for in this issuance.
B. The Service Level Agreement (SLA) and the Annual Operational Plan (AOP) for 2009 shall be processed and integrated as one document. The CHDs shall also be responsible for approval of agreements on the AOPs. The Secretary of Health will approve the Memoranda of Agreement for all PIPHs.
C. Detailed appraisal of new PIPHs and of all AOPs shall be delegated to CHDs.
D. JAC Review of PIPH/AOPs will focus on health outcome results orientation, impact on poor population, and matching plans with available funds.
E. Key local government officials will present their PIPH while key officials of the CHDs will present the AOPs to the JAC. Primary TA providers assigned to the CHD will assist in the appraisal and presentation of PIPHs/AOPs.
F. JAC Review recommendations will serve to enrich PIPHs/AOPs reviewed. The JAC recommendation shall not be cause to hold back immediate implementation of PIPHs/ AOPs, specifically those initiatives funded by the LGU counterpart.
VI. SPECIFIC GUIDELINES
A. Development and Appraisal of PIPH
1. PIPH development and appraisal shall give particular care to the following:
a. Better participation of municipalities, NGOs, private providers, peoples organizations and client/consumers in the planning process.
b. Setting goals based on ME3 and objectives based on LGU Scorecard parameters
c. Reform interventions including the following:
- Service Delivery: Public-Private Partnerships (e.g. for TB-DOTS, for CSR & for Health Facility Development, etc.)
- Regulation: Botika ng Barangay
- Financing: Identification and enrollment of poor in PhilHealth, Increasing local Budgets for health and Extra-budgetary financing sources
- Governance: ILHZ formation, Development of Human Resource for Health, Health Information System Development
2. AOP development, appraisal and implementation shall give particular care to the following:
a. By May 2009:
Public-Private Partnerships, interventions to benefit the poor and Geographically Isolated and Disadvantaged Areas (GIDA), MNCHN operations, and municipal & city level investment planning
b. By August 2009
Hospitals and Facilities, Drugs and Pharmaceuticals, human resources, province-wide financial guidelines governing multiple sources of funds for PIPH/AOP implementation
c. Utilization of LGU Scorecard Indicators in Situational Assessment, and for planning intervention for PPAs in AOP
d. CHD issuance of clearances on matters concerning technical specifications and program standards arising from the PPMP based on comparisons with technical specifications and program standards, as stipulated the DOH website. The CHDs shall refer the requests for clearances to the appropriate DOH Central Office unit in cases when technical specification and program standards are not provided for in the DOH website.
e. Infrastructure upgrade must be consistent with Rationalization Plan if available, or focused on Provincial Hospitals, Core Referral Hospitals of functional ILHZ and Primary Care Facilities (RHUs, Health Centers, BHS) while Rationalization Plan is not completed
f. Matching Fund requirements with available funds from all sources
3. CHDs shall be accountable for the detailed appraisal of the PIPH/AOPs and for ensuring readiness of plan for submission for JAC review. It shall be the responsibility of the CHD Director to ensure consistency of the SLA and the AOP of the province with the PIPH and the corresponding MOA signed by the Secretary of Health. The DOH, through the respective CHD, and the Provincial Governor shall concur the AOP in writing, with the Provincial Health Officer, and the Assistant Regional Director, being the PIPH point persons shall sign as witnesses.
4. Primary TA providers assigned to CHDs shall assist CHDs and LGUs in developing plans, appraising completed plans, and presenting plans for JAC review.
5. PIPH appraisal will be according to the guidelines found in DM No. 2008-0006 (Adoption of the PIPH Appraisal Tool for the Assessment of the PIPH of the Roll-out Convergence Provinces, January 4, 2008).
6. AOP appraisal will be according to DM No. 2009-0027 (Utilization of the Appraisal Tool in the Review of the 2009 Annual Operational Plan (AOP) in the FOURmula One (F1) Pilot and Roll-out Sites and Other Provinces, January 27, 2009).
B. Integration of SLA and AOP
1. Upon approval and validation of new PIPHs for the nationwide roll-out provinces, CHDs shall immediately coordinate with LGUs in the drafting of the SLA for 2009 alongside the LGUs formulation of the AOP 2009 and its sub-plans.
2. CHDs shall be guided below with the status of 2009 AOP development and how this will be synchronized with the preparation and approval of the 2009 SLA:
Status of Development Required Support from CHD A. Provinces who have already submitted to the DOH-Central Office but without SLA
- Consultation with concerned provinces their 2009 AOP re: 2009 SLA vis-a-vis 2009 AOP
- Facilitate the signing of the 2009 SLA and submission of said document to the DOH-Central Office through FIMO
B. Provinces whose 2009 AOP are still with the CHD for review and without SLA - Check for consistency and completeness of both documents (2009 SLA and 2009 AOP) C. For those provinces whose AOP are still in the LGUs for finalization and without SLA - Consultation with concerned provinces re: 2009 SLA vis-a-vis 2009 AOP
- Facilitate the preparation and signing of the 2009 SLA and AOP and submission of same to DOH-Central Office through FIMO
3. Parties to the SLA shall be the CHDs on behalf of the DOH, and the LCEs on behalf of the provinces. The CHD Director IV and the Provincial Governor shall be the respective signatories. The CHD Director III, Provincial Health Officer II, and the OIC of the DOH Accounting Division shall sign as witnesses (Annex A)[*]
4. The SLA shall be based in part on fund ceilings computed by the DOH Central Office and Foreign Assistance Providers (FAPs), while the AOP shall be based on the PIPH (Annex B)[*].
C. Streamlined JAC Review
1. The JAC will have access to all copies of the PIPH an AOPs through a web portal where all PIPHs/AOPs submitted for JAC review will be uploaded. The BLHD, with the assistance of the IMS shall upload electronic copies of all submitted AOPs and Appraisal Reports to a secure online portal with access controls restricted to the JAC and the JAC Technical Secretariat.
2. The JAC shall be convened to review and enhance the plans of LGUs with its technical and financial resources, on the premises of CHDs having completed detailed appraisal of the PIPH/AOP submitted for review.
The JAC Review shall:
a. Focus review on the orientation of plans on (i) Results, (ii) the poor, (iii) and on appropriate fund ceilings for each specific fund source
b. Consist of the following structure:
1. A situationer of trends in F1 results, investments, and status of PIPH/AOP development in the country
2. CHD presentation of appraisal report and highlights of content of AOPs in the province, based on the focus orientation of the JAC
3. Local government presentation of its PIPH highlighting focus orientation of the JAC
4. Discussion with JAC members on recommendations on plans presented
3. The JAC recommendations shall not intend to hold back release of funds nor to hold back LGUs from initiating implementation of PIPHs/AOPs. The comments and recommendations of the JAC shall apply enhancement through measures which may include, but are not limited to the following categories:
a. Recommendations for improvement of the plan that will be delegated to CHDs and its primary TA provider, to oversee application of enhancements to 2009 plans when possible, but certainly to enhance 2010 plans submitted for JAC review.
b. Components of the plan that will not be funded by DOH or ODA partners, and as such would necessitate adequate budget allocation from the LGU.
4. The JAC shall ensure the proper facilitation of financing agreements. It shall recommend appropriate financing sources for activities in the PIPHs/AOPs, in consideration of fund availability and fund sources.
VII. SEPARABILITY CLAUSE
In the event that any provision or part hereof is declared unauthorized or rendered invalid by any court or competent authority, those provision that are not affected by such declaration shall remain valid and effective.
VIII. REPEALING CLAUSE
Provision from previous issuances that are inconsistent or contrary to the provisions of this Order are hereby rescinded and modified accordingly.
This Order shall take effect immediately.
Adopted: 12 March 2009
(SGD.) FRANCISCO T. DUQUE, III MD, MSc
Secretary of Health
[*] Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Quezon City.