Wednesday, June 8, 2016

Meeting DOH Secretary Janette Garin up close

Knowing how busy Cabinet secretaries are, I accepted an invitation to be one of the bloggers to meet and greet Department of Health (DOH) Secretary Janette Garin. It was probably one of her last acts under the Aquino administration but it was good to know what health programs were carried out under her watch and which ones she will be endorsing to the incoming administration.

A little background on Sec. Garin

Sec. Janette, I found out, is a native of Leyte and married to an Ilonggo. A kababayan!

Although a physician by education, Sec. Garin comes from a political family. She began with campus politics, then SK. After one term in politics, she decided to pursue her medical studies and fulfill her dreams as a doctor. But after medicine, she helped her husband's campaign in Iloilo. A few days before the election, one of the candidates had a stroke and she was pushed as a substitute candidate. She became a Board Member of Iloilo.

Her plans to do full medical practice was interrupted when circumstances again pushed her to run for Congress. She was elected Representative of the 1st District of Iloilo for 3 years (2004-2013). In that time, she was a large part of the Magna Carta for Women, Cheaper Medicines Law, the Responsible Parenthood, and Reproductive Health Law

In 2013, she was appointed Undersecretary of the DOH. When then DOH Secretary Ona left DOH, she was appointed DOH Secretary. She served in this position for 19 months under the Aquino administration.

A Review of DOH's Health Programs 

Sec. Garin filled us in on the different programs of the DOH, starting with a history of health reforms of the department (Fig. 1). She said that under different administrations, the health reforms were very similar but were just called different names. But under the Aquino administration, they focused on 3 main reforms: Financial Risk Protection, Access to Quality Health Services, and Attainment of Millennium Development Goals (MDGs).

Fig. 1

Financial Risk Protection

Sec. Garin showed a slide on DOH budget from 2012-16 and how much of the budget each year was utilized (Fig. 2). It struck me that the 2016 DOH budget was significantly higher than all previous years at around PhP 120-B (more than double that of 2015). Unfortunately,  the year is not yet over so we still have to see what key projects the increased budget was for and if the budget utilization will be as high as previous years at an average of over 80% and that the premium subsidy for indigents will be a healthy ratio to the budget.

Fig. 2

Most of the poor and 5.8M senior citizens are now covered by PhilHealth (Fig. 3). However, Sec. Garin explained that the 100% coverage in the slide can be a bit misleading since there are those who do not fall under eligibility under the present scheme where a family member designates beneficiaries. Once a beneficiary reaches 21, or gets married and has children, he ceases to be covered by PhilHealth unless he also becomes a member and designates his family as beneficiaries. She plans to recommend to the next administration that PhilHealth membership be made individually.

Fig. 3

Access to Quality Health Services

DOH is defining certain health care services such that there is no competition among clinics, district hospitals, and tertiary/specialty hospitals by aligning the service delivery network (Fig. 4). The "gatekeepers" or primary health facilities are the barangay centers, urban health centers for direct patient care. LGU hospitals are for the basic hospitalization. Tertiary/specialty hospitals are for the more complicated health services needing specialties. Instead of competing, the aim is to make them complement each other.

Fig. 4
DOH under Sec. Garin also set up the HFEP Management Office. This is meant to ensure that the DOH plans continue from one admin to another. This office will allow continuity of all programs and coordinates all involved offices including IT, HR, patient matrix, etc.

She also mentioned that, nationwide, drugs is a big problem. Drug rehabilitation centers are now being put in the regions to decongest Bicutan and to ensure that these drug users are rehabilitated and returned to society.

Finally, Sec. Garin is a huge believer in utilizing valuable assets in the medical field who were underused before but are being deployed now (Fig. 5). DOH is now making use of public health associates (nursing graduates who did not pass the board) who work side by side with licensed nurses and doctors. Even during rapid nurse turnover, public health associates carry institutional memory with them that will help health centers while they are still trying to augment the gaps. DOH is also crafting a TESDA course where public health associates train for skills needed in countries abroad looking for professionals for senior care. Universal health care (UHC) implementers, doctors who did not pass the board, are also being utilized in the medical industry. DOH also highly encourages these UHC implementers to retake the board.  In 2015-16, DOH also focused on deploying midwives, dentists and medical technologists to augment those from the provinces. 

Attainment of MDGs

Sec. Garin enumerated several areas that addressed health-related Millennium Development Goals (MDGs):

* Maternal mortality ratio has dropped from 129 in 2010 to 114 in 2015.

* Fully immunized children (covering rotavirus, IPV, dengue, PCV 13, influenza) has risen to about 90% of those in the school-based immunization program

* While HIV-AIDS cases are on the rise, there is also an increase in anti-retroviral treatment. There are now 40 testing centers and 22 satellite clinics nationwide. Because of regional testing centers, more are being tested locally instead of having them go to Metro Manila. Being sensitive and discreet to protect those who may test positive, many of these tests are done as part of a blood drive which includes tests for other conditions like Hepa B or Hepa C.

* Introduction of vaccines against dengue, polio (Inactivated Polio Vaccine), cervical cancer, measles-rubella-tetanus-diphtheria, and rabies (full dose) to the greater public. Previously, this was only available in the private sector.

* DOH has now shifted to buying maintenance medications (Metoprolol, Amlodipine, Losartan, and Metformin) for diabetes and hypertension. DOH is also starting to look at mental health drugs and cancer drugs (cancer of the breast, leukemia, childhood cancer, prostate, stomach, colon).

* DOH has provided the flu vaccine to 2.1M indigent senior citizens

* Creation of a DOH Academy, a competency building unit established May 2015. It is linked to Ateneo School of Government, UP courses, and potentially, Lee Kuan Yew University in Singapore where trainings count as credits towards masteral units or continuing education credits.

* Hospital scorecard (cleanliness, availability of medicines, availability of human resource, service delivery network, and PhilHealth utilization) -- a performance measurement tool to incentivize improvement of quality of health services and guide performance-based budgeting. A team evaluates and hospital gets funding based on scorecard.

While Sec. Garin is in transition now as part of the turnover to the next administration, it looks to me like all these programs are already set in motion so that the next DOH Secretary just needs to continue what has already been started. I am looking forward to a much better health care system for our country in the future.

Some of the bloggers with Sec. Janette Garin

Slides courtesy of DOH.

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